Minimally invasive robotic cervicothoracic fusion: a case report and review of literature

Minimally invasive surgery (MIS) of the posterior cervical spine with robotic assistance has recently emerged to treat degenerative disc disease. Robotic arms and 3D neuronavigation with preoperatively planned placement are used to achieve real-time intraoperative guidance, reducing screw malposition through increased accuracy and stability. This results in decreased blood loss, postoperative pain, and quicker recovery time compared to other techniques. We aim to demonstrate a novel technical approach to posterior cervical spine fusion using robotic assistance and discuss its advantages. In a patient with right hand weakness and a right paracentral disc herniation of the cervicothoracic spine, we performed a MIS percutaneous and robotically assisted posterior spinal fusion at C7-T2, with complete C7-T1 and T1-2 right-sided facetectomies and also a T1-T2 discectomy. Preoperative software planning and a robotic platform attachment configuration was used. There was immediate postoperative improvement in upper extremity strength and the patient was discharged without complications. Postoperative imaging confirmed accurate hardware placement, and follow-up at both 3- and 4-month confirmed improved upper extremity strength with sensation intact throughout. MIS robotic posterior cervicothoracic fusion can effectively be used to improve patient outcomes. Further implementation of robotic assistance during cervical fusion in larger studies is needed to further evaluate its effectiveness

A systematic review of the management of postoperative scars with silicone gel-based products in randomized controlled trials

Although postoperative scarring may be considered a cosmetic concern, it can greatly impact a patient's quality of life. This extends beyond psychosocial burden influenced by hypertrophic scars and keloids, as patients also experience discomfort and pain. This systematic review evaluates the efficacy of silicone gel (SG)-based products in preventing postoperative abnormal scar formation. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a PubMed search was performed to find randomized, controlled trials investigating the effect of SG-based products on postoperative wound healing. The search yielded 359 publications, but only 30 studies published between 1991-2022 were found to fit the inclusion criteria. Outcomes were extracted from the literature and subsequent quality and risk of bias assessments were performed. Most studies indicated improvement of at least one quality of the scar with the use of SG-based products. The greatest potential variable increasing bias was an inadequate control group. Studies also suffered from small sample sizes, use of unvalidated scar assessment scales, lack of double-blinding, and short follow-up periods. Overall, SG-based products demonstrated potential in preventing abnormal scar formation during postoperative healing, but further studies are required to validate the results of current literature

Engorged venous plexus mimicking adjacent segment disease: Case report and review of the literature.

BackgroundAn engorged venous plexus may mimic nerve compression from a herniated disk on the magnetic resonance (MR) studies as they both have similar signal intensities. During a laminectomy, if an engorged venous plexus is encountered instead of a disk herniation, there may be marked unanticipated bleeding.Case descriptionA 58-year-old female who had a prior anterior lumbar interbody fusion later returned with recurrent radiculopathy. Adjacent segment disease from a spinal disk herniation was suspected based on the surgical history, physical examination, and imaging (MRI) findings. Rather than a disk, an engorged venous plexuses (EVP) was encountered intraoperatively.ConclusionHere, we discussed our findings regarding a lumbar EVP rather than a herniated disk and reviewed the current literature. Although rare, a higher index of suspicion for these vascular malformations based on combined historical information and MRI studies should allow one to better detect and/or anticipate an EVP rather than a routine disk

Maternal immune activation impairs cognitive flexibility and alters transcription in frontal cortex.

BACKGROUND:Epidemiological studies suggest that the risk of neurodevelopmental disorders such as autism spectrum disorder (ASD) and schizophrenia is increased by prenatal exposure to viral or bacterial infection during pregnancy. It is still unclear how activation of the maternal immune response interacts with underlying genetic factors to influence observed ASD phenotypes. METHODS:The current study investigated how maternal immune activation (MIA) in mice impacts gene expression in the frontal cortex in adulthood, and how these molecular changes relate to deficits in cognitive flexibility and social behavior, and increases in repetitive behavior that are prevalent in ASD. Poly(I:C) (20 mg/kg) was administered to dams on E12.5 and offspring were tested for social approach behavior, repetitive grooming, and probabilistic reversal learning in adulthood (n = 8 vehicle; n = 9 Poly(I:C)). We employed next-generation high-throughput mRNA sequencing (RNA-seq) to comprehensively investigate the transcriptome profile in frontal cortex of adult offspring of Poly(I:C)-exposed dams. RESULTS:Exposure to poly(I:C) during gestation impaired probabilistic reversal learning and decreased social approach in MIA offspring compared to controls. We found long-term effects of MIA on expression of 24 genes, including genes involved in glutamatergic neurotransmission, mTOR signaling and potassium ion channel activity. Correlations between gene expression and specific behavioral measures provided insight into genes that may be responsible for ASD-like behavioral alterations. CONCLUSIONS:These findings suggest that MIA can lead to impairments in cognitive flexibility in mice similar to those exhibited in ASD individuals, and that these impairments are associated with altered gene expression in frontal cortex