Journal of spine surgery最新文献

{"title":"Comparison of outcomes in open and full endoscopic lumbar discectomies for treating lumbar radiculopathy in an Australian cohort.","authors":"Jeremy Rajadurai, Houchen Gong, Shanu Gambhir, Yingda Li","doi":"10.21037/jss-24-116","DOIUrl":"https://doi.org/10.21037/jss-24-116","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic spine surgery (ESS) has evolved as a new minimally invasive surgical (MIS) approach to the lumbar spine. ESS allows smaller incisions, less paraspinal muscle splitting and surgical trauma compared to conventional open and MIS approaches. We present the first non-inferiority comparison of ESS and open approaches to treat lumbar radiculopathy in an Australian cohort. The aim of this study is to assess if ESS is non-inferior to open approaches for the treatment of lumbar radiculopathy in post operative outcomes of pain and disability scores, in order to address the paucity in data for outcomes of ESS in Australian patients.</p><p><strong>Methods: </strong>In this retrospective cohort study, routinely collected prospective data were collated from consecutive patients who had single level endoscopic discectomies for radiculopathy by two surgeons at a single institution between December 2020 and October 2022. Data collected included Visual Analogue Scores for Back (VAS-B) and leg (VAS-L) pain as well as Oswestry Disability Index (ODI) scores, length of stay (LOS) and complication rates. These were compared to data from consecutive patients who underwent open discectomies from August 2020 to September 2022 by the same surgeons at other private hospitals where the endoscope was unavailable, otherwise deemed suitable for either approach, allowing direct comparison of consecutive patients operated on for comparable pathologies differentiated only by equipment availability.</p><p><strong>Results: </strong>Analysis included 92 endoscopic and 97 open cases. Non-inferiority was established at 6-week with median VAS-L (1.0 <i>vs.</i> 1.8, between group difference -0.5, P<0.001), VAS-B (1.0 <i>vs.</i> 1.0, between group difference -0.3, P=0.002) and ODI (18 <i>vs.</i> 20, between group difference -0.5, P<0.001) and 6-month for ODI (14 <i>vs.</i> 20, between group difference -1.6, P<0.001). Six-month median VAS-L and VAS-B was identical between groups (1.0 and 2.0), however this was not statistically significant. LOS was lower in ESS (LOS <24 h 93% <i>vs.</i> 78%, P=0.005). Reoperation rates were similar (10% <i>vs.</i> 7%, P=0.73). There were fewer complications in the endoscopic cohort than in the open cohort (5% <i>vs.</i> 6%), however this was not statistically significant.</p><p><strong>Conclusions: </strong>ESS is non-inferior to open decompression for the management of lumbar radiculopathy up to 6 months. LOS was also found to be lower in ESS. There were fewer complications with ESS however this was not statistically significant.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 1","pages":"24-32"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microscopically-assisted Uninstrumented Surgical Tumor Decompression as an alternative to open surgery for symptomatic metastatic epidural spinal cord compression.","authors":"Camryn E Harvie, Richard J Chung, Sriyaa Suresh, John C O'Donnell, Alexander J Schupper, Arthur L Jenkins","doi":"10.21037/jss-24-135","DOIUrl":"https://doi.org/10.21037/jss-24-135","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The current standard of care recommends spinal tumor decompression surgery prior to radiation. However, the differences in open &lt;i&gt;vs.&lt;/i&gt; minimally invasive surgery (MIS), extent of vertebroplasty, and role of instrumentation remains unclear across the literature. This study aims to assess whether our proposed Microscopically-Assisted Uninstrumented Spinal Tumor Decompression (MUST-D) technique using vertebral augmentation (VA) offers a surgical advantage over standard open instrumented fusion in the treatment of symptomatic metastatic epidural spinal cord compression (MESCC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-institution retrospective cohort study evaluated patients who underwent either standard open decompression with instrumented fusion (Control) or MIS with vertebrectomy and cement augmentation (MUST-D) for MESCC decompression from November 2006 to June 2016. Demographic, surgical, and follow-up data were extracted from medical records. The inclusion criteria were radiographic evidence of MESCC, pathology-confirmed spinal metastasis, and symptoms of vertebral instability or neural compression. Outcomes included length of operation, anesthesia duration, estimated blood loss (EBL), hospital stay, complications, time until radiation therapy (RTx), Hauser Ambulation Index (HAI), Cobb angle, mortality, and survival.