Unveiling the axonal connectivity between the precuneus and temporal pole: Structural evidence from the cingulum pathways.

Neuroimaging studies have consistently demonstrated concurrent activation of the human precuneus and temporal pole (TP), both during resting-state conditions and various higher-order cognitive functions. However, the precise underlying structural connectivity between these brain regions remains uncertain despite significant advancements in neuroscience research. In this study, we investigated the connectivity of the precuneus and TP by employing parcellation-based fiber micro-dissections in human brains and fiber tractography techniques in a sample of 1065 human subjects and a sample of 41 rhesus macaques. Our results demonstrate the connectivity between the posterior precuneus area POS2 and the areas 35, 36, and TG of the TP via the fifth subcomponent of the cingulum (CB-V) also known as parahippocampal cingulum. This finding contributes to our understanding of the connections within the posteromedial cortices, facilitating a more comprehensive integration of anatomy and function in both normal and pathological brain processes. PRACTITIONER POINTS: Our investigation delves into the intricate architecture and connectivity patterns of subregions within the precuneus and temporal pole, filling a crucial gap in our knowledge. We revealed a direct axonal connection between the posterior precuneus (POS2) and specific areas (35, 35, and TG) of the temporal pole. The direct connections are part of the CB-V pathway and exhibit a significant association with the cingulum, SRF, forceps major, and ILF. Population-based human tractography and rhesus macaque fiber tractography showed consistent results that support micro-dissection outcomes.

Thoracolumbar Fractures: Comparing the Effect of Minimally Invasive Versus Open Schanz Screw Techniques on Sagittal Alignment.

STUDY DESIGN: This is a retrospective comparative cohort study. PURPOSE: This study aims to compare the effects of minimally invasive surgery (MIS) and open surgery (OS) on global sagittal alignment (GSA) in surgically managed thoracolumbar fractures. OVERVIEW OF LITERATURE: The optimal treatment of traumatic thoracolumbar fractures (TLF) remains controversial. Both MIS techniques with polyaxial screws and OS techniques with Schanz screws have gained widespread use. The effect of each technique on the global sagittal alignment has not been reported. METHODS: From 2014 to 2021, 22 patients with traumatic TLF underwent open posterior stabilization using an open transpedicular Schanz screw-rod construct and were compared to 15 patients who underwent minimally invasive surgery using a polyaxial percutaneous pedicle screw-rod construct. The reported radiological parameters measured on preoperative supine CT scan and immediate postop standing X-ray and on final follow-up whole spine standing X-rays included pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), preoperative segmental kyphosis (Preop-K), immediate post-operative segmental kyphosis (postop-Ki), final post-operative segmental kyphosis (postop-Kf), sagittal-vertica-axis (SVA), and spino-sacral angle (SSA). RESULTS: The average age of the OS group was 42.5 years; 5 patients had AO type B, and 17 patients had AO type A (A3 and A4) fractures. The average follow-up was 16.8 months. The average radiological parameters were: PI = 54.9°, PI-LL = 3°, PT = 17.6°, preop-K = 16.2°, postop-Ki = 8.7°, final postop-Kf = 14.3°, SVA = 4.58 cm, and SSA = 101.8°. The average age of the MIS group was 43.4 years; 5 patients had AO type B, and 10 patients had AO type A fractures. The average follow-up was 25 months. The average radiological parameters were as follows: PI = 51°, PI-LL = 8°, PT = 18°, preop-K = 18.4°, postop-Ki = 11.6°, postop-Kf = 14.3°, SVA = 6.4 cm, SSA = 106°. CONCLUSION: The fixation technique did not significantly affect the final correction of the local kyphosis and global spine alignment parameters.

Microsurgical and Descriptive Three-Dimensional Analysis of the Subarticular Trigone: A Guidemap for Standardizing Lateral Recess Decompression.

