Patients with acute ischemic stroke (AIS) frequently exhibit alterations in thyroid function. Though, the association between free thyroxine levels and stroke severity, in addition to the pathophysiological implications of thyroid hormone fluctuations, has not been entirely elucidated and remains unclear in AIS patients.
Aims
To assess the association between free thyroxine (fT4) and free triiodothyronine (fT3) levels and both stroke severity and inflammatory markers in patients’ subsequent acute minor and severe ischemic strokes.
Methods
This study involved 142 patients with acute minor and severe ischemic stroke (104 males and 38 females). Thyroid hormone levels and inflammatory biomarkers were measured for all contributors. Stroke severity was determined utilising the National Institutes of Health Stroke Scale (NIHSS scores). Multiple regression analysis was conducted to control for potential confounders. Furthermore, a receiver operating characteristic (ROC) curve for fT4 was generated to assess its predictive value for stroke severity.
Results
Patients with severe ischemic stroke showed significantly higher fT4 levels and lower fT3 levels in comparison with those who have minor ischemic stroke. Free T3 was negatively correlated with ESR (r = –0.454, P < 0.001), CRP (r = –0.169, P = 0.04), and NIHSS scores (r = –0.547, P < 0.001). In contrast, fT4 was positively correlated with ESR (r = 0.262, P = 0.002), CRP (r = 0.39, P < 0.001), and NIHSS scores (r = 0.418, P < 0.001). Multiple regression analysis displayed that NIHSS scores were independently associated with fT3, whereas both NIHSS scores and CRP were independently associated with fT4. ROC analysis proved that the AUC for fT4 was 0.739 (95 % CI, 0.657–0.822).
Conclusion
Higher fT4 and lower fT3 levels are linked with greater stroke severity and elevated inflammatory markers in patients with acute severe ischemic stroke in comparison with those who experienced minor stroke.
背景：急性缺血性脑卒中（AIS）患者经常表现出甲状腺功能的改变。尽管如此，游离甲状腺素水平与脑卒中严重程度之间的关系，以及甲状腺激素波动的病理生理影响，在AIS患者中尚未完全阐明，目前仍不清楚。目的探讨游离甲状腺素（fT4）和游离三碘甲状腺原氨酸（fT3）水平与急性轻度和重度缺血性卒中患者卒中严重程度和炎症标志物之间的关系。方法142例急性轻、重度缺血性脑卒中患者（男104例，女38例）。测量了所有参与者的甲状腺激素水平和炎症生物标志物。采用美国国立卫生研究院卒中量表（NIHSS评分）确定卒中严重程度。采用多元回归分析控制潜在混杂因素。此外，生成fT4的受试者工作特征（ROC）曲线，以评估其对脑卒中严重程度的预测价值。结果重度缺血性脑卒中患者fT4水平明显高于轻度缺血性脑卒中患者，fT3水平明显低于轻度缺血性脑卒中患者。游离T3与ESR （r = -0.454, P < 0.001）、CRP （r = -0.169, P = 0.04）、NIHSS评分（r = -0.547, P < 0.001）呈负相关。fT4与ESR （r = 0.262, P = 0.002）、CRP （r = 0.39, P < 0.001）、NIHSS评分（r = 0.418, P < 0.001）呈正相关。多元回归分析显示NIHSS评分与fT3独立相关，而NIHSS评分和CRP均与fT4独立相关。ROC分析证实，fT4的AUC为0.739 （95% CI, 0.657-0.822）。结论与轻度脑卒中患者相比，急性重度缺血性脑卒中患者较高的fT4和较低的fT3水平与脑卒中严重程度和炎症标志物升高有关。
{"title":"Association between free thyroxine and free triiodothyronine levels with inflammation markers in acute minor and severe ischemic stroke patients","authors":"Omar Khalid Suhail , Muhtada Ali Challoob , Hiba Qasim Mahmoud","doi":"10.1016/j.jocn.2025.111827","DOIUrl":"10.1016/j.jocn.2025.111827","url":null,"abstract":"<div><h3>Background</h3><div>Patients with acute ischemic stroke (AIS) frequently exhibit alterations in thyroid function. Though, the association between free thyroxine levels and stroke severity, in addition to the pathophysiological implications of thyroid hormone fluctuations, has not been entirely elucidated and remains unclear in AIS patients.</div></div><div><h3>Aims</h3><div>To assess the association between free thyroxine (fT4) and free triiodothyronine (fT3) levels and both stroke severity and inflammatory markers in patients’ subsequent acute minor and severe ischemic strokes.</div></div><div><h3>Methods</h3><div>This study involved 142 patients with acute minor and severe ischemic stroke (104 males and 38 females). Thyroid hormone levels and inflammatory biomarkers were measured for all contributors. Stroke severity was determined utilising the National Institutes of Health Stroke Scale (NIHSS scores). Multiple regression analysis was conducted to control for potential confounders. Furthermore, a receiver operating characteristic (ROC) curve for fT4 was generated to assess its predictive value for stroke severity.</div></div><div><h3>Results</h3><div>Patients with severe ischemic stroke showed significantly higher fT4 levels and lower fT3 levels in comparison with those who have minor ischemic stroke. Free T3 was negatively correlated with ESR (r = –0.454, P < 0.001), CRP (r = –0.169, P = 0.04), and NIHSS scores (r = –0.547, P < 0.001). In contrast, fT4 was positively correlated with ESR (r = 0.262, P = 0.002), CRP (r = 0.39, P < 0.001), and NIHSS scores (r = 0.418, P < 0.001). Multiple regression analysis displayed that NIHSS scores were independently associated with fT3, whereas both NIHSS scores and CRP were independently associated with fT4. ROC analysis proved that the AUC for fT4 was 0.739 (95 % CI, 0.657–0.822).</div></div><div><h3>Conclusion</h3><div>Higher fT4 and lower fT3 levels are linked with greater stroke severity and elevated inflammatory markers in patients with acute severe ischemic stroke in comparison with those who experienced minor stroke.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"145 ","pages":"Article 111827"},"PeriodicalIF":1.8,"publicationDate":"2025-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839242","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}
High-Grade Gliomas (HGGs), including glioblastomas (GBM), are aggressive brain tumors with a 5-year survival rate of 7.2% with little understanding on the socioeconomic impact on outcomes. This study aimed to examine how socioeconomic factors of patients and healthcare providers impact treatment choices and outcomes in HGG management through a narrative and manual approach to data collection and synthesis, as a precursor to a systematic review and analysis that will quantitatively approach the question.
