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Abstract While lumbar spinal fusion using rigid rods is a prevalent surgical technique, it can lead to complications such as adjacent segment disease (ASDis). Dynamic stabilization devices serve to maintain physiological spinal motion and alleviate painful stress, yet they are accompanied by a substantial incidence of construct failure and subsequent reoperation. Compared to traditional rigid devices, Isobar TTL semi-rigid stabilization devices demonstrate equivalent stiffness and effective stabilization capabilities. Furthermore, when contrasted with dynamic stabilization techniques, semi-rigid stabilization offers improved load distribution, a broader range of motion within the fixed segment, and reduced mechanical failure rates. This paper will review and evaluate the clinical and biomechanical performance of Isobar TTL semi-rigid stabilization devices. A literature search using the PubMed, EMBASE, CNKI, Wanfang, VIP, and Cochrane Library databases identified studies that met the eligibility criteria. Twenty-eight clinical studies and nine biomechanical studies were included in this systematic review. The VAS, the ODI, and Japanese Orthopedic Association scoring improved significantly in most studies. UCLA grading scale, Pfirrmann grading, and modified Pfirrmann grading of the upper adjacent segments improved significantly in most studies. The occurrence rate of ASD was low. In biomechanical studies, Isobar TTL demonstrated a superior load sharing distribution, a larger fixed segment range of motion, and reduced stress at the rod–screw/screw–bone interfaces compared with titanium rods. While findings from mechanical studies provided promising results, the clinical studies exhibited low methodological quality. As a result, the available evidence does not possess sufficient strength to substantiate superior outcomes with Isobar semi-rigid system in comparison to titanium rods. To establish more conclusive conclusions, further investigations incorporating improved protocols, larger sample sizes, and extended follow-up durations are warranted.

Transforaminal interbody fusion (TLIF) has gained increased popularity over recent decades and is being employed as an established surgical treatment for several lumbar spine pathologies, including degenerative spondylosis, spondylolisthesis, infection, tumor and some cases of recurrent disc herniation. Despite the seemingly acceptable fusion rates after TLIF (up to 94%), the literature is still limited regarding the specific location and quality of fusion inside the fixated segment. In this single-institution, retrospective population-based study, we evaluated all post-operative computed tomography (CT) of patients who underwent TLIF surgery at a medium-sized medical center between 2010 and 2020. All CT studies were performed at a minimum of 1 year following the surgery, with a median of 2 years. Each CT study was evaluated for post-operative fusion, specifically in the posterolateral and intervertebral body areas. The fusion's quality was determined and classified in each area according to Lee's criteria, as follows: (1) definitive fusion: definitive bony trabecular bridging across the graft host interface; (2) probable fusion: no definitive bony trabecular crossing but with no gap at the graft host interface; (3) possible arthrosis: no bony trabecular crossing with identifiable gap at the graft host interface; (4) definite pseudarthrosis: no traversing trabecular bone with definitive gap. A total of 48 patients were included in this study. The median age was 55.6 years (SD ± 15.4). The median time from surgery to post-operative CT was 2 years (range: 1–10). Full definitive fusion in both posterolateral and intervertebral areas was observed in 48% of patients, and 92% showed definitive fusion in at least one area (either posterolateral or intervertebral body area). When comparing the posterolateral and the intervertebral area fusion rates, a significantly higher definitive fusion rate was observed in the posterolateral area as compared to the intervertebral body area in the long term follow-up (92% vs. 52%, p < 0.001). In the multivariable analysis, accounting for several confounding factors, including the number of fixated segments and cage size, the results remained statistically significant (p = 0.048). In conclusion, a significantly higher definitive fusion rate at the posterolateral area compared to the intervertebral body area following TLIF surgery was found. Surgeons are encouraged to employ bone augmentation material in the posterolateral area (as the primary site of fusion) when performing TLIF surgery. [ABSTRACT FROM AUTHOR]

While lumbar spinal fusion using rigid rods is a prevalent surgical technique, it can lead to complications such as adjacent segment disease (ASDis). Dynamic stabilization devices serve to maintain physiological spinal motion and alleviate painful stress, yet they are accompanied by a substantial incidence of construct failure and subsequent reoperation. Compared to traditional rigid devices, Isobar TTL semi-rigid stabilization devices demonstrate equivalent stiffness and effective stabilization capabilities. Furthermore, when contrasted with dynamic stabilization techniques, semi-rigid stabilization offers improved load distribution, a broader range of motion within the fixed segment, and reduced mechanical failure rates. This paper will review and evaluate the clinical and biomechanical performance of Isobar TTL semi-rigid stabilization devices. A literature search using the PubMed, EMBASE, CNKI, Wanfang, VIP, and Cochrane Library databases identified studies that met the eligibility criteria. Twenty-eight clinical studies and nine biomechanical studies were included in this systematic review. The VAS, the ODI, and Japanese Orthopedic Association scoring improved significantly in most studies. UCLA grading scale, Pfirrmann grading, and modified Pfirrmann grading of the upper adjacent segments improved significantly in most studies. The occurrence rate of ASD was low. In biomechanical studies, Isobar TTL demonstrated a superior load sharing distribution, a larger fixed segment range of motion, and reduced stress at the rod–screw/screw–bone interfaces compared with titanium rods. While findings from mechanical studies provided promising results, the clinical studies exhibited low methodological quality. As a result, the available evidence does not possess sufficient strength to substantiate superior outcomes with Isobar semi-rigid system in comparison to titanium rods. To establish more conclusive conclusions, further investigations incorporating improved protocols, larger sample sizes, and extended follow-up durations are warranted. [ABSTRACT FROM AUTHOR]

