Publications

@article{pmid41611975,

title = {Assessing pedicle morphology in pediatric spinal deformity: can magnetic resonance imaging match computed tomography? A systematic review},

author = {Paolo Brigato and Davide Palombi and Sergio De Salvatore and Sergio Sessa and Timothee de Saint Denis and Leonardo Oggiano and Lorenzo Maria Gregori and Andrea Magistrelli and Pier Francesco Costici},

doi = {10.1007/s43390-026-01290-5},

issn = {2212-1358},

year  = {2026},

date = {2026-07-01},

journal = {Spine Deform},

volume = {14},

number = {4},

pages = {1121--1133},

abstract = {BACKGROUND: Pediatric spinal deformities frequently require surgical correction, and precise preoperative planning is essential to ensure optimal outcomes and minimize complications. A key aspect of planning involves assessing pedicle morphology to determine appropriate screw sizing. This systematic review examines whether magnetic resonance imaging (MRI) can serve as a reliable, radiation-free alternative to computed tomography (CT). While MRI shows promising potential, current evidence presents mixed results regarding its accuracy and clinical applicability compared to CT.nnMETHODS: Following PRISMA guidelines, a systematic review was performed. Literature from Medline, Scopus, Embase, and the Cochrane Library, up to August 2025, was analyzed. Search terms included "scoliosis," "pediatric deformity," "pedicle morphology," "pedicle dimension," "magnetic resonance imaging," and "computed tomography." The extracted data included study details, patient demographics, scoliosis etiology, radiographic techniques, pedicle measurement methods, and outcomes of MRI-CT comparison. Risk of bias was assessed using the MINORS tool.nnRESULTS: Of 319 identified studies, 6 met the inclusion criteria (n = 428 patients). A total of 12,633 pedicles were analyzed across the studies, with MRI and CT used for preoperative assessment. MRI showed good concordance with CT for most measurements though accuracy decreased for more severe pedicle abnormalities. MRI was generally reliable for preoperative planning but had limitations, especially for pedicle sizing.nnCONCLUSION: While MRI offers a radiation-free alternative for preoperative assessment of pedicle morphology in pediatric spinal deformity surgery, current evidence is limited to retrospective studies and shows variable accuracy, particularly in severe or complex cases. CT generally remains more reliable for precise pedicle evaluation and continues to represent the standard of care. Future advancements in MRI technology may help improve its accuracy and expand its role in clinical practice, but stronger prospective evidence is needed before it can be considered a full substitute for CT.},

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@article{pmid42141252,

title = {Impact of Fetoscopic Surgery on the Myometrium: Experimental Study in an Ovine Model of Myelomeningocele},

author = {Enora Parc and Eugénie Jolivet and Corentin Maillet and Yoann Athiel and Jean-Marie Jouannic and Lucie Guilbaud},

doi = {10.1002/pd.70177},

issn = {1097-0223},

year  = {2026},

date = {2026-07-01},

journal = {Prenat Diagn},

volume = {46},

number = {8},

pages = {1258--1266},

abstract = {OBJECTIVE: To investigate uterine healing at delivery after fetoscopic myelomeningocele (MMC) closure in an ovine model.nnMETHODS: This descriptive study was conducted in Romane ewes. Fetal MMC lesions were created after hysterotomy at 75 days of gestation. Fetoscopic MMC closure using three trocars was performed at 90 days of gestation and cesarean delivery at 143 days. Subtotal hysterectomy was performed, and each hysterectomy specimen was examined in fresh condition. The areas of interest and the surrounding intact tissue were then sampled en bloc and fixed in 4% buffered formaldehyde solution for 3-6 weeks. Macroscopic appearance of the scars was assessed in fresh condition. Microscopic examinations were conducted in fixed samples.nnRESULTS: The uteri of six ewes were studied. Macroscopic examination revealed identifiable fetoscopic scars without any scar dehiscence. There was no evidence of a difference in thickness between scarred and healthy adjacent myometrium, although a slightly lower proportion of muscle fibers was observed in scarred areas.nnCONCLUSIONS: Our study demonstrates that myometrial healing of trocar orifices is complete 53 days after fetoscopic MMC closure in an ovine model. Given the limitations of an ovine model, further studies are needed to determine the risk of uterine rupture and the optimal obstetric management of patients after fetoscopic MMC closure.},

