Head Causality A new Computational Neuroscience Method

Purpose The patient-reported outcome measure (PROM)-based evaluation in lumbar degenerative disc disease (DDD) is today's gold standard but has limitations. We studied the impact of lower extremity motor deficits (LEMDs) on PROMs and a new objective outcome measure. Methods We evaluated patients with lumbar DDD from a prospective two-center database. LEMDs were graded according to the British Medical Research Council (BMRC; 5 (normal) - 0 (no movement). The PROM-based evaluation included pain (VAS), disability (ODI & RMDI) and health-related quality of life (hrQoL; SF-12 PCS/MCS & EQ-5D index). Objective functional impairment (OFI) was determined as age- and sex-adjusted Timed-Up and Go (TUG) test value. 17-AAG Results One-hundred and five of 375 patients (28.0%) had a LEMD. Patients with LEMD had slightly higher disability (ODI 52.8 vs. 48.2, p=0.025; RMDI 12.6 vs. 11.3, p=0.034) but similar pain and hrQoL scores. OFI T-scores were significantly higher in patients with LEMD (144.2 vs. 124.3, p=0.006). When comparing patients with high- (BMRC 0-2) vs. low-grade LEMD (BMRC 3-4), no difference was evident for the PROM-based evaluation (all p>0.05) but patients with high-grade LEMD had markedly higher OFI T-scores (280.9 vs. 136.0, p=0.001). Patients with LEMD had longer TUG test times and OFI T-scores than matched controls without LEMDs. Conclusion Our data suggest that PROMs fail to sufficiently account for LEMD-associated disability, which is common and oftentimes bothersome to patients. The objective functional evaluation with the TUG test appears to be more sensitive to LEMD-associated disability. An objective functional evaluation of patients with LEMD appears reasonable.Objective The objective was to compare Cobb angle measurements performed using an Oxford Cobbmeter and digital computer software (Surgimap) in a series of 83 AIS patients. Methods Two independent observers measured the Cobb angles for 123 curves on 83 consecutive long radiographs of patients with AIS using both Oxford Cobbmeter and digital computer software (Surgimap). The measurements were repeated a week. Curves were classified according to the severity into mild, moderate, and severe. The results were statistically analyzed for intraobserver and interobserver reliability. Results The mean Cobb angle was 48.12° ± 19.75° (10.54° - 110.76°). Globally the results of curve measurements were comparable between and within both observers using both methods, with small mean differences. According to ICC, there was high inter and intra-observer high agreement for both methods. All readings were ˃ 0.9. There was a good inter-observer (κ = 0.745, 0.693) and a very good inter-observer agreement (κ = 0.810, 0.804) for both methods for curve classification. However, poor agreement was observed as regards to the measurement time, being less with Oxford Cobbometer. Conclusion The results of this study indicate that the Surgimap digital computer software measurement is an equivalent measuring tool to the Oxford Cobbmeter in Cobb angle measurement. Both have high intra and inter-observer agreement for measurement and for curve classification, with small measurement differences. Oxford Cobbmeter is advantageous in being quicker, and therefore it is the method of choice for manual measurement, where PACS or digital system is not available.Although spinal cord stimulators (SCS) continue to gain acceptance as a viable non-pharmacologic option for the treatment of chronic back pain, recent trends are not well established. The aim of this study was to 1) evaluate recent overall demographic and regional trends in paddle lead SCS placement 2) determine if differences in trends exist between private-payer and Medicare beneficiaries. A retrospective review of Medicare and private-payer insurance records from 2007-2014 was performed to identify patients who underwent a primary paddle lead SCS placement via a laminectomy (CPT-63655). Each study cohort was queried to determine the annual rate of SCS placements and demographic characteristics. Yearly SCS implantation rates within the study cohorts were adjusted per 100,000 beneficiaries. A chi-squared analysis was used to compare changes in annual rates. A total of 31,352 Medicare and 2,935 private-payer patients were identified from 2007-2014. Paddle lead SCS placements ranged from 5.9 to 17.5 (p less then 0.001), 1.9 to 5.9 (p less then 0.001), and 5.2 to 14.5 (p less then 0.001) placements per 100,000 Medicare, private-payer, and overall beneficiaries respectively from 2007-2014. SCS placements peaked in 2013 with 19.6, 7.1, and 16.8 placements per 100,000 Medicare, private-payer, and overall patients. There was an overall increase in the annual rate of SCS placements from 2007-2014. Paddle lead SCS placements peaked in 2013 for Medicare, private-payer, and overall beneficiaries. The highest incidence of implantation was in the Southern region of the United States and among females. Yearly adjusted rates of SCSs were higher among Medicare patients at all time points.Objective To assess the safety and effectiveness of percutaneous endoscopic lumbar discectomy (PELD) under epidural anesthesia (EA) and general anesthesia (GA) for treating lumbar disc herniation (LDH). Methods A retrospective study involving 86 patients with LDH managed by PELD under EA and GA was conducted from July 2018 to March 2019. These patients were divided into two groups according to the type of anesthesia. Patient's demographics data as well as the operation time, complications, fluoroscopy shots, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) and Mac Nab scores of the 2 groups were recorded. All of the patients were followed-up at 6 months after operation. Results There was no significant differences were detected in the preoperative demographics between the groups (P > 0.05). 2 (4.8%) cases under GA developed transient motor weakness, 3(7.4%) cases presented numbness of lower limb and 1 (2.4%) cases had CES (cauda equina syndrome) after operation. In EA group,1 (2.2%) cases had motor weakness and 3(6.7%) cases had lower limb numbness, which resolved completely at the last follow-up. There was significant difference between preoperative VAS, JOA and ODI scores and postoperative scores (P 0.05). Conclusion EA and GA in PELD are effective and safe, and no significant difference in complications was observed. Based on our experience, we recommended junior surgeons to perform PELD under EA for getting feedback from the patient to avoid nerve injury and reduce the radiation dose. The concentration of ropivacaine in EA should be considered carefully.