Introduction Idiopathic normal pressure hydrocephalus (iNPH) is increasingly relevant in the aging population. Despite improved diagnostic criteria, postoperative outcome remains variable and difficult to predict. Preoperative expectations may substantially influence perceived treatment success, and caregivers often play a key role in the decision-making process. Research question This study evaluated whether physicians assess postoperative outcomes more accurately than primary caregivers. Material and Methods This single-centre study combined a prospective pre–post interventional cohort design with a cross-sectional component. Patients with iNPH undergoing first-time ventriculoperitoneal shunt surgery were included. Symptom severity was assessed preoperatively and at follow-up using standardized grading scales. Primary caregivers (PCGs), neurosurgical residents, and board-certified neurosurgeons independently predicted postoperative outcomes, which were subsequently compared with observed treatment results. Results Forty-one patients were screened between January 2022 and June 2025. The study cohort had a mean age of 74.1 years (SD 7.3), 57% male, mean symptom duration 23.9 months (SD 14.1) and a mean Charlson comorbidity index of 4.1 (SD 1.3). At a median follow-up of 48 days (range 36–118) after ventriculoperitoneal shunt surgery, mean symptom improvement was Δ 2.2 points (95% CI 1.6–2.7; p < 0.001), with the greatest improvement observed in gait disturbance and urinary incontinence. Revision surgery was required in 17% of patients. Correlation between predicted and observed outcome was strongest among neurosurgical specialists (r=0.79), followed by residents (r=0.74), while PCGs demonstrated only moderate agreement (r=0.56). Discussion and Conclusion Our study supports the efficacy of CSF shunt surgery in iNPH and demonstrates that neurosurgical expertise aligns more closely with actual postoperative outcome than the expectations of PCGs. Structured preoperative counselling may help improve expectation management and reduce discrepancies between anticipated and observed treatment benefit.

Tumor heterogeneity in breast cancer is well recognized, but research has largely focused on primary tumors, while metastatic lesions, particularly brain metastases (BM), remain understudied. With the rising incidence of BM in metastatic breast cancer (MBC) and their poor prognosis, a deeper understanding of the molecular mechanisms driving BM formation, progression, and immune evasion is crucial for developing better therapeutic strategies. We performed an integrated analysis of BM and matched primary breast tumors using immunohistochemistry, in-situ hybridization, tumor-infiltrating lymphocyte (TIL) quantification, and bulk RNA sequencing. Tumor receptor status, gene expression profiles, immune cell composition, and pathway alterations were analyzed in ten patients with paired samples. Changes in receptor status were observed between primary tumors and BM, including alterations in estrogen receptor and HER2 expression. RNA sequencing revealed differentially expressed genes and pathways, with an apparent downregulation of immune-related genes in BM. Immune profiling suggested a shift in the tumor microenvironment, with BM showing lower B- and CD8 + T-cell infiltration and a relative increase in M2 macrophages and follicular helper T-cells. While these findings are descriptive and limited by sample size, they point towards a potentially more immunosuppressive milieu in BM that may contribute to immune evasion and reduced responsiveness to checkpoint inhibitor therapy. Our study highlights molecular and immunological differences between primary breast tumors and BM. The altered immune landscape in BM, characterized by diminished TIL infiltration and an increase in immunosuppressive cells, warrants further investigation in larger, more homogeneous cohorts.

Abstract Objective Cervical spondylodiscitis is a rare but complex disease due to its potential for severe neurological impairments and post-infectious deformity. The reported mortality rate ranges from 5 to 10%. Radical surgical treatment is usually followed by antibiotic therapy. There is, however, no uniform treatment guideline. Implant choice, extent of fusion and duration of treatment vary across centers. The aim of this study is to analyze a decade of treatment of patients suffering from primary cervical spondylodiscitis to gain insights for improving existing treatment strategies. Methods This is a retrospective analysis of surgically treated patients suffering from cervical spondylodiscitis between January 2014 and December 2024 in two academic spine centers. Following ethical approval, pre- and postoperative imaging and clinical course were evaluated. Outcome analysis included assessment of implant complications, corrections of sagittal and coronal profiles, complication rates, length of hospital stay, neurological deficits, pain intensity, and 1-year survival. Clinical and radiological reassessments were performed at or shortly after completion of antibiotic therapy. Results The study included 33 patients (52% males) with a median age at diagnosis of 68 years (IQR 59–76 years). The most common pathogen was staphylococcus aureus (39%). All patients underwent surgical debridement, predominantly by ventral decompression and fusion (90%). Following surgery, a significant number of patients showed an improvement in cervical radiculopathy and neck pain ( n = 24/33, p < 0.0001). One patient required revision surgery due to screw misplacement during the same hospital stay. The average inpatient stay was 23 days (21 days), with 15 patients requiring postoperative treatment in the intensive care unit. Within a median clinical follow-up of three months there was radiological evidence of implant-loosening in five (15%) patients. Three (9%) patients died within one year because of sepsis, all of whom were older than 75 years and had significant comorbidities (ASA score > 3). Conclusion Our study supports the effectiveness of surgical treatment for cervical spondylodiscitis in short to medium-term outcome analysis, particularly through ventral decompression and fusion. The significant improvement in radiculopathy and pain reduction post-surgery underscores the treatment benefits. However, 1-year mortality is still high in geriatric patients with relevant comorbidities. Future studies should focus on long-term outcomes and complications to further optimize the treatment strategy for this dangerous condition.

