Antonio-Daniel Corlatescu

Background: Enhanced recovery pathways and modern fixation systems have shortened admission after lumbar spine surgery, yet the interplay between implant choice, comorbidity, and early morbidity remains incompletely defined. Methods: We undertook a retrospective, single-center cohort study of lumbar procedures performed at SANADOR Clinical Hospital (Bucharest, Romania) between 1 January 2023 and 31 May 2024. Eighty-six adult patients (64 women, 22 men; mean age 64.9 ± 10.8 years) met the inclusion criteria. Outcomes included length of stay (LOS), early postoperative neurological change (Frankel/American Spinal Injury Association (ASIA) Impairment Scale), and unplanned reoperation within 90 days. Analyses were performed in Python 3.11 (pandas, SciPy, statsmodels) and verified in IBM SPSS 28.0; α = 0.05. Results: Spondylolisthesis was the predominant diagnosis (60.5%), followed by lumbar stenosis (17.4%). Instrumentation was used in 75 cases (87.2%). Median LOS was 3 days (mean 3.8 ± 2.1), and most patients were discharged by postoperative day 4. LOS did not differ by interbody cage status (Mann–Whitney p = 0.459; median 3 vs. 3 days). Early postoperative neurological change occurred in 34.9% but improved or resolved in all cases by discharge; no permanent motor deficits were observed. Unplanned reoperation within 90 days occurred in 17.6%. In multivariable logistic regression for prolonged hospitalization (LOS > 4 days), early postoperative neurological change was associated with increased odds of prolonged LOS (OR 4.45, 95% CI 1.29–15.43; p = 0.018), whereas age showed only a borderline association (OR 1.06 per year, 95% CI 1.00–1.14; p = 0.065). Conclusions: In this single-center retrospective cohort, postoperative hospitalization was generally short. Prolonged LOS was more closely associated with early postoperative neurological change than with baseline comorbidity or interbody cage use. These findings should be interpreted as short-term, context-specific observations from a complex, predominantly instrumented referral cohort.

In less than 30 years, Deep Brain Stimulation (DBS) has evolved from an antiparkinsonian rescue intervention into a flexible neuromodulatory therapy with the potential for personalized, adaptive, and enhancement-focused interventions. In this review we collected evidence from seven areas: (i) modern eligibility criteria, and ways to practically improve on these, outside of ‘Core Assessment Program of Surgical Interventional Therapies in Parkinson’s Disease’ (CAPSIT-PD); (ii) cost-effectiveness, where long-horizon models now show positive incremental net monetary benefit for Parkinson’s disease, and rechargeable-devices lead the way in treatment-resistant depression and obsessive–compulsive disorder; (iii) anatomical targets, from canonical subthalamic nucleus (STN) / globus pallidus internus (GPi) sites, to new dual-node and cortical targets; (iv) mechanistic theories from informational lesions, antidromic cortical drive, and state-dependent network modulation made possible by optogenetics and computational modeling; (v) psychiatric and metabolic indications, and early successes in subcallosal and nucleus-accumbens stimulation for depression, obsessive–compulsive disorder (OCD), anorexia nervosa, and schizophrenia; (vi) procedure- and hardware-related safety, summarized through five reviews, showing that the risks were around 4% for infection, 4–5% for revision surgery, 3% for lead malposition or fracture, and 2% for intracranial hemorrhage; and (vii) future directions in connectomics, closed-loop sensing, and explainable machine learning pipelines, which may change patient selection, programming, and long-term stewardship. Overall, the DBS is entering a “third wave” focused on a better understanding of neural circuits, the integration of AI-based adaptive technologies, and an emphasis on cost-effectiveness, in order to extend the benefits of DBS beyond the treatment of movement disorders, while remaining sustainable for healthcare systems.

Background: Patellofemoral instability arises from the interplay between trochlear morphology and malalignment of the extensor vector. Although each factor is individually well described, their combined mechanical effects have not been quantified within a single finite element framework. Objective: To investigate how lateral trochlear inclination (LTI) and tibial tuberosity position interact to influence patellofemoral contact mechanics and stability across clinically relevant knee flexion angles. Methods: A subject-specific finite element model of the femur–patella–tibia complex was reconstructed from high-resolution CT data. Cortical and cancellous bone, patellar cartilage, the MPFL, and patellar tendon were included. Three trochlear morphologies were simulated (LTI = 15°, 10°, 5°) under native alignment (Case A) and after 10 mm lateral tibial tuberosity translation (Case B). Flexion at 30°, 60°, and 90° was imposed via solver-applied tibial displacement. Primary outcomes were contact pressure, contact area, MPFL stress, and lateral patellar translation. Instability was defined as >5 mm lateral translation or >50% reduction in contact area, consistent with the biomechanical literature. Model convergence (5 mm lateral patellar translation and near-complete loss of cartilage contact by 60°, simulating lateral dislocation. Sensitivity testing confirmed robustness to material property uncertainty. Conclusions: Shallow trochlear inclination dissipates articular load but destabilises the patella, an effect magnified by tibial tuberosity lateralisation. While these findings highlight thresholds at which stability may be compromised, they derive from a single-subject model and should be interpreted as hypothesis-generating rather than prescriptive. Broader validation across multiple geometries and loading conditions is required before clinical translation.

