Posterior approach interbody fusion techniques such as posterior lumbar interbody fusion and transforaminal interbody fusion are known as the workhorse procedures for lumbar spinal fusion. Over the years, advancements in procedural steps, technique, and technology have sought to improve patient outcomes. Within the last 2 decades, considerable emphasis has been placed upon minimally invasive techniques utilizing tubular retractors and conscious sedation. Innovation in materials engineering, visualization technology such as endoscopes, and enabling technologies such as augmented reality and robotics have served to enhance the procedures and their outcomes.

Artificial intelligence (AI) has evolved from science fiction to a technology infiltrating everyday life. In neurosurgery, clinicians and researchers are exploring ways to implement this powerful tool to improve the safety and efficiency of the perioperative process. Current applications include preoperative diagnosis, intraoperative detection and recommendations, and technical skills assessment and feedback. Although the potential benefits are evident, AI integration into neurosurgical workflows requires discussions around ethical regulations, cybersecurity, privacy concerns, and data and algorithm ownership.

Spinal fractures, spinal cord injuries, and nerve root injuries are commonly encountered entities for spine surgeon. While many cases have well-researched presentations, outcomes, and standards of care there are many patients for which the appropriate clinical management is less clear. Other patients present with injuries with clear treatment preferences that are impossible to implement based on comorbidities or preference. The authors present a few recent cases of spinal injury where multiple treatment pathways could be considered and individual patient-related factors changed the course of treatment.

This is a critical review of the data supporting current endoscopic surgical techniques for the spine, limitations, economic barriers to adoption, and the future of the field. Endoscopic spine approaches can be applied to all levels of the spine, with many robust trials supporting its clinical outcomes. Although financial limitations with starting an endoscopic program can be justified by its cost effectiveness and positive societal impact, challenges facing its widespread adoption are present and more endoscopic spine programs are needed. Technological advancements will further enhance endoscopic techniques as they become an integral part of a spine surgeon's repertoire.

Cerebrospinal fluid (CSF) leaks are a challenging condition characterized by the loss of CSF, leading to severe orthostatic headaches and other debilitating symptoms. Diagnosis and management require a multifaceted approach involving clinical evaluation, imaging, and various treatment modalities to improve patient outcomes and quality of life.

This review article explores the advancements in sacropelvic fixation, comparing traditional and modern techniques, with a focus on iliac and sacral 2 alar-iliac screw fixations. It addresses the biomechanical challenges inherent in securing the lumbosacral junction and discusses the integration of current and future technologies like robotics and augmented reality to improve surgical outcomes. The article underscores the importance of these innovations in enhancing stability and reducing complications in complex spinal surgeries.

The purpose of this work is to provide an understanding of the medicolegal landscape with regards to ambulatory surgery centers and physician owned hospitals, trends in our healthcare system, the benefits of facility ownership for both outpatient and inpatient spine surgery, and the effect of each on physicians and patients.

Chronic subdural hematoma (cSDH) is a common neurosurgical disease that is increasing in incidence worldwide. While surgical evacuation can relieve mass effect and alleviate neurologic symptoms, drainage alone does not address underlying cSDH pathophysiology, likely resulting in high rates of recurrence. Middle meningeal artery embolization (MMAE) has emerged as a promising adjunct to conventional cSDH to reduce recurrence risk. Despite positive results from multiple randomized controlled trials demonstrating MMAE efficacy, questions remain about its optimal role in routine patient care. This review summarizes the contemporary management of cSDH, discusses the emerging role of MMAE, and highlights lingering questions and future directions.

This article discusses the evidence supporting the resection of glioblastoma beyond the borders of contrast-enhancing tumor. While several techniques for this have been described, including a so-called FLAIRectomy, lobectomy, or via the use of adjuncts such as fluorescence or intraoperative MRI, the optimal extent of additional resection has yet to be established. Many authors have noted a survival benefit with supramarginal resection without significant additional morbidity.

Anterolateral approaches to the lumbar spine provide direct access to the disc space. These techniques facilitate thorough discectomy, which is essential for successful arthrodesis. They improve segmental lordosis without osteotomy and indirectly decompress neural elements in carefully selected patients. Benefits include shorter operative times, reduced blood loss, and rapid postoperative mobilization compared to posterior approaches. Each technique has specific advantages and limitations, thus none is inherently superior to another. Detailed knowledge of these techniques is essential for modern spine surgeon to provide personalized operative plan for each patient.

