Background/Objectives: Minimally invasive spine surgery (MISS) is complex and requires proficiency with a variety of technological and robotic modalities. Acquiring these skills is a long and involved process, often with a steep learning curve. This paper seeks to characterize the state of MISS training in neurosurgical and orthopedic residency programs, focusing on their effectiveness at minimizing substantial learning curves in the field, as well as highlighting potential areas for future growth. Methods: We conducted a scoping review of the PubMed, Scopus, and Embase databases utilizing the PRISMA extension for scoping reviews. Results: Of the 100 studies initially identified, 16 were included in our final analysis. MISS training types could be broadly grouped into four categories: virtual simulation (including AR and VR), physical models, hybrid didactic and simulation, and mentored training. Training with these modalities led to improvements in resident performance across multiple different MISS techniques, including percutaneous pedicle screw fixation, MIS dural repair, MIS-TLIF, MIS-LLIF, MIS-ULBD, microscopic discectomy/disk herniation repair, percutaneous needle placement, and surgical navigation. Specific improvements included reduced error rate, operation time, and fluoroscopy exposure, as well as increased procedural knowledge, accuracy, and confidence. Conclusions: The incorporation of MISS training modalities in spine surgery residency leads to increases in simulated performance and could serve as a means of overcoming significant learning curves in the field.

» Cervical disc arthroplasty (CDA) offers a potential alternative for patients with degenerative disc disease, improving long-term outcomes such as preserved range of motion, decreased incidence of adjacent segment degeneration, and lower morbidity. » CDA offers potential advantages over anterior cervical discectomy and fusion in regard to length of stay, cost, and routine discharge, but the motion-preserving design may introduce novel complications and failure modalities that are poorly understood. » Complications of CDA may include heterotopic ossification, decreased range of motion, persistent or worsening pain, unintended fusion, and permanent neurologic deficit. » Preventing CDA failures begins with careful recognition of contraindications such as cervical instability, osteoporosis or osteopenia, previous surgery at the surgical level(s), and extensive facet joint arthropathy. » Complication profiles associated with CDAs vary in accord with device characteristics, highlighting a potential need for matching prosthesis design with patient-specific factors.

Objective: To describe the surgical technique and early clinical outcomes of prone-transpsoas single-position corpectomy (PTP-corpectomy) for the management of complex thoracolumbar spinal pathology. Background: PTP-corpectomy is an emerging technique for providing simultaneous lateral and posterior spinal access without patient repositioning. The previous literature describes the PTP approach for interbody fusions; however, evaluation of its use for corpectomy is limited. This case series reports our experience with the PTP-corpectomy procedure at our institution. Methods: We retrospectively reviewed seven patients who underwent PTP-corpectomy surgery for complex spinal pathologies, including severe kyphoscoliosis, traumatic burst fractures, and revision in 2022–2025. Collected variables included demographics, comorbidities, surgical history, perioperative details, radiographic imaging, and clinical outcomes. Results: All seven patients successfully underwent PTP-corpectomy. The average operative time was 460.6 ± 147.1 min, and the estimated blood loss (EBL) was 892.9 ± 898.3 mL. Average length of stay (LOS) postoperatively was 6.7 ± 3.0 days. One case required revision of a preexisting construct and complex wound closure with plastic surgery, which had significantly increased operative time and blood loss (767 min, 2700 mL). Excluding this complicated case, the average time was 409 ± 63.7 min, and EBL was 591.7 ± 454.3 mL. All seven patients maintained clinical stability postoperatively, demonstrating improvements in pain and functional status at latest follow-up. Follow-up time ranged from 41 to 375 days. Conclusions: Our experience adds to the limited body of evidence that the PTP approach is well suited for corpectomy procedures, and that it is feasible, safe, and effective at improving clinical outcomes for complex spinal pathologies. This series adds to the limited case volume describing this technique in the current literature. Future studies with larger patient populations are warranted to further validate these findings.

Method for quantifying striatal innervation by measuring mean fluorescence intensity using ImageJ. This protocol outlines the image preprocessing steps required prior to analysis with ImageJ tools as well as the ImageJ pipeline to quantify striatal innervation. Here DAT and TH immunofluorescence coronal sections but this method can be adapted for other markers and XYZ planes.

Background/Objectives: Minimally invasive spine surgery (MISS) is complex and requires proficiency with a variety of technological and robotic modalities. Acquiring these skills is a long and involved process, often with a steep learning curve. This paper seeks to characterize the state of MISS training in neurosurgical and orthopedic residency programs, focusing on their effectiveness at minimizing substantial learning curves in the field, as well as highlighting potential areas for future growth. Methods: We conducted a scoping review of the PubMed, Scopus, and Embase databases utilizing the PRISMA extension for scoping reviews. Results: Of the 100 studies initially identified, 16 were included in our final analysis. MISS training types could be broadly grouped into four categories: virtual simulation, physical models, hybrid didactic and simulation, and mentored training. Training with these modalities led to improvements in resident performance across multiple different MISS techniques, including percutaneous pedicle screw fixation, MIS dural repair, MIS-TLIF, MIS-LLIF, MIS-ULBD, microscopic discec-tomy/disc herniation repair, percutaneous needle placement, and surgical navigation. Specific improvements included reduced error rate, operation time, and fluoroscopy exposure, as well as increased procedural knowledge, accuracy, and confidence. Conclusions: The incorporation of MISS training modalities in spine surgery residency leads to increases in simulated performance and could serve as a means of overcoming significant learning curves in the field.

Background/Objectives: Intraoperative neuromonitoring (IOM) is commonly used in instrumented spine surgery; however, its utility is often debated. We sought to determine if IOM changes were independently associated with specific postoperative outcomes in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Methods: We performed a retrospective analysis of patients who underwent MIS-TLIF with IOM at a single institution. Collected data included demographics, comorbidities, surgical history, operative indications, operative spinal levels, IOM findings, and postoperative outcomes. Single and multivariate logarithmic regression analyses were performed to assess the correlation of each preoperative variable with IOM alerts, as well as the association between IOM alerts and postoperative outcomes. Results: A total of 439 patients were identified, 21 of whom experienced an IOM alert. No preoperative variables were significantly associated with IOM alerts. However, the presence of an IOM alert significantly increased the log odds of postoperative foot drop (1.93–6.55, p < 0.001), for which there was also a high specificity (95.9%) and negative predictive value (99.8%). However, likely due to low event rates, IOM had a low negative predictive value (16.7%). Further multivariate analysis also identified an IOM alert as a significant predictor of postoperative neurological deficits and chronic complications, although these pooled categories included foot drop. When IOM subtypes were investigated, both the SSEP and MEP significantly increased the log odds of postoperative foot drop (p < 0.001). Conclusions: An IOM alert during MIS-TLIF may be associated with chronic complications and postoperative neurological deficits, particularly foot drop. These findings highlight IOM’s potential use as an effective intraoperative screening tool to rule out iatrogenic foot drop but also its limited value to independently predict rare postoperative complications.