To evaluate the clinical significance of the “Eiffel-by-night” (EBN) sign in hypertrophic pachymeningitis, focusing on its frequency, etiological associations, and prognostic value for recurrence, which improves diagnostic workflows, facilitating earlier, targeted therapeutic interventions.
Methods
We conducted a retrospective observational study at the Autoimmune Meningitis Outpatient Clinic at Hospital das Clínicas, Universidade de São Paulo (Brazil), from January 2024 to April 2025, including patients with HP confirmed by MRI dural thickening and enhancement, excluding infectious and neoplastic cases. Clinical, cerebrospinal fluid (CSF), and imaging data were obtained from medical records. Two independent raters assessed the presence of the EBN sign on post-contrast T1-weighted on baseline and follow-up MRIs, comparing EBN+ and EBN– groups.
Results
Forty-five patients fulfilled eligibility criteria; 8 (17.7 %) of whom were EBN+, mostly middle-aged women. EBN sign was more common in idiopathic HP (62.5 %), and less so in IgG4-related disease, neurosarcoidosis, and ANCA-associated vasculitis. Clinical and CSF profiles were similar between groups, except for two male EBN+ patients, with marked pleocytosis. Most EBN+ patients (75 %) had a relapsing disease course. The sign persisted in 86 % of cases on the last follow-up.
Conclusion
The EBN sign occurred in fewer than one-fifth of HP cases, primarily in idiopathic disease. Despite no clear clinical or CSF distinctions, its persistence correlated with frequent relapse.
目的探讨“夜间艾菲尔”（Eiffel-by-night， EBN）征象在肥厚性厚性脑膜炎中的临床意义，重点分析其出现频率、病因关联及复发的预后价值，以改善诊断流程，促进早期、有针对性的治疗干预。方法：研究人员于2024年1月至2025年4月在巴西圣保罗大学（Universidade de o Paulo） das医院Clínicas自身免疫性脑膜炎门诊进行回顾性观察研究，纳入经MRI硬膜增厚和增强确诊的HP患者，排除感染性和肿瘤性病例。临床、脑脊液（CSF）和影像学资料均来自医疗记录。两名独立评分者评估对比后基线和随访mri t1加权的EBN征象的存在，比较EBN+组和EBN -组。结果45例患者符合入选标准；EBN+ 8例（17.7 %），以中年妇女为主。EBN征象在特发性HP中更为常见（62.5 %），而在igg4相关疾病、神经结节病和anca相关血管炎中较少。除了2例男性EBN+ 患者有明显的多细胞增多外，两组患者的临床和脑脊液特征相似。大多数EBN+ 患者（75 %）有复发病程。在最后一次随访中，86 %的病例仍存在该症状。结论EBN征在HP病例中的发生率不到五分之一，主要见于特发性疾病。尽管没有明确的临床或脑脊液区别，但其持续存在与频繁复发相关。
{"title":"“Eiffel-by-night” sign in hypertrophic pachymeningitis: Clinical and radiological correlates","authors":"Daniela Ohlweiler Brescovit , Leandro Tavares Lucato , Luiz Henrique Martins Castro , Suely Kazue Nagahashi Marie , Guilherme Diogo Silva","doi":"10.1016/j.clineuro.2025.109291","DOIUrl":"10.1016/j.clineuro.2025.109291","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the clinical significance of the “Eiffel-by-night” (EBN) sign in hypertrophic pachymeningitis, focusing on its frequency, etiological associations, and prognostic value for recurrence, which improves diagnostic workflows, facilitating earlier, targeted therapeutic interventions.</div></div><div><h3>Methods</h3><div>We conducted a retrospective observational study at the Autoimmune Meningitis Outpatient Clinic at Hospital das Clínicas, Universidade de São Paulo (Brazil), from January 2024 to April 2025, including patients with HP confirmed by MRI dural thickening and enhancement, excluding infectious and neoplastic cases. Clinical, cerebrospinal fluid (CSF), and imaging data were obtained from medical records. Two independent raters assessed the presence of the EBN sign on post-contrast T1-weighted on baseline and follow-up MRIs, comparing EBN+ and EBN– groups.</div></div><div><h3>Results</h3><div>Forty-five patients fulfilled eligibility criteria; 8 (17.7 %) of whom were EBN+, mostly middle-aged women. EBN sign was more common in idiopathic HP (62.5 %), and less so in IgG4-related disease, neurosarcoidosis, and ANCA-associated vasculitis. Clinical and CSF profiles were similar between groups, except for two male EBN+ patients, with marked pleocytosis. Most EBN+ patients (75 %) had a relapsing disease course. The sign persisted in 86 % of cases on the last follow-up.</div></div><div><h3>Conclusion</h3><div>The EBN sign occurred in fewer than one-fifth of HP cases, primarily in idiopathic disease. Despite no clear clinical or CSF distinctions, its persistence correlated with frequent relapse.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109291"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-25DOI: 10.1016/j.clineuro.2025.109293
Ahmed Abdelwahab , Hasna Loulida , Mohammad Mahdi Bagheri Asl , Marwa Abdelrasoul , Qian Chang Gallo , Erick Lemon , Sami Al Kasab , Nathan C. Rowland , Alejandro M. Spiotta , Istvan Takacs
Objectives
Current commercial stereotactic frames have several limitations and are geometrically complex. They utilize imaginary, physically unreachable reference points, and they are expensive. We designed a three-dimensional, low-cost, and easy-to-assemble frame that can both visualize and physically reach the reference point at (0, 0, 0). Our frame allows simultaneous bilateral targeting via distinct trajectories, thereby reducing operative time while providing wider facial exposure for airway protection.
