Brain & spine最新文献

{"title":"Outcome measures after anterior cervical decompression and fusion surgery –non-respondents do not bias the results: A Finnish spine register (FinSpine) study","authors":"N. Klimko ,&nbsp;N. Danner ,&nbsp;H. Salo ,&nbsp;A. Malmivaara ,&nbsp;V. Leinonen ,&nbsp;J. Huttunen","doi":"10.1016/j.bas.2024.104179","DOIUrl":"10.1016/j.bas.2024.104179","url":null,"abstract":"<div><h3>Introduction</h3><div>Comprehensive national spine registers are used in the Nordic countries. Register data is inherently incomplete, raising concerns about the derived results due to non-respondent bias. Few studies have addressed the effect of non-respondents on the integrity of patient-reported outcome data in national spine registers, suggesting that outcome measures after spine surgery may not differ between respondents and non-respondents.</div></div><div><h3>Research question</h3><div>Using the Finnish national spine register (FinSpine), we aimed to assess whether non-respondents would bias patient-reported outcomes at 12 months following anterior cervical decompression and fusion (ACDF) surgery.</div></div><div><h3>Material and methods</h3><div>FinSpine data from 5563 ACDF surgeries since 2016 were analyzed, supplemented with prescription records from the Finnish Social Insurance Institution and subcohort data from Kuopio University Hospital. Patients were grouped based on whether they completed post-operative outcome surveys. Outcomes were compared on neck and upper extremity pain, functional capacity, quality of life, sleep quality, return to work, regular use of pain medication, and opioid purchases 12 months after surgery.</div></div><div><h3>Results</h3><div>Out of 5563 ACDF patients, 1362 (24.5%) purchased opioids during the first post-operative year. There were no significant differences in the mean cumulative opioid purchases between respondents and non-respondents. In the subcohort (n = 60), all non-respondents (n = 29) were reached and interviewed. There were no differences between respondents and non-respondents in any outcome measures at 12 months.</div></div><div><h3>Discussion and conclusion</h3><div>Non-respondents do not bias the assessment of outcome measures following ACDF at 12 months, supporting the validity and reliability of national quality registers like FinSpine for clinical research.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104179"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102238","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":"Prognostic factors of thalamic and thalamopeduncular low-grade gliomas in children: A systematic review and recommendations for surgical management","authors":"Jana Táborská ,&nbsp;Adéla Bubeníková ,&nbsp;Petr Skalický ,&nbsp;Jakub Táborský ,&nbsp;David Horváth ,&nbsp;Michal Zápotocký ,&nbsp;Ondřej Bradáč ,&nbsp;Vladimír Beneš 3rd","doi":"10.1016/j.bas.2025.104183","DOIUrl":"10.1016/j.bas.2025.104183","url":null,"abstract":"<div><h3>Introduction</h3><div>Pediatric low-grade gliomas arising from the thalamus or thalamopeduncular junction are rare. Prognostic factors are thus seldom reported in the literature.</div></div><div><h3>Research question</h3><div>This systematic review aims to define the factors influencing the prognosis of pediatric patients with thalamic and thalamopeduncular low-grade gliomas.</div></div><div><h3>Material and methods</h3><div>An extensive literature search in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed and included Web of Science, Scopus, and OVID interface (Medline and Embase). Original articles were selected if they provided data on 10 or more patients under 18 years old with separate or retrievable data for thalamic or thalamopeduncular low-grade gliomas, as well as at least one prognostic factor and its corresponding outcome. The risk of bias and applicability were assessed using The Quality Assessment of Prognostic Accuracy Studies criteria.