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BACKGROUND: The first instance of a robotic-assisted surgery occurred in neurosurgery; however, it is now more common in other fields such as urology and gynecology. This study aims to characterize the prevalence of robotic surgery among current neurosurgery programs as well as identify trends in clinical trials pertaining to robotic neurosurgery. METHODS: Each institutions website was analyzed for the mention of a robotic neurosurgery program and procedures. The future potential of robotics in neurosurgery was assessed by searching for current clinical trials pertaining to neurosurgical robotic surgery. RESULTS: Of the top 100 programs, 30 offer robotic cranial and 40 offer robotic spinal surgery. No significant differences were observed with robotic surgical offerings between geographic regions in the US. Larger programs (faculty size 16 or over) had 20 of the 30 robotic cranial programs (66.6%), whereas 21 of the 40 robotic spinal programs (52.5%) were at larger programs. An initial search of clinical trials revealed 223 studies, of which only 13 pertained to robotic neurosurgery. Spinal fixation was the most common intervention (six studies), followed by Deep Brain Stimulation (DBS, two studies), Cochlear implants (two studies), laser ablation (LITT, one study), and endovascular embolization (one study). Most studies had industry sponsors (9/13 studies), while only five studies had hospital sponsors. CONCLUSION: Robotic neurosurgery is still in its infancy with less than half of the top programs offering robotic procedures. Future directions for robotics in neurosurgery appear to be focused on increased automation of stereotactic procedures such as DBS and LITT and robot-assisted spinal surgery.

BackgroundAnkylosing spondylitis (AS) is a chronic, progressive, inflammatory disease of the spine and SI joints. Diagnostic criteria and treatments have continued to evolve, necessitating a historical compendium of AS and its management. This paper aims to review the historical context underlying the discovery of AS, as well as the major diagnostic and therapeutic discoveries in the last two centuries.MethodsA scoping review of the literature pertaining to AS was performed via the Pubmed, Scopus, and Web of Science databases. Future directions of AS treatments were assessed by querying the clinicaltrials.gov website.ResultsThe history of AS can be traced as far back as ancient Egypt (as evidenced by the discovery of its presence in ancient Egyptian mummies) to the late 20th century, when the inherited nature of AS was linked to a genetic factor, HLA-B27. Each discovery made throughout the years led to further investigations into the pathophysiology, diagnosis, and treatment of AS. The criteria to differentiate AS from rheumatoid arthritis were first reported in 1893. Since then, diagnostic criteria for AS have undergone a series of changes before the present-day diagnostic criteria for AS were ultimately determined in 2009 by the Assessment of Spondyloarthritis International Society.ConclusionAs the pathophysiology of AS is better understood, healthcare providers are able to diagnose and treat the condition more effectively. In particular, earlier diagnosis and multiple treatment options have facilitated efficient and more effective treatment.

A syrinx involves cystic dilation of the central canal of the spinal cord due to the accumulation of cerebrospinal fluid and often results in a neurological deficit. While treatment options vary, surgical management is often utilized and requires an open durotomy. A 70-year-old female presented with one year of progressive low back pain with associated leg numbness, urinary incontinence, bilateral foot drop, and imbalance resulting in multiple falls. MRI revealed a terminal syrinx at the level of the conus medullaris. She underwent an uncomplicated T12-L1 laminectomy for syrinx fenestration and syringo-subarachnoid shunt placement, resulting in improved bladder/bowel function, strength, sensation, and ambulation. The necessary midline durotomy was closed with a running 6-0 prolene suture fastened at the start and end of the suture line with the novel use of the COR-KNOT MICRO TM device (LSI Solutions, Victor, New York, US). We present the successful surgical management of a progressively symptomatic terminal syrinx using a syringo-subarachnoid shunt and the novel use of the COR-KNOT MICRO TM titanium fastener device for dural closure. Earlier shunting should be considered in the disease course of terminal syrinx, and the successful novel use of a titanium fastener on the dura warrants further investigation., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: TF serves as a research fellow for LSI. This relationship begun approximately 1 year after the use of their device in this case report and therefore did not influence the use of this device or outcomes reported. ., (Copyright © 2024, Furst et al.)