Glioblastoma (GBM) is the most aggressive form of primary brain cancer and is associated with poor overall survival and expensive, resource intensive treatments. We performed a systematic literature review to quantify the costs and cost-effectiveness of modern glioblastoma care across global healthcare systems. A comprehensive literature search on PubMed, MEDLINE, and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the search string (Glioblastoma OR GBM) AND (costs OR cost-effectiveness OR economic burden) identified 21 studies eligible for our research question. Costs were reviewed for all treatment modalities of the current Stupp protocol. After considering the current consumer price indexes and purchasing power parities, these were then standardized to the value of US Dollars () in 2024. A total of 15,547 real world GBM patients were analyzed. Direct medical costs displayed extreme heterogeneity, ranging from cumulative costs of356,481 in the United States to approximately 18,908 in India. The Stupp protocol exceeded willingness-to-pay thresholds in middle income economies. Economic evaluations of Tumor treating fields revealed Incremental Cost-Effectiveness Ratios (ICER) ranging from862,361.37 to 940,344.39 per Life Year Gained (LYG) in France to252,590.08 per LYG in the United States, and a more favorable per Quality Adjusted Life Year (QALY) of 45,813.91 in China. The cost of modern GBM treatment varies greatly between the analyzed countries with adjuvant treatment and inpatient care being the most important cost drivers in western countries in the direct medical costs analyses. Cost models show that the Stupp protocol remains a significant financial burden in resource-limited settings, underlining the cost-effectiveness of surgery in modern GBM management. There is, however, a need for uniform cost reporting to correctly assess cost-effectiveness across global healthcare systems.

Background:Unilateral monosegmental radiculopathy, caused by foraminal soft disc nerve root compression, can be treated with posterior cervical foraminotomy (PCF). Conventional fluoroscopy is widely used for level localization and verifying decompression extent intraoperatively. However, the failure rate increases, especially in obese patients and the lower cervical spine. Can intraoperative three-dimensional (3D) navigation improve outcomes in PCF compared with conventional fluoroscopy? Materials and Methods:In this retrospective study, we analyzed two groups: 42 patients (mean age: 54 ± 10 years) who underwent PCF using intraoperative 3D navigation (study group) and 63 patients (mean age: 51 ± 11 years) who underwent PCF with conventional fluoroscopy (control group). Each cohort was divided into upper (C3-C6) and lower cervical spine (C6-T1) subgroups. Differences were explored by Mann-Whitney U and Friedman tests. Results:Both groups experienced significant postoperative symptom improvement, with no significant neurological differences. Subgroup analyses revealed no significant differences between surgeries in the upper (C3-C6) and lower (C6-T1) cervical spine. Only blood loss in the C3-C6 group differed significantly between control and study groups. Conclusion:Intraoperative 3D navigation was successfully used for PCF, resulting in significant symptom relief. Outcomes after PCF with 3D navigation appeared comparable to those achieved with conventional fluoroscopy, without statistical evidence of a clear advantage. Thus, technical complexity should be considered when selecting the surgical method.

