Journal of neurosurgery. Spine最新文献

{"title":"Mapping, classification, and surgical strategy for vertebral artery variation in posterior atlantoaxial joint release, distraction, and fusion surgery for basilar invagination and atlantoaxial instability.","authors":"Yue-Qi Du, Wanru Duan, Mao-Yang Qi, Jia-Lu Wang, Bo-Yan Zhang, Hong-Feng Meng, Tian-Yu Jin, Can Zhang, Peng-Hao Liu, Jian Guan, Feng-Zeng Jian, Zan Chen","doi":"10.3171/2024.12.SPINE24185","DOIUrl":"https://doi.org/10.3171/2024.12.SPINE24185","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to develop a vertebral artery (VA) classification system that improves risk assessment using a 2D map of the VA position at the craniovertebral junction (CVJ), and to outline surgical strategies for managing anomalous VAs during the posterior atlantoaxial joint release, distraction, and fusion technique in the treatment of basilar invagination (BI) and atlantoaxial instability (AAI).</p><p><strong>Methods: </strong>In this retrospective study, 125 patients (mean age 44.1 years) with BI and AAI who underwent surgery between January 2019 and April 2021 using the atlantoaxial joint release, distraction, and fusion technique were included. A distribution map was used to better delineate the course of VA and its relationship with the atlantoaxial facet. Under the concept of the current technique, the morphology of VA was reclassified according to the severity of anomaly and surgical risk. Intraoperative risks were graded, and different strategies for handling anomalous vessels were discussed based on the classification.</p><p><strong>Results: </strong>A system of mapping VA distribution was proposed and showed that up to 27% of VAs coursed posterior to the atlantoaxial facet joint, which evidently hampered the facet joint release and manipulation. The VAs coursed in the inferomedial field less frequently. Based on the surgical risk of the posterior atlantoaxial joint release, distraction, and fusion technique, the morphology of VA was classified into 5 types. Additionally, patients were categorized into low-risk, medium-risk, high-risk, and contraindicated groups, according to bilateral VA patterns and institutional surgical experience. Different intraoperative strategies for handling anomalous vessels were introduced and discussed. Intragenic VA injury occurred in 2 of 125 patients (1.6%).</p><p><strong>Conclusions: </strong>The authors introduced a novel method of describing the VA course at the CVJ, called VA mapping, and a VA classification system was proposed to enhance the understanding of risk evaluation in the context of atlantoaxial joint release, distraction, and fusion. A risk stratification system was determined based on bilateral VA patterns, and specific surgical strategies were formulated. The overall iatrogenic VA injury rate was 1.6%, indicating the proposed classification and surgical protocol are reliable and reproducible for minimizing the risk of intraoperative VA injury.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of the day of the week on clinical outcomes following anterior cervical discectomy and fusion surgery.","authors":"Stephen M Bergin, Joshua Woo, Sarah E Johnson, Connor Barrett, Giorgos Michalopoulos, Mohamad Bydon, Erica F Bisson, Regis W Haid, Steven D Glassman, Andrew K Chan, Dean Chou, Michael Y Wang, John J Knightly, Oren N Gottfried, Christopher I Shaffrey, Michael S Virk, Kai-Ming G Fu, Mark E Shaffrey, Paul Park, Kevin T Foley, Cheerag D Upadhyaya, Eric A Potts, Luis M Tumialán, Jay D Turner, Juan S Uribe, Matthew J McGirt, Paul K Kim, Praveen V Mummaneni, Khoi D Than","doi":"10.3171/2024.11.SPINE24609","DOIUrl":"https://doi.org/10.3171/2024.11.SPINE24609","url":null,"abstract":"<p><strong>Objective: </strong>Previous research suggests elective surgical procedures performed later in the week have worse outcomes. This study investigated whether the day of the week on which elective anterior cervical discectomy and fusion (ACDF) surgery was performed impacts clinical outcomes.</p><p><strong>Methods: </strong>Using data from the Quality Outcomes Database, a nationwide, multicenter prospective registry, this study included patients undergoing elective ACDF for cervical spondylosis. Patients were categorized into groups based on the surgery day (early week, Monday and Tuesday; late week, Thursday and Friday). Analyzed outcomes included postoperative complications, readmissions, reoperations, and patient-reported outcomes. Statistical methods included the independent t-test, Pearson's chi-square test, and multivariable logistic regression.