Journal of Craniovertebral Junction and Spine最新文献

{"title":"Clinical characteristics of postoperative anterior arch fracture of the atlas following C1 laminectomy: 14-year experience of a single neurosurgical center.","authors":"Yushi Nagano, Hitoshi Yamahata, Masanori Yonenaga, Jun Sugata, Ryutaro Makino, Nayuta Higa, Shingo Fujio, Tomoko Hanada, Ryosuke Hanaya","doi":"10.4103/jcvjs.jcvjs_145_26","DOIUrl":"10.4103/jcvjs.jcvjs_145_26","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative anterior arch fracture of the atlas (PAFA) is a rare but increasingly recognized complication of C1 laminectomy. However, the pathophysiology remains poorly understood. We retrospectively investigated the incidence of PAFA and associated risk factors.</p><p><strong>Methods: </strong>We retrospectively reviewed the records of patients who underwent C1 laminectomy at our institution between January 2010 and December 2023. The clinical records and radiological findings were analyzed. Atlantodental interval (ADI) and retro-odontoid distance (ROD) were measured using preoperative sagittal reconstructed computed tomography or T1-weighted magnetic resonance imaging.</p><p><strong>Results: </strong>In total, 51 patients were included in this study. The indications for surgery included posterior fossa lesions, Chiari malformation type I, cervical canal stenosis at C1, and spinal tumors. During follow-up (mean, 69 ± 34 months), PAFA developed in three (5.9%) patients. All patients underwent decompression surgery for cervical canal stenosis at C1. The mean interval between surgery and fracture detection was 11 ± 5 months. Two patients presented with neck pain, which improved with conservative treatment. One patient developed a vertebral artery occlusion and cerebral infarction associated with lateral mass displacement. Patients with PAFA were significantly older (<i>P</i> = 0.04) and had a significantly greater ROD (8.4 ± 3.1 vs. 3.2 ± 2.4 mm; <i>P</i> = 0.01) than those without; ADI did not differ significantly between groups.</p><p><strong>Conclusions: </strong>PAFA is an uncommon but important complication of C1 laminectomy, particularly in elderly patients with cervical canal stenosis at the craniocervical junction. An increased ROD may radiologically predict fracture risk. PAFA can occasionally lead to serious vascular complications; thus, careful postoperative surveillance is recommended, particularly during the first postoperative year.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"493-499"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041883","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":"Spinal deformities and the \"Goel instability concept\".","authors":"Atul Goel","doi":"10.4103/jcvjs.jcvjs_236_26","DOIUrl":"10.4103/jcvjs.jcvjs_236_26","url":null,"abstract":"","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"447-450"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042032","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":"Risk factors for cervical kyphotic deformity following laminoplasty in degenerative cervical myelopathy: A systematic review and meta-analysis.","authors":"Negin Safari Dehnavi, Sadegh Bagherzadeh, Mohammad Sina Mirjani, Faramarz Roohollahi, Mahmoud Shehni, Abolfazl Paeenmahali, Mark Greenberg, Jay Kumar, Patrick Kim, Puya Alikhani, Mohsen Rostami","doi":"10.4103/jcvjs.jcvjs_77_26","DOIUrl":"10.4103/jcvjs.jcvjs_77_26","url":null,"abstract":"<p><p>Postoperative cervical kyphotic deformity (KD) is a recognized complication after laminoplasty for degenerative cervical myelopathy (DCM). This review identified predictors of KD to improve preoperative risk stratification, pooling studies of DCM patients using a random-effects model, with sensitivity and publication bias analyses. Thirty-nine studies (4423 patients) were included, with KD in 20.9% of cases. Age and sex were not significantly associated with KD. Higher body mass index and smoking history showed modest but significant associations. 