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Purpose: A standard 6–12-week course of antibiotics is recommended for pyogenic spondylitis. Recent evidence supports early minimally invasive posterior fixation surgery; however, its effect on antibiotic treatment duration is unclear. This study aims to identify factors associated with prolonged antibiotic treatment in thoracolumbar pyogenic spondylitis patients resistant to conservative treatment and assess whether early surgery can reduce treatment duration. Methods: We retrospectively reviewed 74 patients with thoracolumbar pyogenic spondylitis undergoing minimally invasive posterior fixation at nine facilities. Patients were grouped based on antibiotic duration (≥ 6 or < 6 weeks) and timing of surgery (≤ 3 weeks or > 3 weeks of starting antibiotics). Univariable and multivariable logistic regression analyses were used to identify factors associated with prolonged antibiotic treatment and study the outcomes of patients undergoing early surgery. Results: Forty-nine patients (66%) required prolonged antibiotic treatment. The presence of an iliopsoas abscess (p = 0.0006) and elevated C-reactive protein (CRP) levels (≥ 10 mg/dL, p = 0.015) were independently associated with prolonged antibiotic treatment. Early surgery significantly reduced total antibiotic duration (5.3 weeks vs. 9.9 weeks, p < 0.0001) without increasing the incidence of postoperative infection recurrences and unplanned additional surgeries. Despite factors associated with prolonged antibiotic treatment, early surgery consistently shortened the treatment duration compared to late surgery. Conclusions: Early surgery (within three weeks) with minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis is associated with reduced antibiotic duration and overall treatment duration regardless of the presence of prolonging factors like iliopsoas abscess and elevated CRP levels. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to evaluate the difference in treatment duration and unplanned additional surgeries between patients with unidentified causative organisms on empiric antibiotics and those with identified organisms on selective antibiotics in treating thoracolumbar pyogenic spondylitis with minimally invasive posterior fixation. Methods: This multicenter retrospective cohort study included patients with thoracolumbar pyogenic spondylitis refractory to conservative treatment who underwent minimally invasive posterior fixation. Patients were divided into the identified (known causative organism) and unidentified groups (unknown causative organism). We analyzed data on demographics, antibiotic use, surgical outcomes, and infection control indicators. Results: We included 74 patients, with 52 (70%) and 22 (30%) in the identified and unidentified groups, respectively. On admission, the identified group had higher C-reactive protein (CRP) levels and more iliopsoas abscesses. The duration to postoperative CRP negative was similar in the identified and unidentified groups (7.13 vs. 6.48 weeks, p = 0.74). Only the identified group had unplanned additional surgeries due to poor infection control, affecting 6 of 52 patients (12%). Advanced age and causative organism identification increased the additional surgery odds (odds ratio [OR], 8.25; p = 0.033 and OR, 6.83; p = 0.034, respectively). Conclusion: The use of empiric antibiotics in minimally invasive posterior fixation was effective without identifying the causative organism and did not prolong treatment duration. In patients with identified organisms, 12% required unplanned additional surgery, indicating a more challenging infection control. Causative organism identification was associated with the need for additional surgery, suggesting a more cautious treatment strategy for these patients. [ABSTRACT FROM AUTHOR]

Background: The current study aimed to evaluate the bone union rate between infected vertebrae after minimally invasive posterior fixation without bone grafting in thoracolumbar pyogenic spondylitis. Methods: This retrospective multicenter cohort study evaluated 75 patients of posterior fixation for thoracolumbar pyogenic spondylitis that have been recorded at six relevant institutions from January 2016 to December 2022. Data on age, sex, location of infected vertebrae, number of infected disks, comorbidity, Pola classification, number of vertebrae fixed according to surgery, implant failure requiring revision surgery, and distance according to the type of infected vertebrae after surgery were evaluated. Further, their association with postoperative bone union was investigated > 12 months postoperatively. Results: Finally, 40 patients were included in the study. In total, 32 (80%) patients achieved bone union at the infected vertebrae after minimally invasive posterior fixation without bone grafting. The mean duration from surgery to union was 10.7 months. Twenty-six (65%) patients initially achieved bone union at the lateral and/or anterior bridging callus. Patients with multiple-level infected disks (33%, 2/6 patients) had a lower bone union rate than those with a single-level infected disk (88%, 30/34 patients) (p = 0.0095). Conclusions: In 80% of patients, bone union at the infected vertebrae was achieved after minimally invasive posterior fixation without bone grafting in thoracolumbar pyogenic spondylitis. A total of 65% of the patients achieved initial bone union at the lateral and/or anterior bridging callus. Moreover, patients with multiple-level infected disks had a low bone union rate. Hence, the treatment strategy should be cautiously considered. Trial registration: This study was registered retrospectively and all procedures used in this study including the review of patient records were approved by the institutional review board. [ABSTRACT FROM AUTHOR]

Abstract Background The current study aimed to evaluate the bone union rate between infected vertebrae after minimally invasive posterior fixation without bone grafting in thoracolumbar pyogenic spondylitis. Methods This retrospective multicenter cohort study evaluated 75 patients of posterior fixation for thoracolumbar pyogenic spondylitis that have been recorded at six relevant institutions from January 2016 to December 2022. Data on age, sex, location of infected vertebrae, number of infected disks, comorbidity, Pola classification, number of vertebrae fixed according to surgery, implant failure requiring revision surgery, and distance according to the type of infected vertebrae after surgery were evaluated. Further, their association with postoperative bone union was investigated > 12 months postoperatively. Results Finally, 40 patients were included in the study. In total, 32 (80%) patients achieved bone union at the infected vertebrae after minimally invasive posterior fixation without bone grafting. The mean duration from surgery to union was 10.7 months. Twenty-six (65%) patients initially achieved bone union at the lateral and/or anterior bridging callus. Patients with multiple-level infected disks (33%, 2/6 patients) had a lower bone union rate than those with a single-level infected disk (88%, 30/34 patients) (p = 0.0095). Conclusions In 80% of patients, bone union at the infected vertebrae was achieved after minimally invasive posterior fixation without bone grafting in thoracolumbar pyogenic spondylitis. A total of 65% of the patients achieved initial bone union at the lateral and/or anterior bridging callus. Moreover, patients with multiple-level infected disks had a low bone union rate. Hence, the treatment strategy should be cautiously considered. Trial registration This study was registered retrospectively and all procedures used in this study including the review of patient records were approved by the institutional review board.

