Posterior Procedures Research Articles

Minimally invasive prone lateral retropleural or retroperitoneal antepsoas approach spinal surgery using the rotatable radiolucent Jackson table.

Prone lateral spinal surgery for simultaneous lateral and posterior approaches has recently been proposed to facilitate surgical room efficiency. The purpose of this study is to evaluate the feasibility and outcomes of minimally invasive prone lateral spinal surgery using a rotatable radiolucent Jackson table. From July 2021 to June 2023, a consecutive series of patients who received minimally invasive prone lateral spinal surgery for various etiologies by the same surgical team were reviewed. A Mizuho Jackson Modular Table System was used for all prone lateral surgeries. All patients received combined lateral and posterior approach surgery on the same day. The lateral approaches were performed with the Jackson table rotated 30-40 degrees away from the surgical side. A table-mounted oblique lumbar interbody fusion (OLIF) retractor was applied in retropleural/retroperitoneal spaces. Minimally invasive lateral procedures such as discectomy or mini-open corpectomy were performed after adequate exposure. Posterior procedures were performed with the Jackson table rotated back horizontally. The disease etiologies, surgical levels, blood loss, operation time, and surgical procedures were collected and analyzed. The study included 64 patients with a mean age of 61.8 years (range, 26-88 years). The disease etiologies were 11 (17.2%) deformities, 15 (23.4%) degenerations, 25 (39.1%) infections, 9 (14.1%) traumas, and 4 (6.3%) tumors. The mean length of the surgical level was 4.1±2.0 (range, 2-10), with surgical levels ranging from T8 to L5 laterally and T6 to the ilium posteriorly. The mean blood loss was 863±843 mL (range, 50-4,600 mL) and the mean operation time was 314±148 minutes (range, 92-785 minutes). Of the lateral approaches, there were 25 retropleural and 39 retroperitoneal approaches (36 antepsoas approach). Surgical procedures performed included lateral discectomies, mini-open corpectomies, interbody reconstruction and fusion, and various posterior techniques such as pedicle screw instrumentation, cement augmentation, decompression, osteotomy, and spinal endoscopy. Patients who received both prone lateral retropleural and retroperitoneal approaches had significant improvement in the sagittal Cobb angle of the lateral surgical level, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) at 1 year postoperatively. Minimally invasive prone lateral spinal surgery is a feasible option for patients requiring combined lateral and posterior approach spinal surgery. Both lateral retropleural and retroperitoneal antepsoas approaches can be applied in combination with various posterior surgical procedures in the prone position using the rotatable radiolucent Jackson table.

Effects of two posterior procedures for treatment of cervical hyperextension injury with multilevel spinal stenosis: A retrospective study

BackgroundCervical hyperextension injuries (CHI), commonly resulting in central cord syndrome and spinal instability, often affect the elderly with preexisting degenerative spinal changes, leading to a need for surgical interventions that address both the compression and stability of the cervical spine. This study compares the clinical outcomes of two posterior decompression and fixation procedures for treating cervical hyperextension injury in patients with preexisting multilevel spinal canal stenosis.MethodsPatients suffering from cervical hyperextension injury combined with multilevel spinal stenosis were divided into two groups. They received laminoplasty combined with selective unilateral pedicle screw fixation or laminectomy combined with bilateral lateral mass screw fixation. The clinical records including demographic data, operation time, length of hospital stay, estimated blood loss and surgical complications were collected, and clinical outcomes were evaluated using the American Spinal Injury Association (ASIA) impairment scale. Preoperative and postoperative cervical lordosis were measured.ResultsPostoperative AISA scores were significantly increased compared with that before surgery in both groups, there was no significant differences between groups. The intraoperative blood loss in the laminoplasty group was significantly less than that in the laminectomy group and there were no significant differences in operation time and length of hospital stay between the two groups. No significant difference was found in the incidence of overall surgical complications between the two groups. There was no significant difference in the cervical lordosis after surgery compared with that before surgery in both groups.ConclusionsFor patients suffering from cervical hyperextension injury combined with preexisting multilevel spinal stenosis, both cervical laminoplasty with selective unilateral pedicle screw fixation and laminectomy with bilateral lateral mass screw fixation could achieve satisfactory clinical outcomes.

