Neuropathology

Failure to replace removed growth friendly implants results in deteriorating radiographic outcomes

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In a registry-based comparative cohort study (early onset scoliosis patients after implant removal) Matan S Malka et al. from the Morgan Stanley Children’s Hospital (Columbia Univ, New York). Arkansas Children’s Hospital; Shriners Philadelphia; Seattle Children’s Hosp. published in Spine Deformity Journal, to evaluate if re-implanting growth-friendly constructs within 12 months after implant removal (ROI) stabilizes deformity compared to observation-only. Early re-implantation (< 12 mo post-ROI) significantly reduces 2‑year coronal Cobb progression compared to no replacement 1).

Critical Review

– Strengths:

Multicenter registry with well-defined exposure groups.

Radiographic outcomes measured at a meaningful 2‑year follow-up.

Statistically robust with p-values: Cobb 81° vs 53° (p=0.003); progression ≥5°: 64% vs 30% (p=0.04)

– Limitations:

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The modified Brain Injury Guidelines: safe, sensitive, but not yet specific

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In a retrospective cohort review, Freeman et al. from the University of Colorado, Aurora published in the Journal of Neurosurgery analyzed the sensitivity and specificity of the modified Brain Injury Guidelines (mBIG)—especially mBIG 3 criteria—to predict neurosurgical intervention, and explored the predictive value of individual radiographic parameters.

→ mBIG 3 criteria showed 99.5% sensitivity, and combined mBIG 2+3 reached 100% sensitivity. → Specificity remains low:

  • mBIG 3: 37.2%

  • mBIG 2+3: 18.1%

→ Isolated IPH or SAH in mBIG 3 with GCS 13–15 are poor predictors of intervention. → Authors propose eliminating routine repeat head CT in mBIG 1–2 cases.

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🧠 Critical Review

➤ Strengths:

  • Large sample (n = 1128) over 3.5 years (May 2020–Dec 2023).
  • Addresses key clinical issue: reducing unnecessary repeat CTs.
  • High sensitivity makes mBIG a safe exclusion tool, especially mBIG 2+3.

➤ Limitations:

  • Retrospective design → risk of selection bias and unmeasured confounding.
  • Low specificity → risk of overtriage, especially in mBIG 3.
  • Single-center → limits external generalizability.
  • Sparse detail on intervention timing and type.
  • No external validation; subgroup analyses were post hoc.

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The Causal Effects Between Circulating Inflammatory Proteins and Osteoarthritis: A Mendelian Randomization and Transcriptomic Analysis

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In a bidirectional two-sample Mendelian randomization and transcriptomic analysis Lin et al. from the Xiangya Hospital, Changsha published in the Journal of Pain Research  to investigate the causal relationship between circulating inflammatory proteins and osteoarthritis (OA) using Mendelian randomization and transcriptomic data. The study suggests causal roles for various inflammatory proteins in osteoarthritis pathogenesis. Certain proteins (e.g., interleukin-8, fractalkine) are associated with higher OA risk, while others (e.g., interleukin-10 receptor subunit alpha) correlate with lower risk. Additionally, OA itself may causally influence inflammatory protein levels, particularly in a joint-specific manner (hip vs knee). Six key OA-related inflammation-related genes (IRGs) were identified as potential biomarkers 2).

Critical Review:

This study leverages the strengths of two-sample Mendelian Randomization (MR) to address directionality in inflammation-OA associations, bolstered by transcriptomic analysis. However, several issues warrant scrutiny:

– Causality overreach: While MR reduces confounding, it still relies on assumptions (e.g., no pleiotropy), which are not exhaustively addressed here. The evidence remains “suggestive” rather than definitive.