This study aimed to establish a predictive nomogram model for recollapse of fractured vertebra after posterior pedicle screw fixation in thoracolumbar fractures (TLFs). Patients undergoing posterior pedicle screw fixation for TLFs at our hospital between January 2016 and December 2021 were retrospectively reviewed. Patients were divided into 2 groups according to the presence or absence of recollapse of the fractured vertebra at the final follow-up. The predictors for fractured vertebra recollapse were identified by univariate and multivariable logistic regression analysis, and a nomogram model was developed. The prediction performance and internal validation were established. A total of 224 patients were included in this study. Of these, 46 (20.5%) patients developed recollapse of fractured vertebra. Age, thoracic and lumbar injury severity score, screw distribution in the fractured vertebra, and anterior vertebral height compression ratio were associated with vertebral recollapse. These predictors were used to construct a predictive nomogram. The area under the receiver operating characteristic curve of the nomogram model was 0.891. The concordance index was 0.891, and it was 0.877 with bootstrapping validation. The calibration curves and decision curve analysis also suggested that the nomogram model had excellent predictive performances for fractured vertebra recollapse. A clinical nomogram incorporating 4 variables was constructed to predict fractured vertebra recollapse after posterior pedicle screw fixation for TLFs. The nomogram demonstrated good calibration and discriminative abilities, which may help clinicians to make better treatment decisions. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study. Objective: Odontoid synchondrosis fracture is rare, and there is a paucity of literature on its surgical treatments. This case series study analyzed patients treated with C1 to C2 internal fixation with or without anterior atlantoaxial release and discussed the clinical effectiveness of the procedure. Methods: Data were retrospectively collected from a single-center cohort of patients who had undergone surgical treatments for displaced odontoid synchondrosis fracture. The operation time and blood loss volume were recorded. Neurological function was assessed and classified using the Frankel grades. The odontoid process tilting angle (OPTA) was used to evaluate fracture reduction. Fusion duration and complications were also analyzed. Results: Seven patients (1 boy and 6 girls) were included in the analysis. Three patients underwent anterior release and posterior fixation surgery, and the other 4 underwent posterior-only surgery. The fixation segment was C1 to C2. The average follow-up period was 34.7 ± 8.5 months. The average operation time was 145.7 ± 45.3 min, with an average blood loss volume of 95.7 ± 33.3 mL. The OPTA was corrected from 41.9° ± 11.1° preoperative to 2.4° ± 3.2° at the final follow-up (P <.05). The preoperative Frankel grade of 1 patient was grade C, of 2 patients was grade D, and of 4 patients was grade E. The neurological function of the patients in grade C and grade D recovered to grade E at the final follow-up. None of the patients developed a complication. All the patients achieved odontoid fracture healing. Conclusion: Posterior C1 to C2 internal fixation with or without anterior atlantoaxial release is a safe and effective method for treating young children with displaced odontoid synchondrosis fracture. [ABSTRACT FROM AUTHOR]

Study Design. Finite element analysis. Objective. To investigate the biomechanical effect of four posterior fixation techniques on stability and adjacent segment degeneration in treating thoracolumbar burst fractures with osteoporosis. Summary of Background Data. In terms of stability and adjacent segment degeneration, there remains no consensus or guidelines on the optimal technique for the treatment of thoracolumbar burst fractures in patients with osteoporosis. Materials and Methods. Images of CT scans were imported into MIMICS and further processed by Geomagic to build threedimensional models of the T10-L5 region. A v-shaped osteotomy was performed on the L1 vertebral body to simulate a burst fracture in the setting of osteoporosis. Subsequently, four fixation techniques were designed using SolidWorks software. Range of motion (ROM) of the global spine, ROM distribution, ROM of adjacent segment, Von Mises stress on adjacent intervertebral disks, and facet joints were analyzed. Results. Among the four groups, the cortical bone screw fixation (CBT) showed the highest global ROM at 1.86°, while longsegmented pedicle screw fixation (LSPS) had the lowest global ROM at 1.25°. The LSPS had the smallest percentage of ROM of fractured vertebral body to fixed segment at 75.04%, suggesting the highest stability after fixation. The maximum ROM of the adjacent segment was observed in the CBT at 1.32°, while the LSPS exhibited the smallest at 0.89°. However, the LSPS group experienced larger maximum stress on the adjacent intervertebral disks (9.60 MPa) and facet joints (3.36 MPa), indicating an increasing risk of adjacent segment disease. Conclusion. LSPS provided the greatest stability, while CBT provided the smallest amount of stability. However, the elevated stress on adjacent intervertebral disks and facet joints after LSPS fixation increased the possibility of adjacent segment degeneration. Cement-augmented pedicle screw fixation (CAPS) and combined cortical bone screw and pedicle screw fixation (CBTPS) demonstrated significant biomechanical advantages in providing moderate fixation strength while reducing stress on the intervertebral disks and facet joints. [ABSTRACT FROM AUTHOR]

Abstract Background Minimally invasive posterior fixation surgery for pyogenic spondylitis is known to reduce invasiveness and complication rates; however, the outcomes of concomitant insertion of pedicle screws (PS) into the infected vertebrae via the posterior approach are undetermined. This study aimed to assess the safety and efficacy of PS insertion into infected vertebrae in minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis. Methods This multicenter retrospective cohort study included 70 patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis across nine institutions. Patients were categorized into insertion and skip groups based on PS insertion into infected vertebrae, and surgical data and postoperative outcomes, particularly unplanned reoperations due to complications, were compared. Results The mean age of the 70 patients was 72.8 years. The insertion group (n = 36) had shorter operative times (146 versus 195 min, p = 0.032) and a reduced range of fixation (5.4 versus 6.9 vertebrae, p = 0.0009) compared to the skip group (n = 34). Unplanned reoperations occurred in 24% (n = 17) due to surgical site infections (SSI) or implant failure; the incidence was comparable between the groups. Poor infection control necessitating additional anterior surgery was reported in four patients in the skip group. Conclusions PS insertion into infected vertebrae during minimally invasive posterior fixation reduces the operative time and range of fixation without increasing the occurrence of unplanned reoperations due to SSI or implant failure. Judicious PS insertion in patients with minimal bone destruction in thoracolumbar pyogenic spondylitis can minimize surgical invasiveness.

Abstract Background The emerging of the C2 isthmus screw fixation technique is gaining popularity in the setting of atlantoaxial dislocation or other conditions requiring fixation of C2. However, the biomechanical stability of this fixation is poorly understood. Purpose To compare and elucidate the biomechanical stability of C2 pedicle screw (C2PS), C2 isthmus screw (C2IS) and C2 short isthmus screw (C2SIS) fixation techniques in atlantoaxial dislocation (AAD). Method A three-dimensional finite element model (FEM) from occiput to C3 was established and validated from a healthy male volunteer. Three FEMs, C1 pedicle screw (PS)-C2PS, C1PS-C2IS, C1PS-C2SIS were also constructed. The range of motion (ROM) and the maximum von Mises stress under flexion, extension, lateral bending and axial rotation loading were analyzed and compared. The pullout strength of the three fixations for C2 was also evaluated. Result C1PS-C2IS model showed the greatest decrease in ROM with flexion, extension, lateral bending and axial rotation. C1PS-C2PS model showed the least ROM reduction under all loading conditions than both C2IS and C2SIS. The C1PS-C2PS model had the largest von Mises stress on the screw under all directions followed by C1PS-C2SIS, and lastly the C1PS-C2IS. Under axial rotation and lateral bending loading, the three models showed the maximum and minimum von Mises stress on the screw respectively. The stress of the three models was mainly located in the connection of the screw and rod. Overall, the maximum screw pullout strength for C2PS, C2IS and C2SIS were 729.41N, 816.62N, 640.54N respectively. Conclusion In patients with atlantoaxial dislocations, the C2IS fixation provided comparable stability, with no significant stress concentration. Furthermore, the C2IS had sufficient pullout strength when compared with C2PS and C2SIS. C2 isthmus screw fixation may be a biomechanically favourable option in cases with AAD. However, future clinical trials are necessary for the evaluation of the clinical outcomes of this technique.

