Classification of Osteophytes Occurring in the Lumbar Intervertebral Foramen.

BACKGROUND: Surgeons have limited knowledge of the lumbar intervertebral foramina. This study aimed to classify osteophytes in the lumbar intervertebral foramen and to determine their pathoanatomical characteristics, discuss their potential biomechanical effects, and contribute to developing surgical methods. METHODS: We conducted a retrospective, non-randomized, single-center study involving 1224 patients. The gender, age, and anatomical location of the osteophytes in the lumbar intervertebral foramina of the patients were recorded. RESULTS: Two hundred and forty-nine (20.34%) patients had one or more osteophytes in their lumbar 4 and 5 foramina. Of the 4896 foramina, 337 (6.88%) contained different types of osteophytes. Moreover, four anatomical types of osteophytes were found: mixed osteophytes in 181 (3.69%) foramina, osteophytes from the lower endplate of the superior vertebrae in 91 (1.85%) foramina, osteophytes from the junction of the pedicle and lamina of the upper vertebrae in 39 foramina (0.79%), and osteophytes from the upper endplate of the lower vertebrae in 26 (0.53%) foramina. The L4 foramen contained a significantly higher number of osteophytes than the L5 foramen. Osteophyte development increased significantly with age, with no difference between males and females. CONCLUSIONS: The findings show that osteophytic extrusions, which alter the natural anatomical structure of the lumbar intervertebral foramina, are common and can narrow the foramen.

Improving the Visualization of Superior Longitudinal Fascicule-2 and Superior Longitudinal Fascicule -3 Using Photoshop Filters.

BACKGROUND AND OBJECTIVES: Several studies are currently exploring the anatomical origins of superior longitudinal fascicule (SLF) 2 and SLF-3, which are components of the frontoparietal network. This study aimed to achieve optimum visualization of the anatomical corridors of these fibers using Photoshop filters. METHODS: Four postmortem brain hemispheres were dissected in accordance with the method proposed by Klingler and Ludwig. Dissections were performed under a surgical microscope (Carl Zeiss AG, Oberkochen, Germany) at 4× and 40× magnification. All dissections were documented at each stage using a professional digital camera (Canon EOS 600D) with a macro 100 mm lens (Canon), ring-flash attachment (Canon), and professional tripod (Manfrotto 808 C4). We aimed to improve the visual quality of the images by avoiding monotone using various the features and filters in Photoshop. RESULTS: SLF-2 originates from the angular gyrus (Brodmann area [BA] 39) in the right hemisphere and has been observed to project fibers from BA7 and BA19 and toward BA8, 9, 10, and 46. Further, these fibers traverse from the depths of BA40, 2, 3, 1, and 6 as they progress. SLF-2 also projects fibers from the supramarginal gyrus in the left hemisphere. SLF-3 lies between the supramarginal gyrus and the inferior frontal lobe in both the right and left hemispheres. CONCLUSIONS: The visual descriptions of the dissections were enriched after using Photoshop to avoid monotony. Increasing the visual quality with Photoshop features enable us to gain a better understanding of these pathways. Additionally, it facilitates the comprehension of the symptoms associated with pathology. We hope these results will further aid in reducing the occurrence of postoperative complications.

Dentate Nucleus: Connectivity-Based Anatomic Parcellation Based on Superior Cerebellar Peduncle Projections.

OBJECTIVE: Projections from the dentate nucleus (DN) follow a certain organized course to upper levels. Crossing and noncrossing fibers of the dentatorubrothalamic (DRT) tract terminate in the red nucleus and thalamus and have various connections throughout the cerebral cortex. We aimed to establish the microsurgical anatomy of the DN in relation to its efferent connections to complement the increased recognition of its surgical importance and also to provide an insight into the network-associated symptoms related to lesions and microsurgery in and around the region. METHODS: The cerebellum, DN, and superior cerebellar peduncle (SCP) en route to red nucleus were examined through fiber dissections from the anterior, posterior, and lateral sides to define the connections of the DN and its relationships with adjacent neural structures. RESULTS: The DN was anatomically divided into 4 areas based on its relation to the SCP; the lateral major, lateral anterosuperior, posteromedial, and anteromedial compartments. Most of the fibers originating from the lateral compartments were involved in the decussation of the SCP. The ventral fibers originating from the lateral anterosuperior compartment were exclusively involved in the decussation. The fibers from the posteromedial compartment ascended ipsilaterally and decussated, whereas most anteromedial fibers ascended ipsilaterally and did not participate in the decussation. CONCLUSIONS: Clarifying the anatomofunctional organization of the DN in relation to the SCP could improve microneurosurgical results by reducing the complication rates during infratentorial surgery in and around the nucleus. The proposed compartmentalization would be a major step forward in this effort.

Surgical outcomes of decompressive laminectomy by transspinous approach for degenerative lumbar spinal stenosis.

OBJECTIVE: To assess clinical and radiographical outcomes of transspinous decompression technique for the treatment of degenerative central lumbar spinal stenosis. METHODS: The single-centre, non-randomised interventional, prospective, observational study was conducted Neurosurgery Clinic of Mazhar Osman Research and Training Hospital for Psychiatry and Neurology, Istanbul, Turkey from May 2013 and May 2016 and comprised adult patients with refractory symptoms from degenerative central lumbar spinal stenosis who underwent lumbar spinous processsplitting laminectomy. Pre- and post-operative Oswestry Disability Index score, visual analogue scale for overall pain, maximum walking distance and anteroposterior diameter of the spinal canal on magnetic resonance imaging were assessed on follow up examination. SPSS 22 was used for data analysis. RESULTS: Of the 89 patients, 7(7.86%) were lost to follow-up, while 82(92.14%) completed the study. Of them, 42(51%) were women and 40(49%) were men. Overall mean age was 63.86±10.02 years (range: 40-85 years). A total of 95 transspinous decompressive laminectomies were performed. Mean number of decompressed spinal segments was 1.16. Median duration of surgical procedure was 45 min, while mean length of hospital stay was 1.22±0.47 days. Mean decrease in pre operative Oswestry Disability Index scoreat 1-year was 56.4% and overall visual analogue scale was 55.9%.Mean increase of 155.2% was documented over pre-operative maximum walking distance. Radiological assessment revealed a 40.7% increase in the mean and anteroposteriordiameter of the spinal canal at the level of the target lesion. The improvement in various parameters was statistically significant (p<0.001).. CONCLUSIONS: Lumbar spinous process-splitting laminectomy led to significant improvement with respect to patient-reported perceived recovery, functional disability and radiological evidence of effective surgical decompression in patients with lumbar spinal stenosis..