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The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging and invasive procedures, e.g., biopsy. It is essential to qualify the patient for an appropriate treatment using dedicated scales. Decompression of the spinal cord is a critical issue to save or restore neurological function in a patient with spine metastases. Surgical treatment ought to meet three criteria: release spinal cord and nerve roots, restore the spine’s anatomical relations, and ensure the internal stabilization of the spine. A good result from surgical treatment enables the continuation of radiotherapy, chemotherapy, hormone therapy, and targeted molecular therapy. Stereotactic radiosurgery and stereotactic body radiotherapy are more effective ways of treating spine metastases than conventional external beam radiotherapy. They allow higher doses of radiation, concentrated precisely at the tumor site. Our review summarizes the established and emerging concepts in the treatment of spine metastases. A holistic approach to the patient enables the selection of the appropriate therapy.

Background Myelin basic protein (MBP) is the second most abundant protein in central nervous system myelin. Since the 1980s, it has been regarded as a marker of brain tissue injury in both trauma and disease. There have been no recent reports regarding MBP in aneurysmal subarachnoid haemorrhage (SAH). Methods One hundred four SAH patients with ruptured aneurysms underwent endovascular treatment within 24 h of rupture, and 156 blood samples were collected: 104 on days 0–3, 32 on days 4–6 and 20 on days 9–12 post-SAH. MBP levels were assayed using ELISA and compared with the clinical status on admission, laboratory results, imaging findings and treatment outcome at 3 months. Results MBP levels on days 0–3 post-SAH were significantly higher among poor outcome patients (p p = 0.005), patients who underwent intracranial intervention (p p p = 0.009) and ICH (p = 0.039). There was clinically relevant correlation between MBP levels on days 0–3 post-SAH and 3-month Glasgow Outcome Scale (cc = − 0.42) and also ICH volume (cc = 0.48). All patients who made a full recovery had MBP levels below detection limit on days 0–3 post-SAH. Following endovascular aneurysm occlusion, there was no increase in MBP in 86 of the 104 patients investigated (83%). Conclusions The concentration of MBP in peripheral blood after intracranial aneurysm rupture reflects the severity of the brain tissue injury (due to surgery or ICH) and correlates with the treatment outcome. Endovascular aneurysm occlusion was not followed by a rise in MBP in most cases, suggesting the safety of this technique.

Background Clinical, psychological and demographic variables have been investigated to determine factors involved in quality of life of patients with chronic pain. It has been stressed that chronic pain is more associated with beliefs about pain, than with pain intensity. Objective The main aim of this retrospective cross-sectional study was to examine differences between postoperative beliefs about pain control, perception of pain and mood disturbances in patients treated operatively due to neck or lumbar discopathy and degenerative spine disease. Methods Forty-four patients treated operatively due to lumbar and forty-one patients treated surgically due to cervical discopathy filled in the Visual Analogue Scale (VAS), The Beck Depression Inventory (BDI-PL) and Beliefs about Pain Control Questionnaire (BPCQ-PL). Patients with lumbar and cervical discopathy additionally completed disease-specific outcome measures. Results The patient groups do not differ significantly in regards to BPCQ-PL, BDI-PL or VAS. Both study samples differ in regards to dependencies related to beliefs that pain is controlled by powerful others and about internal control of pain. Conclusions Cognitive-behavioral interventions, concerning depression and beliefs about pain control, may be appropriate for both lumbar and cervical surgical populations, to improve post-surgical functioning.

OBJECTIVES The medical and social care of drug-resistant epilepsy (DRE) entails significant costs. Approximately 30 to 40 percent of patients with DRE who underwent vagus nerve stimulator (VNS) implantation achieve an above 50 percent reduction in seizure frequency. The study objective was to analyze the effect of VNS on clinical effects improvement and therapy cost reduction in patients with DRE over a 2-year follow-up period. The second purpose of the study was to compare average costs of VNS treatment of patients with DRE in selected countries, taking into account the purchasing power parity. MATERIALS AND METHODS The study included all the patients who had VNS implanted at our department between 2014 and 2018. Data on clinical events and medical costs were collected prospectively and obtained from medical documentation. We also reviewed relevant literature on costs of VNS therapy in patients with DRE from the last 18 years. RESULTS Resource utilization and epilepsy-related events were reduced during the follow-up period compared to the baseline. Average total cost was estimated at EUR 7703.59 in year 1 and at EUR 7108.38 in year 2 following VNS implantation. Average direct costs of VNS treatment of patients with DRE over the last 18 years varied between the countries and ranged from EUR 24 790.43 in the United States to EUR 64.84 in the United Kingdom. CONCLUSION Vagus nerve stimulator is a cost-effective therapy yielding measurable clinical and therapeutic outcomes over the long term. Moreover, the analysis contained in this review highlights the poor consensus of methodological approaches.

Introduction. Recent instrumentation and software advancement enabled to develop new, high‑throughput targeted metabolomics methods for in‑depth exploration of metabolome in a quantitative manner.Material and Methods. The presented targeted metabolomics approach allows to analyze both of serum and CSF in the same way, with identical sample preparation procedures. The analyses were carried out using high‑performance liquid chromatography system coupled to triple quadrupole tandem mass spectrometer with electrospray ion source (LC‑ESI‑QqQ‑MS/MS). Results. The applied targeted metabolomics approach enabled to determine a wide panel of metabolites from different chemical classes of compounds including: acylcarnitines, amino acids and biogenic amines, glycerophospholipids, sphingolipids and sum of hexoses. Finally, 148 metabolites in serum and 57 in cerebrospinal fluid were determined.Conclusions. Here we presented the results of successful implementation of the method of analysis of low‑molecular weight compounds in human serum and CSF using targeted metabolomics. The evaluation of selected groups of metabolites resulted in obtaining the mean concentrations of panel of metabolites in serum and CSF, which gives a valuable information about the metabolome of these matrices.