Effect of Posterior Decompression on the Spinal Cord of Thoracic Ossification of the Posterior Longitudinal Ligament: A Finite Element Analysis

Thoracic ossification of the posterior longitudinal ligament (T-OPLL) causes myelopathy. Although posterior decompression for T-OPLL has shown positive results, patients with kyphotic curvatures often endure poor outcomes. Posterior decompression with fusion (PDF) has demonstrated better results compared to posterior decompression alone. This study aims to evaluate the effects of the posterior procedures for T-OPLL. A 3-dimensional finite element model of the C2-T12 spine, created from medical images, was used to develop the following T3-T4 OPLL compression models: an intact model (no surgery), 25% canal occupancy ratio (COR) OPLL, a discontinuous 25% COR OPLL, a continuous 50% COR OPLL, and a discontinuous 50% COR OPLL. These models were analyzed to evaluate the effects of posterior decompression (laminectomy [LN]) with varied fixation lengths (LN T3-T4, PDF T3-T4, LN T2-T5, and PDF T2-T5) in neutral, flexion, and extension positions. Increased discontinuity in OPLL led to increased stress on the spinal cord. Posterior decompression reduced spinal cord stress in the neutral posture. However, in flexion and extension, spinal cord stress increased for LN T3-T4, LN T2-T5, and PDF T3-T4 compared to the neutral posture. Notably, PDF T2-T5 prevented an increase in spinal cord stress during these motions. Effective management of intervertebral mobility and the appropriate length of decompression are crucial for addressing the thickness and mobility of T-OPLL.

The new proposal of the relationship between axial pain and hinge fracture and facet involvement after open-door laminoplasty with titanium spacers.

This was a retrospective, observational study. Postoperative axial pain (AP) is a well-known complication of cervical posterior surgery. It can be caused by various reasons, but the etiology remains unclear. This study aimed to investigate risk factors for postoperative AP after open-door laminoplasty. A previous meta-analysis revealed muscle damage, female, age of <60 years, and longer collar application as possible risk factors for postoperative AP after cervical posterior procedures. However, the postoperative AP etiology, specifically for open-door laminoplasty, has been inconclusive and remains conflicting. This retrospective study included 129 adult patients who underwent open-door cervical laminoplasty for degenerative diseases in our single institution from January 2015 to October 2021. Postoperative AP was defined as intolerable pain on the neck or shoulder that lasted for >1 month postoperatively. We compared the demographic and radiographic characteristics of AP and non-AP groups. Postoperative AP developed in 62 (48.1%) patients. Intraoperative hinge fracture (HF) and facet involvement by miniscrews were significantly greater in the AP group than in the non-AP group (P < 0.05). Using a logistic regression model, multivariate analysis revealed that HF was significantly associated with postoperative AP (odds ratio = 2.83, 95% confidence interval = 1.28-6.44, P = 0.011). HF and facet involvement were risk factors for postoperative AP after open-door laminoplasty with titanium spacers. Careful surgical manipulation is required to prevent postoperative AP.

Fasciotomy and Occupational Separation among US Service Members with Lower Extremity Chronic Exertional Compartment Syndrome.

Lower extremity chronic exertional compartment syndrome (LE-CECS) can limit rigorous physical activity, particularly in the US military, and fasciotomy is a potential treatment. Associations between LE-CECS, fasciotomy, and occupational outcomes appear understudied. We studied active-duty US service members to identify whether LE-CECS diagnoses and fasciotomy for LE-CECS predict military service separation. We conducted a retrospective cohort study of 1,103,417 individuals who entered service during 2011 to 2017. Distributions of separation statuses and independent variables were tabulated, and sex-specific multivariable regression models were computed for separation outcomes. LE-CECS was associated with a 474% medical service separation risk in men (95% confidence interval (CI) for adjusted risk ratio: 5.21 to 6.33) and a 282% increase in women (CI: 2.99 to 4.88). Among 1947 patients with LE-CECS, men saw a 57% nonmedical separation risk increase (CI: 1.27 to 1.93) and women had a 119% increase (CI: 1.10 to 4.35) when anterior and/or lateral compartment procedures occurred. Men with LE-CECS and any posterior procedures saw a 47% nonmedical separation risk increase (CI: 1.17 to 1.86). Men with anterior and/or lateral procedures and any posterior procedures experienced 36% (CI: 1.09 to 1.71) and 78% (CI: 1.40 to 2.26) medical separation risk increases, respectively. No statistically significant risk increases for the outcomes were otherwise seen for women. LE-CECS was associated with increased military service discharge risks. Among the affected patients, positive effects on career longevity were not seen in association with fasciotomy. However, fasciotomy could simply serve as a marker of the most refractory cases that are least likely to continue service. More study is needed to clarify causal pathways and identify patients who may derive career benefits from surgical treatment.

