Reformers claim that public subsidies and regulation of political finance reduce corruption in politics, while observers worry that they have no impact on corruption, or even increase it. Despite national-level debates and billions of dollars spent, few studies have tested this relationship. The authors argue that political finance reform mitigates corruption by reducing private moneys importance in politics and increasing the sanctions for corrupt behavior. Elite interviews from Paraguays political finance reform illustrate the argument and elaborate the theoretical mechanisms. The study evaluates the argument using an original dataset measuring political subsidies from 175 countries from 1900–2015, as well as disaggregated corruption measures from the Varieties of Democracy project. The findings support the thesis that political finance reform reduces corruption, even in countries where such reforms are unevenly implemented.
Reformers claim that public subsidies and regulation of political finance reduce corruption in politics, while observers worry that they have no impact on corruption, or even increase it. Despite national-level debates and billions of dollars spent, few studies have tested this relationship. The authors argue that political finance reform mitigates corruption by reducing private moneys importance in politics and increasing the sanctions for corrupt behavior. Elite interviews from Paraguays political finance reform illustrate the argument and elaborate the theoretical mechanisms. The study evaluates the argument using an original dataset measuring political subsidies from 175 countries from 1900–2015, as well as disaggregated corruption measures from the Varieties of Democracy project. The findings support the thesis that political finance reform reduces corruption, even in countries where such reforms are unevenly implemented.
No planned iO-Flex foraminotomies were aborted. Neurologic complications included transient dysesthetic pain in 1 patient (3.2%, n = 31), and transient numbness in 3 patients (9.7%, n = 31). There were no motor deficits. The composite nerve complication rate was 12.7%. Preoperative visual analog scale scores decreased from a mean of 7.1 (n = 31, standard deviation [SD] 2.0) to a mean of 3.5 (n = 30, SD 2.5). If asked to repeat their decision to do surgery, 81% of patients would redo the procedure. The rate of patient dissatisfaction was 19%.
Neural mapping using stimulated electromyography has recently become a popular nerve injury avoidance technique, particularly during lateral lumbar interbody fusion procedures.18–20 Neural mapping is also advocated with the iO-Flex foraminotomy system.10 MMG is an alternative to electromyography for detection of muscle activation after electrical stimulation of nerves within or near the operative field. Rather than detecting an electrical response, it detects the mechanical response in the muscle.21 Unlike electromyography, in which the signal is often contaminated by electrical noise and difficult to analyze,22,23 MMG offers a clear signal that is devoid of background noise, thus allowing detection of muscle responses from very low electrical stimulation currents.21,22 The SentioMMG system, which we used, has the added benefits of being a surgeon-driven nerve monitoring system and of not requiring neuromonitoring personnel. In our study, no attempts at iO-Flex foraminotomy were aborted. Confidence in nerve safety was given by large differentials between the MMG responses to electrical stimulation by the deep and superficial electrodes of the Neuro Check. The average percent differential between the electrodes, which are a few millimeters apart, was 332%. The average difference in stimulation currents between the electrodes was 7.2 mA. This large differential between superior and inferior surfaces of the Neuro Check device makes it clear where the nerve is located. Of note, nerve mapping only mitigates neurologic injury; vascular structures within the neuroforamen are still at risk. Injury to vascular structures and resultant bleeding may be a cause of sensory complications due to irritation of the dorsal root ganglion.
All continuous data were described using means, standard deviations (SDs), medians, minimums, and maximums while categorical data are described using counts and percentages. The difference in VAS scores was calculated by subtracting preoperative VAS from postoperative VAS scores. This difference was compared between subgroups using Wilcoxon rank-sum tests for 2-level subgroups and using Kruskal-Wallis tests for subgroups with 3 or more levels. Categorical responses were compared between groups using Fishers exact tests due to small cell counts. Statistical significance was set at P < .05. All analyses were performed using SAS 9.4 (SAS Institute, Inc., Cary, North Carolina).
Regarding pain relief, the mean preoperative VAS score was 7.1 (n = 31, SD 2.0); mean postoperative VAS score was 3.5 (n = 30, SD 2.5) ( ). Comparing patients who underwent foraminotomy alone versus those who underwent foraminotomy with discectomy, the mean VAS score differences were 3.9 (n = 13) and 3.4 (n = 17), respectively (P = .7) ( ). Mean VAS differences between first-time surgeries and revision cases were 3.8 (n = 24) and 3.2 (n = 6), respectively (P = .774) ( ).
Decompression of lumbar foramina using the flexible shaver system and MMG nerve mapping is safe and effective, although the short-term sensory complication with this technique may be higher than previously reported. Patient satisfaction with iO-Flex foraminotomy is comparable to reported satisfaction outcomes for traditional lumbar decompression.