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 59 MESCC surgeries, 21 (36%) had MUST-D and 38 (64%) had open surgery (60.8 &lt;i&gt;vs.&lt;/i&gt; 59.2 years, P=0.62). Preoperative Spine Instability Neoplastic Score (SINS) (P=0.40) and index level of surgery (P=0.44) were similar between groups. The MUST-D group had reduced length of operation (P&lt;0.001), anesthesia duration (P=0.004), hospital stay (P=0.01) and complications (P&lt;0.001) compared to the control group. Trends toward decreased EBL were observed (P=0.06). Postoperatively, the MUST-D group had shorter time to RTx compared to the control group (P=0.03). Despite similar pre-operative ambulation, the MUST-D group had a shorter time to ambulation postoperatively compared to the control group (0.41 &lt;i&gt;vs.&lt;/i&gt; 3.68 days, P=0.02). Moreover, the MUST-D group demonstrated improvement in 30-day HAI ambulation score, whereas the control group worsened (-1.60 &lt;i&gt;vs.&lt;/i&gt; 0.33, P=0.008). Both groups had improved Cobb angle, with no new instability or focal kyphosis across a mean follow-up period of 1.51 years. No differences were observed in 1-year mortality (P=0.16) or Kaplan-Meier survival estimates (P=0.18). However, of patients who died, the MUST-D group demonstrated a longer time to death (P=0.04).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings indicate that the MUST-D technique provides surgical advantages compared to standard open surgery for MESCC, with significant improvement in perioperative outcomes. Although both groups had similar 1-year mortality, the MUST-D cohort demonstrated shorter time to RTx, faster postoperative ambulation, improved 30-day ambula","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 1","pages":"74-87"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rate of fusion using novel synthetic bone graft mixed with cellular allograft product in lumbar fusions.","authors":"Samuel Bartrom, Micah Smith","doi":"10.21037/jss-24-87","DOIUrl":"https://doi.org/10.21037/jss-24-87","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Over 400,000 spine fusions are performed in the United States annually with 75% involving the lumbar region. It is the indicated treatment of many chronic orthopedic conditions that fail conservative management. There are numerous surgical approaches; however, common to all is the removal of the intervertebral disc and the insertion of a bone graft which promotes arthrodesis. Iliac crest autografts are regarded as the \"gold standard\" bone graft material for lumbar fusions; however, they come with a significant complication rate. Recently developed biologic mixtures, such as the one used in this study, have illustrated similar qualities to autograft material. This study aims to observe how the mixture of a cellular allograft with a fully synthetic bone graft will affect the rate of arthrodesis in patients undergoing lumbar fusions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective chart review on patients who received a lumbar interbody fusion using a combination of Vimax&lt;sup&gt;®&lt;/sup&gt; and Osteoflo&lt;sup&gt;®&lt;/sup&gt; between May 26, 2021, to December 31, 2022, was performed. Demographic information was obtained. Pre-operative radiographs were measured in addition to 2-week, 6-week, 3-month, 6-month, and 1-year post-operative radiographs. Post-operative radiographs were examined to assign a Bridwell fusion grade to interbody and lateral mass fusions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 129 patients receiving 211 lateral mass fusions and 199 interbody fusions were studied. A proportion of 3.3% of lateral mass fusions recorded a Bridwell Grade I (complete fusion) at 3 months post-operative and 77.8% at 1 year post-operative. Among interbody fusions, 14.1% were assigned a Bridwell Grade I at 3-month post-operative and 92.0% at the 1-year post-operative timepoint. Non-modifiable risk factors such as age and sex at birth had no impact on arthrodesis rate at 1 year for lateral mass or interbody fusions. Additionally, there was no significant difference in long-term fusions rates at the 1-year post-operative mark between obese and