Background: Minimally invasive posterior fixation surgery for pyogenic spondylitis is known to reduce invasiveness and complication rates; however, the outcomes of concomitant insertion of pedicle screws (PS) into the infected vertebrae via the posterior approach are undetermined. This study aimed to assess the safety and efficacy of PS insertion into infected vertebrae in minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis. Methods: This multicenter retrospective cohort study included 70 patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis across nine institutions. Patients were categorized into insertion and skip groups based on PS insertion into infected vertebrae, and surgical data and postoperative outcomes, particularly unplanned reoperations due to complications, were compared. Results: The mean age of the 70 patients was 72.8 years. The insertion group (n = 36) had shorter operative times (146 versus 195 min, p = 0.032) and a reduced range of fixation (5.4 versus 6.9 vertebrae, p = 0.0009) compared to the skip group (n = 34). Unplanned reoperations occurred in 24% (n = 17) due to surgical site infections (SSI) or implant failure; the incidence was comparable between the groups. Poor infection control necessitating additional anterior surgery was reported in four patients in the skip group. Conclusions: PS insertion into infected vertebrae during minimally invasive posterior fixation reduces the operative time and range of fixation without increasing the occurrence of unplanned reoperations due to SSI or implant failure. Judicious PS insertion in patients with minimal bone destruction in thoracolumbar pyogenic spondylitis can minimize surgical invasiveness. [ABSTRACT FROM AUTHOR]

Background: The emerging of the C2 isthmus screw fixation technique is gaining popularity in the setting of atlantoaxial dislocation or other conditions requiring fixation of C2. However, the biomechanical stability of this fixation is poorly understood. Purpose: To compare and elucidate the biomechanical stability of C2 pedicle screw (C2PS), C2 isthmus screw (C2IS) and C2 short isthmus screw (C2SIS) fixation techniques in atlantoaxial dislocation (AAD). Method: A three-dimensional finite element model (FEM) from occiput to C3 was established and validated from a healthy male volunteer. Three FEMs, C1 pedicle screw (PS)-C2PS, C1PS-C2IS, C1PS-C2SIS were also constructed. The range of motion (ROM) and the maximum von Mises stress under flexion, extension, lateral bending and axial rotation loading were analyzed and compared. The pullout strength of the three fixations for C2 was also evaluated. Result: C1PS-C2IS model showed the greatest decrease in ROM with flexion, extension, lateral bending and axial rotation. C1PS-C2PS model showed the least ROM reduction under all loading conditions than both C2IS and C2SIS. The C1PS-C2PS model had the largest von Mises stress on the screw under all directions followed by C1PS-C2SIS, and lastly the C1PS-C2IS. Under axial rotation and lateral bending loading, the three models showed the maximum and minimum von Mises stress on the screw respectively. The stress of the three models was mainly located in the connection of the screw and rod. Overall, the maximum screw pullout strength for C2PS, C2IS and C2SIS were 729.41N, 816.62N, 640.54N respectively. Conclusion: In patients with atlantoaxial dislocations, the C2IS fixation provided comparable stability, with no significant stress concentration. Furthermore, the C2IS had sufficient pullout strength when compared with C2PS and C2SIS. C2 isthmus screw fixation may be a biomechanically favourable option in cases with AAD. However, future clinical trials are necessary for the evaluation of the clinical outcomes of this technique. [ABSTRACT FROM AUTHOR]

Neurofibromatosis-1 (NF1) presents complex challenges due to its multisystemic effects, including kyphoscoliosis, dural ectasia, and arteriovenous fistulas (AVF). We present a case of a 31-year-old male with NF1 exhibiting severe cervical kyphoscoliosis, dural ectasia, a bisected cervical cord, and an arteriovenous fistula, highlighting the intricacies of managing such intricate cases. Rapid weakening in the patient's right arm and leg prompted imaging revealing severe cervical kyphotic deformity and a dural fold dividing the spinal cord. Surgical intervention addressed a high-flow arteriovenous fistula involving the right vertebral artery and an epidural vein, necessitating sacrifice of the artery. Posterior fusion and laminectomy were performed, resulting in stable neurological status postoperatively and significant improvement in sensory loss and weakness at three months. This case underscores the importance of a tailored posterior-only approach, involving dural fold release, to allow the spinal cord to relocate to a less tense position, thus demonstrating effective decompression in complex NF1 cases with concurrent kyphotic deformity and vertebral artery AVF.

Dyspnea has been reported to occur following posterior occipitocervical fusion. However, there are no documented cases of dyspnea following posterior fixation of the middle and lower cervical spine without posterior occipitocervical fusion. An 80-year-old woman underwent corrective fusion from T4 to the ilium for kyphoscoliosis. Sixteen months later, the patient developed cervical kyphosis (dropped head syndrome) with proximal junctional kyphosis, leading to a pedicle subtraction osteotomy at T4 and an extended fixation to C2. On the sixth postoperative day, the patient experienced respiratory arrest, prompting a reoperation to reduce cervical lordosis, ultimately resolving the respiratory dysfunction. Excessive correction of cervical kyphosis should be avoided to prevent the occurrence of postoperative dyspnea, even in cases where posterior occipitocervical fusion has not been performed. [ABSTRACT FROM AUTHOR]

Neurofibromatosis-1 (NF1) presents complex challenges due to its multisystemic effects, including kyphoscoliosis, dural ectasia, and arteriovenous fistulas (AVF). We present a case of a 31-year-old male with NF1 exhibiting severe cervical kyphoscoliosis, dural ectasia, a bisected cervical cord, and an arteriovenous fistula, highlighting the intricacies of managing such intricate cases. Rapid weakening in the patient's right arm and leg prompted imaging revealing severe cervical kyphotic deformity and a dural fold dividing the spinal cord. Surgical intervention addressed a high-flow arteriovenous fistula involving the right vertebral artery and an epidural vein, necessitating sacrifice of the artery. Posterior fusion and laminectomy were performed, resulting in stable neurological status postoperatively and significant improvement in sensory loss and weakness at three months. This case underscores the importance of a tailored posterior-only approach, involving dural fold release, to allow the spinal cord to relocate to a less tense position, thus demonstrating effective decompression in complex NF1 cases with concurrent kyphotic deformity and vertebral artery AVF. [ABSTRACT FROM AUTHOR]

Abstract Background Pedicle screw loosening and breakage are common causes of revision surgery after lumbar fusion. Thus, there remains a continued need for supplemental fixation options that offer immediate stability without the associated failure modes. This finite element analysis compared the biomechanical properties of a novel cortico-pedicular posterior fixation (CPPF) device with those of a conventional pedicle screw system (PSS). Methods The CPPF device is a polyetheretherketone strap providing circumferential cortical fixation for lumbar fusion procedures via an arcuate tunnel. Using a validated finite element model, we compared the stability and load transfer characteristics of CPPF to intact conditions under a 415 N follower load and PSS conditions under a 222 N preload. Depending on the instrumented levels, two different interbody devices were used: a lateral lumbar interbody device at L4–5 or an anterior lumbar interbody device at L5-S1. Primary outcomes included range of motion of the functional spinal units and anterior load transfer, defined as the total load through the disk and interbody device after functional motion and follower load application. Results Across all combinations of interbody devices and lumbar levels evaluated, CPPF consistently demonstrated significant reductions in flexion (ranging from 90 to 98%), extension (ranging from 88 to 94%), lateral bending (ranging from 75 to 80%), and torsion (ranging from 77 to 86%) compared to the intact spine. Stability provided by the CPPF device was comparable to PSS in all simulations (range of motion within 0.5 degrees for flexion–extension, 0.6 degrees for lateral bending, and 0.5 degrees for torsion). The total anterior load transfer was higher with CPPF versus PSS, with differences across all tested conditions ranging from 128 to 258 N during flexion, 89–323 N during extension, 135–377 N during lateral bending, 95–258 N during torsion, and 82–250 N during standing. Conclusion Under the modeled conditions, cortico-pedicular fixation for supplementing anterior or lateral interbody devices between L4 and S1 resulted in comparable stability based on range of motion measures and less anterior column stress shielding based on total anterior load transfer measures compared to PSS. Clinical studies are needed to confirm these finite element analysis findings.