</p><p><strong>Results: </strong>The study analyzed 19,818 patients, with 41.7% undergoing surgery early in the week and 36.9% later. There were no significant differences in 30-day mortality, readmissions, or reoperations between the two groups. Early-week surgical procedures were associated with a higher incidence of postoperative dysphagia requiring nasogastric tubes (0.6% vs 0.3%, p = 0.02) and a higher incidence of vocal cord paralysis (0.5% vs 0.3%, p = 0.01). The data indicate a surgical selection bias with more complex surgical procedures and higher risk patients typically scheduled earlier in the week, which likely contributed to the increased rates of dysphagia. Conversely, patients who underwent operations on Fridays were more likely to be discharged on the same day compared to those earlier in the week (p = 0.02), without a significant difference in length of stay overall. Surgical procedures performed later in the week were more likely to be performed at ambulatory surgical centers rather than inpatient facilities (p < 0.01), indicating a strategic selection of healthier patients for end-of-week procedures.</p><p><strong>Conclusions: </strong>The day of elective ACDF surgery does not affect mortality, readmissions, or reoperation rates. However, early-week surgical procedures may see slightly higher rates of postoperative dysphagia and vocal cord paralysis, likely due to the scheduling of more complex cases or higher risk patients during these days. Overall, the authors' data confirm that day of surgery does not influence overall patient recovery significantly. This information is useful for surgical planning and for providing patient reassurance that the day of the week does not significantly impact surgical outcomes.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-11"},"PeriodicalIF":2.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technique and outcomes of the trans-superior articular process approach for endoscopic thoracic discectomy.","authors":"Junseok Bae, Pratyush Shahi, Yong-Soo Choi, Sang-Ho Lee","doi":"10.3171/2024.12.SPINE241184","DOIUrl":"https://doi.org/10.3171/2024.12.SPINE241184","url":null,"abstract":"<p><strong>Objective: </strong>Transforaminal endoscopic thoracic discectomy (TETD) has been shown to lead to favorable outcomes in cases with symptomatic thoracic disc herniation (TDH). However, due to various anatomical constraints, developing a transforaminal corridor especially in the upper and middle thoracic spine is often difficult and foraminoplasty is required to gain access into the foramen. Conventional foraminoplasty with a bone reamer or endoscopic drill can be associated with inadvertent facet removal and increases the risk of injury to the neural tissue. The objective of this study was to describe the technique and outcomes of the trans-superior articular process (SAP) approach for endoscopic thoracic discectomy under local anesthesia for paramedian and central herniations. The trans-SAP approach involves making a pilot hole in the lateral part of the SAP with a Jamshidi needle followed by enlargement of the tract with manual side-cutting bone drills. This creates a trans-SAP corridor for insertion of the working cannula and endoscope to access the central and paracentral disc and perform adequate decompression. Although the trans-SAP approach is already being utilized for endoscopic lumbar discectomy and decompression, it has not been previously described for the thoracic spine.</p><p><strong>Methods: </strong>This was a retrospective review of prospectively collected data. Patients who underwent trans-SAP endoscopic thoracic discectomy for symptomatic TDH and had a minimum follow-up of 6 months were included. Outcome measures included patient-reported outcome measures (PROMs) (visual analog scale [VAS] and Oswestry Disability Index [ODI]) and complication rates. PROMs were analyzed at the preoperative and 1-month, 3-month, 6-month, and last postoperative follow-up timepoints.