Brain & spine最新文献

Introduction: Postoperative pain management is a challenge after lumbar spine surgery. Erector spinae plane (ESP) block is one solution and seems to limit opioid consumption after lumbar fusion. This RCT explored the effectiveness of ESP block versus placebo in non-instrumented spine surgery within an ERAS program.

Research question: The hypothesis suggested the superiority of ESP block across all endpoints, emphasizing its potential as a safe and effective element.

Material and methods: In this prospective, single-center, randomized, double-blinded controlled trial using a 1:1 allocation with an intent-to-treat, patients undergoing non-fusion lumbar surgery for one or two levels were included from January to November 2022. Ultrasound-guided ESP block was performed by an anesthesiologist injecting levobupivacaine or saline solution (placebo). The primary outcome was total morphine consumption at 72 h.

Results: We included 100 individuals (50 in each arm). Total morphine consumption at 72 h did not differ between the ESP block and placebo groups, nor did cumulative pain score, intraoperative sufentanil administration, 1-month ODI and pain scores. In the daily analysis, morphine consumption was greater in the placebo group at day 0, and in the ESP block group from day 1 to day 3, without significance. The pain scores throughout the first 72 postoperative hours were <3/10 in both groups.

Discussion and conclusion: The groups did not differ in morphine consumption at 72 h postoperatively. Increased morphine dose after the first 24 h in the ESP block group could suggest a rebound effect. In patients undergoing non-instrumented spine surgery, the ESP block does not confer additional analgesic benefits.

Introduction: The preservation of the human self-a fundamental yet underexplored aspect of neurosurgical practice-has gained increasing attention in recent years.

Research question: How can neural correlates of self-consciousness be identified, monitored, and protected during brain tumor surgery, and how might this reshape the concept of "onco-functional balance"?

Material and methods: This review synthesizes emerging evidence from neuroimaging, neuropsychology, and intraoperative neurophysiology to build a framework for integrating the concept of self into modern neurosurgical practice.

Results: We describe the anatomical and functional basis of bodily and cognitive self-awareness, highlighting the roles of interoception, multisensory integration, and higher-order cortical networks such as the medial prefrontal cortex, insula and temporoparietal junction. We outline perioperative tools for clinical assessment, including validated scales for anosognosia and disownership, as well as the Self-Other Voice Discrimination (SOVD) paradigm and Heartbeat-Evoked Potentials (HEPs), which offer quantifiable markers of self-processing.

Discussion and conclusion: We argue for a reconceptualization of "eloquent" cortex to include regions critical for the preservation of self. As neurosurgery advances toward precision-guided, patient-centered care, protecting the self must become an explicit goal alongside motor, sensory, and language preservation. Future directions include real-time intraoperative monitoring of HEPs, development of functional risk maps for self-related structures, and broader implementation of personalized, neurocognitive surgical planning.Ultimately, this work proposes a shift from an "onco-functional" to an "onco-functional-identity" paradigm-where the integrity of the patient's personality, agency, and awareness becomes a measurable, preservable endpoint of neurosurgical care.

Objective: Generation Z (born 1997-2010) is the first generation to grow up entirely in the digital age. This study investigates how this generation perceives neurosurgery as a career path in German-speaking countries.

Research question: What are the motivations, barriers, and expectations of Generation Z regarding a career in neurosurgery, and how do these differ between medical students and residents?

Methods: A 20-item online survey (including Likert scales, single-choice, and numeric rating scales) was distributed via professional and student associations in Germany and Switzerland between February 9 and March 30, 2025. Participants included medical students and residents. Data were analyzed using Stata 18.0.

Results: A total of 351 responses were analyzed (65 % students, 35 % residents; mean age 25 years; 58 % female). Interest in neurosurgery was significantly higher among residents (80 %) than students (52 %, p < 0.001), especially in clinical semesters (57 % vs. 36 %, p = 0.006). The average likelihood of pursuing neurosurgery was 70/100, higher among residents (90 vs. 56, p < 0.001). Key motivations included fascination with surgery (students: 58 %, residents: 62 %), scientific interest, and clinical variety. Deterrents were a lack of mentorship (13 % vs. 24 %) and rigid hierarchies. Students prioritized flexibility (37 %), while residents favored more hands-on training (35 %, p = 0.002). Work-life balance was a major concern for both groups (≥74 %). Structured mentorship was important to 88 % (p = 0.024).

