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Background and Objectives: Access to neurosurgical care is limited in low-income and middle-income countries (LMICs) and in marginalized communities in high-income countries (HICs). International partnerships represent one possible means of addressing this issue. Insights from surgeons in HICs have been explored, but data from LMICs' counterparts are scarce. We aimed to study the perspectives of neurosurgeons and trainees from LMICs regarding global neurosurgery (GN) collaborations and interests, motivators, and challenges in participating., Methods: An online survey was conducted targeting neurosurgeons and trainees from LMICs. The survey explored demographics, previous experiences, ongoing activities, interests, and barriers related to GN activities. Data were collected between July 2022 and December 2022 and analyzed., Results: Responses involved 436 individuals. The most represented region (25%) was sub-Saharan Africa, and most respondents were male (87.8%) aged 35-49 years. Interest in GN was high, with 91% after its developments. Most respondents (96.1%) expressed interest in training, professional, or research experience in HICs, but only 18.1% could cover the expenses. A majority (73.2%) strongly agreed to return to their home country for work after HIC training. Ongoing HIC-LMIC partnerships were reported by 27.8% of respondents. Clinical exposure emerged as the most relevant motivating factor (87%), while financial concerns, lack of opportunities, and lack of program support were identified as important barriers. Funding and dedicated time were highlighted as the most crucial facilitators., Conclusion: Understanding the perspectives of neurosurgeons and trainees from LMICs is essential to expanding HICs-LMICs collaborations and improving access to neurosurgical care worldwide. Financial support and targeted interventions are needed to address barriers and promote equitable partnerships in GN., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Five billion people worldwide lack access to safe, timely, and affordable surgical and anesthesia care. This deficit is greatest in low- and middle-income countries, especially for specialty surgical services including neurosurgery, due to insufficient personnel, resources, and infrastructure. The southeastern European nation of the Republic of Moldova is one such middle-income country., Methods: Discussions with key individuals involved in neurosurgical care in Moldova were conducted to characterize the history and current state of neurosurgery in Moldova. Via a process of chain referral sampling, all practicing neurosurgeons in Moldova were invited to participate in the execution and authorship of this project., Results: Developing from origins in the Soviet Union, neurosurgery became part of the national health system in the 1940s, with the creation of the first neurosurgery department in 1999. Eleven hospitals, including eight public and three private, offer neurosurgical services, with 239 beds and 5330 cases performed in 2023. Most attending neurosurgeons and residents are male, but this is changing as women comprise over one-third of residents in training. There is one neurosurgery residency program and a 2-year fellowship in endovascular neurosurgery in Moldova, with further fellowship training received outside of the country. CT and MRI are available at most centers., Conclusions: This article provides the first-ever description of the history and current state of neurosurgery in Moldova and presents key recommendations to guide the international neurosurgery community in developing neurosurgical care in countries with an unmet need., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Degenerative cervical myelopathy (DCM) is estimated to affect 2% of the adult population. DCM occurs when degenerative processes cause compression and injure the spinal cord. Surgery to remove the stress caused by the compression of the spinal cord is the mainstay of treatment, with a range of techniques in use. Although various factors are described to inform the selection of these techniques, there needs to be more consensus and limited comparative evidence., Objective: The main objective of this survey was to explore the variation of practice and decision-making, with a focus on laminectomy versus laminectomy and fusion in posterior surgery of the cervical spine. We present the results of a survey conducted among the principal investigators (PIs) of the National Institute for Health and Care Research (NIHR) randomized controlled trial on posterior laminectomy with fixation for degenerative cervical myelopathy (POLYFIX-DCM)., Methods: A series of 7 cases were shared with 24 PIs using SurveyMonkey. Each case consisted of a midsagittal T2-weighted magnetic resonance imaging and lateral cervical x-rays in flexion and extension. Surgeons were asked if their preferred approach was anterior or posterior. If posterior, they were asked whether they preferred to instrument and whether they had the equipoise to randomize in the NIHR POLYFIX-DCM trial. Variability in decision-making was then explored using factors reported to inform decision-making, such as alignment, location of compression, number of levels operated, presence of mobile spondylolisthesis, and patient age., Results: The majority of PIs (16/30, 53%) completed the survey. Overall, PIs favored a posterior approach (12/16, 75%) with instrumentation (75/112, average 66%) and would randomize (67/112, average 62%) most cases. Factors reported to inform decision-making poorly explained variability in responses in both univariate testing and with a multivariate model (R2=0.1). Only surgeon experience of more than 5 years and orthopedic specialty training background were significant predictors, both associated with an anterior approach (odds ratio [OR] 1.255; P=.02 and OR 1.344; P=.007, respectively) and fusion for posterior procedures (OR 0.628; P<.001 and OR 1.344; P<.001, respectively). Surgeon experience also significantly affected the openness to randomize, with those with more than 5 years of experience less likely to randomize (OR -0.68; P<.001)., Conclusions: In this representative sample of spine surgeons participating in the POLYFIX-DCM trial as investigators, there is no consensus on surgical strategy, including the role of instrumented fusion following posterior decompression. Overall, this study supports the view that there appears to be a clinical equipoise, and conceptually, a randomized controlled trial appears feasible, which sets the scene for the NIHR POLYFIX-DCM trial., (©Stefan Yordanov, Xiaoyu Yang, Oliver Mowforth, Andreas K Demetriades, Marcel Ivanov, Pierluigi Vergara, Adrian Gardner, Erlick Pereira, Antony Bateman, Alexander Alamri, Jibin Francis, Rikin Trivedi, Mark Kotter, Benjamin Davies, Alexandru Budu, POLYFIX-DCM research Collaborative Group. Originally published in JMIR Formative Research (https://formative.jmir.org), 12.09.2023.)