Early Experience with Prone Lateral Interbody Fusion in Deformity Correction: A Single-Institution Experience.

Background/Objectives: Lateral spine surgery offers effective minimally invasive deformity correction, but traditional approaches often involve separate anterior, lateral, and posterior procedures. The prone lateral technique streamlines this process by allowing single-position access for lateral and posterior surgery, potentially benefiting from the lordosing effect of prone positioning. While previous studies have compared prone lateral to direct lateral for adult degenerative diseases, this retrospective review focuses on the outcomes of adult deformity patients undergoing prone lateral interbody fusion. Methods: Ten adult patients underwent single-position prone lateral surgery for spine deformity correction, with a mean follow-up of 18 months. Results: Results showed significant improvements: sagittal vertical axis decreased by 2.4 cm, lumbar lordosis increased by 9.1°, pelvic tilt improved by 3.3°, segmental lordosis across the fusion construct increased by 12.2°, and coronal Cobb angle improved by 6.3°. These benefits remained consistent over the follow-up period. Correlational analysis showed a positive association between improvements in PROs and SVA and SL. When compared to hybrid approaches, prone lateral yielded greater improvements in SVA. Conclusions: Prone lateral surgery demonstrated favorable outcomes with reasonable perioperative risks. However, further research comparing this technique with standard minimally invasive lateral approaches, hybrid, and open approaches is warranted for a comprehensive evaluation.

Thirty-Year Experience Treating Syndromic Craniosynostosis: Long-Term Outcomes following Cranial Expansions.

Children with syndromic craniosynostosis require multiple cranial expansion procedures. The purpose of this study was to determine how many expansions are typically performed through maturity, to assess complication rates, and to identify trends that might reduce the burden of care. A retrospective chart review was conducted of all consecutive patients undergoing cranial vault enlargement procedures for syndromic craniosynostosis performed by a single surgeon. Of 444 patients treated with Apert or Crouzon/Pfeiffer syndromes, 348 had complete long-term records. The mean age at last follow-up was 16.9 years. Initial cranial expansions were performed at a significantly younger age for those beginning care at outside centers: 7.7 months versus 25.7 months in Dallas; 26.4% had ventriculoperitoneal shunts (syndrome-specific incidences: Apert syndrome, 16%; Crouzon syndrome, 27%; and Pfeiffer syndrome, 54%). Of 498 procedures, 80% were anterior, 18% were posterior, and 2% were midvaults. The overall complication rate was 2%, with no differences found between anterior and posterior procedures. Those treated solely in Dallas underwent a mean of 1.9 expansions. Children with Pfeiffer syndrome underwent more expansions (2.7) than those with Apert or Crouzon syndrome. Factors correlating with more expansions included earlier surgical interventions, use of distraction, ventriculoperitoneal shunts, and treatment begun at outside centers (3.1 procedures). Children with syndromic craniosynostosis treated at a single center underwent an average of 2 skull expansion procedures with a 2% complication rate. Calvarial distraction, ventriculoperitoneal shunts, and earlier surgical interventions were all associated with higher numbers of expansion procedures. Further research is needed to determine whether these correlations are causal. Therapeutic, IV.

A novel growth-friendly system alleviates pulmonary dysplasia in early-onset scoliosis combined with thoracic insufficiency syndrome: Radiological, pathological, and transcriptomic assessments

