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Mental state as a predictor of outcome in spinal stenosis surgery: Four quadrants model integrating patient satisfaction and functional outcome. 心理状态是脊柱狭窄症手术疗效的预测因素:整合患者满意度和功能结果的四象限模型。
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-09-07 eCollection Date: 2024-01-01 DOI: 10.1016/j.bas.2024.103902
Judith van Grafhorst, Wouter van Furth, Carmen Vleggeert-Lankamp

Introduction: Mental status, characterised by anxiety and depression, significantly influences physical well-being, particularly in patients with spinal stenosis symptoms.

Research question: The prevalence of depression and anxiety in our cohort. The correlation between psychological distress and physical outcome after surgery, including postoperative recovery and satisfaction.

Materials and methods: Questionnaires evaluating anxiety and depression (HADS), functionality (ODI), quality of life (EQ-5D), and perceived recovery (Likert-scale) were sent to a randomly selected cohort of 450 lumbar spinal stenosis patients, with or without spondylolisthesis, who underwent surgery between 2007 and 2013. Results are presented, dichotomised by HADS score (score ≥8 indicating psychologically impaired) and in a Four Quadrants Model integrating functional outcomes and perceived recovery separately for psychologically impaired and non-impaired cases.

Results: Among the 147 included patients, 32 (22%) exhibited anxiety and/or depression (impaired cases). Satisfactory outcome (perceived recovery) was reported in 29.0% of the impaired cases and 78.3% of the non-impaired cases (p < 0.001). The mean postoperative functionality score of the impaired cases was 42.46 ± 16.24, in contrast to 18.48 ± 18.25 for the non-impaired cases (p < 0.001). In the impaired group, only 12.5% achieved both a good functional outcome (ODI ≤24) and satisfactory perceived recovery, compared with 58.4% in the non-impaired group.

Discussion and conclusion: Patients reporting anxiety and/or depression demonstrate an inferior long-term outcome after spinal stenosis surgery compared to non-impaired patients. This clinically relevant difference underscores the importance of addressing depression and anxiety in preoperative counselling to optimize patient satisfaction and functional outcomes.

导言:以焦虑和抑郁为特征的精神状态会严重影响患者的身体健康,尤其是有椎管狭窄症状的患者:研究问题:我们的队列中抑郁和焦虑的流行率。心理困扰与术后身体状况(包括术后恢复和满意度)之间的相关性:向随机抽取的 450 名在 2007 年至 2013 年期间接受手术的腰椎管狭窄症患者(伴有或不伴有脊柱滑脱症)发送了评估焦虑和抑郁(HADS)、功能(ODI)、生活质量(EQ-5D)和感知恢复(Likert 量表)的问卷。研究结果按HADS得分(得分≥8分表示心理受损)进行二分法,并采用四象限模型对心理受损和未受损病例的功能结果和感知康复情况分别进行整合:在纳入的 147 名患者中,有 32 人(22%)表现出焦虑和/或抑郁(心理受损病例)。29.0%的心理受损病例和 78.3%的非心理受损病例(P 讨论和结论:与无障碍患者相比,焦虑和/或抑郁患者在椎管狭窄手术后的长期疗效较差。这一临床相关性差异强调了在术前咨询中解决抑郁和焦虑问题以优化患者满意度和功能预后的重要性。
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引用次数: 0
Enhanced recovery after adolescent idiopathic scoliosis surgery care pathway: Perioperative strategy to improve outcome. 青少年特发性脊柱侧凸手术后加强康复护理路径:改善疗效的围手术期策略。
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-31 eCollection Date: 2024-01-01 DOI: 10.1016/j.bas.2024.103326
Ph Creyf, N Parisi, S Munting, M Caudron, R Rossillon, Ch Detrembleur, Munting E

Intro: AIS surgery generates a high inflammatory stress response which might influence the outcome in the perioperative period. Enhanced Recovery After Surgery (ERAS) is a global multidisciplinary care pathway aimed to improve patient's recovery.

Research question: The purpose of this article is to expose our actual ERAS protocol for AIS surgery and compare it with the earlier non ERAS management in our institution.Our primary outcome focus on the re-hospitalisation and complications rates at 30 and 90 days postoperatively. Our secondary outcomes focus on the overall morphine consumption, pain scores and side effects during the hospitalisation.

Material: We compare the results of the ERAS group (2019-2022) with the previous existing classical care pathway (2017-2019). The data were collected in our standard medical files.

