Towards a common language in neurosurgical outcome evaluation: the NEON (NEurosurgical Outcome Network) proposal.

BACKGROUND: The aim of this study was to achieve a consensus on the minimum set of outcome measures and predictors to be used in the neurosurgical practice and on the timing of outcome assessment. METHODS: A consensus building approach was employed. All neurosurgical departments in Lombardy (Italy) were invited to participate by the Carlo Besta Neurologic Institute IRCCS Foundation. Three workshops were organized during which a multidisciplinary group called Neurosurgical Outcome Network (NEON) was created and the methodology to select outcome measures, predictors, and timing of outcome assessment was established. Eight working groups were created for the different neurosurgical diseases (neuro-oncological, skull base, vascular, traumatic, spinal, peripheral nervous system, malformation, functional) and 8 workshops were organized to identify the outcome measures and predictors specific for each of the neurosurgical diseases based on the experts' clinical practice and the existing literature. RESULTS: A total of 20 neurosurgical departments participated in this study. Specific outcome measures, predictors and the timing of outcome assessment were identified for each of the 8 neurosurgical diseases. Moreover, a list of variables common to all pathologies were identified by the NEON group as further data to be collected. CONCLUSIONS: A consensus on the minimum set of outcome measures and predictors and the timing of outcome assessments for 8 neurosurgical diseases was achieved by a group of neurosurgeons of the Lombardy region, called NEON. These sets could be used in future studies for a more homogeneous data collection and as a starting point to reach further agreement also at national and international level.

The effectiveness of short hybrid stabilization with sublaminar bands and transpedicular screws in the treatment of thoracolumbar spine fractures.

BACKGROUND: Long constructs have always been widely recommended for the treatment of thoracolumbar fractures, due to their biomechanical stability and minimal postoperative loss of correction. However, short constructs have significant advantages, since they enable for better postoperative lumbar mobility and reduce the risk of adjacent segment degeneration. The purpose of this study is to evaluate the safety and efficacy of hybrid screw/sublaminar bands short constructs, used for the treatment of thoracolumbar fractures. METHODS: From June 2015 until November 2017, 20 consecutive patients (14 male, 6 female) with an average age of 52.9 years, exhibiting at least one traumatic fracture in the thoracolumbar region, were treated with hybrid screw/sublaminar bands short constructs. The data for analysis included: duration of the intervention, intraoperative blood loss, complications, and clinical and radiographic postoperative results, compared with the standard for thoracolumbar fixation. RESULTS: The use of this type of construct allowed for simple reduction, stabilization of the fractures, and restoration of the physiological spine curvatures. During the postoperative period none of the patients had neurological worsening. 18 out of 20 patients were followed up for two years. One patient sustained implant failure six months after surgery and underwent a surgical implant revision with traditional long fixation. After two years, stability and fusion were obtained in all patients, along with correct spine alignment. CONCLUSIONS: Hybrid screw/sublaminar bands short constructs seem to be effective in the treatment of thoracolumbar fractures, providing the same clinical results of the state-of-the-art pedicular screw/rod long constructs, but in addition they allow for better postoperative lumbar mobility and subsequently reduce the risk of adjacent segments degeneration. The results of this clinical case series might support the initiation of prospective randomized trials with more patients, a longer follow-up period, and control groups.