Brain & spine最新文献

{"title":"Kinematic limitations during stair ascent and descent in patients with adult spinal deformity","authors":"Marc Fakhoury ,&nbsp;Rami Rachkidi ,&nbsp;Karl Semaan ,&nbsp;Krystel Abi Karam ,&nbsp;Maria Saadé ,&nbsp;Elma Ayoub ,&nbsp;Celine Chaaya ,&nbsp;Ali Rteil ,&nbsp;Elena Jaber ,&nbsp;Elio Mekhael ,&nbsp;Nabil Nassim ,&nbsp;Mohamad Karam ,&nbsp;Julien Abinahed ,&nbsp;Ismat Ghanem ,&nbsp;Abir Massaad ,&nbsp;Ayman Assi","doi":"10.1016/j.bas.2024.104153","DOIUrl":"10.1016/j.bas.2024.104153","url":null,"abstract":"<div><h3>Background</h3><div>Adults with spinal deformity (ASD) are known to have spinal malalignment, which can impact their quality of life and their autonomy in daily life activities. Among these tasks, ascending and descending stairs is a common activity of daily life that might be affected.</div></div><div><h3>Research question</h3><div>What are the main kinematic alterations in ASD during stair ascent and descent?</div></div><div><h3>Methods</h3><div>112 primary ASD patients and 34 controls filled HRQoL questionnaires and underwent biplanar X-from which spino-pelvic radiographic parameters were calculated. Patients were divided into 3 groups: 44 with sagittal malalignment (ASD-Sag: PT &gt; 25°, SVA&gt;5 cm or PI-LL&gt;10°), 42 with isolated thoracic hyperkyphosis (ASD-HyperTK: TK &gt; 60°), 26 with isolated frontal spine deformity (ASD-Front: Cobb&gt;20°). All participants underwent 3D motion analysis of the whole body while ascending and descending a stair step from which kinematic waveforms were extracted.</div></div><div><h3>Results</h3><div>During stair ascent, ASD-Sag exhibited an increased thorax flexion (20 vs 5°), a decreased lumbar lordosis L1L3-L3L5 (7 vs 14°), and an increased ROM of lumbo-pelvic joint (15 vs 10°, all p &lt; 0.05), compared to controls. Similar compensations were shown while descending the stairstep. ASD-HyperTK had similar kinematic limitations as ASD-Sag but to a lesser extent. ASD-Front had normal kinematic patterns. PCS-SF36 correlated to thorax flexion (r = −0.45) and ODI was correlated to pelvic tilt ROM (r = 0.46).</div></div><div><h3>Discussion and conclusion</h3><div>ASD subjects with sagittal malalignment tend to ascend and descend stairs with increased thorax flexion, making them more prone to falls. Compensation mechanisms occur at the head and lumbo-pelvic levels to maintain balance and avoid falling forward.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104153"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933954","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 onco-functional balance in diffuse gliomas: Evolution of the concept over the past decade – And the next steps","authors":"Hugues Duffau","doi":"10.1016/j.bas.2024.104170","DOIUrl":"10.1016/j.bas.2024.104170","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104170"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030362","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":"Sagittal changes in the dens significantly slowed after 12 years of age","authors":"Zhi-Jun Sha ,&nbsp;Sheng-Yu Fu ,&nbsp;Zhao-Rui Wang ,&nbsp;Hai-Feng Hang ,&nbsp;Ai-Bing Huang","doi":"10.1016/j.bas.2025.104233","DOIUrl":"10.1016/j.bas.2025.104233","url":null,"abstract":"<div><h3>Introduction</h3><div>The odontoid process is an important component of the upper cervical, and the process of ossification for odontoid does not cease completely until skeletal maturity.</div></div><div><h3>Research question</h3><div>The aim of the study was to obtain the inclination parameters of the dens in many healthy children and to analyze the trends and variations in the inclination of the dens.</div></div><div><h3>Material and methods</h3><div>All the CT data obtained from our hospital was reviewed for next measurement. Posterior edge of odontoid angle (PEOA), anterior edge of odontoid angle (AEOA), odontoid retroflection angle (ORA), posterior dens angulation angle (PDAA), screw insertion angle (SIA), and pB-C2 line were measured and analyzed.</div></div><div><h3>Results</h3><div>A total of 219 patients were divided into 6 groups based on age at an interval of 3 years. The mean values of PEOA and PDAA dropped dramatically with age up to the ten to twelve-year group and then decreased slightly until 18 years old. Moreover, the AEOA and ORA declined gradually from birth to adulthood. These parameters were statistical significance within different age groups. However, the SIA was largely unchanged from birth to 18 years old and appeared to be independent of age. In contrast, the PB-C2 line has a distinguish distribution, with an increase up to the nine to twelve-year age group and then gradually decreased until 18 years old.