Background: Dropped head syndrome (DHS) is uncommon and involves severe weakness of neck-extensor muscles resulting in a progressive reducible cervical kyphosis. The first-line management consists of medical treatment targeted at diagnosing underlying pathologies. However, the surgical management of DHS has not been well studied. Methods: Here, we systematically reviewed the PubMed and Cochrane databases for DHS using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All relevant articles up to March 31, 2022, were analyzed. The patient had to be ≥18 years with DHS and had to have undergone surgery with outcomes data available. Outcomes measurements included neurological status, rate of failure (RF), horizontal gaze, and complications. Results: A total of 22 articles selected for this study identified 54 patients who averaged 68.9 years of age. Cervical arthrodesis without thoracic extension was performed in seven patients with a RF of 71%. Cervicothoracic arthrodesis was performed in 46 patients with an RF of 13%. The most chosen upper level of fusion was C2 in 63% of cases, and the occiput was included only in 13% of patients. All patients neurologically stabilized or improved, while 75% of undergoing anterior procedures exhibited postoperative dysphagia and/or airway-related complications. Conclusion: The early surgery for patients with DHS who demonstrate neurological compromise or progressive deformity is safe and effective and leads to excellent outcomes.

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BACKGROUND:The coronavirus disease 2019 (COVID-19) pandemic is considered one of our time's most significant global health crises, and its sequel is expected to be long-lasting. The shutdown of institutions, social distancing requirements, and decreased elective surgical exposure have disturbed neurosurgical training and education worldwide. REVIEW:This review examines initiatives adopted to provide continued medical education for surgeons, trainees, and medical students during the pandemic. A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocol; quiring PubMed, Cochrane COVID-19 Study Register, Scopus, and Google Scholar for ("COVID-19" AND "Education" AND "Neurosurgery"). Out of 598 studies, 21 articles met the inclusion criteria. Studies showed that many institutions and societies worldwide adopted virtual learning for continuing medical education during the pandemic.CONCLUSION: Data showed that online educational methods added educational value that can be considered an adjunct or replacement for traditional learning methods. It proved effective and carried a high satisfaction and engagement rate between surgeons, trainees, and medical students in neurosurgery.

Background: Data exist of the benefits of antifibrinolytics such as tranexamic acid (TXA) in general spine surgery. However, there are limited data of its use in oncological spine patients. Methods: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane, OVID, and Embase databases were searched. Search terms: “tranexamic acid”, “aprotinin,” “aminocaproic acid,” “spine surgery,” “spine tumors,” and “spine oncology.” Included studies were full text publications written in English with patients treated with either agent or who had surgery for oncological spine disease (OSD). Results: Seven hundred results were reviewed form the different databases, seven were selected. A total of 408 patients underwent spine surgery for OSD and received antifibrinolytics. There was a male predominance (55.2%) and mean age ranged from 43 to 62 years. The most common tumor operated was metastatic renal cancer, followed by breast and lung. Most studies administered TXA as a bolus followed by an infusion during surgery. Median blood loss was of 667 mL (253.3–1480 mL). Patients with TXA required 1–2 units less of transfusion and had 56–63 mL less of postoperative drainage versus no TXA. The median incidence of deep venous thrombosis (DVT) was 2.95% (0–7.9%) and for pulmonary embolism (PE) was 4.25% (0–14.3%). The use of TXA reduced intraoperative blood loss, transfusions and reduced postoperative surgical drainage output compared to no TXA use in patients with OSD. Conclusion: In this review, we found that TXA may diminish intraoperative blood loss, the need for transfusion and postoperative drainage from surgical drains when used in OSD without major increase in rates of DVT or PE.