Brain & spine最新文献_第7页

Ankle kinematics during walking differ from healthy controls in patients with cervical spinal stenosis with myelopathy but not in those without myelopathy 颈椎管狭窄伴脊髓病变患者行走时的踝关节运动学特征与健康对照组不同，而非脊髓病变患者则不同

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102888

引用次数: 0

Predictive factors for cranioplasty complications – A decade's experience 颅骨成形术并发症的预测因素 - 十年的经验

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102925

Introduction

Cranioplasty (CP) following craniectomy provides cerebral protection, improves cerebrospinal fluid dynamics, and restores cosmesis. Although often viewed as minor, CP can have major complications.

Research question

This study aims to identify the predictive factors for post-operative complications in patients undergoing CP after decompressive craniectomy.

Methods

We conducted a retrospective study at a tertiary hospital, analyzing patients who underwent CP after decompressive craniectomy (DC) from 2008 to 2019. Patient demographics, medical history, and surgery details were retrieved from hospital records. Complications included symptomatic intracerebral haemorrhage, extradural or subdural haemorrhage, hydrocephalus, infection, or bone resorption.

Results

The study included 168 patients: 139 adults (mean age 47.6 ± 12.68 years) and 29 pediatric patients (mean age 11.8 ± 5.62 years), with a slight male predominance. The overall complication rate was 26.2%, with infection being the most common (8.9%). Predictive factors for CP complications identified by binomial logistic regression, controlling for age and sex, included primary coagulopathy (14.3-fold risk increase, p = 0.034), intraoperative ventricular puncture (7.9-fold risk increase, p = 0.009), and intraoperative dural layer breach (2.8-fold risk increase, p = 0.033). Pre-CP home living was a protective factor.

Conclusions

CP requires vigilant management to prevent complications. Primary coagulopathy, intraoperative ventricular puncture, and dural layer breach are significant risk factors for complications.

引言颅骨切除术后的颅骨成形术（CP）可保护大脑、改善脑脊液动力学并恢复外观。本研究旨在确定颅骨减压术后接受颅骨成形术（CP）患者术后并发症的预测因素。方法我们在一家三甲医院进行了一项回顾性研究，分析了 2008 年至 2019 年期间颅骨减压术（DC）后接受 CP 的患者。患者的人口统计学特征、病史和手术细节均来自医院病历。并发症包括症状性脑内出血、硬膜外或硬膜下出血、脑积水、感染或骨吸收：其中成人患者 139 例（平均年龄 47.6 ± 12.68 岁），儿童患者 29 例（平均年龄 11.8 ± 5.62 岁），男性患者略占多数。总体并发症发生率为 26.2%，其中感染最为常见（8.9%）。通过二项逻辑回归确定的CP并发症预测因素包括原发性凝血功能障碍（风险增加14.3倍，p = 0.034）、术中脑室穿刺（风险增加7.9倍，p = 0.009）和术中硬脑膜层破损（风险增加2.8倍，p = 0.033），并控制了年龄和性别。CCP前的家庭生活是一个保护因素。原发性凝血病、术中脑室穿刺和硬膜层破损是并发症的重要风险因素。

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引用次数: 0

Non-technical skills for neurosurgeons: An international survey 神经外科医生的非技术技能：国际调查

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102923

Introduction

Neurosurgery is considered a technically demanding specialty; nonetheless, it also requires non-technical skills (NTSs) to reach mastery.

Research question

This study seeks to understand how important NTSs are perceived by neurosurgeons across diverse roles and socio-economic backgrounds. The objective is to identify key NTSs and explore their role in surgical precision, teamwork, and collaboration.

Material and method

An international survey involving 372 neurosurgeons from various socio-economic and cultural contexts was conducted. The extensive sample and inclusive methodology provide a comprehensive perspective on the perceived importance of NTSs in neurosurgery.

Results

The survey results highlight the universal significance of NTSs among neurosurgeons. Attention to detail, humility, and self-awareness are considered essential for surgical precision, effective teamwork, and collaboration. The findings underscore the necessity for integrated training programs that combine NTSs with technical skills.

