Search

Copyright of Česká a Slovenská Neurologie a Neurochirurgie is the property of Czech Medical Association of JE Purkyne and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction in adults, often progressing silently. Static magnetic resonance imaging (MRI) is the standard imaging tool but may miss compression caused by neck movement. Dynamic MRI, by capturing flexion and extension views, provides a clearer picture of spinal cord compression, aiding surgical planning and improving outcomes. However, its use is limited due to higher costs and specialized requirements, making its clinical value essential to assess., Methods: Eighty-two CSM patients undergoing posterior decompression surgery were divided into 2 groups: static MRI-based planning (n = 43) and combined static and dynamic MRI-based planning (n = 39). Neurological outcomes were evaluated using modified Japanese Orthopaedic Association and visual analog scale scores preoperatively and postoperatively. Compression levels identified on static and dynamic MRI were compared., Results: Demographic characteristics were similar between groups. Dynamic MRI identified additional compression levels, mainly at C5-C6 and C6-C7, in 18 patients. Patients in the dynamic MRI group showed significantly greater improvements in modified Japanese Orthopaedic Association scores (mean: 15.8 ± 1.6 vs. 14.5 ± 1.8, P = 0.01) and visual analog scale scores (mean: 3.2 ± 1.4 vs. 4.5 ± 1.8, P = 0.01) compared to the static MRI group., Conclusions: Dynamic cervical MRI enhances the identification of compression levels overlooked by static MRI, improving surgical precision and postoperative outcomes in CSM patients. Incorporating dynamic MRI into routine preoperative evaluations may be particularly beneficial for complex, multilevel cases., (Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.)

Study Design: Retrospective clinical study., Objectives: The aim is to assess and contrast the results of full endoscopic lumbar discectomy (FELD) and lumbar microdiscectomy (LMD) for L5-S1 disc herniation, with a specific emphasis on postoperative pain reduction and surgical effectiveness., Background: Although minimally invasive spine operations are becoming more popular, there is still little research on the comparative effectiveness of FELD and LMD., Materials and Methods: The research had a total of 50 patients who received surgical intervention for L5-S1 disc herniation, with 25 patients getting full endoscopic interlaminar discectomy and the other 25 patients undergoing LMD. Clinical outcomes were assessed using the Visual Analog Scale for low back and leg pain, collected preoperatively and at the end of 1 week, 3 months, and 6 months postsurgery. Patient satisfaction was evaluated using Odoms criteria at the same intervals., Results: The study included 50 patients (26 men, 24 women), with a mean age of 51.11 ± 13.76 years. The groups had no significant differences in demographic data. Back and leg pain Visual Analog Scale scores decreased more significantly in the FELD group after 1 week of surgery ( P < 0.001), although the declines at 3 months and 6 months were not significantly different between the two groups. According to Odoms criteria, patient satisfaction was favorable in both groups and significantly better in the FELD group than in the LMD group at 1 week postoperatively [excellent in 20 patients (80%) in the FELD group vs 9 patients (36%) in the LMD group ( P = 0.025)]. However, patient satisfaction at 3 months and 6 months did not differ between the groups., Conclusion: This study demonstrates that FELD offers significant early postoperative advantages over LMD at the L5-S1 level when compared with pain and satisfaction scales., Level of Evidence: Level III., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The estimation of survival is extremely important for metastatic disease in the spine. The aim of this study was to determine the factors affecting the outcome of patients with spinal metastasis, primarily the character of neurologic deficit and the histopathology of the tumor., Method: A retrospective examination was made of 158 patients with spinal metastasis who were followed up in our clinic between 2010 and 2020 and underwent surgical intervention. The patients were examined in respect of demographic characteristics, the primary tumor, comorbidities, preoperative-postoperative visual aAnalog scale scores, preoperative-postoperative neurologic examinations and neurologic deficit if present and ambulation status, postoperative survival duration, tumor localization, characteristics of the surgeries, complications, the Karnofsky Performance Scale, revised Tokuhashi, and Tomita scores., Results: Spinal metastasis was seen more frequently in males (72.8% male, 27.8% female). Male gender, multiple level involvement, intradural localization, and Karnofsky Performance Scale <70 were seen to cause a shorter survival time. Patients with a primary focus of hematologic malignancy, breast cancer, and lymphoma had a longer survival. The revised Tokuhashi and Tomita scores were observed to be successful in the prediction of survival. A decrease in postoperative visual analog scale score had a positive effect on functional survival. The absence of preoperative neurological deficit and the patient's ability for preoperative and postoperative ambulation affected survival positively. The overall survival period decreased in patients who were mobilized in the early postoperative period but became nonmobile in the late period, and