Results: Our ERAS care pathway for AIS surgery lead to consequently improve the outcome regarding the VAS scores, the morphine consumption, the LOS and the complication and re hospitalisation rates.

Discussion: Regarding our results, ERAS care pathway for AIS surgery appears to be efficient in terms of benefits on complications rates, LOS and opioid consumption.Intrathecal morphine and "anti-inflammatory" anaesthesia provides a good quality of pain management and allows the patient to get up early.A superiority trial might be interesting to highlight the role of the ERAS pathway in AIS surgery.

介绍:AIS手术会产生较高的炎症应激反应,这可能会影响围手术期的结果。术后强化恢复(ERAS)是一个全球性的多学科护理路径,旨在改善患者的恢复情况:本文的目的是揭示本院 AIS 手术的实际 ERAS 方案,并将其与早期的非 ERAS 管理进行比较。我们的主要结果是术后 30 天和 90 天的再住院率和并发症发生率。我们的次要结果是住院期间的吗啡总用量、疼痛评分和副作用:我们将 ERAS 组(2019-2022 年)的结果与之前现有的经典护理路径(2017-2019 年)进行了比较。数据收集于我们的标准医疗档案中:结果:我们的ERAS护理路径对AIS手术的VAS评分、吗啡消耗量、LOS、并发症和再次住院率等方面的结果均有改善:鞘内吗啡和 "抗炎 "麻醉提供了良好的疼痛管理质量,并允许病人早起。
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引用次数: 0
Is the ICP pulse waveform P2/P1 ratio during -6° head-down tilt associated with relative VO2 peak? A non-invasive intracranial compliance monitoring approach. -6°头向下倾斜时的ICP脉冲波形P2/P1比值与相对VO2峰值有关吗?无创颅内顺应性监测方法。
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-29 eCollection Date: 2024-01-01 DOI: 10.1016/j.bas.2024.103327
Rafaella Mendes Zambetta, Étore De Favari Signini, Aparecida Maria Catai, Thainá Cristina Ramos Dos Santos, Eloisa Soares Michaliski, Ana Karoline Nazario, Gabriela Nagai Ocamoto, Gustavo Frigieri, Thiago Luiz Russo

Background: Spaceflights influence intracranial compliance (ICC). P2/P1 ratio, from the intracranial pressure (ICP) waveform, provides information about ICC. Additionally, non-invasive methods for ICC monitoring are needed for spaceflights. Furthermore, astronauts try to maintain good levels of cardiorespiratory fitness before and during spaceflights, not only to sustain exploratory missions, but also to prevent diseases in extreme environments.

Objective: to correlate cardiorespiratory fitness levels with the P2/P1 ratio during a microgravity analog [-6° head-down tilt (HDT)].

Method: 34 individuals (11 women), mean age of 31.7 (±6.3) years and BMI 24.2 (±3.2) performed a cardiopulmonary exercise testing (CPET) with an incremental protocol on a cycle ergometer to determine the cardiopulmonary fitness through peak relative oxygen uptake (VO2 peak) of each individual. On the second test, which was conducted in an interval of 15 days of the CPET, participants remained for 30 min at HDT with P2/P1 ratio acquired using a non-invasive strain gauge sensor. The average of the last 5 min was used for analysis. The mean P2/P1 ratio and relative VO2 peak were correlated using the Spearman test.

Results: Volunteers presented 1.05 ± 0.2 of P2/P1 ratio and VO2 peak of 47.5 ± 7.6 mL/kg/min. The Spearman test indicated a negative and low correlation between the P2/P1 ratio and VO2 peak (ρ = -0.388; p = 0.023).

Conclusion: The study suggests that the better the cardiorespiratory fitness, the better ICC in a weightlessness simulation.

