Thoracic Spine Surgery Research Articles

Negative Pressure Wound Therapy: An Analysis of Its Effectiveness on the Reduction of Postoperative Infection in Posterior Spine Surgery.

Negative pressure wound therapy (NPWT) has been used for postsurgical wound management across various disciplines, including spinal surgery. However, its efficacy in reducing wound infection rates after posterior thoracolumbar spine surgery remains uncertain. A retrospective review was conducted at a single institution, examining 266 patients who underwent posterior thoracic, lumbar, or thoracolumbar spine surgery performed by 1 neurosurgeon. Data included NPWT usage, type of surgery, infection rates, prior spinal surgeries, demographics, comorbidities, smoking status, and immune profiles. Statistical analysis was performed to evaluate correlations. Of the 266 patients, 122 (46%) were males, 144 (54%) were females, and 213 (80%) were Black. Patients had a mean age of 56.4 years and an average body mass index of 29.6 kg/m2. NPWT was applied to 153 patients (57.5%). Postoperative wound infections occurred in 35 patients (13%), with 19 (54%) in the NPWT group. Overall, NPWT use was not associated with a statistically significant reduction in infection rates (P= 0.69). However, analysis of patients with multiple comorbidities showed a significant decrease in infections with NPWT (P < 0.01). A total of 198 patients (74.4%) had at least 1 comorbidity, and 10.1% (n= 20) had 2 or more major comorbidities. NPWT significantly reduced infection rates in patients with multiple comorbidities, suggesting its potential benefit in managing wound infections in this subgroup. This finding is particularly relevant for an urban, minority patient population, highlighting the importance of tailored wound care strategies.

Accuracy of Pedicle Screw Placement Using the ExcelsiusGPS Robotic Navigation Platform: An Analysis of 728 Screws.

Robotic platforms have increased in sophistication for pedicle screw placement. Here, we review our institutional experience using ExcelsiusGPS to assess the accuracy rate of pedicle screw placement throughout the spine and characterize predictors of placement inaccuracy. Retrospective cohort study. Patients from 2017 to 2022 undergoing spinal fusion surgery with ExelsiusGPS-assisted screw implantation at a single tertiary center were retrospectively identified. Patient demographics, preoperative symptoms, and operative details were collected. Postoperative computed tomography was used to classify screw placement accuracy according to the Gertzbein and Robbins scale (GRS). A stepwise multivariable ordered logistic regression analysis determined independent risk factors for clinically inaccurate screws (GRS C/D/E). One hundred and seventeen patients were included. Mean age was 60.6 ± 13.2 years, with 57% men, 72% white, and mean body mass index of 29.9 ± 6.4 kg/m2. Seven hundred and twenty-eight screws were placed, predominantly in the thoracic (29.5%) and lumbar (52.6%) regions. Accuracy classification indicated 670 GRS A, 31 GRS B, 22 GRS C, 4 GRS D, and 1 GRS E screws. The clinically acceptable screw placement rate (GRS A/B) was 96%. Male gender (odds ratio [OR]: 2.12, P = 0.03), revision surgery (OR: 2.43, P = 0.02), and thoracic level screw insertion (OR: 2.33, P = 0.01) were independently associated with inaccurate screw placement and explained 8.7% of the variability seen. Of the 728 screws placed, 3 required revision after postoperative imaging revealed loosening or pedicle breach. ExcelsiusGPS-assisted screw insertion has high placement accuracy and low revision rates. Identification of predictors of inaccuracy illustrates that similar variables, such as placement in the thoracic spine and revision surgery status, apply to both freehand and robotic screw placement. Robotic spine surgery is an accurate, reliable tool that can improve patient outcomes. Factors like male gender, thoracic screw placement, and revision surgery status are associated with lower screw placement accuracy, and these factors should inform surgical decision-making when using robotic assistance.