Abstract Purpose The purpose of this study was analyzing the effect of subsequent vertebral body fractures on the clinical outcome in geriatric patients with thoracolumbar fractures treated operatively. Methods Retrospectively, all patients aged ≥ 60 with a fracture of the thoracolumbar spine included. Further inclusion parameters were acute and unstable fractures that were treated by posterior stabilization with a low to moderate loss of reduction of less than 10°. The minimal follow-up period was 18 months. Demographic data including the trauma mechanism, ASA score, and the treatment strategy were recorded. The following outcome parameters were analyzed: the ODI score, pain level, satisfaction level, SF 36 score as well as the radiologic outcome parameters. Results Altogether, 73 patients were included (mean age: 72 years; 45 women). The majority of fractures consisted of incomplete or complete burst fractures (OF 3 + 4). The mean follow-up period was 46.6 months. Fourteen patients suffered from subsequent vertebral body fractures (19.2%). No trauma was recordable in 5 out of 6 patients; 42.8% of patients experienced a low-energy trauma (significant association: p

Rigid spinal fusion with instrumentation has been widely applied in treating degenerative spinal disorders and has shown excellent and stable surgical results. However, adjacent segment pathology or implants' loosening could be problematic due to the spine's segmental fusion. Therefore, this study verified a novel concept for posterior stabilization with polyethylene inserts inside a pedicle screw assembly using bone models. We observed that although the gripping capacity of the dynamic pedicle screw system using a tensile and compression tester was less than half that of the rigid pedicle screw system, the flexion‐extension moment of the dynamic pedicle screws was significantly lower than that of the rigid pedicle screws. Furthermore, while the bending force of the rigid pedicle screw assembly increased linearly with an increase in the bending angle throughout the test, that of the dynamic pedicle screw assembly also increased linearly until a bending angle of 2.5° was reached. However, this angle decreased at a bending angle of more than 2.5°. Additionally, the fatigue test of 1.0 × 106 cycles showed that the pull‐out force of the dynamic pedicle screws from two different polyurethane foam blocks was significantly higher than that of the rigid pedicle screws. Therefore, based on our results, we propose that the device can be applied in clinical cases to reduce screw loosening and adjacent segment pathology. [ABSTRACT FROM AUTHOR]

Introduction: Fractures in ankylosing spine disorders (ASD) are associated with high complication and mortality rates. During the posterior stabilization of these fractures, reduction is often partial, resulting in the persistence of a significant anterior diastasis. Our objective was to evaluate the safety and efficiency of isolated posterior stabilization in elderly ASD patients, without direct reduction of the anterior diastasis, in terms of clinical and radiological outcomes, complications, and mortality. Methods: This retrospective study included 46 patients, mean age 79.3 years, with ASD, who underwent isolated posterior stabilization, open or percutaneous, for thoracolumbar fractures. The average follow-up was 21.7 months, with a minimum follow-up of 6 months. Autonomy (Parker score) and radiological results (lordotic angulation) were analyzed pre-and post-operatively. Results: Autonomy was maintained at the last follow-up, with no significant difference in Parker’s score. The consolidation rate was 94.6%. No implant failure was recorded. Despite the absence of an anterior procedure, lordotic angulation was significantly reduced by 2.6° at 6 months (p = 0.02). The rate of surgical complications following open surgeries was 10.9% (n = 5), of which 6.5% were infections. No surgical complications were reported in percutaneous surgeries. The rate of medical complications was 67.4% (n = 31), with a rate of 88.2% in the open surgery group, compared to 55.2% in the percutaneous surgery group. An open approach was associated with a five-fold higher risk of complications (p = 0.049). Nine patients died during follow-up (19.6%). Conclusions: Isolated posterior stabilization in the treatment of thoracolumbar spine fractures in elderly ASD patients is a safe technique promoting autonomy preservation, and high radiological bony healing with acceptable complication and mortality rates. The persistent anterior gap is partially reduced when the spine is loaded and does not seem to require an anterior procedure, thus decreasing complications. Percutaneous surgery should be the technique of choice to reduce surgical complications.

