Anterior Surgery Research Articles

‘It’s just my knee’: a qualitative study investigating the process of reframing and young athletes’ perceived quality of life between anterior cruciate ligament injury and surgery

ObjectivesTo understand the factors influencing young athletes’ perceptions of quality of life (QOL) following an anterior cruciate ligament (ACL) rupture, prior to reconstructive surgery.DesignQualitative descriptive study using semi-structured interviews and...

AB090. SOH24AB_047. The efficacy of anchored stand-alone spacers in comparison to conventional cage and plate in anterior cervical discectomy and fusion surgery: a meta-analysis of randomised controlled trials for clinical and radiological outcomes

AB090. SOH24AB_047. The efficacy of anchored stand-alone spacers in comparison to conventional cage and plate in anterior cervical discectomy and fusion surgery: a meta-analysis of randomised controlled trials for clinical and radiological outcomes

The Effect of Closed Kinetic Chain Exercises on Lower Extremity Function in Male Football Players After Anterior Cruciate Ligament Reconstruction Surgery

Background and Aims : Anterior cruciate ligament (ACL) injury is the most common knee injuries in sports. This study aims to assess the effect of closed kinetic chain exercises on lower extremity function in football players with ACL reconstruction surgery. Methods This is a quasi-experimental study that was conducted on 22 male football players with a history of ACL injuruy referred to a hopspital from Ahvaz, Iran. They were randomly divided into two groups of 11, including exercise and control. The performance of the two groups was measured using shuttle run test, figure-of-eight hop test, hop test from side to side, and agility hop test in the pre-test and post-test phases. The exercise group performed closed kinetic chain exercises (side lunge, plie squat, hip bridge, walking backwards, front lunge, squat, and plank) for 6 weeks, 3 sessions per week, each for 35 minutes. No exercise was performed in the control group. For data analysis, repeated measures analysis of variance (ANOVA) and independent t-test were used. The significance level was set at 0.05. Results In the pre-test phase, no significant difference was observed between the two groups in the functional tests of shuttle run test, figure-of-eight hop test, side to side hop test, and agility hop test (P>0.05). In the post-test phase, the ANOVA results showed that the exercise group performed better in shuttle run test, figure-of-eight hop test, side to side hop test, and agility hop test (P≤0.05). The results of Bonferroni post hoc test showed that the exercise group in the mentioned tests, both immediately after and one month after the exercises, their performance in the mentioned tests improved (P≤0.05). Conclusion The closed kinetic chain exercise can be used to increase the lower extremity performance of male football players with ACL injury.

How Biofeedback With Surface EMG Can Contribute to the Diagnosis and Treatment of AMI in the Knee

Background: Arthrogenic muscle inhibition (AMI) is a complex neurological phenomenon that is actually very common. AMI can appear following a knee injury or knee surgery. If it is not addressed, the patient's function can be negatively affected. There is currently no specific tool for the diagnosis and treatment of AMI. Indications: Following surgery or injury to the knee, AMI causes defective activation of the quadriceps, sometimes combined with a knee extension deficit. A clinical classification of AMI has been proposed recently to help with making the diagnosis and to guide treatment. In this article, we describe how biofeedback and surface electromyography (EMG) can be used in the early diagnosis and treatment of knee AMI. Technique Description: Biofeedback is based on transformation of physiological variables into a visual or auditory signal. This allows the patient to learn how to control physical and bodily functions, which were previously considered as involuntary processes. This technique requires the use of a specific device that transforms the measured physiological signals—neuromuscular activation in this instance—into visual signals. This tool incorporates surface EMG, with electrodes connected to a measuring unit. This unit is connected to a screen that shows the neuromuscular activation in real time. Thus, EMG biofeedback can be used to help clinicians make a diagnosis and to specifically treat the AMI. Results: We have used biofeedback in patients who have a knee injury or who have undergone knee surgery. Both the therapist and patient were able to objectively see the presence of AMI using the biofeedback device. For treatment, the therapist works with a patient by providing clear instructions and increasingly more challenging goals. We show examples of how patients were able to eliminate their AMI by using biofeedback. Discussion/Conclusion: EMG biofeedback is a promising tool for the diagnosis and treatment of AMI after an anterior cruciate ligament (ACL) tear and ACL reconstruction surgery. The next steps are to define thresholds and a rehabilitation protocol that will be used in a clinical trial. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Association between passing return-to-sport testing and re-injury risk in patients after anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis.