5-level laminoplasty constructs were associated with increased KD risk, whereas operative time, blood loss, and most construct-related variables were not predictive. Radiographic parameters reflecting sagittal balance and alignment demand demonstrated the strongest associations with KD. Increased T1 slope, greater T1S-cervical lordosis (TS-CL) mismatch, and larger sagittal vertical axis (SVA) measurements (Center of Gravity of Head-C7 SVA and C2-C7 SVA) were significantly associated with KD. Dynamic motion analysis revealed that reduced extension reserve and increased flexion excursion, rather than total range of motion (ROM), characterized higher-risk patients. Magnetic resonance imaging-related factors and thoracolumbar spinopelvic parameters were not significantly associated with KD. Threshold analysis identified CGH-C7 SVA >30.6 mm and extension ROM <11.4° as the most discriminative predictors. Postoperative KD after laminoplasty is primarily determined by preoperative sagittal alignment demand and dynamic motion reserve rather than by general demographics or most comorbidities. Incorporating radiographic and functional parameters - particularly TS-CL mismatch, anterior head translation, and extension reserve - into preoperative evaluation may enhance risk stratification in patients undergoing laminoplasty for DCM.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"473-485"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041948","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":"Multiple Ponte osteotomies with low implant density: Is it enough for correction of Scheuermann's kyphosis?","authors":"Ahmed Adel Abdelazim Kamel Elnagar, Youssry Mohamed Kamal Elhawary, Yasser Hassan Samir Elmeligy, Mahmoud Mohamed Abousayed","doi":"10.4103/jcvjs.jcvjs_120_26","DOIUrl":"10.4103/jcvjs.jcvjs_120_26","url":null,"abstract":"<p><strong>Context: </strong>Posterior-only pedicle screw fixation is now the leading surgical treatment for Scheuermann's kyphosis (SK). However, high-density screw constructs increase the risk of malpositioning complications and elevate overall surgical costs.</p><p><strong>Aims: </strong>To evaluate the safety and clinical efficacy of the low screw density (LSD) technique combined with multiple Ponte osteotomies for the correction of SK.</p><p><strong>Settings and design: </strong>This prospective case series was conducted at Kasr Al-Aini and Al-Salam International Hospitals.</p><p><strong>Subjects and methods: </strong>This study was conducted between December 2020 and December 2022 and enrolled 30 patients who underwent posterior-only correction using the LSD approach and multilevel Ponte osteotomies.</p><p><strong>Results: </strong>The cohort (mean age 20.5 years; range 13-37) presented with a mean preoperative maximum kyphosis of 85.9° (range 75°-108°) and a mean pelvic incidence-lumbar lordosis (PI-LL) mismatch of 25.9°. Following surgery, the mean maximum kyphosis improved to 46.2° (range 37°-63°), and the PI-LL mismatch was reduced to 7.7°. These corrections remained stable at the 1- and 2-year follow-ups, with no statistically significant loss of sagittal alignment.</p><p><strong>Conclusions: </strong>The LSD technique, supported by multiple Ponte osteotomies, is a safe and effective surgical strategy for correcting SK, providing stable deformity correction with reduced instrumentation.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"530-534"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041877","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":"Predicting neurological recovery after thoracolumbar spine trauma: The role of injury morphology and admission American Spinal Injury Association Impairment Scale grade.","authors":"Aizul Khursheed, Idrees Ayoub, Mohsin Fayaz, Ashar Reza, Sarbjit Singh Chhiber","doi":"10.4103/jcvjs.jcvjs_160_26","DOIUrl":"10.4103/jcvjs.jcvjs_160_26","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the association between fracture morphology, admission American Spinal Injury Association Impairment Scale (AIS) grade, and early neurological outcome in a surgically treated cohort of thoracic and thoracolumbar spine injuries.</p><p><strong>Materials and methods: </strong>We conducted a retrospective review of 50 consecutive patients who underwent surgery for thoracic or thoracolumbar spine injury at a single tertiary center. Injury morphology was abstracted from operative and radiological records and classified, according to the AOSpine framework, as compression/burst-type injury (type A) or translational injury (type C); a small number of chronic injuries were analyzed separately. Neurological status was assessed using the AIS at admission and discharge. AIS grades were coded ordinally from A = 1 to E = 5, and neurological recovery was defined as the change in AIS grade between admission and discharge. Associations were evaluated using Spearman's correlation, the Wilcoxon signed-rank test, the Kruskal-Wallis test, and Fisher's exact test, with statistical significance set at a two-sided α of 0.05.