World neurosurgery最新文献

{"title":"Efficacy and safety of endovascular thrombectomy for large vessel occlusion stroke beyond 24 hours from time last known well: a systematic review and meta-analysis.","authors":"Jian Wu, Wen-Ya Gao, Min-Gang Liang, Fu-Li Yan, Ming-Fei Yang, Bin Liu","doi":"10.1016/j.wneu.2025.123943","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123943","url":null,"abstract":"<p><strong>Background: </strong>Endovascular thrombectomy (EVT) has become the standard of care for selected patients with acute ischemic stroke within 24 hours of symptom onset. However, the efficacy and safety of EVT for stroke presenting beyond 24 hours is undetermined.</p><p><strong>Methods: </strong>We performed a systematic review and meta-analysis to examine the outcomes of EVT in patients with acute ischemic stroke beyond 24 hours from onset. The primary outcome was 90-day functional independence defined as the modified Rankin Scale score of 0-2 (mRS 0-2). Secondary outcomes included successful reperfusion defined as Thrombolysis in Cerebral Infarction 2b-3 (TICI 2b-3), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.</p><p><strong>Results: </strong>Six studies enrolled a total of 5,868 patients to compare the prognosis of EVT for stroke patients treated beyond 24 hours versus within 6-24 hours. The study results indicated that there was no difference in the rate of successful reperfusion (RR 1.00, 95% CI 0.94-1.06, P = 0.96) and sICH (RR 0.63, 95% CI 0.35-1.16, P = 0.14) between the two groups of patients who underwent EVT at different times. Four studies involving 707 patients compared the outcomes of EVT versus best medical treatment (BMT), including thrombolysis, for stroke patients treated beyond 24 hours. Compared to patients receiving BMT, those undergoing EVT were more likely to achieve 90-day functional independence (RR 1.96, 95% CI 1.27-3.01, P < 0.05) and a lower risk of sICH (RR 3.52, 95% CI 1.11-11.20, P = 0.03), with no significant difference in 90-day mortality rates (RR 0.86, 95% CI 0.58-1.28, P = 0.46).</p><p><strong>Conclusions: </strong>Our study found that the EVT time window did not significantly affect TICI 2b-3 and sICH, and EVT showed better therapeutic effects than BMT for stroke patients beyond 24 hours. Specifically, patients who underwent EVT beyond 24 hours had a higher proportion of functional independence at 90 days and a lower risk of sICH. Therefore, EVT remains an effective treatment option for patients with large vessel ischemic stroke beyond the traditional 24-hour time window.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123943"},"PeriodicalIF":1.9,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744077","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":"Explainable Machine Learning Models for Prediction of Surgical Site Infection After Posterior Lumbar Fusion Surgery Based on Shapley Additive Explanations","authors":"PeiYang Wang,&nbsp;Lei Liu,&nbsp;ZhiYang Xie,&nbsp;GuanRui Ren,&nbsp;YiLi Hu,&nbsp;MeiJi Shen,&nbsp;Hui Wang,&nbsp;JiaDong Wang,&nbsp;YunTao Wang,&nbsp;Xiao-Tao Wu","doi":"10.1016/j.wneu.2025.123942","DOIUrl":"10.1016/j.wneu.2025.123942","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to develop machine learning (ML) models combined with an explainable method for the prediction of surgical site infection (SSI) after posterior lumbar fusion surgery.</div></div><div><h3>Methods</h3><div>In this retrospective, single-center study, a total of 1016 consecutive patients who underwent posterior lumbar fusion surgery were included. A comprehensive dataset was established, encompassing demographic variables, comorbidities, preoperative evaluation, details related to diagnosed lumbar disease, preoperative laboratory tests, surgical specifics, and postoperative factors. Utilizing this dataset, 6nullML models were developed to predict the occurrence of SSI. Performance evaluation of the models on the testing set involved several metrics, including the receiver operating characteristic curve, the area under the receiver operating characteristic curve, accuracy, recall, F1 score, and precision. The Shapley Additive Explanations (SHAP) method was employed to generate interpretable predictions, enabling a comprehensive assessment of SSI risk and providing individualized interpretations of the model results.</div></div><div><h3>Results</h3><div>Among the 1016 retrospective cases included in the study, 36 (3.54%) experienced SSI. Out of the six models examined, the Extreme Gradient Boost model demonstrated the highest discriminatory performance on the testing set, achieving the following metrics: precision (0.9000), recall (0.8182), accuracy (0.9902), F1 score (0.8571), and area under the receiver operating characteristic curve (0.9447). By utilizing the SHAP method, several important predictors of SSI were identified, including the duration of indwelling jugular vein catheter, blood urea nitrogen levels, total protein levels, sustained fever, creatinine levels, triglycerides levels, monocyte count, diabetes mellitus, drainage time, white blood cell count, cerebral infarction, estimated blood loss, prealbumin levels, Prognostic Nutritional Index, low back pain, posterior fusion score, and osteoporosis.