Discussion and conclusion

The study emphasizes the importance of effective training methods such as simulations, mentorship, and role-playing in equipping neurosurgeons to navigate the complexities of their profession. Future research should focus on optimizing teaching methods for NTSs, comparing traditional courses, online modules, and hybrid training programs. Addressing the global disparity in neurosurgical care, particularly in low- and middle-income countries, is crucial for improving patient outcomes worldwide.

引言神经外科被认为是一门对技术要求很高的专业；然而，它也需要非技术性技能（NTS）才能达到精通的程度。材料和方法进行了一项国际调查，涉及来自不同社会经济和文化背景的 372 名神经外科医生。广泛的样本和包容性的方法提供了一个全面的视角，以了解神经外科医生对 NTS 重要性的认识。结果调查结果凸显了 NTS 在神经外科医生中的普遍意义。注重细节、谦逊和自我意识被认为是手术精确度、有效团队合作和协作的关键。讨论和结论该研究强调了模拟、导师指导和角色扮演等有效培训方法对神经外科医生掌握复杂专业技能的重要性。未来的研究应侧重于优化神经外科医生的教学方法，比较传统课程、在线模块和混合培训项目。解决全球，尤其是中低收入国家在神经外科护理方面的差距，对于改善全球患者的治疗效果至关重要。

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引用次数: 0

Inter-observational analysis of computed tomography parameters to predict nonobvious posterior ligament complex injury in neurologically intact patients with thoracolumbar trauma 对计算机断层扫描参数进行观察间分析，以预测神经系统完好的胸腰椎创伤患者的非明显后韧带复合体损伤情况

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102855

Joana Araújo de Azevedo , Carolina Garcez Martins , Nuno Oliveira , Pedro Varanda , Bruno Direito-Santos

Introduction

Assessing the integrity of the posterior ligament complex (PLC), as a key element in the characterization of an unstable Thoracolumbar fracture (TLF), is challenging, but crucial in the choice of treatment.

Research question

How to create a reproducible score using combined parameters of Computed Tomography (CT) to predict nonobvious PLC injury. How CT parameters relate with PLC status.

Material and methods

Retrospective analysis of neurologically intact patients with an acute traumatic TLF, who underwent CT and Magnetic Resonance Imaging (MRI) within 72 h, in the Emergency Department of a single institution between January 2016 and 2022. Four investigators rated independently 11 parameters on CT and PLC integrity on MRI. The interrater reliability of the CT parameters was evaluated, and two risk scores were created to predict PLC injury on CT using the coefficients of the multivariate logistic regression.

Results

154 patients were included, of which 62 with PLC injury. All CT measurements had excellent or good interrater reliability. Patients with Horizontal Fracture of the lamina or pedicle (HLPF), Spinous process fracture (SPF) and Interspinous Distance Widening (IDW) were positively associated with PLC injury (p < 0.001, p < 0.001 and p = 0.045, respectively). Risk Score 2 (RS2), which included only statistically significant variables, had a total of 75.9% of correct classifications (p < 0.001), with a sensitivity of 71.0% and specificity of 78.3% to estimate PLC injury detected in the MRI.

Discussion and conclusion

Standardized procedures pre-established in the CT measurement protocol were effective. Identically to early findings, those three CT measurements showed a positive relation to PLC injury, thus enhancing the conclusions of previous studies. Comparing to the reliability of the CT findings above mentioned, the score was less precise.