Methods
In a prospective phantom experiment (August–October 2025), five operators each performed five passes at four radiopaque intracranial targets (100 attempts). Before every pass, the frame was physically re-zeroed to the reference point. For each attempt, we recorded the three-dimensional Euclidean target registration error (TRE) and the signed axis-specific offsets. Linear mixed-effects modelling with operator and target location as random factors, intraclass correlation, and Bland-Altman agreement were utilized for statistical analyses.
Results
All 100 trajectories contacted their intended target. Mean±SD TRE was 0.19 ± 0.07 mm. Every attempt fell within 1 mm of the target (100 %, 95 %CI 96.4–100 %). Axis-wise biases were negligible (Δx = 0.01 mm, Δy = -0.01 mm, Δz = -0.01 mm; all p > 0.33). Bland-Altman limits of agreement were ±0.23 mm (x), ±0.24 mm (y), and ±0.24 mm (z) with no trend across the measurement range. Mixed-effects modelling attributed 12.5 % of the residual variance to operators, 7.1 % to target location, and 80.4 % to unexplained (within-trial) error; the adjusted ICC was 0.20, indicating low between-operator variability relative to total variance. Neither repetition order (p = 0.38) nor location (p = 0.08) influenced TRE. The mean setup-to-trajectory time was under 10 min per operator.
Conclusion
Our stereotactic system delivered reproducible, near-millimeter accuracy in phantom testing while simplifying setup, reducing operative time, and eliminating expensive software dependency. These findings justify advancing to cadaveric studies and early clinical trials to broaden access to frame-based stereotaxy for urgent procedures, such as external ventricular drain placement, across diverse healthcare environments.
{"title":"Development of a stereotactic frame for neurosurgery targeting: A prospective pre-clinical study","authors":"Ahmed Abdelwahab , Hasna Loulida , Mohammad Mahdi Bagheri Asl , Marwa Abdelrasoul , Qian Chang Gallo , Erick Lemon , Sami Al Kasab , Nathan C. Rowland , Alejandro M. Spiotta , Istvan Takacs","doi":"10.1016/j.clineuro.2025.109293","DOIUrl":"10.1016/j.clineuro.2025.109293","url":null,"abstract":"<div><h3>Objectives</h3><div>Current commercial stereotactic frames have several limitations and are geometrically complex. They utilize imaginary, physically unreachable reference points, and they are expensive. We designed a three-dimensional, low-cost, and easy-to-assemble frame that can both visualize and physically reach the reference point at (0, 0, 0). Our frame allows simultaneous bilateral targeting via distinct trajectories, thereby reducing operative time while providing wider facial exposure for airway protection.</div></div><div><h3>Methods</h3><div>In a prospective phantom experiment (August–October 2025), five operators each performed five passes at four radiopaque intracranial targets (100 attempts). Before every pass, the frame was physically re-zeroed to the reference point. For each attempt, we recorded the three-dimensional Euclidean target registration error (TRE) and the signed axis-specific offsets. Linear mixed-effects modelling with operator and target location as random factors, intraclass correlation, and Bland-Altman agreement were utilized for statistical analyses.</div></div><div><h3>Results</h3><div>All 100 trajectories contacted their intended target. Mean±SD TRE was 0.19 ± 0.07 mm. Every attempt fell within 1 mm of the target (100 %, 95 %CI 96.4–100 %). Axis-wise biases were negligible (Δx = 0.01 mm, Δy = -0.01 mm, Δz = -0.01 mm; all p > 0.33). Bland-Altman limits of agreement were ±0.23 mm (x), ±0.24 mm (y), and ±0.24 mm (z) with no trend across the measurement range. Mixed-effects modelling attributed 12.5 % of the residual variance to operators, 7.1 % to target location, and 80.4 % to unexplained (within-trial) error; the adjusted ICC was 0.20, indicating low between-operator variability relative to total variance. Neither repetition order (p = 0.38) nor location (p = 0.08) influenced TRE. The mean setup-to-trajectory time was under 10 min per operator.</div></div><div><h3>Conclusion</h3><div>Our stereotactic system delivered reproducible, near-millimeter accuracy in phantom testing while simplifying setup, reducing operative time, and eliminating expensive software dependency. These findings justify advancing to cadaveric studies and early clinical trials to broaden access to frame-based stereotaxy for urgent procedures, such as external ventricular drain placement, across diverse healthcare environments.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109293"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-03DOI: 10.1016/j.clineuro.2026.109309
Sean Y. Li , Aritra Nag , David Ben-Israel , Alfred Bowles Jr. , Sandeep Muram , Deven Reddy , Michael L. Kelly
Background
Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors (SRIs) are common medications used in the management of post-stroke depression. However, their antiplatelet effects may increase the risk of intracerebral hemorrhage (ICH) in patients already at elevated risk following ischemic stroke.
Methods
A retrospective cohort study of adults with an ischemic stroke encounter diagnosis was conducted using the TriNetX database. Patients prescribed an SRI within 1 day to 3 months post-stroke were compared with patients without SRI prescriptions. Demographic, clinical, laboratory, and medication covariates were adjusted between the two cohorts using 1:1 propensity score matching (PSM). The primary outcome was nontraumatic ICH within 3 years. A p-value < 0.01 and 95 % confidence intervals (CIs) < 0.9 and > 1.1 were considered statistically significant.
Results
After PSM, 42,310 patients were included in the SRI cohort and the non-SRI cohort. The overall incidence of ICH was significantly more frequent in the SRI group (HR [95 % CI]: 1.48 [1.29, 1.71]). ICH risk remained significant after excluding patients with alcohol or substance use disorders in a secondary analysis. GI bleeding events and mortality rates were also higher in the SRI cohort (HR [95 % CI]: 1.37 [1.27, 1.48] and HR [95 % CI]: 1.54 [1.47, 1.61], respectively) when compared to the non-SRI cohort.
