Brain & spine最新文献

{"title":"The current state of cranioplasty in Europe – Results from a European cranioplasty survey","authors":"Paul Vincent Naser ,&nbsp;Parmenion Tsitsopoulos ,&nbsp;Friederike Zacharias ,&nbsp;Ana M. Castaño-Leon ,&nbsp;Andras Buki ,&nbsp;Bart Depreitere ,&nbsp;Thomas Van Essen ,&nbsp;Tommi K. Korhonen ,&nbsp;Harry Mee ,&nbsp;Iftakher Hossain ,&nbsp;Jussi Posti ,&nbsp;Laura Lippa ,&nbsp;Marios C. Papadopoulos ,&nbsp;Nicole Terpolilli ,&nbsp;Niklas Marklund ,&nbsp;Ondra Petr ,&nbsp;Peter Toth ,&nbsp;Teemu Luoto ,&nbsp;Sandro M. Krieg ,&nbsp;Andreas W. Unterberg ,&nbsp;Christos Tsitsipanis","doi":"10.1016/j.bas.2025.104214","DOIUrl":"10.1016/j.bas.2025.104214","url":null,"abstract":"<div><h3>Introduction</h3><div>Cranioplasty, a surgical procedure to restore skull integrity and aesthetic contour following decompressive craniectomy, poses challenges in material selection and timing, driven by the lack of guidelines and ongoing regulatory changes.</div></div><div><h3>Research question</h3><div>This study aimed to provide an overview of current cranioplasty practices in Europe, explicitly addressing a potential shift towards alloplastic materials and the management of patients with concomitant hydrocephalus.</div></div><div><h3>Material and methods</h3><div>An online survey was conducted among European neurosurgical centers from January to March 2024, collecting data on material preferences, timing of procedures, and management strategies for cranioplasty. Descriptive and statistical analyses were performed on 110 complete responses.</div></div><div><h3>Results</h3><div>Respondents favored alloplastic materials over autologous bone for cranioplasty, citing regulatory constraints and reduced infection risk as primary reasons. Variability was observed in the timing of procedures and the management of patients with hydrocephalus, with most centers adopting staged approaches.</div></div><div><h3>Discussion and conclusion</h3><div>The shift towards alloplastic materials in cranioplasty reflects regulatory pressures rather than material-specific considerations. Despite variability in practice, our findings underscore the need for standardized guidelines and further research to optimize patient outcomes. This study provides valuable insights into current practices and highlights areas for future investigation in cranioplasty.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104214"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520490","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":"Prevalence and natural development of thoracolumbar kyphosis in achondroplasia: A systematic review and meta-analysis","authors":"Chady Omara ,&nbsp;Rania A. Mekary ,&nbsp;Carmen L.A. Vleggeert-Lankamp","doi":"10.1016/j.bas.2024.104177","DOIUrl":"10.1016/j.bas.2024.104177","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracolumbar kyphosis (TLK) is a frequently reported spinal deformity in achondroplasia, which in combination with the characteristic narrow spinal canal in achondroplasia predisposes for symptomatic spinal stenosis. There is however no consensus on the optimal treatment, due to limited data on diagnostic criteria, the natural development and the prevalence of TLK.</div></div><div><h3>Research question</h3><div>This study aims to assess the prevalence, natural development, and diagnostic criteria for pathological TLK in individuals with achondroplasia.</div></div><div><h3>Material and methods</h3><div>A systematic review and meta-analysis were conducted. Studies involving achondroplasia patients, which reported TLK measurement methods were included. The primary outcome was the pooled prevalence of TLK, stratified by age.</div></div><div><h3>Results</h3><div>Eight studies, encompassing 852 patients, met the inclusion criteria. Pathological TLK was most frequently defined as a Cobb angle of 20° or greater, between T10 and L2. TLK was present in 87% (95% CI 80%–91%) of patients under two years old, decreasing to 33% (24%–43%) at age three, 26% (19%–35%) between five and ten years, and 23% (16%–31%) in patients aged 10–20 years.</div></div><div><h3>Discussion and conclusion</h3><div>Pathological TLK in achondroplasia, defined as a Cobb angle of 20° or greater, appears primarily in early childhood and often resolves by walking age. However, approximately one-fourth of cases persist into adulthood, with factors such as developmental motor delay and vertebral wedging contributing to this persistence. Routine clinical and radiological evaluations during childhood, along with conservative management, are recommended to mitigate the need for surgery during adulthood.