</div></div><div><h3>Results</h3><div>The study selection process resulted in the inclusion of 14 articles out of the initial pool of 876 references. These 14 articles encompassed data from 446 patients. The prognostic factors reported were the extent of resection in ten studies, age and radiotherapy in four studies, bilateral involvement and molecular genetics in two studies, and sex and dissemination in one study each. Significant prognostic factors included the extent of resection, bilateral involvement, histology, and radiotherapy.</div></div><div><h3>Discussion and conclusion</h3><div>The reported factors considered significant for prognosis align with previously published data. The maximal safe resection, as a potentially curative modality for thalamic low-grade glioma, and the multidisciplinary approach to each patient should be a standard of care. Given the excellent long-term outlook of these patients, the extent of resection should not be pursued at the risk of neurological function since additional therapeutic possibilities are available today, such as molecular-targeted agents.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104183"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102302","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":"Revisiting the Endoscopic vs. Microscopic colloid cysts resection battle with emphasis on endoscope assisted technique","authors":"Ahmed Al Menabbawy ,&nbsp;Amr Elsamman ,&nbsp;Tamim Essawy ,&nbsp;Reem Elwy ,&nbsp;Sebastian Lehmann ,&nbsp;Loay Shoubash ,&nbsp;Ehab El Refaee ,&nbsp;Nasser M.F. El-Ghandour ,&nbsp;Mohamed Ramadan ,&nbsp;Ahmed Zohdi","doi":"10.1016/j.bas.2024.104181","DOIUrl":"10.1016/j.bas.2024.104181","url":null,"abstract":"<div><h3>Introduction</h3><div>Colloid cysts are challenging regarding their location. Surgical resection remains the therapeutic option of choice for symptomatic cysts. However, choosing the optimal surgical approach is still a subject of debate.</div></div><div><h3>Research question</h3><div>The aim of the study is to compare three surgical approaches; Pure endoscopic (PE), pure microscopic (PM) and endoscope assisted microsurgical (EA).</div></div><div><h3>Material and methods</h3><div>Retrospective data extraction from our database was done and we included patients who underwent surgical resection for colloid cysts since 2008. Patients were categorized into three groups based on the forementioned surgical techniques. Outcome measures assessed included extent of resection (EOR), morbidity using modified Rankin Scale (mRS), hospital stay duration (HSD), and complications.</div></div><div><h3>Results</h3><div>41 patients met our inclusion criteria and were divided as follows; PM 13 patients (31.7%), PE 19 patients (46.3%) and EA with 9 patients (22.0%). Mean age (SD) was 37.4 ± 12.2. Male: Female is 1:1.05 and average follow-up was 3.9 ± 2.8 years. Gross total resection(GTR) reached 92.3% (12/13) using PM, 78.9% (15/19) with PE and 100% (9/9) under EA. Morbidity was 15.4%, 10.5% and 0% respectively (mRS &gt;2). Hospital stay duration was significantly shorter in PE and EA (p = 0.012).</div></div><div><h3>Discussion and conclusion</h3><div>EA excision of colloid cysts is safe and effective. When compared to PE and PM approaches, it can combine the advantages of both tools utilizing the microscope and endoscope to achieve a safe, gross total resection while minimizing hospitalization duration. The choice of surgical approach, however, should be individualized based on the cyst's location, size, and the surgeon's expertise and preference.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104181"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081934","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":"Proximal facet joint violation and breaches after percutaneous insertion of 311 lumbar pedicle screws using the pedicle axis fluoroscopic view","authors":"Miltiadis Georgiopoulos MD, PhD ,&nbsp;Lior M. Elkaim MD ,&nbsp;Qais S. Alrashidi MD ,&nbsp;Oliver Lasry MDCM, PhD ,&nbsp;Jeff D. Golan MD","doi":"10.1016/j.bas.2025.104274","DOIUrl":"10.1016/j.bas.2025.104274","url":null,"abstract":"<div><h3>Introduction</h3><div>Violation of the non-fused proximal facet joints (PFJ) above instrumentation might be associated with accelerated arthritis and adjacent-segment disease. Standard fluoroscopic views do not allow for an exclusion of PFJ violation and have been associated with high rates of this complication.