Brain & spine最新文献

{"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}

{"title":"The utilization of hypoalbuminemia as a prognostic metric in patients with spinal metastases: A scoping review","authors":"Jessica Ryvlin ,&nbsp;Namal Seneviratne ,&nbsp;Ali Haider Bangash ,&nbsp;C. Rory Goodwin ,&nbsp;Michael H. Weber ,&nbsp;Raphaële Charest-Morin ,&nbsp;John H. Shin ,&nbsp;Anne L. Versteeg ,&nbsp;Mitchell S. Fourman ,&nbsp;Saikiran G. Murthy ,&nbsp;Yaroslav Gelfand ,&nbsp;Reza Yassari ,&nbsp;Rafael De la Garza Ramos","doi":"10.1016/j.bas.2025.104223","DOIUrl":"10.1016/j.bas.2025.104223","url":null,"abstract":"<div><h3>Introduction</h3><div>Hypoalbuminemia is associated with poor outcomes in cancer patients, but its role in spinal metastases remains unclear.</div></div><div><h3>Research question</h3><div>This study aimed to identify albumin cutoff values defining hypoalbuminemia and describe the association between serum albumin and outcomes in patients with spinal metastases.</div></div><div><h3>Material and methods</h3><div>A narrative review of articles up to December 2022 was conducted using PubMed/Medline, EMBASE, and Web of Science databases. Variables extracted included study design, patient characteristics, serum albumin levels, treatments, and levels of evidence. Outcomes included survival/mortality, complications, ambulatory status, readmission, length of stay, discharge disposition, and blood loss.</div></div><div><h3>Results</h3><div>Thirty-eight studies comprising 21,401 patients were analyzed. Most studies (92%) were Level of Evidence III. Albumin was evaluated as a continuous variable in 18% of studies and as a dichotomous variable in 76%, with 3.5 g/dL being the most common threshold for hypoalbuminemia. Primary outcomes evaluated were survival/mortality (71% of studies), complications (34%), and reoperation/readmission (11%). Of studies examining the association between hypoalbuminemia and survival/mortality, 74% found a significant association. An association between albumin levels and complications was found in 54% of relevant studies.</div></div><div><h3>Discussion and conclusion</h3><div>The findings of this study suggest that a threshold of 3.5 g/dL seems most appropriate to define hypoalbuminemia in patients with spinal metastases. However, evidence also supports a level-dependent effect. The most consistent significant association was between low albumin and survival at both fixed and continuous time points. There is less evidence to support an association between hypoalbuminemia and other endpoints such as perioperative complications.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104223"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520489","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 outcome measures following lateral versus posterior sacroiliac joint fusion: Systematic review and meta-analysis","authors":"Khalid Medani ,&nbsp;Abdulrhman Alsalama ,&nbsp;Rakesh Kumar ,&nbsp;Shlok Patel ,&nbsp;Megh Patel ,&nbsp;Sunil Manjila","doi":"10.1016/j.bas.2025.104212","DOIUrl":"10.1016/j.bas.2025.104212","url":null,"abstract":"<div><h3>Introduction</h3><div>Sacroiliac joint fusion (SIJF) is indicated in patients with chronic Sacroiliac joint (SIJ) pain or instability and is usually performed using minimally invasive techniques through lateral or posterior approach.</div></div><div><h3>Research question</h3><div>Our study aims to compare the lateral approach to the posterior one in SIJF through meta-analysis of other studies. The outcome of each approach is measured using the visual analog scale (VAS), Oswestry disability index (ODI), or both.</div></div><div><h3>Materials and methods</h3><div>The study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Articles were extracted using Pubmed advance search till February 27th, 2023. Articles included were those limited to either lateral, posterior or both approaches. Articles written in a non-English language, case reports and smaller-than-three case series were excluded from the study. Risk of bias was assessed using the Newcastle-Ottawa and Jadad scales. Stata-17 software program was used for statistical analysis and creation of forest plots.</div></div><div><h3>Results</h3><div>Forty-eight articles were available for the quantitative analysis, which represents a total of 2562 subjects. The average duration of postoperative follow-up was 21 months (3–72 months) and 17 months (6–72 months) for the VAS and ODI outcomes, respectively. The average percentage of improvement in the VAS was 57% (22–80%) in the lateral approach versus 58% (29–94%) in the posterior approach (p = 0.986). The average percentage of improvement in the ODI was 42% (11–75%) in the lateral approach versus 31% (11–65%) in the posterior one (p = 0.272). A trend towards performing posterior approaches more frequently was noted in studies published after 2017.</div></div><div><h3>Discussion and conclusion</h3><div>Approach selection for SIJF depends mainly on patient's characteristics and surgeon's experience. Our study demonstrated no difference in VAS outcome between lateral and posterior approach. Lateral approach appeared to be superior in ODI outcome although not statistically significant. The main limitation of the study is the selection-bias as the majority of articles included were observational. Therefore, randomized procedural trials are needed to validate these findings.