Brain & spine最新文献

{"title":"Navigated percutaneous placement of cervical pedicle screws: An anatomical feasibility study","authors":"G. Schmeiser ,&nbsp;C. Blume ,&nbsp;N. Hecht ,&nbsp;S. Mattes ,&nbsp;H. Ittrich ,&nbsp;R. Kothe","doi":"10.1016/j.bas.2025.104199","DOIUrl":"10.1016/j.bas.2025.104199","url":null,"abstract":"<div><h3>Introduction</h3><div>Percutaneous cervical pedicle screw placement is challenging due to complex anatomy, and requires navigation support. It is unclear how to ensure navigation accuracy in minimally invasive procedures.</div></div><div><h3>Research question</h3><div>How accurate is image-guided percutaneous pedicle screw positioning after referencing with only one clamp for the complete subaxial cervical spine?</div></div><div><h3>Materials and methods</h3><div>In six cadavers, all subaxial cervical pedicles were fitted with screws using a standardized procedure. Briefly, a reference clamp was placed via a small skin incision on spinous process C7. The procedure started from C3 and progressed towards C7, without additional imaging, using one registration for all vertebrae. Screws were placed using a navigated screwdriver. Cone-beam CT was performed at three time-points. Screw position was directly intraoperatively evaluated by the surgeons using a modified classification—from Grade 1 (perfect placement) to Grade 5 (highly inaccurate)—and these data were re-evaluated by two independent radiologists.</div></div><div><h3>Results</h3><div>In six human specimens, 10 guidewires each were placed bilaterally in C3–C7. One screw (1.7%) was intraoperatively classified as Grade 3, but as Grade 4 in the second assessment. All other screws were classified as Grades 1–2 (89.8%) or 3 (8.5%). Screw placement accuracy was not significantly impacted by distance to the clamp or side selection.</div></div><div><h3>Discussion</h3><div>In percutaneously navigated screw placement with intraoperative imaging, safe screw placement was possible with a reference clamp on C7. Clinical application of this technique has been limited to individual cases. We also propose a new classification for improving screw accuracy and clinical consequences.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104199"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387278","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":"Blood biomarkers to identify patients with different intracranial lesion combinations after traumatic brain injury","authors":"Pia Koivikko ,&nbsp;Ari J. Katila ,&nbsp;Riikka SK. Takala ,&nbsp;Iftakher Hossain ,&nbsp;Teemu M. Luoto ,&nbsp;Rahul Raj ,&nbsp;Mari Koivisto ,&nbsp;Olli Tenovuo ,&nbsp;Kaj Blennow ,&nbsp;Peter Hutchinson ,&nbsp;Henna-Riikka Maanpää ,&nbsp;Mehrbod Mohammadian ,&nbsp;Virginia F. Newcombe ,&nbsp;Jean-Charles Sanchez ,&nbsp;Jussi Tallus ,&nbsp;Mark van Gils ,&nbsp;Henrik Zetterberg ,&nbsp;Jussi P. Posti","doi":"10.1016/j.bas.2025.104195","DOIUrl":"10.1016/j.bas.2025.104195","url":null,"abstract":"<div><h3>Introduction</h3><div>There is a lack of studies examining the most promising blood biomarkers for traumatic brain injury (TBI) in relation to gross pathology types.</div></div><div><h3>Research question</h3><div>To examine whether the admission levels of blood biomarkers can discriminate patients with different combinations of traumatic intracranial findings from patients with negative computed tomography (CT) scans.</div></div><div><h3>Material and methods</h3><div>One hundred thirty patients with all severities of TBI were studied. Seventy-five had CT-positive and 55 CT-negative findings. CT-positive patients were divided into three clusters (CL) using the Helsinki CT score: focal lesions (CL1), mixed lesions (CL2) and mixed lesions + intraventricular haemorrhage (CL3). CT scans were obtained upon admission and blood samples taken within 24 h from admission. S100 calcium-binding protein B (S100B), glial fibrillary acidic protein (GFAP), heart fatty-acid binding protein (H-FABP), neurofilament light (NF-L), interleukin-10 (IL-10), total-tau (t-tau), and β-amyloids 1–40 (Aβ40) and 1–42 (Aβ42) were analysed from plasma samples. CT-negative cluster was used as control.</div></div><div><h3>Results</h3><div>GFAP, Aβ40 and Aβ42 levels differed between the clusters, but not significantly. NF-L and t-tau discriminated CL1 from CT-negative cluster with AUCs of 0.737 and 0.771, respectively. NF-L, t-tau and GFAP discriminated CL2 from CT-negative cluster with AUCs of 0.839, 0.781 and 0.840, respectively. All biomarkers analysed were able to discriminate CL3 and CT-negative cluster.