Brain & spine最新文献

{"title":"Pre-operative visualization of cerebral vasculature using photon-counting CT ultra-high resolution pure lumen imaging.","authors":"Victor Volovici, Yasmin Sadigh, Marcel Dijkshoorn, Anke van der Eerden, Renske Gahrmann","doi":"10.1016/j.bas.2026.107451","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107451","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative neuronavigation relies on multimodal imaging to delineate lesion anatomy and surrounding neurovascular structures. Ultra-high-resolution photon-counting CT (UHR PCCT) provides submillimeter vascular and osseous detail and may improve surgical planning compared with conventional CT and MRI.</p><p><strong>Research question: </strong>To evaluate the potential added value of UHR PCCT for preoperative neuronavigation in selected complex intracranial lesions.</p><p><strong>Materials and methods: </strong>We performed a selected retrospective observational pilot study of patients who underwent preoperative PCCT angiography and/or venography for neuronavigation between 2023 and 2026 at a tertiary neurosurgical center. Of 45 examinations, twenty patients were selected based on lesion complexity, vascular involvement, and size. PCCT findings were compared with conventional CT and MRI. Operative reports were retrospectively reviewed for intraoperative use of PCCT-derived findings.</p><p><strong>Results: </strong>The cohort comprised twelve meningiomas, two aneurysms, one arteriovenous malformation, and five other intracranial lesions. Median age was 53 years (IQR 46-63), and 80% were female. PCCT demonstrated additional arterial anatomical information in eleven patients (55%), including perforators in two (10%), and additional tumor vascular supply in seven patients (35%). Additional venous anatomical information was identified in six and skull base, orbital, or osseous findings in eight (40%) patients. The additional PCCTA findings were used intraoperatively in all patients.</p><p><strong>Discussion and conclusion: </strong>UHR PCCT demonstrates substantial potential as a comprehensive imaging modality for neurosurgical navigation and provides additional neurovascular and osseous anatomical information in this selected cohort. The definitive intraoperative use of these findings merits prospective comparative validation of PCCT as a complementary preoperative imaging modality.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107451"},"PeriodicalIF":2.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119342","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":"Implementing a multimodal simulation-based curriculum in a neurosurgery residency program: The University of Milan experience.","authors":"Giovanni Carone, Nicolò Castelli, Elisa Pellencin, Torstein R Meling, Marco Locatelli, Francesco DiMeco, Alessandro Perin","doi":"10.1016/j.bas.2026.107457","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107457","url":null,"abstract":"<p><strong>Introduction: </strong>Neurosurgical training must balance progressive autonomy with patient safety. Simulation-based education, including 3D-printed models and digital platforms, offers standardized environments to practice key surgical skills.</p><p><strong>Research question: </strong>To evaluate the impact of a structured, PGY-adapted, multimodal simulation curriculum on neurosurgical residents' self-reported confidence.</p><p><strong>Material and methods: </strong>A one-day simulation curriculum was implemented at the Besta NeuroSim Center (University of Milan). Thirty-eight neurosurgical residents (PGY1-PGY5) completed modules on multilayer closure, ventriculostomy (EVD placement), and meningioma and glioma resection using patient-specific 3D-printed models and digital/haptic simulators, as well as intraoperative ultrasound (ioUS) training. Confidence was assessed pre- and post-course using a 5-point Likert scale; satisfaction was collected post-course.</p><p><strong>Results: </strong>Confidence increased across most tasks and training levels, with the greatest relative gains in tumor resection and ioUS interpretation, where baseline confidence was lowest. Overall confidence improved from 1.2 to 2.0 in PGY1 and from 3.0 to 3.67 in PGY5. Satisfaction was high, with enjoyment scores ranging from 4.2 to 4.75 and willingness to recommend from 4.6 to 4.9.</p><p><strong>Discussion and conclusion: </strong>A structured, multimodal simulation curriculum is feasible within a neurosurgical residency program and improves self-reported confidence across training levels. These findings support the integration of simulation-based training to enhance standardization and promote a patient safety-driven culture.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107457"},"PeriodicalIF":2.