World neurosurgery最新文献

{"title":"Enabling technology with minimally invasive strategies: robot-assisted Cortical Bone Trajectory screws fixation in lateral transpsoas interbody fusion.","authors":"Nicola Marengo, Federico Pecoraro, Enrico Lo Bue, Stefano Colonna, Flavio Panico, Alberto Morello, Marco Ajello, Francesco Zenga, Diego Garbossa, Fabio Cofano","doi":"10.1016/j.wneu.2025.123890","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123890","url":null,"abstract":"<p><strong>Objectives: </strong>The robot-assisted cortical bone trajectory (CBT) screw placement is safer than the traditional fluoroscopy-assisted approach. This is the first technical note reporting a novel technique of robot-assisted CBT screws placement with a subfascial transmuscular approach.</p><p><strong>Technical note: </strong>After a lumbar interbody cage position, the second step consists in the robot-assisted placement of CBT screws in a prone position. A median skin incision is performed, ensuring an incision as small as possible. CBT screw direction and trajectory are planned on the sterile robot touchscreen display. A navigated drill is used to breach the cortical surface of the entry point. Then, a navigated drill bit is used to complete the exposure of the screw trajectory. The screw is placed with the support of the robotic arm. In the single-position the surgical field must be prepared since the first surgical step. All the navigation references are placed on the same iliac crest. The following steps resemble the ones described for the double-position.</p><p><strong>Conclusion: </strong>This is the first reported technical note about robot-assisted transmuscular CBT screw placement for posterior fixation in LLIF. The surgical technique proposed aims to combine the advantages of CBT screws and the use of innovative robot-assisted technology.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123890"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630860","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":"Otolaryngology-Assisted Approach for Anterior Cervical Discectomy and Fusion","authors":"M. Benjamin Larkin ,&nbsp;Anthony K. Allam ,&nbsp;Cyrus B. King ,&nbsp;N. Eddie Liou ,&nbsp;Alexander E. Ropper","doi":"10.1016/j.wneu.2025.123887","DOIUrl":"10.1016/j.wneu.2025.123887","url":null,"abstract":"<div><div>First introduced in 1955, anterior cervical discectomy and fusion (ACDF) surgery has seen minimal changes over the years. Its reproducibility, impressive long-term results, and minimal complication rates have established it as one of the most frequently performed cervical spinal fusion surgeries. Yet, postoperative dysphagia remains a concern with a 60% incidence rate. An otolaryngologist's expertise regarding cervical fascial anatomy can inform the spine surgeon's approach to an ACDF to potentially reduce postoperative dysphagia rates. We describe an illustrative case of a 35-year-old woman who presented with 8/10 neck and arm pain along with numbness in her fourth and fifth digits for the past 6 months despite multiple conservative treatments. Cervical spine magnetic resonance imaging demonstrated a large C6-7 central disc herniation resulting in severe foraminal stenosis and moderate C5-6 disc herniation. A C5-7 ACDF was performed. Successful ACDF can be performed using an otolaryngologist-assisted neck approach. Rather than opening the 3 layers of the deep cervical fascia individually and serially, the fascial layers were reflected medially by opening the carotid sheath, where the fascial layers coalesce, and performing the dissection to the spine in a lateral-to-medial fashion. This approach may help decrease rates of dysphagia.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123887"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning in Predicting the Cognitive Improvement of Ventriculoperitoneal Shunt for Chronic Normal Pressure Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage","authors":"Youjia Zhu ,&nbsp;Luyu Xue ,&nbsp;Feng Zhao ,&nbsp;Qizhang Yang ,&nbsp;Shengjie Feng ,&nbsp;Chao Bo ,&nbsp;Shiheng Su ,&nbsp;Lingyang Hua ,&nbsp;Li Yin","doi":"10.1016/j.wneu.2025.123771","DOIUrl":"10.1016/j.wneu.2025.123771","url":null,"abstract":"<div><h3>Background</h3><div>Chronic normal pressure hydrocephalus (CNPH) is a recognized sequela of aneurysmal subarachnoid hemorrhage (ASAH). Ventriculoperitoneal shunt (VPS) is a conventional treatment for hydrocephalus, though its effectiveness for CNPH post-ASAH remains unclear.