Background Lateral recess decompression has remained a cornerstone spinal procedure for decades. Despite its popularity, a significant lack of evidence in the literature exists concerning microsurgical anatomy and pertinent surgical landmarks, resulting in non-standardized nomenclature, descriptions, and surgical approaches. Objective This study provides an in-depth microsurgical and descriptive analysis of the subarticular trigone (SAT), serving as an anatomical guide and a tool to foster consistency in nomenclature and standardization of surgical approaches. Methods We analyzed 35 high-resolution lumbar spine CT scans, employing three-dimensional (3D) processing techniques. The SAT is introduced to delineate the bony prominence enveloping the superiomedial quadrant of the pedicle. The SAT encompasses two zones: (1) a superior zone above the superior pedicular line, corresponding to the medial part of the body of the ascending facet (AF), and (2) an inferior zone between the superior and middle pedicular lines, corresponding to the root of the AF and the medial pars/superior lamina. The superior subarticular point (SSP) and medial subarticular point (MESP) serve as key reference landmarks. The SAT forms the roof of the lateral recess and the region requiring resection during decompression of the traversing root in this anatomical corridor. Various measurements, including SSP and MESP to lateral pars, tip of the facet and spino-laminar junction distance, mean width of the sublaminar ridge (SLR), and percentage of the facet that requires resection for adequate SAT decompression, were carried out. Results The mean distance of the SSP to the lateral pars ranges from 7 to 9.2 mm, to the tip of the descending from 9.3 to 10.1 mm, and to the spino-laminar junction from 6.7 to 8.1 mm. The MESP is located at a mean distance of 5.4-6.9 mm from the medial pedicular line. The mean width of the SLR varies from 18.6 to 29.4 mm. Finally, the percentage of total facet width that needs to be removed to adequately decompress the SAT extends from 32% at L4 to 36% at L1. Conclusions This study presents comprehensive insights into the surgical, descriptive, and correlative anatomy of the lateral recess, emphasizing the SAT. The extrapolated data offer a framework for achieving uniformity in surgical planning and advocate for standardized nomenclature.

Establishing connectivity through microdissections of midbrain stimulation-related neural circuits.

Comprehensive understanding of the neural circuits involving the ventral tegmental area is essential for elucidating the anatomo-functional mechanisms governing human behaviour as well as the therapeutic and adverse effects of deep brain stimulation for neuropsychiatric diseases. While the ventral tegmental area has been successfully targeted with deep brain stimulation for different neuropsychiatric diseases, the axonal connectivity of the region has not been fully understood. Here using fiber micro-dissections in human cadaveric hemispheres, population-based high-definition fiber tractography, and previously reported deep brain stimulation hotspots, we find that the ventral tegmental area participates in an intricate network involving the serotonergic pontine nuclei, basal ganglia, limbic system, basal forebrain, and prefrontal cortex, which is implicated in the treatment of obsessive-compulsive disorder, major depressive disorder, Alzheimer's disease, cluster headaches, and aggressive behaviors.

Deep brain stimulation of symptom-specific networks in Parkinson's disease.

Deep Brain Stimulation can improve tremor, bradykinesia, rigidity, and axial symptoms in patients with Parkinson's disease. Potentially, improving each symptom may require stimulation of different white matter tracts. Here, we study a large cohort of patients (N = 237 from five centers) to identify tracts associated with improvements in each of the four symptom domains. Tremor improvements were associated with stimulation of tracts connected to primary motor cortex and cerebellum. In contrast, axial symptoms are associated with stimulation of tracts connected to the supplementary motor cortex and brainstem. Bradykinesia and rigidity improvements are associated with the stimulation of tracts connected to the supplementary motor and premotor cortices, respectively. We introduce an algorithm that uses these symptom-response tracts to suggest optimal stimulation parameters for DBS based on individual patient's symptom profiles. Application of the algorithm illustrates that our symptom-tract library may bear potential in personalizing stimulation treatment based on the symptoms that are most burdensome in an individual patient.

The lateral retrocanthal transorbital endoscopic approach to the middle fossa: cadaveric stepwise approach and review of quantitative cadaveric data.

OBJECTIVE: The lateral retrocanthal transorbital endoscopic approach (LRCTEA) facilitates trajectory to the middle fossa, preserving the lateral canthal tendon and thus avoiding postoperative complications such as eyelid malposition. Here, the authors sought to define the surgical anatomy and technique of LRCTEA using a stepwise approach in cadaveric heads and offer an in-depth examination of existing quantitative data from cadaveric studies. METHODS: The authors performed LRCTEA to the middle cranial fossa under neuronavigation in 7 cadaveric head specimens that underwent high-resolution (1-mm) CT scans preceding the dissections. RESULTS: The LRCTEA provided access to middle fossa regions including the cavernous sinus, Meckel's cave, and medial temporal lobe. The trajectories and endpoints of the approach were confirmed using electromagnetic neuronavigation. A stepwise approach was delineated and recorded. CONCLUSIONS: The authors' cadaveric study delineates the surgical anatomy and technique of the LRCTEA, providing a stepwise approach for its implementation. As these approaches continue to evolve, their development and refinement will play an important role in expanding the surgical options available to neurosurgeons, ultimately improving outcomes for patients with complex skull base pathologies. The LRCTEA presents a promising advancement in skull base surgery, particularly for accessing challenging middle fossa regions. However, surgeons must remain vigilant to potential complications, including transient diplopia, orbital hematoma, or damage to the optic apparatus.

