Nuevo nomenclátor estandarizado de Neurocirugía: criterios e indicadores cuantitativos y cualitativos de baremación de actos médicos / A new standardized nomenclature in neurosurgery: Criteria and quantitative and qualitative evaluation indicators of medical procedures

Objetivos: Actualizar el nomenclátor de actos médicos de la especialidad de Neurocirugía, eliminando actos en desuso y añadiendo las nuevas técnicas quirúrgicas desarrolladas en los últimos años, para que se adapte fielmente a la práctica médica habitual de nuestra especialidad, así como establecer los principios generales y definir los criterios de baremación, indicadores cuantitativos y escalas de valoración. Material y método: La elaboración del nuevo nomenclátor se dividió en 3 fases: 1) identificación y selección de los actos médicos, 2) establecimiento del grado de dificultad de cada uno de ellos basado en la experiencia y el tiempo necesarios para su realización, así como el porcentaje y gravedad de las posibles complicaciones y 3) consenso con los miembros de la SENEC mediante su envío individualizado, realizando los retoques necesarios y posterior aprobación en asamblea de la especialidad. Resultados: El nuevo nomenclátor cuenta con 255 actos médicos agrupados en 4 grupos: consultas y visitas, actos terapéuticos, procedimientos diagnósticos e intervenciones quirúrgicas. Se han eliminado 42 procedimientos recogidos en el nomenclátor de la OMC por obsoletos, no ser propios de la especialidad o resultar demasiado vagos. Se han introducido nuevas técnicas y se han definido de forma más precisa los actos médicos. Conclusiones: Este nomenclátor proporciona una terminología actualizada y servirá para ofertar la cartera de servicios, medir y conocer el valor relativo de nuestra actividad y de los costes aproximados de los procedimientos, y adicionalmente, para realizar estudios comparativos longitudinales. Debe constituir una herramienta para mejorar la atención de los pacientes y minimizar la variabilidad geográfica en todos los ámbitos asistenciales.(AU)

Purpose: Update the list of medical acts in the specialty of neurosurgery, eliminating obsolete acts and adding the new surgical techniques developed in recent years, so that they are faithfully adapted to the usual medical practice of our specialty, as well as establishing the general principles and defining the grading criteria, quantitative indicators and assessment scales. Material and method: The elaboration of the new nomenclator was divided into three phases: (1) identification and selection of medical acts, (2) establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion, as well as the percentage and severity of the possible complications and (3) consensus with the members of the SENEC through their individualized submission, making the necessary adjustments and subsequent approval in the general assembly of SENEC. Results: The new nomenclator has 255 medical acts grouped into four groups: consultations and visits, therapeutic acts, diagnostic procedures and surgical interventions. Forty-two procedures included in the OMC nomenclator have been eliminated due to being obsolete, not related to the specialty or being too vague. New techniques have been included and medical acts have been more precisely defined. Conclusions: This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services, measure and know the relative value of our activity and the approximate costs of the procedures, and additionally, to carry out longitudinal comparative studies. It should be a tool to improve patient care and minimize geographic variability in all healthcare settings.(AU)

A new standardized nomenclature in neurosurgery: Criteria and quantitative and qualitative evaluation indicators of medical procedures.

PURPOSE: Update the list of medical acts in the specialty of Neurosurgery, eliminating obsolete acts and adding the new surgical techniques developed in recent years, so that they are faithfully adapted to the usual medical practice of our specialty, as well as establishing the general principles and defining the grading criteria, quantitative indicators and assessment scales. METHODS: The elaboration of the new nomenclator was divided into 3 phases: 1) identification and selection of medical acts, 2) establishment of the degree of difficulty of each of them based on the experience and the time necessary for their completion, as well as the percentage and severity of the possible complications and 3) consensus with the members of the SENEC through their individualized submission, making the necessary adjustments and subsequent approval in the general assembly of SENEC. RESULTS: The new nomenclator has 255 medical acts grouped into 4 groups: consultations and visits, therapeutic acts, diagnostic procedures and surgical interventions. 42 procedures included in the OMC nomenclator have been eliminated due to being obsolete, not related to the specialty or being too vague. New techniques have been included and medical acts have been more precisely defined. CONCLUSIONS: This nomenclator provides up-to-date terminology and will serve to offer the portfolio of services, measure and know the relative value of our activity and the approximate costs of the procedures, and additionally, to carry out longitudinal comparative studies. It should be a tool to improve patient care and minimise geographic variability in all healthcare settings.

