Month: September 2025

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Outcomes After Decompression Only Versus Decompression and Fusion for Lumbar Facet Cysts: A Systematic Review and Meta-Analysis

Neurosurgery 97:536–544, 2025

This meta-analysis compared decompression only (DO) versus decompression and fusion (DF) for lumbar facet cysts. DF reduced cyst recurrence and improved back pain resolution but had longer hospital stays. Reoperation and radiculopathy resolution rates were similar between groups. Most studies lacked standardized criteria for choosing DF over DO.

• Lumbar facet cysts (LFCs) are associated with facet degeneration and segmental instability; surgical management is debated between decompression only (DO) and decompression with fusion (DF).

• This systematic review and meta-analysis included 9 comparative studies with 3393 patients (DO: 1940, DF: 1453).

• Spondylolisthesis rates were significantly higher in the DF group (65.8% vs 24.3% in DO).

• DO had higher odds of cyst recurrence (6.3% vs 0%) and lower odds of back pain resolution (56.6% vs 74.5%) compared to DF.

• Reoperation rates (DO 7.2%, DF 5.9%) and radiculopathy resolution (DO 77.3%, DF 87.2%) were similar between groups.

• Length of hospital stay was shorter in the DO group.

• Criteria for choosing DF vs DO varied and were often not clearly defined across studies.

• The study concludes DF reduces cyst recurrence and improves back pain resolution but has longer hospital stays; reoperation and radiculopathy outcomes are comparable.

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External Ventricular Drain Misadministration Events

Operative Neurosurgery 29:345–350, 2025

This systematic review examines misadministration events involving external ventricular drains (EVDs), including the first reported case of blood transfusion through an EVD. It highlights risk factors, advocates for ISO 80369-6 NRFit connectors to prevent misconnections, and recommends enhanced protocols and staff education to improve patient safety.

• External ventricular drains (EVDs) are widely used in neurosurgery but carry risks of misadministration due to connector similarity with IV lines.

• A systematic review identified 7 reports (8 cases) of EVD misadministration, involving drugs like gadolinium, anesthetics, antiepileptics, and, for the first time, blood products.

• The first reported case of blood transfusion into an EVD resulted in patient death, highlighting the severity of such errors.

• Main contributing factors include unfamiliarity with EVD systems, similar appearance to IV tubing, and poor visibility during procedures.

• The new ISO 80369-6 standard and NRFit connectors, with a smaller diameter than Luer connectors, are designed to prevent misconnections.

• Adoption of NRFit connectors, staff training, and clear equipment labeling are key recommended preventive strategies.

• Current guidelines from professional organizations support design changes and staff education but lack universal protocols for EVD management.

• Further research and widespread implementation of standardized connectors are needed to improve patient safety.

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