Conclusions
SRI use following ischemic stroke was associated with an increased risk of ICH. These findings highlight the potential for cautious risk–benefit assessment when prescribing SRIs post-stroke and can serve as the basis for prospective studies with detailed clinical validation.
{"title":"Serotonin reuptake inhibition and intracerebral hemorrhage risk after ischemic stroke: A multicenter retrospective study","authors":"Sean Y. Li , Aritra Nag , David Ben-Israel , Alfred Bowles Jr. , Sandeep Muram , Deven Reddy , Michael L. Kelly","doi":"10.1016/j.clineuro.2026.109309","DOIUrl":"10.1016/j.clineuro.2026.109309","url":null,"abstract":"<div><h3>Background</h3><div>Selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors (SRIs) are common medications used in the management of post-stroke depression. However, their antiplatelet effects may increase the risk of intracerebral hemorrhage (ICH) in patients already at elevated risk following ischemic stroke.</div></div><div><h3>Methods</h3><div>A retrospective cohort study of adults with an ischemic stroke encounter diagnosis was conducted using the TriNetX database. Patients prescribed an SRI within 1 day to 3 months post-stroke were compared with patients without SRI prescriptions. Demographic, clinical, laboratory, and medication covariates were adjusted between the two cohorts using 1:1 propensity score matching (PSM). The primary outcome was nontraumatic ICH within 3 years. A p-value < 0.01 and 95 % confidence intervals (CIs) < 0.9 and > 1.1 were considered statistically significant.</div></div><div><h3>Results</h3><div>After PSM, 42,310 patients were included in the SRI cohort and the non-SRI cohort. The overall incidence of ICH was significantly more frequent in the SRI group (HR [95 % CI]: 1.48 [1.29, 1.71]). ICH risk remained significant after excluding patients with alcohol or substance use disorders in a secondary analysis. GI bleeding events and mortality rates were also higher in the SRI cohort (HR [95 % CI]: 1.37 [1.27, 1.48] and HR [95 % CI]: 1.54 [1.47, 1.61], respectively) when compared to the non-SRI cohort.</div></div><div><h3>Conclusions</h3><div>SRI use following ischemic stroke was associated with an increased risk of ICH. These findings highlight the potential for cautious risk–benefit assessment when prescribing SRIs post-stroke and can serve as the basis for prospective studies with detailed clinical validation.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109309"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145910668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-07DOI: 10.1016/j.clineuro.2026.109316
Noriko Usuki , Toshihiro Ueda , Masataka Takeuchi , Masafumi Morimoto , Yoshifumi Tsuboi , Ryoo Yamamoto , Satoshi Takaishi , Kentaro Tatsuno , Hidemichi Ito , Takahiro Shimizu , Yoshihisa Yamano , on behalf of the K-NET Registry Investigators
Purpose
Mechanical thrombectomy (MT) is now the standard of care for large vessel occlusion (LVO), leading to a decline in recent reports on the outcomes of intravenous tissue plasminogen activator (tPA) alone. This study aimed to assess the real-world effectiveness of intravenous tPA alone in the MT era, using data from the Kanagawa Intravenous and Endovascular Treatment (K-NET) registry, a prospective multicenter registry of acute ischemic stroke (AIS) in Japan.
Methods
Among 3954 AIS patients registered between 2018 and 2021, 767 received intravenous tPA without MT. Primary outcomes were the proportions of patients achieving a modified Rankin Scale (mRS) score of 0–1 or 0–2 at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Outcomes were further analyzed by occlusion site and stroke subtype.
Results
The median age was 77 years, and 42.9 % were female. The median National Institutes of Health Stroke Scale (NIHSS) score at presentation was 8. LVO was present in 24.1 % of patients. Favorable outcomes (mRS 0–2) at 90 days were observed in 47 % of all patients, and 56 % of those with pre-stroke mRS scores of 0–1. By the occlusion site, favorable outcome rates were highest in M3–4 occlusions (59 %) and lowest in internal carotid artery (ICA) occlusions (22 %). By stroke subtype, lacunar infarction (LI) showed the best outcomes (63.5 %), while cardioembolism (CE) had the worst (38.3 %). The overall sICH rate was 2.2 %, highest in basilar artery (BA) / vertebral artery (VA) occlusions (6.1 %) and CE cases (4.5 %).
Conclusion
Even in the MT era, intravenous tPA alone provides favorable outcomes in selected patients with AIS, particularly those without LVO. However, the proportion of LVO cases not receiving MT indicates gaps in referral and transfer systems. These findings underscore the significance of tPA alone as an important therapeutic option and as a potential indicator of the performance and equity of regional stroke care systems.
