Carl Moritz Zipser

Background: Diagnostic criteria are critical for the accurate diagnosis of neurological diseases, which are among the most challenging to define. They help to standardize global efforts in healthcare delivery and scientific investigation. Despite their importance, no standardised methodology or preferred framework exists for developing these criteria. This scoping review aims to evaluate the structure, components and development process of existing diagnostic criteria across neurological disorders in order to identify common features that may inform the development of diagnostic criteria for neurological disorders. Methods: Neurological disorders were identified using the International Classification of Diseases, 11th Revision (ICD-11) and Lerner’s monograph entitled Diagnostic Criteria in Neurology. PubMed was searched for guideline-based diagnostic criteria published within the last ten years. Neuropsychiatric conditions were retrieved from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Extracted variables for qualitative analysis included clinical manifestations, neurological examination, imaging, laboratory parameters, neurophysiology, disease course, development methodology and structure. A sensitivity analysis was conducted to account for large clustered data. Results: A total of 332 diagnostic criteria were identified across multiple neurological subspecialties. “Typical clinical manifestations” ( n = 317/332, 95.5%) – largely referring to clinical symptoms and not examination findings – were the most frequently included diagnostic component. Structurally, checklists ( n = 232/332, 70%) were the most used methodological framework. Most criteria were developed through consensus statements (35.8%, n = 119/332). Conclusions: Across neurological disorders, diagnostic criteria consistently prioritize clinical manifestations supported by examination findings and ancillary investigations. Future criteria should remain adaptable to advances in diagnostic technologies while ensuring accessibility across diverse clinical settings.

Background: Recent work has demonstrated that individuals with degenerative cervical myelopathy (DCM) often experience symptoms of fatigue that are underrepresented in the literature. Conversely, understanding fatigue is highly important to people living with DCM. The AO Spine RECODE-DCM (Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy) study group recently determined that no suitable fatigue scales exist for DCM. Objective: An assessment of content validity of existing fatigue scales used in other populations was undertaken to determine whether any such scales are suitable for DCM. Methods: An expert panel of people with DCM was convened. The panel comprised members of the RECODE-DCM steering committee, and their DCM ranged in severity from mild to severe; all resided in the United Kingdom or the United States. They were presented with 19 instruments in use for other pathologies and developed a quantitative description of relevance to DCM. The committee scored each scale on clarity and comprehensiveness. We conducted a preliminary qualitative analysis of comments on the various attributes of each instrument to establish themes distinguishing high-scoring from lower-scoring instruments. Results: The highest-scoring scales were the (1) Modified Fatigue Impact Scale for Spinal Cord Injury (relevance=3.78; comprehensiveness=3.56; clarity=4), (2) Multidimensional Assessment of Fatigue (3.67, 3.56, and 3.89, respectively), and (3) Functional Assessment of Chronic Illness Therapy–Fatigue Scale (3.56, 3.56, and 3.89, respectively). Common themes used in discussing various instruments were sleep, pain, psychosocial factors, and employment. Conclusions: The Modified Fatigue Impact Scale for Spinal Cord Injury, Multidimensional Assessment of Fatigue, and Functional Assessment of Chronic Illness Therapy–Fatigue Scale appear to be the most appropriate and validated instruments for assessing fatigue in patients with DCM. These scales demonstrate strong psychometric properties while addressing the unique symptomatic profile and functional limitations characteristic of DCM, enabling more accurate measurement and clinical monitoring of fatigue in this patient population.

Background: Neurological disorders affect approximately 3 billion people globally, yet clinical trial success is often hindered by poorly selected outcome measures, impacting trial design, compliance, and interpretation. Over the past 25 years, Core Outcome Sets (COS) have emerged as standardized tools to enhance outcome selection, ensuring comparability across studies and reflecting the priorities of both researchers and patients. Despite the success of COS initiatives in other fields, their development in neurology remains limited, leaving many trialists without disease-specific guidance. Objectives: This study aimed to conduct an AI-assisted thematic synthesis of outcome domains from existing COS, with the goal of identifying structural patterns common to these sets and generating descriptive reference framework to inform future COS development. Methods: COS-Neuro was developed using AI-assisted thematic framework analysis, complemented by expert review. A modified five-step thematic analysis was conducted without pre-determined codes: 1. Dataset Gathering – Data was collected from the COMET database, and COS domains for neurological disorders were coded. 2. Prompt Design & Testing – Large language models (LLMs), including ChatGPT 3.5, Google Gemini 1.5 Flash and Meta Llama-2-70b, were trialled, and prompts refined based on their outputs. 3. Thematic Analysis – LLMs categorised domains into core areas. 4. Human Refinement – Experts reviewed LLM-generated core areas and selected those most appropriate for further interpretation. 5. Clinical Validation – Experts validated the domains, core areas, and concepts. This approach integrated AI with expert oversight to develop an AI-descriptive thematic map of existing neurological COS. Results: Utilising LLMs, particularly ChatGPT, an AI-assisted conceptual framework synthesising existing neurological COS was developed based on the analysis of 112 published COS. Through adaptation of the OMERACT model, the final framework comprised four overarching concepts, 13 core areas, and 75 domains identified through expert consensus. Conclusion: COS-Neuro provides a preliminary AI-assisted descriptive synthesis of existing neurological COS, organised using the OMERACT Filter 2.1 as a structural reference. This hypothesis-generating framework may serve as a foundational resource for future COS research and trial design, particularly in areas where no disease-specific COS exists. However, it requires prospective validation through disease-specific, multi-stakeholder consensus processes before clinical application. COS-Neuro also demonstrates the feasibility of AI-assisted thematic synthesis in this context and warrants evaluation in other specialties.

