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Study Design.: Retrospective review, single-institution cohort studies. Objective.: To compare patients with earlier (i.e. <1.5 yr) and later (i.e. >1.5 yr) repeat lumbar surgery to patients with no repeat surgery according to clinical characteristics at index surgery. Background.: Grouping patients as earlier or later repeat surgery may reveal different associations when compared with patients with no repeat surgery. Patients and Methods.: Patients undergoing index surgery for diverse conditions reported preoperative demographic/clinical variables, including comorbidity and depressive symptoms. Extent (i.e. complexity) of surgery was assigned based on a valid index that included decompression, fusion, and instrumentation. Co-existing disease at nonoperated levels was ascertained from imaging reports. Postoperative records of all medical visits up to the time of this study (12 yr) were reviewed for repeat surgery. Patients were grouped as earlier (<1.5 yr) or later surgery (≥1.5 yr) and compared with patients with no repeat surgery in separate multivariable analyses. Results.: Among 1334 patients (51% men, mean age 59), 82% did not have repeat surgery, 7% had earlier and 11% had later repeat surgery. Compared with no surgery, earlier surgery was associated with more comorbidity (OR: 1.7, CI: 1.1–2.6, P =0.02), positive depression screen (OR: 1.9, CI: 1.2–2.9, P =0.006), opioid use (OR: 1.8, CI: 1.2–2.8, P =0.008), and greater extent of index surgery (OR: 1.1, CI: 1.0–1.1, P =0.0009). Compared with no surgery, later surgery was associated with preindex lumbar surgery (OR: 1.9, CI: 1.3–2.8, P =0.0005) and disease at nonoperated levels at index surgery (OR: 1.6, CI: 1.0–2.4, P =0.05). Earlier surgeries were more likely to involve only the same vertebra as index surgery (51% vs. 16%) and later surgeries were more likely to involve only other levels (5% vs. 36%, P =0.01). Conclusions.: Earlier and later repeat lumbar surgeries differed in complexity and residual disease compared with no repeat surgery. These findings have implications for patient counseling regarding short-term and long-term postoperative spine health. [ABSTRACT FROM AUTHOR]

Objective: To assess the factors influencing the type and timing of Alveolar Bone Grafting (ABG) among cleft centers throughout India. To examine the decision-making criteria for orthodontic treatment and the timing of ABG. Design: Cross sectional survey Method: This survey was based on a convenience-based sample selected from cleft teams across India. The survey was formulated using the SurveyMonkey platform and emailed to 40 cleft teams. The survey included questions on demographics, timing, surgical protocol, orthodontic protocol, radiograph prescription rate, assessment methods for the success of ABG and three scenarios for evaluating the timing of the bone graft. The Chi-squared test was performed to evaluate the difference in opinion between specialists. The inter-examiner reliability was assessed using Kappa statistics. Results: Thirty-five units completed the questionnaire. Most units operate with 1-2 surgeons, with 42.9% of them treating cleft patients for under 5 years. Only 11.4% of centres routinely advised oblique occlusal radiographs for post-surgery evaluation, and 31.4% prescribed CBCT. However, 40% of cleft teams did not perform audits to evaluate the success of ABG, and less than 50% advised radiographs six months post-surgery. Around 26% of centres do not routinely provide orthodontic treatment pre-ABG. The inter-examiner reliability for case scenarios showed poor agreement between the clinicians. Conclusion: The survey showed a serious lack of consensus in the ABG treatment among cleft teams in India and emphasises the need for standardised protocols for the treatment of children with cleft palate. There is an urgent need to develop core outcome set in cleft. [ABSTRACT FROM AUTHOR]

Objective: Epilepsy surgery outcomes tend to be judged by the percentage in seizure reduction without considering the effect on specific seizure types, particularly tonic-clonic seizures, which produce the greatest morbidity and mortality. We assess how often focal to bilateral tonic-clonic seizures (BTCS) stop and how often they appear de novo after epilepsy surgery., Methods: Analysis of a prospectively maintained epilepsy surgery database between 1986 and 2022 that characterizes the burden of BTCS after resective epilepsy surgery. Patients were stratified according to presence or absence of preoperative BTCS and whether these were active (defined as ≥1 BTCS/year prior to surgery) or remote., Results: A total of 804 patients were followed for a median of 7 years (interquartile range [IQR] = 3-13 years) after epilepsy surgery, most being temporal lobe resections (91%, 95% confidence interval [CI] = 89-93%). At last visit, 72% of patients (95% CI = 69-75%) were seizure-free for 1 year or more. Of 521 patients with preoperative BTCS, 300 (58%, 95% CI = 53%-61%) no longer had them after surgery. BTCS recurred in 221 patients, but 128 of them (58%, 95% CI = 51%-64%) had no BTCS in the last year of follow-up. Those patients who continued to experience BTCS after surgery had a median reduction of 92% in yearly BTCS frequency (IQR = 65%-98%, p < .001). Of 283 patients with no preoperative BTCS, 17 developed de novo BTCS (6%, 95% CI = 4%-9%), with a median of 2 BTCS during the entire follow-up period. Forty-seven percent (95% CI = 42%-53%) of patients without preoperative BTCS became seizure-free after surgery, compared with 33% (95% CI = 29-37, p < .001) of patients with preoperative BTCS., Significance: Epilepsy surgery markedly reduces or eliminates BTCS, which should have a potential positive impact on morbidity and mortality. This favors offering surgery even if the chance of seizure freedom is not high and calls for a new surgical outcome scale to factor in seizure severity reduction., (© 2025 International League Against Epilepsy.)