Tomasz Klepinowski

Purpose This meta-analysis aimed to compare the clinical effectiveness and safety of interlaminar endoscopic lumbar discectomy (IELD) and transforaminal endoscopic lumbar discectomy (TELD) for symptomatic lumbar disc herniation, and to identify factors that guide the selection of the optimal surgical approach. Methods A comprehensive systematic review was performed by searching PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials and cohort studies published from 2013 to 2024. The inclusion criteria encompassed studies comparing interlaminar endoscopic lumbar discectomy and transforaminal endoscopic lumbar discectomy in adult patients aged 18 years and older. Primary clinical outcomes evaluated included operative duration, radiation exposure, postoperative pain measured by the visual analog scale (VAS) for back and leg pain, functional disability assessed via the Oswestry Disability Index (ODI), complication rates, reoperation rates, and length of hospital stay. Data synthesis was conducted using a random-effects model, with subgroup analyses stratified by operative spinal level and study design. Results A total of 17 studies involving 2,066 patients (TELD = 1,040; IELD = 1,026) met the inclusion criteria. TELD was associated with faster recovery and earlier mobilization, particularly in randomized studies. IELD was linked to shorter operative times and significantly lower radiation exposure, whereas TELD tended to result in reduced postoperative back pain, likely due to better preservation of anatomical structures. No significant differences were observed in complication or recurrence rates between the two approaches. However, substantial heterogeneity across studies limited the generalizability of these findings. Conclusions Both TELD and IELD are effective and safe surgical options for the treatment of lumbar disc herniation, each offering distinct advantages in operative parameters and clinical outcomes. Current evidence does not conclusively favor one approach over the other. A major limitation in drawing definitive comparisons is the scarcity of large-scale, high-quality randomized controlled trials involving homogeneous patient populations.

The persistent falcine sinus (PFS) is a rare anatomical variant connecting straight sinus, or its tributaries, to the superior sagittal sinus and may be critically important during posterior interhemispheric transfalcine approach. We aimed to systematically evaluate the current literature, identify the gaps, and quantitatively assess the global pooled prevalence of PFS. PubMed/Medline and EMBASE databases have been searched by two authors. A quality check and risk of bias were assessed both qualitatively with Anatomical Quality Assessment (AQUA) tool, and quantitatively evaluating Luis Furuya-Kanamori (LFK) index of Doi plot asymmetry. A PRISMA-compliant systematic review and random-effects meta-analysis was conducted. Of 127 de-duplicated records, a total of five articles met the eligibility criteria including 5,457 participants with a combined sample-size weighted mean age of 22.8 years. Four studies utilized magnetic resonance imaging for PFS detection whereas one used computed tomography angiogram. The global pooled prevalence of PFS was estimated at 2.5% (95% CI 0.7–5.4%, I2 = 94.6, Cochran’s Q = 73.4, p < 0.05). Meta-regression was conducted to explore the sources of heterogeneity. Moreover, four studies reported a rate of associated congenital anomalies, which was calculated to be 22.9% (95% CI 0-76.1%, I2 = 95.9, Cochran’s Q = 73.5, p < 0.05), higher in older and lower in the most recent series. 3.1 mm sinus caliber may be the cutoff point distinguishing between truly persistent (smaller) versus de novo recanalized (larger) falcine sinus with the area under curve of 0.929. PFS is a variant of intracranial venous channel with the pooled prevalence of 2.5% that may coexist with congenital anomalies. The low-to-moderate certainty of evidence and substantial heterogeneity warrant cautious interpretation of the calculated epidemiological pooled estimates.

Purpose Os Odontoideum (OO) is an anatomical anomaly of the craniocervical junction, which may lead to severe instability, resulting in potentially fatal spinal cord compression. Considering clinical improtance of OO, the aim of this study was to provide a thorough synthesis of data on its epidemiology, specifically regarding its prevalence with neurosurgical considerations. Methods The major electronic databases (Pubmed/Medline, Embase, Scopus, ScienceDirect) were thoroughly searched up to July 18th, 2025. Studies reporting original data on the prevalence of OO were deemed eligible for inclusion. The extracted data subsequently underwent qualitative assessment. A random effects model based on the DerSimonian-Laird approach was employed. The AQUA tool was used to evaluate the quality and risk of bias of the included studies. Results Of the initial 1,638 records, 19 studies (n = 18,521 patients) met the inclusion criteria. Most of the studies revealed “low” risk of bias. The lowest prevalence of OO was found in the general population (0.21%, 95%CI: 0.00-0.72, I² = 50%). OO was more commonly found in subjects with craniofacial malformations (1.9%, 95%CI: 0.90–3.24, I² = 0%) and among patients undergoing craniocervical junction fixation (10.84%, 95%CI: 5.19–18.11, I² = 83%; random-effects meta-regression with Knapp-Hartung adjustment, p = 0.0006). The highest prevalence of OO was observed in a subgroup of patients with both 21 trisomy and craniocervical junction symptoms (30.86%, 95%CI: 14.82–49.49, I² = 42%). Conclusions OO is rare among the general population. However, its prevalence is significantly higher in individuals with craniofacial malformations or 21 trisomy. Knowledge of the epidemiology of OO may facilitate earlier and more accurate diagnosis, particularly in high-risk patient populations. However, substantial heterogeneity warrants cautious interpretation. In pursuance of establishing the odds ratio, a greater number of case-control studies should be conducted.