Background The pathophysiology of brain injury following aneurysmal subarachnoid haemorrhage (SAH) is associated with numerous mediators. The aim of the study is to analyse protein changes after SAH in cerebrospinal fluid (CSF) using mass spectrometry (MS). Methods CSF samples were obtained from forty-four control subjects, seven good outcome and ten poor outcome SAH patients. CSF samples were collected at specific time intervals after SAH (days 1, 5 and 10). MALDI-TOF (Matrix Assisted Laser Desorption/Ionization Time-of-Flight) and ClinProTools software were utilised for MS, MS/MS (Mass Spectrometry) spectra collection and analysis. Selected masses were identified. The MALDI-TOF profiling experiments allowed for the targeted selection of potential markers in SAH. The study was performed in three steps by comparison of CSF samples: (1) from the control group and SAH patients (both good and poor outcome groups); (2) collected on days 1, 5 and 10 within the groups of poor SAH and good SAH patients, respectively; (3) from poor outcome SAH and good outcome patients at days 1, 5 and 10. Results 15 new proteins whose CSF level is alternated by SAH presence, SAH treatment outcome and time passed since aneurysm rupture were identified. Conclusions We demonstrated new proteins which might play a role in different stages of subarachnoid haemorrhage and could be a new target for further investigation.

Inflammation following subarachnoid hemorrhage (SAH) involves numerous mediators with biomarker properties. Preliminary studies indicated that clusterin, a multifunctional chaperon protein, was a potential biomarker in SAH. We aimed to clarify the status of clusterin in SAH.From 27 patients with severe SAH, 47 cerebrospinal fluid (CSF) samples were collected 0-3, 5-7, and 10-14 days after SAH. Control CSF was collected from 25 age- and sex-matched healthy control subjects undergoing spinal anesthesia for minor surgery. Clusterin concentrations were assayed using enzyme-linked immunosorbent assay and compared with inflammatory markers, imaging findings, and treatment outcome.In healthy control subjects, mean CSF clusterin level (1908.5 ng/mL ± 36.0) was significantly higher than in the patient group (P0.001). In the patient group, mean clusterin level was 741.1 ng/mL ± 759.2 0-3 days, 601.6 ng/mL ± 507.2 5-7 days, and 639.2 ng/mL ± 446.8 10-14 days after SAH. Clusterin level failed to differentiate between good (Glasgow Outcome Scale 4-5) and poor (Glasgow Outcome Scale 1-3) outcomes 0-3 days and 10-14 days after SAH (P = 0.238 and P = 0.225), but significantly higher levels of CSF clusterin were found 5-7 days after SAH in patients with good outcome (P = 0.017). There was a significant correlation between CSF clusterin level 5-7 days after SAH and Glasgow Outcome Scale at 3 months (correlation coefficient = 0.633). The best correlation was found for World Federation of Neurological Societies scale (correlation coefficient = -0.741).SAH is associated with immediate decrease in CSF clusterin concentrations. Clusterin level at one point was a good predictor of outcome, and it may serve as a biomarker.

Parkinson’s disease (PD) is a major public health problem. Since currently there are no reliable diagnostic tools to reveal the early steps of PD, new methods should be developed, including those searching the variations in human metabolome. Alterations in human metabolites could help to establish an earlier and more accurate diagnosis. The presented research shows a targeted metabolomics study of both of the serum and CSF from PD patients, atypical parkinsonian disorders (APDs) patients, and the control. The use of the LC-MS/MS system enabled to quantitate 144 analytes in the serum and 51 in the CSF. This information about the concentration enabled for selection of the metabolites useful for differentiation between the studied group of patients, which should be further evaluated as candidates for markers of screening and differential diagnosis of PD and APDs. Among them, the four compounds observed to be altered in both the serum and CSF seem to be the most important: tyrosine, putrescine, trans-4-hydroxyproline, and total dimethylarginine. Furthermore, we indicated the metabolic pathways potentially related to neurodegeneration processes. Our studies present evidence that the proline metabolism might be related to neurodegeneration processes underlying PD and APDs. Further studies on the proposed metabolites and founded metabolic pathways may significantly contribute to understanding the molecular background of PD and improving the diagnostics and treatment in the future.

Introduction. High-mobility group box 1 (HMGB1) is an alarmin with proinflammatory potential determined by redox status of the cysteines at position 23 and 45. It may also play a role as a biomarker in biological fluids. The aim of this study was the identification of different HMGB1 redox forms in cerebrospinal fluid (CSF) obtained from subarachnoid hemorrhage patients. Material and Methods. 6 CSF samples were collected from aneurysmal subarachnoid haemorrhage patients. Commercially available HMGB1 isoforms served as a positive control. Immunoprecipitation and electrophoretic isolation of HMGB1 protein were performed, then both CSF and control were analyzed using mass spectrometry technique. To distinguish between fully reduced (thiol group at C23 and C45) and disulfide (disulfide bond connecting C23 and C45) HMGB1 forms, top-down sequencing of the spectra was performed. Results. Top-down sequencing analysis allowed to distinguish between HMGB1 isoforms only in commercially available standard without preceding immunoprecipitation and electrophoresis. MALDI spectra differ i.e. on the fully reduced HMGB1 spectrum fragmentation occurs before and beyond C22, which is not present on the disulfide HMGB1 spectrum. Analysis of HMGB1 isolated from CSF obtained from subarachnoid hemorrhage patients gave no results. Conclusions. Top-down sequencing enables to distinguish between redox forms of HMGB1. Electrophoresis and tryptic digestion cannot precede mass spectrometry analysis of redox forms of HMGB1 due to the reduction of disulfide bonds during these processes. Preferred method of isolation of HMGB1 for direct analysis using top-down sequencing mustn’t include protein digestion or degradation.

