Neurosurgical focus最新文献

{"title":"Napsin A as a key prognostic biomarker in spinal metastases of lung cancer: implications for survival and neurological function.","authors":"Albert Antar, Abdel-Hameed Al-Mistarehi, A Daniel Davidar, Yuanxuan Xia, Pritika Papali, Shreya Sriram, Melanie Alfonzo Horowitz, Shahab Aldin Sattari, Sushanth Neerumalla, Carly Weber-Levine, Sang Hun Lee, Kristin J Redmond, Ali Bydon, Timothy F Witham, Nicholas Theodore, Mark H Bilsky, Daniel Lubelski","doi":"10.3171/2025.2.FOCUS24897","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24897","url":null,"abstract":"<p><strong>Objective: </strong>Lung cancer's propensity for metastasizing to the spine significantly impacts morbidity and mortality. Understanding the impact of somatic mutations on the prognosis of these metastases is crucial for treatment development and optimization.</p><p><strong>Methods: </strong>A retrospective analysis was performed on a neurosurgical cohort of 76 patients with lung cancer with spinal metastasis (LCSM) at a single comprehensive cancer center from 2013 to 2023. Data on patient demographics, tumor biomarkers, treatment modalities, and outcomes were collected and analyzed.</p><p><strong>Results: </strong>Of the 76 patients, 72 (95%) had non-small cell lung cancer, predominantly adenocarcinoma (83%). Patients with EGFR (epidermal growth factor receptor) mutations (n = 19, 25%) had an increased median overall survival (OS) of 3.40 years compared with 1.39 years for those without EGFR mutations (p = 0.01) as well as increased median survival after spinal metastasis (1.73 years vs 0.98 years, p = 0.01). Patients with KRAS (Kirsten rat sarcoma viral oncogene homolog) mutations (n = 16, 21%) had a decreased median OS of 0.71 years compared with 2.60 years for those without KRAS mutations (p = 0.03). Napsin A expression was associated with an improved median OS of 5.41 years compared with 1.39 years (p = 0.01), an increased median survival after spinal metastasis (2.29 years vs 0.71 years, p = 0.01), and better postoperative Frankel grades (OR 10.011, p < 0.01) compared with those without expression. Cytokeratin 7 (CK7) expression was associated with decreased OS in an accelerated failure time (AFT) model (time ratio [TR] 0.562, p = 0.025). Targeted therapy was associated with an increased median OS (3.40 years vs 1.28 years, p < 0.01) and an improved median survival after spinal metastasis (1.73 years vs 0.70 years, p < 0.01). In an AFT model, immunotherapy (TR 2.15, p = 0.007) and targeted therapy (TR 2.20, p = 0.001) were associated with improved OS, while spinal radiotherapy was negatively associated with OS (TR 0.46, p = 0.015).</p><p><strong>Conclusions: </strong>Somatic mutations in EGFR and KRAS and expression of napsin A and CK7 significantly influence survival in patients with LCSM. Mutations in EGFR and expression of napsin A, along with targeted therapy, were associated with better patient outcomes, emphasizing the need for personalized treatment strategies to improve survival and neurological function.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E18"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991353","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":"Durability of carbon fiber-reinforced PEEK spinal instrumentation in spine oncology: a single-institution longitudinal experience.","authors":"Mark Damante, Seth B Wilson, Jacob Ward, Kofi Mensah-Arhin, Shivam Gandhi, Anas Bardeesi, David Xu, Joshua Palmer, J Bradley Elder, Vikram B Chakravarthy","doi":"10.3171/2025.2.FOCUS24976","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24976","url":null,"abstract":"<p><strong>Objective: </strong>Carbon fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation is increasingly being used in patients with spine tumors as the body of literature supporting its benefit in local disease surveillance and radiation planning grows. Small single-institution experiences with short-term follow-up have yet to demonstrate issues with construct durability despite different biomechanical properties of CFR-PEEK compared to titanium. In this study the authors evaluated CFR-PEEK hardware failures in patients with surgically treated spine tumors who had long-term follow-up.</p><p><strong>Methods: </strong>This is an IRB-approved retrospective cohort study of patients with spine tumors who underwent instrumented spinal fusion with CFR-PEEK or titanium instrumentation at a single tertiary care center. Inclusion criteria were as follows: 1) age > 18 years; 2) pedicle screw fixation with CFR-PEEK or titanium; and 3) minimum 6 months of follow-up. The surgical indication was reviewed and agreed upon at a multidisciplinary spine tumor board meeting.