Clinical and surgical outcome in patients with cervical spondylodiscitis-a single-center retrospective case series of 24 patients.

Objective: Cervical spondylodiscitis is a rare pathology, with an incidence of 0.5-2.5 per 100,000 population, posing significant potential risks. This type of infection can lead to neurological impairment in up to 29% of patients. Radical surgical debridement of the infected segment, fusion, and an intravenous antibiotic regimen remains the gold standard in most spine centers. This study aimed to analyze the surgical outcome in a tertiary spine center based on disease severity. Methods: In this study, we retrospectively included all patients diagnosed with cervical spondylodiscitis and treated at the University Hospital Augsburg between January 2017 and May 2022. We collected and analyzed baseline parameters on clinical presentation with symptoms, laboratory parameters, radiological appearance, and surgical parameters such as type of approach and implant, as well as neurological and radiological outcomes. Descriptive statistics were performed using SPSS, and relevant correlations were examined using the t-test for independent samples and the chi-square test. Results: Twenty-four patients (9%) with cervical spondylodiscitis were identified. Twenty-two (92%) surgically treated patients were subdivided into the complicated discitis group (n = 14, 64%) and the uncomplicated discitis group (n = 8, 36%). Seventeen patients (71%) presented with sepsis on admission, 17 patients (71%) were diagnosed with epidural abscess on primary imaging, and 5 patients (21%) had more than one discitis lesion at a distant spinal segment. The presence of epidural abscess was significantly associated with systemic sepsis (OR = 6.2; p = 0.03) and myelopathy symptoms (OR = 14.4; p = 0.00). The most frequently detected specimen was a multisensitive Staphylococcus aureus (10 patients, 42%). Six patients (25%) died after a median of 20 days despite antibiogram-accurate therapy, five of whom were diagnosed with a complicated type of discitis. The follow-up data of 15 patients (63%) revealed permanent neurological damage in 9 patients (38%). Notably, the surgical approach was a significant factor for revision surgery (p = 0.008), as three out of five (60%) ventrodorsal cases with complicated discitis were revised. Conclusion: Cervical spondylodiscitis represents a severe infectious disease that is often associated with permanent neurological damage or a fatal outcome, despite adequate surgical and antibiotic treatments. Complicated types of discitis may require a more challenging surgical and clinical course.

Intraoperative radiotherapy combined with spinal stabilization surgery-a novel treatment strategy for spinal metastases based on a first single-center experiences.

INTRODUCTION: Current treatment of spinal metastases (SM) aims on preserving spinal stability, neurological status, and functional status as well as achieving local control. It consists of spinal surgery followed by radiotherapy and/or systemic treatment. Adjuvant therapy usually starts with a delay of a few weeks to prevent wound healing issues. Intraoperative radiotherapy (IORT) has previously been successfully applied during brain tumor, breast and colorectal carcinoma surgery but not in SM, including unstable one, to date. In our case series, we describe the feasibility, morbidity and mortality of a novel treatment protocol for SM combining stabilization surgery with IORT. METHODS: Single center case series on patients with SM. Single session stabilization by navigated open or percutaneous procedure using a carbon screw-rod system followed by concurrent 50 kV photon-IORT (ZEISS Intrabeam). The IORT probe is placed via a guide canula using navigation, positioning is controlled by IOCT or 3D-fluroscopy enabling RT isodose planning in the OR. RESULTS: 15 (8 female) patients (71 ± 10y) received this treatment between 07/22 and 09/23. Median Spinal Neoplastic Instability Score was 8 [7-10] IQR. Most metastasis were located in the thoracic (n = 11, 73.3%) and the rest in the lumbar (n = 4, 26.7%) spine. 9 (60%) patients received open, 5 (33%) percutaneous stabilization and 1 (7%) decompression only. Mean length of surgery was 157 ± 45 min. Eleven patients had 8 and 3 had 4 screws placed. In 2 patients radiotherapy was not completed due to bending of the guide canula with consecutive abortion of IORT. All other patients received 8 Gy isodoses at mdn. 1.5 cm [1.1-1.9, IQR] depth during 2-6 min. The patients had Epidural Spinal Cord Compression score 1a-3. Seven patients (46.7%) experienced adverse events including 2 surgical site infection (one 65 days after surgery). CONCLUSION: 50 kV photon IORT for SM and consecutive unstable spine needing surgical intervention is safe and feasible and can be a promising technique in selected cases.