Management of glioblastoma in elderly patients: A review of the literature.

High grade gliomas are the most common primary aggressive brain tumours with a very poor prognosis and a median survival of less than 2 years. The standard management protocol of newly diagnosed glioblastoma patients involves surgery followed by radiotherapy, chemotherapy in the form of temozolomide and further adjuvant temozolomide. The recent advances in molecular profiling of high-grade gliomas have further enhanced our understanding of the disease. Although the management of glioblastoma is standardised in newly diagnosed adult patients there is a lot of debate regarding the best treatment approach for the newly diagnosed elderly glioblastoma patients. In this review article we attempt to summarise the findings regarding surgery, radiotherapy, chemotherapy, and their combination in order to offer the best possible management modality for this group of patients. Elderly patients 65-70 with an excellent functional level could be considered as candidates for the standards treatment consisting of surgery, standard radiotherapy with concomitant and adjuvant temozolomide. Similarly, elderly patients above 70 with good functional status could receive the above with the exception of receiving a shorter course of radiotherapy instead of standard. In elderly GBM patients with poorer functional status and MGMT promoter methylation temozolomide chemotherapy can be considered. For elderly patients who cannot tolerate chemotherapy, hypofractionated radiotherapy is an option. In contrast to the younger adult patients, it seems that a careful individualised approach is a key element in deciding the best treatment options for this group of patients.

Parcellating the vertical associative fiber network of the temporoparietal area: Evidence from focused anatomic fiber dissections.

Introduction: The connectivity of the temporoparietal (TP) region has been the subject of multiple anatomical and functional studies. Its role in high cognitive functions has been primarily correlated with long association fiber connections. As a major sensory integration hub, coactivation of areas within the TP requires a stream of short association fibers running between its subregions. The latter have been the subject of a small number of recent in vivo and cadaveric studies. This has resulted in limited understanding of this network and, in certain occasions, terminology ambiguity. Research question: To systematically study the vertical parietal and temporoparietal short association fibers. Material and methods: Thirteen normal, adult cadaveric hemispheres, were treated with the Klinger's freeze-thaw process and their subcortical anatomy was studied using the microdissection technique. Results: Two separate fiber layers were identified. Superficially, directly beneath the cortical u-fibers, the Stratum proprium intraparietalis (SP) was seen connecting Superior Parietal lobule and Precuneal cortical areas to inferior cortical regions of the Parietal lobe, running deep to the Intraparietal sulcus. At the same dissection level, the IPL-TP fibers were identified as a bundle connecting the Inferior Parietal lobule with posterior Temporal cortical areas. At a deeper level, parallel to the Arcuate fasciculus fibers, the SPL-TP fibers were seen connecting the Superior Parietal lobule to posterior Temporal cortical areas. Discussion and conclusion: To our knowledge this is the first cadaveric dissection study to comprehensively study and describe of the vertical association fibers of the temporoparietal region while proposing a universal terminology.

Preoperative neurocognitive function as an independent survival prognostic marker in primary glioblastoma.

Background: Aim of the present study is to investigate whether preoperative neurocognitive status is prognostically associated with overall survival (OS) in newly diagnosed glioblastoma (GBM) patients. Methods: Ninety patients with dominant-hemisphere IDH-wild-type GBM were assessed by Mini Mental Status Exam (MMSE), Trail Making Test (TMT) A and B parts, and Control Word Association Test (COWAT) phonemic and semantic subtests. Demographics, Karnofsky Performance Scale, tumor parameters, type of surgery, and adjuvant therapy data were available for patients. Results: According to Cox proportional hazards model the neurocognitive variables of TMT B (P < .01), COWAT semantic subset (P < .05), and the MMSE (P < .01) were found significantly associated with survival prediction. From all other factors, only tumor volume and operation type (debulking vs biopsy) showed a statistical association (P < .05) with survival prediction. Kaplan Meier Long rank test showed statistical significance (P < .01) between unimpaired and impaired groups for TMT B, with median survival for the unimpaired group 26 months and 10 months for the impaired group, for COWAT semantic (P < .01) with median survival 23 months and 12 months, respectively and for MMSE (P < .01) with medial survival 19 and 12 months respectively. Conclusions: Our study demonstrates that neurocognitive status at baseline-prior to treatment-is an independent prognostic factor for OS in wild-type GBM patients, adding another prognostic tool to assist physicians in selecting the best treatment plan.

