Neurospine最新文献

{"title":"Atlantoaxial Reconstruction: The Artful Evolution of Craniovertebral Junctional Spine Surgery.","authors":"Sang Hoon Hwang, Seung Jun Ryu, Min Han Kim, Jong Koo Lee, Sun Woo Jang, Danbi Park, Chong Man Kim, Jin Hoon Park","doi":"10.14245/ns.2550960.480","DOIUrl":"10.14245/ns.2550960.480","url":null,"abstract":"<p><p>The atlantoaxial (C1-2) junction is among the most technically demanding regions for cervical spine surgery owing to its complex osseoligamentous anatomy and proximity to critical neurovascular structures. Numerous posterior fixation constructs have been developed to optimize biomechanical rigidity and promote arthrodesis. Since Gallie's introduction of posterior wiring with autologous bone grafts in 1939, evolving techniques have focused on enhancing fusion rates while minimizing risk to adjacent structures. This paper outlines the historical evolution of C1-2 posterior instrumentation, current fixation strategies, bone fusion techniques, and reduction methods. A systematic literature search identified 61 relevant studies on C1-2 fusion. Additional references were manually reviewed to provide a comprehensive context. Of these, 41 studies were narratively summarized to outline the historical and conceptual evolution of C1-2 fusion techniques, while the remaining 20 post-2000 studies on contemporary surgical modifications were systematically reviewed and tabulated for technical details and clinical outcomes. C1-2 fusion techniques have evolved significantly over time. Early methods primarily involved posterior wiring with autologous bone grafts, but later transitioned to rigid segmental fixation using pedicle screw constructs, resulting in improved fusion rates and clinical outcomes. Interarticular fusion, when concurrently performed, enhances the biological fusion environment, contributing to favorable clinical results. C1 lateral mass, posterior arch, pedicle screws and C2 pedicle, lamina screws give us much stronger stability and higher fusion rates. Interarticular fusion using local bone also gives us technical easiness guaranteeing high fusion rate overcoming inconvenience of wiring and iliac bone harvest. Interarticular height reduction and interarticular fusion should be discriminated.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 3","pages":"634-649"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12518907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Contribution of Paraspinal Sarcopenia on Sagittal Imbalance in Degenerative Kyphosis.","authors":"Ming Wang, Abdukahar Kiram, Jie Li, Yunlong Xu, Jingtan Hu, Xiaodong Qin, Yu Wang, Jun Qiao, Benlong Shi, Saihu Mao, Zezhang Zhu, Yong Qiu, Zhen Liu","doi":"10.14245/ns.2550436.218","DOIUrl":"10.14245/ns.2550436.218","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the correlation between paraspinal sarcopenia (PS) and sagittal imbalance (SI) in degenerative kyphosis (DK), and to explore the correlation between paraspinal muscle (PSM) function loss and morphology change in DK.</p><p><strong>Methods: </strong>One hundred thirty-eight patients with DK and 204 with lumbar spinal stenosis (LSS) were enrolled. The spinopelvic parameters and sagittal vertical axis (SVA) were measured. Patients were divided into the sagittal balance (SB, SVA ≤ 5 cm, n = 61) and SI (SVA > 5 cm, n = 77) groups. Sagittal balanced LSS patients were served as control group. PSM function was evaluated by measuring the maximal voluntary exertion (MVE) and endurance time (ET). Magnetic resonance imaging-derived cross-sectional area (CSA) and fat infiltration rate (FI%) of PSM at T10-L5 were normalized to intervertebral disc CSA. Psoas CSA and FI% were calculated at L3-4 disc level. The correlation assessment using Spearman rank correlation coefficient and multiple linear regression. Logistic regression was used to identify the risk factors of SI.</p><p><strong>Results: </strong>Significantly lower ET, MVE, relative CSA (rCSA) and higher rFI% was found in the SI group than in the SB and control. The PS were correlated with spinopelvic parameters and regional kyphosis, while lack of correlation was found between the rFI% and MVE. Logistic regression and Youden index analysis showed ET < 15.5 seconds, MVE < 1.3 N/kg, and rCSA (L1-5) atrophy to be potential risk factors for SI in DK.