Journal of spine surgery最新文献

{"title":"The percentage of sacroiliac fusions done in the U.S. by non-surgical specialties has increased.","authors":"Mathew Cyriac, Bela P Delvadia, Julianna E Winter, Jacob S Budin, Olivia C Lee, William F Sherman","doi":"10.21037/jss-24-60","DOIUrl":"https://doi.org/10.21037/jss-24-60","url":null,"abstract":"<p><strong>Background: </strong>Surgical fusion of the sacroiliac (SI) joint is often performed to manage chronic lower back or buttock pain. When Current Procedural Terminology (CPT) codes were introduced, SI joint fusion procedures were done primarily by orthopaedic surgeons and neurosurgeons. The purpose of this study was to examine the utilization of SI joint fusion CPT codes by physician specialty over time.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using the PearlDiver database. The database was queried using CPT codes to identify patients who underwent SI joint fusion via percutaneous, open, or trauma codes. Specialties queried included surgical specialties (orthopaedic surgery and neurosurgery) and non-surgical specialties [physical medicine and rehabilitation (PM&R), neurology, anesthesiology, pain medicine]. Total number and number per year of SI joint fusion procedures were identified for each specialty group. Trends of SI fusion billing for the years 2015 to 2021 were compared between surgical specialties and non-surgical specialties.</p><p><strong>Results: </strong>Comparing 2015 and 2021, the SI fusion codes submitted across all three groups (percutaneous, open, and trauma) increased for non-surgical specialties compared to surgical specialties. Between 2015 and 2021, the total number of percutaneous procedures submitted by all specialties increased by 294%, while the number of procedures being submitted by non-surgical specialties increased by 25,050%.</p><p><strong>Conclusions: </strong>Our study demonstrated how quickly and to what degree the procedure market can react to higher work relative value unit (RVU) value codes. Despite requiring less overall time and utilizing an intra-articular rather than a transfixing approach, non-surgical specialties submitted the same CPT code as surgical specialties performing the transfixing procedure at an increasing rate during the study period. With the introduction of new technologies to perform SI fixation and a new code to capture the intra-articular procedure, future studies could examine whether the number of SI fusion procedures performed by the various physician specialties stabilizes over time.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 4","pages":"627-634"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007588","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":"Osseointegration and fixation opportunities of sacroiliac instrumentation: a preclinical evaluation in a large animal model.","authors":"David W Polly, Michael J Gardner, Dan Wills, James Crowley, Matthew Pelletier, Tian Wang, Ian Bailey, Scott Yerby, William R Walsh","doi":"10.21037/jss-24-67","DOIUrl":"10.21037/jss-24-67","url":null,"abstract":"<p><strong>Background: </strong>Implant fixation is often the cornerstone of musculoskeletal surgical procedures performed to provide bony fixation and/or fusion. The aim of this study was to evaluate how different design features and manufacturing methods influence implant osseointegration and mechanical properties associated with fixation in a standardized model in cancellous bone of adult sheep.</p><p><strong>Methods: </strong>We evaluated the <i>in vivo</i> performance of three titanium alloy implants: (A) iFuse-TORQ implant; (B) Fenestrated Sacroiliac Device; and (C) Standard Cancellous Bone Screw in the cancellous bone of the distal femur and proximal tibia in 8 sheep. Group A was produced using additive manufacturing [three-dimensional (3D) printing] while Groups B and C were made with traditional methods. The <i>vivo</i> responses of the implants at the implant-bone interface were examined using mechanical testing (push out and removal torque), polymethyl methacrylate (PMMA) histology combined with fluorochrome labels and quantitative histomorphometry of bone ongrowth, ingrowth and through growth at 3 and 6 weeks.