An Applied Anatomic Guide to Anterior Temporal Lobectomy and Amygdalohippocampectomy: Laboratory Cranial and White Matter Dissections to Inform Surgical Practice.

BACKGROUND AND OBJECTIVES: Anterior temporal lobectomy and amygdalohippocampectomy is a challenging procedure because of the deep surgical trajectory and complex regional neurovascular anatomy. A thorough knowledge of the involved anatomic structures is crucial for a safe and effective procedure. Our objective is to explore the white matter pathways in or around the operative corridor and to illuminate the 3-dimensional relationships of the pertinent operative parenchymal and skull base anatomy, aiming to inform and simplify surgical practice. METHODS: Four normal, adult, cadaveric, formalin-fixed cerebral hemispheres (2 left and 2 right) treated with the Klinger's technique and 2 formalin-fixed and colored-latex-injected cadaveric heads (4 sides) were used. Focused white matter and cadaveric dissections were used to study the relevant anatomy implicated during an anterior temporal lobectomy. Four illustrative cases were also included. Digital photographs from every dissection step were obtained. RESULTS: Major white matter pathways that are inevitably traversed during the approach are the inferior longitudinal fasciculus, uncinate fasciculus, and inferior arm of the cingulum. Tracts that can be potentially injured, should the dissection plane tilt inadvertently superiorly or posteriorly, are the inferior fronto-occipital fasciculus, Meyer's loop, superior longitudinal fasciculus/arcuate fasciculus complex, and basal ganglia. Consistent cranial and parenchymal landmarks that can act as a roadmap during the procedure are recorded and paired with their intraoperative equivalent to provide a thorough, yet simple, stepwise guide for the surgeon. CONCLUSION: White matter dissections, cadaveric cranial dissections, and intraoperative images are put together to provide a simplified stepwise surgical manual for anterior temporal lobectomy. Laboratory investigations that focus on the intricate 3-dimensional relationships of the pertinent operative anatomy from the surgeon's eye may enrich anatomic knowledge and push surgical boundaries, to minimize complication rates and ultimately improve patient outcomes.

C2 stentoplasty: an alternative to conventional vertebroplasty in the treatment of axis metastatic lesions: a systematic review with meta-analysis and case series.

BACKGROUND: Vertebroplasty has been recently described in the literature as a potential treatment for C2 metastatic lesions. Stentoplasty may represent a safest and equally alternative to the latter. OBJECTIVE: To describe a novel technique, stentoplasty, as an alternative for the treatment of metastatic involvement of C2 and to assess its efficacy and safety. To systematically evaluate the pertinent literature regarding the clinical outcomes and complications of C2 vertebroplasty in patients with metastatic disease. METHODS: A systematic review of C2 vertebroplasty, in the English language medical literature was conducted for the needs of this study. Additionally, a cohort of five patients, presenting with cervical instability (SINS > 6) and/or severe pain (VAS > 6) from metastatic involvement of C2 and treated with stentoplasty in our department is presented. Outcomes evaluated include, pain control, stability, and complications. RESULTS: Our systematic review yielded 8 studies that met the inclusion criteria, incorporating 73 patients that underwent C2 vertebroplasty for metastatic disease. There was a reduction in VAS scores following surgery from 7.6 to 2.1. Eleven patients had complications (15%), 3 (4%) required additional stabilization and decompression, 6 (8.2%) had odynophagia and the incidence of cement leak was 31.5% (23/73). With regard to our cohort, all 5 patients presented with severe neck pain (average VAS 6.2 (2-10)) with or without instability (average SINS 10 (6-14)) and underwent C2 stentoplasty. Mean duration of the procedures was 90 min (61-145) and 2.6 mls (2-3) of cement was injected. Postoperatively VAS improved from 6.2 to 1.6 (P = 0.033). No cement leak or other complications were recorded. CONCLUSION: A systematic review of the literature demonstrated that C2 vertebroplasty can offer significant pain improvement with a low complication rate. At the same time, this is the first study to describe stentoplasty in a small cohort of patients, as an alternative for the treatment of C2 metastatic lesions in selected cases, offering adequate pain control and improving segmental stability with a high safety profile.