Inconsistent results have been obtained regarding the association between return-to-sport (RTS) testing and the risk of subsequent re-injury following anterior cruciate ligament reconstruction (ACLR). We therefore conducted a systematic review and meta-analysis to assess the potential association between passing of RTS and the risk of re-injury for patients after ACLR. This meta-analysis was registered in INPLASY with the registration number INPLASY202360027. The electronic databases MedLine, EmBase, and the Cochrane library were systematically searched to identify eligible studies from their inception up to September 2023. The investigated outcomes included knee injury, secondary ACL, contralateral ACL injury, and graft rupture. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using the random-effects model. A total number of nine studies involving 1410 individuals were selected for the final quantitative analysis. We noted that passing RTS test was not associated with the risk of subsequent knee injury (OR: 0.95; 95% CI: 0.28-3.21; P = 0.929), secondary ACL injury (OR: 0.98; 95% CI: 0.55-1.75; P = 0.945), and contralateral ACL injury (OR: 1.53; 95% CI: 0.63-3.71; P = 0.347). However, the risk of graft rupture was significantly reduced (OR: 0.49; 95% CI: 0.33-0.75; P = 0.001). This study found that passing RTS test was not associated with the risk of subsequent knee injury, secondary ACL injury, and contralateral ACL injury, while it was associated with a lower risk of graft rupture. Thus, it is recommended that patients after ACLR pass an RTS test in clinical settings.

Clinical results after surgical treatment for degenerative cervical myelopathy: a retrospective 1-year follow-up descriptive analysis

Background Degenerative cervical myelopathy (DCM) poses a significant challenge globally, often requiring surgical intervention for moderate to severe cases. Choosing between anterior and posterior surgical approaches remains controversial, highlighting the need to consider various factors such as sagittal balance and compression severity. Methods This retrospective cohort study described patients with DCM who underwent surgery at Carlos Van Buren Hospital between 2014 and 2021. Inclusion criteria involved clinical evidence of myelopathy and cervical spinal cord compression at two or more levels, with data collected preoperatively and postoperatively at 12 months. Results Of the 66 patients analyzed, both anterior and posterior approaches demonstrated substantial clinical improvements postoperatively, with 83% of patients showing overall improvement and 59.1% achieving the minimal clinically important difference (MCID) in mJOA scores. Notably, anterior surgeries showed slightly higher rates of MCID achievement and fewer instances of disease progression postoperatively compared to posterior surgeries. Conclusions Our descriptive findings underscore the benefits of both anterior and posterior surgical approaches for DCM, with slight outcome variations. Individualized treatment, considering factors such as clinical symptoms, compression type, and cervical alignment, is crucial. Future research should prioritize comprehensive outcome measures to inform treatment strategies.

Nontraditional approaches to sedation for anterior segment surgery: a narrative review.

Surgical and anesthetic technological advancement have made both cataract and noncataract anterior segment surgery significantly less invasive and time-intensive, facilitating the transition of some of these procedures from the operating room under monitored anesthesia care (MAC) to the office-based setting without MAC. This transition has been aided by the popularization of nonintravenous approaches to achieving patient sedation for these procedures. In this review, we discuss the literature surrounding traditional and nontraditional methods of achieving patient sedation for anterior segment surgery. Our survey of the literature suggests that nonintravenous (IV) approaches to sedation for these procedures may be just as safe, effective, and satisfactory to patients as traditional IV approaches. As anterior segment surgery becomes less invasive and less time-intensive, providers considering transitioning their cataract and anterior segment surgery out of the operating room and into the office-based setting without MAC anesthesia should consider the non-IV sedation options outlined in this review to achieve adequate patient sedation and comfort.

