Estimating the prevalence of neurosurgical interventions in adults with spina bifida using the Health Facts data set: implications for transition planning and the development of adult clinics

2021 ◽  
pp. 1-8
Keyword(s):  
Spina Bifida ◽  
Transition Planning ◽  
Care Delivery ◽  
Spinal Dysraphism ◽  
Temporal Trends ◽  
Tethered Cord ◽  
Neurosurgical Procedures ◽  
Coordinated Care ◽  
Data Set ◽  
Surgical Interventions

OBJECTIVE As the care of patients with spina bifida continues to evolve, life expectancy is increasing, leading to a critical need for transition planning from pediatric-based to adult-based care. The burden of neurosurgical care for adults with spina bifida remains unknown. In this study, the authors sought to use a large national data set to estimate the prevalence of neurosurgical interventions in adults with spina bifida. METHODS This study utilized Health Facts, which is a de-identified proprietary data set abstracted from all Cerner electronic health records. It includes 69 million unique patients with > 500 million encounters in 580 centers. Validation, technical exclusions, and data filters were applied to obtain an appropriate cohort of patients. The ICD-9 and ICD-10 codes for all types of spinal dysraphism, as well as the Current Procedural Terminology (CPT) codes for hydrocephalus procedures, spinal cord untethering, and Chiari decompression, were queried and records were retrieved. Demographic variables along with differences in age groups and temporal trends were analyzed. RESULTS Overall, 24,764 unique patients with ≥ 1 encounter with a spinal dysraphism diagnosis between 2000 and 2017 were identified. The pediatric cohort included 11,123 patients with 60,027 separate encounters, and the adult cohort included 13,641 patients with 41,618 separate encounters. The proportion of females was higher in the adult (62.9%) than in the pediatric (51.4%) cohort. Annual encounters were stable from 2 to 18 years of age, but then decreased by approximately half with a precipitous drop after age 21 years. The sex distribution of adults and children who underwent procedures was similar (54.6% female adults vs 52.4% female children). Surgical interventions in adults were common. Between 2013 and 2017, there were 4913 procedures for hydrocephalus, with 2435 (49.6%) adult patients. Similarly, 273 (33.3%) of the 819 tethered cord procedures were performed in adults, as were 307 (32.9%) of 933 Chiari decompressions. CONCLUSIONS The Health Facts database offered another option for studying care delivery and utilization in patients aging with spina bifida. The median age of this population has now reached early adulthood, and a significant number of neurosurgical procedures were performed in adults. An abrupt drop in the rate of encounters occurred at 21 years of age, possibly reflecting transition issues such as access-to-care problems and lack of coordinated care.

scholarly journals Spinal dysraphism with tripedus morphology: A case report

2021 ◽  
pp. 509-511
Author(s):  
Mohd Monis ◽  
Shagufta Wahab ◽  
Divyashree Koppal ◽  
Aiman Ibbrahim
Keyword(s):  
Case Report ◽  
Spina Bifida ◽  
Vertebral Column ◽  
Rare Case ◽  
Surgical Intervention ◽  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Lower Back ◽  
Rare Case Report ◽  
Spinal Mri

This is a rare case report of a 5-month-old child with a complex spinal dysraphic state, and an accessory limb (tripedus morphology), accessory genitalia, and anal dimple. The child was brought to the hospital with an accessory limb arising from the back. On clinical examination, an accessory limb arising from the lower back with a partially developed foot with the presence of toes and nails was noted. Spinal MRI was advised which revealed dysraphic features including spina bifida with the low lying and posteriorly tethered cord with diastematomyelia along with a supernumerary appendage attached to the vertebral column having rudimentary bones resembling those of extremities. The presence of an accessory limb with spinal dysraphism is quite a rare anomaly. The condition can be treated by surgical intervention and involves excision of the accessory limb with adequate dural and paraspinal muscle cover.

scholarly journals A rare case of thoracic myelocystocele associated with type 1 split cord malformation with low lying tethered cord, dorsal syrinx and sacral agenesis: Pentad finding

2015 ◽  
Vol 6 (01) ◽  
pp. 087-090 ◽  
Author(s):  
Dipanker Singh Mankotia ◽  
Guru Dutta Satyarthee ◽  
Bhawani Shankar Sharma
Keyword(s):  
Spina Bifida ◽  
Surgical Management ◽  
Rare Case ◽  
Clinical Presentation ◽  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Split Cord Malformation ◽  
Rare Form ◽  
Sacral Agenesis

ABSTRACTMyelocystocele is a rare form of spinal dysraphism. Thoracic myelocystocele is still rarer. The occurrence of thoracic myelocystocele associated with type-1 split cord malformation, low lying tethered cord, dorsal syrinx and spina bifida is extremely rare. Clinical presentation of such a rare case and an early surgical management is discussed briefly.

