Brain & spine最新文献

{"title":"Mapping motor cortex “hand knob” metrics to symptom hemidominance in Parkinson's disease: from width comparison to machine learning","authors":"Friedrich Erhart ,&nbsp;Konstantin Hölzl ,&nbsp;Agnes Langer ,&nbsp;Christof Brücke ,&nbsp;Josa M. Frischer ,&nbsp;Gregor Kasprian ,&nbsp;Karl Rössler ,&nbsp;Klaus Novak","doi":"10.1016/j.bas.2026.105933","DOIUrl":"10.1016/j.bas.2026.105933","url":null,"abstract":"<div><h3>Introduction</h3><div>Parkinson's disease typically shows unilateral symptom dominance. Even though general neurodegeneration is well-documented, side-specific cortex affection has not been exhaustively studied.</div></div><div><h3>Research question</h3><div>Specifically, we hypothesize that symptom hemidominance in Parkinson's disease might be associated with motor cortex “hand knob” size. To that end, we retrospectively analyzed 47 Parkinson's patients via structured morphometry, that had undergone standardized MRI for later deep brain stimulation surgery. Additionally, 25 control patients imaged with the same technical setup but without Parkinson's disease were investigated.</div></div><div><h3>Material and methods</h3><div>Main dimensions of the “hand knob” (e.g. width and length) and compound measures (e.g. area and volume) were registered. Data analysis ranged from classical statistics for e.g. width comparison to advanced machine learning algorithms for integrated multivariable computation (e.g. t-SNE, Random Forest, Neural Networks and Naïve Bayes).</div></div><div><h3>Results</h3><div>Left “hand knob” width appeared smaller in patients with right symptom hemidominance in exploratory univariable analyses (p = 0.026, uncorrected). In the control group this was not the case (p = 0.235). Complementary “hand knob” computations showed similar outcomes. All machine learning models concordantly suggested that integrated multivariable “hand knob” metrics can predict symptom side differences.</div></div><div><h3>Discussion and conclusion</h3><div>Symptom hemidominance and “hand knob” parameters seem to possibly be connected. Specific cortical motor morphology dynamics of the “hand knob” might exist in hemidominant Parkinson's – for which we provide hitherto overlooked, indicative evidence based on a simple yet fundamental imaging inquiry complemented with advanced machine learning. The hypothesis-generating insights presented here shall inspire further research of cortical motor structures in Parkinson's.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105933"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dural manifestation of capillary hemangiomas – a case presentation and systematic review","authors":"Severin Rüssli ,&nbsp;Sabrina Bäbler ,&nbsp;Julien Thiel ,&nbsp;Michael Zeh ,&nbsp;Elisabeth Rushing ,&nbsp;Ulf C. Schneider","doi":"10.1016/j.bas.2026.105952","DOIUrl":"10.1016/j.bas.2026.105952","url":null,"abstract":"<div><h3>Introduction</h3><div>Dural capillary hemangiomas (CHs) are exceedingly rare benign vascular lesions, posing significant diagnostic challenges due to the absence of specific clinical or radiological features.</div></div><div><h3>Research question</h3><div>We report the case of an adolescent patient with symptomatic fronto-temporal dural CH and provide a comprehensive systematic review of all reported cases in the literature.</div></div><div><h3>Methods</h3><div>We conducted a systematic review, searching PubMed/Medline, Embase, and Web of Science using the terms \"intracranial AND capillary hemangioma\" and \"dural AND capillary hemangioma.\" Only peer-reviewed English articles reporting histopathologically confirmed dural CHs were included.</div></div><div><h3>Results</h3><div>The reported case was an adolescent patient with a dural lesion who underwent complete surgical resection due to suspicion of malignant pathology based on unusual clinical and radiological presentation. This lesion was consequently identified as CH on histopathological examination. In our systematic review we included 26 articles on dural CHs from the existing literature, reporting 35 cases over a period of 32 years, including our case.</div></div><div><h3>Discussion and conclusion</h3><div>Dural CHs exhibit distinct demographic patterns characterized by adult predominance and female predilection in comparison to extracranial CHs. Nonspecific imaging characteristics in CHs necessitate histopathological confirmation for definitive diagnosis. Surgical intervention has been demonstrated to yield favorable outcomes with minimal recurrence rates. Findings from this review suggest that current management may be driven more by diagnostic uncertainty and concerning presentations than by growth characteristics. Dural CHs should be considered in the differential diagnosis of contrast enhancing dural lesions, particularly in adults. Standardized documentation of future cases would facilitate better understanding of natural history and optimize management strategies for this rare entity.