Brain & spine最新文献

Introduction: Rehabilitation of individuals with spinal cord injury (SCI) is improving in tertiary-healthcare settings of low-middle-income countries (LMICs). However, rehabilitation and integration within the community is yet a distant target.

Research question: What are the patients-reported challenges in rehabilitation and community-integration which open opportunities to change lives of individuals with SCI.

Material and methods: Clinical-records and interviews of 24 adults with SCI were examined to report socio-demographic information, functioning, disability, cost-of-care, health-related- quality-of-life and environmental-barriers.

Results: Fifty-percent individuals belonged to lower-middle socio-economic strata. Functioning independence (SCIM) was highest in indoor (9.0 ± 1.4); and least in outdoor-mobility (9.3 ± 4.0) 7.8yr after injury. Individuals from lower-income-strata had no access to indoor water(n = 5) and toilet(n = 8) facilities. WHO-QoL was lowest (39.5 ± 15.0) in environmental domain. Seventy-percent individuals employed before SCI, could not return to previous jobs. Post-injury, 8 were employed in alternate lesser paid jobs; whereas 16 were dependent on family. Cost-of-care was covered either by self(n = 1), government health-insurance (n = 1); private health-insurance (n = 3); employer (n = 5); NGO (n = 2), family (n = 12).

Discussion and conclusion: Patient-reported challenges in rehabilitation and community-integration of individuals with SCI, highlight gaps in access to basic amenities in houses, inaccessible transport and public spaces and financial-hardships caused by lack of coverage of rehabilitation costs and unemployment in the low socioeconomic strata despite numerous health policies and schemes. These challenges prompt urgent research in the health system and open opportunities for strategic-planning of context-specific, participatory, sustainable, climate-resilient measures to rebuild lives and facilitate respectful integration in society and alleviation of socio-economic burden of SCI.

Introduction: Controversy exists regarding the optimal management of type II odontoid fractures in the geriatric population. The objective of this study was to determine the current treatment patterns of spine surgeons for geriatric patients (≥70 years) with type II odontoid fractures.

Research question: How much do treatment practices for type II odontoid fractures in the geriatric population differ amongst spine surgeons?

Methods: The European Association of Neurosurgical Societies (EANS) Spine Section distributed a 39-items web-based survey among spine surgeons between July 2024 and February 2025.

Results: A total of 154 responses were collected from 119 neurosurgeons (77.8 %) and 34 orthopedic surgeons (22.2 %). Participants were predominantly from Europe (92.7 %), and 63.2 % have been in practice >10 years. Fracture displacement, comorbidities and age were the most influential factors for decision-making. For non-displaced fractures, 78.8 % of respondents recommended conservative treatment for patients aged 70-80 years, and 83.7 % for those aged 80-90 years. For displaced fractures, 70.9 % preferred surgery for patients aged 70-80 years, whereas this preference decreased to 47.9 % for those aged 80-90 years. Posterior C1-2 fixation was the most common technique for 67.3 % of respondents, and 48.3 % prescribe a collar postoperatively. 51.3 % routinely order CT imaging postoperatively to assess for bony fusion. For conservative treatment, 59.3 % prescribe an external orthosis for 3 months.

Discussion and conclusion: Our survey found both variability and consistency in treatment practices of geriatric type II odontoid fractures, reflecting the ongoing debate and lack of consensus in clinical decision-making.

Study design: retrospective cohort study.

Objective: This study aims to assess the utility of Hounsfield units (HU) derived from computed tomography (CT) scans as a predictive marker for the risk of adjacent fractures (AF) following kyphoplasty.

Methods: In a retrospective analysis at a high-volume care hospital, 93 patients who underwent single-level kyphoplasty between January 2012 and December 2020 were included. The study focused on the correlation between HU values in vertebrae adjacent to the operated level and the occurrence of AF. Patient demographics, fracture characteristics, and time to AF occurrence were recorded. Bone density was assessed using HU measurements from CT scans, focusing on the trabecular bone.

Results: The median time to AF occurrence was 10 weeks, with no significant correlation to patient demographics or fracture location. A marked association was observed between reduced bone density, as measured by HU in the vertebrae adjacent to the kyphoplasty site, and the incidence of AF. Particularly, the bone density in the vertebra immediately superior to the operated site showed a statistically significant relationship with the occurrence of AF.

Conclusion: This study underscores the potential of HU measurements in CT scans as a predictive tool for AF risk post-kyphoplasty. Reduced bone density in adjacent vertebrae emerged as a significant risk factor. These findings highlight the necessity for vigilant postoperative monitoring and a proactive approach in managing bone health in patients undergoing kyphoplasty for osteoporotic fractures.