Conclusion: Generation Z demonstrates above-average interest in neurosurgery but emphasizes the need for better mentorship, work-life balance, and training reforms. Tailored educational strategies and modernized work models may enhance recruitment and long-term engagement in neurosurgical careers.

Introduction: Preoperative physical and psychological conditioning or 'prehabilitation', has emerged as a potential strategy to enhance surgical outcomes. While recent studies have investigated the role prehabilitation in spinal surgery, its specific role in lumbar disc herniation remains insufficiently defined.

Objective: To evaluate the impact of preoperative physical therapy/rehabilitation on postoperative outcomes and complications in patients undergoing surgery for lumbar disc herniation, compared to standard preoperative care. before surgery for lumbar disc herniation in the global outcome compared with the preoperative usual care in waiting list.

Methods: This systematic review searched 4 databases from January 2000 to March 2023. All studies (randomized clinical trials and observational studies) assessing the effects of prehabilitation in adult patients undergoing lumbar spine surgery, were eligible for inclusion. Five studies (n = 736) met inclusion criteria.

Results: All included studies reported short-term improvements in pain, functional outcomes, and psychological readiness following prehabilitation. However, these benefits were not sustained at 6- or 12-months follow-up in most studies. Outcomes converged between intervention and control groups over time. One study highlighted that higher-intensity, supervised programs yielded greater early benefits than unsupervised protocols.

Conclusion: Prehabilitation appears to be a promising intervention for enhancing short-term recovery following lumbar spine surgery. Nevertheless, its long-term effectiveness remains uncertain. The current evidence is limited by clinical heterogeneity and lack of lumbar disc herniation specific trials. Future long-term, standardized, high-quality studies are essential to define its role in surgical outcomes.

Introduction: Outcome measurement is a cornerstone of modern medicine. A range of tools are commonly used for outcome assessment in lumbar disc herniation (LDH) treatment.

Research question: What are the outcome measurement tools (OMTs) that have been used in the randomized controlled trials (RCTs) for LDH for the last 25 years?

Material and methods: The search covered only RCT of adult patients with LDH for the period January 01, 2000-December 31, 2024. Two authors reviewed independently the RCTs' relevance to the topic of our scoping review. The reviewed and selected RCTs were analyzed, and relevant data was extracted, standardized and classified.

Results: We identified 168 RCTs and 29 outcome measurement tools covering 6 main domains: pain measurement - 6 tools, disability - 4 tools, quality of life - 2 tools, clinical parameters - 9 tools, psychological facet - 3 tools and self-perceived recovery - 5 tools. The number of tools used per RCT was most frequently 3 (26.2 %) or 4 (21.4 %).

Discussion and conclusion: Measuring outcome in patients with LDH is a complex and multidimensional task. The RCTs involving surgical treatment usually applied tools from 4 domains: pain, disability, clinical parameters and QOL. The most frequently used tools for the different domains were respectively: VAS, ODI, a mixture of clinical parameters and SF-36/12. A new group of outcome measuring tools based on computer adapted tests, wearable devices and digital outcome measures are on the horizon trying to impose new standards but their application needs further investigation.

Introduction: Vertebral fractures and epidural compression are common complications in Multiple Myeloma (MM). Although non-surgical management is generally preferred, internationally accepted management guidelines are lacking. This study aimed to assess current international treatment approaches and clinical conditions guiding decision-making in MM vertebral lesions.

Research question: Assessing international treatment standards for MM vertebral column lesions.

Material and methods: A survey was distributed to members of the AO Spine Knowledge Forum Tumor, an expert forum specialized on the treatment of oncologic spine disease. The survey consisted of 25 questions, of which 15 assessed the participant's background, clinical expertise, and experienced treatment standards regarding MM vertebral lesions, followed by ten fictional case examples with seven possible treatment scenarios each.