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105952"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overall survival following treatment of central nervous system meningeal melanocytomas: Insights from the national cancer database (NCDB)","authors":"Victor Gabriel El-Hajj ,&nbsp;Jad El Choueiri ,&nbsp;Flavio Vasella ,&nbsp;Victor E. Staartjes ,&nbsp;Mohamad Bydon ,&nbsp;Adrian Elmi-Terander","doi":"10.1016/j.bas.2025.105922","DOIUrl":"10.1016/j.bas.2025.105922","url":null,"abstract":"<div><h3>Introduction</h3><div>Central nervous system (CNS) melanocytomas are rare, pigmented tumors derived from leptomeningeal melanocytes. Although generally benign, they can exhibit locally aggressive behavior and recur. Despite increasing recognition, data on their clinical outcomes and optimal management remain limited.</div></div><div><h3>Research question</h3><div>This study aimed to evaluate the survival outcomes of patients with CNS melanocytomas, using a large national registry, and to explore the prognostic relevance of tumor location and treatment modalities.</div></div><div><h3>Methods</h3><div>We queried the National Cancer Database (NCDB) for cases of CNS melanocytomas diagnosed between 2004 and 2017. Patient demographics, tumor characteristics, treatment details, and survival outcomes were collected. Kaplan-Meier survival analysis was used to study overall survival (OS).</div></div><div><h3>Results</h3><div>A total of 143 patients with CNS melanocytomas were identified, including 58 spinal (40.6 %), 49 intracranial (34.3 %), 36 tumors of unspecified location (25.2 %). The median age at diagnosis was 59 years, with males comprising 48.3 % of the cohort. Gross total resection (GTR) was reported in 28 patients (19.6 %), while adjuvant radiotherapy was performed in 51 patients (35.7 %). The 1- and 5-year OS rates were approximately 80 % and 50 %, respectively. There were no significant differences in OS based on sex, age, tumor location, extent of resection, or use of adjuvant radiotherapy (p ≥ 0.05).</div></div><div><h3>Discussion and conclusion</h3><div>Despite advances in surgical techniques and radiation therapy, the optimal management of CNS melanocytomas remains an area of ongoing investigation. Since our findings failed to demonstrate a survival benefit from GTR or the use of adjuvant radiotherapy, future prospective studies should focus on refining treatment indications.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105922"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracranial primary collision tumours: A comprehensive systematic review on preoperative radiological accuracy and neuro-oncological insights","authors":"Saqiba Jadoon ,&nbsp;Mary Solou ,&nbsp;Ahmad A. Moussa ,&nbsp;Athanasios Zisakis","doi":"10.1016/j.bas.2026.105943","DOIUrl":"10.1016/j.bas.2026.105943","url":null,"abstract":"<div><h3>Background</h3><div>Intracranial collision tumours, characterized by the coexistence of two histologically distinct neoplasms within the same anatomical region without histological transition or metastatic interaction, are rare in neuro-oncology. Their atypical imaging appearance often mimics solitary lesions, posing diagnostic challenges.</div></div><div><h3>Research question</h3><div>How accurately can preoperative neuroimaging identify both components of intracranial collision tumours, and what factors influence detection?</div></div><div><h3>Methods</h3><div>A systematic review was conducted following PRISMA guidelines and registered with PROSPERO (CRD420251008646). Included studies were adult case reports and series, including histologically confirmed intracranial collision lesions with preoperative neuroimaging. Tumour-to-tumour metastasis, synchronous, composite, or recurrent tumours were excluded.</div></div><div><h3>Results</h3><div>A total of 67 published cases were analysed, with a male-to-female ratio of 28:38 and a mean age of 52.4 years (SD = 15.95), ranging from 18 to 87 years. Meningioma was the most prevalent tumour type (65.7 %), commonly paired with glioblastoma (26.9 %). The sellar region was the most frequent location (34.3 %), followed by the two frontal lobes (31.3 %). Preoperative diagnosis correctly identified both lesions in only 26.9 % of cases. Detection rates varied by anatomical location (p = 0.0095), whereas no clear association was observed with tumour pair type (p = 0.1351). Surgical resection was the primary treatment, frequently combined with chemo-radiotherapy. Recurrence occurred in 17.9 %, especially in high-grade tumour components such as glioblastoma. Mean survival was 8.6 months, with 11.9 % mortality. No statistically significant survival differences were observed between tumour pair types (p = 0.149).</div></div><div><h3>Conclusion</h3><div>Intracranial collision tumours remain diagnostically challenging. Improved neuroimaging and molecular understanding are crucial to enhance early diagnosis and optimize clinical management.