Study Design: Retrospective comparative study. Objectives: To compare radiological and functional outcomes of patients with fixation constructs utilizing pedicle screw stabilization at the fracture level (FL group) versus patients with non-fracture level (NFL group) fixation in single level fractures of the thoracolumbar junction (T11-L1). Methods: 53 patients of whom fracture level screw was used in 34 (FL group) were compared to 19 patients in NFL group. Radiological parameters analyzed were sagittal index, bi-segmental kyphosis (Cobb) angle and degree of vertebral height restoration. Prospectively collected patient reported functional outcomes and post-operative complications were also studied. Stepwise regression analysis adjusted by age, gender and functional scores was performed to account for the small numbers and unequal sizes of the groups. Results: Back pain score was significantly lower in the FL group (P < 0.025). Core Outcome Measures Index scores and leg pain scores, though low in the FL group, were not statistically significant. The regression analysis showed that the inclusion of the fracture-level screw was independently associated with a greater change in sagittal index and vertebral height restoration post-operatively. Sagittal index was maintained through to final follow up as well. The bi-segmental Cobb's angle correction was not associated with fracture-level screw construct. There was no significant difference between the groups for revision surgery, deep infection, implant failure or length of hospital stay. Conclusion: The inclusion of the fracture-level pedicle screws in the fixation construct significantly improves the immediate and final measured radiological parameters, with improved functional scores in single level unstable vertebral fractures of the thoracolumbar junction. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was analyzing the effect of subsequent vertebral body fractures on the clinical outcome in geriatric patients with thoracolumbar fractures treated operatively.Methods: Retrospectively, all patients aged ≥ 60 with a fracture of the thoracolumbar spine included. Further inclusion parameters were acute and unstable fractures that were treated by posterior stabilization with a low to moderate loss of reduction of less than 10°. The minimal follow-up period was 18 months. Demographic data including the trauma mechanism, ASA score, and the treatment strategy were recorded. The following outcome parameters were analyzed: the ODI score, pain level, satisfaction level, SF 36 score as well as the radiologic outcome parameters.Results: Altogether, 73 patients were included (mean age: 72 years; 45 women). The majority of fractures consisted of incomplete or complete burst fractures (OF 3 + 4). The mean follow-up period was 46.6 months. Fourteen patients suffered from subsequent vertebral body fractures (19.2%). No trauma was recordable in 5 out of 6 patients; 42.8% of patients experienced a low-energy trauma (significant association: p < 0.01). There was a significant correlation between subsequent vertebral body fracture and female gender (p = 0.01) as well as the amount of loss of reduction (p = 0.02). Thereby, patients with subsequent vertebral fractures had significant worse clinical outcomes (ODI: 49.8 vs 16.6, p < 0.01; VAS pain: 5.0 vs 2.6, p < 0.01).Conclusion: Patient with subsequent vertebral body fractures had significantly inferior clinical midterm outcome. The trauma mechanism correlated significantly with both the rate of subsequent vertebral body fractures and the outcome. Another risk factor is female gender. [ABSTRACT FROM AUTHOR]

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Abstract Background The evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly. Methods Retrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization and long-segmental stabilization. Results Fifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n = 38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03). Conclusion Unstable fractures of the midthoracic spine are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral body fractures during follow-up.

Abstract Background The kinematic alignment (KA) technique in total knee arthroplasty (TKA) aims to restore the native alignment of pre-disease knee joint anatomy. Determining the individualized alignment targets is crucial for pre-operative planning, which can be set according to different original knee phenotypes. Five most common knee phenotypes have been categorized for KA-TKA alignment target setting in our previous study. The purpose of this study was to investigate the distribution of the five phenotypes in advanced OA knee patients and evaluate the clinical outcomes of this phenotype-oriented KA-TKA using the generic instrument, with particular emphasis on alignment strategy, surgical technique, survivorship, radiographic and functional outcomes. Methods The clinical data of 123 patients (88 women, 35 men) who had undergone 140 TKAs in our hospital were reviewed. All the TKAs were performed with alignment targets set according to the original phenotypes of the knee, with the KA method, using the generic total knee instrument. The patients’ demographics, preoperative and postoperative knee alignment angles, one-year postoperative range of motion (ROM), Oxford knee scores (OKS), Combined knee society score (CKSS) were collected and analyzed. Results The 3 years survivorship was 99.3% for all cause of revision, and 100% with revision other than infection as the endpoint. The preoperative phenotypes of the knee were as follows: neutral alignment 20.1% (type 1: 3.6%, type 2: 16.5%), varus alignment 71.2% (type 3: 46.0%, type 4: 25.2%), and valgus alignment (type 5: 8.6%). Using our protocol, patients with different knee phenotypes could get similar great functional improvement though the postoperative alignment parameters were significantly different between the knee phenotypes (P