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167180","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":"Clinical and radiological features of infectious spondylodiscitis in an Italian cohort: a retrospective study.","authors":"Patrizia Pasculli, Michele Antonacci, Maria Antonella Zingaropoli, Serena Bozzini, Federica Marincola, Federica Dominelli, Federica Ciccone, Leonardo Bosi, Stefano Perotti, Miriam Lichtner, Maria Rosa Ciardi, Claudio Maria Mastroianni","doi":"10.1016/j.bas.2026.107456","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107456","url":null,"abstract":"<p><strong>Introduction and research question: </strong>Infectious spondylodiscitis (IS) is a rare spinal infection that affects the vertebrae, intervertebral discs, and adjacent structures. Despite many advances, delays in diagnosis and treatment remain prevalent. The primary objective of this retrospective observational study was to improve clinical outcomes, support differential diagnosis, and provide guidance for management when the identification of a pathogen is not feasible.</p><p><strong>Materials and methods: </strong>A comprehensive investigation was conducted to examine clinical, radiological, and laboratory characteristics of patients diagnosed with microbiologically confirmed spondylodiscitis.</p><p><strong>Results discussion and conclusion: </strong>A total of 70 patients diagnosed with infectious spondylodiscitis (IS) were enrolled over a period of 12 years (2013-2025). Patients were stratified into two groups: a) IS with an identified pathogen and b) IS with unknown etiology. The first group comprised 43 patients in whom the pathogen was identified through a blood culture or tissue biopsies (61.4%). These patients experienced a higher frequency of concurrent involvement of multiple spinal sites(p = 0.0196), a considerably prolonged hospital stay (p = 0.0355) and more severe baseline pain (p = 0.0256) in comparison with IS with unknown etiology. Additionally, the presence of infection in several sites were found to be associated with an increased probability to identify the causative pathogen (p = 0.0354).The early and accurate diagnosis of the condition is crucial, and this can be facilitated using clinical, laboratory, and imaging parameters, especially magnetic resonance imaging (MRI). The integration of clinical parameters with pain assessment has the potential to facilitate clinical prediction, inform invasive diagnostic decisions, and enhance treatment response monitoring.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107456"},"PeriodicalIF":2.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654465/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168656","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":"Permanent neurological morbidity after microsurgical resection of hereditary hemorrhagic telangiectasia-associated brain arteriovenous malformations: a systematic review and illustrative case.","authors":"Ján Buvala, Christopher S Ogilvy, Juraj Šteňo, Juraj Klepoch, Vladimír Javorka, Michaela Jezberová, Peter Jankovič, Parvez M Shaikh, Andrej Šteňo","doi":"10.1016/j.bas.2026.107455","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107455","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal management of brain arteriovenous malformations (AVMs) in patients with hereditary hemorrhagic telangiectasia (HHT) remains controversial. Some authors recommend conservative management based on the presumed lower rupture risk compared to sporadic AVMs, others advocate surgical treatment. No systematic review has focused on permanent neurological morbidity following resection of HHT-associated AVMs, leaving a significant gap in the literature.</p><p><strong>Research question: </strong>Do the unique genetic features and angio-architecture of HHT-associated AVMs result in a different profile of postoperative neurological morbidity compared to sporadic AVMs?</p><p><strong>Materials and methods: </strong>A systematic search of PubMed, Embase, and Cochrane databases (1947-April 2026) was conducted per PRISMA 2020 guidelines; 18 publications reporting surgically treated HHT-associated brain AVMs were identified, 12 were included in the comparative analysis. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Permanent morbidity rates were compared with unselected sporadic AVM series using Fisher's exact test with sensitivity analyses.</p><p><strong>Results: </strong>Among 91 patients, pooled incidence of new permanent neurological deficits was 9.9% (95% CI: 4.6-18.0%). No significant difference was found compared to unselected sporadic AVM cohorts. One study contributed 78% of permanent deficit events; its exclusion reduced the rate to 2.9%. No postoperative mortality was reported.