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The coronavirus disease 2019 (COVID-19) pandemic has changed health care delivery across the United States. Few analyses have specifically looked at quantifying the financial impact of the pandemic on practicing neurosurgeons. A survey analysis was performed to address this need.A 19-question survey was distributed to practicing neurosurgeons in the United States and its territories. The questions evaluated respondents' assessments of changes in patient and procedural volume, salary and benefits, practice expenses, staffing, applications for government assistance, and stroke management. Responses were stratified by geographic region.The response rate was 5.1% (267/5224). Most respondents from each region noted a50% decrease in clinic volume. Respondents from the Northeast observed a 76% decrease in procedure volume, which was significantly greater than that of other regions (P = 0.003). Northeast respondents were also significantly more likely to have been reassigned to nonneurosurgical clinical duties during the pandemic (P0.001). Most respondents also noted decreased salary and benefits but experienced no changes in overall practice expenses. Most respondents did not experience significant reductions in nursing or midlevel staffing. These trends were not significantly different between regions.The COVID-19 pandemic has led to decreases in patient and procedural volume and physician compensation despite stable practice expenses. Significantly more respondents in the Northeast region noted decreases in procedural volume and reassignment to nonneurosurgical COVID-related medical duties. Future analysis is necessary as the pandemic evolves and the long-term clinical and economic implications become clear.

The National Institutes of Health has developed a new metric, the Relative Citation Ratio (RCR), to assess the impact of research articles and compare academic productivity across different fields. Global surgery, obstetrics, trauma, and anesthesia (SOTA) are young and increasingly popular fields attracting researchers and funding. This study analyzed the RCR of global neurosurgery; compared it with other global SOTA specialties; and discussed the implications for researchers, academic institutions, and aspiring global neurosurgeons.Metadata were downloaded from the National Institutes of Health RCR website for 12 established global surgery specialties, including global neurosurgery. The authors performed descriptive and bivariable inferential analyses to evaluate differences in the number of total publications, median number of citations per year, and median RCR for each specialty for which data were available.Global pediatric surgery had the highest median citations per year (2.00, interquartile range: 0.63-3.50; P = 0.048) and median relative citation ratio (1.36, interquartile range: 0.33-1.95; P = 0.693). In comparison, global neurosurgery articles had 0.20 median citations per year (IQR: 0-1.5) and 0.54 (IQR: 0.12-1.30) median relative citations. The median expected citations per year for all SOTA articles was 1.77.We observed strong development of global neurosurgery and SOTA research. Overall, the use of the RCR will facilitate standardized interfield and intrafield academic productivity comparisons. Based on the results presented in this study, global neurosurgery is a promising career route for young and aspiring academic neurosurgeons.

Diversity, equity, and inclusion within the healthcare workforce are conducive to providing culturally competent care. However, few existing studies have assessed the level of racial and ethnic diversity among resident physicians and residency applicants. Our objective was to provide a comparative analysis of the trends in racial and ethnic representation within different subspecialties in medicine.Using data from the American Association of Medical Colleges and the Journal of the American Medical Association, we evaluated the racial and ethnic identification of residency applicants and current residents in 9 procedural-focused specialties from 2005 to 2019 and performed a descriptive analysis to compare the different levels of racial and ethnic diversity in these specialties.Among the specialties analyzed during the study period, neurosurgery had the greatest magnitude of differences between Black/African-American residency applicants and current residents. The percentage of Black/African-American applicants was 92% greater than that of Black/African-American residents (10% of applicants vs. 5.2% of residents). In contrast, the percentage of White neurosurgery residents was 17.6% greater than that of White neurosurgery applicants (53.9% of applicants vs. 63.4% of residents). Similar trends were noted in all the specialties evaluated. Obstetrics and gynecology demonstrated the least disparity between Black/African-American applicants and residents (13.7% of applicants vs. 10.2% of residents; 35.4% difference). Hispanic and Asian representation varied widely between specialties.Among the surveyed specialties, neurosurgery demonstrated the greatest disparity between the percentage of Black/African-American residency applicants and current residents. To further drive progress in this domain, we advocate for a series of initiatives designed to increase underrepresented minority participation in neurosurgery practice and scholarship.

