Posterior Surgery Research Articles

Visceral fat: the hidden culprit behind thoracolumbar surgery infections

ObjectiveThis study aimed to explore the relationship between visceral fat area (VFA) and the risk of surgical site infection (SSI) after thoracolumbar posterior surgery.MethodsA retrospective analysis was conducted on 1,491 patients who had undergone posterior thoracolumbar surgery from January 1, 2022, through May 30, 2023. Inclusion criteria were age ≥18 years, undergoing thoracolumbar posterior surgery, and having complete clinical data with a follow-up duration exceeding 1 year. Exclusion criteria included minimally invasive surgery, preoperative infections, traumatic skin injuries, combined tumors, and patients with long-term steroid use or immune system diseases. VFA was measured using CT scans, and patients were categorized based on VFA ≥100 cm2 as having visceral fat obesity. The incidence of SSI was assessed according to the CDC criteria. Logistic regression analysis was used to identify risk factors for SSI.ResultsThe incidence of SSI was 2.4% (36 out of 1,491 patients). Multivariate logistic regression analysis showed that VFA was the most significant predictor of SSI [P < 0.001; Exp(B) = 1.026; 95% CI, 1.013–1.040], indicating a 2.6% increased infection risk per 1 cm2 increase in VFA. Other significant risk factors included BMI [P = 0.024; Exp(B) = 1.138; 95% CI, 1.018–1.273]. Patients with visceral fat obesity had a significantly higher infection rate (5.7% vs. 1.2%, P < 0.001).ConclusionVFA is a significant risk factor for SSI following thoracolumbar posterior surgery. Preoperative assessment of VFA can help identify high-risk patients and guide preventive measures to reduce SSI incidence and improve surgical outcomes.

Ten-Year Clinical Outcomes After Decompression Surgery for Lumbar Spinal Stenosis: The Impact of Preoperative Modic Changes.

Study DesignRetrospective Cohort Study.ObjectiveModic changes (MCs) have been associated with low back pain; however, their prognostic value in surgical outcomes-particularly in patients with lumbar spinal stenosis (LSS) treated with decompression alone-remains unclear. Few studies have investigated the progression and long-term clinical impact of MCs. This study aimed to evaluate the 10-year progression of MCs and their association with clinical outcomes following posterior decompression surgery for LSS.MethodsThis study included 62 patients who underwent posterior decompression for LSS and completed a 10-year follow-up with MRI and clinical assessments. MCs and disc degeneration were evaluated using standardized MRI criteria. Japanese Orthopaedic Association (JOA) scores and recovery rates were assessed preoperatively and at follow-up. Outcomes were compared between Modic-negative patients and those with preoperative Modic Type 1 or Type 2 changes. Analysis of covariance adjusted for confounding variables.ResultsThe prevalence of MCs increased from 37.1% preoperatively to 74.2% at 10years. Type 1 changes were dynamic, often progressing to Type 2 or 3. Type 2 changes were more stable and associated with significantly lower postoperative JOA scores and recovery rates compared to Modic-negative or Type 1 patients (P < 0.05), after adjustment for age, sex, sagittal alignment parameters, and disc degeneration. Type 2MCs were also linked with minimal improvement in back pain.ConclusionModic changes, particularly Type 2, are associated with inferior long-term outcomes. These findings suggest that Modic Type 2 may serve as a prognostic marker of advanced degeneration and may be associated with reduced recovery following decompression surgery.

Safety and efficacy of erector spinae plane block for perioperative analgesia in posterior spinal fusion surgery for pediatric idiopathic scoliosis: a meta-analysis

Safety and efficacy of erector spinae plane block for perioperative analgesia in posterior spinal fusion surgery for pediatric idiopathic scoliosis: a meta-analysis

Scleral perforation during posterior scleral fixation: incidence and management strategies.