Clinical study of percutaneous endoscopic thoracic spine surgery via trench technique for thoracic spinal cord ventral decompression

To evaluate the feasibility, safety, and early effectiveness of percutaneous endoscopic thoracic spine surgery via the trench technique for ventral decompression in central calcified thoracic disc herniation (CCTDH) and thoracic ossification of the posterior longitudinal ligament (T-OPLL). Seven patients with single-segment CCTDH or T-OPLL admitted between June 2017 and May 2020 and meeting the selection criteria were retrospectively analyzed. There were 3 males and 4 females with an average age of 51.7 years ranging from 41 to 62 years. There were 2 patients with T-OPLL (T 1, 2 in 2 cases) and 5 patients with CCTDH (T 1, 2 in 1 case, T 7, 8 in 1 case, T 10, 11 in 2 cases, T 11, 12 in 1 case). Five patients with thoracic axial pain and intercostal neuralgia had a preoperative visual analogue scale (VAS) score of 6.0 (5.0, 6.5), and 7 patients had a preoperative Japanese Orthopaedic Association (JOA) score of 21 (21.0, 22.0). Transforaminal approach was used in 4 cases and transpedicular approach in 3 cases. Ventral decompression of thoracic spinal cord was performed by thoracic endoscopy combined with trench technique. The operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications were recorded. Thoracic spine CT and MRI were performed preoperatively and postoperatively to evaluate the surgical decompression, VAS score was used to evaluate the pain of thoracic back and lower limbs, and JOA score was used to evaluate the functional recovery. Modified MacNab criteria was used to evaluate the effectiveness. All surgeries were successfully completed. The operation time ranged from 60 to 100 minutes, with an average of 80.4 minutes; the intraoperative blood loss ranged from 40 to 75 mL, with an average of 57.1 mL; the postoperative hospital stay ranged from 4 to 7 days, with an average of 5.4 days. CT and MRI examinations indicated that the decompression was adequate. All 7 patients were followed up 3-22 months, with an average of 13.3 months. One case developed postoperative wound infection, and 1 case developed pneumonia; the remaining patients did not have any complications such as wound infection or cerebrospinal fluid leakage. Five patients with thoracic axial pain and intercostal neuralgia had VAS scores of 2.0 (1.5, 2.5) at 1 day after operation and 2.0 (1.0, 2.0) at last follow-up, both of which were significantly lower than the preoperative scores ( P<0.05). At 1 day after operation, the JOA scores for all 7 patients were 22.0 (21.0, 24.0), which showed no significant difference compared to the preoperative score ( P>0.05); however, at last follow-up, the score improved to 24.0 (24.0, 26.0), which was significant compared to the preoperative scores ( P<0.05). At last follow-up, the effectiveness was assessed using the modified MacNab criteria, the results were excellent in 2 cases, good in 3 cases, fair in 2 cases, and the excellent and good rate was 71.4%. Using the trench technique, percutaneous endoscopic thoracic spine surgery can achieve the ventral decompression in CCTDH and T-OPLL, providing a new approach for surgical treatment of CCTDH and T-OPLL.

Does Post-Tetanic Transcranial Stimulation Augment the Wave Amplitudes of Spinal Cord Evoked Potential (Tc-SCEP)?

Prospective within-subjects study. Although motor-evoked potential (MEP) amplitude can reportedly be increased by tetanic stimulation of the peripheral nerves before transcranial electrical stimulation (TES), no reports have described on whether tetanic transcranial stimulation augments the wave amplitudes of spinal cord-evoked potentials (Tc-SCEP). The primary purpose of this study was to investigate whether tetanic stimulation induces waveform amplification of Tc-SCEP. The secondary purpose was to elucidate the mechanism of the amplification effect of tetanic stimulation. We recruited 20 patients who underwent cervical or thoracic spine surgeries. We compared the compound muscle active potentials (CMAPs) of Tc-MEP and Tc-SCEP before and after tetanic stimulation of the median or tibial nerve. Although the CMAP wave amplitudes of the abductor pollicis brevis (APB) and abductor hallucis (AH) showed significant enlargement on Tc-MEP following tetanic stimulation of the median and tibial nerves, an augmentation effect regarding Tc-SCEP (203μV [without tetanic stimulation], 212μV [tetanic stimulation of the median nerve], and 208μV [tetanic stimulation of tibial nerve]) could not be demonstrated. Although MEP amplitudes can be enlarged by tetanic stimulation of the peripheral nerves, the amplification mechanism may not involve the lateral corticospinal tract from the brain stem to the anterior horn.