{"title":"Recent outcomes of intravenous tissue plasminogen activator (t-PA) alone in the era of mechanical thrombectomy: A sub-analysis of the Kanagawa Intravenous and Endovascular Treatment (K-NET) registry","authors":"Noriko Usuki , Toshihiro Ueda , Masataka Takeuchi , Masafumi Morimoto , Yoshifumi Tsuboi , Ryoo Yamamoto , Satoshi Takaishi , Kentaro Tatsuno , Hidemichi Ito , Takahiro Shimizu , Yoshihisa Yamano , on behalf of the K-NET Registry Investigators","doi":"10.1016/j.clineuro.2026.109316","DOIUrl":"10.1016/j.clineuro.2026.109316","url":null,"abstract":"<div><h3>Purpose</h3><div>Mechanical thrombectomy (MT) is now the standard of care for large vessel occlusion (LVO), leading to a decline in recent reports on the outcomes of intravenous tissue plasminogen activator (tPA) alone. This study aimed to assess the real-world effectiveness of intravenous tPA alone in the MT era, using data from the Kanagawa Intravenous and Endovascular Treatment (K-NET) registry, a prospective multicenter registry of acute ischemic stroke (AIS) in Japan.</div></div><div><h3>Methods</h3><div>Among 3954 AIS patients registered between 2018 and 2021, 767 received intravenous tPA without MT. Primary outcomes were the proportions of patients achieving a modified Rankin Scale (mRS) score of 0–1 or 0–2 at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Outcomes were further analyzed by occlusion site and stroke subtype.</div></div><div><h3>Results</h3><div>The median age was 77 years, and 42.9 % were female. The median National Institutes of Health Stroke Scale (NIHSS) score at presentation was 8. LVO was present in 24.1 % of patients. Favorable outcomes (mRS 0–2) at 90 days were observed in 47 % of all patients, and 56 % of those with pre-stroke mRS scores of 0–1. By the occlusion site, favorable outcome rates were highest in M3–4 occlusions (59 %) and lowest in internal carotid artery (ICA) occlusions (22 %). By stroke subtype, lacunar infarction (LI) showed the best outcomes (63.5 %), while cardioembolism (CE) had the worst (38.3 %). The overall sICH rate was 2.2 %, highest in basilar artery (BA) / vertebral artery (VA) occlusions (6.1 %) and CE cases (4.5 %).</div></div><div><h3>Conclusion</h3><div>Even in the MT era, intravenous tPA alone provides favorable outcomes in selected patients with AIS, particularly those without LVO. However, the proportion of LVO cases not receiving MT indicates gaps in referral and transfer systems. These findings underscore the significance of tPA alone as an important therapeutic option and as a potential indicator of the performance and equity of regional stroke care systems.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109316"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-26DOI: 10.1016/j.clineuro.2025.109292
Razan R. Faraj , Rommi Kashlan , Hithardhi Duggireddy , Ryan S. Chung , David J. Cote , Robert G. Briggs , Reem A. Dawoud , Angela P. Mihalic , Gabriel Zada , Jonathan A. Grossberg
Objective
With the recent change to pass/fail USMLE Step 1 assessment and increasing reliance on other metrics of applicant ability, neurosurgery residency programs face challenges in evaluating the academic potential of applicants. This study examines the relative contributions of first-author publications, research year completion, and total publication volume to match success.
Methods
Data were drawn from the Texas STAR (Seeking Transparency in Applications to Residency) survey between 2022 and 2025, including 2674 U.S. MD applicants and a detailed 2025 sub-cohort (n = 58) with authorship data. Logistic regression models, Chi-squared tests, and t-tests were used to examine associations between publication patterns and match outcomes. Covariates included Step 2 CK score (categorized), geographic connection, and away rotation participation.
Results
When mutually adjusted, first-author publication count was strongly predictive of match success (OR=2.76 per additional first-authored paper, 95 % CI: 1.82–4.67, p < 0.001), while total publication count was negatively associated with matching when controlling for authorship (OR=0.64, 95 % CI: 0.46–0.84, p < 0.001). Completion of a research year was associated with a significantly higher number of first-author publications (mean=3.96 vs. 2.53, p = 0.0023), but not with greater total publication volume (mean=8.04 vs. 6.41, p = 0.07). A greater number of research experiences was inversely associated with match success (OR=0.53 per experience, 95 % CI: 0.38–0.68, p < 0.001).
Conclusion
First-authored papers better predict match success than total publication count in neurosurgery residency applications. Dedicated research years appear to support meaningful productivity rather than sheer volume. These findings delineate how research experience is weighted in neurosurgery residency selection and may be helpful for medical students applying into neurosurgery.
{"title":"Redefining research productivity in neurosurgery residency applications through the predictive value of authorship order and research year engagement","authors":"Razan R. Faraj , Rommi Kashlan , Hithardhi Duggireddy , Ryan S. Chung , David J. Cote , Robert G. Briggs , Reem A. Dawoud , Angela P. Mihalic , Gabriel Zada , Jonathan A. Grossberg","doi":"10.1016/j.clineuro.2025.109292","DOIUrl":"10.1016/j.clineuro.2025.109292","url":null,"abstract":"<div><h3>Objective</h3><div>With the recent change to pass/fail USMLE Step 1 assessment and increasing reliance on other metrics of applicant ability, neurosurgery residency programs face challenges in evaluating the academic potential of applicants. This study examines the relative contributions of first-author publications, research year completion, and total publication volume to match success.</div></div><div><h3>Methods</h3><div>Data were drawn from the Texas STAR (Seeking Transparency in Applications to Residency) survey between 2022 and 2025, including 2674 U.S. MD applicants and a detailed 2025 sub-cohort (n = 58) with authorship data. Logistic regression models, Chi-squared tests, and t-tests were used to examine associations between publication patterns and match outcomes. Covariates included Step 2 CK score (categorized), geographic connection, and away rotation participation.</div></div><div><h3>Results</h3><div>When mutually adjusted, first-author publication count was strongly predictive of match success (OR=2.76 per additional first-authored paper, 95 % CI: 1.82–4.67, p < 0.001), while total publication count was negatively associated with matching when controlling for authorship (OR=0.64, 95 % CI: 0.46–0.84, p < 0.001). Completion of a research year was associated with a significantly higher number of first-author publications (mean=3.96 vs. 2.53, p = 0.0023), but not with greater total publication volume (mean=8.04 vs. 6.41, p = 0.07). A greater number of research experiences was inversely associated with match success (OR=0.53 per experience, 95 % CI: 0.38–0.68, p < 0.001).</div></div><div><h3>Conclusion</h3><div>First-authored papers better predict match success than total publication count in neurosurgery residency applications. Dedicated research years appear to support meaningful productivity rather than sheer volume. These findings delineate how research experience is weighted in neurosurgery residency selection and may be helpful for medical students applying into neurosurgery.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109292"},"PeriodicalIF":1.6,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-24DOI: 10.1016/j.clineuro.2025.109263
Mohsen Rostami , Sadegh Bagherzadeh , Navid Moghadam , Faramarz Roohollahi , Cesar Carballo Cuello , Jay Kumar , Mark Greenberg , Puya Alikhani
Background
Proximal junctional kyphosis (PJK) and failure (PJF) are critical complications following adult spinal deformity (ASD) surgery. The use of transverse process hooks (TPH) at the upper instrumented vertebra (UIV) has been proposed as a “soft-landing” alternative to rigid pedicle screws (PS), but it remains controversial whether the implant choice or the magnitude of correction is the primary driver of PJK. This study aimed to determine if TPH fixation independently reduces the risk of junctional complications compared to PS in high-risk ASD patients undergoing three-column osteotomies (3CO).