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104212"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577776","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":"Physical therapies after surgery for lumbar disc herniation- evidence synthesis from 55 randomized controlled trials (RCTs) and a total of 4,311 patients","authors":"Alexandros G. Brotis ,&nbsp;Adamantios Kalogeras ,&nbsp;Theodosios Spiliotopoulos ,&nbsp;Kostas N. Fountas ,&nbsp;Andreas K. Demetriades","doi":"10.1016/j.bas.2025.104238","DOIUrl":"10.1016/j.bas.2025.104238","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of physical therapy after lumbar disc herniation surgery is unclear.</div></div><div><h3>Research question</h3><div>To determine the impact of physical therapy following LDH surgery (Q1), investigate the effects of activity limitations (Q2), the best time to start physical therapy (Q3), the significance of supervised physical rehabilitation (Q4), the types of physical therapies used (Q5), and the role of additional approaches, such as education, manipulation, and acupuncture, in enhancing the effectiveness of rehabilitation (Q6).</div></div><div><h3>Material and methods</h3><div>This systematic review searched three databases from inception to May 2024. Independent reviewers screened studies, assessed and extracted data, and critically appraised the quality of the available evidence.</div></div><div><h3>Results</h3><div>This systematic review included 55 randomized controlled trials with 4311 patients. We demonstrated that physical therapy after lumbar disc surgery is effective in alleviating pain and improving function and quality of life after surgery for lumbar disc herniation. Exercise regimens aimed at enhancing the endurance, flexibility, and strength of the back musculature are generally efficacious, with the exception of exercises involving neural mobilization. Imposing limitations on physical activity does not yield substantial advantages; however, the occurrence rate of potential complications, the optimal timing for initiating activity and the cost-effectiveness of supervised exercise remain subjects of ongoing discourse. Concurrent application of manual therapy, acupuncture, educational interventions, and behavioral and occupational therapy has the potential to augment outcomes.</div></div><div><h3>Discussion and conclusion</h3><div>Physical therapy improves functional outcomes after lumbar disc surgery. Further studies should address its safety, and cost-effectiveness, and provide dissemination and applicability tools.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104238"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628073","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 “Treatment-limiting decisions in patients with severe traumatic brain injury in the Netherlands”","authors":"Sadia Farhana","doi":"10.1016/j.bas.2024.104157","DOIUrl":"10.1016/j.bas.2024.104157","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104157"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11700240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933955","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":"Advancements and emerging insights in thoracolumbar spine trauma","authors":"Jonathan Neuhoff,&nbsp;Alex Vaccaro,&nbsp;Cumhur Oner,&nbsp;Klaus Schnake,&nbsp;Frank Kandziora","doi":"10.1016/j.bas.2024.104150","DOIUrl":"10.1016/j.bas.2024.104150","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104150"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11722167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142973664","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":"Answer to the letter to the editor concerning “Current state of preoperative embolization for spinal metastasis – A survey by the EANS spine section”","authors":"S. Motov,&nbsp;F. Stengel,&nbsp;F. Ringel,&nbsp;O. Bozinov,&nbsp;M.N. Stienen","doi":"10.1016/j.bas.2024.104160","DOIUrl":"10.1016/j.bas.2024.104160","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104160"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985652","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":"Do clinical outcomes in individuals with malignant gliomas differ between sexes?","authors":"Maria Goldberg ,&nbsp;Laura-Sophie Frank ,&nbsp;Ghaith Altawalbeh ,&nbsp;Chiara Negwer ,&nbsp;Arthur Wagner ,&nbsp;Jens Gempt ,&nbsp;Bernhard Meyer ,&nbsp;Amir Kaywan Aftahy","doi":"10.1016/j.bas.2024.104172","DOIUrl":"10.1016/j.bas.2024.104172","url":null,"abstract":"<div><h3>Introduction</h3><div>Sex-related differences in the epidemiology of malignant gliomas are acknowledged; however, information regarding their clinical characteristics and outcomes after surgery is limited.</div></div><div><h3>Research question</h3><div>To identify sex-specific differences of all patients with high-grade glioma at our institution and assessed clinical outcomes and prognostic factors.</div></div><div><h3>Material and methods</h3><div>This single-center study included those who underwent surgery for malignant gliomas between 2010 and 2020. Categorical, normally distributed, and skewed continuous variables were compared between men and women using the chi-square test, independent samples <em>t</em>-test, and Mann–Whitney <em>U</em> test, respectively. Survival was calculated using the log-rank and Kaplan–Meier methods.