Introduction: Total hip arthroplasty is a major orthopedic intervention, which is increasingly performed, and involves a variable duration of postoperative hospitalization. Estimating this duration is essential for optimizing resources and improving perioperative planning. Materials and Methods: The retrospective study included 85 patients admitted to an orthopedic clinic between 2020 and 2025, undergoing primary hip arthroplasty. Pre- and postoperative clinical, biological, and surgical data were collected. Based on these variables, the H.I.P.P.O. (Hip Intervention Patient Prognostic Outcome) score was developed, using a Random Forest algorithm to predict the length of stay (short, medium, long). Results: The model achieved an overall accuracy of 80%. The most important predictors were as follows: day of surgery, type of prosthesis, preoperative fibrinogen, INR, APTT, preoperative hemoglobin, age, and presence of liver cirrhosis. The H.I.P.P.O. score allowed efficient stratification of patients and showed a high capacity to identify cases at risk of prolonged hospitalization (F1 score = 0.857). Conclusions: The H.I.P.P.O. score is a practical, interpretable, and clinically applicable tool that integrates biological and organizational factors to predict the length of stay after hip arthroplasty. It can support surgical decision making and optimize perioperative management.

Osteosarcoma (OS) is the most common primary bone malignancy in children and adolescents, which is also considered an aggressive disease due to its rapid growth rate, ability to metastasize early, and complex and heterogeneous tumor microenvironment (TME). Although we are developing improved surgical and chemotherapeutic approaches, the presence of metastatic or recurrent disease is still detrimental to the patient’s outcome. Major advances in understanding the molecular mechanisms of OS are needed to substantially improve outcomes for patients being treated for OS. This review integrates new data on the molecular biology, pathophysiology, and immune landscape of OS, as well as introducing salient areas of tumorigenesis underpinning these findings, such as chromothripsis; kataegis; cancer stem cell dynamics; and updated genetic, epigenetic, and glycosylation modifiers. In addition, we review promising biomarkers, diagnostic platforms, and treatments, including immunotherapy, targeted small molecule inhibitors, and nanomedicine. Using genomic techniques, we have defined OS for its significant genomic instability due to TP53 and RB1 mutations, chromosomal rearrangements, and aberrant glycosylation. The TME is also characterized as immunosuppressive and populated by tumor-associated macrophages, myeloid-derived suppressor cells, and regulatory T cells, ultimately inhibiting immune checkpoint inhibitors. Emerging fields such as glycomics and epigenetics, as well as stem cell biology, have defined promising biomarkers and targets. Preclinical studies have identified that glycan-directed CAR therapies could be possible, as well as metabolic inhibitors and 3D tumor models, which presented some preclinical success and could allow for tumoral specificity and enhanced efficacy. OS is a biologically and clinically complex disease; however, advances in exploring the molecular and immunologic landscape of OS present new opportunities in biomarkers and the development of new treatment options with adjunctive care. Successful treatments in the future will require personalized, multi-targeted approaches to account for tumor heterogeneity and immune evasion. This will help us turn the corner in providing improved outcomes for patients with this resilient malignancy.

The spine is a complex structure critical for stability, force transmission, and neural protection, with spinal fractures and spondylolisthesis posing significant challenges to its integrity and function. Spinal fractures arise from trauma, degenerative conditions, or osteoporosis, often affecting transitional zones like the thoracolumbar junction. Spondylolisthesis results from structural defects or degenerative changes, leading to vertebral displacement and potential neurological symptoms. Diagnostic and classification systems, such as AO Spine and TLICS, aid in evaluating instability and guiding treatment strategies. Advances in surgical techniques, including minimally invasive approaches, pedicle screws, interbody cages, and robotic-assisted systems, have improved precision and recovery while reducing morbidity. Vertebral augmentation techniques like vertebroplasty and kyphoplasty offer minimally invasive options for osteoporotic fractures. Despite these innovations, postoperative outcomes vary, with challenges such as persistent pain and hardware complications necessitating tailored interventions. Future directions emphasize predictive analytics and enhanced recovery strategies to optimize surgical outcomes and patient quality of life.