Minimally Invasive Transforaminal Lumbar Interbody Fusion: Meta-analysis of the Fusion Rates. What is the Optimal Graft Material?

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is an increasingly popular procedure with several potential advantages over traditional open TLIF. OBJECTIVE: The current study aimed to compare fusion rates of different graft materials used in MIS-TLIF, via meta-analysis of the published literature. METHODS: A Medline search was performed and a database was created including patient's type of graft, clinical outcome, fusion rate, fusion assessment modality, and duration of follow-up. Meta-analysis of the fusion rate was performed using StatsDirect software (StatsDirect Ltd, Cheshire, United Kingdom). RESULTS: A total of 1533 patients from 40 series were included. Fusion rates were high, ranging from 91.8% to 99%. The imaging modalities used to assess fusion were computed tomography scans (30%) and X-rays (70%). Comparison of all recombinant human bone morphogenetic protein (rhBMP) series with all non-rhBMP series showed fusion rates of 96.6% and 92.5%, respectively. The lowest fusion rate was seen with isolated use of autologous local bone (91.8%). The highest fusion rate was observed with combination of autologous local bone with bone extender and rhBMP (99.1%). The highest fusion rate without the use of BMP was seen with autologous local bone + bone extender (93.1%). The reported complication rate ranged from 0% to 35.71%. Clinical improvement was observed in all studies. CONCLUSION: Fusion rates are generally high with MIS-TLIF regardless of the graft material used. Given the potential complications of iliac bone harvesting and rhBMP, use of other bone graft options for MIS-TLIF is reasonable. The highest fusion rate without the use of rhBMP was seen with autologous local bone plus bone extender (93.1%).

Unilateral tubular approach for bilateral laminotomy: effect on ipsilateral and contralateral buttock and leg pain.

PURPOSE: Tubular laminotomy is an effective procedure for treatment of lumbar spinal stenosis (LSS) and lateral recesses stenosis. Most surgeons familiar with the procedure agree that the tubular approach appears to afford a more complete decompression of the contralateral thecal sac and nerve root, as compared to the ipsilateral approach. With this study we sought to answer the question whether this is reflected in clinically significant differences between the ipsilateral and contralateral side pain improvements. METHODS: In a retrospective case study, patients with LSS and lateral recesses stenosis who started out with VAS scores that were similar on the right and left side were included. All patients underwent a tubular (MIS) "over the top" laminotomy from a unilateral approach and through one incision. Surgeries were performed by a single surgeon in a single center. At the last follow-up, the extent of VAS score improvement on the approach (ipsilateral) side was compared to that of the contralateral side. RESULTS: Thirty-three patients were included in. At the latest follow-up of 25.8 ± 3.4 months, there were statistically significant improvements in ODI and back VAS scores (p = 0.002 and p < 0.0001, respectively). In addition, buttock VAS scores were significantly improved both on the ipsilateral and the contralateral side (p < 0.001, and p = 0.001, respectively). Similarly, leg VAS scores were improved significantly on both sides (p < 0.001, and p = 0.001, respectively). There were no statistically significant differences between the extent of pain improvement on the ipsilateral and the contralateral side. CONCLUSIONS: MIS tubular laminotomy through a unilateral approach results in clinically effective bilateral decompression of LSS and lateral recesses, regardless of the approach side.

Compresión medular: aproximación multidisciplinar a una auténtica urgencia neurooncológica. Réplica / Spinal cord compression: a multidisciplinary approach to an authentic neuro-oncological emergency

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[Spinal cord compression: a multidisciplinary approach to a real neuro-oncological emergency. Reply]. / Compresion medular: aproximacion multidisciplinar a una autentica urgencia neurooncologica. Replica.