Focused ultrasound (FUS) technology provides unique advantages as a therapy targeting the central nervous system (CNS). We aimed to investigate and summarize the potential applications of FUS in the context of spinal cord diseases. Search strategies were created using a combination of keywords and standardized index terms. Searches were run in April 2025 in the Ovid Cochrane Central Register of Controlled Trials, EBSCO MegaFILE, Ovid Embase, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science Core Collection to retrieve all relevant studies from inception until 2024. A narrative and comprehensive summary of the current body of evidence was performed. Current preclinical studies indicate the potential use of spinal cord FUS in blood-spinal cord barrier (BSCB) disruption, neuromodulation, and inflammatory regulation following spinal cord injury. Targeted CNS drug delivery with BSCB disruption using FUS has proven promising in the context of neuro-oncology and neurotrauma. Additionally, FUS has been explored for neuromodulation in managing neuropathic pain and spasticity. FUS to the spinal cord may also provide anti-inflammatory effects and alter the local cellular response to injury. While therapeutic FUS ablation of brain structures has been extensively studied, research on similar applications within the spinal cord was less prevalent and faces multiple challenges. FUS is a highly promising technique with multiple advantages and potential applications in the treatment of spinal cord diseases. Current research efforts have shifted focus towards translational studies, while human trials are currently limited.

Introduction: Vinca alkaloids are used to treat a diversity of malignancies. Inadvertent intrathecal application is followed by severe neurological consequences, with fatal outcomes in the majority of the reported cases. Therapy of choice has been experimental.

Research question: What are the outcomes of inadvertent intrathecal application of vinca alkaloids and how should it be treated? What is the role of irrigation of the cerebrospinal fluid (CSF) in order to remove the vinca alkaloid and potentially toxic metabolites?

Material and methods: In this paper we report the case of a 53-year-old man who was, in the course of his treatment for acute lymphoblastic leukemia (ALL), inadvertently injected with vindesine intrathecally. The patient survived following aggressive and invasive treatment, which included irrigation of the CSF via external ventricular and lumbar drains. We also conducted a systematic review of similar published cases.

Result: A total of 31 cases with intrathecal inadvertent vinca alkaloid injection were identified. Including the case described in this report only two patients were injected with vindesine (n = 2, 6.5 %), all other received vincristine. Only 6/31 (19.4 %) patients survived the acute phase of the vinca alkaloid intoxication. 6/15 (40.0 %) patients receiving some sort of CSF irrigation survived (cf. 0/12 without irrigation therapy). All survivors were left with very significant neurological deficits.

Discussion and conclusion: The combined evidence suggests that intrathecal administration of vincristine is universally fatal without treatment, while CSF irrigation carries a chance of survival. Patients are, however, left with severe neurological deficits such as paraplegia.

Introduction: Recurrent lumbar disc herniation (RLDH) is defined as the reappearance, following initial discectomy, of disc material and pain after a period of at least six symptom-free months. Redo surgery is usually considered following unsuccessful conservative management or in the presence of neurological deficits.

Research question: Given the lack of consensus on the ideal surgical strategy for RLDH, we conducted this study to evaluate when lumbar fusion (LF) should be considered in the treatment of RLDH.

Material and methods: A literature search was conducted on PubMed, Google Scholar and clinicaltrials.gov focusing on the treatment of recurrent disc herniation using microdiscectomy alone or through fusion. The quality of the studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale and Cochrane Risk of Bias Tool 2.0. The weighted mean difference was calculated for both binary and continuous outcomes.

Results: This resulted in a list of 900 references, from which 11 studies were identified as meeting the inclusion criteria for the study. There were four prospective studies and seven retrospective studies. A comparison of LF and redo discectomy (RD) revealed no significant differences in clinical outcome scores. LF resulted in significantly higher intraoperative blood loss, longer hospitalizations and longer surgeries. No further differences were identified.

Discussion and conclusions: Both LF and RD represent safe and effective treatment options in first RLDH. The choice of surgical strategy should integrate the eventual co-existence of clinical and radiological features of segmental instability, as well subjective aspects, such as surgeons' training and patient preference.

Traumatic Central Cord Syndrome (TCCS) presents complex challenges in the management of spinal cord injury. Characterized by disproportionate upper limb weakness, TCCS is the most common clinical spinal cord syndrome, typically affecting males in a bimodal age distribution. Mechanisms include hyperextension injuries in older adults with degenerative cervical spine disease and high-energy trauma in younger individuals. Diagnosis is based on neurological assessment, with the American Spinal Injury Association (ASIA) Impairment Scale used for severity classification. Management strategies, including surgical and medical approaches, may influence functional outcomes, although high-quality comparative evidence is limited. Surgical decompression and stabilization are often pursued to relieve mechanical compression, while nonoperative strategies may be considered in selected cases with less severe neurological deficits. The timing of surgical intervention remains a subject of ongoing debate and must be individualized. Neurocritical care considerations are increasingly recognized as potentially important in the early phase of TCCS. Experimental and clinical investigations into intraspinal pressure (ISP), mean arterial pressure (MAP), and spinal perfusion pressure (SPP) monitoring suggest these parameters may aid in minimizing secondary injury, though their routine clinical use is not yet established. Complications such as venous thromboembolism, infection, pressure injuries, and autonomic dysfunction are common and require comprehensive management. The role of corticosteroids remains controversial. This narrative review synthesizes current knowledge on TCCS, with emphasis on diagnostic, surgical, and neurocritical care considerations. As the field advances, further evidence is needed to clarify optimal management pathways and improve outcomes in this challenging clinical entity.