</p><p><strong>Results: </strong>New bone formed directly on all groups and no adverse reactions were noted. Osseointegration via ongrowth, ingrowth and through growth was a function of implant design. Implant designs that provide osseointegration via ongrowth, ingrowth and through growth improve implant fixation in torsion. The 3D printed surface in group A was rougher and outperformed traditional manufacturing surfaces of groups B and C in torsion. The porous domains and fenestrations in the design of group A allowed for bone ingrowth and through growth, which accounted for the superior torsional properties.</p><p><strong>Conclusions: </strong>Implant designs that provide osseointegration via ongrowth, ingrowth and through growth improve implant fixation.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 4","pages":"616-626"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007491","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 case series in vertebral body tethering results in improvement in coronal Cobb angle but deterioration in axial rotation: a 3-dimensional analysis.","authors":"Teenie Kwan Tung Wong, Kenny Yat Hong Kwan, Jason Pui Yin Cheung, Kenneth Man Chee Cheung","doi":"10.21037/jss-24-59","DOIUrl":"10.21037/jss-24-59","url":null,"abstract":"<p><strong>Background: </strong>Vertebral body tethering (VBT) has shown improvements in coronal and sagittal plane correction in adolescent idiopathic scoliosis (AIS) patients, but axial correction over time remains unexplored. Three-dimensional (3D) spine reconstruction was used to analyse correctional changes in all spinal planes post VBT surgery.</p><p><strong>Case description: </strong>AIS subjects who underwent thoracic VBT surgery with a minimum 2-year follow-up were assessed. Biplanar radiographs were used for 3D spinal reconstructions, 3D coronal, sagittal thoracic kyphosis (TK), lumbar lordosis (LL), and axial rotation measurements were compared at pre-operative (pre-op), immediate post-operative (post-op), 1-year, and 2-year follow-up. Eight patients (7 females, 1 male) with a mean age of 11.8±1.3 years with right thoracic curves (mean 50.4°±8.1°) were followed for 26.8±4.1 months. Mean coronal Cobb angle showed significant improvement: 28.4°, 19.2°, and 27.1° at post-op, 1-year, and 2-year follow-up (P<0.001). Minimal changes were seen in sagittal plane: TK-35.2°, 39.0°, 31.3°, 37.0°; LL-46.1°, 42.8°, 36.5°, 42.8° (pre-op, post-op, 1-year, 2-year) respectively. Apical axial rotation improved from -5.5°±5.0° to -1.4°±4.8° post-op, then deteriorated to -3.2°±4.9° at 1 year and -7.0°±5.9° at 2 years, with no significant changes.</p><p><strong>Conclusions: </strong>This is the first case series to use 3D radiographic digital measurements to reveal apical axial rotation progression in thoracic curves despite improved coronal curvature. While larger scales studies with longer follow-up are needed to verify our findings, surgeons and patients should be aware of such findings in their decision to select VBT as their procedure of choice.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 4","pages":"687-696"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007483","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 prone lateral retropleural or retroperitoneal antepsoas approach spinal surgery using the rotatable radiolucent Jackson table.","authors":"Yu-Cheng Yeh, Yung-Hsueh Hu, Ping-Yeh Chiu, Fu-Cheng Kao, Ming-Kai Hsieh, Chia-Wei Yu, Tsung-Ting Tsai, Po-Liang Lai, Tsai-Sheng Fu, Chi-Chien Niu, Lih-Huei Chen, Wen-Jer Chen","doi":"10.21037/jss-24-71","DOIUrl":"https://doi.org/10.21037/jss-24-71","url":null,"abstract":"<p><strong>Background: </strong>Prone lateral spinal surgery for simultaneous lateral and posterior approaches has recently been proposed to facilitate surgical room efficiency. The purpose of this study is to evaluate the feasibility and outcomes of minimally invasive prone lateral spinal surgery using a rotatable radiolucent Jackson table.</p><p><strong>Methods: </strong>From July 2021 to June 2023, a consecutive series of patients who received minimally invasive prone lateral spinal surgery for various etiologies by the same surgical team were reviewed. A Mizuho Jackson Modular Table System was used for all prone lateral surgeries. All patients received combined lateral and posterior approach surgery on the same day. The lateral approaches were performed with the Jackson table rotated 30-40 degrees away from the surgical side. A table-mounted oblique lumbar interbody fusion (OLIF) retractor was applied in retropleural/retroperitoneal spaces. Minimally invasive lateral procedures such as discectomy or mini-open corpectomy were performed after adequate exposure. Posterior procedures were performed with the Jackson table rotated back horizontally. The disease etiologies, surgical levels, blood loss, operation time, and surgical procedures were collected and analyzed.