This study aimed to evaluate clinical and radiological outcomes of patients who underwent anterior cervical discectomy and fusion (ACDF) without additional anterior plate fixation.A retrospective, single-center analysis was conducted. Clinical outcomes were assessed by the Visual Analog Scale (VAS) scores, Neck Disability Index (NDI), and Odom's criteria. Radiological outcomes were evaluated based on changes in segmental disc height (subsidence), and Cobb angle by X-rays. Fusion was defined as a consistent distance between spinous processes.The study population consisted of 98 patients (mean age of 55.8 years) with a follow-up of 22.1 months. Procedures included 55 one-level, 33 two-level, and 10 three-level surgeries. The study results demonstrated good clinical outcomes, with statistically significant reductions in NDI scores with notable improvements in VAS (p < 0.001). Radiologically, we recorded a subsidence and reduction in Cobb angle of 1.6 mm/2.2 degrees in one-level, 3.8 mm/3.0 degrees in two-level, and 2.5 mm/2.4 degrees in three-level surgeries, respectively. Complete postoperative fusion was recorded for 86.7% patients, comprising rates of 87.3% for one-level, 90.9% for two-level, and 70.0% for three-level procedures. No revision surgery had to be performed.ACDF without additional plating appears to be an effective procedure for the surgical treatment of single- and multilevel degenerative cervical disease with good clinical outcome.

Quality of life (QoL) is a crucial factor which has to be taken into account in the treatment of vestibular schwannomas. This study compared microsurgical and radiosurgical treatments, focusing on three. (1) evaluating post-treatment clinical outcomes, (2) assessing the effect on QoL and (3) analyzing complication rates, particularly in geriatric patients. In this retrospective study, 586 patients underwent either microsurgery or gamma knife radiosurgery between 1990 and 2013. Demographic and treatment data were collected, including quality of life (QoL) assessments using the Short Form 36 (SF-36) and evaluations of the Karnofsky Performance Status (KPS). Complication rates were also analyzed. The study included 194 microsurgery patients and 392 radiosurgery patients. Radiosurgery patients showed significantly better postoperative hearing and facial nerve function (p < 0.05). QoL scores were higher in the radiosurgery group for physical and emotional role functioning, while microsurgery patients (including aged 65 years and older) reported better scores for bodily pain and general health perceptions. Neurological complications were 41.9% in the microsurgery group, most of them being permanent (92.9%). Radiosurgery generally showed better preservation of hearing, facial nerve function, and quality of life compared to microsurgery, although both treatments appeared equally effective in older patients.

Surgical site infection (SSI) is a serious complication after cranioplasty. Due to the relatively frequent occurrence of post-cranioplasty SSI, the utility of autologous bone flap swab cultures surrounding cryopreservation as a reliable predictor has been the subject of an ongoing debate. This bicentric study aims to contribute to this topic by conducting an in-depth analysis of bone flaps obtained via decompressive craniectomies. This study had three major aims: assessments of 1) bacterial contamination of bone flaps after decompressive craniotomy, 2) impact of cryoconservation on contamination rates and 3) potential effectiveness of anti-infective treatment to reduce the germ load prior to cranioplasty. Cryopreserved bone flaps from two centers were used. Microbiological cultivations of swabs prior to and after cryopreservation were taken and assessed for aerobic and anaerobic growth over a 14-day incubation period. Additionally, in a subset of bone flaps, swab testing was repeated after thorough rinsing with an anti-infectant (octenidine-phenoxyethanol) followed by saline. All 63 bone flaps (patients median age at surgery: 59 years) were obtained via decompressive craniectomies. Swabs done prior to cryopreservation revealed a 54

PURPOSE:To assess whether the Modified 5 (mFI-5) and 11 (mFI-11) Factor Frailty Indices associate with postoperative mortality, complications, and functional benefit in supratentorial meningioma patients aged over 80 years. METHODS:Baseline characteristics were collected from eight centers. Based on the patients' preoperative status and comorbidities, frailty was assessed by the mFI-5 and mFI-11. The collected scores were categorized as "robust (mFI=0)", "pre-frail (mFI=1)", "frail (mFI=2)", and "significantly frail (mFI≥3)". Outcome was assessed by the Karnofsky Performance Scale (KPS); functional benefit was defined as improved KPS score. Additionally, we evaluated the patients' functional independence (KPS≥70) after surgery. RESULTS:The study population consisted of 262 patients (median age 83 years) with a median preoperative KPS of 70 (range 20 to 100). The 90-day and 1-year mortality were 9.0% and 13.2%; we recorded surgery-associated complications in 111 (42.4%) patients. At last follow-up within the postoperative first year, 101 (38.5%) patients showed an improved KPS, and 183 (69.8%) either gained or maintained functional independence. "Severely frail" patients were at an increased risk of death at 90 days (OR 16.3 (CI95% 1.7-158.7)) and one year (OR 11.7 (CI95% 1.9-71.7)); nine (42.9%) of severely frail patients died within the first year after surgery. The "severely frail" cohort had increased odds of suffering from surgery-associated complications (OR 3.9 (CI 95%) 1.3-11.3)), but also had a high chance for postoperative functional improvements by KPS≥20 (OR 6.6 (CI95% 1.2-36.2)). CONCLUSION:The mFI-5 and mFI-11 associate with postoperative mortality, complications, and functional benefit. Even though "severely frail" patients had the highest risk morbidity and mortality, they had the highest chance for functional improvement.

