World neurosurgery最新文献

{"title":"Litigation Involving Delay of Spinal Care During the COVID-19 Pandemic: A Review of Reported Legal Cases in the United States","authors":"Mayur S. Patel ,&nbsp;Arianna D. Carfora ,&nbsp;Kathleen Botterbush ,&nbsp;Dominic Franceschelli ,&nbsp;Justin Zhang ,&nbsp;Andrew Grossbach ,&nbsp;Phillippe Mercier ,&nbsp;Tobias A. Mattei","doi":"10.1016/j.wneu.2025.123910","DOIUrl":"10.1016/j.wneu.2025.123910","url":null,"abstract":"<div><h3>Background</h3><div>During the coronavirus disease 2019 (COVID-19) pandemic, access to medical care was delayed worldwide. In multiple instances, the pandemic has led to delay in care, suboptimal 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.</div></div><div><h3>Methods</h3><div>A retrospective review of the legal database 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 spinal pathology, delay length and reason, legal cause of action, state/region of occurrence, and case outcome.</div></div><div><h3>Results</h3><div>Thirty-two cases met the criteria for full review. The average reported delay in litigated cases 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 disease with pain as the predominant symptom (96.88%), followed by neurological 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.</div></div><div><h3>Conclusions</h3><div>This study provides granular detail about the characteristics of litigation related to delay of spinal care secondary to the COVID-19 pandemic in the United States. Most plaintiffs were inmates who had difficulty obtaining a specialist appointment, imaging, or treatment. In many cases the reason for litigation were unattended requests for simple and low-cost interventions.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 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 MD ,&nbsp;Takumi Inaba MD ,&nbsp;Tomokazu Sekine MD ,&nbsp;Kazuhiro Nakamura MD, PhD ,&nbsp;Tomosato Yamazaki MD, PhD ,&nbsp;Yoji Komatsu MD, PhD","doi":"10.1016/j.wneu.2025.123909","DOIUrl":"10.1016/j.wneu.2025.123909","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney failure is a global public health challenge and is associated with a higher risk of intracerebral hemorrhage (ICH). ICH is known to result in a poorer prognosis in hemodialysis (HD) patients than in non-HD patients.</div></div><div><h3>Methods</h3><div>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 2 groups were compared based on demographic and clinical factors, and multivariate analyses were performed to identify risk factors for adverse outcomes.</div></div><div><h3>Results</h3><div>The HD group showed a significantly younger age (68.1 vs. 72.9, <em>P</em> = 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 (<em>P</em> &lt; 0.01). Detailed analysis of ICH characteristics revealed a higher rate of hematoma enlargement in the HD group (<em>P</em> &lt; 0.01). Multivariate analysis confirmed dialysis and anticoagulant use as significant risk factors for hematoma enlargement.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 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,&nbsp;Jia Song,&nbsp;Hai-Tao Liu,&nbsp;Zhi-Hui Liang,&nbsp;Fu-Chao Zhou,&nbsp;Jiang Shao,&nbsp;Yue-Hui Zhang","doi":"10.1016/j.wneu.2025.123912","DOIUrl":"10.1016/j.wneu.2025.123912","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate short-segment fixation (SSF), with or without advanced osteotomy, for treating thoracolumbar kyphosis caused by osteoporotic vertebral compression fractures (OVCFs).</div></div><div><h3>Methods</h3><div>This retrospective analysis included 28 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 and the Oswestry Disability Index.</div></div><div><h3>Results</h3><div>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 (<em>P</em> &lt; 0.05). The visual analog scale scores and Oswestry Disability Index at the last follow-up were significantly improved compared with those before surgery (<em>P</em> &lt; 0.05). Five patients developed low back pain within 6 months of surgery (proximal junctional kyphosis in 4 patients and internal fixation fractures in 1 patient), and 2 of these patients underwent a second surgery. In the long-term follow-up, 2 patients had proximal junctional kyphosis/distal junctional kyphosis 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 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}

