Management of cerebrospinal fluid leak after a minimally invasive lumbar decompression procedure: illustrative case.

Background: Neurogenic claudication caused by lumbar stenosis is a prevalent disorder of the spinal canal for which many treatment options exist. The mild (minimally invasive lumbar decompression) procedure has recently been introduced as a safe and effective alternative to medical management in the treatment of lumbar stenosis. However, data on complications are rarely reported, and the incidence of complications, when reported, is frequently assessed at 0% in the literature.

Is There an Association Between Spine Surgeon Academic Productivity and Patient Satisfaction Ratings?

Background And Objectives: Physician rating websites (PRWs) are increasingly used by patients to find health care providers. This study explores spine neurosurgeon PRW ratings and their relationship with academic productivity.

Methods: A retrospective study was conducted from November 2022 to May 2023 that included 1990 neurological surgeons listed in the American Association of Neurological Surgeons database with a subspecialty in spine.

Surgical Management of High-Grade Meningiomas.

Maximal resection with the preservation of neurological function are the mainstays of the surgical management of high-grade meningiomas. Surgical morbidity is strongly associated with tumor size, location, and invasiveness, whereas patient survival is strongly associated with the extent of resection, tumor biology, and patient health. A versatile microsurgical skill set combined with a cogent multimodality treatment plan is critical in order to achieve optimal patient outcomes.

Hematologic and Inflammatory Predictors of Outcome in Patients with Brain Arteriovenous Malformations.

Objective: This study investigated the prognostic value of admission blood counts for arteriovenous malformation (AVM) outcomes and compared admission blood counts for patients with ruptured and unruptured AVMs.

Methods: A retrospective analysis of patients who underwent surgical treatment for a ruptured cerebral AVM between February 1, 2014, and March 31, 2020, was conducted. The primary outcome was poor neurologic outcome, defined as a modified Rankin Scale score ≥2 in patients with unruptured AVMs or >2 in patients with ruptured AVMs.

Early Treatment of Ruptured Cerebral Arteriovenous Malformations: Analysis of Neurological Outcomes and Health Care Costs.

Background: The timing of surgical resection is controversial when managing ruptured arteriovenous malformations (AVMs) and varies considerably among centers.

Objective: To retrospectively analyze clinical outcomes and hospital costs associated with delayed treatment in a ruptured cerebral AVM patient cohort.

Methods: Patients undergoing surgical treatment for a ruptured cerebral AVM (January 1, 2015-December 31, 2020) were retrospectively analyzed.

Direct puncture of the superior ophthalmic vein for carotid cavernous fistulas: a 21-year experience.

Background: Direct puncture of the superior ophthalmic vein (SOV) is an alternative approach to traversing the inferior petrosal sinus for embolization of carotid cavernous fistulas (CCFs).

Objective: To analyze direct SOV puncture for the treatment of CCFs and review the literature.

Methods: All patients at a single center, treated for a CCF with direct SOV cannulation between January 1, 2000, and December 31, 2020, were retrospectively analyzed.

Emerging pathogenic mechanisms in human brain arteriovenous malformations: a contemporary review in the multiomics era.

A variety of pathogenic mechanisms have been described in the formation, maturation, and rupture of brain arteriovenous malformations (bAVMs). While the understanding of bAVMs has largely been formulated based on animal models of rare hereditary diseases in which AVMs form, a new era of "omics" has permitted large-scale examinations of contributory genetic variations in human sporadic bAVMs. New findings regarding the pathogenesis of bAVMs implicate changes to endothelial and mural cells that result in increased angiogenesis, proinflammatory recruitment, and breakdown of vascular barrier properties that may result in hemorrhage; a greater diversity of cell populations that compose the bAVM microenvironment may also be implicated and complicate traditional models.

Pyoderma Gangrenosum Masquerading as Wound Infection in the Early Postoperative Period After Lumbar Spine Deformity Correction Surgery.

