World neurosurgery最新文献

{"title":"Incidence and risk factors of delayed facial paralysis after vestibular schwannoma resection: A systematic review and meta-analysis.","authors":"Xiezhuo Zhang, Hongbo Wen, Guohuan Chen","doi":"10.1016/j.wneu.2025.123938","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123938","url":null,"abstract":"<p><strong>Objective: </strong>Delayed facial nerve paralysis (DFNP) is a common complication after vestibular schwannoma surgery. Previous studies have focused on immediate FNP, and the risk factors for developing DFNP remain largely unclear. This study aimed to determine the incidence and risk factors of DFNP in patients after vestibular schwannoma resection.</p><p><strong>Materials and method: </strong>Up to 8 October 2024, PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, and China Science and Technology Journal Database (VIP database) were searched to extract the related data of DFNP. The pooled incidence of DFNP was calculated. Possible risk factors of DFNP were conducted to report the odds ratio (OR)/weighted mean difference (WMD), and their 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Twenty-seven studies were included, and 8,656 patients underwent vestibular schwannoma resection. The incidence of DFNP in patients with vestibular schwannoma who underwent microsurgical resection was 12.3% (95%CI: 9.4%, 15.1%). The results of the influencing factor analysis showed that age (WMD: -4.28, 95%CI: -5.66, -2.91) and tumor size (WMD: 0.17, 95%CI: 0.01, 0.22) were related to the incidence of DFNP in patients after vestibular schwannoma resection.</p><p><strong>Conclusion: </strong>DFNP is a complication after vestibular schwannoma surgery that cannot be ignored. The risk factors (age and tumor size) of DFNP in patients after vestibular schwannoma surgery still need to be considered, and clinical management of high-risk groups should be strengthened in clinical practice.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123938"},"PeriodicalIF":1.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700981","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":"Microanatomy of the Temporal Division of the Facial Nerve in the Periorbital Region Applied to Minimally Invasive Keyhole Approaches","authors":"Ali Tayebi Meybodi,&nbsp;Ahmet Ozak,&nbsp;Andrea L. Castillo,&nbsp;Oscar Alcantar-Garibay,&nbsp;Michael T. Lawton,&nbsp;Mark C. Preul","doi":"10.1016/j.wneu.2025.123752","DOIUrl":"10.1016/j.wneu.2025.123752","url":null,"abstract":"<div><h3>Background</h3><div>Minimally invasive keyhole approaches to the anterior skull base and circle of Willis require small incisions near distal branches of the temporal division (TD) of the facial nerve. Few studies have focused on planning the incision to avoid the TD branches and maximize exposure in these approaches. This study aimed to define a safe zone away from the TD branches for skin incision during minimally invasive keyhole approaches using reliable and practical skin landmarks.</div></div><div><h3>Methods</h3><div>In 5 cadaveric heads (10 sides), a Cartesian system was established with the orbitomeatal line connecting the lateral canthus and the external acoustic meatus (x-axis). A perpendicular line was drawn to the x-axis at the lateral canthus (y-axis). TD branches were dissected proximally to distally until the nerve-muscle junction of the orbicularis oculi and fronto-occipitalis muscles. Nerve-muscle junction points were registered in the Cartesian system. Probabilistic heat maps were generated to define a periorbital safe zone.</div></div><div><h3>Results</h3><div>A median of 3 branches each innervated the orbicularis oculi and fronto-occipitalis. A semicircular area centered on the lateral canthus with a radius of 10 mm was found to have low (&lt;10%) chance of containing a TD branch. This safe zone could be extended posteriorly to 15 mm inferior to the orbitomeatal line.</div></div><div><h3>Conclusions</h3><div>Identifying a safe zone for preserving TD branches is crucial for surgical incisions planned in the superolateral region of the orbit. This study provides a clinically applicable and reproducible landmark for planning incisions commonly used during minimally invasive keyhole approaches.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123752"},"PeriodicalIF":1.