Methods
The study initially intended as a meta-analysis based on a literature search performed across MEDLINE, PubMed, and EMBASE using predefined terms was converted to a narrative review in view of the substantial heterogeneity in both socio-economic status (SES) definitions and outcome reporting.
Results and Discussion
A review of 15 out of 261 studies identified 16 SES variable-outcome combinations, namely income (n = 7), a Socioeconomic Status Index (SES index; n = 6), an Area Deprivation Index (ADI; n = 2), and a Frailty Index (n = 1). Median hazard ratio was 0.760 (n = 11), overall survival ranged from 4 – 8.16 months (mean = 5.52 months; n = 4), and incidence ratios > 1 (n = 2); all favoring higher SES groups. Further narrative analysis showcases nuance in the results with survival differences disappearing in longer time frames. The indication of early diagnosis in higher SES categories could also imply that better survival is instead driven by earlier diagnosis rather than a direct impact onto disease progression. Regardless, this overall infers that the SES impacts are limited to a short period of time without affecting eventual prognosis in a meaningful manner.
Conclusion
These findings, based off a limited set of studies, suggest that there is at least a temporary impact of SES differences onto varied dimensions of HGG treatment and outcomes. Reducing effects with time also suggests that these SES differences might have significant implications for palliative care and quality of life care during HGG treatment protocols. Given limited exploration especially outside of HGGs, further studies that investigate more detail onto SES are warranted, particularly in the dimensions of early-diagnosis and palliative care.
{"title":"Socioeconomic factors in high-grade glioma treatment and outcomes: A systematic and narrative review of a heterogeneous evidence Base","authors":"Pumudu Weerasekara , Chayu Damsinghe , Sunil Lakshman Perera","doi":"10.1016/j.jocn.2025.111826","DOIUrl":"10.1016/j.jocn.2025.111826","url":null,"abstract":"<div><h3>Introduction</h3><div>High-Grade Gliomas (HGGs), including glioblastomas (GBM), are aggressive brain tumors with a 5-year survival rate of 7.2% with little understanding on the socioeconomic impact on outcomes. This study aimed to examine how socioeconomic factors of patients and healthcare providers impact treatment choices and outcomes in HGG management through a narrative and manual approach to data collection and synthesis, as a precursor to a systematic review and analysis that will quantitatively approach the question.</div></div><div><h3>Methods</h3><div>The study initially intended as a <em>meta</em>-analysis based on a literature search performed across MEDLINE, PubMed, and EMBASE using predefined terms was converted to a narrative review in view of the substantial heterogeneity in both socio-economic status (SES) definitions and outcome reporting.</div></div><div><h3>Results and Discussion</h3><div>A review of 15 out of 261 studies identified 16 SES variable-outcome combinations, namely income (n = 7), a Socioeconomic Status Index (SES index; n = 6), an Area Deprivation Index (ADI; n = 2), and a Frailty Index (n = 1). Median hazard ratio was 0.760 (n = 11), overall survival ranged from 4 – 8.16 months (mean = 5.52 months; n = 4), and incidence ratios > 1 (n = 2); all favoring higher SES groups. Further narrative analysis showcases nuance in the results with survival differences disappearing in longer time frames. The indication of early diagnosis in higher SES categories could also imply that better survival is instead driven by earlier diagnosis rather than a direct impact onto disease progression. Regardless, this overall infers that the SES impacts are limited to a short period of time without affecting eventual prognosis in a meaningful manner.</div></div><div><h3>Conclusion</h3><div>These findings, based off a limited set of studies, suggest that there is at least a temporary impact of SES differences onto varied dimensions of HGG treatment and outcomes. Reducing effects with time also suggests that these SES differences might have significant implications for palliative care and quality of life care during HGG treatment protocols. Given limited exploration especially outside of HGGs, further studies that investigate more detail onto SES are warranted, particularly in the dimensions of early-diagnosis and palliative care.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111826"},"PeriodicalIF":1.8,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145837245","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 : 2025-12-24DOI: 10.1016/j.jocn.2025.111825
Murat Alpua , Mehmet Hamamcı
Objective
This study evaluated the content quality and reliability of Guillain-Barré Syndrome (GBS) videos published on YouTube.
Methods
A total of 114 videos were reviewed, starting with the most viewed videos, based on the keyword “Guillain-Barré Syndrome.” Fifty English videos meeting the eligibility criteria were included in the analysis. The videos were evaluated by two independent neurologists using the Global Quality Scale (GQS), mDISCERN, and JAMA criteria.
