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The purpose of this study was to compare the efficacy of the lateral approach and posterior approach in the treatment of lumbar degenerative diseases. Through a systematic search of relevant articles published on or before July 20, 2023, in the Embase, PubMed, and Cochrane libraries, the 2 authors independently extracted data and used the Newcastle‒Ottawa scale to evaluate the quality of the included studies. Using Stata16 software, the continuous variables were presented as the standard mean deviation, and the bipartite variables were analyzed using the pooled odds ratio with 95% confidence interval. A total of 13,892 articles were screened and 10,908 studies were identified after deleting duplicates, of which 41 met the criteria and were included in the meta-analysis. The meta-analysis showed that the lateral approach was superior to the posterior approach in reducing blood loss, operation time, and hospital stay. At the same time, compared with the posterior approach, the lateral approach has more advantages in the long-term Japanese Orthopaedic Association score and Oswestry Disability Index score, adjusting mid- and long-term LL and short- and long-term disc height. Lateral and posterior surgery have similar clinical effects in the treatment of lumbar degenerative diseases and can significantly reduce pain and improve postoperative SL. At the same time, the lateral approach has more advantages in improving long-term quality of life, reducing the long-term disability index, adjusting mid- and long-term LL and short- and long-term disc height. [ABSTRACT FROM AUTHOR]

Abstract Objective We aimed to observe the clinical effect of single-stage posterior surgery on HIV-positive patients with thoracolumbar tuberculosis. Methods From October 2015 to October 2019, 13 HIV-positive patients with thoracolumbar tuberculosis who underwent single-stage posterior surgery were retrospectively analyzed (observation group), and 13 HIV-negative patients with thoracolumbar tuberculosis who were matched with the gender, age, operative site, and surgical approach during the same period were selected as the control group. Postoperative complications, hemoglobin, albumin, CD4+T lymphocyte count, operative site, operative time, and blood loss were recorded between the two groups. The clinical efficacy was evaluated by the visual analog scale (VAS), American Spinal Injury Association (ASIA) scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphotic angle, correction rate of kyphosis, angle loss, and bone graft fusion time. Results In the observation group, 7 patients had postoperative complications, including 1 patient with cerebrospinal fluid leakage, 1 patient with nerve root irritation, 1 patient with an opportunistic infection, and 4 with delayed wound healing. In the control group, 2 patients developed postoperative complications, including 1 with nerve root irritation and 1 with delayed wound healing. There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). CD4+T lymphocyte count, hemoglobin, and albumin in HIV-positive patients with postoperative complications were statistically different from those without postoperative complications (P all 0.05). Conclusion Single-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis could achieve satisfactory clinical efficacy through comprehensive preoperative evaluation, standardized perioperative antiviral and anti-tuberculosis treatments, and prevention of postoperative complications.

Objective The type AO B2 thoracolumbar fracture is a kind of flexion‐distraction injury and the effect of disc injury on treatment results of patients with B2 fracture remains unclear. The objective of the current study was to compare and analyze the outcomes in AO Type B2 thoracolumbar fracture patients with and without disc injuries in terms of the Cobb angle of kyphosis, the incidence of complication, and the rate of implant failure. Methods This is a retrospective study. Of the 486 patients with thoracolumbar fractures who underwent posterior fixation, 38 patients with AO type B2 injuries were included. All the patients were divided into two groups according to changes in the adjoining discs. Disc injury group A included 17 patients and no disc injury group included 21 patients. Clinical and radiologic parameters were evaluated before surgery, after surgery, and at follow‐up. Clinical outcomes included visual analogue scale (VAS) scores, incidence of complications, and incidence of implant failure. Radiologic assessment was accomplished with the Cobb angle (CA), local kyphosis (LK), percentage of anterior vertebral height (AVBH%), intervertebral disc height, and intervertebral disc angle. Fisher's precision probability tests were employed and chi square test were used to compare categorical variables. Paired sample t tests and independent‐sample t tests were used to compare continuous data. Results Disc injury mainly involved the cranial disc (15/19, 78.9%). The mean follow‐up period for the patients was 30.2 ± 20.1 months. No neurologic deterioration was reported in the patients at the last follow‐up. Radiological outcomes at the last follow‐up showed significant differences in the CA (18.59° ± 13.74° vs 8.16° ± 9.99°, P = 0.008), LK (12.74° ± 8.00° vs 6.55° ± 4.89°, P = 0.006), and %AVBH (77.16% vs 90.83%, P = 0.01) between the two groups.Implant failure occurred after posterior fixation in five patients with disc injury who did not undergo interbody fusion during the initial surgery. Additionally, in the subgroup analysis, interbody fusion in the implant failure group were significantly different than in the no implant failure group (0% vs 75%, P = 0.009). Conclusions AO B2 fracture patients with disc injury have higher risk of complications, especially implant failure after posterior surgery. Interbody fusion should be considered in AO type B2 fracture patients with disc injury.

Wound dehiscence after cervical spine surgery is a well-known complication that can be a challenge for spine surgeons to manage, especially in cases of exposed implants. However, few studies have focused primarily on this phenomenon in cervical spine surgery to date. This investigation sought to determine the frequency of wound dehiscence following posterior cervical spine surgery and identify patient-based risk factors. The medical data of 405 consecutive patients (290 male and 115 female; mean age: 68.9 years) who underwent posterior cervical spine surgery were retrospectively examined. Logistic regression models were employed to examine the prevalence, characteristics, and risk factors of postoperative wound dehiscence. We observed that 5.2% of cervical spine surgery patients experienced procedural postoperative wound dehiscence. In comparisons of dehiscence and non-dehiscence groups, significant differences were found for posterior instrumented fusion (81.0% vs. 45.3%; P < 0.01), extended T1 fusion (57.1% vs. 12.8%; P < 0.01), occipitocervical fusion (19.0% vs. 6.2%; P = 0.048), fused intervertebral levels (4.0 vs. 1.5; P < 0.01), surgical time (246 minutes vs. 165 minutes; P < 0.01), blood loss volume (228 mL vs. 148 mL; P = 0.023), and dialysis (14.3% vs. 1.8%; P = 0.011). Multivariate analysis identified extended T1 fusion and dialysis to be significantly associated with wound dehiscence with odds ratios of 5.82 and 10.70, respectively. The observed frequency of postoperative wound dehiscence in cervical spine surgery was 5.2%. As extended T1 fusion and dialysis may increase the risk of dehiscence after surgery, patients who display such risk factors may require additional observation and care. [ABSTRACT FROM AUTHOR]