</div></div><div><h3>Research question</h3><div>We adopted the use of the pedicle axis view (PAV) and investigated our results and potential correlations.</div></div><div><h3>Materials and methods</h3><div>We performed a retrospective cohort study of cases of percutaneous pedicle screw insertion in the lumbar spine, using the PAV. Various factors were investigated on postoperative CT scans, e.g. presence of PFJ violation, PFJ angles and analysis of breaches.</div></div><div><h3>Results</h3><div>Overall, 311 screws were inserted using the PAV. The percentage of screws that resulted in PFJ violation was 3.7 % (n = 6). Higher PFJ angles played a role with an odds ratio of 1.21 (95 % CI: 1.03–1.43). The majority of the screws (68.1 %) did not cause cortical breaches. Regarding the rates of breaches, 14.9 % were minor cortical breaches and 11.6 % were moderate. 1.9 % of the screws caused severe breaches, but none of those were located medially or inferiorly. None of the observed breaches led to new symptoms or revision.</div></div><div><h3>Discussion and conclusion</h3><div>The adoption of the fluoroscopic PAV for percutaneous lumbar pedicle screws led to low rates of proximal facet joint violation and severe breaches. Moreover, PFJ violation was more prevalent with higher PFJ angles and surgeons should remain vigilant in such cases. None of the observed breaches were clinically relevant.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104274"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harnessing machine learning to predict and prevent proximal junctional kyphosis and failure in adult spinal deformity surgery: A systematic review","authors":"Paolo Brigato ,&nbsp;Gianluca Vadalà ,&nbsp;Sergio De Salvatore ,&nbsp;Leonardo Oggiano ,&nbsp;Giuseppe Francesco Papalia ,&nbsp;Fabrizio Russo ,&nbsp;Rocco Papalia ,&nbsp;Pier Francesco Costici ,&nbsp;Vincenzo Denaro","doi":"10.1016/j.bas.2025.104273","DOIUrl":"10.1016/j.bas.2025.104273","url":null,"abstract":"<div><h3>Introduction</h3><div>Adult spinal deformity (ASD) surgery involves high costs and risks, with Proximal Junctional Kyphosis (PJK) and Proximal Junctional Failure (PJF) being major concerns. Artificial intelligence (AI) and machine learning (ML) offer potential in predicting and preventing these complications. This review examines the role of AI in predicting PJK/PJF, its effectiveness, and future research needs.</div></div><div><h3>Research question</h3><div>Can AI-based models accurately predict PJK/PJF after ASD surgery, and what factors affect their performance?</div></div><div><h3>Material and methods</h3><div>A systematic review was conducted following PRISMA guidelines, analyzing Medline, Scopus, Embase, and Cochrane Library databases up to December 2024. Keywords included “Adult Spinal Deformity,” “PJK,” “PJF,” “AI,” and “ML.” Data extracted included study characteristics, patient demographics, surgical details, AI model parameters, and performance metrics. Bias risk was assessed using the MINORS score.</div></div><div><h3>Results</h3><div>Among 164 studies, 7 met inclusion criteria (n = 2179 patients). Mean age was 63.2 ± 3.7 years, BMI 26.1 ± 2.4 kg/m², and fusion levels 9.82 ± 1.8. PJK/PJF occurred in 41.1 %. AI models (Random Forest, supervised learning) had accuracy from 72.5 % to 100 % (AUC up to 1.0). Key predictors included age, BMD, spinal alignment, and implant type.</div></div><div><h3>Discussion and conclusions</h3><div>AI and ML models show promise in predicting PJK/PJF after ASD surgery. However, larger multicenter studies with standardized definitions, BMD assessments, and preoperative MRI integration are needed for broader clinical application and validation.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104273"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144072741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In-vitro study of the third occipital nerve near the C2-3 facet joint and the association between its morphology and the presence of a third occipital nerve notch","authors":"Nicolas Van Vlasselaer,&nbsp;Ben Serrien,&nbsp;Erik Cattrysse","doi":"10.1016/j.bas.2025.104282","DOIUrl":"10.1016/j.bas.2025.104282","url":null,"abstract":"<div><h3>Introduction</h3><div>Occipital neuralgia, a debilitating condition characterized by headaches and neck pain, has been linked to the third occipital nerve (TON). Despite its potential role in this condition, the TON's relationship with surrounding structures, particularly the facet joint at the C2-3 level, remains poorly understood.