The influence of osteoporotic vertebral fractures on global sagittal alignment in elderly patients: a systematic review and meta-analysis.

BACKGROUND: Thoracic kyphosis, or loss of lumbar lordosis, is often equated with osteoporosis because vertebral fractures are assumed to be a major causative factor, in addition to degeneration related to age. Despite the few studies aiming to measure the natural change in global sagittal alignment (GSA) that occurs with advancing age, the overall effect of conservatively managed osteoporotic vertebral compression fractures (OVCF) on the GSA in the elderly remains poorly understood. OBJECTIVE: To systematically evaluate the relevant literature regarding the influence of OVCF on the GSA compared to patients of similar age without fractures using the following radiological parameters: Pelvic Incidence (PI), Pelvic Tilt (PT), Lumbar Lordosis (LL), Thoracic Kyphosis (TK), Sagittal Vertical Axis (SVA) and Spino-sacral Angle (SSA). METHODS: A systematic review of the English language literature dating up until October 2022, was undertaken utilizing the PRISMA guidelines. RESULTS: Of a total of 947 articles, 10 studies met the inclusion criteria (4 Level II, 4 level III and 2 level IV evidence) and were subsequently analyzed. Overall, 584 patients (8 studies) of mean age 73.7 years (69.3-77.1) had acute OVCF of one or more vertebra that were managed conservatively. The male to female ratio was 82:412. Five studies mentioned the number of fractured vertebrae, with a total of 393 in 269 patients (average of 1.4 fractured vertebrae per patient). Their pre-operative radiological parameters on standing X-rays showed a mean PI of 54.8°, PT 24°, LL 40.8°, TK 36.5°, PI-LL 14°, SVA 4.8 cm, and SSA 115°. In addition, 437 patients were used as a control group with osteoporosis without fractured vertebrae, (6 studies) with an average age of 72.4 years (67-77.8) and male to female ratio of 96:210 (5 studies). They all had upright X-rays to assess their global sagittal alignments. Radiological parameters showed an average PI of 54.3°, PT 17.3°, LL 43.4°, TK 31.25°, PI-LL 10.95°, SVA 1.27 cm and SSA 125°. A statistical analysis comparing the OVCF group with the control group (4 studies), showed a significant increase in PT of 5.97° (95%CI 2.63, 9.32; P < 0.0005), a significant increase in TK by 8.28° (95%CI 2.15, 14.4; P < 0.008), an increase in PI-LL by 6.72° (95%CI 3.39, 10.04; P < 0.0001), an increase in SVA by 1.35 cm (95%CI 0.88, 1.83; P < 0.00001), and a decrease in SSA by 10.2° (95%CI 10.3, 23.4; P < 0.00001). CONCLUSION: Osteoporotic vertebral compression fractures managed conservatively appear to be a significant causate factor of global sagittal imbalance.

Association between preoperative neurocognitive status and IDH1 mutation status in high-grade gliomas.

Background: High-grade glioma (HGG) patients present with variable impairment in neurocognitive function (NCF). Based on that, isocitrate dehydrogenase 1 (IDH1) wild-type HGGs are more aggressive than IDH1 mutant-type ones, we hypothesized that patients with IDH1 wild-type HGG would exhibit more severe NCF deficits than their IDH1 mutant counterparts. Methods: NCF was assessed by Mini Mental Status Exam (MMSE), Trail Making Test (TMT), Digit Span (DS), and Controlled Word Association Test (COWAT) tests in 147 HGG patients preoperatively. Results: Analyses between IDH1 groups revealed a significant difference on MMSE concentration component (p ≤ .01), DS (p ≤ .01), TMTB (p ≤ .01), and COWAT (p ≤ .01) scores, with the IDH1 wild group performing worse than the IDH1 mutant one. Age and tumor volume were inversely correlated with MMSE concentration component (r = -4.78, p < .01), and with MMSE concentration (r = -.401, p < .01), TMTB (r = -.328, p < .01), and COWAT phonemic scores (r = -.599, p < .01), respectively, but only for the IDH1 wild-type group. Analyses between age-matched subsamples of IDH1 groups revealed no age effect on NCF. Tumor grade showed nonsignificance on NCF (p > .05) between the 2 IDH1 mutation subgroups of grade IV tumor patients. On the contrary, grade III group showed a significant difference in TMTB (p < .01) and DS backwards (p < .01) between IDH1 subgroups, with the mutant one outperforming the IDH1 wild one. Conclusions: Our findings indicate that IDH1 wild-type HGG patients present greater NCF impairment, in executive functions particularly, compared to IDH1 mutant ones, suggesting that tumor growth kinetics may play a more profound role than other tumor and demographic parameters in clinical NCF of HGG patients.