Background: Anterior transthoracic, posterolateral (i.e., costotransversectomy/lateral extracavitary), and transpedicular approaches are now utilized to address anterior, anterolateral, or lateral thoracic disk herniations (TDH). Notably, laminectomy has not been a viable option for treating TDH for decades due to the much lower rate of acceptable outcomes (i.e., 57% for decompressive laminectomy vs. over 80% for the posterolateral, lateral, and transthoracic procedures), and a higher risk of neurological morbidity/paralysis. Methods: Patients with TDH averaged 48-56.3 years of age, and presented with pain (76%), myelopathy (61%-99%), radiculopathy (30%-33%), and/or sphincter loss (16.7%-24%). Those with anterior/anterolateral TDH (30-74%) were usually myelopathic while those with more lateral disease (50-70%) exhibited radiculopathy. Magnetic resonance (MR) studies best defined soft-tissue/disk/cord pathology, CAT scan (CT)/Myelo-CT studies identified attendant discal calcification (i.e. fully calcified 38.9% -65% vs. partial calcification 27.8%), while both exams documented giant TDH filling > 30 to 40% of the canal (i.e., in 43% to 77% of cases). Results: Surgical options for anterior/anterolateral TDH largely included transthoracic or posterolateral approaches (i.e. costotransversectomy, lateral extracavitary procedures) with the occasional use of transfacet/transpedicular procedures mostly applied to lateral disks. Notably, patients undergoing transthoracic, lateral extracavitary/costotransversectomy/transpedicular approaches may additionally warrant fusions. Good/excellent outcomes were quoted in from 45.5% to 87% of different series, with early postoperative adverse events reported in from 14 to 14.6% of patients. Conclusion: Anterior/anterolateral TDH are largely addressed with transthoracic or posterolateral procedures (i.e. costotransversectomy/extracavitary), with a subset also utilizing transfacet/transpedicular approaches typically adopted for lateral TDH. Laminectomy is essentially no longer considered a viable option for treating TDH. [ABSTRACT FROM AUTHOR]

Objective: We aimed to observe the clinical effect of single-stage posterior surgery on HIV-positive patients with thoracolumbar tuberculosis. Methods: From October 2015 to October 2019, 13 HIV-positive patients with thoracolumbar tuberculosis who underwent single-stage posterior surgery were retrospectively analyzed (observation group), and 13 HIV-negative patients with thoracolumbar tuberculosis who were matched with the gender, age, operative site, and surgical approach during the same period were selected as the control group. Postoperative complications, hemoglobin, albumin, CD4+T lymphocyte count, operative site, operative time, and blood loss were recorded between the two groups. The clinical efficacy was evaluated by the visual analog scale (VAS), American Spinal Injury Association (ASIA) scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphotic angle, correction rate of kyphosis, angle loss, and bone graft fusion time. Results: In the observation group, 7 patients had postoperative complications, including 1 patient with cerebrospinal fluid leakage, 1 patient with nerve root irritation, 1 patient with an opportunistic infection, and 4 with delayed wound healing. In the control group, 2 patients developed postoperative complications, including 1 with nerve root irritation and 1 with delayed wound healing. There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). CD4+T lymphocyte count, hemoglobin, and albumin in HIV-positive patients with postoperative complications were statistically different from those without postoperative complications (P all < 0.05). No tuberculosis recurrence was found at the last follow-up, ESR and CRP returned to normal, and there were no statistically significant differences in bone graft fusion time, VAS score, ASIA scale, correction rate of kyphosis, and angle loss between two groups (P all > 0.05). Conclusion: Single-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis could achieve satisfactory clinical efficacy through comprehensive preoperative evaluation, standardized perioperative antiviral and anti-tuberculosis treatments, and prevention of postoperative complications. [ABSTRACT FROM AUTHOR]

Abstract Background Although treatment options for rheumatoid arthritis (RA) have evolved significantly since the introduction of biologic agents, degenerative lumbar disease in RA patients remains a major challenge. Well-controlled comparisons between RA patients and their non-RA counterparts have not yet been reported. The objective of the present study was to compare postoperative outcomes of lumbar spine surgery between RA and non-RA patients by a retrospective propensity score-matched analysis. Methods Patients who underwent primary posterior spine surgery for degenerative lumbar disease in our prospective multicenter study group between 2017 and 2020 were enrolled. Demographic data including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, diabetes mellitus, smoking, steroid usage, number of spinal levels involved, and preoperative patient-reported outcome (PRO) scores (numerical rating scale [NRS] for back pain and leg pain, Short Form-12 physical component summary [PCS], EuroQOL 5-dimension [EQ-5D], and Oswestry Disability Index [ODI]) were used to calculate a propensity score for RA diagnosis. One-to-one matching was performed and 1-year postoperative outcomes were compared between groups. Results Among the 4567 patients included, 90 had RA (2.0%). RA patients in our cohort were more likely to be female, with lower BMI, higher ASA grade and lower current smoking rate than non-RA patients. Preoperative NRS scores for leg pain, PCS, EQ-5D, and ODI were worse in RA patients. Propensity score matching generated 61 pairs of RA and non-RA patients who underwent posterior lumbar surgery. After background adjustment, RA patients reported worse postoperative PCS (28.4 vs. 37.2, p = 0.008) and EQ-5D (0.640 vs. 0.738, p = 0.03), although these differences were not significant between RA and non-RA patients not on steroids. Conclusions RA patients showed worse postoperative quality of life outcomes after posterior surgery for degenerative lumbar disease, while steroid-independent RA cases showed equivalent outcomes to non-RA patients.