Methods
A retrospective review of 132 ASD patients undergoing 3CO with spinopelvic fixation (70 TPH, 62 PS) and a minimum 2-year follow-up was performed. Demographics, surgical data, radiographic parameters, complications, and patient-reported outcomes (PROMs) were compared. A multivariate logistic regression was performed to identify independent predictors of PJK, controlling for patient factors and postoperative alignment.
Results
The TPH group had significantly lower rates of PJK (21.4 % vs. 37.0 %, p = 0.04) and PJF (17.1 % vs. 32.2 %, p = 0.04). While overall reoperation rates were similar (41.4 % vs. 45.1 %, p = 0.66), the reasons for revision differed: symptomatic PJF was the primary indication in the PS group, versus other mechanical failures (e.g., pseudarthrosis, rod fracture) in the TPH group. Crucially, multivariate logistic regression identified TPH use as an independent protective factor against PJK (Adjusted Odds Ratio = 0.329, p = 0.020), while postoperative alignment parameters, such as SVA and LL, were not significant predictors. PROMs were similar between groups.
Conclusions
In complex ASD surgery requiring 3CO, TPH fixation at the UIV is an independent protective factor against PJK. While TPH significantly reduces the risk of junctional failure, it appears to transfer mechanical stress elsewhere, leading to different modes of late construct failure without changing the overall reoperation rate.
Clinical Relevance
This study provides strong evidence that TPH at the UIV mitigates the risk of PJK independent of the magnitude of sagittal correction. This supports its use as a valuable strategy to reduce proximal junctional complications, though surgeons must remain vigilant for other potential modes of mechanical failure.
Level of Evidence
Level III, retrospective comparative study.
近端关节后凸（PJK）和失能（PJF）是成人脊柱畸形（ASD）手术后的重要并发症。在上固定椎体（UIV）上使用横突钩（TPH）已被提议作为刚性椎弓根螺钉（PS）的“软着陆”替代方案，但对于PJK的主要驱动因素是植入物的选择还是矫正幅度仍存在争议。本研究旨在确定在接受三柱截骨术（3CO）的高风险ASD患者中，与PS相比，TPH固定是否能独立降低结膜并发症的风险。方法回顾性分析132例ASD患者行3CO联合脊柱骨盆固定术（TPH 70例，PS 62例），随访至少2年。比较了人口统计学、手术资料、放射学参数、并发症和患者报告的结果（PROMs）。采用多变量逻辑回归来确定PJK的独立预测因素，控制患者因素和术后对齐。结果TPH组PJK发生率（21.4 % vs. 37.0 %,p = 0.04）和PJF发生率（17.1 % vs. 32.2 %,p = 0.04）显著低于TPH组。虽然总体再手术率相似（41.4% % vs. 45.1% %,p = 0.66），但翻修的原因不同：PS组的主要指征是症状性PJF，而TPH组的主要指征是其他机械故障（如假关节、棒骨折）。关键是，多因素logistic回归发现TPH是预防PJK的独立保护因素（调整优势比= 0.329,p = 0.020），而术后对齐参数，如SVA和LL，不是显著的预测因素。两组之间的prom相似。结论在需要3CO的复杂ASD手术中，UIV处TPH固定是预防PJK的独立保护因素。虽然TPH显著降低了连接失败的风险，但它似乎将机械应力转移到其他地方，导致不同模式的后期构建失败，而不改变总体再手术率。临床相关性本研究提供了强有力的证据表明，与矢状面矫正的大小无关，UIV处的TPH减轻了PJK的风险。尽管外科医生必须对其他潜在的机械故障模式保持警惕，但这支持了其作为减少近端接合并发症的有价值策略的使用。证据等级：III级，回顾性比较研究。
{"title":"Clinical and radiological outcomes of transverse process hooks versus pedicle screws at the upper instrumented vertebra in adult spinal deformity patients undergoing three-column osteotomy: A retrospective comparative study","authors":"Mohsen Rostami , Sadegh Bagherzadeh , Navid Moghadam , Faramarz Roohollahi , Cesar Carballo Cuello , Jay Kumar , Mark Greenberg , Puya Alikhani","doi":"10.1016/j.clineuro.2025.109263","DOIUrl":"10.1016/j.clineuro.2025.109263","url":null,"abstract":"<div><h3>Background</h3><div>Proximal junctional kyphosis (PJK) and failure (PJF) are critical complications following adult spinal deformity (ASD) surgery. The use of transverse process hooks (TPH) at the upper instrumented vertebra (UIV) has been proposed as a “soft-landing” alternative to rigid pedicle screws (PS), but it remains controversial whether the implant choice or the magnitude of correction is the primary driver of PJK. This study aimed to determine if TPH fixation independently reduces the risk of junctional complications compared to PS in high-risk ASD patients undergoing three-column osteotomies (3CO).</div></div><div><h3>Methods</h3><div>A retrospective review of 132 ASD patients undergoing 3CO with spinopelvic fixation (70 TPH, 62 PS) and a minimum 2-year follow-up was performed. Demographics, surgical data, radiographic parameters, complications, and patient-reported outcomes (PROMs) were compared. A multivariate logistic regression was performed to identify independent predictors of PJK, controlling for patient factors and postoperative alignment.</div></div><div><h3>Results</h3><div>The TPH group had significantly lower rates of PJK (21.4 % vs. 37.0 %, p = 0.04) and PJF (17.1 % vs. 32.2 %, p = 0.04). While overall reoperation rates were similar (41.4 % vs. 45.1 %, p = 0.66), the reasons for revision differed: symptomatic PJF was the primary indication in the PS group, versus other mechanical failures (e.g., pseudarthrosis, rod fracture) in the TPH group. Crucially, multivariate logistic regression identified TPH use as an independent protective factor against PJK (Adjusted Odds Ratio = 0.329, p = 0.020), while postoperative alignment parameters, such as SVA and LL, were not significant predictors. PROMs were similar between groups.</div></div><div><h3>Conclusions</h3><div>In complex ASD surgery requiring 3CO, TPH fixation at the UIV is an independent protective factor against PJK. While TPH significantly reduces the risk of junctional failure, it appears to transfer mechanical stress elsewhere, leading to different modes of late construct failure without changing the overall reoperation rate.</div></div><div><h3>Clinical Relevance</h3><div>This study provides strong evidence that TPH at the UIV mitigates the risk of PJK independent of the magnitude of sagittal correction. This supports its use as a valuable strategy to reduce proximal junctional complications, though surgeons must remain vigilant for other potential modes of mechanical failure.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective comparative study.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109263"},"PeriodicalIF":1.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145594798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.clineuro.2025.109280