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104177"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11761886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048862","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":"Reorganizing outpatient spine services increased efficiency and patient satisfaction","authors":"Arkan Sam Sayed-Noor ,&nbsp;Thomas Torstensson ,&nbsp;Björn Knutsson","doi":"10.1016/j.bas.2025.104245","DOIUrl":"10.1016/j.bas.2025.104245","url":null,"abstract":"<div><h3>Introduction</h3><div>The workload in orthopedic outpatient departments is increasing while the available medical resources are often limited.</div></div><div><h3>Research questions</h3><div>Can reorganizing the outpatient work routines for referred patients with spinal disorders improve cost-effectiveness and patient's experience of care (PEC) without negatively affecting the waiting time required for the healthcare guarantee?</div></div><div><h3>Material and methods</h3><div>We compared our standard routine (control group) to a new routine (study group) for evaluating referrals of patients with spinal complaints. In the control group, the referral was first evaluated by a spinal surgeon, and when deemed indicated, a visit to a spinal surgeon was booked. In the study group, a spinal surgeon first evaluated all referral notes and either assigned a spinal surgeon or a physiotherapist to meet the patient, depending on certain criteria. If considered eligible for surgical intervention, the patient is appointed for a follow-up visit to the spinal surgeon. For both groups, calculations were made for the number of waiting days and visits, as well as the cost. Also, we compared the PEC between the two groups through telephone interviews.</div></div><div><h3>Results</h3><div>The number of waiting days and visits, as well as the cost, were significantly reduced (p &lt; 0.01) in the study group. Also, the study group showed slightly higher mean values for the PEC components, with significant differences related to the waiting time, treatment with respect, and taking account of patient knowledge.</div></div><div><h3>Discussion and conclusions</h3><div>Reorganizing outpatient work routines could eliminate the need for locum doctors while maintaining patient satisfaction and reducing costs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104245"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143715867","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":"Comment on shortened treatment with nimodipine in aneurysmal subarachnoid hemorrhage","authors":"Begoña Guardiola ,&nbsp;Jon Pérez-Bárcena ,&nbsp;Daniel Agustín Godoy ,&nbsp;Juan Antonio Llompart-Pou","doi":"10.1016/j.bas.2025.104394","DOIUrl":"10.1016/j.bas.2025.104394","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104394"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144887324","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":"Surgical indications and techniques in ischemic cerebellar stroke – results from an international survey","authors":"Silvia Hernandez-Duran ,&nbsp;Sami Ridwan ,&nbsp;Beate Kranawetter ,&nbsp;Daniel Dubinski ,&nbsp;Thomas M. Freiman ,&nbsp;Veit Rohde ,&nbsp;Florian Gessler ,&nbsp;Sae-Yeon Won","doi":"10.1016/j.bas.2025.104314","DOIUrl":"10.1016/j.bas.2025.104314","url":null,"abstract":"<div><h3>Introduction</h3><div>Space-occupying ischemic cerebellar stroke (SOCS) is a neurological emergency, often leading to rapid deterioration due to brainstem compression and hydrocephalus.</div></div><div><h3>Research question</h3><div>The aim of this survey was to characterize surgical indications and techniques in SOCS.</div></div><div><h3>Methods</h3><div>An international survey was conducted, comprising 21 items. The first section inquired about general center characteristics and caseload. Secondly, surgical indications and techniques were investigated. The survey was carried out online via GoogleForms® from October to December 2024.