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Comparative assessment of stereoelectroencephalography and subdural electrodes in invasive epilepsy monitoring: a systematic review and meta‑analysis

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In a systematic review and metaanalysis of double‑arm comparative studies Bandopadhay et al. from the Houston Methodist Hospital published in the Journal of Neurosurgery to compare safety and seizure‑outcome profiles of stereoelectroencephalography (SEEG) vs. subdural electrodes (SDE) in pharmacoresistant epilepsy using quantitative double‑arm data SEEG demonstrated a higher rate of favorable seizure outcomes (RR 1.14, 95% CI 1.02–1.27; p=0.02) and lower complication rates overall (RR 0.49, 95% CI 0.37–0.66; p<0.00001). The benefit was significant in general adult cohorts but less pronounced in pediatric or older groups 1).

 

Critical Appraisal

* Strengths:

  • Restricting to double‑arm designs reduces cross‑study heterogeneity.
  • Large pooled cohort: 1,632 SEEG vs. 1,482 SDE patients.
  • Age‑stratified subgroup analysis adds nuance to applicability.

* Limitations:

  • Potential for publication bias—likely underreporting of negative or null comparative studies.

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Management of patients discharged from the hospital after VPS surgery

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In a Letter to the Editor Lu et al. published in the Journal of Neurosurgery to discuss ventriculoperitoneal shunt management strategies for discharged patients 1).

Critical Appraisal

– Strengths:

  1. Highlights a clinically important gap—post-discharge VPS care.
  2. Sparks important discussion on outpatient monitoring and follow-up protocols.

– Limitations:

  1. Absence of abstract/data: no study design, patient numbers, follow-up length or outcomes described.

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Autologous rib graft augmentation for occipitocervical fusion in pediatric patients and a novel radiographic grading scale

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In a retrospective cohort study Shahin et al. from the Doernbecher Children’s Hospital and Oregon Health & Science University, Portland published in the Journal of Neurosurgery Pediatrics to assess whether screw‑fixed autologous rib grafts improve fusion rates in pediatric occipitocervical fusion (OCF), and validate a novel imaging-based fusion grading scale independent of graft type. Screw‑anchored rib autograft achieved 100 % solid fusion at ≥3 months (n=16), compared to 57 % fusion (4/7) and 43 % resorption/pseudarthrosis in standard allograft/BMP group (p=0.0066). The new 0–2 radiographic grade correlated well with CT-defined outcomes 11)

Critical review

1. Study design & cohort: Retrospective, single‑institution, relatively small sample (n=21 total; final rib‑graft cohort n=17 minus one without CT). Comparison spans two eras (2015–2016 vs. 2016–2022), risks secular trends or surgeon learning‑curve bias.

2. Intervention vs. control: Cohort 1 received standard instrumentation with allograft/BMP; cohort 2 received screw‑fixed rib graft. But several cohort 2 cases were revisions from cohort 1, confounding the groups. No randomization.

3. Outcomes & follow-up: Fusion assessed at ≥3 months by blinded neuroradiologists with a 0–2 grading scale—clear and reproducible. However, mid / long‑term (>1 year) follow-up beyond early fusion rate not well characterized.

4. Results interpretation: Dramatic fusion improvement is compelling, but may reflect both graft technique and instrumentation changes over time. Lack of halo/BMP/lab comparisons limiting.

5. Radiographic grading scale: Solid concept, but needs external validation across graft types and institutions.

6. Safety & complications: No donor‑site morbidity or hardware failures reported over 5+ years. But small sample limits detection of rare complications.

7. Limitations:

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Surgical versus Non-Surgical Treatment of Thoracolumbar Burst Fractures in Neurologically Intact Patients: A Prospective International Multicentre Cohort Study

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In a Prospective multicentre cohort study Dvorak et al. from the University of British Columbia ( – Vancouver), Univ. Medical Center Utrecht, Malteser Waldrankenhaus St. Marien (Erlangen), Univ. of Washington (Seattle), etc. published in the Global Spine Journal to examine whether surgical vs non‑surgical treatment accelerates clinically meaningful improvement (MCID of 12.8 points ODI) in neurologically intact thoracolumbar burst fracture patients within 1 year. Similar median time to reach MCID in both groups (~25 days). Post‑hoc suggests surgery may achieve ‘minimal disability’ (ODI <20) faster (69 vs 82 days; P=0.057). Larger trials needed 2)

Critical Appraisal

  • Strengths: Prospective design, multicentre/international inclusion enhances generalizability; uses accepted ODI threshold.
  • Limitations: Not randomized—treatment selection bias possible; statistical power limited—non-significant trend (P=0.057) may be false negative; outcome centered on ODI improvement, lacking radiographic, complication, or cost analysis within this paper.

