Background/aim: To investigate the histopathological effects of reabsorbable polyethylene glycol hydrogel (RPGH, Coseal) on epidural fibrosis (EF) following laminectomy in rats. Materials and methods: A total of 24 rats were equally divided into three groups. In the first group, no treatment was applied after laminectomy (control group, Group 1). In the second group, hemostasis was achieved after laminectomy, and 2 mm absorbable gelatin sponge soaked in saline was placed over the epidural space and the wound was closed (Group 2). In the third group, hemostasis was achieved following laminectomy, and 0.5 mL RPGH (Coseal, Group 3) was squeezed over the dura mater, and the wound was closed. A histopathological examination was undertaken to evaluate arachnoidal invasion and EF. Results: The results of EF in the Group 2 and Group 3 were significantly lower compared to the Group 1 (p = 0.023 and p = 0.002, respectively). No statistically significant difference was found between the Group 2 and Group 3 in terms of EF (p = 0.957). There was also no statistically significant difference between the mean arachnoidal invasion of the three groups (p > 0.171). However, the rate of arachnoidal invasion was the lowest in the Group 3. Conclusion: Intraoperative Coseal, a polyethylene glycol polymer, tends to reduce the risk of epidural fibrosis, although this is not statistically significant.

This study aimed to evaluate the radiological and clinical outcomes of combining kyphoplasty (KP) with posterior dynamic stabilization (PDS) in patients with vertebral compression fractures (VCFs) over a 1-year follow-up period. A retrospective analysis was conducted on 40 patients who underwent KP and PDS procedures between 2006 and 2023. The cohort consisted of 16 men and 24 women, with a mean age of 71.32 ± 12.14 years (range, 61-89). Fractures were categorized using both the Arbeitsgemeinschaft für Osteosynthesefragen (AO) thoracolumbar classification and the Osteoporotic Fracture (OF) classification systems. Radiographic measurements included vertebral kyphosis angle (VKA), local kyphosis angle (LKA), and percentage of vertebral collapse (PVC). Clinical outcomes were assessed using Visual Analog Scale (VAS) scores recorded preoperatively, at 3 months postoperatively, and at 1-year follow-up. These data points were then compared. Significant reductions in VKA and LKA were observed in the early postoperative period, at 3 months, and at 1 year compared to preoperative measurements (p < 0.05) However, changes in VKA between the early postoperative period and subsequent follow-ups at 3 months and 1 year were not statistically significant (p > 0.05). PVC and VAS scores also showed significant improvement at all postoperative time points compared to baseline (p < 0.05). The significant postoperative improvements in LKA, VKA, PVC, and VAS scores, along with the low incidence of fracture progression or new fractures, suggest that KP supplemented with PDS yields favorable radiological and clinical outcomes in patients with unstable osteoporotic VCFs.

Background and Objectives: The authors aimed to describe their experience performing frameless stereotactic biopsies using an Autoguide Robotic Platform and to compare the outcomes with a frame-based stereotactic technique. We would like to emphasize the importance of this study, as it is the first in the literature to use sodium fluorescein for confirmation in intracranial biopsies taken with a Stealth Autoguide Robotic Platform. Materials and Methods: We retrospectively evaluated 30 patients who underwent a stereotactic intracranial biopsy between June 2018 and March 2024. The patients were divided into two groups: The robotic biopsy group (n = 15) underwent a frameless image-guided stereotactic intracranial biopsy with a Stealth Autoguide Robotic Platform and optical neuronavigation system (Stealth-Station S8, Medtronic, Minneapolis, MN, USA) using intraoperative sodium fluorescein. The frame-based (Integra, CRW, New Jersey, USA) stereotactic biopsy group (n = 15) underwent a stereotactic biopsy with the use of a stereotactic planning system (Atlas Integra Software, NJ, USA and Brainlab AG, Munich, Germany) without sodium fluorescein. Preoperative MRI and CT scans were performed in all the patients. Their external cranial anatomy was registered using either facial tracing or O-Arm (Medtronic Sofamor Danek, Inc., Memphis, TN, USA). Results: The robotic biopsy group demonstrated a diagnostic yield of 93.3% (14/15), while the frame-based group achieved 100% (15/15), with no significant difference (p = 0.609). The mean calculated tip error in the robotic biopsy group was 0.42 ± 0.19 mm (range: 0.1–0.7 mm) and the postoperative targeting accuracy in the frame-based biopsy group was 0.51 ± 0.23 mm (range: 0.2–0.9 mm), with no significant difference (p = 0.287). The robotic biopsy group demonstrated a significantly shorter mean surgical time (40.26 ± 6.13 vs. 52.47 ± 8.92 min, p = 0.002). Conclusions: Both frame-based and robotic-assisted stereotactic biopsy techniques achieve comparable diagnostic accuracy and targeting precision. However, a robotic biopsy significantly reduces the surgical time compared to a frame-based technique. The use of intraoperative sodium fluorescein is a valuable adjunct method for confirming that biopsy specimens are obtained from the intended target site.