in those who were nonmobile in both the early and late postoperative periods., Conclusions: The neurologic and ambulatory status, the Tomita and Tokuhashi scores, intradural localization, and gender are the factors with a significant effect on prognosis., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Lumbar degenerative disc disease (LDDD) significantly contributes to low back pain, with a complicated etiology involving genetic and environmental facts. The aim of study was to investigate the association between the TaqI (rs731236) polymorphism of the vitamin D receptor (VDR) gene with LDDD., Methods: In total, 248 patients with symptomatic LDDD and 146 control subjects were examined. The evaluation of clinical features of patients with LDDD comprised radiodiagnostic magnetic resonance imaging, neurologic examinations, pain scores including the visual analog scale (VAS), and disability investigation with Oswestry Disability Index (ODI). Genotyping of the VDR gene polymorphism was conducted using polymerase chain reaction-based methods., Results: Individuals of the LDDD group who were VDR TaqI AA genotype carriers were significantly greater than the other group (P = 0.014), whereas those with GG genotype were significantly lower (P = 0.028) in the patient group. In addition, VAS and ODI scores were significantly lower in the GG genotype carrier group, whereas AA genotype carriers had the greatest scores (P = 0.004). Carrying the G allele decreased the risk of LDDD 1.7 times (P = 0.014) and carrying the A allele enhanced the risk 1.8 times (P = 0.028). Moreover, G-allele carriers had significantly lower VAS (P = 0.002) and ODI scores (P < 0.0001)., Conclusions: VDR TaqI (rs731236) GG genotype and G allele have protective potential, whereas the AA genotype and A allele are risk factors for LDDD. The findings reveal a statistically significant association of the TaqI (rs731236) polymorphism of VDR gene polymorphism with LDDD. This result highlights the potential role of genetic factors in developing LDDD and suggests avenues for future research in genetic screening and personalized treatment strategies., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Cervical spondylotic myelopathy (CSM) is a prevalent cause of spinal cord dysfunction in adults, primarily from degenerative changes. The efficacy of treatment strategies, especially surgical approaches, remains debated., Objective: This study aimed to assess the long-term impact of posterior fusion laminectomy on the posterior longitudinal ligament (PLL) thickness, disc complex, and myelomalacia signal changes in CSM patients., Methods: A single-centre, prospective study from January 2020 to December 2021 included CSM patients without ossified posterior longitudinal ligament (OPLL). Magnetic resonance imaging (MRI) data from baseline, 6, and 12 months postoperatively were collected. Measurements on the MRI were performed using the Osirix MD software, focusing on the PLL width, myelopathic foci dimensions, and canal diameter., Results: Out of the 82 initially enrolled patients, 64 were considered for analysis. Postoperatively, a significant reduction in PLL width and myelopathic foci dimensions was observed, alongside a considerable increase in the canal diameter. Clinical outcomes based on the Modified Japanese Orthopaedic Association (mJOA) scale also showcased marked improvements post-surgery., Conclusions: Posterior fusion laminectomy effectively reduces anterior pressure in CSM patients. This treatment may represent an optimal surgical approach for selected CSM cases. Furthermore, more extensive studies with extended follow-up are advocated., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background The treatment of spinal schwannomas, which is the most common nerve sheath tumor, is total microsurgical resection. The localization, size and relationship with the surrounding structures of these tumors are crucial in terms of preoperative planning. A new classification method is presented in this study for the surgical planning of spinal schwannoma. Methods All patients who underwent surgery for spinal schwannoma between 2008 and 2021 were reviewed retrospectively, along with radiological images, clinical presentation, surgical approach, and postoperative neurological status. Results A total of 114 patients, 57 male, and 57 females were included in the study. Tumor localizations were cervical in 24 patients, cervicothoracic in one patient, thoracic in 15 patients, thoracolumbar in eight patients, lumbar in 56 patients, lumbosacral in two patients, and sacral in eight patients. All tumors were divided into seven types according to the classification method. Type 1 and Type 2 groups were operated on with a posterior midline approach only, Type 3 tumors were operated on with a posterior midline approach and extraforaminal approach, and Type 4 tumors were operated on with only an extraforaminal approach. While the extraforaminal approach was sufficient in type 5 patients, partial facetectomy was required in 2 patients. Combined surgery including hemilaminectomy and extraforaminal approach was performed in the type 6 group. A posterior midline approach with partial sacrectomy/corpectomy was performed in Type 7 group. Conclusion Effective treatment of spinal schwannoma depends on preoperative planning, which includes correctly classifying tumors. In this study, we present a categorization scheme that covers bone erosion and tumor volume for all spinal localizations., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)