</p><p><strong>Discussion and conclusion: </strong>No significant difference in permanent neurological morbidity was demonstrated between HHT-associated and sporadic AVM resections. However, the small sample size precludes definitive conclusions. These hypothesis-generating findings may aid in individualized risk assessment and shared decision-making. An illustrative case is presented to demonstrate the clinical context motivating this review.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107455"},"PeriodicalIF":2.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119403","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":"Clinical course and surgical outcomes of cerebral cavernous malformations: Insights from a large single-center experience.","authors":"Pavlina Lenga, Janis T Linke, Edgar Tessmann, Bogdana Suchorska, Johannes Walter, Sandro M Krieg, Moritz Scherer","doi":"10.1016/j.bas.2026.107454","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107454","url":null,"abstract":"<p><strong>Introduction: </strong>Clinical decision-making for cerebral cavernous malformations (CCMs) requires balancing hemorrhage risk against surgery-related morbidity, yet clinically applicable risk stratification remains limited.</p><p><strong>Research question: </strong>To examine hemorrhage during recorded follow-up, postoperative complications, and functional outcomes after conservative and surgical management of CCMs.</p><p><strong>Material and methods: </strong>We retrospectively analyzed 268 patients treated between 2014 and 2021. Clinical, radiological, and treatment variables were collected. Functional outcome was assessed using the modified Rankin Scale (mRS), analyzed as an ordinal outcome using paired nonparametric tests. Recorded untreated observation was censored at surgery; hemorrhage rates were reported with exact 95% confidence intervals (CIs).</p><p><strong>Results: </strong>At baseline, most patients presented with hemorrhage and 25.4% of lesions were infratentorial. Most were managed conservatively (72.8%), whereas 27.2% underwent surgery. Median time from diagnosis to surgery was 48 days. Postoperative neurological complications occurred in 20/73 patients (27.4%), including seizure-related events (11.0%), diplopia in (4.1%), and hemiparesis in (4.1%). Among 68 surgical patients with paired assessments, median mRS was 1 [IQR 1-1] at baseline and 0 [0-1] at last follow-up; residual disability was greater in brainstem lesions. Two new radiographic hemorrhages were documented during 250.3 person-years in 129 patients with untreated observation (0.80/100 person-years; 95% CI 0.10-2.89). Age was not associated with postoperative complications (OR 1.01/year, 95% CI 0.97-1.04).</p><p><strong>Discussion and conclusion: </strong>In this tertiary-center cohort, favorable functional recovery was observed in selected surgical patients, but brainstem CCMs remained associated with residual morbidity. Sparse hemorrhage events and confounding by indication precluded treatment comparisons or a validated risk-stratification framework.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107454"},"PeriodicalIF":2.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119320","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":"Passive intraoperative motor fMRI under general anesthesia during open-craniotomy glioma surgery: a prospective technical feasibility study.","authors":"Jonathan Wais, Julia Shawarba, Vitalij Zeiser, Gilbert Hangel, Philipp Lazen, Georg Widhalm, Florian Ph S Fischmeister, Ammar Mallouhi, Gregor Kasprian, Karl Roessler","doi":"10.1016/j.bas.2026.107446","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107446","url":null,"abstract":"<p><strong>Introduction: </strong>Sensorimotor localization is important during peri-Rolandic glioma surgery. We assessed passive intraoperative motor functional MRI (pifMRI) under general anesthesia.</p><p><strong>Research question: </strong>Can pifMRI provide useable sensorimotor maps before and after resection for neuronavigation and comparison with cortical stimulation?</p><p><strong>Material and methods: </strong>Eight adults (24-72 years; median, 57.5) underwent pifMRI intraoperatively in a two-room 3-T intraoperative MRI setting. With cranium open, blood oxygen level-dependent signals were elicited by passive flexion-extension of digits II-V. Maps were integrated into neuronavigation and used for corticospinal tract tractography. Given the exploratory sample and absent systematic coordinate-level recording, analyses were descriptive.