BackgroundThe posterior procedure utilizing growth-friendly techniques is the golden standard for patients with early-onset scoliosis combined with thoracic insufficiency syndrome (EOS + TIS). Pulmonary hypoplasia is the main cause of dying prematurely in the EOS + TIS. This study assessed the therapeutic impact of a novel growth-friendly system on the pulmonary development of piglet's EOS + TIS model. MethodsThe animal procedure period lasts 12 weeks, of which the construction of the EOS + TIS was performed at 0–8 weeks, and implantation of a novel growth-friendly system was applied at 8–12 weeks. During the animal procedure, X-rays and CT were performed to observe scoliosis, thorax, and lungs. After 12 weeks, pathological changes in lung tissue were assessed using HE and IHC staining. RNA-seq characterized novel growth-friendly system-associated differentially expressed genes (DEGs) and validated using RT-qPCR, western blotting, and IHC. ResultsImplantation of the novel growth-friendly system increased body weight, body length, and total lung volume, as well as decreased the coronal and sagittal Cobb angles for the EOS + TIS model. It also ameliorated EOS + TIS-induced thickening of the alveolar wall, increased alveolar spaces, and decreased alveolar number and diameter. In lung tissue, a total of 790 novel growth-friendly system-associated DEGs were identified, and they were mainly involved in the regulation of immune, inflammatory, calcium transport, and vascular development. Among these DEGs, BDKRB1, THBS1, DUSP1, IDO1, and SPINK5 were hub genes, and their differential expression was consistent with RNA-seq results in lung tissues. ConclusionThe novel growth-friendly system has mitigated scoliosis and pulmonary hypoplasia in the EOS + TIS model. We further elucidate the molecular mechanisms underlying the amelioration of pulmonary hypoplasia.

A process capability function approach to multiple response surface optimization based on a posterior procedure

Multiple response surface optimization (MRSO) aims to determine a setting of input variables that simultaneously optimizes multiple responses. The process capability function (PCF) approach is an attractive alternative to MRSO because it considers both the mean and variance of the responses systematically through the process capability index. In MRSO, the responses are often in conflict. Thus, the preference information of a decision maker (DM) on the tradeoffs among the responses should be considered. However, the existing PCF methods are based on an unrealistic assumption that all DM preference information is given in advance. In this article, a posterior preference articulation procedure based on the PCF approach, called P-PCF, is proposed. P-PCF first generates nondominated solutions using the ε-constraint method and then allows the DM to select his/her preferred cluster or final solution using the K-means clustering method. The proposed method is illustrated using a well-known MRSO problem.

Clinical Observation of Posterior Approach for Surgical Treatment of Thoracolumbar Pseudarthrosis in Ankylosing Spinal Disorders

To evaluate the surgical effectiveness of posterior procedure with long segment stabilization for treating thoracolumbar pseudarthrosis associated with ankylosing spinal disorders (ASD) without anterior fusion or osteotomy. Twelve patients with thoracolumbar pseudarthrosis in ASD were enrolled. All patients underwent posterior long-segment stabilization procedures. In some patients, the percutaneous technique or the aid of a robot or O-arm navigation was utilized for pedicle screw implantation. The clinical results were evaluated by means of the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Radiological outcomes were evaluated for bone fusion, anterior column defect, local kyphotic correction (LK) and position of the pedicle screws. All patients experienced effective bone fusion at the sites of pseudarthrosis. The mean operative time was 161.7±57.1 min, and the average amount of blood loss was 305.8 ± 293.2 ml. For six patients who underwent surgery with the assistance of a robot or O-arm navigation, there was no statistically significant difference observed in terms of operative time and mean blood loss compared to those who used the freehand technique (P>0.05). The VAS score, ODI value, and mean LK angle showed significant improvements at the final follow-up (P<0.05). The accuracy of pedicle screw placement was 96%. Posterior surgery with long-segment fixation, without anterior fusion or osteotomy, can achieve satisfactory outcomes in ASD patients with thoracolumbar pseudarthrosis. The application of percutaneous techniques, as well as the assistance of robots or navigation technique may be a good choice for the treatment of pseudarthrosis in ASD patients.

Oblique lateral interbody fusion for lumbosacral fractional curve correction in degenerative lumbar scoliosis.

