Improved intraoperative tidal volume during deformity correction in a 16-year-old with spina bifida, severe kyphoscoliosis, and thoracic insufficiency syndrome: illustrative case.

Background: Severe kyphoscoliosis in spina bifida patients can result in thoracic insufficiency syndrome, which significantly compromises pulmonary function. While traditional clinical measures for spina bifida focus primarily on bladder function and motor strength, this case highlights pulmonary function as an essential additional indicator.

Observations: The authors report on the case of a 16-year-old male with spina bifida and severe thoracic kyphoscoliosis presenting with progressive respiratory difficulty limiting ambulation.

Air in the Spine: A Rare Gas-Filled Cyst.

Gas-containing intraspinal synovial cysts are rare, and few surgical reports are available. This case highlights the importance of considering synovial cysts on the differential for presentations of radiculopathy and demonstrates successful surgical management in a rare case. A 63-year-old man with progressive low back pain and neurogenic claudication was found to have a gas-filled synovial cyst at L4-L5 causing severe central canal stenosis.

Accuracy of Pedicle Screw Placement Using the ExcelsiusGPS Robotic Navigation Platform: An Analysis of 728 Screws.

Background: Robotic platforms have increased in sophistication for pedicle screw placement. Here, we review our institutional experience using ExcelsiusGPS to assess the accuracy rate of pedicle screw placement throughout the spine and characterize predictors of placement inaccuracy.

Study Design: Retrospective cohort study.

Augmented Reality Versus Freehand Spinopelvic Fixation in Spinal Deformity: A Case-Control Study.

Purpose: This study sought to compare screw placement accuracy and outcomes between freehand (FH) and AR-guided pelvic fixation. While pelvic fixation is a critical technique in spinal deformity surgery, S2-alar iliac (S2AI) screw placement poses challenges.

Methods: We conducted a case-control study of 50 consecutive patients who underwent spinopelvic fixation at a single institution.

Comparison of accuracy, revision, and perioperative outcomes in robot-assisted spine surgeries: systematic review and meta-analysis.

Objective: Pedicle screw placement guidance is critical in spinal fusions, and spinal surgery robots aim to improve accuracy and reduce complications. Current literature has yet to compare the relative merits of available robotic systems. In this review, the authors aimed to 1) assess the current state of spinal robotics literature; 2) conduct a meta-analysis of robotic performance based on accuracy, speed, and safety; and 3) offer recommendations for robotic system selection.

Synthesis and evaluation of a novel vancomycin-infused, biomimetic bone graft using a rat model of spinal implant-associated infection.

Background: Postoperative infection is a complication of spinal fusion surgery resulting in increased patient morbidity. Strategies including intraoperative application of powdered vancomycin have been proposed to reduce the incidence of infection; however, such antimicrobial effects are short-lived.

Methods: Instrumentation of the L4-L5 vertebrae was performed mimicking pedicle screw and rod fixation in 30 rats.

Augmented Reality and Virtual Reality in Spine Surgery: A Comprehensive Review.

Augmented reality (AR) and virtual reality (VR) are powerful technologies with proven utility and tremendous potential. Spine surgery, in particular, may benefit from these developing technologies for resident training, preoperative education for patients, surgical planning and execution, and patient rehabilitation. In this review, the history, current applications, challenges, and future of AR/VR in spine surgery are examined.

Tethered spinal cord tension assessed via ultrasound elastography in computational and intraoperative human studies.

Background: Tension in the spinal cord is a trademark of tethered cord syndrome. Unfortunately, existing tests cannot quantify tension across the bulk of the cord, making the diagnostic evaluation of stretch ambiguous. A potential non-destructive metric for spinal cord tension is ultrasound-derived shear wave velocity (SWV).

Assessing the Accuracy of Spinal Instrumentation Using Augmented Reality (AR): A Systematic Review of the Literature and Meta-Analysis.

Technological advancements, particularly in the realm of augmented reality (AR), may facilitate more accurate and precise pedicle screw placement. AR integrates virtual data into the operator's real-world view, allowing for the visualization of patient-specific anatomy and navigated trajectories. We aimed to conduct a meta-analysis of the accuracy of pedicle screw placement using AR-based systems.

Reduction of cervicothoracic spondyloptosis in an ambulatory patient: when traction fails.

Introduction: Cervical spondyloptosis is a rare complication of high-energy trauma which often results in significant patient morbidity and mortality. The authors present a case of spondyloptosis of C7 over T1 with minimal radicular symptoms and otherwise complete spinal cord sparing. This case highlights the surgical challenges faced with cervical spondyloptosis and the techniques used when traction fails.

Augmented reality in spine surgery - past, present, and future.

Background Context: Augmented reality (AR) is increasingly recognized as a valuable tool in spine surgery. Here we provides an overview of the key developments and technological milestones that have laid the foundation for AR applications in this field. We also assess the quality of existing studies on AR systems in spine surgery and explore potential future applications.

Synovial Cyst in the Setting of an Interspinous Fusion Device.

Synovial cysts of the spine are degenerative cystic lesions that can lead to severe symptoms secondary to compression of the spinal cord, individual nerve roots, and/or the cauda equina. Some believe the etiology of this entity is related to increased motion across the facet joint and instability. We report a case of a lumbar synovial cyst located at the same level as a previously inserted spinous process fusion device.

Learning Curves for Robot-Assisted Pedicle Screw Placement: Analysis of Operative Time for 234 Cases.