Accuracy and Safety of Freehand Placement of Upper Thoracic Pedicle Screws Supported Solely by Anteroposterior, i.e., Frontal, X-Ray Fluoroscopy (C-Arm): Technical Note Including 23 Patients

IntroductionThe biomechanical resistance and the surgical morbidity of spinal posterior pedicle screw fixation relies on the intraosseous position of the implants. Upper thoracic pedicle screws are particularly demanding given their convergence and thin character. We present our experience as military surgeons of free hand placement of upper thoracic pedicle screws supported by antero-posterior, i.e. frontal X-ray fluoroscopy solely. Materials and methodsMonocentric retrospective analysis at Sainte-Anne Military Teaching Hospital between 2017 and 2024 of patients operated on using upper thoracic pedicle screws (levels T1 to T5) using antero-posterior fluoroscopy solely. Results23 patients were included (mean age 59, male/female 3.6), 16 traumas and 7 neoplastic lesions), with 15 cervicothoracic junction fixation and 8 upper thoracic spine surgeries. 124 screws were inserted (T1 to T5). 85% (106/124) were graded 0 (Gertzbein-Robbins scale) whereas 14.5% (18/124) displayed some degree of misplacement (grade 1 to 3): all the T1 screws (22/22) were accurately placed compared to 83% (20/24) of T2 screws, 88% (30/34) of T3 screws, 85% (17/20) of T4 screws, and finally 71% (17/24) of T5 screws, without any clinical consequences. There were 3 surgical revisions (1 asymptomatic misplaced screw, 2 mechanical failures in trauma). Last, 92.7% (n=51/55) of the screws inserted during working hours were accurately placed compared to 79.7% (n=55/69) during after-hours surgeries (p=0.039) ConclusionClinically speaking, placement of upper thoracic pedicle screws using antero-posterior fluoroscopy solely appears safe. The surgical technique is simple enough to be used in strained resources settings such as a mobile field surgical team.

Delayed chylous fluid leakage at the surgical site following thoracic corpectomy via a lateral extracavitary approach: illustrative case.

Chylous fluid leakage following spinal surgery is a rare and potentially difficult-to-manage complication that can lead to wound complications, pain, or nutritional deficiencies. Although the thoracic duct is localized near the thoracic spine, reports of thoracic duct injuries secondary to posterior thoracic spine surgery are rare. The authors present the case of a 57-year-old male with a known history of metastatic renal cell carcinoma to the thoracic spine who had undergone a thoracolumbar fusion with thoracic corpectomy and presented with concern for a chyle leak almost a year after his surgery. The patient had a complicated oncological history and underwent decompression and fusion to treat his significant thoracic metastatic disease. A year later, he presented with back pain and a significant fluid collection at the surgical site, which was drained and found to be consistent with chyle. The patient was treated conservatively, and imaging of the thoracic duct a few months later demonstrated no direct injury, likely indicating either transient injury or potential obstruction of the thoracic duct from metastatic disease. This case demonstrates a rare, potential complication when treating extensive thoracic metastatic disease as well as the workup and potential treatments when facing thoracic duct injury. https://thejns.org/doi/10.3171/CASE24280.

