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Intraosseous basivertebral nerve ablation is indicated for the treatment of chronic vertebrogenic low back pain with failure of at least 6 months of conservative treatment. This article details patient positioning and setup, step-by-step instructions for the procedure, and postoperative management. Pearls and pitfalls are also discussed. In addition, an instructional procedure video accompanies this paper and can be found online (at https://vimeo.com/791578426/de0e90cfbe).

Evidence-based medicine drives medical decision-making in the modern era, which has historically favored randomized control trials. Despite their notoriety, randomized control trials have multiple disadvantages when applied to spinal surgery. Observational studies are popular in spinal surgery literature and are seen in various forms, such as retrospective studies and prospective cohort studies. For researchers, learners, and practicing spine surgeons, this paper describes options for study design when applied to spinal surgery.

Developing a well-written research paper is an important step in completing a scientific study. This paper is where the principle investigator and co-authors report the purpose, methods, findings, and conclusions of the study. A key element of writing a research paper is to clearly and objectively report the study’s findings in the Results section. The Results section is where the authors inform the readers about the findings from the statistical analysis of the data collected to operationalize the study hypothesis, optimally adding novel information to the collective knowledge on the subject matter. By utilizing clear, concise, and well-organized writing techniques and visual aids in the reporting of the data, the author is able to construct a case for the research question at hand even without interpreting the data.

Ankylosing spondylitis (AS) is a common form of axial spondyloarthritis, characterized by inflammatory back pain, radiographic sacroiliitis, excess spinal bone formation, and a high prevalence of HLA-B27. Commonly, AS patients require spinal surgery for kyphotic deformities, spinal trauma, and spinal infections. For preoperative management, proper interruption considering each specific half-lives of disease-modifying antirheumatic drugs are necessary to avoid complications, such as infections. When feasible, bone quality assessment before surgery is mandatory. For intraoperative measurements, airway management should be carefully evaluated, especially in patients with severe cervical deformities. Cardiac, renal, and pulmonary assessment should be made considering specific pathologic characteristics involved in AS patients, such as pulmonary restrictive disease and chronic anti-inflammatory drugs use. Multimodal neurophysiological intraoperative monitoring is recommended once these patients had a high risk for neurological deterioration. At the postoperative period, early oral intake, early mobilization, and aggressive pain control may decrease complications and enhance recovery. AS presents several unique challenges that require specific attention around spine surgery. This includes handling preoperative and postoperative pharmacotherapeutics, intraoperative airway management, and the mitigation of postoperative complications. In this paper, we provide a literature review of optimal strategies for the perioperative management for patients with AS.

Extrusion and sequestration of the nucleus pulposus involving the spinal canal or the foramina/recesses complicates up to 28% of the lumbar disc herniations. The transpars/translaminar anatomical approach is well described and its advantages when handling with a lateral, foraminal extruded disc herniation are appreciated and recognized. Nevertheless, this approach presents several pitfalls such as the risk of disconnecting the pars interarticularis, which may cause segmental instability. This particular eventuality is because of the particular anatomical conformation of the pars interarticularis. Although already part of the modern surgical armamentarium for general, orthopedic, cranial and spinal surgeons, the use of the ultrasonic scalpel technique for such approach has never been discussed to date, to the best of our knowledge. The purpose of the present paper is therefore to introduce and describe the stepwise technique along with an extensive discussion of the facilitating role of the ultrasonic scalpel in the translaminar/transpars approach in the management of extruded disc herniation of the lumbar spine.

The success of obtaining answers in any research project relies on how well the investigators are able to ask the right question. The PICO (Patient, Intervention, Comparator, Outcomes) approach provides a framework to develop this question utilizing four major elements: Population, Intervention, Comparison, Outcomes. This paper provides a framework for both the young and the experienced surgeon in the use of the PICO approach to construct a clear research question.

Supplemental Digital Content is available in the text.Lumbar radiofrequency ablation is indicated for the treatment of chronic axial low back pain that is mediated by facet arthropathy which has failed more conservative treatment options. This article details proper equipment and medications, patient positioning and setup, step-by-step instructions for multiplanar fluoroscopic visualization, cannula placement, and postoperative management. Pearls and pitfalls are also discussed. In addition, an instructional procedure video (Supplemental Digital Content 1, http://links.lww.com/CLINSPINE/A90) accompanies this paper.

In using observational, nonrandomized data, there is often interest in studying the effect of a particular treatment on a specific outcome. However, the imbalance of potential confounding variables between the treatment groups can distort the relationship between treatment and outcome. Propensity score matching is one, increasingly utilized, method to help account for such imbalances, allowing for a more accurate estimation of the influence of treatment on outcome. In this paper, we provide the clinician with an overview of propensity score matching techniques and provide a practical example of how this has been used in clinical research relevant to spine surgery.