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374755","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":"Kinematic analysis of the hindbrain via dynamic neck motion in adult patients with Chiari malformation type I: A radiological study with clinical implications.","authors":"Hao Deng, Tao Chen, Guolian Chen, Wei Tang, Zhijian Huang, Yi Yan, Yongzhi Xia","doi":"10.1016/j.wneu.2025.123925","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123925","url":null,"abstract":"<p><strong>Background: </strong>The influence of cervical motion on the hindbrain in patients with Chiari malformation type I (CMI) remains under investigation. In this study, the kinematic effects of cervical extension and flexion on cerebellar tonsillar herniation were evaluated.</p><p><strong>Methods: </strong>The clinical data of 27 adult CMI patients were retrospectively studied, and sex- and age-matched patients with cervical spondylopathy were included as controls. Several linear, angular variables related to the hindbrain and mobility of the neck were assessed on midsagittal views of neutral and dynamic cervical MR images.</p><p><strong>Results: </strong>The distance of cerebellar tonsillar herniation (D-Ton) in the CMI group was 10.15 ± 0.74 mm in the cervical neutral position, 11.24 ± 0.81 mm (p <0.001) in flexion, and 9.12 ± 0.65 mm (p <0.001) in extension. D-Ton in the control group remained unchanged in three different cervical positions. No significant differences were found in the tissue strain of the tonsils (Ton-Strain), the distance from the obex (D-Obex), the anterior margin of the pontomedullary (D-Pon), or the cervicomedullary (D-Medu) junction to the McRae line between different cervical positions in either group.</p><p><strong>Conclusions: </strong>The mobility of the ectopic tonsils and the degree of cervical motion were verified in adult CMI patients. The herniated tonsils largely ascended with extension and descended with flexion, without obvious tonsillar tissue strain, whereas the brain stem remained stable. Tonsillar motion may be a potential marker of CMI and may therefore help surgeons confirm CMI as well as tailor surgical procedures for such patients.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123925"},"PeriodicalIF":1.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693511","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":"Brain tissue oxygen combined with intracranial pressure monitoring in patients with severe traumatic brain injury: An updated systematic review and meta-analysis following the OXY-TC trial.","authors":"Yu Chang, Chia-En Wong, Hao-Hsiang Hsu, Kuan-Yu Chi, Jung-Shun Lee, Yen-Ta Huang, Chih-Yuan Huang","doi":"10.1016/j.wneu.2025.123926","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123926","url":null,"abstract":"<p><strong>Introduction: </strong>Severe traumatic brain injury (TBI) is associated with high mortality and long-term disability. Effective TBI management, aimed at minimizing secondary brain damage, requires constant monitoring of intracranial pressure (ICP) with or without brain tissue oxygen pressure (PbtO2). The recent OXY-TC trial suggested that combined ICP + PbtO2 monitoring does not improve the 6-month neurological outcomes, prompting a meta-analysis to reassess the clinical role of PbtO2 monitoring.</p><p><strong>Methods: </strong>We conducted systematic review and meta-analysis by searching the PubMed, Medline, and Cochrane databases for randomized controlled trials and prospective studies on adult severe TBI patients, comparing clinical outcomes of ICP monitoring alone versus ICP + PbtO2 monitoring. Data extraction and quality assessments were performed independently by two reviewers. Meta-analyses were conducted using a random-effects model, focusing on 6-month mortality and favorable functional outcomes.</p><p><strong>Results: </strong>Six studies met the inclusion criteria. The ICP + PbtO2 group is more likely to have favorable outcomes (OR: 1.39, 95% CI: 1.01-1.92, I² = 0%) 6 months following TBI. There were no statistically significant differences in the 6-month mortality (odds ratio, OR: 0.75, 95% confidence interval, CI: 0.52-1.10; I² = 0%).</p><p><strong>Conclusion: </strong>Our research findings partially align with the OXY-TC trial regarding the primary endpoint, demonstrating that brain tissue oxygen-guided therapy does not significantly reduce mortality rates in TBI patients 6 months post-injury. However, in contrast to the OXY-TC trial, we observed that the PbtO2 monitoring group showed a significantly higher proportion of favorable outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123926"},"PeriodicalIF":1.9,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693504","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":"Original Uniportal Bichannel and Dual-Media Spinal Endoscopy System Assists Elderly Patients with Thoracolumbar Kyphosis Associated with Osteoporosis: Technical Note and Preliminary Clinical Results","authors":"Muhang Tian ,&nbsp;Xinbo Wu ,&nbsp;Yingchuan Zhao ,&nbsp;Yanjie Zhu ,&nbsp;Yunshan Fan ,&nbsp;Haijian Ni ,&nbsp;Fangjing Chen ,&nbsp;Shisheng He","doi":"10.1016/j.wneu.2025.123785","DOIUrl":"10.1016/j.wneu.2025.123785","url":null,"abstract":"<div><h3>Background</h3><div>The uniportal bichannel and dual-media spinal endoscopy (UBD) system is an original endoscopic system developed by the authors. This technical note describes a single-center case series of elderly patients with thoracolumbar kyphosis (TLK) with osteoporosis treated with the assistance of the UBD system.