Directional electrodes in deep brain stimulation: Results of a survey by the European Association of Neurosurgical Societies (EANS).

Introduction: Directional Leads (dLeads) represent a new technical tool in Deep Brain Stimulation (DBS), and a rapidly growing population of patients receive dLeads. Research question: The European Association of Neurosurgical Societies(EANS) functional neurosurgery Task Force on dLeads conducted a survey of DBS specialists in Europe to evaluate their use, applications, advantages, and disadvantages. Material and methods: EANS functional neurosurgery and European Society for Stereotactic and Functional Neurosurgery (ESSFN) members were asked to complete an online survey with 50 multiple-choice and open questions on their use of dLeads in clinical practice. Results: Forty-nine respondents from 16 countries participated in the survey (n = 38 neurosurgeons, n = 8 neurologists, n = 3 DBS nurses). Five had not used dLeads. All users reported that dLeads provided an advantage (n = 23 minor, n = 21 major). Most surgeons (n = 35) stated that trajectory planning does not differ when implanting dLeads or conventional leads. Most respondents selected dLeads for the ability to optimize stimulation parameters (n = 41). However, the majority (n = 24), regarded time-consuming programming as the main disadvantage of this technology. Innovations that were highly valued by most participants included full 3T MRI compatibility, remote programming, and closed loop technology. Discussion and conclusion: Directional leads are widely used by European DBS specialists. Despite challenges with programming time, users report that dLeads have had a positive impact and maintain an optimistic view of future technological advances.

Treatment of a symptomatic cervical cerebrospinal fluid fistula after full endoscopic cervical foraminotomy with CT-guided epidural fibrin patch.

BACKGROUND: There is only limited data on the management of cerebrospinal fluid (CSF) fistulas after cervical endoscopic spine surgery. We investigated the current literature for treatment options and present a case of a patient who was treated with CT-guided epidural fibrin patch. METHODS: We present the case of a 47-year-old female patient with a suspected CSF fistula after endoscopic decompression for C7 foraminal stenosis. She was readmitted 8 days after surgery with dysesthesia in both upper extremities, orthostatic headache and neck pain, which worsened during mobilization. A CSF leak was suspected on spinal magnetic resonance imaging. A computer tomography (CT)-guided epidural blood patch was performed with short-term relief. A second CT-guided epidural fibrin patch was executed and the patient improved thereafter and was discharged at home without sensorimotor deficits or sequelae. We investigated the current literature for complications after endoscopic spine surgery and for treatment of postoperative CSF fistulas. RESULTS: Although endoscopic and open revision surgery with dura repair were described in previous studies, dural tears in endoscopic surgery are frequently treated conservatively. In our case, the patient was severely impaired by a persistent CSF fistula. We opted for a less invasive treatment and performed a CT-guided fibrin patch which resulted in a complete resolution of patient's symptoms. DISCUSSION AND CONCLUSION: CSF fistulas after cervical endoscopic spine procedures are rare complications. Conservative treatment or revision surgery are the standard of care. CT-guided epidural fibrin patch was an efficient and less invasive option in our case.

Intraoperative radiotherapy during awake craniotomies: preliminary results of a single-center case series.

