Differential DNA methylation associated with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: a systematic review.

Recent studies suggest that differential DNA methylation could play a role in the mechanism of cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH). Considering the significance of this matter and a lack of effective prophylaxis against DCI, we aim to summarize the current state of knowledge regarding their associations with DNA methylation and identify the gaps for a future trial. PubMed MEDLINE, Scopus, and Web of Science were searched by two authors in three waves for relevant DNA methylation association studies in DCI after aSAH. PRISMA checklist was followed for a systematic structure. STROBE statement was used to assess the quality and risk of bias within studies. This research was funded by the National Science Centre, Poland (grant number 2021/41/N/NZ2/00844). Of 70 records, 7 peer-reviewed articles met the eligibility criteria. Five studies used a candidate gene approach, three were epigenome-wide association studies (EWAS), one utilized bioinformatics of the previous EWAS, with two studies using more than one approach. Methylation status of four cytosine-guanine dinucleotides (CpGs) related to four distinct genes (ITPR3, HAMP, INSR, CDHR5) have been found significantly or suggestively associated with DCI after aSAH. Analysis of epigenetic clocks yielded significant association of lower age acceleration with radiological CVS but not with DCI. Hub genes for hypermethylation (VHL, KIF3A, KIFAP3, RACGAP1, OPRM1) and hypomethylation (ALB, IL5) in DCI have been indicated through bioinformatics analysis. As none of the CpGs overlapped across the studies, meta-analysis was not applicable. The identified methylation sites might potentially serve as a biomarker for early diagnosis of DCI after aSAH in future. However, a lack of overlapping results prompts the need for large-scale multicenter studies. Challenges and prospects are discussed.

Performance of successful ambulatory cervical spine surgery: safety, efficacy, and early experiences of first 100 cases in Poland.

BACKGROUND: Ambulatory anterior cervical discectomy and fusion (ACDF) is a promising method, but not common in Poland. OBJECTIVE: That is why the purpose of this study was to demonstrate the experience of performing ACDF in patients with degenerative spinal diseases. METHODS: This study at the Spine Centre involved a single-center, multi-surgeon evaluation of 100 patients undergoing ACDF. RESULTS: Outcomes assessed included pain severity, measured by the visual analogue scale, which improved from 4.28 ± 0.76 preoperatively to 1.11 ± 0.59 one month postoperatively. The Core Outcome Measures Index-neck (COMI-neck) scale also showed significant improvement: before surgery, 30% of patients scored their condition severity between 4-6, and 70% scored 7-10; 6 months postoperatively, the scores were 0-3 for 55% of patients, 4-6 for 45%, and 7-10 for none. Only 2% of patients experienced moderate, temporary complications, with no serious complications or postoperative hematomas observed. CONCLUSION: The study supports the feasibility, safety, and efficacy of performing ACDF in an ambulatory setting, suggesting that with appropriate patient selection and surgical protocols, ambulatory ACDF can be more broadly implemented.

Fully Endoscopic Spine Separation Surgery in Metastatic Disease-Case Series, Technical Notes, and Preliminary Findings.

Objective: This report aims to describe the surgical methodology and potential effectiveness of endoscopic separation surgery (ESS) in patients with metastatic spine disease. This concept may reduce the invasiveness of the procedure, which can potentially speed up the wound healing process and, thus, the possibility of faster application of radiotherapy. Materials and Methods: In this study, separation surgery for preparing patients for stereotactic body radiotherapy (SBRT) was performed with fully endoscopic spine surgery (FESS) followed by percutaneous screw fixation (PSF). Results: Three patients with metastatic spine disease in the thoracic spine were treated with fully endoscopic spine separation surgery. The first case resulted in the progression of paresis symptoms that resulted in disqualification from further oncological treatment. The remaining two patients achieved satisfactory clinical and radiological effects and were referred for additional radiotherapy. Conclusions: With advancements in medical technology, such as endoscopic visualization, and new tools for coagulation, we can treat more and more spine diseases. Until now, spine metastasis was not an indication for the use of endoscopy. This method is very technically challenging and risky, especially at such an early stage of application, due to variations in the patient's condition, morphological diversity, and the nature of metastatic lesions in the spine. Further trials are needed to determine whether this new approach to treating patients with spine metastases is a promising breakthrough or a dead end.

