Background and Aims: Measuring stroke recovery poses a significant challenge, given the complexity of the recovery process. We aimed to identify a standardized and data-driven set of metrics of stroke rehabilitation in the literature that ensures the inclusion of all recovery domains and subdomains in the literature. Methods: A systematic review was conducted by four reviewers using the PRISMA guidelines on PubMed, MEDLINE, and Embase for stroke recovery articles between 2004 and 2024. The inclusion criteria comprised experimental/observational studies, including ischemic and hemorrhagic stroke. All studies had ≥20 participants who were ≥18 years of age, and had a follow-up of ≥3 months. Outcomes included demographics, geographic origin, stroke mechanism, domains and subdomains, metrics used, and follow-up. A bias assessment was performed using the Newcastle-Ottawa Scale and the Cochrane Risk of Bias 2.0 tool. This study was registered with PROSPERO (CRD42024551753). Results: Our search included 324 studies with a sample of 85,156 participants. The study identified seven domains (perception, physical and motor function (PF), speech and language (S&L), cognition, activities of daily living (ADL), quality of life (QoL), and social interaction) and 96 constituent subdomains that encompass the complete landscape of the stroke recovery literature identified. The domains of PF and ADL constituted the vast share of the literature, albeit reducing in their relative representation over time, while domains such as perception and QoL have been increasingly studied since 2004. Using the domains, the study identified the set and frequency of all commonly used metrics to measure stroke recovery in the literature, of which the NIHSS (n = 72), BI (n = 55), and mRS (n = 51) were the most commonly used. We identified eighteen standard metrics that ensure the inclusion of all seven domains and 96 subdomains. Summary of Review and Conclusions: The identified set of domains and metrics within this study can help inform further clinical research and decision-making by providing a standardized set of metrics to be used for each domain. This approach ensures lesser represented domains and subdomains are also included during testing, providing a more complete view and measure of stroke recovery.

Introduction: Traumatic brain injury (TBI) poses a significant public health challenge with profound impacts at individual, family, community, and societal levels. Early during the COVID-19 pandemic, the neighborhood of Elmhurst, Queens in New York City was a hotspot dubbed the “epicenter of the epicenter” of the crisis in the United States, requiring major changes in healthcare resource allocation. This study investigates how different phases of the COVID-19 pandemic affected the incidence, severity, and clinical outcomes of TBI in this geographical area. Methods: TBI admissions to NYC Health + Hospitals/Elmhurst, a Level 1 Trauma Center, during the first six months of 2019, 2020, and 2021 were retrospectively analyzed. Data were grouped into three periods: pre-pandemic (1/1/19–6/30/19 and 1/1/20–2/29/20) [Group 1], first COVID-19 wave (3/1/20–6/30/20) [Group 2], and second COVID-19 wave (1/1/21–6/30/21) [Group 3]. Univariate analyses were conducted to explore factors potentially associated with TBI outcomes; variables that reached statistical significance (p < 0.05) were included in a binary logistic regression analysis dichotomized into good outcome (discharge to home or acute rehabilitation disposition) and poor outcome (discharge to skilled nursing facility/subacute rehabilitation, hospice, or in-hospital mortality). Results: Analysis of 443 TBI patients (median age 56 [range 38, 73]; mean admissions/week 5.6 ± 2.7) demonstrated no significant variance in age (H = 0.92; p = 0.63), sex (χ² = 1.4, p = 0.51), or ethnicity (χ² = 17.1; p = 0.07) across groups. Group 2 had significantly fewer weekly admissions (3.9 ± 2.6) compared to Groups 1 (5.9 ± 2.2; p = 0.02) and 3 (6.1 ± 2.9; p = 0.01). Over the course of the pandemic, the proportion of uninsured patients decreased from 15 to 4%, while Medicaid and Medicare coverage rates rose from 25 to 41% and 20% to 28%, respectively (p < 0.001). A binary logistic regression model dichotomized by discharge outcome for all 443 TBI patients confirmed that increasing age (OR = 0.95; 95% CI 0.93–0.97; p < 0.001) and Injury Severity Score (OR = 0.88; 95% CI 0.83–0.93; p < 0.001) were inversely correlated with good outcome, while higher Glasgow Coma Scale (OR = 1.26; 95% CI 1.17–1.36; p < 0.001) was positively correlated. Of particular interest, Black/Hispanic ethnicity (OR = 0.36; 95% CI 0.19–0.66; p = 0.002) and public health insurance (Medicaid/Medicare) coverage (OR = 0.83; 95% CI 0.68–1.00; p = 0.05) were both associated with less favorable outcomes. Neither group designation, patient sex, COVID-19 status, or need for neurosurgical intervention was correlated with outcome (p > 0.05). Conclusion: Despite the changes in TBI admission patterns throughout New York City during the COVID-19 pandemic, the quality of patient outcomes at our institution remained relatively consistent across the pandemic’s different phases, as assessed by discharge disposition. However, two important socioeconomic factors—ethnicity and health insurance status—were significantly associated with outcome, underscoring the need for systemic changes to address ongoing disparities in neurotrauma care.

