OBJECTIVE Surgery for metastatic spinal tumors can have a substantial impact on patients’ quality of life by alleviating pain, improving function, and correcting spinal instability when indicated. The decision to operate is difficult because many patients with cancer are frail. Studies have highlighted the importance of preoperative nutritional status assessments; however, little is known about which aspects of nutrition accurately inform clinical outcomes. This study investigates the interaction and prognostic importance of various nutritional and frailty measures in patients with spinal metastases. METHODS A retrospective analysis of consecutive patients who underwent surgery for spinal metastases between 2014 and 2020 at the Massachusetts General Hospital was performed. Patients were stratified according to the New England Spinal Metastasis Score (NESMS). Frailty was assessed using the metastatic spinal tumor frailty index. Nutrition was assessed using the prognostic nutritional index (PNI), preoperative body mass index, albumin, albumin-to-globulin ratio, and platelet-to-lymphocyte ratio. Outcomes included postoperative survival and complication rates, with focus on wound-related complications. RESULTS This study included 154 individuals (39% female; mean [SD] age 63.23 [13.14] years). NESMS 0 and NESMS 3 demonstrated the highest proportions of severely frail patients (56.2%) and nonfrail patients (16.1%), respectively. Patients with normal nutritional status (albumin-to-globulin ratio and PNI) had a better prognosis than those with poor nutritional status when stratified by NESMS. Multivariable regression adjusted for NESMS and frailty showed that a PNI > 40.4 was significantly associated with decreased odds of 90-day complications (OR 0.93, 95% CI 0.85–0.98). After accounting for age, sex, primary tumor pathology, physical function, nutritional status, and frailty, a preoperative nutrition consultation was associated with a decrease in postoperative wound-related complications (average marginal effect −5.00%; 95% CI −1.50% to −8.9%). CONCLUSIONS The PNI was most predictive of complications and may be a key biomarker for risk stratification in the 90 days following surgery. Nutrition consultation was associated with a reduced risk of wound-related complications, attesting to the importance of this preoperative intervention. These findings suggest that nutrition plays an important role in the postsurgical course and should be considered when developing a treatment plan for spinal metastases.

Purpose In Uganda, the burden of neural tube defects (NTDs) poses a serious neurosurgical and public health challenge; however, published data on this patient population is lacking. We sought to characterize the NTD patient population, maternal characteristics, referral patterns of these patients, and quantify the burden of NTDs in Southwestern Uganda. Methods A retrospective neurosurgical database at a referral hospital was reviewed to identify all patients with neural tube defects treated between 08/2016 and 05/2022. Descriptive statistics were used to characterize the patient population and maternal risk factors. Results 232 patients were identified (121 male, 52.2%). Median age at presentation was 2 days (IQR: 1–8). 86.8% of NTD patients presented with spina bifida (n = 204) and 31 with encephalocele (13.2%). The most common location of dysraphism was lumbosacral (n = 180, 88%). Median length of stay was 12 days (IQR: 7–19). One-third of all patients presented from Isingiro, Mbarara, and Kasese. The median maternal age was 26 years (IQR: 22–30). The majority of mothers received only primary education (n = 100, 43.7%). The majority of mothers reported prenatal folate use (n = 158, 67.2%) and regular antenatal care (ANC) (n = 220, 93.6%), although only 23.4% underwent an antenatal ultrasound (n = 55). Of all patients, 80% were delivered vaginally (n = 188). Overall, 67.4% of patients were discharged (n = 157) and 10% died (n = 23). Conclusions This is the first study to describe the NTD patient and maternal population in Southwestern Uganda. A prospective case-control study is necessary to identify unique demographic and genetic risk factors associated with NTDs in this region.

OBJECTIVE In Uganda, the burden of neural tube defects (NTDs) poses a serious neurosurgical and public health challenge; however, published data on this patient population are lacking. The authors sought to characterize the population of patients with NTDs, maternal characteristics, and referral patterns of these patients, and to quantify the burden of NTDs in southwestern Uganda. METHODS A retrospective neurosurgical database at a referral hospital was reviewed to identify all patients with NTDs treated between August 2016 and May 2022. Descriptive statistics were used to characterize the patient population and maternal risk factors. A Wilcoxon rank-sum test and chi-square test were used to determine the association between demographic variables and patient mortality. RESULTS A total of 235 patients were identified (121 male, 52%). The median age at presentation was 2 days (IQR 1–8 days). A total of 87% of patients with NTDs presented with spina bifida (n = 204) and 31 presented with encephalocele (13%). The most common location of dysraphism was lumbosacral (n = 180, 88%). Of all patients, 80% were delivered vaginally (n = 188). Overall, 67% of patients were discharged (n = 156) and 10% died (n = 23). The median length of stay was 12 days (IQR 7–19 days). The median maternal age was 26 years (IQR 22–30 years). The majority of mothers received only primary education (n = 100, 43%). The majority of mothers reported prenatal folate use (n = 158, 67%) and regular antenatal care (n = 220, 94%), although only 23% underwent an antenatal ultrasound (n = 55). Mortality was associated with younger age at presentation (p = 0.01), need for blood transfusion (p = 0.016) and oxygen supplementation (p < 0.001), and maternal education level (p = 0.001). CONCLUSIONS To the authors’ knowledge, this is the first study to describe the population of patients with NTDs and their mothers in southwestern Uganda. A prospective case-control study is necessary to identify unique demographic and genetic risk factors associated with NTDs in this region.