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Objectives: To compare the clinical and radiographic outcomes of oblique lateral lumbar interbody fusion and minimally invasive transforaminal lumbar interbody fusion in patients with grade‐1 L4/5 degenerative spondylolisthesis. Methods: Based on the inclusion and exclusion criteria, the comparative analysis included consecutive patients with grade‐1 degenerative spondylolisthesis who underwent oblique LIF (OLIF, n = 36) or minimally invasive transforaminal LIF (MI‐TLIF, n = 45) at the Department of Spine Surgery, Beijing Jishuitan Hospital from January 2016 to August 2017. Patient satisfaction Japanese Orthopaedic Association score, visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), radiographic outcomes including anterior/posterior disc heights (ADH/PDH), foraminal height (FH), foraminal width (FW), cage subsidence, cage retropulsion, and fusion rate were assessed during a 2‐year follow‐up. Continuous data are presented as mean ± standard deviation and were compared between groups using the independent sample t‐test. Categorical data are presented as n (%) and were compared between groups using the Pearson chi‐squared test or Fisher's exact test. Repetitive measurement and analysis of variance was employed in the analysis of ODI, back pain VAS score, and leg pain VAS score. Statistical significance was defined as p < 0.05. Results: The OLIF and MI‐TLIF groups comprised 36 patients (age, 52.1 ± 7.2 years; 27 women) and 45 patients (age, 48.4 ± 14.4 years; 24 women), respectively. Satisfaction rates at 2 years post procedure exceeded 90% in both groups. The OLIF group had less intraoperative blood loss (140 ± 36 vs 233 ± 62 mL), lower back pain VAS score (2.42 ± 0.81 vs 3.38 ± 0.47), and ODI score (20.47 ± 2.53 vs 27.31 ± 3.71) at 3 months follow‐up (with trends toward lower values at 2 years follow‐up), but higher leg pain VAS scores at all postoperative time points than the MI‐TLIF group (all p < 0.001). ADH, PDH, FD, and FW improved in both groups post‐surgery. At the 2 year follow‐up, the OLIF group had a higher rate of Bridwell grade‐I fusion (100% vs 88.9%, p = 0.046) and lower incidences of cage subsidence (8.33% vs 46.67%, p < 0.001) and retropulsion (0% vs 6.67%, p = 0.046) than the MI‐TLIF group. Conclusions: In patients with grade‐I spondylolisthesis, OLIF was associated with lower blood loss and greater improvements in VAS for back pain and ODI and radiologic outcomes than MI‐TLIF. The OLIF is more suitable for these patients with low back pain as the main symptoms are accompanied by mild or no leg symptoms before operation. [ABSTRACT FROM AUTHOR]

This study was designed to analyze the causes of cervical adjacent segment degenerative disease (ASDis), evaluate the surgical outcomes of longitudinal spinous‐splitting laminoplasty with coral bone (SLAC) during cervical reoperation, and accumulate data on reoperation with SLAC in a primary hospital. Based on the inclusion and exclusion criteria, we conducted a retrospective study involving 52 patients who underwent cervical reoperation for ASDis using SLAC at the spinal surgery department of the Beijing Jishuitan Hospital from 1998 to 2014. Among them, 39 were treated with anterior cervical fusion and internal fixation during the first operation (anterior cervical corpectomy with fusion [ACCF], n = 24; anterior cervical discectomy and fusion [ACDF], n = 11; and cervical disc arthroplasty [CDA], n = 4). Outcomes were the Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) score, upper limb/neck and shoulder evaluated using a visual analogue scale (VAS), and rates of ASDis. In patients who underwent an anterior cervical approach in the first instance, the incidence of ASDis was significantly higher in the C3/4 gap than in the other gaps. In the ACCF group, the lateral radiograph of the cervical spine revealed that the distance between the anterior cervical plate and the adjacent segment disc was <5 mm in 15 (62.5%) cases and five (12.8%) cases, respectively, the internal fixation screws broke into the annulus of the adjacent segment. After the first SLAC, ASDis developed at C2/3 and C3/4 in four (30.8%) and eight (61.5%) cases, respectively. After reoperation, all cases were followed up for >5 (average, 6.2) years. The pre‐reoperation and last follow‐up values were as follows: mean Japanese Orthopaedic Association score, 10.2 ± 1.5 vs 15.5 ± 0.7 (P = 0.03); neck disability index, 26.2 vs 13.6 points (P = 0.01); upper‐limb visual analog scale (VAS) score, 6.1 vs 2.6 points (P = 0.04); and neck and shoulder VAS score, 6.6 vs 2.1 points (P = 0.03). SLAC is a simple technique in which the local anatomy is clearly visible and satisfactory clinical outcomes are obtained. [ABSTRACT FROM AUTHOR]