Objective The Council of State Neurosurgical Societies (CSNS) surveyed neurosurgeons applying for oral board certification in 2008 to assess their preparedness to practice. This survey was repeated in 2013 for a subsequent group of board applicants to evaluate the quality of neurosurgery training and identify opportunities for improvement. Methods Applicants for the American Board of Neurological Surgeons (ABNS) oral examination from 2008-2013 were provided an anonymous survey focused on clinical and socioeconomic skills. Survey responses were compared with the published results of a similar survey using an inferential statistical analysis. Results 110/655 neurosurgeons responded (response rate 16.8%). Significantly more respondents from the 2013 survey felt prepared to perform the following techniques: Angiography, endoscopic surgery, anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), kyphoplasty, deep brain stimulation. Significantly more respondents in 2013 attested to receiving appropriate education on Health Insurance Portability and Accountability Act (HIPAA) and pay-for-performance practice models of healthcare. However, significantly fewer respondents in 2013 felt prepared in open vascular neurosurgery techniques. In both surveys, fewer than 35% of respondents felt adequately prepared in endovascular neurosurgery techniques, medical coding, negotiating an employment contract, and issues regarding practice management and the economics of neurosurgery. Conclusion The 2013 survey suggests that candidates for board certification in neurosurgery perceive themselves to be adequately prepared to independently perform nearly all neurosurgical procedures. However, additional work is required to optimize neurosurgery training in endovascular procedures and the socioeconomic aspects of neurosurgery practice.

Objective We investigated whether a sex-related difference exists in the postoperative complication risk and health-related quality of life measures after surgery for adult spinal deformity. Methods We performed a retrospective study of 156 adult patients with a diagnosis of adult spinal deformity who had undergone spinal surgery. The primary outcome variables included the postoperative complication rates and changes in the health-related quality of life measures. Adjusted odds ratios were estimated by multivariate logistic regression with the inclusion of covariate terms for sex, smoking, preoperative optimization, American Society of Anesthesiologists grade, depression, osteoporosis, invasiveness of surgery (number of vertebral levels fused), and baseline functional disability. Results At presentation, the women were more likely to be smokers (74 women [71.15%]; 23 men [42.31%]; P = 0.01) and to have a greater prevalence of depression (36 women [34.62%]; 10 men [19.23%]; P = 0.06). The women had also presented with more severe baseline pain (visual analog scale for back pain score, 7.24 vs. 6.00 [P = 0.02]; visual analog scale for leg pain score, 5.87 vs. 5.59 [P = 0.07]) and worse functional disability (patient-reported outcomes measurement information system score, 6.82 vs. 5.65 [P = 0.01]; Oswestry disability index, 45.42 vs. 37.07 [P = 0.01]). However, postoperatively, the women experienced greater improvement in pain and disability compared with the men. The unadjusted odds of a postoperative complication was greater for the women (odds ratio, 1.14; 95% confidence interval, 0.55–2.33). On multivariate logistic regression analysis, the association between sex and postoperative complications was attenuated after controlling for other baseline variables. Conclusions In the present study, after adjustment for important baseline prognostic factors, no differences were found in the postoperative complication rates or extent of functional improvement when stratified by sex. Both sexes responded equally well to corrective surgery for symptomatic adult spinal deformity.

Objective Spinal involvement in neurocysticercosis is rare and can lead to debilitating injury if not diagnosed and treated early. We aim to provide the reader with a thorough analysis of the best available evidence regarding patient characteristics, optimal treatment modality, and outcomes in cases of spinal neurocysticercosis. Methods A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was made according to the PRISMA guidelines. An illustrative case of intramedullary–cervical spinal disease is also presented for illustrative purposes. Results A total of 46 reports of 103 patients fitting the screening criteria were identified. Isolated spinal involvement was seen in 46.15% of patients. Most infections (76.92%) had an intradural extramedullary localization, with 43.27% of cases involving >1 spinal cord level. The most common presenting symptoms were motor deficits (77.88%), pain syndromes (64.42%), and sensory deficits (53.85%). Combined surgical resection and pharmacologic therapy was the most frequently used treatment modality (49.04%) and had the highest proportion of patients reporting symptomatic improvement at follow-up (78.43%). Combination therapy had a significantly higher rate of neurologic recovery compared with surgery alone (P = 0.004) or medical treatment (P = 0.035). Conclusions Spinal involvement in neurocysticercosis should be considered in patients from or who traveled to endemic areas presenting with ring-enhancing lesions. Combined treatment with surgery followed by cysticidal and steroid medication seems to be superior to surgery or medical treatment in isolation and seems to provide the highest chances of recovery.