</div></div><div><h3>Conclusions</h3><div>ML-based prediction tools can accurately assess the risk of SSI after posterior lumbar fusion surgery. Additionally, ML combined with SHAP could provide a clear interpretation of individualized risk prediction and give physicians an intuitive comprehension of the effects of the model's essential features.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123942"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744079","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":"Revolution in Surgical Anatomy During the 16th Century: The Neglected Encounters Between Andreas Vesalius and Ambroise Paré","authors":"Thomas J. On ,&nbsp;Yuan Xu ,&nbsp;Jonathan A. Tangsrivimol ,&nbsp;Kivanc Yangi ,&nbsp;Marian T. Park ,&nbsp;Charles J. Prestigiacomo ,&nbsp;T. Forcht Dagi ,&nbsp;Mark C. Preul","doi":"10.1016/j.wneu.2025.123810","DOIUrl":"10.1016/j.wneu.2025.123810","url":null,"abstract":"<div><div>A new era of medicine and surgery began in the mid-16th century, driven by upheavals in religion, art, and science as well as advancements in printing. Two notable contributions were the clinical applications of Andreas Vesalius's anatomy and the surgical innovations of Ambroise Paré. Vesalius and Paré were contemporaries, overlapping in their education, anatomic interests, military experience, professional stature, and visionary use of anatomical illustrations. Nevertheless, their personal intersections, mutual adventures, and conjoint contributions have not been adequately described. During the mid-1530s, Vesalius and Paré performed dissections at the Paris Faculty of Medicine under Jacobus Sylvius. At the Siege of Metz in 1552, the two served opposing armies, Vesalius with Charles V and Paré with Francis I. After Paré surrendered to Spanish forces at Hesin in 1553, Vesalius, then a surgeon to the Spanish emperor, bade Paré to demonstrate his surgical techniques. Vesalius also attempted to convince Paré to change sides, but Paré demurred. In 1559, Henry II of France was mortally injured while jousting. Paré, the royal surgeon, took charge, but Vesalius was also summoned from Brussels, and both were engaged in Henry's management. Later, Vesalius permitted Paré to reproduce his illustrations in Paré’s 1561 <em>Anatomie Universelle</em> and 1575 <em>Oeuvres</em>. Paré’s <em>Oeuvres</em>, reprinted through the mid-1800s, perpetuated Vesalian images and helped ensure their ongoing survival. Although Vesalius's <em>Fabrica</em> and Paré’s <em>Oeuvres</em> were at the forefront of medical science, both men faced years of criticism, likely stemming from their challenges to established norms of practice and the jealousy of their peers.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123810"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143472727","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":"Treatment Outcomes of Epidural Blood Patch Guided by a Novel Overflow Leak Test with Computed Tomography Myelography in Patients with Intracranial Hypotension: A Case Series","authors":"Eiichi Nakai ,&nbsp;Hitoshi Fukuda ,&nbsp;Hajime Kuroiwa ,&nbsp;Yu Kawanishi ,&nbsp;Tomohito Kadota ,&nbsp;Tetsuya Ueba","doi":"10.1016/j.wneu.2025.123941","DOIUrl":"10.1016/j.wneu.2025.123941","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the treatment outcomes of epidural blood patch (EBP) guided by a novel overflow leak test (OLT) combined with computed tomography myelography (CTM) in patients with intracranial hypotension, with focus on consistency and discrepancy between CTM and OLT findings.</div></div><div><h3>Methods</h3><div>CTM followed by OLT was performed in 18 adults with a cerebrospinal fluid pressure of ≤60 mmH₂O. Patients were categorized according to consistency or discrepancy between CTM and OLT findings: Group A, matching leak signals in CTM and OLT; Group B, leak signals detected by OLT only; Group C, discrepancy in leak signal sites between CTM and OLT; Group D, no leak signal detected by both CTM and OLT. EBPs were applied according to the treatment policy, and associations between the radiological categorization and treatment outcomes were determined. Thereafter, using CT and magnetic resonance imaging phantoms, we investigated the minimal amount of injected agent leaking from the lumbar puncture site visible, which could result in a false-positive signal in CTM and OLT.