Purpose Superficial surgical site infection (SSSI) is a prominent problem in spine surgery. Intracutaneous sutures and staple-assisted closure are two widely used surgical techniques for skin closure. Yet, their comparative impact on wound healing and infection rates is underexplored. Our goal was to address this gap and compare wound healing between these two techniques. Methods This study was a multicenter international prospective randomized trial. Patient data were prospectively collected at three large academic centers, patients who underwent non-instrumented lumbar primary spine surgery were included. Patients were intraoperatively randomized to either intracutaneous suture or staple-assisted closure cohorts. The primary endpoint was SSSI within 30 days after surgery according to the wound infection Centers for Disease Control and Prevention (CDC) classification system. Results Of 207 patients, 110 were randomized to intracutaneous sutures and 97 to staple-assisted closure. Both groups were homogenous with respect to epidemiological as well as surgical parameters. Two patients (one of each group) suffered from an A1 wound infection at the 30-day follow up. Median skin closure time was faster in the staple-assisted closure group (198 seconds vs. 13 seconds, p < 0,001). Conclusion This study showed an overall low superficial surgical site infection rate in both patient cohorts in primary non instrumented spine surgery.

BACKGROUND:Spinal surgery has to address the challenge of a dramatic increase of the growing number of older persons. The purpose of the present study was to project the numbers of surgically treated degenerative spine disease (DSD) in Austria from 2017 until 2080 to provide potential future scenarios that the Austrian Health system might have to face.METHODS:Current numbers on demographic information from Austria as well as population projections for 2017-2080 were obtained from Statistics Austria (STAT). A lower/main/upper scenario reflecting low/main/high growth and ageing scenarios deducted from fertility, life expectancy and immigration calculations was used. Information on prevalence of surgically treated DSD was obtained from the Austrian Spine Register.RESULTS:The population in Austria (evaluated in 2017) was 8.78 millions and is estimated to evolve to 7.86/10.0/13.1 millions by 2080. The total number of surgically treated DSD recorded in the Spine Register was 9300 and was estimated to be 9300/11200/13700 in 2080. The number of subjects with surgically treated DSD were expected to increase in the age-strata (main scenario), 100% corresponds to the number in each age and gender stratum: 0-40 years by (male/female) 2%/2%, 40-50 years -7%/-7%, 50-59 years -11%/-9%, 60-69 years 21%/16%, 70-79 years 51%/31%, 80-89 years 211%/129% and 90+years 698%/411%.CONCLUSIONS:Total numbers of subjects with DSD in Austria will increase from 2017 to 2080. The increase will be substantial in those aged 80+ and those aged 90+. The assumptions of this analysis were taken conservatively. Hence, the future socio-economic burden to society might be greater as projected by the study.

Abstract BACKGROUND Demographic changes will lead to an increase in old patients, a population with significant risk of postoperative morbidity and mortality, requiring neurosurgery for meningiomas, Objective: To evaluate outcome of supratentorial meningioma patients aged ≥80 years. This multicenter study aims to report neurofunctional status after resection, to identify factors associated with outcome, and to validate a previously proposed decision support tool. METHODS Neurofunctional status was assessed by the Karnofsky Performance Scale (KPS). Patients were categorized in poor (KPS ≤40), intermediate (KPS 50-70), and good (KPS ≥80) preoperative subgroups. Volumetric analyses of tumor and peritumoral brain edema (PTBE) were performed; volumes were scored as small (< 10 cm3), medium (10-50 cm3), and large ( >50 cm3). RESULTS The study population consisted of 262 patients. Median age at surgery was 83.0 years. Median preoperative KPS was 70; 117 (44.7%) patients were allotted to the good, 113 (43.1%) to the intermediate, and 32 (12.2%) to the poor subgroup. Median tumor and PTBE volumes were 30.2 cm3 and 27.3 cm3; large PTBE volume correlated with poor preoperative KPS status (P = .008). The 90-day and 1-year mortality rates were 9.0% and 13.2%. Within the first postoperative year, 101 (38.5%) patients improved, 87 (33.2%) were unchanged, and 74 (28.2%) were functionally worse (including deaths). Each year-increase of age associated with 44% (23–70%) increased risk of 90-day and 1-year mortality. In total, 111 (42.4%) patients suffered from surgery-associated complications. Maximum tumor diameter ≥5cm (odds ratio 1.87 (1.12–3.13)) and large tumor volume (odds ratio 2.35 (1.01–5.50)) associated with an increased risk of complications. Among patients with poor preoperative status and large PTBE, most (58.3%) benefited from surgery. CONCLUSION Patients with poor preoperative status and large PTBE most often showed postoperative improvements. The decision support tool may be of help in identifying cases that most likely benefit from surgery.

