Endoscopic Contralateral Transaxillary Discectomy for Recurrent Disc Herniation.

This video aims to describe an endoscopic surgical approach for accessing difficult to reach pathology such as disc herniations after previous surgery. The relatively small size of endoscopic instruments facilitates significant freedom of movement inside the spinal canal. The authors have experience with interlaminar approaches for contralateral pathology such as disc herniations, recurrent disc herniations, spinal stenosis, and facet cysts.

Endoscopic Transforaminal Thoracic Decompression for Removal of a Giant Calcified Thoracic Disc Herniation.

To demonstrate the preoperative workup, surgical planning and execution of transforaminal endoscopic thoracic discectomy (TETD) for a giant calcified disc herniation. Surgeries for symptomatic thoracic disc herniations are rare and challenging. The main goal is to achieve sufficient decompression with minimal manipulation of the spinal cord.

Contact heat evoked potentials reveal distinct patterns of spinal cord impairment in degenerative cervical myelopathy beyond MRI lesions.

Background: Magnetic resonance imaging may suggest spinal cord compression and structural lesions in degenerative cervical myelopathy (DCM) but cannot reveal functional impairments in spinal pathways. We aimed to assess the value of contact heat evoked potentials (CHEPs) in addition to MRI and hypothesized that abnormal CHEPs may be evident in DCM independent of MR-lesions and are related to dynamic mechanical cord stress.

Methods: Individuals with DCM underwent neurologic examination including segmental sensory (pinprick, light touch) and motor testing.

A novel augmented reality-based simulator for enhancing orthopedic surgical training.

Background: Total Hip Arthroplasty (THA) is a well-established and common orthopedic surgery. Due to the complexity involved in THA, orthopedic surgeons require rigorous training. However, the current gold standard, the tutor-guided and -evaluated apprenticeship model is time-consuming, costly, and poses risks to patients.

Sex Differences in Patient-rated Outcomes After Lumbar Spinal Fusion for Degenerative Disease: A Multicenter Cohort Study.

Study Design: Heterogeneous data collection via a mix of prospective, retrospective, and ambispective methods.

Objective: To evaluate the effect of biological sex on patient-reported outcomes after spinal fusion surgery for lumbar degenerative disease.

Summary Of Background Data: Current literature suggests sex differences regarding clinical outcome after spine surgery may exist.

An Experimental Model for Fluid Dynamics and Pressures During Endoscopic Lumbar Discectomy.

Objective: Endoscopic spine surgery is an emerging technique of minimally invasive spine surgery. However, headache, seizure, and autonomic dysreflexia are possible irrigation-related complications following full-endoscopic lumbar discectomy (FELD). Pressure elevation through fluid irrigation may contribute to these adverse events.

Stability of medially and laterally malpositioned screws: a biomechanical study on cadavers.

Background Context: Pedicle screw instrumentation is widely used in spine surgery. Axial screw misplacement is a common complication. In addition to the recognized neurovascular risks associated with screw misplacement, the biomechanical stability of misplaced screws remains a subject of debate.

SafeRPlan: Safe deep reinforcement learning for intraoperative planning of pedicle screw placement.

Spinal fusion surgery requires highly accurate implantation of pedicle screw implants, which must be conducted in critical proximity to vital structures with a limited view of the anatomy. Robotic surgery systems have been proposed to improve placement accuracy. Despite remarkable advances, current robotic systems still lack advanced mechanisms for continuous updating of surgical plans during procedures, which hinders attaining higher levels of robotic autonomy.

The Expression of Toll-like Receptors in Cartilage Endplate Cells: A Role of Toll-like Receptor 2 in Pro-Inflammatory and Pro-Catabolic Gene Expression.

Introduction: The vertebral cartilage endplate (CEP), crucial for intervertebral disc health, is prone to degeneration linked to chronic low back pain, disc degeneration, and Modic changes (MC). While it is known that disc cells express toll-like receptors (TLRs) that recognize pathogen- and damage-associated molecular patterns (PAMPs and DAMPs), it is unclear if CEP cells (CEPCs) share this trait. The CEP has a higher cell density than the disc, making CEPCs an important contributor.

Pedicle Screw Placement with Augmented Reality Versus Robotic-Assisted Surgery.

Study Design: This was a single-center prospective clinical and radiographic analysis of pedicle screw instrumentation with Robotic-assisted navigation (RAN) and augmented reality (AR).

Objective: This study aimed to compare the accuracy of lumbosacral pedicle screw placement with RAN versus AR.

Summary Of Background Data: RAN and AR have demonstrated superior accuracy in lumbar pedicle screw placement compared to conventional free-hand techniques.

Domain adaptation strategies for 3D reconstruction of the lumbar spine using real fluoroscopy data.