Awake craniotomies are performed to avoid postoperative neurological deficits when resecting lesions in the eloquent cortex, especially the speech area. Intraoperative radiotherapy (IORT) has recently focused on optimizing the oncological treatment of primary malignant brain tumors and metastases. Herein, for the first time, we present preliminary results of IORT in the setting of awake craniotomies. From 2021 to 2022, all patients undergoing awake craniotomies for tumor resection combined with IORT were analyzed retrospectively. Demographical and clinical data, operative procedure, and treatment-related complications were evaluated. Five patients were identified (age (mean ± standard deviation (SD): 65 ± 13.5 years (y)). A solid left frontal metastasis was detected in the first patient (female, 49 y). The second patient (male, 72 y) presented with a solid metastasis on the left parietal lobe. The third patient (male, 52 y) was diagnosed with a left temporoparietal metastasis. Patient four (male, 74 y) was diagnosed with a high-grade glioma on the left frontal lobe. A metastasis on the left temporooccipital lobe was detected in the fifth patient (male, 78 y). After awake craniotomy and macroscopic complete tumor resection, intraoperative tumor bed irradiation was carried out with 50 kV x-rays and a total of 20 Gy for 16.7 ± 2.5 min. During a mean follow-up of 6.3 ± 2.6 months, none of the patients developed any surgery- or IORT-related complications or disabling permanent neurological deficits. Intraoperative radiotherapy in combination with awake craniotomy seems to be feasible and safe.

The prevention of obesity starting from the kindergarten by means of peer educator mothers and WhatsApp messages.

BACKGROUND: Early-life diet plays a crucial role in the development of body weight issues. We therefore investigated the effectiveness of a peer-education intervention, aiming at encouraging the intake of fruits and vegetables and of a healthy mid-morning snack, targeting the mothers of 3-8 years old children attending kindergarten and primary school. STUDY DESIGN: Experimental approach. METHODS: The study involved 924 children (intervention group) and 450 children (control group). The intervention was carried out by organizing three meetings at school with the participation of healthcare professionals, mothers and teachers in a maieutic way. The meetings focused on i) discussing the issues that mothers face with their children's nutrition; ii) possible solutions; iii) identification of "leading mothers" playing as peer-educators. As control a similar intervention targeting only the teachers, without involving the mothers, was also carried out. The effectiveness of such interventions was evaluated by external evaluators, before, the interventions and 3 and 9 months after the interventions. RESULTS: The check, carried out 3 months after the intervention, showed a significant improvement with respect to the mid-morning snack, and the consumption of the main dishes as well as fruits; the check carried out 9 months after the intervention, showed that such improvements were maintained in the case of the mid-morning snack and the fruit intake. No improvement was observed in relation to the control group. CONCLUSIONS: This is the first example of an intervention promoting a healthy diet involving mothers of children attending kindergarten and primary school as peer educators and it actually improved the dietary habits.

E-mail messages can be effective to make the health education activity of family pediatricians more effective.

Background: Not all family pediatricians carry on their health education tasks constantly and they do not often use effective communication strategies. To deal with this situation it is useful to find ways that are easy to implement, reproducible in the most diverse contexts and that can be accepted even by the least motivated pediatricians. We have been experimenting a training method, based on sending a series of e-mail messages, assessing their feasibility and effectiveness. Study design: Experimental approach. Methods: The intervention consisted of sending 21 email to 141 family pediatricians. In order to assess the intervention effectiveness, we first select randomly 20 pediaticians out of the 141 and before the intervention we interviewed in their offices 400 parents of 2-14 years-old children (20 parents for each of the 20 family pediatricians); similary 5-6 months after the intervention, we selected randomly other 20 pediatricians and interviewed 355 parents. The emails mentioned the 5 A's model as well as the motivational interview, the model of the stages of change and the counseling techniques. They also enclosed communication material to be reproduced and given to the parents, as well as recommendations and guidelines. Five messages contained self-assessment tests. Results: Following the intervention, out of 26 questions asked to mothers, there was a significant improvement in the response to 10 questions and a worsening in the response to a single question. The overall difference between before and after the intervention is very significant (p <0.0001). Conclusions: The intervention was proved to be very effective and easily reproducible. It is necessary to confirm these findings with further studies based on the use of a control group too. It appears to be the first time that email messages are sent in order to train family pediatricians on the behavior change counseling.

[Reducing tinnitus intensity : Pilot study to attenuate tonal tinnitus using individually spectrally optimized near-threshold noise]. / Reduktion der Tinnituslautstärke : Pilotstudie zur Abschwächung von tonalem Tinnitus mit schwellennahem, individuell spektral optimiertem Rauschen.