Objective: The type AO B2 thoracolumbar fracture is a kind of flexion‐distraction injury and the effect of disc injury on treatment results of patients with B2 fracture remains unclear. The objective of the current study was to compare and analyze the outcomes in AO Type B2 thoracolumbar fracture patients with and without disc injuries in terms of the Cobb angle of kyphosis, the incidence of complication, and the rate of implant failure. Methods: This is a retrospective study. Of the 486 patients with thoracolumbar fractures who underwent posterior fixation, 38 patients with AO type B2 injuries were included. All the patients were divided into two groups according to changes in the adjoining discs. Disc injury group A included 17 patients and no disc injury group included 21 patients. Clinical and radiologic parameters were evaluated before surgery, after surgery, and at follow‐up. Clinical outcomes included visual analogue scale (VAS) scores, incidence of complications, and incidence of implant failure. Radiologic assessment was accomplished with the Cobb angle (CA), local kyphosis (LK), percentage of anterior vertebral height (AVBH%), intervertebral disc height, and intervertebral disc angle. Fisher's precision probability tests were employed and chi square test were used to compare categorical variables. Paired sample t tests and independent‐sample t tests were used to compare continuous data. Results: Disc injury mainly involved the cranial disc (15/19, 78.9%). The mean follow‐up period for the patients was 30.2 ± 20.1 months. No neurologic deterioration was reported in the patients at the last follow‐up. Radiological outcomes at the last follow‐up showed significant differences in the CA (18.59° ± 13.74° vs 8.16° ± 9.99°, P = 0.008), LK (12.74° ± 8.00° vs 6.55° ± 4.89°, P = 0.006), and %AVBH (77.16% vs 90.83%, P = 0.01) between the two groups.Implant failure occurred after posterior fixation in five patients with disc injury who did not undergo interbody fusion during the initial surgery. Additionally, in the subgroup analysis, interbody fusion in the implant failure group were significantly different than in the no implant failure group (0% vs 75%, P = 0.009). Conclusions: AO B2 fracture patients with disc injury have higher risk of complications, especially implant failure after posterior surgery. Interbody fusion should be considered in AO type B2 fracture patients with disc injury. [ABSTRACT FROM AUTHOR]

Background: Different approaches are employed to treat patients with Pott’s disease who are candidates for surgical intervention. Each of these approaches has advantages and disadvantages. Objectives: This retrospective study presents the surgical, clinical, and radiological outcomes of posterior alone single-stage debridement and grafting of single-level tuberculous discitis using local graft from the decompression and nearby spinous processes. Patients and Methods: Between 2012 to June 2016, 15 patients with thoracic tuberculous spondylitis were operated up through posterior approach starting with one side fixation thorough debridement of the lesion and the use of local graft form decompression and spinous process bone. Clinical evaluation was done using Visual Analogue Scale (VAS) for back pain, Oswestry Disability Index (ODI), and Frankel Grade classification. Radiological assessment of kyphotic angle and fusion was also performed. Results: The mean operative time was 115.3 ± 23.6 minutes. The mean amount of blood loss was 571.3 ± 142.4 ml. Hospital stay ranged from 3 to 7 days (mean 4 ± 0.6 days). Patients were followed for 30.27 ± 6.5 months. All patients showed significant improvement in clinical and radiological parameters. Twelve patients showed neurological improvement. One patient required reoperation for neurological deterioration. Radiological follow-up showed solid fusion within 6 months postoperatively. Conclusion: Single-stage debridement of thoracic Pott’s lesion with the use of transpedicular fixation and local graft under perioperative coverage of antitubercular chemotherapy yielded satisfactory results avoiding the need for the more morbid and technically demanding anterior procedures and the graft donor site morbidity.

• Spinal deformity after cervical cord tumor resection in adults were reviewed. • Overall incidence of deformity was 0%–41.7%, respectively. • Postoperative instability occurred in 19.2%–20.5% after cervical laminectomy. • Risk factors were younger age, C2 laminectomy, and more laminectomy level. To investigate the incidence of cervical spine deformity and instability after posterior cervical spinal cord tumor (CSCT) resection without fusion or fixation in adults and examine relevant risk factors by reviewing and summarizing previously reported studies. We selected peer reviewed articles published between January 1990 and December 2020 from the MEDLINE and Cochrane Library databases using relevant key words. Articles in which the authors mainly described spinal cord tumor resection through posterior surgery without fusion or fixation in adults were selected for analysis. Patient's data including age, sex, extensive number of laminectomy levels, laminectomy at C2, C3, or C7, multilevel facetectomy, facet destruction, preoperative cervical kyphosis, and preoperative motor deficit were documented. Comparable factors were assessed using the odds ratio (OR) and weighted mean difference (WMD) of 95% confidence intervals (CI). Among 133 articles identified, 18 met selection criteria. Overall incidence of deformity and instability after CSCT surgery was 0%–41.7% and 0%–20.5%, respectively. Younger age (WMD, −5.5; 95% CI, −10.52 ∼ −0.49; P = 0.03), C2 laminectomy (OR, 5.33; 95% CI, 2.39 ∼ 11.91; P < 0.0001), more laminectomy level (WMD, 2.77; 95% CI, 1.78 ∼ 3.76; P < 0.00001) were identified as risk factors for deformity and instability after CSCT surgery. Patients undergoing CSCT resection should receive careful follow-up for postoperative spinal deformity and instability. Younger age, C2 laminectomy, and more laminectomy level were significantly associated with occurrence of deformity and instability after CSCT surgery. Upfront spinal fixation at the time of resection should be considered in selected patients. [ABSTRACT FROM AUTHOR]

Abstract Background The purpose of the study was to investigate whether pelvic incidence (PI) will affect the occurrence of PJK in Lenke 5 AIS patients after correction surgery and try to explore a better surgical scheme based on PI. Methods Lenke 5C AIS patients that underwent correction surgery with a minimum of a 2-year follow-up were identified. Demographic and radiographic data were collected preoperatively, postoperatively, and at the final follow-up. The comparison between the PJK and the Non-PJK group was conducted and the subgroup analysis was performed based on the preoperative value of PI to investigate the potential mechanism of PJK. Clinical assessments were performed using the Scoliosis Research Society (SRS)-22 questionnaire. Results The mean preoperative Cobb angle of the TL/L curve was 53.4°±8.6. At the final follow-up, the mean TL/L Cobb angle was drastically decreased to 7.3°±6.8 (P