Background The aim of this study is to present our 10 years of experience in endovascular treatment of ruptured posterior inferior cerebellar artery (PICA) saccular aneurysms and to compare clinical presentation and outcome after endovascular treatment between patients with PICA aneurysms and patients with aneurysms in different locations. Methods and findings Out of 932 patients with a ruptured intracranial aneurysm treated endovascularly in our institution, 38 aneurysms were located at the posterior inferior cerebellar artery. Clinical presentation, mean aneurysm diameter and outcome of the therapy in this group were compared with the same for ruptured aneurysms in other locations. Patients discharged with favourable outcomes were checked angiographically in the follow-up period. Thirty-four patients with ruptured PICA aneurysms were treated by selective endovascular coiling. Two patients with wide-necked aneurysms had endovascular stents implanted. In two cases, the parent vessel was occluded due to failure to catheterise the target aneurysm. The evaluated variables did not differ significantly between two groups, but significantly more ruptured aneurysms in the PICA group were under 6 mm in diameter. 29.4% of controlled aneurysms needed additional reembolisation in the follow-up period. Conclusions Clinical presentation, extension of subarachnoid haemorrhage and outcome after endovascular treatment did not differ significantly between patients with ruptured aneurysms located on the PICA and patients with aneurysms located elsewhere intracranially. Endovascular treatment is an effective method of therapy in patients with ruptured PICA aneurysms. In our experience, even when sacrificing of the PICA is required, the results of treatment are favourable.

Schwannomas in the presacral region of vertebral column occur sporadically and are usually diagnosed incidentally during diagnostic procedures applied as a response to nonspecific complaints associated with vertebral column or abdominal cavity. This study focuses not only on the presentation of the case of the patient with giant schwannoma in the retrorectal area, but on the highlighting of the problems associated with diagnosis and treatment of tumours located in this anatomic region as well. The presented case involves a 23-year old woman. The diagnosis of the disease was made during gynecological examination accompanied by ultrasonography of pelvic organs. Neurological examination disclosed no deviations from the normal condition. MR imaging allowed to determine precise location of the tumour and its anatomic relations to pelvic visceral and vascular structures. The patient underwent a successful surgery using laparotomy. Histological examination revealed structures of schwannoma. Surgical radicality and the lack of relapse were confirmed by MR imaging taken five years after the surgery.

Accurate prognosis of outcome in subarachnoid haemorrhage (SAH) identifies salvageable poor-grade patients. Widely available and independent prognostic factors are needed, thus value of six routine blood tests is established. Prospectively collected database of 116 aneurysmal SAH patients was reviewed for white blood cell (WBC) count and concentration of C-reactive protein (CRP), sodium, potassium, glucose and haemoglobin on day 0, 1, 2, 3–4 and 5–7 post-SAH. All patients were admitted within 24 h, treated endovascularly within 48 h and assessed neurologically at admission and at three months post-SAH. Multivariate logistic regression and receiver operating curve were analyzed for each type of parameter assessed on specific day post-SAH. We have identified three different types of blood tests with the largest area under the curve (AUC). The three types of parameters identified as the most accurate, independent prognostic factors for mortality are WBC count on day 1 (p Early alterations in routine blood tests provide an accurate prognosis of death in SAH independently from well-established prognostic tools.

Attempts to clarify mechanisms of early brain injury in subarachnoid hemorrhage (SAH) revealed a high-mobility group box 1 (HMGB1) protein involvement in sterile inflammation initiated by aneurysm rupture. This study aims at assessing the prognostic value of HMGB1 in comparison with traditional biomarkers.Ten patients with Fisher grade 4 SAH and acute hydrocephalus underwent endovascular coiling and ventriculostomy. HMGB1 level was measured in cerebrospinal fluid (CSF) samples collected on first, fifth, and 10th day. HMGB1 level in first sample was correlated with treatment outcome assessed in Glasgow outcome scale (GOS) at 3 months. Obtained results were compared with plasma inflammatory markers, clinical grading scales, and imaging grading scales. HMGB1 level in consecutive samples was analyzed in search of concentration trends correlating with patients' outcome.HMGB1 level in CSF of SAH patients, in contrast to control group, is significantly elevated (P.001). Good (GOS3) and poor (GOS ≤ 3) outcome patients differ significantly in HMGB1 level on admission (P.01). The strongest correlation to patients' outcome was found for Hunt and Hess scale (R = -.887, P.01), HMGB1 level (R = -.859, P.01), and World Federation of Neurological Surgeons scale (R = -.832, P.01). Constant and high HMGB1 level of 10 ng/mL or more in consecutive CSF samples identifies nonsurvivors.HMGB1 protein is elevated in SAH patients. Changes in the concentration of HMGB1 in consecutive samples of the CSF correlate with outcome. Our results encourage further proteomic investigation.

Background No research group has ever investigated the level of kinesiophobia in a well defined group of preoperative patients treated due to cervical discopathy and degenerative spine disease, confirmed by X-ray and magnetic resonance imaging (MRI) examinations. We aimed to investigate the degree of kinesiophobia and the differences in pain-related and psychosocial characteristics between patients with high and low levels of kinesiophobia, in relation to factors commonly associated with neck pain. Material/methods Sixty-five consecutive patients with cervical discopathy and coexisting degenerative changes were assessed pre-surgically. The mean pain duration was 31.7 SD 34.0 months. Patients completed the Polish versions of the Tampa Scale for Kinesiophobia (TSK-PL) on 2 occasions, and the following once: Neck Disability Index (NDI-PL), State-Trait Anxiety Inventory (STAI-PL), Coping Strategies Questionnaire (CSQ-PL), and the Visual Analogue Scale (VAS-PL). Results A high level of kinesiophobia was indicated in 81.5% and 87.7% of patients in first and second completion, respectively. Patients with high and low kinesiophobia differ in regards to the recreation section of NDI-PL (p=0.012), gender (p=0.043), and sports activity (p=0.024). Correlations were identified between TSK-PL and marital status (p=0.023) and sports activity (p=0.024). Conclusions Kinesiophobia levels are higher in patients with chronic cervical pain before surgical treatment. Fear of movement tends to be higher in women and among patients avoiding sports recreation before surgical treatment. Although sports activity and socio-demographic data are predictors of kinesiophobia, psychological, pain-related, and clinical data are not. These findings should be considered when planning rehabilitation after surgical treatment of cervical discopathy and coexisting degenerative changes.