Purpose: Previous studies have shown that percutaneous pedicle screw (PPS) posterior fixation without anterior debridement for pyogenic spondylitis can improve patient quality of life compared with conservative treatment. However, data on the risk of recurrence after PPS posterior fixation compared with conservative treatment is lacking. The aim of this study was to compare the recurrence rate of pyogenic spondylitis after PPS posterior fixation without anterior debridement and conservative treatment. Methods: The study was conducted under a retrospective cohort design in patients hospitalized for pyogenic spondylitis between January 2016 and December 2020 at 10 affiliated institutions. We used propensity score matching to adjust for confounding factors, including patient demographics, radiographic findings, and isolated microorganisms. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for recurrence of pyogenic spondylitis during the follow-up period in the matched cohort. Results: 148 patients (41 in the PPS group and 107 in the conservative group) were included. After propensity score matching, 37 patients were retained in each group. PPS posterior fixation without anterior debridement was not associated with an increased risk of recurrence compared with conservative treatment with orthosis (HR, 0.80; 95% CI, 0.18–3.59; P = 0.77). Conclusions: In this multi-center retrospective cohort study of adults hospitalized for pyogenic spondylitis, we found no association in the incidence of recurrence between PPS posterior fixation without anterior debridement and conservative treatment. [ABSTRACT FROM AUTHOR]

Background: Pedicle screw loosening and breakage are common causes of revision surgery after lumbar fusion. Thus, there remains a continued need for supplemental fixation options that offer immediate stability without the associated failure modes. This finite element analysis compared the biomechanical properties of a novel cortico-pedicular posterior fixation (CPPF) device with those of a conventional pedicle screw system (PSS). Methods: The CPPF device is a polyetheretherketone strap providing circumferential cortical fixation for lumbar fusion procedures via an arcuate tunnel. Using a validated finite element model, we compared the stability and load transfer characteristics of CPPF to intact conditions under a 415 N follower load and PSS conditions under a 222 N preload. Depending on the instrumented levels, two different interbody devices were used: a lateral lumbar interbody device at L4–5 or an anterior lumbar interbody device at L5-S1. Primary outcomes included range of motion of the functional spinal units and anterior load transfer, defined as the total load through the disk and interbody device after functional motion and follower load application. Results: Across all combinations of interbody devices and lumbar levels evaluated, CPPF consistently demonstrated significant reductions in flexion (ranging from 90 to 98%), extension (ranging from 88 to 94%), lateral bending (ranging from 75 to 80%), and torsion (ranging from 77 to 86%) compared to the intact spine. Stability provided by the CPPF device was comparable to PSS in all simulations (range of motion within 0.5 degrees for flexion–extension, 0.6 degrees for lateral bending, and 0.5 degrees for torsion). The total anterior load transfer was higher with CPPF versus PSS, with differences across all tested conditions ranging from 128 to 258 N during flexion, 89–323 N during extension, 135–377 N during lateral bending, 95–258 N during torsion, and 82–250 N during standing. Conclusion: Under the modeled conditions, cortico-pedicular fixation for supplementing anterior or lateral interbody devices between L4 and S1 resulted in comparable stability based on range of motion measures and less anterior column stress shielding based on total anterior load transfer measures compared to PSS. Clinical studies are needed to confirm these finite element analysis findings. [ABSTRACT FROM AUTHOR]

Objective: To investigate the biomechanical characteristics of different posterior fixation techniques in treatment of osteoporotic thoracolumbar burst fractures by finite element analysis.Methods: The Dicom format images of T10-L5 segments were obtained from CT scanning of a volunteer, and transferred to the Geomagic Studio software, which was used to build digital models. L1 osteoporotic burst fracture and different posterior fixation techniques were simulated by SolidWorks software. The data of ROM, the maximum displacement of fixed segment, ROM of fractured L1 vertebrae, the stress on the screws and rods as well as on fractured L1 vertebrae under different movement conditions were collected and analysed by finite element analysis.Results: Among the four groups, the largest ROM of fixed segment, the maximum displacement of fixed segment and ROM of fractured vertebrae occurred in CBT, and the corresponding data was 1.3°, 2.57 mm and 1.37°, respectively. While the smallest ROM of fixed segment, the maximum displacement of fixed segment and ROM of fractured vertebrae was found in LSPS, and the corresponding data was 0.92°, 2.46 mm and 0.89°, respectively. The largest stress of screws was 390.97 Mpa, appeared in CBT, and the largest stress of rods was 84.68 MPa, appeared in LSPS. The stress concentrated at the junction area between the root screws and rods. The maximum stress on fractured vertebrae was 93.25 MPa, appeared in CBT and the minimum stress was 56.68 MPa, appeared in CAPS. And the stress of fractured vertebrae concentrated in the middle and posterior column of the fixed segment, especially in the posterior edge of the superior endplate.Conclusion: In this study, long-segment posterior fixation (LSPF) provided with the greatest stability of fixed segment after fixation, while cortical bone screw fixation (CBT) provided with the smallest stability. Cement-augmented pedicle screw-rod fixation (CAPS) and combined using cortical bone screw and pedicle screw fixation (CBT-PS) provided with the moderate stability. CBT-PS exhibited superiority in resistance of rotational torsion for using multiple connecting rods. CAPS and CBT-PS maybe biomechanically superior options for the surgical treatment of burst TL fractures in osteoporotic patients.

Abstract Background Few studies reported treatment of unstable traumatic spondylolisthesis of the axis using posterior fixation without fusion. The aim of this study was to evaluate the results and feasibility of posterior fixation without fusion in treating unstable traumatic spondylolisthesis of the axis. Methods Eleven patients with traumatic spondylolisthesis of the axis were included in this study, and posterior fixation without fusion using screw-rod system was performed for them. The clinical outcomes were assessed using the Visual Analog Scale (VAS), the Neck Disability Index (NDI), and the Odom’s grading system. Plain radiography was used to measure the displacement and angulation of C2-C3, and cervical lordosis. Plain radiography and computed tomography were also used to observe the bony fusions of fracture lines and postoperative spontaneous fusion of C2-C3. Results The mean follow up time was 24.6 months (range, 12–72 months). The VAS and NDI scores were significantly improved at the final follow-up compared with those before operation (P

We report the case of a 57-year-old man who developed osteoradionecrosis (ORN) at the occipitocervical (OC) junction after radiation therapy for nasopharyngeal carcinoma. During soft-tissue debridement using a nasopharyngeal endoscope, the anterior arch of the atlas (AAA) was spontaneously disrupted, which was later spat out. Radiographic examination revealed complete disruption of the AAA that caused OC instability. We performed posterior OC fixation. The patient experienced successful postoperative pain relief. AAA disruption secondary to ORN at OC junction can cause severe instability. Posterior OC fixation alone may be an effective procedure if the necrotic pharyngeal region is mild and endoscopically controllable.

Objective Existing freehand techniques of screw placement mainly emphasized on various entry points and complex trajectory reference. The aim of this study is to illustrate a standardized and reliable freehand technique of pedicle screw insertion for open pedicle screw fixation with a universal entry point and a stereoscopic trajectory reference system and report the results from a single surgeon's clinical experience with the technique. Method In this study, the author respectively reviewed a total of 200 consecutive patients who had undergone open freehand pedicle screw fixation with Superior Articular Process (SAP) technique from January 2019 to May 2020. For accuracy and safety, all 200 cases had undergone postoperative X‐ray while 33 cases including spinal deformity, infection, and tumor had received additional CT‐scan. Screw accuracy was analyzed via a CT‐based classification system with Student's t test. Results A total of 1126 screws had been placed from T1‐S1 with SAP‐guided freehand technique and the majority had been confirmed safe in X‐ray without the need of CT scan. A total of 316 screws in deformity or infectious or tumor cases had undergone additional CT scan with 95.5% (189 of 198 screws) accuracy in thoracic group and 94.9% (112 of 118 screws) in lumbar group. The accuracy had been 90.5% (114 of 126 screws) in deformity group and 95.8% (182 of 190 screws) in non‐deformity group. All perforation cases had been rated Grade B (

Pedicle or lateral mass screws, which are usually used to fix atlantoaxial instability, increase the risk of vertebral artery (VA) injury in patients with bone or arterial anomalies or osteoporotic bone. Here, we report the use of a unilateral C1 posterior arch screw-C2 laminar screw posterior fixation with a contralateral C1 lateral mass screw for VA preservation in a patient with bow hunter’s syndrome (BHS). A 65-year-old male presented with recurrent loss of consciousness in the right rotational and backward-bending head positions for 1 year. Cerebral angiography in the same head position showed that the left VA was disrupted at C1/2 and the right VA was hypoplastic. The patient was diagnosed with BHS. C1-2 posterior fixation and iliac bone grafting were performed. The left VA was on the dominant side, and the VA was in a high position; thus, a C1 posterior arch screw was selected for the left side, a C1 lateral mass screw was selected for the right side, and a C2 laminar screw with O-arm navigation and a C-arm was used to prevent arterial injury. Intraoperative findings revealed no VA injury, and postoperative computed tomography showed the screw at the planned site. In a patient with BHS, posterior fixation with a unilateral C1 posterior arch screw-C2 laminar screw prevented VA injury because the screw could be inserted while avoiding the VA.

