Posterior Complex Research Articles

Necessity of applying anatomical unit resection surgery in suspected posterior oral squamous cell carcinoma

ObjectiveAnatomic unit resection surgery (AURS), previously introduced, significantly improves the prognosis of oral cell squamous carcinoma (OSCC) patients with posterior oral anatomical complex (POAC) involvement. This study aims to evaluate the necessity of AURS in patients with OSCC suspected to involve the POAC.MethodsWe conducted a retrospective study of 127 patients diagnosed OSCC with identical POAC involvement or suspected POAC involvement. Patients were classified based on the extent of POAC involvement determined from preoperative imaging. Kaplan-Meier analysis was performed to identify the impact of surgery approaches on the prognosis of patients. Univariable and multivariable cox analysis were conducted to identify independent prognostic factors of the patients.ResultsIn total, 65 patients with suspected POAC involvement, 24 cases underwent AURS while 41 underwent conventional surgery. 62 patients with identical POAC involvement, 31 cases underwent AURS while 31 underwent conventional surgery. The AURS group demonstrated significantly superior disease-free survival (DFS) rates (75.0% vs. 43.9%) and local-regional control rates (79.2% vs. 48.8%) for suspected POAC involvement. For identical POAC involvement, AURS also resulted in better DFS (51.6% vs. 19.4%) and local-regional control (64.5% vs. 25.8%). Surgery protocol, tumor involvement level, lymphatic invasion and pN staging were identified as independent prognostic factors for both DFS and local-regional control.ConclusionsAURS is a necessary surgical approach for both suspected and identical POAC involvement in OSCC patients, significantly improving prognosis and local-regional control rate.

The importance of the posterior osteoligamentous complex of the lumbar spine: dogma changing biomechanical insights.

During full flexion of the spine, the paraspinal muscles are largely inactive. This suggests that passive structures like the posterior osteoligamentous complex (POLC), consisting of interspinous and supraspinous ligaments and the spinous processes, play a key role in spinal stability and protection of the spinal column. The POLC, however, is often resected or damaged during spinal decompression surgeries, whereas the biomechanical implications of this resection or damage are not yet fully understood. A stepwise reduction study was performed on three fresh frozen cadaveric torsi (aged 30-78 years) using a custom setup which only allows sagittal plane motion. After preloading and locking in full flexion, the posterior lumbar structures were gradually resected in the following order: Skin, fascia, musculature, facet joints, ligamentum flavum, posterior ligamentous complex, and posterior longitudinal ligaments. Load cells measured force increase on the fixation frame after each resection step. The load increased sequentially with each resection, demonstrating load transfer from the passive structures onto the fixation frame. The POLC, including the supraspinous and interspinous ligaments at L2-L5, accounted for 69 - 74% of the measured passive load resistance in full flexion, representing the largest contribution. Facet joints with their capsules contributed 10-18%, while muscular contributions were negligible (< 2%). The experiment indicates that the POLC is the primary passive stabilizer of the fully flexed lumbar spine. Surgical resection of this structure can redistribute loads and increase stresses on remaining spinal tissues, potentially leading to spinal instability, accelerated degeneration, and poor clinical long-term outcomes.

Real-time ultrasound-guided neuraxial puncture in elderly patients: a randomized controlled trial comparing paramedian transverse and parasagittal approaches.

Historically, spinal anesthesia has been performed using anatomical landmarks. This study aimed to compare the efficacy and procedural outcomes of real-time ultrasound-guided parasagittal oblique (RTU-PO) and real-time ultrasound-guided paramedian transverse (RTU-PT) approaches in elderly patients undergoing elective surgery under spinal anesthesia. Seventy-seven elderly patients scheduled for elective surgery under spinal anesthesia were enrolled in this study. Patients were randomized to receive spinal anesthesia using either RTU-PO (38 patients) or RTU-PT (39 patients) technique. The primary measure outcome was the rate of successful dural puncture at the first attempt in both groups. The secondary outcomes included the overall success rate of spinal anesthesia, time to identify the posterior complex on ultrasound, time to perform spinal anesthesia, total procedural time, number of needle redirections and passes, number of separate skin punctures, patients' satisfaction, and incidences of complications in both groups. Baseline demographic and anatomical characteristics were not different between the two groups. The incidence of successful spinal anesthesia at first attempt was 60.5% with RTU-PO and 56.4% with RTU-PT (P=0.71). All other secondary outcomes were comparable between the two groups except for the time to identify posterior complex that was higher in the RTU-PT versus the RTU-PO group (36±18 vs. 20±11 seconds; P=0.0001). In elderly patients undergoing elective surgeries under spinal anesthesia, the RTU-PO and the RTU-PT techniques are comparable in almost all aspects.