Objective: This study focused on the assessment of paravertebral ossification (PO) after cervical disc arthroplasty (CDA) using computed tomography (CT) images. Methods: In this retrospective study, 52 patients (from 2004 to 2010) who received CDA at a single center were included (32 males). Preoperative and follow‐up X‐ray and CT images of all patients who underwent single‐level CDA were collected. PO from the C2/3 to C7/T1 in each patient was graded based on a CT grading system. Each segment was divided into operative level, adjacent level, or non‐adjacent level. The McAfee' classification system was used to grade PO using X‐ray plain film. The range of motion (ROM) and scores of neurological symptoms (Japanese Orthopaedic Association [JOA] score and Neck Disability Index [NDI]) at both preoperative and final follow‐up time were acquired. Progression and classification of PO in each group was compared using the chi‐square test. ROM between groups were compared using independent t‐test. JOA score and NDI between groups were compared using Mann–Whitney U test. Results: The average follow‐up time was 81.2 months. In comparison with the preoperative status, the progression of PO development in left and right areas (the Luschka joints areas) in the operative level groups was significantly more severe (area L,χ2 value = 36.612, P < 0.001; area R, χ2 value = 39.172, P < 0.001) than the non‐adjacent level groups. In contrast, although the prevalence of PO in all areas of the adjacent level groups was higher than that of the non‐adjacent level group in the same segments, there was no significant difference (P > 0.05) in the progression of PO development. The follow‐up high‐grade (grades III and IV) PO incidence rate using X‐ray grading system (3.85%) was significantly lower than that using CT grading system in area L (42.31%) and R (38.46%), but close to that in area A (5.77%) and P (1.92%). The final follow‐up ROM was not significantly different with preoperative ROM in patients with low‐grade PO (9.47° ± 4.12° vs. 9.76° ± 3.69°, P = 0.794). However, in patients with high‐grade PO, the final follow‐up ROM was significantly lower than preoperative ROM (5.77° ± 3.32° vs. 9.28° ± 4.15°, P < 0.001). There was no significant difference for JOA score and NDI at follow‐up between patients with high‐grade and low‐grade PO (JOA, 16.2 ± 1.1 vs. 16.8 ± 0.9, P = 0.489; NDI, 8.9 ± 6.1 vs. 8.0 ± 7.3, P = 0.317). Conclusion: High‐grade PO was observed in the areas of the Luschka joints at the operative level after CDA, which was difficult to observe using X‐ray plain film. The PO formation at adjacent segments was not significant. [ABSTRACT FROM AUTHOR]

Objectives: To compare the clinical outcomes of percutaneous robot‐assisted minimally invasive pedicle screw insertion versus freehand fluoroscopy‐assisted pedicle screw insertion using a traditional open technique in elderly patients undergoing an oblique lumbar interbody fusion (OLIF) procedure. Methods: Based on the inclusion and exclusion criteria, 80 patients with lumbar degenerative disease who attended the spinal surgery department of the Beijing Jishuitan Hospital between January 2017 and April 2018 were enrolled in the present study. Patients were randomized 1:1 to undergo percutaneous robot‐assisted minimally invasive pedicle screw insertion (experimental group, n = 40) or freehand fluoroscopy‐assisted pedicle screw insertion using a traditional open technique (control group, n = 40). Outcomes were accuracy of screw placement evaluated on postoperative CT using the modified Gertzbein and Robbins scale, operative time, blood loss, postoperative drainage, lower back and leg pain evaluated using a visual analogue scale (VAS), lumbar function evaluated using the Oswestry disability index (ODI), and complication rates. Results: A total of 344 vertebral pedicle screws were inserted: 170 screws in the experimental group, and 174 screws in the control group. Accurate screw placement was significantly higher in the experimental group (98.2% [167/170]) than in the control group (93.1% [162/174]). Clinical outcomes showed significant differences between the experimental and control groups in operative time, intraoperative blood loss, and postoperative VAS for lower back pain in the immediate postoperative period. Conclusion: Robot‐assisted pedicle screw insertion in OLIF is an effective strategy for the management of elderly patients with lumbar degenerative diseases. [ABSTRACT FROM AUTHOR]

