Brain & spine最新文献

{"title":"Experiences of being diagnosed with unruptured intracranial aneurysm in a population-based health survey: A qualitative interview study.","authors":"Mathilde Vea Iversen, Ingvild Mathiesen Rosenlund, Jørgen Gjernes Isaksen, Alexandra Brandt Ryborg Jønsson, Tor Ingebrigtsen","doi":"10.1016/j.bas.2026.107469","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107469","url":null,"abstract":"<p><strong>Introduction: </strong>Most unruptured intracranial aneurysms (UIA) are small and carry a low rupture risk. Many patients are therefore not treated with occlusion but managed conservatively. Evidence on the psychological impact of living with an untreated UIA is limited and conflicting.</p><p><strong>Research question: </strong>To explore experiences of receiving a diagnosis of a UIA and having to live with it over time.</p><p><strong>Material and methods: </strong>The Tromsø7 health survey examined 1862 participants with magnetic resonance angiography and 85 diagnosed with conservatively managed UIAs were eligible for inclusion. We invited 24 based on purposive maximum-variation sampling according to age, sex, and aneurysm size, and 18 consented. Twelve participated in semi-structured interviews before data saturation was achieved. We excluded two because the interviews revealed exclusion criteria (cognitive impairment and treated aneurysm). Data from 10 interviews conducted median eight years after diagnosis were included in a thematic analysis.</p><p><strong>Results: </strong>In retrospective narratives, many participants recalled experiencing serious worry or fear shortly after the diagnosis. Most described a subsequent process of adaption to the uncertainty through trust in clinicians, resilience, normalization and meaning-making, which enabled them to reestablish normality in everyday life. Concerns could resurface around follow-ups. Few described persistent anxiety at the time of the interview. The diagnosis motivated healthy lifestyle changes for many.</p><p><strong>Discussion and conclusion: </strong>The interviews revealed substantial psychosocial impacts of having to live with untreated UIAs. We suggest these insights could inform decision-making in contexts where clinicians and patients must balance the potential benefits and burdens of imaging and surveillance.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107469"},"PeriodicalIF":2.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, predictors, and clinical outcome of patients with undetected aneurysms on initial DSA after aneurysmal subarachnoid hemorrhage.","authors":"Carolin Albrecht, Laura Aberle, Ann-Kathrin Joerger, Hraq Sarkis, Arthur Wagner, Tobias Boeckh-Behrens, Julian Schwarting, Christian Maegerlein, Jan Kirschke, Bernhard Meyer, Maria Wostrack","doi":"10.1016/j.bas.2026.107468","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107468","url":null,"abstract":"<p><strong>Introduction: </strong>Digital subtraction angiography (DSA) is the gold standard for diagnosing ruptured intracranial aneurysms in aneurysmal subarachnoid hemorrhage (aSAH). However, aneurysms may occasionally remain undetected on initial DSA, potentially delaying treatment and increasing the risk of rebleeding. The primary aim was the incidence of aneurysms missed on initial DSA; secondary aims were characteristics, diagnostic yield and outcome.</p><p><strong>Material and methods: </strong>We retrospectively analyzed patients with aSAH treated between March 2006 and October 2023 with initial negative DSA. Demographic, clinical and radiological characteristics were assessed. Neurological outcomes were evaluated using the Glasgow Outcome Scale and modified Rankin Scale and compared with a matched cohort of patients with immediate aneurysm detection.</p><p><strong>Results: </strong>Among 1221 patients with aSAH, 14 (1.1%) had initially negative DSA findings with subsequent aneurysm detection. Repeat DSA identified the aneurysm in eight patients (57.1%). MRI was performed in 13 patients and contributed to aneurysm detection in three cases (21.4%). A third DSA revealed aneurysms in two additional patients (14.3%), while one aneurysm was identified during surgical exploration. The mean interval between initial and repeat diagnostics was five days (range 1-14). Rebleeding occurred in three patients (21.4%) before aneurysm diagnosis. Delayed-detection aneurysms were significantly smaller than aneurysms identified on initial DSA (1.8 mm vs. 6.7 mm, p < 0.05).</p><p><strong>Discussion and conclusion: </strong>Ruptured aneurysms may be missed on initial DSA, particularly when small. Repeat DSA, complemented by MRI when appropriate, should be performed during the same hospital stay, even in perimesencephalic hemorrhage patterns, to avoid delayed treatment and adverse outcomes.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107468"},"PeriodicalIF":2.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebrospinal fluid C-reactive protein to diagnose healthcare-associated meningitis after neurosurgical procedures: An exploratory retrospective diagnostic accuracy study.","authors":"M Foppen, I O Kommers, S E Olie, H H M Schotman, D Verbaan, M C Brouwer","doi":"10.1016/j.bas.2026.107466","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107466","url":null,"abstract":"<p><strong>Introduction: </strong>Neurosurgical procedures are frequently complicated by postoperative meningitis. Current diagnostic methods are insufficient and time-consuming. Cerebrospinal fluid C-reactive protein (CSF CRP) has shown excellent diagnostic accuracy for patients with a community-acquired meningitis and can be determined quickly.