</p><p><strong>Conclusion: </strong>DK patients with SI demonstrate acerbated PS that indicated by significant PSM dysfunction and morphological alterations. We highlight the significance of PSM combined evaluation and revealed that PS plays an indispensable role in the progression of SI, providing novel insights into the underlying sagittal compensatory mechanisms.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 3","pages":"680-691"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12518903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in Metastatic Disease Spinal Oncology: Novel Technology Without Forgetting the Fundamentals of Surgical Treatment.","authors":"Harsh Jain, Ranbir Ahluwalia, Ilya Laufer, Scott L Zuckerman","doi":"10.14245/ns.2550476.238","DOIUrl":"10.14245/ns.2550476.238","url":null,"abstract":"<p><p>Metastatic spine disease represents a growing therapeutic challenge that demands a balance between incorporating emerging technologies while respecting the fundamental principles during clinical decision-making. Advances in adjuvant therapies, including stereotactic body radiotherapy (SBRT) and chemotherapy, have significantly improved long-term patient survival. Surgical decision-making should be guided by well-established frameworks such as the NOMS (neurologic, oncologic, mechanical, systemic) criteria, the ESCC (epidural spinal cord compression) scale, and the SINS (spinal instability neoplastic score), ensuring a structured and evidence-based approach to treatment. The integration of minimally invasive techniques, including percutaneous instrumentation, ablation techniques, and biportal endoscopic approaches, has reduced surgical morbidity and facilitated faster recovery. Additionally, carbon fiber implants are revolutionizing spinal stabilization by allowing better postoperative visualization of any local recurrence and easier radiation planning. SBRT has emerged as a critical modality, offering precise, high-dose radiation with minimal toxicity to the spinal cord, improving local tumor control and patient outcomes. A multidisciplinary approach remains paramount, requiring collaboration between spine surgeons, radiation oncologists, and medical oncologists. In this narrative review, we aim to provide a comprehensive overview of the current state of metastatic spine tumor management, focusing on: (1) fundamentals of metastatic spine care, (2) minimally invasive surgical techniques, (3) the use of carbon fiber screws, (4) SBRT, and (5) ways to maximize patient safety.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 3","pages":"829-845"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12518916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin A Deficiency Induces Congenital Vertebral Malformation via Retinoic Acid Signaling Mediated Sclerotome Dysplasia.","authors":"Xu'an Huang, Yingxi Chen, Jiafeng Dai, Yuchang Zhou, Xin Wan, Zhen Wang, Xiaodi Hu, Yang Jiao, Haoyu Cai, Junduo Zhao, Heng Sun, Yizhen Huang, Hongyi Zhou, Haojie Chen, Bolun Qu, Dahai Zhu, Yong Zhang, Jianxiong Shen","doi":"10.14245/ns.2550632.316","DOIUrl":"10.14245/ns.2550632.316","url":null,"abstract":"<p><strong>Objective: </strong>Congenital vertebral malformations (CVMs) arise from abnormal sclerotome development. Our previous study has indicated that vitamin A deficiency (VAD) induced congenital spinal deformity in rats. However, the phenotype observed through x-ray and the mechanism were still unclear.</p><p><strong>Methods: </strong>Rats in VAD group were fed with a diet without added vitamin A, while rats in control group were fed with a normal diet. After mating, embryos were collected, and neonatal rats were euthanized. Micro-computed tomography and x-ray were utilized to detect the vertebral malformation. We applied whole mount in situ hybridization to visualize the expression patterns of Pax1 and Raldh-2 in embryos. Laser capture microdissection combined RNA-seq of sclerotome was performed.</p><p><strong>Results: </strong>The incidence of CVMs in neonatal rats was 32.65% in VAD group and 0% in control group. All malformations observed were butterfly vertebrae. In VAD group, we observed downregulation of Pax1 in sclerotome and Raldh-2 in somite. The enriched gene ontology terms were related to developmental process of skeletal system. The enriched pathways were related to osteoblast and osteoclast differentiation, somitogenesis, and retinol metabolism. Real-time quantitative polymerase chain reaction validated that retinoic acid (RA) signaling was downregulated in the sclerotome, leading to the suppression of osteoblast differentiation through a non-Smad-dependent bone morphogenetic protein (BMP) signaling pathway.