导言评估后韧带复合体（PLC）的完整性是鉴定不稳定型胸腰椎骨折（TLF）的关键因素，具有挑战性，但对治疗方法的选择至关重要。研究问题如何使用计算机断层扫描（CT）的综合参数创建一个可重复的评分，以预测非明显的PLC损伤。材料与方法回顾性分析 2016 年 1 月至 2022 年期间在一家机构急诊科接受 CT 和磁共振成像（MRI）检查的神经功能完好的急性创伤性 TLF 患者。四名研究人员分别独立评定 CT 的 11 项参数和 MRI 的 PLC 完整性。评估了CT参数的交互可靠性，并创建了两个风险评分，利用多变量逻辑回归系数预测CT上的PLC损伤。所有的 CT 测量结果都具有极佳或良好的互测可靠性。片层或椎弓根水平骨折（HLPF）、棘突骨折（SPF）和棘间距增宽（IDW）与 PLC 损伤呈正相关（分别为 p < 0.001、p < 0.001 和 p = 0.045）。风险评分 2（RS2）仅包括具有统计学意义的变量，其正确分类率为 75.9%（p <0.001），对 MRI 检测到的 PLC 损伤的估计灵敏度为 71.0%，特异性为 78.3%。与早期研究结果相同，这三种 CT 测量结果与 PLC 损伤呈正相关，从而加强了之前研究的结论。与上述 CT 结果的可靠性相比，评分的精确度较低。

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引用次数: 0

Posterior cranial fossa meningiomas: Comparison of results between patients older and younger than 70 years 后颅窝脑膜瘤：70 岁以上和 70 岁以下患者的结果比较

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102790

Luciano Mastronardi, Alberto Campione, Amer Ahmad Alomari

Introduction

Surgical strategy for meningioma resection in the elderly is controversial: diverse studies in the literature have pointed at the age as a negative prognostic factor in terms of postoperative results.

Research question

The aim of this study is to compare surgical outcomes after resection of posterior fossa meningiomas in <70 and ≥ 70 years-old age groups.

Material and methods

We reviewed 72 patients affected by posterior fossa meningiomas who underwent surgical treatment at San Filippo Neri Hospital, Rome, Italy between September 2010 and December 2022. We analyzed data regarding tumor size, clinical presentation, extent of resection and complication/mortality.

Results

The groups consisted of 52 (72,2%) young and 20 (27,8%) elderly patients. Gross total resection rate was significantly higher among youngsters (p = 0,013), mainly for planned subtotal removal in older patients. At 3-month follow-up, clinical improvement was seen in 19 (36,5%) young and 7 (35,0%) elderly patients, which raised at last follow-up, being 84,6% (44) and 80,0% (16), respectively (p = 0,406). Two cases of progression/recurrence among the elderly and 1 among youngsters were observed; one case of mortality among the elderly was reported.

Discussion and conclusions

Safety data regarding postoperative complications and mortality in our series seem to confirm that there is no significant difference between older and younger patients, as long as older patients are carefully selected. Therefore, if surgery is proposed, it should be radical if gross total resection could be safely attempted.

导言老年人脑膜瘤切除术的手术策略存在争议：不同的文献研究均指出年龄是影响术后效果的不利预后因素。研究问题本研究旨在比较 70 岁和≥ 70 岁年龄组后窝脑膜瘤切除术的手术效果。我们分析了有关肿瘤大小、临床表现、切除范围和并发症/死亡的数据。年轻患者的总切除率明显更高（P = 0.013），主要是老年患者计划的次全切除。在 3 个月的随访中，19 名年轻患者（36.5%）和 7 名老年患者（35.0%）的临床症状有所改善，在最后一次随访中，临床症状有所改善，分别为 84.6%（44 例）和 80.0%（16 例）（p = 0.406）。讨论和结论我们的系列研究中有关术后并发症和死亡率的安全数据似乎证实，只要仔细挑选老年患者，老年患者和年轻患者之间并无明显差异。因此，如果建议进行手术，在可以安全地尝试全切除的情况下，应采取根治性手术。

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引用次数: 0

Assessing the impact of distortion correction on Gamma Knife radiosurgery for multiple metastasis: Volumetric and dosimetric analysis 评估变形校正对伽玛刀放射外科治疗多发性转移瘤的影响：体积和剂量分析

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102791

Yavuz Samanci , M. Orbay Askeroglu , Ali Haluk Düzkalir , Selcuk Peker

Introduction

Magnetic resonance imaging (MRI) is a robust neuroimaging technique and is the preferred method for stereotactic radiosurgery (SRS) planning. However, MRI data always contain distortions caused by hardware and patient factors.