Abstract Background Posterior pelvic ring injuries are challenging for surgeons to treat adequately due to difficulties with reduction and stabilization. Surgical intervention is a beneficial option to protect neurological structures and provide sufficient stability for early mobilization. The gull wing plate (GWP) is a pre-contoured anatomical locking plate with six screws, and its design is unique among posterior transiliac tension-band plates. The purpose of this study was to investigate clinical results of the GWP. Methods Patients who had an unstable posterior pelvic ring injury and underwent internal fixation with GWP were retrospectively analyzed at a trauma center. Demographic data, fracture type, perioperative data, and radiological evaluation with computed tomography (CT) were collected. Clinical outcomes were graded using the functional independence measure (FIM) and Majeed outcome score. Results Twenty-six patients were enrolled (mean age, 54 years), and the mean follow-up period was 23 months. The mean Injury Severity Score was 24 points, and internal fixation was performed 6.6 days post-trauma. CT evaluation showed the lateral surface angle of the uninjured ilium was approximately 68°. The GWP pre-contoured anatomical design closely matched this angle. The mean FIM and Majeed score were 119 and 76 points, respectively, which were graded as excellent (n = 14), good (n = 9), or fair (n = 3). Conclusions With the retrospective single-center data available, the GWP seems to be a minimally-invasive alternative, provides reliable stability of the posterior pelvic ring and allows for rehabilitation within normal ranges.

The usefulness of minimally invasive posterior fixation without debridement and autogenous bone grafting remains unknown. This multicenter case series aimed to determine the clinical outcomes and limitations of this method for thoracolumbar pyogenic spondylitis. Patients with thoracolumbar pyogenic spondylitis treated with minimally invasive posterior fixation alone were retrospectively evaluated at nine affiliated hospitals since April 2016. The study included 31 patients (23 men and 8 women; mean age, 73.3 years). The clinical course of the patients and requirement of additional anterior surgery constituted the study outcomes. The postoperative numerical rating scale score for lower back pain was significantly smaller than the preoperative score (5.8 vs. 3.6, p = 0.0055). The preoperative local kyphosis angle was 6.7°, which was corrected to 0.1° after surgery and 3.7° at the final follow-up visit. Owing to failed infection control, three patients (9.6%) required additional anterior debridement and autogenous bone grafting. Thus, in this multicenter case series, a large proportion of patients with thoracolumbar pyogenic spondylitis could be treated with minimally invasive posterior fixation alone, thereby indicating it as a treatment option for pyogenic spondylitis. [ABSTRACT FROM AUTHOR]

Extreme lateral interbody fusion (XLIF) may be performed with a standalone interbody cage, or with the addition of unilateral or bilateral pedicle screws; however, decisions regarding supplemental fixation are predominantly based on clinical indicators. This study examines the impact of posterior supplemental fixation on facet micromotions, cage loads and load-patterns at adjacent levels in a L4-L5 XLIF at early and late fusion stages. CT data from an asymptomatic subject were segmented into anatomical regions and digitally stitched into a surface mesh of the lumbosacral spine (L1-S1). The interbody cage and posterior instrumentation (unilateral and bilateral) were inserted at L4-L5. The volumetric mesh was imported into finite element software for pre-processing, running nonlinear static solves and post-processing. Loads and micromotions at the index-level facets reduced commensurately with the extent of posterior fixation accompanying the XLIF, while load-pattern changes observed at adjacent facets may be anatomically dependent. In flexion at partial fusion, compressive stress on the cage reduced by 54% and 72% in unilateral and bilateral models respectively; in extension the reductions were 58% and 75% compared to standalone XLIF. A similar pattern was observed at full fusion. Unilateral fixation provided similar stability compared to bilateral, however there was a reduction in cage stress-risers with the bilateral instrumentation. No changes were found at adjacent discs. Posterior supplemental fixation alters biomechanics at the index and adjacent levels in a manner that warrants consideration alongside clinical information. Unilateral instrumentation is a more efficient option where the stability requirements and subsidence risk are not excessive. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to evaluate the effect of body mass index percentile (BMI%) at postoperative and medium follow-up in AIS patients undergoing posterior instrumented fusion (PSF). Methods: We analyzed 87 clinical records of patients (19 male, 68 female) who underwent PSF. The patients were divided into four groups considering BMI%: underweight (UW), normal weight (NW), overweight (OW), and obesity (OB). Demographic, clinical (SRS-22), and radiographic data were collected. The primary outcome was to assess both the surgical and clinical outcomes, whilst the secondary outcome was to compare the radiological findings among the studied groups. Follow-ups were set preoperatively, at 6 months and 5 years. Results: Our results did not show significant differences of clinical outcomes among the studied groups, except for a longer surgical time and a higher hemoglobin decrease in UW and OB patients (p = 0.007). All BMI categories showed similar radiographic outcomes, with no statistical significance at final follow-up. OB patients showed a worse percentage of major curve correction compared to baseline and to UW and OW patients. Conclusions: The present study does not underline substantial differences in clinical and radiographic results among any of the studied groups. However, UW and OB patients showed a worse postoperative progress. Counseling should be provided for patients and families and the achievement of a normal BMI% should be recommended. [ABSTRACT FROM AUTHOR]

We report the case of a 57-year-old man who developed osteoradionecrosis (ORN) at the occipitocervical (OC) junction after radiation therapy for nasopharyngeal carcinoma. During soft-tissue debridement using a nasopharyngeal endoscope, the anterior arch of the atlas (AAA) was spontaneously disrupted, which was later spat out. Radiographic examination revealed complete disruption of the AAA that caused OC instability. We performed posterior OC fixation. The patient experienced successful postoperative pain relief. AAA disruption secondary to ORN at OC junction can cause severe instability. Posterior OC fixation alone may be an effective procedure if the necrotic pharyngeal region is mild and endoscopically controllable. [ABSTRACT FROM AUTHOR]

Risk of injury to normal vertebral artery (VA) unlike that associated with an anomalous VA is infrequent during posterior C1-C2 reduction for congenital atlantoaxial dislocation (AAD). An ischemic event resulting from such indirect injury is a rare occurrence. A 14-year-old boy with severe AAD/ basilar invagination underwent C1-C2 joint manipulation and fixation with an uneventful intraoperative course. Although his immediate postsurgical period was unremarkable, he sustained sudden and rapid neurological worsening on day 3. He developed multiple posterior fossa infarcts and finally succumbed. VA can be indirectly injured possibly due to excessive distraction/manipulation of C1-C2 joints. The lesson learnt is that anticipation of such injuries along with proactive anticoagulation treatment can potentially alter patient outcome. [ABSTRACT FROM AUTHOR]

Abstract Background This retrospective study aimed to determine the feasibility and efficacy of endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion in patients with upper cervical spine tuberculosis. Methods Between June 2008 and January 2016, 17 patients (10 men and 7 women) with upper cervical spine tuberculosis underwent endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion. Anti-tuberculosis treatment was administered for 2–4 weeks preoperatively and 12–18 months postoperatively. The clinical and radiographic data of the patients were analyzed. Results The operation was successfully completed in all patients. Neck pain and stiffness were relieved after the surgery in all patients. The mean operation time was 210.0 ± 21.2 min, and the mean intraoperative blood loss was 364.7 ± 49.6 mL. The mean follow-up duration was 68.1 ± 6.7 months. The erythrocyte sedimentation rate returned to normal by 3 months postoperatively. Visual analog scale scores for neck pain were significantly lower postoperatively than preoperatively. All patients had significant postoperative neurological improvement. Patient-reported outcomes, as measured using the Kirkaldy-Willis criteria, were as follows: excellent, 12 patients; good, 4 patients; fair, 1 patient; and poor, 0 patients. Bone fusion was achieved at 10.9 ± 1.9 months after the surgery; no cases of instrument loosening or fracture occurred. Conclusion Endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion is a feasible and effective surgical method for the treatment of upper cervical spine tuberculosis. It can be used to restore upper cervical spine stability and facilitate spinal healing.