</div></div><div><h3>Method</h3><div>A comprehensive anatomical study was conducted on 35 embalmed and 5 fresh-frozen human body donors to investigate the relationship between the TON and the C2-3 facet joint. The TON was dissected, and its morphology described using a checklist. 3D coordinates of anatomical landmarks were registered using a Microscribe digitizer, nerve crossing angles and crossing locations were calculated. A logistic regression model was used to examine the association between the presence of a TON notch and degenerative/morphological characteristics.</div></div><div><h3>Results</h3><div>A slight notch was observed in 33 % of the facet joints and a clear notch in 7.7 % of the facet joints. Higher levels of joint degeneration, more lateral crossings of the TON, and a small separation between the nerve and the facet joint were independently associated with a higher odds of a TON notch. Additionally, a correlation was observed between the location and the angle of the nerve crossing and with the presence of a notch.</div></div><div><h3>Conclusion</h3><div>This study highlights the importance of degenerative and morphological factors in the occurrence of a TON notch in the C2-C3 facet joint. These results may have important clinical implications for diagnosis and treatment of occipital neuralgia and underscore the need for detailed anatomical assessments in patients with occipital headaches.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104282"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144089595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Repetitive intraarterial therapy with Milrinone and Nimodipine for severe refractory Vasospasm: own series and narrative literature review","authors":"Bernhard Wambacher ,&nbsp;Julia Kappel ,&nbsp;Joachim Vavrik ,&nbsp;Michel Loyoddin ,&nbsp;Martin Ortler ,&nbsp;Camillo Sherif","doi":"10.1016/j.bas.2025.104260","DOIUrl":"10.1016/j.bas.2025.104260","url":null,"abstract":"<div><h3>Introduction</h3><div>Cerebral vasospasm (VSP) following aneurysmal subarachnoid hemorrhage remains a major source of morbidity. The best rescue treatment option remains uncertain. Intraarterial (ia) Milrinone and Nimodipine were suggested as safe treatment options.</div></div><div><h3>Research question</h3><div>We aimed to evaluate the effect of repetitive endovascular intraarterial (ia) combined Milrinone and Nimodipine administration as rescue therapy for severe refractory cerebral VSP.</div></div><div><h3>Material &amp; methods</h3><div>In this retrospective single center series, we included only patients with refractory VSP despite maximum standard conservative therapy. Inclusion criteria for endovascular rescue treatment were elevated transcranial Doppler (TCD) &gt; 180 cm/s and/or significant clinical neurological deterioration. Patients received ia therapy with Nimodipine 2 mg followed by Milrinone 5 mg. Repetitive reinterventions were indicated in cases of refractory VSP. We evaluated pre- and direct posttreatment neurological status, mRS at final clinical follow-up, TCD values and measured the DSA pre-postinterventional vessel diameters.</div></div><div><h3>Results</h3><div>38 aSAH patients received ia therapy. Of those, 18 patients (47.4 %) received ≥3 interventions (average:3.4 ± 2.6; maximum:11). Immediate improvement of neurological deficits was seen in 31/38 patients (81.6 %). Overall mortality was low (3/38, 7.9 %). The clinical follow-up after 4 months showed persistent improvement in 24/38 patients (63.2 %) with good clinical outcomes (mRS ≤3). Immediate postinterventional angiographic improvement of vessel diameter was shown in 97,7 % (127/130) of all interventions. Neither severe cardiovascular nor reintervention-related adverse events were observed.