BACKGROUND:The aim of this study was to compare the intraoperative and postoperative outcomes between a robot-assisted versus a navigated transpedicular fusion technique.METHODS:This retrospective analysis included patients who underwent transpedicular posterior fusion of the spine due to trauma, pyogenic spondylodiscitis and osteoporosis. Surgery was done either with a robot-assisted or a percutaneous navigated transpedicular fusion technique. The outcome analysis included the duration of surgery, the radiation exposure, the postoperative screw position and complications.RESULTS:A total of 60 patients were operated and 491 screws were analysed. No statistical difference was seen in the applied cumulative effective radiation dose per patient. The radiological assessment revealed a more accurate screw placement with robot assistance. A learning curve could be observed in robot-assisted fusion.CONCLUSION:Robot-assisted and navigated transpedicular fusion techniques are both effective and safe. Robot-assisted transpedicular spine fusion goes along with higher placement accuracy but its implementation needs an adequate learning curve.

BACKGROUND AND OBJECTIVES: Demographic changes will lead to an increase in old patients, a population with significant risk of postoperative morbidity and mortality, requiring neurosurgery for meningiomas. This multicenter study aims to report neurofunctional status after resection of patients with supratentorial meningioma aged 80 years or older, to identify factors associated with outcome, and to validate a previously proposed decision support tool. METHODS: Neurofunctional status was assessed by the Karnofsky Performance Scale (KPS). Patients were categorized in poor (KPS ≤40), intermediate (KPS 50-70), and good (KPS ≥80) preoperative subgroups. Volumetric analyses of tumor and peritumoral brain edema (PTBE) were performed; volumes were scored as small (<10 cm 3 ), medium (10-50 cm 3 ), and large (>50 cm 3 ). RESULTS: The study population consisted of 262 patients, and the median age at surgery was 83.0 years. The median preoperative KPS was 70; 117 (44.7%) patients were allotted to the good, 113 (43.1%) to the intermediate, and 32 (12.2%) to the poor subgroup. The median tumor and PTBE volumes were 30.2 cm 3 and 27.3 cm 3 ; large PTBE volume correlated with poor preoperative KPS status ( P = .008). The 90-day and 1-year mortality rates were 9.0% and 13.2%, respectively. Within the first postoperative year, 101 (38.5%) patients improved, 87 (33.2%) were unchanged, and 74 (28.2%) were functionally worse (including deaths). Each year increase of age associated with 44% (23%-70%) increased risk of 90-day and 1-year mortality. In total, 111 (42.4%) patients suffered from surgery-associated complications. Maximum tumor diameter ≥5 cm (odds ratio 1.87 [1.12-3.13]) and large tumor volume (odds ratio 2.35 [1.01-5.50]) associated with increased risk of complications. Among patients with poor preoperative status and large PTBE, most (58.3%) benefited from surgery. CONCLUSION: Patients with poor preoperative neurofunctional status and large PTBE most often showed postoperative improvements. The decision support tool may be of help in identifying cases that most likely benefit from surgery.

