Brain & spine最新文献

{"title":"Evaluation of the SITE score for de-novo spinal infection patients in clinical practice – A case-based approach","authors":"Manuel Kramer ,&nbsp;Martin N. Stienen ,&nbsp;Benjamin Martens ,&nbsp;Felix C. Stengel ,&nbsp;Stefan Motov","doi":"10.1016/j.bas.2025.104228","DOIUrl":"10.1016/j.bas.2025.104228","url":null,"abstract":"<div><h3>Study design</h3><div>Validation study.</div></div><div><h3>Introduction</h3><div>De-novo spinal infections (DNSI) are a concerning healthcare problem. The treatment is established case-based in the absence of clear guidelines. The recently proposed Spinal-Infection-Treatment-Evaluation (SITE) score combines clinical and radiological variables to support decision-making, but it has not been validated among non-spine surgeons.</div></div><div><h3>Research question</h3><div>We aimed to validate this novel score in a real-life setting among surgeons from different clinical specialties.</div></div><div><h3>Methods</h3><div>A single-center study was conducted from 1/10/2023 until 31/12/2023. We collected clinical and radiological data of DNSI patients, treated at our institution. We created fifteen representative specific case presentations, including all spinal locations. A survey was designed to distribute the specific case presentations among physicians from the departments that agreed to participate. Participants were asked to score each case by using the SITE score and calculated intra-class correlation coefficients (ICC3).</div></div><div><h3>Results</h3><div>Forty-eight survey forms were analyzed (seven spine-surgeons, 41 others) Spine surgeons demonstrated good interobserver reliability (ICC3 = 0.78). Non-spine surgeons showed poor interobserver reliability (ICC3 = 0.48). Subgroup analysis by specialty revealed overall low reliability scores (internal medicine ICC3 = 0.48, orthopaedics ICC3 = 0.43, other surgical specialties ICC3 = 0.56, infectiology ICC3 = 0.55). Participants with more frequent exposure to DNSI (&gt;10 per year; n = 9) showed higher reliability, achieving similar scores to spine surgeons (ICC3 = 0.7).</div></div><div><h3>Discussion and conclusions</h3><div>We found acceptably high interobserver values for the SITE score only for spine surgeons and non-spine surgeons with frequent exposure to DNSI. The reliability of the score was much lower when applied by physicians from other specialties with lesser experience of DNSI.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104228"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593664","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":"Epidural steroid injections in lumbar disc herniation- Evidence synthesis from 72 randomised controlled trials (RCTs) and a total of 7701 patients","authors":"Alexandros G. Brotis ,&nbsp;Theodosios Spiliotopoulos ,&nbsp;Adamantios Kalogeras ,&nbsp;Kostas N. Fountas ,&nbsp;Andreas K. Demetriades","doi":"10.1016/j.bas.2025.104216","DOIUrl":"10.1016/j.bas.2025.104216","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of epidural steroid injection in treating sciatica still remains debatable.</div></div><div><h3>Research question</h3><div>To compare epidural steroid injection with other manipulations in terms of pain control, quality of life and other parameters (Q1), compare the various available ESI alternatives regarding the approach (Q2), compare ESI to analgesia (Q3), identify the ideal ESI protocol (Q4), compare different guiding techniques (Q5) and determine the role of ESI as e predictive factor for the outcome.</div></div><div><h3>Material and methods</h3><div>This systematic review searched three databases from inception to February 2024. Independent reviewers assessed and gathered the data and also the quality of evidence was critically appreciated.</div></div><div><h3>Results</h3><div>The systematic review included 72 randomized controlled trials 7701 patients. There was a big variation among the aim of the studies. ESI proved to surpass other conservative methods for treating sciatica, however it does not provide long-term results. US- guided as well asFL-guided ESI was proved to have superior results. On the other hand, the role of ESIs in predicting the requirement for surgery is understudied. Comparing the different approaches in ESI the TFESI proved mostly to have better results.Surgery still remains the method with the most instant results providing also long-term treatment.</div></div><div><h3>Discussion and conclusions</h3><div>ESI has superior results to other conservative treatment modalities for sciatica; However surgery seems to have more immediate effect and better long term outcome. Apart from different approaches, additional agents such as amitriptyline proved to have effect when administered additionally to ESI. More studies need to be conducted for ESI as a predictive factor for the outcome or need of surgery.