</div></div><div><h3>Discussion and conclusion</h3><div>In this series repetitive ia interventions combining Milrinone and Nimodipine showed promising clinical results and low mortality for refractory VSP. Larger prospective randomized clinical trials are warranted.</div></div><div><h3>Trial registration</h3><div>ISRCTN, study ID ISRCTN36126862 registered 21.11.2018, retrospectively registered, <span><span>http://www.isrctn.com/ISRCTN36126862</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104260"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144154364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-craniotomy infections: A point-by-point approach","authors":"Giovanni Carone ,&nbsp;Marta Bonada ,&nbsp;Evelyn Gisell Belotti ,&nbsp;Eugenia D'Angeli ,&nbsp;Annica Piccardi ,&nbsp;Fabio Martino Doniselli ,&nbsp;Guido Gubertini ,&nbsp;Cecilia Casali ,&nbsp;Francesco DiMeco ,&nbsp;Massimiliano Del Bene","doi":"10.1016/j.bas.2025.104193","DOIUrl":"10.1016/j.bas.2025.104193","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-craniotomy neurosurgical infections (PCNIs) significantly challenge daily neurosurgical practice, affecting patient outcomes and imposing economic burdens on healthcare systems. Despite advances in surgical techniques and infection control protocols, PCNIs still contribute to surgical-related morbidity and mortality.</div></div><div><h3>Research question</h3><div>To address these unresolved questions through a comprehensive literature review.</div></div><div><h3>Material and methods</h3><div>We conducted a detailed literature review using the keywords \"Infection, Craniotomy, Neurosurgery,\" on PubMed, which yielded 2330 articles. Out of these, 171 were selected, based on relevance, and rigorously reviewed. The review aimed to answer thirteen major questions stemming from the management of PCNIs.</div></div><div><h3>Results</h3><div>PCNI incidences range from 0.7% to 8%, predominantly caused by gram-positive bacteria, especially Staphylococcus species. Significant risk factors identified include CSF leakage, emergency surgery, and certain tumour types, with infections typically manifesting post-discharge. Diagnostic approaches integrate clinical, radiological, and laboratory assessments, with advances in molecular diagnostics showing promising precision. While antibiotic prophylaxis remains effective, emerging resistance warrants cautious application. Surgical intervention is often indispensable for managing organ-space infections, with a trend towards bone flap preservation and one-step cranioplasty procedures in certain cases.</div></div><div><h3>Discussion and conclusion</h3><div>The management of PCNIs remains a major challenge. There is a critical need for standardization of definitions and data reporting. Advancements in diagnostic and therapeutic strategies may bring future improvements in clinical outcomes, despite antibiotic resistance phenomena and the complexity of surgical decisions required. Ultimately, major engagement is aimed at refining and updating clinical protocols to improve and standardize the management of PCNIs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104193"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102204","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":"Diagnosis and management of de novo non-specific spinal infections: European Association of Neurosurgical Societies (EANS) Spine Section Delphi consensus recommendations","authors":"Andreas Kramer ,&nbsp;Santhosh G. Thavarajasingam ,&nbsp;Jonathan Neuhoff ,&nbsp;Benjamin Davies ,&nbsp;Giuseppe Barbagallo ,&nbsp;Bertrand Debono ,&nbsp;Bart Depreitere ,&nbsp;Sven O. Eicker ,&nbsp;Nikolay Gabrovsky ,&nbsp;Marisa L. Gandia-Gonzalez ,&nbsp;Marcel Ivanov ,&nbsp;Radek Kaiser ,&nbsp;Stanislav Kaprovoy ,&nbsp;Nikolay Konovalov ,&nbsp;Jesus Lafuente ,&nbsp;Andrzej Maciejczak ,&nbsp;Bernhard Meyer ,&nbsp;Paulo Pereira ,&nbsp;Yana Petrova ,&nbsp;Wilco C. Peul ,&nbsp;Florian Ringel","doi":"10.1016/j.bas.2024.104178","DOIUrl":"10.1016/j.bas.2024.104178","url":null,"abstract":"<div><h3>Introduction</h3><div>The management of de novo non-specific spinal infections (spondylodiscitis - SD) remains inconsistent due to varying clinical practices and a lack of high-level evidence, particularly regarding the indications for surgery.