{"title":"Integrating Single-Cell Sequencing and Transcriptome Analysis to Investigate the Role of Ferroptosis in Ischemic Stroke and the Molecular Mechanisms of Immune Checkpoints","authors":"Weidong Han ,&nbsp;Xiaonan Bian ,&nbsp;Haiyang Fu ,&nbsp;Min Liu ,&nbsp;Hongliang Wang ,&nbsp;Haimei Liu","doi":"10.1016/j.wneu.2025.123908","DOIUrl":"10.1016/j.wneu.2025.123908","url":null,"abstract":"<div><h3>Background</h3><div>Early diagnosis of ischemic stroke (IS) remains challenging. Given the crucial role of ferroptosis in IS, this study aims to identify key genes associated with ferroptosis in IS, providing insights into its molecular mechanisms and potential biomarkers for early detection.</div></div><div><h3>Methods</h3><div>The single-cell transcriptome dataset GSE247474 from the Gene Expression Omnibus. Ferroptosis scores in astrocytes were calculated using the WP_FERROPTOSIS gene set, and differential analysis was conducted to compare ferroptosis activity between the disease and control groups. Key ferroptosis-related genes were identified using Lasso regression and support vector machine algorithms, and their diagnostic potential was assessed through receiver operating characteristic curve analysis. Additionally, we performed immune infiltration analysis and transcription factor network prediction. Pseudotime analysis was used to explore the differentiation trajectories of astrocytes and T-cell subsets.</div></div><div><h3>Results</h3><div>Astrocytes in the disease group showed significantly higher ferroptosis scores than those in the control group. Using machine learning algorithms, we identified 3 key ferroptosis-related genes—SLC3A2 (solute carrier family 3 member 2), FDFT1 (farnesyl-diphosphate farnesyltransferase 1), and BACH1 (BTB and CNC homology 1)—and validated their diagnostic value (area under the curve &gt;0.9). Immune infiltration analysis revealed that SLC3A2 and BACH1 expression levels were positively correlated with CD4⁺ follicular T cells and negatively correlated with CD4⁺ memory T cells. FDFT1 showed positive correlations with both mast cells and CD4⁺ memory T cells. Pseudotime analysis demonstrated dynamic changes in key gene expression along the differentiation trajectories of astrocytes and T cells.</div></div><div><h3>Conclusions</h3><div>SLC3A2, FDFT1, and BACH1 are potential molecular markers for IS diagnosis.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123908"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674607","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":"Ultrasound-Guided External Ventricular Drain Insertion After Decompressive Craniectomy","authors":"Alick P. Wang ,&nbsp;Ryan Sandarage ,&nbsp;Anne-Sophie Parent ,&nbsp;Aneesh Karir ,&nbsp;Husain Shakil ,&nbsp;Brian J. Drake ,&nbsp;John Sinclair","doi":"10.1016/j.wneu.2025.123915","DOIUrl":"10.1016/j.wneu.2025.123915","url":null,"abstract":"<div><h3>Background</h3><div>Ultrasound guidance offers real-time visualization of patient-specific anatomy during external ventricular drain (EVD) insertion. A craniectomy defect provides a sonolucent window, enabling the use of a large, low-frequency probe with deep penetration and a wide field of view. While specialized burr-hole probes exist, use of a curvilinear probe through a craniectomy defect for bedside EVD placement has not been previously described.</div></div><div><h3>Methods</h3><div>Using a curvilinear probe, we performed ultrasound-guided bedside insertion of a left frontal EVD through a hemicraniectomy flap.</div></div><div><h3>Results</h3><div>Bedside ultrasound enabled visualization of the entire supratentorial ventricular system. Drain insertion was successfully performed, with immediate sonographic visualization of the catheter tip in the left frontal horn. Placement was confirmed with a computed tomography scan.</div></div><div><h3>Conclusions</h3><div>Bedside ultrasound-guided EVD insertion in post-craniectomy patients can be a valuable method for safely accessing the ventricle in the face of abnormal or distorted anatomy.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123915"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673658","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":"Utilization of a Telemetric Prechamber in the Management of Patients with Normal Pressure Hydrocephalus","authors":"Miroslav Cihlo ,&nbsp;Pavel Trávníček ,&nbsp;Svatopluk Řehák ,&nbsp;Lucie Kukrálová ,&nbsp;Karel Zadrobílek ,&nbsp;Jan Pospíšil ,&nbsp;Pavel Dostál ,&nbsp;Vlasta Dostálová","doi":"10.1016/j.wneu.2025.123914","DOIUrl":"10.1016/j.wneu.2025.123914","url":null,"abstract":"<div><h3>Background and Objectives</h3><div>Normal pressure hydrocephalus is a preventable and treatable cause of dementia. A telemetric prechamber allows individually tailored ventriculoperitoneal shunt valve adjustments in patients treated with the shunting procedure.