Congenital neurological disorders

2018 ◽  
Author(s):  
Simon Rinaldi
Keyword(s):  
Cerebral Palsy ◽  
Spina Bifida ◽  
Neurological Disorders ◽  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Foramen Magnum ◽  
Structural Relationships ◽  
Adult Medicine ◽  
Vertebral Arch ◽  
Chiari Malformations

This chapter covers four congenital neurological disorders which may be encountered in adult medicine: cerebral palsy, Chiari malformations, spina bifida, and tethered cord syndromes. Cerebral palsy is a disturbance of motor function arising from damage to the developing fetal or infant brain. It usually refers to a disorder resulting from a non-progressive insult which occurred at less than 3 years of age. Chiari malformations are congenital abnormalities of the anatomy and structural relationships of the cerebellum, the brainstem, and the foramen magnum. Dysraphism is a failure of opposition of anatomical structures which are normally fused. Spinal dysraphism is synonymous with spina bifida, a failure of embryological fusion of the neural tube. In all types, the vertebral arch fails to completely form. The tethered cord syndromes involve a restriction of the normal cephalad migration of the conus during life. This can occur both with and without spina bifida.

Assessing variability in surgical decision making among attending neurosurgeons at an academic center

2020 ◽  
Vol 132 (6) ◽  
pp. 1970-1976
Author(s):  
Ashwin G. Ramayya ◽  
H. Isaac Chen ◽  
Paul J. Marcotte ◽  
Steven Brem ◽  
Eric L. Zager ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Repeated Measures ◽  
Elective Surgery ◽  
Statistical Tests ◽  
Neurosurgical Procedures ◽  
P Values ◽  
Surgical Interventions ◽  
Radiology Reports ◽  
Operative Notes ◽  
First Time

OBJECTIVEAlthough it is known that intersurgeon variability in offering elective surgery can have major consequences for patient morbidity and healthcare spending, data addressing variability within neurosurgery are scarce. The authors performed a prospective peer review study of randomly selected neurosurgery cases in order to assess the extent of consensus regarding the decision to offer elective surgery among attending neurosurgeons across one large academic institution.METHODSAll consecutive patients who had undergone standard inpatient surgical interventions of 1 of 4 types (craniotomy for tumor [CFT], nonacute redo CFT, first-time spine surgery with/without instrumentation, and nonacute redo spine surgery with/without instrumentation) during the period 2015–2017 were retrospectively enrolled (n = 9156 patient surgeries, n = 80 randomly selected individual cases, n = 20 index cases of each type randomly selected for review). The selected cases were scored by attending neurosurgeons using a need for surgery (NFS) score based on clinical data (patient demographics, preoperative notes, radiology reports, and operative notes; n = 616 independent case reviews). Attending neurosurgeon reviewers were blinded as to performing provider and surgical outcome. Aggregate NFS scores across various categories were measured. The authors employed a repeated-measures mixed ANOVA model with autoregressive variance structure to compute omnibus statistical tests across the various surgery types. Interrater reliability (IRR) was measured using Cohen’s kappa based on binary NFS scores.RESULTSOverall, the authors found that most of the neurosurgical procedures studied were rated as “indicated” by blinded attending neurosurgeons (mean NFS = 88.3, all p values < 0.001) with greater agreement among neurosurgeon raters than expected by chance (IRR = 81.78%, p = 0.016). Redo surgery had lower NFS scores and IRR scores than first-time surgery, both for craniotomy and spine surgery (ANOVA, all p values < 0.01). Spine surgeries with fusion had lower NFS scores than spine surgeries without fusion procedures (p < 0.01).CONCLUSIONSThere was general agreement among neurosurgeons in terms of indication for surgery; however, revision surgery of all types and spine surgery with fusion procedures had the lowest amount of decision consensus. These results should guide efforts aimed at reducing unnecessary variability in surgical practice with the goal of effective allocation of healthcare resources to advance the value paradigm in neurosurgery.