Analysis of risk factors for postoperative delirium in elderly patients undergoing spinal surgery

To investigate the risk factors of postoperative delirium in elderly patients undergoing spine surgery. The basic case data of 566 patients who underwent spine surgery under general anesthesia from January 2021 to January 2023 were retrospectively analyzed. There were 296 males and 270 females with an average age of (71.58 ± 4.21) years old. There were 195 cases of cervical spine surgery, 26 cases of thoracic spine surgery and 345 cases of lumbar spine surgery.According to the occurrence of postoperative delirium, the patients were divided into postoperative delirium group(41 patients) and non-delirium group (525 patients). Univariate analysis was used to analyze the possible influencing factors such as gender, age, weight, smoking history, drinking history, surgical site, preoperative anxiety, intraoperative hypotension times, blood loss and so on, and binary Logistic regression was used to analyze the univariate factors with P<0.05. A total of 41 patients developed postoperative delirium. Univariate analysis showed that age (P=0.000), duration of surgery (P=0.039), preoperative anxiety (P=0.001), blood loss (P=0.000), history of opioid use (P=0.003), history of stroke (P=0.005), C-reactive protein (P=0.000), sodium ion(P=0.000) were significantly different between delirium group and non-delirium group. These factors were included in the binary Logistic regression analysis, and the results showed that age [OR=0.729, 95%CI(0.569, 0.932), P=0.012], opioid use [OR=21.500, 95%CI(1.334, 346.508), P=0.031], blood loss [OR=0.932, 95%CI(0.875, 0.993), P=0.029], C-reactive protein [OR=0.657, 95%CI(0.485, 0.890), P=0.007], preoperative anxiety [OR=23.143, 95%CI(1.859, 288.090), P=0.015], and sodium [OR=1.228, 95%CI(1.032, 1.461), P=0.020] were independent risk factors for the development of delirium after spinal surgery in elderly patients. Age, opioid use, blood loss, preoperative anxiety, elevated c-reactive protein, and hyponatremia are independent risk factors for the development of postoperative delirium in elderly patients undergoing spinal surgery.

Short-term assessment of functional outcomes and quality of life after thoracic and lumbar spinal metastasis surgery.

Because of improvements in initial tumor identification and treatment, as well as longer life expectancies, more people are receiving diagnoses for spinal metastases. The aim of this study was to assess early functional outcomes and quality of life (QOL) after surgical management of patients with spinal metastases. In this prospective cohort study, a total of 33 patients with thoracic and lumbar spine metastases who underwent surgical management between November 2021 and August 2023 were followed up for 1 year or until death. Oswestry Disability Index and the Eastern Cooperative Oncology Group Performance Status were used for the functional outcome; QOL was assessed using European Quality of Life 5-Dimensions (EuroQOL-5D). Scores were recorded preoperatively, 4 weeks postoperatively, and 6 and 12 months postoperatively. The mean age was 52.12 ± 13.4 years (range: 23-70 years), 22 (66.7%) were females, and 11 (33.3%) were males. Patients were divided into three groups according to the revised Katagiri score: 12 (36.4%) patients were at low risk (0-3), 18 (54.5%) patients were at intermediate risk (4-6), and 3 (9.1%) patients were at high risk (7-10). The mean survival was 5.44 ± 3.46 months (range 1-13), and there was no perioperative death (within 1 month postoperative). Sixteen (48.5%) patients survived for more than 1 year and 17 (51.5%) patients died from different causes related to the natural history of tumor metastasis. Following surgical treatment of the spinal metastases, improvements in QoL and functional results were seen in the short-term. For patients with a projected life expectancy of longer than 3 months, surgery is a good alternative.

Assessing the Accuracy and Safety Thresholds of Patient-Specific Screw Guide Template System in Cervical and Thoracic Spine Surgeries Using DAST Measurements.