背景:太空飞行会影响颅内顺应性(ICC):太空飞行会影响颅内顺应性(ICC)。颅内压(ICP)波形的 P2/P1 比值可提供有关 ICC 的信息。此外,太空飞行需要非侵入性的 ICC 监测方法。此外,宇航员在太空飞行前和飞行期间努力保持良好的心肺功能水平,不仅是为了维持探索任务,也是为了在极端环境中预防疾病。目的:在微重力模拟[-6°头向下倾斜(HDT)]过程中,将心肺功能水平与 P2/P1 比率联系起来:34人(11名女性),平均年龄为31.7(±6.3)岁,体重指数为24.2(±3.2),在循环测力计上进行了心肺运动测试(CPET),采用递增方案,通过每个人的相对摄氧量峰值(VO2峰值)来确定心肺功能。第二次测试是在 CPET 进行 15 天后进行的,参与者在 HDT 下保持 30 分钟,使用无创应变仪传感器获取 P2/P1 比率。最后 5 分钟的平均值用于分析。平均 P2/P1 比值和相对 VO2 峰值之间的相关性采用 Spearman 检验:结果:志愿者的 P2/P1 比率为 1.05 ± 0.2,VO2 峰值为 47.5 ± 7.6 mL/kg/min。斯皮尔曼检验表明,P2/P1 比值与 VO2 峰值之间存在低度负相关(ρ = -0.388;p = 0.023):研究表明,心肺功能越好,失重模拟中的 ICC 越好。
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引用次数: 0
Cerebral contusions - Pathomechanism, predictive factors for progression and historical and current management. 脑挫伤--病理机制、病情发展的预测因素以及历史和当前的治疗方法。
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-28 eCollection Date: 2024-01-01 DOI: 10.1016/j.bas.2024.103329
Unni Jirlow, Iftakher Hossain, Otto Korhonen, Bart Depreitere, Elham Rostami

Introduction: Cerebral contusions (CCs) are common traumatic brain injuries known for their propensity to progress. Understanding their mechanical pathogenesis and predictive factors for progression is crucial for optimal management.

Research question: To provide an overview of current knowledge on CCs, including pathomechanisms, predictive factors of contusion progression, and management strategies.

Material and methods: A literature search was conducted using PubMed, Scopus and ISI web of knowledge focused on articles in English with the words "cerebral contusion" together with the words "traumatic brain injury", "pathomechanism", "progression of contusion", "predictive factors" and "management" alone or in combination.

Results: The management of CCs has evolved alongside the advances in neurointensive care, yet there is no consensus. Evidence on the effectiveness of early surgery, importantly, for the group which has the potential to expand, is limited. Some predictive factors for contusion progression have been identified, including age, injury mechanism, coagulopathy and initial contusion volume which could help to guide decision-making.

Discussion and conclusion: While various theories exist on pathomechanisms and several predictive factors for progression have been proposed, consensus on optimal management remains elusive. Individualized care guided by the predictive factors is essential. Challenges posed by antithrombotic medications highlight the need for early intervention strategies.Decompressive craniectomy could serve as a potential tool in severe traumatic brain injury management including contusions. Conducting large cohort studies to refine predictive models and harmonizing management approaches would help to improve outcomes of patients with CCs.

导言:脑挫伤(CCs)是一种常见的脑外伤,以其易进展而闻名。了解其机械致病机理和进展的预测因素对于优化治疗至关重要:研究问题:概述目前有关 CC 的知识,包括病理机制、挫伤进展的预测因素和管理策略:使用 PubMed、Scopus 和 ISI 知识网进行文献检索,重点检索英文文章,文章内容包括 "脑挫伤"、"创伤性脑损伤"、"病理机制"、"挫伤进展"、"预测因素 "和 "管理 "等单独或组合词:结果:随着神经重症监护技术的进步,CC 的处理方法也在不断发展,但目前尚未达成共识。早期手术的有效性证据有限,重要的是,对于有可能扩大的人群而言。已经确定了一些挫伤进展的预测因素,包括年龄、损伤机制、凝血功能障碍和初始挫伤量,这些因素有助于指导决策:讨论和结论:虽然关于挫伤进展的病理机制存在各种理论,也提出了一些预测因素,但最佳治疗方法仍未达成共识。以预测因素为指导的个体化治疗至关重要。抗血栓药物带来的挑战凸显了早期干预策略的必要性。减压开颅术可作为严重脑外伤(包括挫伤)治疗的潜在工具。开展大型队列研究以完善预测模型并统一管理方法将有助于改善CC患者的预后。
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引用次数: 0
Management of C2 fractures following multiple classifications, a narrative review. 对 C2 骨折进行多种分类后的处理,叙述性综述。
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-15 eCollection Date: 2024-01-01 DOI: 10.1016/j.bas.2024.102928
Michael McDermott, Guisela Quinteros, Federico Landriel, Chase Stastny, Daniel Raskin, Guillermo Ricciardi, Andrei Fernandes Joaquim, Charles Carazzo, Amna Hussein, Jahangir Asghar, Alfredo Guiroy

Introduction: Classifications are helpful for surgeons as they can be a resource for decision-making, often providing the individual indicators that may deem a case necessary for surgery. However, when there are multiple classifications, the decision-making might be compromised. That is the case with C2 fractures. For this reason, this study was designed to review the different classifications of axis fractures.