</div></div><div><h3>Methods</h3><div>This article presents a retrospective case series including 4 patients with TLK with osteoporosis treated with assistance of the UBD system. Demographic, clinical, imaging, and procedure-related data are reported.</div></div><div><h3>Results</h3><div>All 4 patients achieved satisfactory correction of TLK. The regional kyphosis angle and TLK improved significantly in the patients, correcting from 24.73 ± 6.51° to 5.46 ± 2.16° (<em>P</em> &lt; 0.001) and 29.28 ± 4.02° to 6.33 ± 3.13° (<em>P</em> &lt; 0.001). The patients showed an improvement in visual analog scale and Oswestry Disability Index scores postoperatively (<em>P</em> &lt; 0.001). No complications were observed.</div></div><div><h3>Conclusions</h3><div>This study suggests that use of the UBD system to assist in treatment of elderly patients with rigid TLK with osteoporosis is a safe and effective approach.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123785"},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415274","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":"Drivers of Intraoperative Costs for Transsphenoidal Endoscopic Surgery for Sellar Lesions: A Time-Driven Activity-Based Cost Analysis","authors":"Advith Sarikonda ,&nbsp;Danyal Quraishi ,&nbsp;Steven Glener ,&nbsp;D. Mitchell Self ,&nbsp;Karim Hafazalla ,&nbsp;Emily Isch ,&nbsp;Ashmal Sami ,&nbsp;Cheritesh Amaravadi ,&nbsp;Faisal Shaikh ,&nbsp;Kevin D. Judy ,&nbsp;James J. Evans ,&nbsp;Nicholas Clark ,&nbsp;Christopher J. Farrell ,&nbsp;Ahilan Sivaganesan","doi":"10.1016/j.wneu.2025.123792","DOIUrl":"10.1016/j.wneu.2025.123792","url":null,"abstract":"<div><h3>Background</h3><div>Neurosurgeons lack precise insights into the true costs of transsphenoidal endoscopic surgery for sellar and suprasellar lesions (TESS), including pituitary adenomas, craniopharyngiomas, and apoplexy. To address this critical knowledge gap, we employ time-driven activity-based costing (TDABC) for TESS.</div></div><div><h3>Methods</h3><div>We analyzed 221 TESS procedures performed between 2017 and 2022 at a large academic medical center. Costs were calculated using TDABC. Software was developed to extract information regarding all resources utilized intraoperatively. Supply cost was calculated as the aggregate of expenses related to implants, consumables, medications, and surgical tray sterilization. Personnel cost was determined by multiplying the per-minute wages of all intraoperative personnel by the amount of time they spent in the operating room. Patient and disease-specific variables were collected. Multivariable regression models were performed to assess predictors of cost.</div></div><div><h3>Results</h3><div>The average total cost of a TESS procedure was $7557 ± $2,365, with primary cost drivers being supplies ($2,811, 37%) and personnel ($4,426, 59%). On multivariable regression, factors independently associated with higher total cost were hospital site (β-coefficient: $1,028, <em>P</em> &lt; 0.001), intraoperative blood loss (β-coefficient: $12, <em>P</em> &lt; 0.001), length of stay (β-coefficient: $23, <em>P</em> = 0.015), and the use of a nasoseptal flap (β-coefficient: $731, <em>P</em> = 0.012). Conversely, apoplexy was associated with lower total cost (β-coefficient: $−1,149, <em>P</em> = 0.001), which was explained by faster operating room times and lower personnel cost (β-coefficient: $−702, <em>P</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>This study represents the first application of intraoperative TDABC for transsphenoidal endoscopic surgery. Such efforts can promote value-based healthcare by identifying areas for cost reduction and surgical resource management.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123792"},"PeriodicalIF":1.