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Purpose: We aim to investigate the associations between lumbar paraspinal muscles and sagittal malalignment in patients undergoing lumbar three-column osteotomy. Methods: Patients undergoing three-column osteotomy between 2016 and 2021 with preoperative lumbar magnetic resonance imaging (MRI) and whole spine radiographs in the standing position were included. Muscle measurements were obtained using a validated custom software for segmentation and muscle evaluation to calculate the functional cross-sectional area (fCSA) and percent fat infiltration (FI) of the m. psoas major (PM) as well as the m. erector spinae (ES) and m. multifidus (MM). Spinopelvic measurements included pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), L1–S1 lordosis (LL), T4–12 thoracic kyphosis (TK), spino-sacral angle (SSA), C7–S1 sagittal vertical axis (SVA), T1 pelvic angle (TPA) and PI–LL mismatch (PI − LL). Statistics were performed using multivariable linear regressions adjusted for age, sex, and body mass index (BMI). Results: A total of 77 patients (n= 40 female, median age 64 years, median BMI 27.9 kg/m2) were analyzed. After adjusting for age, sex and BMI, regression analyses demonstrated that a greater fCSA of the ES was significantly associated with greater SS and SSA. Moreover, our results showed a significant correlation between a greater FI of the ES and a greater kyphosis of TK. Conclusion: This study included a large patient cohort with sagittal alignment undergoing three-column osteotomy and is the first to demonstrate significant associations between the lumbar paraspinal muscle parameters and global sagittal alignment. Our findings emphasize the importance of the lumbar paraspinal muscles in sagittal malalignment.

Loss of mobility and musculoskeletal pain due to degenerative conditions is a major cause of reduced quality of life, especially in aging populations. Therefore, incidences of arthroplasty of hip and knee joint and spinal surgeries are rising. The simultaneous presence of spinal conditions and hip or knee osteoarthritis poses challenges in therapeutic decision-making and may lead to persistent complaints following operative treatments. While some studies have addressed the effects of preexisting spinal conditions and former spinal fusion surgery in arthroplasty outcomes, only few have investigated the effects of arthroplasty on lumbar spinal surgery outcomes.

Collagen is the primary structural protein of connective tissues. Disrupting the maintenance and turnover of connective tissues can lead to age-related changes and conditions, potentially influencing surgical outcomes negatively. The identification of reliable predictor biomarkers for revision spinal surgery is crucial. However, literature is scarce in exploring the role of imaging parameters. The intersection of skin ultrasound (US) parameters and their connection to connective tissues and advanced glycation end-products (AGEs), formed through the glycation of proteins like collagen contributing to age-related decline in tissue elastic properties, remains an area of ongoing investigation.

Evaluating the overall quality of care involves considering patient-reported outcomes. While in theory, postoperative functional improvement, as indicated by the Oswestry disability index (ODI), should result in postoperative patient satisfaction, the exact correlation has not been consistently evidenced in the literature. This study seeks to demonstrate the extent of ODI improvement required for achieving patient satisfaction two years post elective lumbar surgery.

The facet joints in the lumbar region, together with the intervertebral disc, regional ligaments and paraspinal muscles, provide stability to the disco-vertebral motion segments in different spinal position. The development of degenerative spondylolisthesis begins with dehydration of the intervertebral disc that leads to altered spinal load-bearing dynamics and an increased load on the facet joints. Failure of the biomechanical function of the facet joints leads to osteoarthritic changes in it and is implicated in spinal disorders such as degenerative spondylolisthesis. The presence of vacuum phenomenon in the facet joints is a sign of advanced arthropathy.

Degenerative lumbar spondylolisthesis (DLS) is a prevalent spinal condition that can result in significant disability. DLS is thought to result from a combination of disc and facet joint degeneration, as well as various biological, biomechanical, and behavioral factors. One hypothesis suggests that the progressive degeneration of segmental stabilizers, notably the paraspinal muscles, could contribute to a vicious cycle of increasing slippage.

The synthesis of glycosides incorporating basic nitrogen atoms is a longstanding challenge in organic synthesis. By leveraging the reactivity of glycosyl anions, a general method has been developed that enables use of glycosyl donors incorporating unprotected, basic amines.

The recommended timing for returning to common activities after cervical spine surgery varies widely among physicians based on training background and personal opinion, without clear guidelines or consensus. The purpose of this study was to analyze spine surgeons’ responses about the recommended timing for returning to common activities after different cervical spine procedures.

While reductive cross-electrochemical coupling is an attractive approach for the synthesis of complex molecules at both small and large scale, two barriers for large-scale applications have remained: the use of stoichiometric metal reductants and a need for amide solvents. In this communication, new conditions that address these challenges are reported. The nickel-catalyzed reductive cross-coupling of aryl bromides with alkyl bromides can be conducted in a divided electrochemical cell using acetonitrile as the solvent and diisopropylamine as the sacrificial reductant to afford coupling products in synthetically useful yields (22–80%). Additionally, the use of a combination of the ligands 4,4′,4″-tri-tert-butyl-2,2′:6′,2′-terpyridine and 4,4′-di-tert-butyl-2,2′-bipyridine is essential to achieve high yields.

Epidural steroid injections (ESIs) are a common, effective treatment of lumbar radiculopathy and sciatica. Although the negative skeletal effects of oral glucocorticoids are well established, little is known about the impact of ESI on bone quality.