BACKGROUND CONTEXTSpinal arachnoid web (SAW) is a rare condition characterized by focal thickening of the arachnoid membrane causing displacement and compression of the spinal cord with progressive symptoms and neurological deficits. Recent reports and clinical experience suggest that SAW is a distinct entity with specific radiological findings and treatment strategies distinguishable from other arachnopathies and potential differential diagnoses.PURPOSETo better define the diagnostic and clinical features, treatment options and outcomes of surgically treated SAW.STUDY DESIGNMulticentric retrospective cohort study.PATIENT SAMPLETwelve cases of SAW surgically treated at three different centers.OUTCOME MEASURESSelf-reported and neurological outcome measurements (pain, sensory-motor deficits, vegetative dysfunctions) were assessed at follow-up timepoints.METHODSRetrospective review of prospectively collected data on all patients surgically treated for SAW from three participating neurosurgical centers between 2014 and 2020. Clinicopathological data, including neurological presentation, radiological and histological findings and outcome data were analyzed.RESULTSTwelve radiologically and surgically confirmed cases of SAW were analyzed. Mean patient age was 54.7 [±12.7], 67% were male. All SAWs were located in the posterior thoracic dural sac. On magnetic resonance imaging (MRI), the "scalpel sign" - a characteristic focal dorsal indentation of the spinal cord resembling a scalpel blade - was identified in all patients. A focal intramedullary syrinx was present in 83%. Preoperative clinical symptoms included signs of myelopathy, pain, weakness and sensory loss, most commonly affecting the trunk/upper back or lower extremities. Laminectomy or laminoplasty with intradural excision of the SAW was the surgical treatment of choice in all cases. Intraoperative ultrasound was valuable to visualize the cerebrospinal fluid (CSF) flow obstruction, confirm the SAW location before dura incision and to control adequacy of resection. After surgery, sensory loss and weakness in particular showed significant improvement.CONCLUSIONSThe present study comprises the largest series of surgically treated SAW, underscoring the unique clinical, radiographic, histopathological, and surgical findings. We want to emphasize SAW being a distinct entity of spinal arachnopathy with a favorable long-term outcome if diagnosed correctly and treated surgically. Intraoperative ultrasound aids visualizing the SAW before dural incision, as well as verifying restored CSF flow after resection.

Die Fehleinschätzung oder verzögerte Behandlung spinaler Notfälle kann langfristige neurologische Defizite bedingen. Leitsymptome und klinische Zeichen müssen daher rasch erkannt und diagnostisch eingeordnet werden können. Therapeutisch ist das oberste Ziel die Rückbildung bestehender sowie das Vorbeugen neuer neurologischer Defizite. Im Beitrag soll auf verschiedene Szenarien in Hinblick auf Erkennung und Erstbehandlung eingegangen werden.

Multisystem inflammatory syndrome in children (MIS-C) is a novel syndrome of multisystemic inflammation affecting children. This case report documents an exceptional and severe complication of an epidural hematoma in a 3-year-old boy under the treatment of MIS-C. During the course of the disease, the patient suffered from a hypocoagulable state and an extensive multisegmental epidural hematoma in the cervical spinal canal. This led to severe anterior spinal cord compression and tetraparesis. Extensive emergency surgery had to be carried out to reverse rapid clinical deterioration.

STUDY DESIGN:Retrosepctive analysis of prospectively collected data from the multicentre Canadian Surgical Spine Registry (CSORN). OBJECTIVE:Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in North America. Few studies have evaluated return to work (RTW) rates after DCM surgery. Our goals were to determine rates and factors associated with postoperative RTW in surgically managed patients with DCM. METHODS:Data was derived from the prospective, multicenter Canadian Spine Outcomes and Research Network (CSORN). From this cohort, we included all nonretired patients with at least 1-year follow-up. The RTW rate was defined as the proportion of patients with active employment at 1 year from the time of surgery. Unadjusted and adjusted analyses were used to identify patient characteristics, disease, and treatment variables associated with RTW. RESULTS:Of 213 surgically treated DCM patients, 126 met eligibility, with 49% working and 51% not working in the immediate period before surgery; 102 had 12-month follow-up data. In both the unadjusted and the adjusted analyses working preoperatively and an anterior approach were associated with a higher postoperative RTW (P < .05), there were no significant differences between the postoperative employment groups with respect to age, gender, preoperative mJOA (modified Japanese Orthopaedic Association) score, and duration of symptoms (P > .05). Active preoperative employment (odds ratio = 15.4, 95% confidence interval = 4.5, 52.4) and anterior surgical procedures (odds ratio = 4.7, 95% confidence interval = 1.2, 19.6) were associated with greater odds of RTW at 1 year. CONCLUSIONS:The majority of nonretired patients undergoing surgery for DCM had returned to work 12 months after surgery; active preoperative employment and anterior surgical approach were associated with RTW in this analysis.