</div></div><div><h3>Results</h3><div>Complete recovery following EBP was achieved for 13 (72%) patients; these included 50%, 82%, 100%, and 0% patients in Groups A, B, C, and D, respectively. In CT myelography phantoms, even 1 μL of contrast agent produced positive findings, whereas OLT phantoms required a minimum of 1000 μL.</div></div><div><h3>Conclusions</h3><div>These results suggest the potential additive diagnostic value of OLT when performed with CTM. The discrepancy in radiological findings could be partly explained by susceptibility to the contrast agent leaking from the lumbar puncture site.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123941"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744082","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":"Clinical Efficacy of Biportal versus Uniportal Endoscopic Discectomy for Far Lateral Lumbar Disc Herniation: A Retrospective Study Analysis","authors":"Zhang Zhiqiang ,&nbsp;Yang Jiandong ,&nbsp;Huang Zhi ,&nbsp;Abdiaziz Ahmed Mohamed ,&nbsp;Zhang Liang ,&nbsp;Feng Xinmin","doi":"10.1016/j.wneu.2025.123788","DOIUrl":"10.1016/j.wneu.2025.123788","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to compare the clinical efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopy (UBE) in treating far lateral lumbar disc herniation (FLLDH).</div></div><div><h3>Methods</h3><div>A retrospective analysis was performed on 42 patients treated for FLLDH at our hospital between January 2020 and October 2023, comprising 17 UBE cases and 25 PTED cases. Patients were followed up for six months. The study compared operation time, hospital stay, cross-sectional area of the intervertebral foramen, and clinical efficacy using a visual analog scale (VAS), the Oswestry Disability Index, and modified Macnab criteria.</div></div><div><h3>Results</h3><div>Both surgical procedures were successful. The UBE group had a significantly shorter operation time than the PTED group (108.0 ± 35.3 vs. 84.3 ± 25.4 minutes; <em>P</em> = 0.023). There were no significant differences in hospitalization periods or cross-sectional area of the intervertebral foramen between the groups. The UBE group had better VAS scores for back pain at 1-day (2.72 ± 0.84 vs. 2.12 ± 0.70, <em>P</em> = 0.015) and 1-month (1.76 ± 0.66 vs. 1.29 ± 0.77, <em>P</em> = 0.047) postoperation compared to the PTED group. However, both groups showed significant improvements in VAS and Oswestry Disability Index scores after surgery, with no statistically significant difference at the final follow-up. The modified Macnab criteria at the final follow-up demonstrated similar good-to-excellent satisfactory outcomes in both the PTED and UBE groups, at 92% and 94.1%, respectively.</div></div><div><h3>Conclusions</h3><div>Both UBE and PTED techniques are clinically effective for treating FLLDH, with UBE having a shorter operation time than PTED.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123788"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433965","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 Possible Role of Wnt/β-Catenin Pathway in Central Neurocytoma","authors":"Evrim Önder ,&nbsp;Kutsal Doğan ,&nbsp;Gökhan Veli Alkan","doi":"10.1016/j.wneu.2025.123944","DOIUrl":"10.1016/j.wneu.2025.123944","url":null,"abstract":"<div><h3>Background</h3><div>Central neurocytoma (CN) is a rare intraventricular tumor with unclear molecular features. Ki-67 indices more than 4% indicate aggressive behavior, classifying these as atypical central neurocytoma (ACN). Pathway alteration studies revealed limited results. Despite histological similarities to oligodendrogliomas, CNs lack definitive molecular markers, necessitating alternative diagnostic approaches.</div></div><div><h3>Methods</h3><div>In this study, we aimed to explore the involvement of the Wnt/β-catenin signalling pathway in CN by evaluating the immunohistochemical expressions of β-catenin and lymphoid enhancer-binding factor 1 (LEF-1). We have documented a total number of 15 CNs. Among 15 cases, 4 were in the atypical category.</div></div><div><h3>Results</h3><div>Patient ages were between 11 and 47 years. Ki-67 indices in ACN cases were 7%, 7%, 9%, and 15%. β-catenin demonstrated diffuse membranous staining without any nuclear positivity in 12 cases. Three cases had focal nuclear expression in addition to patchy membranous staining. The nuclear β-catenin positivity was between 3% and 5%. Among these 3 cases, 1 was ACN and showed 5% nuclear positivity. These 3 cases also demonstrated scattered nuclear positivity with LEF-1. Nuclear staining with LEF-1 was weak and highest in the ACN case with 3% nuclear positivity. There was no additional case staining with LEF-1.