</p><p><strong>Results: </strong>The mean age was 36.3 ± 14.0 years (70% of males); the thoracolumbar junction (T11-L2) was involved in 37 (74%) patients. Burst-type injuries predominated (43/50, 86%); 5 (10%) patients had translational injuries. All five translational injuries presented as complete (AIS A) and none improved, whereas burst-type injuries spanned the full AIS range and improved in 19/43 (44%). Overall, 20/50 patients (40%) improved by ≥1 grade, and none deteriorated. Recovery was strongly determined by admission completeness (incomplete [B-D] 75% vs. complete [A] 38% vs. intact [E] 0%; Kruskal-Wallis <i>P</i> < 0.001), and admission grade was very strongly correlated with discharge grade (Spearman ρ =0.93, <i>P</i> < 0.001). The translation-versus-burst difference in recovery did not reach significance given the small number of translational injuries (Fisher <i>P</i> = 0.14).</p><p><strong>Conclusions: </strong>In this surgically treated cohort, injury morphology appeared to reflect initial neurological severity rather than independently predict early recovery. Translational injuries were uniformly complete and showed no improvement, whereas burst-type injuries were heterogeneous and more frequently recovered. Admission AIS grade and injury completeness were the principal determinants of outcome, and no postoperative neurological deterioration was observed. Prospective studies with formal AOSpine subtyping and longer follow-up are warranted.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"547-552"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042010","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":"C2-C3 anterior cervical discectomy: Anatomical considerations and outcomes.","authors":"Zvipo Mutsa Chisango, Siddharth Jasti, Firas Batrash, Jacob Glueck, Nicolas L Carayannopoulos, Puru Sadh, Jinseong Kim, Scott Mallozzi, Bassel G Diebo, Bryce A Basques, Alan H Daniels","doi":"10.4103/jcvjs.jcvjs_150_26","DOIUrl":"10.4103/jcvjs.jcvjs_150_26","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior cervical discectomy and fusion (ACDF) at C2-C3 is technically demanding due to complex neurovascular anatomy and limited surgical access. Comprehensive anatomical guidance for this approach remains limited. We provide a detailed anatomical review of the anterior approach to C2-C3 and present institutional clinical outcomes for this procedure across a range of indications.</p><p><strong>Materials and methods: </strong>A comprehensive literature review was synthesized with surgical experience to describe relevant anatomy and technical considerations for C2-C3 ACDF. In this retrospective series, patient demographics, operative details, complications, and outcomes were analyzed for patients undergoing ACDF, including C2-C3 at our institution.</p><p><strong>Results: </strong>Eight patients (75% female, mean age: 60.6) underwent ACDF, including C2-C3 between 2022 and 2025. Indications included proximal junctional failure, trauma, infection, rheumatoid arthritis, and degenerative myelopathy. Fusions ranged from single-level C2-C3 to multilevel C2--C7 constructs. Mean operative time was 78.9 min with mean blood loss of 21.9 cc. Complications occurred in 37.5% of patients, including persistent dysphagia (n = 2) and failed extubation (n = 1). No direct neurovascular injuries occurred. Mean length of stay was 16.4 days.</p><p><strong>Conclusions: </strong>ACDF at C2-C3 requires mastery of anatomy, including positioning, sequential dissection, and identification of neurovascular structures. Careful attention to anatomical principles allows this procedure to be performed safely without producing specific neurovascular injury, although dysphagia and airway-related morbidity remain common complications. This work provides practical strategies for navigating this challenging level.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"535-541"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041901","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 and functional outcomes of intradural extramedullary spinal tumors: A single-center retrospective study.","authors":"Jignesh Joshi, Srikant Balasubramaniam, Banumathy Srikant","doi":"10.4103/jcvjs.jcvjs_136_26","DOIUrl":"10.4103/jcvjs.jcvjs_136_26","url":null,"abstract":"<p><strong>Background: </strong>Intradural extramedullary (IDEM) spinal tumors are the most common intradural spinal neoplasms, typically benign and slow-growing. They cause neurological deficits through progressive spinal cord compression. Surgical excision remains the mainstay of treatment, with generally favorable outcomes.</p><p><strong>Objective: </strong>To analyse the clinical profile, surgical management, and functional outcomes of patients with IDEM spinal tumors.