Research question

Can these distortions potentially compromise the effectiveness and safety of SRS treatments?

Material and methods

Twenty-six MR datasets with multiple metastatic brain tumors (METs) used for Gamma Knife radiosurgery (GKRS) were retrospectively evaluated. A commercially available software was used for distortion correction. Geometrical agreement between corrected and uncorrected tumor volumes was evaluated using MacDonald criteria, Euclidian distance, and Dice similarity coefficient (DSC). SRS plans were generated using uncorrected tumor volumes, which were assessed to determine their coverage of the corrected tumor volumes.

Results

The median target volume was 0.38 cm³ (range,0.01–12.38 cm3). A maximum displacement of METs of up to 2.87 mm and a median displacement of 0.55 mm (range,0.1–2.87 mm) were noted. The median DSC between uncorrected and corrected MRI was 0.92, and the most concerning case had a DSC of 0.46. Although all plans met the optimization criterion of at least 98% of the uncorrected tumor volume (median 99.55%, range 98.1–100%) receiving at least 100% of the prescription dose, the percent of the corrected tumor volume receiving the total prescription dose was a median of 95.45% (range,23.1–99.5%).

Discussion and conclusion

MRI distortion, though visually subtle, has significant implications for SRS planning. Regular utilization of corrected MRI is recommended for SRS planning as distortion is sometimes enough to cause a volumetric miss of SRS targets.

引言磁共振成像（MRI）是一种强大的神经成像技术，也是立体定向放射外科（SRS）规划的首选方法。材料与方法回顾性评估了用于伽玛刀放射外科手术（GKRS）的 26 个多发性转移性脑肿瘤（MET）磁共振数据集。使用市售软件进行畸变校正。使用 MacDonald 标准、欧几里得距离和 Dice 相似性系数 (DSC) 评估了校正和未校正肿瘤体积之间的几何一致性。使用未校正的肿瘤体积生成SRS计划，并对其进行评估，以确定其是否覆盖校正后的肿瘤体积。结果中位靶体积为0.38立方厘米（范围为0.01-12.38立方厘米）。MET的最大位移量为2.87毫米，中位位移量为0.55毫米（范围为0.1-2.87毫米）。未校正磁共振成像与校正磁共振成像之间的中位 DSC 为 0.92，最令人担忧的病例的 DSC 为 0.46。虽然所有计划都符合未校正肿瘤体积至少98%（中位数99.55%，范围98.1-100%）接受至少100%处方剂量的优化标准，但校正后肿瘤体积接受总处方剂量的百分比中位数为95.45%（范围23.1-99.5%）。建议定期使用校正 MRI 进行 SRS 规划，因为畸变有时足以导致 SRS 目标的容积丢失。