non-obese groups. Comorbidities did not affect the rate of arthrodesis 1-year post-operative apart from depression and hypertension. Patients with depression, and those without hypertension, exhibited significantly reduced lateral mass fusion rates with no difference in interbody fusion rates. While significant variations in rates of fusion were noted amongst surgical approaches at intermediate time points, no difference was observed 1 year post-operatively. Significant improvements in spondylolisthesis, anterior disc height, posterior disc height, and foraminal height were observed at each post-operative period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The cellular allograft and synthetic mixture demonstrated significant arthrodesis rate at 92%, which trends higher than historically reported results for iliac crest autograft. Important to note, the absence of reduced arthrodesis rate in particular at-risk","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 1","pages":"33-44"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A single straight expandable cage via a hybrid posterior-transforaminal approach with rhBMP-2 or allograft provides high fusion rates with low risk of subsidence.","authors":"Charlie Faulks, Kaiwen Cabbabe, Dean T Biddau, Nigel R Munday, Gregory M Malham","doi":"10.21037/jss-24-82","DOIUrl":"https://doi.org/10.21037/jss-24-82","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Due to the ongoing debate surrounding the clinical impact of surgical technique; cage type (expandable &lt;i&gt;vs.&lt;/i&gt; static), cage shape (straight &lt;i&gt;vs.&lt;/i&gt; banana), or technique [posterior lumbar interbody fusion (PLIF) &lt;i&gt;vs.&lt;/i&gt; transforaminal lumbar interbody fusion (TLIF)], the aim of this study was to evaluate the mid-term clinical and radiographic outcomes of patients who underwent a hybrid posterior-TLIF (P-TLIF) with a single straight expandable titanium cage using recombinant human bone morphogenetic protein-2 (rhBMP-2) or demineralised bone allograft (DBA) bone substitute.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective analysis of data from consecutive patients who underwent a hybrid P-TLIF by a senior spine surgeon between August 2017 and May 2022. A single straight expandable interbody cage was inserted obliquely after laminectomy and bilateral facetectomies. Cages were packed with either rhBMP-2 or DBA. Consecutive patients received rhBMP-2 prior to withdrawal (Australia, March 2020), and then DBA was used. Patient-reported outcome measures (PROMs) included visual analogue scale (VAS) back and leg pain, Oswestry disability index (ODI) and 12-Item Short Form Survey (SF-12) measured at preoperative, postoperative 6-week, 6-month, 12-month, and 24-month. Computed tomography (CT) imaging, assessed by an independent radiologist, was conducted postoperative day-2 for instrumentation positioning then at either 6-, 12-, or 24-month to assess subsidence and interbody/posterolateral fusion (Bridwell classification). If fusion was achieved no further CTs were undertaken.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;This cohort consisted of 81 (54.3% female) patients with a mean age of 57.3±12.5 years. rhBMP-2 was used in 60 (74.1%) and DBA in 21 (25.9%) patients. Total clinical complication rate was 27.2% including five patients requiring reoperation. Asymptomatic radiologic subsidence rate was 7.4% and clinical subsidence rate was 1.2%. Total (interbody and posterolateral) fusion was achieved at 6-month in 34.4% and 55.7%, 12-month in 76.8% and 88.4%, and 24-month in 86.3% and 93.2% of patients. There was a non-significant difference in fusion rates at each timepoint between rhBMP-2 and DBA. Preoperative pain, disability, and function all significantly improved postoperatively. Mean VAS back/leg (7.8±0.8, 7.7±0.9), and ODI (35.8±6.6) significantly (P&lt;0.001) decreased (2.7±1.8, 1.9±2.3, 13.6±5.8); SF-12 physical/mental (27.4±3.8)/(38.1±8.3) showed significant improvements (P&lt;0.001) at 12-month follow-up (47.1±8.8, 52.1±8.7). The mean follow-up time was 20.3±6.1 [12-24] months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A hybrid P-TLIF with a single straight titanium expandable cage permitted safe cage insertion, guided repositioning, and controlled expansion. Patients demonstrated significant improvements in pain, disability and function with low subsidence and high CT fusion rates over 24-month follow-up. The use of DBA in this