Purpose: The aim of this review is to systematically screen the literature for clinical and biomechanical studies dealing with posterior stabilization of acute traumatic mid-thoracic vertebral fractures in patients with normal bone quality. Methods: This review is based on articles retrieved by a systematic search in the PubMed and Web of Science database for publications up to December 2018 dealing with the posterior stabilization of fractures of the mid-thoracic spine. Results: Altogether, 1012 articles were retrieved from the literature search. A total of 960 articles were excluded. A total of 16 articles were dealing with the timing of surgery in polytraumatized patients, patients suffering of neurologic deficits after midthoracic fractures, and the impact of concomitant thoracic injuries and were excluded. Thus, 36 remaining original articles were included in this systematic review depicting the topics biomechanics, screw insertion, and outcome after posterior stabilization. The overall level of evidence of the vast majority of studies is low. Conclusion: High quality studies are lacking. Long-segmental stabilization is indicated in unstable midthoracic fractures with concomitant sternal fractures. Generally, long-segmental constructs seem to be the safer treatment strategy considering the relative high penetration rate of pedicle screws in this region. Thereby, navigated insertion techniques and intraoperative 3D-imaging help to improve pedicle screw placement accuracy. [ABSTRACT FROM AUTHOR]

Chiari I malformation is characterized by the downward displacement of cerebellar tonsils through the foramen magnum. While discussing the treatment options for Chiari I malformation, the points of focus include: (1) Has the well-established procedure of posterior fossa decompression become outdated and has been replaced by posterior C1–2 stabilization in every case? (2) In case posterior stabilization is required, should a C1–2 stabilization, rather than an occipitocervical fusion, be the only procedure recommended? The review of literature revealed that when there is bony instability like atlantoaxial dislocation (AAD), occipito-atlanto-axial facet joint asymmetry or basilar invagination (BI) associated with Chiari I malformation, one should address the anterior bony compression as well as perform stabilization. This takes care of the compromised canal at the foramen magnum and re-establishes the cerebrospinal fluid flow along the craniospinal axis; and also provides treatment for CVJ instability. In the cases with a pure Chiari I malformation without AAD or BI and with completely symmetrical C1–2 joints, however, posterior fossa decompression with or without duroplasty is sufficient to bring about neurological improvement. The latter subset of cases with pure Chiari I malformation have, thus, shown significant (>70%) rates of neurological improvement with posterior fossa decompression alone. A C1–2 posterior stabilization is a more stable construct due to the strong bony purchase provided by the C1–2 lateral masses and the short lever arm of the construct. However, in the cases with significant bleeding from paravertebral venous plexus; a very high BI, condylar hypoplasia and occipitalized atlas; gross C1–2 rotation or vertical C1–2 joints with unilateral C1 or C2 facet hypoplasia, as well as the presence of subaxial scoliosis; maldevelopment of the lateral masses and facet joints (as in very young patients); or, the artery lying just posterior to the C1–2 facet joint capsule (being endangered by the C1–2 stabilization procedure), it may be safer to perform an occipitocervical rather than a C1–2 fusion.

Background: The evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly.Methods: Retrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization and long-segmental stabilization.Results: Fifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n = 38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03).Conclusion: Unstable fractures of the midthoracic spine are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral body fractures during follow-up. [ABSTRACT FROM AUTHOR]

Background: The kinematic alignment (KA) technique in total knee arthroplasty (TKA) aims to restore the native alignment of pre-disease knee joint anatomy. Determining the individualized alignment targets is crucial for pre-operative planning, which can be set according to different original knee phenotypes. Five most common knee phenotypes have been categorized for KA-TKA alignment target setting in our previous study. The purpose of this study was to investigate the distribution of the five phenotypes in advanced OA knee patients and evaluate the clinical outcomes of this phenotype-oriented KA-TKA using the generic instrument, with particular emphasis on alignment strategy, surgical technique, survivorship, radiographic and functional outcomes.Methods: The clinical data of 123 patients (88 women, 35 men) who had undergone 140 TKAs in our hospital were reviewed. All the TKAs were performed with alignment targets set according to the original phenotypes of the knee, with the KA method, using the generic total knee instrument. The patients' demographics, preoperative and postoperative knee alignment angles, one-year postoperative range of motion (ROM), Oxford knee scores (OKS), Combined knee society score (CKSS) were collected and analyzed.Results: The 3 years survivorship was 99.3% for all cause of revision, and 100% with revision other than infection as the endpoint. The preoperative phenotypes of the knee were as follows: neutral alignment 20.1% (type 1: 3.6%, type 2: 16.5%), varus alignment 71.2% (type 3: 46.0%, type 4: 25.2%), and valgus alignment (type 5: 8.6%). Using our protocol, patients with different knee phenotypes could get similar great functional improvement though the postoperative alignment parameters were significantly different between the knee phenotypes (P < 0.05).Conclusion: The early outcomes of this phenotype-oriented KA-TKA using generic total knee instruments are promising. Setting individualized alignment target according to original knee phenotype is rational and practical. The residual varus alignment did not cause any aseptic loosening in the 3 years follow-up. Long-term survivorship and functional outcomes need to be evaluated in future studies. [ABSTRACT FROM AUTHOR]