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@article{pmid42088080,

title = {EAU-ESPU-ERN eUROGEN-ERN ITHACA-ERN ERKNet-IFSBH Guidelines on Spinal Dysraphism in Children and Adolescents: Summary of the Guideline},

author = {Christian Radmayr and Kate Abrahamsson and Guy Bogaert and Michaela Dellenmark-Blom and Wout Feitz and Anju Goyal and Jean-Marie Jouannic and Rianne Lammers and Michal Maternik and Giovanni Mosiello and Sylvia Roozen and Ulla Sillen and Raimund Stein and Serdar Tekgül and Lisette 't Hoen and Alexander Von Gontard and Johan Vande Walle and Yuhong Yuan and Rien J M Nijman},

doi = {10.1016/j.euros.2026.04.002},

issn = {2666-1683},

year  = {2026},

date = {2026-06-01},

journal = {Eur Urol Open Sci},

volume = {88},

pages = {39--53},

abstract = {BACKGROUND AND OBJECTIVE: Neurogenic bladder in children and adolescents presents complex challenges requiring comprehensive management strategies. Traditional guideline development often lacks input from diverse stakeholders, potentially overlooking crucial aspects of care. We present a novel approach to guideline development that integrates perspectives from pediatric urologists, nephrologists, psychiatrists, and patient representatives from the very beginning of the guideline development process. For this purpose, the European Association of Urology (EAU) Paediatric Urology Guidelines Panel worked together with European Reference Networks (eUrogen, ITHACA, ERKNet), the ESPU (European Society for Paediatric Urology), as well as the International Federation for Spina Bifida and Hydrocephalus (IFSBH), a professional organization with global coverage for people living with disabilities.nnMETHODS: A broad literature search was performed covering the timeframe from 2020 to 2024. Recommendations were developed and rated as strong or weak, based on the quality of the evidence, benefit/ harm ratio, and potential patient preferences.nnKEY FINDINGS AND LIMITATIONS: Spinal cord disorders have a profound impact on urinary, renal, and bowel functions, as well as on sexuality and fertility issues, necessitating lifelong management to preserve quality of life and prevent complications, such as urinary tract deterioration in individuals with spinal dysraphism. Timely diagnosis and appropriate multidisciplinary therapeutic management are critical, with comprehensive clinical evaluations-such as urodynamic studies-playing a central role. Treatment strategies should be individualized, incorporating a multidisciplinary approach that addresses not only medical and functional aspects but also considerations related to sexuality and fertility. Continuous monitoring and follow-up care underscore the significance of sustained management for patients with spinal dysraphism.nnCONCLUSIONS AND CLINICAL IMPLICATIONS: This summary of the 2025 EAU/ESPU/ERN eUrogen/ERN ITHACA/ERN ErkNet/IFSBH guideline provides updated guidance for evidence-based management of children and adolescents with spinal dysraphism.},

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@article{pmid41381820,

title = {Scoliosis associated with Chiari I malformation after posterior fossa decompression: a systematic review and meta-analysis of 380 pediatric patients},

author = {Davide Palombi and Paolo Brigato and Alberto Benato and Sergio De Salvatore and Pier Francesco Costici and Timothee de Saint Denis and Eleftherios Archavlis and Luca Massimi and Leoanrdo Oggiano and Gianpiero Tamburrini},

