Journal of Craniovertebral Junction and Spine最新文献

{"title":"Morphometric analysis of some important parameters for the transoral approach to the occipito-atlanto-axial region: MDCT study.","authors":"Musa Acar, Serdar Karaköse, Elif Iyiduran","doi":"10.4103/jcvjs.jcvjs_64_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_64_25","url":null,"abstract":"<p><strong>Context: </strong>Transoral approach is a frequently preferred method for the craniocervical region. Interventions in this area are performed for decompression purposes or to provide craniocervical fixation. To get a good result, knowing the anatomy of the region in detail will make the entrepreneur's job much easier.</p><p><strong>Aims: </strong>The aim of the study is to contribute to the surgeons' perspective during the intervention by creating reference values in transoral approaches to the cervical region.</p><p><strong>Settings and design: </strong>This study is a retrospective descriptive file screening study.</p><p><strong>Methods: </strong>The study was performed using cranial computed tomography images of 200 patients. These patients consisted of 100 men and 100 women. The age range of the individuals included in the study varies between 20 and 80. In our study, the parameters measured and recorded in the coronal, sagittal, and axial plane.</p><p><strong>Statistical analysis used: </strong>SPSS 22 was used for statistical analysis.</p><p><strong>Results: </strong>In our study, seven different parameters were measured and recorded. Our results were evaluated between genders and in terms of lateralization. The obtained averages were tested statistically.</p><p><strong>Conclusions: </strong>To plan and conclude a successful surgical intervention, it is necessary to have a good command of the area to be operated on. The data we present in our study will help surgeons dealing with the region in this sense. In addition, our study will contribute to the creation of a database on healthy individuals in Turkish society.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"232-236"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776817","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 Comparison of different posterior arthrodesis techniques versus anterior dens screw for odontoid fractures: A systematic review and meta-analysis.","authors":"Pavlos Texakalidis, Stavros Matsoukas, Michael Cloney, Mykhaylo Krushelnytskyy, Kevin Swong, Najib El Tecle, Tyler Koski, Nader S Dahdaleh","doi":"10.4103/jcvjs.jcvjs_42_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_42_25","url":null,"abstract":"<p><strong>Background and objectives: </strong>Odontoid fractures are often managed surgically. The most common approaches are anterior dens screw (ADS) and posterior arthrodesis (PA), with the latter being associated with significantly higher fusion rates. PA techniques can include wiring, C1-C2 transarticular (TA) screws, and C1 lateral mass (LM)-C2 pars/pedicle screws. Most comparative studies group multiple PA techniques together when comparing PA versus ADS. Our objective was to systematically review the literature and identify studies that separately provide fusion rates of each different posterior C1-C2 arthrodesis (PA) technique utilized compared to ADS.</p><p><strong>Methods: </strong>A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A random effects meta-analysis was performed, and the <i>I²</i> statistic was used to assess heterogeneity.</p><p><strong>Results: </strong>In total, 15 studies comprising 685 patients (ADS: 377; wiring: 58; TA: 150; C1 LM-C2 pars/pedicle screws: 100). The average age of the patients ranged across the included studies between 22 and 82.4 years old. The mean last follow-up was >12 months in eight studies. Only two studies reported a follow-up period of <6 months. Most of the odontoid fractures were type II based on the Anderson-D'Alonzo classification. Use of C1 LM-C2 pars/pedicle screws was associated with significantly higher odds of fusion compared to ADS (C1 LM-C2 pars/pedicle: 97%; ADS: 87.2%; odds ratio [OR]: 3.89; 95% confidence interval [CI]: 1.34-11.29; <i>I^2:</i> 0%). TA screws were associated with significantly higher odds of fusion compared to ADS (TA: 98%; ADS: 87%; OR: 4.19; 95% CI: 1.67-10.47; <i>I^2:</i> 0%). There was no difference in the rate of fusion between wiring and ADS (wiring: 84.4%; ADS: 92.6%; OR: 0.34; 95% CI: 0.08-1.40; <i>I^2:</i> 48.8%).