</p><p><strong>Research question: </strong>This study investigates the diagnostic accuracy of CSF CRP for detecting postoperative meningitis.</p><p><strong>Materials and methods: </strong>We performed a retrospective monocenter cohort study, including patients in whom a postoperative meningitis was suspected within 30 days after neurosurgery. To assess the diagnostic accuracy of CSF CRP, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating curve (ROC) and area under the curve (AUC) with 95% confidence interval (CI) were calculated.</p><p><strong>Results: </strong>Forty-five patients were included of whom 8 (18%) were diagnosed with postoperative meningitis. Two of eight patients (25%) with a meningitis had a detectable CSF CRP concentration (>0.30 mg/L) compared to eighteen of 37 (49%) without a meningitis. With a cut-off value of 0.30 mg/L, CSF CRP had a 25% sensitivity, 51% specificity, 10% PPV and 76% NPV. The AUC was 0.43 (95% CI 0.22-0.66).</p><p><strong>Discussion and conclusion: </strong>The diagnostic accuracy of CSF CRP to diagnose a postoperative meningitis is poor and treatment decisions should not be based on this parameter.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107466"},"PeriodicalIF":2.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial nail impalement injuries: a call for structured, multidisciplinary management.","authors":"Inibehe Ime Okon, Oluwatobiloba Israel Popoola, Shafin Bin Amin, Rameesha Shauket, Ismail Bozkurt, Ugwu Onyedika Mitchell, Kehinde Precious Fadele, Ayesha Nasir, Sarah, Bipin Chaurasia","doi":"10.1016/j.bas.2026.107462","DOIUrl":"10.1016/j.bas.2026.107462","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107462"},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675885/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracranial-intracranial bypass as hemodynamic rescue for inflammatory intracranial stenosis: A case series and literature review.","authors":"Daniele Starnoni, Danielle Golub, Naveed Kamal, Amir R Dehdashti","doi":"10.1016/j.bas.2026.107463","DOIUrl":"10.1016/j.bas.2026.107463","url":null,"abstract":"<p><strong>Introduction: </strong>Inflammatory intracranial stenosis is an uncommon cause of cerebral ischemia. Although medical therapy remains the first-line treatment, some patients continue to experience recurrent symptoms driven by hemodynamic failure. In this setting, the role of extracranial-intracranial bypass remains poorly defined.</p><p><strong>Research question: </strong>Can extracranial-intracranial bypass serve as an adjunctive hemodynamic rescue strategy in selected patients with refractory inflammatory intracranial stenosis?</p><p><strong>Material and methods: </strong>We retrospectively reviewed three patients who underwent surgical revascularization for inflammatory intracranial stenosis and performed a focused literature review of reported bypass cases for vasculitis-related intracranial steno-occlusive disease. Clinical presentation, imaging findings, perfusion assessment, operative strategy, graft patency, and outcomes were analyzed descriptively.</p><p><strong>Results: </strong>All patients had recurrent ischemic symptoms with progressive intracranial steno-occlusive disease and/or impaired cerebrovascular reserve. No bypass required direct anastomosis to a donor or recipient vessel known to show evidence of active inflammation. No intraoperative complications, early postoperative ischemic events, wound complications, or early graft failures occurred. During follow-up, subsequent ischemic events, when present, involved territories remote from the bypass-dependent cortex.</p><p><strong>Discussion and conclusion: </strong>Extracranial-intracranial bypass does not treat the inflammatory disease itself but may provide targeted hemodynamic support in highly selected patients with refractory ischemic symptoms and impaired cerebrovascular reserve. The present experience is exploratory, and further collaborative reporting is needed to clarify indications, timing, and durability.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107463"},"PeriodicalIF":2.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic third ventriculostomy for idiopathic normal pressure hydrocephalus: association of cerebrospinal fluid flow dynamics with outcome.","authors":"Karel Pištěk, Martin Sameš, Daniel Adámek, Tomáš Radovnický","doi":"10.1016/j.bas.2026.107452","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107452","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic third ventriculostomy (ETV) has been proposed for selected patients with idiopathic normal pressure hydrocephalus (iNPH), but predictors of sustained benefit are uncertain. Phase-contrast MRI (PC-MRI) may quantify cerebrospinal fluid (CSF) pulsatility and support patient selection.</p><p><strong>Research question: </strong>Is sustained clinical improvement after primary ETV associated with preoperative aqueductal CSF flow parameters measured by PC-MRI?