To analyze the reliability of the newly developed patient-specific Screw Guide Template (SGT) system as an intraoperative navigation device for spinal screw insertion. We attempted to place 428 screws for 51 patients. The accuracy of the screw track was assessed by deviation of the screw axis from the preplanned trajectory on postoperative CT. The safety of the screw insertion was evaluated by the bone breach of the screw. The bone diameter available for screw trajectory (DAST) was measured, and the relations to the bone breach were analyzed. In the inserted screws, 98.4% were defined as accurate, and 94.6% were contained in the target bone. In the cervical spine, the screw deviation between breaching (0.57 mm) and contained screws (0.43 mm) did not significantly differ, whereas DAST for breaching screws (3.62 mm) was significantly smaller than contained screws (5.33 mm) (p<0.001). Cervical screws with ≥4.0 mm DAST showed a significantly lower incidence of bone breach (0.4%) than ≤3.9 mm DAST (28.3%) (p<0.001). In the thoracic spine, screw deviation and DAST had significant differences between breaching (1.54 mm, 4.41 mm) and contained (0.75 mm, 6.07 mm) (p<0.001). The incidence of the breach was significantly lower in thoracic screws with ≥5.0 mm (1.9%) than ≤4.9 (21.9%) DAST (p<0.001). This study demonstrated that our SGT system could support precise screw insertion for 98.4% accuracy and 94.6% safety. DAST was recommended to be ≥4.0 and ≥5.0 mm in the cervical and thoracic spines for safe screw insertion.

Differences in the Demographics and Clinical Characteristics between the Ossification of the Posterior Longitudinal Ligament and Ossification of the Ligamentum Flavum in Patients Who Underwent Thoracic Spinal Surgery for Compressive Myelopathy.

Ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) are related diseases associated with the ossification of spinal ligaments that can occasionally lead to thoracic myelopathy. We retrospectively analyzed the clinical data of 34 consecutive patients who underwent thoracic spinal surgeries for OPLL and/or OLF at our hospital between July 2010 and June 2022, and statistically compared data between patients with thoracic OPLL (TOPLL; n = 12) and those with thoracic OLF (TOLF; n = 22). The mean age of the TOPLL group was significantly lower than that of the TOLF group (53.7 vs. 68.4 years). The TOPLL group exhibited a greater female predominance than the TOLF group (58.3% vs. 18.2%). The median body mass index of the TOPLL group was significantly higher than that of the TOLF group (33.0 vs. 26.0 kg/m2). Patients with TOPLL significantly required instrumented fusion and repetitive surgical intervention more than those with TOLF (83.3% vs. 9.1%; 50.0% vs. 0.0%). Although neurological deterioration just after the intervention was more common in patients with TOPLL (41.7% vs. 4.6%), no difference was observed in thoracic Japanese Orthopaedic Association score and recovery rate in the chronic phase between TOPLL and TOLF. The TOPLL group had a younger onset, female dominance, and a greater degree of obesity when compared with the TOLF group. The surgery for TOPLL is challenging, considering that it requires long-range decompression and fusion, subsequent operations, careful management, and long-term follow-up, when compared to TOLF, which necessitates only simple decompression.

Postoperative Thoracic Cord Compression Induced by a Dural Sealant System (DuraSeal®): A Case Report and Literature Review

Cerebrospinal fluid (CSF) leakage is a rare complication that can occur due to dural defects during spinal surgery, hindering the improvement of the surgical site and increasing the possibility of infection. DuraSeal® is a dural sealing adhesive that prevents CSF leakage and is used as an adjunct to enable the watertight repair of dural defects when the dura is damaged during spinal surgery. In the present case, DuraSeal® was applied to repair a dural defect in the surgical area after thoracic spine surgery, and no neurological problems occurred immediately after surgery. However, a day later, the patient’s paraparesis worsened; therefore, reoperation was performed and the symptoms improved.

Differences in microorganisms causing infection after cranial and spinal surgeries.