The Most Significant Factor Affecting Gait and Postural Balance in Patients' Activities of Daily Living Following Corrective Surgery for Deformity of the Adult Spine.

Background and Objectives: Gait ability and spinal postural balance affect ADL in patients who underwent adult spinal deformity (ASD) surgery. However, it is still unclear how to determine what the cause is. This study was done to investigate various factors affecting gait, postural balance and activities of daily living (ADL) in patients who were operated on for ASD over a period of one year, following corrective surgery. Materials and Method: A cohort of 42 (2 men, 40 women, mean age, 71.1 years) who were operated on for ASD were included in this study. According to Oswestry Disability Index (ODI), based on their ADL, patients were segregated into satisfied and unsatisfied groups. Gait and postural balance abilities were evaluated before and after the operative procedure. Radiographs of spine and pelvis as well as the rehabilitation data (static balance, standing on single-leg; dynamic postural adaptation, timed up and go test (TUG); Gait Capability, walk velocity for a distance of 10 m) were acquired 12 months after surgery and analyzed. Spinopelvic parameters such as (lumbar lordosis (LL), pelvic tilt (PT), sagittal vertical axis (SVA), pelvic incidence (PI)) were marked and noted. The factors which affect patients' satisfaction with their ADL were evaluated. Results: The ADL satisfied group included 18 patients (1 man, 17 women, mean age 68.6 years) and the unsatisfied group included 24 patients (1 man, 23 women, mean age 73.1 years). One year after the surgery, the two groups were tested. TUG (8.5 s vs. 12.8 s), 10 m walk velocity (1.26 m/s vs. 1.01 m/s), and single leg standing test (25 s vs. 12.8 s) were regarded as notably different. According to logistic regression analysis, only TUG was extracted as a significant factor. The cut-off value was 9.7 s, with sensitivity 75%, specificity 83%, area under the curve 0.824, and a 95% confidence interval of 0.695-0.953. Conclusions: A significant factor among all evaluations in postoperative ASD patients was TUG, for which the cut-off value for ADL satisfaction was 9.7 s.

Types of high-riding vertebral artery: a classification system for preoperative planning of C2 instrumentation based on 908 potential screw insertion sites.

BACKGROUND CONTEXT: Our recent studies indicated that a high-riding vertebral artery (HRVA) is a common variant posing a risk of injuring the vessel during C2 instrumentation. However, several different types fit in the current definition of HRVA, which may require a different strategy for C2 screw placement. PURPOSE: To classify HRVA and provide a clinical aid for preoperative planning of C2 instrumentation. A secondary goal was to estimate coexistence of each HRVA type with the ipsilateral narrow C2 pedicle (NP). STUDY DESIGN: A retrospective observational study involving radiologic measurements of the estimated number of anonymized cervical computed tomography (CT) scans. STROBE checklist was applied. PATIENT SAMPLE: A total of 908 potential screw insertion sites (PSIS) of 454 consecutive cervical CT scans were analyzed. The sample size was estimated using ScalaR SP function in RStudio. OUTCOME MEASURES: Three types of HRVA based on a series of C2 vertebral morphological parameters including the C2 isthmus height (C2IsH) and C2 internal height (C2InH). Also, the prevalences of each HRVA type and coexisting NP based on the C2 pedicle width (C2PW). METHODS: HRVA was defined as C2IsH of ≤5 mm and/or C2InH of ≤2 mm measured 3 mm lateral to the lateral border of the spinal canal. A narrow pedicle was defined as C2PW of ≤4 mm. Measurements were done using Syn.govia software. Interobserver, intraobserver, and inter-software agreement coefficients for C2IsH, C2InH, and C2PW parameters were adopted from our previous study. K-means cluster analysis was applied. RESULTS: Prevalence of at least 1 HRVA was 24.9% (n=113 subjects) and 16.2% of PSIS (n=147 sites). Based on the measurements and K-means clustering, the following 3 types of HRVA have been distinguished: type 1-isthmic with only C2IsH being reduced and normal C2InH; type 2-internal with only C2InH being reduced and C2IsH within normal limits; type 3-isthmo-internal with both C2IsH and C2InH being reduced. Kruskal-Wallis test followed by unadjusted and Bonferroni-adjusted post-hoc multiple comparison analysis detected significant differences across the types. The prevalences of the newly identified types were as follows: 78.2%, 8.8%, and 12.9% for type 1, type 2, and type 3, respectively. 73.9% of type 1 HRVA, 53.8% of type 2 HRVA, and 100% of type 3 HRVA had a concomitant ipsilateral NP. Prediction of the HRVA types by the K-means clustering has been evaluated. Screw placement techniques for each type are proposed and discussed. CONCLUSION: We present the first classification system for the high-riding vertebral artery distinguishing 3 types based on the large homogenous cohort, which may serve as an adjunct to preoperative planning of C2 instrumentation. External validation of this classification scheme shall determine its further clinical utility.

