Tag: Incidence

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Cage migration in multilevel stand-alone lateral lumbar interbody fusion: incidence and clinical correlations

J Neurosurg Spine 44:426–435, 2026

This clinical case series compares the incidence and outcomes of lateral interbody cage migration (LCM) following multilevel stand-alone lateral lumbar interbody fusion (LLIF) versus LLIF with posterior pedicle screw instrumentation in 87 age-matched patients. The retrospective analysis reports similar LCM rates (7% vs 5%), no significant differences in complications, and comparable improvements in Oswestry Disability Index and pain scores at ≥1 year follow-up.

The report details patient selection, radiographic assessment methods, operative characteristics, and risk-factor analysis, emphasizing meticulous selection for multilevel stand-alone LLIF. Authors conclude multilevel stand-alone LLIF can be safe in selected patients but call for prospective studies to validate findings and clarify factors contributing to cage migration.

Lateral Cage Migration (LCM) Incidence: LCM occurred in 7% of multilevel stand-alone LLIF cases and 5% of LLIF cases with posterior instrumentation; this difference was not statistically significant.

Patient Selection Criteria: Optimal candidates for multilevel stand-alone LLIF have neutral sagittal and coronal balance, mild to moderate facet arthropathy, stable grade 1 spondylolisthesis, absence of severe central canal stenosis, normal or mildly reduced bone mineral density, and comorbidities or age that increase surgical risk with posterior fixation.

Clinical Outcomes: Both cohorts (stand-alone and posterior instrumentation) showed significant postoperative improvement in Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, with no significant differences between groups.

Complication Rates: Postoperative complication rates were similar between groups (23% stand-alone vs. 20% posterior instrumentation), and no intraoperative complications were reported in either group.

Biomechanical Considerations: Supplemental posterior instrumentation increases construct stability, but clinical significance in preventing LCM in well-selected patients remains unclear; stand-alone LLIF can be safe with meticulous patient selection.

Role of Lateral Plates: Adding lateral plates to stand-alone LLIF does not significantly improve stability or reduce cage migration/subsidence in multilevel constructs and may increase cost and risk.

Risk Factors for LCM: No significant demographic, radiographic, or procedural risk factors for LCM were identified in this study; all patients with LCM had normal bone density, and meticulous surgical technique and patient selection are emphasized.

Study Limitations: Retrospective design, single institution, and small sample size may limit generalizability; prospective studies are needed for further validation.

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Incidence and Risk Factor of Implant Dislocation After Cervical Disk Arthroplasty: A Retrospective Cohort Analysis of 756 Patients

Neurosurgery 93:330–338, 2023

Implant dislocation after cervical disk arthroplasty (CDA) is obviously a critical complication, but no information about the incidence and associated risk factor has been reported.

OBJECTIVE: To investigate the incidence and risk factor of implant dislocation after CDA by a retrospective cohort analysis.

METHODS: A retrospective review of a consecutive series of CDA performed between January 2009 and March 2021 at a single institution was conducted. Analyses of chart records and radiological data established the incidence and associated risk factor of implant dislocation after CDA. A Kaplan-Meier survival estimation of implant survival was performed.

RESULTS: A total of 756 consecutive patients were included in this analysis. Five patients (0.7%) had a migration and even dropout of the artificial disk. The overall cumulative survival rate of the implant reached approximately 99.3% of the 756 patients. Preoperative kyphosis was significantly related to implant dislocation (P = .016), with an odds ratio of 15.013.

CONCLUSION: The incidence of implant dislocation after CDA is as low as 0.7% or 5/756 patients. Preoperative kyphosis significantly increases the risk of postoperative implant dislocation by a factor of 15. The migrating implants could be revealed on radiographs as early as 0.9 to 1.4 months postoperatively and were revised to anterior cervical diskectomy and fusion within half a year. No new event of implant dislocation occurred half a year postoperatively. The overall cumulative survival rate of the implant reached 99.3% of the 756 patients. In conclusion, CDA remains a safe and reliable procedure.

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Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis

J Neurosurg 130:1065–1079, 2019

Hydrocephalus is one of the most common brain disorders, yet a reliable assessment of the global burden of disease is lacking. The authors sought a reliable estimate of the prevalence and annual incidence of hydrocephalus worldwide.

METHODS The authors performed a systematic literature review and meta-analysis to estimate the incidence of congenital hydrocephalus by WHO region and World Bank income level using the MEDLINE/PubMed and Cochrane Database of Systematic Reviews databases. A global estimate of pediatric hydrocephalus was obtained by adding acquired forms of childhood hydrocephalus to the baseline congenital figures using neural tube defect (NTD) registry data and known proportions of posthemorrhagic and postinfectious cases. Adult forms of hydrocephalus were also examined qualitatively.

RESULTS Seventy-eight articles were included from the systematic review, representative of all WHO regions and each income level. The pooled incidence of congenital hydrocephalus was highest in Africa and Latin America (145 and 316 per 100,000 births, respectively) and lowest in the United States/Canada (68 per 100,000 births) (p for interaction < 0.1). The incidence was higher in low- and middle-income countries (123 per 100,000 births; 95% CI 98–152 births) than in high-income countries (79 per 100,000 births; 95% CI 68–90 births) (p for interaction < 0.01). While likely representing an underestimate, this model predicts that each year, nearly 400,000 new cases of pediatric hydrocephalus will develop worldwide. The greatest burden of disease falls on the African, Latin American, and Southeast Asian regions, accounting for three-quarters of the total volume of new cases. The high crude birth rate, greater proportion of patients with postinfectious etiology, and higher incidence of NTDs all contribute to a case volume in low- and middle-income countries that outweighs that in high-income countries by more than 20-fold. Global estimates of adult and other forms of acquired hydrocephalus are lacking.