BackgroundRigid interspinous process fixation (ISPF) has received consideration as an efficient, minimally disruptive technique in supporting lumbar interbody fusion. However, despite advantageous intraoperative utility, limited evidence exists characterizing midterm to long-term clinical outcomes with ISPF. The objective of this multicenter study was to prospectively assess patients receiving single-level anterior (ALIF) or lateral (LLIF) lumbar interbody fusion with adjunctive ISPF.MethodsThis was a prospective, randomized, multicenter (11 investigators), noninferiority trial. All patients received single-level ALIF or LLIF with supplemental ISPF (n = 66) or pedicle screw fixation (PSF; n = 37) for degenerative disc disease and/or spondylolisthesis (grade ≤2). The randomization patient ratio was 2:1, ISPF/PSF. Perioperative and follow-up outcomes were collected (6 weeks, 3 months, 6 months, and 12 months).ResultsFor ISPF patients, mean posterior intraoperative outcomes were: blood loss, 70.9 mL; operating time, 52.2 minutes; incision length, 5.5 cm; and fluoroscopic imaging time, 10.4 seconds. Statistically significant improvement in patient Oswestry Disability Index scores were achieved by just 6 weeks after operation (P

Objective: Existing freehand techniques of screw placement mainly emphasized on various entry points and complex trajectory reference. The aim of this study is to illustrate a standardized and reliable freehand technique of pedicle screw insertion for open pedicle screw fixation with a universal entry point and a stereoscopic trajectory reference system and report the results from a single surgeon's clinical experience with the technique. Method: In this study, the author respectively reviewed a total of 200 consecutive patients who had undergone open freehand pedicle screw fixation with Superior Articular Process (SAP) technique from January 2019 to May 2020. For accuracy and safety, all 200 cases had undergone postoperative X‐ray while 33 cases including spinal deformity, infection, and tumor had received additional CT‐scan. Screw accuracy was analyzed via a CT‐based classification system with Student's t test. Results: A total of 1126 screws had been placed from T1‐S1 with SAP‐guided freehand technique and the majority had been confirmed safe in X‐ray without the need of CT scan. A total of 316 screws in deformity or infectious or tumor cases had undergone additional CT scan with 95.5% (189 of 198 screws) accuracy in thoracic group and 94.9% (112 of 118 screws) in lumbar group. The accuracy had been 90.5% (114 of 126 screws) in deformity group and 95.8% (182 of 190 screws) in non‐deformity group. All perforation cases had been rated Grade B (<2 mm) without significant difference between the medial and the lateral (p < 0.05). No cases had been detected with significant neurological deficiencies. The mean intraoperative X‐ray shots were 0.73 per screw. Conclusion: SAP‐guidance is a reliable freehand technique for thoracic and lumbar pedicle screw instrument. It allows accurate and safe screw insertion in both non‐deformity and deformity cases with less radiation exposure. [ABSTRACT FROM AUTHOR]

Introduction: Spinal fractures with subsequent bone fragment dislocation are among the injuries most feared by patients and physicians. The surgical strategy is tailored to the individual patient's characteristics and often consists of pedicle instrumentation with rod-screw systems. Short instrumentation has been associated with worse spinal correction and increased complications. However, recent studies have suggested similar results in terms of kyphosis correction and the maintenance of sagittal alignment compared to longer instrumentation., Material and Methods: This single-center retrospective study was conducted between January 2018 and April 2021. We included 35 single lumbar burst fractures AO Spine grade A3 or A4 with evidence of intra-canal fragments. Patients underwent minimally invasive percutaneous posterior lumbar instrumentation with pedicle screws. Patients received short segmental fixation involving only one level above and below the fractured vertebra., Results: An immediate postoperative computed tomography (CT) scan demonstrated a significant reduction in vertebral kyphotic deformation (11.7° ± 1.6 vs 16.7° ± 5, p<0.001) and sagittal Cobb angle (9.8° ± 1.3 vs 11.7° ± 1.5, p < 0.001). The correction was slightly reduced but remained significant at 12 months for both kyphotic (12.3° ± 1.4, p = 0.03) and sagittal Cobb (10.3° ± 0.9, p = 0.04). Upper lumbar vertebrae showed even larger correction indices compared to lower lumbar segments. No implant failure or screws pullout was seen at the last follow-up., Conclusions: Short spinal fixation is a safe and effective treatment of complete and incomplete burst fractures with posterior bone fragment dislocation. All included patients fared well and achieved good kyphotic correction with no perioperative or long-term complications.

Background: Posterior pelvic ring injuries are challenging for surgeons to treat adequately due to difficulties with reduction and stabilization. Surgical intervention is a beneficial option to protect neurological structures and provide sufficient stability for early mobilization. The gull wing plate (GWP) is a pre-contoured anatomical locking plate with six screws, and its design is unique among posterior transiliac tension-band plates. The purpose of this study was to investigate clinical results of the GWP. Methods: Patients who had an unstable posterior pelvic ring injury and underwent internal fixation with GWP were retrospectively analyzed at a trauma center. Demographic data, fracture type, perioperative data, and radiological evaluation with computed tomography (CT) were collected. Clinical outcomes were graded using the functional independence measure (FIM) and Majeed outcome score. Results: Twenty-six patients were enrolled (mean age, 54 years), and the mean follow-up period was 23 months. The mean Injury Severity Score was 24 points, and internal fixation was performed 6.6 days post-trauma. CT evaluation showed the lateral surface angle of the uninjured ilium was approximately 68°. The GWP pre-contoured anatomical design closely matched this angle. The mean FIM and Majeed score were 119 and 76 points, respectively, which were graded as excellent (n = 14), good (n = 9), or fair (n = 3). Conclusions: With the retrospective single-center data available, the GWP seems to be a minimally-invasive alternative, provides reliable stability of the posterior pelvic ring and allows for rehabilitation within normal ranges. [ABSTRACT FROM AUTHOR]

Background: Chiari 1 malformation has crowding at craniovertebral junction (CVJ), treated by Foramen magnum decompression (FMD) but is associated with high failure rates, which is explained by recently introduced concept of central instability. So, we propose a new concept of relieving this crowding without affecting stability.Objective: To derive a threshold for coring out of internal surface of C1 posterior arch instead of complete laminectomy accompanying FMD.Methods and Material: We prospectively included nine patients with a mean age of 25.33 ± 7.97 years, diagnosed with ACM-1 without AAD, who were operated with FMD and lax duraplasty and C1 laminectomy. The preoperative dural diameter and area covered under the dura at the level of C1 were measured and compared with the postoperative state. Results were analyzed to derive a cut-off threshold which could be drilled from the inner aspect of C1 arch.Results: The postoperative AP diameter of the dura increased statistically significantly from pre-op; however, the AP extension was less than the preoperative diameter with posterior arch included. Likewise, the area spanned by the dura increased statistically significantly from pre-op but was less than the cumulative area of dura with C1 arch included in pre-op. Analyzing all, a mean cut-off of 50.58% was achieved.Conclusion: The authors suggest FMD with partial coring (~50%) of the inner part of arch of C1, instead of full-thickness laminectomy with a wider length of coring as the target, and this will serve the purpose intended, without increasing mobility. [ABSTRACT FROM AUTHOR]