</p><p><strong>Conclusion: </strong>We established a VAD-induced CVMs model. Non-Smad-dependent BMP pathway and RA signaling pathway may be related to the pathogenesis of CVMs. Our findings demonstrate that VAD may be one of the causes of CVMs, which is hypothesized to serve as a novel therapeutic target for the nonsurgical treatment of CVMs in the future.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 3","pages":"748-762"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12518919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Endonasal Transnasopharyngeal Approach for Ventral Craniovertebral Junction Lesions: A Technical Note.","authors":"Takeshi Hongo, Yusuke Morinaga, Sotaro Oshida, Shunsuke Shibao, Ryu Kurokawa, Yasuhiro Tsunemi, Takashi Kashiwagi, Tsuguhisa Nakayama, Hiroyoshi Akutsu","doi":"10.14245/ns.2550964.482","DOIUrl":"10.14245/ns.2550964.482","url":null,"abstract":"<p><strong>Objective: </strong>Lesions of the ventral craniovertebral junction are difficult to access owing to their deep location and proximity to critical neurovascular and pharyngeal structures. In this study, we aimed to describe the surgical technique and clinical outcomes of the endoscopic endonasal transnasopharyngeal approach for ventral craniovertebral junction lesions and highlight key considerations regarding approach selection, airway management, and occipitocervical stabilization.</p><p><strong>Methods: </strong>We retrospectively reviewed 7 patients who underwent the endoscopic endonasal transnasopharyngeal approach for ventral craniovertebral junction lesions. The analysis included preoperative planning for surgical access, intraoperative technique, postoperative management, airway and nutritional strategies, and the need for occipitocervical fixation. One representative case is presented to illustrate key technical steps.</p><p><strong>Results: </strong>Of the 7 patients, 6 had neoplastic lesions and 1 had basilar invagination. Despite a relatively large mean lesion size of 39.4 mm, subtotal or greater resection was achieved in 5 of the 6 tumor cases. Occipitocervical fixation was performed in 2 cases. Two patients underwent prophylactic tracheostomy because of anticipated airway compromise. Of the 5 orally intubated cases, 3 were extubated immediately and 2 by postoperative day 2. Oral feeding resumed by day 10 in 6 cases. No postoperative infections or cerebrospinal fluid leakage occurred. One patient experienced transient velopharyngeal insufficiency, which resolved spontaneously.</p><p><strong>Conclusion: </strong>The endoscopic endonasal transnasopharyngeal approach is a safe and effective option for ventral craniovertebral junction lesions when appropriately selected. Careful preoperative evaluation and individualized management of airway and spinal stability are essential for favorable outcomes.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 3","pages":"737-747"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12518908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Fracture Deficit Volume on Fusion Success in Anterior Odontoid Screw Fixation.","authors":"JinWoo Jung, Young San Ko, Yu Sung Yoon, Dae-Chul Cho","doi":"10.14245/ns.2550536.268","DOIUrl":"10.14245/ns.2550536.268","url":null,"abstract":"<p><strong>Objective: </strong>Anterior odontoid screw fixation (AOSF) has several advantages over posterior C1-2 fusion for Grauer type II and shallow type III odontoid fractures. However, the risk factors for fusion failure, particularly in terms of 3-dimensional (3D) measurements, remain unclear. This study investigated the impact of fracture deficit volume (FDV), a novel 3D measurement, on fusion outcomes in patients undergoing AOSF.</p><p><strong>Methods: </strong>We enrolled 44 patients with Grauer type II or shallow type III odontoid fractures treated with AOSF at a single institution. Radiological assessments included preoperative and postoperative measurements of the fracture gap and fracture displacement on computed tomography (CT) scans. FDV was calculated through 3D CT reconstruction of preoperative and immediate postoperative CT to quantify the spatial gap between the edges of the fractures. Fusion outcomes were defined as solid union, fibrous union, or nonunion. Logistic regression and a generalized additive model (GAM) were used to identify risk factors for fusion failure after AOSF.