1 mSv (range, 7.7-10.6 mSv). The radiation dose received by the surgical staff was 0 mSv. The postoperative course was excellent. Posterior miniopen fixation using Cirq robotic assistance coupled with an intraoperative computed tomography navigation system is a major innovation that can improve the accuracy of pedicle screw positioning, with acceptable patient radiation and reduced surgical team exposure. Posterior miniopen fixation using Cirq robotic assistance coupled with an intraoperative computed tomography navigation system is a major innovation that can improve the accuracy of pedicle screw positioning, with acceptable patient radiation and reduced surgical team exposure. Hypertrophy of the ligamentum flavum (LF) contributes to the development of spinal stenosis. Smad proteins can mediate the fibrogenesis activity through the transforming growth factor β (TGF-β ) pathway, but which Smad protein plays a more important role in the hypertrophy process of LF is unclear. The LF samples were obtained from 50 patients. After the LF cells (LFCs) were cultured, small interfering ribonucleic acid (siRNA) that target human phosphorylated-Smad2, 3, or 4 (p-Smad2,3,4) genes was transfected into LFCs. Next, proteins from cells were extracted and the protein levels of Smad2, Smad3, and Smad4 were detected by Western blot. The messenger ribonucleic acid level of TGF-β was measured by real-time polymerase chain reaction (PCR). Furthermore, an enzyme-linked immunosorbent assay was performed to test the impact of Smad2 downstream of the TGF-β signaling pathway. Degeneration of the LF was characterized by an increase in disorganized elastic fibers and fibrotic transformation by extracellular collagen deposition. The gene expression analysis of fibrotic genes in LFCs showed that knockdown of phosphorylated-Smad2 by siRNA significantly reduced the protein expression level of TGF-β compared with other groups. The enzyme-linked immunosorbent assay suggested that the protein expression level of Smad2 can influence the downstream events of TGF-β signaling pathway in the LFCs. Our findings suggest that Smad2 plays a potential role in the pathologic development of hypertrophy of LF. We also found that Smad2 knockdown by Smad-siRNA can influence the TGF-β signaling pathway through decreasing expression of TGF-β , tumor necrosis factor α, and nuclear factor κb. Our findings suggest that Smad2 plays a potential role in the pathologic development of hypertrophy of LF. We also found that Smad2 knockdown by Smad-siRNA can influence the TGF-β1 signaling pathway through decreasing expression of TGF-β1, tumor necrosis factor α, and nuclear factor κb. YouTube is one of the most widely accessed platforms for patients seeking information across all medical specialties. More than 50% of patients engage with online information before seeing a physician. There has been no qualitative analysis of neuromodulation content on YouTube. By evaluating the search interest of neuromodulation terms via Google Trends, the authors selected 3 search terms to assess on YouTube. For each term, the top 20 videos were selected, 10 sorting by view count and 10 by relevance. DISCERN criteria were used to evaluate each video. Statistical analysis was performed with R software to discover associations among video characteristics and DISCERN scores (DSs). Neuromodulation, deep brain stimulation, and spinal cord stimulation terms were searched. There were 52 unique and 8 duplicate videos, which were excluded. The videos received 6,984,743 combined views (134,321 average). Neurosurgeons were the most common authors, producing 22 videos, followed by anesthesiologists with 10 videos. https://www.selleckchem.com/products/Decitabine.html Statistical analysis showed that videos that were sponsored (DS 44.79 vs. 34.53; P < 0.011), had board-certified physicians (DS 42.88 vs. 31.25; P < 0.004), and had credentials of the video producer (DS 41.82 vs. 34.42; P < 0.044) were more likely to have higher DSs. Spinal cord stimulation videos had the lowest quality of the search terms (DS 30.9 vs. 39.2, 42.6; P < 0.043). Certain characteristics of YouTube videos are associated with higher quality. Video producers should aim to use these characteristics and follow DISCERN criteria when preparing online videos. Certain characteristics of YouTube videos are associated with higher quality. Video producers should aim to use these characteristics and follow DISCERN criteria when preparing online videos. Although studies have evaluated the economic burden to medical students desiring a neurosurgery residency broadly, a detailed breakdown of costs has not been reported. Given that the Association of American Medical Colleges and Society of Neurological Surgeons have recommended neurosurgery residency programs for the 2021 residency application cycle cancel away rotations and in-person interviews, our objective was to evaluate cost savings to medical students applying during this time and the implications. Using the 2019-2020 Texas STAR Dashboard database, we queried responses from neurosurgery residency applicants. We recorded application costs, away rotation costs, interview costs, and total costs for medical school seniors applying to neurosurgery residency. Demographic information for applicants was also recorded. Mean and median costs were reported with percentile distributions and geographic comparisons. A Kruskal-Wallis H test was used to determine differences in mean costs by medical school region. Our cohort included 121 U.S. allopathic applicants to neurosurgery residency. Mean application costs were $1711, away rotation costs were $3840, interview costs were $6400, and total costs were $11,882. No significant difference was observed for mean total costs for applicants from schools in the central ($10,525/applicant), northeast ($11,311/applicant), south ($12,660/applicant) and west ($12,404/applicant) regions (P= 0.181). There was no significant difference in the mean application fees, away rotation costs, or interview costs among regions. In the COVID-19 era, neurosurgery residency applicants could save >$10,000 through the use of virtual interviews and lack of away rotations. There are potential geographic trends; however, further evaluation should be performed. $10,000 through the use of virtual interviews and lack of away rotations. There are potential geographic trends; however, further evaluation should be performed.