Introduction: Syringomyelia is a rare disease of the spinal cord, and postoperative syringomyelia is an extremely rare complication. There are very few scientific reports on this subject in the literature, which is why we decided to review them and report our case of a patient after resection of a meningioma of the foramen magnum; we diagnosed syringomyelia in the course of postoperative complications. Methods: PubMed MEDLINE, Scopus, and Web of Science were searched. The PRISMA checklist was followed for a systematic structure. We paid special attention to publications describing syringomyelia only as a complication of invasive procedures and not as a pathology co-occurring with other diseases. In addition, our studies were based exclusively on the adult population. Results: As a result of the literature analysis, we selected 5 papers that met the established criteria, which are case studies describing the 5 patients. In each of them, syringomyelia was diagnosed after a procedure on the central nervous system (or spine). In three papers, it was decided to treat the syringomyelia that developed in this way surgically, and in the remaining two, conservative treatment and adjustment of the already inserted ventriculoperitoneal shunt were performed. The case of a patient described by us after resection of a meningioma of the foramen magnum required surgical treatment of syringomyelia after two years due to significant progression of the syrinx and the occurrence of troublesome clinical symptoms. In all cases described (including ours), significant clinical improvement was ultimately achieved, allowing patients to return to their daily activities. Conclusions: Iatrogenic syringomyelia is an extremely rare complication that is poorly described in the literature. The large heterogeneity and small number of reported cases make it difficult to draw clear conclusions. Further studies and analyses describing this topic are necessary, and will allow for a better understanding of the mechanism and standardized treatment. However, based on our work, we suggest that interventions on the ventricular system in particular may increase the probability of postoperative syringomyelia.

Introduction. Approximately 21% of patients who undergo cervical laminoplasty for cervical spondylotic myelopathy (CSM) develop postoperative kyphotic deformity (KD). Radiologic parameters (RPs) on preoperative sagittal X-ray have consistently shown to be the strongest predictors for KD but their acquisition requires manual labor from specialists. Thus, the authors developed a novel artificial intelligence (AI) model to autonomously retrieve the predictors. Material and methods. A total of 259 patients’ sagittal X-rays were retrospectively obtained from the internal center between 2016 and 2024 for training. Patients with spinal deformities, prior surgical interventions, or tumors/malignancies within the cervical region were excluded. Data augmentation techniques were used to amplify the dataset, and a custom attention U-net architecture was used. Prospective enrollment of patients diagnosed with CSM over nine months at the internal and external center was performed for validation. Results. A total of 28 (77.8%) patients with CSM were prospectively obtained. The mean age was 66.0 ± 10.5 years, and 20 (71.4%) were females. The mean duration for human extraction of all RPs among the 2 neurosurgeons was 116.2 ± 17.5 seconds, whereas AI performed the task in 0.7 ± 0.0 seconds (p < 0.001). No significant difference was observed between the AI-obtained RPs and the physicians’ report RP values, except for the center of gravity of the head to the C7 sagittal vertical axis, which reported a significant mean difference (p = 0.049); however, the extent of the difference was minimal (2.3 ± 4.0 mm). Conclusions. This study automated the extraction of RPs for postoperative KD following laminoplasty. The trained model is publicly available for software developers to implement on a standalone platform or as a plugin on a medical imaging viewer. The model thus incentivizes the development of a risk scoring system for KD that utilizes the AI-acquired RPs to improve the evidence-based practice when selecting the surgical approach. Keywords: AI cervical kyphotic deformity deep learning laminoplasty predictors

