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Objective: The aim of this study is to explain the technique used for removing and replacing a novel percutaneous interspinous device (PID). Procedure: Three male patients, with a mean age of 66 years (range 62-72), were included in the study due to displacement ( N = 2) or misplacement ( N = 1) of the novel PID. This occurred after a mean of 23.3 ± 10.5 days from the initial placement (range 13-34) at the L4-L5 level ( N = 1) and L3-L4 level ( N = 2). Following the removal of the PID, four new devices were implanted. Conclusion: The novel PID can be safely removed either immediately after its placement during the procedure or after a certain period of days or months from its implantation. The removal procedure can be performed percutaneously under imaging guidance, by closing the four retractable wings, using the same instrumentation as utilized during the initial implantation., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To evaluate safety and efficacy of the novel percutaneous interspinous device (PID) for the treatment of symptomatic degenerative lumbar spinal stenosis (DLSS) in 3 different centers., Methods: From November 2016 to March 2020, 255 patients (male 125, mean age 71.2 years old range 49-91 years old) with neurogenic claudication, confirmed by electromyography, related to mono or bi-segmental lumbar central canal and/or foraminal stenosis were enrolled in the study. Magnetic resonance (MR) and/or computer tomography (CT), physical exam, and Visual Analogue Scale (VAS) and Zurich Claudication Questionnaire (ZCQ) were performed before and 6 months after the procedure. All treatments were performed under fluoroscopic guidance with local anesthesia and mild sedation. Technical success was defined as correct placement of the Lobster® (Demetrios Medical, Firenze, Italy) PID as demonstrated by computer tomography (CT) performed immediately after treatment; spinoplasty was performed in selected patients., Results: PID placement was accomplished with a 99.6% success rate (257/258). The one device that was not implanted was due to a spinous process fracture. In 28 patients, more than 1 device was implanted in the same session (max 3 PIDs); 6 patients required a second implant in different session. A total of 172 prophylactic spinoplasties were performed (59.3%). No major complications occurred; 3 device misplacements were successfully treated with percutaneous retrieval and new device deployment. 99.6% of patients experienced clinical improvement., Conclusion: Lobster PID is an effective and safe minimally invasive decompression method for central canal and neural foraminal stenosis when patients are correctly selected., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Vertebral augmentation has been used to treat painful vertebral compression fractures and metastatic lesions in millions of patients around the world. An international group of subject matter experts have considered the evidence, including but not limited to mortality. These considerations led them to ask whether it is appropriate to allow the subjective measure of pain to so dominate the clinical decision of whether to proceed with augmentation. The discussions that ensued are related below.

Purpose: To evaluate clinical and radiological outcomes of a series of patients treated with a removable percutaneous interspinous process spacer (IPS) (LobsterProject® Techlamed®) for symptomatic degenerative lumbar spinal stenosis (DLSS)., Methods: All patients treated in two centres with this IPS during 2019 were retrospectively reviewed. Procedures were performed under deep sedation or general anaesthesia by two interventional radiologists. Patients were clinically evaluated before intervention and at 3-month follow-up with Visual Analog Scales for pain (VAS), Oswestry Disability Index (ODI) and radiologically with MRI or CT scans. Neural foramina were independently measured for each patient on pre- and post-procedural CT scans by two radiologists., Results: Fifty-nine patients were treated in the selected period of which fifty-eight had complete documentation (mean age 71.2 ± 9.2 years [55-92], 32 males, 26 females). Forty-eight interventions were performed under deep sedation and ten under general anaesthesia, without procedural complications. Clinical follow-up at 3 months showed a significant reduction of pain (VAS from 83 ± 9 to 29 ± 19, - 65%; p < 0.001) and an improvement in functional outcomes (ODI from 31 ± 12 to 13 ± 10%, - 58%; p < 0.001). There was one case of unsatisfactory positioning post procedure, two cases of posterior migration at 3-month follow-up and one case of spinous process fracture. Mean neural foramina area increased from 77 ± 23 to 95 ± 27 mm 2 (+ 26%; p < 0.001) with very good inter-observer reliability (Cronbach's alpha = 0.899)., Conclusion: Percutaneous minimally invasive insertion of a removable IPS device demonstrates a favourable safety profile, good clinical outcomes at 3 months, and apparent anatomical increase in foraminal dimensions., Trial Registration: ClinicalTrials.gov Identifier: NCT05203666-Release Date: 21 st January 2022, retrospectively registered., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The prevalence of sacroiliac Joint (SIJ) disease as a cause of LBP is considered to range from 21% to 25%. Nevertheless, SIJ instability is frequently underestimated. Although conventional surgery has been used for several years in an attempt to stabilize the SIJ, a new percutaneous system has been proposed for articular fusion. Recently a new "one-step" fixation procedure has been proposed. We describe the case of a patient with painful SIJ instability treated with a fully CT-guided technique in simple analogue sedation.