Muhammad Muaz , Vineet Kumar
{"title":"Critique on “Identifying poor prognostic factors in patients with spontaneous spinal epidural hematoma: Insights from 47 cases at a single institution”","authors":"Muhammad Muaz , Vineet Kumar","doi":"10.1016/j.clineuro.2025.109280","DOIUrl":"10.1016/j.clineuro.2025.109280","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109280"},"PeriodicalIF":1.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145682348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine the most appropriate assessment scale and timing of the tap test for predicting improvements in dementia severity after shunt surgery in patients with idiopathic normal-pressure hydrocephalus (iNPH).
Methods
Data were extracted from an observational study that followed patients with iNPH as follows: Patients diagnosed with possible iNPH and scheduled for a tap test were enrolled. Patients diagnosed with probable iNPH by the tap test underwent shunting and followed up for 3 months after shunting. Patients with missing data in the tap test assessment items (gait speed: 3 consecutive days before tapping and 3 consecutive days after tapping; cognition: before tapping, 1 day after tapping and 1 week after tapping; and urinary dysfunction: before tapping and 1 week after tapping) or in the Clinical Dementia Rating (CDR) assessed before tapping and 3 months after shunting were excluded from this study.
Results
54 patients were included in the analysis. The change in CDR-Sum of Boxes (CDR-SoB) score after shunt surgery was significantly correlated with the change in Mini-Mental State Examination (MMSE) score (β = −0.417, p < 0.001) and Frontal Assessment Battery (FAB) score (β = −0.379, p = 0.002) 3 months after shunt surgery after adjusting for age and sex. The change in MMSE score after shunt surgery was correlated with the change in MMSE score 1 day after tapping (β = 0.411, p = 0.001), the change in the minimum Timed Up and Go test score across repeated tests after tapping (β = −0.376, p = 0.004) and attention/concentration in Wechsler Memory Scale-Revised 1 day after tapping (β = −0.289, p = 0.024). The change in FAB score after shunt surgery was correlated with the change in the maximum FAB score across repeated tests after tapping (β = 0.523, p < 0.001).
Conclusion
Combining MMSE and FAB assessments during the tap test may yield more useful information in assessing cognitive impairment than using either MMSE or FAB alone.
目的：确定特发性常压脑积水（iNPH）患者分流术后痴呆严重程度改善的tap试验的最合适评估量表和时间。方法：从一项观察性研究中提取数据，该研究对iNPH患者进行如下随访：诊断为可能的iNPH并计划进行tap测试的患者入组。通过tap试验诊断为可能的iNPH的患者接受分流治疗，并在分流后随访3个月。在叩击测试评估项目（步态速度：叩击前连续3天、叩击后连续3天；认知能力：叩击前、叩击后1 天、叩击后1周；泌尿功能障碍：叩击前、叩击后1周）或叩击前、分流后3个月临床痴呆评分（CDR）数据缺失的患者排除在本研究之外。结果：54例患者纳入分析。分流手术后CDR-Sum of Boxes （CDR-SoB）评分的变化与Mini-Mental State Examination （MMSE）评分的变化具有显著相关性（β = -0.417, p ）。结论：tap试验中结合MMSE和FAB评估可能比单独使用MMSE或FAB更能提供评估认知功能障碍的有用信息。
{"title":"Predicting dementia severity changes after shunt surgery for idiopathic normal-pressure hydrocephalus: Role of the tap test and cognitive assessments","authors":"Fuyuki Koizumi , Hideki Kanemoto , Takashi Suehiro , Shunsuke Sato , Yuto Satake , Daiki Taomoto , Kenji Yoshiyama , Koichi Hosomi , Haruhiko Kishima , Manabu Ikeda","doi":"10.1016/j.clineuro.2025.109288","DOIUrl":"10.1016/j.clineuro.2025.109288","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the most appropriate assessment scale and timing of the tap test for predicting improvements in dementia severity after shunt surgery in patients with idiopathic normal-pressure hydrocephalus (iNPH).</div></div><div><h3>Methods</h3><div>Data were extracted from an observational study that followed patients with iNPH as follows: Patients diagnosed with possible iNPH and scheduled for a tap test were enrolled. Patients diagnosed with probable iNPH by the tap test underwent shunting and followed up for 3 months after shunting. Patients with missing data in the tap test assessment items (gait speed: 3 consecutive days before tapping and 3 consecutive days after tapping; cognition: before tapping, 1 day after tapping and 1 week after tapping; and urinary dysfunction: before tapping and 1 week after tapping) or in the Clinical Dementia Rating (CDR) assessed before tapping and 3 months after shunting were excluded from this study.</div></div><div><h3>Results</h3><div>54 patients were included in the analysis. The change in CDR-Sum of Boxes (CDR-SoB) score after shunt surgery was significantly correlated with the change in Mini-Mental State Examination (MMSE) score (β = −0.417, p < 0.001) and Frontal Assessment Battery (FAB) score (β = −0.379, p = 0.002) 3 months after shunt surgery after adjusting for age and sex. The change in MMSE score after shunt surgery was correlated with the change in MMSE score 1 day after tapping (β = 0.411, p = 0.001), the change in the minimum Timed Up and Go test score across repeated tests after tapping (β = −0.376, p = 0.004) and attention/concentration in Wechsler Memory Scale-Revised 1 day after tapping (β = −0.289, p = 0.024). The change in FAB score after shunt surgery was correlated with the change in the maximum FAB score across repeated tests after tapping (β = 0.523, p < 0.001).</div></div><div><h3>Conclusion</h3><div>Combining MMSE and FAB assessments during the tap test may yield more useful information in assessing cognitive impairment than using either MMSE or FAB alone.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109288"},"PeriodicalIF":1.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145826974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-28DOI: 10.1016/j.clineuro.2025.109277