Objective: To compare the incidence and risk factors of superior facet joint violation (FJV) during cortical bone trajectory screw placement in robot‐assisted approach versus conventional technique. Methods: A retrospective study, including 69 patients having cortical bone trajectory (CBT) screw instrumentation for symptomatic degenerated diseases or trauma, was conducted between June 2015 to January 2019. All patients underwent CBT surgery performed by the same team of experienced surgeons. Patients were randomly divided into two groups: a conventional group (CG, 46 cases) and a robot group (RG, 23 cases). The surgical robotic system was used for screw instrumentation in the robot group and the traditional screw instrumentation with fluoroscopic guidance was used in the conventional group. Cortical screws followed a medio‐to‐lateral path in the transverse plane and a caudal‐to‐cephalad path in the sagittal plane. Preoperative and postoperative computed tomography (CT) scans were obtained to determine the degree and incidence of FJV. The violation status of facet joint was evaluated according to the modified classification: grade 0, no violation; grade 1, screw shaft, screw head or rod within 1 mm of or abutting the facet joint, but did not enter the articular facet joint; grade 2, screw shaft, screw head or rod clearly in the facet joint. The following factors that may contribute to the occurrence of FJV were analyzed: age, sex, body mass index (BMI), proximal fusion level, fusion length, the side of screw, preoperative vertebral slip, superior facet angle, and degenerative scoliosis. The chi‐squared test and Student's t‐test were used for analysis of the variables for significance (P < 0.05). Results: FJV occurred in 41.3% of patients in CG and 17.3% of patients in RG. A chi‐squared analysis revealed a significantly lower rate of FJV for RG compared with CG (P = 0.04). In the CG, 17 of the 109 cephalad screws were grade 1 (15.6%), and five were grade 2 (4.6%). In the RG, three of the 46 cephalad screws were grade 1 (6.5%), and three were grade 2 (6.5%). There was a statistically significant difference in the incidence of FJV between the left and right screw with fluoroscopy‐assisted CBT screw instrumentation (P < 0.05). A significant correlation between scoliosis with the FJV was found in CG (P < 0.05) and in RG (P < 0.05). With regard to superior facet angle, a measurement ≥45° was a significant risk factor of FJV in CG (P < 0.05) and in RG (P < 0.05). Conclusions: A robot‐assisted approach could reduce the incidence of FJV compared with the conventional approach in CBT technique. [ABSTRACT FROM AUTHOR]

Atlantoaxial transarticular facet screw fixation (Magerl technique) and C1 lateral mass screws combined with C2 pedicle screws fixation (Harms technique) are the most commonly used techniques for posterior internal fixation in the upper cervical spine. Upper cervical spinal surgery is a technically demanding and challenging procedure because of complicated anatomical structures and frequent occurrence of anomalies. Accurate insertion of screws allows for stable and secure internal fixation, which is necessary for both techniques. Traditional methods under fluoroscopic assistance in this region cannot meet the requirements of high levels of accuracy and security during the procedure. Robot‐assisted spinal surgery can provide accurate and reliable guidance during the screw insertion, which is evidenced in the literature. As a recently developed technique, robot‐assisted surgery is supposed to be performed by skilled surgeons who have received standard training for robotic surgery. The standardized upper cervical spinal surgery assisted by the robot system needs to be introduced to these surgeons. Based on the consensus of consultant specialists, the literature review, and our local experience, this guideline included the introduction of the robotic system, the workflow of robot‐assisted procedures, and the precautions to take during procedures. This guideline aims to provide a standardization of the robotic surgery for posterior atlantoaxial internal fixation. [ABSTRACT FROM AUTHOR]

The pedicle screw placement procedure is the most commonly used technique for spinal fixation and can provide reliable three‐column stabilization. Accurate screw placement is necessary in clinical practice. To avoid screw malposition, which may decrease the stiffness of the screw‐rod construct or increase the likelihood of neural and vascular injuries, the surgeons must fully understand the regional anatomy. Deformities, such as scoliosis, kyphosis or congenital anomalies, may complicate the application of the pedicle screw placement technique and increase the chance of screw encroachments. Incidences of pedicle screw malposition vary in different districts and hospitals and with surgeons and techniques. Today, the minimally invasive spinal surgery is well developed. However, the narrow corridors and limited views for surgeons increase the difficulty of pedicle screw placement and the possibility of screw encroachment. Evidenced by previous studies, robotic surgery can provide accurate screw placement, especially in settings of spinal deformities, anatomical anomalies, and minimally invasive procedures. Based on the consensus of consultant specialists, the literature review and our local experiences, this guideline introduces the robotic system and describes the workflow of robot‐assisted procedures and the precautions to take during procedures. This guideline aims to outline a standardized method for robotic surgery for thoracolumbar pedicle screw placement. [ABSTRACT FROM AUTHOR]