Results
The mean GQS score for the videos was 3.08 ± 0.75, mDISCERN score was 3.14 ± 0.78, and JAMA score was 2.22 ± 0.76. Thirty-two percent of the videos were produced by health/medical information channels, 18 % by “other” producers, 14 % by patients, 12 % by physicians, and the remainder by associations, TV programs, hospitals, and other healthcare professionals. There were significant differences in quality scores between the producer groups; videos created by physicians had the highest scores for GQS (3.83 ± 0.41) and JAMA (2.83 ± 0.41) (p < 0.05). No significant correlation was found between the number of views and quality metrics, but the number of likes was positively correlated with GQS, mDISCERN, and JAMA scores (p < 0.05). The content quality of the most viewed videos was generally moderate.
Conclusion
Most GBS videos on YouTube have moderate quality and credibility. Higher scores for videos created by healthcare professionals highlight the importance of expert input in online health content. These findings suggest the need to develop scientifically based, accessible video content to reduce the risk of misinformation and increase patient and public health literacy.
{"title":"Reliability of online health information: evaluation of Guillain-Barré Syndrome videos on YouTube","authors":"Murat Alpua , Mehmet Hamamcı","doi":"10.1016/j.jocn.2025.111825","DOIUrl":"10.1016/j.jocn.2025.111825","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluated the content quality and reliability of Guillain-Barré Syndrome (GBS) videos published on YouTube.</div></div><div><h3>Methods</h3><div>A total of 114 videos were reviewed, starting with the most viewed videos, based on the keyword “Guillain-Barré Syndrome.” Fifty English videos meeting the eligibility criteria were included in the analysis. The videos were evaluated by two independent neurologists using the Global Quality Scale (GQS), mDISCERN, and JAMA criteria.</div></div><div><h3>Results</h3><div>The mean GQS score for the videos was 3.08 ± 0.75, mDISCERN score was 3.14 ± 0.78, and JAMA score was 2.22 ± 0.76. Thirty-two percent of the videos were produced by health/medical information channels, 18 % by “other” producers, 14 % by patients, 12 % by physicians, and the remainder by associations, TV programs, hospitals, and other healthcare professionals. There were significant differences in quality scores between the producer groups; videos created by physicians had the highest scores for GQS (3.83 ± 0.41) and JAMA (2.83 ± 0.41) (p < 0.05). No significant correlation was found between the number of views and quality metrics, but the number of likes was positively correlated with GQS, mDISCERN, and JAMA scores (p < 0.05). The content quality of the most viewed videos was generally moderate.</div></div><div><h3>Conclusion</h3><div>Most GBS videos on YouTube have moderate quality and credibility. Higher scores for videos created by healthcare professionals highlight the importance of expert input in online health content. These findings suggest the need to develop scientifically based, accessible video content to reduce the risk of misinformation and increase patient and public health literacy.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111825"},"PeriodicalIF":1.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834087","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 : 2025-12-24DOI: 10.1016/j.jocn.2025.111819
Brian Carlson , Todd Laffaye , Landon Gray , Abhijith R. Bathini , Anwesha Dubey , Devi Prasad Patra
Introduction
The use of Artificial Intelligence (AI) has grown dramatically in recent years. In addition to its use for data analysis, its applications have extended to manuscript writing. In this article, we analyze the policies within top neurosurgical journals surrounding AI use for manuscript writing, its implementation, and whether disclosure of this practice affects article citation metrics.
Methods
Neurosurgical journals with h-indices ≥ 100 and with “spin*” or “neurosurg*” (including translations in other languages) and no other medical subspecialty within their title were included (n = 9). Each journal’s policy surrounding AI use in manuscript writing was assessed for whether disclosure was mandated, and if so, requirements for the disclosure. A search was performed using each journal’s respective database to find articles that disclosed AI use. Data extracted from each article included: article acceptance and online publication date, type of article, section containing the AI disclosure, total citations, AI program used, and the stated purpose of AI use. A cohort of non-AI-assisted articles was created to assess whether AI disclosure impacts the total number of citations received after publication.
Results
All nine journals mandated disclosure, however, there were variations in the contents required from each disclosure, where in the manuscript the disclosure must be, limitations for AI use, and whether the journal provided a template for how to disclose AI use. A total of 67 publications were included in this review. The journal with the greatest number of articles was World Neurosurgery (n = 41, 61 %), and the journal with the greatest percentage of articles published disclosing AI use since January 1, 2022, was Neurosurgical Focus (0.68 %). Despite the low prevalence across all journals assessed, the rate of growth for articles written with AI has steadily increased. No significant difference was found in the total number of citations between articles that disclosed AI and a cohort of similar articles that did not (W = 85.5, p = 0.69562).
Conclusions
The number of articles declaring AI use was lower than expected. However, such articles have been growing exponentially. Policies surrounding AI use and its implementation varied across journals. We therefore provide recommendations to promote similarity in guidelines between journals, as this will lessen confusion among authors and promote transparency within the medical research community.
