Brain & spine最新文献

Introduction: There is a wide-ranging published literature around low back pain management. However, heterogeneity of selection criteria and outcomes limits the ability for an accurate line of evidence. One of the main causes of low back pain is lumbar disc herniation. There are some gaps of knowledge regarding the effectiveness of educating lumbar disc herniation patients on its treatment compliance and outcome.

Objective: To investigate the effectiveness of educating lumbar disc herniation patients on its treatment compliance and outcome.

Methods: This systematic review searched 3 databases from January 2000 to March 2023. All full-text English studies (randomized clinical trials and observational studies) examining outcomes in lumbar disc herniation patients were eligible for inclusion.

Results: Five studies with a total of 1046 lumbar disc herniation patients were included in this study. The mean age of participants ranged from 40 to 60 years old, and 36.63 %-58.00 % were female. Functional outcome was reported in all studies and symptomatic outcome comprised 3 domains, leg pain, back pain and general pain. Other variable outcomes included work status, quality of life and symptoms improvement satisfaction.

Discussion: This study showed some heterogeneity in the types of outcomes used across the management of lumbar disc herniation patients, with particularly scarce information regarding the effect of patient education in treatment compliance. Therefore, it is important and necessary the development of future clinical studies to help standardize reporting across medical practice in the context of lumbar disc herniation pathology.

Introduction: Lumbar disc herniation (LDH) is a leading cause of radiculopathy and low back pain, contributing significantly to global disability. Management strategies include conservative and surgical treatments, but clinical decision-making lacks standardization, particularly in surgical indications, timing, and criteria for transitioning from conservative management.

Research question: What are the surgical indications, criteria for transitioning from conservative to surgical management in LDH, and what role do motor deficits play?

Material and methods: Following PRISMA guidelines, a systematic search across major databases identified 20 studies. Risk of bias was assessed using the Newcastle Ottawa Scale and RoB 1 tools. A qualitative synthesis was conducted, and the Index of Qualitative Variation (IQV) quantified variability in indications.

Results: Among the studies that reported specific indications, imaging-confirmed nerve root compression (reported in 18/20 studies) and severe/refractory pain (reported in 17/20 studies) were the most consistent indications, while thresholds for sensory deficits (reported in 8/20 studies) varied widely. Early surgery (48 h-6 weeks) was associated with superior recovery, particularly for mild/moderate motor deficits graded ≤ MRC 3/4, achieving >90 % recovery rates. Delayed surgery (>6 weeks) resulted in prolonged symptoms and poorer outcomes, especially in severe cases. Transition criteria included a patient-specific combination of failure of conservative therapy (n = 12) after a most frequently 4-6-week trial, neurological progression, and worsening imaging findings. Significant heterogeneity was observed in thresholds for motor and sensory deficits, with high IQV scores for definitions of conservative treatment failure (IQV = 0.96) and motor deficit (IQV = 0.96).

Discussion and conclusion: Significant heterogeneity in surgical indications, timing, and decision-making highlights the urgent need for standardized, evidence-based guidelines to optimize clinical decisions and improve outcomes in LDH management.

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.