World neurosurgery最新文献

{"title":"Right-Angled Fenestrated Picket Fence Clipping Technique for an Anterior Communicating Artery Aneurysm","authors":"Sarah A. Hamimi ,&nbsp;Awinita Barpujari ,&nbsp;Jaeha Kim ,&nbsp;Mikaeel Habib ,&nbsp;Austin J. Borja ,&nbsp;Sami Almasri ,&nbsp;Om H. Gandhi ,&nbsp;Omar A. Choudhri","doi":"10.1016/j.wneu.2025.124783","DOIUrl":"10.1016/j.wneu.2025.124783","url":null,"abstract":"<div><div>Anterior communicating artery (AComm) aneurysms account for approximately 25% of all cerebral aneurysms.<span><span>1</span></span>, <span><span>2</span></span>, <span><span>3</span></span> Their management remains challenging due to significant anatomic and morphologic variability, and a high recurrence rate after primary endovascular coiling.<span><span>⁴</span></span> Recurrence is often due to coil compaction and thrombus incorporation into the aneurysm wall, necessitating more complex treatments such as stenting, flow diversion, or microsurgical clip reconstruction. The picket fence clipping technique is a strategy for treating large or recurrent aneurysms when conventional clipping across the neck is not feasible.<span><span>⁵</span></span> In this report, we present a modified picket fence clipping technique using multiple right-angled fenestrated clips for a recurrent AComm aneurysm. The patient is a 42-year-old man with a history of subarachnoid hemorrhage from a ruptured large AComm aneurysm previously treated with coiling (<span><span>Video 1</span></span>). He presented with worsening intractable headaches, and follow-up imaging revealed coil compaction and residual aneurysm filling at the base. Due to the aneurysm's wide neck and complex morphology, a right orbital pterional skull base approach was recommended for clip reconstruction, with intraoperative angiography, and possible bypass. Intraoperatively, nine clips were used to reconstruct the aneurysm neck while preserving flow in all branch vessels. The patient recovered without complication and was discharged on postoperative day four. This case highlights the utility of right-angled fenestrated clips in a modified picket fence construct, providing a versatile and effective solution for managing complex, recurrent AComm aneurysms with residual coils and thrombus.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"206 ","pages":"Article 124783"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901185","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":"Expansive Craniotomy versus Standard Decompressive Craniectomy in Refractory Intracranial Hypertension: A Systematic Review and Meta-Analysis","authors":"Rachel Saunders ,&nbsp;Jemima Rees ,&nbsp;Valentina Di Pietro ,&nbsp;Philip J. O'Halloran ,&nbsp;David J. Davies ,&nbsp;Antonio Belli ,&nbsp;Andrew R. Stevens","doi":"10.1016/j.wneu.2025.124729","DOIUrl":"10.1016/j.wneu.2025.124729","url":null,"abstract":"<div><h3>Background</h3><div>Raised intracranial pressure can have devastating consequences on mortality and outcome after acute brain injury. Decompressive craniectomy (DC) is an established surgical procedure for controlling refractory intracranial hypertension; however, this requires subsequent cranioplasty. Expansive craniotomy (EC) techniques, where the bone flap is returned but only partially fixed in place, have been developed to avoid the need for cranioplasty. However, comparative safety and efficacy is not well defined.</div></div><div><h3>Methods</h3><div>A systematic review to identify studies comparing EC with DC was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, including all study types except systematic/scoping reviews. Meta-analysis was performed for three outcomes (mortality, acute reoperation rate, and Glasgow Outcome Scale).</div></div><div><h3>Results</h3><div>A total of 29 studies met the inclusion criteria, and are summarized in narrative review. Eight studies were included in meta-analysis: two randomized controlled trials and six case-control studies. Meta-analysis found no significant difference in mortality. EC was associated with improved Glasgow Outcome Scale score (mean difference, 0.44; <em>P</em> &lt; 0.05); however, this may be attributable to selection bias. There was a marginal increase in early additional surgery rates associated with EC (risk difference, 0.08; <em>P</em> = 0.05). Risk of bias was moderate to high across included studies.</div></div><div><h3>Conclusions</h3><div>Current evidence cannot robustly inform clinical decision-making on the use of EC. Based on reports of success of EC, EC appears to be a valid alternative to DC in selected cases; however, greater acute reoperation rates because of inadequate decompression is a risk. Overall, there is strong support for an appropriately powered randomized controlled trial to robustly evaluate EC.