Minimally Invasive Approaches to Spinal Cerebrospinal Fluid Leak Repair: Current Strategies and a Novel Technique.

Spinal cerebrospinal fluid (CSF) leaks can be caused by tears in the dura and are challenging to treat. Traditional methods of treating spinal CSF leakage include nonsurgical management, epidural blood patches (EBP), and direct surgical repair. Minimally invasive surgery (MIS) is rapidly progressing within neurosurgery due to its advantages for patient safety and comfort.

SymTC: A symbiotic Transformer-CNN net for instance segmentation of lumbar spine MRI.

Intervertebral disc disease, a prevalent ailment, frequently leads to intermittent or persistent low back pain, and diagnosing and assessing of this disease rely on accurate measurement of vertebral bone and intervertebral disc geometries from lumbar MR images. Deep neural network (DNN) models may assist clinicians with more efficient image segmentation of individual instances (discs and vertebrae) of the lumbar spine in an automated way, which is termed as instance image segmentation. In this work, we proposed SymTC, an innovative lumbar spine MR image segmentation model that combines the strengths of Transformer and Convolutional Neural Network (CNN).

Robotic-assisted single-position lateral for multilevel circumferential lumbar interbody fusion: how I do it.

Background: Lateral lumbar interbody fusion supplemented with insertion of pedicle screws is a surgical procedure that has gained popularity in the last years, becoming an important tool in the armamentarium of spine surgeons. In recent years, there is a trend to complete both procedures in a single position, thus avoiding flipping the patient prone to insert the pedicle screws.

Methods: We describe a step-by-step workflow of the robotic-assisted technique for multilevel lateral lumbar interbody fusion supplemented with posterior instrumentation.

Neurological Surgery Residency Programs in the United States: A National Cross-Sectional Survey.

Background And Objectives: The Accreditation Council for Graduate Medical Education has approved 117 neurological surgery residency programs which develop and educate neurosurgical trainees. We present the current landscape of neurosurgical training in the United States by examining multiple aspects of neurological surgery residencies in the 2022-2023 academic year and investigate the impact of program structure on resident academic productivity.

Methods: Demographic data were collected from publicly available websites and reports from the National Resident Match Program.

Single-Position Lateral Approach for Revision Thoracolumbar Corpectomy With Delayed Ipsilateral Kidney Atrophy: Technical Note and Discussion of Complications.

Improvements in navigation technology have enabled surgeons to safely offer single-position fusion surgeries, demonstrating shorter operating times and reduced length of stay (LOS) as compared to traditional lateral and prone dual-position surgeries. However, no studies to date describe revision thoracolumbar corpectomy with simultaneous posterior rod removal and replacement in the lateral position. Furthermore, this is the first reported complication of delayed ipsilateral kidney atrophy following lateral lumbar surgery.

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.

Augmented Reality in Spinal Surgery: Highlights From Augmented Reality Lectures at the Emerging Technologies Annual Meetings.

Introduction Augmented reality (AR) is an advanced technology and emerging field that has been adopted into spine surgery to enhance care and outcomes. AR superimposes a three-dimensional computer-generated image over the normal anatomy of interest in order to facilitate visualization of deep structures without the ability to directly see them. Objective To summarize the latest literature and highlight AR from the annual "Spinal Navigation, Emerging Technologies and Systems Integration" meeting lectures presented by the Seattle Science Foundation (SSF) on the development and use of augmented reality in spinal surgery.

Defining the Time Benefit of Awake Versus General Anesthesia for Single-Level Lumbar Spine Surgery.

Background: Awake anesthesia with monitored anesthesia care (MAC) might confer time benefits compared with traditional general anesthesia (GA) in the setting of single-level lumbar spine surgery. Therefore, we sought to define the quantitative time difference spent in the operating room between the MAC and GA approaches for single-level lumbar spine surgery.

Methods: A prospectively maintained database of the senior surgeon was reviewed for single-level lumbar spine surgeries from 2019 to 2020 performed with the patient under either GA or MAC.

Cervical Subarachnoid Drain for the Treatment of Cerebrospinal Fluid Leak: 2-Dimensional Operative Video.

Cerebrospinal fluid (CSF) leak is a common phenomenon encountered by the neurosurgeon. It is most commonly come across after a neurosurgical procedure, but it can be seen idiopathically. Treatment usually ranges from conservative management through cerebrospinal fluid diversion to direct surgical repair.

