Month: October 2025

Posted on

Which interbody device minimized nonunion, subsidence, and reoperation after anterior cervical discectomy and fusion?

J Neurosurg Spine 43:453–463, 2024

This meta-analysis found that allograft spacers in anterior cervical discectomy and fusion (ACDF) result in lower nonunion and revision rates compared to PEEK cages, with no significant difference in subsidence risk. Allograft offers enhanced fusion and minimizes revision without increasing subsidence.

• Allograft and PEEK cages are the most commonly used interbody spacers in anterior cervical discectomy and fusion (ACDF), replacing autograft due to lower donor site morbidity.

• This meta-analysis included 10 studies with 1462 patients comparing allograft and PEEK cages for ACDF, analyzing nonunion, subsidence, and reoperation rates.

• Allograft showed a significantly lower rate of nonunion than PEEK cages (OR 0.33, p = 0.01), indicating better fusion outcomes.

• Reoperation due to nonunion was significantly higher with PEEK cages compared to allograft (OR 0.28, p < 0.01), but overall reoperation rates for any cause were not significantly different.

• No significant difference was found in the incidence or amount of subsidence between allograft and PEEK cages.

• Allograft’s osteoconductive properties likely contribute to its higher fusion rate, while PEEK cages may lead to fibrous interface formation, reducing solid fusion.

• Meta-regression showed no significant effect of smoking, age, or number of fused levels on nonunion rates.

• Conclusion: Allograft is advantageous over PEEK cages in ACDF due to higher fusion rates and lower revision risk, without increasing subsidence

Posted on

Outcome comparison between interposition and “contactless” transposition microvascular decompression approaches for trigeminal neuralgia

J Neurosurg 143:970–981, 2025

This study compared interposition and “contactless” transposition (Teflon and pericranial sling) microvascular decompression techniques for trigeminal neuralgia. Both were effective, but sling transposition showed improved midterm pain control and fewer complications. The only significant predictor of pain freedom was MRI evidence of clear nerve compression.

• Microvascular decompression (MVD) is a main surgical treatment for trigeminal neuralgia (TN), traditionally using Teflon interposition between nerve and artery.

• Recurrence of TN pain after MVD is often due to Teflon complications, prompting the development of “contactless” transposition techniques such as Teflon and pericranial sling transpositions.

• This retrospective study compared outcomes of interposition, Teflon transposition, and pericranial sling transposition in 305 TN patients.

• Sling transposition was mainly used for severe compression by the superior cerebellar artery and involved securing the artery to the tentorium with a pericranial graft.

• All techniques had similar short-term pain relief and complication rates, but sling transposition showed significantly higher pain-free rates at 2 years compared to other methods.

• Clear vascular compression on MRI was the only significant predictor of pain freedom in multivariate analysis.

• Sling transposition uses autologous tissue, avoids foreign body reactions, and may provide more durable pain control, but is technically more complex.

• Further long-term studies are needed to confirm the durability of sling transposition for TN pain control.

Posted on

Enhanced Recovery After Surgery Protocol for Microvascular Decompression in Trigeminal Neuralgia: A Retrospective Matched Cohort Study

Neurosurgery 97:936–944, 2025

Implementation of an enhanced recovery after surgery (ERAS) protocol for microvascular decompression in trigeminal neuralgia significantly reduced hospital length of stay, improved postoperative pain scores, and decreased transient hearing alterations compared to conventional care, without increasing complications, according to a retrospective matched cohort study.

• Enhanced Recovery After Surgery (ERAS) protocol was implemented for microvascular decompression (MVD) in trigeminal neuralgia (TN) patients and compared to conventional care in a retrospective matched cohort study.

• ERAS protocol included preoperative counseling, scalp block, small incisions, minimal muscle dissection, total intravenous anesthesia without narcotics, early enteral feeding, and early mobilization.

• 130 patients (65 ERAS, 65 non-ERAS) were analyzed after propensity score matching for key demographics and comorbidities.

• ERAS group had significantly shorter hospital length of stay (1.46 vs 2.95 days, P < .001) and lower postoperative verbal pain scores (1.63 vs 2.48, P = .03) than controls.

• ERAS patients experienced fewer transient postoperative subjective hearing alterations (0 vs 6 cases, P = .03).

• No significant difference in postoperative Barrow Neurological Institute (BNI) pain scores or major complications between groups.

• Subgroup analysis showed ERAS patients discharged at 24 hours had even lower pain scores than controls.

• Study limitations include retrospective design, small sample size, and use of subjective pain scores; larger randomized trials are needed.

Proudly powered by WordPress