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"206 ","pages":"Article 124729"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764047","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":"Addressing the Neurosurgery Workforce Shortage in the United States: Present Strategies for the Future","authors":"Jason Silvestre,&nbsp;Robert J. Ferdon,&nbsp;Anthony J. Minerva,&nbsp;Robert A. Ravinsky,&nbsp;Charles A. Reitman","doi":"10.1016/j.wneu.2025.124742","DOIUrl":"10.1016/j.wneu.2025.124742","url":null,"abstract":"","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"206 ","pages":"Article 124742"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145782934","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":"Survival Impact of Surgery, Radiation, and Socioeconomic Factors in Spinal Hemangioblastoma: A Population-Based Study","authors":"Ali Ebada,&nbsp;Nicholas Bever,&nbsp;Christopher J. Carron,&nbsp;Jose E. Marin Sanchez,&nbsp;Bradley Guidry,&nbsp;Mazin Al Tamimi,&nbsp;Salah G. Aoun","doi":"10.1016/j.wneu.2025.124764","DOIUrl":"10.1016/j.wneu.2025.124764","url":null,"abstract":"<div><h3>Background</h3><div>Spinal hemangioblastomas are rare, highly vascular benign tumors, with management typically centered on gross total resection. However, factors associated with overall survival (OS) remain poorly defined, particularly the roles of surgical extent, radiation therapy (RT), and socioeconomic variables. We aimed to evaluate clinical and demographic predictors of survival in a contemporary population-based cohort.</div></div><div><h3>Methods</h3><div>Patients with spinal cord or cauda equina hemangioblastoma were identified from the Surveillance, Epidemiology and End Results database (1975–2022). Demographic, tumor, and treatment characteristics—including age, sex, race, income, surgical extent, and RT—were collected. Univariable and multivariable Cox proportional hazards models were used to evaluate associations with OS.</div></div><div><h3>Results</h3><div>Among 223 patients, older age (<em>P</em> <!-->&lt;<!--> <!-->0.001) and lower household income (<em>P</em> <!-->=<!--> <!-->0.028) were independently associated with worse survival. Extent of resection (subtotal resection or observation vs. gross total resection) and RT were not significantly associated with OS (<em>P</em> <!-->=<!--> <!-->0.117). Kaplan-Meier analysis showed no survival difference by surgery (<em>P</em> <!-->=<!--> <!-->0.89) or between pediatric and adult patients (<em>P</em> <!-->=<!--> <!-->0.1), with all pediatric patients alive at last follow-up. Although RT correlated with worse survival on univariate analysis (<em>P</em> <!-->=<!--> <!-->0.005), this did not persist after adjustment, likely reflecting confounding by indication.</div></div><div><h3>Conclusions</h3><div>Older age and lower income were associated with worse OS in patients with spinal hemangioblastoma, while neither surgical extent nor RT predicted survival. These findings suggest that subtotal resection or observation may be appropriate in select cases without compromising outcomes and emphasize the importance of addressing socioeconomic barriers in this rare, benign disease.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"206 ","pages":"Article 124764"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145879205","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":"Correlation Between Spinal-Pelvic Parameters and Ossification of the Thoracolumbar Ligamentum Flavum: A Cross-Sectional Study","authors":"Luyang Wang ,&nbsp;Tian Zhou ,&nbsp;Qianmei Gao ,&nbsp;Xizhong Zhu ,&nbsp;Xingchen Li ,&nbsp;Haiyang Wu ,&nbsp;Yusheng Xu","doi":"10.1016/j.wneu.2025.124772","DOIUrl":"10.1016/j.wneu.2025.124772","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the correlation between spinal-pelvic parameters and ossification of the ligamentum flavum (OLF) in the thoracolumbar segment.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients diagnosed with lumbar intervertebral disc degeneration between January 2021 and December 2024. All patients were divided into 2 groups: the non-OLF group and the OLF group. Comprehensive clinical data were collected for all participants, including age, sex, body mass index, disease duration, and the presence of comorbidities, as well as smoking and alcohol consumption history. Comparisons of spinal-pelvic parameters, including sacral slope (SS), pelvic tilt (PT), pelvic incidence, lumbar lordosis, and thoracolumbar kyphosis (TLK), were performed between the 2 groups. Multivariable logistic regression was used to assess the associations between each imaging parameter and the presence of OLF, and receiver operating characteristic curves were plotted.