Introduction. Neurosurgical emergencies are complex tasks. The current learning environment limits students’ ability to manage acute neurosurgical emergencies due to legal and safety concerns. Simulation provides an opportunity to participate in the care of neurosurgical emergencies and develop clinical decision making skills. Aim. We aim to determine whether neuroscience simulation curriculum improves student ability to: manage a critically ill patient, recognize neurosurgical emergencies, to assess how stress tolerance affects experience during simulations and effectiveness of students performance. The third objective is to develop a tool for student assessment.Material and Methods. The simulation was performed on SimMan 3G Human Patient Simulator (Laerdal Medical). Scenarios included common neurosurgical emergencies. Students were assessed before and after the course by completing a Likert type questionnaire. Response data was analysed using Cronbach’s reliability for Likert-type response data and Spearman's monotonic correlation. Results. 60 students of fifth and sixth year of medical studies attended the course. 39 students of them replied to the questionnaire. The simulated clinical experience was positive and it improved their knowledge about neurosurgical emergencies. There was an improvement in their confidence. Improvement in individual and team performance was also observed.Conclusions. Neurosurgical simulations improve students` ability to recognize neurosurgical emergencies. The level of stress related to simulation is important factor of the education process and should be reduced to improve students’ development. Our questionnaire is an effective tool for assessment of students experience during clinical simulations.

BACKGROUND/AIM One of the current hypotheses assumes that brain tumors exert an immunosuppressive influence on the surrounding cellular environment. Interleukin-10 (IL-10) is one of the immunosuppressive cytokines modifying the biological activity of cancer. The aim of this study was to assess the expression of IL10R in CD45+ cells within primary brain tumors and metastases and establish its association with tumor basic immunophenotype. PATIENTS AND METHODS Tissue samples were obtained intraoperatively during surgeries of 32 patients suffering from meningiomas (n=9), gliomas (n=12) and metastatic tumors (n=11). Expression was assessed with flow cytometry and immunohistochemical reactions. RESULTS Expression of IL10R subunits within the leukocyte population (CD45+ cells) was significantly higher in primary tumors than in metastases. CONCLUSION To the best of our knowledge, this is the first study describing a correlation between the IL10R expression on leukocytes and histological types of brain tumors.

Background: The authors are aware of only one article investigating amino acid concentrations in cerebrospinal fluid (CSF) in patients with ruptured intracranial aneurysms, and this was published 31 years ago. Since then, both management of subarachnoid haemorrhage (SAH) and amino acid assay techniques have seen radical alterations, yet the pathophysiology of SAH remains unclear. Objective: To analyse the pattern of concentrations of amino acids and related compounds in patients with different outcomes following aneurysmal SAH. Methods: 49 CSF samples were collected from 23 patients on days 0-3, 5 and 10 post-SAH. Concentrations of 33 amino acids and related compounds were assayed by liquid chromatography tandem-mass spectrometry in patients with good (Glasgow Outcome Scale 1-3) and poor (Glasgow Outcome Scale 4-5) outcome. Results: Of the 33 compounds assayed, only hydroxyproline and 3-aminoisobutyric acid appeared not to increase significantly following SAH. In poor outcome patients we found significantly higher concentrations of aspartic acid (p=0.038), glutamic acid (p=0.038) and seven other compounds on day 0-3 post-SAH; glutamic acid (p=0.041) on day 5 post-SAH, and 2-aminoadipic acid (p=0.033) on day 10 post-SAH. The most significant correlation with Glasgow outcome scale at three months was found for aminoadipic acid on day 10 post-SAH (cc= -0.81). Conclusions: Aneurysmal rupture leads to a generalised increase of amino acids and related compounds in CSF. The patterns differ between good and poor outcome cases. Increased excitatory amino acids are strongly indicative of poor outcome.

Receptors for advanced glycation end-products (RAGE) mediate the inflammatory reaction that follows aneurysmal subarachnoid haemorrhage. Soluble RAGE (sRAGE) may function as a decoy receptor. The significance of this endogenous anti-inflammatory mechanism in subarachnoid haemorrhage (SAH) remains unknown. The present study aims to analyse sRAGE levels in the cerebrospinal fluid (CSF) of SAH patients. sRAGE levels were assayed by ELISA kit in 47 CSF samples collected on post-SAH days 0–3, 5–7, and 10–14 from 27 SAH patients with acute hydrocephalus. CSF levels of sRAGE were compared with a control group and correlated with other monitored parameters. In the control group, the CSF contained only a trace amount of sRAGE. By contrast, the CSF of 20 SAH patients collected on post-SAH days 0–3 was found to contain statistically significant higher levels of sRAGE (mean concentration 3.91 pg/mL, p<0.001). The most pronounced difference in CSF sRAGE levels between good and poor outcome patients was found on days 0–3 post-SAH but did not reach the significance threshold (p=0.234). CSF sRAGE levels did not change significantly during hospitalisation (p=0.868) and correlated poorly with treatment outcome, systemic inflammatory markers, and other monitored parameters. Our study revealed an early and constant increase of sRAGE level in the CSF of SAH patients.

Background Pain catastrophizing, appraisals of pain control, styles of coping, and social support have been suggested to affect functioning in patients with low back pain. We investigated the relation of chronic pain coping strategies to psychological variables and clinical data, in patients treated surgically due to lumbar disc herniation and coexisting spondylotic changes. Material/Methods The average age of study participants (n=90) was 43.47 years (SD 10.21). Patients completed the Polish versions of the Chronic Pain Coping Inventory-42 (PL-CPCI-42), Beck Depression Inventory (BDI-PL), Coping Strategies Questionnaire (CSQ-PL), Beliefs about Pain Control Questionnaire (BPCQ-PL), and Roland-Morris Disability Questionnaire (RMQ-PL). Results In the PL-CPCI-42 results, resting, guarding and coping self-statements were frequently used as coping strategies (3.96 SD 1.97; 3.72 SD 1.72; 3.47 SD 2.02, respectively). In the CSQ-PL domains, catastrophizing and praying/hoping were frequently used as coping strategies (3.62 SD 1.19). The mean score obtained from the BDI-PL was 11.86 SD 7.23, and 12.70 SD 5.49 from the RMDQ-PL. BPCQ-PL results indicate that the highest score was in the subscale measuring beliefs that powerful others can control pain (4.36 SD 0.97). Exercise correlated significantly with beliefs about internal control of pain (rs=0.22). We identified associations between radiating pain and guarding (p=0.038) and between sports recreation and guarding (p=0.013) and task persistence (p=0.041). Conclusions Back pain characteristics, depressive mood, disability, and beliefs about personal control of pain are related to chronic LBP coping styles. Most of the variables related to advancement of degenerative changes were not associated with coping efforts.