</p><p><strong>Results: </strong>Thirty-eight patients were included (mean age 48.9 years). Most disc herniations (55.3%) were central (63.1%) and located in the middle thoracic spine (55.3%). The mean operative time and hospital stay were 42 minutes and 1.3 days, respectively. The mean follow-up duration was 11.5 months. The mean VAS score significantly improved from 7.8 preoperatively to 3.5 at 1 month, 2.5 at 3 months, 2 at 6 months, and 1.5 at the latest follow-up (p < 0.001). The mean ODI score significantly improved from 68.3 preoperatively to 30.5 at 1 month, 22.1 at 3 months, 15.8 at 6 months, and 13.2 at the latest follow-up (p < 0.001). One patient (2.6%) had a complication (recurrent disc herniation).</p><p><strong>Conclusions: </strong>Trans-SAP endoscopic thoracic discectomy can be a safe and effective surgical option for patients with symptomatic TDH.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive value of the Fried frailty phenotype in evaluating postoperative outcomes in lumbar spine fusion surgery.","authors":"Basma A Mohamed, Sandra C Yan, Ken Porche, Cynthia Garvan, Daniel J Hoh","doi":"10.3171/2024.11.SPINE24869","DOIUrl":"https://doi.org/10.3171/2024.11.SPINE24869","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this paper was to validate the Fried frailty phenotype (FFP) in predicting postoperative outcomes in patients undergoing lumbar spine fusion surgery.</p><p><strong>Methods: </strong>This is a retrospective analysis of the medical records of patients aged 65 years and older who underwent elective lumbar spine surgery between July 2015 and August 2021 at a single institution. The 11-item modified frailty index (mFI-11) and FFP were used to calculate frailty. The Charlson Comorbidity Index (CCI) was used to assess the comorbidity burden. Outcome measures included length of hospital stay (LOS), complication rates, and nonhome discharge. The authors evaluated the correlations among the mFI-11, FFP, and CCI using Spearman correlation testing. After categorizing frailty, they used multivariable regression to determine the relationships between the FFP, mFI-11, CCI, and postoperative outcome measures.</p><p><strong>Results: </strong>A total of 248 patients were included in the analysis. According to the FFP, 23% of patients were frail, and based on the mFI-11, 22% were frail. The FFP and mFI-11 were significantly correlated (rs = 0.20, p = 0.0019). LOS was not found to be significantly correlated with CCI and mFI-11. However, LOS was significantly correlated with the FFP (rs = 0.15, p < 0.0197). The FFP was found to be significantly associated with wound complications, with 44% of those with wound complications identified as frail (p = 0.0339). With regard to nonhome discharge, 52% identified as frail were discharged to a skilled nursing facility, and 31% identified as frail were discharged to inpatient rehabilitation (p = 0.0007). In contrast, the mFI-11 was not found to be significantly related to any complications or nonhome discharge. In the multiple regression model, the FFP was the best independent predictor of nonhome discharge after adjusting for mFI-11 and age. The odds of a nonhome discharge were four times higher for patients classified as frail using the FFP (OR 4.118, 95% CI 2.005-8.458; p = 0.0001).</p><p><strong>Conclusions: </strong>The FFP strongly predicts nonhome discharge in patients undergoing elective lumbar spine fusion for degenerative spine disease. Frailty as identified using the FFP is significantly correlated with increased LOS, wound complications, and nonhome discharge, while the mFI-11 was not associated with LOS, complications, or nonhome discharge.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantitative assessment of postural stability in individuals with degenerative cervical myelopathy compared with healthy controls.","authors":"Guanqing Li, Jingye Wu, Tenghui Ge, Jintao Ao, Zhongning Xu, Qingyun Li, Ronghui Cai, Shuquan Zhang, Yuqing Sun","doi":"10.3171/2024.12.SPINE24970","DOIUrl":"https://doi.org/10.3171/2024.12.SPINE24970","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to quantitatively assess postural stability using force plate center of pressure (COP) parameters in a large sample of Chinese patients with degenerative cervical myelopathy (DCM), compare the results with healthy controls, and examine correlations between balance measures (COP parameters, brief Balance Evaluation Systems Test [Brief-BESTest] scores) and clinical assessments, including MRI findings.