Study Design: Retrospective cohort study. Objective: This study aimed to determine how kyphoplasty and vertebroplasty procedure volumes, specialty-specific usage, and payments have changed among the Medicare patient population from 2015 to 2023. Summary of Background Data: Vertebral augmentation procedures, specifically kyphoplasty and vertebroplasty, are used to treat vertebral compression fractures. Published studies have found kyphoplasties to be associated with lower rates of cement leakage and more favorable postoperative vertebral alignment, including improved local kyphotic angle. Methods: We used an aggregated data set that contains Medicare Part B procedure data at the physician level from 2015 to 2023 (n=1819 unique physicians total). We filtered for kyphoplasty and vertebroplasty Current Procedural Terminology codes, and then analyzed overall trends in procedure volume, payment, and specialty usage over time. We used statistical tests to identify differences in these parameters between kyphoplasty and vertebroplasty. Results: From 2015 to 2023, the total number of both kyphoplasty and vertebroplasty procedures decreased with a compound annual growth rate (CAGR) of −5.4% and −16.8%, respectively. In 2019, 2020, 2022, and 2023, there were more kyphoplasty procedures than vertebroplasty procedures ( P <0.05). 76.0% of all kyphoplasties were performed by orthopedic surgery, diagnostic radiology, and neurosurgery, whereas 87.3% of vertebroplasties were performed by diagnostic radiology and interventional radiology. From 2015 to 2023, kyphoplasties received higher payment amounts than vertebroplasties ( P <0.0001). The average payment amount for kyphoplasties slightly increased overall from 2015 to 2023, with a CAGR of 6.9%. Although previous studies have identified similar trends up until 2018, our study provides an updated understanding. Conclusions: Our analysis of a comprehensive Medicare data set found that kyphoplasties are more common than vertebroplasties, and the use of both procedures has decreased slightly over time. Diagnostic and interventional radiology both perform a large proportion of these procedures. Level of Evidence: Level IV.

BACKGROUND: Spinal epidermoid cysts are rare tumors typically found in the lumbosacral region in the intradural extramedullary space. These tumors are usually caused by defects in neural tube closure or acquired through iatrogenic or traumatic insult, with either mechanism leading to the inclusion of epidermal cells in cystic compartments in the spine. Although benign, these cysts can cause symptoms including back pain and weakness, and patients often undergo resection. OBSERVATIONS: We present a unique case of an intramedullary spinal epidermoid cyst appearing in the T6–7 region of a 69-year-old male. Furthermore, subcutaneous epidermoid cysts within the same region as the spinal tumor were observed. A review of the literature revealed that while intramedullary spinal epidermoid cysts are rare, their concurrent appearance with subcutaneous cysts has not been observed, demonstrating the novelty of this case. LESSONS: This case demonstrates the possible occurrence of epidermoid cysts in the intramedullary space, in superior spinal regions, and in the older population. Additionally, such cysts should remain on the differential in individuals with myelopathic symptoms and associated subcutaneous inclusion cysts on the back. Careful imaging to guide diagnoses and surgical planning is crucial. https://thejns.org/doi/10.3171/CASE26313

BACKGROUND: Bilateral facet dislocation results from flexion and distraction forces that tear the posterior ligamentous complex, disrupt the facet joint capsules, and can cause fracture of the superior articular processes of the facet joints, leading to vertebral subluxation and potentially serious spinal cord injury. When clinically feasible, the typical management is rapid closed reduction followed by fusion, typically by means of anterior, posterior, or circumferential fixation. However, the risk of construct failure in the event of anterior-only fixation is not fully understood. Since construct failure can result in recurrent vertebral subluxation and spinal cord injury, understanding the risk and mode of failure can guide clinicians in the selection of the optimal surgical approach. OBSERVATIONS: The authors present a unique case of a failed anterior-alone fusion for bilateral facet dislocation that resulted in spinal cord injury. A subsequent review of the literature identified specific risk factors that can contribute to construct failure. LESSONS: Age, bilateral facet injury, extensive damage to the posterior ligamentous complex, and fractures to the endplate, facets, or pedicles increase the risk of construct failure of anterior-alone fixation following subaxial cervical facet dislocations. A combined anterior-posterior fixation may be recommended in such circumstances. https://thejns.org/doi/10.3171/CASE24563