doi = {10.1007/s43390-025-01252-3},

issn = {2212-1358},

year  = {2026},

date = {2026-05-01},

journal = {Spine Deform},

volume = {14},

number = {3},

pages = {755--766},

abstract = {PURPOSE: Chiari I Malformation (CIM) is occasionally associated with scoliosis, especially in the presence of syringomyelia (SyM). While posterior fossa decompression (PFD) is often performed before spinal fusion, its impact on scoliosis progression remains unclear. Some studies report curve stabilization or improvement, while others show continued progression. This systematic review and meta-analysis aim to evaluate whether PFD influences CIM patients' scoliosis outcomes and identify predictive factors for curve behavior, improving multidisciplinary surgical management.nnMETHODS: A systematic literature search was conducted in PubMed, Cochrane, Embase, Medline, Scopus, and Web of Science up to June 2025, following PRISMA guidelines. Inclusion criteria included pediatric patients (< 19 years) diagnosed with CIM who underwent PFD as the first treatment and had concurrent scoliosis (major curve angle > 10°). Data from 11 retrospective studies comprising 380 patients were analyzed. Pooled proportions of improvement, stability, and progression were calculated using random-effects models. Subgroup analyses were performed for duroplasty, and metaregression explored predictors, including age at surgery and baseline Cobb angle.nnRESULTS: The mean age at PFD was 10.3 years, with a mean preoperative curve of 37°. Syringomyelia was present in 92.6% of patients. After PFD, 55% (95% CI 46-63%) of curves improved or stabilized, while 45% (95% CI 37-54%) progressed. In the duroplasty subgroup (6 studies, 189 patients), success and progression rates were similar to the overall cohort (54% vs. 46%). Syrinx improvement was observed in 94% (95% CI 82-98%), with higher rates in duroplasty cases (97%). Metaregression demonstrated that older age at surgery (OR per year = 1.24, 95% CI 1.10-1.39; p < 0.001) and greater baseline Cobb angle (OR per + 5° = 0.79, 95% CI 0.65-0.96; p = 0.012) were independent predictors of scoliosis progression. Ultimately, 37.8% of patients required spinal fusion.nnCONCLUSION: This meta-analysis suggests that PFD is associated with scoliosis improvement in nearly half of pediatric patients with CIM, but a significant proportion still experiences curve progression. Younger age at surgery and lower preoperative major curve angle are associated with better outcomes. Future prospective studies with standardized criteria and extended follow-up periods are needed to refine treatment strategies.},

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@article{pmid41812417,

title = {Is multimodal monitoring effective in detecting neurological changes in cases of severe idiopathic scoliosis after halo gravity traction?: a series of 70 patients},

author = {Lou Richard and Anne Isabelle Vermersch and Elie Saghbini and Clélia Thouement and Reda Kabbaj and Raphael Vialle and Mathilde Gaume},

doi = {10.1016/j.neucli.2026.103144},

issn = {1769-7131},

year  = {2026},

date = {2026-04-01},

journal = {Neurophysiol Clin},

volume = {56},

number = {2},

pages = {103144},

abstract = {OBJECTIVE: Severe scoliosis, defined by a Cobb angle exceeding 80°, requires surgical correction and is associated with a high risk of postoperative neurological complications. These complications may be reduced by halo gravity traction (HGT) and neuromonitoring. This study evaluated the outcomes of preoperative and intraoperative multimodal neuromonitoring by somatosensory evoked potential (SSEP) and motor evoked potential (MEP) in patients undergoing HGT before and during spinal surgery for severe idiopathic scoliosis. The secondary objective was to investigate any changes in SSEP associated with traction.nnMETHODS: A single-center retrospective review was conducted including all patients who underwent surgery for severe idiopathic scoliosis following HGT. Demographic data were collected. Pre-traction, post-traction, and postoperative Cobb angle corrections were reported. Complications, preoperative and intraoperative neuromonitoring data were recorded.nnRESULTS: 70 patients with an average age at surgery of 14.4 years were included. The mean postoperative correction rate was 68.79%±7.57. Postoperatively, five deficits were observed, with one being permanent. There were 19 neuromonitoring alerts during surgery (27.14%). One false negative occurred, while 15 alerts did not result in postoperative deficits. Abnormal SSEP before traction or at the beginning of the intervention was associated with an intraoperative alert. SSEP latencies increased, and amplitude decreased between the period before traction was applied and the beginning of the surgery.nnCONCLUSIONS: Multimodal neuromonitoring by MEP and SSEP presents a high number of alerts with low postoperative deficit. Traction appeared to increase SSEP latencies and decrease amplitudes. However, multimodal monitoring remains a valuable tool for reducing the risk of neurological deficits in severe scoliosis undergoing preoperative HGT.},