Pedicle or lateral mass screws, which are usually used to fix atlantoaxial instability, increase the risk of vertebral artery (VA) injury in patients with bone or arterial anomalies or osteoporotic bone. Here, we report the use of a unilateral C1 posterior arch screw-C2 laminar screw posterior fixation with a contralateral C1 lateral mass screw for VA preservation in a patient with bow hunter's syndrome (BHS). A 65-year-old male presented with recurrent loss of consciousness in the right rotational and backward-bending head positions for 1 year. Cerebral angiography in the same head position showed that the left VA was disrupted at C1/2 and the right VA was hypoplastic. The patient was diagnosed with BHS. C1-2 posterior fixation and iliac bone grafting were performed. The left VA was on the dominant side, and the VA was in a high position; thus, a C1 posterior arch screw was selected for the left side, a C1 lateral mass screw was selected for the right side, and a C2 laminar screw with O-arm navigation and a C-arm was used to prevent arterial injury. Intraoperative findings revealed no VA injury, and postoperative computed tomography showed the screw at the planned site. In a patient with BHS, posterior fixation with a unilateral C1 posterior arch screw-C2 laminar screw prevented VA injury because the screw could be inserted while avoiding the VA. [ABSTRACT FROM AUTHOR]

Background Thoracolumbar spine constitutes the most common site for spinal tuberculosis. Though the treatment of spinal tuberculosis is antitubercular drugs initially, the patient with neurologic weakness warrants definitive surgical procedure of decompression and stabilization. Even though many investigators have reported favorable results with anterior decompression and stabilization surgery, due to the increased morbidity and complications, the posterior-only approach with decompression and stabilization has evolved as the operation of choice in recent time. Methods All patients aged between 18 and 70 years with clinically and radiologically proven symptomatic thoracolumbar spinal tuberculosis who failed with conservative treatment for 4 weeks or developed neurologic weakness between the treatments are included in this study. All patients were offered decompression and posterior stabilization with transpedicular screws and rods after explaining the above procedure. Clinical outcome was measured by modified Frankel grading; AIS (American Spinal Injury Association impairment score) grade impairment score; and pain assessment done with visual analog scale (VAS) pre- and postoperatively and at 3, 6, and 9 months of interval. Results The postoperative pain relief, neurologic improvement as per modified Frankel grade, AIS grade, and improvement in erythrocyte sedimentation rate and C-reactive protein were significant as compared with the preoperative status. The surgical interventions thus prove to have adequate relief to the patient and arresting the disease progression. The surgical outcome has very minimal intra- and postoperative complications. Conclusion Single-stage decompression and posterior stabilization in thoracolumbar spinal tuberculosis is safe, effective, and results in good clinical outcome. The advantages of surgery include thorough debridement, decompression, and achievement of spinal stabilization.

Introduction: This study compared the effects of posterior fixation (PF) of the remnant tube with fibrin tissue glue to prevent sharp angulation and gastric twist and traditional techniques on postoperative dysphagia and vomiting.Methodology: In total, 200 patients scheduled to undergo laparoscopic sleeve gastrectomy (LSG) as a bariatric surgical intervention were randomly classified into 2 groups (LSG + PF and LSG alone). We compared postoperative dysphagia symptoms among patients who underwent PF and those who did not. The Dysphagia Handicap Index (DHI) results were compared statistically among these groups.Results: The study included a total of 191 patients (85.9% (n = 164) women and 14.1% (n = 27) men) who underwent LSG for obesity. The groups were similar in terms of the patient demographics. The DHI scores of the LSG + PF group were statistically significantly lower than those of the LSG alone group.Conclusion: Adoption of a standardized method of PF with a standardized surgical procedure after LSG considerably reduced the rate of surgical complications. [ABSTRACT FROM AUTHOR]

Purpose: Posterior multilevel fixation of traumatic instability in ankylosing spinal disease (ASD) can be performed by open surgery (OS) or minimally invasive surgery (MIS). We investigated whether both methods differ based on the reduction results and perioperative parameters. Methods: In this retrospective cohort study, OS and MIS groups were investigated. The bisegmental Cobb angles and dislocation angles were measured using pre- and postoperative CT images, and the initial malalignment and achieved reduction were calculated. Cut-seam time, calculated blood loss, transfusion number, fluoroscopy time, pedicle screw placement accuracy, duration of ICU stay, in-patient stay, and complications (bleeding, postoperative thrombosis and embolism, and postoperative mortality) were recorded. Results: Seventy-five ASD patients with spine fractures (Ø 75 ± 11 years, male: 52, female: 23) (MIS: 48; OS: 27) were included in this study. The extent of reduction did not differ in the OS and MIS groups (p = 0.465; MIS:− 1 ± 3°, OS:−2 ± 6°). The residual postoperative malalignment angle was not significantly different (p = 0.283). Seventy-eight of the implanted screws (11%) showed malpositioning. No difference was found between OS and MIS (MIS, 37 [7%]; OS, 41 [16%]; p = 0.095). MIS was associated with less blood loss (OS: 1.28 ± 0.78 l, MIS: 0.71 ± 0.57 l, p = 0.001), cut-seam time (MIS: 98 ± 44 min, OS: 166 ± 69 min, p < 0.001), and hospital stay (MIS: Ø14 ± 16 d, OS: Ø38 ± 49 d, p = 0.02) than OS. Conclusion: OS and MIS show equally limited performance in terms of the fracture reduction achieved. The MIS technique was superior to OS based on the perioperative outcome. Therefore, MIS should be preferred over OS for unstable spinal injuries, excluding C-type fractures, in ASD patients without neurological impairment. [ABSTRACT FROM AUTHOR]

Purpose: Traumatic thoracolumbar vertebral fractures are frequently treated with posterior fixation (PF) and vertebral augmentation. Sometimes, it is deemed too risky to offer vertebral augmentation under fluoroscopic guidance alone. Adjuvant CT/fluoroscopy-guided percutaneous vertebroplasty (PVP) could be offered in certain scenarios. The aim was to evaluate feasibility, safety and effectiveness of PVP in patients presenting with vertebral non-union (VNU) following PF performed without concomitant vertebral augmentation. Materials and Methods: All patients treated in our institution with PVP between July 2015 and July 2020 were retrospectively reviewed. Patients treated with CT/fluoroscopy-guided PVP under local anesthesia for symptomatic VNU following PF were selected. Three criteria were established to assess cement distribution, considering vertebral filling of: (1) fracture cleft, (2) anterior two-thirds of the vertebral body, (3) from superior to inferior endplates. Numeric pain rating scale (NPRS) assessing grade of discomfort (0 = no pain; 10 = worst pain) and complications were evaluated before and 1 month after PVP. Results: Ten patients were identified (mean age 53 ± 12y). Mean time between PF and PVP was 9.6 [2–35] months. Two patients required further cement injection with a second PVP. Eight patients had satisfactory vertebral filling according to the three criteria. Mean NPRS reduction was 2.7(-42%, p < 0.05). No significant complications occurred. Conclusions: Combined CT/fluoroscopy guidance seems a useful tool to perform PVP in VNU following PF, even in presence of orthopedic metalwork. Interventional radiologists may help in these scenarios, performing an adjuvant PVP under local anesthesia. In this small series, the procedure seems safe and effective and could be taken in consideration as alternative to revision surgery. [ABSTRACT FROM AUTHOR]

