The Re-Evaluation of Frailty in Predicting Complications after Long-Segment Spinal Fusion for Adult Spinal Deformity.

OBJECTIVE: To evaluate on a national scale how frailty status (stratified using the 5-item Modified Frailty Index (mFI-5)) affects the operative characteristics of and complications after long-segment spinal fusion (LSF) for adult spinal deformity (ASD). METHODS: Adults undergoing LSF of ≥3 vertebrae in the National Surgical Quality Improvement Program database years 2015-2020 were split into 2 cohorts: nonfrail with mFI = 0 or 1; frail with mFI ≥2. Demographics, operative characteristics, and 30-day complications were contrasted between the cohorts using the Student's t-test, the Fisher's exact test, or a multivariate analysis when appropriate. RESULTS: In the 340 LSF cases collected, 268 fell into the nonfrail cohort and 72 into the frail cohort. The frail cohort constituted a high rate of geriatric age (65.3% vs. 38.1%; P < 0.001), higher body mass index (32.9 ± 0.86 vs. 30.2 ± 0.39; P = 0.005), and more comorbidities in 9 of 14 measures. After surgery, the frail cohort experienced more urinary tract infections (odds ratio [OR], 3.33; confidence interval [CI], 1.01-10.94; P = 0.04). However, the frail cohort shared similarities with the nonfrail cohort in terms of length of stay (5.11 ± 0.51 vs. 6.01 ± 1.62 days; P = 0.60), home discharge (OR, 0.76; CI, 0.42-1.39; P = 0.38), readmission (OR, 2.45; CI, 0.87-6.89; P = 0.09), and overall rate of complications (OR, 0.89; CI, 0.50-1.59; P = 0.70). CONCLUSIONS: Despite trends found in past studies of ASD, this analysis showed that the frailty status of mFI ≥2 is a poor predictor of surgical and hospitalization course and overall complications in LSF when examined up to 30 days postoperatively.

The Effective Use of Laser Ablation to Treat Mesial Temporal Lobe Epilepsy in the Setting of Implanted Responsive Neurostimulation.

BACKGROUND: Up to 16% of patients with responsive neurostimulation (RNS) implants for bilateral temporal epilepsy are found to have seizures originating mainly from just 1 lobe. OBJECTIVE: To describe the first use of laser interstitial thermal therapy (LITT) in a patient with a bilateral RNS implant to ablate the predominant temporal lobe and help control seizures. METHODS: A 55-year-old woman treated for temporal lobe epilepsy with conflicting information regarding lateralization underwent RNS implantation. She was then discovered to have seizures with electrographic onset nearly all from the right amygdala and hippocampus. She was offered LITT to ablate the affected region in the right temporal lobe, followed by reimplantation of the RNS lead in the remnant of the right hippocampal tail. RESULTS: Despite the positioning of the RNS ferrule on the operative side and the depth electrode in the contralateral lobe, we observed no significant artifact and obtained stable LITT temperature mapping using magnetic resonance. Laser ablation and RNS device replacement proceeded without complications. The patient has remained seizure-free for 6 months since the ablation in the setting of weaning antiseizure medications and regaining ambulation. CONCLUSION: LITT ablation can safely and effectively be performed in a patient with a concurrent RNS implant. Maintenance of the RNS device after ablation allows for continual detection and management of seizures.