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Study Design: A retrospective cohort study. Objective: To evaluate the effect of O-arm navigation in percutaneous surgeries for thoracolumbar fracture in comparison to the use of conventional fluoroscopic technique. Summary of Background Data: O-arm navigation is a progressive surgical tool, with extensive research papers reporting its effects. Whereas, there were not many papers describing its accuracy and facet impingement rate when compared with fluoroscopy-guided technique in percutaneous surgeries, especially at varying fracture levels. Materials and Methods: We conducted a retrospective comparative study of 97 consecutive patients of single-level neurological intact thoracolumbar fractures from November 2015 to October 2017 and they were all treated with percutaneous pedicle screw implantation. Screws were classified as 4 grades of perforations and 3 grades of facet joint violation. The association between variables such as anatomic perforation, functional perforation, and facet impingement were investigated by χ2 test, Fisher exact test or t test. A P-value of

Extrusion and sequestration of the nucleus pulposus involving the spinal canal or the foramina/recesses complicates up to 28% of the lumbar disc herniations. The transpars/translaminar anatomical approach is well described and its advantages when handling with a lateral, foraminal extruded disc herniation are appreciated and recognized. Nevertheless, this approach presents several pitfalls such as the risk of disconnecting the pars interarticularis, which may cause segmental instability. This particular eventuality is because of the particular anatomical conformation of the pars interarticularis. Although already part of the modern surgical armamentarium for general, orthopedic, cranial and spinal surgeons, the use of the ultrasonic scalpel technique for such approach has never been discussed to date, to the best of our knowledge. The purpose of the present paper is therefore to introduce and describe the stepwise technique along with an extensive discussion of the facilitating role of the ultrasonic scalpel in the translaminar/transpars approach in the management of extruded disc herniation of the lumbar spine.

Supplemental Digital Content is available in the text., Cervical radiculopathy is characterized by compression of the roots of the nerve. When conservative treatment fails and symptoms persist or increase in severity, surgical treatment is considered. Anterior cervical discectomy with or without fusion is regarded as the standard treatment for cervical disk herniation. Recently, there is an evolving trend in spinal surgery towards less invasive techniques. Nucleoplasty is a minimally invasive technique in which radiofrequency technology is used for percutaneous decompression. During the last years nucleoplasty has been proven to be a safe and effective treatment to alleviate radiculopathy, caused by a contained disk herniation. Nucleoplasty is usually performed on an outpatient basis and is associated with a fast recovery time. This paper will describe the preoperative and postoperative management of cervical nucleoplasty as well as the surgical technique, accompanied by a video.

Atlanto-axial rotatory-subluxation (AARS) is the most common pediatric cervical spine injury. Patients usually present with contralateral rotation and inclination of the upper cervical spine after minor trauma, or associated with an infection of the upper respiratory tract. According to the authors, initial management of patients with acute and chronic AARS type I-II should comprise closed reduction and immobilization with a cervical collar or a Halo-Body-Jacket. Surgical options of open reduction or C1/2 fusion should be restricted to irreducible or recurrent subluxations. This paper reviews the detailed technique of transoral closed reduction of AARS, as well as the preoperative and postoperative considerations.

This study was a case series.The purpose of this paper was to present a case series of fresh stress fractures (spondylolysis) in the lumbar spines of adult athletes.Lumbar spondylolysis is a stress fracture of the pars interarticularis, which is generally considered a disease of children or adolescence. There is only 1 case series written in English reporting on adult-onset fresh spondylolysis.Eleven patients aged 20-27 years are included in this case series. A retrospective analysis was made of events that may cause stress fracture such as traumatic episodes or sports activities, spinal level, radiologic findings, stage of spondylolysis, treatment, and prognosis.Among the 11 patients, two had bilateral early-stage spondylolysis, 7 had unilateral early-stage spondylolysis and 2 had unilateral progressive-stage spondylolysis. Three occurred subsequent to a preexisting terminal-stage spondylolysis in the contralateral side, 1 occurred subsequent to a terminal-stage spondylolysis at the adjacent spinal level, and 1 occurred subsequent to a terminal-stage spondylolysis at a distant level. Thirteen pedicles adjacent to the pars interarticularis in the 11 patients showed bone marrow edema-like signal on magnetic resonance imaging. Six spondylolyses were found at L5, 2 each at L3 and L4, and 1 spondylolysis at L2. The 11 patients were divided into 4 groups according to suspected pathogenic mechanism: preexistent spondylolysis in the contralateral side, alteration of the athletic event, apparent traumatic episode, and others. Conservative treatment was prescribed for return to sports in all cases. Although 1 patient retired because of persistent low back pain, the remaining 10 patients returned to competition.Although lumbar spondylolysis is generally recognized to occur in childhood or adolescence, fresh lumbar spondylolysis should be included in the differential diagnosis of adult low back pain when patients are high-level athletes. Conservative treatment should be attempted for adult patients.