</div></div><div><h3>Methods</h3><div>We included ASAH patients with CNPH who underwent VPS surgery. Changes in the modified Rankin Scale (mRS) before and after surgery were analyzed to evaluate VPS benefits. The least absolute shrinkage and selection operator identified relevant variables and predictive models were constructed using 8 supervised machine learning algorithms to assess VPS benefit.</div></div><div><h3>Results</h3><div>Among 75 patients (39 males and 36 females), 48 (64%) benefited from VPS, while 27 (36%) did not. The beneficial group showed a longer disease course, higher cerebrospinal fluid (CSF) pressure, lower red and white blood cell counts in CSF, and lower modified Fisher (MF) and Hunt–Hess (HH) grades compared to the nonbeneficial group. Univariate logistic regression analysis indicated that disease course, CSF pressure, red blood cell/white blood cell (WBC) counts in CSF, WBC count in blood, MF grade, HH grade, and preoperative mRS were associated with favorable VPS outcomes. The extreme gradient boosting (XGB) model demonstrated the highest area under the curve of 0.946 and lowest residual error. A nomogram was subsequently developed and demonstrated a satisfactory performance.</div></div><div><h3>Conclusions</h3><div>VPS benefits in CNPH patients after ASAH were associated with disease course, CSF pressure, red blood cell/WBC counts in CSF, WBC count in blood, MF and HH grades, and preoperative mRS. The XGB model demonstrated optimal predictive performance, with an area under the curve of 0.946.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123771"},"PeriodicalIF":1.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143425916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trend Toward Vaginal Versus Cesarean Deliveries in Pregnant Patients with Unruptured Intracranial Aneurysms in the 2010s: A Nationwide Inpatient Analysis","authors":"Richard Chiu ,&nbsp;Ryan G. Chiu ,&nbsp;Faraaz Azam ,&nbsp;Srivats Srinivasan ,&nbsp;Amy Zheng ,&nbsp;Jonathan A. White","doi":"10.1016/j.wneu.2025.123738","DOIUrl":"10.1016/j.wneu.2025.123738","url":null,"abstract":"<div><h3>Objective</h3><div>The safety of spontaneous vaginal delivery in pregnant patients with known unruptured intracranial aneurysms (UIAs) has been supported by increasing evidence over the past 2 decades. However, the extent to which this increased evidence has since influenced changes, if any, in actual clinical practice, has yet to be studied.</div></div><div><h3>Methods</h3><div>Using the 2012 to 2020 Nationwide Inpatient Sample, trends in vaginal versus caesarian delivery among mothers with UIAs were assessed in temporal fashion and compared to overall trends in delivery modality during the same period. Demographic, hospital, and insurance characteristics were also assessed for relationship with method of delivery.</div></div><div><h3>Results</h3><div>A total of 6,624,556 obstetrical patients presented for elective delivery in the 2012–2020 Nationwide Inpatient Sample. This included 419 patients with UIA included in the final analysis. Patients in later years were over twice as likely to have been given a trial of vaginal delivery (odds ratio: 2.01, 95% confidence interval: 1.29 to 3.14, <em>P</em> = 0.002). This was also statistically significantly different from overall rates of vaginal versus caesarian delivery in the overall cohort (<em>P</em> &lt; 0.001). Hospital, regional, demographic and payer characteristics analyzed were not significantly associated with delivery method.</div></div><div><h3>Conclusions</h3><div>There was a significant trend over the 2010s toward permitting more spontaneous vaginal deliveries for obstetrical patients with known UIAs.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123738"},"PeriodicalIF":1.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Barriers to a Neurosurgical Career for Medical Students and Unspecialized Residents Worldwide: A Systematic Literature Review","authors":"Kathleen R. Ran ,&nbsp;Oishika Das ,&nbsp;Samuel B. Kankam ,&nbsp;Olaoluwa E. Dada ,&nbsp;Ganiat A. Giwa ,&nbsp;Andreas Seas ,&nbsp;Sumil K. Nair ,&nbsp;Michelle Odonkor ,&nbsp;Marcus Spann ,&nbsp;Nancy Abu-Bonsrah ,&nbsp;Judy Huang ,&nbsp;Mari L. Groves ,&nbsp;Jordina Rincon-Torroella","doi":"10.1016/j.wneu.2025.123886","DOIUrl":"10.1016/j.wneu.2025.123886","url":null,"abstract":"<div><div>Globally, a large deficit of neurosurgeons exists along with a growing burden of disease requiring neurosurgical care. Also, considerable geographical disparities remain in the neurosurgical