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105943"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145978097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive evacuation of chronic subdural hematoma: Repurposing a spinal rigid endoscope","authors":"M. Majovsky ,&nbsp;T. Moravec ,&nbsp;A. Khadanovich ,&nbsp;P. Vacek ,&nbsp;R. Kučera ,&nbsp;Š. Prokop ,&nbsp;V. Masopust ,&nbsp;D. Netuka","doi":"10.1016/j.bas.2025.105923","DOIUrl":"10.1016/j.bas.2025.105923","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic subdural hematoma (cSDH) is a common neurosurgical condition, particularly in the elderly. Standard treatment with burr-hole evacuation may be insufficient in septated or recurrent cases. Endoscopic techniques improve visualization and completeness of evacuation, but dedicated cranial neuroendoscopes are not universally available.</div></div><div><h3>Research question</h3><div>Can a spinal rigid endoscope be safely and effectively repurposed for the endoscopic evacuation of recurrent, septated cSDH?</div></div><div><h3>Materials and methods</h3><div>We present a single-case proof-of-concept study using a rigid spinal endoscope (Elliquence, LLC) originally designed for spine surgery. The system includes a 30° angled optic, integrated working channel, and compatibility with suction, irrigation, and bipolar coagulation tools. A small frontoparietal craniotomy was performed, and the spinal endoscope was introduced into the subdural space for inspection, evacuation, and hemostasis.</div></div><div><h3>Results</h3><div>The endoscope enabled visualization of organized clots, fibrous septa, and fragile neovessels, all of which were managed under direct vision. A subdural drain was accurately placed. Postoperative CT confirmed significant hematoma reduction by 83 % and midline re-expansion. The patient experienced full neurological recovery without complications.</div></div><div><h3>Discussion and conclusion</h3><div>Repurposing a spinal endoscope provides a practical alternative for endoscopic cSDH evacuation, particularly in settings lacking cranial neuroendoscopic systems. The technique enhances visualization, enables membrane and vessel management, and supports precise drain placement. Further studies are warranted to assess efficacy, safety, and reproducibility in larger cohorts.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105923"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145926966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Swipe, watch, learn? An analysis of TikTok as a source of patient education on spondylolisthesis","authors":"Celine Akta ,&nbsp;Moses El Kayali ,&nbsp;Lukas Schönnagel,&nbsp;Luis Bürck,&nbsp;Maximilian Muellner,&nbsp;Friederike Schömig,&nbsp;Matthias Pumberger,&nbsp;Tom Folkerts","doi":"10.1016/j.bas.2026.105960","DOIUrl":"10.1016/j.bas.2026.105960","url":null,"abstract":"<div><h3>Introduction</h3><div>Social media has become a major source of health information. TikTok, a rapidly expanding global platform that enables broad dissemination of medical content, yet the accuracy and reliability of such information remain uncertain. In this context, assessing the educational quality of videos on spondylolisthesis is of increasing clinical relevance.</div></div><div><h3>Research question</h3><div>To evaluate the quality, reliability, and educational value of TikTok videos on spondylolisthesis and identify factors associated with higher-quality content.</div></div><div><h3>Material and methods</h3><div>TikTok was searched in August 2025 using the keyword “spondylolisthesis.” Video metrics, uploader type and content category were recorded. Two orthopedic surgeons independently assessed reliability and quality using the DISCERN tool, Journal of the American Medical Association (JAMA) benchmarks, and Global Quality Score (GQS).</div></div><div><h3>Results</h3><div>A total of 254 TikTok videos were screened, of which 82 met inclusion criteria, totaling 4.15 million views and 55,967 likes. Private users uploaded 46.3%, surgeons 28.0%, physiotherapists 23.2%, and researchers 2.4%. Overall quality was poor (DISCERN 34.1 ± 17.6; JAMA 1.8 ± 1.1; GQS 2.6 ± 1.1). Videos by surgeons and physiotherapists scored significantly higher (p &lt; 0.001), and educational content outperformed patient experiences (p &lt; 0.001). Longer videos correlated with higher quality scores, while engagement metrics were not predictive.</div></div><div><h3>Discussion and conclusion</h3><div>Most TikTok videos on spondylolisthesis showed low quality and limited reliability. Educational content produced by healthcare professionals performed better, while popularity metrics were not indicative of quality. Spine specialists should recognize TikTok's growing role in patient education and contribute accurate, evidence-based content to improve information quality.