{"title":"The use of Artificial Intelligence in neurosurgical manuscript writing: Journal specific policies and their implementation","authors":"Brian Carlson , Todd Laffaye , Landon Gray , Abhijith R. Bathini , Anwesha Dubey , Devi Prasad Patra","doi":"10.1016/j.jocn.2025.111819","DOIUrl":"10.1016/j.jocn.2025.111819","url":null,"abstract":"<div><h3>Introduction</h3><div>The use of Artificial Intelligence (AI) has grown dramatically in recent years. In addition to its use for data analysis, its applications have extended to manuscript writing. In this article, we analyze the policies within top neurosurgical journals surrounding AI use for manuscript writing, its implementation, and whether disclosure of this practice affects article citation metrics.</div></div><div><h3>Methods</h3><div>Neurosurgical journals with h-indices ≥ 100 and with “spin*” or “neurosurg*” (including translations in other languages) and no other medical subspecialty within their title were included (n = 9). Each journal’s policy surrounding AI use in manuscript writing was assessed for whether disclosure was mandated, and if so, requirements for the disclosure. A search was performed using each journal’s respective database to find articles that disclosed AI use. Data extracted from each article included: article acceptance and online publication date, type of article, section containing the AI disclosure, total citations, AI program used, and the stated purpose of AI use. A cohort of non-AI-assisted articles was created to assess whether AI disclosure impacts the total number of citations received after publication.</div></div><div><h3>Results</h3><div>All nine journals mandated disclosure, however, there were variations in the contents required from each disclosure, where in the manuscript the disclosure must be, limitations for AI use, and whether the journal provided a template for how to disclose AI use. A total of 67 publications were included in this review. The journal with the greatest number of articles was <em>World Neurosurgery</em> (n = 41, 61 %), and the journal with the greatest percentage of articles published disclosing AI use since January 1, 2022, was <em>Neurosurgical Focus</em> (0.68 %). Despite the low prevalence across all journals assessed, the rate of growth for articles written with AI has steadily increased. No significant difference was found in the total number of citations between articles that disclosed AI and a cohort of similar articles that did not (W = 85.5, p = 0.69562).</div></div><div><h3>Conclusions</h3><div>The number of articles declaring AI use was lower than expected. However, such articles have been growing exponentially. Policies surrounding AI use and its implementation varied across journals. We therefore provide recommendations to promote similarity in guidelines between journals, as this will lessen confusion among authors and promote transparency within the medical research community.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111819"},"PeriodicalIF":1.8,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834063","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 : 2025-12-23DOI: 10.1016/j.jocn.2025.111818
Zach Pennington , Derrick Obiri-Yeboah , Abdelrahman Hamouda , Nikita Lakomkin , William E. Krauss , Michelle J. Clarke , Brett A. Freedman , Melvin D. Helgeson , Ahmad N. Nassr , Arjun S. Sebastian , Anthony L. Mikula , Jeremy L. Fogelson , Benjamin D. Elder
Background
Thousands of anterior cervical diskectomy and fusion (ACDF) procedures are performed annually. Increased interbody size offers better immediate segmental lordosis and disc height restoration but may increase the risk of subsequent subsidence. Our objective was to identify factors for subsidence and segmental lordosis loss following ACDF.
Methods
The charts of patients undergoing 1–3 level ACDF at a single-institution were queried for demographics, pre- and postoperative radiographic alignment, bone health (Hounsfield units on CT), procedural details, and interbody characteristics. Outcomes of interest were subsidence ≥2 mm and ≥3° loss in segmental lordosis (SL).
Results
199 patients (median 61.5 yr; 52.8 % male) were included – 98 single-level; 70 two-level, and 31 three-level. Forty treated levels (12.1 %) ≥3° decrease in SLand 19 (5.7 %) experienced ≥2 mm subsidence. Levels showing ≥3° loss of correction occurred in older patients (p = 0.021) and those with greater postoperative C2-7 lordosis (p = 0.002), postoperative SL (p < 0.001), and perioperative change in SL (p < 0.001). Subsidence was associated with allograft spacer use, lower postoperative segmental lordosis (p = 0.022) and greater postoperative disc height (p = 0.023). Decreased time to loss of SL was predicted by greater postoperative C2-7 lordosis (HR 1.04 per °; 95 % CI [1.00, 1.08]; p = 0.041) and greater postoperative SL (HR 1.27 per °; [1.13, 1.43]; p < 0.001). Shorter subsidence time was predicted by allograft [versus titanium] spacer use (HR 21.40; [5.61, 81.54]; p < 0.001) and greater postoperative disc height (HR 1.63 per mm; [1.37, 1.94]; p < 0.001).
Conclusion
