Neurosurgical Review

Purpose to comprehensively identify determining factors of perceived neck pain in a non-deformity population, integrating psychological and sagittal balance parameters.Methods a cross-sectional study of prospectively collected data was conducted on patients admitted for cervical spondylosis at two tertiary university hospitals between April 2024 and August 2025. Eligible cases were retrieved from the PANDA Registry. Records were excluded if standing X-ray was unavailable and/or not-evaluable (e.g. shoulder prosthesis); or if the admission pathology involved the cranio-cervical junction, tumors, deformities, spinal cord disease, or infections. Preoperative data included demographic, clinical (VAS neck), psychological (SCL-27, I-TIPI, CD-RISC10), and sagittal balance variables (McGregor slope, C1-C2 lordosis, C2 slope, C2-C7 lordosis, cSVA, T1 slope, cervical mismatch). Correction for multiple comparisons was applied within pre-specified hypothesis domains.Results one-hundred-thirty records were included. Intra-rater reliability for radiographic parameters was excellent (> 0.9). After categorization of patients by neck pain severity, pairwise analysis showed that only C1-C2 lordosis remained significantly higher in patients exhibiting severe neck pain (VAS < 7 vs. VAS ≥ 7). When stratified for moderate-to-severe neck pain (VAS ≥ 4), several SCL-27 scales, namely dysthymic, vegetative, agoraphobic, sociophobic, and GSI scores, and C1C2 lordosis showed significant differences. Correlation analysis using VAS neck as the dependent variable demonstrated a significant positive correlation with SCL-27 dysthymic and vegetative scores. C1-C2 lordosis showed a significant inverse correlation with neck pain. In univariate analysis, only SCL-27 dysthymic, vegetative, and GSI scores emerged as significant univariate associations of VAS neck. After correction for multiple comparisons, the SCL-27 vegetative, dysthymic and GSI scores retained significance, whereas C1-C2 lordosis did not.Conclusion in a non-deformity population, sagittal balance parameters alone do not adequately explain patient-perceived neck pain. These findings support the preoperative use of psychological assessments, especially the SCL-27, as a useful tool in preoperative screening and individualised counselling.

Ventricular catheter placement (VCP) is a life-saving intervention frequently performed in emergency departments and intensive care units. The free hand technique is the most commonly used approach for placing catheters. This study demonstrates the anatomical and radiological relationship between catheters inserted through the most commonly used access points and the anatomical structures in their path. Moreover, we calculate the insertion angles and catheter lengths that should be specified during VCP. Six donated human heads, fixed in 10% formalin and injected with colored silicone dye, were used in this study. Ventricular catheters were inserted through Kocher's, Paine's, Keen's, Frazier's, and Dandy's points under navigation. Dissection was performed from the skin to the inner wall of the ventricle while preserving the inserted catheters. The insertion angle and delivery length for each access point were measured both in the donated human heads and in 50 patients with hydrocephalus. In addition, magnetic resonance tractography was performed, and the relationship of each catheter with anatomical structures was presented as a three-dimensional model. Catheters inserted from Keen's and Paine's points pass through regions containing dense and crucial vascular structures. Catheters inserted from Keen's, Paine's, and Frazier's points enter the cortex through eloquent areas. The catheter inserted from Keen's point passes through the most diverse white matter pathway. Catheters inserted from Kocher's and Dandy's points pass through regions with less dense cortical vascular structures. Moreover, they pass through noneloquent cortical structures and fewer white matter tracts. This is the first anatomical dissection and tractography report describing the relationship between catheters introduced through the most common ventricular access sites and the anatomical structures along their path from the skin to the ventricle. Understanding the anatomical and radiological three-dimensionality of VCP will increase the safety of its applications.

BACKGROUND: Surgical decompression is regarded as standard treatment for degenerative cervical myelopathy (DCM). However, the timing of surgery remains a critical yet unresolved issue in clinical practice. Therefore, this meta-analysis aimed to evaluate the impact of symptom duration on surgical outcomes and determine the optimal timing for surgery. METHODS: A systematic search was conducted on 16th November 2025 using PubMed, Ovid, Scopus, and Web of Science databases to identify eligible articles. Studies comprising patients with DCM undergoing surgery, assessing outcome by mJOA score at a minimum of 12 months of follow-up, were included. A risk of bias in the included studies was assessed using the Quality in Prognostic Studies (QUIPS) tool. RESULTS: From 1522 records, 14 studies encompassing a total of 3162 patients were included in the current meta-analysis. Symptom duration was significantly associated with postoperative mJOA score according to univariate (OR: 2.15; 95% CI: 1.64-2.81) and multivariate data (OR: 1.78; 95% CI: 1.23-2.57). Meta-regression showed that neither baseline mJOA score nor age affected the association. Moreover, early surgery resulted in reduced neck pain and disability measured by the NDI score (OR: 1.56; 95% CI: 1.24-1.95), but not quality of life according to EQ-5D (OR: 1.47; 95% CI: 0.74-2.89). At the 6-month and 12-month cut-off points, patients with longer symptom duration had significantly worse outcomes in terms of mJOA score, and after exclusion of high-risk-of-bias studies, only at the 12-month cut-off point. However, the test for subgroup differences was insignificant (p = 0.89). CONCLUSION: Longer symptom duration is associated with poor surgical outcomes. Therefore, the duration of symptoms should be regarded as a clinically meaningful factor when counseling patients with DCM and planning surgical intervention. An optimal threshold for symptom duration, indicating when the surgery should be performed to prevent poor outcomes, cannot be recommended due to limitations of published data and needs to be established by further well-designed prospective studies. Future research should also aim to define optimal time cut-offs across different degrees of DCM severity and varied disease trajectories.