Background And Objectives: Robot-assisted pedicle screw placement is associated with greater accuracy, reduced radiation, less blood loss, shorter hospital stays, and fewer complications than freehand screw placement. However, it can be associated with longer operative times and an extended training period. We report the initial experience of a surgeon using a robot system at an academic medical center.

Robot-assisted screw fixation in a cadaver utilizing magnetic resonance imaging-based synthetic computed tomography: toward radiation-free spine surgery. Illustrative case.

Background: Synthetic computed tomography (sCT) can be created from magnetic resonance imaging (MRI) utilizing newer software. sCT is yet to be explored as a possible alternative to routine CT (rCT). In this study, rCT scans and MRI-derived sCT scans were obtained on a cadaver.

Interventional approaches to symptomatic Tarlov cysts: a 15-year institutional experience.

Background: Tarlov cysts are perineural collections of cerebrospinal fluid most often affecting sacral nerve roots, which may cause back pain, extremity paresthesias and weakness, bladder/bowel dysfunction, and/or sexual dysfunction. The most effective treatment of symptomatic Tarlov cysts, with options including non-surgical management, cyst aspiration and injection of fibrin glue, cyst fenestration, and nerve root imbrication, is debated.

Methods: Retrospective chart review was conducted for 220 patients with Tarlov cysts seen at our institution between 2006 and 2021.

Patient Optimization for the Prevention of Proximal Junctional Kyphosis.

Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are well-recognized challenges of surgery for adult spinal deformity (ASD). Multiple risk factors have been identified for PJK/PJF, including osteoporosis, frailty, neurodegenerative disease, obesity, and smoking. Several surgical techniques to mitigate risk of PJK/PJF have been identified; however, patient optimization is also critical.

A novel rodent model of chronic spinal implant-associated infection.

Background Context: Bacterial infection of spinal instrumentation is a significant challenge in spinal fusion surgery. Although the intraoperative local application of powdered vancomycin is common practice for mitigating infection, the antimicrobial effects of this route of administration are short-lived. Therefore, novel antibiotic-loaded bone grafts as well as a reliable animal model to permit the testing of such therapies are needed to improve the efficacy of infection reduction practices in spinal fusion surgery.

Treatment of hydrocephalus following posterior fossa tumor resection: a multicenter collaboration from the Hydrocephalus Clinical Research Network.

Objective: Persistent hydrocephalus following posterior fossa brain tumor (PFBT) resection is a common cause of morbidity in pediatric brain tumor patients, for which the optimal treatment is debated. The purpose of this study was to compare treatment outcomes between VPS and ETV in patients with persistent hydrocephalus following surgical resection of a PFBT.

Methods: A post-hoc analysis was performed of the Hydrocephalus Clinical Research Network (HCRN) prospective observational study evaluating VPS and ETV for pediatric patients.

Spinal dysraphism in exstrophy: a single-center study of a 39-year prospective database.

Objective: The two main objectives of this study were to explore the rate of spinal dysraphism within bladder and cloacal exstrophy and to analyze the relationship between spinal dysraphism surgery, including timing of spinal dysraphism surgery, with urological and neurological outcomes.

Methods: A prospectively maintained IRB-approved database of pediatric exstrophy patients treated from 1982 to 2021 was retrospectively reviewed for patients with spinal dysraphism. Spinal dysraphism was categorized into the following 7 subtypes: lipoma-based closed defect, myelomeningocele, meningocele, diastematomyelia, myelocystocele, low-lying conus with tethered cord/fatty filum, and sacral bony defect.

In-Human Report of S2 Alar-Iliac Screw Placement Using Augmented Reality Assistance.

Background: S2 alar-iliac (S2AI) screws provide spinopelvic fixation with the advantages of minimized dissection, easier rod contouring, and decreased symptomatic screw-head prominence. However, placement of S2AI screws may be challenging because of the anatomy of the lumbosacral junction. Augmented reality is a nascent technology that may enhance placement of S2AI screws.

Porcine Model of Spinal Cord Injury: A Systematic Review.

Spinal cord injury (SCI) is a devastating disease with limited effective treatment options. Animal paradigms are vital for understanding the pathogenesis of SCI and testing potential therapeutics. The porcine model of SCI is increasingly favored because of its greater similarity to humans.

Pearls and pitfalls of posterior superior iliac spine reference frame placement for spinal navigation: cadaveric series.

Background: Navigation and robotics are important tools in the spine surgeon's armamentarium and use of these tools requires placement of a reference frame. The posterior superior iliac spine (PSIS) is a commonly used site for reference frame placement, due to its location away from the surgical corridor and its ability to provide solid fixation. Placement of a reference frame requires not only familiarity with proper technique, but also command of the relevant anatomy.

Management of traumatic sacral spondyloptosis: illustrative case.

Background: Grade V spondylolisthesis, or spondyloptosis, is a complication of high-energy trauma that is most commonly reported at the lumbosacral junction. Sacral intersegmental spondyloptosis is extremely rare. The authors present a case of spondyloptosis of S1 on S2 with a comminuted fracture of S2 and complex fractures of the L4 and L5 transverse processes, resulting in severe stenosis of the lumbosacral nerve roots.

Applications of elastography in operative neurosurgery: A systematic review.

Elastography is an imaging technology capable of measuring tissue stiffness and consistency. The technology has achieved widespread use in the workup and management of diseases of the liver, breast, thyroid, and prostate. Although elastography is increasingly being applied in neurosurgery, it has not yet achieved widespread adoption and many clinicians remain unfamiliar with the technology.