C1-2 Stenosis Caused by Posterior Osteophytes: An Unusual Cause of Cord Compression.

Cervical spinal stenosis most commonly occurs at the subaxial spine. C1-C2 stenosis is relatively unusual but can be present in certain congenital or syndromic conditions such as rheumatoid arthritis. In this manuscript, we highlight the case of a 42-year-old lady who presented with neck pain and signs of high cervical myelopathy.

Key Takeaways From the ISASS Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery | Part 2: Polytomous Rasch Analysis of Learning Curve and Surgeon Endorsement of Biportal, Interlaminar, and Transforaminal Endoscopic Stenosis Decompression, Discectomy, and Laminectomy in Combination With Interspinous Process Spacers.

Background: The International Society for the Advancement of Spine Surgery hosted the second of a series of 4 webinars on endoscopic spine surgery techniques. The second webinar focused on the application of unilateral biportal endoscopy for discectomy and laminectomy in combination with interbody fusion and interspinous process spacers. This series was intended to identify current trends with contemporary modern endoscopic spine surgery techniques.

Insights on High-Value Procedures From the ISASS 4-Part Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery Based on Surgeon Experience.

Background: The authors conducted a comprehensive review and integration of insights from 4 webinars hosted by the International Society for the Advancement of Spine Surgery (ISASS) to arrive at recommendations for best clinical practices for guideline development for endoscopic spine surgery. This perspective article discusses the limitations of traditional surgical trials and amalgamates surgeons' experience and research on various cutting-edge techniques.

Methods: Data were extracted from surveys conducted during each webinar session involving 3639 surgeons globally.

Machine Learning Models Leveraging Smartphone-Based Patient Mobility Data Can Accurately Predict Functional Outcomes After Spine Surgery.

The development of adjacent segment disease or the progression of spondylosis following the surgical treatment of spinal stenosis and spondylolisthesis is well documented and can lead to subsequent functional decline after a successful index surgery. The early detection of negative inflection points during patients' functional recovery can improve timely intervention. In this study, we developed machine learning (ML) models to predict the occurrence of post-operative decline in patient mobility.

Novel Combination of Lateral Interbody Fusion and Endoscopic Ipsi-Contra Decompression for Severe Stenosis From Lumbar Spondylolisthesis: A Case Report.

Minimally invasive surgical approaches to the spine that leverage indirect decompression are gaining increasing popularity. While there is excellent literature on the value of indirect decompression, there are limitations to this procedure. Specifically, in patients with severe stenosis and neurogenic claudication, there is a concern among many surgeons regarding the adequacy of indirect decompression alone.

Determining Differences in Perioperative Functional Mobility Patterns in Lumbar Decompression Versus Fusion Patients Using Smartphone Activity Data.

Background And Objectives: Smartphone activity data recorded through high-fidelity accelerometry can provide accurate postoperative assessments of patient mobility. The "big data" available through smartphones allows for advanced analyses, yielding insight into patient well-being. This study compared rate of change in functional activity data between lumbar fusion (LF) and lumbar decompression (LD) patients to determine preoperative and postoperative course differences.

Endoscopic-assisted fusion for lumbar pars fracture repair in an adolescent patient.

Minimally invasive repair of pars defects can be achieved via means of cannulation followed by tubular decortication. Given these injuries typically occur in pediatric and adolescent patients, minimal disruption to surrounding tissue during the repair is ideal. The use of an endoscopic approach to assist with repair and fusion across the pars defect is a novel consideration in the pediatric demographic, and in this case report we highlight our experience and rationale for this in treating a 14-year-old male athlete with lumbar 5 pars fracture.

Defining the minimal clinically important difference in smartphone-based mobility after spine surgery: correlation of survey questionnaire to mobility data.

Objective: Patient-reported outcome measures (PROMs) are the gold standard for assessing postoperative outcomes in spine surgery. However, PROMs are also limited by the inherent subjectivity of self-reported qualitative data. Recent literature has highlighted the utility of patient mobility data streamed from smartphone accelerometers as an objective measure of functional outcomes and complement to traditional PROMs.

Social Media Presence Across U.S. Neurosurgical Residency Programs and Subspecialties.

Objective: U.S. neurosurgery programs are increasingly using social media accounts.

Size matters - From the working channel to the wavelength of light: Optimizing visualization in endoscopic spine surgery.