</p><p><strong>Results: </strong>The study included 64 patients with a mean age of 61.8 years (range, 26-88 years). The disease etiologies were 11 (17.2%) deformities, 15 (23.4%) degenerations, 25 (39.1%) infections, 9 (14.1%) traumas, and 4 (6.3%) tumors. The mean length of the surgical level was 4.1±2.0 (range, 2-10), with surgical levels ranging from T8 to L5 laterally and T6 to the ilium posteriorly. The mean blood loss was 863±843 mL (range, 50-4,600 mL) and the mean operation time was 314±148 minutes (range, 92-785 minutes). Of the lateral approaches, there were 25 retropleural and 39 retroperitoneal approaches (36 antepsoas approach). Surgical procedures performed included lateral discectomies, mini-open corpectomies, interbody reconstruction and fusion, and various posterior techniques such as pedicle screw instrumentation, cement augmentation, decompression, osteotomy, and spinal endoscopy. Patients who received both prone lateral retropleural and retroperitoneal approaches had significant improvement in the sagittal Cobb angle of the lateral surgical level, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) at 1 year postoperatively.</p><p><strong>Conclusions: </strong>Minimally invasive prone lateral spinal surgery is a feasible option for patients requiring combined lateral and posterior approach spinal surgery. Both lateral retropleural and retroperitoneal antepsoas approaches can be applied in combination with various posterior surgical procedures in the prone position using the rotatable radiolucent Jackson table.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 4","pages":"663-679"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007543","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":"Kyphoplasty in the setting of corynebacterium striatum septicemia with postoperative osteomyelitis requiring salvage vertebrectomy: a case report.","authors":"Zachary M Stauber, Quinn T Ehlen, Nicholas A Mirsky, Marshall E Stauber","doi":"10.21037/jss-24-31","DOIUrl":"https://doi.org/10.21037/jss-24-31","url":null,"abstract":"<p><strong>Background: </strong>Kyphoplasty (KP) is a well-established procedure with a low complication risk, however, the procedure's safety in patients with comorbidities and in the setting of systemic infection remains uncertain with no clear guidelines. We present a unique case of KP in the setting of recurrent septicemia, which required subsequent salvage vertebrectomy.</p><p><strong>Case description: </strong>We present a clinical case of a 59-year-old diabetic male patient with a recent foot ulcer, positive for <i>Corynebacterium striatum</i> and <i>Enterococcus</i>. Shortly after discharge, the patient was admitted for signs of septicemia positive for <i>Corynebacterium striatum</i> and <i>Pseudomonas aeruginosa</i>. The patient had also sustained an acute L1 compression fracture at the time of septic presentation. A KP was performed, just 10 days after original septicemia diagnosis. 5 months later, the patient presented with continued incapacitating back pain at the operative site, and a diagnose revealing osteomyelitis at the location of the L1 KP positive for <i>Corynebacterium striatum</i>, treated with vancomycin and daptomycin. The cement and surrounding bone were compromised and instability developed, requiring an L1 vertebrectomy with T9-L4 posterior fusion with allograft. The patient has been followed for 1.5 years postoperatively with full recovery, decreased pain, and improved quality of life. We discuss the importance of KP safety in the setting of recurrent systemic infection.</p><p><strong>Conclusions: </strong>While current cases in literature discuss the infectious risk of KP, this case emphasizes the extended time in which osteomyelitis can recur in patient with systemic infections. Care must be taken preoperatively and perioperatively to ensure there is minimal risk of further bacterial seeding into implanted materials. Preoperative infection status should be monitored via blood culture and inflammatory markers. Preoperative and perioperative antibiotics should be administered and perioperative cultures should be collected in case of postoperative infection. Further cases, prospective, and retrospective studies are necessary to fully understand the adequate guidelines to performing KP in the setting of systemic infection.