</p><p><strong>Results: </strong>Useable activation in the primary sensorimotor region was obtained in all patients. Stimulation at pifMRI-defined regions elicited motor responses in all patients. However, negative sites and coordinate-level distances were not recorded, precluding diagnostic-accuracy and distance analyses. Post-resection pifMRI was obtained in seven patients. Median tumor volume decreased from 17.05 to 2.78 cm³; median extent of resection was 84.5% (range, 44%-100%). Six patients developed new or worsened deficits; five recovered fully and one improved by 3 months. All five patients with preoperative focal motor seizures were Engel Ia at 3 months, an uncontrolled observation not attributable to pifMRI. Mean imaging time was 48 min 45 s; each pifMRI acquisition lasted about 5 min.</p><p><strong>Discussion and conclusions: </strong>This prospective series supports the feasibility of acquiring and integrating pifMRI during glioma surgery, including after resection. Correspondence with positive stimulation sites is hypothesis-generating with no quantitative validation of mapping accuracy or clinical efficacy.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107446"},"PeriodicalIF":2.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13654473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168074","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":"Penetrating brain injury from captive-bolt guns: A retrospective multicenter study of 77 cases.","authors":"Norbert Svoboda, Jakub Petrzelka, Ivana Roskova, Pavel Poczos, Jiri Dostal, Hynek Zitek, Stefan Reguli, Anhelina Khadanovich, Marek Grubhoffer, Martin Cerny, David Netuka, Martin Majovsky","doi":"10.1016/j.bas.2026.107453","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107453","url":null,"abstract":"<p><strong>Background: </strong>Captive bolt guns (CBG), designed for animal slaughter, are occasionally misused in self-harm or assault. Data on associated cranial injuries remain limited. This study provides the largest multicenter analysis to date of CBG-related penetrating brain injuries, focusing on epidemiological, clinical, and radiological characteristics and predictors of outcome.</p><p><strong>Methods: </strong>A retrospective multicenter study was conducted across seven Czech Level 1 trauma centers between 2005 and 2025. Clinical, radiological, and epidemiological data were analyzed. Correlation and ROC analyses identified predictors of mortality and poor functional outcome (GOSE ≤ 4). Thirty-day mortality and long-term survival after self-inflicted CBG injury were compared with those of patients with self-inflicted conventional firearm brain injuries treated at Military University Hospital Prague.</p><p><strong>Results: </strong>77 patients (mean age 58; 75 male) were included. Most injuries were self-inflicted (97%) and had midline entry sites (70%). Thirty-day mortality was 56%, and poor neurological outcome occurred in 78%. Lower admission GCS, basal cistern compression, diffuse subarachnoid hemorrhage, larger intracerebral hematoma volume, and longer intracranial tract length were associated with poor outcome. Surgical treatment was associated with lower 30-day mortality. ROC-derived thresholds were 11.5 mL for hematoma volume and 60.5 mm for tract length. Five-year Kaplan-Meier mortality was 78.2% after self-inflicted CBG injury and 82.1% after conventional firearm injury (log-rank p = 0.228).</p><p><strong>Conclusions: </strong>CBG injuries represent a rare but distinct subtype of penetrating brain trauma characterized by unique radiological features and delayed mortality. These findings may improve prognostic assessment and support early clinical decision-making in patients with CBG-related brain injury.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107453"},"PeriodicalIF":2.7,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13677420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149225542","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":"Letter to the editor concerning \"Development and validation of a machine learning model utilizing the ACS-NSQIP database for predicting early postoperative Re-operation in lumbar microdiscectomy\" by M.M. Dagli et al.","authors":"Jin Yan, Yang Liu, Kaiyuan Yang, Boyan Su","doi":"10.1016/j.bas.2026.107449","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107449","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107449"},"PeriodicalIF":2.7,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119372","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":"Epidemiology and treatment trends in cervical, thoracic and lumbar disc herniation- a nationwide analysis.","authors":"Joan Alsolivany, Anton Früh, Ahmad Almahozi, Nora Dengler, Nils Hecht, Peter Vajkoczy, Christina Susanne Mark-Sargut, Tarik Alp Sargut","doi":"10.1016/j.bas.2026.107448","DOIUrl":"https://doi.org/10.1016/j.bas.2026.107448","url":null,"abstract":"<p><strong>Objective: </strong>Degenerative disc herniations are a major contributor to neurological disability and healthcare utilization. However, nationwide data on temporal demographic trends and treatment patterns in cervical and thoracolumbar disc herniation remain limited. This study aimed to analyze long-term epidemiological and treatment trends in Germany over a 10-year period.