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@article{pmid41135643,

title = {[PRIUM-Cell: In utero myelomeningocele prenatal repair program using mesenchymal stromal cells]},

author = {Lucie Guilbaud and Yoann Athiel and Justine Nasone and Timothée de Saint-Denis and Éléonore Blondiaux and Hina Simonnet and Pauline Lallemant-Dudek and Agnès Rigouzzo and Marie-Pierre Bonnet and Jean-Roch Fabreguettes and Jérôme Larghero and Jean-Marie Jouannic},

doi = {10.1016/j.gofs.2025.10.020},

issn = {2468-7189},

year  = {2026},

date = {2026-04-01},

journal = {Gynecol Obstet Fertil Senol},

volume = {54},

number = {4},

pages = {228--233},

abstract = {BACKGROUND AND RATIONALE: Myelomeningocele (MMC), also known as Spina Bifida, is a congenital malformation of the spinal cord that results in a complex disability including motor deficits, sphincter disorders and cerebral anomalies. Benefit of fetal MMC surgery has been demonstrated since 2011, but remains partial, with persistent motor and sphincter disorders. We have developed an adjuvant treatment to improve spinal cord repair during fetal surgery: a patch composed of umbilical cord-derived mesenchymal stromal cells (UC-MSCs). Our in vitro and in vivo experiments in the ovine model of MMC demonstrated that the UC-MSC patch improves motor and urinary functions by promoting neuronal preservation in the spinal cord. We also confirmed the absence of maternal, fetal, and neonatal adverse effects. Our hypothesis is that this adjuvant therapy can similarly improve spinal cord repair in human fetuses, thereby improving clinical outcomes in affected children. The goal of the PRIUM-Cell clinical trial is to assess the use of UC-MSC patches as an adjuvant therapy during open fetal surgery for MMC in humans.nnSTUDY DESIGN AND METHODS: This is an open-label study enrolling pregnant individuals with a fetus diagnosed with MMC located between spinal levels T1 and S1, associated with Chiari type 2 malformation. The allogeneic UC-MSC patch will contain 17 million UC-MSCs embedded in a semi-rigid scaffold. The patch will be applied directly to the fetal spinal cord during open fetal surgery performed between 23 and 26 weeks, following our center's standard protocol. Intensive maternal-fetal monitoring will be conducted for 7 days postoperatively during hospitalization, then weekly until delivery. The primary endpoint is successful completion of surgery with no neonatal adverse events. Secondary endpoints will be efficacy for the child at 8 weeks and 36 months, and safety for the mother from surgery to the postpartum period, and for the child up to 36 months of age.nnFUTURE DIRECTIONS: If our hypotheses are confirmed, we intend to conduct a Europe-wide phase III clinical trial.},

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@article{pmid41339540,

title = {Spinal dysraphism in adulthood: do they have different symptoms and outcomes? Evaluating the impact on the Quality of Life and the need for transitional care from pediatric to adult population},

author = {Davide Palombi and Mariapia Masino and Gabriele Ciaffi and Timothee de Saint Denis and Claudia Rendeli and Gianpiero Tamburrini and Luca Massimi},