</p><p><strong>Material and methods: </strong>In this prospective single-centre observational study, patients with iNPH underwent primary ETV after standardized diagnostic work-up. Preoperative assessment included the Kiefer scale and PC-MRI measurements at the cerebral aqueduct: peak velocity (PV), aqueductal stroke volume (ASV), and net ASV. Clinical follow-up was performed for 12 months. Sustained response was defined as an NPH recovery rate ≥3 at 3 and 12 months without secondary ventriculoperitoneal shunt implantation. Analyses were exploratory.</p><p><strong>Results: </strong>Thirty-one patients were included, of whom 10 (32.3%) achieved sustained clinical improvement. Responders demonstrated significantly higher preoperative ASV values compared to non-responders. Among the evaluated parameters, ASV was the only variable significantly associated with clinical response. Receiver operating characteristic (ROC) analysis demonstrated good discriminatory capacity for ASV (area under the curve [AUC] 0.83). An exploratory cut-off value of 280 μl yielded a sensitivity of 90%, specificity of 71%, positive predictive value of 60%, and negative predictive value of 94%.</p><p><strong>Discussion and conclusion: </strong>Higher preoperative ASV was associated with sustained clinical improvement after primary ETV in this small iNPH cohort. PC-MRI-derived ASV may help identify candidates unlikely to benefit from ETV, but the proposed threshold requires external validation before clinical use.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107452"},"PeriodicalIF":2.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of SPECT-CT in the evaluation of lumbar spine pathology - A Narrative Review.","authors":"Katarzyna Pleśniar, Jake McDonnell, Rohan Tewari, Stacey Darwish, Joseph S Butler","doi":"10.1016/j.bas.2026.107461","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107461","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic low back pain is frequently associated with multilevel degenerative abnormalities that may not identify the symptomatic structure. Single-photon emission computed tomography combined with computed tomography (SPECT-CT) combines metabolic and anatomical imaging and has been proposed as an adjunct where conventional imaging is inconclusive.</p><p><strong>Research question: </strong>To critically assess current evidence concerning the diagnostic and clinical utility of SPECT-CT in lumbar degenerative pathology.</p><p><strong>Materials and methods: </strong>PubMed was searched for English-language publications dated from 2000 to 2025 concerning SPECT-CT, lumbar pathology and low back pain. Primary clinical studies, technical studies, relevant reviews and guidelines were synthesised narratively, with direct and contextual evidence distinguished.</p><p><strong>Results: </strong>The evidence base is heterogeneous and predominantly observational. SPECT-CT can anatomically localize sites of increased osseous tracer uptake and may provide additional information in selected diagnostically challenging cases. However, interpretation is limited by non-standardised positivity thresholds, interobserver variability, discordance with MRI, imperfect agreement with diagnostic blocks, absence of a validated reference standard and limited controlled evidence that SPECT-CT-guided management improves outcomes.</p><p><strong>Discussion and conclusion: </strong>SPECT-CT may have an adjunctive role in carefully selected patients with unresolved diagnostic uncertainty where the result is likely to alter management. Current evidence is insufficient to support routine use or to conclude that SPECT-CT independently identifies the true pain source, improves treatment selection or improves outcomes over conventional diagnostic pathways.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107461"},"PeriodicalIF":2.7,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteoporotic vertebral compression fractures: Increased post-facture mortality, particularly in males.","authors":"Andreas K Andresen, Jacob Stampe Frølich, Leah Y Carreon, Anne Pernille Hermann, Tanja Gram Petersen, Jan Sørensen, Mikkel Ø Andersen","doi":"10.1016/j.bas.2026.107460","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107460","url":null,"abstract":"<p><strong>Introduction: </strong>With the on-going demographic shift towards older populations, osteoporosis is an increasing public health issue. Mortality rates after a hip fracture in the elderly have been extensively studied and reported. However, similar information has not been reported after an osteoporotic vertebral compression fracture (OVCF).</p><p><strong>Research question: </strong>What is the mortality rate after a hospital diagnosed OVCF stratified by sex?</p><p><strong>Materials and methods: </strong>Using data from the Danish National Health registry, individuals with OVCFs between January 2010 and December 2023 were identified and matched 1:5 with a Control group without OVCF on age, gender, and municipality. Differences in mortality rates at intervals from 30 days to 3 years were calculated and compared for OVCF cases and Controls. A similar analysis was used to explore sex differences for individuals with OVCF.</p><p><strong>Results: </strong>A total of 37,948 patients with OVCF, 12,693 males and 25,255 females were matched with 63,243 and 123,477 Controls, respectively. Individuals with OVCF had statistically significantly higher mortality rates than Controls. Mortality among individuals with OVCF was statistically significantly higher for males than for females.