</div></div><div><h3>Conclusions</h3><div>The rarity of CN is a limitation to discover its nature. There is no evidence for the possibility of targeted therapies. Still, there are few findings suggesting the involvement of the Wnt/β-catenin pathway. Although our findings may suggest some alterations of this pathway, they are limited to make an interpretation. Multicenter studies have great importance in clarifying genetic modifications in CN and the possibility of targeted therapies.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123944"},"PeriodicalIF":1.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744081","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":"Cerebral Contrast Staining on Dual-Energy Computed Tomography After Coil Embolization of Unruptured Intracranial Aneurysms: Frequency, Risk Factors, and Clinical Implications","authors":"Byeong-su Park ,&nbsp;Jung Hoon Han ,&nbsp;Won Ki Yoon ,&nbsp;Sang-Il Suh","doi":"10.1016/j.wneu.2025.123930","DOIUrl":"10.1016/j.wneu.2025.123930","url":null,"abstract":"<div><h3>Objective</h3><div>Cerebral contrast staining (CCS) postendovascular procedures may mimic subarachnoid hemorrhage. This study investigates CCS frequency and risk factors using dual-energy computed tomography (DECT) following coil embolization of unruptured intracranial aneurysms.</div></div><div><h3>Methods</h3><div>A retrospective analysis included 232 patients undergoing coil embolization and immediate DECT imaging between October 2018 and March 2023. CCS was defined as hyperattenuation on iodine overlay images absent on virtual noncontrast images. Logistic regression identified predictors of CCS.</div></div><div><h3>Results</h3><div>CCS occurred in 95 patients (40.9%), predominantly in anterior circulation aneurysms (48.1%) compared to posterior circulation (14.3%, <em>P</em> = 0.001). High CCS rates occurred particularly in posterior communicating (59.1%) and anterior communicating/anterior cerebral artery aneurysms (59.0%). Low-osmolar contrast media had higher CCS incidence (56.4%) compared to iso-osmolar media (30.4%, <em>P</em> &lt; 0.001). CCS-positive patients had higher contrast volume (186.35 ± 46.62 mL vs. 171.62 ± 34.89 mL; <em>P</em> = 0.009) and longer procedures (158.41 ± 41.25 vs. 135.28 ± 35.07 min, <em>P</em> &lt; 0.001). Multivariate analysis identified posterior communicating artery aneurysms, low-osmolar contrast media, procedure duration, and contrast volume as independent CCS predictors. Demographic factors and blood pressure variability were unrelated. One transient contrast-induced encephalopathy case occurred; no hemorrhages were identified.</div></div><div><h3>Conclusions</h3><div>CCS is common after coil embolization, especially with longer procedures, anterior aneurysms, and low-osmolar contrast media. DECT effectively differentiates CCS from hemorrhage, potentially reducing unnecessary follow-up imaging.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123930"},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731841","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":"Progress on Direct Regulation of Systemic Immunity by the Central Nervous System","authors":"Xiaotian Tan,&nbsp;Junming Zhang,&nbsp;Weiming Chen,&nbsp;Tunan Chen,&nbsp;Gaoyu Cui,&nbsp;Zhi Liu,&nbsp;Rong Hu","doi":"10.1016/j.wneu.2025.123814","DOIUrl":"10.1016/j.wneu.2025.123814","url":null,"abstract":"<div><div>This article reviews the research progress on the direct regulation of the immune system by the central nervous system (CNS). The traditional “neuro-endocrine-immune” network model has confirmed the close connection between the CNS and the immune system. However, due to the complex mediating role of the endocrine system, its application in clinical treatment is limited. In recent years, the direct regulation of the peripheral immune system through the CNS has provided new methods for the clinical treatment of neuroimmune-related diseases. This article analyzes the changes in the peripheral immune system after CNS injury and summarizes the effects of various stimulation methods, including transcranial magnetic stimulation, transcranial electrical stimulation, deep brain stimulation, spinal cord stimulation, and vagus nerve stimulation, on the peripheral immune system. Additionally, it explores the clinical research progress and future development directions of these stimulation methods. It is proposed that these neural regulation techniques exhibit positive effects in reducing peripheral inflammation, protecting immune cells and organ functions, and improving immunosuppressive states, providing new perspectives and therapeutic potential for the treatment of immune-related diseases.