Posterior Ligamentum Complex Preservation Alleviate ASD-Related Biomechanical Deterioration in Lumbar Interbody Fusion Models: A Finite Element Analysis.

There are differences in the extent of excision of articular processes, spinal processes and posterior ligamentum complexes (PLC) for posterior approach lumbar interbody fusion. Given that the biomechanical significance of these structures has been verified and that deterioration of the biomechanical environment is the main trigger for complications in both fused and adjacent motion segments, changes in decompression ranges may affect the potential risk of adjacent segmental disease (ASD) biomechanically; however, this topic has yet to be identified. Posterior lumbar interbody fusion (PLIF) with different decompression strategies was simulated in a well-validated lumbosacral model. The excision and preservation of the cranial motion of the segmental PLC and the lateral articular process in the fusion segment were simulated in this model. The stress distribution in the cranial motion segment was computed under different loading conditions to determine the potential risk of ASD. Compared to complete bilateral articular process excision, preservation of the lateral two-thirds of the articular process did not alleviate stress concentration on the cranial motion segment both in PLC preserved and excised models. In contrast, preservation of the cranial segmental PLC can obviously alleviate the stress concentration tendency of the cranial intervertebral disc under flexion loading conditions. Preservation of the lateral parts of the articular process cannot optimize the biomechanical environment, in contrast, PLC preservation can effectively alleviate ASD related biomechanical deterioration of the cranium segment.

Current research status of static computer-aided implant surgery in the posterior region and complex cases

This article explores the current research status of oral implant guides in the posterior teeth area and special cases, with a focus on analyzing the application, advantages, and disadvantages of static implant guides and digital implant guides. Traditional implant guides have certain limitations in operation and precision. However, digital implant guides have significantly enhanced the accuracy and safety of implantation through 3D printing and computer-aided technologies, reducing surgical risks and improving patient comfort and satisfaction. In the posterior teeth area, the utilization of digital implant guides can effectively handle special circumstances in the upper and lower posterior regions, such as patients with insufficient bone mass and limited mouth opening. Studies indicate that digital guides perform exceptionally well in immediate implantation and full-arch implantation, increasing the success rate and efficiency of the surgery. Simultaneously, in the special case of mandibular reconstruction, the introduction of digital technology assists surgeons in achieving higher treatment accuracy and reduces surgical time and trauma.

The effectiveness of sacral lateral branch radiofrequency neurotomy for posterior sacroiliac joint complex pain in patients selected by dual sacral lateral branch blocks; A real-world cohort study

Previous study of spinal neurotomy procedures indicates that stringent block selection improves outcomes. However, this pattern is not established for sacral lateral branch radiofrequency neurotomy (SLBRFN). Few SLBRFN studies have used stringent block selection criteria such as ≥80% pain reduction following dual sacral lateral branch blocks (SLBB). Evaluate the effectiveness of SLBRFN in patients with ≥80% pain relief following dual SLBBs. Retrospective single-arm cohort study of consecutive patients from two Canadian musculoskeletal and pain clinics who underwent first-time SLBRFN after report of ≥80% pain relief following dual diagnostic SLBBs. Patients were identified by electronic medical record query between 2016 and 2022. The primary outcome was the proportion of individuals with a ≥50% reduction in the numeric pain rating scale (NPRS) score three months after SLBRFN. Secondary outcomes included the proportion of responders achieving the minimal clinically important difference (MCID) on the pain disability quality-of-life questionnaire (PDQQ), and the duration and mean percentage of pain relief among those with recurrent symptoms after a successful SLBRFN. Of the 70 participants included, 32 (45.7%; 95% CI=34.6-57.3) reported a ≥50% reduction in NPRS, and 35 (50.0%; 95% CI=38.6-61.4) achieved the MCID on the PDQQ at 3-months. Among the 17 patients who reported a return of symptoms, the mean duration of relief was 8.0±3.5 months, and the mean percentage of pain relief was 77.9%±16.4%. Logistic regression models revealed that the use of multi-tined RF probes and lower patient BMI were associated with treatment success. SLBRFN reduced pain and disability in approximately 50% of patients at 3 months when selected using relatively restrictive selection criteria. Treatment success was associated with multi-tined RF probe type and lower patient BMI. Larger prospective studies assessing long-term outcomes are needed to further evaluate the impact of different selection criteria and techniques on SLBRFN effectiveness.