</p><p><strong>Conclusions: </strong>C1-C2 TA screws and C1 LM-C2 pars/pedicle screws are both associated with statistically significant higher rates of fusion compared to ADS for odontoid fractures. ADS showed higher rates of fusion compared to wiring, although this did not reach statistical significance.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"126-132"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776876","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":"Inter-laminar micro-endoscopic discectomy versus microdiscectomy in single-level posterolateral lumbar disc herniation: A comparative study.","authors":"Mohamed Mohi Eldin, Ahmed Salah El Din Hassan, Omar Youssef Abdallah AboHamed, Ahmed Abdelaziz Nazem Hassan, Ahmed Hussein Omar","doi":"10.4103/jcvjs.jcvjs_32_24","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_32_24","url":null,"abstract":"<p><strong>Background: </strong>Patients with neurological impairments or those unresponsive to conservative therapy may undergo surgical discectomy. The techniques include open discectomy (OD), microdiscectomy (MD), microendoscopic discectomy (MED), and percutaneous endoscopic discectomy. MED combines the benefits of MD and OD with minimal tissue damage. This study compared MD versus MED outcomes in patients with sciatica from lumbar disc herniation.</p><p><strong>Patients and methods: </strong>This prospective clinical study included 50 patients who underwent single-level discectomy at Cairo University Hospital. The patients were divided into two groups: 25 patients who underwent MD in Group I and 25 who underwent MED in Group II.</p><p><strong>Results: </strong>In our study, 64% (16/25) of the MED group rated their postoperative condition as excellent, 28% (7/25) as good, 4% (1/25) as fair, and 4% (1/25) as poor, according to the modified McNab criteria. In the MD group, 60% (15 patients) reported excellent satisfaction; 28% (7 patients), good; 8% (2 patients), fair; and 4% (1 patient), poor satisfaction. Overall, 90% (45 patients) of patients across both groups had excellent to good outcomes, irrespective of the discectomy type. When categorizing excellent and good outcomes as successes and fair and poor as failures, the MED group's success rate was 92%, compared to 88% for MD. There was no significant difference in patient satisfaction between the two groups.</p><p><strong>Conclusion: </strong>MED and MD showed equivalent efficacy in treating radicular pain caused by lumbar disc herniation. Patients in both groups showed significant improvements in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. No significant differences were found between the groups in VAS, ODI, or complication rates, validating both surgical techniques for lumbar disc herniation. Compared with OD, MED showed reduced blood loss, smaller incisions, shorter hospital stays, and longer operation times. Although MED requires a steep learning curve, it remains safe even during the initial learning period, with outcomes and complication rates similar to those of MD.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"142-147"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776816","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":"Occipitocervical surgery rescue: The \"<i>Catcher's Mitt</i>\" technique.","authors":"Samuel Adida, Roberta K Sefcik, Ricardo J Fernández de-Thomas, Ananya Sen, Edward G Andrews, Nitin Agarwal, Paul A Gardner, D Kojo Hamilton","doi":"10.4103/jcvjs.jcvjs_87_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_87_25","url":null,"abstract":"<p><p>Instability of the occipitocervical junction may compress neural elements, resulting in progressive disability. After the <i>Kickstand Rod</i> technique was developed to correct for thoracolumbar scoliosis, the <i>Candy Cane</i> construct was developed for chin-on-chest deformity at the cervicothoracic junction as a similar three-rod approach. Demonstrated is a four-rod iteration utilized to stabilize the occipitocervical junction and correct condylar instability, termed the <i>Catcher's Mitt</i> technique. A 34-year-old woman with Goldenhar syndrome, hemihypertrophy, and a complex neurosurgical history including Chiari decompression, clival chordoma resection, and a previous cervical fusion presented with quadriparesis, dysphagia, and bilateral upper extremity paresthesias. She was found to have pontomedullary and craniocervical instability with occipital translation and subluxation of the atlantooccipital joint, contributing to