Vratko Himic , Roxanne C. Mayrand , Zachary C. Gersey , Adham M. Khalafallah , Victor M. Lu , Sima Vazquez , Long Di , Daniel M. Aaronson , Ashish H. Shah , Ricardo J. Komotar , Michael E. Ivan
Purpose
The use of neuronavigation with superimposed mapping tools has enabled visualization of key fiber tracts and improved peri-operative planning. However, a limitation of these approaches is their reliance on a static underlying brain atlas, particularly in neurosurgical patients with brain tumors. A tool that enables qualification and quantification of brain region connectivity could refine approaches to surgical resection.
Methods
We utilized a machine learning imaging platform, Quicktome™, to generate individualized functional parcels and tracts that dynamically adapt to perioperative change. The connectome was derived from a combination of diffusion tensor imaging and resting-state function magnetic resonance imaging. Matrices were generated from the functional MRI of four patients with intracranial neoplasms and the pre- and post-operative parcellation values were compared. The individual correlation and strength of regions were quantified. Hypo- and hyper-connected regions were marked as anomalous.
Results
We present a case series of four patients to illustrate the correlation of the anomaly matrices with post-operative neurological changes. These include: post-operative delirium originating associated with salience network hypoconnectivity; visual hemineglect linked to hypoconnectivity in the dorsal attention network; and quantifiable improvements in the language network following the resolution of expressive aphasia. All differences between pre-and post-operative paired correlation values were statistically significant.
Conclusion
We demonstrate a novel approach to quantifying the extent to which anomalies in the functional connectome correlate with post-operative neurological changes. This has relevance in post-operative prognostication, provision of specialist therapy services, and could serve as a useful tool in surgical education and pre-operative planning.
{"title":"Anomaly changes in the functional connectome of post-operative neurosurgical patients: A case series","authors":"Vratko Himic , Roxanne C. Mayrand , Zachary C. Gersey , Adham M. Khalafallah , Victor M. Lu , Sima Vazquez , Long Di , Daniel M. Aaronson , Ashish H. Shah , Ricardo J. Komotar , Michael E. Ivan","doi":"10.1016/j.clineuro.2025.109277","DOIUrl":"10.1016/j.clineuro.2025.109277","url":null,"abstract":"<div><h3>Purpose</h3><div>The use of neuronavigation with superimposed mapping tools has enabled visualization of key fiber tracts and improved peri-operative planning. However, a limitation of these approaches is their reliance on a static underlying brain atlas, particularly in neurosurgical patients with brain tumors. A tool that enables qualification and quantification of brain region connectivity could refine approaches to surgical resection.</div></div><div><h3>Methods</h3><div>We utilized a machine learning imaging platform, Quicktome™, to generate individualized functional parcels and tracts that dynamically adapt to perioperative change. The connectome was derived from a combination of diffusion tensor imaging and resting-state function magnetic resonance imaging. Matrices were generated from the functional MRI of four patients with intracranial neoplasms and the pre- and post-operative parcellation values were compared. The individual correlation and strength of regions were quantified. Hypo- and hyper-connected regions were marked as anomalous.</div></div><div><h3>Results</h3><div>We present a case series of four patients to illustrate the correlation of the anomaly matrices with post-operative neurological changes. These include: post-operative delirium originating associated with salience network hypoconnectivity; visual hemineglect linked to hypoconnectivity in the dorsal attention network; and quantifiable improvements in the language network following the resolution of expressive aphasia. All differences between pre-and post-operative paired correlation values were statistically significant.</div></div><div><h3>Conclusion</h3><div>We demonstrate a novel approach to quantifying the extent to which anomalies in the functional connectome correlate with post-operative neurological changes. This has relevance in post-operative prognostication, provision of specialist therapy services, and could serve as a useful tool in surgical education and pre-operative planning.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109277"},"PeriodicalIF":1.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-15DOI: 10.1016/j.clineuro.2025.109286
Zach Pennington , Anthony L. Mikula , Abdelrahman Hamouda , Derrick Obiri-Yeboah , Michael L. Martini , Andrew J. Grossbach , Gabriella L. Paganucci , Ahmad N. Nassr , Brett A. Freedman , Arjun Sebastian , Jeremy L. Fogelson , Benjamin D. Elder
Objective
To assess paraspinal muscularity and bone quality contribution to PJK risk.