</div></div><div><h3>Discussion and conclusion</h3><div>All studied biomarkers distinguished the most severely injured cluster, CL3, from CT-negative cluster. The results may reflect the severity of TBI but also show that biomarkers have a variable ability to identify patients with combinations of intracranial traumatic lesions in the examined time window.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104195"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350172","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 regarding the response to “Multidisciplinary consensus-based statement on the current role of Middle Meningeal Artery embolization (MMAE) in chronic SubDural Hematoma (cSDH)”","authors":"M. Foppen,&nbsp;W.P. Vandertop,&nbsp;D. Verbaan","doi":"10.1016/j.bas.2025.104186","DOIUrl":"10.1016/j.bas.2025.104186","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104186"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102293","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":"Neuropathic pain appears to be the main symptom associated with higher disease burden and lower pain alleviation in degenerative lumbar disease fusion patients","authors":"Alexander Cristea ,&nbsp;Bart F.J. Heijnen ,&nbsp;Seung Won Park ,&nbsp;Aleksandr Krutko ,&nbsp;Carlos Santos ,&nbsp;Wolfgang Senker ,&nbsp;Vasileios Arzoglou ,&nbsp;Paulo Pereira","doi":"10.1016/j.bas.2025.104224","DOIUrl":"10.1016/j.bas.2025.104224","url":null,"abstract":"<div><h3>Introduction</h3><div>The role of neuropathic pain (NP) in persisting pain after degenerative lumbar disease (DLD) fusion surgery appears to be underrecognized and undertreated.</div></div><div><h3>Research question</h3><div>This study assessed NP in DLD patients before and after lumbar interbody fusion (LIF) surgery, and the NP-related burden of disease up to 12-months post-op.</div></div><div><h3>Materials and methods</h3><div>Within a prospective, multi-center, data-monitored study, a sub-cohort of 146 DLD patients underwent LIF. NP was assessed pre-op and 3-months post-op with a validated Douleur Neuropathique-4 questionnaire. Outcomes were analyzed based on NP occurrence at baseline and post-op. Medication use, back-pain, leg-pain, Oswestry Disability Index (ODI), and quality of life (QoL) were determined pre-op, 3-months and 12-months post-op. Fusion success was evaluated via x-ray and/or CT-scan. Changes were analyzed using paired t-tests and ANCOVA to test for group differences.</div></div><div><h3>Results</h3><div>NP was present pre-op in 51% of the DLD patients associated with higher back- and leg-pain, and lower QoL. LIF resulted in significant pain relief and improved QoL for all patients. Patients presenting NP post-op had significantly lower back- and leg-pain relief, ODI and QoL up to 1-year post-op. Opioid consumption was higher in the NP group, whereas DM and PVD occurrence, and fusion rates were similar.</div></div><div><h3>Discussion and conclusion</h3><div>NP occurred frequently in DLD patients, both before and after spine fusion surgery. Patients with post-operative NP reveal a significant association between NP, lower pain alleviation and higher disease burden up to 12-months post-op, despite higher opioid consumption. NP occurred independently of DM, PVD and fusion success.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104224"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535010","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":"Risk factors for unintended discontinuation of tumor-specific treatment after tumor surgery in glioblastoma patients aged 70 or older","authors":"Thomas Eibl,&nbsp;Franziska Goschütz,&nbsp;Adrian Liebert,&nbsp;Leonard Ritter,&nbsp;Hans-Herbert Steiner,&nbsp;Karl-Michael Schebesch,&nbsp;Markus Neher","doi":"10.1016/j.bas.2025.104253","DOIUrl":"10.1016/j.bas.2025.104253","url":null,"abstract":"<div><h3>Purpose</h3><div>The most beneficial treatment option for newly diagnosed glioblastoma is maximum safe resection and adjuvant therapy. Elderly patients carry a higher perioperative risk for complications, thus, predictors of unfavorable surgical outcome must be evaluated more intensively. Consequently, we sought to evaluate surgery-related paradigms leading to discontinuation of adjuvant treatment after initial neurosurgical resection.