</div></div><div><h3>Results</h3><div>A total of 386 patients including 325 in non-OLF group and 61 in OLF group was included. Baseline analysis revealed that patients in the OLF group had significantly higher TLK and PI, greater SS, and were older compared to the non-OLF group. Additionally, hypertension was more prevalent in the OLF group. In contrast, gender distribution, smoking status, diabetes mellitus, body mass index, lumbar lordosis, and PT did not differ significantly between the 2 groups. Univariate logistic regression identified height, hypertension, SS, TLK, and age as significant factors associated with OLF. Multifactorial analysis confirmed that TLK was the only significant predictor for OLF occurrence. A receiver operating characteristic curve analysis developed based on TLK yielded a moderate area under the curve of 0.734.</div></div><div><h3>Conclusions</h3><div>TLK was found to be significantly associated with the presence of OLF; notably, an increase in TLK correlated with an elevated risk of developing OLF. A predictive model incorporating TLK and basic demographic factors demonstrated moderate diagnostic value.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"206 ","pages":"Article 124772"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145890020","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":"Impact of Pain on Lumbar Spine Functional Assessment: Are Sufficient Flexion and Extension Achieved?","authors":"Tomonori Morita ,&nbsp;Arihiko Tsukamoto ,&nbsp;Ryunosuke Fukushi ,&nbsp;Akimitsu Oyama ,&nbsp;Makoto Emori ,&nbsp;Hiroyuki Takashima ,&nbsp;Jukyo Matsumoto ,&nbsp;Toshihiko Yamashita ,&nbsp;Atsushi Teramoto","doi":"10.1016/j.wneu.2025.124752","DOIUrl":"10.1016/j.wneu.2025.124752","url":null,"abstract":"<div><h3>Background</h3><div>There is currently no universally accepted standard for evaluating lumbar spinal instability, and assessment criteria vary across institutions, potentially leading to inconsistent decision-making when choosing between decompression alone and decompression with fusion. To address the need for consistent and reproducible functional radiographs, we investigated the influence of pain on lumbar motion during functional radiography.</div></div><div><h3>Methods</h3><div>We prospectively analyzed patients with lumbar degenerative spondylolisthesis who underwent both conventional flexion (CF) and hands-on-knees (HK) flexion-extension radiography between January 2022 and February 2025. The HK method provides a clear endpoint by having patients place their hands on their knees, enabling deeper flexion. Clinical assessments before imaging involved the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Visual Analog Scale for low back and leg pain. The changes in lumbar lordosis during flexion [ΔLL(flex)] and extension were calculated and correlated with clinical scores. Sagittal translation was measured in CF and HK flexion–extension radiographs and compared between methods.</div></div><div><h3>Results</h3><div>Among 150 patients (103 females; mean age, 76.0 years), the median ΔLL(flex) was 10.8° with CF and 30.0° with HK (<em>P</em> <!-->&lt;<!--> <!-->0.001). ΔLL(flex) was negatively correlated with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and Visual Analog Scale scores in CF (all <em>P</em> <!-->&lt;<!--> <!-->0.01), but not in HK. The changes in lumbar lordosis during extension showed no significant correlations. Sagittal translation was significantly greater in HK than in CF. Both intrarater and inter-rater reliability were good.</div></div><div><h3>Conclusions</h3><div>Pain may limit flexion during conventional radiography, potentially underestimating instability. The HK method may help establish objective criteria and surgical planning through improved reproducibility.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"206 ","pages":"Article 124752"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145805785","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":"Low Molecular Weight Heparin Initiated 3 Hours After Venous Sinus Stenting May Reduce Bleeding Risk in Patients with Cerebral Venous Sinus Stenosis","authors":"Guangyu Han ,&nbsp;Da Zhou ,&nbsp;Xiangqian Huang ,&nbsp;Shuling Wan ,&nbsp;Mengqi Wang ,&nbsp;Xunming Ji ,&nbsp;Ran Meng","doi":"10.1016/j.wneu.2026.124791","DOIUrl":"10.1016/j.wneu.2026.124791","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess whether the timing of low molecular weight heparin (LMWH) initiation after venous sinus stenting affects early hemorrhagic risk in patients with cerebral venous sinus stenosis (CVSS).