Background: This study presents a comprehensive analysis of 135 cases of vestibular schwannoma (VS) treated between 2006 and 2022 at the National Institute of Neurology and Neurovascular Diseases in Bucharest, Romania. The investigation focuses on the clinical presentation, treatment outcomes, and demographic trends of VS patients, highlighting region-specific insights that fill critical gaps in Eastern European data. Methods: Patients were treated with either open surgery (93.3%) or gamma knife radiosurgery (6.6%). The study identifies predominant symptoms, including hearing impairment, facial palsy, and balance disorders, with variations observed across age and gender subgroups. Comorbidities such as hypertension and obesity were prevalent, and they influenced perioperative risks. Results: Post-treatment outcomes showed a significant correlation between clinical symptoms and treatment modalities, with a majority achieving favorable results. The findings emphasize the need for tailored approaches in VS management and underscore the importance of region-specific factors in influencing clinical outcomes. Conclusions: This study contributes to refining treatment strategies and improving healthcare delivery for VS patients in Romania and beyond.

Background and Objectives: The Index of Response to Stimulation (IRES) is a new index that we introduce in this study to grade the effectiveness of vagus nerve stimulation in the treatment of drug-resistant epilepsy. We assessed 76 patients at 6, 12, and 18 months after VNS evaluating improvement with the IRES in four key dimensions: seizure duration decrease, seizure intensity decrease, improvement in quality of life, and seizure frequency decrease. This scale goes from 0, meaning no improvement, to 8, meaning maximal improvement, making the scale a really good measure of clinical utility. Materials and Methods: This retrospective study followed 76 patients aged 20–65, assessing changes in their IRES scores after VNS therapy using the ASPIRE SR 106 device. Therapy settings were adjusted biweekly to optimize efficacy and patient tolerance. Results: There were improvements in the control of the seizures, measured in terms of increased IRES scores. Improvements were associated with quality-of-life enhancements for the patient and a lesser frequency and intensity of the seizures, testifying further to the predictive ability of the IRES toward successful outcomes. This fact reveals that epilepsy treatment must be individual, according to the profile of the patient. Conclusions: The study confirms the IRES to be a valid tool for the assessment of the impact of VNS on drug-resistant epilepsy and promotes it as an integral part of the evaluation of the patient for personalized therapy. The findings encourage the use of IRES among the elements that support patient selection and insist on its role in the advancement of precision medicine and optimization of treatment.

Background: Cerebral cavernous malformations (CCMs), particularly when located in the cerebellum, pose unique clinical challenges due to the risk of hemorrhage and proximity to critical neurovascular structures. Surgical resection is often necessary to prevent further neurological deterioration. This case report describes the management of a symptomatic cerebellar cavernoma, emphasizing the use of microsurgical techniques and long-term follow-up. The objective of this study is to illustrate the surgical approach and outcomes of a patient with a hemorrhagic cerebellar cavernoma. Methods: A 63-year-old female presented with vertigo, and neuroimaging revealed a hemorrhagic cavernous malformation located in the right cerebellar hemisphere. Follow-up was conducted at two months and one year postoperatively, with serial imaging to assess lesion recurrence and neurological recovery. Results: Complete resection of the cavernoma was achieved without postoperative neurological deficits. Imaging at two months and one year post-surgery showed no signs of recurrence or new lesion formation. The patient remained asymptomatic, with no cranial nerve deficits or other long-term complications. Conclusions: This case demonstrates the effectiveness of microsurgical resection in treating symptomatic cerebellar cavernomas. The use of advanced intraoperative tools, such as neuronavigation and IONM, contributed to the successful outcome and prevention of postoperative complications. Long-term follow-up remains crucial to monitor for recurrence or the development of de novo lesions.

Background/Objectives: Superior cerebellar artery (SCA) aneurysms are exceedingly rare, posing unique diagnostic and management challenges due to their complex anatomical location within the posterior circulation. The proximity of the SCA to vital structures, such as the brainstem and cerebellum, along with the significant role of poorly controlled hypertension in aneurysm formation, further complicates treatment. This case aims to highlight the surgical approach and management strategies employed in treating a rare SCA aneurysm in a patient with longstanding hypertension. Methods: A 68-year-old female presented with an acute onset of severe headache, nausea, and vomiting, later confirmed to be due to a ruptured SCA aneurysm. The patient’s history of poorly controlled hypertension was identified as a major contributing factor to the aneurysm’s development and rupture. Due to the aneurysm’s wide-neck morphology and irregular shape, microsurgical clipping was selected as the treatment method. The occipito-parietal far-lateral approach was employed to gain optimal access to the aneurysm, minimizing the risk to adjacent neurovascular structures. Results: Microsurgical clipping successfully excluded the aneurysm while preserving the parent artery. The surgical approach enabled precise aneurysm isolation and ensured no postoperative neurological deficits. The patient recovered well, with no significant complications, and hypertension management was emphasized as a vital element of the patient’s long-term care. Conclusions: The surgical technique effectively achieved complete aneurysm exclusion with preservation of the parent artery and no associated neurological deficits. The patient’s recovery was uneventful, highlighting the efficacy of the approach. Long-term management of hypertension remains a critical component to prevent recurrence and ensure sustained outcomes.