World Neurosurg
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Lumbar pedicle screw placement surgery involves various assistive technologies, including fluoroscopic, stereotactic, or robotic navigation and intraoperative neuromonitoring (IONM). We aimed to discern neurosurgeons' preferences for screw placement techniques and IONM utility, while also considering the influence of experience. ⋯ This national survey shows that stereotactic navigation is the predominant technique for pedicle screw placement among less experienced neurosurgeons, with seasoned neurosurgeons leaning toward fluoroscopic guidance. Robotic guidance was the least used technique with no observed difference based on experience. Neurosurgeons employing multiple techniques use IONM the most, compared with surgeons who only use stereotactic navigation and/or robotic guidance.
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The prevalence of osteoporotic vertebral fractures has increased with aging populations, necessitating effective treatments such as percutaneous kyphoplasty combined with posterior screw fixation. However, biomechanical research on the effects of using short screws on fixation stability and bone stress or on the impact of bone cement bonding to screws on structural strength is lacking. This study aimed to optimize short-segment fixation strategies for osteoporotic thoracolumbar burst fractures by analyzing the biomechanical effects of pedicle screw length and bone-cement augmentation. ⋯ Short screws in injured vertebrae without contact with the bone cement can achieve satisfactory stability and stress distribution. It is feasible to implant short screws in the injured vertebrae, reduce the number of bilaterally injured vertebrae, and inject bone cement through the non-pedicle approach during the surgical procedure, which simplifies the surgical process.
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The NEXUS criteria have been introduced in the 1990s to assist emergency department physicians to decide whether to perform radiographic work-up following cervical whiplash injury. Four criteria have been described on these profile radiographs of the cervical spine including angulation between cervical endplates, 3-mm listhesis, posterior facet joints overlap, and widened interspinous space. ⋯ Hence, we present the striking case of a young female patient whose radiographs displayed slight but abnormal signs of lower cervical spine instability, but was nonetheless discharged home with dynamic X-rays of the cervical spine to be performed in a delayed setting. We hope that these striking features will help us remind the importance of radiologic semiology of posttraumatic unstable cervical spine.
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Case Reports
Surgical Video: Percutaneous fusion and endoscopic resection of a thoracic metastatic tumor.
While endoscopic approaches to the spine have become increasingly utilized for spinal degenerative disease, there is a paucity of literature regarding the role of endoscopic approaches in spinal oncology.1 The endoscopic approach offers patients lower risk of wound infection, wound dehiscence, and postoperative hematoma when compared with an open approach.1 In many spinal oncology patients, an endoscopic approach allows for prompt postoperative radiation when compared with an open approach.2 Both the lower complication profile and decreased time to postoperative radiation highlight the importance of considering an endoscopic approach to metastatic spinal tumors. We present a case of a patient with a metastatic carcinoma to the thoracic spine resected via an endoscopic approach. The patient's tumor was first treated with endovascular embolization, followed by endoscopic hemilaminectomy, foraminotomy, and tumor resection. ⋯ Per institutional guidelines, the current case Video 1 did not classify as human subject research or require institutional review board review. In the Video 1, particular focus is placed on the surgical techniques involved in the endoscopic approach for resection a spinal metastatic tumor. With the increasing utilization of endoscopic approaches to the spine, the described technique for resection of spinal metastatic lesions will become increasingly relevant to spinal oncology surgeons.
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Deep brain stimulation (DBS) is a well-established treatment for motor circuit disorders such as Parkinson disease, dystonia, and essential tremor, particularly when pharmacological interventions are insufficient.1-3 The increase in DBS-related publications and the growing number of patients receiving DBS highlight the acceptance and refinement of the procedure.3,4 Despite its widespread use, comprehensive anatomical knowledge of deep brain nuclei remains critical for enhancing clinical efficacy. Accurate targeting of the complex three-dimensional anatomy of the target nuclei is crucial for maximizing therapeutic effects and minimizing adverse side effects. However, existing anatomical guides often lack depth perception.5,6 We dissected specimens prepared using the Klingler method,7 proceeding sequentially from lateral to medial, medial to lateral, and superior to inferior. ⋯ Our models were evaluated via augmented reality within a real-world context, and radiological models of these nuclei generated through segmentation were analyzed. Thus, our models and videos offer a novel method for visualizing the complex anatomy of deep brain nuclei, which could help enhance the precision of DBS procedures and may improve patient outcomes. This advanced understanding of spatial anatomical relationships may be beneficial for the continued development and success of DBS therapy.