</div></div><div><h3>Results</h3><div>A total of 216 answers were received. Most respondents worked at an academic hospital (57 %) and were consultants (76 %). A certified stroke unit was present in 169 cases (87 %), and a dedicated neuro-ICU was also common (65 %). While most respondents (189/195, 97 %) performed surgery for SOCS, less than half (93/195, 48 %) had standardized indications for it. Infarct volume was considered when indicating surgery in 136/195 (70 %) of cases, with 30 mL being the most common threshold (62/136, 46 %). Concomitant brainstem infarction did not represent a contraindication for surgery. Suboccipital decompressive craniectomy was the most common surgical technique (155/194, 80 %), but a standardized craniectomy size was seldom (75/155, 48 %). Infarct resection was additionally performed in 125/194, 64 % cases. External ventricular drains (186/194, 86 %), duraplasty (112/194, 52 %), and resection of C1 arch (62/194, 29 %) were variably added to surgery.</div></div><div><h3>Conclusions</h3><div>Our survey reveals that while surgery is routinely performed for SOCS, neither indications nor techniques are standardized. Evidence must grow stronger to create guidelines to indicate and delineate surgery in SOCS.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104314"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631443","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":"Interpersonal and systemic factors in initiating, developing and maintaining collaborations between European neurosurgical departments and institutions in low-resources settings: A qualitative study","authors":"Nicolò Marchesini ,&nbsp;Vicki M. Butenschoen ,&nbsp;Andreas K. Demetriades ,&nbsp;Said Idrissa Ahmada ,&nbsp;Fazlul Hoque ,&nbsp;Thomas Kapapa ,&nbsp;Patrick D. Kamalo ,&nbsp;Pablo González-López ,&nbsp;Rupavathana Mahesperan ,&nbsp;Ondra Petr ,&nbsp;Wilco Peul ,&nbsp;Nicephorus Boniface Rutabasibwa ,&nbsp;Ellianne J. dos Santos Rubio ,&nbsp;Abenezer Tirsit Aklilu ,&nbsp;Jake Timothy ,&nbsp;Enoch O. Uche ,&nbsp;Magnus Tisell","doi":"10.1016/j.bas.2025.104303","DOIUrl":"10.1016/j.bas.2025.104303","url":null,"abstract":"<div><h3>Introduction</h3><div>Neurosurgical care in low- and middle-income countries faces persistent challenges, including insufficient infrastructure, lack of trained surgeons, and limited access to sustainable training programs. Collaborative initiatives with high-income countries aim to address these gaps. However, in-depth studies of European-led partnerships and the interpersonal and systemic factors underpinning their success remain limited.</div></div><div><h3>Research question</h3><div>What are the most salient interpersonal and systemic factors relevant to the a) initiation, b) development, and c) maintenance of effective and sustainable collaborations between European neurosurgical departments and institutions in resource-limited settings?</div></div><div><h3>Material and methods</h3><div>We conducted a prospective qualitative study using semi-structured interviews with fourteen matched neurosurgeons—seven from European centers and seven from LMIC institutions—engaged in such collaborations. Data were collected virtually between May and August 2024. Transcripts were analyzed thematically to identify major themes, which were coded and categorized.</div></div><div><h3>Results</h3><div>Twelve themes emerged, grouped into three stages: a) initiation: trust and personal connections, systematic planning and foundations, local context and needs, institutional and government support; b) development: capacity building and skills development, academic and research growth, challenges to development and adaptation; c) maintenance: sustainability and independence, resources and logistical support, communication and continuous commitment, outcome measures and accountability, and challenges to maintenance and advices for continuity.</div></div><div><h3>Discussion and conclusions</h3><div>Findings highlight recurring interpersonal and systemic dynamics central to successful long-term partnerships. This study provides context-specific, real-world insights into their practical execution. Future efforts should focus on developing targeted recommendations to strengthen global neurosurgical collaborations and address inequities in access to care.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104303"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470365","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":"Effect of orbitotomy on surgical freedom in Endoscopic Transorbital Approach (ETOA) to the skull base: An anatomical study","authors":"Calvin Hoi-kwan Mak ,&nbsp;Ben Chat Fong Ng ,&nbsp;Stacey Carolyn Lam ,&nbsp;Tse Tat Shing ,&nbsp;Hunter Kwok-lai Yuen ,&nbsp;Hao-Chun Hsu ,&nbsp;Sebastien Froelich","doi":"10.1016/j.bas.2025.104300","DOIUrl":"10.1016/j.bas.2025.104300","url":null,"abstract":"<div><h3>Introduction</h3><div>To investigate the angle of attacks and surgical freedom in different extents of orbitotomy for Endoscopic Transorbital Approach to the skull base.