Journal of spine surgery最新文献

{"title":"Prevalence of occult spina bifida in isthmic versus degenerative spondylolisthesis: retrospective radiographic review of consecutive surgical patients.","authors":"Anmar Al-Witri, Yingda Li","doi":"10.21037/jss-24-151","DOIUrl":"10.21037/jss-24-151","url":null,"abstract":"<p><strong>Background: </strong>Spondylolisthesis is defined as the anterior or posterior translation of one vertebral body over another. Spina bifida occulta (SBO) is a developmental anomaly characterized by the incomplete fusion of the laminae of one or more vertebral arches along the midline. Currently, there is no documented prevalence of SBO in patients with degenerative spondylolisthesis (DS) undergoing spinal surgery. This study aims to estimate the prevalence of SBO in patients with DS undergoing spine surgery and compare it with that in patients with isthmic spondylolisthesis (IS) undergoing surgery.</p><p><strong>Methods: </strong>Our study is a cross-sectional retrospective review of consecutive patient records from two major tertiary hospitals in Sydney, Australia, covering the period from January 1^st, 2015 to December 31^st, 2023. Patients diagnosed with spondylolisthesis at spinal levels L4/L5 or L5/S1 were identified and screened for the presence of SBO.</p><p><strong>Results: </strong>Among the patients who underwent spinal surgery, 23.4% were found to have spondylolisthesis due to either degenerative changes or isthmic pars defects at L4/L5 or L5/S1. Within the DS group, the prevalence of SBO was 11.9% (all at the S1 level), while 24.7% of the IS group exhibited SBO. The male-to-female ratio for patients with IS and SBO was 3.6:1, compared to 0.66:1 for those with DS and SBO.</p><p><strong>Conclusions: </strong>SBO is a frequently overlooked anatomical variation in adult spine surgery, particularly in cases of degenerative and IS. With a prevalence of 11.9% in DS, it is crucial for spine surgeons to be vigilant, especially during open posterior lumbar spine fusion surgeries, to prevent unintended durotomy and neurological damage. Awareness of the absence of the S1 spinous process is essential for effective surgical planning, particularly when using navigated spinous process clamps for pedicle screw placement.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 2","pages":"227-233"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560464","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":"Contemporaneously diagnosed lumbosacral spinal subdural hematoma and cranial subdural hematoma with cerebral contusions following isolated head trauma: a case report and review of the literature.","authors":"Ibrahim Nabhan, Nova Kristine de Los Reyes-Nabhan, Farschad Tabesch, Andrei Slavici, Michael Rauschmann","doi":"10.21037/jss-24-120","DOIUrl":"10.21037/jss-24-120","url":null,"abstract":"<p><strong>Background: </strong>Concurrent spinal subdural hematoma (SSDH) and cranial subdural hematoma (CSDH) have been sporadically reported. However, concurrent SSDH and CSDH with intracerebral hemorrhage (ICH) is extremely rare.</p><p><strong>Case description: </strong>A previously healthy 19-year-old man presented with symptoms of intracranial hypertension and back pain with radiculopathy without focal neurologic deficits. Craniospinal magnetic resonance imaging (MRI) detected bilateral CSDHs, cerebral contusions, and lumbosacral, anterior SSDH simultaneously, 1 week after isolated head trauma and unremarkable cranial computed tomography (CT). A positive \"inverted Mercedes-Benz sign\" in axial T1 and T2 sequences confirmed the diagnosis. We report the first case of contemporaneously diagnosed SSDH and CSDH with cerebral contusions following head trauma without spinal trauma, whereby all pathologies were managed conservatively. Furthermore, we performed a review of pertinent literature available in PubMed. Twelve cases with contemporaneous diagnosis of CSDH and SSDH within a narrow diagnostic timeframe of ≤48 hours were published since 2005. All but one was male with a mean age of 41.5 years (range, 11-70 years). Fifty percent reported cranial trauma. Nine cases (66.7%) had headaches, and 10 patients (83.3%) reported radiculopathy. Nine patients (66.7%) reported cranial and spinal symptoms. All 5 patients (41.7%) treated conservatively for both pathologies showed complete clinical and radiological resolution at follow-up.</p><p><strong>Conclusions: </strong>Our case exemplifies the effectiveness and favorable outcome of conservative management in neurologically intact SSDH with radiculopathy. Twelve cases of concurrent CSDH and SSDH diagnosed within a timeframe of ≤48 hours were included in the review. We discuss three theories proposed in the literature explaining pathomechanisms of traumatic SSDH and its plausible causational relationship with CSDH. SSDH can occur with all types of intracranial hemorrhage. Lower thresholds for ordering cranial imaging upon evidence of traumatic SSDH could allow detection of occult CSDH. Spinal imaging should be conducted in head trauma patients with spinal symptoms regardless of neurologic status to exclude possible SSDH. Older patients with higher risk of rebleeding often receive surgical evacuation of CSDHs. Extensive SSDHs with neurologic deficits are surgically evacuated to relieve neural compression. Conservative management of CSDH and/or SSDH is reasonable in younger patients without deficits. Regardless of management strategies, prognosis is generally good with very low complication rates.