Results: 51 international experts completed the survey, 51 % being of orthopedic, and 44 % of neurosurgical background, while 5 % were radio-oncologists. 84 % of the participants stated they "see vertebral lesions in MM in general as a non-surgical disease". As strongest indicators to perform surgery, neurological deficits (74 %), and potentially unstable lesions (20 %) were chosen. Clinical and radiological follow-up is performed by 83 %, however only in 46 % at defined intervals. 89 % would choose "less invasive" surgical strategies in MM than in similar lesions related to metastatic spine disease.

Discussion and conclusion: The participating experts agreed towards a more restrained and less invasive management of MM patients, however the applicability of surgical scores, standards for follow-up, and indications as well as surgical strategies for MM vertebral lesions varied widely, illustrating the need for international guidelines standardizing treatment.

Introduction: Meningiomas remain the most frequently occurring intracranial, extra-axial, space-occupying lesions. Aspects such as neurocognitive function and quality of life become more and more crucial. Several meningioma patients present with evidence of neurocognitive impairment, behavioral disorders, or even psychiatric symptoms.

Research question: This review synthesizes the current literature on neurocognitive evaluation in intracranial meningioma patients, focusing on the range of cognitive domains affected (Q1), the assessment tools utilized (Q2), and the relationship between tumor characteristics and cognitive outcomes (Q3).

Materials and methods: A PRISMA-compliant systematic review was performed. We searched PubMed, Scopus, and Dimensions, to identify relevant studies published to date. Additionally, we examined the reference lists of the selected studies. The most recent literature search was conducted on January 31, 2025.

Results: We included 30 studies. The neurocognitive domains examined encompass a range of functions, such as executive functioning, memory, attention, perceptual speed, visuospatial abilities, verbal fluency, cognitive flexibility, and cognitive function. The most frequently used tests as demonstrated in current literature are WAIS, RAVLT, WMS, TMT, Stroop test and CNS Vital signs. Tumor size, increased age, peritumoral edema and skull base meningiomas were all associated with worse performance in various cognitive domains.

Discussion and conclusion: Our analysis reveals that meningiomas can significantly impact cognitive function, affecting various domains such as memory, executive function, attention, and language. Most of these domains seem to improve postoperatively. A common battery test for neurocognitive evaluation in all meningioma patients would provide us with more comparable and reliable results.

Introduction: Achondroplasia (Ach) is the most common form of dwarfism, and lumbar spinal stenosis (LSS) becomes the primary problem for adult Ach patients.

Research question: This study aims to determine the cutoff values of LSS for surgical decompression.

Material methods: MRIs of adult achondroplasts with symptomatic lumbar spinal stenosis referred to our Medical Centre between 2019 and 2022 were reviewed. The degree of lumbar spinal stenosis was assessed by the Schizas scale and dural sac cross-sectional area (DSCA). Regression analysis was used to evaluate the association between treatment decisions and the degree of stenosis, while receiver operating characteristic (ROC) analysis was performed to identify cutoff values. A follow-up survey was conducted to validate clinical effectiveness.

Results: In total, 68 patients were included (mean age: 46.2 ± 15.4 years; 60 % female). Individuals subjected to decompression had higher Schizas scales (p < 0.001) and smaller DSCA (62.5 ± 34.3 mm² vs 91.0 ± 40.2 mm², p < 0.001). ROC analysis demonstrated that lumbar decompression was indicated at levels with Schizas grade C or D or a DSCA less than 62 mm². Follow-up investigation revealed less favorable clinical outcomes in patients exceeding the severity thresholds of either the Schizas scale or DSCA.

Discussion and conclusion: Schizas scales C and D or DSCA smaller than 62 mm² should alert the surgeons that the non-surgical approach is prone to fail. Furthermore, this threshold also facilitate clinically relevant interpretation of lumbar MRIs by non-specialists in achondroplasia patients.