Study Design: Retrospective case-control study.Objectives: Few studies have compared the costs of single-level (1) posterior instrumented fusion alone (PSF), (2) posterior interbody fusion with PSF (PLIF), and (3) lateral interbody fusion with PSF (circumferential LLIF). The purpose of this study was to compare costs associated with these procedures.Methods: Charts were reviewed and patients followed-up with a telephone questionnaire. Medicare reimbursement data was used for cost estimation from the payer’s perspective. Multivariate survival analysis was performed to assess time to elevated resource use (greater than 90% of study patients or $68 672).Results: A total of 337 patients (PSF, 45; PLIF, 222; circumferential LLIF, 70) were included (63% follow-up at 6 years). PSF and circumferential LLIF patients were 3 times more likely to reach the cutoff value compared with PLIF patients (P= .017).Conclusions: Circumferential LLIF and PSF patients were more likely to have higher resource use than PLIF patients and thus incur greater costs at 6-year follow-up.

Study Design Retrospective cohort study.Objective The U.S. Food and Drug Administration issued a warning in 2008 against off-label bone morphogenetic protein (BMP-2) use. We aimed to determine (off-label) BMP-2 use in two periods and associations with complications.Methods We included 340,393 patients undergoing spinal fusions from the Premier Perspective database (2006 to 2012). BMP-2 use was determined from billing in 2006 to 2008 versus 2009 to 2012. Outcomes included revisions, length of hospital stay (LOHS), and cost of hospital stay (COH). Multilevel regressions measured associations between BMP-2 and outcomes; odds ratios (ORs) and 95% confidence intervals (CIs) are reported.Results BMP-2 use decreased from 18.7% in 2006 to 11.5% in 2012. Off-label use remains but is decreasing, particularly for cervical anterior (5.1 versus 2.0%) and cervical posterior procedures (15.3 versus 8.5%; both p?

We describe the gram-scale total synthesis of (±)-ibogamine in nine steps and 24% overall yield. The approach features a Mitsunobu fragment coupling and macrocyclic Friedel–Crafts alkylation to establish the nitrogen-containing core of ibogamine. A regio- and diastereoselective hydroboration allows for simultaneous formation of the tetrahydroazepine and isoquinuclidine ring systems via sulfonamide deprotection and concomitant intramolecular cyclization.

The vertebral bone quality (VBQ) score that is based on non-contrast enhanced T1-weighted MRI was recently introduced as a novel measure of bone quality in the lumbar spine and shown to be a significant predictor of healthy versus osteopenic/osteoporotic bone.

Cadaveric study.

A discectomy study on human cadaveric lumbar spine.

•Although multiple factors have been implicated, our case series highlights SSEP stimulation as a common etiology of arrhythmia.•Significant bradycardia and CA during spine surgery does not always require termination of the surgical procedure.•Decision making should be undertaken in each case individually based on patient condition and circumstances of each event.•Surgeons and anesthesiologists should be aware of and prepared to treat significant cardiac arrhythmias during spine surgery even in otherwise healthy patients without known risk factors.

We present a complicated case of recurrence of gestational trophoblastic neoplasms (GTN), mixed ETT and choriocarcinoma at an abdominal cesarean scar. This tumor consisted of typical morphologic and immunophenotypic features of ETT and choriocarcinoma. The tumor recurred despite the patient undergoing chemotherapy. The patient had this abdominal mass resected three times. The elements of ETT and coexisting choriocarcinoma varied each time. Due to re-recurrence of the tumor, the following decisions had been made: total abdominal hysterectomy, bilateral salpingectomy, right-sided inguinal lymph node biopsy. At the time of this report, recurrence was negative.

Amniotic fluid embolism (AFE) is the second leading cause of maternal mortality in the USA with an incidence of 1 : 15,200 births. The case fatality rate and perinatal mortality associated with AFE are 13–30% and 9–44%, respectively. This rare but devastating complication can be difficult to diagnose as many of the early signs and symptoms are nonspecific. Compounding this diagnostic challenge is a lack of effective treatment regimens which to date are mostly supportive. We present the case of a 26-year-old woman who suffered from suspected AFE and was successfully treated with the novel regimen of Atropine, Ondansetron, and Ketorolac (A-OK). The authors acknowledge that this case does not meet the new criteria proposed, by Clark in 2016, but feel that it is important to share this case report, due to dramatic patient response to the provided supportive therapy presented in this case report. We hope this case report will prompt further research into this novel approach to treating AFE with Atropine, Ondansetron, and Ketorolac.

Introduction. Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a relatively uncommon but traumatic condition occurring in the later stage of pregnancy as a complication of severe preeclampsia or eclampsia. Prompt brain computed tomography (CT) or magnetic resonance imaging (MRI) and a multidisciplinary management approach are required to improve perinatal outcome. Case. A 37-year-old, Gravida 6, Para 1-0-4-1, Hispanic female with a history of chronic hypertension presented at 26 weeks and 6 days of gestational age. She was noted to have hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome accompanied by fetal growth restriction (FGR), during ultrasound evaluation, warranting premature delivery. The infant was delivered in stable condition suffering no permanent neurological deficit. Conclusion. HELLP syndrome is an uncommon and traumatic obstetric event which can lead to neurological deficits if not managed in a responsive and rapid manner. The central aggravating factor seems to be hypertension induced preeclamptic or eclamptic episode and complications thereof. The syndrome itself is manifested by hemolytic anemia, increased liver enzymes, and decreasing platelet counts with a majority of neurological defects resulting from hemorrhagic stroke or subarachnoid hemorrhage (SAH). To minimize adverse perinatal outcomes, obstetric management of this medical complication must include rapid clinical assessment, diagnostic examination, and neurosurgery consultation.