Greater disc height predicted subsequent subsidence and greater SL restoration predicted SL loss following 1–3 level ACDF. Matching the interbody to the “natural” disc height of adjacent levels and using titanium versus corticocancellous allograft spacers may reduce the risk of subsidence and loss of correction.
{"title":"Risk factors for subsidence and loss of segmental lordosis segmental lordosisfollowing 1–3-level anterior cervical diskectomy and fusion for degenerative disease: A time-to-event analysis","authors":"Zach Pennington , Derrick Obiri-Yeboah , Abdelrahman Hamouda , Nikita Lakomkin , William E. Krauss , Michelle J. Clarke , Brett A. Freedman , Melvin D. Helgeson , Ahmad N. Nassr , Arjun S. Sebastian , Anthony L. Mikula , Jeremy L. Fogelson , Benjamin D. Elder","doi":"10.1016/j.jocn.2025.111818","DOIUrl":"10.1016/j.jocn.2025.111818","url":null,"abstract":"<div><h3>Background</h3><div>Thousands of anterior cervical diskectomy and fusion (ACDF) procedures are performed annually. Increased interbody size offers better immediate segmental lordosis and disc height restoration but may increase the risk of subsequent subsidence. Our objective was to identify factors for subsidence and segmental lordosis loss following ACDF.</div></div><div><h3>Methods</h3><div>The charts of patients undergoing 1–3 level ACDF at a single-institution were queried for demographics, pre- and postoperative radiographic alignment, bone health (Hounsfield units on CT), procedural details, and interbody characteristics. Outcomes of interest were subsidence ≥2 mm and ≥3° loss in segmental lordosis (SL).</div></div><div><h3>Results</h3><div>199 patients (median 61.5 yr; 52.8 % male) were included – 98 single-level; 70 two-level, and 31 three-level. Forty treated levels (12.1 %) ≥3° decrease in SLand 19 (5.7 %) experienced ≥2 mm subsidence. Levels showing ≥3° loss of correction occurred in older patients (p = 0.021) and those with greater postoperative C2-7 lordosis (p = 0.002), postoperative SL (p < 0.001), and perioperative change in SL (p < 0.001). Subsidence was associated with allograft spacer use, lower postoperative segmental lordosis (p = 0.022) and greater postoperative disc height (p = 0.023). Decreased time to loss of SL was predicted by greater postoperative C2-7 lordosis (HR 1.04 per °; 95 % CI [1.00, 1.08]; p = 0.041) and greater postoperative SL (HR 1.27 per °; [1.13, 1.43]; p < 0.001). Shorter subsidence time was predicted by allograft [versus titanium] spacer use (HR 21.40; [5.61, 81.54]; p < 0.001) and greater postoperative disc height (HR 1.63 per mm; [1.37, 1.94]; p < 0.001).</div></div><div><h3>Conclusion</h3><div>Greater disc height predicted subsequent subsidence and greater SL restoration predicted SL loss following 1–3 level ACDF. Matching the interbody to the “natural” disc height of adjacent levels and using titanium versus corticocancellous allograft spacers may reduce the risk of subsidence and loss of correction.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111818"},"PeriodicalIF":1.8,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827856","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 : 2025-12-23DOI: 10.1016/j.jocn.2025.111824
Angie H. Kim , Arnaldo A. Arbini , Ilya Kister
Background
Multiple sclerosis (MS) and neurosarcoidosis (NS) can present as similar neuro-radiologic syndromes. Neither disease has pathognomonic clinical or laboratory findings and differentiating between them may be challenging. We hypothesized that cerebrospinal fluid (CSF) immune cell profiles, including CD4/CD8 cell ratio and proportion of B cells, might help to distinguish NS from MS.
Methods
Patients with probable or definite NS who were evaluated at the NYU MS Comprehensive Care Center (New York) and had CSF flow cytometry done as part of diagnostic workup were matched by age, sex, and race/ethnicity to MS patients with available CSF flow cytometry. All patients who received immunomodulatory therapy within 3 months of lumbar puncture were excluded. Flow cytometry was performed using BD FACSCanto™ and FACSCanto™ II Cell Analyzers (BDBiosciences, San Jose, CA) and manually verified by a hematopathologist. Group comparisons were made with an unpaired two-tailed Student’s t-test, Chi-square test, or Wilcoxon rank sum test, as appropriate; p < 0.05 was considered significant.
Results
We identified 19 patients with NS and matched them with 19 MS patients by age, sex, and race/ethnicity (mean age NS v. MS: 56.9 ± 10.8 vs. 56.3 ± 9.7 years, p = 0.858; 68 % female in both groups; 74 % vs. 68 % non-white, p = 0.935). NS patients had significantly higher CSF leukocyte counts (16.0 ± 19.9 vs. 2.1 ± 2.6 cells/mm3, p < 0.0001) and protein levels (101.2 ± 88.9 mg/dL vs. 35.7 ± 19.6, p = 0.003), while MS patients had more CSF-restricted oligoclonal bands (7.7 ± 5.3 vs. 1.7 ± 2.4, p < 0.00042). No differences were found in CSF glucose concentrations or IgG indices. Proportions of all immune cells in CSF were similar in NS and MS, including the CD4/CD8 ratio and percentages of B cells.
Conclusion
Clinically available CSF flow cytometry immune profiles do not offer added discriminatory value for differentiating NS from MS. More granular immunophenotyping may be needed to improve diagnostic precision.
