BackgroundThis study is a descriptive review of the literature aimed at examining the efficacy of the use of intraoperative epidural steroids in lumbar disc surgery, a matter that remains controversial.MethodsThe relevant clinical trials were selected from databases and reviewed. The methodological quality of each included study was assessed and graded for perceived risk of bias. All the documented significant and non-significant findings were collected. Our outcome targets were reduction in postoperative pain scores, consumption of analgesia, duration of hospital stay and no increase in complication rates. The variation in the timing of postoperative pain assessments necessitated grouping the outcome into three postoperative stages; early: 0 to 2 weeks, intermediate: more than 2 weeks to 2 months and late: more than 2 months to 1 year.ResultsSixteen trials that were published from1990 to 2012 were eligible. At least one significant reduction in pain score was reported in nine of the eleven trials that examined pain in the early stage, in four of the seven trials that examined pain in the intermediate stage and in two of the eight trials that examined pain in the late stage. Seven of the nine trials that looked at consumption of postoperative analgesia reported significant reduction while six of the ten trails that examined the duration of hospital stay reported significant reduction. None of the trials reported a significant increase of steroid-related complications.ConclusionsThere is relatively strong evidence that intraoperative epidural steroids are effective in reducing pain in the early stage and reducing consumption of analgesia. There is also relatively strong evidence that they are ineffective in reducing pain in the late stage and in reducing duration of hospital stay. The evidence for their effectiveness in reducing pain in the intermediate stage is considered relatively weak. The heterogeneity between the trials makes it difficult to make undisputed conclusions and it indicates the need for a large multicenter trial with validated outcome measures that are recorded at fixed time intervals.

ObjectivesThe objective of this study was to identify the top 50 countries in the world in clinical neurology research and to use their data to assess the impact of a number of country-specific characteristics on scientific productivity in clinical neurology.MethodsThe SCImago Journal & Country Rank (SCR) web site was used to identify the top 50 countries in the world based on their total documents in clinical neurology. Using their data 5 country-specific characteristics and 6 productivity indicators (total documents, total cites, h-index, citable documents, self-cites and citations per document) were correlated and examined statistically.ResultsThe number of universities in the world top 500 and the number of clinical neurology journals enlisted in SCR correlated significantly with each of the 6 indicators. The gross domestic product (GDP) per capita and the percentage of GDP spent on research and development (R & D) correlated significantly with 3 and 4 out of the 6 indicators respectively. The population size did not correlate significantly with any of the 6 indicators.ConclusionsThe number of universities in the world top 500 and the number of clinical neurology journals enlisted in SCR appear to have a strong impact on scientific productivity. GDP per capita and spending on R & D appear to have a moderate impact on productivity that is influenced by the indicator used. Furthermore, population size appears to have no significant impact on productivity in clinical neurology research.

Introduction We aim to assess the impact of the quantity of intradiscal cement leak during kyphoplasty on the rate of progression of degenerative changes in the affected disc. Methods Of 316 kyphoplasty procedures, we identified 32 episodes of intradiscal cement leak in 26 patients. The quantity of cement leaked was graded from I to IV. Disc degenerative changes were assessed at presentation and follow-up using radiographical scoring and magnetic resonance imaging (MRI) grading systems. Data for low-grade leaks (grade I) were compared with the medium- and high-grade leaks (grades II-IV) using a chi-squared test. Results Median follow-up radiographic and MRI assessments were made at 18 and 21 months, respectively. Medium- and high-grade leaks were associated with a significantly higher radiographic disc degeneration scores compared with low-grade leaks (P = 0.04295) but no difference was found in MRI disc degeneration grades and in adjacent vertebral fracture rates. Conclusions Our findings indicate that the quantity of cement leaking into the disc space significantly influences the rate of progression of disc degeneration.

We report a child with osteopetrosis, oxycephaly and Chiari type I malformation who presented with raised intracranial pressure. During cranial expansion surgery the patient developed sudden cardiac arrest which we believe was probably related to the Chiari malformation. The case highlights a previously unrecognized association between osteopetrosis, craniosynostosis and a persistently open fontanelle at age 4 years. In addition it supports the existing literature in emphasizing the need for careful preoperative work up, choice of approach and operative technique in children with complex craniosynostosis and Chiari malformation.