</p><p><strong>Results: </strong>A total of 190 patients undergoing CFR-PEEK instrumentation were identified during the study period; 148 had at least a 6-month follow-up. Of those 148, the median follow-up was 13.7 months. In total, there were 861 CFR-PEEK pedicle screws, 266 CFR-PEEK spinal rods, and 15 CFR-PEEK corpectomy cages included in the study. Percutaneous CFR-PEEK instrumentation was performed in 13 cases. There were 6 (4.1%) CFR-PEEK cases of mechanical/hardware failure, with a median interval time to failure of 5.51 (range 2.74-9.38) months. There were no hardware-related complications in the 26 patients who received CFR-PEEK instrumentation and who had a > 24-month follow-up.</p><p><strong>Conclusions: </strong>This institutional experience provides the largest cohort with long-term follow-up to evaluate CFR-PEEK-related instrumentation failure in patients with spine tumors. The rate of hardware failure among CFR-PEEK instrumented constructs was comparable to that in the current literature for titanium implants used in degenerative spine and spine oncology treatment. Importantly, there were no hardware failures noted among patients with extended long-term survival, reinforcing the durability of CFR-PEEK instrumentation.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E10"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002923","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 surgery and radiation on radicular pain and myotomic weakness in patients with metastatic spine disease.","authors":"Arthur R Bartolozzi, Ori Barzilai, Ilya Laufer, Arjun Sahgal, Laurence D Rhines, Daniel M Sciubba, Aron Lazary, Michael H Weber, James M Schuster, Stefano Boriani, Chetan Bettegowda, Paul M Arnold, Michelle J Clarke, Michael G Fehlings, Ziya L Gokaslan, Charles G Fisher, Mark Bilsky, Nicolas Dea","doi":"10.3171/2025.2.FOCUS24915","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24915","url":null,"abstract":"<p><strong>Objective: </strong>Surgery is typically indicated for mechanical pain in metastatic spine disease or severe neurological compromise, but how radicular pain responds to oncological treatment is not well described. The primary aim of this study was to describe how radicular pain responds to oncological treatment, while secondary aims included pain outcomes between patients with mechanical and tumoral pain and motor improvement in patients with weakness due to nerve root compression.</p><p><strong>Methods: </strong>Patients treated with surgery and/or radiotherapy for spinal metastases were identified from an international multicenter prospective cohort. The primary outcome was the numeric rating scale (NRS) score for pain at 3 months posttreatment. Motor recovery from radicular compression in patients with myotomic weakness and low-grade epidural compression was also analyzed.</p><p><strong>Results: </strong>Of 284 patients, 129 (45%) had radicular pain ± axial pain and 155 (55%) had axial pain alone. The two groups did not significantly differ in age, comorbidities, tumor characteristics, or treatment. Two hundred two patients (71%) underwent surgery ± radiotherapy, whereas 82 (29%) had radiotherapy alone. The NRS score of patients with radicular pain improved from 6.7 to 3.4 at 3 months, a statistically significantly higher magnitude than in patients with isolated axial pain (p = 0.021). The NRS score at 3 months was similar for both groups (p = 0.876). Patients with radicular pain experienced a larger improvement with surgery compared with radiotherapy alone (p = 0.007) but had higher pretreatment pain (mean NRS score 7.0 vs 5.6, p = 0.013). Twenty-three patients identified with radicular/myotomic weakness (mean American Spinal Injury Association score 96.3 ± 3.2) at baseline improved 2.1 ± 3.8 points at 3 months.</p><p><strong>Conclusions: </strong>The magnitude of pain improvement for patients with radicular pain following surgery and radiotherapy for metastatic spine disease is higher than for patients with axial pain alone. Surgery is associated with a larger improvement in radicular pain than radiotherapy alone. These results will allow clinicians to tailor treatment options for patients with metastatic spine disease.