her neurological decline. A single midline incision and periosteal dissection exposed her prior O to C6 instrumented fusion. Existing rods were replaced, and a third plate-rod was placed on the right from O to C6. On the left, a fourth plate rod was positioned from C1 to C6. Four top-loading connectors secured the accessory rods to the primary construct. After confirming a stable lordotic alignment, distraction across the accessory rods was used to assist with coronal correction. The <i>Catcher's Mitt</i> construct improved this patient's sagittal and coronal plane deformity. Postoperatively, the cervical sagittal vertical axis improved by 25 mm and the chin-brow angle by 20 mm. Significant improvements in functional status were achieved at 2-year follow-up. A one-stage posterior approach with construct augmentation using third and fourth accessory rods can correct atlantooccipital subluxation following failed occipitocervical fusion.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"254-256"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776818","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":"Standalone cages versus plate-augmented fusion in multilevel anterior cervical discectomy and fusion: A 12-month prospective study balancing clinical equivalence and radiological superiority.","authors":"Sayed Mohamed Elgoyoushi","doi":"10.4103/jcvjs.jcvjs_79_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_79_25","url":null,"abstract":"<p><strong>Purpose: </strong>Anterior cervical discectomy and fusion (ACDF) is a gold standard treatment for multilevel degenerative cervical pathology, yet controversy persists regarding the necessity of anterior cervical plates (ACPs) in modern cage-based constructs. This prospective study compares the clinical and radiological outcomes of standalone cages versus plate-augmented systems in multilevel ACDF, addressing critical debates on biomechanical stability versus procedural simplicity.</p><p><strong>Materials and methods: </strong>A prospective cohort of 100 patients undergoing multilevel ACDF (2+ levels) was equally divided into two groups: standalone cages (Group I, <i>n</i> = 50) and cages with ACP (Group II, <i>n</i> = 50). Clinical outcomes (Visual Analog Scale [VAS] for neck/arm pain and Neck Disability Index [NDI]) and radiological parameters (fusion rates and cervical lordosis) were assessed preoperatively and at 6/12 months postoperatively. Complications including dysphagia, pseudoarthrosis, and C5 palsy were systematically recorded.</p><p><strong>Results: </strong>Both the groups demonstrated significant improvements in VAS (neck: 7.2→2.1 vs. 7.0→1.9; arm: 6.8→1.8 vs. 6.5→1.7) and NDI (48%→18% vs. 50%→16%) at 12 months (<i>P</i> > 0.05). Radiologically, Group II exhibited superior outcomes: (1) fusion rates: 94% versus 82% (<i>P</i> = 0.03) and (2) lordosis maintenance: 12.5° versus 9.8° (<i>P</i> = 0.01). Complication rates were comparable (dysphagia: 8% vs. 10%; pseudoarthrosis: 6% vs. 4%; P > 0.05).</p><p><strong>Conclusion: </strong>While standalone cages achieve comparable short-term symptom relief, plate augmentation offers superior radiological stability in multilevel ACDF, preserving alignment and optimizing fusion success without increasing perioperative risks. These findings support selective plate use in complex, multilevel constructs while affirming standalone cages as a viable option for patients with contraindications to plating. This study refines evidence-based decision-making in cervical spine surgery, balancing innovation with biomechanical rigor.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"200-204"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776823","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 impact of operative level on patient-reported outcome measures following single-level posterior lumbar decompression for disc herniation.","authors":"Jonathan Dalton, Robert J Oris, Omar H Tarawneh, Gregory R Toci, Rajkishen Narayanan, Dominic Finan, Hannah Bash, Marco Goldberg, John J Mangan, Barrett I Woods, Mark F Kurd, Ian David Kaye, Jose A Canseco, Alan S Hilibrand, Alexander R Vaccaro, Gregory D Schroeder, Christopher K Kepler","doi":"10.4103/jcvjs.jcvjs_66_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_66_25","url":null,"abstract":"<p><strong>Objective: </strong>To compare the impact of upper versus lower lumbar decompression on patient-reported outcome measures (PROMs).