Background: Although treatment options for rheumatoid arthritis (RA) have evolved significantly since the introduction of biologic agents, degenerative lumbar disease in RA patients remains a major challenge. Well-controlled comparisons between RA patients and their non-RA counterparts have not yet been reported. The objective of the present study was to compare postoperative outcomes of lumbar spine surgery between RA and non-RA patients by a retrospective propensity score-matched analysis.Methods: Patients who underwent primary posterior spine surgery for degenerative lumbar disease in our prospective multicenter study group between 2017 and 2020 were enrolled. Demographic data including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, diabetes mellitus, smoking, steroid usage, number of spinal levels involved, and preoperative patient-reported outcome (PRO) scores (numerical rating scale [NRS] for back pain and leg pain, Short Form-12 physical component summary [PCS], EuroQOL 5-dimension [EQ-5D], and Oswestry Disability Index [ODI]) were used to calculate a propensity score for RA diagnosis. One-to-one matching was performed and 1-year postoperative outcomes were compared between groups.Results: Among the 4567 patients included, 90 had RA (2.0%). RA patients in our cohort were more likely to be female, with lower BMI, higher ASA grade and lower current smoking rate than non-RA patients. Preoperative NRS scores for leg pain, PCS, EQ-5D, and ODI were worse in RA patients. Propensity score matching generated 61 pairs of RA and non-RA patients who underwent posterior lumbar surgery. After background adjustment, RA patients reported worse postoperative PCS (28.4 vs. 37.2, p = 0.008) and EQ-5D (0.640 vs. 0.738, p = 0.03), although these differences were not significant between RA and non-RA patients not on steroids.Conclusions: RA patients showed worse postoperative quality of life outcomes after posterior surgery for degenerative lumbar disease, while steroid-independent RA cases showed equivalent outcomes to non-RA patients. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective multicenter study.Objective: To identify the impact of the intervertebral level of stenosis on surgical outcomes of posterior decompression for cervical spondylotic myelopathy (CSM).Summary Of Background Data: As the upper affected cervical levels in elderly patients result from degenerative changes in the lower cervical levels with aging, it is usually difficult to determine the influence of the upper affected cervical levels on surgical outcomes after posterior decompression for CSM in older age.Methods: This study involved 636 patients with CSM who underwent posterior decompression. According to the most stenotic intervertebral level, patients were divided into upper (n = 343, the most stenotic intervertebral level was C2/3, C3/4, or C4/5) and lower (n = 293, the most stenotic intervertebral level was C5/6, C6/7, or C7/T1) cervical stenosis groups. Propensity score matching of the baseline factors (characteristics, comorbidities, and neurological function) was performed to compare surgical outcomes, the Japanese Orthopaedic Association (JOA) scores, and visual analog scale (VAS) for neck pain between the upper (n = 135) and lower (n = 135) cervical stenosis groups.Results: Before propensity score matching, age at surgery was older and pre- and postoperative JOA scores were lower in the upper cervical stenosis group (P < 0.001, P < 0.001, and P < 0.001, respectively). Following matching, baseline factors were comparable between the groups. Postoperative JOA scores, preoperative-to-postoperative changes in the JOA scores, and the JOA score recovery rate were not significantly different between the groups (P = 0.866, P = 0.825, and P = 0.753, respectively). No differences existed in postoperative VAS for neck pain and preoperative-to-postoperative changes in VAS for neck pain between the groups (P = 0.092 and P = 0.242, respectively).Conclusion: The intervertebral level of stenosis did not affect surgical outcomes after posterior decompression for CSM.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Myelopathy is a neurological deficit related to the spinal cord, and cervical spondylosis is its leading cause. The majority of middle-aged people have radiological evidence of significant cervical spine degeneration. The most characteristic symptoms are: neck pain with reduced range of motion, pain and paraesthesias in shoulders, gait disturbance, weakness or instability of lower extremities, loss of manual dexterity, and glove-distribution sensory loss in hands. The pathophysiology of cervical spondylotic myelopathy involves static, dynamic, and ischaemic factors. There are two surgical approaches: anterior and posterior. The posterior approach includes laminectomy and laminoplasty. The anterior approach includes anterior discectomy and fusion, and anterior corpectomy and fusion. This paper reviews the pathophysiology and clinical manifestation of cervical spondylotic myelopathy, and surgical approaches to treat patients with this disease.

Abstract Background Although microendoscopic partial laminectomy for patients with degenerative cervical myelopathy (DCM) has been reported and demonstrated good results, a detailed comparison of its mid-term surgical results with those of laminoplasty (LP) has not been reported. The aim of this study was to compare the surgical outcomes, complications, and imaging parameters of cervical microendoscopic interlaminar decompression (CMID) via a midline approach versus conventional laminoplasty, with a minimum follow-up period of 2 years. Methods Two hundred and fifty-four patients who underwent either LP or CMID for DCM between May 2008 and April 2015 were enrolled. All patients routinely underwent LP (C3–6 or C3–7) before December 2011, whereas CMID was performed at the one or two affected level(s) only in patients with single- or two-level spinal cord compression after 2012. Surgical procedure (CMID): For single-level patients (e.g., C5–6), partial laminectomy of C5 and C6 was performed under a microendoscope. For two-level patients (e.g., C5–6-7), decompression was completed by performing a C6 laminectomy. We compared surgical outcomes and radiographic parameters between the CMID and LP groups. Results Of the 232 patients followed up for > 2 years, 87 patients with single- or two-level spinal cord compression, 46 that underwent CMID, and 41 that underwent LP were identified. There were no differences in the baseline demographic data of the patients between the groups. CMID showed better outcomes in terms of postoperative axial pain and quality of life, although both procedures showed good neurological improvement. Two and one patient complained of C5 palsy and hematoma, respectively, only in the LP group. The postoperative range of motion was worse and the degree of postoperative posterior spinal cord shift was larger in the LP group. Conclusion Selective decompression by CMID demonstrated surgical outcomes equivalent to those of conventional LP, which raises a question regarding the requirement of extensive posterior spinal cord shift in such patients. Although the indications of CMID are limited and comparison with anterior surgery is mandatory, it can be a minimally invasive procedure for DCM.