In combined anterior-posterior adult spinal deformity surgery, the optimal combination of anterior and posterior procedures remains unclear. We aimed to demonstrate the radiological outcomes and relevant factors in oblique lateral interbody fusion (OLIF) for lumbosacral fractional curve (FC) correction combined with open posterior surgery in degenerative lumbar scoliosis (DLS). This study involved 42 consecutive patients with DLS who had a major curve (MC) ≥ 20° and an FC (L4 to S1) ≥ 10°, and underwent a combined anterior-posterior surgery Changes in the MC, FC, coronal balance distance, type of coronal imbalance, coronal/sagittal disc angle at L4-5 and L5-S1, L4 and L5 tilt, and sagittal parameters were examined. The associations between FC correction and demographic, surgical, and radiological factors were analysed. The FC decreased from 16.9 ± 7.3° preoperatively to 6.6 ± 4.4° at the last follow-up (P < 0.001). The coronal disc angle at L4-5 and L5-S1 were, respectively, 6.8 ± 2.2° and 6.0 ± 4.1° preoperatively and decreased to 2.2 ± 2.1 and 1.2 ± 1.3° at the last follow-up (both P < 0.001). The changes in FC were greater in uppermost instrumented level > T10 (P < 0.001), and associated with the preoperative FC (r = 0.820, P < 0.001), L4 tilt (r = 0.434, P = 0.007), and L5 tilt (r = 0.462, P = 0.003). OLIF at the FC combined with open posterior surgery is an effective combined anterior-posterior correction strategy in DLS.

Clinical and Radiologic Analysis of Minimally Invasive Anterior-Posterior Combined Surgery for Adult Spinal Deformity: Comparison of Oblique Lateral Interbody Fusion at L5/S1 (OLIF51) versus Transforaminal Interbody Fusion.

Background and Objectives: Although adult spinal deformity (ASD) surgery brought about improvement in the quality of life of patients, it is accompanied by high invasiveness and several complications. Specifically, mechanical complications of rod fracture, instrumentation failures, and pseudarthrosis are still unsolved issues. To better improve these problems, oblique lateral interbody fusion at L5/S1 (OLIF51) was introduced in 2015 at my institution. The objective of this study was to compare the clinical and radiologic outcomes of anterior-posterior combined surgery for ASD between the use of OLIF51 and transforaminal interbody fusion (TLIF) at L5/S1. Materials and Methods: A total of 117 ASD patients received anterior-posterior correction surgeries either with the use of OLIF51 (35 patients) or L5/S1 TLIF (82 patients). In both groups, L1-5 OLIF and minimally invasive posterior procedures of hybrid or circumferential MIS were employed. The sagittal and coronal spinal alignment and spino-pelvic parameters were recorded preoperatively and at follow-up. The quality-of-life parameters and visual analogue scale were evaluated, as well as surgical complications at follow-up. Results: The average follow-up period was thirty months (13-84). The number of average fused segments was eight (4-12). The operation time and estimated blood loss were significantly lower in OLIF51 than in TLIF. The PI-LL mismatch, LLL, L5/S1 segmental lordosis, and L5 coronal tilt were significantly better in OLIF51 than TLIF. The complication rate was statistically equivalent between the two groups. Conclusions: The introduction of OLIF51 for adult spine deformity surgery led to a decrease in operation time and estimated blood loss, as well as improvement in sagittal and coronal correction compared to TLIF. The circumferential MIS correction and fusion with OLIF51 serve as an effective surgical modality which can be applied to many cases of adult spinal deformity.

Philosophies and Surgical Techniques for High-Grade Spondylolisthesis Treatment with Literature Review.

High-grade spondylolisthesis is defined as cases with more than 50% displacement and spondylolisthesis with Meyerding grade III and higher. The surgical management of high-grade spondylolisthesis is highly controversial. Many surgical methods have been reported such as posterior in situ fusion, instrumented posterior fusion with or without reduction, combined anterior and posterior procedures, spondylectomy with reduction of L4 to the sacrum (for spondyloptosis), and posterior interbody fusion with trans-sacral fixation. The literature has recently mentioned minimally invasive transforaminal lumbar interbody fusion for high-grade spondylolisthesis. This study aimed to review the recent literature that describes the surgical outcomes associated with various surgical techniques used for high-grade spondylolisthesis. Recent articles were searched on search engines such as PubMed and Google Scholar using keywords such as "high-grade spondylolisthesis," "surgical techniques," and "complications." The surgical management of high-grade spondylolisthesis is an area of significant controversy. The literature is replete with regards to the need for reduction, decompression, levels of fusion, the nature of instrumentation, surgical approaches including open, minimally invasive, and "mini-open" procedures, and various techniques for reducing the slip and fusion strategy. The three basic options of high-grade spondylolisthesis include in-situ fusion, partial reduction and fusion, and complete reduction. Various techniques have been described for high-grade spondylolisthesis. Spine deformity study group classification gives guidelines about balanced and unbalanced pelvis and advises reduction and fusion in case of unbalanced pelvis for correction of biomechanical and global sagittal alignment. Each of the surgical techniques has its advantages and disadvantages. However, individual authors' experience, skill levels, and anatomic reduction with fusion techniques have yielded encouraging results.