</div></div><div><h3>Discussion and conclusion</h3><div>The inclination of dens was constantly changing during pediatric growth, but the trends were different. These developmental changes slow down significantly after the age of 12 years.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104233"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609858","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":"Validation of the Scandinavian neurotrauma committee guidelines – A retrospective study in region Örebro county","authors":"Samuel Jara Josefsson ,&nbsp;Dhanisha Trivedi ,&nbsp;Patrick Vigren ,&nbsp;András Büki","doi":"10.1016/j.bas.2025.104231","DOIUrl":"10.1016/j.bas.2025.104231","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic Brain Injury (TBI) is a global health concern and a leading cause of trauma-related death worldwide. Computed tomography (CT) scan is the gold standard for screening for intracranial bleeding following TBI. Most cases of TBI are mild, with negative CT scans. Different instruments and guidelines are employed to better predict which patients need a CT scan and to minimise unnecessary radiation exposure and save resources. One such instrument is the Scandinavian Neurotrauma Committee guidelines.</div></div><div><h3>Research question</h3><div>To validate and examine adherence to the Scandinavian Neurotrauma Committee guidelines in Region Örebro County.</div></div><div><h3>Material and methods</h3><div>We executed a retrospective study with review of patient records and data analysis. Descriptive and comparative statistics were used, along with binary logistic regression analysis to account for confounding factors.</div></div><div><h3>Results</h3><div>A total of 505 cases were reviewed. Sensitivity of the guidelines was measured at 95% with specificity at 29%. The positive and negative predictive values were 0.77 and 0.69, respectively. A total of 17 false negative cases were found. One case required surgery, during which a chronic subdural hematoma was identified. Adherence to guidelines was 56%, with the lack of analysis of S100B primarily accounting for non-adherence. A total of 54 CT scans were performed outside of guideline indications.</div></div><div><h3>Discussion and conclusions</h3><div>The guidelines can effectively predict which patients need a CT scan. Increased adherence could potentially decrease the number of CT scans, while inclusion of older age limit as an independent rule-in law for CT scans would increase patient safety.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104231"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143609934","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":"Functional outcome after surgical treatment for spontaneous intracerebral hemorrhages: Development of the HeMAtOma score","authors":"Magnus Sættem ,&nbsp;Ola Lønn Jenssen ,&nbsp;Øystein Vesterli Tveiten ,&nbsp;Stephanie Schipmann ,&nbsp;Rupavathana Mahesparan","doi":"10.1016/j.bas.2025.104240","DOIUrl":"10.1016/j.bas.2025.104240","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous intracerebral hemorrhage (sICH) is a critical medical emergency associated with significant morbidity and mortality. The role of surgical intervention in improving functional outcomes remains a subject of debate.</div></div><div><h3>Objective</h3><div>This study evaluates the functional outcomes of patients undergoing surgical treatment for sICH and identifies risk factors predictive of poor outcomes.</div></div><div><h3>Methods</h3><div>A retrospective analysis of 100 patients treated surgically for sICH at Haukeland University Hospital between 2013 and 2022 was conducted. Baseline characteristics and clinical outcomes were collected. Functional outcomes were assessed using the modified Rankin Scale (mRS) at three months post-surgery. Independent risk factors for unfavorable outcomes (mRS ≥4) were identified through logistic regression.</div></div><div><h3>Results</h3><div>The mean age was 65.5 years (56 % males). At three months, 54 % of patients had an unfavorable outcome, including a 23 % mortality rate. Independent risk factors for poor outcomes included age ≥60 years (OR 7.8, 95 % CI 1.684–36.3, p = 0.009), oral anticoagulant use (OR 10.4, 95 % CI 1.495–72.665, p = 0.018), and hemorrhage location in the basal ganglia (OR 18.5, 95 % CI 3.398–100.717, p &lt; 0.001) or motor cortex (OR 8.6, 95 % CI 2.134–34.973, p = 0.003). These factors formed the basis of a new scoring system—the HeMAtOma score—which demonstrated good discriminatory ability (AUC 0.688) for predicting outcomes.