Journal of Craniovertebral Junction and Spine最新文献

{"title":"Relationship of posterior superior iliac spine morphology and ideal S1 pedicle screw trajectory: A cross-sectional study of closed versus open posterior superior iliac spine morphology.","authors":"Preston Jenkins, Chase Walton, Robert Jackson Ferdon, Brian Yu, Jason Silvestre, Robert A Ravinsky","doi":"10.4103/jcvjs.jcvjs_42_26","DOIUrl":"10.4103/jcvjs.jcvjs_42_26","url":null,"abstract":"<p><strong>Introduction: </strong>S1 pedicle screws are commonly used in spine surgery. As these screws are often the most caudal part of the construct, it is important to achieve solid fixation via the ideal pedicle screw placement with the use of a medialized screw into the sacral promontory, the \"tricortical S1 screw.\" However, this trajectory can be precluded by the presence of a closed posterior superior iliac spine (PSIS) morphology, leading to suboptimal fixation in the sacrum. The aim of this study was to define the prevalence of closed PSIS morphology.</p><p><strong>Methods: </strong>Computed tomography (CT) imaging of the pelvis of a consecutive cohort of patients at a single institution was reviewed to identify the ideal S1 screw trajectory. PSIS morphology was identified as either open or closed, depending on whether a line from the ideal S1 pedicle screw trajectory intersected the PSIS. Statistical analyses included descriptive statistics (95% confidence intervals), group comparisons (one-sample proportion tests, Chi-square, t-tests, and Mann-Whitney U-test), correlations, and logistic regression for morphology predictors. Effect sizes (Cohen's d and Cramer's V) assessed clinical significance alongside statistical significance.</p><p><strong>Results: </strong>Of the 132 patients included in this study, 91 (68.9%) patients demonstrated closed PSIS morphology. Gender was the only significant predictor of closed PSIS morphology, with females being 33% less likely to have closed PSIS morphology.</p><p><strong>Conclusion: </strong>Preoperative CT imaging should be carefully reviewed and scrutinized to assess for closed PSIS morphology, and if closed PSIS morphology is present, plans for alternative fixation methods should be considered and available at the time of surgery.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"379-383"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820131","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":"Complications following thoracolumbar spinal surgery for adult spinal deformity in the setting of rheumatoid arthritis with minimum 2-year follow-up surveillance.","authors":"Neil V Shah, George A Beyer, Samuel Gedailovich, Juhayer S Alam, Adam J Wolfert, Benjamin Krasnyanskiy, Douglas A Hollern, Rohan Desai, Peter G Passias, Carl B Paulino, Virginie Lafage, Vincent Challier, Bassel G Diebo","doi":"10.4103/jcvjs.jcvjs_184_25","DOIUrl":"10.4103/jcvjs.jcvjs_184_25","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objectives: </strong>Given its high and increasing prevalence in the United States, rheumatoid arthritis (RA) has been a growing area of focus for spine surgeons. The literature regarding the long-term outcomes of RA patients undergoing adult spinal deformity (ASD) surgery is limited. Thus, the purpose of this study was to compare the postoperative complications and revisions through 2 years postoperatively between patients with and without RA undergoing ASD surgery.</p><p><strong>Methods: </strong>A retrospective analysis of the New York Statewide Planning and Research Cooperative System database was performed. Patients undergoing spinal fusion for ASD were selected for and divided into two cohorts based on RA status. Univariate analysis compared demographics, complications, length of stay, and revisions between cohorts. Multivariate logistic regression models, adjusted for age, gender, number of levels fused, and Deyo score.