A 64-year-old male farmer with a history of prostate adenocarcinoma, treated with curative radiotherapy 2 years prior, presented with neck pain and weakness. On examination, he had an incomplete spastic tetraparesis (3/5 strength in upper extremities, 5/5 strength in lower extremities) and sensory level below C5. Cervicothoracic MRI showed garland-like compressive epidural masses, suggestive initially of metastases (Figure 1). Stable prostate-specific antigen and negative PET-CT argued against metastases, leading to CT-guided spinal biopsy, which revealed Echinococcus multilocularis cysts. Serology was IgG-positive against alveolar echinococcosis, and chest and abdominal CT showed multiple hepatic cysts. The patient was treated with albendazole for 6 months and underwent surgical decompression, resulting in full motor recovery.

Study Design.: Systematic literature review. Objective.: Update on diagnostic utility of electrophysiology in lumbar spinal canal stenosis (LSCS). Summary of Background.: LSCS is a highly prevalent degenerative spine condition characterized by neurogenic claudication, radicular pain, and muscle weakness. While lumbar spine MRI is the imaging modality for detecting spinal canal narrowing, it correlates poorly with clinical symptoms. Electrophysiological methods, including electromyography (EMG), nerve conduction studies (NCS), and evoked potentials (MEP and SEP), may provide complementary information on neural dysfunction. Current guidelines support paraspinal electromyography (EMG) mapping for symptomatic patients with imaging confirmed stenosis (grade B). In contrast, the diagnostic value of other electrophysiologic tests in LSCS remains uncertain. Methods.: A systematic literature search was conducted in Medline and Embase for original studies on LSCS between 2020 and 2024. Two independent reviewers screened studies for inclusion. The extracted data was synthesized qualitatively. Study quality was assessed using the Robins-V2 tool. PROSPERO registration (CRD42024622427). Results.: Thirteen studies met the inclusion criteria; study quality was moderate. Needle EMG of the limbs was evaluated in 23% of studies to detect denervation as a sign of radiculopathy. Twenty-three percent of the studies examined tibial nerve SEP or cauda equina MEP conduction time for lesion localization, with varying findings and utility for diagnosing LSCS. Surface EMG was investigated in 31% of studies and revealed significantly altered muscle activation patterns and compensatory gait adaptations in LSCS. Conclusion.: There is an increasing number of studies combining surface EMG with gait assessments and tasks. This approach is interesting for being noninvasive, with clinical utility to be further determined. On the basis of previous guidelines, paraspinal mapping is considered the gold-standard electrophysiological diagnostic tool. Interestingly, there were no recent studies on paraspinal mapping, indicating a shift to alternative methods.

BACKGROUND Recent work has demonstrated that individuals with degenerative cervical myelopathy (DCM) often experience symptoms of fatigue that are underrepresented in the literature. Conversely, understanding fatigue is highly important to people living with DCM. The AO Spine RECODE-DCM (Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy) study group recently determined that no suitable fatigue scales exist for DCM. OBJECTIVE An assessment of content validity of existing fatigue scales used in other populations was undertaken to determine whether any such scales are suitable for DCM. METHODS An expert panel of people with DCM was convened. The panel comprised members of the RECODE-DCM steering committee, and their DCM ranged in severity from mild to severe; all resided in the United Kingdom or the United States. They were presented with 19 instruments in use for other pathologies and developed a quantitative description of relevance to DCM. The committee scored each scale on clarity and comprehensiveness. We conducted a preliminary qualitative analysis of comments on the various attributes of each instrument to establish themes distinguishing high-scoring from lower-scoring instruments. RESULTS The highest-scoring scales were the (1) Modified Fatigue Impact Scale for Spinal Cord Injury (relevance=3.78; comprehensiveness=3.56; clarity=4), (2) Multidimensional Assessment of Fatigue (3.67, 3.56, and 3.89, respectively), and (3) Functional Assessment of Chronic Illness Therapy–Fatigue Scale (3.56, 3.56, and 3.89, respectively). Common themes used in discussing various instruments were sleep, pain, psychosocial factors, and employment. CONCLUSIONS The Modified Fatigue Impact Scale for Spinal Cord Injury, Multidimensional Assessment of Fatigue, and Functional Assessment of Chronic Illness Therapy–Fatigue Scale appear to be the most appropriate and validated instruments for assessing fatigue in patients with DCM. These scales demonstrate strong psychometric properties while addressing the unique symptomatic profile and functional limitations characteristic of DCM, enabling more accurate measurement and clinical monitoring of fatigue in this patient population.