</div></div><div><h3>Conclusion</h3><div>Functional outcomes following surgical treatment for sICH remain poor in many cases. The HeMAtOma score provides a practical tool for predicting surgical outcomes, aiding clinical decision-making in emergency settings. Future prospective studies are needed to validate the score.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104240"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769256","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":"Decompressive craniectomy following subarachnoid hemorrhage: A prospective Swedish multicenter study","authors":"Bryndís Baldvinsdóttir ,&nbsp;Erik Kronvall ,&nbsp;Elisabeth Ronne-Engström ,&nbsp;Per Enblad ,&nbsp;Paula Klurfan ,&nbsp;Johanna Eneling ,&nbsp;Peter Lindvall ,&nbsp;Helena Aineskog ,&nbsp;Steen Friðriksson ,&nbsp;Mikael Svensson ,&nbsp;Peter Alpkvist ,&nbsp;Jan Hillman ,&nbsp;Ola G. Nilsson","doi":"10.1016/j.bas.2025.104218","DOIUrl":"10.1016/j.bas.2025.104218","url":null,"abstract":"<div><h3>Introduction</h3><div>Decompressive craniectomy (DC) in patients with severe aneurysmal subarachnoid hemorrhage (aSAH) can be a life-saving procedure. The aim of this nationwide prospective study was to investigate the use of DC in aSAH patients in Sweden.</div></div><div><h3>Research question</h3><div>To explore the risk factors and functional outcome associated with DC in patients with aSAH.</div></div><div><h3>Material and methods</h3><div>Patients treated for aSAH at all neurosurgical centers in Sweden during a 3.5-year period (2014–2018) were prospectively registered. Clinical, radiological and treatment-related factors with regard to DC were analyzed using Chi-Square and logistic regression analysis. Functional outcome was assessed by the extended Glasgow outcome scale one year after the bleeding.</div></div><div><h3>Results</h3><div>During the study period, 1037 patients were treated for aSAH. Thirty-five patients (3.4%) underwent DC. At one year follow-up, 25 of these (71%) had unfavorable functional outcome. Multivariate logistic regression analysis revealed that poor clinical grade before aneurysm treatment, middle cerebral artery (MCA) aneurysm, edema on the initial computed tomography (CT), and adverse events during aneurysm occlusion were independent and significant risk factors for performing DC.</div></div><div><h3>Discussion and conclusion</h3><div>DC is relatively uncommon in aSAH patients and is related to increased risk of unfavorable outcome. However, favorable functional outcome was seen in 29% of patients with DC. Adverse events during aneurysm occlusion were significant risk factors for DC.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104218"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143487943","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":"Artificial intelligence and chordoma: A scoping review of the current landscape and future directions","authors":"Eddie Guo ,&nbsp;Rafael D. Sanguinetti ,&nbsp;Lyndon Boone ,&nbsp;Jiawen Deng ,&nbsp;Husain Shakil ,&nbsp;Mehul Gupta","doi":"10.1016/j.bas.2025.104271","DOIUrl":"10.1016/j.bas.2025.104271","url":null,"abstract":"<div><h3>Introduction</h3><div>Chordomas are rare, locally aggressive tumours that present significant treatment challenges due to their proximity to critical neurovascular structures. Artificial intelligence (AI) methodologies have shown promise in enhancing diagnostic precision, surgical planning, and prognostication in various cancers.</div></div><div><h3>Research question</h3><div>What is the current landscape of AI applications in chordoma management, and what are the key limitations and future directions for integrating AI into clinical practice for this rare malignancy?</div></div><div><h3>Materials and methods</h3><div>We conducted a scoping review following the PRISMA-ScR guidelines and the Arksey and O'Malley framework. A search of five databases with an end date of November 9, 2024, identified peer-reviewed studies assessing AI or machine learning applications in chordoma management. Data extraction focused on study characteristics, methodologies, clinical tasks, and performance metrics.</div></div><div><h3>Results</h3><div>Twenty-one studies published between 2017 and 2024 were included, encompassing 5486 patients. The studies addressed diverse clinical tasks: 7 focused on differentiating chordomas from other tumours or classifying subtypes, 6 on survival prediction, 2 on tumour segmentation, 2 on outcome prediction, and 4 miscellaneous tasks. Common algorithms used included convolutional neural networks, support vector machines, random forests, and clustering algorithms. Limitations identified across studies included small sample sizes, single-center data, reliance on single data modalities, and issues with model interpretability.