Posterior Ankle Impingement: It's Not Only About the Os Trigonum.

Os trigonum and Stieda process are common etiologies for posterior ankle impingement syndrome (PAIS), and diagnosis is typically made by radiographs, computed tomographic, or magnetic resonance imaging. However, these static tests may not detect associated soft tissue and bony pathologies. Posterior ankle and hindfoot arthroscopy (PAHA) is dynamic, providing at least ×8 magnification with full anatomical visualization. The primary aim of this study was to report the prevalence of associated conditions seen with trigonal impingement treated with PAHA. In this retrospective comparative study, patients who underwent PAHA for PAIS due to trigonal impingement, from January 2011 to September 2016, were reviewed. Concomitant open posterior procedures and other indications for PAHA were excluded. Demographic data were collected with pre- and postoperative diagnosis, arthroscopic findings, type of impingement, location, associated procedures, and anatomical etiologies. Trigonal impingements were divided in os trigonal or Stieda and subgrouped as isolated, with flexor hallucis longus (FHL) disorders, with FHL plus other impingement, and with other impingement lesions. A total of 111 ankles were studied-74 os trigonum and 37 Stieda. Isolated trigonal disorders accounted for 15.3% of PAIS (n = 17). Cases having associated conditions had a mode of 3 additional pathologies. FHL disorders were found in 69.4%, subtalar impingement in 32.4%, posteromedial ankle synovitis in 25.2%, posterolateral ankle synovitis in 22.5%, and posterior inferior tibiofibular ligament impingement in 19.8% of cases. Associated pathologies were observed in 58.6% of cases when FHL was not considered. Significant differences were noted comparing os and Stieda (isolated: 20.3% to 5.4%, P = .040; FHL plus others: 35.1% to 59.5%, P = .015). Trigonal bone (os trigonum or Stieda) was found to cause impingement in isolation in a small proportion of cases even when the FHL was considered part of the same disease spectrum. This should alert surgeons when considering removing trigonal impingement. Open approaches may limit the visualization and assessment of associated posterior ankle and subtalar pathoanatomy, thus possibly overlooking concomitant causes of PAIS. Level III, retrospective comparative study.

Arthroscopic Posterior Bone Block Technique for Posterior Shoulder Instability With Glenoid Bone Loss

Background: Posterior instability can be difficult to treat if there is associated bone loss and debate remains about the amount of bone loss that requires intervention. Indications: Arthroscopic posterior bone block technique is useful for recurrent posterior instability with bone loss. It is reserved for patients who have failed soft tissue stabilization with bone loss greater than 10%. Technique Description: After diagnostic arthroscopy, an anterior-superior portal is established. A 30° scope is utilized, although, a 70° scope can be used. The posterior labrum is elevated and dissection is carried along the posterior glenoid neck. If an anterior labral tear is encountered, labral repair is performed. The posterior glenoid is cleared to allow for bone block seating. A fresh, non-frozen distal tibial allograft is prepared to size. Fixation can include screw or button fixation. Other types of fixation can be utilized including tightrope-type fixation, but screws are our preference. We have not had any complications with screw fixation. The graft is predrilled and assembled to the delivery device. A posterior incision is made and dissection is carried under the capsule and labrum to allow for shuttling. The bone block is fixed using two 3.5-mm cannulated screws. After fixation, anchors are placed and remaining capsule and labrum are shifted up to overly the bone block. Postoperative immobilization can be utilized with a standard UltraSling or a gunslinger brace. We typically do not obtain a computed tomography (CT) scan prior to return to activity. Results: There is little literature on arthroscopic posterior bone block, but early results are promising. Distal tibia allograft use in anterior instability has good outcomes and rates of union. Open posterior procedures demonstrate a recurrent dislocation risk of 10%. Current literature supports a similar rate in arthroscopically. Furthermore, there is a learning curve. Complications are similar to open complications, including graft resorption, fixation failure, recurrent dislocation, continued shoulder pain, and glenohumeral arthritis. In our experience, we have not had any wound complications. Discussion/Conclusion: Arthroscopic posterior bone block augmentation presents a reliable technique for posterior instability with associated glenoid bone loss. The use of distal tibia allograft minimizes donor site morbidity. 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.