BACKGROUND Relationships between patient satisfaction with nursing and patient clinical data have not been fully resolved in a Polish sample. Our objectives were to determine clinical factors associated with patient satisfaction with nursing and investigate differences between patients treated surgically for cervical or lumbar discopathy and degenerative changes. MATERIAL AND METHODS This prospective and cross-sectional study included 63 consecutively selected patients treated surgically for lumbar discopathy and degenerative spine disease and 41 patients undergoing surgery for cervical discopathy and degenerative spine disease from 1st June 2009 to 31st September 2010 in the Department of Neurosurgery and Neurotraumatology of Poznan University of Medical Sciences. In the first stage of this study, socio-demographic data, medical history, and clinical patient characteristics were collected. A minimum 12-month follow-up formed the second part. Nineteen patients with lumbar discopathy were excluded because they were unable to answer the questionnaire. Finally, 44 consecutively selected patients treated surgically for lumbar discopathy and 41 patients undergoing surgery due to cervical discopathy were evaluated with the Polish version of the Newcastle Satisfaction with Nursing Scale (NSNS-PL). RESULTS In patients with cervical and lumbar discopathy, the average Experiences of Nursing Care Subscale (ENCS) scores were 82.0 (SD 15.1) and 79.0 (SD 13.5), respectively, whereas the average Satisfaction with Nursing Care Subscale (SNCS) scores were 75.6 (SD 18.1) and 74.4 (SD 16.8), respectively. The study groups did not differ in regards to NSNS subscales. Associations between ENCS and SNCS scores were confirmed in both patient groups (rS=.73, p

STUDY DESIGN: Evaluation and comparison of translated and culturally adapted self-reported measurements. OBJECTIVE: The aim of this prospective study was to cross-culturally adapt the Polish versions of Revised Oswestry Disability Index (RODI-PL), Quebec Back Pain Disability Scale (QDS-PL), and the Low Back Outcome Score (LBOS-PL). SUMMARY OF BACKGROUND DATA: The application of instruments in English, which have undergone translation must be subjected to validation studies. Such studies are necessary above all for instruments that have been adapted to establish their value and usefulness in studies of patient populations where English is not the native language. METHODS: The translation was carried out according to International Quality of Life Association (IQOLA) Project and consisted of the following stages: translation, synthesis of the translations, back translation, expert committee, and testing of the prefinal versions of questionnaires. Eighty-five consecutive patients with low back pain due to spinal disc herniation and degenerative changes completed the QDS-PL, RODI-PL, LBOS-PL, and a Visual Analogue Scale twice within 2-day intervals. Mean duration of LBP was 45.9 months SD 55.5. The evaluation of degenerative changes in the lumbar region was carried out according to the Modic scale. Twenty-nine patients were categorized at type I, 4 patients were registered as type II, and 52 patients were type III. RESULTS: Cronbach α values for the LBOS-PL equaled 0.77, for the RODI-PL 0.85, and 0.95 for the QDS-PL. Item-total correlation confirmed that all scales are internally consistent. Test-retest reliability was excellent for RODI-PL and QDS-PL, but poor for LBOS-PL (0.88, 0.93, and 0.34, respectively). All questionnaires were significantly intercorrelated. We identified the strongest correlation between QDS-PL and RODI-PL (0.823, P < 0.001). The statistically significant correlation was identified between the QDS-PL and Modic Classification (rS = 0.226 P = 0.038). CONCLUSION: QBPDS-PL and RODI-PL are reliable and valid. Furthermore, investigation of the psychometric properties of the LBOS-PL in different spinal conditions is required. There is a relation between the results of the QDS-PL, and different levels of advancement in degenerative disease of the lumbar spine, according to the Modic Classification.

Study Design. Experimental study. Objective. To evaluate the postlaminectomy osteopontin expression in peridural scar tissue and structures within the vertebral canal as well as to correlate these findings with peridural scar extent, scar vascularity, and neurophysiological findings. Summary of Background Data. Postoperative peridural scar formation may be a cause of "failed back surgery syndrome"; however, the exact mechanism is unknown. Osteopontin (OPN) may play important role in this process, as it is involved in wound healing, organ fibrosis, and nerve tissue response to injury. Methods. The experiment was carried out in 2 experimental groups: group I—laminectomy, group II—sham. Six weeks after surgery animals' neurologic status was evaluated by spinal somatosensory-evoked potentials. Histologic assessment include the following: scar extent, thickness of dura, presence of the arachnoid adhesions was performed on hematoxylin and eosin stained transversal sections of the operated level. OPN expression in peridural scar, dorsal root ganglions (DRG) and within vertebral canal was studied using immunohistochemistry. In addition, scar vascularity was assessed with CD31 mAb. Obtained results were analyzed statistically. Results. Laminectomy resulted in significant loss of somatosensory-evoked potentials amplitudes and thicker dura compared to sham surgery. Sham group physiologically expressed OPN in bone tissue. We found significant increase in OPN immunoreactivity in meninges, arachnoid adhesions, and tissue surrounding DRG in group I when compared with group II. Significant postlaminectomy increase in percentage of OPN positive DRG neurons (P = 0.0002, 43.041 ± 3.706 vs. 21.227 ± 3.481), which correlated with scar extent, and scar OPN immunoreactivity was also noted. Conclusion. This study identifies OPN as a major player in formation of epidural fibrosis and a marker of DRG response to peridural scar formation. We confirm previous neurophysiological findings and provide new evidence supporting the theory of DRG involvement in peridural scar-related recurrent radiculopathy. Further studies are warranted to fully assess the relevance of these findings.