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 4","pages":"724-732"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007527","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":"Surgical management of dysphagia due to diffuse idiopathic skeletal hyperostosis: the role of barium swallow fluoroscopy-a case report.","authors":"Anouar Bourghli, Yaser Almonla, Louis Boissiere, Faisal Konbaz, Khaled Almusrea, Ibrahim Obeid","doi":"10.21037/jss-24-84","DOIUrl":"https://doi.org/10.21037/jss-24-84","url":null,"abstract":"<p><strong>Background: </strong>Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition that might lead to dysphagia because of massive osteophytes that may be present at multiple levels. Confirming the symptomatic level to guide surgical management and avoid extensive surgery is important, however, there is no globally accepted consensus on the topic.</p><p><strong>Case description: </strong>We report the case of a 51-year-old man, with no specific past medical history, who has been complaining of a 3-months pain in the left side of the tongue base with sensation of a lump in the throat and dysphagia. Computed tomography scan confirmed DISH between C4 and C7. Barium swallow fluoroscopy demonstrated indentation of the esophagus only at the level of C4-C5, which guided the surgical management that focused on resecting only the major osteophytes at the level of C4-C5, avoiding extensive approach with its subsequent possible complications, and enabling satisfactory clinical and radiological outcomes.</p><p><strong>Conclusions: </strong>The current case thoroughly illustrated the diagnosis and surgical management in the presence of dysphagia from DISH. Through an anterior pre-vascular approach complete resection of the major osteophytes could be done. Barium swallow fluoroscopy showed very high interest in dynamically demonstrating the main level causing the dysphagia symptoms and also confirming satisfactory esophagus decompression and release after surgery.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 4","pages":"758-763"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007569","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: patient selection and workup.","authors":"Sean M Barber, Suraj Sulhan, Lindsey Schwartz, Sanjay Konakondla","doi":"10.21037/jss-24-88","DOIUrl":"https://doi.org/10.21037/jss-24-88","url":null,"abstract":"<p><p>Anterior lumbar interbody fusion (ALIF) is an anterior surgical approach for interbody fusion in the lumbar spine which affords the surgeon unfettered access to the disc space and allows for release of the anterior longitudinal ligament and insertion of a large, lordotic interbody graft. Despite the benefits associated with ALIF when compared with other lumbar interbody fusion techniques, the ALIF approach is associated with a number of unique complications, and certain patient-specific criteria (e.g., vascular anatomy) are important considerations when selecting patients for an ALIF. This review article summarizes the authors' own patient selection criteria for ALIF and describes the items required for pre-operative workup. Notable criteria to consider when planning an ALIF include: patient age, sex, bone density, body mass index, nicotine usage history, the presence-and severity of-medical comorbidities, anatomy of the distal iliac vein/abdominal aorta/iliac bifurcation/iliocaval confluence, history of prior abdominal surgery/infection/radiotherapy, surgical goals, operative level and availability of approach co-surgeons. Pre-operative workup for ALIF procedures should at a minimum consist of magnetic resonance imaging of the lumbar spine, standing X-rays of the lumbar spine with flexion/extension views, scoliosis or long-cassette spinal X-rays and a computed tomography of the lumbar spine without contrast as well as a dual-energy X-ray absorptiometry scan.