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.

Reducing residual forces in spinal fusion using a custom-built rod bending machine.

Background And Objective: As part of spinal fusion surgery, shaping the rod implant to align with the anatomy is a tedious, error-prone, and time-consuming manual process. Inadequately contoured rod implants introduce stress on the screw-bone interface of the pedicle screws, potentially leading to screw loosening or even pull-out.

Methods: We propose the first fully automated solution to the rod bending problem by leveraging the advantages of augmented reality and robotics.

Intraoperative anteroposterior and oblique fluoroscopic views for detection of mediolateral pedicle screw misplacement in the lumbar spine: a randomized cadaveric study.

Backgroud Context: Pedicle screws are commonly used for posterior fixation of the lumbar spine. Inaccuracy of screw placement can lead to disastrous complications.

Purpose: As fluoroscopic assisted pedicle screw instrumentation is the most frequently used technique, the aim of this study was to assess the specificity, sensitivity and accuracy of intraoperative fluoroscopy to detect mediolateral screw malpositioning.

7 T MRI of the Cervical Neuroforamen: Assessment of Nerve Root Compression and Dorsal Root Ganglia in Patients With Radiculopathy.

Objectives: The aim of this study was to assess the diagnostic value of 3-dimensional dual-echo steady-state (DESS) magnetic resonance imaging (MRI) of the cervical spine at 7 T compared with 3 T in patients with cervical radiculopathy.

Materials And Methods: Patients diagnosed with cervical radiculopathy were prospectively recruited between March 2020 and January 2023 before undergoing surgical decompression and received 3-dimensional DESS imaging at 3 T and 7 T MRI. Cervical nerve root compression and the dimensions of the dorsal root ganglia were assessed by 2 radiologists independently.

Superior metal artifact reduction of tin-filtered low-dose CT in imaging of lumbar spinal instrumentation compared to conventional computed tomography.

Objective: To compare the image quality of low-dose CT (LD-CT) with tin filtration of the lumbar spine after metal implants to standard clinical CT, and to evaluate the potential for metal artifact and dose reduction.

Materials And Methods: CT protocols were optimized in a cadaver torso. Seventy-four prospectively included patients with metallic lumbar implants were scanned with both standard CT (120 kV) and tin-filtered LD-CT (Sn140kV).

Biomechanics after spinal decompression and posterior instrumentation.

Purpose: The aim of this study was to elucidate segmental range of motion (ROM) before and after common decompression and fusion procedures on the lumbar spine.

Methods: ROM of fourteen fresh-frozen human cadaver lumbar segments (L1/2: 4, L3/4: 5, L5/S1: 5) was evaluated in six loading directions: flexion/extension (FE), lateral bending (LB), lateral shear (LS), anterior shear (AS), axial rotation (AR), and axial compression/distraction (AC). ROM was tested with and without posterior instrumentation under the following conditions: 1) native 2) after unilateral laminotomy, 3) after midline decompression, and 4) after nucleotomy.

Sonification as a reliable alternative to conventional visual surgical navigation.

Despite the undeniable advantages of image-guided surgical assistance systems in terms of accuracy, such systems have not yet fully met surgeons' needs or expectations regarding usability, time efficiency, and their integration into the surgical workflow. On the other hand, perceptual studies have shown that presenting independent but causally correlated information via multimodal feedback involving different sensory modalities can improve task performance. This article investigates an alternative method for computer-assisted surgical navigation, introduces a novel four-DOF sonification methodology for navigated pedicle screw placement, and discusses advanced solutions based on multisensory feedback.

Residual motion of cortical versus pedicle screw constructs after decompression, interbody fusion and cross-link augmentation.

Purpose: To compare the residual range of motion (ROM) of cortical screw (CS) versus pedicle screw (PS) instrumented lumbar segments and the additional effect of transforaminal interbody fusion (TLIF) and cross-link (CL) augmentation.

Methods: ROM of thirty-five human cadaver lumbar segments in flexion/extension (FE), lateral bending (LB), lateral shear (LS), anterior shear (AS), axial rotation (AR), and axial compression (AC) was recorded. After instrumenting the segments with PS (n = 17) and CS (n = 18), ROM in relation to the uninstrumented segments was evaluated without and with CL augmentation before and after decompression and TLIF.

Residual motion of different posterior instrumentation and interbody fusion constructs.

Purpose: To elucidate residual motion of cortical screw (CS) and pedicle screw (PS) constructs with unilateral posterior lumbar interbody fusion (ul-PLIF), bilateral PLIF (bl-PLIF), facet-sparing transforaminal lumbar interbody fusion (fs-TLIF), and facet-resecting TLIF (fr-TLIF).

Methods: A total of 35 human cadaver lumbar segments were instrumented with PS (n = 18) and CS (n = 17). Range of motion (ROM) and relative ROM changes were recorded in flexion/extension (FE), lateral bending (LB), axial rotation (AR), lateral shear (LS), anterior shear (AS), and axial compression (AC) in five instrumentational states: without interbody fusion (wo-IF), ul-PLIF, bl-PLIF, fs-TLIF, and fr-TLIF.

CD90-positive stromal cells associate with inflammatory and fibrotic changes in modic changes.

Objective: Modic changes (MC) are vertebral bone marrow lesions seen on magnetic resonance images, that associate with disc degeneration and low back pain (LBP). Few studies described MC histopathology qualitatively based on a few patient samples. CD90-positive bone marrow stromal cells were shown to be pro-fibrotic in MC.

Compliance with wearing a thoracolumbar orthosis in nonoperative treatment of osteoporotic vertebral fractures: a prospective sensor-controlled study.