Giant “invasive” schwannomas of the spine occur occasionally, most frequently in the lumbar region. We present the case of a 46-year-old woman with giant “invasive” schwannoma of the lumbar spine, with a 12-year history of illness. The tumour originated in the vertebral canal and passed through the paraspinal muscles and retroperitoneal area to the abdominal cavity. The part of the tumour which was in the abdominal cavity was removed by means of laparotomy during the first operation. In the second one, the remaining part of the tumour was removed completely from the vertebral canal and retroperitoneal area through posterior-lateral access. The spine was stabilized with metal implants. Histological examination revealed cellular schwannoma. During the follow-up the pain resolved while paresis of the right quadriceps muscle of the thigh was still present. Cellular schwannoma is a benign form of schwannoma, but it may cause a local recurrence if not removed completely.

Various electrocardiographic changes are found in patients with increased intracranial pressure. The most common findings are sinus bradycardia, QT prolongation, ST-segment changes, and T- or U-wave abnormalities. The presence of J wave is reported rarely. We describe 3 patients with increased intracranial pressure caused by different cerebral pathologies accompanied by the dynamic formation of J waves in time.

Endovascular treatment seems to be the best approach to posterior circulation fusiform aneurysms. Double stent techniques are frequently used to occlude basilar artery dilations. Unfortunately, there is a limited number of studies that have followed up with patients over prolonged periods of time in order to evaluate delayed complications, such as stenosis, thrombosis or migration of stents. We present an unusual case of in-stent thrombosis 9 years after basilar artery aneurysm treatment to caution about complications associated with double stent implantation.

BACKGROUND The development of a pain-management program tailored to the specific needs of patients with chronic low back pain (CLBP) requires the proper assessment of psychosocial factors affecting each individual. The Chronic Pain Coping Inventory-42 (CPCI-42) refers to coping strategies, which are commonly defined as the cognitive and behavioral techniques an individual may resort to in stressful or demanding situations. Evidence from a number of sources suggests that differences in pain coping strategies may significantly affect how an individual deals with chronic pain. We aimed to adapt the CPCI-42 to Polish cultural conditions (PL-CPCI-42) and then verify its psychometric properties based on a group of patients treated surgically due to herniated lumbar discs and coexisting spondylotic changes. MATERIAL AND METHODS The average age of the study participants (n=90) was 43.47 years (SD 10.21). The average duration of chronic low back pain (CLBP) was 49.37 months (SD 64.71). Lumbosacral spine X-rays and magnetic resonance imaging scans were performed and all patients completed the PL-CPCI-42 and the Polish versions of the Numeric Pain Rating Scale (NPRS-PL) twice. Internal consistency of the PL-CPCI-42, floor and ceiling effects, test-retest reliability, and criterion validity were analyzed. RESULTS Resting, guarding, and coping self-statements were frequently used as coping strategies both in the test and in the retest, in contrast to relaxation and exercise/stretch. The NPRS-PL result was 5.70 cm in the test and 5.66 in the retest. Cronbach's alpha values were recorded for the asking for assistance, coping self-statements, and seeking social support domains (0.83, 0.80, 0.83, respectively). Test-retest reliability of the PL-CPCI-42 varied from 0.53 (relaxation domain) to 0.84 (asking for assistance and coping self-statements domains). CONCLUSIONS The present study provides evidence of the validity of the PL-CPCI-42 and supports its usefulness in assessing chronic pain coping strategies, which are especially important to pain adjustment and in the creation of multidisciplinary pain management programs for patients with severe CLBP.

Background and purpose Synovial cysts of the spine occur most frequently in the lumbosacral region. Methods of treatment vary, but in cases of chronic pain or neurological deficits surgical intervention is undertaken. The aim of this paper is to present indications, surgical technique and efficacy of surgical treatment in patients with synovial cyst of the spinal canal. Material and methods The retrospective analysis included 11 patients, aged from 47 to 72 years, treated at the Department of Neurosurgery and Neurotraumatology, Poznan University of Medical Sciences, between 2004 and 2009. The length of medical history ranged from 2 months to 6 years. Conservative treatment applied before surgery was not effective. Neurological examination revealed unilateral or bilateral sciatica, superficial sensory disturbance or lower limb paresis. Results Synovial cysts were located mainly at the L4-L5 level (9 cases). Magnetic resonance imaging (MRI) of the spine was performed in all patients and showed the cystic lesion attached to the intervertebral joint. Surgical treatment consisted of a unilateral fenestration using microsurgical techniques in most cases. Back pain relief was observed in 9 cases. In 10 patients, symptoms of sciatica disappeared. Neurological deficits disappeared in 5 patients. Conclusions Surgical treatment of spinal synovial cysts is safe, effective and ensures a long-lasting effect. Surgical treatment is indicated in patients in whom the clinical symptoms correlate with the presence of synovial cyst in imaging studies and do not resolve after conservative treatment.

Hemangioma is the most common primary tumor of the spine. Pregnancy is a risk factor increasing the possibility of disclosure or exacerbation of symptoms of spinal hemangioma. This paper presents a case of 32-year-old woman with hemangioma of Th6 vertebrae, which was revealed by paresis of the lower limbs and sphincters dysfunction at 34 weeks gestation. Pregnancy has ended with a cesarean section. Then posterolateral thoracotomy and removal of hemangioma were performed. Spinal cord was decompressed and stabilization of the spine with metal implants was carried out. Histological examination discovered cavernous hemangioma weaving. The patient is followed up in the outpatient clinic. Despite the improvement of neurological status--enhancement of the sensory function and development of bladder and rectal sphincter automatism--she did not regain the ability to walk alone.