The primary aim of this retrospective study was to assess differences in the pathogens causing surgical site infections (SSIs) following craniectomies/craniotomies and open spinal surgery. The secondary aim was to assess differences in rates of SSI among these operative procedures. ANOVA tests with Bonferroni correction and incidence risk ratios (RRs) were used to identify differences in pathogens by surgical site and procedure using retrospective, de-identified records of 19,993 postneurosurgical patients treated between 2007 and 2020. The overall infection rates for craniotomy/craniectomy, laminectomy, and fusion were 2.1%, 1.1%, and 1.5%, respectively, and overall infection rates for cervical, thoracic, and lumbar spine surgery were 0.3%, 1.6%, and 1.9%, respectively. Craniotomy/craniectomy was more likely to result in an SSI than spine surgery (RR 1.8, 95% CI 1.4-2.2, p < 0.0001). Cutibacterium acnes (RR 24.2, 95% CI 7.3-80.0, p < 0.0001); coagulase-negative staphylococci (CoNS) (methicillin-susceptible CoNS: RR 2.9, 95% CI 1.6-5.4, p = 0.0006; methicillin-resistant CoNS: RR 5.6, 95% CI 1.4-22.3, p = 0.02); Klebsiella aerogenes (RR 6.5, 95% CI 1.7-25.1, p = 0.0003); Serratia marcescens (RR 2.4, 95% CI 1.1-7.1, p = 0.01); Enterobacter cloacae (RR 3.1, 95% CI 1.2-8.1, p = 0.02); and Candida albicans (RR 3.9, 95% CI 1.2-12.3, p = 0.02) were more commonly associated with craniotomy/craniectomy cases than fusion or laminectomy SSIs. Pseudomonas aeruginosa was more commonly associated with fusion SSIs than craniotomy SSIs (RR 4.4, 95% CI 1.3-14.8, p = 0.02), whereas Escherichia coli was nonsignificantly associated with fusion SSIs compared to craniotomy SSIs (RR 4.1, 95% CI 0.9-18.1, p = 0.06). Infections with E. coli and P. aeruginosa occurred primarily in the lumbar spine (p = 0.0003 and p = 0.0001, respectively). SSIs due to typical gastrointestinal or genitourinary gram-negative bacteria occur most commonly following lumbar surgery, particularly fusion, and are likely to be due to contamination of the surgical bed with microbial flora in the perianal area and genitourinary tract. Cutibacterium acnes in the skin flora of the head and neck increases risk of infection due to this microbe following surgical interventions in these body sites. The types of gram-negative bacteria associated with craniotomy/craniectomy SSIs suggest potential environmental sources of these pathogens. Based on the authors' findings, neurosurgeons should consider using a two-step skin preparation with benzoyl peroxide, in addition to a standard antiseptic such as alcoholic chlorhexidine for cranial, cervical, and upper thoracic surgeries. Additionally, broader gram-negative bacterial coverage, such as use of a third-generation cephalosporin, should be considered for lumbar/lumbosacral fusion surgical antibiotic prophylaxis.

Preoperative automated screw planning in lumbar and thoracic spine surgery: Three-year single center experience and correlation analysis

Preoperative automated screw planning in lumbar and thoracic spine surgery: Three-year single center experience and correlation analysis

A Case of an Iatrogenic Pseudomeningocele after Thoracic Spinal Cord Tumor Surgery with a Long-Term Follow-Up.

A Case of an Iatrogenic Pseudomeningocele after Thoracic Spinal Cord Tumor Surgery with a Long-Term Follow-Up.

ПРЕИМУЩЕСТВА СТРАТЕГИИ МАЛОИНВАЗИВНОЙ ТОРАКОЭНДОСКОПИЧЕСКОЙ ХИРУРГИИ ПРИ ОПЕРАТИВНЫХ ВМЕШАТЕЛЬСТВАХ НА ГРУДНОМ ОТДЕЛЕ ПОЗВОНОЧНИКА

The technology of video-assisted minimally invasive interventions on the thoracic spine is a promising direction in surgical endoscopy. Thoracic endoscopic spine surgery is effective for the diagnosis and treatment of various pathologies (tumors, inflammation, deformities, degenerative-dystrophic lesions, injuries). The advantages of thoracic endoscopic interventions are – trauma/injury reduction, reduced blood loss, full visualization of the operation area, the ability to control the allocation of surgical instruments, early activation and rehabilitation of patients as a result of minimally invasive technology, reduced hospital stay and treatment costs. Video-assisted minimally invasive interventions on the thoracic spine are a promising area of surgical endoscopy. The use of thoracoscopic technology allows us to move to a qualitatively new level of surgical interventions from anterior surgical approaches for various pathologies of the thoracic spine (tumors, deformities, degenerative-dystrophic lesions, injuries, inflammatory processes).

