Metastasis of Intracranial Meningioma to the Osseous Spine: Systematic Literature Review and Case Report.

Background: Osseous spinal metastases from intracranial meningiomas are rare but represent a serious disease progression. A literature review was performed on this topic to understand the clinical course of patients with this disease entity. We also present a case of spinal metastasis in a patient with a World Health Organization grade III meningioma.

Cerebrospinal Fluid Drainage in Patients with Acute Spinal Cord Injury: A Multi-Center Randomized Controlled Trial.

Objective: The secondary phase of spinal cord injury (SCI) is characterized by ischemic injury. Spinal cord perfusion pressure (SCPP), calculated as the difference between mean arterial pressure (MAP) and intrathecal pressure (ITP), has arisen as a therapeutic target for improving outcomes. Cerebrospinal fluid drainage (CSFD) may reduce ITP and thereby increase SCPP.

Reliability of a Novel Classification System for Thoracic Disc Herniations.

Study Design: This is a cross-sectional survey.

Objective: The aim was to assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs).

Summary Of Background Data: TDHs are complex entities varying substantially in many factors, including size, location, and calcification.

Single-Position Anterior and Lateral Lumbar Fusion in the Supine Position: A Novel Technique for Multilevel Arthrodesis.

Objective: Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion are common techniques that typically require staged procedures when performed in combination. Interest is emerging in single-position surgery to increase operative efficiency. We report a novel surgical technique, supine extended reach lateral fusion, to perform ALIF and lateral lumbar interbody fusion with the patient in a single supine position.

Technical Feasibility of Subaxial Cervical Pedicle Screws for Distal Anchoring of Occipitocervical Fixation Constructs in the Mid-Cervical Spine: Early Clinical Experience.

Occipitocervical fixation and fusion (OCF) is performed for patients who have destabilizing traumatic injuries or pathologies affecting the complex bony and ligamentous structures of the occipitoatlantal and atlantoaxial joint structures. Distal fixation failure and pseudoarthrosis are known risks of these constructs, especially for those constructs ending in the mid-cervical spine. We present the technical feasibility of using cervical pedicle screws (CPSs) as distal fixation anchors to strengthen OCF constructs ending in the mid-cervical spine and present a case series describing our early clinical experience with this technique.

Establishing a Reference Procedure Length for Anterior Cervical Fusions: The Role for Standards in Surgical Process Improvement.

Surgical process improvement strategies are increasingly being applied to specific procedures to improve value. A critical step in any process improvement strategy is the identification of performance benchmarks. Procedure length is a performance benchmark for anterior cervical discectomy and fusion (ACDF) procedures; therefore, we sought to establish reference procedure lengths for 1-level, 2-level, and 3-level ACDFs at both teaching and non-teaching institutions and to describe methods for using this information to advance surgical process improvement initiatives.

Accuracy of Subaxial Cervical Pedicle Screw Placement Using Direct Visualization Versus Computed Tomography-Based Navigation.

Study Design: Retrospective analysis of operative data from cadaveric cervical spines.

Objective: To evaluate the accuracy of neuronavigation compared with laminotomy with direct visualization (DV) of the pedicle for placement of subaxial pedicle screws.

Summary Of Background Data: Subaxial pedicle screws provide superior fixation compared with other posterior cervical fixation strategies.

Hospital use following anterior cervical discectomy and fusion.

Most existing anterior cervical discectomy and fusion (ACDF) outcome studies omit emergency department (ED) use. To our knowledge, this study on ED use following ACDF surgery is the first to use a direct patient chart review and the first to include revision patients, 1-5 levels of ACDFs, and performance of corpectomy in the analysis. This study examines the frequency and basis of hospital service use within 30 days of ACDF surgery, specifically ED visits, hospital readmissions, and returns to the operating room.

Subaxial Cervical Pedicle Screw Placement With Direct Visualization of Pedicle Borders: 2-Dimensional Operative Video.

Pedicle screws provide superior fixation of the subaxial cervical spine to other techniques. However, a high degree of accuracy is required for safe placement given the proximity of pedicles to critical neurovascular structures. A variety of techniques are described to maximize accuracy, including freehand, fluoroscopy-guided, and neuronavigation-based methods.

Perioperative and swallowing outcomes in patients undergoing 4- and 5-level anterior cervical discectomy and fusion.

Objective: Anterior cervical discectomy and fusion (ACDF) is a common and robust procedure performed on the cervical spine. Literature on ACDF for 4 or more segments is sparse. Increasing the number of operative levels increases surgical complexity, tissue retraction, and risks of complications, particularly dysphagia.

Posterior Vertebral Column Subtraction Osteotomy for Recurrent Tethered Cord Syndrome: A Multicenter, Retrospective Analysis.

Background: Few have explored the safety and efficacy of posterior vertebral column subtraction osteotomy (PVCSO) to treat tethered cord syndrome (TCS).

Objective: To evaluate surgical outcomes after PVCSO in adults with TCS caused by lipomyelomeningocele, who had undergone a previous detethering procedure(s) that ultimately failed.

Methods: This is a multicenter, retrospective analysis of a prospectively collected cohort.