</p><p><strong>Materials and methods: </strong>A retrospective study was conducted on 214 patients who underwent microsurgical excision of IDEM tumors between January 2009 and December 2023. Clinical presentation, radiological findings, surgical details, histopathology, complications, and functional outcomes were evaluated. Neurological status was assessed using the Modified McCormick Scale and American Spinal Injury Association impairment scale with a minimum follow-up of 12 months.</p><p><strong>Results: </strong>The majority of patients were >45 years (40.2%) with a slight female predominance (54.7%). Back pain (80.4%) was the most common presenting symptom, followed by motor deficit (60.3%). The thoracic spine was most frequently involved (45.3%). Gross total resection was achieved in 83.6% of cases. Schwannoma (47.2%) and meningioma (30.8%) were the most common histologies. Mean blood loss and operative time were 172 ± 62 ml and 164 ± 43 min, respectively. Complications were low, with cerebrospinal fluid leak (2.8%) and wound infection (3.3%) being the most frequent. Significant postoperative neurological improvement was observed, with most patients achieving Modified McCormick Grade 1-2 at 2-year follow-up.</p><p><strong>Conclusion: </strong>IDEM tumors have a favorable prognosis when managed surgically. Microsurgical excision allows high rates of complete resection with low morbidity. Early intervention is associated with better neurological recovery.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"505-511"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042009","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":"Do revision lumbar spine procedures lead to worse postoperative outcomes? A systematic review with a meta-analysis of patient-reported outcomes.","authors":"Brendon Wang, Jake Lee, Irene Wang, Riya Vasantha Karne, Mohamed Zaazoue, Mark J Lambrechts","doi":"10.4103/jcvjs.jcvjs_168_26","DOIUrl":"10.4103/jcvjs.jcvjs_168_26","url":null,"abstract":"<p><strong>Introduction: </strong>Revision lumbar spine surgery is increasingly performed for recurrent disc herniation, adjacent segment disease, and pseudarthrosis, yet comparative outcomes with primary procedures remain incompletely characterized. This systematic review compared perioperative complications, patient-reported outcomes (PROs), and reoperation risk between primary and revision lumbar surgery.</p><p><strong>Materials and methods: </strong>A Preferred Reporting Items for Systematic reviews and Meta-Analyses-compliant systematic review of PubMed was conducted through July 28, 2025. Studies published after 2000 comparing adult patients undergoing primary versus revision lumbar surgery were included. Data extraction and quality assessment using the Newcastle-Ottawa Scale were performed independently by reviewers. Random-effects meta-analyses were conducted for outcomes reported in at least three studies.</p><p><strong>Results: </strong>Thirty-six studies met inclusion criteria, including lumbar fusion (<i>n</i> = 21), discectomy (<i>n</i> = 11), and complex deformity surgery (<i>n</i> = 4). Revision patients consistently had worse baseline pain and disability. In fusion cohorts, both groups improved postoperatively, but revision surgery was associated with worse absolute PROs and greater perioperative morbidity. Meta-analysis demonstrated a small advantage for primary surgery in 6-month Oswestry Disability Index scores (mean difference: 2.9, 95% confidence interval: 0.42-5.38), which was not maintained at 12 months. Revision discectomy was associated with higher complication and reoperation rates and poorer long-term PROs. Across procedure types, revision surgery demonstrated higher rates of infection, dural tears, thromboembolic events, and blood transfusion.</p><p><strong>Conclusions: </strong>Revision lumbar surgery is associated with greater perioperative risk and lower absolute functional outcomes than primary procedures, although most patients achieve meaningful postoperative improvement. Careful patient selection and preoperative expectation management remain essential.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"451-463"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041847","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 cervical discectomy and fusion beyond radiculopathy: Improvement in vertebral artery flow and dizziness relief.","authors":"Youssef Ahdi Sawiris, Mahmoud Mohammed Ragheb, Ahmed Samir Barakat, Wael Mohammed Tawfik Koptan, Yasser Hassan ElMiligui, Ahmed Maher Sultan","doi":"10.4103/jcvjs.jcvjs_146_26","DOIUrl":"10.4103/jcvjs.jcvjs_146_26","url":null,"abstract":"<p><strong>Background: </strong>Anterior cervical discectomy and fusion (ACDF) is widely used for cervical disc disease, primarily for neural decompression. However, its potential vascular effects - particularly on vertebral artery hemodynamics and cervicogenic dizziness - remain underexplored.