coh","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 1","pages":"1-14"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new minimally invasive cervical pedicle screw (CPS) fixation system using intra-operative computed tomography-guided navigation.","authors":"Christian Blume, Tobias Philip Schmidt, Christian-Andreas Mueller, Alexander Romagna, Miguel Pishnamaz, Hans Clusmann, Ulf Bertram","doi":"10.21037/jss-24-45","DOIUrl":"https://doi.org/10.21037/jss-24-45","url":null,"abstract":"<p><strong>Background: </strong>Since its introduction, placement of cervical pedicle screws (CPS) has been considered a procedure with a very high-risk profile. Minimally invasive CPS placement was not even considered at all. However, as surgical techniques and image guided intra-operative navigation have been refined over the last decade, navigated CPS placement has become a standard procedure in well-established spine centers. Currently, the first off-the-shelf percutaneous CPS placement platforms are becoming available. The aim of this study is to assess feasibility and accuracy of an minimally invasive surgery (MIS) CPS fixation system in a pilot series.</p><p><strong>Methods: </strong>Between January and July 2023, we treated a cohort of ten patients using a new cervical MIS platform. Forty pedicle screws were inserted percutaneously in the c-spine using intra-operative computed tomography (CT) guided navigation and retrospectively analysed for accuracy using a modified Gertzbein & Robbins (G&R) classification. Adverse events and other patient-related data were also documented.</p><p><strong>Results: </strong>Ninety percent of all screws were placed accurately (80% on perfect trajectory, 10% showed minor perforations). Another 10% (four screws) caused pedicle wall breaches between 2 and 4 mm, but were not revised, since misplacement was not associated with neurological deficit or inferior biomechanics. One patient experienced neurological deterioration, but not associated with screw misplacement. The transverse foramen was breached twice, however not endangering the vertebral arteries.</p><p><strong>Conclusions: </strong>In this pilot series MIS CPS placement yielded accurate placement rates comparable to open surgical approaches reported in the literature. Hence, MIS CPS placement appears to be a feasible and safe procedure in selected cases.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 1","pages":"96-103"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive transforaminal lumbar interbody fusion for scoliosis: surgical technique for focal treatment of the lumbosacral fractional curve.","authors":"Andrew K Chan, Pavan S Upadhyayula, Anthony J Tang, Dean Chou","doi":"10.21037/jss-24-127","DOIUrl":"https://doi.org/10.21037/jss-24-127","url":null,"abstract":"<p><p>Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) can be utilized in the treatment of both adult spinal deformity and lumbar degenerative disease. This video focuses on the surgical technique and outcomes of MIS-TLIF aimed at correcting the symptomatic lumbosacral fractional curve, a key driver of pain and disability in scoliosis patients. Our patient is a 72-year-old male with scoliosis, who presented with 6 months of lower back pain radiating to the right distal lower extremity. His pain persisted despite physical therapy, medications, and injections. His symptoms significantly affected his daily activities. Preoperative imaging revealed a 10-degree fractional curve with an associated right-sided concavity, which resulted in impingement of the L4 nerve root in the right L3-4 lateral recess and the right L4-5 foramen. An L4-5 right-sided MIS-TLIF, right-sided L3-4 hemilaminotomy with medial facetectomy, and L3-5 posterior instrumented fusion was offered (L5-S1 was already autofused), and the patient consented to the procedure. The MIS-TLIF involved inferior and superior facetectomies, discectomy, and insertion of an expandable banana-style interbody cage at L4-5. An L3-4 hemilaminotomy with medial facetectomy was performed to decompress the right L4 traversing nerve root, and minimally invasive arthrodesis was achieved through direct facet decortication and packing with autograft and bone morphogenetic protein. Postoperative full-length plain radiographs demonstrated a reduction of the fractional curve to 1 degree. At 1-month follow-up, the patient reported complete resolution of his radicular pain and weakness. Twelve months later, he remained symptom-free and had returned to baseline activities. With a targeted approach to correct the fractional curve, MIS-TLIF can effectively treat symptoms in scoliosis patients. Consent was obtained from the patient for this surgical video.