</p><p><strong>Materials and methods: </strong>Patients undergoing L1-L2, L2-L3, L4-L5, or L5-S1 single-level elective decompression with 1-year PROMs were identified. Included PROMs were the Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg, and Short Form-12 physical (PCS) and mental (MCS) component scores. Minimal clinically important differences (MCID) were calculated. Multivariable regressions assessed the independent predictive ability of operative level controlling for demographic confounders.</p><p><strong>Results: </strong>Three hundred and forty-six patients were included (94 upper lumbar decompressions). Upper lumbar decompression patients were older (64.0 vs. 46.9, <i>P</i> < 0.001), had higher body mass index (BMI) (31.4 vs. 28.4, <i>P</i> < 0.001) and Charlson Comorbidity Index (CCI) (3.15 vs. 1.56, <i>P</i> < 0.001), and more commonly had diabetes (19.5% vs. 7.69%, <i>P</i> = 0.017). These patients had similar 1-year scores in ODI, VAS leg, and MCS but performed worse at 1 year in VAS back (3.58 vs. 2.75, <i>P</i> = 0.016) and at 6 months in ODI (24.5 vs. 17.9, <i>P</i> = 0.005) and were less likely to achieve MCID in PCS (48.8% vs. 64.4%, <i>P</i> = 0.041). However, multivariable regression did not identify upper lumbar decompression as independently associated with 1-year VAS back scores, 6-month ODI scores, or MCID achievement in PCS after controlling for age, BMI, diabetes, and CCI.</p><p><strong>Conclusion: </strong>Patients undergoing upper lumbar decompression demonstrated worse PROMs. However, multivariable analyses suggested these differences were attributable to comorbidity burden and BMI, rather than operative level. This suggests that surgeons and patients can expect similar pain and function improvement from upper lumbar decompression when accounting for baseline patient characteristics.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"218-223"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776838","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":"Comparison of outcomes in the management of Type II odontoid fractures in young patients - Is surgery overrated?","authors":"Jitesh Manghwani, Ganesh Kumar, Nagaraju Venishetty, Anuj Mundra","doi":"10.4103/jcvjs.jcvjs_34_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_34_25","url":null,"abstract":"<p><strong>Introduction: </strong>The options for the management of type II odontoid fractures in young patients include anterior screw fixation, posterior spinal fusion, or halo-vest immobilization (HVI). However, there is a recent trend away from nonoperative management and an increase in primary operative stabilization across several centers. Hence, our study aims to compare the functional and radiological outcomes of type II odontoid fractures in young patients managed with HVI and surgery.</p><p><strong>Materials and methods: </strong>A retrospective analysis of 70 patients with type II odontoid fracture who were managed in our institution with a mean age of 47 years was included in our study. The clinical details included the Neck Disability Index (NDI), Visual Analog Scale (VAS) for neck pain, and S-Range of Movement (ROM)-Neck score. Radiological details included union status, atlanto-dens interval, amount of displacement and angulation, and transverse ligament injury. Both the clinical and radiological parameters were compared between the patients who underwent HVI (<i>n</i> = 28) and surgery (<i>n</i> = 42).</p><p><strong>Results: </strong>The mean ± standard deviation follow-up duration was 4.2 ± 2.5 years in the HVI group and 3.8 ± 2.7 years in the surgery group. Of the clinical parameters, the S-ROM-Neck score was significantly better in the HVI group than in the surgery group (<i>P</i> < 0.001). The length of hospitalization was much shorter in the HVI group (<i>P</i> < 0.001). There were no differences in NDI, VAS for neck pain, and other radiological parameters.</p><p><strong>Conclusion: </strong>For type II odontoid fractures in young patients, HVI had better clinical outcomes compared to the surgery and should be considered the first line of management.