Brain & spine最新文献

Introduction: To evaluate clinical and radiographic outcomes in patients with severe, rigid Adolescent Idiopathic Scoliosis (AIS) (Cobb angle >100°, flexibility index <30 %) treated using a two-stage posterior-only approach with temporary Magnetically Controlled Growing Rods (MCGR).

Material and methods: Between 2019 and 2024, nine patients (eight Lenke 1, one Lenke 3; mean age 15 years; BMI 18.8) underwent staged posterior correction. The first stage included high-density pedicle screw fixation (1.92 screws/vertebra), multiple Ponte osteotomies (mean 4.7), and placement of a concave-side MCGR fixed proximally and distally with a custom construct ("Sistema Quadro"). Postoperative distraction was performed daily for approximately 14 days using an External Remote Controller, achieving a mean rod lengthening of 18.2 mm. The second stage consisted of MCGR removal and definitive posterior spinal fusion.

Results: The main Cobb angle improved from 107.6° to 35.4° (p < 0.0001), corresponding to a mean correction of 65.9 %, obtained in three phases: intraoperative distraction (52.5 %), postoperative lengthening (24.5 %), and final fusion (23 %). Trunk height increased by 9.5 cm and thoracic height by 5.4 cm. Coronal balance improved (25.7 mm-14.4 mm; p = 0.32), as did the clavicle angle (4.4°-0.8°; p = 0.0005). SRS-22 scores rose from 3.3 to 4.4 (p = 0.0011). An inverse correlation was observed between BMI and rod lengthening (PCC = -0.7304; p = 0.026). No complications occurred.

Discussion and conclusions: A two-stage posterior technique utilizing temporary MCGRs, combined with the "Sistema Quadro" construct and a three-phase correction strategy, offers a safe, effective, and well-tolerated surgical approach for severe, rigid AIS. This method facilitates gradual, controlled deformity correction, optimizes clinical and radiographic outcomes, and minimizes perioperative complications.

Background: The coexistence of infective endocarditis (IE) and spondylodiscitis (SD) ranges between 7 % and 30 %, increasing particularly in patients older than 75 years. IE can occur without bacteremia, complicating early diagnosis and therapeutic strategies.

Objectives: To determine the incidence and microbiological spectrum of IE among patients diagnosed and treated with SD, examine the prevalence of associated bacteremia, and evaluate associated clinical outcomes and mortality.

Methods: We conducted a retrospective, monocentric study from January 2016 to December 2020 at a level one spinal surgery center. Included were adult patients (>18 years) with confirmed SD (positive MRI combined with histological and/or microbiological evidence) who underwent echocardiography. Variables analyzed were demographics, localization of SD, microbiological findings, comorbidities, therapeutic approaches, and mortality. Patients were divided into isolated SD and SD with concurrent IE (SD + IE).

Results: Of 312 patients, 31 (9.9 %) had concurrent IE. Bacteremia was documented in 58 % overall but was absent in 16 % of IE cases. Patients with IE had a higher prevalence of coronary artery disease (45 % vs. 26 %; p = 0.0237). Enterococci were significantly more frequent in the IE group (35 % vs. 6 %; p = 0.021). Left heart involvement predominated (80 %), notably the aortic (38.7 %) and mitral valves (29 %). Spinal surgical interventions occurred less frequently in the IE group (45.2 % vs. 85.4 %). Mortality was significantly increased in IE patients (48.4 % vs. 11.74 %; p = 0.0157).

Conclusions: Concomitant infective endocarditis (IE) significantly increases mortality in patients with spondylodiscitis (SD), even in the absence of bacteremia. Routine echocardiographic screening (TTE/TEE) must be standard, as its omission risks missed diagnoses. Interdisciplinary collaboration is essential for timely diagnosis, coordinated treatment, and improved outcomes.

