Brain & spine最新文献

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.

Introduction: In 1960, Lazorthes and Campman introduced the concept of a 'crisis of the third day', which gained prominence in the field of traumatic brain injury (TBI), where it relates to neurological deterioration on the third day after injury. However, evidence regarding this phenomenon remains scarce.

Research question: This study aimed to analyze posttraumatic intracranial pressure (ICP) patterns in a large European cohort to investigate the existence of a third-day crisis and its impact on 12-month functional outcomes.

Materials and methods: Data were analyzed from the prospective Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients with TBI admitted to ICUs in 65 European centers who received ICP monitoring were included. ICP measurements, averaged per day, were analyzed using mixed models. The association between ICP peak timing and functional outcome was examined with multivariable logistic regression.

Results: The study included 886 patients. Average ICP trajectories showed no significant changes over the first seven days post-injury, without elevation around the third day. Among 563 patients with ICP >20 during the first week, 45% reached their highest ICP after the third day. Elevated ICP (>20 mmHg) during the first week was associated with unfavorable 12-month outcomes, but the timing of ICP peak was not linked to functional outcomes.

Discussion and conclusion: This multicenter study challenges the 'crisis of the third day' concept. No distinct ICP or TIL elevations were observed around the third day. Elevated ICP remains a prognostic indicator, but ICP peak timing does not correlate with functional outcomes.

Introduction: Vertebral fractures in postictal patients with no prior acute or chronic trauma history are rare but can lead to severe neurological complications if missed during the initial evaluation.

Research question: What are the prevalence and risk factors associated with vertebral fractures? What are the characteristics of these fractures in terms of their location, severity, and clinical outcome?

Materials and methods: A comprehensive literature search using MeSH terms was conducted. Data from previously published studies and three new cases from the authors' institution were collected. The variables included demographic information, seizure history, medical comorbidities, fracture characteristics, and treatment details. Descriptive statistics summarize the data. Inferential statistics (t-test, Mann-Whitney U test, chi-squared test, Fisher's exact test, and logistic regression) were used to identify the risk factors for vertebral fractures.

Results: The review included nine studies with a total of 19 patients, and three additional unpublished cases from the authors' institution. The median patient age was 50 years, with male predominance. No significant differences were found between the groups in osteoporosis, seizure history, antiepileptic drug use, or alcohol or drug abuse. The most common sites of fracture were the midthoracic spine for compression fractures and thoracolumbar junction for burst fractures. Risk factors for fractures include greater muscle mass, lower bone mineral density, longer convulsions, and recurrent convulsions.

Discussion: The mechanism of injury involved violent muscle contractions during seizures.

Conclusion: This review summarizes the current knowledge and provides evidence for best practices in the management of seizure-induced vertebral fractures.

Introduction: Primary dedifferentiated liposarcomas of the spine mark a rare tumor entity.

Research question and case description: We present a rare case of a primary dedifferentiated liposarcoma of the thoracic spine. A 36-year-old previously completely healthy woman presented with a sudden ascending paresthesia of both legs, persistently increasing over the course of two days before initial presentation.

Case report: Computed tomography and magnetic resonance imaging revealed an expansively growing tumor mass extending from T5 to T6 and absolutely compressing the dural sac and spinal cord. The patient's neurological function completely recovered after emergency posterior decompression via laminectomy with intralesional tumor debulking. The tumor was histologically classified as primary grade 2 dedifferentiated liposarcoma (DDLPS) of the spine and after referral to a sarcoma center, the patient was treated with three courses of polychemotherapy (doxorubicin plus ifosfamide). Chemotherapy was followed by aggressive resection by en-bloc spondylectomy in cooperation with a spine tumor center. Subsequently, the patient also underwent radiation therapy.

Results: The patient still undergoes structured tumor aftercare and is tumor- and metastasis-free 53 months after tumor resection.

Discussion and conclusion: DDLPS rarely occur in the spine, with definitive resection of the tumor being the treatment of choice. Surgery should be accompanied by other (radio-) oncological treatment options in cases where only subtotal resection is possible. Also, referral of patients with primary sarcomas of the spine to specialized sarcoma centers is essential, so they can be provided with individual treatment options and structured interdisciplinary aftercare, that ensure the best possible outcome.

There is increasing interest in monitoring pressure from the injured spinal cord to guide the management of patients with acute, severe traumatic spinal cord injuries (TSCI). This is analogous to monitoring intracranial pressure and cerebral perfusion pressure in traumatic brain injury (TBI). Here, we explore key concepts in this field and novel therapies that are emerging from these ideas. We argue that the Monro-Kellie doctrine, a fundamental principle in TBI, may also apply to TSCI as follows: The injured cord swells, initially displacing surrounding cerebrospinal fluid (CSF) that prevents a rise in spinal cord pressure; once the CSF space is exhausted, the spinal cord pressure at the injury site rises. The spinal Monro-Kellie doctrine allows us to define novel concepts to guide the management of TSCI based on principles employed in the management of TBI such as intraspinal pressure (ISP), intrathecal pressure (ITP), spinal cord perfusion pressure (SCPP), spinal pressure reactivity index (sPRx), and optimum SCPP (SCPP_opt). Draining lumbar CSF and expansion duroplasty are currently undergoing clinical trials as novel therapies for TSCI. We conclude that there is acknowledgement that blood pressure targets applied to all TSCI patients are inadequate. Current research aims to develop individualised management based on ISP/ITP and SCPP monitoring. These techniques are experimental. A key controversy is whether the spinal cord pressure is best measured from the injury site (ISP) or from the lumbar cerebrospinal fluid (ITP).