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123814"},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473137","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":"Unilateral Biportal Endoscopic Discectomy via the Contralateral Sublaminar Approach for Lumbar Disc Herniation with Very High-Grade Migration: A Technical Note and Case Series.","authors":"Yong Jin Park, Man Kyu Park, Sang Kyu Son, Young San Ko","doi":"10.1016/j.wneu.2025.123939","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123939","url":null,"abstract":"<p><strong>Background: </strong>Lumbar disc herniation (LDH) with very high-grade migration is difficult to manage surgically because of its anatomical complexity and the risk of incomplete decompression. The unilateral biportal endoscopic (UBE) contralateral sublaminar approach is a minimally invasive technique that may be an alternative option for managing these cases.</p><p><strong>Methods: </strong>In this multicenter retrospective study, we analyzed the clinical data of 15 patients with LDH with very high-grade upward or downward migration of ruptured disc fragments removed via the UBE contralateral sublaminar approach between June 2022 and June 2024. Clinical outcomes were assessed using the visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and modified MacNab criteria. Radiological outcomes were evaluated on postoperative MR images and serial plain radiographs.</p><p><strong>Results: </strong>The mean operation time was 45.3 minutes, and the average length of hospital stay was 4.1 days. The VAS scores for back and leg pain improved significantly, and the ODI scores were notably lower at the final follow-up. Postoperative MRI confirmed the complete removal of migrated disc fragments in all patients, with no segmental instability observed during the follow-up. The technique allows for effective decompression with minimal bone removal, thereby preserving adjacent structures.</p><p><strong>Conclusions: </strong>This study revealed the feasibility and potential benefits of the UBE contralateral sublaminar approach for LDH with very high-grade migration of ruptured disc fragments. While initial outcomes are promising, further comparative studies with more patients are needed to validate its efficacy and safety.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123939"},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732002","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":"Is Force Control a Safe and Efficient Surgical Technology for Thoracolumbar Fusion Surgery? A Post Market Clinical Follow-Up Study","authors":"David C. Noriega ,&nbsp;Francisco Ardura ,&nbsp;Kirollos Awad ,&nbsp;Shefqet Hajdari ,&nbsp;Israel Sánchez Lite ,&nbsp;Yasser Abdalla","doi":"10.1016/j.wneu.2025.123812","DOIUrl":"10.1016/j.wneu.2025.123812","url":null,"abstract":"<div><h3>Background</h3><div>Early screw loosening, a relevant complication after posterior thoracolumbar fusion, indicates high mechanical stress during rod connection. Force Control is a surgical technology that goes beyond the usual to identify, control, and minimize intended and unintended, usually unnoticed forces to achieve the most stressless fixation. Optimized, extremely lightweight instruments support this principle on part of the pedicle screw system (PSS). The study objective is to evaluate the safety and efficacy of a novel PSS for Force Control fusion surgery.</div></div><div><h3>Methods</h3><div>In this literature-controlled observational study, patients underwent surgery with a PSS that supports Force Control. Safety is demonstrated 1 year postoperatively by noninferiority in screw loosening rate and efficacy by noninferiority in Oswestry Disability Index (ODI) improvement. Secondary endpoints: 2-year ODI, spine-related adverse events, and outcomes. Statistical significance: <em>P</em> &lt; 0.025 (Bonferroni correction 0.05/2).</div></div><div><h3>Results</h3><div>75 patients enrolled, main diagnoses were trauma (73.3%), spinal stenosis (17.3%), and degenerative disc disease (6.7%). Screw loosening rate at 1 year was 2.7%, being not inferior (<em>P</em> = 0.005) to the control group at 9.2%. Mean ODI improvement of 49.3 showed noninferiority (<em>P</em> &lt; 0.001) versus 35.2 in the control group. Mean 2-year ODI was 19, mean visual analog scale back pain improved from 80.3 to 24.1 (3 months) and 21.6 (1 year). The implant-related revision rate was 4.1%.</div></div><div><h3>Conclusions</h3><div>Force Control, aiming to go beyond the familiar by controlling intended and unintended forces to achieve the most stressless fixation, is a safe and efficient method. Lightweight instruments are designed to allow identifying, controlling, and reducing mechanical stress. Patients benefit from Force Control regarding screw loosening and clinical outcome.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123812"},"PeriodicalIF":1.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473134","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}