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 2","pages":"378-386"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575731","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":"Fusion outcomes of structural bone allograft in cervical and lumbar spine surgery: analysis of 147 patients over a decade of follow-up.","authors":"Feifei Wu, Viola Bartoletti, Diletta Trojan, Giulia Montagner, Jacopo Del Verme, Roberto Zanata, Giuseppe Canova, Enrico Giordan","doi":"10.21037/jss-24-130","DOIUrl":"10.21037/jss-24-130","url":null,"abstract":"<p><strong>Background: </strong>There has been a global increase in spinal fusion surgeries, driving the need for improved graft materials. Human structural allografts from tissue banks provide a safe, cost-effective and efficient alternative, circumventing donor site issues and reducing operating time. This study retrospectively analyses the long-term follow-up of human structural grafts used in various spinal fusion surgeries. The analysis aims to highlight that structural bone grafts are a viable option for spinal fusion.</p><p><strong>Methods: </strong>The study included 147 patients over 18 years old who were treated for cervical and lumbar spinal degenerative, traumatic or oncologic conditions at a single hospital from January 2006 to December 2016. Clinical and radiological follow-up was conducted until December 2023. Human structural bone grafts, sourced from cadaver donors and provided by a single tissue bank, were used in all cases.</p><p><strong>Results: </strong>A total of 98 patients underwent cervical surgery. Among these, 77.6% received bone grafting due to cervical spine fracture luxation, 21.4% for severe degenerative conditions, and 1.0% for corpectomy consequent to tumour metastasis. The mean follow-up was 155.0±35.7 months, with no subsidence documented. A total of 49 patients underwent lumbar surgery, with 95.9% receiving human bone grafting for lumbar spine fracture luxation and the remaining patients for multiple myeloma and degenerative conditions. The mean overall follow-up was 144.7±38.9 months, with only 1 case of subsidence registered in this group. In 98.9% of cervical and 97.9% of lumbar patients, satisfactory fusion was achieved and maintained over the years.</p><p><strong>Conclusions: </strong>Homologous structural bone grafting remains an excellent option for spinal fusion in traumatic and degenerative conditions or as a valuable option in spinal revision surgeries and in cases where the use of cages is not feasible due to anatomical constraints.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 2","pages":"256-268"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575734","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":"Venous thromboembolism chemoprophylaxis is not supported following elective spine surgery: a systematic review and meta-analysis of randomized controlled trials.","authors":"Aditya Muralidharan, Davin C Gong, Anthony N Baumann, Joshua D Piche, Kempland C Walley, Osama N Kashlan, Rakesh D Patel, Ilyas S Aleem","doi":"10.21037/jss-24-162","DOIUrl":"10.21037/jss-24-162","url":null,"abstract":"<p><strong>Background: </strong>Pharmacologic venous thromboembolism (VTE) prophylaxis following spine surgery is not standardized. This study aims to compare the rates of VTE between patients receiving chemoprophylaxis <i>vs.</i> no chemoprophylaxis following elective spine surgery.</p><p><strong>Methods: </strong>A comprehensive investigation of searchable electronic databases was performed to capture randomized controlled trials (RCTs) comparing VTE chemoprophylaxis with no chemoprophylaxis after elective spine surgery. Two authors examined the eligibility, risk of bias and quality of studies using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) criteria. Meta-analyses were conducted for risk of developing VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), significant bleeding, and epidural hematoma.</p><p><strong>Results: </strong>After appraising 2,666 articles, eight RCTs were ultimately included in the analysis. These trials involved 1,509 patients, with 1,151 receiving VTE chemoprophylaxis and 358 not receiving it. No significant differences were found between the groups in the incidence of VTE [risk ratio (RR): 1.01; 95% confidence interval (CI): 0.97, 1.05; P=0.68] or DVT (RR: 1.03; 95% CI: 0.99, 1.06; P=0.11). Additionally, there were no significant differences in the risk of severe bleeding (RR: 1.01; 95% CI: 0.97, 1.05; P=0.59), significant bleeding (RR: 1.01; 95% CI: 0.97, 1.04; P=0.75), PE (RR: 1.00; 95% CI: 0.96, 1.03; P=0.81), or epidural hematoma (RR: 1.00; 95% CI: 0.97, 1.03; P>0.99) between the groups.</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis did not find a statistically significant difference in the efficacy of routine use of VTE chemoprophylaxis following elective spine surgery with moderate-quality evidence. Future well-designed randomized trials with adequate power are still needed to assess the safety and efficacy of VTE chemoprophylaxis, especially considering the variability of surgical techniques in elective spine surgery.