Introduction/Aims: Diagnosis of degenerative cervical myelopathy ( DCM ) is frequently delayed. A lack of awareness and standardized screening criteria have been identified as major contributors. The objective of this study was to conduct a survey of international experts to determine the value of various signs and symptoms in diagnosing patients with DCM . This study forms part of a three‐step initiative that aims to develop pragmatic screening criteria for DCM . Methods: An open voluntary English‐language Likert scale survey was disseminated among international networks of experts in DCM . Respondents were asked to rank each sign or symptom on a scale of 0 ( not important at all ) to 10 ( extremely important ); a mean value of ≥ 6.5 was set a priori as the threshold to consider a feature as having significant diagnostic value. Results: Fifteen symptoms and 12 signs were ranked as having significant diagnostic value. The most highly ranked symptoms are primarily related to abnormalities of the upper limb, hand function, and gait. The top‐rated signs included pathological reflexes as well as impairment of motor function, gait, and coordination. Features ranked as significant were largely consistent across professions, levels of experience, and continental regions. Discussion: The integration of expert stakeholder opinion with evidence from existing literature strengthens the clinical framework for identifying key clinical features of DCM . These 27 features will be discussed at an international consensus meeting to establish a standardized clinical screening toolkit that can be used by frontline healthcare professionals to detect patients with DCM .

Study design Protocol for the development of enhanced recovery after surgery (ERAS) recommendations for DCM surgery. Objectives To develop ERAS recommendations in collaboration with the ERAS Society to optimize care for individuals having surgery for degenerative cervical myelopathy (DCM)—the most common type of nontraumatic spinal cord injury. Methods The study protocol was developed in line with the AGREE II checklist for clinical practice guidelines and the ERAS Society standards for guideline development. A multidisciplinary international guideline development group (GDG) including a representative from the ERAS society, clinical experts in the surgical care of people with DCM, and people with lived experience of having surgery for DCM has been established. The recommendations will follow the GRADE methodology and will therefore include the following steps. 1) Framing the health care questions. 2) Selecting and rating the importance of outcomes for each ERAS candidate interventiont. 3) Summarizing the evidence for each ERAS candidate intervention. 4) Judging the quality of evidence for each ERAS candidate intervention. 5) Judging the strength of the recommendations for each ERAS candidate intervention. 6) Developing recommendations statements for the included ERAS interventions and achieving consensus on the ERAS intervention statements to be included in the final guideline. Following the recommendation statements’ development, key stakeholders will be invited to externally review the guidelines. Conclusion ERAS recommendations for DCM aim to reduce the incidence and severity of adverse events, optimize patient outcomes, improve the efficiency and quality of care, and patients’ experience and satisfaction with care.

Study Design: Systematic Review. Objectives: Enhanced Recovery After Surgery (ERAS) is a widely acknowledged approach for improving surgical outcomes. This review aims at analyzing the characteristics of study populations, interventions and outcomes in spine patients. Methods: Embase and Ovid were searched from inception until March 2025. We followed PRISMA guidelines. Study quality and risk of bias were assessed. In addition to a narrative synthesis of the evidence, a meta-analysis of RCTs evaluating length of stay (LOS) for a lumbar spine population was conducted. This review was registered prospectively on PROSPERO (No. CRD42025638293). Results: 1431 records were identified, from which 81 studies were included. Reports of ERAS predominantly exist for degenerative spine pathologies (n = 35/81, 43.2%) and spinal deformities (n = 29/81, 35.8%). Most studied interventions were postoperative analgesia, early mobilisation (both n = 61/81, 75.3%) and patient education (n = 60, 74.1%). The most frequently used outcome measures were LOS (n = 65/81, 92.9%) and complication rates (n = 40/81, 49.4%). The overall median complication rate for ERAS patients was found to be lower (8.8% vs 15.6%). There was a statistically non-significant tendency for ERAS shortening LOS for 1 day in lumbar spine patients [95%CI -2.77, 0.71; P = 0.25]. Conclusions: ERAS in spine surgery appears to be effective in terms of reducing LOS and complication rates. Further efforts at refining pain management and targeted disease-specific interventions are required. Whether ERAS interventions applied to individuals with significant neurological impairment and/or medical frailty, can influence surgical outcomes needs to be further studied.