Augmented reality head-mounted display-based incision planning in cranial neurosurgery: a prospective pilot study.

Objective: Monitor and wand-based neuronavigation stations (MWBNSs) for frameless intraoperative neuronavigation are routinely used in cranial neurosurgery. However, they are temporally and spatially cumbersome; the OR must be arranged around the MWBNS, at least one hand must be used to manipulate the MWBNS wand (interrupting a bimanual surgical technique), and the surgical workflow is interrupted as the surgeon stops to "check the navigation" on a remote monitor. Thus, there is need for continuous, real-time, hands-free, neuronavigation solutions.

"Disruptive Technology" in Spine Surgery and Education: Virtual and Augmented Reality.

Background: Technological advancements are the drivers of modern-day spine care. With the growing pressure to deliver faster and better care, surgical-assist technology is needed to harness computing power and enable the surgeon to improve outcomes. Virtual reality (VR) and augmented reality (AR) represent the pinnacle of emerging technology, not only to deliver higher quality education through simulated care, but also to provide valuable intraoperative information to assist in more efficient and more precise surgeries.

A single institution experience with proximal junctional kyphosis in the context of existing classification schemes - Systematic review.

Background: Proximal junctional kyphosis is a kyphotic deformity following spine instrumentation, predominantly seen in scoliosis patients. There have been previous attempts to develop classification schema of PJK. We analyzed the factors contributing to PJK based upon our own clinical experience with the goal of developing a clinical guidance tool which took into account both etiology and mechanism of failure.

Quantifying Bone Quality Using Computed Tomography Hounsfield Units in the Mid-sagittal View of the Lumbar Spine.

Background: Computed tomography Hounsfield unit (HU) is an alternative tool to the dual energy x-ray absorptiometry scan T-score to quantify the bone quality. DEXA scan can overestimate the bone mineral density. We studied the correlation of the vertebral mid-axial and mid-sagittal HU to the T-score.

The Focused Neurosurgical Examination During Telehealth Visits: Guidelines During the COVID-19 Pandemic and Beyond.

Objective:  To provide guidelines to healthcare workers for performing a focused neurological examination via telemedicine during the coronavirus disease-2019 (COVID-2019) pandemic.

Methods:  We reviewed our department's outpatient clinic visits after the implementation of a telemedicine protocol in response to the COVID-19 crisis. Crossover rates from telehealth to in-person visits were evaluated and guidelines for performing a telemedicine neurological exam were created based on the consensus of 16 neurosurgical attending providers over a four-month period.

Differences Between Neurosurgical Subspecialties in Telehealth Adoption.

Objective: The health care field has been faced with unprecedented challenges during the COVID 19 pandemic. One such challenge was the implementation of enhanced telehealth capabilities to ensure continuity of care. In this study, we aim to understand differences between subspecialties with regard to patient consent and satisfaction following telehealth implementation.

Augmented Reality-assisted Pedicle Instrumentation: Versatility Across Major Instrumentation Sets.

Study Design: Laboratory investigation with phantom spine models.

Objectives: The aim of this study was to demonstrate the ability of Augmented Reality system to track instruments from different companies without major modifications.

Summary Of Background Data: Augmented Reality is an emergent technology with applications in industrial, military, gaming, and medical fields.

Spine surgery is kyphosing to spine surgeon.

Background: Spine surgery is a demanding surgical specialty which requires surgeons to operate for hours on end, often compromising good posture. Sustained poor posture in the operating room (OR) can be the source of many adverse health effects on spine surgeons. This study will analyze posture of a spine surgeon in different types of spine surgery cases.

Head-up display assisted endoscopic lumbar discectomy-A technical note.

Background: Minimally invasive surgery is heavily dependent on indirect visualization and image guidance, often resulting in non-ergonomic postures. Minimally invasive surgeons are more likely to experience neck pain, shoulder pain, and fatigue compared to open surgeons. Spinal endoscopy is rapidly increasing in popularity among minimally invasive spine surgeons.

Establishing validity of the fundamentals of spinal surgery (FOSS) simulator as a teaching tool for orthopedic and neurosurgical trainees.

Background Context: Pedicle screw placement is a demanding surgical skill as a spine surgeon can face challenges including variations in pedicle morphology and spinal deformities. Available CT simulators for spine pedicle placement can be very costly and hands-on cadaver courses are limited by specimen availability and are not readily accessible.

Purpose: To conduct validation of a simulated training device for essential spine surgery skills.