</div></div><div><h3>Methods</h3><div>This single-center, real-world study consecutively enrolled CVSS patients at the subacute or chronic stage who underwent venous sinus stenting from January 2017 to July 2023. Based on the timing of LMWH initiation, patients were categorized into 2 groups: the immediate poststenting group and the third-hour poststenting group. Clinical characteristics, coagulation parameters, computed tomography imaging, and available follow-up data were compared.</div></div><div><h3>Results</h3><div>A total of 105 eligible patients (median age 37.0 years; 75 females and 30 males) were included in the analysis. Among them, 46 patients received immediate LMWH initiation, while 59 received LMWH 3 hours poststenting. Across all patients, postoperative coagulation parameters [e.g., activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen] changed significantly compared with baseline (all <em>P</em> &lt; 0.001). Notably, activated partial thromboplastin time at 3 hours poststenting was significantly lower in the third-hour group than in the immediate group [73.20 (67.40–81.30) s versus 84.35 (80.13–93.23) s, <em>P</em> &lt; 0.001]. The immediate group had a higher incidence of symptomatic intracranial hemorrhage than the third-hour group (8.7% vs. 0.0%, <em>P</em> = 0.034). During follow-up, no stent-related stenosis, restenosis, or delayed bleeding were observed in either group.</div></div><div><h3>Conclusions</h3><div>Delaying LMWH anticoagulation until 3 hours poststenting may effectively reduce bleeding risk in CVSS patients. These findings support optimizing early postoperative anticoagulation timing to enhance procedural safety and warrant validation in prospective studies.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"206 ","pages":"Article 124791"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145949326","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":"Simultaneous Combined Multiportal Approach Using Transcranial and Endoscope-Assisted Midfacial Degloving Routes for Tumors with Skull Base and Extensive Sinonasal Involvement","authors":"Tamás Fischer-Szatmári ,&nbsp;Thannoon Masood ,&nbsp;Seyed Arad Senaobar Tahaei ,&nbsp;Zsolt Bella ,&nbsp;Pál Barzó","doi":"10.1016/j.wneu.2025.124780","DOIUrl":"10.1016/j.wneu.2025.124780","url":null,"abstract":"<div><h3>Background</h3><div>For many years, in cases of excessively extensive tumors affecting the sinonasal region and the skull base—where the novel technique of a combination of transciliary supraorbital keyhole craniotomy and endoscopic endonasal approach would not have yielded satisfactory outcomes due to anatomic limitations—our gold standard technique was a combination of transfacial and tailored transcranial approaches. To reduce surgical invasiveness, complications, and undesirable aesthetic outcomes during the surgical treatment of tumors with extensive sinonasal and skull base involvement, the transfacial approach was left behind in favor of a combination of simultaneously applied tailored transcranial and endoscope-assisted midfacial degloving approaches.</div></div><div><h3>Methods</h3><div>A microscope-assisted tailored transcranial approach was combined with an endoscope-assisted midfacial degloving approach.</div></div><div><h3>Results</h3><div>This paper presents five cases with various histologic types of tumors affecting both the sinonasal area and the skull base. All patients were selected for surgical treatment by our clinical team. The mean operative time was three hours. All procedures were free of intraoperative or postoperative complications, and either total or near-total tumor excision was accomplished. Follow-up revealed no surgery-related issues in any of the patients.</div></div><div><h3>Conclusions</h3><div>Our combined, simultaneous multiportal technique facilitates complete tumor resection with shortened operative times, low measures of intraoperative and postoperative complications, low mortality, and superb aesthetic outcomes.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"206 ","pages":"Article 124780"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901230","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":"Navigating the Surgical Dilemma in Metastatic Spine Disease: Does Age Influence Treatment Strategy and Outcomes?","authors":"Meltem Ivren ,&nbsp;Dilber Yalman ,&nbsp;Basem Ishak ,&nbsp;Sebastian Ille ,&nbsp;Sandro M. Krieg ,&nbsp;Pavlina Lenga","doi":"10.1016/j.wneu.2025.124720","DOIUrl":"10.1016/j.wneu.2025.124720","url":null,"abstract":"<div><h3>Objective</h3><div>Spinal metastases are increasingly common. Yet, the optimal surgical strategy—particularly in elderly patients—remains debated due to perioperative risks. This study examines demographics, clinical presentation, and surgical outcomes, focusing on age-related differences and management of patients with Spinal Instability Neoplastic Score (SINS) 7–12.