Utility of a Novel Biomimetic Spine Model in Surgical Education: Case Series of Three Cervicothoracic Kyphotic Deformities.

Study Design: Evaluation of new technology.

Objectives: To evaluate the utility of a novel biomimetic spine model as a surgical planning and education resource in the treatment of cervical spine deformities (CSD).

Methods: Three patients with CSD were identified and synthetic spine models were manufactured to match the anatomical and biomechanical properties of each patient.

Postural Stability and Dynamic Balance in Adult Spinal Deformity: Prospective Pilot Study.

Objective: We sought to evaluate dynamic balance and postural stability in patients with adult spinal deformity (ASD) compared with published age-matched normative data.

Methods: Eleven patients with ASD were prospectively enrolled. Postural stability was tested using static and dynamic posturography; patients stood on a movable platform with an integrated force plate and performed standardized sensory organization testing (SOT), evaluating the influence of sensory processing on postural stability under 6 conditions, and motor control testing, assessing reflexive postural reactions to an external perturbation.

Range of Motion Testing of a Novel 3D-Printed Synthetic Spine Model.

Study Design: Biomechanical model study.

Objective: The Barrow Biomimetic Spine (BBS) project is a resident-driven effort to manufacture a synthetic spine model with high biomechanical fidelity to human tissue. The purpose of this study was to investigate the performance of the current generation of BBS models on biomechanical testing of range of motion (ROM) and axial compression and to compare the performance of these models to historical cadaveric data acquired using the same testing protocol.

Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events.

Background: Optimal postoperative pain control is critical after spinal fusion surgery. There remains significant variability in the use of postoperative intravenous opioid patient-controlled analgesia (PCA) and few data evaluating its utility compared with nurse-controlled analgesia (NCA) among patients with lumbar fusion.

Objective: To investigate the efficacy of postoperative PCA compared with NCA to improve opiate prescription practices.

Functional improvement in hand strength and dexterity after surgical treatment of cervical spondylotic myelopathy: a prospective quantitative study.

Objective: Cervical spondylotic myelopathy (CSM) is the primary cause of adult spinal cord dysfunction. Diminished hand strength and reduced dexterity associated with CSM contribute to disability. Here, the authors investigated the impact of CSM severity on hand function using quantitative testing and evaluated the response to surgical intervention.

History and advances in spinal neurosurgery.

Insight into the historic contributions made to modern-day spine surgery provides context for understanding the monumental accomplishments comprising current techniques, technology, and clinical success. Only during the last century did surgical growth occur in the treatment of spinal disorders. With that growth came a renaissance of innovation, particularly with the evolution of spinal instrumentation and fixation techniques.

The Living Spine Model: A Biomimetic Surgical Training and Education Tool.

Background: The Living Spine Model (LSM) is a three-dimensionally printed, surgical training platform developed by neurosurgical residents.

Objective: To evaluate the face and content validity of this model as a training tool for open posterior lumbar surgery.

Methods: Six surgeons with varying experience were asked to complete L3-5 pedicle screw fixation and L3-4 laminectomy on an LSM.

Development and first clinical use of a novel anatomical and biomechanical testing platform for scoliosis.

Background: Previous studies have demonstrated that, by using various three-dimensional (3D) printing technologies, synthetic spine models can be manufactured to mimic a human spine in its gross and radiographic anatomy and the biomechanical performance of bony and ligamentous tissue. These manufacturing processes have not, however, been used in combination to create a long-segment, biomimetic model of a patient with scoliosis. The purpose of this study was to describe the development of a biomimetic scoliosis model and early clinical experience using this model as a surgical planning and education platform.

The Barrow Biomimetic Spine: Face, Content, and Construct Validity of a 3D-Printed Spine Model for Freehand and Minimally Invasive Pedicle Screw Insertion.

Study Design: Description and evaluation of a novel surgical training platform.

Objectives: The purpose of this study was to investigate the face, content, and construct validity of 5 novel surgical training models that simulate freehand and percutaneous (minimally invasive surgery [MIS]) pedicle screw placement.

Methods: Five spine models were developed by residents: 3 for freehand pedicle screw training (models A-C) and 2 for MIS pedicle screw training (models D and E).

Implementation of a Standardized Multimodal Postoperative Analgesia Protocol Improves Pain Control, Reduces Opioid Consumption, and Shortens Length of Hospital Stay After Posterior Lumbar Spinal Fusion.

Background: Multimodal analgesia regimens have been suggested to improve pain control and reduce opioid consumption after surgery.

Objective: To institutionally implement an evidence-based quality improvement initiative to standardize and optimize pain treatment following neurosurgical procedures. Our goal was to objectively evaluate efficacy of this multimodal protocol.

Far-lateral Vascularized Rib Graft for Cervical and Lumbar Spinal Arthrodesis: Cadaveric Technique Description.

Background: Rotational vascularized autografts are ideal for achieving spinal arthrodesis because they maintain bony vascularization while avoiding the morbidity and challenges of free-tissue transfer. Although proximal ribs are ideal candidates for vascularized bone grafts, their use is restricted to the thoracic spine. This study describes a novel technique for harvesting lateral rib grafts on an intercostal pedicle for use in cervical and lumbar posterolateral arthrodesis.