To investigate the effect of posterior and anterior internal fixation and fusion on spinal function and trauma stress index in patients with spinal fracture. 102 patients with spinal fracture in the Affiliated Hospital of Xuzhou Medical University from March 2015 to March 2019 were selected, they were divided into two groups: posterior group (n=52, posterior internal fixation and fusion) and anterior group (n=50, anterior internal fixation and fusion) according to the way of operation. The operative related indexes, trauma stress indexes, vertebral parameters, excellent rate of spinal function recovery and complications of the two groups were compared. The excellent and good recovery rate of spinal function in the posterior group was higher than that in the anterior group (P<0.05). The operation time, incision length and hospitalization time of the posterior group were shorter than those of the anterior group, and the amount of intraoperative bleeding was less than that of the anterior group (P<0.05). 6 months after operation, the height of anterior edge and posterior edge of vertebral body in the two groups increased, and that in the posterior group was higher than that in the anterior group (P<0.05), Cobb's angle decreased and the posterior group was lower than the anterior group (P<0.05). Adrenocorticotropic hormone (ACTH), tumor necrosis factor-α (TNF-α), cortisol (COR) were all increased in the two groups 2 weeks after operation, but they were lower in the posterior group than in the anterior group (P<0.05). The incidence of complications in the posterior group was lower than that in the anterior group (P<0.05). Compared with anterior internal fixation and fusion in the treatment of spinal fracture, posterior internal fixation and fusion can effectively improve the spinal function, reduce the incidence of traumatic stress and complications. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective multicenter study.Objective: The aim of this study was to identify the impact of diabetes on surgical outcomes of posterior decompression for cervical spondylotic myelopathy (CSM).Summary Of Background Data: Although some previous studies have reported surgical outcomes of posterior decompression for CSM in diabetic patients, their results were inconsistent.Methods: We included 675 patients with CSM who underwent posterior decompression. Patients were divided into diabetic (n = 140) and nondiabetic (n = 535) groups according to the diabetic criteria for glucose intolerance. Surgical outcomes as assessed by the Japanese Orthopedic Association (JOA) scores and visual analog scale (VAS) for neck pain were compared between groups. Subsequently, the functional outcomes of diabetic patients were compared between the mild (n = 131) and moderately severe (n = 9) groups. All patients were followed up for at least 1 year after surgery.Results: Compared with the nondiabetic group, the diabetic group showed lower pre- and postoperative JOA scores (P = 0.025 and P = 0.001, respectively) and a lower JOA score recovery rate (RR) (P = 0.009). However, the preoperative-to-postoperative changes in JOA scores in the diabetic and nondiabetic groups were not significantly different (P = 0.988). Pre- and postoperative VAS for neck pain and postoperative reduction of neck pain were comparable between groups (P = 0.976, P = 0.913 and P = 0.688, respectively). Although statistical analysis was not performed due to the small underpowered sample size, functional outcomes assessed by the JOA score RR (43.3 ± 37.1% vs. 45.3 ± 33.9%) and preoperative-to-postoperative changes in JOA scores (3.0 ± 2.2 vs. 2.7 ± 2.5) were similar between the mild and moderately severe diabetes groups.Conclusion: CSM patients with diabetes experienced improvements in neurological function and neck pain as a result of posterior decompression to the same extent seen in patients without diabetes.Level of Evidence: 3. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study was to investigate whether pelvic incidence (PI) will affect the occurrence of PJK in Lenke 5 AIS patients after correction surgery and try to explore a better surgical scheme based on PI.Methods: Lenke 5C AIS patients that underwent correction surgery with a minimum of a 2-year follow-up were identified. Demographic and radiographic data were collected preoperatively, postoperatively, and at the final follow-up. The comparison between the PJK and the Non-PJK group was conducted and the subgroup analysis was performed based on the preoperative value of PI to investigate the potential mechanism of PJK. Clinical assessments were performed using the Scoliosis Research Society (SRS)-22 questionnaire.Results: The mean preoperative Cobb angle of the TL/L curve was 53.4°±8.6. At the final follow-up, the mean TL/L Cobb angle was drastically decreased to 7.3°±6.8 (P < 0.001). The incidence of PJK in Lenke 5 AIS was 18.6 %, 21.9 % (7/32) in the low PI group (PI < 45°) and 15.8 % (6/38) in the high PI group (PI ≥ 45°), and there was no statistical difference between the two groups (χ2 = 0.425, P = 0.514). For low PI patients, there is no significant difference where the UIV is located with regards to the TK apex between the PJK and Non-PJK subgroups (χ2 = 1.103, P = 0.401). For high PI patients, PJK was more likely to occur when UIV was cephalad to than caudal to the TK apex (31.25 % vs. 4.7 %, P = 0.038). There was no significant difference in the selection of LIV between the two groups.Conclusions: There is no difference in the incidence of PJK between the Lenke 5 AIS patients with low PI (< 45°) and high PI (≥45°), but the main risk factor of PJK should be different. For patients with low PI, overcorrection of LL should be strictly avoided during surgery. For patients with high PI, the selection of UIV should not be at or cephalad to the apex of thoracic kyphosis to retain more mobile thoracic segments. [ABSTRACT FROM AUTHOR]

Abstract Background Lenke 5 AIS is a kind of three-dimensional deformity and literature reported it usually accompany with coronal or/and sagittal imbalance. However, the postoperative coronal and sagittal balance in these patients has rarely be analyzed previously and the predict factors for postoperative trunk balance are still unclear. To synthetically analysis coronal and sagittal balance of Lenke 5 AIS patients simultaneously and found out predict factors for postoperative coronal or/and sagittal imbalance. Methods Fifty-six Lenke 5 AIS patients who underwent posterior surgery and be followed up more than 2 years were included in this study. Coronal parameters included main curve Cobb angle, lumbosacral hemi-curve Cobb angle, preoperative LEV/LIV tilt and translation and C7-CSVL distance; While sagittal parameters included pelvic incidence(PI), sacral slope(SS), pelvic tilt(PT), lumbar lordosis(LL), thoracic kyphosis(TK), and sagittal vertical axis(SVA). Coronal imbalance was defined as C7-CSVL> 20 mm, and sagittal imbalance defined as (1) SVA > 40 mm or (2) PT 20° or (3) PI-LL > 10°. And relative parameters were compared between balance and imbalance group to find out predict factors. Results All seven final coronal imbalance patients occurred in LIV = L5 group. Preoperative LIV tilt(11.4°) and translation(5.2 mm) in coronal imbalance group were abnormally lower than balance group (21.7° and 15.7 mm respectively). Eighteen patients performed final sagittal imbalance. The PI in these patients (37.7°) was significantly lower than balance group (48.0°). And most of finial sagittal imbalance patients also occurred in LIV = L5 group. Conclusions LIV = L5 as a threshold point, represents higher risk of postoperative coronal and/or sagittal imbalance. Besides, large LEV-S1 curve in reduce-bending film and small PI is directly related to final coronal imbalance and sagittal imbalance respectively.