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432769","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":"Litigation Involving Delay of Spinal Care During the COVID-19 Pandemic: A Review of Reported Legal Cases in the U.S.","authors":"Mayur S Patel, Arianna D Carfora, Kathleen Botterbush, Dominic Franceschelli, Justin Zhang, Andrew Grossbach, Phillippe Mercier, Tobias A Mattei","doi":"10.1016/j.wneu.2025.123910","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123910","url":null,"abstract":"<p><strong>Background: </strong>During the COVID-19 pandemic, access to medical care was delayed around the world. This has led to poor patient outcomes and litigation. This study was designed to assess the incidence and characteristics of litigation in the United States related to delays in spine care secondary to the COVID-19 pandemic.</p><p><strong>Methods: </strong>A retrospective review of LexisNexis following PRISMA guidelines was conducted. LexisNexis was queried for cases, verdicts, and settlements involving a delay of spinal care during the COVID-19 pandemic. Collected data included plaintiffs' demographics and spine pathology, delay length and reason, legal cause of action, state/region, and case outcome.</p><p><strong>Results: </strong>Thirty-two cases met criteria for full review. The average reported delay was 5.64 ± 3.83 months, with 25% having not received the necessary spinal care at the time the claim was filed, most of which were in 2022. Most cases involved lumbosacral pathology with pain as the predominant symptom (96.88%), followed by neurologic deficits (25%). Most cases (62.50%) involved inmates and were based on a claim of cruel and unusual punishment in violation of the 8th Amendment of the U.S. Constitution.</p><p><strong>Conclusions: </strong>This study provided granular detail about the characteristics of litigation related to delay of spinal care due to the COVID-19 pandemic in the U.S. Most plaintiffs were inmates who had difficulty obtaining a specialist, imaging, or treatment. A substantial proportion of the remaining cases were associated with unattended requests for simple and low-cost interventions.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123910"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674609","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":"The characteristics of intracerebral hemorrhages in dialysis patients.","authors":"Hiroki Karita, Takumi Inaba, Tomokazu Sekine, Kazuhiro Nakamura, Tomosato Yamazaki, Yoji Komatsu","doi":"10.1016/j.wneu.2025.123909","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123909","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney failure is a global public health challenge and is associated with a higher risk of intracerebral hemorrhage. Intracerebral hemorrhage (ICH) is known to result in a poorer prognosis in hemodialysis (HD) patients than in non-hemodialysis patients.</p><p><strong>Methods: </strong>This retrospective study examined 445 consecutive cases of ICH to investigate the disparities in outcomes between HD (44 cases) and non-HD (401 cases) patients. The two groups were compared based on demographic and clinical factors, and multivariate analyses were performed to identify risk factors for adverse outcomes.</p><p><strong>Results: </strong>The HD group showed a significantly younger age (68.1 vs. 72.9, p=0.01) and higher frequencies of hypertension, diabetes, anticoagulant use, a history of smoking, and a history of stroke. Clinical outcomes were worse in the HD group (p<0.01). Detailed analysis of ICH characteristics revealed a higher rate of hematoma enlargement in the HD group (p<0.01). Multivariate analysis confirmed dialysis and anticoagulant use as significant risk factors for hematoma enlargement.</p><p><strong>Conclusion: </strong>The study concludes that HD patients with ICH exhibit a higher risk of hematoma enlargement and poorer clinical outcomes. Dialysis and anticoagulant use emerged as significant risk factors for hematoma enlargement. Larger prospective studies are essential for validating these findings.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123909"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674635","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":"Short-segment Fixation for Thoracolumbar Kyphosis Caused by Osteoporotic Vertebral Compression Fractures: A Case Series.","authors":"Qiu-Qi Zhang, Jia Song, Hai-Tao Liu, Zhi-Hui Liang, Fu-Chao Zhou, Yue-Hui Zhang, Jiang Shao","doi":"10.1016/j.wneu.2025.123912","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123912","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate short-segment fixation (SSF), with or without advanced osteotomy, for treating thoracolumbar kyphosis caused by osteoporotic vertebral compression fractures (OVCFs).