</p><p><strong>Results: </strong>A total of 6020 patients were identified, of which 238 (3.9%) patients had RA. Patients with RA had a higher rate of total complications (61.3% RA+ vs. 44.0% RA-, <i>P</i> < 0.001), surgical complications (24.4% RA+ vs. 15.6% RA-, <i>P</i> < 0.001), medical complications (55.9% RA+ vs. 37.2% RA-, <i>P</i> < 0.001), and revision (26.9% vs. 19.1, <i>P</i> = 0.003). RA was identified as an independent predictor of both overall complications (OR: 1.7 [95% confidence interval: 1.2-2.3]; <i>P</i> = 0.001) and revision (odds ratio: 1.6 [CI: 1.05-2.5]; <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>This study found RA to be an independent risk factor for increased complications and subsequent revision surgery after fusion surgery for ASD. Surgeons can use this data when counselling patients with RA regarding their operative risk.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"374-378"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820223","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":"Higher mortality and distinct complications after anterior cervical discectomy and fusion in dialysis patients, despite improvements over prior decade: A national inpatient study.","authors":"Mitchell K Ng, Leonidas E Mastrokostas, Paul G Mastrokostas, William A Green, Joshua Mathew, Gregorio Baek, Yasmine Eichbaum, Yulia Lee, Morgan Hitchner, Jonathan Dalton, Adam Fano, Alec Giakas, Rajendra Singh, Brendan Reitman, Afshin E Razi, Daniel R Fassett, Alan S Hilibrand, Alexander R Vaccaro, Christopher K Kepler, Gregory D Schroeder, Andrew P Alvarez","doi":"10.4103/jcvjs.jcvjs_219_25","DOIUrl":"10.4103/jcvjs.jcvjs_219_25","url":null,"abstract":"<p><strong>Introduction: </strong>Dialysis patients undergoing anterior cervical discectomy and fusion (ACDF) face elevated perioperative risk due to complex comorbidities. This study aimed to (1) identify associations between dialysis status and perioperative complications after ACDF, (2) quantify differences in length of stay (LOS), hospitalization costs, and discharge disposition, and (3) provide a contemporary national benchmark for outcomes in this high-risk population.</p><p><strong>Materials and methods: </strong>The 2016-2022 National Inpatient Sample was queried for adult elective ACDF cases. Dialysis dependence was identified through International Classification of Diseases-10 codes for end-stage renal disease with hemodialysis or peritoneal dialysis. Demographics, comorbidities, complications, LOS, costs, and discharge disposition were compared. Multivariate logistic regression was adjusted for demographic, hospital, and surgical factors.</p><p><strong>Results: </strong>Of 374,975 weighted ACDF admissions, 1155 involved dialysis patients. Dialysis was independently associated with increased odds of cardiovascular complications (odds ratio [OR]: 2.06, 95% confidence interval [CI]: 1.38-3.07), mechanical complications (OR: 2.67, 95% CI: 1.46-4.90), sepsis (OR: 6.46, 95% CI: 2.98-13.98), nonroutine discharge (OR: 2.02, 95% CI: 1.53-2.68), and inpatient mortality (OR: 8.18, 95% CI: 3.22-20.78). Although absolute inpatient mortality was low in both the groups, it was significantly higher in dialysis patients (<i>P</i> < 0.001). The mean LOS was >3 times longer, and hospitalization costs were nearly double (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Dialysis dependence is associated with distinct complications, substantially prolonged LOS, higher costs, and greater likelihood of nonhome discharge following ACDF. Inhospital mortality remains significantly higher in dialysis patients. Our findings support targeted perioperative optimization and early discharge planning to improve outcomes in this population.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"346-352"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820229","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":"Biomechanical comparison of seven occipital-cervical fixation constructs using finite element modeling.","authors":"Ian Polyzois, Jaskaran Singh, Sara Gustafson, Trevor Gascoyne, Franck Le Navéaux, Pierre Legay, Michael Goytan","doi":"10.4103/jcvjs.jcvjs_85_26","DOIUrl":"10.4103/jcvjs.jcvjs_85_26","url":null,"abstract":"<p><strong>Study design: </strong>This was a basic science study.</p><p><strong>Objective: </strong>The objective of this study was to determine which occipital-cervical (OC) fixation construct best balances construct stiffness with minimization of occipital screw pullout forces.