To identify the incidence and clinical outcomes of scleral perforation during posterior fixation suture surgery in strabismus patients. This was a retrospective chart review of patients who underwent posterior fixation suture surgery at the Strabismus Unit of Beyoglu Eye Training and Research Hospital between January 2017 and March 2021. Patients with complete ophthalmological records were included. Data collected included surgical indication, visual acuity, and retinal findings. Patients with suspected scleral perforation were evaluated and monitored in collaboration with the vitreoretinal unit. A total of 152 eyes from 121 patients (67 females, 54 males; mean age: 12.3 ± 16.2years, range 2-55) were included. Scleral perforation occurred in 6 patients (3%), all during medial rectus muscle surgery. Three of these cases were treated with argon laser photocoagulation, and three were observed without intervention. No cases developed retinal detachment, endophthalmitis, or vitreous hemorrhage. Final best-corrected visual acuity remained stable in all affected patients. Scleral perforation is an uncommon complication of the posterior fixation suture procedure, with all observed cases limited to medial rectus surgery. Although visual prognosis was favorable, careful intraoperative technique and postoperative monitoring are essential to detect and manage potential complications.

Neck-related disability, headache, and pain intensity after anterior or posterior cervical decompression surgery in individuals with cervical radiculopathy and neck-related headache: a national registry-based study with 2-year follow-up.

Approximately 50% of all individuals with cervical radiculopathy (CR) have headache, but knowledge on neck-related disability, headache, and pain aoof this study was to investigate and compare outcomes of ACDF and PCF regarding neck-related disability, headache, and neck and arm pain in individuals with CR and neck-related headache. This was a registry-based cohort study with prospectively collected data, including 2-year follow-up, using data from the Swedish Spine Registry (Swespine). All individuals with CR and neck-related headache registered in Swespine who underwent either ACDF (n = 2441) or PCF (n = 448) between January 2014 and March 2021 were included. Outcome measures were neck-related disability as measured by the Neck Disability Index (NDI), headache measured by the headache item of the NDI, and neck and arm pain intensity measured on an 11-point numeric rating scale. Patient-reported data were collected preoperatively and at 1- and 2-year follow-up evaluations. Surgeon-reported data regarding the operation were collected soon after the operation. Between- and within-group differences were analyzed for ACDF and PCF using a linear mixed model. Headache decreased to a greater extent preoperatively by the 2-year follow-up evaluation with PCF than with ACDF (p = 0.021). No other significant between-group differences were found at any follow-up. For all outcome measures, there were significant within-group improvements from preoperatively to both the 1- and 2-year follow-up evaluations after ACDF and PCF (p < 0.001). ACDF and PCF decreased headache in individuals with CR and neck-related headache, but PCF appeared to decrease headache more over time. Both interventions also resulted in similar improvements in neck-related disability and neck and arm pain.

Glucocorticoid use in paediatric posterior fossa tumour surgery and the occurrence of postoperative speech impairment

PurposePostoperative speech impairment (POSI) is a core symptom of cerebellar mutism syndrome (CMS) and is a common complication after the resection of paediatric posterior fossa (PF) tumours. Preoperative glucocorticoids (pGC) are considered standard treatment to reduce tumour oedema; in addition, glucocorticoids are often administered intraoperatively (iGC) to reduce both postoperative nausea and vomiting. The study aims to investigate whether the occurrence of POSI may be associated with pGC and iGC.MethodsIn a prospective observational multicentre study, we included children with a PF tumour requiring either resection or open biopsy. The use of pGC and iGC, including drug type and dose, was registered. Postoperative speech status was classified as mutism, reduced speech, or habitual speech, where mutism and reduced speech were considered POSI of higher and lower severity, respectively. Proportional odds logistic regression with adjustment for tumour type, tumour location, and age was used to analyse the occurrence of POSI associated with glucocorticoids (GC).ResultsFrom August 2014 to November 2024, we recruited 810 children, of whom 605 were included in the primary analysis. We found no association between the use of GC (pGC nor iGC) and the occurrence of POSI. The result did not change when adjusting for tumour type, tumour location, and age. The analysis included both a comparison between using and not using pGC (OR 1.06 [95% CI 0.46 –2.49], reference level: use of pGC) and/or iGC (1.28 [0.58–2.82], reference level: use of iGC), and a dose–response analysis of the occurrence of POSI in relation to doubling the dose of GC (pGC OR 1.28 [0.84–1.98]; iGC OR 1.07 [0.62–1.82]).ConclusionOur study did not find evidence of a significant change in the occurrence of POSI with the use of pGC or iGC, but our results alone cannot rule out that the administration of pGC or iGC may have some effect. Therefore, our data do not call for a change in recommendations for the use of GC as protection against the development of POSI.Trial registration number: Clinicaltrials.gov (NCT02300766). Date of registration: November 25, 2014