Skin closure using skin staples may have higher risk for surgical site infection compared to running subcuticular skin closure with absorbable suture in posterior thoracic and lumbar spine surgeries

Skin closure using skin staples may have higher risk for surgical site infection compared to running subcuticular skin closure with absorbable suture in posterior thoracic and lumbar spine surgeries

Risk Factor Analysis of Surgery-related Complications in Primary Thoracic Spine Surgery for Degenerative Diseases and Characteristics of the Patients Also Undergoing Surgery on the Cervical and/or Lumbar Spine.

A retrospective cohort study using prospectively collected data. This study primarily aimed to investigate the risk factors for surgery-related complications in primary thoracic spine surgery for degenerative diseases using a surgeon-maintained database. The secondary purpose was to elucidate the characteristics of surgically treated thoracic myelopathy that also required cervical and/or lumbar spine surgery in the study period. Few studies reported surgical complications and the feature of tandem spinal stenosis in thoracic myelopathy in detail because of their rarity. This study included 840 thoracic myelopathy patients undergoing primary surgery for degenerative diseases from 2012 to 2021, investigating the effects of diseases, surgical procedures, and patient demographics on postoperative neurological deterioration, dural tear, dural leakage, surgical-site infection, and postoperative hematoma. In thoracic myelopathy patients who were surgically treated and also undergoing cervical and/or lumbar surgery, we investigated the proportion, the effects of diseases, and the order and intervals between surgeries. Multivariate logistic regression revealed that significant risk factors ( P <0.05) for postoperative neurological deterioration were intervertebral disk herniation [odds ratio (OR): 4.59, 95% confidence interval (CI): 1.32-16.0) and degenerative spondylolisthesis (OR: 11.1, 95% CI: 2.15-57.5). Ossification of the ligamentum flavum (OR: 4.12, 95% CI: 1.92-8.86), anterior spinal fusion (OR: 41.2, 95% CI: 4.70-361), and circumferential decompression via a posterior approach (OR: 30.5, 95% CI: 2.27-410) were risk factors for dural tear. In thoracic myelopathy patients surgically treated, 37.0% also underwent degenerative cervical and/or lumbar surgery. Pathologies involving anterior decompression and instability increased the risk of postoperative neurological deterioration. The risk of dural tear was increased when dura mater adhesions were likely to be directly operated upon. It should be recognized that a relatively high proportion (37.0%) of surgically treated thoracic myelopathy patients also underwent cervical and/or lumbar surgery.

Tetraparesis following thoracic spine surgery in a patient with Klippel–Feil syndrome and ABCB4 mutation: a case report

