Jarrah, Ryan

OBJECTIVE Surgical decompression is often indicated for symptomatic cases of cervical radiculopathy. In the cervical spine, minimally invasive posterior cervical foraminotomy (MIS-PCF) and the anterior transcorporeal approach (ATCA) are modern techniques available to surgeons. This systematic review and single-arm meta-analysis aimed to assess surgical and patient-reported outcomes of MIS-PCF and ATCA for cervical radiculopathy. METHODS A systematic review of the literature was conducted using 1) Ovid; 2) Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations; and 3) Scopus databases, which reported outcomes following cervical decompression using MIS-PCF or the ATCA. Specifically, baseline characteristics, operative outcomes, and changes in visual analog scale (VAS) neck pain score were assessed. The quality of the studies was graded using the modified Newcastle-Ottawa Scale for observational studies. RESULTS Forty studies with 1661 patients were identified. The comparative analysis of both techniques revealed no significant differences in complication (7%, 95% CI 5%–10%, p = 0.75) or reoperation rates (5%, 95% CI 3%–7%, p = 0.41). Additionally, there were no significant differences in estimated blood loss (55.39, 95% CI 44.62–66.16 ml, p = 0.55) or operative time (85.15, 95% CI 65.38–104.92 minutes, p = 0.05). The ATCA showed significantly greater improvement (p < 0.01) in VAS neck pain scores following surgery (ATCA point reduction 6.7, 95% CI 6.0–7.5 points vs MIS-PCF 3.0, 95% CI 1.0–5.0 points). CONCLUSIONS The ATCA and MIS-PCF are effective modern techniques for the surgical treatment of radiculopathy. Both approaches showed comparable postoperative outcomes, including complication and reoperation rates. However, the ATCA was shown to provide significantly greater improvement in VAS neck pain scores.

Introduction: The Kosovo War is widely remembered as one of the most brutal conflicts in the modern era. With over 13,000 deaths and 90% of the population displaced as refugees, the impact of the war has led to everlasting levels of trauma that impacts the lives of thousands of Kosovar-Albanians today. Objectives: To characterize the psychosocial impact of the Kosovo war by comprehensively assessing the literature to date. We also provide recommendations to improve outcomes for Kosovar-Albanian patients in the post-war era. Methods: A systematic review was conducted using post-war clinical psychological articles on the Kosovo War. Our search involved utilizing full-text English articles from PubMed, OVID Medline, and EMBASE journals. Keywords used were “Kosovo War”, “Psychosocial”, and “Post Traumatic Stress Disorder”. Results: Our post-traumatic stress disorder (PTSD) analysis yielded a total of 10,134 responses from participants ranging from refugees to the general public. Our results showed 2,997 subjects (30%) who reported or met the criteria for post-traumatic stress disorder. When analyzing refugee participants, there was 1,133 with 60% of them meeting the PTSD criteria. In a filtered cohort of 5,117 subjects measured for adverse events, 3,180 subjects (64%) of subjects had experienced combat, while 3,664 (74%) were exiled from their homes. Conclusion: The psychosocial impact of the Kosovo war is likely under-reported by patients due to cultural stigmas, language barriers, and trust barriers with clinicians. Factors such as age, employment, displacement status, number of traumatic events, socioeconomic vulnerability, and health literacy are associated with poor psychiatric morbidity.

Abstract Introduction: Extracranial vertebral artery aneurysms are rare complications from trauma and multiple diseases. However, the difference between clinical and surgical profiles is not well understood. Objective To investigate the clinical and interventional outcomes following extracranial vertebral artery aneurysms (VAA) treatment through a systematic review of the literature to date. Methods An electronic database search for full-text English articles was conducted following PRISMA guidelines. The search yielded results on clinical and surgical outcomes for extracranial VAAs. These results included patient-specific risk factors, indications, and techniques. Results Our literature search yielded 561 articles, of which 36 studies were qualified to be included in the analysis. A total of 55 patients with multiple various extracranial VAA incidents were included. The mean age of subjects was 42 years (ranging from 13 to 76 years), and most patients were males (71%, n = 39). Blunt trauma was the most frequent risk factor for extracranial VAA formation (35%, n = 19). The majority of aneurysms (60%) were dissecting in nature. The most common form of treatment for extracranial VAAs was a flow diverter (24%, n = 13). Overall, five (9%) patients had long-term adverse neurological complications following intervention with 5% (n = 3) mortality, 2% (n = 1) resulting in unilateral vocal cord paralysis, and 2% (n = 1) resulting in a positive Romberg sign. The mortality rate is 15.7% in the surgical group, whereas the endovascular treatment did not result in any mortality. Conclusion The endovascular approach is a safe and effective treatment of extracranial VAAs due to its relatively low overall complication rate and lack of resulting mortality. This contrasts with the surgical approach, which results in a higher rate of complications, recurrence, and mortality outcomes. An understanding of the factors and clinical outcomes associated with the incidence of extracranial VAAs is essential for the future improvement of patient outcomes.

Study Design Bibliometric literature review. Objective Total disc arthroplasty (TDA) is an evolving technique used by surgeons to preserve neural elements and range of motion in patients with degenerative disc disease, spondylosis and more. In comparison to discectomy, disc arthroplasty has been shown to decrease morbidity, reduce adjacent-level disease, and preserve pre-operative range of motion. The objective of this manuscript is to provide a bibliometric analysis of the use of disc arthroplasty in scientific literature and highlight the main contributing authors and their publication characteristics. Methods The Scopus database was used to perform a title-specific, keyword-based search for all publications until June 2022. The keyword “total disc arthroplasty” was used. The most-cited 100 articles were selected for analysis. Parameters included the following: title, citation count, citations per year, authors, specialty first author, institution, country of origin, publishing journal, Source Normalized, Impact Per Paper (SNIP), and Hirsch index. Results Our search on disc arthroplasty yielded 580 articles that were published, with the first publication on the topic found in 1966. The most cited 100 articles received a total of 8694 citations, with an average of 86.94 citations per article. After assessing countries with the greatest contributions, United States, China, and Germany were top 3 with 54, 14, and 7 articles, respectively. Conclusion The bibliometric analysis provides an overview of how medical research is analyzed in academic medicine. In the present study, we evaluated the global trends in disc arthroplasty for the treatment of degenerative disc disease.