Characteristics and Outcomes of Patients Treated with Cervical Spine Fusion at High Volume Hospitals

High volume (HV) has been associated with improved outcomes in various neurosurgical procedures. The objective of this study was to explore the regional distribution of HV spine centers for cervical spine fusion and compare characteristics and outcomes for patients treated at HV centers versus lower volume centers. The National Inpatient Sample database 2016-2020 was queried for patients undergoing cervical spine fusion for degenerative pathology. HV was defined as case-loads greater than 2 standard deviations above the mean. Patient characteristics, procedures, and outcomes were compared. Of 3895 hospitals performing cervical spine fusion for degenerative pathology, 28 (0.76%) were HV. The Mid-Atlantic and West South Central regions had the highest number of HV hospitals. HV hospitals were more likely to perform open anterior fusion surgeries (P<0.01). Patients treated at HV hospitals were less likely to have severe symptomatology or comorbidities (P<0.01 for all). When controlling for severity and demographics on multivariate analysis, HV centers had higher odds of length of stay ≤1day, favorable discharge, and decreased total charges. Patients who underwent cervical spine fusion surgery at HV hospitals were less complex and had increased odds of length of stay ≤1, favorable discharge, and total charges in the lower 25th percentile than patients treated at non-HV hospitals. Physician comfort, patient selection, institutional infrastructure, and geographic characteristics likely play a role.

An updated classification of the anatomical variations of the internal iliac venous drainage system: Surgical implications for anterior lumbar spinal approaches

BackgroundAdvanced pelvic surgery is associated with potential vascular risks. The aim of this study was to complete the existing classification of the anatomical variations of the internal iliac veins encountered on a series of preoperative angio CT with a view to performing anterior lumbar spine surgery. Materials and MethodsIn this monocentric retrospective study conducted between 2010 and 2020, all preoperative angio CT performed before an anterior lumbar surgery were systematically analyzed. All the abnormalities of the iliac veins were referenced in an updated classification system. Results910 patients (431 men and 479 women) with a mean age of 49 years [16–88] were included. Apart from the most common variant in the population (type I), 64 anatomical variations (7.0%) in the iliac veins were reported and classified according to our new classification. The percentage of coverage of the L4-L5 intervertebral disc is 52%, including 32% by the inferior vena cava before the confluence of the common iliac veins. At the level of the L5-S1 intervertebral disc, the coverage is 30% (same distribution between left and right). ConclusionsVariations of the iliac veins are frequent, and contrary to what one might think, and even if they can represent an anatomical trap during surgery, certain variations do not limit anterior lumbar spine surgery and are not more associated with vascular complications. Nevertheless, these anatomical variations must be known before any advanced pelvic surgery. Depending on their distribution, level L5-S1 is more suitable for ALIF, level L4-L5 for OLIF approaches.

MATHEMATICAL PREDICTION OF CHANGES IN THE LEVELS OF CD40-CD40L TRANSMEMBRANE PROTEIN SYSTEM ACROSS DIFFERENT ANALGESIA TECHNIQUES IN CHILDREN

The impact of the CD40-CD40L on the development of non-communicable neurological conditions is determined by abnormal CD40 expression and may be detrimental to nervous tissue function. Pain is one of the earliest psychophysical functions to develop. Postoperative complications causing pain should be addressed immediately. Regional analgesia techniques can speed up children’s recovery and reduce the need for opioids. They can also lower the incidence of postoperative nausea and vomiting, respiratory complications, and postsurgical pain intensity.The aim of this study was to present a mathematical model that predicts changes in CD40-CD40L levels in children who underwent surgery under various analgesic modalities within the fi rst fi ve days postoperatively. The autoregressive probability model was used to predict the behavior of the experimental data function within 29 days after surgery.Material and Methods. The children were divided into three groups. Group I consisted of 33 children who underwent anterior abdominal wall surgery under general anesthesia with morphine. Group II comprised 27 children who underwent anterior abdominal wall surgery under general anesthesia with the transversalis fascia plane block (TFPB). Group III included 27 children who underwent anterior abdominal wall surgery under general anesthesia with the TFPB, combined with the quadratus lumborum block 4 (QLB-4) via a single injection. The serum CD40L levels were evaluated using the immunoenzymatic assay method. The autoregressive model method based on the Burg algorithm was used to predict the behavior of the experimental data function. To automate the calculation of predictions based on the Burg method, the ‘predict’ function in РТС MathCad Prime 7.0 software was used. All clinical and laboratory studies were conducted in accordance with the World Medical Association Declaration of Helsinki ‘Ethical Principles for Medical Research Involving Human Subjects’. The study is a fragment of the research project of the Department of Children Diseases of Postgraduate Medical Education Faculty, Ivano- Frankivsk National Medical University «Health Status and Adaption of Children from the Precarpathian Region with Somatic Diseases, Their Prevention» 2021-2026, state registration number 0121U111129.Results. On the fi fth day after surgery, the serum CD40-CD40L levels were highest in children who received conventional opioid analgesia. There was no signifi cant diff erence observed between children in the TFPB and TFPB+QLB groups. On the 29th day after surgery, the predicted CD40-CD40L levels were lowest in children who received conventional opioid analgesia combined with the TFPB+QLB.Conclusions. The fi ndings obtained confi rmed the positive eff ect of combined analgesia using opioids and regional nerve block TFPB+QLB in children who received anterior abdominal surgery on suppressing immune mechanisms of pain syndrome involving the CD40-CD40L signaling system.