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"224-231"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776877","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":"Selection of Lower instrumented vertebra in early-onset scoliosis at index growth rod insertion- can we predict distal add-on at graduation surgery?","authors":"Rajneesh Misra, Sai Gautham Balasubramanian, Colin Bruce, Neil Davidson, Jayesh Trivedi, Sudarshan Munigangaiah","doi":"10.4103/jcvjs.jcvjs_86_24","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_86_24","url":null,"abstract":"<p><strong>Background: </strong>There are still no consensus criteria on how to select the lower instrumented vertebra (LIV) for growing rods (GRs) at index surgery. The aim was to evaluate whether the criteria used for adolescent idiopathic scoliosis fusion adapts to early-onset scoliosis (EOS).</p><p><strong>Materials and methods: </strong>Retrospective analysis of prospectively collected data in a consecutive cohort of patients with EOS treated with GR, expanding from index surgery to 2 years after graduation. The LIV was analyzed regarding its relation to the stable vertebra (SV), substantially touched vertebra (STV), and non-substantially touched vertebra (NSTV). Failure of LIV selection was considered when revision surgery with distal add-on was needed during follow-up.</p><p><strong>Results: </strong>A total of 13 patients met the inclusion criteria. The mean chronological age was 9.16 years (at index surgery), 12.9 years (at graduation), and 14.9 years (at final follow-up). The most frequent LIV at index surgery was L4 in four cases, closely followed by L2 and L3 with three cases each at the index surgery. The designation of SV, STV, and non-STV (NSTV) was based on standard anteroposterior radiographs. There were six cases where the LIV at growth rod insertion was the SV. Three of these did not require revision of the LIV at graduation. The remaining three which required revision required addition of one level. There were six cases in which the LIV was higher than the SV. Four of these were one level higher, i.e., STV, and two of these NSTV. Those which were at STV did not require revision of the LIV at graduation. Of the two where the initial LIV was NSTV, one required revision down to four levels below, while the other required extension by one level.</p><p><strong>Conclusions: </strong>For EOS, whenever an SV or STV was chosen, the incidence of revision of LIV was about 30%. The revision required was a distal add-on by one level. If the LIV was any higher than STV, the revision required a distal add-on to more than one level. Choosing a STV or SV as the distal foundation for the construct of EOS correction possibly leads to lesser rates of add-on phenomenon.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"162-169"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776821","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 validity of posterior approach in thoracolumbar spine fracture surgery: A study of 104 cases with literature review.","authors":"Ghassen Elkahla, Amine Trifa, Mehdi Darmoul","doi":"10.4103/jcvjs.jcvjs_50_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_50_25","url":null,"abstract":"<p><strong>Background: </strong>Thoracolumbar spine fractures are the most common fracture in the whole spine. Their treatment is often surgical and the posterior approach is the most frequently realized. The aim of this study is to evaluate the clinical recovery and the radiological alignment improvement in thoracolumbar spine patient's trauma operated through posterior approach.</p><p><strong>Materials and methods: </strong>Retrospective study of 104 thoracolumbar trauma patients operated via posterior approach in our neurosurgery department between 2018 and 2023. Demographic data, clinical, radiological, and surgical characteristics, and outcome were evaluated for each patient.</p><p><strong>Results: </strong>One hundred and four patients were selected; there were 73 males and 31 females with a mean age of 40.94 years. Most of the patients had no significant medical history and were directly transferred from emergency department. Poly trauma was observed in nearly half of the patients. The most common mechanism of injury was fall from height and secondly road traffic accident. At admission, 70% of patients were classified American Spinal Injury Association (ASIA) E, 12.5% ASIA A, and 17.5% had incomplete neurological deficit. Radiological investigations showed that most fractures are located in the thoracolumbar junction (53.85%) followed by lumbar location (36.55%) and thoracic region (9.6%). Most fractures are classified type A (AO classification) with predominance of subtype A3 and A4, frequently located in the thoracolumbar and lumbar region. All patients were operated through posterior approach with pedicle screw fixation and only 36% had in addition posterior decompression. The mean postoperative hospital stay was 5.4 days. The rate of postoperative complications was 2.9%. At the last follow-up, improvement of incomplete neurological deficit was seen in 80% of cases, and a statistically significant correction of the regional kyphosis angle was observed at the thoracolumbar junction.