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 1","pages":"125-134"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The utilization of percutaneous endoscopic lumbar discectomy in recurrent lumbar disc herniation: a systematic review and meta-analysis.","authors":"Saiganesh Ravikumar, Aaron Bloschichak, Sanjeev Kumar","doi":"10.21037/jss-24-47","DOIUrl":"https://doi.org/10.21037/jss-24-47","url":null,"abstract":"<p><strong>Background: </strong>The utilization of percutaneous endoscopic lumbar discectomy (PELD) in lumbar disc herniation (LDH) is well established as a safe, effective intervention. However, in approximately 5-15% of cases herniation recurs. The role of PELD at this juncture is not well established in literature. The aim of this study is to identify the usability of PELD in comparison to other minimally invasive options to treat recurrent lumbar herniated disc.</p><p><strong>Methods: </strong>We searched the PubMed, EMBASE, and Web of Science. Studies with less than 10 patients, published abstracts without full texts, and systematic review papers were excluded. Both transforaminal (TF) and interlaminar (IL) approaches were included. A risk of bias assessment was performed for each study.</p><p><strong>Results: </strong>A total of 614 non-duplicate articles resulted. After applying inclusion/exclusion criteria, 20 papers were selected. Eleven studies were cohort, 1 study was randomized controlled trial, 8 studies were case-series. There were a total of 1,162 patients and 1,165 discs operated on. 714 (61.3%) surgeries were at level L4-5, 390 (33.4%) surgeries were at level L5-S1, and 62 (5.32%) surgeries were at other lumbar levels. 15 studies reported average visual analog scale (VAS) scores or Numerical Rating Score (NRS) of back and leg pain. Pooled weighted averages illustrated a 5.24-point improvement in VAS back scores and a similar 5.26-point improvement in VAS leg scores. Oswestry Disability Index (ODI) was reported in 5 studies with a pooled weighted average ODI showing an improvement of 20.88 units. All studies reported complications encountered, and the pooled rate across studies were: dural tear (n=10, 0.88%), infection (n=1, 0.09%), transient dysesthesia (n=13, 1.14%), transient headache (n=5, 0.44%), instability (n=8, 0.70%), persistent leg pain (n=7, 0.62%), transient weakness (n=1, 0.09%) permanent neurologic deficit (n=1, 0.09%). Seventeen studies (85%) reported re-recurrence rates of herniated disc after PELD, with a total of 58 recurrences out of 1,018 discs, or 5.70% pooled recurrence rate. A meta-analysis revealed there is currently no evidence of clearly superior approach for managing recurrent LDH between open lumbar microdiscectomy, minimally invasive trans-lumbar interbody fusion, microendoscopic discectomy, and IL <i>vs</i>. TF approach of PELD.</p><p><strong>Conclusions: </strong>PELD is a safe, effective technique in the treatment of recurrent LDH. Clinical judgment is required at this time to identify the best surgical modality of management for each patient.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 1","pages":"45-64"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term clinical and radiographic results of expandable cages that expand both height and lordosis for minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).","authors":"Khanathip Jitpakdee, Fabian Sommer, Edna Gouveia, Catherine Mykolajtchuk, Blake Boadi, Jessica Berger, Ibrahim Hussain, Roger Härtl","doi":"10.21037/jss-24-102","DOIUrl":"https://doi.org/10.21037/jss-24-102","url":null,"abstract":"","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 1","pages":"206-209"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Canadian national survey of the medical management of acute traumatic spinal cord injury.","authors":"Mohamed Alhantoobi, Nadeen AlKhoori, Amanda Martyniuk, Markian Pahuta, Desmond Kwok, Sunjay Sharma, Daipayan Guha","doi":"10.21037/jss-24-64","DOIUrl":"https://doi.org/10.21037/jss-24-64","url":null,"abstract":"<p><strong>Background: </strong>The management of patients with acute traumatic spinal cord injury (SCI) remains a significant challenge, with ongoing debate surrounding the optimal targets for mean arterial pressure (MAP), spinal cord perfusion pressure (SCPP), and hemoglobin (Hb) transfusion thresholds. This study aimed to identify areas of consensus and discordance in the management strategies employed by Canadian healthcare providers caring for patients with acute SCI.