Anterior Cruciate Ligament Reconstruction Surgery Outcomes: A Comparison Between Patients Who Underwent the Procedure During the COVID-19 Pandemic and a Cohort Treated Prior to the Pandemic.

Background and objective During the coronavirus disease 2019 (COVID-19) pandemic, many elective orthopedic surgeries, including anterior cruciate ligament reconstruction(ACLR), were temporarily postponed. The purpose of this study was to compare the outcomes of ACLR in patients who underwent surgery during the COVID-19pandemic with those in a cohort treated before the pandemic. Materials and methods This retrospective review compared patients who underwent primary ACLR during two periods: March to June 2020 (the pandemic group) and January to December 2018 (the pre-pandemic group). Matched cohorts (1:1) were created using propensity matching. Time from injury-to-first visit, injury-to-surgery, and first visit-to-surgery were calculated. Subjective and objective outcomes, minimal clinically important difference (MCID) achievement, and complication rates were recorded for up to two years postoperatively. Statistical analysis included 𝛘2 or Fisher's exact tests for categorical data, and t- or Wilcoxon signed-rank tests for continuous data with significance set at P< 0.05. Results The pandemic and pre-pandemic groups consisted of 33 and 217 patients, respectively.Matched cohorts consisted of 33 patients each. The time from injury-to-surgery and the first visit-to-surgery was prolonged in the pandemic group. When unmatched, visual analog scale (VAS) scores at three months postoperatively and Patient-Reported Outcomes Measurement Information System (PROMIS)-pain interference (PI) at six months postoperatively and at the final follow-up were higher in the pandemic group. When matched, PROMIS-PI at six months postoperatively was higher in the pandemic group, and VAS scores at one year postoperatively were higher in the pre-pandemic group. MCID achievement and complication rates did not significantly differ between the groups. Conclusions ACLR procedures were significantly delayed in the early months of the COVID-19 pandemic. While patients treated before and during the pandemic experienced varying pain levels during recovery, their functional outcomes, MCID achievement, and complication rates did not differ significantly.

Cervical Sagittal Alignment and Related Factor Analysis and Prediction Model in Patients Undergoing Revision Surgery After Anterior Cervical Fusion.