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105960"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pressure-controlled fibrinolytic irrigation for membranous and recurrent chronic subdural hematomas","authors":"Marco Bissolo ,&nbsp;Roberto Doria-Medina ,&nbsp;Mazin Omer ,&nbsp;Theresa Bettina Loidl ,&nbsp;Zeynep Mercan ,&nbsp;Mukesch Johannes Shah ,&nbsp;Theo Demerath ,&nbsp;Eva Rohr ,&nbsp;Klaus-Jürgen Buttler ,&nbsp;Jürgen Beck ,&nbsp;Roland Roelz","doi":"10.1016/j.bas.2026.105953","DOIUrl":"10.1016/j.bas.2026.105953","url":null,"abstract":"<div><h3>Introduction</h3><div>Chronic subdural hematoma (cSDH) is a common neurosurgical condition with substantial recurrence after conventional evacuation. In June 2023, we introduced twist-drill craniostomy with pressure-controlled fibrinolytic irrigation therapy (TDC-FIT), developed for patients at elevated recurrence risk.</div></div><div><h3>Research question</h3><div>This study evaluates the safety and effectiveness of TDC-FIT in reducing cSDH recurrence compared with standard approaches.</div></div><div><h3>Methods</h3><div>We performed a retrospective comparative analysis of all consecutive cSDH procedures from January 2021 to December 2024, including twist-drill craniostomy (TDC), open craniotomy (OC), and TDC-FIT. The primary endpoint was reoperation within six months for symptomatic recurrence or inadequate evacuation—defined as residual hematoma ≥10 mm, midline shift, or persistent symptoms. Secondary endpoints included perioperative complications and outcome.</div></div><div><h3>Results</h3><div>A total of 779 procedures were performed in 491 patients: 698 TDC (89.6%), 40 OC (5.1%), 34 TDC-FIT (4.4%), and 7 others. Overall recurrence per procedure was 30.0%. Hematoma-related membranes strongly predicted recurrence (OR 3.4; p &lt; 0.0001). Recurrence after TDC-FIT was 8.8%, significantly lower than TDC (30.1%) and OC (25.0%) (p = 0.024). In membranous hematomas, recurrence reached 45.0% after TDC, 24.3% after OC, and 9.7% after TDC-FIT (p = 0.001). Predictive modeling matched observed recurrence for TDC but markedly overestimated recurrence for TDC-FIT and OC. Adverse events were lowest after TDC (7.4%) and TDC-FIT (8.8%) and highest after OC (20.0%). Over time, practice shifted toward minimally invasive techniques with increasing adoption of TDC-FIT.</div></div><div><h3>Conclusions</h3><div>TDC-FIT demonstrated a favorable safety profile and substantially reduced recurrence compared with conventional techniques, supporting its integration as an effective minimally invasive alternative.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105953"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined anterior, antero-lateral and lateral approaches to the cervical spine. Advocating the brachial plexus approach to the crossing of spine and nerve","authors":"Willem Pondaag,&nbsp;Wilco C. Peul,&nbsp;Martijn J.A. Malessy","doi":"10.1016/j.bas.2026.105977","DOIUrl":"10.1016/j.bas.2026.105977","url":null,"abstract":"<div><h3>Introduction</h3><div>The aim for total resection of large cervical tumors extending from the dura through the neuroforamen in the direction of the brachial plexus presents significant surgical challenges due to the complex anatomy and the risk of neurological injury. Traditional anterior approaches often provide limited visualization of the spinal nerves contributing to the brachial plexus and the phrenic nerve as these are lateral to the tumor mass.</div></div><div><h3>Research question</h3><div>Can a combined anterior, antero-lateral, and lateral approach with early identification of the nerves of the brachial plexus facilitate tumor resection and contribute to preserving neurological function.</div></div><div><h3>Methods</h3><div>A series of four illustrative cases is presented to illustrate this combined surgical approach which allows for tailored access to both medial and lateral aspects of the cervical spine.</div></div><div><h3>Results</h3><div>A combination of approaches enlarged the overview of the course of the nerves and was thereby instrumental in keeping the neurological function intact.</div></div><div><h3>Conclusion</h3><div>We advocate for broader adoption of this novel technique in complex cervical tumor surgeries where preservation of neurological function is paramount.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105977"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis on surgery for lumbar disc herniation: optimal timing of surgery, return to work and outcomes compared with conservative management","authors":"Shaman Ambaliya,&nbsp;Felix De Bruyn,&nbsp;Bart Depreitere","doi":"10.1016/j.bas.2025.105917","DOIUrl":"10.1016/j.bas.2025.105917","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;It has been estimated that between 50 and 90 % of the general population will suffer from low back pain at some point in their lives. 5 %–10 % of this patient population also experiences back-related leg pain caused by underlying spinal pathology such as lumbar disc herniations (LDH). Management options for LDH-related radicular pain include conservative treatment and lumbar disc surgery, the latter of which may be associated with prolonged work absenteeism and substantial socioeconomic consequences. To date, no universal consensus exists regarding the best treatment choice for patients experiencing LDH-related pain. Furthermore no agreement is found regarding the optimal timing of surgery and return to work after surgery leading to the aforementioned societal burden.