The development of pyoderma gangrenosum (PG) after surgical site trauma is a rare, poorly understood immunologic phenomenon. PG is an immunologic disorder characterized by lymphocytic infiltration of the dermis that can manifest with skin necrosis and ulceration. This rare phenomenon can mimic surgical site infection (SSI) when it occurs in the perioperative period and in the region of surgical wounds.

Increasing author counts in neurosurgical journals from 1980 to 2020.

Objective: Scientific productivity, as assessed by publication volume, is a common metric by which the academic neurosurgical field assesses its members. The number of authors per peer-reviewed article has been observed to increase over time across a broad range of medical specialties. This study provides an update to this trend in the neurosurgical literature.

Emerging Technologies in Spinal Surgery: Ultra-Low Radiation Imaging Platforms.

Background: Spine surgery has seen tremendous growth in the past 2 decades. A variety of safety, practical, and market-driven needs have spurred the development of new imaging technologies as necessary tools for modern-day spine surgery. Although current imaging techniques have proven satisfactory for operative needs, it is well-known that these techniques have negative consequences for operators and patients in terms of radiation risk.

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.

Robotics in Spine Surgery: A Technical Overview and Review of Key Concepts.

The use of robotic systems to aid in surgical procedures has greatly increased over the past decade. Fields such as general surgery, urology, and gynecology have widely adopted robotic surgery as part of everyday practice. The use of robotic systems in the field of spine surgery has recently begun to be explored.

Hemiepiphyseodesis for Juvenile and Adolescent Tibia Vara Utilizing Percutaneous Transphyseal Screws.

Background: In juvenile and adolescent tibia vara patients with sufficient growth remaining, implant-controlled hemiepiphyseodesis, or guided growth, can be used to correct deformity. Recent reports have described hardware failure of certain hemiepiphyseodesis implants in overweight patients with tibia vara. We describe our experience using transphyseal screws to correct deformity in this patient population.

Single position spinal surgery for the treatment of grade II spondylolisthesis: A technical note.

Background And Importance: Minimally invasive transpsoas approach to treat lumbar spondylolisthesis is associated with increased clinical benefits.

Clinical Presentation: Robotic and navigation aided deformity correction for grade II spondylolisthesis was performed using transpsoas approach with pedicle screw placement in lateral decubitus position.

Conclusion: Keeping the patient in the lateral decubitus position, we supplemented interbody cage placement with screws.

Experience with definitive instrumented final fusion after posterior-based distraction lengthening in patients with early-onset spinal deformity: single center results.

Limited reports exist with regard to clinical and radiographic details of patients with early-onset spinal deformity (EOSD) undergoing definitive instrumented final fusion (FF) following implantation of a growing construct. Charts and radiographs were queried for all patients who underwent FF after management of EOSD with a distraction-based posterior construct at a single institution from 2006 to 2017. Patients managed during the growth modulation period with either proximal rib or spinal fixation were included.

Sciatica Caused by Venous Varix Compression of the Sciatic Nerve.

Background: The authors report the case of a 76-year-old woman presenting with leg pain, numbness, and weakness mimicking a lumbosacral radiculopathy.

Case Description: Initial lumbar spine magnetic resonance imaging demonstrated mild root compression, but lumbar decompression afforded only transient symptomatic relief. Postoperative magnetic resonance imaging of the lumbosacral plexus and sciatic nerve revealed a gluteal venous varix compressing the sciatic nerve just distal to the piriformis muscle.

Current posttraumatic stress disorder and exaggerated threat sensitivity associated with elevated inflammation in the Mind Your Heart Study.

Objective: Elevated inflammation has been repeatedly observed in posttraumatic stress disorder (PTSD), and it may drive the development of both psychiatric symptoms and physical comorbidities. However, it is not clear if elevated inflammation is a feature of both remitted and current PTSD, and little is known about relationships between specific clusters of PTSD symptoms and inflammation. Exaggerated threat sensitivity, as indexed by threat reactivity and avoidance of perceived threats, may be particularly closely associated with inflammation.