Multistage correction of severe kyphoscoliosis and pulmonary compromise in adults through combined halo-pelvic traction and posterior spinal techniques

Patients with kyphoscoliosis can present with a variety of chief complaints, including axial back pain, concerns about cosmesis, progressively worsening respiratory function, and even neurological deficits. Correction of severe adult kyphoscoliosis remains challenging due to the severity of the deformity and poor cardiopulmonary function. Direct one-stage corrective surgery can lead to enormous complications and unsatisfactory outcomes when dealing with patients with severe kyphoscoliosis. Preoperative halo-pelvic traction (HPT) has become popular in the management of severe scoliosis. The present study aimed to summarize the efficacy and safety of the staged strategy. Patients with severe kyphoscoliosis complicated by severe pulmonary impairment who underwent staged treatment and met the inclusion and exclusion criteria from Jan 2019 to Jan 2020 were retrospectively reviewed. Data including patient demographics, major coronal curve and kyphosis, pulmonary function test results, distraction time, and complications at different stages of treatment were recorded. Twenty-three patients (16 male and 7 female) with severe kyphoscoliosis and severe pulmonary impairment were included in the study. The mean age of these patients was 26.2 ± 5.7 years. The mean duration of traction before posterior release surgery was 4.0 ± 1.0 months and 4.4 ± 1.0 months after posterior release surgery. Mean follow-up was 40.4 ± 3.9 months. The main curve and kyphosis at admission were 145 ± 11.8° and 149 ± 21.7°, respectively. After HPT, the main curve and kyphosis decreased to 114 ± 12.3° and 124 ± 22.9°, respectively. The FVC and FVC% at admission were 1.44 ± 0.63 L and 39.0 ± 16.19%, respectively. The FVC and FVC% improved significantly after HPT. According to the Nash-Moe classification, the rotation of the apical vertebrae was grade IV in all patients, and the rotation did not improve during the traction. The operative time for posterior release was 266 ± 49 min. The average bleeding of posterior release was 600 ± 242 ml. HPT was maintained after the posterior release surgery. The mean operating time of the posterior correction surgery was 588 ± 53 min, and the mean bleeding was 1605 ± 313 ml. Correction rates were 56.6% and 68.5% in the coronal and sagittal planes, respectively. Staged treatment is an effective and safe strategy to correct severe kyphoscoliosis complicated by severe pulmonary impairment. Preoperative HPT combined with posterior release surgery can significantly reduce spinal deformity and improve pulmonary function. Posterior vertebra column resection (PVCR) is an effective technique for correcting kyphoscoliosis, but it is a technically demanding procedure.

From colonizer to culprit: genomic and clinical insights into S. epidermidis from post-surgical endophthalmitis.