Background: Minimally invasive surgery bases many of its benefits on decreasing tissue disruption. Endoscopic spine surgery has continued to push the boundaries to accomplish successful clinical outcomes through the evolution of the endoscope and working channel. As the indications for endoscopic spine surgery increase, a more profound discussion of cannula size selection for endoscopic spine surgery is required.

Dropped head syndrome in a patient with Parkinson's disease and inflammatory myopathy, treated with sternocleidomastoid release and circumferential cervical fusion.

Background: Dropped head syndrome (DHS) is a recently recognised cause of cervical spinal deformity and disability. The combination of Parkinson's disease (PD) and inflammatory myopathy in the genesis of DHS has not been previously reported. Furthermore, the optimal surgical treatment of progressive DHS remains undefined.

A Novel Construct to Treat Destructive Osteomyelitis of the Lumbar Spine in a Patient With Pre-existing Paraplegia.

Treatment for vertebral osteomyelitis varies depending on the extent of pathology and includes both medical and surgical approaches. Pathogen-directed antibiotic therapy is often the first-line treatment, however, refractory cases or those with sepsis, segmental instability, or epidural abscess may be candidates for surgical treatment. Patients with extensive bony destruction often require a corpectomy with the placement of a cage for anterior column reconstruction.

Hounsfield Unit as a Predictor of Adjacent-Level Disease in Lumbar Interbody Fusion Surgery.

Background: Bone density has been associated with a successful fusion rate in spine surgery. Hounsfield units (HUs) have more recently been evaluated as an indirect representation of bone density. Low preoperative HUs may be an early indicator of global disease and chronic process and, therefore, indicative of the need for future reoperation.

Data-driven phenotyping of preoperative functional decline patterns in patients undergoing lumbar decompression and lumbar fusion using smartphone accelerometry.

Objective: Treatment of degenerative lumbar spine pathologies typically escalates to surgical intervention when symptoms begin to significantly impair patients' functional status. Currently, surgeons rely on subjective patient assessments through patient-reported outcome measures to estimate the decline in patient wellness and quality of life. In this analysis, the authors sought to use smartphone-based accelerometry data to provide an objective, continuous measurement of physical activity that might aid in effective characterization of preoperative functional decline in different lumbar spine surgical indications.

Developing a Prediction Model for Identification of Distinct Perioperative Clinical Stages in Spine Surgery With Smartphone-Based Mobility Data.

Background: Spine surgery outcomes assessment currently relies on patient-reported outcome measures, which satisfy established reliability and validity criteria, but are limited by the inherently subjective and discrete nature of data collection. Physical activity measured from smartphones offers a new data source to assess postoperative functional outcomes in a more objective and continuous manner.

Objective: To present a methodology to characterize preoperative mobility and gauge the impact of surgical intervention using objective activity data garnered from smartphone-based accelerometers.

Big Data in the Clinical Neurosciences.

The clinical neurosciences have historically been at the forefront of innovation, often incorporating the newest research methods into practice. This chapter will explore the adoption, implementation, and refinement of big data and predictive modeling using machine learning within neurosurgery. Initial development of national databases arose from surgeons aiming to improve outcome predictions for patients with traumatic brain injury in the 1960s.

Objective Outcomes in Lateral Osteotomy Through Anterior-to-Psoas for Severe Adult Degenerative Spine Deformity Correction.

Multilevel lateral interbody fusion is an acceptable surgical technique in patients with severe degenerative adult spinal deformity (ASD). The current standard-of-care in spine surgery includes the use of patient reported outcome measures (PROMs) to assess post-operative improvement. Objective activity data during the peri-operative period may provide supplementary information for patients recovering from ASD surgery.

Using smartphone-based accelerometers to gauge postoperative outcomes in patients with NPH: Implications for ambulatory monitoring.

Background: The surgical treatment of normal pressure hydrocephalus (NPH) with shunting remains controversial due to the difficulty in distinguishing such pathology from other neurological conditions that can present similarly. Thus, patients with suspected NPH should be carefully selected for surgical intervention. Historically, clinical improvement has been measured by the use of functional grades, alleviation of symptoms, and/or patient/family-member reported surveys.

Optimizing Visualization in Endoscopic Spine Surgery.

Given the inherent limitations of spinal endoscopic surgery, proper lighting and visualization are of tremendous importance. These limitations include a small field of view, significant potential for disorientation, and small working cannulas. While modern endoscopic surgery has evolved in spite of these shortcomings, further progress in improving and enhancing visualization must be made to improve the safety and efficacy of endoscopic surgery.