Complications after early versus late mobilization after an incidental durotomy: a systematic review and meta-analysis.

BACKGROUND: An incidental durotomy (IDT) is a frequent complication of spinal surgery. The conventional management involving a period of flat bed rest is highly debatable. Indeed, there are scanty data and no consensus regarding the need or ideal duration of post-operative bed rest following IDT. OBJECTIVE: To systematically evaluate the literature regarding the outcomes of mobilization within 24 h and after 24 h following IDT in open lumbar or thoracic surgery with respect to the length of hospital stay, minor and major complications. METHODS: A systematic review of the literature using PubMed, Embase and Cochrane and dating up until September 2022 was undertaken following Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Quality of evidence was assessed using a modified version of Sackett's Criteria of Evidence Support. RESULTS: Out of 532 articles, 6 studies met the inclusion criteria (1 Level-I, 4 level-III and 1 Level-IV evidence) and were analyzed. Overall, 398 patients of mean age 59.9 years were mobilized within 24 h. The average length of stay (LOS) for this group was 5.7 days. Thirty-four patients (8.5%) required reoperation while the rate of minor complications was 25.4%. Additionally, 265 patients of mean age 63 years with IDT were mobilized after 24 h. The average LOS was 7.8 days. Twenty patients (7.54%) required reoperation while the rate of minor complications was 55%. Meta-analysis comparing early to late mobilization, showed a significant reduction in the risk of minor complications and shorter overall LOS due to early mobilization, but no significant difference in major complications and reoperation rates. CONCLUSIONS: Although early mobilization after repaired incidental dural tears in open lumbar and thoracic spinal surgery has a similar major complication/ reoperation rates compared to late mobilization, it significantly decreases the risk of minor complications and length of hospitalization.

Does kyphoplasty affect the global sagittal alignment in patients with osteoporotic vertebral fractures? A systematic review and meta-analysis.

BACKGROUND: Osteoporotic vertebral compression fractures (OVCF) are common in elderly patients and may cause local kyphosis due to the vertebral collapse and wedging. Balloon kyphoplasty (BKP) with polymethyl methacrylate is widely used to relieve back pain and restore the height and kyphosis of the destroyed vertebra Johnell (Osteoporos Int 17(12):1726-33, 2006); Wasnich (Bone 18: 179S-183S, 1996); Finnern (Osteoporos Int 14:429-436, 2003). However, the influence of BKP on global sagittal alignment (GSA) in patients with OVCF remains unclear. OBJECTIVE: To systematically evaluate the relevant literature regarding the influence of BKP on the global spinal sagittal alignment using the following radiological parameters: Pelvic Incidence (PI), Pelvic Tilt (PT), Lumbar Lordosis (LL), Thoracic Kyphosis (TK), Sagittal Vertical Axis (SVA) and Spinosacral Angle (SSA). Visual Analogue Score (VAS) was also recorded. METHODS: A systematic review of the English language literature dating up until August 2022, was undertaken utilising the PRISMA guidelines. RESULTS: Of a total of 548 articles, 4 studies met the inclusion criteria (4 level III evidence) and were analyzed. Overall, 201 patients of mean age 73.8 years (69-77) had acute OVCF of one or more vertebra. The male to female ratio was 51:128. The number of fractured vertebrae was 235 (average of 1.17 fractured vertebrae per patient). Their pre-operative radiological parameters on standing x-rays showed a mean PI of 56°, PT 24.1°, LL 44.4°, TK 42.3°, PI-LL 11.7°, SVA 4.9 cm, LL/TK 1 and SSA 114.8°. The average VAS was 7.6 (2.6-10). All the patients underwent BKP and their radiological parameters on standing x-rays post operatively showed a mean PI of 55.3°, PT 23.1°, LL 45.1°, TK 41.4°, PI-LL 10.3°, SVA 4.29 cm, LL/TK 1.07 and SSA 116.8°. Their average VAS post BPK was 2.36 (0-4.8).A statistical analysis comparing the pre/post-operative GSA (111 patients, 3 studies with standard deviations) showed no statistical difference in PT (24.1° vs. 23.5°, P = 0.93), TK (42.3° vs. 42.4°, P = 0.57), PI-LL (14.4° vs.12.4°, P = 0.4), SVA (6.1 cm vs. 5.5 cm, P = 0.19) SSA (114.8° vs. 116.7° P = 0.36). VAS was significantly reduced post BKP (7.1 vs. 2.5 P = 0.004). CONCLUSION: Performing BKP procedures does not significantly affect the global sagittal alignment in patients with osteoporotic vertebral compression fractures. There was however, a significant improvement in pain scores in patients undergoing BKP at 1 or more levels.