Research question: What are the most commonly used classifications for C2 fractures, and how do these classifications compare in terms of clinical utility?

Methods: A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines was performed. Three different Pub-med searches (https://pubmed.ncbi.nlm.nih.gov/) were done to isolate the most common C2 fracture classifications of odontoid process fractures, the posterior element of the axis and axis body fractures.

Results: The search isolated 530 papers. Applying the inclusion and exclusion criteria yielded seven papers on axis body fractures, six on odontoid fractures, and ten on "hangman's fractures." Most of the classifications proposed are modified versions of the classic ones: Benzel's for body fractures, Anderson and D'Alonzo's for odontoid fractures, and Effendi's for "hangman's fractures." The proposal by AO Spine of a different classification seems promising and had good early results of interobserver and intraobserver agreement.

Discussion and conclusion: Currently, no classification is universally accepted or widely used. The emergence of the AO Spine Upper Cervical Injury Classification system seems promising as it encompasses radiological and clinical elements.

导言:分类对外科医生很有帮助,因为它们可以作为决策的资源,通常可以提供认为有必要进行手术的个别指标。然而,当存在多种分类时,决策可能会受到影响。C2 骨折就是这种情况。因此,本研究旨在回顾轴突骨折的不同分类:研究问题:C2骨折最常用的分类方法是什么?按照《系统综述和荟萃分析首选报告项目》(PRISMA)指南进行了系统性文献综述。进行了三次不同的Pub-med检索(https://pubmed.ncbi.nlm.nih.gov/),以分离出最常见的C2骨折分类:蝶骨突骨折、轴后部骨折和轴体骨折:结果:搜索共分离出 530 篇论文。根据纳入和排除标准,得出了七篇关于轴体骨折的论文、六篇关于蝶骨骨折的论文和十篇关于 "刽子手骨折 "的论文。提出的大多数分类方法都是经典分类方法的改进版:Benzel 的分类法适用于轴体骨折,Anderson 和 D'Alonzo 的分类法适用于蝶骨骨折,Effendi 的分类法适用于 "绞刑架骨折"。AO Spine 提出的另一种分类方法似乎很有前途,在观察者之间和观察者内部的一致性方面取得了良好的早期结果:目前,还没有一种分类方法被普遍接受或广泛使用。AO 脊柱上颈椎损伤分类系统的出现似乎很有希望,因为它包含了放射学和临床要素。
{"title":"Management of C2 fractures following multiple classifications, a narrative review.","authors":"Michael McDermott, Guisela Quinteros, Federico Landriel, Chase Stastny, Daniel Raskin, Guillermo Ricciardi, Andrei Fernandes Joaquim, Charles Carazzo, Amna Hussein, Jahangir Asghar, Alfredo Guiroy","doi":"10.1016/j.bas.2024.102928","DOIUrl":"10.1016/j.bas.2024.102928","url":null,"abstract":"<p><strong>Introduction: </strong>Classifications are helpful for surgeons as they can be a resource for decision-making, often providing the individual indicators that may deem a case necessary for surgery. However, when there are multiple classifications, the decision-making might be compromised. That is the case with C2 fractures. For this reason, this study was designed to review the different classifications of axis fractures.</p><p><strong>Research question: </strong>What are the most commonly used classifications for C2 fractures, and how do these classifications compare in terms of clinical utility?</p><p><strong>Methods: </strong>A systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines was performed. Three different Pub-med searches (https://pubmed.ncbi.nlm.nih.gov/) were done to isolate the most common C2 fracture classifications of odontoid process fractures, the posterior element of the axis and axis body fractures.</p><p><strong>Results: </strong>The search isolated 530 papers. Applying the inclusion and exclusion criteria yielded seven papers on axis body fractures, six on odontoid fractures, and ten on \"hangman's fractures.\" Most of the classifications proposed are modified versions of the classic ones: Benzel's for body fractures, Anderson and D'Alonzo's for odontoid fractures, and Effendi's for \"hangman's fractures.\" The proposal by AO Spine of a different classification seems promising and had good early results of interobserver and intraobserver agreement.</p><p><strong>Discussion and conclusion: </strong>Currently, no classification is universally accepted or widely used. The emergence of the AO Spine Upper Cervical Injury Classification system seems promising as it encompasses radiological and clinical elements.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"102928"},"PeriodicalIF":1.9,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neurosurgical intervention in ultra-severe closed traumatic brain injury: Is it worth the effort? 超严重闭合性脑外伤的神经外科干预:这样做值得吗?
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-08-13 eCollection Date: 2024-01-01 DOI: 10.1016/j.bas.2024.102907
Nikolaos Gkantsinikoudis, Iftakher Hossain, Niklas Marklund, Parmenion P Tsitsopoulos