Efficacy and safety of laminoplasty combined with C3 laminectomy for patients with multilevel degenerative cervical myelopathy: a systematic review and meta-analysis.

Laminoplasty (LP) combined with C3 laminectomy (LN) can effectively achieve spinal cord decompression while maintaining the integrity of the posterior ligament-muscle complex, thereby minimizing cervical muscle damage. However, its necessity and safety remain controversial. This study aimed to compare the safety and efficacy of LP and LP combined with C3 LN in the treatment of patients with multilevel degenerative cervical spondylotic myelopathy (DCM). A systematic review and meta-analysis of the literature was performed. A search of PubMed, Web of Science, Embase, and the Cochrane Library databases was conducted from inception through December 2023 and updated in February 2024. Search terms included laminoplasty, laminectomy, C3 and degenerative cervical spondylosis. The literature search yielded 14 studies that met our inclusion criteria. Outcomes included radiographic results, neck pain, neurologic function, surgical parameters, and postoperative complications. We also assessed methodologic quality, publication bias, and quality of evidence. Fourteen studies were identified, including 590 patients who underwent LP combined with C3 LN (modified group, MG) compared to 669 patients who underwent LP (traditional group, TG). The results of the study indicated a statistically significant improvement in cervical range of motion (WMD = 3.62, 95% CI: 0.39 to 6.85) and cervical sagittal angle (WMD = 2.07, 95% CI: 0.40 to 3.74) in the MG compared to the TG at the last follow-up (very low-level evidence). The TG had a higher number of patients with complications, especially C2-3 bone fusion. There was no significant difference found in improvement of neck pain, JOA, NDI, cSVA, T1 slope at latest follow-up. LP combined with C3 LN is an effective and necessary surgical method for multilevel DCM patients to maintain cervical sagittal balance. However, due to the low quality of evidence in existing studies, more and higher quality research on the technology is needed in the future.

Nonoperative Management of Isolated Thoracolumbar Flexion Distraction Injuries: A Single-Center Study.

Nonoperative management is an appealing option for purely transosseous thoracolumbar flexion-distraction injuries given the prospects of osseous healing and restoration of the posterior tension band complex. This study seeks to examine differences in outcomes following flexion-distraction injuries after operative and nonoperative management. This study reviews all patients at a single Level 1 trauma center from 2004 to 2022 with AO Spine B1 thoracolumbar injuries treated operatively vs nonoperatively. Inclusion criteria were age greater than 16 years, computed tomography-confirmed transosseous flexion-distraction injuries, and at least 3 months of follow-up with available imaging. The primary outcome assessed was a change in local Cobb angles, with secondary outcomes consisting of complications, time to return to work, and need for subsequent operative fixation. Initial Cobb angles in the operative (n = 14) vs nonoperative group (n = 13) were -5° and -13°, respectively (P = 0.225), indicating kyphotic alignment in both cohorts. We noted a significant difference in Cobb angles between cohorts at first follow-up (2.6° and -13.9°, P = 0.015) and within the operative cohort from presentation to first follow-up (P = 0.029). At the second follow-up, there was no significant difference in Cobb angles between cohorts (3.6° and -12.6°, P = 0.07). No significant differences were noted in complication rates (P = 1), time to return to work (P = 0.193), or resolution of subjective back pain (P = 0.193). No crossover was noted. Nonoperative management of minimally displaced transosseous flexion-distraction injuries is a safe alternative to surgery. Patient factors, such as compliance with follow-up, and location of the injury should be factored into the surgeon's management recommendation. Overall, no significant differences in outcomes and complications were noted following nonoperative management of AO Spine B1 injuries, indicating the potential for these injuries to be managed conservatively.