{"title":"Assessing the impact of distortion correction on Gamma Knife radiosurgery for multiple metastasis: Volumetric and dosimetric analysis","authors":"Yavuz Samanci , M. Orbay Askeroglu , Ali Haluk Düzkalir , Selcuk Peker","doi":"10.1016/j.bas.2024.102791","DOIUrl":"https://doi.org/10.1016/j.bas.2024.102791","url":null,"abstract":"<div><h3>Introduction</h3><p>Magnetic resonance imaging (MRI) is a robust neuroimaging technique and is the preferred method for stereotactic radiosurgery (SRS) planning. However, MRI data always contain distortions caused by hardware and patient factors.</p></div><div><h3>Research question</h3><p>Can these distortions potentially compromise the effectiveness and safety of SRS treatments?</p></div><div><h3>Material and methods</h3><p>Twenty-six MR datasets with multiple metastatic brain tumors (METs) used for Gamma Knife radiosurgery (GKRS) were retrospectively evaluated. A commercially available software was used for distortion correction. Geometrical agreement between corrected and uncorrected tumor volumes was evaluated using MacDonald criteria, Euclidian distance, and Dice similarity coefficient (DSC). SRS plans were generated using uncorrected tumor volumes, which were assessed to determine their coverage of the corrected tumor volumes.</p></div><div><h3>Results</h3><p>The median target volume was 0.38 cm<sup>3</sup> (range,0.01–12.38 cm3). A maximum displacement of METs of up to 2.87 mm and a median displacement of 0.55 mm (range,0.1–2.87 mm) were noted. The median DSC between uncorrected and corrected MRI was 0.92, and the most concerning case had a DSC of 0.46. Although all plans met the optimization criterion of at least 98% of the uncorrected tumor volume (median 99.55%, range 98.1–100%) receiving at least 100% of the prescription dose, the percent of the corrected tumor volume receiving the total prescription dose was a median of 95.45% (range,23.1–99.5%).</p></div><div><h3>Discussion and conclusion</h3><p>MRI distortion, though visually subtle, has significant implications for SRS planning. Regular utilization of corrected MRI is recommended for SRS planning as distortion is sometimes enough to cause a volumetric miss of SRS targets.</p></div>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S277252942400047X/pdfft?md5=9104082efb61030e51f25abc4b52ac32&pid=1-s2.0-S277252942400047X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140321027","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

Obituary for Dr. Takanori Fukushima 福岛孝则博士的讣告

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102846

Torstein R. Meling, Uwe Spetzger, Ulrich Sure, Tiit Mathiesen, Pierre-Hugues Roche

引用次数: 0

Functional outcomes after retrosigmoid approach to the cerebellopontine angle: Observations from a single-center experience of over 13 years 小脑视网膜角逆行入路术后的功能结果：从一个单一中心超过 13 年的经验中观察到的结果

IF 1.9 Q3 CLINICAL NEUROLOGY

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102909

Introduction

Accessing the posterior base of the skull is complex because of the vital neurovascular structures in the area. However, the retrosigmoid approach (RSA) offers a solution to this challenge.

Research question

To analyze surgical outcome of RSA.

Material and methods

This study involved a retrospective review of patient charts from a single center, focusing on the surgical procedure and outcomes following the operation.

Results

The study included 517 patients suffering from conditions like vestibular schwannomas (VS), metastatic cancers, and trigeminal neuralgia. The most frequent symptoms reported were balance disorders (42.7%), hearing loss (36.5%), walking difficulties (21.2%), headaches (18.9%), facial pain (17.1%), issues with trigeminal nerve function (14.1%), cerebellar dysfunction (13.5%), and facial nerve paralysis (10.2%). The rate of complications stood at 21.1%, with 11.3% of patients needing revision surgery. The median score on the Clavien-Dindo scale was 2, and the rate of mortality related to surgery was 1.0%. Permanent symptom improvement was seen in 72.1% of cases. Temporary new deficits occurred in 43.2% of patients, with facial nerve paralysis being the most common (14.1%). No significant correlation was found between the size of the craniotomy and the extent of tumor resection (p = 0.155), except in the case of VS (p = 0.041). Larger craniotomy sizes were associated with higher rates of complications (p = 0.016), especially CSF leaks (p = 0.006). Complications significantly affected the likelihood and number of new deficits (p < 0.001 for both), particularly postoperative bleeding (p = 0.019, p = 0.001), CSF leaks (p = 0.026, p = 0.039), and hydrocephalus (p = 0.050, p = 0.007).

Conclusions

The potential for complications related to the surgical approach cannot be overlooked. The size of the tumor should not dictate larger surgical approaches due to the associated increase in postoperative complications; a tailored approach that considers the precise tumor location and pathology is crucial for optimizing postoperative outcomes.

