Brain & spine最新文献

Introduction: Thoracolumbar (TL) transition trauma is frequent and challenging. Although short- (SSPF) and long-segment posterior fixation (LSPF) are its mainstay treatment, little is known about their failure rates and reasons behind it.

Research question: understand why TL instrumentations fail and what factors influence it.

Materials and methods: Retrospective, cohort, unicentric analysis on adult patients with acute TL trauma treated with percutaneous transpedicular SSPF or LSPF. Two groups were created, according to the presence of treatment failure at follow-up. We analyzed whether age ≥65 years old, fracture segment, posterior ligamentous complex (PLC) injury, load sharing classification (LSC) score >6, type of instrumentation (SSPF vs LSPF) and abnormal bone mineral density (BMD) were associated with failure. To achieve this, we evaluated radiological parameters at the preoperative, postoperative and follow-up appointments.

Results: 87 patients were included: 60 (69.0%) without failure and 27 (31.0%) with. Age ≥65 years old (aOR = 3.66, p = 0.020), PLC injury (aOR = 2.94, p = 0.048) and SSPF (aOR = 6.75, p = 0.013) were statistically significant factors contributing to failure. The first two also presented shorter times to failure (35.2 vs 69.1 months, p = 0.013, and 25.2 vs 69.1 months, p = 0.037, respectively). In PLC injured patients, there was no statistically significant difference between SSPF vs LSPF.

Discussion and conclusions: We conclude that age >65 years old, PLC injury and SSPF may be correlated with instrumentation failure. The first two factors were also associated with a shorter time to failure.

Introduction: Klippel-Trenaunay Syndrome (KTS) is a rare congenital condition characterized by vascular malformations, bone abnormalities, and limb overgrowth. The genetic basis of KTS is not fully understood, and the diagnosis relies on clinical features. Its clinical spectrum includes several neurosurgical diagnoses, such as cavernous hemangiomas, arteriovenous fistulas, and Chiari I malformation.

Research question: This study investigates the neurological complications associated with KTS, focusing on its coexistence with Chiari I malformation and other neurosurgical entities, through a systematic review and a case report.

Methods materials: A 27-year-old woman with KTS and Chiari I malformation presented with progressive tetraparesis and cranial nerve deficits. Emergency foramen magnum decompression had to be undertaken despite significant coagulation abnormalities. Despite her post-operative period being complicated by splenic rupture requiring splenectomy, she demonstrated gradual neurological recovery.

Results: The patient presented with a significant neurological improvement at her 3-month follow-up, being able to walk independently with a stick. A systematic review of the Pubmed database identified 55 patients with KTS requiring neurosurgical attention. The most common pathology was vascular malformations, followed by CNS tumors, whereas Chiari malformation was rare.

Conclusion: The study highlights the challenges of managing patients with KTS and Chiari I malformation, emphasizing the importance of early diagnosis, through preoperative evaluation and interdisciplinary care. Emergency surgery in KTS patients with neurological deterioration, though high risk, can improve outcomes with careful coordination among neurosurgeons, hematologists, and internists. The rare association of Chiari I malformation with KTS underscores the need for vigilance and a tailored approach to care.

Introduction: Traumatic spinal cord injury (tSCI) is frequently observed in polytrauma patients.

Research question: What is the optimal strategy to manage tSCI in the setting of polytrauma?

Material and methods: This narrative review focuses on: 1) extraspinal damage control surgery and resuscitation, 2) the perioperative protection of the injured spine during emergency surgery, 3) imaging and timing of spinal surgery in polytrauma, 4) early interventions for skin, bowel and bladder, and 5) the multidisciplinary approach to tSCI polytrauma patients.

Results: Damage control resuscitation (DCR) and damage control surgery (DCS), aim to prevent/correct post-traumatic physiological derangements to minimize bleeding until definitive hemostasis is achieved. Spinal protection during emergency surgery is of paramount importance to reduce secondary insults to the injured spine. Imaging, especially magnetic resonance imaging (MRI), is useful for decision-making regarding surgical management of the injured spine. Early decompressive surgery (within 24 h from trauma) is associated with better neurological outcomes. Early consultation with a physical medicine and rehabilitation physician is beneficial to optimize recovery. A close collaboration between different medical specialties involved in the early management of tSCI patients with polytrauma is advisable to improve outcome.

Discussion and conclusion: This narrative review aims to collate basic knowledge regarding acute phase management of tSCI patients in the context of polytrauma. More evidence and data form well-powered studies are necessary in this setting.

Introduction: Middle Meningeal Artery Embolization (MMAE) in patients with chronic SubDural Hematoma (cSDH) is a novel treatment approach, albeit the specific role of MMAE in the treatment of cSDH is not yet defined.