Patients with myelopathy or radiculopathy commonly undergo anterior cervical fusion surgery (ACFS), which has a notable failure rate on occasion. The goal of this study was to compare revision and nonrevision surgery patients in cervical sagittal alignment (CSA) subsequent to ACFS; additionally, to identify the best CSA parameters for predicting clinical outcome after ACFS; and furthermore, to create an equation model to assist surgeons in making decisions on patients undergoing ACFS. The data of 99 patients with symptomatic cervical myelopathy/radiculopathy who underwent ACFS were analyzed. Patients were divided into group A (underwent revision surgery after the first surgery failed) and group B (underwent only the first surgery). We measured and analyzed both preoperative and postoperative CSA parameters, including C2 slope, T1 slope, cervical lordosis C2-C7 (CL), C2-C7 sagittal vertical axis (C2C7 SVA), occiput-C2 lordosis angle (C0-C2), and chin brow vertical angle, and we further computed the correlation between the CSA parameters and created a prediction model. The (T1S-CL)-C2S mismatch differed significantly between groups A and B ([9.95 ± 9.95] 0 , [3.79 ± 6.58] 0 , P < 0.05, respectively). A significant correlation was observed between C2 slope and T1CL in group B relative to group A postoperatively (R 2 = 0.42 versus R 2 = 0.09, respectively). Compared with group B, patients in group A had significantly higher C2C7SVA values, more levels of fusion, and more smokers. The sensitivity, specificity, accuracy, and discrimination of the model were, respectively, 73.5%, 84%, 78.8%, and 85.65%. The causes of revision surgery in cervical myelopathic patients after anterior cervical corpectomy and fusion/anterior cervical diskectomy and fusion are multifactorial. (T1S-CL)-C2S mismatch and high C2C7SVA are the best cervical sagittal parameters that increase the odds of revision surgery, and the effect is more enhanced when comorbidities such as smoking, low bone-mineral density, and increased levels of fusion are taken into account.

370 Is There an Optimal Surgical Approach in Degenerative Cervical Myelopathy?: An Individual Participant Data Meta-Analysis

INTRODUCTION: Contradictions exist about impact of anterior vs. posterior surgical approach on outcomes of degenerative cervical myelopathy (DCM). METHODS: Individual patient data of subjects who underwent surgery for DCM was identified from a pooled dataset of the AO Spine CSM-North America, CSM-International, and CSM-Protect clinical studies. Primary outcomes were changes in short form 36 Physical Component Summary score (SF36-PCS) and mJOA score at 12 months. Secondary outcomes were change in total Neck Disability Index (NDI) score and SF36 Mental Component Summary score (SF36-MCS). Two comparison cohorts were created: i) anterior surgery and ii) posterior surgery. One-stage mixed-effects meta-analysis with study and treatment exposure as random effects was performed and reported with mean differences and 95% confidence intervals. A subgroup analysis planned a priori in mild DCM patients (mJOA 15-17) was performed. RESULTS: A total of 979 patients met eligibility criteria. Patients who had anterior decompressive surgery experienced greater improvements at 1yr of follow-up than those who underwent posterior decompressive surgery in SF36-PCS score (adjusted MD 1.57 [95% CI 0.11 to 3.03], p = 0.0348) and NDI score (adjusted MD 3.32 [95% CI 0.58 to 6.05], p = 0.0172). A greater proportion of patients that underwent anterior surgery achieved clinically important recovery of their NDI (OR 1.49 [95% CI 1.15 to 1.93], p = 0.002; aOR 1.46 [95% CI 1.08 to 1.96], p = 0.013) and SF36-PCS scores at 1yr (OR 1.45 [95% CI 1.12 to 1.88], p = 0.004, aOR 1.34 [95% CI 1.00 to 1.80], p = 0.052). In patients with mild DCM (n = 186), patients who underwent anterior decompressive surgery experienced greater improvements in SF36-PCS score, mJOA score, and Neck Disability Index score than posterior surgical patients. CONCLUSIONS: Anterior surgical decompression for DCM is associated with greater improvements in 1yr patient-reported outcomes than posterior surgical decompression.

1087 Large Incidence and Risk Factors Meta-analysis of Dysphagia in Over 132,000 Anterior, Posterior, and Hybrid Surgeries for Cervical Spondylosis Myelopathy