</div></div><div><h3>Methods</h3><div>We retrospectively included all patients with spinal metastases operated in our department from 2015 to 2024. Data on demographics, neurological status, surgical approach, complications and 90-day mortality were collected.</div></div><div><h3>Results</h3><div>217 patients (median age: 60 years, range: 5–88) were included. Lung (17%), breast (17%), and prostate (12%) were the most common primaries. Older patients presented with worse neurological deficits (Frankel A/B: 36% vs. 5%, <em>P</em> &lt; 0.01) but had comparable short-term mortality (≥65 years: 15% vs. &lt;65 years: 13%, <em>P</em> = 0.837) and lower intraoperative blood loss (260 ± 373 mL vs. 759 ± 860 mL, <em>P</em> &lt; 0.001). Surgical approaches were similar across age groups, with instrumentation in 32% and minimally invasive techniques in 18%. Regarding SINS, older patients were more frequently categorized as potentially unstable (65% vs. 38%, <em>P</em> &lt; 0.001) yet more frequently treated with decompression. Younger patients undergoing instrumentation predominantly had SINS 7–18.</div></div><div><h3>Conclusions</h3><div>Age alone does not determine surgical success or survival in metastatic spine disease. Despite worse baseline status, older patients achieved short-term outcomes comparable to younger patients. Variation in managing SINS 7–12 suggests underuse of instrumentation in older patients underscoring the need for age-inclusive evidence-based guidelines integrating SINS with tumor biology, functional status and prognosis.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"206 ","pages":"Article 124720"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145757976","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":"BMI and Patient-Reported Outcomes Following Spinal Surgery: A Retrospective Review","authors":"Nicholas Bever,&nbsp;Ali Ebada,&nbsp;Mary Ashley Liu,&nbsp;Salah G. Aoun","doi":"10.1016/j.wneu.2025.124725","DOIUrl":"10.1016/j.wneu.2025.124725","url":null,"abstract":"<div><h3>Objective</h3><div>Body mass index (BMI) plays an important role in surgical outcomes following spinal fusion surgery, with increasing BMI linked to greater risk of post-operative complications. However, the relationship between BMI and long-term patient-reported outcome measures (PROMs) lacks investigation. This study aims to evaluate the association between patient BMI and PROMs in patients undergoing spinal fusion surgery.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on patients who underwent spinal fusion surgery at a single academic institution between 2016 and 2024. Demographic, surgical, and PROM data were extracted from existing medical records. Multivariable linear regression models were implemented to control for potential confounders.</div></div><div><h3>Results</h3><div>A total of 1471 patients undergoing spinal fusion were included. Obese patients were younger and had a higher prevalence of diabetes and hypertension compared with other BMI groups. Mean ODI, NDI, VAS Neck, VAS Back, and PROMIS Pain scores differed significantly across BMI categories over 12 months, whereas VAS Arm and VAS Leg did not. In multivariable linear models adjusting for time, demographics, surgical factors, and comorbidities, obesity independently predicted worse ODI, VAS Arm, and VAS Leg scores, and overweight status predicted worse VAS Leg scores. However, BMI was not a consistent independent predictor of MCID achievement across PROMs. Time from surgery, female sex, longer operative duration, greater number of levels fused, and revision status were more robust predictors of both absolute PROM scores and MCID achievement than BMI category.</div></div><div><h3>Conclusions</h3><div>In this large ERAS-based spinal fusion cohort, elevated BMI was associated with significantly worse mean pain and disability scores but did not consistently predict clinically meaningful improvement. Recovery was more strongly influenced by time from surgery, surgical complexity, and demographic factors rather than BMI alone. These findings suggest BMI should not be used in isolation to determine postoperative expectations and support individualized perioperative optimization.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"206 ","pages":"Article 124725"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764062","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}