</p><p><strong>Methods: </strong>This retrospective analysis included twenty-eight patients with thoracolumbar kyphosis caused by OVCFs who underwent SSF at our hospital between 2017 and 2022. The change in the Cobb angle between standing and supine positions was measured to establish whether an advanced osteotomy was necessary. Bone mineral density (T-score) and related hematologic bone metabolism markers were recorded to assess the patient's osteoporosis status. The Cobb angle and sagittal plane parameters were measured before and after surgery to determine the orthopedic outcomes, and function was assessed using a visual analog scale (VAS) and the Oswestry disability index (ODI).</p><p><strong>Results: </strong>A total of 28 patients successfully underwent SSF with or without advanced osteotomy, with no serious complications. The mean follow-up period was 29 ± 3 months. The Cobb angle decreased significantly, from 45° ± 6° before surgery to 11° ± 3° at the last follow-up (P < 0.05). The VAS scores and ODI at the last follow-up were significantly improved compared with those before surgery (P < 0.05). Five patients developed low back pain within six months of surgery (proximal junctional kyphosis in 4 patients, and internal fixation fractures in 1 patient),and two of these patients underwent a second surgery. In the long-term follow -up, two patients had PJK/DJK after the re-trauma. The 21 remaining patients maintained good internal fixation at the last follow-up, with no broken screws or rods, loosening, or displacement.</p><p><strong>Conclusion: </strong>SSF, with or without advanced osteotomy, is an effective treatment for thoracolumbar kyphosis caused by OVCFs, achieving good orthopedic outcomes and improving the quality of life of patients. Continuous standardized anti-osteoporosis treatment is essential for long-term recovery.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123912"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674620","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":"The Effect of Body Mass Index on Surgical Outcomes Following Aseptic Short-Segment Revision Lumbar Fusions: A Retrospective Study","authors":"Nicholas B. Pohl,&nbsp;Jonathan Dalton,&nbsp;Rachel Huang,&nbsp;Rajkishen Narayanan,&nbsp;Omar H. Tarawneh,&nbsp;Yunsoo Lee,&nbsp;Harrison Fellheimer,&nbsp;Maximilliano Buckner,&nbsp;Mark F. Kurd,&nbsp;Ian David Kaye,&nbsp;Jose A. Canseco,&nbsp;Alan S. Hilibrand,&nbsp;Alexander R. Vaccaro,&nbsp;Gregory D. Schroeder,&nbsp;Christopher K. Kepler","doi":"10.1016/j.wneu.2025.123801","DOIUrl":"10.1016/j.wneu.2025.123801","url":null,"abstract":"<div><h3>Background</h3><div>This study investigated the association among preoperative body mass index (BMI) and surgical outcomes, reoperation rate, and 1-year patient-reported outcome measures (PROMs) following 1–3 level revision lumbar fusion.</div></div><div><h3>Methods</h3><div>Patients who underwent a 1–3 level revision lumbar fusion from 2011–2021 were included. Patients were grouped into BMI classes: normal (18.5–24.99), overweight (25.0–29.99), obese class 1 (30.0–34.99), and obese class 2+ (≥35.0). Demographics, surgical characteristics, 1-year reoperations, 90-day readmissions, and 1-year PROMs were compared between cohorts. PROMs included the Short Form-12 Physical Component Score, Mental Component Score, Oswestry Disability Index, Visual Analog Scale Back pain score, and Visual Analog Scale Leg pain score.</div></div><div><h3>Results</h3><div>In total, 743 patients were identified: 115 normal weight, 254 overweight, 206 obese class 1, and 168 obese class 2+. Operative time (<em>P</em> = 0.007) and length of stay (LOS) (<em>P</em> = 0.002) were longer in patients with higher BMI. Multivariate regression demonstrated obese class 2+ was independently associated with longer operative times (estimate: 32.43; <em>P</em> = 0.008) and LOS (estimate: 0.68; <em>P</em> = 0.044). There were no differences in readmission (<em>P</em> = 0.285) or reoperation rates (<em>P</em> = 0.727). All patients received a similar benefit between preoperative and 1-year PROMs.</div></div><div><h3>Conclusions</h3><div>While more obese revision lumbar fusion patients experienced longer operative times and LOS, these patients ultimately experienced similar improvements from surgical intervention at 1 year postoperatively. Regardless of BMI class, all patients had comparable rates of readmission within 90 days and reoperation. These findings support previous lumbar fusion literature and suggest an indicated revision lumbar fusion in higher BMI class patients does not lead to further reoperations or worse PROMs.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"196 ","pages":"Article 123801"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441838","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}