</p><p><strong>Materials and methods: </strong>Finite element analysis was used to simulate seven OC construct variations spanning across C1 with fixation in C2 and C3. Variations included the use of occiput rods, keel plates with varying width, two-hole clamps, two-hole clamps in addition to medial or lateral one-hole clamps, and occiput screw diameter. Modeling was in accordance with ASTM F2706/ISO 12189 guidelines. Materials were in accordance with ASTM F1295/ASTM F1839/ISO 10243 guidelines. Outcomes included bending stiffness, axial screw pullout reaction forces, and von Mises stress distribution to identify stress localization and predicted failure modes. Constructs were ranked using multiattribute utility theory (MAUT).</p><p><strong>Results: </strong>Construct E (comprised two-hole clamps with added one-hole medial clamps) demonstrated the highest bending stiffness (820 N.mm/deg) and the highest MAUT utility score (0.79), representing the optimal balance of stiffness and minimized screw pullout forces. Construct F (comprised two-hole clamps alone) demonstrated the lowest bending stiffness (509 N.mm/deg).</p><p><strong>Conclusions: </strong>A construct composed of medially fixed one-hole and two-hole clamps provided the best balance of bending stiffness and minimized occipital screw pullout reaction forces. Aligning screws near the median plane, using bilateral clamp fixation, and avoiding components that mechanically join the two rods improved construct performance. Increasing occipital screw diameter from 4.5 mm to 5.0 mm had little biomechanical impact. Stress localization at occipital component-rod interfaces suggests a potential weak point with risk of notching and fatigue failure.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"384-391"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820272","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":"Four-level anterior cervical discectomy and fusion versus posterior cervical fusion: Perioperative outcomes, complications, and sagittal alignment in multilevel cervical pathology.","authors":"Dana Saleh, Ahmad Zayd Alkadri, Vito Evola, Atef F Hulliel, Kiana J Yeganeh, Jay Kumar, Alexander Haas, Patrick Kim, Mohsen Rostami, Puya Alikhani","doi":"10.4103/jcvjs.jcvjs_94_26","DOIUrl":"10.4103/jcvjs.jcvjs_94_26","url":null,"abstract":"<p><strong>Background: </strong>Four-level cervical fusion is uncommon for extensive degenerative cervical spondylotic myelopathy or multilevel stenosis, with anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) representing the primary approaches. Direct comparisons of four-level constructs are limited, particularly regarding perioperative outcomes, complications, hardware durability, and sagittal alignment.</p><p><strong>Methods: </strong>Retrospective review of 64 consecutive patients (34 ACDF, 30 PCF) undergoing primary four-level cervical fusion at a single institution (2011-2024) with a minimum 1-year follow-up (mean ~ 44 months). Groups were comparable in demographics, comorbidities, and primary diagnosis (96.9% stenosis ± myelopathy). Outcomes included perioperative metrics, complications, hardware failure, revision rates, and sagittal parameters.</p><p><strong>Results: </strong>ACDF demonstrated significantly longer operative time (285 vs. 200 min, <i>P</i> < 0.001) but shorter hospital length of stay (4.1 vs. 8.3 days, <i>P</i> = 0.04). Transient dysphagia was significantly more common after ACDF (44.1% vs. 6.6%, <i>P</i> < 0.001). Persistent dysphagia (>6 months: 11.7% vs. 0.0%, <i>P</i> = 0.11) and persistent hoarseness (8.8% vs. 3.3%, <i>P</i> = 0.61) showed no significant difference. Hardware failure was markedly higher in ACDF (32.4% vs. 3.3%, <i>P</i> = 0.003). C5 palsy rates were numerically lower in ACDF (5.8% vs. 20.0%, <i>P</i> = 0.13). Overall revision rates were comparable between groups (20.6% vs. 10.0%, <i>P</i> = 0.31). At final follow-up, the ACDF group had a significantly lower C2 slope compared with the PCF group 19.3° vs. 26.2°, <i>P</i> = 0.008), with a significant increase in T1-slope within the ACDF group (<i>P</i> = 0.006).