Background Context: Hyperextension orthoses (HOs) for nonoperative treatment of osteoporotic vertebral fractures (OVFs) are widely prescribed. However, the compliance, how much an HO is worn after it has been prescribed, is widely unknown.

Purpose: This study was performed to assess the wearing time of HOs for OVFs in a prospective blinded, sensor-controlled manner.

Role of C-reactive protein in the bone marrow of Modic type 1 changes.

Modic type 1 changes (MC1) are vertebral bone marrow lesions and associate with low back pain. Increased serum C-reactive protein (CRP) has inconsistently been associated with MC1. We aimed to provide evidence for the role of CRP in the tissue pathophysiology of MC1 bone marrow.

The sitting vs standing spine.

Background: Planning of surgical procedures for spinal fusion is performed on standing radiographs, neglecting the fact that patients are mostly in the sitting position during daily life. The awareness about the differences in the standing and sitting configuration of the spine has increased during the last years. The purpose was to provide an overview of studies related to seated imaging for spinal fusion surgery, identify knowledge gaps and evaluate future research questions.

Posterior spinal instrumentation and decompression with or without cross-link?

Background: Posterior lumbar instrumentation requires sufficient primary stiffness to ensure bony fusion and to avoid pseudarthrosis, screw loosening, or implant failure. To enhance primary construct stiffness, transverse cross-link (CL) connectors attached to the vertical rods can be used. Their effect on the stability of a spinal instrumentation with simultaneous decompression is yet not clear.

Bladder management in patients undergoing spine surgery: An assessment of care delivery.

Background: Lower urinary tract dysfunction is common in the early postoperative phase after spine surgery. Although it is essential for an optimal patient management to balance benefits and harms, it is not known which patient benefit from a perioperative indwelling catheter. We therefore evaluated urological parameters prior and after spine surgery performing a quality assessment of our current clinical practice in bladder management.

Risk factors for L5 pedicle fractures after single-level posterior spinal fusion.

Background Context: Pedicle fractures are a rare but potentially devastating complication of posterior instrumented spinal fusion (PSF). Preoperative awareness of the possible risk factors may help prevent these fractures by modifying the surgical plan. However, the risk factors have not yet been identified.

Musculoskeletal biomechanics of patients with or without adjacent segment degeneration after spinal fusion.

Study Design: A retrospective, single center, case-control study was performed.

Objective: The present study employed patient-specific biomechanical modeling to find potential biomechanical differences after spinal fusion at L4/5 in patients with and without subsequent development of adjacent segment disease (ASD).

Methods: The study population comprised patients who underwent primary spinal fusion at L4/5 and were either asymptomatic during > 4 years of follow-up (CTRL; n = 18) or underwent revision surgery for ASD at L3/4 (n = 20).

[18F]-sodium fluoride PET/MR for painful lumbar facet joint degeneration - a randomized controlled clinical trial.

Background Context: [18F]-sodium fluoride (NaF) PET/MR is a modern diagnostic modality for imaging increased bone turnover. Its merits in detecting painful facet joint osteoarthritis in patients with lumbar back pain are unknown.

Purpose: To perform a prospective randomized controlled study investigating [18F]-NaF PET/MR for detecting painful facet joints in comparison to the standard of care (SOC), including clinical examination and conventional MRI.

Intraoperative Monitoring of CSF Pressure in Patients with Degenerative Cervical Myelopathy (COMP-CORD Study): A Prospective Cohort Study.

Degenerative cervical myelopathy (DCM) is hallmarked by spinal canal narrowing and related cord compression and myelopathy. Cerebrospinal fluid (CSF) pressure dynamics are likely disturbed due to spinal canal stenosis. The study aimed to investigate the diagnostic value of continuous intraoperative CSF pressure monitoring during surgical decompression.

Pro-fibrotic phenotype of bone marrow stromal cells in Modic type 1 changes.

Modic type 1 changes (MC1) are painful vertebral bone marrow lesions frequently found in patients suffering from chronic low-back pain. Marrow fibrosis is a hallmark of MC1. Bone marrow stromal cells (BMSCs) are key players in other fibrotic bone marrow pathologies, yet their role in MC1 is unknown.

Patient-specific statistical shape modeling for optimal spinal sagittal alignment in lumbar spinal fusion.

Purpose: The present study compared patients developing ASD after L4/5 spinal fusion with a control group using a patient-specific statistical shape model (SSM) to find alignment-differences between the groups.

Methods: This study included patients who had undergone spinal fusion at L4/5 and either remained asymptomatic (control group; n = 25, follow-up of > 4 years) or required revision surgery for epifusional ASD (n = 22). Landmarks on preoperative and postoperative lateral radiographs were annotated, and the optimal spinal sagittal alignment was calculated for each patient.

Augmented Reality Navigated Sacral-Alar-Iliac Screw Insertion.

Background: Sacral-alar-iliac (SAI) screws are increasingly used for lumbo-pelvic fixation procedures. Insertion of SAI screws is technically challenging, and surgeons often rely on costly and time-consuming navigation systems. We investigated the accuracy and precision of an augmented reality (AR)-based and commercially available head-mounted device requiring minimal infrastructure.

High-resolution in vivo MR imaging of intraspinal cervical nerve rootlets at 3 and 7 Tesla.

Objectives: No routine imaging technology allows reliable visualization of nerve rootlets inside the spinal canal with positive contrast. The stronger MR signal at 7 T, with optimized protocols, may offer a solution. The purpose was to evaluate the potential of 3D Dual-Echo Steady-State (DESS) MR imaging of the cervical spine at 3 and 7 T in assessing the micro-anatomy of the nerve rootlets.