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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。
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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。
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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]。
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。
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。
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。
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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
Pub Date : 2024-05-01 DOI: 10.1016/j.bas.2024.102825
P. V. ter Wengel, Florence Reith, Charlotte Y. Adegeest, M. Fehlings, Brian K. Kwon, W. P. Vandertop, Cumhur F. Öner
{"title":"Under pressure - A historical vignette on surgical timing in traumatic spinal cord injury","authors":"P. V. ter Wengel, Florence Reith, Charlotte Y. Adegeest, M. Fehlings, Brian K. Kwon, W. P. Vandertop, Cumhur F. Öner","doi":"10.1016/j.bas.2024.102825","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102825","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141023399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Ethical tightrope: Navigating neuro-ethics in brain computer interface (BCI) technology 伦理钢丝绳:脑计算机接口(BCI)技术中的神经伦理导航
Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102800
Allah Yar Yahya Khan, Ammar Anjum, Haseeb Mehmood Qadri (Dr)
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引用次数: 0
Revitalizing neurosurgical frontiers: The EANS frontiers in neurosurgery committee's strategic framework 振兴神经外科前沿:EANS 神经外科前沿委员会的战略框架
Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102794
Aaron Lawson McLean , Ignazio G. Vetrano , Anna C. Lawson McLean , Alfredo Conti , Patrick Mertens , Michael Müther , Jakob Nemir , Simone Peschillo , Antonio Santacroce , Can Sarica , Constantin Tuleasca , Cesare Zoia , Jean Régis , EANS Frontiers in Neurosurgery Committee

Introduction

The field of neurosurgery faces challenges with the increasing involvement of other medical specialties in areas traditionally led by neurosurgeons. This paper examines the implications of this development for neurosurgical practice and patient care, with a focus on specialized areas like pain management, peripheral nerve surgery, and stereotactic radiosurgery.

Research question

To assess the implications of the expanded scope of other specialties for neurosurgical practice and to consider the response of the EANS Frontiers in Neurosurgery Committee to these challenges.

Materials and methods

Analysis of recent trends in neurosurgery, including the shift in various procedures to other specialties, demographic challenges, and the emergence of minimally invasive techniques. This analysis draws on relevant literature and the initiatives of the Frontiers in Neurosurgery Committee.

Results

We explore a possible decrease in neurosurgical involvement in certain areas, which may have implications for patient care and access to specialized neurosurgical interventions. The Frontiers in Neurosurgery Committee's role in addressing these concerns is highlighted, particularly in terms of training, education, research, and networking for neurosurgeons, especially those early in their careers.

Discussion and conclusion

The potential decrease in neurosurgical involvement in certain specialties warrants attention. This paper emphasizes the importance of carefully considered responses by neurosurgical societies, such as the EANS, to ensure neurosurgeons continue to play a vital role in managing neurological diseases. Emphasis on ongoing education, integration of minimally invasive techniques, and multidisciplinary collaboration is essential for maintaining the field's competence and quality in patient care.

引言随着其他医学专科越来越多地涉足传统上由神经外科医生主导的领域,神经外科领域面临着挑战。本文探讨了这一发展对神经外科实践和患者护理的影响,重点关注疼痛管理、周围神经手术和立体定向放射手术等专业领域。材料和方法分析神经外科的最新趋势,包括各种手术向其他专业的转移、人口统计学挑战和微创技术的出现。结果我们探讨了神经外科在某些领域的参与可能减少的情况,这可能会对患者护理和获得专业神经外科干预产生影响。本文强调了神经外科前沿委员会在解决这些问题方面的作用,特别是在神经外科医生,尤其是处于职业生涯初期的神经外科医生的培训、教育、研究和网络方面。本文强调了神经外科学会(如 EANS)审慎考虑对策的重要性,以确保神经外科医生继续在管理神经系统疾病方面发挥重要作用。强调持续教育、整合微创技术和多学科合作对于保持该领域的能力和患者护理质量至关重要。
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引用次数: 0
Term and definition of a deformity after a spine trauma: Results of an international Delphi study 脊柱创伤后畸形的术语和定义:国际德尔菲研究的结果
Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102749
E.E.A. De Gendt , S.P.J. Muijs , L.M. Benneker , F.C. Oner

Introduction

Deformity of the spinal column after trauma could lead to pain, impaired function, and may sometimes necessitate extensive and high-risk surgery. This ‘condition’ has multiple terms and definitions that are used in research and clinics. A specific term and definition of this condition however is still lacking. A uniform and internationally accepted term and definition are necessary to compare cases and treatments in the future.

Research question

Reach consensus on the term and definition of this deformity after spine trauma using a Delphi approach.