</div></div><div><h3>Methods</h3><div>In this pilot, prospective randomized trial, 33 adult patients were divided into Group A (with an implanted telemetric prechamber) and Group B (without an implanted telemetric prechamber). The overall condition, Mini-Mental-State-Examination score, and gait test were evaluated 3, 6, 9, and 12 months after surgery. Additionally, the total number of ventriculoperitoneal shunt valve adjustments and their impact on the patient’s condition (assessed by the idiopathic normal pressure hydrocephalus scale) were assessed.</div></div><div><h3>Results</h3><div>There were no differences in the proportion of patients showing improved gait, cognitive functions, or incontinence. Patients with a telemetric prechamber underwent significantly more valve adjustments (1.6 ± 1.1 vs. 0.8 ± 0.6; <em>P</em> = 0.037). Also, a greater difference (reduction) in the shunt initial and final valve setting was observed in the prechamber group (30.71 ± 24.95 vs. 15.26 ± 13.07 mm H₂O; <em>P</em> = 0.049).</div></div><div><h3>Conclusions</h3><div>A telemetric prechamber allowed more valve adjustments during the follow-up period and a greater difference (reduction) between the initial (perioperative) and final valve pressure settings. However, there was no difference in functional parameters between the groups at any time point of the study.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123914"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674081","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":"Predictive Factors for Postoperative Cerebrospinal Fluid Drainage in Neurosurgical Management of Intracranial Aneurysms.","authors":"Xiaohong Guo","doi":"10.1016/j.wneu.2025.123913","DOIUrl":"https://doi.org/10.1016/j.wneu.2025.123913","url":null,"abstract":"<p><strong>Background: </strong>Management of intracranial aneurysms often requires complex neurosurgical interventions, with some patients necessitating postoperative cerebrospinal fluid (CSF) drainage. Identifying predictive factors for CSF drainage can enhance patient outcomes through targeted interventions and improved perioperative care.</p><p><strong>Methods: </strong>In this retrospective study, 151 patients who underwent surgical treatment for intracranial aneurysms were included. Demographic data, clinical presentation (Hunt-Hess grade, modified Fisher score), surgical details (operative time, intraoperative complications), and postoperative outcomes were reviewed. Both univariate and multivariable logistic regressions were conducted to identify predictors of postoperative CSF drainage. A subgroup analysis compared patients with anterior versus posterior circulation aneurysms.</p><p><strong>Results: </strong>Overall, 67 patients required postoperative CSF drainage. On multivariable analysis, age ≥60, high Hunt-Hess grade, operative time >5 hours, and intraoperative aneurysm rupture significantly increased the odds of drainage (P<0.05). Subgroup analysis revealed that these risk factors conferred an even higher likelihood of CSF drainage in posterior circulation aneurysms. Gender and modified Fisher score did not show significant associations with drainage.</p><p><strong>Conclusions: </strong>Advanced age, high Hunt-Hess grade, prolonged operative time, and intraoperative rupture predict postoperative CSF drainage in patients with intracranial aneurysms. Incorporating both global and subgroup-based risk assessments can help refine perioperative strategies to reduce complications and improve patient outcomes.</p>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":" ","pages":"123913"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674617","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":"Spinal Cord Injury in the 21st Century Part I: A New Demographic","authors":"Angelica Alvarez Reyes ,&nbsp;Sruti Bandlamuri ,&nbsp;Travis M. Dumont ,&nbsp;Venkat Ganapathy ,&nbsp;R. John Hurlbert","doi":"10.1016/j.wneu.2025.123917","DOIUrl":"10.1016/j.wneu.2025.123917","url":null,"abstract":"<div><h3>Background</h3><div>Guidelines for the management of acute spinal cord injury are based on a young age group suffering spinal fracture dislocations caused by high-impact trauma. The purpose of this study was to characterize our recent cervical spinal cord injury (cSCI) experience and compare it to this traditional demographic. We hypothesized that most cSCI patients now fall outside the scope of published guideline principles.