The Effect of Kyphoplasty on Opioid Use in Patients With Vertebral Compression Fractures.

Objective The primary objective of this study was to assess opioid use in the 90 days following kyphoplasty (KP) compared to the period between compression fracture and KP. Methods All patients aged 50-85 who underwent KP following a newly diagnosed vertebral compression fracture (VCF) at a large, urban academic medical center between January 1st, 2015, and January 1st, 2023, were screened for inclusion. Patients were excluded if they had an opioid prescription in the month prior to the compression fracture, had a history of malignancy, or underwent concomitant or other surgical procedures in the 90 days following KP. Opioid measures, including the prescribed amount of morphine milliequivalents (MME) per day, number of opioid days, and total MME (MME per day x number of opioid days), in addition to numerical rating scale (NRS) pain scores, were analyzed pre- and post-KP. Results A total of 27 patients met the eligibility criteria, with a mean age of 69.7 and 59.2% being female. Sixteen patients (59%) had received an opioid prescription between compression fracture and KP (opioid group). The median differences pre- and post-KP in prescribed MMEs per day, number of opioid days, and total MMEs were 17.7 (p=.0009), 11.0 (p=.0004), and 232.5 (p<.0001), respectively. There was a significant difference in NRS pain scores in both the opioid group (6.25, p<.0001) and the non-opioid group (4.36, p<.0001) pre- and post-KP. Conclusion Our findings suggest that KP may be associated with a reduction in both opioid use and pain scores in opioid-naïve patients with VCFs. Larger studies that directly compare KP to conservative management are needed to fully assess the impact of KP on opioid and pain outcome measures.

Neuronal "parts list" and wiring diagram for a visual system.

A catalog of neuronal cell types has often been called a "parts list" of the brain, and regarded as a prerequisite for understanding brain function. In the optic lobe of Drosophila, rules of connectivity between cell types have already proven essential for understanding fly vision. Here we analyze the fly connectome to complete the list of cell types intrinsic to the optic lobe, as well as the rules governing their connectivity. We more than double the list of known types. Most new cell types contain between 10 and 100 cells, and integrate information over medium distances in the visual field. Some existing type families (transmedullary, lobula intrinsic, and lobula plate intrinsic) at least double in number of types, with implications for perception of color, motion, and form. We introduce a new family, serpentine medulla intrinsic, which has more types than any other, and three new families of types that span multiple neuropils. We demonstrate self-consistency of our cell types through automatic assignment of cells by distance in high-dimensional feature space, and provide further validation by selection of small subsets of discriminative features. Our work showcases the advantages of connectomic cell typing: complete and unbiased sampling, a rich array of features based on connectivity, and reduction of the connectome to a drastically simpler wiring diagram of cell types, with immediate relevance for brain function and development.

Lumbar Spine Osteomyelitis After Permanent Spinal Cord Stimulator Implantation: A Case Report.

A spinal cord stimulator (SCS) is an intervention that has become increasingly popular due to its efficacy in treating pain. With the increasing number of SCSs implanted annually, there has been an equal increase in complications, which include infections. We present a patient who underwent an uncomplicated permanent placement of SCS and later developed worsening back pain, weakness, and fever after a mechanical fall and was subsequently found to have vertebral osteomyelitis without an identifiable infection source. While no source or definitive pathogen was discovered, if there is a concern for osteomyelitis radiographically, even in an uncommon situation when medical workup returns inconclusive, explant of the SCS is warranted.

The Importance of Differentiating Parsonage-Turner Syndrome From Cervical Radiculopathy: A Case Report.

Parsonage-Turner syndrome (PTS) is a rare disease process in which one develops acute-onset shoulder pain, followed by progressive weakness of the upper arm and shoulder girdle musculature. PTS is difficult to diagnose as it mimics similar presenting pathologies, most commonly, cervical radiculopathy (CR). Clinical presentation and diagnostic tests are particularly important to identify this rare syndrome, as the treatment for similar conditions may be more invasive. We present an interesting case of a 32-year-old female with severe unilateral shoulder pain, followed by weakness of her upper extremity musculature. The etiology of her symptoms cannot be concluded for certain; however, the aim of this case report is to increase awareness of this rare but potentially debilitating syndrome while also educating providers on the importance of differentiating PTS from the more commonly diagnosed CR.

The Role of Interventional Pain Management in Proteus Syndrome: A Case Report.

Proteus syndrome (PS) is a rare overgrowth disease process with only a few hundred cases being reported in the literature. Abnormal formation of the vertebral bodies causing scoliosis and spinal stenosis are common features that lead to debilitating pain in these patients. We present a case of a 35-year-old male landscaper with a history of PS causing severe scoliosis and vertebral overgrowth who underwent recurrent sets of multilevel zygapophyseal joint injections for management of his axial back pain. This case illustrates the utility of interventional spinal procedures in patients with progressive pain from PS.

FlyWire: online community for whole-brain connectomics.

Due to advances in automated image acquisition and analysis, whole-brain connectomes with 100,000 or more neurons are on the horizon. Proofreading of whole-brain automated reconstructions will require many person-years of effort, due to the huge volumes of data involved. Here we present FlyWire, an online community for proofreading neural circuits in a Drosophila melanogaster brain and explain how its computational and social structures are organized to scale up to whole-brain connectomics. Browser-based three-dimensional interactive segmentation by collaborative editing of a spatially chunked supervoxel graph makes it possible to distribute proofreading to individuals located virtually anywhere in the world. Information in the edit history is programmatically accessible for a variety of uses such as estimating proofreading accuracy or building incentive systems. An open community accelerates proofreading by recruiting more participants and accelerates scientific discovery by requiring information sharing. We demonstrate how FlyWire enables circuit analysis by reconstructing and analyzing the connectome of mechanosensory neurons.

Primary renal lymphoma: An incidental finding in an elderly male.

Primary renal lymphoma (PRL) is a rare disease process which represents less than 1% of all renal masses and is an uncommon type of Non-Hodgkin's Lymphoma. PRL is of clinical significance due to the fact that unlike the more commonly seen renal cell carcinoma, PRL is treated with neoadjuvant chemotherapy followed by nephrectomy. This challenges the long held notion that preoperative biopsies are not necessary prior to nephrectomy for renal masses. In this paper, we present a case of a primary renal lymphoma and discuss its clinical significance.