To describe the clinical characteristics of exogenous episodes of endophthalmitis from which Staphylococcus epidermidis was isolated by vitreous cultures. We also explored the genomic traits of these S. epidermidis isolates and their relatedness to S. epidermidis originating from carriers and from prosthetic joint infections in the same geographical region. S. epidermidis isolated from cases of exogenous endophthalmitis (n = 33) were genome sequenced. Clinical features were retrospectively collected from medical records. The isolates were compared with previously sequenced S. epidermidis isolates from the nares of healthy individuals (n = 151) and from prosthetic joint infections (n = 138). The most common ophthalmological procedure preceding the endophthalmitis was a posterior segment surgery (76%; 25/33), mainly intravitreal injection (70%; 23/33). These patients displayed a significantly shorter time to symptoms compared to those with an anterior segment surgery (median 3 vs. 9 days; p < 0.001), and significantly less phenotypic methicillin resistance (8%, n = 2/25 vs. 50%, n = 4/8; p = 0.02). Most isolates of S. epidermidis originating from endophthalmitis cases did not belong to known healthcare-associated lineages and did not cluster with isolates from prosthetic joint infections. Rather, they were more similar to isolates from the nares of healthy individuals. Genomic data suggest that the S. epidermidis isolated from the vitreous of Swedish cases of postsurgical endophthalmitis may originate from the commensal flora of the individual, and not from the healthcare facilities. The type of preceding surgical procedure (anterior vs. posterior segment) may influence both symptom delay and the presence or absence of methicillin resistance.

Morphometric Assessment of Greater Palatine Canal and Foramen Variations in Cleft Lip and Palate Patients Using CBCT.

Morphometric Assessment of Greater Palatine Canal and Foramen Variations in Cleft Lip and Palate Patients Using CBCT.

Machine learning algorithms for prediction of cerebrospinal fluid leakage after posterior surgery for thoracic ossification of the ligamentum flavum

To develop and validate a machine-learning (ML) model that pre-operatively predicts cerebrospinal-fluid leakage (CSFL) after posterior decompression for thoracic ossification of the ligamentum flavum (TOLF), and to elucidate the key risk factors driving model decisions. Electronic medical-record and imaging data of 318 consecutive TOLF patients who underwent laminectomy between January 2009 and June 2023 were retrospectively analysed (CSFL = 101, 31.8%). The cohort was randomly split 4:1 into training (n = 254) and testing (n = 64) sets. Class imbalance was addressed with two synthetic oversampling techniques, SMOTE and ADASYN. A baseline logistic-regression (LR) model and four ML algorithms—XGBoost, Random Forest, LightGBM and Support Vector Machine (SVM)—were tuned via Bayesian optimisation. Primary endpoints were F1-score and recall; secondary metrics included AUC, accuracy, calibration curves and Brier scores. Probabilities were recalibrated with Platt Scaling and Isotonic Regression, and model interpretability was assessed with SHAP and LIME. Under SMOTE, SVM achieved the best overall performance (F1 = 0.889, recall = 0.881); its Brier score improved to 0.103 after Isotonic Regression. Feature-attribution analyses consistently identified multi-segment involvement, residual spinal-canal area (RrSCA) and related diametric ratios (RrPD, RrDCM), operative time, and intra-operative blood loss as the strongest predictors of postoperative CSFL. A SMOTE-enhanced, isotonic-calibrated SVM provides accurate and reliable CSFL risk estimation in TOLF patients and is freely available as an online tool (https://github.com/DebtVC2022/CSFL_predict). The model supports preoperative risk stratification, patient counselling, and peri-operative management, yet requires prospective, multicentre validation to establish broad clinical utility.

Autograft vs. Xenograft Duraplasty Using the Onlay Technique in Pediatric Posterior Fossa Tumor Surgery: A Comparative Analysis.

Background/Objectives: We aimed to review pediatric patients who underwent surgical treatment for posterior fossa tumors and to share our experience with the various types of dural grafts used in these patients. Methods: We carried out a retrospective study on pediatric patients who received surgical treatment for posterior fossa tumors and underwent duraplasty using either an autograft or a xenograft from January 2018 to December 2022. Data were gathered from patients' medical records, encompassing demographic details. Additional information included tumor locations and the extent of resection. Factors such as postoperative complications like meningitis, pseudo-meningocele, and hydrocephalus were also noted. Results: Our cohort included 50 patients, 13 of whom underwent surgeries with autografts and 37 had xenografts. The patients' tumors were in various areas, including intraventricular or those extending into the ventricle (31) and intracerebellar (17) and extra-axial (2) cases. Subtotal resection occurred in 8 cases, near-total resection in 9, and gross-total resection in 33. Postoperatively, meningitis occurred in 12 patients, pseudo-meningocele in 13, and hydrocephalus in 10, with 9 requiring V/P placement. Conclusions: In conclusion, techniques for dural closure hold great significance in neurosurgery, particularly during pediatric posterior fossa surgeries. Although the modest size of the autograft cohort limited statistical power, our epidural onlay fascia lata autograft produced fewer postoperative complications than the bovine xenograft and achieved outcomes comparable to those reported for watertight closure.