背景：多发性硬化症（MS）和神经结节病（NS）可以表现为相似的神经影像学综合征。这两种疾病都没有典型的临床或实验室发现，区分它们可能具有挑战性。我们假设脑脊液（CSF）免疫细胞谱，包括CD4/CD8细胞比例和B细胞比例，可能有助于区分多发性硬化症和多发性硬化症。方法：在纽约大学多发性硬化症综合护理中心（纽约）评估可能或明确的多发性硬化症患者，并将CSF流式细胞术作为诊断工作的一部分，根据年龄、性别和种族/民族与可用CSF流式细胞术的多发性硬化症患者进行匹配。排除腰椎穿刺后3个月内接受免疫调节治疗的患者。流式细胞术使用BD FACSCanto™和FACSCanto™II细胞分析仪（BDBiosciences, San Jose， CA）进行，并由血液病理学家手工验证。组间比较采用非配对双尾Student's t检验、卡方检验或Wilcoxon秩和检验（视情况而定）；结果：我们确定了19例NS患者，并根据年龄、性别和种族/民族将其与19例MS患者进行匹配（NS与MS的平均年龄：56.9±10.8岁对56.3±9.7岁，p = 0.858；两组中68%为女性；74%对68%为非白人，p = 0.935）。NS患者的脑脊液白细胞计数明显高于NS(16.0±19.9 vs. 2.1±2.6细胞/mm3)，结论：临床上可用的脑脊液流式细胞术免疫图谱不能为NS和ms的鉴别提供额外的鉴别价值，可能需要更多的颗粒免疫表型来提高诊断精度。
{"title":"No differences in the proportions of immune cells in CSF of patients with neurosarcoidosis and multiple sclerosis","authors":"Angie H. Kim , Arnaldo A. Arbini , Ilya Kister","doi":"10.1016/j.jocn.2025.111824","DOIUrl":"10.1016/j.jocn.2025.111824","url":null,"abstract":"<div><h3>Background</h3><div>Multiple sclerosis (MS) and neurosarcoidosis (NS) can present as similar neuro-radiologic syndromes. Neither disease has pathognomonic clinical or laboratory findings and differentiating between them may be challenging. We hypothesized that cerebrospinal fluid (CSF) immune cell profiles, including CD4/CD8 cell ratio and proportion of B cells, might help to distinguish NS from MS.</div></div><div><h3>Methods</h3><div>Patients with probable or definite NS who were evaluated at the NYU MS Comprehensive Care Center (New York) and had CSF flow cytometry done as part of diagnostic workup were matched by age, sex, and race/ethnicity to MS patients with available CSF flow cytometry. All patients who received immunomodulatory therapy within 3 months of lumbar puncture were excluded. Flow cytometry was performed using BD FACSCanto™ and FACSCanto™ II Cell Analyzers (BDBiosciences, San Jose, CA) and manually verified by a hematopathologist. Group comparisons were made with an unpaired two-tailed Student’s <em>t</em>-test, Chi-square test, or Wilcoxon rank sum test, as appropriate; p < 0.05 was considered significant.</div></div><div><h3>Results</h3><div>We identified 19 patients with NS and matched them with 19 MS patients by age, sex, and race/ethnicity (mean age NS v. MS: 56.9 ± 10.8 vs. 56.3 ± 9.7 years, p = 0.858; 68 % female in both groups; 74 % vs. 68 % non-white, p = 0.935). NS patients had significantly higher CSF leukocyte counts (16.0 ± 19.9 vs. 2.1 ± 2.6 cells/mm<sup>3</sup>, p < 0.0001) and protein levels (101.2 ± 88.9 mg/dL vs. 35.7 ± 19.6, p = 0.003), while MS patients had more CSF-restricted oligoclonal bands (7.7 ± 5.3 vs. 1.7 ± 2.4, p < 0.00042). No differences were found in CSF glucose concentrations or IgG indices. Proportions of all immune cells in CSF were similar in NS and MS, including the CD4/CD8 ratio and percentages of B cells.</div></div><div><h3>Conclusion</h3><div>Clinically available CSF flow cytometry immune profiles do not offer added discriminatory value for differentiating NS from MS. More granular immunophenotyping may be needed to improve diagnostic precision.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111824"},"PeriodicalIF":1.8,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827825","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}
Intracranial aneurysm size has become an important predictor of rupture risk. There is, perhaps, an overdependence on aneurysm size during evaluations for management decisions. However, many ruptured intracranial aneurysms (RIA) in clinical practice are smaller than 7 mm. The purpose of this study is to review the literature and perform a meta-analysis to determine the mean size of RIA in the literature.
Methods
The PubMed, Cochrane, Scopus and Web of Science databases were searched from January 1st, 2000 to October 31st, 2024, following PRISMA guidelines to include clinical studies reporting mean size of RIAs. The pooled mean RIA was calculated. Additional exclusion criteria were applied, and subgroup analyses were performed after dividing the RIAs into a “Lower Risk” group (LRG) and a “Higher Risk” group (HRG) as described in the ISUIA trial.
Results
A total of 9876 aneurysms were captured from 55 included studies. The pooled mean size for RIAs was 6.57 mm (95 % CI [6.14–––7.00]). Thirty-nine (70.9 %) of included studies reported mean RIA size < 7 mm. After application of additional exclusion criteria, 6 studies were included in the subgroup analyses, capturing 2774 RIAs. The pooled mean size for RIAs in the subgroup analyses was 5.58 mm (95 % CI [5.21–––5.94]). There were 2076 RIAs in the LRG. The mean RIA size in the LRG was 5.68 mm (95 % CI [5.26–––6.10]). There were 698 RIAs in the HRG. The mean RIA size in the HRG was 5.54 mm (95 % CI [4.86–––6.22]). Spearman’s Rank correlation revealed a very strong positive correlation between RIA size and parent vessel within the LRG (ρ = 0.871, p < 0.001, 95 % CI [0.60 – 0.96]) and a moderate positive correlation within the HRG (ρ = 0.55, p = 0.22, 95 % CI [0.23 – 0.97]).
Conclusions
The mean size of RIAs in the literature was 6.57 mm. There was a positive correlation between mean RIA size and increasing parent vessel diameter. This supports size ratio (SR) as a more appropriate surrogate for size when assessing rupture risk.