Material and methods

An ‘all-rounds invitation’ Delphi process was used in this study among a group of international experts. The first round consisted of an online survey using input from preparatory studies, a typical clinical case and ICD-11 codes. The second round showed the results in-person and discussion was encouraged. Participants voted for rejection of certain terms. In the third round the final vote took place. When >80 % of the votes was for or against a term the term was rejected or accepted.

Results

Response rate was high (≥84 %). The 3 Delphi rounds were completed. Unanimous voting led to the acceptance of the term and abbreviation as PSD. Deformity in any plane, pain, impaired function, and neurological deficit, were deemed important to include in the definition of PSD.

Discussion and conclusion

Unanimous consensus was reached on ‘Posttraumatic spinal deformity: Condition where a trauma to the spine results in a deformity in any plane and results in pain and an impaired function with or without a neurological deficit.’

导言:外伤后脊柱畸形会导致疼痛、功能受损,有时可能需要进行广泛而高风险的手术。这种 "病症 "在研究和临床上有多种术语和定义。然而,目前仍缺乏关于这种病症的专门术语和定义。研究问题采用德尔菲法就脊柱创伤后畸形的术语和定义达成共识。材料和方法在这项研究中,一组国际专家采用了 "全方位邀请 "德尔菲法。第一轮由在线调查组成,调查内容包括前期研究、典型临床病例和 ICD-11 编码。第二轮是当面展示结果并鼓励讨论。与会者投票决定是否否决某些术语。第三轮进行了最终投票。当支持或反对某个术语的票数达到 80% 时,该术语即被否决或接受。完成了 3 轮德尔菲讨论。投票结果一致同意术语和缩写为 PSD。任何平面的畸形、疼痛、功能受损和神经功能缺损都被认为是 PSD 定义中的重要内容:脊柱创伤后畸形:脊柱创伤导致任何平面的畸形,并导致疼痛和功能受损,伴有或不伴有神经功能缺损"。
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引用次数: 0
Sport-related concussion in soccer –a scoping review of available guidelines and a call for action to FIFA & soccer governing bodies 足球运动中与运动相关的脑震荡--对现有指导方针的范围审查以及向国际足联和足球管理机构发出的行动呼吁
Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102763
Andreas K. Demetriades , Imran Shah , Niklas Marklund , Hans Clusmann , Wilco Peul

Introduction

Sport-related concussions (SRC) have been a concern in all sports, including soccer. The long-term effects of soccer-related head injuries are a public health concern. The Concussion in Sport Group (CISG) released a consensus statement in 2017 and several soccer governing associations have published their own SRC guidelines while referring to it but it is unclear whether this has been universally adopted.

Research question

We aimed to investigate whether guidelines published by soccer associations have any discrepancies; and the extent to which they follow the CISG recommendations.

Materials and methods

A scoping review of available soccer-specific SRC guidelines was performed via databases PubMed, Google Scholar, and official soccer association websites via web browser Google. The inclusion criteria were soccer-specific SRC guidelines. Comparisons between guidelines were made concerning the following index items: initial (on-site) assessment, removal from play, re-evaluation with neuroimaging, return-to-sport protocol, special populations, and education.

Results

Nine soccer associations with available guidelines were included in this review. Guidelines obtained were from official associations in the United Kingdom, United States of America, Canada, Australia, and New Zealand. When compared to each other and the CISG recommendations, discrepancies were found within guidelines regarding the index items. Additionally, major soccer associations in some countries famous for soccer were found to have not published any publicly available guidelines.

Discussion and conclusion

SRC guidelines from different soccer associations contain discrepancies which may be detrimental to athletes, both short and long-term. We recommend that all major soccer governing associations publish guidelines that are standardised and accessible to all athletes.

导言与运动相关的脑震荡(SRC)一直是包括足球在内的所有体育运动中的一个令人担忧的问题。与足球相关的头部损伤的长期影响是一个公共健康问题。体育运动脑震荡小组(CISG)于 2017 年发布了一份共识声明,一些足球管理协会在参考该声明的同时也发布了自己的 SRC 指南,但目前尚不清楚该指南是否已被普遍采纳。研究问题我们旨在调查足球协会发布的指南是否存在差异;以及它们在多大程度上遵循了 CISG 的建议。材料和方法通过 PubMed、Google Scholar 等数据库以及 Google 浏览器的足球协会官方网站,对现有的足球特定 SRC 指南进行了范围审查。纳入标准为足球专用 SRC 指南。对指南中的以下指标项目进行了比较:初始(现场)评估、停赛、神经影像学再评估、恢复运动协议、特殊人群和教育。所获得的指南分别来自英国、美国、加拿大、澳大利亚和新西兰的官方协会。通过相互比较和 CISG 建议,发现指南中的指标项目存在差异。此外,我们还发现一些著名足球国家的主要足球协会并没有发布任何公开的指导原则。我们建议所有主要的足球管理协会发布标准化的指导原则,供所有运动员使用。
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引用次数: 0
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