INTRODUCTION: Surgical management of Cervical Spondylotic Myelopathy (CSM) is associated with complications with devastating impacts. Dysphagia is one of these major complications with the incidence rate being not completely known in different surgical approaches. METHODS: PubMed/MEDLINE, SCOPUS, and Cochrane were systematically searched until January 2023. Rates and risk of complications were assessed. Meta-analysis of rates and risks was performed with generalized linear mixed model (GLMM) and inverse variance method, respectively, and compared between techniques. RESULTS: 1196 citations were screened and 39 studies with 60 instances of dysphagia incidence/risk factors reports from over 132,442 patients were identified. Dysphagia’s overall incidence rate was 4.98%[95% confidence interval 3.23-7.61] and was significantly different between surgery groups (Chi2 p &lt; 0.01). It was found in 7.97% [4.95–12.57] of anterior surgeries, 1.52% [0.94–2.45] of posterior ones, and 11.25% [3.38–31.44] of hybrid techniques (statistical comparison: P &lt; A &lt; H). Advanced age (&gt;65) risked dysphagia significantly (OR 1.38 [95%CI 1.11-1.71]). CONCLUSIONS: Chances of posterior surgery being complicated with dysphagia is not negligible and should be discussed with patient before surgery, especially with older adults.

A systematic review of risk factors and adverse outcomes associated with anterior cervical discectomy and fusion surgery over the past decade.

Anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed cervical surgeries in the world, yet there have been several reported complications. To determine the actual incidence of complications related to ACDF as well as any risk variables that may have been identified in earlier research. To evaluate the origin, presentation, natural history, and management of the risks and the complications, we conducted a thorough assessment of the pertinent literature. An evaluation of clinical trials and case studies of patients who experienced one or more complications following ACDF surgery was done using a PubMed, Cochrane Library, and Google Scholar search. Studies involving adult human subjects that were written in the English language and published between 2012 and 2022 were included in the search. The search yielded 79 studies meeting our criteria. The overall rates of complications were as follows: Dysphagia 7.9%, psudarthrosis 5.8%, adjacent segment disease (ASD) 8.8%, esophageal perforations (EPs) 0.5%, graft or hardware failure 2.2%, infection 0.3%, recurrent laryngeal nerve palsy 1.7%, cerebrospinal fluid leak 0.8%, Horner syndrome 0.5%, hematoma 0.8%, and C5 palsy 1.9%. Results showed that dysphagia was a common postoperative sequelae with bone morphogenetic protein use and a higher number of surgical levels being the major risk factors. Pseudarthrosis rates varied depending on the factors such as asymptomatic radiographic graft sinking, neck pain, or radiculopathy necessitating revision surgery. The incidence of ASD indicated no data to support anterior cervical plating as more effective than standalone ACDF. EP was rare but frequently fatal, with no correlation found between patient age, sex, body mass index, operation time, or number of levels.

Isokinetic Testing: Why it is More Important Today than Ever.

Isokinetics is a proven method to train and objectively assess the capability of muscle groups, particularly at the knee. The current re-injury rates and less than optimal return to sport percentages seen following anterior cruciate ligament surgery highlights the need for greater focus on what tests and methods are used to make these critical decisions. Isokinetics remains the best single method to objectively determine dynamic muscle strength, power, rate of force development and endurance. These factors make it well-suited to play a crucial role in influencing the appropriate patient progression through a rehabilitation program and assisting in determining return to play readiness following injury or surgery. In this article we will discuss why we believe isokinetics is a useful and necessary testing method, and elucidate testing parameters and goals used during knee extension/flexion assessment.

Anterior approach in the surgical management of multiple lumbar fractures (clinical case)

Lumbar fractures are an urgent medical problem. They are often feature the compression of dural sac and roots followed by neurological deficit. This case study presents the anterior approach surgery as the method of choice for the management of multiple fractures with damage to the A and В columns ensuring optimal decompression of the spinal canal and deformity correction and avoiding multi-stage interventions.

Minimally Invasive Surgery for Adolescent Idiopathic Scoliosis: A Systematic Review.