</p><p><strong>Methods: </strong>A comprehensive multi-stage survey was developed and administered to healthcare providers actively involved in the management of acute SCI, including neurosurgeons, orthopedic surgeons, intensive care specialists, trauma surgeons, and emergency medicine physicians. The survey assessed preferences related to MAP, SCPP, and Hb transfusion thresholds, as well as opinions on the need for future research in this area.</p><p><strong>Results: </strong>A total of 71 healthcare providers completed the survey, with a 100% completion rate. The majority of participants were from neurosurgery (38.1%), intensive care (31.0%), and orthopedics (25.4%). While 75.7% of participants routinely set a MAP target, only 7.1% set an SCPP target. The most common Hb transfusion threshold was <7 g/dL (50.7%) for patients with neurological deficits, with the majority (62.3%) maintaining this threshold for all patients. A significant proportion (15.9%) would consider transfusing based on clinical status alone, regardless of the Hb level. Two-thirds of participants (66.7%) believed the current equipoise in transfusion targets warrants a randomized controlled trial (RCT), and 79.5% of these respondents indicated a willingness to enroll patients.</p><p><strong>Conclusions: </strong>This survey highlights the significant variability in the management of acute traumatic SCI, particularly regarding MAP, SCPP, and Hb transfusion thresholds among Canadian healthcare providers. The findings underscore the need for the development of evidence-based guidelines and the implementation of multicenter RCTs to establish best practices and optimize the care of this complex patient population.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 1","pages":"114-124"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishment of the prone transpsoas fusion surgery in Australia-a survey and analysis of major complications in early adopters.","authors":"Vijidha Shree Rajkumar, Brian Owler, Bryden Dawes, Idrees Sher, Yi Yuen Wang","doi":"10.21037/jss-24-128","DOIUrl":"https://doi.org/10.21037/jss-24-128","url":null,"abstract":"<p><strong>Background: </strong>Prone transpsoas (PTP) fusion is a single-position variant of direct transpsoas interbody reconstruction that is increasing in popularity in Australia. This technique provides simultaneous access to the anterior and posterior columns while maintaining the familiar prone position and utilising position-specific equipment. However, major vascular, visceral, and neurological complications associated with the procedure remain a concern for spine surgeons. Our study aims to elucidate the safety profile of PTP fusion among early adopters in Australia.</p><p><strong>Methods: </strong>Australian surgeons interested in the PTP approach underwent surgical education and training prior to their first PTP procedure. All PTP-trained surgeons were invited to participate in the study through an online survey of 14 questions querying their PTP experience. Of the 20 PTP-trained surgeons, 16 responded to the survey, representing 293 out of 327 PTP surgeries completed in Australia from March 2023 to May 2024.</p><p><strong>Results: </strong>The survey was completed by 16 surgeons (80%) from the Australian PTP community, encompassing 293 PTP surgeries (90%) completed. The surgeon cohort reported no major vascular or visceral complications. There are two cases (0.68%) of weakness of the psoas muscle, two cases (0.68%) of sustained motor deficits, and four cases (1.37%) of sensory deficits. Additionally, there are two cases (0.68%) of vertebral fractures or implant subsidence requiring re-operation and four cases (1.37%) of surgical site infections.</p><p><strong>Conclusions: </strong>Our study shows the successful establishment of PTP procedure following a PTP surgical training model. The survey's high response rate reinforces the low complication rates encountered by our surgeons and adds to the safety profile of this novel procedure. Additionally, it underscores the significance of surgical education and training opportunities in minimally invasive spinal fusion techniques.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 1","pages":"15-23"},"PeriodicalIF":0.0,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}