</p><p><strong>Conclusion: </strong>The posterior approach with pedicle screw fixation is an effective technique for the treatment of thoracolumbar fracture, leading to a good clinical recovery and radiological satisfactory alignment in most of cases with low rate of complications.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"212-217"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776839","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":"Unilateral C1-C2 vertical distraction injuries: Can we treat conservatively?","authors":"Saurabh Rawall, Zuhair J Mohammed, Sean Taylor, Eric M Vess, Connor J Donley, Sakthivel R Rajaram, Steven M Theiss","doi":"10.4103/jcvjs.jcvjs_32_25","DOIUrl":"https://doi.org/10.4103/jcvjs.jcvjs_32_25","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Traumatic atlantoaxial joint (AAJ) vertical distraction injuries lie on a spectrum of injury involving the craniocervical junction. Isolated injuries can be unstable, requiring surgical stabilization, a highly morbid procedure given C1-C2 joint's primary role in cervical spine rotation. Previous authors established normative C1-C2 lateral mass values to evaluate for vertical AAJ distraction injuries. However, these studies focus on bilateral AAJ injury, with no data on unilateral or incomplete AAJ injuries. Clinical decision-making regarding these partial injuries is fraught with uncertainty, especially given the possibility of delayed instability. As a result, this study seeks to characterize injury patterns and clinical courses of patients with incomplete or unilateral AAJ injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;After receiving Institutional Review Board approval, all magnetic resonance imaging (MRI) and computed tomography (CT) radiology reads from January 1, 2006, to August 1, 2021, at our Level I Trauma Center were queried for the following terms: edema, disruption, avulsion, tear, distraction, or subluxation and transverse ligament, AAJ, or C1-C2 joint, resulting in 2779 patients. Inclusion criteria consisted of age greater than 18 years old, history of recent traumatic injury, and radiographic evidence of unilateral AAJ distraction on CT, defined by a unilateral lateral mass index (LMI) &gt;2.6 mm. MRI scans were classified based on the extent of soft-tissue injury. Demographic data and clinical outcomes were obtained by chart review and summarized using descriptive statistics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Five patients comprised this study: 3 males and 2 females with an average age of 51 years. Four patients were injured by motor vehicle accident and 1 due to fall from standing height. Three patients had concomitant orthopedic extremity fractures requiring operative fixation. The average LMI of the involved joint was 4.2 mm versus 2.0 in the contralateral joint. On MRI, 3 patients exhibited bilateral AAJ effusions. No patients demonstrated complete injury of associated ligaments. All patients were treated conservatively with a rigid cervical collar. No patients demonstrated late instability at an average radiographic follow-up of 876 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Unilateral or incomplete AAJ vertical distraction injuries lie on a spectrum of injury involving the craniocervical junction and more specifically the C1-C2 articulation. MRI is essential to evaluate the ligamentous stabilizers of the craniocervical junction prior to any treatment decisions, but in the absence of an unstable ligamentous injury, incomplete or unilateral vertical distraction injuries can be safely managed conservatively. This study is one of few to examine unilateral ligamentous injury between the atlas and axis of the spine. This study shows that in the absence of injury instability, these injuries can successfully be","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"16 2","pages":"170-175"},"PeriodicalIF":1.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12313040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776840","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}