Introduction: A subgroup of severe Traumatic Brain Injury (TBI) patients, known as ultra-severe (us-TBI), is most commonly defined as a post-resuscitation Glasgow Coma Scale (GCS) of 3-5. There is uncertainty on whether these critically injured patients can benefit from neurosurgical intervention.

Research question: The available evidence regarding the decision-making and outcome following management of us-TBI patients is critically reviewed.

Material and methods: Selected databases (PubMed, Google Scholar, Scopus and Cochrane Library) were searched from 1979 to May 2024 for publications on us-TBI patients, with a focus on treatment strategy, mortality and functional outcomes. Inclusion criteria were adult patients >18 years old with closed head trauma and admission post-resuscitation GCS 3-5. Studies were independently assessed for inclusion by two reviewers, and potential disagreements were solved by consensus.

Results: Where such data could be extracted, mortality rate was 27-100%, and favorable outcome was observed in 4-30% of us-TBI patients. While early aggressive neurosurgical management was associated with decreased mortality, a high proportion of patients survived with unfavorable functional status.

Discussion and conclusion: With supportive care only, outcome of patients with us-TBI is almost universally poor. Early and aggressive neurosurgical intervention in addition to best medical management can lead to favorable functional outcome in selected cases particularly in younger patients with an initial GCS>3 and traumatic mass lesions. There is insufficient data regarding the effectiveness of neurosurgical management on the outcome of us-TBI patients. and the decision to initiate treatment should be based on an individual basis.

导言:严重创伤性脑损伤(TBI)患者的一个亚群被称为超严重(us-TBI),最常见的定义是复苏后格拉斯哥昏迷量表(GCS)为 3-5。这些重伤患者能否从神经外科干预中获益尚不确定:研究问题:对现有证据中有关治疗创伤后脑损伤患者的决策和结果进行严格审查:从1979年至2024年5月,在选定的数据库(PubMed、Google Scholar、Scopus和Cochrane Library)中检索了关于us-TBI患者的出版物,重点关注治疗策略、死亡率和功能结果。纳入标准为年龄大于 18 周岁、患有闭合性头部创伤、入院复苏后 GCS 为 3-5 的成年患者。由两名审稿人对纳入的研究进行独立评估,并通过协商一致的方式解决可能存在的分歧:结果:在能提取到此类数据的研究中,死亡率为 27%-100%,4%-30% 的颅脑损伤患者的预后良好。虽然早期积极的神经外科治疗可降低死亡率,但仍有很高比例的患者在功能状况不佳的情况下存活下来:讨论与结论:仅靠支持性治疗,us-TBI 患者的预后几乎普遍不佳。除了最佳的内科治疗外,早期和积极的神经外科干预可在特定病例中获得良好的功能预后,尤其是对于初始 GCS>3、有外伤性肿块的年轻患者。关于神经外科治疗对 us-TBI 患者预后的有效性,目前还没有足够的数据。
{"title":"Neurosurgical intervention in ultra-severe closed traumatic brain injury: Is it worth the effort?","authors":"Nikolaos Gkantsinikoudis, Iftakher Hossain, Niklas Marklund, Parmenion P Tsitsopoulos","doi":"10.1016/j.bas.2024.102907","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102907","url":null,"abstract":"<p><strong>Introduction: </strong>A subgroup of severe Traumatic Brain Injury (TBI) patients, known as ultra-severe (us-TBI), is most commonly defined as a post-resuscitation Glasgow Coma Scale (GCS) of 3-5. There is uncertainty on whether these critically injured patients can benefit from neurosurgical intervention.</p><p><strong>Research question: </strong>The available evidence regarding the decision-making and outcome following management of us-TBI patients is critically reviewed.</p><p><strong>Material and methods: </strong>Selected databases (PubMed, Google Scholar, Scopus and Cochrane Library) were searched from 1979 to May 2024 for publications on us-TBI patients, with a focus on treatment strategy, mortality and functional outcomes. Inclusion criteria were adult patients >18 years old with closed head trauma and admission post-resuscitation GCS 3-5. Studies were independently assessed for inclusion by two reviewers, and potential disagreements were solved by consensus.</p><p><strong>Results: </strong>Where such data could be extracted, mortality rate was 27-100%, and favorable outcome was observed in 4-30% of us-TBI patients. While early aggressive neurosurgical management was associated with decreased mortality, a high proportion of patients survived with unfavorable functional status.</p><p><strong>Discussion and conclusion: </strong>With supportive care only, outcome of patients with us-TBI is almost universally poor. Early and aggressive neurosurgical intervention in addition to best medical management can lead to favorable functional outcome in selected cases particularly in younger patients with an initial GCS>3 and traumatic mass lesions. There is insufficient data regarding the effectiveness of neurosurgical management on the outcome of us-TBI patients. and the decision to initiate treatment should be based on an individual basis.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"102907"},"PeriodicalIF":1.9,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11388290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Retraction notice to "Decency in neurosurgery" [Brain Spine 4 (2024), 102744]. 神经外科的体面》撤稿通知 [Brain Spine 4 (2024), 102744]。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI: 10.1016/j.bas.2024.102841
Minaam Farooq, Hira Saleem, Amr Badary, Bipin Chaurasia