To compare the construct stability of long-segmental dorsal stabilization in unstable midthoracic osteoporotic fracture situation with complete pedicle screw cement augmentation (ComPSCA) versus restricted pedicle screw cement augmentation (ResPSCA) of the most cranial and caudal pedicle screws. Twelve fresh frozen human cadaveric specimens (Th 4–Th 10) aged 65 years and older were tested in a biomechanical cadaver study. All specimens received a dual-energy X-ray absorption scan and computed tomography scan before testing. Standardized long segmental stabilization was performed. All specimens were matched into pairs. These pairs were randomized into the groups with ComPSCA and ResPSCA. An unstable Th7 fracture was simulated. The maximum load was tested with 6 mm/min until failure or 20 mm had been reached. After testing, a computed tomography scan was performed. The mean age of the specimens was 87.8 years (range 74–101 years). The mean t score was –3.6 (range –1.2 to –5.3). The mean maximum force in the ResPSCA group was 1600 N (range 1119–1880 N) and 1941 N (1183–3761 N) in the ComPSCA group. No statistically significant differences between both study groups (P = 1.0) could be seen. No signs of screw loosening were visible. No statistically significant differences in the maximum loads could be seen. No screw loosening of the non-cemented screws was visible. Thus, the construct stability of long segmental posterior stabilization of an unstable midthoracic fracture using ResPSCA seems to be comparable with ComPSCA under axial compression. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether knee stability, range of motion (ROM) and clinical scores differ between anterior-stabilized (AS) and posterior-stabilized (PS) total knee arthroplasty (TKA). Methods: This prospective randomized controlled trial included 34 patients with severe bilateral knee osteoarthritis who underwent bilateral TKA between June 2010 and July 2011 using AS and PS designs of a single-implant system. AS TKA with ultracongruent inserts was performed in one knee and PS TKA with a cam-post mechanism was performed in the other knee in each patient. Clinical and radiological data from a mean follow-up period of 5 years, including ROM, clinical scores, peak knee torque determined by isokinetic test, knee joint laxity determined by Telos stress views, tourniquet time and subjects' preference were analyzed. Results: The mean postoperative knee flexion angle did not differ between groups until 1 year. Beginning 2 years postoperatively, the knee flexion angle decreased slightly in the AS group and was smaller than that in the PS group (p = 0.004). The mean Knee Society knee score was higher in the PS group than in the AS group after 2 years. The quadriceps strength did not differ between groups. The mean posterior laxity after TKA was 6–8 mm greater in the AS group than in the PS group. No radiological loosening was observed in either group. More subjects preferred PS knees to AS knees. However, this difference was not significant. Conclusion: AS primary TKA was inferior to PS TKA in terms of posterior knee stability, postoperative knee flexion and clinical scores after 2 years. Level of evidence: Therapeutic study, Level 1. [ABSTRACT FROM AUTHOR]

Background: Extensile interventions to provide anterior spinal column support in metastatic spinal cord compression (MSCC) surgery incur added morbidity in this surgically frail group of patients. We present our preliminary results of posterior spinal decompression and stabilization coupled with vertebral body cemented stents for anterior column support in MSCC. Methods: Fourteen patients underwent posterior spinal decompression and pedicle screw construct along with vertebral body stenting (VBS) technique for reconstruction and augmentation of the vertebral body. The primary in all except one was solid organ malignancy and 10 patients (71%) were treatment naïve. The mean revised Tokuhashi score was 10.7 ± 2.7 and the mean spinal instability neoplastic score was 9.6 ± 1.9. All vertebral body lesions were purely lytic and were associated with a cortical defect in the posterior wall. Results: A mean 5.3 ± 2.7 ml low-viscosity polymethyl methacrylate bone cement was injected within the stent at each compression level. No cement extrusion posteriorly was noted in any case from intraoperative fluoroscopy or postoperative radiographs. Five patients died at a mean 6.8 months (range 1-15 months), while the remaining patients have a mean survival of 18 months. Neither further revision surgical intervention nor any neurological deterioration was noted in any patient, who all continued to be ambulatory. The mean postoperative Core Outcome Measures Index score for 11 patients was 4.03 (standard deviation 3.11, 95% confidence interval (1.93-6.12). Conclusion: In lytic vertebral body lesions with posterior wall erosions, cemented VBS technique adds to the surgical armamentarium in MSCC surgery showing promising early results without added complications. [ABSTRACT FROM AUTHOR]