目的：颅内动脉瘤大小已成为动脉瘤破裂风险的重要预测指标。在评估管理决策时，可能过度依赖于动脉瘤的大小。然而，临床上许多破裂的颅内动脉瘤（RIA）小于7mm。本研究的目的是回顾文献，并进行荟萃分析，以确定文献中RIA的平均规模。方法：根据PRISMA指南，检索2000年1月1日至2024年10月31日期间的PubMed、Cochrane、Scopus和Web of Science数据库，纳入报告RIAs平均大小的临床研究。计算混合平均RIA。应用额外的排除标准，并按照ISUIA试验的描述将ria分为“低风险”组（LRG）和“高风险”组（HRG）后进行亚组分析。结果：55项纳入的研究共捕获了9876个动脉瘤。ria的汇总平均大小为6.57 mm （95% CI[6.14—7.00]）。39项（70.9%）纳入的研究报告了平均RIA尺寸。结论：文献中RIA的平均尺寸为6.57 mm。RIA的平均大小与母体血管直径的增加呈正相关。这支持在评估破裂风险时，尺寸比（SR）作为尺寸更合适的替代。
{"title":"Unruptured intracranial aneurysm size should not be the most important factor influencing management decisions: A systematic review of the literature and meta-analysis","authors":"Hunter Brooks , Michael Ortiz , Farhan Siddiq , Bharat Guthikonda","doi":"10.1016/j.jocn.2025.111816","DOIUrl":"10.1016/j.jocn.2025.111816","url":null,"abstract":"<div><h3>Objective</h3><div>Intracranial aneurysm size has become an important predictor of rupture risk. There is, perhaps, an overdependence on aneurysm size during evaluations for management decisions. However, many ruptured intracranial aneurysms (RIA) in clinical practice are smaller than 7 mm. The purpose of this study is to review the literature and perform a <em>meta</em>-analysis to determine the mean size of RIA in the literature.</div></div><div><h3>Methods</h3><div>The PubMed, Cochrane, Scopus and Web of Science databases were searched from January 1st, 2000 to October 31st, 2024, following PRISMA guidelines to include clinical studies reporting mean size of RIAs. The pooled mean RIA was calculated. Additional exclusion criteria were applied, and subgroup analyses were performed after dividing the RIAs into a “Lower Risk” group (LRG) and a “Higher Risk” group (HRG) as described in the ISUIA trial.</div></div><div><h3>Results</h3><div>A total of 9876 aneurysms were captured from 55 included studies. The pooled mean size for RIAs was 6.57 mm (95 % CI [6.14–––7.00]). Thirty-nine (70.9 %) of included studies reported mean RIA size < 7 mm. After application of additional exclusion criteria, 6 studies were included in the subgroup analyses, capturing 2774 RIAs. The pooled mean size for RIAs in the subgroup analyses was 5.58 mm (95 % CI [5.21–––5.94]). There were 2076 RIAs in the LRG. The mean RIA size in the LRG was 5.68 mm (95 % CI [5.26–––6.10]). There were 698 RIAs in the HRG. The mean RIA size in the HRG was 5.54 mm (95 % CI [4.86–––6.22]). Spearman’s Rank correlation revealed a very strong positive correlation between RIA size and parent vessel within the LRG (ρ = 0.871, <em>p</em> < 0.001, 95 % CI [0.60 – 0.96]) and a moderate positive correlation within the HRG (ρ = 0.55, <em>p</em> = 0.22, 95 % CI [0.23 – 0.97]).</div></div><div><h3>Conclusions</h3><div>The mean size of RIAs in the literature was 6.57 mm. There was a positive correlation between mean RIA size and increasing parent vessel diameter. This supports size ratio (SR) as a more appropriate surrogate for size when assessing rupture risk.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111816"},"PeriodicalIF":1.8,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827774","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 : 2025-12-22DOI: 10.1016/j.jocn.2025.111822
Erin Butcho , Pranjal Rai , Niharika Praveen , Dhairya A Lakhani
{"title":"Cerebral air embolism","authors":"Erin Butcho , Pranjal Rai , Niharika Praveen , Dhairya A Lakhani","doi":"10.1016/j.jocn.2025.111822","DOIUrl":"10.1016/j.jocn.2025.111822","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111822"},"PeriodicalIF":1.8,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819465","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}
{"title":"Right orbital intradiploic epidermoid cyst: A rare entity with imaging and surgical insights","authors":"Sarvesh Yadav, Sarvesh Goyal, Hitesh Kumar Gurjar, Shiv Shankar Verma","doi":"10.1016/j.jocn.2025.111814","DOIUrl":"10.1016/j.jocn.2025.111814","url":null,"abstract":"","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111814"},"PeriodicalIF":1.8,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819476","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 : 2025-12-18DOI: 10.1016/j.jocn.2025.111815
Plamen Penchev , Daniela Milanova-Ilieva , Lyubomir Gaydarski , Dobromir Dimitrov , Boris Tablov , Noor Husain , Remzi Hyusein , Cristian Vladimirov , Mihaela Mihaylova , Ivan Lozanov , Darko Stavrev , Petar-Preslav Petrov , Pavel Stanchev , Andrey Velev , Nikolai Ramadanov , Nikolay Peev
Introduction
Acute and chronic postoperative low back pain are frequent occurrences after lumbar spine surgery, contributing to long-term disability and increased analgesic use. Neuromodulation techniques—both invasive and non-invasive—have emerged as promising non-pharmacological interventions. However, current evidence remains fragmented. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of neuromodulation in managing acute and chronic postoperative low back pain.
Methods
We systematically searched PubMed, Scopus, and Cochrane databases from inception up to 30 June 2025 for randomized controlled trials (RCTs) published in English only comparing neuromodulation to sham modulation in patients with postoperative low back pain following lumbar spine surgery. The review protocol was registered in PROSPERO (CRD420251108776). Primary outcomes included pain intensity reduction, analgesic consumption, functional disability, and adverse effects. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) for continuous outcomes were calculated using a frequentist random-effects model. Proportions and 95% CIs for binary outcomes, including adverse events and sex distribution, were computed using the Freeman–Tukey double arcsine transformation to stabilize variance. Heterogeneity was assessed using the I2 statistic and Cochrane’s Q test.
Results
Twelve RCTs involving 413 patients (mean age 53 years; 55 % female) were included, with 207 (50%) receiving neuromodulation. In the pooled analysis, neuromodulation significantly reduced pain intensity (SMD − 0.82; 95 % CI [−1.13, −0.50]; p < 0.00001; I2 = 53 %) and analgesic consumption (SMD − 0.91; 95 % CI [−1.63, −0.20]; p = 0.01; I2 = 81 %) compared to sham. No significant difference was found in functional disability (SMD − 0.31; 95 % CI [−0.85, 0.24]; p = 0.28; I2 = 44 %). The pooled female proportion was 55 % (95 % CI [42.99, 66.95]; I2 = 73 %), and the prevalence of adverse effects was 12.48 % (95 % CI [6.13, 20.39]; I2 = 0 %).