A randomized clinical trial of erector spinae plane block and chronic pain after posterior lumbar surgery

The effectiveness of erector spinae plane block (ESPB) in preventing chronic pain after posterior lumbar surgery remains controversial. The primary hypothesis of this study was that ESPB reduces the incidence of chronic pain for 3 months after posterior lumbar surgery. In this prospective, randomized, parallel-group study, a total of 120 patients who underwent open posterior lumbar decompression surgery under general anesthesia were randomized into two groups. The ESPB group underwent preoperative bilateral ESPB, and the control group did not receive the block. The primary outcome was the incidence of chronic pain at 3 months after surgery. The secondary outcomes included postoperative morphine consumption, time to first ambulation after surgery, length of hospital stay and incidence of chronic pain at 6 months after surgery. At 3 months, chronic pain was reported in 21/56 (37.5%) and 28/58 (48.3%) patients in the ESPB and control groups, respectively (OR = 1.6; 95% CI, 0.7–3.3; p = 0.245). The ESPB group had less postoperative morphine consumption (p < 0.001) and a shorter time to first ambulation after surgery (p = 0.006) than the control group did. The length of hospital stay was similar. There was also no difference in the incidence of chronic pain at 6 months. ESPB did not reduce the incidence of chronic pain after posterior lumbar surgery, but it did facilitate early recovery after surgery.

Hirayama and Granuloma—The Affinity Saga

Abstract Foreign-body granulomas secondary to synthetic materials used in neurosurgery are common. It has been reported that most of them occur after brain surgery than spinal surgery. Hirayama disease, which presents as a slow progressive upper limb muscle weakness and subsequently atrophy, obligates surgical intervention when the conservative management fails. It is managed by posterior cervical surgery followed by dural repair, while anterior cervical surgery is also an option. The component present in duroplasty material, ReDura, may cause exuberant granuloma formation. Foreign-body granuloma at the site of dural repair secondary to the synthetic dural component can cause spinal cord compression worsening the symptoms, requiring surgery. We hereby report a case of a young male with Hirayama disease who underwent posterior cervical surgery followed by duroplasty. The mass effect by the granuloma, secondary to dural repair, was relieved surgically and patient improved neurologically.

ENDOTHELIAL CELL LOSS AFTER PARS PLANA VITRECTOMY WITH SILICONE OIL TAMPONADE

Purpose: To compare the rate of endothelial cell density (ECD) loss in patients undergoing pars plana vitrectomy (PPV) with silicone oil (SO) tamponade, focusing on differences between rhegmatogenous retinal detachment (RRD) and tractional retinal detachment (TRD) cases. Methods: A retrospective analysis was conducted on 427 eyes from patients with RRD (n = 293) and TRD (n = 134) who underwent PPV with SO tamponade. Endothelial cell density changes were recorded, and the impact of factors such as age, gender, surgical technique, SO emulsification, tamponade duration, and postoperative intraocular pressure were evaluated using univariate and multivariate regression models. Results: Patients with TRD showed a significantly higher ECD loss (9.17%) compared with patients with RRD (3.39%). Endothelial cell density loss was particularly severe in patients undergoing combined anterior and posterior surgeries, as the vitrectomy in combination with phacoemulsification group showed a loss of 6.85% and the intraocular lens group exhibited 6.48%. Multivariate regression revealed a 1% increase in ECD loss for every 8-year increase in age (P = 0.006). No significant correlation between transient high intraocular pressure and ECD loss. Conclusion: Patients with TRD are at greater risk of ECD loss after PPV with SO tamponade, particularly in cases involving combined surgeries. Advanced age and the absence of a natural lens were associated with greater ECD loss. Maintaining postoperative intraocular pressure below 40 mmHg is considered safe for ECD. Further investigation into the mechanisms of SO-related endothelial damage is needed.