Axial microinstability secondary to disc degeneration and consequent chronic facet joint syndrome (CFJS) is a well-known pathological entity, usually responsible for low back pain (LBP). Although posterior lumbar fixation (PIF) has been widely used for lumbar spine instability and LBP, complications related to wrong screw introduction, perineural scars and extensive muscle dissection leading to muscle dysfunction have been described. Radiofrequency ablation (RFA) of facet joints zygapophyseal nerves conventionally used for pain treatment fails in approximately 21% of patients. We investigated a "covert-surgery" minimal invasive technique to treat local spinal instability and LBP, using a novel fully CT-guided approach in patients with axial instability complicated by CFJS resistant to radioablation, by introducing direct fully or partially threaded transfacet screws (transfacet fixation - TFF), to acquire solid arthrodesis, reducing instability and LBP. The CT-guided procedure was well tolerated by all patients in simple analogue sedation, and mean operative time was approximately 45 minutes. All eight patients treated underwent clinical and CT study follow-up at two months, revealing LBP disappearance in six patients, and a significant reduction of lumbar pain in two. In conclusion, CT-guided TFF is a fast and safe technique when facet posterior fixation is needed.

Lumbar spinal canal stenosis (LSCS) is one of the most common degenerative diseases in elderly patients. Failure of he treatment can occur, generally related to bone remodelling/fracture of spinous processes. PMMA augmentation of the posterior arch (spinoplasty, SP) has recently been proposed in case of neoplastic involvement. This study evaluated the efficacy of SP as a prophylactic treatment before introducing an interspinous spacer (IS). Moreover, we consider the possibility to treat patients who previously underwent IS implants with subsequent failure of the device, by introducing a second spacer at the same level, performing accessory SP. From January 2009 to September 2011, 174 patients with LSCS underwent CT-guided percutaneous IS implant in our department. From January 2011, all patients with osteoporosis underwent prophylactic SP before introducing the spacer. Moreover, in patients with re-stenosis related to bone remodelling and/or fracture, after strengthening the spinous processes with PMMA introduction, a second similar device was introduced to re-open the stenotic spinal canal. In patients with prophylactic treatment before spacer introduction, no restenosis occurred at three to 12 month follow-up. Patients who underwent second spacer implant at the same level after posterior arch augmentation again obtained a resolution of symptoms, and no further bone remodelling had occurred at follow-up controls. In conclusion, prophylactic SP prevents single spacer failure for bone remodelling/fracture, and allows failure repair by introducing a second spacer at the same level.

We performed CT-guided posterior interbody fusion (PIF) with pedicle screw fixation and distraction to treat degenerative lumbar L4-L5 spondylolisthesis with severe left sciatica. The patient was suffering from L4 nerve root compression related to neural foramina stenosis. The dedicated tools to perform a CT-guided percutaneous PIF technique are described. The procedure was easy to apply with a total surgical time of 90 minutes. The neural foramina were investigated by CT scan reconstruction on sagittal plane demonstrating marked widening after PIF application. The left leg pain completely disappeared in two weeks and the patient remained painless at the three month follow-up control. To our knowledge, there are no other papers on CT-guided PIF procedure in the literature.

Azimuthal single-spin asymmetries of leptoproduced pions and charged kaons were measured on a transversely polarized hydrogen target. Evidence for a naive-T-odd, transverse-momentum-dependent parton distribution function is deduced from nonvanishing Sivers effects for pi(+), pi(0), and K(+/-), as well as in the difference of the pi(+) and pi(-) cross sections.