</p><p><strong>Objective: </strong>The objective of this study was to evaluate whether ACDF improves vertebral artery flow and alleviates dizziness symptoms associated with impaired posterior circulation perfusion.</p><p><strong>Methodology: </strong>A prospective case series of 40 patients with cervical radiculopathy or myelopathy underwent ACDF with polyetheretherketone (PEEK) cages. Vertebral artery peak systolic velocity (PSV) was assessed preoperatively and at 1, 3, 6, and 12 months postoperatively using duplex ultrasonography. Functional outcomes were measured with the Visual Analog Scale for neck and arm pain, the Neck Disability Index, and patient-reported dizziness. Radiographic fusion was confirmed at serial follow-up.</p><p><strong>Results: </strong>PSV decreased significantly, indicating improved vertebral artery flow: right side from 48.85 ± 12.71 to 39.0 ± 7.45 and left side from 48.20 ± 12.02 to 41.54 ± 7.56 (both <i>P</i> < 0.001). Symptomatic dizziness also improved in parallel. Fusion was achieved in 92.5% by 12 months, with minor complications in 12.5%.</p><p><strong>Conclusion: </strong>ACDF may alleviate both neural compression and extrinsic vertebral artery compromise, particularly in younger patients. Given the absence of a control group and reliance on surrogate vascular measures, these results should be considered hypothesis-generating rather than definitive.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"512-518"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041941","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":"Degenerative lumbosacral spondylolisthesis: Instability as the primary pathology and stabilization as definitive treatment. Experience with 28 cases treated by only fixation without any decompression.","authors":"Atul Goel, Apurva Prasad, Abhidha Shah","doi":"10.4103/jcvjs.jcvjs_241_26","DOIUrl":"10.4103/jcvjs.jcvjs_241_26","url":null,"abstract":"<p><strong>Objective: </strong>The objective of the study was to evaluate clinical outcomes in patients with degenerative lumbar spondylolisthesis associated with lumbar canal stenosis treated exclusively with multisegmental spinal stabilization, without conventional decompressive procedures involving bone, ligament, or disc resection. This strategy is based on the hypothesis that spinal instability, rather than neural compression, is the primary pathological driver of symptoms. Degenerative lumbar spondylolisthesis is considered part of a broader spectrum of multilevel \"vertical\" spinal instability, frequently associated with adjacent segment involvement and lumbar canal stenosis.</p><p><strong>Materials and methods: </strong>Between January 2017 and August 2025, 28 patients with symptomatic lumbar canal stenosis and degenerative spondylolisthesis underwent surgical treatment. Fixation was restricted to the affected listhesis level and adjacent unstable segments. No decompressive bone, ligament, disc, or osteophyte resection was performed. Instability was identified using clinical evaluation, radiological assessment, and intraoperative findings. Stabilization was achieved using transarticular facetal screw fixation. Fixation spanned two segments in 9 patients, three segments in 10 patients, four segments in 8 patients, and five segments in 1 patient. Clinical outcomes were assessed using the Oswestry Disability Index, Visual Analog Scale, and patient-reported satisfaction scores.</p><p><strong>Results: </strong>All patients demonstrated immediate postoperative clinical improvement. At a mean follow-up of 29 months, sustained symptom relief and high patient satisfaction were observed. Solid fixation and successful arthrodesis were achieved in all cases. No patient required reoperation or additional surgical intervention.</p><p><strong>Conclusions: </strong>\"Vertical\" spinal instability is the principal pathogenic factor in degenerative lumbar spondylolisthesis and associated canal stenosis. Degenerative lumbar spondylolisthesis rarely exists in isolation and commonly involves multisegmental instability. Stabilization of unstable segments alone is the treatment, and decompressive procedures are unnecessary.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 5","pages":"486-492"},"PeriodicalIF":1.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13607920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041935","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}