Spine 2.0 JNIS style

Abstract

The AJNR published a game changing manuscript in 1997. A group composed mostly of neurointerventionalists described the use of polymethylmethacrylate in painful osteoporotic vertebral compression fractures. Soon thereafter, this then nascent technique began to flourish throughout many parts of the world. Since its inception, the JNIS has published content covering all aspects of neurointervention, including spine intervention; the first issue featured an article prospectively evaluating pain and functional outcomes after vertebroplasty. Over the years, JNIS has featured a variety of articles that advanced our knowledge and improved the capability of percutaneous approaches to treat spinal lesions, for example, in cancer patients. 4 Moreover, the manuscripts have promoted understanding of the capabilities of percutaneous approaches to treating extraspinal locations, for example, sacroplasty, 6 acetabuloplasty, and even calcaneoplasty. JNIS has been receiving an everincreasing number of highquality manuscript submissions. This was very apparent during the most acute period of the COVID-19 pandemic. Topics related to mechanical spine have been a critical part of that growth. This commentary will highlight that subject matter—important spine articles from the last few years. Driven by clinical results, the number of patients treated with cement augmentation increased year over year from the time of the seminal Jensen AJNR paper. The simultaneous 2009 publication of two blinded studies in the NEJM raised some questions regarding the effectiveness of vertebroplasty over a sham procedure. Subsequent randomized control trials demonstrated vertebroplasty provided improved patient outcomes compared with sham procedures. These results have been extensively discussed in JNIS and other venues. The scientific discourse and conflicting results have impacted patient access to cement augmentation. Claimsbased datasets with sufficient scientific rigor can provide important insights, and JNIS remains open to publishing these types of studies. A 10 year Medicare claims database study of vertebral augmentation in multiple myeloma patients demonstrated a reduction in treatments performed after publication of the two NEJM studies described above. It is important to remember that the two NEJM studies focused specifically on osteoporotic and not cancer patients. More recently, HafeziNejad and colleagues found significant regional variations based on the national inpatient sample over a 13 year period. 14 Systematic reviews and metaanalyses have grown in importance as investigators seek to answer specific welldefined research questions by looking at the empirical evidence that fits prespecified eligibility criteria and applying statistical methods that increase the power of individual studies. Preoperative embolization has been an important role for neurointerventional providers since the early days of the field. JNIS investigators determined that such embolization can reduce intraoperative blood loss in decompressive surgery in metastatic renal cell and mixed primary tumor groups. Clarencon and colleagues advanced on traditional preoperative embolization by directly puncturing C2 and placing onyx in a hypervascular metastasis. Advances in computational power and optics have taken JNIS readers to the next dimension by enabling interventionalists to expand their horizons into mixed reality experiences that allow unhindered procedural site visualization using high resolution radiographic imaging. Perhaps most exciting for the editorial staff at JNIS are the international collaborations that enable the journal to share techniques from around the world that are advancing the field of neurointerventional spine care. A group based in Athens studied 138 patients with severe degenerative lumbar disease who underwent interlaminar epidural injection. This study demonstrated unequivocally the criticality of fluoroscopy in the performance of epidural injections, a topic of significance at the most recent Current ProceduralTerminology discussions. 19 The use of radiofrequency ablation with augmentation has been explored by investigators in the pages of JNIS. Reyes et al evaluated 49 patients with 72 painful spinal metastatic lesions showing safety and improved functional outcome using those techniques. These results have now been repeated and verified in the OPuS One study. Investigators from France described an approach that had the unique distinction of bringing a sweet edible into the title. The use of ‘doughnut’ vertebroplasty for 22 patients with circumferential aggressive hemangiomas was provocative. In addition to improving pain in the vast majority of patients, the authors reported a reduction in radicular and neurological symptoms associated with a tendency to regression of the compressive epidural venous component of these lesions. Vertebral augmentation is traditionally utilized to stabilize the anterior column. For years, investigators have considered more complex anterior column implants where isolated polymethylmethacrylate might be insufficient. In one international JNIS publication authors studied the use of vertebral body stents in extensive lytic lesions and concluded that this approach is a safe and effective option for reconstructing the anterior column. These same investigators have pushed JNIS readers to think past the anterior column with their groundbreaking new technique: stentscrew assisted internal fixation. By combining vertebral body stents with percutaneous fenestrated screws, one can minimally invasively treat patients with far more complex lesions including but not limited to pediculosomatic disjunction. The first publication describing the stentscrew assisted internal fixation technique worldwide was in JNIS. With the shift from anterior column augmentation to the concept of vertebral reconstruction, neurointerventional techniques NeuroInterventional Program, Massachusetts General Hospital, Boston, Massachusetts, USA Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia Monash University Faculty of Medicine, Nursing, and Health Sciences, Clayton, Victoria, Australia Neuroradiology, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Ospedale Regionale Lugano, Lugano, Switzerland Neuroradiology, Inselspital of Bern, University of Bern, Bern, Switzerland Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA NeuroInterventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA Radiology, SS Trinita Hospital, Cagliari, Sardinia, Italy Radiology, IOM Mediterranean Oncology Institute, Viagrande, Sicily, Italy Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA Radiology, Ochsner Medical System, New Orleans, Louisiana, USA