</p><p><strong>Discussion and conclusions: </strong>A significantly higher mortality rate among patients with OVCFs compared to non-fracture controls was seen. OVCFs in males were associated with an almost two-fold higher risk of all-cause mortality compared to females. Increased awareness of osteoporosis in the male population and related morbidity should be further addressed in research and clinical practice.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107460"},"PeriodicalIF":2.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping between EQ-5D-5L and EQ-5D-3L in lumbar spine surgery patients: Machine learning compared to crosswalk algorithms.","authors":"Natalie Hong Siu Chang, Casper Friis Pedersen, Mikkel Østerheden Andersen, Leah Yacat Carreon","doi":"10.1016/j.bas.2026.107459","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107459","url":null,"abstract":"<p><strong>Introduction: </strong>The transition from EQ-5D-3L to EQ-5D-5L poses challenges for comparing health-related quality of life across studies and clinical settings. Although official EuroQol crosswalk algorithms are commonly used to map between versions, alternative mapping approaches may be relevant for disease-specific populations.</p><p><strong>Research question: </strong>This study evaluated the performance of machine-learning models for bidirectional mapping between EQ-5D-3L and EQ-5D-5L in patients undergoing evaluation for elective lumbar spine surgery for degenerative conditions.</p><p><strong>Material and methods: </strong>Paired EQ-5D-3L and EQ-5D-5L single-center responses (n = 766) were analyzed using repeated cross-validation. Response-level mapping was performed using parametric ordinal regression models (VGAM, ordinalNet) and tree-based machine-learning models (XGBoost, CatBoost, ordinalForest). Both hard and soft prediction approaches were evaluated on held-out data and compared with the official crosswalk algorithms using RMSE, MAE, bias (mean signed error), R², and CCC.</p><p><strong>Results: </strong>Soft predictions generally showed lower prediction errors and higher predictive R² than official crosswalk algorithms, particularly for 3L-to-5L mapping, while improvements were smaller for 5L-to-3L mapping, and CCC favored the official crosswalk algorithms. Hard predictions showed similar improvements for 3L-to-5L mapping, except for CatBoost, but higher errors and lower predictive R² for 5L-to-3L mapping. Differences between machine-learning models were generally small across all evaluation metrics.</p><p><strong>Discussion and conclusion: </strong>Machine-learning models provided alternative approaches to the official EuroQol crosswalk algorithms, with performance varying by mapping direction and prediction approach. Soft prediction generally showed more favorable predictive performance, particularly for 3L-to-5L mapping. Overall, these findings support further investigation of response-level mapping machine-learning approaches to harmonize mixed-format EQ-5D data.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107459"},"PeriodicalIF":2.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phrenic nerve palsy: Cervical spine stenosis or Parsonage and Turner syndrome? A case series and review of the literature.","authors":"Clémence Hosseini, Gilles Reuter, Manon Hustinx, Fanny Gester, Julien Guiot, Annie Dubuisson","doi":"10.1016/j.bas.2026.107450","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107450","url":null,"abstract":"<p><strong>Introduction: </strong>Phrenic nerve palsy is a rare cause of dyspnea. The differential diagnosis between cervical spine stenosis and Parsonage and Turner syndrome (PTS), the 2 main causesof phrenic nerve palsy, can be challenging.</p><p><strong>Research question: </strong>How to differentiate cervical spine osteoarthritis from PTS in front of a patient with phrenic nerve palsy?</p><p><strong>Material and methods: </strong>We retrospectively reviewed 8 patients suffering from phrenic nerve palsy. Clinical presentation, imaging, and electrophysiological data are analyzed. A literature review is conducted to support the diagnostic management.</p><p><strong>Results: </strong>The 8 patients, 5 men and 3 women, were 36 to 78 year-old. Six patients presented with acute or subacute onset of symptoms, and clinical as well as electrophysiological features were consistent with PTS. In 3 of them, Magnetic Resonance neurography demonstrated hourglass constrictions along the phrenic nerve. No surgery was performed, and they all had a favourable outcome following conservative treatment. In one patient, cervical foraminal stenosis was clearly implicated, with rapid improvement after decompressive surgery. In another case, cervical surgery was performed on severe C3C4 and C4C5 osteophytic changes with no significant clinical improvement; the rapid elevation of the hemidiaphragm over six weeks and the prior recurrent febrile/inflammatory episodes raise doubts in retrospect about the cervical compressive etiology.</p><p><strong>Discussion and conclusion: </strong>Phrenic nerve palsy results mostly from PTS or cervical spine stenosis, requiring distinct diagnostic and therapeutic strategies. A careful clinical, biological, electrophysiological and radiological assessment is essential to distinguish between these entities and provide timely and appropriate management.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107450"},"PeriodicalIF":2.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}