Study Design: A retrospective single-center study.Objective: The aim of this study was to investigate the influence of the K-line in the neck-flexed position (flexion K-line) on the surgical outcome after muscle-preserving selective laminectomy (SL) for cervical spondylotic myelopathy (CSM).Summary Of Background Data: Development of CSM is associated with dynamic factors and cervical alignment. The flexion K-line, which reflects both dynamic and alignment factors, provides an indicator of surgical outcome after posterior decompression surgery for patients with ossification of the posterior longitudinal ligament. However, the value of the flexion K-line for patients with CSM has not been evaluated.Methods: Our study group included 159 patients treated with SL for CSM. Patients were divided into a flexion K-line (+) group and a flexion K-line (-) group. The influence of the flexion K-line on radiological and surgical outcomes was analyzed, with multivariate analysis conducted to identify factors affecting the surgical outcome.Results: Patients in the flexion K-line (-) group were younger (P = 0.003), had a less lordotic cervical alignment (pre-and postoperatively, P < 0.001), a smaller C7 slope (pre-and postoperatively, P < 0.001), and a greater mismatch between the C7 slope and the C2-C7 angle (preoperatively, P = 0.047; postoperatively, P = 0.001). The postoperative increase in Japanese Orthopedic Association (JOA) score and the JOA score recovery rate (RR) were lower for the flexion K-line (-) than for the K-line (+) group (P < 0.001 and P < 0.001, respectively). On multivariate regression analysis, the flexion K-line (-) (β = -0.282, P < 0.001), high signal intensity (SI) changes on T2-weighted image (WI) combined with low SI changes on T1-WI in the spinal cord (β = -0.266, P < 0.001), and older age (β= -0.248, P = 0.001) were predictive of a lower JOA score RR.Conclusion: The flexion K-line may be a useful predictor of surgical outcomes after SL in patients with CSM.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

Introduction: In this retrospective study, we compared odontoid fractures type two patients treated with two methods of anterior and posterior surgery. Materials and Methods: In this cross-sectional retrospective study, 39 patients under 65 years old with odontoid fractures type two and its subtypes witch had anterior and posterior surgery were included in the study. Necessuray experiments and information included open mouth radiography, AP, letral and CT scan if needed, and also demographic information, mechanism of injury, occurrence of neurologic symptoms at the time of admission, the length of hospital and ICU stay, and length of surgery were completed. Finally, the data were analyzed by SPSS software. Results: Among 39 pateints, 25(64.1%) were male and 14(35.9%) were female. The length of ICU stay and surgery in posterior group were significantly higher than anterior group (p<0.05). Any complications such as: displacement, loosening, CSF fistula, esophageal rupture, hypoglossal nerve rupture were not not created or exacerbated. Fusion rate in 12 month was sinnificantly higher in posterior group but after 24 month there was not any significant changes between two groups. Conclusion: According to the results, posterior surgery is the standard and selective method for the treatment of these odontoid type two fractures which have good clinical results and fewer complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Atlantoaxial dislocation often needs surgery for reduction, and posterior screw-rod fixation fusion is the most commonly used surgery. However, the current screw-rod fixation system often increases the reduction effect by increasing the degree of curvature of connecting rod, causing great difficulty of placing rod, which increases the probability of spinal cord injury. OBJECTIVE: To evaluate the preliminary results of fulcrum screws for atlantoaxial dislocation. METHODS: From January 2017 to December 2018, 11 patients with atlantoaxial dislocation were selected from General Hospital of Southern Theater Command of PLA, including 4 males and 7 females, at the age of 8-51 years. All patients were treated with posterior screw-rod fixation fusion: Conventional posterior cervical screws were implanted on both sides of the atlas and pivot screws were implanted on both sides of the axis. Atlantodental interval and Japanese Orthopaedic Association scores were recorded before and after operation. Patients were followed up and underwent X-ray and CT to estimate reduction, fiXation and bone graft fusion. This study was approved by the Ethics Committee of General Hospital of Southern Theater Command of PLA. RESULTS AND CONCLUSION: (1) Eleven patients underwent operations successfully without vertebral artery or spinal nerve injury. {2) All patients were followed up for 3-12 months, with an average of 6 months. The symptoms of neck pain and neurological dysfunction were improved in varying degrees. All patients obtained atlantoaxial bone fusion, with an average fusion time of 6 months. (3) At postoperative 1 week, X-ray and CT images showed that atlantoaxial reduction was satisfactory and internal fiXation was in good position. (4) Atlantodental interval reduced from preoperatively (6.8±1.5) mm to postoperatively (2.4±0.9) mm (r-17.854, P=O.OOO). Japanese Orthopaedic Association score increased from preoperatively (14.1 ±1.3) to postoperatively (15.9±0.9) (r--1 0, P=O.OOO). (5) No complication occurred during follow-up, without recurrence or dislocation. (6) These results showed that using fulcrum screw in posterior screw-rod fixation fusion has an effective reduction for treating atlantoaxial dislocation and its preliminary clinical effects are satisfactory. [ABSTRACT FROM AUTHOR]