引言由于颅骨后底部存在重要的神经血管结构，因此进入该区域非常复杂。材料和方法本研究对一个中心的患者病历进行了回顾性分析，重点关注手术过程和术后效果。结果本研究纳入了517名患有前庭分裂瘤（VS）、转移性癌症和三叉神经痛等疾病的患者。最常见的症状是平衡失调（42.7%）、听力下降（36.5%）、行走困难（21.2%）、头痛（18.9%）、面部疼痛（17.1%）、三叉神经功能问题（14.1%）、小脑功能障碍（13.5%）和面神经麻痹（10.2%）。并发症发生率为 21.1%，其中 11.3% 的患者需要进行翻修手术。克拉维恩-丁度评分的中位数为 2 分，与手术相关的死亡率为 1.0%。72.1%的病例症状得到永久性改善。43.2%的患者出现了暂时性的新缺陷，其中面神经麻痹最为常见（14.1%）。开颅手术的大小与肿瘤切除范围（p = 0.155）之间没有发现明显的相关性，VS 的情况除外（p = 0.041）。开颅手术尺寸越大，并发症发生率越高（p = 0.016），尤其是脑脊液漏（p = 0.006）。并发症会明显影响出现新缺陷的可能性和数量（两者均为 0.001），尤其是术后出血（p = 0.019，p = 0.001）、脑脊液漏（p = 0.026，p = 0.039）和脑积水（p = 0.050，p = 0.007）。肿瘤的大小不应决定采用较大的手术方式，因为这样会增加术后并发症；考虑肿瘤的精确位置和病理的定制手术方式对于优化术后效果至关重要。

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引用次数: 0

Patient-reported outcome from minimal invasive surgery compared with conventional open surgery for thoracolumbar fractures of the spine 脊柱胸腰椎骨折微创手术与传统开放手术的患者报告结果比较

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102782

Girts Murans , Laurynas Meska , Marius Gaurilcikas , Stig Mindedahl Jespersen , Martin Lindberg-Larsen

Study design

retrospective cohort study of prospectively collected data.

Objective

The treatment guidelines for thoracolumbar spinal fractures are controversial although minimally invasive surgery (MIS) is a popular alternative to the traditional open approach (TOA). Limited data exists about outcomes after MIS fracture treatment. The main aim of our study was to evaluate self-reported disability, health-related quality of life, pain, and satisfaction after MIS compared with TOA.

Methods

Of 173 patients operated from 2014 to 2018, 64.7% patients completed the Oswestry Disability Index (ODI), the EQ-5D-5L, and a tailored clinical follow-up questionnaire on employment status, pain, activity level, and satisfaction with treatment.

Results

Of the 112 patients, 34 had MIS and 78 had TOA. Mean follow-up was 56 months. The two groups were comparable on demographic variables apart from mean age - MIS group was 10 years older. The MIS group had better ODI scores (p = 0.046), but the groups were similar regarding return to work and disability retirement. The EQ-5D-5L index for the MIS were very close (mean −0.033, median +0.049) to the Danish population score, while the TOA showed a greater deviation (mean - 0.125, median −0.040). The MIS used less pain medication than the TOA. Both groups were similarly satisfied with treatment results.

Conclusion

Our data indicates that MIS surgery for thoracolumbar spinal fractures can achieve acceptable self-reported outcomes in terms of disability, health-related quality of life, pain, and satisfaction with treatment. However, a randomized controlled trial is needed to determine whether the MIS approach is superior to TOA.

研究设计对前瞻性收集的数据进行回顾性队列研究。目的尽管微创手术（MIS）是传统开放手术（TOA）的流行替代方法，但胸腰椎骨折的治疗指南仍存在争议。有关微创手术治疗骨折后效果的数据十分有限。我们研究的主要目的是评估MIS与TOA相比后的自我报告残疾、健康相关生活质量、疼痛和满意度。方法在2014年至2018年期间接受手术的173名患者中，64.7%的患者完成了Oswestry残疾指数（ODI）、EQ-5D-5L以及关于就业状况、疼痛、活动水平和治疗满意度的定制临床随访问卷。平均随访时间为 56 个月。除平均年龄外，两组患者的人口统计学变量具有可比性--MIS 组比 TOA 组大 10 岁。MIS组的ODI评分更高（p = 0.046），但两组在重返工作岗位和残疾退休方面的情况相似。MIS组的EQ-5D-5L指数（平均值-0.033，中位数+0.049）与丹麦人口得分非常接近，而TOA组的偏差较大（平均值-0.125，中位数-0.040）。MIS 组使用的止痛药物少于 TOA 组。结论我们的数据表明，胸腰椎骨折的 MIS 手术在残疾、与健康相关的生活质量、疼痛和对治疗的满意度方面可以达到可接受的自我报告结果。然而，要确定 MIS 方法是否优于 TOA 方法，还需要进行随机对照试验。