Conclusion
This meta-analysis demonstrates that neuromodulation significantly reduces postoperative pain and opioid consumption after lumbar spine surgery, although it does not improve functional disability. Given the growing need for non-pharmacological pain management strategies, neuromodulation represents a promising evidence-based adjunct in postoperative care. Future high-quality RCTs should refine optimal protocols and evaluate long-term functional outcomes.
简介：急性和慢性术后腰痛是腰椎手术后常见的疼痛，导致长期残疾和增加止痛药的使用。神经调节技术——侵入性和非侵入性——已经成为有前途的非药物干预手段。然而，目前的证据仍然支离破碎。本系统综述和荟萃分析旨在评估神经调节治疗急性和慢性术后腰痛的有效性和安全性。方法：我们系统地检索PubMed、Scopus和Cochrane数据库，从开始到2025年6月30日，检索仅发表英文的随机对照试验（rct），比较腰椎手术后腰痛患者的神经调节和假调节。该审查方案已在PROSPERO注册（CRD420251108776）。主要结局包括疼痛强度降低、镇痛药消耗、功能障碍和不良反应。使用频率随机效应模型计算连续结果的标准化平均差（SMDs）和95%置信区间（ci）。使用Freeman-Tukey双反正弦变换计算二元结果（包括不良事件和性别分布）的比例和95% ci，以稳定方差。采用I2统计量和Cochrane’s Q检验评估异质性。结果：纳入12项随机对照试验，共纳入413例患者（平均年龄53岁，55%为女性），其中207例（50%）接受神经调节。在汇总分析中，与假手术相比，神经调节显著降低了疼痛强度（SMD - 0.82; 95% CI [-1.13, -0.50]; p 2 = 53%）和镇痛药消耗（SMD - 0.91; 95% CI [-1.63, -0.20]; p = 0.01; I2 = 81%）。两组功能障碍无显著差异（SMD = 0.31; 95% CI [-0.85, 0.24]; p = 0.28; I2 = 44%）。合并女性比例为55% (95% CI [42.99, 66.95]; I2 = 73%)，不良反应发生率为12.48% （95% CI [6.13, 20.39]; I2 = 0%）。结论：这项荟萃分析表明，神经调节可显著减少腰椎手术后的疼痛和阿片类药物的消耗，尽管它不能改善功能障碍。鉴于对非药物疼痛管理策略的需求日益增长，神经调节代表了一种有前途的循证辅助术后护理。未来高质量的随机对照试验应完善最佳方案并评估长期功能结果。
{"title":"Efficacy of Neuromodulation in Postoperative Acute and Chronic Low Back Pain after Lumbar Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials with Trial Sequential Analysis and Meta-Regression","authors":"Plamen Penchev , Daniela Milanova-Ilieva , Lyubomir Gaydarski , Dobromir Dimitrov , Boris Tablov , Noor Husain , Remzi Hyusein , Cristian Vladimirov , Mihaela Mihaylova , Ivan Lozanov , Darko Stavrev , Petar-Preslav Petrov , Pavel Stanchev , Andrey Velev , Nikolai Ramadanov , Nikolay Peev","doi":"10.1016/j.jocn.2025.111815","DOIUrl":"10.1016/j.jocn.2025.111815","url":null,"abstract":"<div><h3>Introduction</h3><div>Acute and chronic postoperative low back pain are frequent occurrences after lumbar spine surgery, contributing to long-term disability and increased analgesic use. Neuromodulation techniques—both invasive and non-invasive—have emerged as promising non-pharmacological interventions. However, current evidence remains fragmented. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of neuromodulation in managing acute and chronic postoperative low back pain.</div></div><div><h3>Methods</h3><div>We systematically searched PubMed, Scopus, and Cochrane databases from inception up to 30 June 2025 for randomized controlled trials (RCTs) published in English only comparing neuromodulation to sham modulation in patients with postoperative low back pain following lumbar spine surgery. The review protocol was registered in PROSPERO (CRD420251108776). Primary outcomes included pain intensity reduction, analgesic consumption, functional disability, and adverse effects. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) for continuous outcomes were calculated using a frequentist random-effects model. Proportions and 95% CIs for binary outcomes, including adverse events and sex distribution, were computed using the Freeman–Tukey double arcsine transformation to stabilize variance. Heterogeneity was assessed using the I<sup>2</sup> statistic and Cochrane’s Q test.</div></div><div><h3>Results</h3><div>Twelve RCTs involving 413 patients (mean age 53 years; 55 % female) were included, with 207 (50%) receiving neuromodulation. In the pooled analysis, neuromodulation significantly reduced pain intensity (SMD − 0.82; 95 % CI [−1.13, −0.50]; p < 0.00001; I<sup>2</sup> = 53 %) and analgesic consumption (SMD − 0.91; 95 % CI [−1.63, −0.20]; p = 0.01; I<sup>2</sup> = 81 %) compared to sham. No significant difference was found in functional disability (SMD − 0.31; 95 % CI [−0.85, 0.24]; p = 0.28; I<sup>2</sup> = 44 %). The pooled female proportion was 55 % (95 % CI [42.99, 66.95]; I<sup>2</sup> = 73 %), and the prevalence of adverse effects was 12.48 % (95 % CI [6.13, 20.39]; I<sup>2</sup> = 0 %).</div></div><div><h3>Conclusion</h3><div>This meta-analysis demonstrates that neuromodulation significantly reduces postoperative pain and opioid consumption after lumbar spine surgery, although it does not improve functional disability. Given the growing need for non-pharmacological pain management strategies, neuromodulation represents a promising evidence-based adjunct in postoperative care. Future high-quality RCTs should refine optimal protocols and evaluate long-term functional outcomes.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"144 ","pages":"Article 111815"},"PeriodicalIF":1.8,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145794007","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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