Extremely Rare Complications in Uniportal Spinal Endoscopy: A Systematic Review with Unique Case Analyses.

Background: Endoscopic spine surgery represents a significant advancement in the minimally invasive treatment of spinal disorders, promising reduced surgical invasiveness while aiming to maintain or improve clinical outcomes. This study undertakes a comprehensive review of the literature on endoscopic spine surgery, with a particular focus on cataloging and analyzing the range of complications, from common postoperative issues to more severe, casuistic outcomes like dural tears and nerve damage. Methods: Our methodology encompassed a detailed review of meta-analyses, prospective randomized trials, cohort studies, and case reports to capture a broad spectrum of complications associated with endoscopic spine techniques. The emphasis was on identifying both the frequency and severity of these complications to understand better the procedural risks. Results: The findings suggest that endoscopic spine surgery generally exhibits a lower complication rate compared to traditional surgical approaches. Nonetheless, the identification of specific, rare complications peculiar to endoscopic methods underscores the critical need for surgeons' advanced skills, continuous learning, and awareness of potential risks. Conclusions: Recognizing and preparing for the potential complications associated with the rapid adoption of endoscopic techniques is paramount to ensuring patient safety and improving surgical outcomes in minimally invasive spine surgery.

Evaluation and Rehabilitation after Adult Lumbar Spine Surgery.

Purpose: With an increase in the proportion of elderly patients, the global burden of spinal disease is on the rise. This is gradually expected to increase the number of surgical procedures all over the world in the near future. As we know, rehabilitation following spine surgery is critical for optimal recovery. However, the current literature lacks consensus regarding the appropriate post-operative rehabilitation protocol. The purpose of this review is to evaluate the optimal protocol for rehabilitation after lumbar spine surgery in adults. Materials and Methods: The goals of rehabilitation after lumbar spine surgery are to improve physical and psychosocial function and may include multiple modalities such as physical therapy, cognitive behavioral therapy, specialized instruments, and instructions to be followed during activities of daily living. In recent years, not only are a greater number of spine surgeries being performed, but various different techniques of lumbar spine surgery and spinal fusion have also emerged. (1) Our review summarizes post-operative rehabilitation under the following headings-1. Historical aspects, 2. Subjective functional outcomes, and (3) Actual rehabilitation measures, including balance. Results: Physical therapy programs need to be patient-specific and surgery-specific, such that they consider patient-reported outcome measures and take into consideration the technique of spinal fusion used and the muscle groups involved in these surgeries. By doing so, it is possible to assess the level of functional impairment and then specifically target the strengthening of those muscle groups affected by surgery whilst also improving impaired balance and allowing a return to daily activities. Conclusions: Rehabilitation is a multi-faceted journey to restore mobility, function, and quality of life. The current rehabilitation practice focuses on muscle strengthening, but the importance of spinal balance is less elaborated. We thus equally emphasize muscle strengthening and balance improvement post-lumbar spine surgery.