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104216"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680315","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":"Predictive factors for ventriculoperitoneal shunt placement in aneurysmatic subarachnoid hemorrhages","authors":"Renato Pereira ,&nbsp;Beatriz Torres ,&nbsp;João Nogueira ,&nbsp;Frederica Coimbra ,&nbsp;Miguel Afonso ,&nbsp;Carlos Alegria ,&nbsp;Renata Marques","doi":"10.1016/j.bas.2024.104164","DOIUrl":"10.1016/j.bas.2024.104164","url":null,"abstract":"<div><h3>Introduction</h3><div>Aneurysmatic subarachnoid hemorrhages (aSAH) are life-threatening events with high mortality and morbidity. Hydrocephalus is a common complication, initially managed with an external ventricular drain (EVD). Persistent hydrocephalus often requires ventriculoperitoneal shunt (VPS) placement to relieve intracranial pressure and prevent further neurological damage.</div></div><div><h3>Research question</h3><div>What factors predict the need for VPS placement in patients with aSAH, and how does a new predictive model compare to the Mayo Age, Grades, EVD score (MAGE score)?</div></div><div><h3>Materials and methods</h3><div>A retrospective study of 105 patients with aSAH treated with EVD between 2014 and 2023 was conducted. Patients were divided into two groups: those requiring VPS (n= 45) and those not requiring VPS (n= 60). Sociodemographic, clinical, and treatment variables were analysed, and a new predictive model (SAH-VP) was developed and compared to the MAGE score.</div></div><div><h3>Results</h3><div>Patients who required VPS had higher WFNS scores on admission (p= 0.045), more infections requiring antibiotics (p= 0.002), more failed weaning attempts (p= 0.004), more failed closure attempts (p= 0.002), and longer EVD use (p&lt; 0.01). The new SAH-VP model demonstrated an area under the curve (AUC) of 0.800.</div></div><div><h3>Discussion and conclusion</h3><div>There is no consensus on the factors predicting VPS need in SAH patients. This study identified key predictors and developed a new predictive model, SAH-VP, which could improve patient management by identifying those at higher risk of requiring VPS, offering an alternative to the existing MAGE score.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104164"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11718286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973689","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":"Thoracolumbar fractures: Factors predicting failure of percutaneous short- and long-segment posterior fixation","authors":"David Ferreira ,&nbsp;António Cruz ,&nbsp;Ana Vilela ,&nbsp;Joana Azevedo ,&nbsp;André Santos Moreira ,&nbsp;João Pereira ,&nbsp;Paulo Gil Ribeiro ,&nbsp;Nuno Oliveira ,&nbsp;Pedro Varanda ,&nbsp;Bruno Direito-Santos","doi":"10.1016/j.bas.2024.104151","DOIUrl":"10.1016/j.bas.2024.104151","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracolumbar (TL) transition trauma is frequent and challenging. Although short- (SSPF) and long-segment posterior fixation (LSPF) are its mainstay treatment, little is known about their failure rates and reasons behind it.</div></div><div><h3>Research question</h3><div>understand why TL instrumentations fail and what factors influence it.</div></div><div><h3>Materials and methods</h3><div>Retrospective, cohort, unicentric analysis on adult patients with acute TL trauma treated with percutaneous transpedicular SSPF or LSPF. Two groups were created, according to the presence of treatment failure at follow-up. We analyzed whether age ≥65 years old, fracture segment, posterior ligamentous complex (PLC) injury, load sharing classification (LSC) score &gt;6, type of instrumentation (SSPF vs LSPF) and abnormal bone mineral density (BMD) were associated with failure. To achieve this, we evaluated radiological parameters at the preoperative, postoperative and follow-up appointments.</div></div><div><h3>Results</h3><div>87 patients were included: 60 (69.0%) without failure and 27 (31.0%) with. Age ≥65 years old (aOR = 3.66, <em>p</em> = 0.020), PLC injury (aOR = 2.94, <em>p</em> = 0.048) and SSPF (aOR = 6.75, <em>p</em> = 0.013) were statistically significant factors contributing to failure. The first two also presented shorter times to failure (35.2 vs 69.1 months, <em>p</em> = 0.013, and 25.2 vs 69.1 months, <em>p</em> = 0.037, respectively). In PLC injured patients, there was no statistically significant difference between SSPF vs LSPF.</div></div><div><h3>Discussion and conclusions</h3><div>We conclude that age &gt;65 years old, PLC injury and SSPF may be correlated with instrumentation failure. The first two factors were also associated with a shorter time to failure.