Background: Minimally invasive surgical (MIS) techniques have gained popularity as a safe and effective alternative to open surgery for degenerative, traumatic, and metastatic spinal pathologies. In adolescent idiopathic scoliosis, MIS techniques comprise anterior thoracoscopic surgery (ATS), posterior minimally invasive surgery (PMIS), and vertebral body tethering (VBT). In the current systematic review, the authors collected and analyzed data from the available literature on MIS techniques in AIS. Methods: The articles were shortlisted after a thorough electronic and manual database search through PubMed, EMBASE, and Google Scholar. Results: The authors included 43 studies for the review; 14 described the outcomes with ATS, 13 with PMIS, and 16 with VBT. Conclusions: While the efficacy of the ATS approach is well-established in terms of comparable coronal and sagittal correction to posterior spinal fusion, the current use of ATS for instrumented fusion has become less popular due to a steep learning curve, high pulmonary and vascular complication rates, implant failures, and increased non-union rates. PMIS is an effective alternative to the standard open posterior spinal fusion, with a steep learning curve and longer surgical time being potential disadvantages. The current evidence, albeit limited, suggests that VBT is an attractive procedure that merits consideration in terms of radiological correction and clinical outcomes, but it has a high complication and re-operation rate, while the most appropriate indications and long-term outcomes of this technique remain unclear.

Opioid-Free Analgesia is Safe and Effective in Anterior Cervical Spine Surgery: A Randomized Controlled Trial.

Randomized controlled trial (RCT). Compare the efficacy of a multimodal, opioid-free (OF) pain management pathway with a traditional opioid-containing (OC) pathway in patients undergoing anterior cervical procedures. Previous studies have compared opioid-based pain regimens to opioid-sparing regimens following cervical spine surgery, but have been limited by high rates of crossover, retrospective designs, reliance on indwelling pain catheters, opioid utilization for early postoperative analgesia, and/or a lack of patient-reported outcome measures. This is a RCT in which patients were allocated to either an OF or OC perioperative pain management protocol. Eligible study participants included adult (age up to 18y) patients who underwent primary, 1-level or 2-level anterior cervical surgery [anterior cervical discectomy and fusion (ACDF), anterior cervical disc arthroplasty (ACDA), or hybrid (ACDF and ACDA at different levels)] for degenerative pathology. The primary outcome variable was subjective pain level at 24 hours postoperative. The final study cohort consisted of 50 patients (22 OF, 28 OC). Patients in the OF group reported lower median postoperative pain levels at 6 hours (4 for OF vs. 7 for OC; P =0.041) and 24 hours (3 for OF vs. 5 for OC; P =0.032). At 2-week and 6-week follow-up, pain levels were similar between groups. Patients in the OF group reported greater comfort at 12 hours (9 for OF vs. 5 for OC; P =0.003) and 24 hours (9 for OF vs. 5 for OC; P =0.011) postoperatively. Notably, there were no significant differences in patients' reported pain satisfaction, overall surgical satisfaction, or overall sense of physical and mental well-being. In addition, there were no significant differences in falls, delirium, or constipation postoperatively. A multimodal OF pain management pathway following anterior cervical surgery for degenerative disease results in statistically noninferior pain control and equivalent patient-reported outcome measures compared with a traditional OC pathway.

Pediatric Cervical Kyphosis: A Retrospective Multicenter Analysis and Literature Review.

This study aims to investigate cervical kyphosis in children, which has gained increasing attention in recent years due to its higher incidence and its association with tumor surgeries, and to shed light on the unique anatomical and biomechanical differences between pediatric and adult populations regarding cervical sagittal alignment. Additionally, it explores the diverse causes and management approaches, which often pose significant challenges. Furthermore, this study presents the management outcomes from three spine centers in the Middle East. A retrospective analysis was conducted on patient records from 2009 to 2021 in three centers located in Saudi Arabia, Egypt, and Jordan. Demographic and clinical data were collected, imaging studies were reviewed, and various treatment modalities and their corresponding outcomes were documented and analyzed. Additionally, a literature review on pediatric cervical kyphosis and its management was performed. Seventeen patients were included in this study. The average age at presentation was 11.9 years. Among the participants, 14 underwent surgical treatment, 1 was treated with Minerva orthosis, and 2 were observed. The mean follow-up period was 32.4 months. In surgically treated patients, a statistically significant higher degree of correction was achieved when combining anterior and posterior surgeries compared to performing standalone anterior or posterior surgery (P-value = 0.014). Although rare, pediatric cervical kyphosis is a significant condition within the spectrum of pediatric deformities and frequently occurs as a component of syndromes or as a result of iatrogenic factors. Neck pain and myelopathy are the most commonly observed symptoms. Thorough evaluation and complex surgical interventions are typically required for most cases.