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Aim&lt;/h3&gt;&lt;div&gt;To evaluate the evidence related to the following topics concerning lumbar disc herniations (LDHs): the comparison between surgical and non-surgical management of LDHs, the optimal timing of lumbar disc surgery and the optimal return to work time after surgery.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A comprehensive search strategy was used to search Scopus, Web of Science, Embase, Pedro, PubMed, CINAHL (via EBSCO), Cochrane central register of controlled trials (CENTRAL), Clinical Trials Registry Platform (ICTRP) and &lt;span&gt;&lt;span&gt;Clinicaltrials.gov&lt;/span&gt;&lt;svg&gt;&lt;path&gt;&lt;/path&gt;&lt;/svg&gt;&lt;/span&gt; for articles concerning the comparison between surgical and non-surgical management, the optimal timing of surgery and return to work after surgery for LDHs. Grey literature and unpublished data was screened via Google Scholar. Risk of bias and methodological quality were independently assessed by two reviewers using the RoB 2 tool and the ROBINS-I tool by Cochrane. Random-effects meta-analyses were performed for outcomes where sufficient methodological and clinical homogeneity was present.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;15 randomized controlled trials (RCTs), 18 prospective cohort studies (PCS), 8 retrospective cohort studies and 5 hybrid studies were identified providing information concerning our research topics. Meta-analysis of RCTs demonstrated that surgery resulted in better outcomes at short term evaluation in patients suffering from acute sciatica, at long-term (&gt;1 year) follow-up the outcomes of surgery were however comparable with conservative care. Discectomy results in significantly better outcomes than non-surgical techniques developed for treating LDHs. No universal consensus can be found throughout the literature regarding the optimal timing of surgery. Early return to work after surgery for LDHs does not result in inferior outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Surgery leads to a better decrease in leg pain and disability at short-term follow-up when compared with as usual conservative care, at long-term follow-up outcomes after surgery become comparable with conservative care. Discectomy remains to be th","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105917"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Idiopathic spinal cord herniation: A Case Report under Neuromonitoring and Meta-analysis of 211 reviewed Cases","authors":"Umida Elmuradova ,&nbsp;Ziad Omran ,&nbsp;Stefanie Hammersen ,&nbsp;Sven R. Kantelhardt ,&nbsp;Ali Mulhem","doi":"10.1016/j.bas.2026.105958","DOIUrl":"10.1016/j.bas.2026.105958","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic spinal cord herniation (ISCH) is a rare condition caused by a ventral or ventrolateral dural defect. Two surgical strategies are used: <strong>non-closure (Group I),</strong> consisting of reduction and adhesiolysis with or without enlargement of the defect, and <strong>closure</strong> (Group II), involving reduction followed by direct or indirect dural repair. This study compared these approaches.</div></div><div><h3>Methods</h3><div>We reported a case of ISCH treated under neuromonitoring. We conducted a systematic review and meta-analysis including surgically treated cases confirmed by MRI or CT myelography, excluding traumatic, iatrogenic, and discogenic etiologies. Outcomes included neurological status at final follow-up, recurrence, and surgical complications.</div></div><div><h3>Results</h3><div>A 50-year-old patient with progressive Brown–Séquard syndrome underwent surgery; neuromonitoring deterioration during attempted closure prompted conversion to non-closure. At the final follow-up, a clinical improvement without recurrence or complications was observed. Through the review, we identified 211 patients, including our case (mean age 50.99 ± 13.25 years; 58.7% female). Median follow-up was 24.16 months. In Group I, 53 improved, 4 were unchanged, and 2 worsened; in Group II, 114 improved, 27 were unchanged, and 9 worsened. Non-closure was associated with higher odds of improvement in the unadjusted analysis (POR 2.74, 95% CI 1.09–6.90, p = 0.032), but this association attenuated after adjustment (adjusted POR 2.53, 95% CI 0.69–9.31, p = 0.16). Complication rates were 3.38% vs 8.00% (OR 0.40, 95% CI 0.04–1.90); recurrence occurred once in each Group.</div></div><div><h3>Conclusions</h3><div>Both strategies are comparable. The non-closure could be a better choice, since it requires less manipulation. Intraoperative neuromonitoring is a valuable decision-making tool in ISCH surgery.</div></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":"6 ","pages":"Article 105958"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187881","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}