[This retracts the article DOI: 10.1016/j.bas.2023.102744.].

[本文撤回文章 DOI:10.1016/j.bas.2023.102744.]。
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引用次数: 0
Impact of implant removal on quality of life and loss of correction in the treatment of traumatic fractures of the thoracolumbar spine. 在治疗胸腰椎创伤性骨折的过程中,移除植入物对生活质量和矫正损失的影响。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-28 eCollection Date: 2024-01-01 DOI: 10.1016/j.bas.2024.102845
André El Saman, Simon Lars Meier, Florian Rüger, Jason Alexander Hörauf, Ingo Marzi

Background: Benefit of implant removal in spine surgery remains unclear. While there is mostly consensus about necessity of implant removal in posterior-only stabilized patients, the effect of this measure in cases with combined anterior-posterior stabilization is undetermined. With this work we present a retrospective analysis of 87 patients with traumatic thoracolumbar vertebral fractures concerning quality of life (QOL), loss of correction (LOC) and range of motion (ROM). The effect of implant removal on the outcome 18-74 months after surgery was analyzed to determine how implant removal affects radiologic, functional and quality-of life-related parameters.

Patients and methods: 87 patients suffering from a traumatic vertebral body fracture (T11 - L2) were included. Quality of life was determined using four different scoring systems (SF 36, VAS, Oswestry, LBOS). Clinical examination included range of motion. Radiologic findings were correlated with QOL.

Results: Patients with removal of the internal fixator had a trend towards better range of motion than patients with posterior instrumentation left in place. Radiologic findings showed no correlation to QOL. Implant removal led to better values in Oswestry and SF-36. 69% of patients after removal reported a reduction of their symptoms.All patients with persistence of severe pain after implant removal belonged to subgroup II.2 (anterior monosegmental fusion with bone graft).

Conclusion: Removal of the internal fixator can lead to a reduction of symptoms. Patient selection is crucial for successful indication. Radiologic findings do not correlate with QOL.

背景:脊柱手术中移除假体的益处仍不明确。虽然对于单纯后路稳定的患者来说,移除假体的必要性已基本达成共识,但对于前后路联合稳定的病例来说,这一措施的效果尚不确定。通过这项研究,我们对 87 例创伤性胸腰椎骨折患者进行了回顾性分析,分析内容涉及生活质量(QOL)、矫正丧失(LOC)和活动范围(ROM)。分析了移除植入物对术后 18-74 个月疗效的影响,以确定移除植入物对放射学、功能和生活质量相关参数的影响。患者和方法:共纳入 87 名外伤性椎体骨折(T11 - L2)患者。生活质量采用四种不同的评分系统(SF 36、VAS、Oswestry、LBOS)进行测定。临床检查包括活动范围。放射学检查结果与生活质量相关:结果:与保留后路器械的患者相比,移除内固定器的患者的活动范围有改善的趋势。放射学检查结果与 QOL 无关。移除内固定器后,患者的 Oswestry 和 SF-36 评分均有所提高。69%的患者在移除内固定器后症状有所减轻。所有在移除内固定器后仍有剧烈疼痛的患者都属于II.2亚组(前路单节融合并植骨):结论:取出内固定器可减轻症状。结论:移除内固定器可减轻症状,但患者的选择是成功适应症的关键。放射学结果与 QOL 无关。
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引用次数: 0
Under pressure - A historical vignette on surgical timing in traumatic spinal cord injury. 压力之下 - 外伤性脊髓损伤手术时机的历史小故事。
Q3 CLINICAL NEUROLOGY Pub Date : 2024-05-03 eCollection Date: 2024-01-01 DOI: 10.1016/j.bas.2024.102825
Paula Valerie Ter Wengel, Florence Reith, Charlotte Y Adegeest, Michael G Fehlings, Brian K Kwon, W Peter Vandertop, Cumhur F Öner

