Journal of neurosurgical sciences最新文献

{"title":"Historical evolution of extracranial-intracranial bypass: a single-center 45-year experience.","authors":"Davide Boeris, Octavian Vatavu, Maria Fragale, Martina Giordano, Davide Colistra, Elisa Colombo, Mariangela Piano, Marco Cenzato","doi":"10.23736/S0390-5616.25.06503-8","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06503-8","url":null,"abstract":"<p><strong>Background: </strong>The technique for extracranial-intracranial (EC-IC) bypass was introduced in 1976. Over the subsequent 45 years, indications and surgical techniques have significantly evolved. This study aims to analyze the trends in patient demographics, bypass techniques, and clinical indications for bypass surgeries performed at our institution from 1976 to 2020.</p><p><strong>Methods: </strong>We conducted a retrospective review of patient records, using digital medical records available from 2001 and manually reviewing paper records for cases prior to that year. A comprehensive analysis was performed on surgical procedure descriptions and indications for bypass surgery.</p><p><strong>Results: </strong>A total of 374 patients underwent EC-IC bypass surgery from 1976 to 2020. The frequency of surgeries increased until 1985, followed by a marked decline in 1986. From 1996 onward, the average number of bypass surgeries performed annually was 4 until 2010, and this number increased to 7 from 2011 to 2020. Indications and detailed techniques were recorded in 284 cases. Between 1976 and 2000, occlusive cerebrovascular disease (OCVD) was the predominant indication for bypass surgery (69.2%); however, in the last two decades, the primary indication shifted to flow preservation for complex aneurysms (74.8%). Prior to 2011, the primary focus was on internal carotid artery (ICA) aneurysms, while in the last decade, middle cerebral artery (MCA) aneurysms have gained prominence. High-flow (HF) graft-mediated bypasses were mainly utilized for the management of complex aneurysms; notably, there has been a decline in HF bypass requirements, with only 10% of flow preservation surgeries needing this technique in the past decade.</p><p><strong>Conclusions: </strong>Our study underscores the significant evolution of cerebral bypass surgery over the past 45 years, with flow preservation for complex aneurysms currently being the leading indication for EC-IC bypass. The superficial temporal artery to middle cerebral artery (STA-MCA) bypass remains the most frequently performed technique. Moreover, the use of HF EC-IC bypass has declined in the last decade, reflecting the emergence of alternative methods for flow preservation.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing short term clinical outcomes of elective robot-assisted vs. non-robot assisted posterior lumbar interbody fusions: a NSQIP analysis.","authors":"Taylor Furst, Aman Singh, Prasanth Romiyo, Jonathan Stone, Tyler Schmidt","doi":"10.23736/S0390-5616.25.06535-X","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06535-X","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic lumbar degenerative changes impact millions of patients per year. Recent technological advances have increased the usability of robot-assisted spinal fusions to treat this pathology. Although the safety profile of robotic systems appears favorable, the impact of robotics on surgical outcomes and efficiency remains unclear.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Project (NSQIP) database was queried for cases of elective posterior lumbar interbody fusions in adult patients with data available regarding the use of robotics. Univariate and multivariate analyses were performed. The purpose of this study is to compare rates of 30-day unplanned readmissions, unplanned reoperation (return to operating room [RTOR]), postoperative complications, non-home discharges, operative time, blood transfusions and length of stay (LOS) in adult elective robot-assisted (robot-assisted posterior lumbar interbody fusion [rPLIF] / transforaminal lumbar interbody fusion [TLIF]) vs. non-robotic PLIF/TLIF (nPLIF/TLIF).</p><p><strong>Results: </strong>There was no statistically significant difference in rates of 30-day readmissions (6.0% vs. 4.4%, P=0.48), RTOR (4.0% vs. 3.0%, P=0.66), postoperative complications (10.0% vs. 11.2%, P=0.51) nor need for blood transfusion (6.0% vs. 6.5%, P=0.59) between rPLIF/TLIF and nPLIF/TLIF cohorts, respectively. There were no differences in LOS or operative time between groups (LOS: rPLIF/TLIF = 3.5±3.3 days, nPLIF/TLIF = 3.6±2.8 days, P=0.29; operative time: rPLIF/TLIF = 208.7±101.1 minutes, nPLIF/TLIF = 225.1±100.4 minutes, P=0.087).