</div></div><div><h3>Discussion and conclusion</h3><div>AI applications in chordoma management show potential in improving diagnostic accuracy, surgical planning, and prognostication. Future research should focus on collaborative efforts for larger, diverse datasets with external validation cohorts, interpretable multimodal models, and validation through prospective clinical trials.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104271"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143906277","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":"Is there a weekend effect in severe traumatic brain Injury? An observational, population-based study from the Norwegian Trauma registry","authors":"Joakim Stray Andreassen ,&nbsp;Mattis A. Madsbu ,&nbsp;David Andreas Thomas Werner ,&nbsp;Clemens Weber","doi":"10.1016/j.bas.2025.104263","DOIUrl":"10.1016/j.bas.2025.104263","url":null,"abstract":"<div><h3>Introduction</h3><div>Traumatic brain injury is prevalent and with severe injury the mortality is high. The aim of this study was to explore differences in mortality rates between weekday and weekend admissions for patients with severe traumatic brain injury (TBI) in Norway based on data from the National Trauma Registry of Norway (NTR).</div></div><div><h3>Research question</h3><div>Are mortality rates higher for patients with severe traumatic brain injury admitted on weekends compared to weekdays?</div></div><div><h3>Materials and methods</h3><div>This study is an observational cohort study based on prospectively collected, population-based data from the NTR. The study period was between January 01, 2017 and December 31, 2020 and included all patients with severe TBI registered in the database.</div></div><div><h3>Results</h3><div>During the 4 years-study period 627 patients with severe TBI were identified; the median age was 53.0 years (IQR 32.0-71.0). Weekend admissions involved significantly younger patients with a median age of 50.0 years compared to a median age of 57.0 years on weekdays (p = 0.013). Overall, the 30-day mortality rate was 39 %, with higher mortality observed on weekdays compared to weekends (43 % vs. 34 %; p = 0.025). Logistic regression analysis showed that age and higher AIS head injury severity were significantly associated with 30-day mortality, while admission timing (weekend vs. weekday) showed no association.</div></div><div><h3>Discussion and conclusion</h3><div>Weekend admissions in severe TBI are frequent and involves younger patients compared to weekdays. Our study did not find a weekend effect on the mortality rate for severe TBI in Norway based on data from the NTR.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104263"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143912626","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":"The influence of government-issued lockdowns during the COVID-19 pandemic on traumatic brain injuries in Tyrol, Austria","authors":"Victoria Schön ,&nbsp;Alina Farbmacher ,&nbsp;Lukas Grassner ,&nbsp;Barbara Klein ,&nbsp;Claudius Thomé ,&nbsp;Daniel Pinggera","doi":"10.1016/j.bas.2024.104159","DOIUrl":"10.1016/j.bas.2024.104159","url":null,"abstract":"<div><h3>Introduction</h3><div>In February 2020, COVID-19 infections started to spread in Austria. This was followed by governmental actions and constraints such as lockdowns, quarantine protocols, and a ban on outdoor sports. The goal of this study was to investigate the influence of these measures on the number of traumatic brain injuries (TBI) in the state of Tyrol.</div></div><div><h3>Methods</h3><div>The incidence of TBI during lockdowns and restrictions of outdoor activities in 2020 and 2021 were compared with corresponding periods in previous years. The data was retrospectively collected and analyzed.</div></div><div><h3>Results</h3><div>During the first lockdown in the winter of 2020/2021, there was a notably lower incidence of moderate and severe TBIs compared to the corresponding period in 2019/2020 (p = 0.016). Similarly, there was a reduction in TBIs from sports accidents during this period (p = 0.010). However, when comparing other lockdown periods to the previous years, no differences were observed.</div></div><div><h3>Conclusion</h3><div>The various governmental measures restricting mobility aimed to contain the COVID-19 pandemic but showed little influence on the number of TBI cases. Only a lockdown in the accident-prone winter months has influenced the incidence of TBIs.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104159"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973694","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}