Increasing the neurosurgical caseload at a military hospital: initial experience with a joint military-Veterans Affairs (VA) sharing agreement.

OBJECTIVE: Neurosurgeons at David Grant Medical Center (DGMC) have had low surgeon case volumes. Meanwhile, veterans have had long waits because of inadequate neurosurgical coverage. DGMC and Department of Veteran Affairs (VA) agreed to share resources to treat an underserved VA patient population. We analyzed number of cases, admissions, relative weighted product (RWP), and outpatient visits before and after this unique military-VA agreement. METHODS: Number of operations, hospital admissions, RWP, and outpatient visits (January 2004-November 2007) were noted before or after October 2006. To normalize data, metric (e.g, number of cases) totals were divided by number of months neurosurgeons were available. RESULTS: Before the agreement, two neurosurgeons performed 210 operations over 52 months (4.0 cases/month). After the agreement, two neurosurgeons performed 177 cases over 26 months (6.8 cases/month). This corresponded to a 2.2-, 2.2-, and 2.0-fold increase in hospital admissions, RWP, and outpatient visits, respectively. CONCLUSIONS: The sharing agreement resulted in 1.7-fold increase in operative cases. This military-VA venture provides military neurosurgeons with more surgical cases and provides neurosurgical care to a previously underserved patient population.

Resolution of an aggressive ideopathic diskitis.

We report a case of thoracic spine diskitis of unknown cause that had aggressive and destructive features on MR images. Results of two biopsies were unremarkable. The process began after sneezing, also produced extensive paraspinous enhancement, and resolved without antibiotic therapy both clinically and radiologically after four months. A discussion of case similarities to Reflex Sympathetic Dystrophy (RSD) in the extremities render this possibly the first reported imaging evidence of RSD in the axial skeleton.