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E14"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035641","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":"Intraoperative ultrasound imaging features in high-grade metastatic spinal cord compression treated with separation surgery.","authors":"Esteban Ramirez Ferrer, Gil Kimchi, Martin C Tom, Vikram B Chakravarthy, Behrang Amini, Romulo Augusto Andrade de Almeida, Juan Pablo Zuluaga-Garcia, Francisco Call-Orellana, Robert Y North, Christopher A Alvarez-Breckenridge, Laurence D Rhines, Claudio E Tatsui","doi":"10.3171/2025.2.FOCUS24965","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24965","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to identify and characterize intraoperative ultrasound (iUS) findings during separation surgery for treatment of high-grade malignant epidural spinal cord compression that correlate with adequate decompression and prognostication of functional status.</p><p><strong>Methods: </strong>A retrospective review identified 24 iUS images and videos obtained in 8 patients (age range 48-68 years) who underwent separation surgery for high-grade epidural compression. The following iUS parameters were assessed: the ventral and dorsal distances between the dura mater and spinal cord (i.e., subarachnoid compartments), the distance between the spinal cord and residual tumor, anteroposterior and lateral diameters of the spinal cord, presence of spinal cord deformation, presence of hyperechoic signal within the spinal cord, and measurement of the angular deformation of the spinal cord on the sagittal plane. Additionally, surgical data, such as perioperative neurological status, estimated blood loss, neurophysiological changes, and procedure type, were documented.</p><p><strong>Results: </strong>The minimum distance between the residual tumor and the spinal cord was 5 mm (mean 6.9, range 5-10 mm). The mean spinal cord sagittal deformation angle after decompression was 172°. The mean widths of the dorsal and ventral subarachnoid compartments were 1.5 mm and 3.3 mm, respectively. The mean anteroposterior and transverse diameters of the spinal cord were 5.6 mm and 9.2 mm, respectively. All patients with hyperechoic punctate areas in the white matter of the spinal cord experienced new or persistent neurological deficits, which improved during hospitalization.</p><p><strong>Conclusions: </strong>Intraoperative US is a practical and effective tool for assessing the extent of separation achieved during surgery for spinal metastases. The ultrasonographic features described in this study are easily reproducible and could be used to develop a standardized approach for evaluating spinal cord decompression in cases of separation surgery. Future longitudinal studies are needed to validate if intramedullary hyperechoic signal has prognostic value for neurological recovery and if the distance from the spinal cord to residual disease serves as a predictor of local control.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E8"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036200","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":"Investigating distress levels in patients with metastatic spine disease undergoing surgical intervention.","authors":"Dana G Rowe, Joshua Woo, Ellen O'Callaghan, Connor Barrett, Emily J Luo, Tanner J Zachem, Tara Dalton, Michael Goodin, Kerri-Anne Crowell, Margaret O Johnson, Melissa M Erickson, C Rory Goodwin","doi":"10.3171/2025.2.FOCUS24963","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24963","url":null,"abstract":"<p><strong>Objective: </strong>Cancer patients often experience high levels of distress, which are particularly pronounced in the perioperative period. However, there is a dearth of research on distress rates in patients with metastatic spine disease (MSD). This study aims to assess pre- and postoperative distress levels in patients with MSD undergoing surgical intervention, as well as the association between distress and sociodemographic factors.</p><p><strong>Methods: </strong>The authors retrospectively queried electronic medical records from a single institution for demographic and clinical data on patients with MSD who underwent surgical intervention between 2015 and 2023. Data included pre- (within 30 days of surgery) and postoperative (within 30 and 90 days of surgery) National Comprehensive Cancer Network's distress thermometer (NCCN-DT) scores. The proportion of patients with clinically significant distress (DT score ≥ 4) at each time point was examined, as well as changes between baseline distress and distress 30 days postoperatively. The association between clinically significant distress and sex, age, race/ethnicity, and marital status was assessed. A p value < 0.05 was considered significant.