Beyond Barrels: Diverse Thalamocortical Projection Motifs in the Mouse Ventral Posterior Complex.

Thalamocortical pathways from the rodent ventral posterior (VP) thalamic complex to the somatosensory cerebral cortex areas are a key model in modern neuroscience. However, beyond the intensively studied projection from medial VP (VPM) to the primary somatosensory area (S1), the wiring of these pathways remains poorly characterized. We combined micropopulation tract-tracing and single-cell transfection experiments to map the pathways arising from different portions of the VP complex in male mice. We found that pathways originating from different VP regions show differences in area/lamina arborization pattern and axonal varicosity size. Neurons from the rostral VPM subnucleus innervate trigeminal S1 in point-to-point fashion. In contrast, a caudal VPM subnucleus innervates heavily and topographically second somatosensory area (S2), but not S1. Neurons in a third, intermediate VPM subnucleus innervate through branched axons both S1 and S2, with markedly different laminar patterns in each area. A small anterodorsal subnucleus selectively innervates dysgranular S1. The parvicellular VPM subnucleus selectively targets the insular cortex and adjacent portions of S1 and S2. Neurons in the rostral part of the lateral VP nucleus (VPL) innervate spinal S1, while caudal VPL neurons simultaneously target S1 and S2. Rostral and caudal VP nuclei show complementary patterns of calcium-binding protein expression. In addition to the cortex, neurons in caudal VP subnuclei target the sensorimotor striatum. Our finding of a massive projection from VP to S2 separate from the VP projections to S1 adds critical anatomical evidence to the notion that different somatosensory submodalities are processed in parallel in S1 and S2.

Anatomical and Radiological Findings of Abnormal Calcified Structures within and around the Foramen Transversarium and Its Clinical Implications.

The foramen transversarium is a vital anatomical structure found in the cervical vertebrae of the spine. Typically, it serves as a passageway for important neurovascular structures, including the vertebral artery and vein, as well as the vertebral nerve. However, abnormal calcification or ossification of soft tissues in and around this area can lead to various clinical implications. Understanding the presence and implications of abnormal ossified structures in and around the foramen transversarium is crucial for clinicians involved in the diagnosis and management of cervical spine disorders. Accordingly, this present study was designed to evaluate the abnormal ossified structures anatomically and radiologically within and around the foramen transversarium. This study was conducted on 182 (26 sets of cervical vertebrae) dried human cervical vertebrae obtained from the respective departments of anatomy and on 190 (95 males and 95 females) adult patients who visited the radiology department for neck-related problems such as stiff neck, neck/shoulder pain, dizziness, vertigo, imbalance, visual disturbances, and cognitive impairment. Among 182 examined cervical vertebrae, unilateral complete accessory foramen transversarium was found in 23 vertebrae (12.63%), bilateral complete in 19 (10.44%), bilateral incomplete in 6 (3.29%), unilateral complete double in 4 (2.19%), and unilateral complete absence of foramen transversarium in 3 (1.64%). Stenosis due to aberrant osteophytes was noted in 9 vertebrae (4.9%). Out of 190 patients, three males presented with cervical kyphosis, severe spinal canal stenosis, and spinal cord compression due to ossification of the posterior longitudinal ligament and osteophyte complexes at C3-C6, with the most significant compression at C5-C6. A thorough understanding of abnormal ossifications in and around the foramen transversarium is crucial for the management of cervical spine disorders; imaging modalities such as X-ray, computed tomography, and magnetic resonance imaging are crucial for recognizing and intervening in these cases, which is essential to prevent adverse neurological outcomes associated with vertebral artery involvement.

Finite element analysis of endoscopic cross-overtop decompression for single-segment lumbar spinal stenosis based on real clinical cases.