Purpose: To report the preliminary results of a novel full percutaneous interbody fusion technique for the treatment of degenerative disc disease (DDD) resistant to conservative treatment with posterior stabilization with rods and screws and transforaminal placement of an 8-mm-width intradiscal cage.Materials and Methods: A total of 79 patients with lumbar spine DDD resistant to medical therapy and/or spondylolisthesis up to grade 2 were treated. We performed preoperative X-rays, CT and MRI. The outcomes were assessed using the VAS score and the Oswestry Disability Index at a 1-, 6- and 12-month follow-up and also included X-rays to evaluate the correct bone fusion and the absence of complications.Results: Mean operation time was 130 min, and mean postoperative time until hospital discharge was 2 days. Postoperative values for VAS scores and ODI improved significantly compared to preoperative data: Mean preprocedural VAS was 7.49 ± 0.69 and decreased at 12-month follow-up to 1.31 ± 0.72, and mean preprocedural ODI was 29.94 ± 1.67 and decreased at 12-month follow-up to 12.75 ± 1.44. No poor results were reported, and no postprocedural sequelae were observed.Conclusions: In our experience, this preliminary report shows a feasible and safe full percutaneous alternative procedure and represents a minimally invasive management of degenerative disc disease with low back pain resistant to medical therapy with or without lumbar spondylolisthesis up to grade 2. [ABSTRACT FROM AUTHOR]

Study DesignThis is a retrospective study.PurposeTo determine the efficacy and safety of a posterior transpedicular approach with regard to functional and radiological outcomes in people with thoracic and thoracolumbar spinal tuberculosis.Overview of LiteratureSpinal tuberculosis can cause serious morbidity, including permanent neurological deficits and severe deformities. Medical treatment or a combination of medical and surgical strategies can control the disease in most patients, thereby decreasing morbidity incidence. A debate always existed regarding whether to achieve both decompression and stabilization via a combined anterior and posterior approach or a single posterior approach exists.MethodsThe study was conducted at the Indian Spinal injuries Centre and included all patients with thoracic and thoracolumbar Pott's disease who were operated via a Posterior transpedicular approach. Data regarding 60 patients were analyzed with respect to the average operation time, preoperative and postoperative, 6 months and final follow-up American Spinal Injury Association (ASIA) grading, bony fusion, implant loosening, implant failure, preoperative, postoperative, 6 months and final follow-up kyphotic angles, a loss of kyphotic correction, Oswestry disability index (ODI) score, and visual analog scale (VAS) score. Data were analyzed using either a paired t -test or a Wilcoxon Signed Rank test.ResultsThe mean operation time was 260±30 minutes. Fifty-five patients presented with evidence of successful bony fusion within a mean period of 6±1.5 months. Preoperative dorsal and lumbar angles were significantly larger than postoperative angles, which were smaller than final follow-up angles. The mean kyphotic correction achieved was 12.11±14.8, with a mean decrease of 5.97 and 19.1 in VAS and ODI scores, respectively.ConclusionsAnterior decompression and posterior stabilization via a posterior transpedicular approach are safe and effective procedures, with less intraoperative surgical duration and significant improvements in clinical and functional status.

Primary spinal tumors are rarely seen, and representing 4-8% of all central nervous system tumors. Extradural tumors constitute approximately 40% of intraspinal tumors whereas intradural-extramedullary tumors make up the remaining approximately 60%. These tumors are classified as extradural, intradural, extramedullary, and intramedullary depending on their origin and anatomic location. Intradural extramedullary spinal tumors form schwannomas and meningiomas. Spinal meningiomas are usually intradural extramedullary tumors. Meningiomas can be seen in epidural localization, extradural extension only, with nerve rostral invasion as, vertebral meningioma, or as multiple spinal meningioma. Spinal meningiomas are the most common intradural-extramedullary tumors and are generally slowgrowing. Spinal meningiomas may have different clinical manifestations depending on their location and size. Surgical treatment should be planned according to the size of the tumor in the clinical situation after diagnosis. This study reports the case of a 57-year-old female patient presenting with a one-month history of increasing weakness in the lower extremities and numbness in the upper extremities. In addition, the report includes a literature review.