Introduction: It was not even a century ago when a spinal cord injury (SCI) would inevitably result in a fatal outcome, particularly for those with complete SCI. Throughout history, there have been extensive endeavours to change the prospects for SCI patients by performing surgery, even though many believed that there was no way to alter the catastrophic course of SCI. To this day, the debate regarding the efficacy of surgery in improving the neurological outcome for SCI patients persists, along with discussions about the timing of surgical intervention.

Research question: How have the historical surgical results shaped our perspective on the surgical treatment of SCI?

Material and methods: Narrative literature review.

Results: Throughout history there have been multiple surgical attempts to alter the course of SCI, with conflicting results. While studies suggest a potential link between timing of surgery and neurological recovery, the exact impact of immediate surgery on individual cases remains ambiguous. It is becoming more evident that, alongside surgical intervention, factors specific to both the patient and their surgical treatment will significantly influence neurological recovery.

Conclusion: Although a growing number of studies indicates a potential correlation of surgical timing and neurological outcome, the precise influence of urgent surgery on an individual basis remains uncertain. It is increasingly apparent that, despite surgery, patient- and treatment-specific factors will also play a role in determining the neurological outcome. Notably, these very factors have influenced the results in previous studies and our views concerning surgical timing.

导言:一个世纪前,脊髓损伤(SCI)还不可避免地会导致致命的结果,尤其是对完全性脊髓损伤患者而言。纵观历史,尽管许多人认为无法改变脊髓损伤的灾难性后果,但人们一直在努力通过手术改变脊髓损伤患者的前景。时至今日,关于手术能否有效改善 SCI 患者神经功能预后的争论仍在继续,关于手术干预时机的讨论也在继续:材料和方法:叙述性文献综述:材料和方法:叙述性文献综述:纵观历史,人们曾多次尝试通过手术来改变 SCI 的病程,但结果却不尽相同。虽然研究表明手术时机与神经功能恢复之间存在潜在联系,但立即手术对个别病例的确切影响仍不明确。越来越明显的是,除了手术干预外,患者及其手术治疗的具体因素也会对神经功能的恢复产生重大影响:尽管越来越多的研究表明手术时机与神经功能预后可能存在关联,但紧急手术对个体的确切影响仍不确定。越来越明显的是,尽管进行了手术,但患者和治疗的特定因素也将在决定神经功能结果方面发挥作用。值得注意的是,正是这些因素影响了之前的研究结果以及我们对手术时机的看法。
{"title":"Under pressure - A historical vignette on surgical timing in traumatic spinal cord injury.","authors":"Paula Valerie Ter Wengel, Florence Reith, Charlotte Y Adegeest, Michael G Fehlings, Brian K Kwon, W Peter Vandertop, Cumhur F Öner","doi":"10.1016/j.bas.2024.102825","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102825","url":null,"abstract":"<p><strong>Introduction: </strong>It was not even a century ago when a spinal cord injury (SCI) would inevitably result in a fatal outcome, particularly for those with complete SCI. Throughout history, there have been extensive endeavours to change the prospects for SCI patients by performing surgery, even though many believed that there was no way to alter the catastrophic course of SCI. To this day, the debate regarding the efficacy of surgery in improving the neurological outcome for SCI patients persists, along with discussions about the timing of surgical intervention.</p><p><strong>Research question: </strong>How have the historical surgical results shaped our perspective on the surgical treatment of SCI?</p><p><strong>Material and methods: </strong>Narrative literature review.</p><p><strong>Results: </strong>Throughout history there have been multiple surgical attempts to alter the course of SCI, with conflicting results. While studies suggest a potential link between timing of surgery and neurological recovery, the exact impact of immediate surgery on individual cases remains ambiguous. It is becoming more evident that, alongside surgical intervention, factors specific to both the patient and their surgical treatment will significantly influence neurological recovery.</p><p><strong>Conclusion: </strong>Although a growing number of studies indicates a potential correlation of surgical timing and neurological outcome, the precise influence of urgent surgery on an individual basis remains uncertain. It is increasingly apparent that, despite surgery, patient- and treatment-specific factors will also play a role in determining the neurological outcome. Notably, these very factors have influenced the results in previous studies and our views concerning surgical timing.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"4 ","pages":"102825"},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11096936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140961334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Endovascular therapy for cerebral vasospasm after aneurysmal subarachnoid hemorrhage: Single-center experience in a high-volume neurovascular unit 动脉瘤性蛛网膜下腔出血后脑血管痉挛的血管内治疗:单中心高容量神经血管病房的经验
IF 1.9 Q3 CLINICAL NEUROLOGY Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.104133
Carolin Albrecht , Raimunde Liang , Dominik Trost , Isabel Hostettler , Martin Renz , Bernhard Meyer , Claus Zimmer , Jan Kirschke , Christian Maegerlein , Jannis Bodden , Charlotte Lingg , Arthur Wagner , Tobias Boeckh-Behrens , Maria Wostrack , Julian Schwarting