Background: Although microendoscopic partial laminectomy for patients with degenerative cervical myelopathy (DCM) has been reported and demonstrated good results, a detailed comparison of its mid-term surgical results with those of laminoplasty (LP) has not been reported. The aim of this study was to compare the surgical outcomes, complications, and imaging parameters of cervical microendoscopic interlaminar decompression (CMID) via a midline approach versus conventional laminoplasty, with a minimum follow-up period of 2 years.Methods: Two hundred and fifty-four patients who underwent either LP or CMID for DCM between May 2008 and April 2015 were enrolled. All patients routinely underwent LP (C3-6 or C3-7) before December 2011, whereas CMID was performed at the one or two affected level(s) only in patients with single- or two-level spinal cord compression after 2012. Surgical procedure (CMID): For single-level patients (e.g., C5-6), partial laminectomy of C5 and C6 was performed under a microendoscope. For two-level patients (e.g., C5-6-7), decompression was completed by performing a C6 laminectomy. We compared surgical outcomes and radiographic parameters between the CMID and LP groups.Results: Of the 232 patients followed up for > 2 years, 87 patients with single- or two-level spinal cord compression, 46 that underwent CMID, and 41 that underwent LP were identified. There were no differences in the baseline demographic data of the patients between the groups. CMID showed better outcomes in terms of postoperative axial pain and quality of life, although both procedures showed good neurological improvement. Two and one patient complained of C5 palsy and hematoma, respectively, only in the LP group. The postoperative range of motion was worse and the degree of postoperative posterior spinal cord shift was larger in the LP group.Conclusion: Selective decompression by CMID demonstrated surgical outcomes equivalent to those of conventional LP, which raises a question regarding the requirement of extensive posterior spinal cord shift in such patients. Although the indications of CMID are limited and comparison with anterior surgery is mandatory, it can be a minimally invasive procedure for DCM. . [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate clinico-radiological outcomes of posterior surgery (decompression + instrumentation + transpedicular bone graft) in osteoporotic burst fracture associated with neurological deficit [OFND]. Materials and Methods: Forty patients with neurological deficit due to delayed osteoporotic vertebral collapse managed by posterior surgery (decompression + instrumentation + transpedicular bone graft) with minimum 2 years follow-up were included in the study. Approval from the Institutional Review Board was taken. Demographic data (age, sex, mode of injury, and the severity of osteoporosis); clinical parameters (Visual Analog Score [VAS], Oswestry Disability Index [ODI], Frankel grade), radiological parameters (local kyphosis), and surgical variables (blood loss, surgery duration, and intraoperative events) were recorded. Neurological worsening/improvement, complications, and implant failures were noted. Results: Significant improvement was noted in VAS (preoperative 8.20 ± 0.65/postoperative 4.1 ± 0.64) and ODI (preoperative 76.54 ± 6.96/postoperative 30.5 ± 6.56). Complete neurological recovery was noted in 37 patients (Frankel Grade E), three patients remained nonambulatory (Frankel Grade C). Significant improvement was noted in local kyphosis angle (preoperative = 21.80 ± 2.70; postoperative 11.40 ± 1.80), with 10% loss of correction (2.5 ± 0.90) at final follow-up. Symptomatic implant failure was noted in two patients and proximal junctional failure in one patient requiring an extension of fixation. Conclusions: OFND can be managed with a single posterior-only surgery with significant improvement in neurology and functional scores of patients. Aggressive kyphosis correction is often not required and optimal correction of kyphosis is noticed due to prone-positioning alone. Transpedicular grafting is safe and simple alternative to cement augmentation or anterior surgery for collapsed vertebrae. [ABSTRACT FROM AUTHOR]

Myelopathy is a neurological deficit related to the spinal cord, and cervical spondylosis is its leading cause. The majority of middle-aged people have radiological evidence of significant cervical spine degeneration. The most characteristic symptoms are: neck pain with reduced range of motion, pain and paraesthesias in shoulders, gait disturbance, weakness or instability of lower extremities, loss of manual dexterity, and glove-distribution sensory loss in hands. The pathophysiology of cervical spondylotic myelopathy involves static, dynamic, and ischaemic factors. There are two surgical approaches: anterior and posterior. The posterior approach includes laminectomy and laminoplasty. The anterior approach includes anterior discectomy and fusion, and anterior corpectomy and fusion. This paper reviews the pathophysiology and clinical manifestation of cervical spondylotic myelopathy, and surgical approaches to treat patients with this disease. [ABSTRACT FROM AUTHOR]

Study DesignRetrospective study.PurposeThe aim of our study was to analyze the safety and effectiveness of posterior pedicle screw fixation for treatment of pyogenic spondylodiscitis (PSD) without formal debridement of the infected tissue.Overview of LiteraturePosterior titanium screw fixation without formal debridement of the infected tissue and anterior column reconstruction for the treatment of PSD is still controversial.MethodsFrom March 2008 to June 2013, 18 patients with PSD underwent posterior titanium fixation with or without decompression, according to their neurological deficit. Postero-lateral fusion with allograft transplantation alone or bone graft with both the allogenic bone and the autologous bone was also performed. The outcome was assessed using the visual analogue scale (VAS) for pain and the Frankel grading system for neurological status. Normalization both of C-reactive protein (CRP) and erythrocyte sedimentation rate was adopted as criterion for discontinuation of antibiotic therapy and infection healing. Segmental instability and fusion were also analyzed.ResultsAt the mean follow-up time of 30.16 months (range, 24–53 months), resolution of spinal infection was achieved in all patients. The mean CRP before surgery was 14.32±7.9 mg/dL, and at the final follow-up, the mean CRP decreased to 0.5±0.33 mg/dL (p

Study DesignRetrospective study.PurposeTo study short to mid-term outcome of surgically managed elderly patients of tuberculous spondylodiscitis with posterior only approach in terms of decision making and challenges in treatment, choice of implants and outcomes.Overview of LiteratureTuberculous spondylodiscitis in the elderly is increasing due to longer survival rates. It presents with varied clinical manifestations needing surgical management. Management in tuberculous spondylodiscitis has been scarcely reported in the elderly, with a paucity of data on the choice of implants and approach.MethodsSixteen patients (five males, 11 females) older than 70-years-of-age culture and/or histopathology proven tuberculous spondylodiscitis were included in the study. All patients were operated using a single posterior approach. Pedicle screw with rods (PS/rods) or spinal loop with sublaminar wires (SL/SLW) were used for fixation. Clinical and surgical details were recorded. Sagittal correction achieved postoperatively and loss of correction at follow-up were noted.ResultsThe mean age was 73.6 years (range, 70 to 80 years). The mean follow up was 44.5 months (range, 24 to 84 months). The mean immediate postoperative correction of sagittal deformity was 11.3 degrees; this correction was lost by a mean of 3.1 degrees at last follow-up. All 10 patients with deficit showed neurological recovery and all but one of the seven non-walkers were capable of independent ambulation at follow-up. Patients with SL/SLW and PS/rods had similar radiological outcome at final follow up.ConclusionsOperative management gives satisfactory results in elderly patients with tuberculous spondylodiscitis. The posterior approach provides adequate exposure for decompression and rigid fixation, providing satisfactory clinical and radiological outcomes. SSL/SLW and pedicle screw rod construct both give similar radiological results if used appropriately in patients.