</p><p><strong>Results: </strong>Solid fusion was achieved in 77.3% of patients. A reduction in the FDV with respect to the preoperative value was significantly associated with successful fusion (p=0.028), whereas patients presenting an increased FDV postoperatively were more likely to exhibit fusion failure (p=0.006). Age≥65 years, a fracture gap≥2 mm, and an increased FDV postoperatively were significant risk factors for fusion failure. GAM analysis revealed a linear relationship between a reduced FDV and improved fusion rates (adjusted R2=0.186, p=0.018).</p><p><strong>Conclusion: </strong>The risk of fusion failure is greater in elderly patients, those with a fracture gap greater than 2 mm, and those with an increased FDV postoperatively. Among the modifiable risk factors, FDV had the greatest impact on fusion outcomes after AOSF.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 3","pages":"859-869"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12518897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Factors in Craniocervical Realignment for Crainovertebral Junction Kyphosis With Negative Cervical Imbalance: A Comprehensive Study.","authors":"Dong Hun Kim, Jae Taek Hong, Jin Young Kim, Kang Bin Koo, Dae Hee Lee, Jung Woo Hur, Ho Jin Lee, Il Sup Kim","doi":"10.14245/ns.2550990.495","DOIUrl":"10.14245/ns.2550990.495","url":null,"abstract":"<p><strong>Objective: </strong>To elucidate the clinical outcomes of craniocervical realignment surgery in patients with craniovertebral junction (CVJ) kyphosis accompanied by negative sagittal imbalance, and to identify radiological predictors associated with favorable outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 28 patients who underwent craniocervical realignment between 2014 and 2022 for CVJ kyphosis with accompanying negative sagittal imbalance. Clinical outcomes were evaluated using the Neck Disability Index (NDI), visual analogue scale for neck pain, and the Japanese Orthopaedic Association (JOA) score. Radiographic parameters included the C0-2 angle and the C2-7 sagittal vertical axis (SVA). Favorable outcomes were defined as an improvement of more than 20 points in the NDI and a JOA recovery rate exceeding 50%. Multiple linear regression and receiver operating characteristic (ROC) curve analyses were conducted to identify independent predictors and to determine optimal threshold values.</p><p><strong>Results: </strong>Significant improvements in both clinical outcomes and radiographic alignment were observed in association with craniocervical realignment surgery. Patients who achieved favorable outcomes exhibited greater postoperative changes in the C0-2 angle and the C2-7 SVA. Multivariate analysis identified changesm in the C0-2 angle (p=0.019) and C2-7 SVA (p=0.010) as independent predictors of NDI improvement, while age (p=0.033) and C2-7 SVA change (p=0.037) were independently associated with the JOA recovery rate. ROC curve analysis determined optimal cutoff values of ≥10.65° for C0-2 angle change and ≥19.2 mm for C2-7 SVA change, with corresponding area under the curve values of 0.872 and 0.802, respectively.</p><p><strong>Conclusion: </strong>Craniocervical realignment appears to be a viable surgical option for patients with CVJ kyphosis and negative sagittal imbalance. Postoperative changes in C0-2 angle and C2-7 SVA were found to be associated with favorable clinical and functional outcomes, suggesting their potential role as prognostic factors.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 3","pages":"725-736"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12518899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of the COVID-19 Pandemic on School-Based Scoliosis Screening Program in South Korea.","authors":"Hong Jin Kim, Jae Hyuk Yang, Hyung Rae Lee, Seung Woo Suh, Dong-Gune Chang","doi":"10.14245/ns.2550634.317","DOIUrl":"10.14245/ns.2550634.317","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the trends in school-based scoliosis screening programs, with a focus on the impact of coronavirus disease 2019 (COVID-19) pandemic, including its effects on referral numbers and radiological profiles of patients with adolescent idiopathic scoliosis (AIS).</p><p><strong>Methods: </strong>A total of 298,666 volunteer individuals participated in the school-based scoliosis screening program, classified into 2 groups; prepandemic group (between 2017 and 2019, n=201,160) and postpandemic group (between 2021 and 2023, n=97,506). The data included referral volumes, the prevalence rate of AIS, and trends in both referral patterns and the characteristics of the screened population.