</div></div><div><h3>Methods</h3><div>Patients receiving microsurgical tumor resection for newly diagnosed glioblastoma CNS WHO grade 4 were evaluated. Further inclusion criteria was age &gt;70 years. Comorbidities were summarized using the Charlson Comorbidity Index (CCI), the 5 and 11 item modified frailty index (mFI-5 and mFI-11) and the CHA₂DS₂-VASc Score. Primary endpoint was discontinuation of tumor-specific before completion of adjuvant radiotherapy or radio-chemotherapy.</div></div><div><h3>Results</h3><div>102 patients were included, mean age was 76.2 ± 4.2 years. The median extent of contrast-enhancing tumor volume was 99.1 ± 5.9 %. Surgical morbidity and mortality prohibited beginning of adjuvant treatment in 19 patients (18.6 %) and overall discontinuation of treatment before completion of radiotherapy was observed in 26/87 patients (29.9 %). Treatment failure was associated with increasing patient age (p = 0.04) and greater comorbidity scores. The mFI-5 and mFI-11 outperformed the CCI and the CHA₂DS₂-VASc Score. Two or more points in the 5- and 11-item mFI were significantly associated with increased risk of treatment failure (p = 0.004 and p = 0.001, respectively).</div></div><div><h3>Conclusion</h3><div>In Glioblastoma patients, advanced age and comorbidities are relevant confounders and put patients at risk for surgery-related morbidity. Nevertheless, it can be aimed at a maximum safe resection with acceptable surgical morbidity.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104253"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143833067","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":"Suicidal ideation after subthalamic stimulation in Parkinson's Disease: A critical concern","authors":"Gideon Sorlelodum Alex ,&nbsp;Oluwatobiloba Israel Popoola ,&nbsp;Inibehe Ime Okon","doi":"10.1016/j.bas.2025.104247","DOIUrl":"10.1016/j.bas.2025.104247","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104247"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777641","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":"nTMS in spinal cord injury: Current evidence, challenges and a future direction","authors":"Josephine Jung ,&nbsp;Sabina Patel ,&nbsp;Azharul Khan ,&nbsp;Alba Diaz Baamonde ,&nbsp;Ana Mirallave-Pescador ,&nbsp;Yasir A. Chowdhury ,&nbsp;David Bell ,&nbsp;Irfan Malik ,&nbsp;Nick Thomas ,&nbsp;Gordan Grahovac ,&nbsp;Francesco Vergani ,&nbsp;Aminul I. Ahmed ,&nbsp;José Pedro Lavrador","doi":"10.1016/j.bas.2025.104234","DOIUrl":"10.1016/j.bas.2025.104234","url":null,"abstract":"<div><div>Spinal Cord Injury (SCI) has devastating consequences for patients and their families. Over the last few decades, a renewed interest in the utilization of non-invasive and cost-effective therapeutic technologies in the management of patients with SCI has emerged. This includes stimulation with navigated transcranial magnetic stimulation (nTMS) in order to improve the outcome for these patients alongside with existing clinical tools. nTMS has shown encouraging preliminary results in both clinical assessment and rehabilitation (motor and pain) of patients with SCI. However, different protocols – stimulation parameters, length of treatment and combination with other modalities – and patient selection criteria hampered definitive conclusions. So far, none of these have been adapted in regular clinical practice. In this article, we provide an overview on different assessment and therapeutic strategies using nTMS and review their effectiveness.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104234"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143680314","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":"Comparative analysis of mini-open trans-thoracic transpleural and posterior approaches in thoracic disc herniation surgery: A 10-year retrospective review","authors":"Ali Baram ,&nbsp;Giorgio Cracchiolo ,&nbsp;Marco Riva ,&nbsp;Gabriele Capo ,&nbsp;Leonardo Anselmi ,&nbsp;Carlo Brembilla ,&nbsp;Stefania Radice ,&nbsp;Maria Pia Tropeano ,&nbsp;Carla Anania ,&nbsp;Emanuela Morenghi ,&nbsp;Maurizio Fornari ,&nbsp;Federico Pessina","doi":"10.1016/j.bas.2025.104244","DOIUrl":"10.1016/j.bas.2025.104244","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracic disc herniations (TDHs) are rare, and surgery is typically reserved for patients with radiculopathy, myelopathy, or intractable back pain. Despite established algorithms, the optimal surgical strategy remains debated.