</p><p><strong>Methods: </strong>This cross-sectional observational study included 141 patients with DCM (diagnosed from June 2022 to May 2024) and 141 age- and sex-matched healthy controls. Postural balance was assessed using COP parameters and Brief-BESTest scores. Clinical assessments included the modified Japanese Orthopaedic Association (mJOA) score, 10-second grip and release test, 10-second step test, and Hoffman sign. MRI findings included the cross-sectional area (CSA) of the spinal cord at the most compressed level and increased signal intensity on T2-weighted images. COP parameters were compared between patients with DCM and controls, while correlations between COP parameters and Brief-BESTest scores and clinical/MRI findings were analyzed within the DCM cohort.</p><p><strong>Results: </strong>Patients with DCM had significantly greater COP values in path length, ellipse area, average velocity, and average acceleration compared with controls (all p < 0.001), indicating notable balance impairment. Brief-BESTest scores and COP parameters showed moderate to strong correlations with mJOA scores (ρ = 0.310-0.768) and varied significantly across mJOA severity levels (p < 0.01). Moderate correlations were observed between CSA and balance measures (ρ = 0.212-0.487), while increased signal intensity on MRI had limited impact. Both the grip and release and step tests also correlated moderately with balance measures (ρ = 0.245-0.640).</p><p><strong>Conclusions: </strong>Patients with DCM showed substantial balance impairment compared with healthy controls, with COP parameters and Brief-BESTest scores correlating well with mJOA scores, highlighting their utility in balance assessment. Moderate associations between CSA and balance suggest that structural MRI changes are relevant to postural stability in DCM. Future research could enhance balance assessment by integrating additional objective tools, such as motion analysis, providing a more comprehensive understanding of the effects of DCM on postural control.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-10"},"PeriodicalIF":2.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buttock pain in lumbar disc herniation: clinical characteristics, risk factors, and surgical outcomes.","authors":"Qianjun Jin, Lunhao Chen, Kai Wu, Zhiyun Feng, Ying Yuan, Yue Wang","doi":"10.3171/2025.1.SPINE241170","DOIUrl":"https://doi.org/10.3171/2025.1.SPINE241170","url":null,"abstract":"<p><strong>Objective: </strong>Buttock pain is a common symptom in patients with lumbar degenerative disorders. While the nature of buttock pain remains unclear, clinicians consider it as either nociceptive back pain or radicular leg pain. Some have proposed that buttock pain may be a mixed symptom of radicular pain and referred pain, although buttock pain in spine practice is less studied. This study aimed to determine the occurrence rate, clinical characteristics, risk factors, and surgical outcomes of buttock pain in patients with lumbar disc herniation (LDH).</p><p><strong>Methods: </strong>A prospective study was performed on patients with single-level LDH who underwent endoscopic discectomy at the authors' hospital between 2020 and 2023. Back pain, buttock pain (the region between the iliac crest and buttock crease), and leg pain were measured using the numeric rating scale (NRS) before and after surgery. On MRI, degenerative findings, including disc degeneration, Modic changes, and endplate defects, were assessed. The location of the hernia was recorded, and disc herniation was classified as contained or uncontained. The presence or absence of annulus rupture was further examined with endoscopy. The associations of buttock pain with MRI and endoscopic findings, back pain, and leg pain were examined.</p><p><strong>Results: </strong>During the defined period, a study was conducted on 321 patients with single-level LDH. Buttock pain presented in 242 (75.4%) patients. Buttock pain was a common symptom for L3-4, L4-5, and L5-S1 LDH. Buttock pain was more common in patients with contained LDH than in those with uncontained LDH (85.8% vs 69.7%, p = 0.001). Furthermore, buttock pain was more common in LDH patients with an intact annulus compared with those patients with a ruptured annulus (86.7% vs 68.7%, p < 0.001), as assessed using endoscopy. Compared with baseline, buttock pain quickly improved on the 2nd day after surgery (NRS score 5.44 ± 2.07 vs 0.84 ± 1.27, p < 0.001). At the 1-year follow-up, buttock pain had resolved in 91.2% of cases and improved in the remaining 8.8% of patients, although they still had some residual buttock pain.