Transcranial Motor Evoked Potentials as a Predictive Modality for Postoperative Deficit in Cervical Spine Decompression Surgery - A Systematic Review and Meta-Analysis.

Systematic Review and Meta-analysis. The purpose of this study was to evaluate whether transcranial motor evoked potential (TcMEP) alarms can predict postoperative neurologic complications in patients undergoing cervical spine decompression surgery. A meta-analysis of the literature was performed using PubMed, Web of Science, and Embase to retrieve published reports on intraoperative TcMEP monitoring for patients undergoing cervical spine decompression surgery. The sensitivity, specificity, and diagnostic odds ratio (DOR), of overall, reversible, and irreversible TcMEP changes for predicting postoperative neurological deficit were calculated. A subgroup analysis was performed to compare anterior vs posterior approaches. Nineteen studies consisting of 4608 patients were analyzed. The overall incidence of postoperative neurological deficits was 2.58% (119/4608). Overall TcMEP changes had a sensitivity of 56%, specificity of 94%, and DOR of 19.26 for predicting deficit. Reversible and irreversible changes had sensitivities of 16% and 49%, specificities of 95% and 98%, and DORs of 3.54 and 71.74, respectively. In anterior procedures, TcMEP changes had a DOR of 17.57, sensitivity of 49%, and specificity of 94%. In posterior procedures, TcMEP changes had a DOR of 21.01, sensitivity of 55%, and specificity of 94%. TcMEP monitoring has high specificity but low sensitivity for predicting postoperative neurological deficit in cervical spine decompression surgery. Patients with new postoperative neurological deficits were 19 times more likely to have experienced intraoperative TcMEP changes than those without new deficits, with irreversible TcMEP changes indicating a much higher risk of deficit than reversible TcMEP changes.

Reconstruction of complicated spinal tuberculosis with long-segment fibula transplantation: a case report

BackgroundTreating complex cases of spinal tuberculosis (STB) that involve multiple vertebral bodies and cause destruction of the spinal structure, kyphotic deformity, and acute nerve injury can be challenging. This report describes the course of treatment and 5-year follow-up of a complex case of multisegmental STB.Case presentationThis report describes a case of tuberculosis affecting the vertebrae extending from thoracic 12 to lumbar 5 in a 60-year-old woman who suffered sudden paralysis in both lower extremities. The patient underwent emergency posterior paraspinal abscess clearance, laminectomy with spinal decompression. Partial correction of the kyphotic deformity via long-segment fixation from the T9 vertebral body to the ilium in a one-stage posterior procedure. The patient’s neurological status was diagnosed as grade E on the American Spinal Injury Association (ASIA) scale after the one-stage operation. Following standardized 4-combination anti-tuberculosis drug therapy for three months in postoperative patients, the patient underwent two-stage transabdominal anterior abscess removal, partial debridement of the lesion and bilateral fibula graft support. One year after the two-stage operation, the patient’s visual analog scale (VAS) score of back pain was 1 point, and the patient’s erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels returned to normal. Five years after the second-stage operation, the Oswestry disability index (ODI) of patient quality of life was 14 points. There was a 4-degree change in the Cobb angle over five years. During the five-year follow-up period, the grafted fibula did not experience any subsidence.ConclusionFor patients with spinal tuberculosis and acute paralysis, it is essential to relieve spinal cord compression as soon as possible to recover spinal cord function. For lesions that cannot be debrided entirely, although limited debridement combined with anti-tuberculosis drug therapy has the risk of sinus formation and tuberculosis recurrence, it is much safer than the risk of thorough debridement surgery. In this case, an unconventional long-segment fibula graft, pelvis-vertebral support, was an effective reconstruction method.