BackgroundKlippel–Feil syndrome is a rare condition described in 1912 by Maurice Klippel and André Feil. It is defined as a congenital cervical fusion of at least two vertebrae, associated with a classical triad of clinical signs: short neck, low posterior hairline, and limited range of movement. However, Klippel–Feil syndrome manifests with a vast spectrum of phenotypes, ranging from no symptoms to complete triad, with or without other associated malformations. Most commonly, CCF results from sporadic mutations, even though autosomal recessive, autosomal dominant, or even X-linked inheritance can be detected. The ATP-binding cassette subfamily B member 4 is only expressed in the liver and is involved in biliary phospholipid secretion. The clinical spectrum includes various hepatobiliary pathologies, including low phospholipid-associated cholelithiasis, and has never been associated with musculoskeletal anomalies.Case presentationA 55-year-old male Caucasian patient presenting with low phospholipid-associated cholelithiasis syndrome with ATP-binding cassette subfamily B member 4 mutation and liver cirrhosis was referred to our clinic for a liver transplant. A period of 6 months before, the patient underwent a T7–T9 posterior fixation for a T8 osteoporotic fracture. Postoperatively, he was tetraparetic, whereas he was neurologically intact before the operation. At admission to our hospital, he was still tetraparetic and presented with clinical signs of cervical myelopathy. Moreover, he suffered a limitation of cervical range of motion in all directions, short neck, and low posterior hairline. Imaging showed multiple cervical and thoracic vertebral bodies fusion, as well as cervical spine stenosis. Based on the available data, we diagnosed a type 3 Klippel–Feil syndrome according to Samartzis’ classification.ConclusionsThe heterogeneity of KFS and the various potential hereditary links that are known indicate that it is important to highlight all potential cases related to known genetic defects. At present, no association between ATP-binding cassette subfamily B member 4 mutation and congenital cervical fusions has been reported. The other important clinical focus of this case is the appearance of spontaneous tetraparesis after thoracic spine surgery. This mechanism remains unclear, but considering different spinal anatomy it might have been due to difficult intubation and patient’s positioning during his previous operation.

Validity of evoked potential as biomarker for predicting early neural function changes after thoracic spinal decompression surgery in patients with neurological deficits.

To evaluate the validity of intraoperative evoked potential (EP) including motor evoked potential (MEP) and somatosensory evoked potentials (SEP) as a biomarker for predicting neural function changes after thoracic spinal decompression (TSD) surgery. A consecutive series of 336 TSD surgeries were reviewed between 2010 and 2021 from four spine center. All patients with TSD were divided into 3 groups according to different intraoperative EP results: group 1, EP alerts; group 2, no obvious EP deterioration; group 3, EP improvement compared with baselines. The lower limb Japanese Orthopedic Association (JOA) scores (as well as early and long-term JOA recovery rate) were utilized to quantitatively assess pre- and postoperative neural function change. Among the 3 subgroups according to the different EP changes, the early JOA recovery rate (RR%) in the EP improvement group was significantly better than the other two groups (51.3 ± 58.6* vs. 27.5 ± 31.2 and 33.3 ± 43.1; p < 0.01) after 3-month follow-up. The mean MEP and SEP amplitude were from 116 ± 57µV to 347 ± 71µV (p < 0.01) and from 1.86 ± 0.24µV to 2.65 ± 0.29µV (p < 0.01) between spinal cord pre-decompression and post-decompression. Moreover, multivariate logistic regression analysis revealed that risk factors of EP improvement were duration of symptom (p < 0.001, OR 10.9) and Preop. neurologic deficit degree (p = 0.013, OR 7.46). The intraoperative EP can predict postoperative neural function changes as a biomarker during TSD. Patient with EP improvement probably has better prognosis for early neural function recovery. The duration of symptom and preoperative neurologic deficit degree may be related to intraoperative EP improvement.

Overview and Prevention of Complications During Biportal Endoscopic Thoracic Spine Surgery

Objective: Although the unilateral biportal endoscopy (UBE) technique has remarkable advantages, thoracic laminectomy by UBE is technically difficult and can potentially lead to serious complications. By reviewing previous articles on thoracic laminectomy by UBE, we aimed to identify the complications of thoracic laminectomy by UBE and to establish specific surgical strategies to avoid complications.Methods: A literature search was performed using the National Center for Biotechnology Information database using the PubMed/MEDLINE search engine. There are 3 published clinical studies in which at least one of these approaches has been performed.Results: In previous articles, several cases of perioperative complications were observed, including spinal cord injury, hyperalgesia, cerebrospinal fluid leakage, headache or neck pain, insufficient decompression, epidural hematoma, subdural hematoma, excessive facet resection, and delayed spinous process fracture.Conclusion: UBE technique has remarkable advantages, but endoscopic thoracic surgery is technically challenging and has the potential to cause serious complications. For avoidable complications, surgeons should be familiar with prevention methods and pitfalls to minimize complications.