To investigate the clinical outcomes of posterior laminectomy on intraspinal neurilemmoma. Twenty-seven patients with intraspinal neurilemmoma admitted to the Second People's Hospital of Changzhou Affiliated to Nanjing Medical University from January 2010 to October 2015 were selected, and they received posterior laminectomy, and there were 5 patients whose nerve root and tumor were removed together because they could not be separated; 17 patients receiving total laminectomy or semi-laminectomy combined with facetectomy on the affected side were treated with spinal dynamic pedicle screw fixation or replantation of lamina or bone graft fusion and internal fixation. The patients were followed up regularly to observe the clinical outcomes after operation. The spinal stability and bone graft fusion were observed via X-ray film in review. Whether there was tumor recurrence was observed via MRI in review according to the individual condition. The operation time was 2.5-8 h (4.2 h on average). The intraoperative blood loss was 420-1,500 ml (760 ml on average). Tumors in 26 patients were totally resected, and tumor in 1 patient was partially resected due to tumor tissue invasion against the anterior sacral vascular plexus. All patients were pathologically confirmed as neurilemmoma after operation. Ten patients suffered from cerebrospinal fluid leakage in different degrees after operation. During the follow-up for 6-75 months after operation, clinical symptoms and neurological functions of all patients were significantly improved; there was 1 case of tumor residual and no recurrence. During the follow-up, the internal fixation in all patients receiving internal fixation of spine was stable with no vertebral instability. Posterior laminectomy can achieve satisfactory clinical outcomes in the treatment of intraspinal neurilemmoma. Internal fixation is needed to reestablish spinal stability during operation for those patients with great damage to spinal stability. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective study comparing postoperative clinical outcomes after cervical laminoplasty between K-line (–) ossification of the posterior longitudinal ligament (OPLL) and Kline (+) OPLL in the neck-flexed position. Objective. To investigate postoperative outcomes using Japanese Orthopedic Association (JOA) scores, and grip-and-release (GR) and foot-tap (FT) test scores after laminoplasty in patients with K-line (–) OPLL in the neck-flexed position. Summary of Background Data. Cervical laminoplasty has been reported to lead to poor outcomes in K-line (–) OPLL and good outcomes in K-line (+) OPLL. The cervical spine, however, continues moving in the extension and flexion direction after laminoplasty. Methods. Patients with cervical myelopathy were divided into K-line (+) and (–) in the neck-flexed position. We compared postoperative outcomes after cervical laminoplasty using recovery rate, as assessed by the JOA score and degree of improvement in the six JOA score items, and performance, as assessed by GR and (FT) tests, between patients with K-line (+) OPLL (n=18) and K-line (–) OPLL (n=23) in the neck-flexed position. Results. Recovery rate of JOA score (23.8%) of patients in the K-line (–) group was significantly lower (P=0.028) than that (46.3%) of K-line (+) group in the neck-flexed position. In the Kline (+) group, significant improvements were seen in all JOA-score items except bladder function; however, in the K-line (–) group, improvements were seen only in upper- and the lower-extremity sensory functions. In the K-line (+) group, mean GR and FT tests significantly improved, but in the K-line (–) group, only mean FT test significantly improved. Conclusion. The K-line (–) OPLL in the neck-flexed position is a risk factor for poor clinical outcome after cervical laminoplasty. [ABSTRACT FROM AUTHOR]

Schwannoma is a relatively common benign spinal cord; however, giant schwannoma is an uncommon pathology, especially the giant lumbosacral schwannoma of the cauda equina. In this report, we present a rare case of giant lumbosacral schwannoma of the cauda equina.

Prolonged length of stay (PLOS) has been associated with increased hospital resource utilization and worsened patient outcomes in multiple studies. In this study, we defined and identified factors associated with PLOS after posterior surgery for cervical spondylotic myelopathy in patients over the age of 65. PLOS was defined as length of stay beyond the “prolongation point” (that is, the day after which discharge rates begin to decline). Using the United States Nationwide Inpatient Sample database, 2742 patients met inclusion criteria, out of whom 16.5% experienced PLOS (stay beyond 6 days). After multivariate analysis, increasing age was independently associated with PLOS (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.02–1.06). Multiple comorbid conditions were associated with PLOS, including alcohol abuse (OR 3.85, 95% CI 1.87–7.94), congestive heart failure (OR 1.72, 95% CI 1.11–2.64), obesity (OR 1.70, 95% CI 1.14–2.55), and deficiency anemia (OR 1.44, 95% CI 1.01–2.05); the strongest associated operative parameter was blood transfusion (OR 2.39, 95% CI 1.75–3.28). Major complications independently associated with PLOS were deep vein thrombosis (OR 18.32, 95% CI 6.50–51.61), myocardial infarction (OR 8.98, 95% CI 2.92–27.56), pneumonia (OR 6.67, 95% CI 3.17–14.05), acute respiratory failure (OR 6.27, 95% CI 3.43–11.45), hemorrhage/hematoma (OR 5.04, 95% CI 2.69–9.44), and implant-related complications (OR 2.49, 95% CI 1.24–4.98). Average total hospital charges for patients who experienced PLOS were $122,965 US dollars, compared to $76,870 for the control group (p < 0.001). Mortality for patients who experienced PLOS was 2.7% versus 0.5% for patients who did not epxerience PLOS (p < 0.001). In conclusion, patients over the age of 65 who underwent posterior surgery for cervical myelopathy and stayed over 6 days in hospital were defined as having PLOS. Hospital charges and mortality rates were significantly higher for patients who experienced PLOS. Potentially modifiable and/or preventable risk factors were also identified. [ABSTRACT FROM AUTHOR]