</p><p><strong>Conclusions: </strong>rPLIF/TLIF and nPLIF/TLIF 30-day readmissions, RTOR, non-home discharges, need for blood transfusion, LOS and operative times are similar within these data, though results should be interpreted with caution given study limitations. Ongoing data on surgical outcomes of robot-assisted lumbar fusions are needed.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Suspected and surgically managed cauda equina syndrome nationwide: epidemiological trends and socioeconomic factors influencing access to care.","authors":"Thomas M Johnstone, Vaibhavi Shah, Ghani Haider, Kelly H Yoo, Martin N Stienen, Anand Veeravagu","doi":"10.23736/S0390-5616.24.06300-8","DOIUrl":"10.23736/S0390-5616.24.06300-8","url":null,"abstract":"<p><strong>Background: </strong>Cauda equina syndrome (CES) is a critical condition requiring timely intervention to prevent severe morbidity. This study investigates the epidemiology and socioeconomic factors influencing access to CES care in USA Emergency Departments.</p><p><strong>Methods: </strong>Data was used from the Nationwide Emergency Department Sample (NEDS) from 2016-2020. Encounters for patients presenting with suspected CES were queried using ICD 10 codes. Incidence estimates for suspected and surgically managed CES were constructed. Encounter characteristics were tabulated to describe aspects of a typical CES presentation to a USA ED. Multivariable regression analysis ascertained the impact of hospital and socioeconomic features on in-hospital mortality, surgical management, length of stay, visit costs, and patient transfer.</p><p><strong>Results: </strong>The incidences of suspected and surgically managed CES rose year-by-year (P=0.006; P=0.005). Uninsured patients (P<0.001) and African American (P=0.002) were less likely to be admitted for care. Patients residing in the wealthiest quartile of zip codes were more likely to be admitted for care (P<0.001). In addition, uninsured (P=0.017) and African American patients (P=0.009) were less likely to receive surgical management of suspected CES. Lastly, uninsured (P<0.001), Hispanic (P=0.038), and rurally located patients (P=0.007) were more likely to be transferred, while patients residing in the wealthiest zip codes (P=0.007) were less likely to be transferred.</p><p><strong>Conclusions: </strong>Socioeconomic factors like race, income, insurance, and residence potentially alter CES management, which may inform health policy and future patient care.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"297-304"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monocentric experience of transforaminal endoscopic lumbar discectomy and foraminotomy outcomes: pushing the indications and avoiding failure. Report of 200 cases.","authors":"Alessandro Grieco, Letizia Dell'aglio, Jacopo Del Verme, Domenico Billeci, Roberto Zanata, Giuseppe Canova, Enrico Giordan","doi":"10.23736/S0390-5616.23.06105-2","DOIUrl":"10.23736/S0390-5616.23.06105-2","url":null,"abstract":"<p><strong>Background: </strong>This paper reports the results of the treatment of our first 200 cases of lumbar disc herniation and foraminal stenosis using full-endoscopic transforaminal lumbar discectomy (FETLD). We analyzed outcomes and radiological parameters to overcome failure and inappropriate indications and also highlighted the red flags for surgeons coming to this field as well as the pathways to success.</p><p><strong>Methods: </strong>Data on endoscopic procedures were retrospectively analyzed between October 2018 and March 2023. We abstracted sex, age, leg pain by NPRS, postoperative satisfaction according to the MacNaab score, postoperative surgical complications/adverse events (≤30 days), and history of any previous surgery. Furthermore, we measured different radiological parameters to determine the grade of stenosis or discopathy.</p><p><strong>Results: </strong>Once the learning curve was completed, patients' satisfaction increased to 94%, with only a small percentage (6%) of patients unsatisfied 30 days after the operation. Perioperatively, 33.5% of the patients experienced mild to moderate transitory paresthesia. Univariate analysis showed a tendency toward a higher risk of failure in those patients with degenerative listhesis (odds ratio [OR] 4.8, 95% CI 0.97-23.9, P=0.055) as well as those with severely degenerated discs (OR 8.7, 95% CI 0.96-79.4, P=0.054). Conversely, the chances of failure seemed to be lower in patients with severe foraminal stenosis.