</div></div><div><h3>Background</h3><div>Endoscopic Transorbital Approach is gaining popularity among skull base surgeons over the last decade.The surgery can be performed with or without orbitotomy to increase surgical freedom for deeply seated intracranial lesion.</div></div><div><h3>Study design</h3><div>This is an anatomical and radiological study in which DICOM data of CT Brain is retrieved and analyzed for 4 types of orbitotomies (Group 1: supraorbital rim with lateral orbital rim resection; Group 2: limited supraorbital rim with lateral orbital rim resection; Group 3: lateral orbital rim resection; Group 4: No orbitotomy) on both sides of 19 patients. Angle of attacks and surgical freedom were calculated with reference to three dimensional coordinates of 4 target points (1. Foramen ovale; 2. Foramen rotundum; 3. End of lacerum segment of internal carotid artery; 4. Internal acoustic meatus) and compared.</div></div><div><h3>Results</h3><div>There is a statistically significant increase in surgical freedom, horizontal and vertical angle (p &lt; 0.001) in Group 1 to 3 compared to Group 4 (No orbitotomy). With greater extent of orbitotomy, there is a larger increase in surgical freedom.</div></div><div><h3>Conclusion</h3><div>Removal of lateral orbital rim is useful to increase the angle of attack to skull base lesions whereas the area of orbitotomy is the main determinant of surgical freedom in ETOA. Lateral orbital rim removal should be considered when ETOA is used for deep seated skull base pathologies.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104300"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144523484","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":"Diagnostic reliability of the FinSpine nationwide spine surgery registry: Comparison between clinical registry diagnoses and blinded imaging assessments","authors":"Jussi P. Repo ,&nbsp;Katri Pernaa ,&nbsp;Liisa Pekkanen ,&nbsp;Juho Hatakka ,&nbsp;Heikki Mäntymäki ,&nbsp;Antti Malmivaara ,&nbsp;Henri Salo ,&nbsp;Eetu Suominen ,&nbsp;Jyrki Kankare ,&nbsp;Jukka Huttunen","doi":"10.1016/j.bas.2025.104325","DOIUrl":"10.1016/j.bas.2025.104325","url":null,"abstract":"<div><h3>Introduction</h3><div>The Finnish national spine surgery registry (FinSpine) collects data on patients, operative procedures, and outcomes.</div></div><div><h3>Research question</h3><div>Is the reliability of diagnosis collection for the FinSpine registry across various institutions sufficient?</div></div><div><h3>Methods and methods</h3><div>A random sample of 110 spine surgeries performed in Finland since 2017 was selected from the FinSpine registry. Details of the operative procedures, including characteristics of the hospitals, primary and secondary diagnoses, the anatomical level of the spine surgery, and the date of the surgery, were recorded. Three experienced spine surgeons assessed radiographic imaging independently on two occasions with a one-month interval. Cohen and Fleiss kappa values were calculated for inter- and intra-rater reliability with registry diagnoses as the standard.</div></div><div><h3>Results</h3><div>Altogether, 85 patients were included in the final analysis. The intra-rater reliability for primary diagnosis was moderate to almost perfect among all three evaluators, with Cohen's kappa values ranging from 0.765 to 0.847. In the inter-rater reliability analysis, there was moderate agreement between evaluators 1 and 2 (Cohen's κ = 0.592, SD 0.061) and evaluators 1 and 3 (κ = 0.595, SD 0.061). The agreement was substantial between evaluators 2 and 3 (κ = 0.676, SD 0.057). The Fleiss' kappa value was 0.622 (95 % CI from 0.570 to 0.673). The inter-rater reliability ranged from 0.596 to 0.652 when the evaluators' diagnoses were compared with those in the registry.</div></div><div><h3>Discussion and conclusion</h3><div>The primary diagnoses recorded in the FinSpine registry are reproducible and reliable, making the registry data valuable for further research and clinical decision-making.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104325"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144614344","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":"Robot-assisted three column trans-intervertebral osteotomy by combined navigated trajectories: A feasibility study and technical report","authors":"Yi Huang ,&nbsp;Jianfeng Yang ,&nbsp;Tianhao Wang ,&nbsp;Wenhao Hu ,&nbsp;Xuesong Zhang ,&nbsp;GuoQuan Zheng ,&nbsp;Yan Wang","doi":"10.1016/j.bas.2025.104330","DOIUrl":"10.1016/j.bas.2025.104330","url":null,"abstract":"<div><h3>Introduction</h3><div>Spinal osteotomy is indicated for malalignment and deformity, but the degree of osseous resection is mainly determined by the surgeon's experience. Navigation and robotics are techniques for the precise placement of pedicle screws.