</p><p><strong>Results: </strong>The prevalence rate of AIS among the screened population was significantly higher in the postpandemic group (49.35%; 95% confidence interval [CI], 48.12-50.59) compared to the prepandemic group (41.47%; 95% CI, 40.71-42.24) (p<0.001). The postpandemic group also exhibited significantly younger age (p<0.001), lower body weight (p<0.001), earlier onset of menarche (p<0.001), and a larger Cobb angle in females (p<0.001) compared to the prepandemic group. Additionally, the proportion of individuals not recognizing their AIS was significantly higher in the postpandemic group (99.74%) compared to the prepandemic group (88.87%) (p<0.001).</p><p><strong>Conclusion: </strong>Lockdown for preventing COVID-19 pandemic negatively affected the school-based scoliosis screening program. While the overall prevalence of AIS remained stable, the detection rate in the screened population increased, accompanied by younger ages, earlier menarche, and higher Cobb angles (in females) following the COVID-19 pandemic.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 3","pages":"794-802"},"PeriodicalIF":3.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12518893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145280796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Correction: Augmented Reality to Improve Surgical Workflow in Minimally Invasive Transforaminal Lumbar Interbody Fusion - A Feasibility Study With Case Series.","authors":"Fabian Sommer, Ibrahim Hussain, Sertac Kirnaz, Jacob L Goldberg, Rodrigo Navarro-Ramirez, Lynn B McGrath, Franziska A Schmidt, Branden Medary, Pravesh Shankar Gadjradj, Roger Härtl","doi":"10.14245/ns.2025.22067.correction","DOIUrl":"10.14245/ns.2025.22067.correction","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":" ","pages":"619"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-, Epidural And Intracranial Pressure Changes During Interlaminar Endoscopy, With and Without Dural Tear.","authors":"Mazda Farshad, Jana Felicitas Schader, Alexandra Stauffer, Carl Moritz Zipser, Najmeh Kheram, José Miguel Spirig, Marie-Rosa Fasser, Jonas Widmer, Vincent Hagel","doi":"10.14245/ns.2550456.228","DOIUrl":"10.14245/ns.2550456.228","url":null,"abstract":"<p><strong>Objective: </strong>Endoscopic spine surgery implies possibly severe complications of the central nervous system, from headache to seizures and autonomic dysreflexia. These adverse events might be due to increased intracranial pressure (ICP), presumably induced by increased spinal intra-/epidural pressure caused by fluid irrigation. This study was designed to perform interlaminar endoscopic lumbar discectomy (IELD) at different irrigation fluid settings while monitoring its effect on intra-/epidural and ICPs, with and without dural tears.</p><p><strong>Methods: </strong>Spinal intradural pressures were measured by introducing catheters through a sacral approach to human cadavers' lumbar, thoracic, and cervical levels. Additionally, an epidural probe was placed at L3-4. ICP was measured by an intraventricular probe. IELD was performed at L3-4, and the effect of varying irrigation pressures by different endoscopic pump systems and gravity-based irrigation on intra-/epidural and ICP pressures was measured before and after durotomy at L3-4.</p><p><strong>Results: </strong>Intradural pressure at L3-4 correlated linearly with increasing irrigation pressure, irrespective of the used pump system (median pressure increase at 100-mmHg irrigation pressure: system I: 7 mmHg, r=0.94, p=0.002; system II: 7 mmHg, r=0.89, p=0.017) or gravity (8 mmHg, r=0.93, p=0.242). This effect was also seen intradurally at the thoracic/cervical spine, epidural, and intracranial level, and was even more pronounced with the maneuver of outflow-occlusion and a dural tear present.</p><p><strong>Conclusion: </strong>While performing IELD, pump pressures correlated linearly to intra-/epidural pressures and ICPs. Pressures did not rise to concerningly high levels without outflow-occlusion, even with increased pump pressures. In the presence of a dural tear, higher pump pressures exacerbated by occlusion may lead to deleterious intradural and ICP elevations.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"22 2","pages":"583-591"},"PeriodicalIF":3.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}