</div></div><div><h3>Research question</h3><div>This study aims to develop consensus recommendations for the diagnosis and management of SD, addressing diagnostic modalities, surgical indications, and treatment strategies.</div></div><div><h3>Material and methods</h3><div>A Delphi process was conducted with 26 experts from the European Association of Neurosurgical Societies (EANS). Sixtytwo statements were developed on diagnostic workup, management decisions, surgical techniques, non-surgical treatment, and follow-up and submitted to the panel of experts.</div></div><div><h3>Results</h3><div>Consensus was reached on 38 of 62 statements. MRI was confirmed as the gold standard for diagnosis. Regarding surgical indications, the panel agreed that any new neurological deficit, even subtle, warrants surgical consideration. Motor deficits with a motor score (MRC) below 4 and bladder or bowel dysfunction were unanimously considered clear indications for surgery. For spinal deformity and instability, thresholds such as kyphosis &gt;20°, scoliosis &gt;10°, and vertebral body collapse &gt;50% were established to guide surgical decision-making. Minimally invasive surgery (MIS) was endorsed whenever feasible, and a 12 week antibiotic treatment regimen was favored in cases of complicated infections.</div></div><div><h3>Discussion and conclusion</h3><div>This EANS consensus provides updated recommendations for SD management, incorporating recent evidence on improved outcomes with surgical therapy. While these guidelines offer a more structured approach to clinical decision-making, further research is required to optimize surgical timing and validate the long-term impact of these treatment strategies.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104178"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048935","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":"Spinal decompression improves walking capacity in patients with lumbar spinal stenosis","authors":"Mikkel Ø. Andersen ,&nbsp;Leah Y. Carreon ,&nbsp;Stefan Hummel ,&nbsp;Elisabeth C. Smith ,&nbsp;Andreas K. Andresen","doi":"10.1016/j.bas.2025.104268","DOIUrl":"10.1016/j.bas.2025.104268","url":null,"abstract":"<div><h3>Introduction</h3><div>Lumbar spinal stenosis (LSS) is a degenerative condition causing back and leg pain, limiting walking due to neurogenic claudication. It affects 9–11 % of the population, rising to 47 % in those over 60, with cases expected to increase as the population ages. Non-surgical treatments are considered first-line options, although their effectiveness remains uncertain. Decompression surgery is still commonly performed for severe cases, even though a review comparing conservative treatments with surgical procedures, including spinal decompression, found no clear superiority of surgery. In Denmark, LSS accounts for 35 % of spinal surgeries in adults.</div></div><div><h3>Research question</h3><div>Does spinal decompression improve walking distance and gait speed in patients suffering from LSS?</div></div><div><h3>Methods</h3><div>Consecutive patients scheduled for decompression due to spinal stenosis enrolled at a regional spine centre. Timed walking distance (maximum of 1000m) was performed at baseline and at 3-, and 12 months post-op.</div></div><div><h3>Results</h3><div>One hundred and one patients were included in the study, mean age was 70.7 years, 77 % were female, with 90 % having had symptoms for more than 6 months prior to surgery.</div><div>Walking distance (123.9m–791.1m, p &lt; .001) and speed (0.91 m/s to 1.17 m/s, p &lt; .001) improved at one year after surgery.</div></div><div><h3>Discussion and conclusion</h3><div>Patients with severe walking impairment caused by spinal stenosis experienced substantial improvement of both walking speed and walking distance at all follow-up time points after undergoing spinal decompression.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104268"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143929173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}