Methods
Defining PJK as ≥ 10° increase in proximal junctional angle from first upright radiograph, thoracolumbopelvic fusion patients experiencing PJK were compared to controls. Baseline radiographic parameters, bone quality in CT Hounsfield units (HU), and paraspinal musculature cross-sectional area (CSA) at L3 and the UIV. Patients were subdivided into type 1–3 PJK based upon the Yagi-Boachie scale. Time-dependent analyses with univariable Cox proportional hazards model were performed.
Results
206 patients were included (59.7 % female; median age 67.1); 26.9 % experienced PJK – 52.5 % type 1, 27.8 % type 2, and 19.7 % type 3. Univariable comparisons showed PJK patients had lower HU at the UIV (137 vs 151; p = 0.047) and UIV+ 1 (137 vs 151; p = 0.028); mean multifidus CSA (p = 0.21) was also nonsignificantly smaller. Average HU were lower in type 2 PJK patients relative to non-PJK and type 1 PJK (p < 0.001). Type 2 failure was predicted by UIV/UIV+ 1, UIV, and UIV+ 1 average HU (all p < 0.01) while type 1 failure was predicted by UIV multifidus CSA (p = 0.03); average HU did not predict type 1 failure.
Conclusions
Poor bone quality may be the strongest predictor of PJK; however, subanalysis by PJK type suggests it only increases the odds of bony or implant/bone interface failure. Decreased multifidus CSA appears to confer risk for type 1 (discoligamentous) PJK, suggesting PJK failure mode is dictated by the interplay of UIV bony and soft tissue integrity.
目的：评价椎旁肌肉和骨质量对PJK风险的影响。方法：将PJK定义为第一次直立x线片近端关节角增加≥ 10°，将经历PJK的胸腰盂融合患者与对照组进行比较。基线x线摄影参数，CT Hounsfield单元（HU）的骨质量，L3和UIV的棘旁肌肉横截面积（CSA）。根据Yagi-Boachie量表将患者细分为1-3型PJK。采用单变量Cox比例风险模型进行时间相关分析。结果：纳入206例患者（59.7 %为女性，中位年龄67.1岁）；26.9 %经历PJK， 52.5 % 1型，27.8 % 2型，19.7 % 3型。单变量比较显示，PJK患者在UIV时的HU较低（137 vs 151, p = 0.047）和UIV+ 1 (137 vs 151, p = 0.028)；平均多裂肌CSA （p = 0.21）也无显著性差异。2型PJK患者的平均HU低于非PJK和1型PJK （p ）结论：骨质量差可能是PJK的最强预测因子；然而，PJK类型的亚分析表明，它只会增加骨或种植体/骨界面失效的几率。多裂肌CSA降低似乎会增加1型（双韧带）PJK的风险，这表明PJK的失败模式是由紫外线照射下骨和软组织完整性的相互作用决定的。
{"title":"Relative influence of paraspinal muscularity and underlying bone quality on proximal junctional kyphosis and failure mode in patients undergoing thoracolumbar instrumented fusion","authors":"Zach Pennington , Anthony L. Mikula , Abdelrahman Hamouda , Derrick Obiri-Yeboah , Michael L. Martini , Andrew J. Grossbach , Gabriella L. Paganucci , Ahmad N. Nassr , Brett A. Freedman , Arjun Sebastian , Jeremy L. Fogelson , Benjamin D. Elder","doi":"10.1016/j.clineuro.2025.109286","DOIUrl":"10.1016/j.clineuro.2025.109286","url":null,"abstract":"<div><h3>Objective</h3><div>To assess paraspinal muscularity and bone quality contribution to PJK risk.</div></div><div><h3>Methods</h3><div>Defining PJK as ≥ 10° increase in proximal junctional angle from first upright radiograph, thoracolumbopelvic fusion patients experiencing PJK were compared to controls. Baseline radiographic parameters, bone quality in CT Hounsfield units (HU), and paraspinal musculature cross-sectional area (CSA) at L3 and the UIV. Patients were subdivided into type 1–3 PJK based upon the Yagi-Boachie scale. Time-dependent analyses with univariable Cox proportional hazards model were performed.</div></div><div><h3>Results</h3><div>206 patients were included (59.7 % female; median age 67.1); 26.9 % experienced PJK – 52.5 % type 1, 27.8 % type 2, and 19.7 % type 3. Univariable comparisons showed PJK patients had lower HU at the UIV (137 vs 151; p = 0.047) and UIV+ 1 (137 vs 151; p = 0.028); mean multifidus CSA (p = 0.21) was also nonsignificantly smaller. Average HU were lower in type 2 PJK patients relative to non-PJK and type 1 PJK (p < 0.001). Type 2 failure was predicted by UIV/UIV+ 1, UIV, and UIV+ 1 average HU (all p < 0.01) while type 1 failure was predicted by UIV multifidus CSA (p = 0.03); average HU did not predict type 1 failure.</div></div><div><h3>Conclusions</h3><div>Poor bone quality may be the strongest predictor of PJK; however, subanalysis by PJK type suggests it only increases the odds of bony or implant/bone interface failure. Decreased multifidus CSA appears to confer risk for type 1 (discoligamentous) PJK, suggesting PJK failure mode is dictated by the interplay of UIV bony and soft tissue integrity.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"261 ","pages":"Article 109286"},"PeriodicalIF":1.6,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145780632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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