Research question: The aim of this work is to provide a consensus-based statement from a multidisciplinary panel on the current role of MMAE in patients with cSDH.

Materials and methods: A literature search was performed using the keywords MMAE and cSDH. Based on the available published data, the panel was asked if a consensus could be reached on the role of MMAE in both de novo as well as in recurrent cSDH.

Results: The panel reached a consensus on the current role of MMAE in both de novo- and recurrent cSDH, as well as in patients on antithrombotics and those with coagulopathy. MMAE should be considered in the following scenarios:1)As "stand-alone" treatment in de novo cSDH requiring intervention but where surgery is prevented due to either coagulopathy or in patients on antithrombotics in whom the risk of suspension is considered unacceptably high,2)as "stand-alone" treatment in recurrent cSDH requiring intervention but where surgery is prevented due to either coagulopathy or in those on antithrombotics in whom the risk of suspension is considered unacceptably high and3)as "adjunct to surgery" in all recurrent cSDH.

Discussion and conclusion: This statement is to be considered an expert consensus opinion of delegates representing key international medical societies of specialists involved in the care of cSDH patients.

Introduction: Patient's experience of care (PEC) is crucial in enhancing and sustaining healthcare quality.

Research question: the primary aim of this study is to establish and assess a new questionnaire index designed to measure PEC following elective spinal surgery. This index serves as a tool to document, enhance, and maintain the quality of healthcare provided in this context.

Material and methods: The studied PEC index comprises 7 questions, each addressing different aspects of perioperative care. Our study involved 300 post-spinal surgery patients, sourced from the Swedish national register for spine surgery. Collected data included age, gender, education level, self-rated health, and primary language. The patients were contacted via telephone by trained interviewers, approximately 35 days after their surgery (with 60 patients re-interviewed after a few weeks). We employed linear regression, t-test, and ANOVA models to examine the associations between the PEC index and the documented variables.

Results: The PEC index demonstrated good internal consistency and reliability (Cronbach alpha = 0.76, interclass correlation coefficient = 0.87). Additionally, the utility measures indicated associations between the PEC index and factors such as higher age (p = 0.014), male gender (p = 0.012), and better self-rated health (p = 0.011).

Discussion and conclusion: The PEC index seems to be a promising tool with a clinically useful composite questionnaire for assessing PEC in patients undergoing elective spine surgery. In clinical settings, the index can accompany other outcome scores to evaluate and compare different diagnoses and management methods.

Introduction: Paraspinal muscle atrophy has been implicated in low back pain (LBP) as well as degenerative disc disease, lumbar spinal stenosis, and disc herniation. The objective of the study was to determine the association of paraspinal muscle morphology with functional outcomes in patients undergoing spine surgery in degenerative spine diseases.

Research question: Can the degree of paraspinal muscle atrophy be a reliable prognostic indicator of post-operative functional outcome in patients undergoing surgery for degenerative lumbar spine disease?

Materials and methods: Forty-one patients with degenerative lumbar spine disease planned for surgery were included. Pre-operative and postoperative MRI-based muscle morphology including total cross-sectional area (TCSA) and muscle atrophy were recorded. Association between muscle parameters and functional status as indicated from the visual analogue scale (VAS), and Oswestry Disability Index (ODI) were assessed, and compared between prior and after surgery.

Results: The MF and ES cross-sectional area on MRI was in proportion to the functional status. (higher ODI and VAS). Preoperative MF TCSA was positively correlated with preoperative ODI ((r = -0.441, p = = 0.032), preoperative VAS (r = -0.338, p = 0.048) and was negatively correlated with change in ODI (r = -0.268, p = 0.016) while preoperative ES TCSA was negatively correlated with preoperative ODI (r = -0.420, p = 0.003). Preoperative ODI, change in ODI and preoperative VAS had significant correlation with muscle atrophy (p < 0.05). There was a positive correlation between preoperative ODI with Grade 2 (r = 0.332, p = 0.016) and Grade 3 (r = 0.299, p = 0.048) MF muscle; and Grade 2 (r = 0.308, p = 0.067) and Grade 3 (r = 0.202, p = 0.018) ES muscles atrophy. The change in ODI, negatively correlated with Grade 3 MF and ES atrophy (r = -0.332, p = 0.018 and r = -0.286, P = 0.011 respectively). Linear regression analysis showed duration of symptom (p = 0.005) was positively associated with preoperative ODI. Age and BMI were negatively associated with improvement in ODI. (p = 0.073, 0.098 respectively).

Discussion and conclusion: Preoperative paraspinal muscle area is an independent variable that affects preoperative functional status. The grade of paraspinal muscle atrophy is a good predictor of preoperative, postoperative and improvement in functional status.