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Study Design: Retrospective cohort study Objectives: To describe the clinical characteristics and surgical outcomes of patients with multilevel-ossification of the posterior longitudinal ligament (mT-OPLL), and to identify risk factors for unfavorable outcomes. Methods: Patients who were diagnosed with mT-OPLL and underwent one-stage thoracic posterior laminectomy combined with selective OPLL resection, spinal cord de-tension, and fusion surgery between August 2012 and October 2020 were recruited. Patients' demographic-, surgical- and radiological-related parameters were collected and analyzed. Neurological status was evaluated with mJOA score, and recovery rate (RR) was calculated using the Hirabayashi formula. According to RR, patients were divided into a favorable outcome group (FOG, RR ≥50%) and an unfavorable outcome group (UOG, RR <50%). Univariate and multivariate analyses were used to compare the difference between the 2 groups and to identify risk factors for unfavorable outcomes. Results: A total of 83 patients were included, with an average age of 50.6 ± 8.3 years. Cerebrospinal fluid leakage (60.2%) and transient neurological deterioration (9.6%) were the most common complications. The average mJOA score improved from preoperative 4.3 ± 2.2 to 9.0 ± 2.4 at the last follow-up, and the mean RR was 74.9 ± 26.3%. Disease duration, preoperative nonambulatory status, and the number of decompressed levels were identified as potential risk factors by Univariate analysis (all P <.05). Multivariate analysis showed that the preoperative disease duration and nonambulatory status were independent risk factors for unfavorable outcomes. Conclusions: Long disease duration and nonambulatory status before surgery were independent risk factors for unfavorable outcomes. [ABSTRACT FROM AUTHOR]

Objective: High-grade dysplastic spondylolisthesis (HGDS) is a relatively rare condition mainly involving the L5/S1 segment of the spine and occurring in children and adolescents. Whether surgical fixation should be L5-S1 monosegmental or extended up to L4 remains controversial. This study aimed to compare clinical outcomes and the risk of adjacent segment spondylolisthesis between L5-S1 monosegmental fixation and L4-S1 double-segmental fixation for pediatric HGDS., Methods: This is a retrospective control study Pediatric patients diagnosed with HGDS between March 2007 and October 2022 at our hospital were followed up, and their data were analyzed. The study involved 39 HGDS patients (average slip, 70.0%) divided into two groups: the L5-S1 monosegmental reduction and fusion group (L5 group, 16 patients) and the L4-S1 double-segmental reduction and fusion group (L4 group, 23 patients). Radiographic parameters and patient-reported outcomes were collected before surgery and at follow-up and compared between the two groups. Additionally, the prevalence of adjacent segment spondylolisthesis and instability (ASS/ASI) was compared between the groups at the last follow-up. Independent sample t-tests were employed to compare normally distributed data between the two groups. Paired sample t-tests were employed to compare preoperative data with postoperative data. The chi-square test was utilized to compare rates., Results: The average age was (12.5 ± 2.3) years. The L4 group had a greater slip percentage (77.6% vs. 59.2%; p < 0.001), a smaller Dub-LSA (60.3° vs. 69.7°; p = 0.022), and a higher slip grade (p = 0.002) than the L5 group, indicating more severe spondylolisthesis in the L4 group. Clinical parameters, namely the visual analog scale, Oswestry disability index, and Japanese Orthopedic Association-29 score, did not significantly differ between the two groups. The L5 group had a higher rate of ASS/ASI than the L4 group (6/16, 37.5% vs. 0/23, 0%; p = 0.002). Of all the ASS/ASI patients, one underwent a second surgery due to L4 spondylolisthesis 2 years after the primary surgery. The remaining five exhibited no symptoms or mild symptoms., Conclusions: For pediatric HGDS, both L5-S1 monosegmental fixation and L4-S1 fixation can achieve satisfactory outcomes. However, there is a higher risk of ASS/ASI following L5-S1 fixation than following L4-S1 fixation., (© 2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Objective: During percutaneous endoscopic interlaminar discectomy (PEID), a range of technologies including medical robotics, visual navigation, and spatial registration have been proposed to expand the application scope and success rate of minimally invasive surgery. The use of robotic technology in surgery is conducive to improving accuracy and reducing risk. This study aims to introduce a precise and efficient targeting method tailored for robot-assisted positioning under C-arm fluoroscopy inPEID., Methods: This study conducted a retrospective analysis of 107 patients with lumbar disc herniation (LDH) who underwent surgical treatment at our hospital from February 2023 to February 2024 (average age: 43.3 ± 13.3 years; 61 males and 43 females). The method entails constructing a specialized end-effector capable of simultaneous fluoroscopy calibration and robot-to-image-space registration. The average time of the surgical procedure and the average number of fluoroscopy exposures were collected. Preoperative and postoperative follow-up data were collected, including assessment scores from the Japanese Orthopedic Association (JOA) and Visual Analog Scale (VAS). Paired t-tests were employed to compare differences in each clinical outcome between the preoperative and follow-up time., Results: These techniques effectively reduce both radiation exposure and operation time. Clinical data reveals that the average time for robot-assisted positioning stands at 2.5 ± 0.7 min, with anteroposterior and lateral radiographs demonstrating accuracies of 2.4 ± 2.8 mm and 3.1 ± 3.7 mm, respectively, during robot-assisted positioning. Postoperative VAS scores for back pain and leg pain were significantly lower than preoperative scores (1.2 ± 1.8 vs. 4.1 ± 2.3, 0.9 ± 2.0 vs. 5.9 ± 1.8; p < 0.05, p < 0.05, respectively). Postoperative JOA scores were significantly higher than preoperative scores (26.1 ± 3.5 vs. 14.5 ± 4.9; p < 0.05)., Conclusions: Through the evaluation of the system in robot-assisted positioning during PEID, this study substantiates the accuracy and reliability of the proposed method in clinical applications., (© 2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Objective: This study aimed to introduce a novel artificial intelligence (AI)-based robotic system for autonomous planning of spinal posterior decompression and verify its accuracy through a cadaveric model., Methods: Seventeen vertebrae from 3 cadavers were included in the study. Three thoracic vertebrae (T9-11) and 3 lumbar vertebrae (L3-5) were selected from each cadaver. After obtaining CT data, the robotic system independently planned the laminectomy path based on AI algorithms before the surgical procedure and automatically performed the decompression during the procedure. A postoperative CT scan was performed, and the deviation of each cutting plane from the preoperative plan was quantitatively analyzed to evaluate the accuracy and safety of the cuts. The duration of laminectomy was also recorded., Results: A total of 285 cuts were made on thoracic and lumbar vertebrae. The average duration for unilateral longitudinal cutting was 16.38 ± 4.76 minutes, while for transverse cutting it was 4.44 ± 1.52 minutes. In terms of accuracy assessment, 3 levels were divided based on the distance between the actual cutting plane and the preplanned plane: 77 (84%) were grade A, 15 (16%) were grade B, and none were grade C. Regarding safety assessment, 74 (80%) were designated safe (grade A), with 18 (20%) classified as uncertain (grade B)., Conclusions: The results confirm the accuracy and preliminary safety of the robotic system for autonomous planning and cutting of spinal decompression.