Introduction

Despite targeted standard therapy, aneurysmal subarachnoid hemorrhage (aSAH) frequently leads to cerebral vasospasms (CVS) of large cerebral arteries, reduced oxygen supply of brain tissue, known as delayed cerebral ischemia (DCI), subsequent development of manifest cerebral infarction and poor neurological outcome.

Research question

The primary aim was to evaluate the efficacy of endovascular spasmolysis (eSL) as a rescue therapy for delayed ischemic neurological deficits (DIND) occurring despite maximum conservative treatment, with the potential benefit of preventing permanent ischemic deficits, and thus, improving overall neurological outcomes.

Material and methods

In our retrospective, monocentric study, we included 310 patients developing CVS during hospitalization and evaluated their clinical and radiographic outcomes. Severe vasospasm was defined by a mean velocity of >200 cm/s in transcranial Doppler ultrasound and/or occurrence of new neurological deficits, and/or decrease of at least 2 points on the Glasgow Coma Scale (GCS), respectively.

Results

92 patients (29.7%) underwent eSL due to persistent symptoms despite conservative therapy. Among endovascularly treated patients, 86% (n = 79) improved angiographically, 71% (n = 44) of 62 patients who underwent eSL due to symptomatic deterioration improved clinically. Clinical worsening due to progressive CVS occurred in 18% of cases (n = 11). Periprocedural complications were observed in 4% (n = 4).

Discussion and conclusion

eSL emerges as a safe and effective therapy for individuals experiencing DIND triggered by large-artery vasospasm following aSAH. The implementation of a standardized, multi-step process for detection and management, coupled with criteria for endovascular interventions, proves to be an efficient preventative approach to enhance neurological outcomes after aSAH.
导言尽管进行了有针对性的标准治疗,动脉瘤性蛛网膜下腔出血(aSAH)仍经常导致大的脑动脉发生脑血管痉挛(CVS)、脑组织供氧减少(称为延迟性脑缺血(DCI))、随后发展为明显的脑梗塞和不良的神经功能预后。研究问题主要目的是评估血管内痉挛溶解术(eSL)作为最大限度保守治疗后仍出现延迟性缺血性神经功能缺损(DIND)的抢救疗法的疗效,其潜在益处是防止永久性缺血性缺损,从而改善整体神经功能预后。材料和方法在我们的回顾性单中心研究中,我们纳入了 310 例住院期间发生 CVS 的患者,并评估了他们的临床和影像学预后。严重血管痉挛的定义是经颅多普勒超声检查的平均速度达到 >200 cm/s,和/或出现新的神经功能缺损,和/或格拉斯哥昏迷量表(GCS)至少下降 2 分。在接受血管内治疗的患者中,86%(79 人)的血管造影结果有所改善,在因症状恶化而接受 eSL 的 62 名患者中,71%(44 人)的临床症状有所改善。18%的病例(11 例)因 CVS 进展导致临床症状恶化。讨论和结论eSL是一种安全有效的疗法,适用于因SAH后大动脉血管痉挛引发的DIND患者。事实证明,实施标准化、多步骤的检测和管理流程,并结合血管内介入治疗标准,是一种有效的预防方法,可提高SAH 后的神经功能预后。
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Brain & spine
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