Outpatient Spine Surgery in Poland: A Survey on Popularity, Challenges, and Future Perspectives.

Objective: This study aimed to investigate the popularity of outpatient spine surgery in Poland, identify factors influencing its adoption, and assess its benefits, challenges, and impact on patient outcomes and healthcare costs. Additionally, the study proposes strategies to improve outpatient spine surgery adoption and ensure its safe implementation in Poland. Materials and Methods: An electronic survey was distributed to members of the Polish Spine Surgery Society and the Polish Neurosurgery Society. Data were analyzed using Matlab R2020b statistical software, employing descriptive statistics to summarize the responses. Results: The survey indicated that 67% of respondents provide spinal procedures commercially, with 58% performing them on an outpatient basis, showing the growing role of the private sector in providing spinal surgery services in Poland. Root nerve blocks and joint blocks were the most common outpatient procedures, followed by microdiscectomy, endoscopic discectomy, and L-S spinal fusion. The public NHF was the most common payer for outpatient procedures. Conclusion: Outpatient spine surgery in Poland is not yet widespread, but improvements can be made to reduce hospital stays and enhance recovery. Changes in reimbursement systems to cover outpatient procedures and addressing physicians' liability concerns, particularly by emphasizing the NO-fault system, are essential. With proper support, outpatient spine surgery could become a valuable addition to Poland's healthcare system.

Outpatient Spine Procedures in Poland: Clinical Outcomes, Safety, Complications, and Technical Insights into an Ambulatory Spine Surgery Center.

PURPOSE: This study evaluated the safety and efficacy of spine procedures performed in an ambulatory spine surgery unit in Poland. PATIENTS AND METHODS: We conducted a retrospective analysis of 318 patients who underwent ambulatory spine surgery between 2018 and 2021, with procedures including microdiscectomy (MLD), anterior cervical discectomy and fusion (ACDF), endoscopic interbody fusion (endoLIF), posterior endoscopic cervical discectomy (PECD), interlaminar endoscopic lumbar discectomy IELD, and transforaminal endoscopic lumbar discectomy (TELD). Patient data were analyzed for pre-operative and post-operative visual analog scale (VAS) scores. RESULTS: The findings indicated that outpatient techniques were safe and effective, with a 2.83% complication rate. All procedures significantly improved VAS scores under short-term observation, and core outcome measurement index (COMI) scores under long-term observation. CONCLUSIONS: Ambulatory spine surgery represents a relatively new approach in Poland, with only a select few centers currently offering this type of service. Outpatient spine surgery is a safe, effective, and cost-effective option for patients requiring basic spine surgeries.

Efficacy of DiscoGel in Treatment of Degenerative Disc Disease: A Prospective 1-Year Observation of 67 Patients.

Patients with degenerative disc disease may suffer from chronic lumbar discogenic (DP) or radicular leg (RLP) pain. Minimally invasive DiscoGel therapy involves the percutaneous injection of an ethanol gel into the degenerated disk's nucleus pulposus. This paper compares the 1-year outcome of such treatment in DP and RLP patients. We operated on 67 patients (49 men and 18 women) aged 20-68 years (mean age 46 ± 11 years) with DP (n = 45) and RLP (n = 22), of at least 6-8 weeks duration, with no adverse effects. We evaluated the treatment outcome with Core Outcome Measures Index (COMI) and Visual Analog Scale (VAS). A year after the ethanol gel injection, in the DP cohort, COMI and VAS dropped by 66% (6.40 vs. 2.20) and 53% (6.33 vs. 2.97), respectively. For the RLP patients, the corresponding values dropped 48% (7.05 vs. 3.68) and 54% (6.77 vs. 3.13). There were no differences between the cohorts in COMI and VAS at the follow-up end. Six months into the study, 74% of DP and 81% of RLP patients did not use any analgesics. Ethanol gel therapy can be effective for many patients. Moreover, its potential failure does not exclude surgical treatment options.