Post-Nephrectomy Lumbar Hernia: A Rare Case and Surgical Repair Using Posterior Component Separation Technique

Lumbar hernia, a rare abdominal wall defect, usually present following surgery. We describe a case of a 50-year-old obese woman who presented with a gradually progressive, reducible swelling in the left lumbar region. One year back, she had undergone open nephrectomy for staghorn calculus. Progressively, the swelling became irreducible over the past month, necessitating further evaluation. Clinical examination along with contrast-enhanced CT suggested a left-sided posterolateral abdominal wall defect (11×9 cm) with small and large bowel loop herniation and absence bowel strangulation. Based on the findings and large defect size, posterior component separation surgery was done with lightweight polypropylene mesh placed retromuscularly and secondary mesh repair for external oblique aponeurosis. The patient had an uneventful postoperative course and was asymptomatic with no recurrence at 5-month follow-up. This case emphasizes the criticality of early diagnosis and customized surgical repair in the management of lumbar hernias following a nephrectomy

External validation of a machine learning prediction model for massive blood loss during surgery for spinal metastases: a multi-institutional study using 880 patients.

External validation of a machine learning prediction model for massive blood loss during surgery for spinal metastases: a multi-institutional study using 880 patients.

Changes in cervical sagittal parameters and the impact on axial symptoms after two types of posterior single-door cervical decompression surgeries.

Changes in cervical sagittal parameters and the impact on axial symptoms after two types of posterior single-door cervical decompression surgeries.

Choosing the right treatment for degenerative cervical myelopathy.

Choosing the right treatment for degenerative cervical myelopathy.

Proximal Thoracic Alignment Change Influences Cervical Sagittal Alignment After Correction Surgery in Patients With Lenke Type 2 Adolescent Idiopathic Scoliosis.

To examine the factors influencing cervical sagittal alignment (CSA) after posterior correction and fusion surgery (PSF) for patients with Lenke type 2 adolescent idiopathic scoliosis (AIS). A total of 102 female patients with Lenke 2 AIS and a minimum 2-year follow-up were included. The upper instrumented vertebra was T2 in all patients. Sagittal and coronal parameters were measured before and 2 years after surgery. Patients were categorized into cervical malalignment (CM) and noncervical malalignment (NCM) groups following Passias' criteria. Radiographic factors influencing CSA were analyzed. Preoperatively, 57 patients (55.9%) were assigned to the CM group and 45 patients (44.1%) to the NCM groups. The cervical lordosis (CL) in CM group was more kyphotic (19.3° vs. 3.3°), smaller proximal thoracic kyphosis (PTK; 9.7° vs. 15.4°), and smaller T1 slope (7.1° vs. 14.0°) than those in the NCM group. Main thoracic kyphosis (MTK) did not show significantly difference between the 2 groups (11.3° vs. 14.4°). Two years after surgery, the CM group demonstrated significant improvements in CSA. PTK increased from 9.7° to 13.5°, T1 slope increased from 7.1° to 10.5°, and cervical kyphosis improved from -19.3° to -8.8°, while MTK remained unchanged (11.3° vs. 11.6°). PSF significantly improved CSA in patients with preoperative CM. Increased PTK, correlated with improved CL, suggests that PSF-induced PTK enhancement, rather than MTK, drives T1 slope and subsequent CSA improvement.

Comparative analysis of facial nerve outcomes in petroclival versus posterior petrous meningioma surgery: A systematic review and meta-analysis of 2884 patients.

Comparative analysis of facial nerve outcomes in petroclival versus posterior petrous meningioma surgery: A systematic review and meta-analysis of 2884 patients.