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104151"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985661","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":"Diagnostic and prognostic performance of urine ubiquitin carboxy-terminal hydrolase L1 across multiple acute brain injury types – A longitudinal prospective cohort study","authors":"Santtu Hellström ,&nbsp;Antti Sajanti ,&nbsp;Aditya Jhaveri ,&nbsp;Abhinav Srinath ,&nbsp;Carolyn Bennett ,&nbsp;Ying Cao ,&nbsp;Fredrika Koskimäki ,&nbsp;Johannes Falter ,&nbsp;Janek Frantzén ,&nbsp;Seán B. Lyne ,&nbsp;Tomi Rantamäki ,&nbsp;Riikka Takala ,&nbsp;Jussi P. Posti ,&nbsp;Susanna Roine ,&nbsp;Sulo Kolehmainen ,&nbsp;Miro Jänkälä ,&nbsp;Jukka Puolitaival ,&nbsp;Romuald Girard ,&nbsp;Melissa Rahi ,&nbsp;Jaakko Rinne ,&nbsp;Janne Koskimäki","doi":"10.1016/j.bas.2024.104173","DOIUrl":"10.1016/j.bas.2024.104173","url":null,"abstract":"<div><h3>Introduction</h3><div>Ubiquitin carboxy-terminal hydrolase L1 (UCH-L1) is recognized as a diagnostic and prognostic blood biomarker for traumatic brain injury (TBI). This study aimed to evaluate whether UCH-L1 concentrations measured in patients' urine post-injury could serve as a diagnostic or prognostic biomarker for outcomes in various types of acute brain injuries (ABI).</div></div><div><h3>Material and methods</h3><div>This pilot study included 46 ABI patients: aneurysmal subarachnoid hemorrhage (n = 22), ischemic stroke (n = 16), and traumatic brain injury (n = 8), along with three healthy controls. Urine samples were collected at early (1.50 ± 0.70 days) and late (9.17 ± 3.40 days) periods post-admission. UCH-L1 and creatinine levels were quantified using ELISA. UCH-L1 concentrations were compared to functional outcomes (modified Rankin Scale, mRS) and dichotomized into favorable (mRS 0–3) and unfavorable (mRS 4–6) groups. Non-parametric statistical tests and ROC analysis was performed.</div></div><div><h3>Results</h3><div>UCH-L1 concentrations in healthy controls were significantly lower compared to both early and late samples after ABI (p ≤ 0.001). The diagnostic performance of urine UCH-L1 at early timepoint showed excellent discriminatory ability, with AUC of 97.6% (95% CI: 93.0–100, p = 0.006 (sensitivity 98%, specificity 100%). Urine UCH-L1 concentrations, both with and without creatinine normalization, did not distinguish between favorable and unfavorable outcomes in either early (p = 0.88 and p = 0.36) or late samples (p = 0.98 and p = 0.30) in any types of ABI.</div></div><div><h3>Discussion and conclusions</h3><div>Although UCH-L1 concentrations in urine did not differentiate between favorable and unfavorable outcomes, a significant difference was observed between healthy subjects and ABI patients. This finding underscores the significant diagnostic utility of urine UCH-L1 concentrations, regardless of the type of acute brain injury.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104173"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017309","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":"Orbitopalpebral emphysema in a child after the removal of a giant meningioma: a case report and mini-review","authors":"Ebba Katsler ,&nbsp;Anders Tolstrup Christiansen ,&nbsp;Annika Reynberg Langkilde ,&nbsp;Jane Skjøth-Rasmussen","doi":"10.1016/j.bas.2024.104168","DOIUrl":"10.1016/j.bas.2024.104168","url":null,"abstract":"<div><h3>Research question</h3><div>to describe and investigate the case of an 11-year-old boy with the concomitant pneumocephalus, subcutaneous- and orbitopalpebral emphysema after the removal of a giant meningioma. Furthermore, our aim is to discuss the findings and the pathophysiology in relation to cases found in literature.</div></div><div><h3>Material and methods</h3><div>We performed a search in PubMed, Cochrane, MEDLINE and Google Scholar by the usage of the words orbital or periorbital, combined with emphysema and neurosurgery. In addition, a manual search was performed from reference lists.</div></div><div><h3>Results</h3><div>In the absence of a trauma and fracture in the orbit, it is considered extremely rare with the simultaneous presentation of an orbital emphysema and pneumocephalus. The literature search revealed 1101 results, with four cases of the simultaneous presentation of orbital emphysema and pneumocephalus after a neurosurgical procedure. Our case of an orbitopalpebral emphysema and pneumocephalus following the removal of a giant meningioma is unique.</div></div><div><h3>Discussion and conclusion</h3><div>Orbital emphysema might give rise to orbital compartment syndrome, an ophthalmologic emergency, that untreated can result in blindness. Differentiating orbitopalpebral emphysema from postoperative swelling can be accomplished through palpation, which might reveal crepitations, and via an acute CT scan that highlights the presence of air.</div><div>Following a neurosurgical procedure, orbital emphysema is an extremely rare phenomenon. Given the rarity of this case, we present informed assumptions and propose a bidirectional migration of air: from intracranial space, to the orbit and subcutaneously to the palpebrae.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104168"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11763510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048936","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":"White cord syndrome: A rare complication of adequate spinal cord decompression. A case report and review of current literature","authors":"Daan N. de Groot ,&nbsp;Kennedy Ogenio ,&nbsp;F. Yaney Jiang ,&nbsp;Niels A. van der Gaag","doi":"10.1016/j.bas.2025.104190","DOIUrl":"10.1016/j.bas.2025.104190","url":null,"abstract":"<div><h3>Introduction</h3><div>This study presents a rare complication following surgery for cervical spinal stenosis, known as white cord syndrome. This complication is characterized by sudden postoperative neurological deterioration and unique radiological features.