scholarly journals Philosophy of care delivery for spina bifida

2020 ◽  
Vol 13 (2) ◽  
pp. 100883 ◽  
Author(s):  
Judy Thibadeau ◽  
William O. Walker ◽  
Jonathan Castillo ◽  
Brad E. Dicianno ◽  
Jonathan C. Routh ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Care Delivery

Lumbar spinal intradural extramedullary lipoma associated with spina bifida and tethered cord

2016 ◽  
Vol 16 (9) ◽  
pp. e611-e612 ◽  
Author(s):  
Zafer Orkun Toktaş ◽  
Baran Yılmaz ◽  
Murat Şakir Ekşi ◽  
Emin Değer ◽  
Deniz Konya ◽  
...  
Keyword(s):  
Spina Bifida ◽  
Tethered Cord ◽  
Intradural Extramedullary ◽  
Lumbar Spinal

scholarly journals The lumbosacral angle does not reflect progressive tethered cord syndrome in children with spinal dysraphism

2010 ◽  
Vol 26 (12) ◽  
pp. 1757-1764 ◽  
Author(s):  
Erwin M. J. Cornips ◽  
Femke G. E. M. Razenberg ◽  
Lodewijk W. van Rhijn ◽  
Dan L. H. M. Soudant ◽  
Elisabeth P. M. van Raak ◽  
...  
Keyword(s):  
Spinal Dysraphism ◽  
Tethered Cord ◽  
Tethered Cord Syndrome

Assessing early unplanned reoperations in neurosurgery: opportunities for quality improvement

2015 ◽  
Vol 123 (1) ◽  
pp. 198-205 ◽  
Author(s):  
Nancy McLaughlin ◽  
Peng Jin ◽  
Neil A. Martin
Keyword(s):  
Quality Improvement ◽  
Quality Indicator ◽  
Outpatient Surgery ◽  
Care Delivery ◽  
Average Length ◽  
Medical Center ◽  
Postoperative Bleeding ◽  
Time Interval ◽  
Neurosurgical Procedures ◽  
Neurosurgical Department

OBJECT Review of morbidities and mortality has been the primary method used to assess surgical quality by physicians, hospitals, and oversight agencies. The incidence of reoperation has been proposed as a candidate quality indicator for surgical care. The authors report a comprehensive assessment of reoperations within a neurosurgical department and discuss how such data can be integrated into quality improvement initiatives to optimize value of care delivery. METHODS All neurosurgical procedures performed in the main operating room or the outpatient surgery center at the Ronald Reagan UCLA Medical Center and UCLA Santa Monica Medical Center from July 2008 to December 2012 were considered for this study. Interventional radiology and stereotactic radiosurgery procedures were excluded. Early reoperations within 7 days of the index surgery were reviewed and their preventability status was evaluated. RESULTS The incidence of early unplanned reoperation was 2.6% (occurring after 183 of 6912 procedures). More than half of the patients who underwent early unplanned reoperation initially had surgery for shunt-related conditions (34.4%) or intracranial tumor (23.5%). Shunt failure was the most common indication for early unplanned reoperation (34.4%), followed by postoperative bleeding (20.8%) and postoperative elevated intracranial pressure (9.8%). The average time interval (± SD) between the index surgery and reoperation was 3.0 ± 1.9 days. The average length of stay following reoperation was 12.1 ± 14.4 days. CONCLUSIONS This study enabled an in-depth assessment of reoperations within an academic neurosurgical practice and identification of strategic opportunities for department-wide quality improvement initiatives. The authors provide a nuanced discussion regarding the use of absolute reoperations as a quality indicator for neurosurgical patient populations.

Tethered Cord in Children with Spina Bifida

2008 ◽  
pp. 267-274 ◽  
Author(s):  
Robin M. Bowman ◽  
David G. McLone
Keyword(s):  
Spina Bifida ◽  
Tethered Cord
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