Introduction: For severe degenerative lumbar spinal stenosis (DLSS), the conventional percutaneous endoscopic translaminar decompression (PEID) has some limitations. The modified PEID, Cross-Overtop decompression, ensures sufficient decompression without excessive damage to the facet joints and posterior complex integrity. Objectives: To evaluate the biomechanical properties of Cross-Overtop and provide practical case validation for final decision-making in severe DLSS treatment. Methods: A finite element (FE) model of L4-L5 (M0) was established, and the validity was verified against prior studies. Endo-ULBD (M1), Endo-LOVE (M2), and Cross-Overtop (M3) models were derived from M0 using the experimental protocol. L4-L5 segments in each model were evaluated for the range of motion (ROM) and disc Von Mises stress extremum. The real clinical Cross-Overtop model was constructed based on clinical CT images, disregarding paraspinal muscle influence. Subsequent validation using actual FE analysis results enhances the credibility of the preceding virtual FE analysis. Results: Compared with M0, ROM in surgical models were less than 10°, and the growth rate of ROM ranged from 0.10% to 11.56%, while those of disc stress ranged from 0% to 15.75%. Compared with preoperative, the growth rate of ROM and disc stress were 2.66%-11.38% and 1.38%-9.51%, respectively. The ROM values in both virtual and actual models were less than 10°, verifying the affected segment stability after Cross-Overtop decompression. Conclusion: Cross-Overtop, designed for fully expanding the central canal and contralateral recess, maximizing the integrity of the facet joints and posterior complex, does no significant effect on the affected segmental biomechanics and can be recommended as an effective endoscopic treatment for severe DLSS.

Isolated, Proximal Tibiofibular Injuries in Athletic Patients: A Critical Analysis Review.

While infrequently reported, isolated injuries to the proximal tibiofibular (TF) joint primarily occur in young, athletic patients participating in sporting activities requiring explosive, high-impact movements, increasing the risk for potential twisting injuries, especially across a hyperflexed knee. The proximal TF joint is stabilized by bony, muscular and ligamentous structures, including both the anterior and posterior proximal TF complexes, with the anterior complex providing more robust stability. Proximal TF injuries frequently involve anterior and lateral displacement of the proximal fibula relative to its native articulation with the tibia. Proper diagnosis is dependent on careful and meticulous history and physical examination, as missed injuries are common, leading to the potential for continued pain, weakness and disability, especially in athletic patients. While spontaneous joint reduction has been reported, injuries may require formal closed reduction, with irreducible and chronic injuries requiring open reduction and stabilization, with recent investigations reporting satisfactory outcomes following anatomic reconstruction of the proximal TF ligament.

Peracetic acid sterilized tendon and ligament allografts for knee reconstruction : For anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and complex knee surgery.

The use of allografts and autografts has been met with mixed views on whether allografts are asuitable alternative to autografts. We aimed to investigate if chemically sterilized allografts show similar rerupture rates to those reported in the literature for allografts and autografts in anterior (ACL) and posterior cruciate ligaments (PCL) and complex knee surgery. Retrospective data on knee reconstructions performed between 2011 and 2015 with tendon/ligamnet allografts sterilized with peracetic acid were collected in the form of aquestionnaire. The inclusion criteria of 2years for each patient were met by 38patients, representing 22ACL reconstructions, 5PCL reconstructions, 3OTHER surgeries, including the Larson technique and medial patellofemoral ligament (MPFL) reconstruction and 8COMPLEX surgeries. The main endpoints were rerupture and complication rate. Secondary endpoints included stability of the knee (Lachman test, Pivot shift test) and the range of motion. The rerupture rate was 7.9% (3grafts). Reruptures only occurred in the ACL group. No reruptures were observed in the PCL, OTHER and COMPLEX surgery groups. Stability improved significantly after surgery and the range of motion returned to values similar to that of healthy knees. Tendon allografts sterilized with peracetic acid show promising low rerupture rates and good clinical scores and the results are comparable to the literature on autografts and other allografts.

Gender effect in affective processing: Alpha EEG source analysis on emotional slides and film-clips.