Introduction: Paget's disease of the bone (PDB) is a chronic disorder characterized by abnormal bone remodeling, often involving the spine. Although spinal stenosis and neural compression are well-documented manifestations, facet joint synovial cysts in PDB are extremely rare, and their development remains unclear.

Research question: We report the case of a PDB patient who presented with progressive radicular symptoms due to an enlarged L1-L2 cyst with marked facet hypertrophy and stenosis.

Materials and methods: We presented a case of a patient who underwent surgical decompression along with cyst excision, during which a thick-walled, hemorrhagic cyst compressing neural structures was identified. Postoperative neurological function exhibited enhancement. To compare with this case, we performed a systematic review adhering to PRISMA guidelines regarding spinal complications associated with PDB, encompassing ten articles and a cumulative total of 87 patients.

Results: The most frequently reported manifestations included spinal stenosis, vertebral fracture, spinal cord compression, cauda equina syndrome, and neurological deficits. The literature only referred to one reported case of synovial cyst in relation to PDB.

Discussions and conclusion: This article and case highlight that, while uncommon, facet joint synovial cysts belong in the correct differential diagnosis of the spinal manifestations of PDB, particularly when there is neural compression. Impeccable imaging and customized surgical planning are significant in the management of such complex cases.

Introduction: Intraoperative ultrasound (IOUS) has gained recognition as a valuable imaging modality for enhancing surgical precision in neurosurgical procedures. However, its routine clinical integration in spine surgery remains limited.

Research question: This study aims to elucidate role of intraoperative ultrasound (IOUS) in spinal surgery and to propose the Spinal Cord Pulsatility Index (SCPI) as a novel, ultrasound-based parameter for evaluating spinal cord decompression.

Material and methods: This retrospective single-center case series included all consecutive patients who underwent spinal surgery with IOUS guidance between June 2024 and January 2025. In a subset of patients undergoing posterior decompression, the SCPI - defined as the ratio between the spinal cord pulsation and the corresponding heart rate - was calculated.

Results: Overall, IOUS was performed in 28 patients, and 3 main IOUS applications were determined: (1) anatomic localization, (2) augmentive use, and (3) spinal cord decompression assessment. Importantly, IOUS was fast and technically feasible in all cases, across regions of the spine and regardless of the surgical approach. In a subset of n = 8 cases, we noted a significant SCPI increase at the time-point of final decompression (*p < 0.05).

Discussion and conclusion: IOUS in spinal surgery serves as a simple, safe, cost-effective, and non-invasive imaging modality for real-time localization of intradural and intramedullary pathologies and supplementary neurovascular structures. Based on the principle of communicating fluid dynamics, the spinal cord pulsation index may serve as a novel parameter for indirect assessment of sufficient spinal cord decompression beyond the levels of surgical exposure.

Background: Extent of resection (EOR) is a well-known prognostic factor in patients with newly diagnosed IDH-wildtype glioblastoma. However, reported survival times across resection categories vary between reports, and outcomes of submaximal or supramaximal resection remain less well defined.

Methods: We conducted a systematic review and meta-analysis on the association between EOR and overall survival (OS) in patients with newly diagnosed IDH-wildtype glioblastoma treated with chemoradiotherapy. Studies were included if OS was reported by EOR category. Risk ratios (RRs) for 1- and 2-year survival were pooled using a random-effects model. Study quality was assessed using the Newcastle-Ottawa Scale.

Results: Thirty-one studies involving 26,167 patients were included. Supramaximal resection (SupraMR) was associated with significantly improved 2-year survival compared to maximal CE resection (MR) (RR 0.70, 95 % CI 0.55-0.88). Compared to submaximal resection (subMR), MR was associated with higher 1-year survival (RR 0.59, 95 % CI 0.53-0.67) and 2-year survival (RR 0.82, 95 % CI 0.77-0.87). Biopsy alone was associated with the poorest outcome. Findings remained robust in sensitivity analyses excluding SEER and RTOG cohorts.