In this study, we address critical barriers hindering the widespread adoption of surgical navigation in orthopedic surgeries due to limitations such as time constraints, cost implications, radiation concerns, and integration within the surgical workflow. Recently, our work X23D showed an approach for generating 3D anatomical models of the spine from only a few intraoperative fluoroscopic images. This approach negates the need for conventional registration-based surgical navigation by creating a direct intraoperative 3D reconstruction of the anatomy.

Cerebrospinal fluid pressure dynamics across the intra- and postoperative setting: Retrospective study of a spine surgery cohort.

Timely and sufficient decompression are critical objectives in degenerative cervical myelopathy (DCM) and spinal cord injury (SCI). We previously investigated intraoperative cerebrospinal fluid pressure (CSFP) for determining surgical outcomes. However, confounding factors during the intra- and postoperative setting need consideration.

Proteomic analysis of serum in a population-based cohort did not reveal a biomarker for Modic changes.

Introduction: Modic changes (MC) are bone marrow lesions of vertebral bones, which can be detected with magnetic resonance imaging (MRI) adjacent to degenerated intervertebral discs. Defined by their appearance on T1 and T2 weighted images, there are three interconvertible types: MC1, MC2, and MC3. The inter-observer variability of the MRI diagnosis is high, therefore a diagnostic serum biomarker complementing the MRI to facilitate diagnosis and follow-up would be of great value.

Multicenter external validation of prediction models for clinical outcomes after spinal fusion for lumbar degenerative disease.

Background: Clinical prediction models (CPM), such as the SCOAP-CERTAIN tool, can be utilized to enhance decision-making for lumbar spinal fusion surgery by providing quantitative estimates of outcomes, aiding surgeons in assessing potential benefits and risks for each individual patient. External validation is crucial in CPM to assess generalizability beyond the initial dataset. This ensures performance in diverse populations, reliability and real-world applicability of the results.

General skin and nasal decolonization with octenisan® set before and after elective orthopedic surgery in selected patients at elevated risk for revision surgery and surgical site infections-a single-center, unblinded, superiority, randomized controlled trial (BALGDEC trial).

Background: The preoperative body surface and nasal decolonization may reduce the risk of surgical site infections (SSI) but yields conflicting results in the current orthopedic literature.

Methods: We perform a single-center, randomized-controlled, superiority trial in favor of the preoperative decolonization using a commercial product (octenidine® set). We will randomize a total number of 1000 adult elective orthopedic patients with a high risk for SSI and/or wound complications (age ≥ 80 years, chronic immune-suppression, American Society of Anesthesiologists score 3-4 points) between a decolonization (octenisan® wash lotion 1 × per day and octenisan® md nasal gel 2-3 × per day; during 5 days) and no decolonization.

Titanium-Coated Polyetheretherketone Cages Vs Full Titanium Cages for Stand-Alone 1- or 2-Level Anterior Cervical Discectomy and Fusion: A Comparative Study.

Background: Anterior cervical discectomy and fusion (ACDF) for the surgical treatment of cervical degenerative disease often includes an intervertebral cage, which restores disc height and lordosis while promoting fusion . Cage materials include titanium (TTN) or polyetheretherketone (PEEK). Controversy in material selection stems from higher fusion rates with TNN, despite a higher subsidence rate, while PEEK cages demonstrate superior preservation of interspace height.

Cervical kyphosis after posterior cervical laminectomy with and without fusion.

Background: Cervical posterior instrumentation and fusion is often performed to avoid post-laminectomy kyphosis. However, larger comparative analyses of cervical laminectomy with or without fusion are sparse.

Methods: A retrospective, two-center, comparative cohort study included patients after stand-alone dorsal laminectomy with (n = 91) or without (n = 46) additional fusion for degenerative cervical myelopathy with a median follow-up of 59 (interquartile range (IQR) 52) months.

Endplate weakening during cage bed preparation significantly reduces endplate load capacity.

Purpose: To analyze the effect of endplate weakness prior to PLIF or TLIF cage implantation and compare it to the opposite intact endplate of the same vertebral body. In addition, the influence of bone quality on endplate resistance was investigated.

Methods: Twenty-two human lumbar vertebrae were tested in a ramp-to-failure test.

Feasibility of blinding spinal manual therapy interventions among participants and outcome assessors: protocol for a blinding feasibility trial.

Introduction: Blinding is a methodologically important aspect in randomised controlled trials yet frequently overlooked in trials of spinal manual therapy interventions for back pain. To help inform the blinding methods of a future, double-placebo-controlled trial comparing spinal manual therapy and nerve root injection for lumbosacral radicular pain, we set four objectives: (1) to assess the feasibility of blinding participants, randomly allocated to an active or placebo-control spinal manual therapy intervention protocol, (2) to assess the feasibility of blinding outcome assessors within the trial, (3) to explore the influence of spinal manual therapy experience and low back pain on blinding, and (4) to explore factors contributing to perceptions about intervention assignment among participants and outcome assessors.

Methods And Analysis: Two-parallel-group, single-centre, placebo-controlled, methodological blinding feasibility randomised trial.