</p><p><strong>Results: </strong>The study identified 265 patients with complete NCCN-DT questionnaires. Nearly half (47.5%) of the patients were female, with 66.0% identifying as Caucasian/White. The mean (± standard deviation) age at surgery was 61.4 ± 12.1 years. Preoperatively, the mean distress score was 3.6 ± 3.1 (range 0-10), with 89 (46.4%) of 192 patients reporting moderate to severe distress (DT ≥ 4). The mean distress score at 30 days postoperatively was 3.2 ± 3.0 (range 0-10), with 43.8% of patients reporting moderate to severe distress. At 90 days postoperatively, the mean distress score was 2.3 ± 2.5 (range 0-9) with 26.6% of patients reporting moderate to severe levels. Non-White patients had significantly higher preoperative distress than their White counterparts (p = 0.03).</p><p><strong>Conclusions: </strong>Distress is a common experience among patients with MSD undergoing surgical intervention. Preoperatively, nearly half of these patients report moderate to severe distress, with distress levels remaining elevated through the 1st month after surgery. These findings highlight the critical need for timely psychosocial interventions to address distress at key stages of the surgical process. Race-based differences in distress rates emphasize the importance of developing targeted support strategies for more vulnerable groups.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E15"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003022","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":"Transpedicular approach for circumferential decompression and separation surgery as a safe and effective way to maximize surgical treatment for spinal metastases: a multicentric study.","authors":"Giuseppe Di Perna, Marco Ajello, Antonio Colamaria, Francesco Carbone, Augusto Leone, Fulvio Tartara, Nicola Marengo, Uwe Spetzger, Diego Garbossa, Fabio Cofano","doi":"10.3171/2025.2.FOCUS24971","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24971","url":null,"abstract":"<p><strong>Objective: </strong>Surgery for spinal metastases has undergone multiple transformations in operative technique, with the goal of enhancing local disease control and facilitating adjuvant therapies. The transpedicular approach offers a minimally invasive strategy for achieving circumferential spinal cord decompression, optimizing conditions for high-dose radiation therapies such as stereotactic body radiation therapy and safe cytoreduction. This study aimed to assess the safety and effectiveness of the transpedicular approach in achieving 360° spinal cord decompression.</p><p><strong>Methods: </strong>In this multicentric retrospective observational study, the medical records of symptomatic patients who underwent circumferential decompression of the dural sac for spinal metastases between January 2018 and June 2023 were analyzed. Assessed data included perioperative complications and clinical outcomes in terms of neurological function and axial pain. Neurological status was evaluated using the American Spinal Injury Association Impairment Scale and modified Medical Research Council scale. Radiological assessments included epidural spinal cord compression grading and the Spine Instability Neoplastic Score. Statistical analyses were conducted to identify predictors of outcomes.</p><p><strong>Results: </strong>Circumferential decompression was successfully achieved in all cases. Neurological improvement was observed in 76.3% of patients at discharge, with sustained functional benefits at a mean follow-up of 19.2 months. Postoperative pain improved in 84.2% of patients. A significant association was found between immediate postoperative neurological improvement and long-term outcomes (p = 0.004). Univariate logistic regression analysis indicated that immediate postoperative improvement significantly reduced the likelihood of deterioration at the last follow-up [Nagelkerke R2 = 0.135, Exp(B) = 0.208; p = 0.004]. The total complication rate was 9.8%. Complications included CSF leaks (2.8%), wound infections (1.9%), and low rates of neurological deterioration (0.9%).</p><p><strong>Conclusions: </strong>The transpedicular approach provides a safe and effective route for circumferential spinal cord decompression in metastatic spinal disease. It minimizes perioperative risks, facilitates high-dose radiation therapy, and achieves favorable neurological and pain outcomes in thoracic and lumbar locations.