Chiari I malformation is characterized by the downward displacement of cerebellar tonsils through the foramen magnum. While discussing the treatment options for Chiari I malformation, the points of focus include: (1) Has the well-established procedure of posterior fossa decompression become outdated and has been replaced by posterior C1-2 stabilization in every case? (2) In case posterior stabilization is required, should a C1-2 stabilization, rather than an occipitocervical fusion, be the only procedure recommended? The review of literature revealed that when there is bony instability like atlantoaxial dislocation (AAD), occipito-atlanto-axial facet joint asymmetry or basilar invagination (BI) associated with Chiari I malformation, one should address the anterior bony compression as well as perform stabilization. This takes care of the compromised canal at the foramen magnum and re-establishes the cerebrospinal fluid flow along the craniospinal axis; and also provides treatment for CVJ instability. In the cases with a pure Chiari I malformation without AAD or BI and with completely symmetrical C1-2 joints, however, posterior fossa decompression with or without duroplasty is sufficient to bring about neurological improvement. The latter subset of cases with pure Chiari I malformation have, thus, shown significant (> 70%) rates of neurological improvement with posterior fossa decompression alone. A C1-2 posterior stabilization is a more stable construct due to the strong bony purchase provided by the C1-2 lateral masses and the short lever arm of the construct. However, in the cases with significant bleeding from paravertebral venous plexus; a very high BI, condylar hypoplasia and occipitalized atlas; gross C1-2 rotation or vertical C1-2 joints with unilateral C1 or C2 facet hypoplasia, as well as the presence of subaxial scoliosis; maldevelopment of the lateral masses and facet joints (as in very young patients); or, the artery lying just posterior to the C1-2 facet joint capsule (being endangered by the C1-2 stabilization procedure), it may be safer to perform an occipitocervical rather than a C1-2 fusion. [ABSTRACT FROM AUTHOR]

The natural healing of spinal tuberculosis occurs by spontaneous fusion of vertebral bodies with or without kyphotic deformity. Late-onset paraplegia secondary to the fracture of fusion mass in tuberculosis is one of the rare conditions which have not been extensively reported. A 56-year-old male patient sustained road traffic accident was diagnosed with a fracture of fusion mass in already healed tuberculosis. He was presented with weakness in both the lower limbs with ASIA-C grading of spinal cord injury. He was treated with posterior instrumented stabilization and decompression. The patient recovered well postoperatively and had regained his complete power of both lower limbs. Late-onset paraplegia in old healed spinal tuberculosis is a well-known entity that may be caused due to transaction of the cord by a bony ridge or when the formed granulation or fibrous tissue constricts the cord. Fusion mass fractures are not very uncommon in conditions such as ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis. Traumatic fractures tend to occur at the adjacent vertebral bodies to the fused ones as the biomechanical stress at the junctional site is far higher than at the center of the fused mass. In healed spinal tuberculosis, resultant deformity would be kyphosis. The angle of kyphosis is directly proportional to the resulting neurological deficit. Fractures of fused mass in healed tuberculosis are similar to the fractures in other ossifying bone lesions. The purpose of this article is to document the rare possibility of late-onset paraplegia in uninstrumented old healed spinal tuberculosis with kyphotic deformity, due to the fracture of fusion mass as seen in ankylosing spondylitis. [ABSTRACT FROM AUTHOR]

An 87-year-old male having a history of C3–7 open-door cervical laminoplasty 20 years ago fell and sustained neck pain and paralysis with complete motor and sensory deficits below C6 (Frankel A). Computed tomography (CT) revealed ankylosis from C2 to C7 due to diffuse idiopathic skeletal hyperostosis (DISH) and a C5/6 fracture with C5 posterior displacement. We performed surgery the day after injury using a posterior approach for stabilization of the spinal column from C3 to T1. Translaminar screws (LS) were placed to the right (hinge side) of C3–7, lateral mass screws (LMS) to the left (open side) of C3–6, and pedicle screws to the left of C7 and bilaterally in T1. Bony fusion was achieved as seen on CT images 6 months after surgery. We conclude that long posterior stabilization using LMS and LS is an effective treatment for cervical fracture in patients with DISH having a history of cervical laminoplasty. [ABSTRACT FROM AUTHOR]

Objective To introduce our technique and results of retropleural/peritoneal lateral pediculectomy for the decompression of thoracolumbar fractures and reconstruction using an expandable titanium cage and circumferential fixation at a single stage. Methods Eighteen patients who had single unstable, burst thoracolumbar fracture were treated by this technique between January 2014 and December 2016 (T12: n = 9, L1: n = 7, L2: n = 2). They were reviewed retrospectively in terms of radiologic outcomes (computed tomography [CT] scan and radiograph), clinical outcomes, and complications. The results were compared with another cohort of thoracolumbar fractures treated by posterior-only surgery. Results There were no radiologic complications implying pseudoarthrosis or instrument failure on the postoperative 6-month CT scan. There was also no neurologic deterioration or infection during the same period. Two patients (11.1%) of iatrogenic injury and 1 patient of trauma-related injury of the dura were secured without any delayed complications. Three patients (16.7%) with transient weakness in left hip flexion immediately after operation were observed and recovered within 2 weeks in all cases. Six patients (33.3%) complained of dysesthesia and/or hypoesthesia on the incision site. Conclusions In this study, we suggest lateral pediculectomy as a distinct anatomic landmark to access and remove bony fragments effectively and safely in unstable thoracolumbar burst fractures. This provides a more straightforward access to the burst fragment and helps the surgeon to make better intraoperative decompression strategies. Moreover, this circumferential instrumentation with anterior support and fusion revealed better restoration of the thoracolumbar spine alignment compared with posterior-only surgery, with acceptable complications rates. Highlights • We present lateral pediculectomy as a technique for decompression of thoracolumbar fractures. • This provides straightforward access to the burst fragment and good decompression strategies. • Circumferential instrumentation and fusion provide good restoration of thoracolumbar alignment. • This technique presents good radiologic and clinical outcomes with an acceptable complication rate. [ABSTRACT FROM AUTHOR]