Past research on gender-related brain asymmetries in emotions was limited and not univocal. The present study analyzed EEG alpha activity (indexing cortical de-activation) from 64 scalp sites in 20 women and 20 men during a counterbalanced block presentation of emotional slides and short video-clips. Stimuli consisted of 45 brief clips of 13 s, divided into 15 erotic (pleasant), 15 neutral and 15 fear (unpleasant) contents. Slides consisted in 45 photo shots (presented for 13 s each) extracted from the videos. As expected, women perceived fear stimuli as more arousing and more unpleasant compared to men. Alpha EEG source analysis revealed gender effects depending on stimulus. Emotional film-clips elicited in both groups a pattern of greater right than left occipital activation. Instead, emotional pictures activated opposite occipital regions, as women showed greater activation in the left, men in the right hemisphere. Men also showed greater activation to Erotic compared to Fear stimuli (i.e., pictures/clips) in the posterior parietal complex. Results point to the relevance of emotional stimulus type to reveal gender effects: clips are ecological, dynamic and engaging, and forced a unified pattern of emotional responses that reset individual differences. Emotional pictures, less engaging, allowed individual differences to emerge and interact with the stimulus category.

Teres minor denervation and pathologies resulting in shoulder joint instability and rotator cuff tears: A retrospective cross-sectional MRI study.

Teres minor denervation (TMD) has gained increasing attention in recent years, particularly with the advent of magnetic resonance imaging (MRI). The potential association between TMD and shoulder instability or rotator cuff tear remains a subject of interest in the orthopedic community. In this retrospective and cross-sectional study, authors aim to investigate the potential association between TMD and shoulder instability or rotator cuff tears. Authors retrospectively analyzed MRI findings from 105 patients with TMD, focusing on rotator cuff pathologies, posterior labrocapsular complex (PLCC) tears, and posteroinferior glenohumeral joint capsule alterations. Authors assessed the association between TMD and rotator cuff and PLCC tears. For the multivariate analysis, partial proportional odds models were constructed for subscapularis (SSC) and SSP tears. Rotator cuff tears were present in 82.9% of subjects, with subscapularis (SSC) tears being the most frequent (77.1%). A significant association was observed between TMD and rotator cuff pathology (P = .002). PLCC tears were found in 82.3% of patients, and humeral position relative to the osseous glenoid was noted in 60% of patients with TMD. A significant association was identified between TMD and shoulder instability or labral/capsular abnormalities (P < .001). More than half of the cases exhibited a long tethering appearance toward the axillary neurovascular bundle on T1-weighted sagittal images. Our findings suggest that TMD is significantly associated with rotator cuff tears and shoulder instability. This study highlights the importance of identifying and treating PLCC tears in patients with TMD to address shoulder instability. Further research is needed to elucidate the role of TMD in the pathogenesis of shoulder instability and rotator cuff pathology.

Prospective Investigation of the Posterior Longitudinal Ligament and Disc Complex after Posterior Stabilization and Decompression Surgery in Patients With Non-OPLL (Ossification of the Posterior Longitudinal Ligament) Cervical Spondylotic Myelopathy

Cervical spondylotic myelopathy (CSM) is a prevalent cause of spinal cord dysfunction in adults, primarily from degenerative changes. The efficacy of treatment strategies, especially surgical approaches, remains debated. This study aimed to assess the long-term impact of posterior fusion laminectomy on the posterior longitudinal ligament (PLL) thickness, disc complex, and myelomalacia signal changes in CSM patients. A single-centre, prospective study from January 2020 to December 2021 included CSM patients without ossified posterior longitudinal ligament (OPLL). Magnetic resonance imaging (MRI) data from baseline, 6, and 12 months postoperatively were collected. Measurements on the MRI were performed using the Osirix MD software, focusing on the PLL width, myelopathic foci dimensions, and canal diameter. Out of the 82 initially enrolled patients, 64 were considered for analysis. Postoperatively, a significant reduction in PLL width and myelopathic foci dimensions was observed, alongside a considerable increase in the canal diameter. Clinical outcomes based on the Modified Japanese Orthopaedic Association (mJOA) scale also showcased marked improvements post-surgery. Posterior fusion laminectomy effectively reduces anterior pressure in CSM patients. This treatment may represent an optimal surgical approach for selected CSM cases. Furthermore, more extensive studies with extended follow-up are advocated.

Arthroscopic Posterior Glenoid Reconstruction With Distal Clavicle Bone-Block

Posterior glenoid bone loss is a potential cause for failure in arthroscopic capsulolabral repair. Although multiple techniques have been described to reconstruct posterior bone defects, they do not reliably yield improved patient outcomes and have high complication rates. We present a technique to reconstruct posterior glenoid bone loss using a distal clavicle autologous bone graft harvested by a mini-open approach and secured arthroscopically with suture buttons. The graft is positioned extra-articularly by repairing the posterior labral complex with a knotless fixation using labral tape.