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Combining rehabilitation nursing with nutritional intervention to improve self-care ability and nutritional status in elderly stroke patients: a randomized controlled trial

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In a randomized controlled trial, Liu Mei et al. from the *Zibo Central Hospital* (China) evaluated whether combining rehabilitation nursing with structured nutritional support could improve elderly stroke prognosis survivors. Published in the *Journal of Health Population and Nutrition* (2025), the study provides evidence that a combined intervention significantly enhances:

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Methodological Strengths

  • Large sample (n=300); randomization supports internal validity
  • Multiple validated tools: NDS, MMSE, BI, FMA, biochemical & anthropometric measures
  • Ethical approval and informed consent ensured

Key Limitations

  • Lack of blinding → potential bias
  • Comparator (‘standard care’) vaguely described
  • No follow-up data: long-term effect unclear
  • No economic evaluation despite resource demands

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Diagnostic and management concordance between chiropractors and neurosurgeons for patients with low back pain

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In a secondary analysis of RCT comparing diagnostic & management decisions Janny Mathieu et al. from:

  1. Université du Québec à Trois‑Rivières, Trois‑Rivières, QC, Canada
  2. CIUSSS‑MCQ, Trois‑Rivières, QC, Canada
  3. Division of Neurosurgery, Faculty of Medecine, Université de Montréal, Montréal, QC, Canada.
  4. Université de Sherbrooke, Longueuil, QC, Canada
  5. Balgrist University Hospital, Zurich, Switzerland
  6. University of Zurich Spine Centre, Zurich, Switzerland
  7. University of Toronto, Toronto, Canada

published in Scientific Reports to assess agreement in diagnosis and management between chiropractors and neurosurgeons for patients referred for Low back pain consultation. Diagnostic concordance was moderate (74.7%, κ = 0.51), management concordance strong (82%), suggesting chiropractors are competent for triage of non‑surgical low back pain, potentially easing surgical consult load 1)

Critical review:

– Strengths:

  1. Real‑world, clinically relevant sample (mean age ~60, N=101).
  2. Direct comparison with neurosurgeons using standardized categories.
  3. Good statistical rigour with κ, CI, p‑values reported.

– Limitations:

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Movie-watching evokes ripple-like activity within events and at event boundaries

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In a neurophysiological observational study Silva et al. from the Hospital Clínic–Barcelona, Barcelona, Spain published in Nature Communications to examine hippocampal and neocortical ripples during movie watching, and their relationship to event segmentation and later memory recall. The hippocampal ripples spike at event boundaries (linked to segmentation), while cortical ripples during events—especially in temporal cortex—predict later recall 1)

Critical Evaluation

Design & methods: – Intracranial recordings in ten epilepsy patients offer impressive temporal and spatial resolution in a naturalistic task. – However, sample size is small and patient population may limit generalizability. – Movie events are naturalistic, but segmentation boundaries may vary across subjects—analytical controls needed.

Results: – Clear increase in hippocampal ripples at event boundaries supports theories of hippocampal involvement in chunking continuous experiences. – Temporal cortex ripple rate correlation with recall is compelling—but causality is untested.

Limitations: – The patient sample’s neurological condition may alter ripple dynamics. – Lacking control comparisons (e.g., non-epileptic controls or different stimuli types). – Could benefit from linking neural dynamics more directly to behavioral performance (e.g., recall detailed metrics).

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