</p><p><strong>Conclusions: </strong>FETLD proved its efficacy in treating several degenerative spine conditions or was useful for avoiding previous scarring in patients already operated on to the same extent. Therefore, FETLD can be safely used in patients with comorbidities, the elderly, and when the invasiveness of an open technique is not suitable.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"324-330"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative seizures during neuro-oncological supratentorial surgery: the role of prophylaxis with levetiracetam and intraoperative monitoring in a consecutive series of 353 patients.","authors":"Francesca Battista, Giovanni Muscas, Alberto Parenti, Maddalena Spalletti, Cristiana Martinelli, Riccardo Carrai, Andrea Amadori, Alessandro Della Puppa","doi":"10.23736/S0390-5616.24.06154-X","DOIUrl":"10.23736/S0390-5616.24.06154-X","url":null,"abstract":"<p><strong>Background: </strong>The aim of this paper was to understand the role of prophylaxis with levetiracetam at skin incision in preventing convulsive intraoperative seizures (IOS) during neurosurgical procedures with and without intraoperative neuromonitoring (IONM).</p><p><strong>Methods: </strong>Authors retrospectively reviewed the Institutional database for cases of supratentorial brain tumors undergoing surgical resection performed from January 2021 to October 2022. Patients were operated on both under general anesthesia and awake, using motor-evoked potentials (MEP) and direct cortical stimulation for cortical mapping. 1000 mg ev of Levetiracetam before skin incision in case of a history of seizures was administrated. We excluded all infratentorial cases.</p><p><strong>Results: </strong>Three hundred fisty three consecutive cases were retrieved. IOS occurred in 22 patients (6.2%). Prophylaxis with Levetiracetam was administered in 149 patients, and IOS occurred in 16 cases (10.7%) in this group of patients. The IOS rate in the case of no Levetiracetam prophylaxis administration (3.5%) was significantly lower (P<0.001, OR=3.38 [1.35-8.45], RR=3.12 [1.32-7.41]). The Penfield technique stimulation evoked seven of all 22 IOS reported (31.8%) (P=0.006, RR 5.4 [1.44 -20.58], OR 21 [2.3-183.9]), and the train-of-five technique stimulation caused two of all registered IOS (8.7%) (P=0.2, RR 2.3 [0.99-5.67], OR 6.5 [0.55-76.17]). Transcranial MEPs evoked no IOS.</p><p><strong>Conclusions: </strong>Under levetiracetam prophylaxis, the IOS rate was not significantly lower than in the group of patients without Levetiracetam prophylaxis, regardless of the histology of the tumor and IONM. Neither the transcranial stimulation (MEP) nor train-of-five technique stimulation increases the risk of convulsive IOS, as Penfield technique stimulation does.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"315-323"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140335968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated spinal artery aneurysm treatment: a systematic review of the literature and an illustrative case of the neuromonitoring-assisted resection.","authors":"Fabio Serpico, Antonio Meola, Federico Saturno Spurio, Corrado Iaccarino, Giacomo Pavesi, Leonello Tacconi","doi":"10.23736/S0390-5616.25.06529-4","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06529-4","url":null,"abstract":"<p><strong>Introduction: </strong>Isolated spinal artery aneurysms (ISAAs) are rare, often presenting with sub-arachnoid hemorrhage (SAH) and severe neurological deficits. Conclusive evidence about the best management approach is lacking.</p><p><strong>Evidence acquisition: </strong>Following PRISMA guidelines, a systematic review of papers about ISAAs management was conducted from 1966 to 2024, evaluating age, sex, risk factors/comorbidities, aneurysm rupture and location, treatment modalities and clinical outcome. An illustrative case of a 65-year-old woman with a an ISAA of a radiculomedullary artery at T8 level was reported.</p><p><strong>Evidence synthesis: </strong>Overall, 106 studies obtained from the literature review showed 138 patients received an ISAA diagnosis and were managed with surgery (52.1%), observation (31.1%), or endovascular treatment (11.5%), with clinical improvement in 76.4%, 86%, 81.2% of cases, respectively. The treatment option was not reported in 5.3% of cases. Only two patients presented neurological worsening related to vasospasm, and none had rebleeding after treatment. The mean follow-up was 8.7 months (range 0.03-73 months). In the reported illustrative case, after left T7-T8 laminectomy and dural opening, a little thrombosed aneurysm was found. Under doppler and neurophysiological monitoring, temporary clips were placed on the afferent and efferent vessel and the aneurysm was resected. The patient reported complete and stable regression of symptoms. No complications were detected after 6 months. Imaging showed complete resection of the aneurysm.