Arthroscopic Management of Posterior Ankle Impingement Syndrome - A Case Series.

Posterior ankle impingement is a common cause of chronic ankle pain. Although nonoperative treatment is initially preferred, there are surgical options if the symptoms are persistent. Minimally invasive arthroscopic procedures reduce surgical trauma and enable an early return to routine activities. We conducted a study including 6 patients who underwent arthroscopic decompression for posterior ankle impingement. Five of them were female patients and one was a male patient. The pathology varied; one had os trigonum (OT), two had stieda processes (SP), and three had OT with posterior osteophyte complex as part of ankle arthritis. In this paper, we discuss the required clinical approach, preoperative investigations, surgical indications, functional outcomes, and complications of arthroscopic treatment. The patients were followed up for a minimum of 6 months and evaluated using American Orthopedic Foot and Ankle Society (AOFAS) score, Visual Analog Scale (VAS), and range of movement (ROM) pre and post-operatively. All the patients reported a significant reduction of pain and an improved ROMs and functional scores at the operated ankles compared to the opposite side. However, one of the patients developed post-operative tingling and numbness at the plantar aspect of the forefoot. Another one developed tingling at the lateral plantar aspect of the foot. One of the patients with SP, had an incomplete excision of the lesion. Ankle arthroscopy is an effective and minimally invasive surgery that has a significant role in managing chronic ankle pain due to posterior impingement that does not respond to conservative management and provides good functional outcomes with minimal complications.

Arthroscopic Posterior Glenoid Osteotomy

Management of posterior shoulder instability in patients with excessive glenoid retroversion can be challenging. However, a corrective posterior glenoid osteotomy is an option. Although various open techniques are available, minimally invasive and arthroscopy surgery are the most advantageous. This study describes the feasibility and safety of an arthroscopic posterior open wedge glenoid osteotomy using an autologous scapular spine graft along with additional posterior capsulolabral complex reattachment. This procedure is a viable option for patients with symptomatic posterior shoulder instability.

Preservation of the Posterior Interspinous Ligamentary Complex in Posterior and Transforaminal Lumbar Interbody Fusion

Posterior and transforaminal lumbar interbody fusion (PLIF and TLIF) allow some variation between surgeons, particularly regarding the extent of resection of the posterior interspinous ligamentary complex (PILC) with uncertain implications for outcome. The aim of this study was to assess the importance of preserving the PILC when performing PLIF or TLIF. Systematic review of clinical outcomes (adjacent segment degeneration (ASDG), fusion rate, reoperation rate, and visual analog scale (VAS) scores for back and leg pain) after PLIF/TLIF matched for integrity of PILC, Oswestry Disability Index (ODI) score, and radiological parameters. A total of 191 patients from 2 studies (1 prospective randomized control trial (RCT) and 1 retrospective observational cohort study) were identified. 102 (53.4%) had fusion (PLIF/TLIF) with preserved PILC. All 120 patients in the RCT underwent a L4–L5 single-level fusion, while the 71 patients in the retrospective cohort underwent surgery between T11 and S1. In the retrospective cohort study, significant differences between groups in mean number of fixed levels (4.8 ± 1.0 vs. 4.2 ± 0.5), decompressed levels (2.4 ± 0.7 vs. 3.0 ± 0.7), and interbody fusions (1.2 ± 0.9 vs. 2.0 ± 1.0) were reported. In each of the studies, all groups reported an improved ODI score at 3 months after surgery and at last follow-up. In each of the studies, the incidence of radiographic ASDG was significantly higher for the PILC resection group in both studies (9.0% vs. 43.0%, p &lt; 0.01 and 23.0% vs. 49.0%, p = 0.042). Lumbar lordosis (which decreased after PILC resection in the RCT, p &lt; 0.05) also differed between groups. Taken as a whole, these results suggest that preservation of the PILC during PLIF/TLIF surgery prevents future ASDG and loss of lumbar lordosis as well as the potential clinical consequences of these changes. Further prospective studies are needed.