Utility of Enabling Technologies in Spinal Deformity Surgery: Optimizing Surgical Planning and Intraoperative Execution to Maximize Patient Outcomes.

The management of adult spinal deformity (ASD) has evolved dramatically over the past century, transitioning from external bracing and in situ fusion to complex, technology-driven surgical interventions. This review traces the historical development of spinal deformity correction and highlights contemporary enabling technologies that are redefining the surgical landscape. Advances in stereoradiographic imaging now allow for precise, low-dose three-dimensional assessment of spinopelvic parameters and segmental bone density, facilitating individualized surgical planning.

Inpatient and Outpatient Palliative Care Utilization Rates of Patients with Spine Metastases.

Study Design: Retrospective review.

Objective: Specialty Palliative Care (PC) can be instrumental in improving patient quality of life for patients with spine metastasis. It is important to identify disparities in access to PC to ensure that equitable care is provided to all patients.

Clinical and Economic Case for Patient-Specific Total Knee Arthroplasty: A Prospective Study.

Introduction: Total knee arthroplasty (TKA) is a common surgical intervention for severe knee arthritis resulting in joint or cartilage destruction, with success largely depending on prosthetic design and surgical technique. This study compares two Cruciate Retaining (CR) TKA systems, the iTotal® Identity CR system (ConforMIS; Wilmington, MA), a patient-specific knee (PSK) system, with the Triathlon® Total Knee System (Stryker; Kalamazoo, MI), a standard off-the-shelf (OTS) system, hypothesizing that the PSK system results in better clinical outcomes and reduced costs.

Methods: This single-center, prospective study included 188 patients (217 knees) who underwent TKA with either the PSK or OTS system from August 2017 to February 2021.

Synthetic osteobiologics in spine surgery: a review.

Osteobiologics are increasingly used in orthopedics and spine surgery to facilitate bone healing and prevent nonunion. Synthetic osteobiologics are artificial materials crafted in laboratories that aim to replicate the natural composition and functionality of bone. Notable materials such as calcium phosphate and calcium sulfate are engineered to mirror the mineral aspect of bone.

Intracranial Gunshot Wounds: An Assessment of Patient Characteristics on Surgical Outcomes.

Background/objective: Intracranial gunshot wounds (GSW) are often fatal, with most patients dying before intervention can occur. Surgical management, when indicated, results in decreased mortality. We sought to assess the neurosurgical outcomes and economic costs of intracranial GSW.

Validation of the graded prognostic assessment and recursive partitioning analysis as prognostic tools using a modern cohort of patients with brain metastases.

Background: Prognostic indices for patients with brain metastases (BM) are needed to individualize treatment and stratify clinical trials. Two frequently used tools to estimate survival in patients with BM are the recursive partitioning analysis (RPA) and the diagnosis-specific graded prognostic assessment (DS-GPA). Given recent advances in therapies and improved survival for patients with BM, this study aims to validate and analyze these 2 models in a modern cohort.

The Prevalence of Intraoperative Neuromonitoring in Anterior Cervical Discectomy and Fusion: Trends, Variances, and Value Appraisal.

Study Design: Retrospective cohort study.

Objective: The purpose of this study was to (1) evaluate recent trends in the use of intraoperative neuromonitoring (IONM) for anterior cervical discectomy and fusion (ACDF) in the United States, (2) assess regional variations in the use of IONM, and (3) assess the association between IONM and clinical outcomes.

Summary Of Background Data: IONM is frequently used during anterior cervical procedures to mitigate the risk of neurological injury.

Upstream CtrA-binding sites both induce and repress pilin gene expression in Caulobacter crescentus.

Pili are bacterial surface structures important for surface adhesion. In the alphaproteobacterium Caulobacter crescentus, the global regulator CtrA activates transcription of roughly 100 genes, including pilA which codes for the pilin monomer that makes up the pilus filament. While most CtrA-activated promoters have a single CtrA-binding site at the - 35 position and are induced at the early to mid-predivisional cell stage, the pilA promoter has 3 additional upstream CtrA-binding sites and it is induced at the late predivisional cell stage.

Gene Therapy and Spinal Fusion: Systematic Review and Meta-Analysis of the Available Data.

Objective: To analyze the extant literature describing the application of gene therapy to spinal fusion.

Methods: A systematic review of the English-language literature was performed. The search query was designed to include all published studies examining gene therapy approaches to promote spinal fusion.

Perioperative Blindness in Spine Surgery: A Scoping Literature Review.

Perioperative vision loss (POVL) is a devastating surgical complication that impacts both the recovery from surgery and quality of life, most commonly occurring after spine surgery. With rates of spine surgery dramatically increasing, the prevalence of POVL will increase proportionately. This scoping review aims to aggregate the literature pertinent to POVL in spine surgery and consolidate recommendations and preventative measures to reduce the risk of POVL.

Scoping review on the state of racial disparities literature in the treatment of neurosurgical disease: a call for action.

Objective: Racial disparities are ubiquitous across medicine in the US. This study aims to assess the evidence of racial disparities within neurosurgery and across its subspecialties, with a specific goal of quantifying the distribution of articles devoted to either identifying, understanding, or reducing disparities.

