No abstract

Two months following penetrating keratoplasty for Acanthamoeba keratitis, a 76-year-old man was referred due to inability to wean high-dose topical steroids. Despite a very healthy graft and minimal pain, a scleral abscess involving three clock hours of the superior conjunctiva was present. The patient underwent conjunctival and scleral excision of the area of apparent infection with adjuvant mitomycin C and double freeze–thaw cryotherapy treatment followed by amniotic membrane graft. Recurrence was confirmed with PCR. Following a multimonth regimen of oral voriconazole and topical polyhexamethylene biguanide, chlorhexidine and moxifloxacin, the patient was weaned from all anti-infectious agents. After cataract surgery and scleral lens fitting, the patient is now 20/20 in the affected eye. This case highlights the need for judicious use of immunosuppressive agents as well as the necessary vigilance to monitor for recurrence with Acanthamoeba infection. It also represents the first reported use of adjuvant mitomycin C and double freeze–thaw cryotherapy for treatment of Acanthamoeba scleral abscess.

Study Design: This article is a research methodology study. Objective: We summarize current ambiguities and inaccuracies regarding lumbar interbody fusion nomenclature and propose a standardized reporting method to improve the clarity of future research and communication among spine surgeons and researchers. Summary of Background Data: Lumbar interbody fusion techniques have seen an impressive degree of refinement over recent years. This innovation has ushered in a plethora of naming conventions for these new surgical approaches. Many of the current trends in naming lumbar fusion techniques are, however, redundant and contradictory, creating unnecessary confusion in the field. Methods: Following an extensive literature review, we developed a 4-part naming convention that highlights the crucial features of lumbar fusion surgical procedures. Results: Current literature regarding lumbar fusions is rife with inconsistent usage and privatization of terminology that can inadvertently result in ambiguous operative vocabulary, potentially compromising the accuracy of future research. We propose a 4-part naming system that highlights crucial features of lumbar interbody fusions, including (1) intra-operative repositioning, (2) patient position, (3) surgical technique, and (4) orientation of the surgical corridor to the psoas muscle. Conclusions: This study raises awareness of current inconsistencies in naming conventions and proposes a standardized system for improving the clarity of lumber interbody fusion terminology for the broader spine community. Level of Evidence: Level V.

Objectives: To develop a typology of poor peer review practices (PPRP) and assess researchers' experiences with PPRP. Design: Exploratory analysis of cross-sectional internet-based survey. Participants: We solicited 500 researchers funded by the NIH extramural grants in 2018 by direct email and 600 bioethicists on a bioethics discussion forum (mcw.bioethics). 112 respondents (~10%) completed the survey. Primary and Secondary Outcomes Measures: The total number of reported PPRP and a five-point scale to assess participants' views about the effect of PPRP on their ability to disseminate their research. Results: The mean number of PPRP experienced per author was 12.5 of 28 (44.6%; range 0-27; 95% CI = 11.2-13.8), with fourteen PPRP experienced by 50% or more of the sample. The number of reported PPRP increased with age (P = 0.01) and total number of published peer-reviewed manuscripts (P = 0.02). Authors belonging to underrepresented groups reported more PPRP compared to represented groups (P = 0.05). Most authors viewed the peer review process favorably, with 67% (74/111) of authors responding "sometimes" or "often" to having received insightful peer reviews that improved the quality of their final papers. However, a total of 57% (63/111) of respondents admitted to previously abandoning a manuscript after receiving what they perceived to be unfair peer reviews. Conclusions: This study introduces a practical list of PPRP and a framework for a typology of PPRP, which could serve as an educational tool for editors and reviewers and further our understanding of poor peer review practices. Future researchers will expand authors' experiences with constructive or helpful peer review practices.

Lateral lumbar interbody fusion (LLIF) is a minimally invasive spine procedure that, unlike posterior approaches, spares dissection of paraspinal musculature and posterior ligamental and facet complexes. The anterior-to-psoas (ATP) lateral technique further minimizes tissue disruption by avoiding dissection through the psoas muscle, thereby lessening posterior retraction force on the lumbar plexus. However, LLIF traditionally requires repositioning the patient from lateral decubitus to prone in a 2-stage surgery, which can lengthen operative time and decrease OR efficiency compared with posterioronly and entirely prone interbody fusions. We present a simultaneous anterior and posterior approach (SAPA) for ATP LLIF, which allows the patient to remain in the lateral decubitus position while two operative windows are created. This enables one surgeon to perform ATP LLIF in the anterior spinal column while another surgeon simultaneously places pedicle screws in the posterior spinal column. Screw insertion in the lateral position can be challenging because of the ergonomically awkward angle which may lead to trajectory deviation; to address this, we used the table-mounted Cirq Robotic Arm (Brainlab AG) which locks onto an ideal trajectory and allows for seamless pedicle screw placement. To fully realize the SAPA technique's capacity for reducing operative time, additional cases are needed to overcome this new technology's learning curve. The patient consented to this procedure. The participants and any identifiable individuals consented to publication of their image. Robotically assisted LLIF using the SAPA technique obviates patient repositioning and has the potential for shorter time under anesthesia and streamlined operative workflow.