Cluneal nerve release: a systematic review.

BACKGROUND: Despite the heterogeneity of chronic lower back pain aetiologies, cluneal nerve entrapment remains underdiagnosed and poorly understood with few studies discussing the efficacy of its surgical release. OBJECTIVE: The current study opts to conduct a systematic review reporting on the efficacy of cluneal nerve surgical decompression in patients with an established diagnosis who fail conservative treatment. We aimed to systematically evaluate the literature regarding the clinical outcomes, recurrence of symptoms and revision rates of surgical intervention. METHODS: A systematic review of the English language literature dating up until May 2022 was undertaken according to the PRISMA guidelines. Isolated case reports were excluded. RESULTS: Of a total of 54 articles, 4 studies met the inclusion criteria (three were level IV evidence and one level III evidence) and were analyzed. Overall, 98 patients of mean age 61 years, (range 17-86) underwent cluneal nerve release with a mean follow-up of 25.5 months (6-58 months). There was significant improvement in symptoms post operatively in the 4 studies. No systemic or local complications were encountered during the surgeries. Four articles reported on revision surgery for recurrent symptoms in 8 patients out of 98 with a rate of 8.2%. Of the reoperated patients, 7/8 had new branches released that were not addressed initially and 1 had neurectomy for an adhered pre-released branch. CONCLUSION: This systematic review demonstrated that cluneal nerve decompression has been performed in a total of 98 patients with significant clinical improvement, zero systemic and local complications and revision rates of 8.2% of the cases.

Reflections on the future of telemedicine and virtual spinal clinics in the post COVID-19 era.

•Both patients and surgeons seem to show significant satisfaction with virtual spinal clinics.•Virtual spinal clinics may be an important adjunct to traditional face-to-face clinics.•Limitations in physical examination constitute main concern.•Patient selection is an important factor in deciding who is a suitable candidate for a virtual spinal clinic.•Medicolegal concerns need to be adequately addressed if spinal virtual clinics are to be routinely used.

Direct Comparison Between the Kawase Approach and Retrosigmoid Intradural Suprameatal Corridor to Access the Petroclival Region Using Computed Tomography Quantitative Volumetric Analysis: A Cadaveric Study.

OBJECTIVE: The anterior petrosectomy, also known as the Kawase approach, and the retrosigmoid intradural suprameatal approach (RISA) have both been used to reduce the petrous apex and access the petroclival region. Our goal was to compare the volumes and 3-dimensional shapes of bony resection obtained through each approach while trying to resemble realistic surgical settings. METHODS: Five cadaveric specimens totaling 10 sides were dissected and analyzed. In every specimen, 1 side was used for the Kawase approach while the opposite side was used for the RISA. Petrosectomy volumes were assessed by comparing preoperative and postoperative thin-sliced computed tomography scans. RESULTS: Petrosectomy volumes were significantly larger through the Kawase approach than through the RISA (0.82 ± 0.11 vs. 0.49 ± 0.07 cm3, P < 0.001). In addition, surgical maneuverability and freedom were greater in the Kawase operative variant. Lastly, the morphology of the bony window achieved through each approach was clearly different: trapezoid for the anterior petrosectomy versus elongated ellipsoid for the RISA. CONCLUSIONS: The Kawase approach invariably results in larger volumes of bony removal than the RISA operative variant, and the volume of petrosectomy that is spatially congruent is only partially identical. The Kawase corridor is best suited for middle fossa lesions that extend into the posterior fossa, while the RISA is suitable for pathologies mainly residing in the posterior fossa and extending into the Meckel cave.