TITLE: Compresion medular: aproximacion multidisciplinar a una autentica urgencia neurooncologica. Replica.

Compresión medular: aproximación multidisciplinar a una auténtica urgencia neurooncológica / Spinal cord compression: a multidisciplinary approach to a real neuro-oncological emergency

La compresión medular debe ser considerada una urgencia neurooncológica de primera magnitud. Bajo este planteamiento, la aproximación multidisciplinar y la rapidez en la instauración de las medidas terapéuticas que procedan son cruciales para optimizar el pronóstico funcional (y quizás vital) de los pacientes afectos. Las actitudes nihilistas hasta ahora imperantes en algunos sectores profesionales, posiblemente derivadas de una percepción de mal pronóstico a corto plazo, deben ser completamente desterradas. La mejora de la supervivencia global de los pacientes oncológicos en su conjunto, la disponibilidad de nuevas técnicas neuroquirúrgicas accesibles a una gran mayoría de nuestros hospitales, y las mejoras evidentes en los equipos y técnicas de radioterapia permiten abordar esta patología con mejores perspectivas de éxito, no sólo en lo que al control de la progresión tumoral propiamente dicha se refiere, sino también en el control del dolor, el mantenimiento de la funcionalidad de la médula espinal y la supervivencia global del paciente. En este contexto, consideramos obligado que todos los hospitales dispongan de protocolos de actuación específicos para la compresión medular aguda. La puesta en marcha en el Centro Médico de Asturias de un protocolo de estas características ha animado a realizar una revisión y actualización sobre el tema, con especial énfasis en las evidencias disponibles para cada una de las modalidades terapéuticas comentadas

Spinal cord compression must be considered a top-priority neuro-oncological emergency. Hence, a multidisciplinary approach and swiftness in establishing appropriate therapeutic measures are crucial to optimise the functional (and perhaps vital) prognosis of these patients. The nihilistic attitudes that have prevailed up until now in some professional sectors, possibly stemming from the perception of a poor short-term prognosis, must be completely eradicated. The overall improvement in survival rates among cancer patients in general, the availability of new neurosurgical techniques in the vast majority of our hospitals and the obvious improvements in radiotherapy equipment and techniques all this pathology to be addressed with greater chances of success. This greater likelihood of accomplishing a better outcome refers not only to the control of the development of the tumour itself, but also to pain control, maintenance of the functioning of the spinal cord and the overall survival of the patient. In this context, we consider it essential for all hospitals to have specific protocols on how to proceed in cases of acute spinal cord compression. The fact that this kind of protocol has been introduced in the Centro Médico de Asturias has prompted us to conduct a review of the current state-of-the-art in this field, with special emphasis on the evidence available for each of the modes of therapy that are discussed

[Spinal cord compression: a multidisciplinary approach to a real neuro-oncological emergency]. / Compresion medular: aproximacion multidisciplinar a una autentica urgencia neurooncologica.

Spinal cord compression must be considered a top-priority neuro-oncological emergency. Hence, a multi-disciplinary approach and swiftness in establishing appropriate therapeutic measures are crucial to optimise the functional (and perhaps vital) prognosis of these patients. The nihilistic attitudes that have prevailed up until now in some professional sectors, possibly stemming from the perception of a poor short-term prognosis, must be completely eradicated. The overall improvement in survival rates among cancer patients in general, the availability of new neurosurgical techniques in the vast majority of our hospitals and the obvious improvements in radiotherapy equipment and techniques all this pathology to be addressed with greater chances of success. This greater likelihood of accomplishing a better outcome refers not only to the control of the development of the tumour itself, but also to pain control, maintenance of the functioning of the spinal cord and the overall survival of the patient. In this context, we consider it essential for all hospitals to have specific protocols on how to proceed in cases of acute spinal cord compression. The fact that this kind of protocol has been introduced in the Centro Medico de Asturias has prompted us to conduct a review of the current state-of-the-art in this field, with special emphasis on the evidence available for each of the modes of therapy that are discussed.