Conclusions: Increasing EOR seems to be associated with improved survival in newly diagnosed IDH-wildtype glioblastoma. SupraMR offers the greatest benefit, while submaximal resection appears to be more favorable than biopsy. These findings support the prognostic relevance of EOR and underscore the need for prospective studies with standardized resection classifications. The balanced summary of survival data for each resection class provided in this review can serve as a basis for effect estimation and sample size calculations in future trials.

Introduction: Endoscopy approaches to lumbar disc herniation (LDH) surgery, particularly unilateral biportal endoscopy (UBE), have gained in popularity because of their minimally invasive nature and potential for good recovery. However, comparisons with conventional microdiscectomy, especially during learning curve, are limited.

Research question: This study compared clinical outcomes, safety, and resource use between UBE and conventional microdiscectomy for LDH during the learning curve of UBE implementation.

Material and methods: This retrospective, single-center study analyzed data for 363 patients who underwent LDH surgery from January 2022 to September 2023. After 1:1 propensity score matching, 302 patients (151 per group) were included. Patients were evaluated preoperatively and at 1, 3, and 12 months postoperatively with the Oswestry Disability Index (ODI), lumbar and radicular pain scales, and satisfaction surveys. Complications, reoperation rates, operative time, hospitalization, and disposable costs were also analyzed.

Results: Both groups experienced significant improvement in ODI and pain scores at all time points, without significant differences between groups. Satisfaction and return-to-work rates were similarly high in both groups. Complication and reoperation rates did not differ significantly. The UBE group featured longer operative times (57 vs. 44 min) and higher disposable costs (€261 vs. €91) than conventional microdiscectomy but a higher outpatient discharge rate (20.5 % vs. 9.3 %).

Discussion and conclusion: UBE is as effective and safe as conventional microdiscectomy for LDH, even during the learning curve. It allows for early adoption without compromising patient outcomes and may offer advantages in outpatient feasibility, despite longer operating times and higher procedural costs.

Introduction: Preoperative screw planning enables the use of modern technologies such as navigation and robotics. To reduce radiation exposure to patients, there is growing interest in Magnetic Resonance Imaging (MRI) technologies.

Research question: This study assesses the use of isotropic MRI and synthetic Computed Tomographies (sCT) for planning lumbar screws.

Methods: Two 3D T1-weighted scans were performed on 22 patients, one isotropic fast spin-echo sequence, and one multi-echo gradient echo sequence for generating sCTs. A total of 200 screws were planned equally split across the isotropic MRIs and sCTs. All scans were then fused to an intraoperative scan for evaluation. Each screw was evaluated by three surgeons using Gertzbein-Robbins classification and a qualitative survey.

Results: A mean interrater agreement of 94.5 % (83 %-100 %) was observed. A significant difference was identified in the Gertzbein-Robbins classification (P = 0.04) where sCT had the most A and B rated screws. The qualitative survey identified differences in screw length and screw positioning but not in screw diameter.

Discussion and conclusion: Nearly 75 % of cases can use modern MRI sequences for planning of lumbar screws. Where the MRI sequence alone is insufficient for total confidence, sCT can be used to supplement the scan and enable effective planning in approximately 90 % of patients without the need for ionizing radiation.

Objective: Complex cranial wound conditions (CCWC), particularly when associated with hydrocephalus and/or implant-related infections, pose a major challenge in neurosurgical complication management. In such cases, moving the shunt system from the cranial to the lumbar compartment appears to be a valuable salvage strategy.

Research question: Can lumboperitoneal shunting (LPS) including differential pressure and gravitational valves serve as an effective rescue strategy in patients with different types of CCWC?

Methods: We conducted a single-center retrospective study of 15 patients treated with LPS implantation for CCWC between March 2023 and August 2025. Clinical data were extracted from medical records, including patient demographics, CCWC type, surgical parameters, complications and outcomes.