</p><p><strong>Methods: </strong>This retrospective population-based study analyzed nationwide hospital discharge data from the German Federal Statistical Office between 2014 and 2023. Patients hospitalized with cervical disc herniation (CDH; ICD-10-GM M50.+) or thoracolumbar disc herniation (TLDH; M51.+) were included. Demographic characteristics, hospitalization rates, treatment procedures, comorbidities, and temporal trends were evaluated descriptively and stratified by diagnosis category.</p><p><strong>Results: </strong>A total of 1,495,546 inpatient cases were identified, including 1,254,674 TLDH cases (83.9%) and 240,872 CDH cases (16.1%). The most affected age group was 45-60 years, with a slight male predominance. Since 2018, a demographic shift toward older patients was observed, with the proportion of individuals aged ≥80 years increasing from 2.1% in 2014 to 4.4% in 2023. Hospitalization rates declined substantially after 2020. Mean length of stay decreased from 6.0 to 4.5 days for TLDH and from 7.1 to 5.2 days for CDH. Injection-based therapies declined markedly, whereas operative volumes remained comparatively stable. The most frequent comorbidities were hypertension, diabetes mellitus, and coronary artery disease across both cohorts throughout.</p><p><strong>Conclusion: </strong>Hospitalizations for CDH and TLDH declined over time, while the proportion of elderly patients increased considerably. The COVID-19 pandemic temporarily reduced hospitalization rates, and hospital stays shortened substantially, reflecting ongoing structural changes in spine care.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107448"},"PeriodicalIF":2.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119411","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 accuracy of pedicle screw placement in thoracolumbar fractures: A comparative study of automated cone-beam CT-based navigation and conventional fluoroscopy.","authors":"Kjell Alexander Thunes Akre, David Andreas Thomas Werner, Maziar Behbahani, Cecilia Isabella Alexandra Avellan, Knut Harboe, Eric Franssen, Anne Kristin Reve, Clemens Weber","doi":"10.1016/j.bas.2026.107447","DOIUrl":"10.1016/j.bas.2026.107447","url":null,"abstract":"<p><strong>Introduction: </strong>Pedicle screw fixation is a standard technique for stabilizing unstable thoracolumbar fractures. Mobile cone-beam CT (CBCT) systems with robotic image acquisition enable automated navigation workflows, but clinical data in spine trauma remain limited.</p><p><strong>Research question: </strong>To compare pedicle screw accuracy and perioperative outcomes between automated CBCT-based navigation and conventional fluoroscopy in thoracolumbar fracture fixation.</p><p><strong>Material and methods: </strong>This single-centre retrospective cohort study included adults with unstable thoracolumbar spine injuries undergoing pedicle screw fixation during a 5.5-year period. In the CBCT group, intraoperative 3D navigation was performed using an automated CBCT system. Perioperative and postoperative variables were recorded, and screw placement was assessed using the Gertzbein-Robbins classification. Outcomes were compared between groups.</p><p><strong>Results: </strong>Forty-six patients were included: 25 treated with automated CBCT-based navigation and 21 with conventional fluoroscopy. Among 313 evaluable screws, 96.8% were graded Gertzbein-Robbins A or B, and no grade E breaches were observed. In CBCT screws, no grade D or E breach occurred, and no screw-related early reoperations were required. Total operative time was longer with CBCT (154 vs. 119 min; p = 0.018), and blood loss was numerically higher (259 vs. 179 mL; p = 0.272), although operative time and blood loss per pedicle screw did not differ significantly between groups. Length of hospital stay and early clinical outcomes were comparable.</p><p><strong>Conclusion: </strong>Automated CBCT-based intraoperative 3D navigation provides high pedicle screw accuracy and comparable perioperative outcomes. CBCT-based navigation enables real-time 3D visualization and intraoperative verification, supporting its role as a reliable imaging modality in spine trauma surgery.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"107447"},"PeriodicalIF":2.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13601038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042142","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}