The psychostimulant methylphenidate (MPD, Ritalin) is the prescribed drug of choice for treatment of ADHD. In recent years, the diagnosis rate of ADHD has increased dramatically, as have the number of MPD prescriptions. Repeated exposure to psychostimulants produces behavioral sensitization in rats, an experimental indicator of a drug’s potential liability. In studies on cocaine and amphetamine, this effect has been reported to involve the nucleus accumbens (NAc), one of the nuclei belonging to the motive circuit. The aim of this study was to investigate the role of the NAc on the expression of behavioral sensitization as a response to MPD exposure. In the present study, 20 male Sprague-Dawley rats were divided randomly into three groups: an intact control group, a sham operated group, and a NAc bilateral electrical lesion group. Locomotor activity was assessed for the first two hours following 2.5 mg/kg MPD injection, using open field monitoring systems. Recordings were made during six days of continuous MPD administration, and then upon re-challenge with the same dose following three days of washout. Acute MPD exposure elicited an increase in locomotor activity in all three groups. However, the NAc lesion group exhibited significantly increased locomotor activity in comparison to sham and control groups. Chronic MPD did not elicit sensitization in the NAc lesion group, while both sham and control groups did exhibit behavioral sensitization to repetitive MPD administration. These findings suggest that the NAc plays a significant role in eliciting locomotor activity as an acute effect of MPD, and in the expression of sensitization due to chronic MPD exposure.

Once the accepted norm during Harvey Cushing's time, the mantra of work to the exclusion of family and lifestyle is now recognized as deleterious to overall well-being. A number of neurosurgical residency training programs have implemented wellness programs to enhance the physical, mental, and emotional well-being of trainees and faculty. This manuscript highlights existing organized wellness education within neurosurgery residency programs in order to describe the motivations behind development, structure, and potential implementation strategies, cost of implementation, and identify successes and barriers in the integration process. This manuscript is designed to serve as a “how-to” guide for other programs who may identify a need in their own trainees and begins the discussion of how to develop wellness, leadership, grit, and resiliency within our future generation of neurosurgeons.

OBJECTIVEWhile blunt spinal trauma accounts for the majority of spine trauma, penetrating injuries affect a substantial number of patients. The goal of this study was to examine the epidemiology of penetrating spine injuries compared with blunt injuries and review the operative interventions and outcomes in the penetrating spine injury group.METHODSThe prospectively maintained trauma database was queried for spinal fractures from 2012 to 2018. Charts from patients with penetrating spine trauma were reviewed.RESULTSA total of 1130 patients were evaluated for traumatic spinal fractures; 154 injuries (13.6%) were secondary to penetrating injuries. Patients with penetrating injuries were significantly younger (29.2 years vs 44.1 years, p < 0.001), more likely male (87.7% vs 69.2%, p < 0.001), and more commonly African American (80.5% vs 33.3%, p < 0.05). When comparing primary insurers, the penetrating group had a significantly higher percentage of patients covered by Medicaid (60.4% vs 32.6%, p < 0.05) or prison (3.9% vs 0.1%, p < 0.05) or being uninsured (17.5% vs 10.3%, p < 0.05). The penetrating group had a higher Injury Severity Score on admission (20.2 vs 15.6, p < 0.001) and longer hospital length of stay (20.1 days vs 10.3 days, p < 0.001) and were less likely to be discharged home (51.3% vs 65.1%, p < 0.05). Of the penetrating injuries, 142 (92.2%) were due to firearms. Sixty-three patients (40.9%) with penetrating injuries had a concomitant spinal cord or cauda equina injury. Of those, 44 (69.8%) had an American Spinal Injury Association Impairment Scale (AIS) grade of A. Ten patients (15.9%) improved at least 1 AIS grade, while 2 patients (3.2%) declined at least 1 AIS grade. Nine patients with penetrating injuries underwent neurosurgical intervention: 5 for spinal instability, 4 for compressive lesions with declining neurological examination results, and 2 for infectious concerns, with some patients having multiple indications. Patients undergoing neurosurgical intervention did not show a significantly greater change in AIS grade than those who did not. No patient experienced a complication directly related to neurosurgical intervention.CONCLUSIONSPenetrating spinal trauma affects a younger, more publicly funded cohort than blunt spinal trauma. These patients utilize more healthcare resources and are more severely injured. Surgery is undertaken for limiting progression of neurological deficit, stabilization, or infection control.