BACKGROUND: Around 15% of the general population is affected by tinnitus, but no real cure exists despite intensive research. Based on our recent causal model for tinnitus development, we here test a new treatment aimed at counteracting the perception. This treatment is based on the stochastic resonance phenomenon at specific auditory system synapses that is induced by externally presented near-threshold noise. OBJECTIVE: This pilot study will investigate whether individually spectrally adapted noise can successfully reduce chronic tonal/narrow-band tinnitus during stimulation. MATERIALS AND METHODS: Hearing loss (HL) as well as tinnitus pitch (TP) and loudness (TL) were audiometrically measured in 22 adults (46.6±16.3 years; 4 women) with tinnitus. Based on these measurements, up to eight different noise stimuli with five intensities (-20 to +20 dB SL) were generated. These were presented for 40 s each via audiologic headphones in a soundproof chamber. After each presentation, the change in TL was rated on a five-level scale (-2 to +2). RESULTS: We found patients (n = 6) without any improvement in their TL perception as well as patients with improvement (n = 16), where stimulation around the TP was most effective. The groups differed in post-hoc analysis of their audiograms: the effectiveness of our new therapeutic strategy obviously depends on the individual HL, and was most effective in normal-hearing tinnitus patients and those with mild HL. CONCLUSION: Subjective TL could be reduced in 16 out of 22 patients during stimulation. For a possible success of a future therapy, the HL seems to be of relevance.

Sub-decapitation in suicidal chainsaw injury: report of a rare case and operative management.

Chainsaw accidents are severe injuries, mostly work-related and concerning upper or lower extremities. Few suicidal chainsaw injuries are reported, all of them fatal. We report the case of a 23-year-old man who attempted suicide by sub-decapitation with a chainsaw, its successful (peri-) operative management, and clinical course along with a discussion of the contemporary management and body of evidence of such lesions. Chainsaw injuries are severe traumas. Stepwise surgery with maximal functional reconstruction is safe and optimal clinical outcome can be achieved.

[Models of tinnitus development : From cochlea to cortex]. / Modelle der Tinnitusentstehung : Von der Cochlea zum Kortex.

The development of subjective tinnitus is still not mechanistically understood and existing models are controversially discussed. In this overview, the authors discuss three of the main models, all of which propose damage to the cochlea as the initial step in tinnitus development. Based on these models, a possible manifestation of tinnitus-related neuronal activity at the perceptually relevant level of the auditory pathway, the auditory cortex, is presented. Furthermore, it is demonstrated that one of the models offers a new view on the phenomenon, which could potentially help patients to better cope with their condition.

[Evaluation of the effectiveness of a nutrition education intervention performed by primary school teachers]. / Valutazione d'efficacia di un intervento di educazione alimentare condotto da insegnanti di scuola media inferiore.

This study values the effectiveness of nutrition education interventions carried out by teachers with active didactic methodologies. The research was carried out by administering a frequency of food intake questionnaire, before and after the intervention. To compare the answers given before and after the educational intervention the Wilcoxon-test was applied to dependent data. Our research confirmed that a substantial percentage of children do not show a correct nutrition and therefore nutrition education interventions are opportune and necessary. In the group with "insufficient execution" particular variations are not taken place. In the group with "sufficient execution" increase the number of subjects having breakfast, particularly with milk and biscuits, and decrease the snakes intake. Moreover there is a general decrease of intake food as meat, fish, vegetables, salami and legumes. So this educational intervention seems to have only partial effectiveness.

Comparison of initial fixation strength between biodegradable and metallic interference screws and a press-fit fixation technique in a porcine model.

The objective of this study was to evaluate the initial fixation strength of a biodegradable interference screw compared with press-fit fixation and a titanium interference screw in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Porcine lower limbs were used. The specimens underwent 500 loading cycles between 60 and 250 N. This corresponds to loads in the graft during aggressive rehabilitation. Thereafter, intact specimens were loaded to failure. Failure mode was defined by visual analysis. Under cyclic loads none of the interference screw fixations failed. In the press-fit group (angle between load axis and tunnel axis 80 degrees), five specimens failed. The mean maximal load to failure was 945 N (+/- 87) for the titanium screw, 797 N (+/- 60) for the biodegradable screw, and 708 N (+/- 211) for the five press-fit specimens that did not fail during cyclic loading. With respect to primary fixation strength, biodegradable screws are a reasonable alternative to titanium interference screws. The press-fit fixation did not provide a secure fixation in all cases. Five press-fit specimens failed under cyclic loads comparable with those seen under conditions of accelerated rehabilitation.