</div></div><div><h3>Results</h3><div>In total, 621 patients with WHO grade IV gliomas were identified (370 (59.58%) male). Men were significantly younger, underwent surgery faster after imaging diagnosis, and had a slightly higher surgical complications incidence than women. Women reported a worse preoperative performance status. Multivariate analysis showed that sex did not affect survival, surgical complications, nicotine or alcohol abuse, or preoperative tumor volume. Age, Karnofsky performance status, neurosurgical resection, and adjuvant radiotherapy with temozolomide showed a survival advantage.</div></div><div><h3>Discussion and conclusions</h3><div>Men are diagnosed with malignant glioma at a younger age than women; however, no advantage in clinical outcomes was observed. No sex-related differences were observed.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104172"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11743585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017312","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 accuracy of 4D-MRA for the detection and localization of spinal dural arteriovenous fistulas: A retrospective 10-year cohort study","authors":"Frederick J.A. Meijer ,&nbsp;Vincent Raymaekers ,&nbsp;Sjoert A.H. Pegge ,&nbsp;Jeroen HD. Boogaarts","doi":"10.1016/j.bas.2024.104176","DOIUrl":"10.1016/j.bas.2024.104176","url":null,"abstract":"<div><h3>Research question</h3><div>The goal of this study was to assess the diagnostic accuracy of spinal time-resolved contrast-enhanced MR angiography (4D-MRA) for the detection and localization of spinal dural arteriovenous fistulas (SDAVF) in our institution.</div></div><div><h3>Material and methods</h3><div>Single center retrospective cohort study of patients with the clinical suspicion of a SDAVF. Patients were included who had undergone spinal 4D-MRA in the period January 2010–February 2021. A subgroup was identified, who had subsequent digital subtraction angiography (DSA), or clinical/radiological follow-up. Diagnostic performance measures of 4D-MRA were calculated (sensitivity, positive predictive value, specificity, and negative predictive value) with DSA serving as the reference standard.</div></div><div><h3>Results</h3><div>Overall, 120 patients with the clinical suspicion of having a SDAVF and who underwent spinal 4D-MRA were identified. A subgroup of 30 patients had both 4D-MRA and DSA, or follow-up. In this group, the sensitivity of 4D-MRA for the detection of a SDAVF was 100% and specificity was 91% (positive predictive value of 95% and a negative predictive value of 100%). Sidedness was correctly identified on 4D-MRA in 74% of the cases and the level of the SDAVF in 68%.</div></div><div><h3>Discussion and conclusion</h3><div>The results indicate that 4D-MRA has a high sensitivity and specificity for the detection and localization of a SDAVF, which is in line with previous studies published in literature. Furthermore, 4D-MRA can serve to guide DSA and shorten the procedural time, which reduces the risk of angiography related complications, and decreases patient discomfort.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104176"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11753963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030287","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":"Augmented reality (AR) in microsurgical multimodal image guided focal pediatric epilepsy surgery: Results of a retrospective feasibility study","authors":"Julia Shawarba ,&nbsp;Matthias Tomschik ,&nbsp;Jonathan Wais ,&nbsp;Fabian Winter ,&nbsp;Christian Dorfer ,&nbsp;Florian Mayer ,&nbsp;Martha Feucht ,&nbsp;Karl Roessler","doi":"10.1016/j.bas.2024.104180","DOIUrl":"10.1016/j.bas.2024.104180","url":null,"abstract":"<div><h3>Introduction and research question</h3><div>Augmented reality (AR) is increasingly being used to improve surgical planning and assist in real time surgical procedures. A retrospective investigation was conducted to study its feasibility in pediatric epilepsy surgery at a single institution.</div></div><div><h3>Methods</h3><div>Functional neuronavigation using multimodal imaging data (fMRI, DTI-tractography, PET, SPECT, sEEG) were used to augment the surgical navigation by transferring MRI imaging reconstructions as AR maps into the surgical microscope overlaying the surgical field.</div></div><div><h3>Results</h3><div>Altogether, 43 patients (17 female, 0–18 yrs, mean 9 yrs) were operated between 10/2020 and 10/2023 and fulfilled the inclusion criteria. 26 patients (60.5%) had an extra-temporal and 17 (39.5%) a temporal seizure origin. The 3 top histological diagnoses encountered were: FCD (32.6%), ganglioglioma (23.3%) and DNET (11.6%). Preoperative MRI studies showed no epileptogenic lesion in 11 patients (25.6%, MRI negativ group), which necessitated implantation of depth electrodes before resection. There were no adverse events while using AR enhanced neuronavigation. Altogether, of 24 patients with a follow up of more than one year, 83.3% displayed a favorable ILAE grade 1 seizure outcome (75% ILAE 1a), 14 % experienced a transient hemiparesis, 4.3% a permanent quadrantanopia and one needed a subdural-peritoneal shunt.</div></div><div><h3>Discussion and conclusion</h3><div>AR supported navigated microscope resection allowed targeting and removal of lesional as well as non-lesional (sEEG defined) epileptogenic zones in pediatric epilepsy surgery with low morbidity and an expected seizure outcome.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104180"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11786778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081398","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}