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 2","pages":"242-255"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575744","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":"Comparative effectiveness of transforaminal epidural steroid injection: subpedicular versus Kambin's triangle technique: a single-centre experience.","authors":"Wongthawat Liawrungrueang, Sung Tan Cho, Jaruphitchaya Homlakhorn, Peem Sarasombath","doi":"10.21037/jss-24-140","DOIUrl":"10.21037/jss-24-140","url":null,"abstract":"<p><strong>Background: </strong>Transforaminal epidural steroid injection (TFESI) is a widely employed intervention for managing radicular pain associated with spinal pathology. Among the various techniques utilized for TFESI, the subpedicular and Kambin's triangle approaches are prominent. This study aims to comprehensively evaluate and compare the therapeutic effectiveness and safety profiles of these two techniques of TFESI in alleviating pain and improving functional outcomes.</p><p><strong>Methods: </strong>A retrospective analysis of 100 patients with unilateral radicular leg pain due to single-level lumbar disc herniation (LDH) was conducted. Patients were categorized into two groups: subpedicular TFESI (n=50) and Kambin's triangle TFESI (n=50). Pain intensity was assessed using the numerical rating scale (NRS), and functional outcomes were evaluated via the Oswestry Disability Index (ODI). Data were collected at baseline, immediate post-procedure, and follow-ups at 1, 3, 6, and 8 months. Adverse events, procedure duration, and costs were also analyzed.</p><p><strong>Results: </strong>Both groups showed significant improvements in NRS and ODI scores from baseline to final follow-up (P<0.001). The mean operation time was 25.55±2.01 min for the subpedicular technique and 24.16±3.56 min for the Kambin's triangle technique, with no significant difference (P=0.23). Similarly, treatment costs were comparable (mean 214±5.32 <i>vs.</i> 211±4.36 USD; P=0.43). No significant differences in pain relief, functional improvement, or adverse event rates were observed between the two techniques.</p><p><strong>Conclusions: </strong>Both the subpedicular and Kambin's triangle techniques for TFESI show comparable efficacy and safety in managing radicular leg pain from LDH. Clinicians can select either method based on patient-specific factors and surgeon preference. However, additional prospective studies are necessary to validate these results and further inform clinical decision-making.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 2","pages":"296-306"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575729","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":"Preoperative optimization of obese spine patients with GLP-1 receptor agonists: enhancing surgery and improving outcomes.","authors":"David Barkyoumb, Fauziyya Muhammad, Zachary A Smith, Hakeem J Shakir","doi":"10.21037/jss-24-152","DOIUrl":"10.21037/jss-24-152","url":null,"abstract":"<p><p>In this paper, we propose a novel pharmaceutical approach to preoperative medical optimization for spinal surgery: glucagon-like peptide-1 receptor agonists (GLP-1 RAs). The adverse effects of obesity on spinal surgery outcomes are well-documented, with obese patients facing increased rates of surgical site infections, venous thromboembolism, revision, and mortality. Despite this robust body of evidence, current preoperative weight loss strategies are limited, as bariatric surgery represents the most effective, yet invasive, option. However, GLP-1 RAs offer a promising solution. These medications have repeatedly demonstrated remarkable efficacy in creating weight loss rivaling bariatric surgery. Furthermore, their convenience, dependability, and ability to control glucose, on top of evidence suggesting their potentially osteogenic, lean mass-preserving and cardioprotective properties, make GLP-1 RAs a strong, multi-dimensional solution. Although several studies have emerged examining the effect of these agents on perioperative outcomes in spinal surgery, there have yet to be any published investigations analyzing the utility of GLP-1 RAs as a weight-targeted tool for medical optimization specifically in spinal surgery. In this paper, we outline the significance of obesity's adverse influence on spinal surgery outcomes, highlight the gap in available weight loss interventions, and elucidate the osteogenic and lean mass-preserving benefits of GLP-1 RAs. In doing so, we have identified GLP-1 RAs as an exceptional tool for mitigating obesity-related complications in spinal surgery. Further focused investigation has the potential to significantly improve surgical outcomes for this population of patients.