Fractures of the second cervical vertebrae (C2) and its odontoid process account for one of the most frequent cervical spine injuries that cause significant mortality and morbidity. The goal of injury treatment is to restore atlantoaxial complex stability. This article reports a young male patient aged 19 years who underwent surgical treatment due to odontoid fractures type III. A 19-year-old male patient came with a chief complaint of weakness in the upper and lower extremities for 3 weeks before admission. The patient underwent a series of physical and radiological examinations and was diagnosed with atlanto-odontoid fracture dislocation Anderson and D'Alonzo classification type III and motoric aphasia due to traumatic subdural hygroma. The patient underwent temporary cervical traction with Garden-Wells tongs and planned for posterior stabilization with the Sonntag procedure. Three and six months follow-ups showed significant clinical improvement in range of motion (ROM). Surgical modalities of stabilization are more commonly chosen in patients with type II and type III odontoid fractures. We performed posterior stabilization with C1-C2 fusion using a modified Gallie (Sonntag) procedure and trans articular screw placement using the Magerl technique. The Gallie procedure was chosen because it could limit atlas displacement effectively which significantly improved Neck Disability Index (NDI) and visual analog score (VAS). We presented a rare case of Atlanto-odontoid fractures treated with a surgical procedure using a posterior approach that resulted in a excellent outcomes. • Fractures of the 2nd cervical vertebrae (C2) is one of the most frequent cervical injuries with high morbidity and mortality • Anterior direct osteosynthesis or temporary posterior stabilization utilizing the Harms approach are better possibilities. • We reported a young male patient aged 19 years who underwent Sonntag procedure due to odontoid fractures type III. • Post-operative showed good functional outcome with preservation of neck movement. [ABSTRACT FROM AUTHOR]

Background and Aim: Defining a new screwing method for C7 posterior stabilization in case of a cervical rib existence aimed in this report. Materials and Methods: Ten adult patients, five of which without cervical rib (Group 1) and the other five of which (Group 2) with cervical rib that has been chosen from the radiology archive. Axial, sagittal, coronal sections of cervical computed tomography and three dimensional images were obtained. Lateral mass sizes of all cases were measured and compared between two groups. The relationship between cervical rib and lateral mass was identified in Group 2. Results: The mean length, width, and height of lateral masses were measured respectively, as 5.4, 17.6, and 12.7 mm in Group 1. The measurement of Group 2 (with cervical rib) revealed the mean length of 20.7, the width of 20.4, and the height of 15.9 mm. When both groups were compared, there were no significant differences between the width and height of the lateral masses. However, axial measurements of Group 2 revealed a remarkable and significant length for screwing. Conclusion: In patients with cervical rib, directing lateral mass screw toward cervical rib conjoint can present a simple and reliable alternative method in C7 posterior stabilization process.

A simultaneous odontoid decompression and bilateral posterior atlanto-axial facetal distraction, C1-2 joint spacer/bone graft placement and stabilization may be performed utilizing the 'posterior-only' approach. This procedure may be performed utilizing a single posterior midline incision, a bilateral posterior approach to the C1-2 facet joints and a bilateral posterolateral approach to the odontoid process and C2 body. It may be carried out in situations where a C1-2 non-reduction/partial reduction using a 'posterior alone' procedure is anticipated due to the complex bony/soft tissue configuration anterior at the thecal sac existing at the cervicomedullary junction. In the four cases described in this report, the procedure led to a successful circumferential decompression at the level of foramen magnum along with posterior C1-2 facetal distraction and stabilization in various complex craniovertebral junction anomalies (atlantoaxial dislocation [AAD] and/or a high basilar invagination [BI] associated with a significantly retroverted dens, along with a rotatory component, due to grossly asymmetrical facet joints). This technique may also be utilized in those diseases that result in an anterior osteoligamentous mass at the CVJ associated with C1-2 instability. [ABSTRACT FROM AUTHOR]