Results: The cohort included 8 female and 7 male patients, with a median age of 53 years (range, 25-87). CCWC secondary to CSF fistulas following tumor resection accounted for 9 cases, VPS-associated infection for 3 cases, and decompressive craniectomy for 3 cases. In 5 patients, wound healing was further impaired by prior radiation and chemotherapy. Median surgical time was 60 min (IQR, 47-82), and median hospitalization was 6 days (IQR, 3-15). Wound healing resolved after LPS implantation in all but one patient. Complications occurred in 2 patients, both related to overdrainage. Implant survival rate was 100 %.

Conclusion: LPS implantation represents a valuable salvage strategy for patients with CCWC, particularly in the context of decompressive craniectomy, radiation-exposed tissue, or prior implant-associated infection. LPS promotes cranial wound healing while ensuring CSF diversion, with adjustable gravitational valves being essential especially in craniectomized patients.

Introduction: Lumbar disc herniation is a frequent cause of radicular leg pain and has a pronounced impact on the quality of life. While guidelines discommend surgery in the acute phase of the condition, literature on conservative treatment is relatively scarce. In this systematic review, prognostic factors for success of conservative management are investigated as well as the effect of physiotherapy on leg pain.

Methods: We searched PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Pedro, Web of Science, Scopus, CINAHL, ICTRP, and Clinicaltrials.gov from commencement to September 2022. Following screening 22 reports were included in the analysis and assessed for risk of bias by using the RoB 2 tool for randomized trials and the ROBINS-I tool for prospective cohort studies.

Results: Fifteen papers with moderate to high risk of bias reported on prognostic factors for treatment success following nonsurgical management. Extruded disc morphology was associated with better outcomes in two articles. Severe baseline symptoms and receiving workers compensation were associated with worse outcomes in three and two studies, respectively. Physiotherapy reportedly had a beneficial effect on radicular leg pain in 5 out of 7 studies with low to moderate risk of bias.

Conclusion: Certain physiotherapy actions seem to have value with respect to the relief of radicular symptoms in the conservative management of LDH with radicular pain. Severe baseline symptoms seems to be a risk factor for poor outcome after conservative management. There is a need for high-quality evidence on non-surgical treatments to match the literature on surgical treatment.

Introduction: Lumbar disc herniation (LDH) is a leading cause of global back pain with significant socioeconomic impact. Conservative physiotherapy, including exercise, manipulation, and traction therapies, is a common first-line treatment. However, their relative efficacy and applicability to specific subgroups remain unclear.

Research question: This systematic review and meta-analysis evaluated the efficacy of these three modalities, identified factors influencing variability, and explored subgroup-specific applications.

Material and methods: Following PRISMA guidelines, a systematic review was conducted with searches of PubMed, MEDLINE, EMBASE, OVID, Scopus, and grey literature. Forty-three studies were included in the qualitative synthesis and 20 in the meta-analysis. Random-effects models estimated pooled standardized mean changes (SMCs), and meta-regression examined covariates influencing variability.

Results: The pooled SMC across modalities was 2.28 (95 % CI: 1.51, 3.05), indicating large treatment effects, though heterogeneity was high (I² = 97.9 %). Traction therapy had the highest effect size (SMC = 2.52, 95 % CI: 1.57, 3.37), followed by exercise therapy (SMC = 1.97, 95 % CI: 0.46, 3.48) and manipulation therapy (SMC = 1.91, 95 % CI: 0.24, 4.04). Follow-up duration significantly influenced effect sizes (p < 0.001), with shorter durations associated with larger effects. Qualitative findings suggested potential subgroup benefits for complex or chronic pain patients, but quantitative evidence for subgroup differentiation was limited.

Discussion and conclusion: Conservative therapies may effectively reduce LDH-related pain and disability, with traction therapy demonstrating the largest pooled effect size. High heterogeneity and methodological inconsistencies limit subgroup-specific recommendations. Rigorous trials and standardized methodologies are essential for optimizing evidence-based care for LDH patients.