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 2","pages":"339-346"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575737","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":"Anterior lumbar interbody fusion implants: a narrative review of current trends and future directions.","authors":"Alfred-John Bayaton, Michael R McDermott, Hannah J Grimmett, Mihir Chadra, Ashish Patel","doi":"10.21037/jss-24-114","DOIUrl":"10.21037/jss-24-114","url":null,"abstract":"<p><strong>Background and objective: </strong>Anterior lumbar interbody fusion (ALIF) is a safe and effective type of lumbar interbody fusion (LIF) technique. Each LIF technique requires implants specifically designed to accommodate its distinct anatomical corridor and dimensional constraints. This narrative review is about the implants used for ALIF. Specifically, what materials are used to create the implants, and how those properties collectively contribute to arthrodesis. It also summarizes the role of additive manufacturing, also known as 3D printing, in the creation of the next generation of ALIF implants.</p><p><strong>Methods: </strong>Relevant articles were identified through a comprehensive search of PubMed and Google Scholar, using keywords like \"Anterior Lumbar Interbody Fusion (ALIF)\", \"ALIF Implants\", \"3D-Printed Implants\", \"Medical Applications of 3D Printing\", \"Off-the-Shelf (OTS) Implants\", \"Patient-Specific Implants\". Only peer-reviewed, English-language publications discussing implant materials, properties, or 3D printing integration for ALIF were included.</p><p><strong>Key content and findings: </strong>Titanium and polyetheretherketone (PEEK) are the primary materials used in ALIF implants. Recent advances in 3D printing technology can create implants with specific design features previously unattainable with conventional methods, which can improve their overall durability and utility. These 3D-printed implants can be customized in terms of porosity, stiffness, and surface texture to promote fusion, increase implant longevity, and support indirect decompression. 3D printed patient-specific implants are now available. Implants are built to specifically match the computed tomography or magnetic resonance imaging rendering of the patient's anatomy.</p><p><strong>Conclusions: </strong>ALIF is a safe and effective procedure for patients with appropriate indications. The anatomical corridor utilized in ALIF allows for the placement of implants with a large footprint, which, along with specific implant properties, contributes to the high fusion rates associated with this technique. Advances in 3D printing technology now enable the production of titanium and PEEK ALIF implants with enhanced design features, further improving the procedure's safety and efficacy profile.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 2","pages":"328-338"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575726","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":"Intramedullary epithelioid malignant peripheral nerve sheath tumour arising from sporadic schwannoma in the thoracic spine: first case report and review of the literature.","authors":"Shams Albrefkany, Kantha Siddhanth Gujjari, Tarundeep Dhaliwal, Bi Yi Chen, Adrian Praeger, Amitha Thomas, Beena Kumar, Craig Timms","doi":"10.21037/jss-24-143","DOIUrl":"10.21037/jss-24-143","url":null,"abstract":"<p><strong>Background: </strong>Intramedullary schwannomas and malignant peripheral nerve sheath tumours (MPNSTs) are extremely rare entities. This report documents the first known case in the literature of an intramedullary spinal MPNST, specifically of epithelioid subtype, to arise from an intramedullary schwannoma. Whilst epithelioid malignant peripheral nerve sheath tumours (EMPNSTs) are less likely overall to arise from a benign peripheral nerve sheath tumour (BPNST) compared to a conventional MPNST, there is a predisposition if the primary tumour is a schwannoma and if the patient does not have neurofibromatosis type 1 (NF1).</p><p><strong>Case description: </strong>We present the case of a patient with an intradural T11/12 schwannoma containing intramedullary and extramedullary components. Resection of the extramedullary component was performed initially. Three years later, the patient developed significant myelopathy related to the residual intramedullary portion of the antecedent tumour. A redo thoracic laminectomy and debulking of the intramedullary lesion was performed. Histopathology revealed a diagnosis of EMPNST. This represents the first case of an intramedullary spinal MPNST arising from an intramedullary schwannoma, the first report of an intramedullary EMPNST and only the fourth report of an intramedullary spinal MPNST.</p><p><strong>Conclusions: </strong>This rare case highlights a potentially unique relationship between sporadic schwannomas and EMPNST. Despite its rarity, clinical suspicion should be maintained regarding the malignant transformation of an incompletely resected schwannoma, especially in unusual locations such as the intramedullary spine.