</div></div><div><h3>Methods</h3><div>Cross-sectional cohort study. A detailed review was performed of cSCI patients admitted to our level 1 trauma institution over a 12-month period identifying demographics, injury types, and coded diagnoses cross-referenced from multiple archival systems</div></div><div><h3>Results</h3><div>Fifty-one patients with cSCI from blunt trauma were identified over the 1-year study period of which 82% did not have a spinal fracture or dislocation. cSCI patients without fracture/dislocation were older (mean age 62), had low-impact injuries (93%), and lower American Spinal Injury Association grades (98%). Patients with fracture/dislocation were younger (mean age 48), had high-impact injuries (77%), and higher American Spinal Injury Association grades (66%). Ninety-eight percent of our cSCI patients without fracture/dislocation presented with sensory and motor changes preferentially involving hands and arms in contrast to 11% of patients with fracture dislocation (<em>P</em> &lt; 00001).</div></div><div><h3>Conclusions</h3><div>cSCI patients without fracture/dislocation now represent the large majority of spinal cord injuries at our level I trauma center. The demographic is most consistent with central cord syndrome, implicating unique pathophysiology and natural history. Extrapolation of management principles from previous guideline efforts is not intuitively generalizable to this patient population.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123917"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674623","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":"Comparison of Unilateral and Bilateral Robot-Assisted Percutaneous Kyphoplasty in Treating Osteoporotic Vertebral Compression Fracture","authors":"Ruoyu Yang,&nbsp;Zhiwei Huang,&nbsp;Shanzhong Shao,&nbsp;Jinrun Liu,&nbsp;Shuyang Xia,&nbsp;Wei Li,&nbsp;Yinshun Zhang,&nbsp;Jun Qian,&nbsp;Fulong Dong,&nbsp;Cailiang Shen,&nbsp;Hui Tao","doi":"10.1016/j.wneu.2025.123911","DOIUrl":"10.1016/j.wneu.2025.123911","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the efficacy and safety of unilateral and bilateral robot-assisted percutaneous kyphoplasty (RAPKP) in treating thoracolumbar osteoporotic vertebral compression fractures.</div></div><div><h3>Methods</h3><div>Our study retrospectively analyzed 78 patients (unilateral group: 48, bilateral group: 30) with osteoporotic vertebral compression fracture treated with RAPKP from January 2020 to July 2022. The operation time, X-ray exposure time, bone cement volume, postoperative bone cement distribution, preoperative and postoperative pain visual analog scale (VAS) scores, Oswestry Dysfunction Index (ODI), Cobb angle, vertebral height, bone cement leakage, adjacent vertebral fracture, and postoperative computed tomography (CT) in both groups were recorded.</div></div><div><h3>Results</h3><div>All patients were successfully treated with RAPKP and followed up for 19.90 ± 5.38 months. Our results showed that the VAS core, ODI, vertebral height, and Cobb angle at postoperative follow-up were significantly improved in both groups compared to the preoperative period (<em>P</em> &lt; 0.05). The operation time in the bilateral group (46.20 ± 6.89 minutes) was not statistically different from the unilateral group (42.54 ± 10.16 minutes) (<em>P</em> &gt; 0.05), while the volume of bone cement injected was significantly more in the bilateral group (5.93 ± 1.81 mL) than in the unilateral group (4.73 ± 0.51 mL) (<em>P</em> &lt; 0.05). In addition, the distribution of bone cement in the bilateral group was significantly better than that in the unilateral group (<em>P</em> &lt; 0.05). There were no significant differences in X-ray exposure dose between the 2 groups (<em>P</em> &gt; 0.05). Bone cement leaked in 9 cases (18.75%) in the unilateral group and 6 cases (20.00%) in the bilateral group (<em>P</em> &gt; 0.05). No neurovascular injury or infection occurred. There were 8 cases (16.67%) of adjacent vertebral fracture in the unilateral group and 4 cases (13.33%) in the bilateral group (<em>P</em> &gt; 0.05). Postoperative CT ratios of adjacent vertebrae (operated vertebra/upper adjacent vertebra: unilateral: 10.65 ± 2.7, bilateral: 11.32 ± 3.1; operated vertebra/lower adjacent vertebra: unilateral: 11.67 ± 3.0, bilateral: 12.48 ± 2.9) (<em>P</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>Unilateral or bilateral RAPKP improves patients’ VAS, ODI, sagittal index, and Cobb angle. Unilateral RAPKP possesses the advantage of fewer puncture injuries. However, bilateral RAPKP has better postoperative cement distribution, and we believe that bilateral RAPKP has a better long-term prognosis, so we recommend bilateral RAPKP.</div></div>","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":"197 ","pages":"Article 123911"},"PeriodicalIF":1.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674606","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}