Methods: The authors searched the MEDLINE, EMBASE, and Scopus databases by using keywords to represent the concepts of neurosurgery, patients, racial disparities, and specific study types.

Robotic-Assisted Minimally Invasive Spinopelvic Fixation for Traumatic Sacral Fractures: Case Series Investigating Early Safety and Efficacy.

Background: High-energy traumatic sacral fractures, particularly U-type or AOSpine classification type C fractures, may lead to significant functional deficits. Traditionally, spinopelvic fixation for unstable sacral fractures was performed with open reduction and fixation, but robotic-assisted minimally invasive surgical methods now present new, less invasive approaches. The objective here was to present a series of patients with traumatic sacral fractures treated with robotic-assisted minimally invasive spinopelvic fixation and discuss early experience, considerations, and technical challenges.

Characteristics of patients who return to work after undergoing surgery for cervical spondylotic myelopathy: a Quality Outcomes Database study.

Objective: Return to work (RTW) is an important surgical outcome for patients who are employed, yet a significant number of patients with cervical spondylotic myelopathy (CSM) who are employed undergo cervical spine surgery and fail to RTW. In this study, the authors investigated factors associated with failure to RTW in the CSM population who underwent cervical spine surgery and who were considered to have a good surgical outcome yet failed to RTW.

Methods: This study retrospectively analyzed prospectively collected data from the cervical myelopathy module of a national spine registry, the Quality Outcomes Database.

Intraoperative localization and "snowman" muscle pledget repair for ventral dural defect in a case of spontaneous intracranial hypotension.

Background: This image report with technical notes is the first to illustrate and describe the technique used to treat spinal cerebrospinal fluid (CSF) leaks with the "snowman" muscle pledget. A 49-year-old male presented with orthostatic headaches as well as the left abducens nerve palsy. Patient's workup including findings of diffuse meningeal enhancement on magnetic resonance imaging, lumbar puncture opening pressure of 4 cm H2O, and CT myelogram demonstrating evidence of ventral spinal thoracic CSF leak.

A Clinical PET Imaging Tracer ([F]DASA-23) to Monitor Pyruvate Kinase M2-Induced Glycolytic Reprogramming in Glioblastoma.

Purpose: Pyruvate kinase M2 (PKM2) catalyzes the final step in glycolysis, a key process of cancer metabolism. PKM2 is preferentially expressed by glioblastoma (GBM) cells with minimal expression in healthy brain. We describe the development, validation, and translation of a novel PET tracer to study PKM2 in GBM.

Randomized Controlled Trials in Functional Neurosurgery-Association of Device Approval Status and Trial Quality.

Introduction: Randomized controlled trials (RCTs) have been critical in evaluating the safety and efficacy of functional neurosurgery interventions. Given this, we sought to systematically assess the quality of functional neurosurgery RCTs.

Methods: We used a database of neurosurgical RCTs (trials published from 1961 to 2016) to identify studies of functional neurosurgical procedures (N = 48).

Difference-Frequency Ultrasound Imaging With Non-Linear Contrast.

Conventional ultrasound imaging is based on the scattering of sound from inhomogeneities in the density and the speed of sound and is often used in medicine to resolve pathologic compared to normal tissue. Here we demonstrate a difference-frequency ultrasound (dfUS) imaging method that is based on the interaction of two sound pulses that propagate non-collinearly and intersect in space and time. The dfUS signal arises primarily from the second-order non-linear coefficient, a contrast mechanism that differs from linear and harmonic US imaging.

Diffusion tensor magnetic resonance imaging of the optic nerves in pediatric hydrocephalus.

Objective: While conventional imaging can readily identify ventricular enlargement in hydrocephalus, structural changes that underlie microscopic tissue injury might be more difficult to capture. MRI-based diffusion tensor imaging (DTI) uses properties of water motion to uncover changes in the tissue microenvironment. The authors hypothesized that DTI can identify alterations in optic nerve microstructure in children with hydrocephalus.

Patient Satisfaction and Press Ganey Scores for Spine Versus Nonspine Neurosurgery Clinics.

Study Design: Retrospective survey review.

Objective: We seek to evaluate satisfaction scores in patients seen in neurosurgical spine versus neurosurgical nonspine clinics.

Summary Of Background Data: The Press Ganey survey is a well-established metric for measuring hospital performance and patient satisfaction.

Minimally invasive lumbar pedicle screw fixation using cortical bone trajectory - Screw accuracy, complications, and learning curve in 100 screw placements.

Cortical bone trajectory (CBT) is a novel pedicle insertion technique with comparable or superior mechanical properties and reduced invasiveness compared to traditional methods. We describe the screw accuracy, complications, and learning curve associated with CBT use. A prospective cohort study was performed involving 22 patients who underwent lumbar fusion with CBT screw placement.

Rapid-sequence brain magnetic resonance imaging for Chiari I abnormality.

OBJECTIVE Fast magnetic resonance imaging (fsMRI) sequences are single-shot spin echo images with fast acquisition times that have replaced CT scans for many conditions. Introduced as a means of evaluating children with hydrocephalus and macrocephaly, these sequences reduce the need for anesthesia and can be more cost-effective, especially for children who require multiple surveillance scans. However, the role of fsMRI has yet to be investigated in evaluating the posterior fossa in patients with Chiari I abnormality (CM-I).