</div></div><div><h3>Research question</h3><div>What are the clinical, surgical, and radiological outcomes of anterior and posterior surgical approaches for TDHs over a 10-year period?</div></div><div><h3>Material and methods</h3><div>A retrospective analysis of 54 patients who underwent surgery for TDHs (2013–2022) was performed. Patients were grouped by surgical approach: anterior (34 patients) and posterior (20 patients). Data included preoperative and postoperative outcomes such as operative times, hospital stays, complications, reoperations, and assessments using the Frankel scale, Nurick score, and Visual Analog Scale (VAS) for pain.</div></div><div><h3>Results</h3><div>Both approaches improved clinical outcomes. No significant differences in postoperative Nurick or VAS pain scores were observed. However, the anterior approach showed better Frankel score improvements but was associated with longer operative times and hospital stays. Complications were more frequent in the anterior group.</div></div><div><h3>Discussion and conclusion</h3><div>Both approaches effectively alleviate symptoms in symptomatic TDHs. The anterior approach offers greater neurological improvement but carries higher complication risks. Surgical strategy should be tailored based on herniation characteristics and surgeon expertise. Anterior approaches are ideal for central, large, or calcified herniations, while posterior approaches are preferable for lateral ones.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104244"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143792762","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":"Inflammation and macrophage polarization are associated with Modic change type in lumbar radiculopathy","authors":"Wensen Li ,&nbsp;Niek Djuric ,&nbsp;Christiaan Mink ,&nbsp;Carmen L.A. Vleggeert-Lankamp","doi":"10.1016/j.bas.2025.104249","DOIUrl":"10.1016/j.bas.2025.104249","url":null,"abstract":"<div><h3>Introduction</h3><div>Lumbar disc herniation (LDH) typically manifests as sciatica, attributed to nerve root mechanical compression and/or inflammation. Modic changes (MC), classified as type I or type II, are deemed to represent endplate vascular insufficiency and are hypothesized to create an inflammatory environment. Macrophages infiltrating disc tissue can be polarized into pro-inflammatory M1 or anti-inflammatory M2 phenotypes.</div></div><div><h3>Research question</h3><div>This study aims to investigate the interplay among inflammatory cells, including M1 and M2 macrophages, Modic Changes, and hernia size and type in patients suffering from sciatica due to a LDH.</div></div><div><h3>Material and methods</h3><div>This prospective cohort study selected patients undergoing microdiscectomy for LDH. Macrophage infiltration (CD68, CD192, CD163), MC classification on MRI, and hernia parameters were analyzed.</div></div><div><h3>Results</h3><div>132 out of 187 patients demonstrated macrophages in the lumbar disc tissue. Most samples demonstrated severe inflammation (50 %), and most macrophages were of the M1 phenotype (48 %). MC were present in 45 % of patients, and only 19 % of these demonstrated MC type I. MC type I were highly associated with both severe (p = 0.016) and M1 macrophage-dominant inflammation (p = 0.048). Larger and non-contained herniations associated with increased inflammation (p = 0.029/p = 0.002), while larger herniations associated with the presence of MC type II (p = 0.027).</div></div><div><h3>Discussion and conclusions</h3><div>This study elucidates a close association of MC type I and M1 macrophage. MC type II were observed more often in patients with larger HNPs. This is indicative for MC typing as an important factor in prediction modelling and it suggests the potential for personalized treatment strategies.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104249"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143800460","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":"Subgaleal drainage with one burr-hole for chronic subdural hematomas: Our two-years’ experience","authors":"Franziska A. Schmidt ,&nbsp;Victoria Schön ,&nbsp;Ondra Petr,&nbsp;Christian F. Freyschlag,&nbsp;Claudius Thomé","doi":"10.1016/j.bas.2025.104185","DOIUrl":"10.1016/j.bas.2025.104185","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"5 ","pages":"Article 104185"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11787435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143082050","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}