Background and purpose Vertebral haemangiomas are relatively common, benign vascular lesions; symptomatic ones that cause spinal cord compression are rare, however. Only 0.9–1.2% of all vertebral haemangiomas are symptomatic. The aim of the paper is to present indications, operative techniques and stabilization methods in patients with symptomatic vertebral haemangiomas. Material and methods Clinical analysis included 7 patients treated between 1995 and 2007. There were 4 females and 3 males, aged 24 to 63 yrs (average age 44 yrs). Symptomatic vertebral haemangiomas were diagnosed on the basis of neuroradiological studies. Surgery was applied in all cases. Implantation of internal stabilization followed vertebral haemangioma resection. Results Localization of vertebral haemangiomas included 1 case in the cervical, 5 cases in the thoracic and 1 case in the lumbar segment of the vertebral column. Symptoms of medulla compression were observed in 7 patients. Neurological symptoms were caused usually by hypertrophy or ballooning of the posterior cortex of the vertebral body into the vertebral canal. The anterior surgical approach was carried out in 2 cases, posterolateral in 3 cases and posterior in 2 cases. Spinal stability was secured by various implant systems and autogenic bone grafts. Bone defects in the vertebral body were filled with acrylic cement in 4 patients. In histological examinations, cavernous types were found in all patients. Neurological condition improved after the treatment in 5 patients. Conclusions No standard therapy exists for symptomatic thoracic vertebral haemangiomas. However, immediate surgical intervention is necessary in cases with acute compressive myelopathy before the symptoms become irreversible.

Background Even though there are several region-specific functional outcome questionnaires measuring neck disorders that have been developed in English-speaking countries, no Polish version has ever been validated. The purpose of our study was to translate, culturally adapt and validate the Neck Disability Index (NDI) and Copenhagen Neck Functional Disability Scale (CDS) for Polish-speaking patients with neck pain. Methods The translation was carried out according to the International Quality of Life Association (IQOLA) Project. Sixty patients were treated due to degenerative and discopathic disorders in the cervical spine filled out the NDI-PL and the CDS-PL. The pain level was evaluated using the Visual Analog Scale. The mean age of the assessed group was 47.1 years (SD 8.9). We used Cronbach's alpha to assess internal consistency. We assessed the test-retest reliability using the Intraclass Correlation Coefficients (ICCs). The Spearman's rank correlation coefficient (rS) was used to determine dependency between quantitative characteristics. The Mann-Whitney test was applied to determine dependency between quantitative and qualitative characteristics. Results The Cronbach's alpha values were excellent for the NDI-PL in the test and in the retest (0.84, 0.85, respectively), and for the CDS-PL (0.90 in the test and in the retest). Intraclass Correlation Coefficients were excellent for the CDS-PL and NDI-PL and equalled 0.93 (95% CI from 0.89 to 0.95) and 0.87 (95% CI from 0.80 to 0.92), respectively The concurrent validity was good in the test and in the retest (rs = 0.42 p < 0.001; rs = 0.40 p = 0.002, respectively) for NDI-PL and for CDS-PL (rs = 0.42 p < 0.001; rs = 0.40 p = 0.001, respectively). The adapted questionnaires showed a strong inter-correlation both in the test (0.87 p < 0.001) and in the retest (0.79 p < 0.001). Conclusions The present versions of the NDI-PL and CDS-PL, the first to be published in Polish, have proven to be reliable and valid for patients with degenerative changes in the cervical spine. The NDI-PL and CDS-PL have excellent internal consistency and test-retest reliability, and good concurrent validity. The adapted questionnaires showed a strong inter-correlation both in the test and in the retest. No ceiling or floor effects were detected in the NDI-PL and CDS-PL. The NDI-PL and CDS-PL are comparable with other versions and can be recommended and used in international comparative studies.

Scar formation after spine surgery in the lumbosacral region may be the cause of failed back surgery syndrome. Therefore efforts are made to find materials preventing excessive scar formation at the site of surgery. The aim of the study was to evaluate the usefulness of TachoComb application in prevention of epidural scar formation in a rat experimental model. This paper additionally presents a review of literature concerning other methods of local suppression of scar formation after posterior approaches to the lumbar spine.The experimental study was carried out on 14 male Wistar rats. Rats were divided into 2 groups. Laminectomy was performed in the first group (control group: n=5). In the second group of animals (n=9) laminectomy was followed by TachoComb application on the exposed dura. Neurological condition of the studied animals was evaluated based on clinical observation, neurological tests and recording of somatosensory evoked potentials. Post mortem histological examination was the main method of assessment of the experimental material.Presence of scar in the vertebral canal, its extent and severity differed between experimental groups. Electrophysiological results were also different between studied groups.TachoComb prevents epidural scar formation after lumbar spine surgery. Its positive effect concerning neural transmission at the level of the medulla was proven by electrophysiological tests in which the amplitude of components I and II of SSEP in the TachoComb group were significantly higher than in the control group.

Widespread use of antibiotics resulted in considerable reduction of spondylitis, but despite that progress there are some cases where conservative treatment has failed. In these patients surgical intervention should be carefully considered. Early surgery in patients with increasing neurological deficits causes the uncertainty which exists in relation to possible complications. Fewer doubts are associated with surgical treatment of late consequences (spine deformity, instability, etc). The goal of this study was to present indications for surgery, operative techniques of transpedicular stabilization and results of treatment of thoracic and lumbar spondylitis.Clinical analysis includes 18 patients with spondylitis treated in the Department of Neurosurgery and Neurotraumatology University of Medical Sciences in Poznan between 1997 and 2004. There were 7 males (39%) and 11 females (61%) in the study group, and their mean age was 57+/-10 years (range 49-69). Spondylitis within thoracic segments was found in 15 (83%) cases and 3 (17%) patients had spondylitis within lumbar segments. Indications for early surgical intervention included increasing neurological symptoms, spine instability and failed conservative treatment. All patients underwent transpedicular stabilization following medulla and nerve root decompression.Non-specific inflammation was observed in 14 (78%) cases, and specific inflammation was discovered in 4 (22%) cases (bacteriological and histopathological findings). Very good and satisfactory results were achieved in 16 (89%) patients. Complications occurred in 4 (22%) patients.Spondylitic spine surgery limits inflammatory reaction, strengthens diagnosis, repairs vertebral column stability and improves neurological condition. Transpedicular stabilization is an effective method of achieving of internal spondylodesis.