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E7"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037248","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":"Introduction. Advances in spine tumor management: innovations in surgery, radiation, and biomarkers.","authors":"Mark H Bilsky, Fabio Ynoe Moraes, C Rory Goodwin, Daniel Lubelski, Michelle J Clarke","doi":"10.3171/2025.2.FOCUS24672","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24672","url":null,"abstract":"","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E1"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029570","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":"Innovative dura-splitting strategy for resection of spinal meningioma along with the inner layer of dura mater.","authors":"Lei Wang, Jinlu Gan, Nan Tang, Shunan Hu, Deqiang Lei, Hongyang Zhao, Yingchun Zhou","doi":"10.3171/2025.2.FOCUS24659","DOIUrl":"https://doi.org/10.3171/2025.2.FOCUS24659","url":null,"abstract":"<p><strong>Objective: </strong>Spinal meningioma is a common extramedullary tumor that can theoretically be cured by complete microsurgical resection. However, complete resection of the tumor is challenging with traditional surgical strategies due to the variable relative position of meningioma and spinal cord, as well as the risk of CSF leakage, which leads to high recurrence rates in the long term. The aim of this study was to explore an innovative dura-splitting strategy to resect the tumor, along with the attached inner dural layer, and evaluate the clinical prognosis.</p><p><strong>Methods: </strong>The authors retrospectively reviewed cases of spinal meningioma treated using the dura-splitting technique, from 2019 to 2023, and the traditional Simpson grade I resection, from 2016 to 2023. The functional status of patients was assessed preoperatively and postoperatively using the numeric rating scale (NRS) for pain and modified McCormick Scale (mMS) for spinal function. Postoperative complications and tumor recurrence were also recorded.</p><p><strong>Results: </strong>The study included 123 patients with spinal meningiomas, with 97 patients in the dura-splitting group and 26 in the Simpson grade I group. In the dura-splitting group, the mean maximal diameter of the tumors was 20.9 ± 7.5 mm, with 47.4% of tumors located ventrally or ventrolaterally to the spinal cord. The mean follow-up duration for the dura-splitting group was 32.8 ± 18.6 months. At the 6-month follow-up visit, mMS grades showed significant improvement (p < 0.001), with an evident decline in NRS scores in patients with pain (p < 0.001). Compared with the Simpson grade I group, the dura-splitting group demonstrated better pain reduction (p = 0.009). During hospitalization, CSF-related complications were significantly lower in the dura-splitting group (7.2%) compared with the Simpson grade I group (23.1%, p = 0.02). One patient in the Simpson grade I group required revision due to recurrent CSF leakage. No tumor recurrence or other surgical complications were observed in either group at the last follow-up visit.</p><p><strong>Conclusions: </strong>The dura-splitting strategy enabled complete resection of spinal meningioma and circumferential excising of the affected inner layer of dura mater to achieve negative resection margin. In comparison to traditional Simpson grade I resection, this innovative technique offers a favorable prognosis with low complication rates, suggesting it is a valuable addition to the surgical options for spinal meningioma.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 5","pages":"E3"},"PeriodicalIF":3.3,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014469","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":"Comparison of volitional control and strength in elbow flexion after ipsilateral C7 transfer or double fascicular transfer in C5-6 brachial plexus injuries.","authors":"Ying-Hsuan Lee, Isabelle Citron, Tommy Nai-Jen Chang, Yenpo Lin, David Chwei-Chin Chuang, Johnny Chuieng-Yi Lu","doi":"10.3171/2025.1.FOCUS24884","DOIUrl":"10.3171/2025.1.FOCUS24884","url":null,"abstract":"<p><strong>Objective: </strong>Recovery of function after nerve injury requires strength, as well as plasticity, to allow independent control of the reinnervated muscle group. The aim of this study was to compare the recovery of strength and volitional control of elbow flexion in patients with C5-6 brachial plexus injuries who underwent reconstruction by either ipsilateral posterior division of C7 to anterior division of upper trunk nerve transfer (hereafter, ipsilateral C7 transfer) or double fascicular nerve transfer (DFT), in which fascicles of the ulnar nerve and fascicles of the median nerve are transferred to biceps and brachialis branches, respectively.