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INTRODUCTION: Spondylodiscitis (SD) is an infection of the intervertebral disc with involvement of the adjacent vertebral bodies. Diagnostic tests with CT-guided biopsy only provide a positive yield in 14%-48% of cases. Percutaneous endoscopic debridement and drainage (PEDD) has recently shown promise in the treatment of spondylodiscitis. RESEARCH QUESTION: The purpose of this study is to determine differences in pathogen identification and clinical outcomes for PEDD versus CT-guided needle biopsy in SD patients. MATERIALS AND METHODS: We conducted a systematic review of the literature using PRISMA guidelines to determine differences in positive microbiology results, perioperative complications, pain control, and long-term clinical outcomes for PEDD vs. CT-guided needle biopsy in SD patients. RESULTS: 1078 studies were evaluated, 87 of which underwent full review. 15 studies met the inclusion and exclusion criteria, including 7 PEDD, 7 CT-guided biopsy, and 1 CT-guided biopsy vs. PEDD article, for a total of 192 PEDD patients and 604 CT-guided biopsy patients. We found 36.59% of CT-guided biopsy patients had positive microbiology results, compared to 84.38% of PEDD patients. No major perioperative complications occurred as a result of the PEDD procedure. Of the five PEDD studies that reported pain outcomes, greater than 80% of patients experienced relief after intervention. DISCUSSION AND CONCLUSION: These results suggest that PEDD may improve pathogen identification while simultaneously reducing pain compared to CT-guided needle biopsy in SD. Although current treatment guidelines recommend CT-guided biopsy, in patients with severe back pain and suspected SD, PEDD can be considered an alternative intervention.

BackgroundSurgical treatment of scoliosis includes long and invasive multi-level instrumentation and correction which may result in high rates of postoperative complications, especially in elderly patients with osteopenia or multiple comorbidities. Minimally invasive surgical options may benefit these patients.Case descriptionA 73-year-old female patient with a history of degenerative lumbar scoliosis, L4-5 pseudarthrosis, and resulting L5-S1 adjacent segment following prior unsuccessful lateral L4-5 interbody fusion presented to the clinic with severe lower back pain and lower extremity radiculopathy. The decision was made to proceed with surgical correction via a robotic-guided prone transpsoas (PTP) approach, which is a novel approach similar to lateral lumbar interbody fusion (LLIF) with the patient in a prone decubitus position. Excellent spinal alignment was achieved with no complications. On two-month follow-up, imaging revealed pedicle screws at the L3, L4, L5 levels and at the sacrum without change and continued interbody cages position with no signs or symptoms of infection.DiscussionMinimally invasive procedures have demonstrated benefit in spine surgery especially for at risk populations. The LLIF procedure has been well established for use in a wide range of spinal pathologies given its noted benefits in increasing spinal column stability through posterior fixation and indirect decompression. However, only marginal improvements in segmental lordosis are expected and there are reports of neurological complications. The PTP procedure has emerged as an alternative to LLIF for the treatment of spinopelvic pathologies. This approach enables greater improvements to spinal lordosis through single-position surgery while simultaneously reducing intraoperative repositioning and providing the known benefits of lateral interbody surgery.ConclusionOur experience suggests that the PTP approach is safe and effective because it does not require patient repositioning, easily interfaces with robotic guidance, and achieves increased lordosis gains via the prone positional effect compared to LLIF and comparable approaches.

BackgroundEpendymomas are rare tumors originating from neuroepithelial cells lining the wall of the ventricles or central canal of the spinal cord. While these tumors mainly occur within the central nervous system (CNS), there are occasional reports in children and young adult patients with a primary tumor occurrence outside of the CNS. Ependymomas of the sacrococcygeal region have been infrequently described in the literature with no standard of care established. We present a case report and review of the literature regarding this rare entity.Case descriptionA 24-year-old woman presented with right gluteal pain worsened by sitting and a palpable soft tissue mass of the sacrococcygeal region. Magnetic resonance imaging revealed a 3.7 cm cystic mass centered in the right gluteal region. She underwent a biopsy at an outside institution, with histology revealing myxopapillary ependymoma. The patient was referred to our hospital and underwent an interdisciplinary neurosurgical and orthopedic oncology en bloc resection of the ependymoma, which intraoperatively appeared to originate from the coccygeal nerve.ConclusionIn the present report, the authors demonstrate that a myxopapillary ependymoma may present as an isolated gluteal mass attached to the coccygeal nerve, without frank CNS involvement. Furthermore, an interdisciplinary approach to surgical resection of this lesion appears to represent an effective treatment modality.

