An Experimentally Validated Mathematical Model of Axial Spinal Compression to Visualize Vertebral Compression Fracture.

The finite element analysis (FEA) model established in this study predicts the mechanical behavior of a vertebral body under pure compression loading. Four human and four porcine cadaveric spines were used in the region from T9-T12 (human) and T12-T14 (porcine) to derive biomechanical failure data under pure axial compression. By implementing the data from these axial crush experiments and combining them with computed tomography (CT)-derived three-dimensional (3D) reconstructions of vertebrae, this new model mathematically predicts the behavior of the spine in vertebral compression fractures (VCFs).

Pseudomyogenic hemangioendothelioma in the thoracic spine treated with en bloc spondylectomy via staged anterior-lateral and posterior approach: illustrative case.

Background: Pseudomyogenic hemangioendothelioma (PMHE) is a rare vascular tumor with intermediate malignant potential, most commonly affecting young males and typically involving the soft tissues of the lower extremities. Spinal involvement is exceedingly rare, particularly as an isolated bony lesion without soft tissue extension, posing challenges in establishing standardized treatment approaches.

Observations: This report details a unique case of thoracic PMHE in a 60-year-old woman managed with a multistaged surgical approach, including preoperative embolization and en bloc spondylectomy.

Predicting Morbidity and Mortality After Transjugular Intrahepatic Portosystemic Shunt Placement: A Review of Existing Models and Future Directions.

Transjugular intrahepatic portosystemic shunt (TIPS) is a key therapeutic intervention in the management of portal hypertension and its complications, such as variceal bleeding, hepatic hydrothorax, and refractory ascites. TIPS has historically been used as a lifesaving measure or as a bridge to liver transplantation (LT). Despite its efficacy, creation of a TIPS can be associated with significant morbidity, particularly in patients with decompensated cirrhosis.

Direct oral anticoagulants versus Vitamin K antagonists for left ventricular thrombus management.

Background: This study compared the rates of intracranial hemorrhage (ICH), ischemic stroke, transient ischemic attack (TIA), and major bleeding events between patients receiving direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs) for left ventricular thrombus (LVT) management.

Methods: In this retrospective analysis of claims data, 3152 patients receiving treatment for LVT were identified. Two cohorts were exactly matched on age, sex, and pertinent comorbidities.

Timing of external ventricular drain placement and its effects on in-hospital outcomes in traumatic brain injury: A propensity score-matched analysis.

Objective: Patients with traumatic brain injury (TBI) often develop elevated intracranial pressure (ICP) and require emergency external ventricular drain (EVD) placement to decompress the cerebral ventricles. In patients who are initially stable, elevated ICP may develop later during hospitalization, necessitating delayed EVD placement. In these patients, it is unclear if early empiric placement can help reduce mortality.

A national study of neurosurgical residency competency development.

Objective: The aim of this study was to evaluate milestone progression across 6 Accreditation Council for Graduate Medical Education (ACGME) core competencies and 20 subcompetencies among neurosurgery residents, focusing on the attainment of level 4 proficiency by the final postgraduate year (PGY 7), and to identify patterns of co-occurring deficiencies.

Methods: A retrospective cohort analysis was conducted using national ACGME Milestone data from 2478 neurosurgery residents across 120 programs in the United States, covering 2018 to June 2022 evaluations. Semiannual milestone scores were analyzed using mean, standard deviation, median, and interquartile range.

An Appraisal of the Quality of Development and Reporting of Predictive Models in Spine Surgery.

Study DesignLiterature review.ObjectiveThe Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement was developed to improve the generalizability of predictive models. This study systematically evaluated the quality of predictive models related to spine procedures and assessed their compliance with the TRIPOD guidelines.

Rapid and Simultaneous Initiation of Guideline-Directed Kidney Therapies in Patients with CKD and Type 2 Diabetes.

The global incidence of CKD continues to rise, with type 2 diabetes as a major contributor. At any stage of CKD, patients with concurrent CKD and type 2 diabetes are at heightened cardiovascular risk and have a greater likelihood of dying from cardiovascular causes than progressing to kidney failure. Consequently, the use of "four pillars" of CKD therapy, including renin-angiotensin system inhibitors, sodium-glucose cotransporter 2 inhibitor, nonsteroidal mineralocorticoid receptor antagonists, and glucagon-like peptide-1 receptor agonists, has been advocated to reduce cardiovascular-kidney risk.

Transvenous biopsy of abdominal-pelvic lesions with no safe percutaneous access: How we do it.

Recent developments in cancer genomics have allowed for comprehensive genomic profiling of tumors, thereby allowing oncologists to provide targeted therapies for patients with advanced cancers. This has made it even more important to obtain adequate core biopsies of lesions targeted for biopsies. While most lesions can be biopsied safely percutaneously using CT and ultrasound guidance, some lesions do not have a safe percutaneous window, thereby necessitating alternative biopsy techniques, such as transvenous biopsies, to aid in diagnosis and treatment.

Predictors of hospitalization for longer than one day following elective single-level anterior cervical discectomy and fusion: a retrospective case-control database study.

Study Design: A retrospective case-control study.