Objective: Type II odontoid fractures need surgical stabilization for disabling neck pain and instability. Anterior odontoid screw fixation is a well-known technique. However, certain patients require posterior fixation. We present our surgical results and experiences with nine cases managed by the Goel-Harms technique. Materials and Methods: This is a retrospective review of nine patients operated on between January 2019 and December 2021 for Type II odontoid fractures with posterior fixation technique. Their clinical profile was collected from case files. The radiological data were retrieved from radiology archives. The indications for surgery were instability and refractory neck pain. The surgical decision for posterior fixation was guided by fracture morphology. Results: The mean age of presentation was 37.22 ± 9.85 years. Seven patients had Type II, and two had Type IIa odontoid fracture. All patients presented with unbearable neck pain. One patient had a quadriparesis. The fracture line was anterior-inferior sloping in six, posterior-inferior sloping in two, and transverse in one case. The anterior-posterior displacement of fracture ranged from 0 to 7 mm (mean 2.44 ± 2.18 mm). Partial transverse ligament tear without the Atlanto Axial Dislocation was present in three patients. The C1-C2 joint distraction was required in five cases. C1-C2 joint spacer was required in two cases. Following surgery, neck pain was relieved in all cases. Complete fracture alignment was achieved in eight patients. There were no postoperative complications. At the mean follow-up of 16.22 ± 9.61 months, there was no implant failure. Conclusions: Posterior C1-C2 fixation by the Goel-Harms technique is an excellent alternative to anterior fixation in selected cases. [ABSTRACT FROM AUTHOR]

Objective Posterior fossa decompression is the treatment of choice in type 1 Chiari malformation (CM-1) without bony instability. Although surgical fixation has been recommended by a few authors recently, comparative studies to evaluate these treatment strategies using objective outcome tools are lacking. Methods Seventy-three patients with pure CM-1 (posterior fossa bony decompression [PFBD], n = 21; posterior fossa bony and dural decompression [PFBDD], n = 40; and posterior fixation [PF], n = 12) underwent a postoperative outcome assessment using Chicago Chiari Outcome Score (CCOS). Logistic regression analysis detected predictors of an unfavorable outcome. Results Minimally symptomatic patients generally underwent a PFBD while most of the clinically severe patients underwent a PFBDD (p = 0.049). The mean CCOS score at discharge was highest in the PF (12.0 ± 1.41) and lowest in PFBDD group (10.98 ± 1.73, p = 0.087). Patients with minimal preoperative clinical disease severity (adjusted odds ratio [AOR], 4.58; 95% confidence interval [CI], 1.29–16.31) and PFBDD (AOR, 7.56; 95% CI, 1.70–33.68) represented risks for an unfavorable short-term postoperative outcome. Though long-term outcomes (CCOS) did not differ among the 3 groups (p = 0.615), PFBD group showed the best long-term improvements (mean follow-up CCOS, 13.71 ± 0.95), PFBDD group improved to a comparable degree despite a poorer short-term outcome while PF had the lowest scores. Late deteriorations (n = 3, 4.1%) occurred in the PFBDD group. Conclusion Minimally symptomatic patients and PFBDD predict a poor short-term postoperative outcome. PFBD appears to be a durable procedure while PFBDD group is marred by complications and late deteriorations. PF does not provide any better results than posterior fossa decompression alone in the long run.

Background: To evaluate the safety and efficacy of vertebroplasty with short segmented cement augmented pedicle screws fixation for severe osteoporotic vertebral compression fractures (OVCF) with posterior/anterior wall fracture patients. Methods: A retrospective study of 48 patients of DGOU type-4 (vertebra plana) OVCF with posterior/anterior wall fracture, were treated by vertebroplasty and short segment PMMA cement augmented pedicle screws fixation. Radiological parameters (kyphosis angle and compression ratio) and clinical parameters Visual analogue scale (VAS) and Oswestry disability index (ODI) were analysed. Results: A significant improvement was noted in VAS (preoperative, 7.90±0.60; final follow-up 2.90±0.54) and ODI (77.10±6.96 to 21.30±6.70), (P

BACKGROUND: Lateral mass screw fixation is the treatment of choice for posterior cervical stabilization. Long or misdirected screws carry a risk of injury to spinal nerve roots or vertebral artery. This study was aimed to assess the gross anatomic and CT measurements of typical cervical vertebrae for the selection of lateral mass screws. METHODS: Dimensions of the articular pillars were measured on 1) Dry cervical vertebrae with Vernier calipers and 2) Multiplanar reformations of CT scans of the same vertebrae with Viewer software package. The data was statistically evaluated. RESULTS: The transverse diameter of the articular pillars with Vernier calipers varied from 6.0 to 15.4 mm (mean=10.5 mm ± 1.5) and on CT scans ranged from 8.2 - 16.1 mm (mean=11.6 mm ± 1.4). The antero-posterior diameter, an estimate of the screw length by Roy-Camille technique varied from 3.9 to 12.7 mm (mean=8.6 mm ± 1.6) by Vernier calipers and from 6.4 to 13.3 mm (mean=9.1 ± 1.2) on CT scans. The oblique AP diameter, an estimate of screw length by Magerl method varied from 10.8 to 20.3 mm (mean=14.9 mm ± 1.8) by Vernier calipers and from 11.4 to 19.3 mm (mean=14.5 mm ± 1.7) on CT. The CT measurements for height, transverse and AP diameter of the articular pillars were 0.5 - 1.0 mm larger than dimensions by Vernier calipers. No statistically significant difference was observed between the caliper and CT measurements for the oblique AP diameter. CONCLUSION: CT measurements of the articular pillars may slightly overestimate the desired screw length selected by spine surgeons when compared to actual anatomy. Although means of the articular pillars correspond to the screw lengths used, substantial number of observations below 10 mm for Roy-Camille trajectory and below 14 mm for Magerl trajectory requires careful preoperative planning and intra-operative confirmation to avoid long/misdirected lateral mass screws.

This article discussed the application value of oblique lateral interbody fusion (OLIF) combined with posterior fixation in the treatment of patients with L4/L5 lumbar spondylolisthesis and spinal stenosis based on CT and magnetic resonance imaging techniques. A retrospective study of 118 patients with L4/L5 lumbar spondylolisthesis and spinal stenosis who underwent OLIF combined with posterior fixation was selected for a retrospective study, and the patients were divided according to the 1-year follow-up effect. There were 92 cases in the excellent group and 26 cases in the non-excellent group. The results showed that the height of the intervertebral space, the area of the intervertebral foramen, and the area of the spinal canal in the excellent group were all larger than those in the non-excellent group (P<0.05). The increase in the cross-sectional area of L4 and L5 psoas major and the cross-sectional area of L4 and L5 paraspinal muscles in the excellent group were greater than those in the non-excellent group (P<0.05). The ODI reduction and VAS reduction scores of the excellent group were greater than those of the non-excellent group (P<0.05). The increase of intervertebral space height, intervertebral foramen area, spinal canal area, L4 and L5 paravertebral muscle cross-sectional area were significantly positively correlated with the difference in ODI before and after surgery (P<0.05). CT and MRI are used to follow up patients with L4/L5 lumbar spondylolisthesis and spinal stenosis after OLIF combined with posterior fixation, it can observe the situation of postoperative foraminal stenosis and the recovery of psoas major and paraspinal muscles after clinical symptoms are relieved. The recovery situation is of certain value for judging the patient's lumbar function recovery and surgical effect. [ABSTRACT FROM AUTHOR]

Background: Two elderly patients with dropped head syndromes (DHS) were successfully treated with circumferential cervical surgery. Case Description: The two patients, respectively, 72 and 53 years of age, both underwent two-staged surgical procedures. The first surgery included the posterior placement of bilateral pedicle screws with multilevel facetectomies, followed by multilevel anterior cervical discectomy/fusion and posterior rod fixation. Conclusion: Circumferential decompression/fusion successfully addressed chin on chest deformity in two older patients. [ABSTRACT FROM AUTHOR]