OBJECTIVEThe need for anterior column reconstruction after thoracolumbar burst fractures remains controversial. Here, the authors present their experience with minimally invasive lateral thoracolumbar corpectomies for traumatic fractures.METHODSBetween 2012 and 2019, 59 patients with 65 thoracolumbar fractures underwent 65 minimally invasive lateral corpectomies (MIS group). This group was compared to 16 patients with single-level thoracolumbar fractures who had undergone open lateral corpectomies with the assistance of general surgery between 2007 and 2011 (open control group). Comparisons of the two groups were made with regard to operative time, estimated blood loss, time to ambulation, and fusion rates at 1 year postoperatively. The authors further analyzed the MIS group with regard to injury mechanism, fracture characteristics, neurological outcome, and complications.RESULTSPatients in the MIS group had a significantly shorter mean operative time (228.3 ± 27.9 vs 255.6 ± 34.1 minutes, p = 0.001) and significantly shorter mean time to ambulation after surgery (1.8 ± 1.1 vs 5.0 ± 0.8 days, p < 0.001) than the open corpectomy group. Mean estimated blood loss did not differ significantly between the two groups, though the MIS group did trend toward a lower mean blood loss. There was no significant difference in fusion status at 1 year between the MIS and open groups; however, this comparison was limited by poor follow-up, with only 32 of 59 patients (54.2%) in the MIS group and 8 of 16 (50%) in the open group having available imaging at 1 year. Complications in the MIS group included 1 screw misplacement requiring revision, 2 postoperative femoral neuropathies (one of which improved), 1 return to surgery for inadequate posterior decompression, 4 pneumothoraces requiring chest tube placement, and 1 posterior wound infection. The rate of revision surgery for the failure of fusion in the MIS group was 1.7% (1 of 59 patients).CONCLUSIONSThe minimally invasive lateral thoracolumbar corpectomy approach for traumatic fractures appears to be relatively safe and may result in shorter operative times and quicker mobilization as compared to those with open techniques. This should be considered as a treatment option for thoracolumbar spine fractures.

BACKGROUND The practice of surgeons running overlapping operating rooms has recently come under scrutiny. OBJECTIVE To examine the impact of hospital policy allowing overlapping rooms in the case of patients admitted to a tertiary care, safety-net hospital for urgent neurosurgical procedures. METHODS The neurosurgery service at the hospital being studied transitioned from routinely allowing 1 room per day (period 1) to overlapping rooms (period 2), with the second room being staffed by the same attending surgeon. Patients undergoing neurosurgical intervention in each period were retrospectively compared. Demographics, indication, case type, complications, outcomes, and total charges were tracked. RESULTS There were 59 urgent cases in period 1 and 63 in period 2. In the case of these patients, the length of stay was significantly decreased in period 2 (13.09 d vs 19.52; P = .006). The time from admission to surgery (wait time) was also significantly decreased in period 2 (5.12 d vs 7.00; P = .04). Total charges also trended towards less in period 2 (${\$}$150 942 vs ${\$}$200 075; P = .05). Surgical complications were no different between the groups (16.9% vs 14.3%; P = .59), but medical complications were significantly decreased in period 2 (14.3% vs 30.5%; P = .009). Significantly more patients were discharged to home in period 2 (69.8% vs 42.4%; P = .003). CONCLUSION As a matter of policy, allowing overlapping rooms significantly reduces the length of stay in the case of a vulnerable population in need of urgent surgery at a single safety-net academic institution. This may be due to a reduction in medical complications in these patients.