Purpose: To understand the risk factors for prolonged hospitalization following anterior cervical discectomy and fusion (ACDF) to reduce postoperative complications and better identify optimal candidates for elective ACDF.

Overview Of Literature: Despite the proven safety of ACDF, many patients may experience prolonged postoperative hospitalization.

Clinical risk factors for mortality in low severity acute epidural hematoma.

Background: Epidural hematomas (EDH) pose life-threatening risks with considerable morbidity and mortality if left untreated. The prognosis for patients with low-severity acute EDH managed conservatively is variable, with limited understanding of risk factors. This study aims to identify clinical risk factors for mortality in low-severity acute epidural hematoma patients managed conservatively, helping clinicians recognize cases where deviation from conservative management may be necessary.

Delineating Neurosurgery Resident Development: Insights from a 10-Year National Accreditation Council for Graduate Medical Education Milestones and Learning Trajectories.

Background And Objectives: The Accreditation Council for Graduate Medical Education Milestones assessment system provides a structured framework for evaluating the developmental progression of neurosurgery residents. Understanding the variability in learning trajectories and identifying critical intervention points are essential for refining educational strategies and enhancing training outcomes. In this article, we aim to identify learning trajectories of neurosurgery residents and pinpoint pivotal junctures for potential interventions to aid residents struggling to meet expected competency levels.

Enhancing Glioblastoma Resection with NIR Fluorescence Imaging: A Systematic Review.

Glioblastoma (GB) is among the most aggressive and difficult-to-treat brain tumors, with a median survival of only 12-15 months despite maximal treatments, including surgery, radiotherapy, and chemotherapy. Extensive surgical resection improves survival in glioblastoma patients; however, achieving complete resection is often hindered by limitations in neurosurgical guidance technologies for accurate tumor margin detection. Recent advancements in fluorescence-guided surgery (FGS) and imaging techniques have significantly enhanced the precision and extent of glioblastoma resections.

Treatment of iatrogenic vertebral artery injury during C1-C2 arthrodesis with a covered stent.

Iatrogenic vertebral artery injury (VAI) has been described in the context of both anterior and posterior approaches to the cervical spine.1 2 Endovascular treatment of VAI primarily entails vessel sacrifice or vascular reconstruction. The latter option offers the advantage of achieving hemostasis while maintaining parent vessel patency.

Risk factors for abusive head trauma in the pediatric population.

Objective: Abusive head trauma (AHT) is the leading cause of death from physical child abuse in children younger than 5 years of age in the United States. The mortality rate among patients with AHT is 25%, and the recurrence rate of child abuse rises to 35% when there is a lack of intervention. Thus, identifying child abuse is crucial yet especially challenging for infants and toddlers as they are preverbal.

Effect of cannabis use history on postoperative opioid utilization in lumbar fusion patients: an American retrospective study.

Study Design: A retrospective cohort study.

Purpose: To examine the effect of cannabis use history on postoperative opioid utilization in patients undergoing one- to three-level lumbar fusion for degenerative spine disease.

Overview Of Literature: Strategies to minimize dosing and chronic opioid use are needed for spine surgery given their widespread prescription for postsurgical pain management.

Comparison of In-Hospital Mortality and Neurosurgical Intervention Between Intracranial Gunshot Wounds Arising From Long Guns and Handguns: A Propensity Score Matched Study.

Background And Objectives: Patients with intracranial gunshot wounds (IC-GSWs) often present with severe neurological injuries requiring prompt neurological evaluation. Neurosurgical intervention is reserved for those with reasonable chances of survival. Handguns and long guns, such as shotguns and rifles, have differing mechanisms of injury which may influence surgical candidacy and outcomes.

Caring for the Caregivers: Improving Mental Health among Health Professionals Using the Behavioral Health Professional Workforce Resilience ECHO Program.

Behavioral health professionals are at high risk for burnout and poor mental health. Our objective was to understand the impact of the Behavioral Health Providers Workforce Resiliency (BHPWR) ECHO Program on the resilience and burnout of participating behavioral health professionals. We assessed the first two years (March 2022 to March 2024) of the BHPWR ECHO, a national program operating from the University of New Mexico (N = 1585 attendees), using a mixed-methods design.

Surgical Video: Percutaneous Fusion and Endoscopic Resection of a Thoracic Metastatic Tumor.

While endoscopic approaches to the spine have become increasingly utilized for spinal degenerative disease, there is a paucity of literature regarding the role of endoscopic approaches in spinal oncology. The endoscopic approach offers patients lower risk of wound infection, wound dehiscence, and postoperative hematoma when compared with an open approach. In many spinal oncology patients, an endoscopic approach allows for prompt postoperative radiation when compared with an open approach.

The Impact of Preoperative Spinal Injection Timing on the Postoperative Complications of Lumbar Fusion.

Objective: To determine the impact of epidural spinal injections (ESIs) on postoperative surgical complications.

Methods: This retrospective all-payer database analysis identified 202,181 adult patients undergoing one- to three-level transforaminal lumbar interbody fusion (TLIF) from 2010 to 2020. A 1:1 exact matching on comorbidities and demographics was performed, creating 2 cohorts: 1) patients who received an ESI within 90 days of surgery and 2) patients who did not receive an ESI.