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 2","pages":"347-353"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575735","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 importance of stabilisation in enabling bone fusion demonstrated by successful revision of failed occipitocervical fusion using patient-specific atlantoaxial joint spacers: a case report.","authors":"Alper Yataganbaba, William C H Parr, Jackson C Hill, Kevin A Seex","doi":"10.21037/jss-24-157","DOIUrl":"10.21037/jss-24-157","url":null,"abstract":"<p><strong>Background: </strong>The surgical management of occipitocervical junction (OCJ) pathologies is challenging due to the unique anatomy and biomechanics. Ehlers-Danlos syndrome (EDS) is a heterogeneous group of rare hereditary disorders of connective tissue (HDCTs) resulting from mutations in collagen genes. In OCJ pathologies related to EDS, occipitocervical fusion (OCF) is preferred when conservative treatment proves insufficient. The literature indicates that complications associated with OCF are more common in patients with EDS and other HDCTs. The management of failure in OCF surgery is particularly challenging. This case report provides an example of surgical management of failed OCF using patient-specific atlantoaxial joint spacers.</p><p><strong>Case description: </strong>In this case report, we describe a male patient with EDS who underwent OCF and experienced complete reabsorption of the bone graft and nonunion. The condition was then successfully treated using custom-made, anatomically conforming 3D-printed titanium alloy (Ti-6Al-4V) facet joint devices. The clival-axial angle was increased from 127.5 degrees after the first operation to 152.4 degrees with the facet joint devices. At 8 months postoperatively, X-rays demonstrated no change in alignment. At the 15-month follow-up, the patient reported no symptoms except for morning muscle spasms.</p><p><strong>Conclusions: </strong>Although an extensive body of literature studies the effects of EDS on connective tissue and its clinical manifestations, studies investigating its impact on bone biology and bone fusion are limited. The C1-2 level is the most susceptible to nonunion and implant failure in OCF procedures. In the case we present, nonunion and implant failure occurred specifically at this level. One of the significant advancements in C1-2 fusion in recent years is the technique described by Goel in 2004, particularly for basilar invagination and atlantoaxial dislocation. This method involves C1-2 facet distraction using intraarticular spacers and bone grafts. In this case report, the 2004 technique developed by Goel was modified to use patient-specific 3D-printed titanium cages in the C1-2 joint space. The addition of patient-specific titanium cages aided physiological realignment, which may have led to greater stability than screw fixation alone and most importantly a solid fusion in an obviously difficult fusion environment.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 2","pages":"354-362"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575741","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":"Combined anterior and posterior instrumented fusion for correction of severe cervical kyphotic and coronal deformity in vertebral osteomyelitis: a case report with literature review.","authors":"Amanda Bingaman, Rohan V Gupta, Srinivasa P Kanuparthi, Bong-Soo Kim","doi":"10.21037/jss-24-133","DOIUrl":"10.21037/jss-24-133","url":null,"abstract":"<p><strong>Background: </strong>Vertebral osteomyelitis (VO) can cause devastating neurological injury when there is a failure in early identification or prompt initiation of targeted antimicrobial therapy. Surgery is indicated for severe cases, such as those with a pathologic fracture or deformity producing spinal instability, or epidural abscess causing severe spinal cord compression with new neurologic deficit. A delayed severe combined kyphotic and coronal cervical deformity after cervical decompression is rare, and appropriate surgical management requires careful selection of approach and intraoperative technique.</p><p><strong>Case description: </strong>We present a medically complex 58-year-old male who developed a severe combined kyphotic and coronal cervical deformity in a delayed fashion after an initial posterior cervical decompression for symptomatic epidural abscess associated with VO. The patient underwent a combined two-stage anterior and posterior approach. The patient tolerated both surgeries without complication and follow-up imaging demonstrated correction of cervical sagittal and coronal alignment. Interestingly, despite appropriate antibiotic therapy, intraoperative culture during deformity correction yielded growth of the initial culprit microorganism.</p><p><strong>Conclusions: </strong>A two-stage anterior and posterior approach with multi-level anterior cervical decompression and instrumented fusion followed by posterior cervicothoracic instrumented fusion addresses the primary surgical goals of affected spinal segment decompression, restoration of appropriate spinal alignment, and prevention of further deformity or neurologic compromise. This report highlights suitability of techniques accessible to most spinal surgeons for correction of a multiplanar deformity, contributes to the ongoing discussion regarding instrumentation in the setting of an active spinal infection, and emphasizes the importance of close clinical and radiographic follow-up in this patient population.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"11 2","pages":"363-370"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12226177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575728","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}