doi = {10.1007/s00381-025-07073-z},

issn = {1433-0350},

year  = {2025},

date = {2025-12-01},

journal = {Childs Nerv Syst},

volume = {41},

number = {1},

pages = {399},

abstract = {INTRODUCTION: Spinal lipomas are common forms of closed spinal dysraphism, typically diagnosed in childhood but sometimes remaining unrecognized until adulthood. Adult presentation often includes pain, sensory disturbances, and urogenital dysfunction. While pediatric surgical management is well studied, adult outcomes, especially psychosocial ones, remain poorly understood. This study evaluates surgical, neurological, and psychosocial outcomes in adults undergoing their first surgery, comparing them with those of patients treated in childhood and followed into adulthood. It also emphasizes the importance of transitional care across the lifespan.nnMETHODS: This retrospective cohort study included 24 patients treated at a single institution: 12 adults (SDA) undergoing first-time surgery from 2022 to 2023, and 12 historical controls (PSD) treated in childhood (2000 to 2005). Pre- and postoperative data were collected using a 14-item questionnaire assessing neurological, functional, and psychosocial outcomes. Statistical comparisons were performed within and between groups.nnRESULTS: The median age at surgery was 30 years in SDA vs. 2 years in PSD. 75% of SDA patients had never been previously diagnosed with spinal dysraphism. Only urinary continence showed significant improvement neurologically in SDA patients (p = 0.025). However, psychosocial outcomes including pain, quality of life, social participation, and self-esteem, significantly improved postoperatively in the adult group. No surgical complications occurred in SDA; two CSF leaks were observed in PSD. Comparison of long-term outcomes revealed similar results across groups, except for a higher level of self-esteem in PSD patients (p = 0.039).nnCONCLUSION: Surgical treatment of spinal lipomas in adulthood can provide meaningful symptomatic and psychosocial benefits, even without gross-total resection. This study underscores the limitations of viewing spinal dysraphism through a strict pediatric-adult binary and highlights the need for individualized, stage-specific care. The findings advocate for structured, lifelong transitional care pathways that integrate psychological and social support, addressing the full spectrum of patient well-being.},

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@article{pmid40714359,

title = {Synthetic mid-urethral slings in female spina bifida patients with stress urinary incontinence: Is it worth it?},

author = {Alicia Blondeau and Samia Laraqui and Goncalo Mendes and Juliette Hascoet and Camille Haudebert and Charlène Brochard and Claire Richard and Caroline Voiry and Laurent Siproudhis and Krystel Nyangoh Timoh and Andrea Manunta and Emmanuelle Samson and Benoit Peyronnet},

doi = {10.1016/j.fjurol.2025.102938},

issn = {2950-3930},

year  = {2025},

date = {2025-12-01},

journal = {Fr J Urol},

volume = {35},

number = {13-14},

pages = {102938},

abstract = {INTRODUCTION: The aim of this study was to report the outcomes of synthetic mid-urethral slings (MUS) in female patients with spina bifida and stress urinary incontinence (SUI).nnMETHODS: All female patients with spina bifida who were seen at a national referral center between 2007 and 2021 and who had a history of MUS for SUI were included in a retrospective study. The primary outcome of interest was the continence status at 1year as per patients' subjective perception categorized as complete continence, improved continence, unchanged or worsened SUI.nnRESULTS: Out of 339 female spina bifida patients; 11 patients had undergone a MUS insertion and were included for analysis (3.2%). The median age was 30years (range: 19-52years). There were four postoperative complications (36.4%). The three patients fully continent at three months were still fully continent at one year (27.3%) while three had improved continence (27.3%) and five had unchanged continence (45.5%). After a median follow-up of 102months, only one patient was still fully continent (9.1%) and three patients had still improved continence (27.3%). Five patients (45.5%) underwent a subsequent anti-incontinence procedure. The only adverse predictor of improved/complete continence at 1year was a sacral neurological level (OR=0.05; p=0.03).nnCONCLUSION: MUS in women with spina bifida and SUI appears to be safe but less effective than in the non-neurogenic population which may be explained by different underlying pathophysiological mechanisms. These findings question the relevance of this treatment option in these complex population, especially in the current mesh controversy era.},

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