In deep brain stimulation (DBS) surgery, acute high blood pressure (BP) is a risk factor for intracranial hemorrhage. To minimize pain and hypertensive conditions, sufficient local anesthesia is mandatory. We evaluated whether local instillation of anesthetics (LA) or a scalp block (SB) is superior concerning intraoperative hemodynamics and analgesia. We retrospectively analyzed intraoperative cardiovascular parameters and perioperative medication in 47 patients (LA = 29, SB = 18) undergoing DBS surgery. Primary study end points were intraoperative systolic BP and heart rate. Secondary end points were use of intraoperative antihypertensives and perioperative analgesics. Patients who had SB showed lower mean systolic BP and heart rate compared with patients who had LA. Patients who had LA required more antihypertensive medication to stabilize BP. BP was higher, particularly during the first 90 minutes of surgery, in patients who had LA. Thereafter, more antihypertensives were necessary to achieve sufficient BP control in the LA group. The dose of analgesics did not differ significantly between both groups during and after surgery. Our data suggest that SB might be superior to LA for DBS surgery with respect to BP control and hemodynamics. The need for analgesics does not differ substantially between both anesthetic treatment options.

The use of robotics in spine surgery has gained popularity. This study aims to assess the current state of robotics and raise awareness of its educational implications. What are the current adoption trends and barriers to the implementation of robotic assistance in spine surgery? An online questionnaire comprising 27 questions was distributed to AO spine members between October 25th and November 13th, 2023, using the SurveyMonkey platform (https://www.surveymonkey.com; SurveyMonkey Inc., San Mateo, CA, USA). Statistical analyses (descriptive statistics, Pearson Chi-Square tests) and generation of all graphs were performed using SPSS Version 29.0.1.0 (IBM SPSS Statistic). We received 424 responses from AO Spine members (response rate = 9.9 %). The participants were mostly board-certified orthopedic surgeons (46 %, n = 195) and neurosurgeons (32%, n = 136). While 49% (n = 208) of the participants reported occasional or frequent use of navigation assistance, only 18 % (n = 70) indicated the use of robotic assistance for spinal instrumentation. A significant difference based on the country's median income status (p < 0.001) and the respondent's number of annual instrumentation procedures (p < 0.001) has been observed. While 11 % (n = 47) of all surgeons use a spinal robot frequently, 36 % (n = 153) of the participants stated they don't need a robot from a current perspective. Most participants (77%, n = 301) concluded that high acquisition costs are the primary barrier for the implementation of robotics. Although the hype for robotics in spine surgery increased recently, robotic systems remain non-standard equipment due to cost constraints and limited usability.

Directional Leads (dLeads) represent a new technical tool in Deep Brain Stimulation (DBS), and a rapidly growing population of patients receive dLeads. 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. 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. 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. 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.

Objectives While the efficacy of deep brain stimulation (DBS) to treat various neurological disorders is undisputed, the surgical methods differ widely and the importance of intraoperative microelectrode recording (MER) or macrostimulation (MS) remains controversially debated. The objective of this study is to evaluate the impact of MER and MS on intraoperative lead placement. Patients and Methods We included 101 patients who underwent awake bilateral implantation of electrodes in the subthalamic nucleus with MER and MS for Parkinson's disease from 2009 to 2017 in a retrospective observational study. We analyzed intraoperative motor outcomes between anatomically planned stimulation point (PSP) and definite stimulation point (DSP), lead adjustments and Unified Parkinson's Disease Rating Scale Item III (UPDRS-III), levodopa equivalent daily dose (LEDD), and adverse events (AE) after 6 months. Results We adjusted 65/202 leads in 47/101 patients. In adjusted leads, MS results improved significantly when comparing PSP and DSP (p < 0.001), resulting in a number needed to treat of 9.6. After DBS, UPDRS-III and LEDD improved significantly after 6 months in adjusted and nonadjusted patients (p < 0.001). In 87% of leads, the active contact at 6 months still covered the optimal stimulation point during surgery. In total, 15 AE occurred. Conclusion MER and MS have a relevant impact on the intraoperative decision of final lead placement and prevent from a substantial rate of poor stimulation outcome. The optimal stimulation points during surgery and chronic stimulation strongly overlap. Follow-up UPDRS-III results, LEDD reductions, and DBS-related AE correspond well to previously published data.

Introduction Persistent spine pain syndrome type 2 (PSPS2) represents a significant burden to the individual and society. Treatment options include revision surgery, stabilisation surgery of the spine, neuromodulation, analgesics and cognitive behavioural therapy. Nevertheless, structured treatment algorithms are missing as high-level evidence on the various treatments is sparse. The aim of this study is to compare higher frequency neuromodulation with instrumentation surgery in patients suffering from PSPS2. Methods and analysis The sPinal coRd stimulatiOn coMpared with lumbar InStrumEntation for low back pain after previous lumbar decompression (PROMISE) trial is a prospective randomised rater blinded multicentre study. Patients suffering from PSPS2 with a functional burden of Oswestry Disability Index (ODI) >20 points are randomised to treatment via spinal cord stimulation or spinal instrumentation. Primary outcome is back-related functional outcome according to the ODI 12 months after treatment. Secondary outcomes include pain perception (visual analogue scale), Short Form-36, EuroQOL5D, the amount of analgesics, the length of periprocedural hospitalisation and adverse events. Follow-up visits are planned at 3 and 12 months after treatment. Patients with previous lumbar instrumentation, symptomatic spinal stenosis, radiographical apparent spinal instability or severe psychiatric or systemic comorbidities are excluded from the study. In order to detect a significant difference of ≥10 points (ODI) with a power of 80%, n=72 patients need to be included. The recruitment period will be 24 months with a subsequent 12 months follow-up. The beginning of enrolment is planned for October 2022. Ethics and dissemination The PROMISE trial is the first randomised rater blinded multicentre study comparing the functional effectiveness of spinal instrumentation versus neuromodulation in patients with PSPS2 in order to achieve high-level evidence for these commonly used treatment options in this severely disabling condition. Patient recruitment will be performed at regular outpatient clinic visits. No further (print, social media) publicity is planned. The study is approved by the local ethics committee (LMU Munich, Germany) and will be conducted according to the Declaration of Helsinki. Trial registration number NCT05466110.