workforce distribution. Augmenting and diversifying the neurosurgical workforce requires addressing barriers which deter medical students and unspecialized residents from pursuing a neurosurgical career. Current studies have largely investigated these challenges on a national scale. Investigation into barriers to a neurosurgical career from a global perspective has been limited. Identifying these barriers across high- and low/middle-income countries is critical to recruiting a more robust neurosurgical workforce and reducing global disparities in access to neurosurgical care. We conducted a systematic review to identify perceived barriers encountered by medical students and unspecialized residents to pursuing a neurosurgical career worldwide. We compared studies performed in high- versus low/middle-income countries and identified shared challenges related to gender stereotypes, work-life balance, academic rigor, and financial compensation. Our findings form a basis for formulating global solutions to augment the neurosurgical workforce.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123886"},"PeriodicalIF":1.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Claude 3.5 Sonet and ChatGPT-4 in Posterior Cervical Fusion Patient Guidance","authors":"Rauf Nasirov","doi":"10.1016/j.wneu.2025.123889","DOIUrl":"10.1016/j.wneu.2025.123889","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluates the role of ChatGPT-4 and Claude 3.5 Sonet in postoperative management for patients undergoing posterior cervical fusion. It focuses on their ability to provide accurate, clear, and relevant responses to patient concerns, highlighting their potential as supplementary tools in surgical aftercare.</div></div><div><h3>Methods</h3><div>Ten common postoperative questions were selected and posed to ChatGPT-4 and Claude 3.5 Sonet. Ten independent neurosurgeons evaluated responses using a structured framework that assessed accuracy, response time, clarity, and relevance. A 5-point Likert scale also measured satisfaction, quality, performance, and importance. Advanced statistical analyses were used to compare the 2 artificial intelligence platforms, including sensitivity, specificity, <em>P</em> values, confidence intervals, and Cohen's d.</div></div><div><h3>Results</h3><div>Claude 3.5 Sonet outperformed ChatGPT-4 across all metrics, particularly in accuracy (96.5% vs. 80.6%), response time (92.9% vs. 76.4%), clarity (94.6% vs. 75.4%), and relevance (95.5% vs. 74.0%). Likert scale evaluations showed significant differences (<em>P</em> &lt; 0.001) in satisfaction, quality, and performance, with Claude achieving higher ratings. Statistical analyses confirmed large effect sizes, high inter-rater reliability (kappa: 0.85–0.92 for Claude), and narrower confidence intervals, reinforcing Claude's consistency and superior performance.</div></div><div><h3>Conclusions</h3><div>Claude 3.5 Sonet demonstrated exceptional capability in addressing postoperative concerns for posterior cervical fusion patients, surpassing ChatGPT-4 in accuracy, clarity, and practical relevance. These findings underscore its potential as a reliable artificial intelligence tool for enhancing patient care and satisfaction in surgical aftercare.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123889"},"PeriodicalIF":1.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in the Management of Oligodendrogliomas: A Multinational and Multidisciplinary Survey Study","authors":"Kelly Jiang ,&nbsp;Anita Kalluri ,&nbsp;Michelle Odonkor ,&nbsp;Daniel Martinez Heinemann ,&nbsp;Carly Weber-Levine ,&nbsp;Divyaansh Raj ,&nbsp;Joshua Materi ,&nbsp;Maureen Rakovec ,&nbsp;Estela Pineda ,&nbsp;Kristin J. Redmond ,&nbsp;Carlos Romo ,&nbsp;David O. Kamson ,&nbsp;Matthias Holdhoff ,&nbsp;Karisa C. Schreck ,&nbsp;José Juan González Sánchez ,&nbsp;Chetan Bettegowda ,&nbsp;Jordina Rincon-Torroella","doi":"10.1016/j.wneu.2025.123716","DOIUrl":"10.1016/j.wneu.2025.123716","url":null,"abstract":"<div><h3>Objective</h3><div>Oligodendrogliomas present challenges in management despite their favorable prognosis. Optimal therapeutic strategies are not well-established. We aimed to characterize current practice patterns and identify areas of discordance in oligodendroglioma management.</div></div><div><h3>Methods</h3><div>A 20-question survey was distributed February-July 2023 to 4 professional neurosurgery/neuro-oncology societies to assess practices in oligodendroglioma management. The survey collected data on demographics, diagnostic practices, and treatment decisions. Data analysis was performed using chi-square/Fisher's exact tests.