</p><p><strong>Conclusions: </strong>Buttock pain is a common symptom in patients with L3-S1 LDH. Buttock pain is not related to back pain and radiating leg pain and thus should be considered as an independent symptom in LDH. Similar to radiating leg pain, buttock pain can be effectively treated with endoscopic discectomy.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management strategies for cervical schwannomas: a comprehensive review.","authors":"Aqib H Zehri, Luke A Mugge, U Kumar Kakarla, Jay D Turner, Laura A Snyder","doi":"10.3171/2024.11.SPINE24802","DOIUrl":"https://doi.org/10.3171/2024.11.SPINE24802","url":null,"abstract":"<p><strong>Objective: </strong>The authors' goal was to provide a comprehensive overview of the pathophysiology, clinical presentation, and management strategies of cervical schwannomas.</p><p><strong>Methods: </strong>A thorough literature review of diagnostic imaging techniques, particularly MRI, was conducted to identify characteristic features of cervical schwannomas, such as avid Gd uptake and scalloping. Histological and immunohistochemical analyses, including stains for S100 and SOX10, were evaluated to confirm the diagnosis and differentiate schwannomas from other tumors, such as meningiomas and metastatic disease. Various surgical approaches, including posterior midline, anterolateral, and far lateral, were assessed as described in the literature for their effectiveness in resecting tumors while preserving neurological function. The role of stereotactic body radiation therapy (SBRT) was also examined for patients who were ineligible for surgery.</p><p><strong>Results: </strong>Imaging and histological analyses effectively distinguish cervical schwannomas from other spinal tumors. Resection remains the cornerstone of treatment, with tailored approaches to ensure optimal tumor removal and preservation of neurological function. Subtotal resection poses a higher recurrence risk than gross-total resection, necessitating regular MRI monitoring. SBRT offers a promising nonsurgical alternative because it achieves good local control and symptomatic relief. However, outcomes of SBRT vary, especially in patients with neurofibromatosis type 2.</p><p><strong>Conclusions: </strong>A multidisciplinary approach is crucial for managing cervical schwannomas, integrating resection, regular monitoring, and nonsurgical treatments such as SBRT to optimize patients' outcomes and quality of life.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-9"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nerve transfers for axillary nerve repair in brachial plexus injuries: results from 206 patients.","authors":"Pavel Haninec, Jan Hradecky, Martin Ouzky, Filip Samal, Libor Mencl","doi":"10.3171/2024.11.SPINE24637","DOIUrl":"https://doi.org/10.3171/2024.11.SPINE24637","url":null,"abstract":"<p><strong>Objective: </strong>Restoration of axillary nerve function is one of the main priorities of brachial plexus surgery. Neurotization, the transfer of a functional but less important donor nerve to a nonfunctional, more important recipient nerve, has become a leading treatment option. A variety of donor nerves, from different segmental levels of the spinal cord, have been used to reinnervate the axillary nerve. This study aimed to describe the clinical results of commonly used donor nerves.</p><p><strong>Methods: </strong>A group of 206 patients with a minimum follow-up period of 24 months was analyzed. Axillary nerve injuries were part of C5-6 injuries in 68 patients, C5-7 injuries in 61 patients, and complete injuries in 55 patients. Twenty-two patients had an isolated axillary nerve injury. The median age was 31 years, and the median time between trauma and surgery was 6 months. The following were used as donor nerves: the thoracodorsal nerve in 69 patients, triceps branch of the radial nerve in 25 patients, lower subscapular nerve in 19 patients, long thoracic nerve in 38 patients, intercostal nerves in 27 patients, and fascicle transfer from the ulnar or median nerve in 23 patients. Successful deltoid recovery was defined as a Medical Research Council grade above 3, electromyographic signs of reinnervation, and an increase in deltoid muscle mass.</p><p><strong>Results: </strong>The overall success rate was 60.19% but varied greatly between different types of brachial plexus injuries and available donors. Upper brachial plexus injuries had a success rate of 75.0%, C5-7 injuries had a rate of 65.5%, and complete injuries had a rate of 29.0%. Patients with isolated axillary nerve injuries had a success rate of 77.27%. Donor nerves with the highest success rate were the triceps branch of the radial nerve (80%), followed by the subscapular nerve (78.9%), fascicle transfer from the ulnar or median nerve (73.9%), and thoracodorsal nerve (71.1%). Lower success rates were associated with the long thoracic nerve (36%) and intercostal nerves (29.6%).