Lesions of the cranio-vertebral junction which affect bony structures and ligaments may cause instability and compression of the nervous and vascular structures. The goal of surgery is decompression of these structures and stabilization. The paper presents indications for performing the stabilisation procedure with CCD implementation in three patients suffering respectively from rheumatoid arthritis and neoplastic disease. In one patient spinal instability and spinal cord compression were due to rheumatoid disease and surgery included anterior spinal decompression in connection with posterior stabilisation. In two patients with neoplasms the retromandibular decompression with posterior stabilisation was performed.

Degenerative lumbar spondylolisthesis occurs most often at the L4-L5 level and is characterized by anterior displacement of L4 vertebra on L5 vertebra. The aim of the study is to present both the decompression of nerve elements of the vertebral canal and the method of spine internal stabilization in patients with degenerative lumbar spondylolisthesis.Clinical analysis comprises 11 patients treated surgically because of the degenerative spondylolisthesis. Intervertebral dislocation of more than 20% included 4 patients where the vertebral column stabilization was achieved by transpedicular stabilization as well as intervertebral and posterolateral spinal fusion (group I). In spondylolisthesis of less than 20% (4 patients) spondylodesis with intervertebral cages and posterolateral osseous grafts were carried out (group II). In the remaining 3 cases spondylolisthesis was smaller than 20% with denivelation of the intervertebral space (group III). There were nervous structures deliberated and spondylodesis was unnecessary.Low back pain and sciatic neuralgia were relieved in 9 (82%) patients. Neurological deficits were subsided completely in 7 (78%) cases.The evaluation of the degree of vertebral displacement, height of the intervertebral space and assessment of vertebral column stability allowed to determine the strategy of surgery in patients with degenerative lumbar spondylolisthesis.

The aim of this study was to evaluate the effectiveness of surgery treatment in patients with posttraumatic fractures with dislocation of the cervical spine.A retrospective review was carried out in 24 patients suffering from posttraumatic fractures of cervical spine segments with dislocation treated surgically at the Department and Clinic of Neurosurgery and Neurotraumatology, University of Medical Sciences in Poznań between 1998-2002. The study included 19 (79.2%) males and 5 (20.8%) females, aged from 16 to 60 years (the average age was 35.5). Traumatic lesions of cervical vertebral segments were localized as follows: level C3-C4 - 3 cases; C4-C6 - 17 cases; and at C6-Th1 - 4 cases. A three-grade scale was used to assess the severity of spinal cord trauma. On admission a complete transverse spinal cord syndrome was observed in 6 patients. Radiological investigations included X-ray (24 cases), CT (2 cases) and MRI (22 cases). With this in mind, the osteometric indices of the spine axis deformity were established: the index of anterior displacement of the vertebrae, the angle of local kyphosis (assessed by the Cobb's technique) and the lordosis curvature index.In all cases the operation was performed using the anterior approach. Surgery included anterior decompression and stabilization of the cervical spine by means of a bone graft or acrylic cement and trapezoidal or "S" plate. The postoperative neurological condition improved in 21 (87.5) patients and correction of the cervical axis was achieved in 24 (100%) cases. Postoperative neurological deficits were intensified in 2 cases and were regressive. The mortality rate was 4.2% (1 case).Osteometric radiological indices enable the bone structure posttraumatic lesions of the cervical vertebral column to be evaluated. This type of internal stabilization makes it possible to restore the alignment of the anterior column and immobilization of the appropriate vertebral segments.

A 32 year-old woman with cervico-brachial pain and progressive neurological disorders was admitted to the Department and Clinic of Neurosurgery and Neurotraumatology of the K. Marcinkowski University of Medical Sciences in Poznań. Neurological examination revealed right hemiparesis with muscular atrophy in the right upper limb, progressing in the past 3 months. MRI demonstrated relatively large herniations of C4-C5 and C5-C6 discs with spinal and nerve compressions. A surgery was carried out. Discectomy of C4-C5 and C5-C6 discs was performed using the anterior vertebral approach. After the removal of C4-C5 and C5-C6 discs and C5 vertebral body a fragment of the iliac bone strut was wedged between C4 and C6 vertebral bodies. The bone graft was fixed to C4 and C6 vertebral bodies with a titanium plate. Within 6 hours after the surgery the patient developed a complete loss of motor functions in the upper and lower limbs. MRI scan of the cervical spine showed a huge anterior epidural hematoma compressing the spinal cord. An emergency re-operation and removal of the hematoma was performed by the anterior approach. A complete neurological recovery followed during the first 24 postoperative hours.

The Author(s) 2013. This article is published with open access at Springerlink.com Abstract The perspective of trunk deformity is a matter of special concern for adolescent idiopathic scoliosis (AIS) patients. No research group has ever reported interviewing patients and their parents regarding differences in percep- tion of body appearance in the course of Cheneau brace treatment. We aimed to investigate the level of agreement in the field of concerns and perceptions of spinal appear- ance in relation to brace- and scoliosis-related data between parents and female patients with AIS, treated with a Che- neau brace, by means of the Spinal Appearance Ques- tionnaire-pl (SAQ-pl). In this cross-sectional study forty- one pairs of parents and female patients with AIS were asked to separately complete the Polish versions of the Spinal Appearance Questionnaire-pl patient form (SAQ-pl patient form) and the SAQ-pl parent form. Age of patients was 13.60 years SD 1.60 (range 10-17). Patients scored 2.70 (SD 0.60) and parents scored 2.70 SD 0.60 in the total score of the SAQ-pl. The study groups do not differ sig- nificantly in regards to the SAQ-pl results. The percentage of consistent answers on SAQ-pl items ranges from 34.10 % (item 20) to 78 % (item 8). Height, age and brace- wearing time per day, were significantly related to the differences in the patient-parent General perception of body shape (rs =- 0.51, rs =- 0.34, rs = 0.36, respec- tively). Parents and female patients with AIS have similar concerns and perceptions of spinal appearance. The dis- crepancies in General perception of spinal appearance between parents and AIS females decrease with age of patient. Parental emotional support may contribute to minimizing the risk factors of psychological impairment, especially in late adolescents with AIS.