Septo-optic dysplasia is defined by a variable combination of dysgenesis of midline brain structures including optic nerve hypoplasia and hypothalamic-pituitary dysfunction often associated with a wide variety of brain malformations of cortical development. Multiple congenital anomalies have been reported only sporadically. Despite recent demonstration of the possible pathogenic role of HESX1/Hesx1 gene (a homeobox gene important for development of prosencephalon), the etiology of most cases of septo-optic dysplasia still remains unclear. This report describes eight children (4 males, 4 females; age 2 to 17 years) with septo-optic dysplasia who manifested dysmorphic features (involving not only the midline facial structures) and a spectrum of additional clinical and imaging features including autism, facial hemangioma, and holoprosencephaly. Full mutational screening for the HESX1 gene in seven of eight children was negative. Based on the extreme variability of the clinical and imaging phenotypes hereby observed, on literature review, and on septo-optic dysplasia animal models, this study confirmed that the phenotypic heterogeneity in septo-optic dysplasia is high. We suggest that: (1) dysmorphic features are more frequent than previously thought--they may represent a relevant part of the phenotype; (2) septo-optic dysplasia should be recategorized as an heterogeneous malformation syndrome (septo-optic dysplasia complex) (encompassing multiple brain, endocrine, and systemic anomalies) rather than a single precisely defined entity.

Perfusion MRI (magnetic resonance imaging) of the pituitary gland was performed in 20 healthy volunteers and 63 patients with various lesions involving the pituitary gland. All patients underwent sequential contrast-enhanced MRI using spoiled gradient recalled sequences with high temporal resolution (7 seconds). Four pituitary areas (pituitary stalk, posterior lobe, postero-superior, and antero-inferior adenohypophysis) were tested with a selected region of interest. Maximal contrast percentual variation was calculated. The timing of enhancement in normal patients matched perfectly with normal pituitary vascularization. Abnormal timing in pathological condition was investigated.

The possibility of increasing Hb F in vivo using drugs like 5-azacytidine, hydroxyurea, and butyrate has been established. However, in many cases this does not entail an increase in total hemoglobin. We report on a patient with Hb Lepore/beta-thalassemia being treated with hydroxyurea (30 mg/Kg/day) because of the presence of erythroid extramedullary masses with severe neurological abnormalities. During therapy the patient showed a remarkable improvement in neurological signs due to the reduction in extra-medullary masses, a significant increase in both total hemoglobin (from 5.8 to 9.7 g/dl) and Hb F (from 4.9 g/dl to 9.1 g/dl). The marked improvement in hemoglobin level in our patient with Hb Lepore/beta-thalassemia suggests gamma-globin gene activation due to the DNA structure determined by the crossover event.

We describe an unusual labyrinthine malformation in a case of Goldenhar syndrome studied with CT and steady-state MR imaging. A single posterosuperior semicircular canal was found with no common crus formation. The malformation could not be attributed to any embryologic development. Nosologic considerations are discussed.

The blood-ocular barrier (BOB) shares similar neuroepithelial origin, microanatomy and functions with the blood-brain barrier. There are many natural (e. g. diabetes, hypertension) or iatrogenic (chemotherapy, retinal photocoagulation) conditions which can cause a BOB breakdown, resulting in visual acuity impairment or loss. The authors examined 42 patients affected by BOB damage in different pathological conditions. All patients previously underwent a conventional fluoroangiographic (FA) study. Nine patients with normal FA exam were evaluated also. Despite normal MRI findings immediately after Gd-DTPA injection, contrast leakage into the vitreous body or into the aqueous fluid was demonstrated in delayed scans (40-50 min after contrast administration), proving the existence of a BOB damage (sensitively 94 %). Although FA exam remains the choice modality in BOB breakdown demonstration, we propose MRI as a useful diagnostic tool when optic media opacity (cataract, haemovitreous, intraocular silicon oil) occurs, preventing direct retinal fundus imaging and/or an early screening tool.

The case is reported of a patient with idiopathic intracranial hypertension examined with magnetic resonance imaging. Marked enhancement of the optic nerve heads was found, which might be related to blood-retinal barrier breakdown related to a sudden rise in intracranial cerebrospinal fluid pressure.