</div></div><div><h3>Results</h3><div>Sixty-three physicians responded, representing 12 countries. Diagnostic practices were consistent among respondents. However, variations in management recommendations were observed. Providers were divided between rarely (36.5%), sometimes (25.4%), and often (30.2%) using temozolomide (TMZ) as sole chemotherapy for patients with newly diagnosed oligodendroglioma. For patients with subtotal resection of grade 2 oligodendroglioma, 33.3% of providers recommended upfront radiation/chemotherapy, 27.0% recommended observation, and the remaining 39.7% were divided among options including surgery, chemotherapy, and clinical trials. European providers more frequently recommended surgery (33.3% vs. 0.0%), whereas radiation/chemotherapy (35.7% vs. 26.7%) or observation (31.0% vs. 13.3%) was more commonly recommended by U.S./Canada providers (<em>P</em> = 0.009). Providers also disagreed on adjuvant therapy for grade 3 oligodendroglioma. 47.6% recommended radiation/procarbazine, lomustine, and vincristine, and 33.3% recommended radiation/TMZ. This decision varied by region, with European providers more frequently recommending radiation/procarbazine, lomustine, and vincristine (86.7% vs. 33.3%) and U.S./Canadian providers more frequently recommending radiation/TMZ (40.5% vs. 6.7%; <em>P</em> = 0.004).</div></div><div><h3>Conclusions</h3><div>This study underscores the complexity of oligodendroglioma management and the importance of ongoing research to refine therapeutic strategies. Further studies, especially with the introduction of isocitrate dehydrogenase inhibitors in practice, are warranted to track practice patterns and reassess recommendations.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123716"},"PeriodicalIF":1.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 Pituitary Stalk Sacrifice on Recurrence and Endocrine Dysfunction During Craniopharyngioma Surgery: A Systematic Review of the Literature","authors":"Ernest J. Bobeff ,&nbsp;Bartosz M. Szmyd ,&nbsp;Ming Shen ,&nbsp;Dariusz J. Jaskólski ,&nbsp;Theodore H. Schwartz","doi":"10.1016/j.wneu.2025.123769","DOIUrl":"10.1016/j.wneu.2025.123769","url":null,"abstract":"<div><h3>Background</h3><div>Craniopharyngioma is a benign, locally invasive tumor of the sellar-suprasellar region. Surgery can be curative but may require sacrifice of the pituitary stalk, which often leads to hypopituitarism. The risk/benefit of this maneuver is not well understood.</div></div><div><h3>Methods</h3><div>We performed a systematic English literature search on craniopharyngioma surgery with data on stalk preservation. We used meta-analysis for odds ratio in R software (R Foundation for Statistical Computing, Vienna, Austria). We have also used available raw data for recurrence risk using the Kaplan-Meier curve.</div></div><div><h3>Results</h3><div>Significantly lower recurrence risk was noted in patients in whom the stalk was sacrificed (11% vs. 23%, <em>P</em> = 0.003). This held true in patients after endoscopic endonasal approach (EEA) regardless of the extent of resection (<em>P</em> = 0.001) and in patients with gross total resection after EEA (<em>P</em> = 0.032). Survival analysis confirmed lower recurrence risk in adults with gross total resection after EEA and stalk sacrifice (<em>P</em> = 0.007, log-rank test). In patients with stalk sacrifice, the risk of panhypopituitarism was more than doubled (85% vs. 40%; <em>P</em> &lt; 0.001), as was the risk of somatotrope insufficiency (89% vs. 32%; <em>P</em> &lt; 0.001). Additionally, there was an approximate 30% increase in the risk of hypocortisolemia (94% vs. 62%; <em>P</em> &lt; 0.001), hypothyroidism (96% vs. 59%; <em>P</em> &lt; 0.001), gonadotrope insufficiency (92% vs. 59%; <em>P</em> &lt; 0.001), and diabetes insipidus (80% vs. 55%; <em>P</em> &lt; 0.001). The risk of weight gain was also significantly increased (30% vs. 16%; <em>P</em> = 0.025).</div></div><div><h3>Conclusions</h3><div>Our review indicates that stalk sacrifice is often required to achieve a durable cure in patients with craniopharyngiomas. While stalk sacrifice increases the risk of postoperative endocrinopathy, even if the stalk is preserved, many patients will still become hypopituitary.