</div></div><div><h3>Research question</h3><div>Can an innovative combined navigated trajectory (CNT) design based on a spinal robot achieve precise 3-column osteotomy.</div></div><div><h3>Materials and methods</h3><div>The Mazor X Stealth Edition (MXSE) robotic system was used to design and execute type II trans-intervertebral osteotomy (TIO) via CNT. Preoperative CT images of a synthetic spine model and a cadaveric specimen were processed to create multitrajectory plans aligned in the sagittal plane, traversing the pedicle bases. The intraoperative workflow included a robotic setup, bone mount bridge fixation, pre- and postresection registration, and robotic trajectory drilling followed by osteotomy completion via a bone chisel.</div></div><div><h3>Results</h3><div>After posterior element resection, the osteotomy vertebrae were successfully registered in both the synthetic and cadaveric models. Multitrajectory drilling followed by chisel combination achieved complete TIO. Quantitative analysis revealed that the deviation of the posterior vertebral wall from the preoperative plan was less than 2 mm in both specimens, with corresponding length and angle differences of −4.00 %/–1.55° (synthetic) and −6.95 %/–2.59° (cadaveric).</div></div><div><h3>Discussion and conclusion</h3><div>Combined navigated trajectory spinal resection is a possible technique for quantitative spinal osteotomy using MXSE. Biomechanical and clinical studies are needed to further evaluate the suitability and safety of this technique.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104330"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144702744","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":"Influence of subaxial cervical spine surgery on the sagittal alignment of the cervical and global spine. A prospective observational study","authors":"M. Bolcha ,&nbsp;J. Lodin ,&nbsp;D. Cihlář ,&nbsp;M. Sameš ,&nbsp;P. Vachata","doi":"10.1016/j.bas.2025.104373","DOIUrl":"10.1016/j.bas.2025.104373","url":null,"abstract":"<div><h3>Introduction</h3><div>Sagittal balance is essential for posture, horizontal gaze and avoiding overloading the posterior segment of the spine.</div></div><div><h3>Research question</h3><div>Does single- or double-level anterior cervical discectomy and fusion (ACDF) alter (1) cervical and global sagittal parameters and (2) outcomes in patients with kyphotic versus non-kyphotic alignment?</div></div><div><h3>Material and methods</h3><div>In a prospective cohort, 103 adults underwent 1–2-level ACDF. Standing radiographs were obtained pre-operatively and 24 months post-operatively. Analysed were six cervical parameters, thoracolumbar curves and spinopelvic angles. Pain was rated on a Visual analogue scale and disability with the Neck Disability Index.</div></div><div><h3>Results</h3><div>Kyphotic spines (n = 43) converted to lordosis (median ΔC2–C7 Cobb = +6.4°, CI 95 % 3,84-10,9) with concomitant reductions in C2–C7 SVA and rise in T1 slope (all p &lt; 0.05); thoracolumbar and pelvic parameters were unchanged. Non-kyphotic spines (n = 60) showed no significant radiographic shifts. Both groups clinically improved: Kyphotic group VAS neck −2, VAS Arm −4 (p = 0,00037), non-kyphotic group VAS neck −3, VAS arm −3 (p = 0,00001) and clinical gains were independent of lordotisation magnitude. In the kyphotic group, the significant importance of the T1S-CL parameter was found. No reoperations, adjacent-segment disease or serious complications occurred.</div></div><div><h3>Discussion and conclusion</h3><div>Single-/double-level ACDF affect local sagittal paramethers, correct kyphosis and modulates the cervicothoracic junction, but does not influence distal spinal or pelvic alignment. Pain relief and functional improvement are comparable in kyphotic and non-kyphotic patients, irrespective of relordotization magnitude. Patients may not require aggressive lordosis correction, based on their individual sagittal profiles. Nonetheless, these results and conclusions are limited to single-/double-level ACDFs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104373"},"PeriodicalIF":2.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772088","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}