Convection-enhanced delivery for central nervous system gene therapy is an emerging treatment strategy to modify the course of previously untreatable or inadequately treated neurologic conditions, including brain tumors, metabolic disorders, epilepsy, and neurodegenerative disorders. Ongoing nervous system gene therapy clinical trials highlight advantages and ongoing challenges to this therapeutic paradigm.

Microneurosurgical techniques remain crucial for managing neurosurgical diseases, especially in low- and middle-income countries (LMICs) where other advanced treatment modalities are not available. The global distribution of these techniques is uneven due to disparities in infrastructure, equipment, and training. Medical professionals from LMICs face barriers in reaching training centers in high-income countries, as well as in accessing microsurgical techniques. To address these disparities in microsurgery training, we offer free and accessible microsurgery training model by combining the donations of microsurgery kits with a comprehensive support system that includes live-streamed, offline, and in-person assistance within LMICs.

Neurosurgeons require post-graduate training to deliver safe, effective, and evidence-based care; to continually improve and adapt their methods through assessing the effect of their care and patient outcomes; and to train the future neurosurgeons of tomorrow to surpass current standards of care. We describe methods used by global collaborations to address these training needs on a worldwide scale, their risks, and their perceived benefits.

Health care disparities between high-income countries (HICs) and low- and middle-income countries (LMICs) are well established. The focus of the surgical aspect of health was identified in the early twenty-first century, and efforts to provide safe surgical intervention require the shift of resources from HICs to LMICs with specialized surgeons, anesthesiologists, and equipment. This intervention may make a difference on the short run; however, to achieve a long-term self-sustaining surgical service in the region of need, education and training of local physicians is key.

This article provides a thorough analysis of the evolution and current state of global neurosurgery, emphasizing the transformative power of partnerships between various stakeholders to address the stark inequities in neurosurgical care, especially in LMICs. It discusses the transition from reliance on short-term medical missions to the development of sustainable, locally led neurosurgical programs through education, training, and infrastructure development. The article highlights the importance of long-term educational exchanges, innovative digital learning platforms, and strategic collaborations with foundations, philanthropic organizations, and academic institutions to build local capacities, enhance global neurosurgical competency, and promote self-sufficiency in neurosurgical care across different regions.

Medical technology plays a significant role in the reduction of disability and mortality due to the global burden of disease. The lack of diagnostic technology has been identified as the largest gap in the global health care pathway, and the cost of this technology is a driving factor for its lack of proliferation. Technology developed in high-income countries is often focused on producing high-quality, patient-specific data at a cost high-income markets can pay. While machine learning plays an important role in this process, great care must be taken to ensure appropriate translation to clinical practice.

The field of global neurosurgery seeks to improve access to neurosurgery and reduce health disparities worldwide. This process depends on intensive collaboration between partners in high-income and low-to-middle income country (LMIC) settings. Several such collaborations have propelled global neurosurgery forward, and long-standing partnerships in particular have brought subspecialty care and training to new locations. Recently, there have been more reports of collaborations between LMICs themselves. In this narrative study, we summarize the state of collaboration in global neurosurgery and discuss how the field is likely to change moving forward.

Neurosurgical education and training are the essential tenets for the development of a sustainable workforce. However, opportunities for training are limited in most parts of the world due to socioeconomic constraints and an inadequate workforce. This global deficit has triggered a huge drive to expand training opportunities. Although training programs are increasing numerically, most of these programs focus on basic residency training with no opportunities for fellowships and continuing education. Herein, we use the Foundation of International Education in Neurological Surgery as a global success model to elucidate on the role of fellowships, distant continuing education, and funding in neurosurgery.

This article delves into academic global neurosurgeons' role in addressing the inequities in neurosurgical care globally. It outlines a comprehensive training framework incorporating global health education, research, and leadership development into neurosurgery residency programs. The article highlights the importance of interdisciplinary collaboration, cultural humility, and sustainable partnerships and advocates for a holistic approach to global neurosurgery. It underscores the necessity of integrating global health principles into neurosurgical training and practice, aiming to cultivate a new generation of neurosurgeons equipped to tackle the complex health challenges of our interconnected world.