Iatrogenic lumbar artery pseudoaneurysm after lumbar transpedicular fixation: Case report.

Only a few cases of iatrogenic lumbar injury have been reported in the literature. A 58-year-old male with severe back pain was admitted to our department. The patient was qualified for the transpedicular stabilization with interbody fixation at L4/L5 and L5/S1 levels. On the first day after surgery, the patient was mobile and reported significant pain relief. He was discharged the same day. After 2 weeks, the patient returned with severe right lower abdominal pain and radicular pain in his right leg. He was administered to the Neurology Department where the presence of a lumbar muscle hematoma and lumbar artery pseudoaneurysm were discovered. He was transferred to the Vascular Surgery Department where aortography was performed and the pseudoaneurysm was embolized. After few days, the patient's overall condition improved significantly. Eight weeks after surgery, he was pain-free. Our case shows how initially innocuous symptoms may be the result of serious complications.

Safety and efficacy of cervical disc arthroplasty in preventing the adjacent segment disease: a meta-analysis of mid- to long-term outcomes in prospective, randomized, controlled multicenter studies.

OBJECTIVES: Cervical disc arthroplasty (CDA) has become an alternative treatment for cervical radiculopathy and myelopathy. This technique preserves appropriate motion at both the index and adjacent disc levels and consequently may prevent adjacent segment degeneration (ASD). The authors performed a meta-analysis to compare the safety and efficacy of CDA to those of the gold standard, anterior cervical discectomy and fusion (ACDF). Both surgical and clinical parameters were employed to verify the hypothesis that CDA can reduce the risk of ASD. METHODS: The meta-analysis comprised high-quality randomized controlled trials that compared CDA and ACDF treatments of cervical degenerative disc disease. Included papers reported data for at least one of the following outcomes: 1) surgical parameters, 2) questionnaire clinical indices (pre- and postoperative values), and 3) complication rates at 24 months; in addition, for ASD we analyzed 60 month or longer follow-ups. We used mean differences (MDs) or ORs to compare treatment effects between CDA and ACDF. RESULTS: Twenty studies with 3,656 patients (2,140 with CDA and 1,516 with ACDF) met the inclusion criteria. CDA surgery, with mean duration longer than that of ACDF, was associated with higher blood loss. Visual analog scale neck pain score was significantly smaller for CDA (mean difference =-2.30, 95% CI [-3.72; -0.87], P=0.002). The frequency of dysphagia/dysphonia (OR =0.69, 95% CI [0.49; 0.98], P=0.04) as well as the long-term ASD rate for CDA was significantly smaller (OR =0.33, 95% CI [0.21; 0.50], P<0.0001). CONCLUSION: A significantly lower probability of ASD reoperations in the CDA cohort after a 60-month or longer follow-up was the most important finding of this study. Despite the moderate quality of this evidence, the pooled data corroborated for the very first time that CDA was efficacious in preventing ASD.

Translation, validation, and cross-cultural adaptation of the Polish version of the pain sensitivity questionnaire.

INTRODUCTION: The purpose of this study was to provide a translation, cross-cultural adaptation, and validation of the Polish language version of the pain sensitivity questionnaire (PSQ). The process followed widely accepted guidelines. METHODS: The translated questionnaire underwent thorough psychometric testing. In total, the data of 144 subjects (mean age 52.53±13 years), who underwent evaluation for lower back pain, were included. RESULTS: The exploratory factor analysis revealed a two-factor structure, PSQ-moderate and PSQ-minor. The internal consistency was good (Cronbach's α was 0.96). There was a fair and significant correlation between the results of the PSQ and the coping strategy questionnaire (CSQ; Spearman's rho was 0.27). The test-retest reliability was favorable, and the intraclass correlation coefficient (ICC) for the CSQ total was 0.93 with a mean interval of 9.04 days between administrations. CONCLUSION: Our results show that the Polish version of the PSQ is valid and can be recommended for Polish-speaking patients.