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 4","pages":"706-714"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007486","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":"Role of endoscopic sequestrectomy in the treatment of therapy-resistant radiculopathy in patients with extreme obesity: technical note and case report.","authors":"Daniel Staribacher, Guenther C Feigl, Dzmitry Kuzmin","doi":"10.21037/jss-24-36","DOIUrl":"https://doi.org/10.21037/jss-24-36","url":null,"abstract":"<p><strong>Background: </strong>Surgical treatment of therapy-resistant radiculopathy associated with lumbar herniated discs in patients with extreme obesity is a challenge for neurosurgeons. In addition to technical problems in surgery due to the abundant subcutaneous adipose tissue and perioperative risks, there are significant anesthetic risks when anesthesia is performed with a patient in the prone position. A surgical procedure should preferably be minimally traumatic and quick with minimal risks of complications. Large studies show good results with minimally invasive techniques, namely microsurgical and endoscopic ones. However, in the case of surgeries in patients with extreme obesity, an endoscopic approach seems to be preferable because the spinal canal is quickly reached through a small skin incision using this approach.</p><p><strong>Case description: </strong>We describe in detail the successful surgical treatment of a 48-year-old patient with extreme obesity (body mass index 54.3 kg/m²) and therapy-resistant immobilizing radiculopathy at the L4 level on the left by minimally invasive endoscopic sequestrectomy. Following the surgery, the patient was rapidly mobilized and discharged on the 4th postoperative day. No complications were reported in the early and late postoperative periods.</p><p><strong>Conclusions: </strong>The endoscopic approach can be successfully used for the treatment of therapy-resistant radiculopathy in patients with extreme obesity and can be considered as the main technique of surgical treatment, being both quick and minimally traumatic.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 4","pages":"733-737"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732313/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007563","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 evolution and promise of endoscopic spine surgery.","authors":"Ralph J Mobbs","doi":"10.21037/jss-24-155","DOIUrl":"https://doi.org/10.21037/jss-24-155","url":null,"abstract":"","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 4","pages":"772-774"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007582","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":"Non-instrumented management of traumatic atlanto-axial rotatory subluxation: surgical technique.","authors":"Oluwaseun Omoba, Ryan Farrell, William Chase Johnson, Samon Tavakoli, David Wallace, Viktor Bartanusz, Cristian Gragnaniello, Fassil B Mesfin, Michael McGinity","doi":"10.21037/jss-24-44","DOIUrl":"https://doi.org/10.21037/jss-24-44","url":null,"abstract":"<p><p>Atlantoaxial rotatory subluxation (AARS) in the adult population is primarily trauma-induced. Conservative and surgical treatments have both been used successfully in treating AARS. In cases where AARS cannot be reduced by conservative measures, open reduction and fusion is the conventional treatment approach. This report details a novel approach for treating adult AARS, where an open reduction was performed without instrumentation or fusion. The patient, a 48-year-old female involved in a high-speed vehicular collision, initially underwent conservative treatment with Gardner Wells Tongs and manual traction. Despite these efforts, X-ray and computed tomography (CT) scans indicated persistent subluxation. Subsequently, the patient was taken to the operating room, where successful open reduction was achieved without the need for fusion or instrumentation. Preoperative imaging revealed rotatory subluxation of C1-2 with a comminuted and displaced fracture of the right C1-2 facet joint and a nondisplaced fracture of the base of the occiput. The surgical technique involved precise manual manipulation using a Cloward spreader and real-time assessment with O-arm 3D X-ray tomography to ensure successful reduction. The absence of significant laxity or instability during intraoperative testing led to the conclusion that fusion was unnecessary. This approach minimizes invasive tissue dissection and preserves natural cervical range of motion (ROM). Postoperatively, the patient was asymptomatic with no joint instability and demonstrated satisfactory alignment at follow-up.</p>","PeriodicalId":17131,"journal":{"name":"Journal of spine surgery","volume":"10 4","pages":"697-705"},"PeriodicalIF":0.0,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007467","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}