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123769"},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and Public Perceptions of Simulation Training in Neurosurgery: A Two-Stage Cross-Sectional Survey","authors":"Oliver E. Burton ,&nbsp;Joachim Starup-Hansen ,&nbsp;Jigishaa Moudgil-Joshi ,&nbsp;Simon C. Williams ,&nbsp;Chan Hee Koh ,&nbsp;Hani J. Marcus","doi":"10.1016/j.wneu.2025.123746","DOIUrl":"10.1016/j.wneu.2025.123746","url":null,"abstract":"<div><h3>Background</h3><div>The use of simulation in neurosurgery is a widespread and popular means of training worldwide. However, little is known about patient and public acceptability of simulation in neurosurgical training and the potential consequences of this for future simulation development.</div></div><div><h3>Methods</h3><div>A two-stage questionnaire strategy was utilized, the first gathering insights from neurosurgical inpatients, and the second from the general public. These questionnaires assessed general understanding of the concept of simulation in neurosurgery, the relative importance of factors affecting simulation training, and acceptability of different simulation modalities and means of providing feedback to trainees.</div></div><div><h3>Results</h3><div>Seventeen inpatients responded to the first-stage survey, and 192 members of the public responded to the second-stage survey. Familiarity with the concept of simulation training in neurosurgery was generally lacking. Fidelity was established as the most important element of simulation training by the public, with cadavers and physical models the most acceptable form of simulation training. Augmented reality solutions were least popular among the public. There was enthusiasm for both artificial intelligence and telementoring as training feedback solutions.</div></div><div><h3>Conclusions</h3><div>Patients and the public are accepting of the use of simulation training in neurosurgery. Future development should focus on improving access to high-fidelity simulation and exploring the use of artificial intelligence and telementoring in providing trainee feedback.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123746"},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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 Spinal Instrumentation on Early Postoperative Inflammatory Markers: A Comparative Analysis in the Same Patient Cohort with or without Instrumentation","authors":"Hiroyuki Aono ,&nbsp;Shota Takenaka ,&nbsp;Yukitaka Nagamoto ,&nbsp;Hidekazu Tobimatsu ,&nbsp;Tomoya Yamashita ,&nbsp;Masayuki Furuya ,&nbsp;Hiroyuki Ishiguro ,&nbsp;Motoki Iwasaki","doi":"10.1016/j.wneu.2025.123681","DOIUrl":"10.1016/j.wneu.2025.123681","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative inflammatory parameters are important markers of surgical site infection. Some authors have reported that spine surgery with instrumentation elevates C-reactive protein (CRP) levels more than that without instrumentation does. However, those studies compared early postoperative inflammatory markers with or without instrumentation in different patients, although CRP levels vary widely among patients. Therefore, we investigated the impact of early postoperative inflammatory reaction with or without instrumentation in the same patients.</div></div><div><h3>Methods</h3><div>Data were examined for 72 patients who had undergone lumbar surgery twice, once with instrumentation and once without instrumentation. CRP level, white blood cell (WBC) count, and neutrophil count (NC) were measured before surgery and at 1, 3, 7, and 14 days after surgery. All surgeries with instrumentation were posterior lumbar interbody fusion (PLIF) and all without instrumentation were laminotomy.</div></div><div><h3>Results</h3><div>Comparison of peak CRP between procedures with instrumentation and those without instrumentation showed a consistent peak on day 3 for all patients across both types of surgical procedures. After PLIF, there was a significantly elevated CRP, WBC, and NC in comparison to these for laminotomy. There were significant interactions between time and PLIF in relation to CRP, WBC, and NC levels. There were significant interactions between time and number of levels in relation to CRP and NC.</div><div>Age, gender, blood loss, and duration of surgery did not influence the observed elevations of all markers.</div></div><div><h3>Conclusions</h3><div>Early postoperative trends were significantly higher after PLIF than after laminotomy for all three indices, with a significant interaction between time and number of levels for CRP and NC.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123681"},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}