PCDD/F, PCB and PAH content of Brazilian compost.

The level of polychlorinated dibenzo-p-dioxins, polychlorinated dibenzofurans (PCDD/F), polychlorinated biphenyls (PCB) and polycondensated aromatic hydrocarbons (PAH) in compost of different degree of maturation from 21 Brazilian municipal solid waste (MSW) compositing plants has been evaluated. The study shows that most PCDD/F concentrations are above the levels acceptable in Baden-Württemberg (FRG), being 17 ng I-TE/kg, especially for compost from metropolitan areas. These results are similar to those found for Germany. For PCB, the average of the sum of the concentrations of the six congeners PCB 28, 52, 101, 138, 153 and 180 is about 3 times lower in relation to German samples being less than the value indicated by the Baden-Württemberg legislation (0.2 mg/kg).

Cortical versus cancellous interference fixation for bone-patellar tendon-bone grafts.

The objective of this study was to evaluate the initial fixation strength of a metal interference screw (9 x 25 mm; Arthrex, Naples, FL) with respect to its position relative to the bone plug in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Porcine lower limbs were used. In group 1 (n = 20) the screw was placed adjacent to the cortex of the bone plug. In group 2 (n = 20) the screw was placed between the cancellous surfaces of the tibial tunnel and the bone plug. Specimens were loaded to failure using an universal material testing machine. Failure mode was defined by visual analysis of the specimens after loading. Primary fixation strength was not significantly different for both groups. Maximum force was 779 +/- 179 N (group 1, cortical side) and 743 +/- 143 N (group 2, cancellous side). There was a difference in failure modes. In group 1, testing resulted predominantly in tendon ruptures and bone plug fractures (70%). In group 2, bone plug pullouts were predominant (75%). From these data we conclude that the position of the screw relative to the bone plug influences failure mode but not the initial fixation strength.

Fixation strength of a biodegradable interference screw and a press-fit technique in anterior cruciate ligament reconstruction with a BPTB graft.

The objective of this study was to evaluate the fixation strength of a biodegradable interference screw (Arthrex, Naples, FL) compared with press fit fixation and a titanium interference screw in anterior cruciate ligament (ACL) reconstruction using a bone-patellar tendon-bone (BPTB) graft. Porcine lower limbs were used. Ultimate failure loads of the biodegradable screw (805.2 N; range 680 to 995 N) did not differ significantly from ultimate failure loads of titanium interference screws (768.6 N; range 544 to 1094 N). Press fit fixation provided significant (P < .01) lower fixation strength (462.5 N; range 80 to 825 N). These results support the conclusion that biodegradable interference screws are a reasonable alternative in terms of primary fixation strength.

Depression by nicotine of pain-related nociceptive activity in the rat thalamus and spinal cord.

To assess the possible role of nicotinergic control in nociception and pain, experiments were carried out on rats under urethane anesthesia in which nociceptive activity was elicited by electrical stimulation of afferent C fibers in the sural nerve and recorded from single neurones in the thalamus and from ascending axons in the spinal cord. Intravenous administration of nicotine (0.01-0.5 mg/kg) depressed the nociceptive activity evoked in the thalamus and the spinal cord in a dose-dependent way. The maximum depression in thalamus and spinal cord was 40% of control activity and obtained at a dose of 0.025 mg/kg. Likewise, local administration of nicotine to the spinal cord by intrathecal injection (5, 10, and 30 micrograms) reduced the nociceptive activity evoked in neurones of the thalamus and in ascending axons of the spinal cord, the maximum of the depression being 40% of control activity. The depressant effect of nicotine (0.05 mg/kg) was reduced by mecamylamine (1 mg/kg) but not by atropine (0.5 mg/kg). It is concluded that the antinociceptive effect of nicotine is due to a specific action of the alcaloid at the spinal level.