Franciscan Health

Augmented reality (AR) provides real-time three-dimensional visualization for spinal instrumentation, though its role in spinopelvic stabilization remains limited. While AR-assisted pedicle and S2 alar-iliac screw placement has been reported, AR guidance for a dual-iliac quad-rod construct in spinopelvic dissociation has not. We describe AR-assisted minimally invasive placement of L4-L5 pedicle screws and bilateral iliac screws using intraoperative three-dimensional planning. Fixation was completed without complications and remained stable at last follow-up. This case suggests AR navigation may support accurate and efficient execution of complex minimally invasive spinopelvic fixation.

Background Human gastric cancer remains a diagnostic and therapeutic challenge worldwide. Improved prognostic biomarkers may support treatment planning, including surgery, neoadjuvant and adjuvant therapies. We offer a new liquid biopsy approach, integrated with esophagogastroduodenoscopy (EGD) to evaluate gastric fluid recovered from a large patient cohort (n=1,056 patients), demonstrating the value of a simple DNA concentration analysis to provide diagnostic support and prognosis in gastric cancer. Methods We performed an exploratory study to evaluate gastric fluid DNA (gfDNA) concentration in patients with normal gastric mucosa or diagnosed with peptic diseases, preneoplastic conditions, or cancer. Key variables including sex, gastric fluid pH, use of proton-pump inhibitors, tumor subtype, clinical stage, and disease outcomes were considered. Results gfDNA concentrations were significantly increased in gastric cancer versus all groups (mean 26.86 ng/µL; 95% CI: 20.05 to 33.79; p=3.61e-12) and as compared to non-malignant controls (normal mucosa and peptic diseases; mean 10.77 ng/µL; 95% CI: 9.23 to 12.33; p=9.55e-13), and preneoplastic conditions (mean 10.10 ng/µL; 95% CI: 7.59 to 12.60; p=1.10e-5). gfDNA concentrations were higher in advanced tumors (T3; mean 25.66 ng/µL; 95% CI: 19.46 to 31.85) compared to early-stage disease (T2 and below; mean 15.12 ng/µL; 95% CI: 9.73 to 20.50; p=5.97e-4). Our findings also suggest gfDNA prognostic value for gastric cancer diagnosed subjects. In this subset, patients with gfDNA concentrations >1.28 ng/µL showed longer progression-free survival (p=0.009), which correlated with increased tumor-infiltrating immune cells (p=0.001), remaining significant after adjusting for tumor stage (p=0.014). Conclusions While high gfDNA indicates gastric cancer in a general population and may contribute to disease management, its diagnostic clues should be integrated with further work up such as tissue biopsies, to ensure comprehensive and accurate clinical assessment. However, in patients with established gastric cancer, gfDNA is a potential prognostic marker, and subjects with high gfDNA content might paradoxically have better outcomes. The elevated presence of immune cell infiltrates—compared to those observed in peptic diseases and pre-neoplastic lesions (including their associated gastric cavity DNA shedding)—may serve as a critical missing link to resolve this empirical paradox.

Introduction: Type III endoleaks are a significant complication following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs). They are characterized by persistent blood flow into the aneurysm sac due to structural defects in the endograft - either component separation (Type IIIa) or fabric disruption (Type IIIb). Incidence varies by device and study but generally ranges between 2% - 4%. Case Presentation: A 96-year-old female with a history of nonobstructive CAD, sinus bradycardia, HTN, and an infrarenal AAA s/p recent EVAR, presented with constant, non-radiating lower abdominal pain for approximately 1.5 weeks. The pain had worsened and resembled the discomfort experienced prior to her initial AAA diagnosis. Vitals were BP 149/54, HR 58, and SpO2 95%. Labs remarkable for Hgb 10.9 (at baseline), Cr 1.6, troponin 7, and lactic 1.2. CTA revealed a stable aneurysm sac measuring 5.7cm, but a hyperdensity anterior to the proximal iliac stents raised concern for possible Type III endoleak. No feeding vessels were seen to suggest a Type II endoleak. The patient was taken to the cath lab for further evaluation and potential intervention. Intra-procedural aortography demonstrated a widely patent endograft with no evidence of Type I, II, or III endoleak, despite multiple angiographic projections. However, due to the concerning CTA and ongoing symptoms, an additional endoprosthesis was deployed across the entire right iliac limb. Her symptoms resolved postoperatively, and she was discharged home in stable condition. Discussion: Type III endoleaks necessitate prompt intervention due to their strong association with aneurysm rupture and increased long-term mortality. The 5-year survival rate for patients with post-EVAR Type III endoleaks is approximately 66%, compared to 84% in patients without endoleaks. Endovascular repair remains first-line treatment, typically involving relining the affected segment with additional stent grafts or using endovascular sealing techniques. While both CTA and conventional angiography have high sensitivity and specificity, angiography may detect endoleaks missed or misclassified by CTA. This case illustrates the diagnostic challenges posed by occult or intermittent endoleaks. Despite the absence of angiographic confirmation, empiric intervention led to symptom resolution, emphasizing the importance of clinical judgment when imaging and procedural findings are discordant.

Study Design: A questionnaire study. Objective: To characterize spine surgeons’ opinions regarding treating elite athletes with cervical disc arthroplasty (CDA) and assess current recommendations regarding time to return to training and competition. Summary of Background Data: CDA is increasingly recommended to elite athletes as a surgical treatment option for degenerative cervical conditions but remains controversial due to limited research on indications and return to play guidelines. Methods: Surveys were designed to obtain spine surgeons’ opinions regarding treating elite athletes with CDA, including sport-specific considerations and current recommendations regarding time to return to training and competition. The surveys were administered electronically to members of the Cervical Spine Research Society (CSRS) via their membership listserv. Survey data was analyzed to identify patterns in recommendations for the use of CDA as a treatment option for elite athletes. Results: Sixty surgeons responded to the survey. Surgeons generally agreed (93.3%) that being an elite athlete was not a contraindication to a single-level disc arthroplasty. Some surgeons (73.3%) did report at least one absolute contraindication for CDA in elite athletes. Respectively, 53.3% and 66.7% of surgeons reported they would consider 2-level CDA or hybrid procedures for elite athletes. Opinions varied on the safety of returning to specific sports based on the number of CDAs surgeons perform annually. Surgeons recommended different timelines for resuming activity, most commonly advising clearance at 2 weeks for light cardio, 6 weeks for full cardio and strength training, and twelve weeks for sport-specific training and full competition. A total of 46.7% of surgeons were still concerned about either litigation or criticism in offering CDA to elite athletes. Conclusions: CDA as a treatment option for elite athletes has increased in recent years, and many surgeons feel quite comfortable with allowing return to most sports after a one-level CDA.