CONCLUSIONS For the first time in a global model, the annual incidence of pediatric hydrocephalus is estimated. Low and middle-income countries incur the greatest burden of disease, particularly those within the African and Latin American regions. Reliable incidence and burden figures for adult forms of hydrocephalus are absent in the literature and warrant specific investigation. A global effort to address hydrocephalus in regions with the greatest demand is imperative to reduce disease incidence, morbidity, mortality, and disparities of access to treatment.

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Characteristics and long-term outcome of 251 patients with dural arteriovenous fistulas in a defined population

DAVF-headache

J Neurosurg 118:923–934, 2013

Management of dural arteriovenous fistulas (DAVFs) has changed during the last decades due to increased knowledge of their pathophysiology and natural history as well as advances in treatment modalities. The authors describe the characteristics and long-term outcome of a large consecutive series of patients with DAVFs.

Methods. Altogether 251 patients with 261 DAVFs were treated in 2 of the 5 neurosurgery departments at Helsinki and Kuopio University Hospitals between 1944 and 2006. Clinical data and radiological examinations were reviewed to assess patients’ overall long-term clinical outcome.

Results. The detection rate of DAVFs increased markedly in the 1970s and again in the 1990s when digital subtraction angiography was introduced. The incidence of DAVFs in a defined southern Finnish population was 0.51 per 100,000 individuals per year, which represents 32% of all the brain arteriovenous malformations. In the early part of the series, DAVFs were treated by proximal ligation of the feeding arteries. Later, most of the patients underwent preoperative embolization and subsequent craniotomy, and since 2000 stereotactic radiosurgery has been increasingly used in the treatment of DAVFs. Fifty-nine percent of the 261 fistulas were totally occluded. Treatment-related major complications were seen in 21 patients.

Conclusions. The advances in diagnostic methods (digital subtraction angiography, CT, and MRI) increased the detection rate of DAVFs, and as treatment modalities developed, the results of treatment and outcome of patients markedly improved with the introduction of endovascular techniques and stereotactic radiosurgery. Microsurgery is of limited use in DAVFs resistant to other treatment modalities.

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The Association Between Weather and Spontaneous Subarachnoid Hemorrhage: An Analysis of 155 US Hospitals

Neurosurgery 68:132–139, 2011 DOI: 10.1227/NEU.0b013e3181fe23a1

A seasonal and meteorological influence on the incidence of spontaneous subarachnoid hemorrhage (SAH) has been suggested, but a consensus in the literature has yet to emerge.

OBJECTIVE: This study examines the impact of weather patterns on the incidence of SAH using a geographically broad analysis of hospital admissions and represents the largest study of the topic to date.

METHODS: We retrospectively analyzed SAH admissions to 155 US hospitals during the calendar years 2004 to 2008 (N = 7758). Daily weather readings for temperature, pressure, and humidity were obtained for the same period from National Oceanic and Atmospheric Administration weather stations located near each hospital. The daily values of each weather variable were associated with the daily volume of SAH admissions using a combination of correlation and time-series analyses.

RESULTS: No seasonal trends were observed in the monthly volume of SAH admissions during the study period. No significant correlation was detected between the daily SAH admission volume and the day’s weather, the previous day’s weather, or the 24-hour weather change.

CONCLUSION: This study represents the most comprehensive investigation of the association between weather and spontaneous SAH to date. The results suggest that neither season nor weather significantly influences the incidence of SAH.

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Cell phones and brain tumors: a review including the long-term epidemiologic data

Vini G. Khurana, PhD, FRACS, Charles Teo, MBBS, FRACS, Michael Kundi, PhD, Lennart Hardell, MD, PhD, Michael Carlberg, MSc.

Surgical Neurology Volume 72, Issue 3, Pages 205-214 (September 2009) doi:10.1016/j.surneu.2009.01.019

The debate regarding the health effects of low-intensity electromagnetic radiation from sources such as power lines, base stations, and cell phones has recently been reignited. In the present review, the authors attempt to address the following question: is there epidemiologic evidence for an association between long-term cell phone usage and the risk of developing a brain tumor? Included with this meta-analysis of the long-term epidemiologic data are a brief overview of cell phone technology and discussion of laboratory data, biological mechanisms, and brain tumor incidence.

In order to be included in the present meta-analysis, studies were required to have met all of the following criteria: (i) publication in a peer-reviewed journal; (ii) inclusion of participants using cell phones for ≥10 years (ie, minimum 10-year “latency”); and (iii) incorporation of a “laterality” analysis of long-term users (ie, analysis of the side of the brain tumor relative to the side of the head preferred for cell phone usage). This is a meta-analysis incorporating all 11 long-term epidemiologic studies in this field.

The results indicate that using a cell phone for ≥10 years approximately doubles the risk of being diagnosed with a brain tumor on the same (“ipsilateral”) side of the head as that preferred for cell phone use. The data achieve statistical significance for glioma and acoustic neuroma but not for meningioma.

Conclusion

The authors conclude that there is adequate epidemiologic evidence to suggest a link between prolonged cell phone usage and the development of an ipsilateral brain tumor.

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