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引用次数: 0

Towards a standardized reporting of the impact of magnetic resonance imaging on the decision-making of thoracolumbar fractures without neurological deficit: Conceptual framework and proposed methodology 实现磁共振成像对无神经功能缺损的胸腰椎骨折决策影响的标准化报告：概念框架和拟议方法

Brain & spine

Pub Date : 2024-01-01 DOI: 10.1016/j.bas.2024.102787

Mohamed M. Aly , Sebastian F. Bigdon , Ulrich J.A. Speigl , Gaston Camino-Willhuber , Saleh Baeesa , Klaus J. Schnake

Introduction

A recent meta-analysis showed that only four prior studies have shown that magnetic resonance imaging (MRI) can change the fracture classification in 17% and treatment decisions in 22% of cases. However, previous studies showed a wide methodological variability regarding the study population, the definition of posterior ligamentous complex (PLC) injury, and outcome measures.

Research question

How can we standardize the reporting of the impact of MRI for neurologically intact patients with thoracolumbar fractures?

Material and methods

All available literature regarding the impact of MRI on thoracolumbar fracture classification or decision-making were reviewed. Estimating the impact of MRI on the TLFs' classification is an exercise of analyzing the CTs' accuracy for PLC injury against MRI as a ''Gold standard''and should follow standardized checklists such as the Standards for the Reporting of Diagnostic Accuracy Studies. Additionally, specific issues related to TLFs should be addressed.

Results

A standardized approach for reporting the impact of MRI in neurologically intact TLF patients was proposed. Regarding patient selection, restricting the inclusion of neurologically intact patients with A- and B-injuries is crucial. Image interpretation should be standardized regarding imaging protocol and appropriate criteria for PLC injury. The impact of MRI can be measured by either the rate of change in fracture classification or treatment decisions; the cons and pros of each measure is thoroughly discussed.

Discussion and conclusion

We proposed a structured methodology for examining the impact of MRI on neurologically intact patients with TLFs, focusing on appropriate patient selection, standardizing image analysis, and clinically relevant outcome measures.

导言最近的一项荟萃分析显示，之前只有四项研究表明磁共振成像（MRI）可以改变17%病例的骨折分类和22%病例的治疗决策。然而，之前的研究在研究人群、后韧带复合体（PLC）损伤的定义和结果测量方面存在很大的方法学差异。研究问题我们如何才能规范磁共振成像对神经系统完好的胸腰椎骨折患者的影响的报告？材料和方法回顾了所有关于磁共振成像对胸腰椎骨折分类或决策影响的现有文献。估算 MRI 对 TLF 分类的影响是将 CT 分析 PLC 损伤的准确性与 MRI 作为 "金标准 "进行对比的一项工作，应遵循标准化检查表，如《诊断准确性研究报告标准》（Standards for the Reporting of Diagnostic Accuracy Studies）。此外，还应解决与 TLF 相关的具体问题。结果提出了一种标准化方法，用于报告 MRI 对神经系统完好的 TLF 患者的影响。在患者选择方面，限制纳入神经功能完好的 A 型和 B 型损伤患者至关重要。图像解读应规范成像方案和 PLC 损伤的适当标准。MRI 的影响可以通过骨折分类的变化率或治疗决定来衡量；我们对每种衡量方法的利弊进行了深入讨论。讨论和结论我们提出了一种结构化方法，用于研究 MRI 对神经系统完好的 TLF 患者的影响，重点是适当的患者选择、标准化图像分析和临床相关的结果衡量。

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引用次数: 0