</p><p><strong>Conclusions: </strong>The authors conclude that nerve transfers can be effective treatment options for axillary nerve injuries. Knowing the potential success rates of the less used donor nerves, i.e., from different segmental levels of the spinal cord, is of utmost importance, especially for extensive brachial plexus injuries.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-8"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes after en bloc resection with sacrectomy of advanced colorectal carcinomas that invade the sacrum: a multiinstitutional descriptive series.","authors":"Thomas A Pieters, Andrew M Hersh, Aladine A Elsamadicy, Zach Pennington, Gabrielle Santangelo, Salem Najjar, Bethany Hung, Roee Ber, Chady Atallah, Jonathan Efron, Susan Gearhart, Bashar Safar, Jean-Paul Wolinsky, Daniel M Sciubba, Sheng-Fu Larry Lo","doi":"10.3171/2024.10.SPINE24391","DOIUrl":"https://doi.org/10.3171/2024.10.SPINE24391","url":null,"abstract":"<p><strong>Objective: </strong>Management of locally invasive colorectal carcinoma at any stage currently involves surgical excision followed by chemoradiotherapy; however, the prognosis is poor, with a 5-year overall survival (OS) of only 5%. Failure to achieve gross-total resection is associated with poorer OS, and patients with residual tumor postresection (R1 or R2 resection) have a median OS of 7 months compared with 23 months in those who undergo resection with negative margins (R0 resection). For tumors that have invaded the sacrum, sacrectomy becomes necessary to achieve R0 resection. The objective of this study was to provide a descriptive multicenter account of resection for locally invasive colorectal carcinoma with sacral invasion, focusing on the association of tumor morphometry with surgical planning and perioperative outcomes.</p><p><strong>Methods: </strong>Demographic, comorbidity, clinical, tumor-specific, operative characteristic, and outcome data were collected on all patients who underwent resection of colorectal carcinoma with concurrent sacral resection between January 2005 and May 2022. Patients were grouped into those having undergone surgery for purely palliative intent, or those with resection with attempt at local control and dichotomized into level of osteotomy (either proximal or distal to the S2-3 level).</p><p><strong>Results: </strong>Twenty-two patients (median age 50.5 [IQR 43.3-60.0] years, 54.5% female) underwent sacrectomy for colorectal carcinoma. Operative records indicated intent for local control in 14 patients and palliative in the remaining 8 patients. Palliative surgical intent was based primarily on the presence of distant metastases. There was no significant difference in median local progression-free survival between patients undergoing osteotomy proximal to the S2-3 level and those undergoing osteotomy distal to the S2-3 level.</p><p><strong>Conclusions: </strong>En bloc resection is believed to offer the best local control in patients with locally invasive colorectal carcinoma. The present descriptive series highlights outcomes of en bloc resection with partial or full sacrectomy in patients with tumors showing local extension into the sacrum. Complications are common, most often in the form of wound dehiscence or infection, and many patients require placement in a rehabilitation or intermediate-care facility upon discharge. However, for those with stage III (locally aggressive) disease, median OS exceeds 16 years, suggesting that such aggressive management with en bloc resection may be warranted in properly selected patients.</p>","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-7"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum. Shorter survival time of adolescents and young adult patients than older adults with spinal cord glioblastoma: a multicenter study.","authors":"Toshiki Endo","doi":"10.3171.2025.1.SPINE23642a","DOIUrl":"10.3171.2025.1.SPINE23642a","url":null,"abstract":"","PeriodicalId":16562,"journal":{"name":"Journal of neurosurgery. Spine","volume":" ","pages":"1-2"},"PeriodicalIF":2.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}