Introduction: Maximal resection has a pivotal role in the treatment of glioblastoma (GB), prolonging both progression free survival (PFS) and overall survival (OS). Only few studies analyze the delicate equilibrium between maximal resection, clinical outcome and prognosis.

Research question: the aim of this work is to determine the impact of neurological impairment on PFS, OS and access to adjuvant therapies on patients with GB operated with perilesional resection technique.Material and Methods: this retrospective study encompassed patients operated for GB at Fondazione IRCCS San Gerardo dei Tintori Monza (IT), from 2015 to 2023. Histological diagnosis was performed according to the WHO 2021 classification. Patients were more than 18 years old, with pre- and postoperative MRI, who underwent surgery and adjuvant treatments at our Institution.

Results: A total of 209 patients fulfilled the criteria. Patients with improvement or complete regression of preoperative deficit had a higher rate of access to adjuvant therapies (p = 0.015). Patients with hemiparesis at discharge had the worst PFS (median 4.60 months) followed by patients with aphasia (6.60 months), and patients with normal neurological examination (9.67 months; p < 0.0001). The median OS was 17.93 months for patients with hemianopia, 6.40 for patients with hemiparesis and 15.7 months for those with aphasia (p < 0.0001).

Discussion and conclusion: Hemianopia has no impact on the patient's prognosis, while hemiparesis and aphasia at discharge worsen both PFS and OS prolonging time-to-treatment. When resecting GB, it is mandatory to avoid major neurological deficits that concur which reduce OS and PFS.

Introduction: Conventional MRI (T1 and T2-weighted sequences) is the standard for diagnosing spinal cord injuries but often lacks specificity, showing limited correlation with microstructural changes and function. This creates a diagnostic gap, especially in patients with mild or ambiguous symptoms, delaying early intervention.

Research question: Can advanced MRI techniques-such as quantitative MRI (qMRI), functional MRI (fMRI), Magnetic Resonance Spectroscopy (MRS), and Transmagnetic Stimulation (TMS)-address the limitations of conventional MRI by providing enhanced diagnostic metrics and biomarkers of spinal cord integrity?

Material and methods: This study reviews advanced MRI modalities and their potential to provide quantifiable insights into spinal cord microstructure and function. It also explores the role of artificial intelligence (AI) in analyzing complex datasets to support more comprehensive diagnostics.

Results: Advanced MRI techniques show promise in improving diagnostic accuracy and enabling individualized prognostic assessments. Parameters specific to each modality could serve as biomarkers for injury extent and neurological recovery, supporting their potential as clinical endpoints in therapy trials.

Discussion and conclusion: These advanced imaging techniques, combined with AI for data integration, offer a transformative potential for personalized diagnostics in spinal cord injury. Yet, significant technical and validation challenges remain, requiring large, multicenter studies to confirm their effectiveness and enable clinical application. Successfully addressing these challenges could close the diagnostic gap, optimize patient outcomes, and redefine spinal cord injury management.

Introduction: Decompressive lumbar spine surgery is a common procedure for disc herniation and spinal stenosis. Besides intervention under general anesthesia (GA), awake surgery (AS) in local or spinal anesthesia offers potential benefits regarding GA-related side effects and simplified periprocedural management.

Research question: Within this systematic analysis, we sought to compare postsurgical outcomes of spinal decompression surgeries in GA and AS.

Methods: Following the PRISMA guidelines, we extracted all relevant studies from three databases and collected all data concerning surgery duration, blood loss, postoperative duration of hospitalization, postoperative pain (VAS), and disability indices (ODI).

Results: In total, we identified 11 studies covering 1350 patients. AS was associated with shorter surgery duration [Mean difference (MD) -8.52 (95 % confidence interval (CI) -14.56, -2.49) min] as well as lower relative risk for postoperative complications [risk ratio (RR) 0.86 (0.75, 0.99)] and nausea and vomiting [RR 0.58 (0.51, 0.66)]. There were no significant differences in estimated blood loss [MD -27.59 (-61.85, -9.97) ml], hospital stay duration [MD -1.6 (-3.95, 0.75) d], pain [MD -0.22 (-1.35, 0.92) VAS] and disability scales [MD -0.8 (-3.54, 1.94) ODI]. Selected studies were considerably heterogeneic (I ²  = 0-99.89 %).

Discussion and conclusion: Awake surgery is a safe and promising alternative to GA in decompressive spine surgery, however, high heterogeneity of the present literature warrant confirmation in future prospective, randomized trials.