</p><p><strong>Conclusions: </strong>Surgical resection under neurophysiological monitoring is an excellent treatment option to both eliminate the risk of rebleeding, while preserving the neurological function. Observation and endovascular treatment may lead to comparable neurological outcomes. Larger multicentric studies with longer follow-up are needed to determine the best management option.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current role of MMAE in chronic subdural hematomas: a real advantage? A critical analysis of the EMBOLIZE study.","authors":"Laura Lippa, Corrado Iaccarino, Marco M Fontanella, Franco Servadei","doi":"10.23736/S0390-5616.25.06462-8","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06462-8","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144760367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What have we learned in fluorescein-guided resection of brain metastases? An update after 79 consecutive cases.","authors":"Jacopo Falco, Morgan Broggi, Emanuele Rubiu, Francesco Restelli, Bianca Pollo, Marco Schiariti, Paola Lanteri, Mario Stanziano, Emanuele LA Corte, Elio Mazzapicchi, Ignazio G Vetrano, Paolo Ferroli, Francesco Acerbi","doi":"10.23736/S0390-5616.23.06134-9","DOIUrl":"10.23736/S0390-5616.23.06134-9","url":null,"abstract":"<p><strong>Background: </strong>Cerebral metastasis (CM) is the most common malignancy affecting the brain. Individualized treatment of CM still represents a challenge for neuro-oncological teams: in patient eligible for surgery, complete tumor removal is the most relevant predictor of overall survival (OS) and neurological outcome. The development of surgical microscopes harboring specific filter able to elicit the fluorescent response from sodium fluorescein (SF) has facilitated fluorescein-guided microsurgery and the identification of pathological tumor tissue, especially at the tumor margins. In this study, we analyzed the effect of SF on the visualization and resection of a large monoinstitutional cohort of CM.</p><p><strong>Methods: </strong>Surgical database of FLUOCERTUM study (Besta Institute, Milan, Italy) was retrospectively reviewed to find CM surgically removed with a fluorescein-guided technique from March 2016 to December 2022. SF was intravenously injected (5 mg/kg) immediately after induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW560 filter (Carl Zeiss Meditec, Oberkochen, Germany). In the most recent cases, biopsies at the tumor margins were performed to evaluate the ability of fluorescein to discriminate between fluorescent and nonfluorescent tissue at the lesion borders.</p><p><strong>Results: </strong>Seventy-nine patients were included; most of them showed a bright, diffuse fluorescent staining that markedly enhanced tumor visibility; 11 melanomas presented a specific faint enhancement of the black pigmented central nodule with high fluorescence at tumor boundaries. Only in a minimal percentage of cases (N.=4-5.1%), fluorescein enhancement was tenuous, thus not providing a significant help during tumor resection. Altogether, in more than 90% of cases, SF was considered useful in the identification of tumoral tissue and in achieving a high rate of CM resection; thus, gross total resection was achieved in 96.2% (N.=76) of patients and in no case the detection of tumor remnants was an unexpected event. The resulted sensitivity and specificity of fluorescein in identifying tumor tissue at the tumor margin was 88.9% with a predictive positive value of 88.9%. No adverse event was registered during the postoperative course.</p><p><strong>Conclusions: </strong>The use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data showed a positive effect of fluorescein-guided surgery on intraoperative visualization during resection of CM, suggesting a role in improving the extent of resection of these lesions.