Background: The molecular mechanisms underlying aneurysmal subarachnoid hemorrhage (aSAH) and delayed ischemic neurologic deficit (DIND) remain poorly understood. We hereby present the study investigating epigenome-wide profile of DNA methylation in adults with aSAH and DIND. Methods: A prospective observational epigenome-wide association study (EWAS) was conducted with DNA extracted from the peripheral whole blood of subjects with aSAH. DNA methylation profiling was conducted using Infinium MethylationEPIC v2.0 BeadChip microarray with a total number of 814 206 probes. Healthy matched controls were obtained from the publicly available dataset (GSE246337, n = 500) with 1:1 matching. DIND was determined by a combination of clinical symptoms and radiographic vasospasm. Differentially methylated probes (DMPs) were identified using linear regression model with Benjamini-Hochberg correction. This study was registered with ClinicalTrials.gov (NCT06881329). Results: 122 participants were included: 61 prospectively recruited with aSAH and 61 external age-, sex-, race-, and ethnicity-matched controls. Among aSAH patients, 32 developed DIND (52%). Overall, with linear regression, we identified 2642 DMPs associated with aSAH after multiple testing correction, and the lack of significant DIND-associated methylation changes. Specifically, as the top hit, we detected significant hypomethylation of cg15004555 (Δβ = −0.254) in aSAH patients, annotated to exon 2 of AIM2 , a gene whose expression is critical for AIM2-driven inflammasome activation. The functional enrichment analysis revealed that genes associated with the identified methylation changes were enriched in ontology terms related to specific biological processes such as immune response, pain modulation, phosphorus metabolism, as well as cellular components including cis-Golgi network or beta-catenin complex. Conclusions: Our prospective observational EWAS identified significant DNA methylation changes in the blood cells and demonstrated a functional link to specific biological processes in aSAH. Further validation studies are necessary to confirm our findings.

C2 pars interarticularis length (C2PIL) required for pars screws has not been thoroughly studied in subjects with high-riding vertebral artery (HRVA). We aimed to measure C2PIL specifically on the sides with HRVA, define short pars, optimal pars screw length, and incorporate C2PIL into HRVA clusters using machine learning algorithms. A clinical anatomical study based on cervical CT was conducted with STROBE-compliant case–control design. HRVA was defined as accepted. Interobserver, intraobserver, and inter-software agreement coefficients for HRVA were adopted from our previous study. Sample size was estimated with pwr package and C2PIL was measured. Cut-off value and predictive statistics of C2PIL for HRVA were computed with cutpointr package. Unsupervised machine learning clustering was applied with all three pars parameters. 345 potential screw insertion sites (PSIS) were grouped as HRVA (143 PSIS in 110 subjects) or controls (202 PSIS in 101 subjects). 68% participants were females. The median C2PIL in HRVA group was 13.7 mm with interquartile range (IQR) of 1.7, whereas in controls it was 19.8 mm (IQR = 2.7). The optimal cut-off value of C2PIL discriminating HRVA was 16.06 mm with sensitivity of 96.5% and specificity of 99.3%. Therefore, clinically important short pars was defined as ≤ 16 mm rounding to the nearest screw length. Two clusters were created incorportating three parameters of pars interarticularis. In preoperative planning, the identified C2PIL cut-off of ≤ 16 mm may assist surgeons in early recognition of HRVA. The average screw lengths of 14 mm for bicortical and 12 mm for safer unicortical purchase in HRVA cases may serve as practical intraoperative reference points, particularly in situations requiring rapid decision-making or when navigation systems are unavailable. Moreover, C2PIL complements the classic HRVA parameters within the dichotomized clustering framework.

The management of spinal infections, such as spondylodiscitis, remains a complex challenge. With advancements in technology, spinal endoscopy has emerged as a promising minimally invasive approach. This systematic review and case series aims to evaluate the efficacy of endoscopic techniques in treating primary and post-operative spinal infections. A comprehensive literature review was conducted using databases such as PubMed, MEDLINE, and Cochrane Library, focusing on studies from 2000 to 2023. Our case series included patients treated with endoscopy for spinal infections in our institution between 2020 and 2023. The findings suggest that endoscopic techniques are associated with reduced tissue trauma, shorter hospital stays, and faster recovery, while maintaining comparable clinical outcomes to traditional open surgery. Despite the relatively high pathogen identification rates and favorable clinical outcomes, complications such as residual infection and the need for re-operations were noted. These results emphasize the need for further research to optimize endoscopic procedures in spinal infection management, potentially paving the way for this technique to become a standard treatment option.