</p><p><strong>Methods: </strong>Patients with isolated C5-6 injuries from February 2003 to October 2022 at a single tertiary center underwent ipsilateral C7 transfer or DFT for elbow flexion. Additional shoulder abduction reconstruction was performed with intraplexus or extraplexus nerve transfers. Primary outcomes were strength (Medical Research Council [MRC] grade) and volitional control (Plasticity Grading Scale [PGS] score). Shoulder recovery was evaluated by the degree of abduction.</p><p><strong>Results: </strong>Twelve patients received ipsilateral C7 transfer and 20 patients received DFT. There were no significant differences in the final MRC strength (100% vs 80%, p = 0.271) and the mean time to attain MRC grade M3 (17.1 ± 10.9 months vs 19.4 ± 24.4 months, p = 0.357) between the ipsilateral C7 and DFT groups, respectively. In the DFT group, volitional control was distributed as follows: PGS score 1 (no plasticity) (15%), PGS score 2 (30%), PGS score 3 (50%), and PGS score 4 (complete volitional control) (5%). All patients who received ipsilateral C7 transfers achieved a PGS score of 3. A higher rate of good to excellent plasticity (PGS score 3-4) occurred in the ipsilateral C7 group compared with the DFT group (100% vs 55%, p = 0.012). The mean shoulder abduction was 91.3° ± 52.2° in the ipsilateral C7 group and 82.8° ± 56.8° in the DFT group (p = 0.655).</p><p><strong>Conclusions: </strong>Ipsilateral C7 transfer and DFT showed comparable strength recovery for elbow flexion. However, ipsilateral C7 transfer demonstrated better plasticity without compromise of hand grip. Ipsilateral C7 transfer should be considered as an alternative to DFT to improve hand function following reinnervation.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 4","pages":"E4"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764032","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":"Correlation between electromyography findings and plasticity grading score after long-term phrenic nerve to musculocutaneous nerve transfer in brachial plexus injuries.","authors":"Simon Miedema, Francisco Vargas, Eugenia Conti, Martin Bourguet, Martijn Malessy, Mariano Socolovsky","doi":"10.3171/2025.1.FOCUS24866","DOIUrl":"10.3171/2025.1.FOCUS24866","url":null,"abstract":"<p><strong>Objective: </strong>Patients with complete traumatic brachial plexus injuries often require nerve transfers to restore lost function. Phrenic nerve (PN)-musculocutaneous nerve (MCN) transfer can be used to restore elbow flexion. The degree to which reinnervated muscles achieve independent control requires central plastic changes. The central program of the PN donor nerve needs to disconnect and establish connections with that of the recipient MCN. This study aimed to improve understanding of the brain's changes after PN-MCN transfer by correlating electromyography (EMG) findings with clinical plasticity grading scale (PGS) scores.</p><p><strong>Methods: </strong>A prospective study was conducted on patients who underwent PN-MCN transfer after brachial plexus injury. EMG assessments were systematically performed under 3 distinct conditions: 1) normal respiration with the arm at rest, 2) deep respiration with the arm at rest, and 3) voluntary elbow flexion performed without inspiration. Motor unit potentials (MUPs) detected within a 150-msec interval were systematically categorized using a 5-point scale. Brain plasticity was clinically evaluated using the 4-point PGS.</p><p><strong>Results: </strong>Twelve patients with a mean age of 21.8 years were included in the study. A significant negative correlation was found between EMG activity during deep breathing and PGS outcomes (correlation coefficient [CC] -0.623, p = 0.031). Likewise, EMG activity during deep breathing showed a negative correlation with EMG activity during voluntary elbow flexion (CC -0.811, p = 0.002). Only 1 patient (8%) demonstrated complete disconnection between the donor and recipient neural pathways.</p><p><strong>Conclusions: </strong>The authors' findings indicate a significant correlation between clinical measures of brain plasticity and EMG outcomes. Additionally, complete cerebral disconnection was rarely attained, with most patients retaining residual influence from the original donor function.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":"58 4","pages":"E2"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764036","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}