Reducing chemical fertilizers is critical for maintaining soil health and minimizing environmental damage. Biochar-based organic fertilizers reduce fertilizer inputs, improve soil fertility, increase crop productivity, and reduce environmental risks. In this study, a pot experiment was conducted in a greenhouse to assess the potential of biochar-based organic and inorganic fertilizers to improve soil fertility and Okra yield. Seven treatments with three replicates were arranged in a completely randomized design (CRD). Three treatments included biochar-blended formulations (i) biochar mixed with mineral NPK fertilizer (BF), (ii) biochar mixed with vermicompost (BV), and (iii) biochar mixed with goat manure (BM); two treatments included biochar enrichment formulations (iv) biochar enriched with cow urine (BCU) and (v) biochar enriched with mineral NPK fertilizer in aqueous solution (BFW), and the remaining two included control treatments; (vi) control (CK: no biochar and no fertilizers) and (vii) fertilized control (F: only recommended NPK fertilizer and no biochar). Mineral NPK fertilizers in BF, BFW, and F were applied at the recommended rate as urea, di-ammonium phosphate (DAP), and muriate of potash (MOP). Organic fertilizers in BV, BM, and BCU treatments were applied in equal quantities. All biochar-amended treatments showed improved soil chemical properties with higher pH, organic carbon, total N, and available P and K compared to the two non-biochar control plots (CK and F). Biochar blended with goat manure (BM) showed the highest effect on soil fertility and fruit yield. BM (51.8 t ha−1) increased fruit yield by 89% over CK (27.4 t ha−1) and by 88% over F (27 t ha−1). Similarly, cow urine-enriched biochar (BCU) (35 t ha−1) increased fruit yield by 29% and 28% compared to CK and F, respectively. Soil pH, OC, and nutrient availability (total N, available P, and available K) showed a significantly positive relationship with fruit yield. The study suggests that using biochar-based organic fertilizers, such as BCU and BM, could outperform recommended mineral fertilizers (F) and produce higher yields and healthy soils, thereby contributing to mitigating the current food security and environmental concerns of the country. [ABSTRACT FROM AUTHOR]

The role of quasar feedback in galaxy evolution remains poorly understood. Throughout this work, we explore the effects of negative feedback on star formation in quasar host galaxies, analysing two distinct populations of quasars. The first is a sample of high-redshift (z > 2) low-ionisation broad absorption line quasars (LoBALs) - a class of quasars hosting energetic mass outflows, in which we find evidence for prolific star formation (>750Mʘyr–1) exceeding that of non-BAL quasars at the same redshift. The second is a population of 207 low-redshift (z < 0.3) quasars, in which we find an enhancement in the SFRs of quasar hosts compared to the underlying galaxy population, with no quasars residing in quiescent hosts over the last 2Gyr. Overall, we find no evidence for galaxy-wide quenching in either population, rather we suggest that the dominant effect of quasar activity is to enhance star formation in the galaxy. [ABSTRACT FROM AUTHOR]

Case: A 59-year-old woman presented with progressively worsening neck pain and radicular symptoms. Cervical radiographs revealed C1-C2 dynamic instability. Magnetic resonance imaging and computed tomographic angiogram revealed an anomalous right vertebral artery with intracanal trajectory at C1. A unilateral left C1-C2 fusion with a C1 lateral mass screw and C2 transarticular screw placement was performed due to the anomalous artery. At 14-month follow-up, the patient's cervical symptoms had resolved., Conclusion: In this patient with an aberrant vertebral artery who was indicated for C1-C2 fusion, a unilateral contralateral fusion with a C1 lateral mass screw and C2 transarticular screw was a satisfactory treatment option., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C412)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Introduction: Spondylodiscitis (SD) is an infection of the intervertebral disc with involvement of the adjacent vertebral bodies. Diagnostic tests with CT-guided biopsy only provide a positive yield in 14%-48% of cases. Percutaneous endoscopic debridement and drainage (PEDD) has recently shown promise in the treatment of spondylodiscitis., Research Question: The purpose of this study is to determine differences in pathogen identification and clinical outcomes for PEDD versus CT-guided needle biopsy in SD patients., Materials and Methods: We conducted a systematic review of the literature using PRISMA guidelines to determine differences in positive microbiology results, perioperative complications, pain control, and long-term clinical outcomes for PEDD vs. CT-guided needle biopsy in SD patients., Results: 1078 studies were evaluated, 87 of which underwent full review. 15 studies met the inclusion and exclusion criteria, including 7 PEDD, 7 CT-guided biopsy, and 1 CT-guided biopsy vs. PEDD article, for a total of 192 PEDD patients and 604 CT-guided biopsy patients. We found 36.59% of CT-guided biopsy patients had positive microbiology results, compared to 84.38% of PEDD patients. No major perioperative complications occurred as a result of the PEDD procedure. Of the five PEDD studies that reported pain outcomes, greater than 80% of patients experienced relief after intervention., Discussion and Conclusion: These results suggest that PEDD may improve pathogen identification while simultaneously reducing pain compared to CT-guided needle biopsy in SD. Although current treatment guidelines recommend CT-guided biopsy, in patients with severe back pain and suspected SD, PEDD can be considered an alternative intervention., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)