</div></div><div><h3>Research question</h3><div>Our aim is to provide an overview of white cord syndrome, its management, and prognosis based on a case study and literature review.</div></div><div><h3>Materials and methods</h3><div>We describe the case of an 82-year-old woman who developed near-complete tetraplegia following a cervical laminectomy from C3 to C6 for a cervical stenosis. In addition, a literature review was conducted, identifying 25 reported white cord syndrome cases.</div></div><div><h3>Results</h3><div>Postoperative MRI revealed no hemorrhage or residual stenosis but showed a new intramedullary T2 hyperintense signal, indicative of white cord syndrome. The patient’s neurological function improved significantly over three months after blood pressure augmentation, dexamethasone administration, and intensive rehabilitation. Review of the literature suggests that white cord syndrome is a rare complication, often presents as immediate postoperative deficits, and is managed primarily through dexamethasone and adequate spinal cord perfusion. Recovery is generally favorable but variable, with MRI changes often persisting despite clinical improvement.</div></div><div><h3>Conclusion</h3><div>White cord syndrome is a rare but serious complication following spinal decompression surgery, requiring prompt diagnosis and intervention. The exact pathophysiology remains unclear. Despite its rarity, it is crucial for clinicians to be aware of this condition so that diagnosis and treatment—encompassing adequate spinal cord perfusion, dexamethasone administration, and physiotherapy—can be promptly initiated. This also highlights the importance of patient education on potential postoperative risks.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104190"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143101925","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":"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":"The identification of low-pathogenic bacteria on removed spinal implants and implications for antimicrobial prophylaxis","authors":"Ann-Kathrin Joerger ,&nbsp;Vicki M. Butenschoen ,&nbsp;Susanne Feihl ,&nbsp;Sebastian Rühling ,&nbsp;Jan S. Kirschke ,&nbsp;Bernhard Meyer ,&nbsp;Sandro M. Krieg","doi":"10.1016/j.bas.2024.104152","DOIUrl":"10.1016/j.bas.2024.104152","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of low-pathogenic bacteria cultured from removed spinal implants is unclear and the efficacy of perioperative single-dose antibiotics against such bacteria remains underexplored.</div></div><div><h3>Research question</h3><div>This study aims to investigate whether pedicle screw loosening is associated with pathogens and if the choice of perioperative antibiotics can prevent these bacteria.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 93 patients with implants removed between 01/01/2018 and 03/31/2020. Patients with both loosened and non-loosened implants were included. The latter group was subdivided into cases where implants were exchanged due to adjacent segment degeneration (ASD) and those with elective implant removal after fracture healing. Bacterial cultures from removed implants were analyzed for resistance profiles against the prophylactic single-shot antibiotics administered during implantation. Patients with acute infection, spondylodiscitis, deep wound infection, empyema, and carbon/polyetheretherketone spinal implants were excluded.</div></div><div><h3>Results</h3><div>Bacterial isolates were detected in both loosened (41%) and non-loosened (27%) implants (p = 0.23). The most frequently cultivated bacteria were <em>Cutibacterium acnes</em> and <em>Staphylococcus epidermidis</em>. Sensitivity to the administered antibiotics was 75%. While <em>Cutibacterium acnes</em> was entirely sensitive, <em>Staphylococcus epidermidis</em> was completely resistant. Patients with loosened implants without bacteria had a significantly lower bone mineral density (BMD) than patients with implants removed due to ASD. However, patients with loosened implants and positive bacterial cultures had comparable BMD to ASD patients.</div></div><div><h3>Conclusions</h3><div>The high rate of sensitive <em>Cutibacterium acnes</em> and resistant <em>Staphylococcus epidermidis</em> on removed spinal implants suggests a need to revisit current antimicrobial prophylaxis. Further research is required to determine the clinical significance of low-virulence bacteria, especially on non-loosened implants.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104152"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916418","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}