Comparison of two surgical interventions for lumbar brucella spondylitis in adults: a retrospective analysis

This retrospective study aimed to compare the clinical efficacy of the posterior procedure with the combined anterior and posterior procedure in the surgical management of lumbar Brucella spondylitis. From January 2015 to June 2020, a total of 62 patients presenting with lumbar Brucella spondylitis underwent either one-stage posterior pedicle fixation, debridement, and interbody fusion (Group A, n = 33) or anterior debridement, bone grafting, and posterior instrumentation (Group B, n = 29). All patients were followed up for an average of 25.4 ± 1.5 months and achieved complete resolution of lumbar Brucella spondylitis. No significant differences between the groups were observed in terms of age or pre-operative, three-month postoperative and final follow-up indices of the VAS, ESR, CRP, lordosis angle, ODI scores, fusion time, and time of serum agglutination test conversion to negative (P > 0.05). Each patient exhibited notable improvements in neurological function, as assessed by the JOA score rating system. Group A demonstrated significantly shorter operative duration, intraoperative blood loss, and hospital stay compared to Group B (P < 0.05). Superficial wound infection was observed in one case in Group A, whereas Group B experienced one case each of intraoperative peritoneal rupture, postoperative ileus, iliac vein injury, and superficial wound infection. This study supports the efficacy of both surgical interventions in the treatment of lumbar Brucella spondylitis, with satisfactory outcomes. However, the posterior approach demonstrated advantages, including reduced surgical time, diminished blood loss, shorter hospital stays, and fewer perioperative complications. Consequently, the one-stage posterior pedicle fixation, debridement, and interbody fusion represent a superior treatment option.

Factors Influencing Surgical Decision-Making in the Posterior Laminectomy With Fixation for Degenerative Cervical Myelopathy (POLYFIX-DCM) Trial: Survey Study.

Degenerative cervical myelopathy (DCM) is estimated to affect 2% of the adult population. DCM occurs when degenerative processes cause compression and injure the spinal cord. Surgery to remove the stress caused by the compression of the spinal cord is the mainstay of treatment, with a range of techniques in use. Although various factors are described to inform the selection of these techniques, there needs to be more consensus and limited comparative evidence. The main objective of this survey was to explore the variation of practice and decision-making, with a focus on laminectomy versus laminectomy and fusion in posterior surgery of the cervical spine. We present the results of a survey conducted among the principal investigators (PIs) of the National Institute for Health and Care Research (NIHR) randomized controlled trial on posterior laminectomy with fixation for degenerative cervical myelopathy (POLYFIX-DCM). A series of 7 cases were shared with 24 PIs using SurveyMonkey. Each case consisted of a midsagittal T2-weighted magnetic resonance imaging and lateral cervical x-rays in flexion and extension. Surgeons were asked if their preferred approach was anterior or posterior. If posterior, they were asked whether they preferred to instrument and whether they had the equipoise to randomize in the NIHR POLYFIX-DCM trial. Variability in decision-making was then explored using factors reported to inform decision-making, such as alignment, location of compression, number of levels operated, presence of mobile spondylolisthesis, and patient age. The majority of PIs (16/30, 53%) completed the survey. Overall, PIs favored a posterior approach (12/16, 75%) with instrumentation (75/112, average 66%) and would randomize (67/112, average 62%) most cases. Factors reported to inform decision-making poorly explained variability in responses in both univariate testing and with a multivariate model (R2=0.1). Only surgeon experience of more than 5 years and orthopedic specialty training background were significant predictors, both associated with an anterior approach (odds ratio [OR] 1.255; P=.02 and OR 1.344; P=.007, respectively) and fusion for posterior procedures (OR 0.628; P<.001 and OR 1.344; P<.001, respectively). Surgeon experience also significantly affected the openness to randomize, with those with more than 5 years of experience less likely to randomize (OR -0.68; P<.001). In this representative sample of spine surgeons participating in the POLYFIX-DCM trial as investigators, there is no consensus on surgical strategy, including the role of instrumented fusion following posterior decompression. Overall, this study supports the view that there appears to be a clinical equipoise, and conceptually, a randomized controlled trial appears feasible, which sets the scene for the NIHR POLYFIX-DCM trial.

Uniportal Thoracoscopic Bisegmentectomy of Medial and Posterior Basal Segment (S7+S10)

When a tumor is located in the medial (S7) or posterior (S10) basal segment, it is sometimes necessary to perform a bisegmentectomy of S7 and S10 (S7+S10) to achieve a sufficient surgical margin. In this report, we present surgical techniques for uniportal thoracoscopic S7+S10 bisegmentectomy. The surgical technique consists of anterior and posterior procedures to dissect the basal pulmonary vein. This approach allows en bloc resection of S7+S10 and en bloc preservation of the remaining lobe.