INTRODUCTION Quality measurement and performance metrics are becoming increasingly emphasized in health care. Recognizing the need for accurate and reliable data in quality measurement, practitioners and researchers moved away from administrative databases and towards registries. Our study looks to determine the accuracy of the GCS recorded in the trauma registry at our institution. METHODS Our hospital trauma registry was queried for all TBI patients from 2013 to 2017. GCS from the trauma registry (tGCS) was compared to the neurosurgery consult note (nGCS). Patients were excluded if there was no neurosurgery consult note or if the note was time-stamped more than 2 h from patient arrival. RESULTS There were 468 patients included in the final cohort. tGCS significantly differed from nGCS (6.6 vs 7.9, P < .001). There were 337 patients who would be considered severe TBI (tGCS = 8). Of these patients, the tGCS and nGCS also significantly differed (4.4 vs 6.3, P <.001). There were 188 (40.2%) patients with a tGCS of 3 and 89 (19.0%) with a nGCS of 3. The difference is statistically significant with a Fisher's Exact Test giving a P-value of < .001. There was a higher discrepancy between tGCS and nGCS in patients who survived in the entire cohort (1.61 vs 0.50, P < .001), the severe TBI patients (2.52 vs 0.61, P < .001) and the GCS 3 patients (4.08 vs 0.73, P < .001). Binomial regression modeling found that nGCS correlated with mortality more than tGCS or the highest GCS (hiGCS). CONCLUSION The GCS is meant to be an accurate, objective measure of a patient's mental status. However, significant disagreement when it is assessed by the trauma surgery team compared to the neurosurgery team. The difference is likely due to the time between assessments, as it allows for patient stabilization and reversal of pharmaceutical agents as patients who survived had a significantly larger change in GCS than those that died. Predictive modeling showed that the GCS recorded by the neurosurgery team is a better predictor of survival.

has changed significantly as research has expanded the knowledge of concussion.METHODS: A Google Forms survey was completed by total 250 high school students and their parents assessing demographic characteristics, as well as experience with, attitude towards, and knowledge of sports-related concussion. Statistical analysis was performed using Chisquare, Fisher's exact, and t-test methods. Statistical significance was defined as p < 0.05.RESULTS: 45% of students reported having a prior concussion. Parents were more concerned about concussion than students (71% vs. 56%, p = 0.004). Previously concussed students were more concerned about concussion than non-concussed students (73% vs. 58%, p = 0.007). Parents were more likely to consider stopping participation in an activity than their students (65% vs. 22%, p < 0.0001). 8% of previously concussed students had stopped participation in an activity due to concussion. Concussion knowledge was similar between parents and students who played and did not play contact sports. Students were more willing to conceal a concussion than their parents (49% vs. 4%, p < 0.001).CONCLUSION: Parents of high school students had greater concern about concussion than their students. Students were much more willing to conceal a concussion than their parents. The finding that 49% of high school students would conceal a concussion in order to continue participation in activities is concerning. More education is needed among the high school population.

INTRODUCTION The practice of surgeons performing overlapping surgery has recently come under scrutiny. We sought to examine the impact of overlapping rooms on surgery wait time and length of stay in patients admitted to a tertiary care, safety-net hospital for urgent neurosurgical procedures. METHODS Our hospital functions as a safety-net, tertiary care, level-1 trauma center in the Southern United States. The neurosurgery service transitioned from routinely allowing one room per day (period 1) to overlapping rooms (period 2), with the second room being staffed by the same attending surgeon. Patients undergoing neurosurgical intervention in each period were retrospectively compared. Case urgency, patient demographics, case type, indication, length of stay and time from admission to surgery were tracked. RESULTS >452 total cases were reviewed (201 in period 1 & 251 in period 2), covering 7 months in each period. 122 of the cases were classified as “urgent” (59 in period 1 and 63 in period 2). In the these patients, length of stay was significantly decreased in period 2 (13.09 days vs 19.52, p = .002) and the time from admission to surgery for urgent cases trended towards a shorter time (5.12 days vs 7.00, p = .084). Insurance status of these patients was 26.2% uninsured, 39.3% Medicaid, 18.9% Medicare, 9% commercial and the remainder workers compensation, liability or prisoner care. Multivariate regression analysis revealed that being in period 1, having Medicare, having trauma as the indication for surgery, and undergoing a non-cranial or non-spinal procedure as significant factors for increased length of stay. CONCLUSION Recent studies suggest overlapping surgeries are safe for patients. In the case of our safety net hospital, allowing the neurosurgery service to run overlapping rooms significantly reduces length of stay in a vulnerable population who is admitted in need of urgent surgery.