The Neurosurgery articles published by Webmedcentral http://www.webmedcentral.com 2013-05-20T17:04:43+01:00 http://www.webmedcentral.com/ http://www.webmedcentral.com/images/Header_Logo.gif text/html 2010-07-23T10:22:33+01:00 http://www.webmedcentral.com/ Mr. Mohammad S Walid http://www.webmedcentral.com/article_view/448 Background: The purpose of this study is to investigate the economic impact of opioid-antidepressant-anxiolytic use in spine surgery patients.Methods: The charts of 816 spine surgery inpatients of the Medical Center of Central Georgia were retrospectively reviewed and data on preoperative use of opioids, antidepressants and anxiolytics as well as history of depression were collected and analyzed for any impact on length of stay and hospital charges. Surgery was either lumbar microdiskectomy (LMD), anterior cervical decompression and fusion (ACDF), or lumbar decompression and fusion (LDF).Results: LDF patients with history of depression had higher prevalence of combined opioid, antidepressant and anxiolytic use compared with the rest of the patients (20%). However, graphing opioid-antidepressant-anxiolytic use in each type of spine surgery against the average length of stay and hospital charges showed an increase in stay and charges in the LDF group without a history of depression (or possibly undiagnosed depression).Conclusion: LDF patients without history of depression who are on all three medications (opioids, antidepressants and anxiolytics) are more likely to stay longer in hospital and seem to consume more hospital resources than others. text/html 2010-09-10T20:39:24+01:00 http://www.webmedcentral.com/ Dr. Mark Lyons http://www.webmedcentral.com/article_view/593 Background: Chronic abdominal pain without a structural or metabolic gastroenterological etiology can be extremely challenging to diagnose and treat. Patients presenting with an associated radicular pattern of pain may alert the clinician to a possible structural neurologic cause of the symptoms.Methods: We present the case of a 70 year old woman who presented to our institution with an 18 month history of right upper quadrant abdominal pain. She had no associated symptoms or provoking factors. She underwent an extensive gastroenterology evaluation, including colonoscopy that was unrevealing. Ultrasound demonstrated gallstones and she was evaluated for cholecystectomy. She subsequently developed right costal margin pain. Her symptoms remained stable over the course of the next year. Follow-up general surgical evaluation was still unconvincing that the gallstones were the etiology of her symptoms. A thoracic spinal MR demonstrated a large intradural extramedullary mass at T8. Patient’s neurologic exam was normal.Results: She underwent a thoracic laminectomy and resection of a meningioma using intraoperative electrophysiological monitoring. Her abdominal pain resolved.Conclusions: Patients can present with months to years of elusive abdominal symptoms only to be eventually found to be harboring an undiagnosed spinal tumor. We discuss the case and review the literature reports of spinal tumors masquerading as chronic abdominal pain. text/html 2013-01-08T09:31:31+01:00 http://www.webmedcentral.com/ Dr. Ergun Karavelioglu http://www.webmedcentral.com/article_view/3938 Vertebral osteomyelitis is a rare but serious complication of spinal-epidural analgesia and anesthesia. We report two cases of two level vertebral osteomyelitis and psoas abscess without spinal epidural abscess after spinal and epidural anesthesia. The first patient with psoas abscess was successfully treated with CT guided needle drainage and posterior spinal decompression with L1-L2 instrumented fusion and antibiotics. Second patient was successfully treated with antibiotics and posterior decompression with T12-L1 and L4-L5 posterior instrumented fusion