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"305-314"},"PeriodicalIF":1.3,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136397767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic and clinical progression from acute to chronic subdural hematoma: a systematic review.","authors":"Adrian Liebert, Leonard Ritter, Karl-Michael Schebesch, Thomas Eibl","doi":"10.23736/S0390-5616.25.06510-5","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06510-5","url":null,"abstract":"<p><strong>Introduction: </strong>While some patients require immediate surgery for acute subdural hematoma (ASDH), others can be managed conservatively. A subset of patients, however, may experience the progression of ASDH to a relevant chronic subdural hematoma (CSDH). This systematic review aims to synthesize studies focusing on ASDH which progress to CSDH.</p><p><strong>Evidence acquisition: </strong>We searched relevant databases for articles. Six issues were addressed: Which percentage of conservatively managed ASDH progressed to CSDH requiring treatment?, What were possible risk factors for this progression?, How long was the time span for chronification?, How did the clinical status change during chronification?, How did the radiographic parameters change during chronification?, How was this entity surgically treated?</p><p><strong>Evidence synthesis: </strong>Fourteen studies met the inclusion criteria. The proportion of conservatively managed ASDH patients who eventually required surgery due to CSDH ranged from 6.5% to 45.3%. Several risk factors for progression were identified, with initial hematoma size and midline shift being the most significant. The majority required surgery within two to three weeks following trauma. As ASDH progressed to CSDH, a notable deterioration in clinical status occurred for many patients, including a decline in consciousness. While the hematoma density decreased, its size and midline shift increased. Most patients underwent burr hole trephination.</p><p><strong>Conclusions: </strong>The progression of ASDH to CSDH often led to an increase in hematoma size and midline shift, resulting in the worsening of clinical symptoms. Surgery was typically required within the second or third week after trauma for these patients.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence and machine learning in the management of patients with degenerative cervical myelopathy: a systematic review.","authors":"Vikas N Vattipally, Ritvik R Jillala, Carlos A Aude, Arjun K Menta, Jacob Jo, Liam P Hughes, Jawad M Khalifeh, Tej D Azad","doi":"10.23736/S0390-5616.25.06504-X","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06504-X","url":null,"abstract":"<p><strong>Introduction: </strong>Degenerative cervical myelopathy (DCM) is a debilitating condition caused by compression of the spinal cord. Despite established surgical treatments, accurate diagnosis and prognostication remain challenging in part due to the variability in clinical presentation and lack of screening tools. Machine learning (ML) has emerged as a promising approach to address these challenges through its predictive capabilities for diagnosis, decision-making, and prognostication. Given the recent advent of ML, there is a need to systematically synthesize its applications to the treatment of patients with DCM.</p><p><strong>Evidence acquisition: </strong>A systematic review was performed in accordance with PRISMA guidelines. We searched five databases (PubMed, Embase, Cochrane, Scopus, Web of Science) in November 2024 and included studies employing predictive ML techniques among a population of patients with DCM. Studies primarily focused on ML applications to neuroimaging were excluded. Variables such as study focus, number of patients with DCM, and ML approaches used were extracted.</p><p><strong>Evidence synthesis: </strong>Thirty full-text studies were included in this review. These studies encompassed 11,407 patients, with 84% (N.=9615) holding a diagnosis of DCM. Most studies (N.=16, 53%) used ML to predict outcomes for patients with DCM, including functional recovery, quality-of-life, and postoperative complications. Thirteen studies (43%) focused on the diagnosis of DCM using ML-augmented screening tools, and the remaining study focused on surgical decision-making. Support vector machine was the most used ML approach (N.=14 studies, 47%) followed by random forest (N.=8 studies, 27%). Throughout the studies included, ML algorithm predictions were demonstrated to outperform traditional statistical methods.</p><p><strong>Conclusions: </strong>ML models are a promising step forward for diagnosis, clinical decision-making, and prognostication for patients with DCM. Further validation in large, multi-institutional cohorts is needed to help improve translatability to clinical practice.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}