</p><p><strong>Conclusion: </strong>Four-level ACDF offers perioperative efficiency with shorter hospital length of stay but is associated with higher rates of dysphagia, hoarseness, and hardware failure compared to PCF. In contrast, PCF provides greater hardware durability. Approach selection should be individualized based on pathology location, sagittal goals, and patient risk profile. Prospective studies with functional outcomes are needed to optimize the management of four-level cervical reconstruction.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"408-414"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820226","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":"Management of aneurysmal bone cysts of the spine and sacrum: A narrative review.","authors":"Justin Hyde, Mark Ehioghae, Brock Adams, Robert Henshaw, Seyed Kalantar, Jonathan P Japa, Kevin Yoon, Aaron Phung, Sean Bae, Ala Alshomali, Jamie Lee, Addisu Mesfin","doi":"10.4103/jcvjs.jcvjs_67_26","DOIUrl":"10.4103/jcvjs.jcvjs_67_26","url":null,"abstract":"<p><p>This narrative review summarizes contemporary diagnosis and management of aneurysmal bone cysts (ABCs) of the spine and sacrum, emphasizing axial-specific risks, decision thresholds, and adjunctive therapies. A PubMed/MEDLINE review was performed focusing on the last 10 years, with selective inclusion of earlier foundational studies. Search terms combined \"aneurysmal bone cyst\" with anatomy-specific modifiers (\"spine,\" \"vertebral,\" and \"sacrum\") and domains relevant to axial care, including molecular diagnostics such as ubiquitin-specific peptidase 6, imaging, biopsy, differential diagnosis, operative strategies, embolization, percutaneous therapies, and recurrence. ABCs are benign but locally aggressive lesions that frequently involve posterior elements, extend toward the canal, and threaten neurologic function and stability. Imaging may demonstrate expansile osteolysis and fluid-fluid levels but lacks specificity in axial disease; biopsy remains essential to exclude malignant mimics and secondary ABC-like change. Management is individualized based on neurologic compromise, instability, deformity, and lesion extent. Surgical options range from intralesional curettage to more extensive excision with stabilization, while adjuncts such as selective arterial embolization, doxycycline sclerotherapy, and denosumab may support hemorrhage control and local control in selected cases. Recurrence remains most strongly associated with incomplete resection and younger age. Prospective, spine-specific comparative studies are needed to standardize treatment selection, define the sequencing of adjuncts, and clarify long-term outcomes.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"339-345"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820264","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":"Clinical and radiological results of percutaneous facet cage stabilization and indirect decompression in cervical spondylosis.","authors":"Ismail Iştemen, Mahmut Ferat, Durdu Mehmet Babaoğlan, Can Sezer, Erencan Kılcı, Deniz Dükünlü, Mehmet Volkan Harput, Rıdvan Açıkalın","doi":"10.4103/jcvjs.jcvjs_62_26","DOIUrl":"10.4103/jcvjs.jcvjs_62_26","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical and radiological outcomes of percutaneous cervical facet cage stabilization and indirect decompression in patients with cervical spondylotic radiculopathy and myelopathy.</p><p><strong>Materials and methods: </strong>This retrospective study included 25 patients who underwent bilateral percutaneous cervical facet cage placement between 2022 and 2024. Patients with Kang Grade 1-2 cervical stenosis who underwent indirect decompression without additional decompressive surgery and had at least 1 year of follow-up were included. Clinical outcomes were assessed using the Visual Analog Scale scores for neck and arm pain, Modified Japanese Orthopedic Association score, Neck Disability Index, and Oswestry Disability Index. Radiological evaluation included C2-C7 Cobb angle, C2 sagittal vertical axis, foraminal height, facet height, interspinous height, posterior disc space height, and fusion status.</p><p><strong>Results: </strong>The study included 25 patients (14 males and 11 females), with a mean age of 57 years. Significant improvement was observed in all clinical outcome measures at the 1-year follow-up (<i>P</i> < 0.05). Mean facet height increased by 2.4 mm, interspinous height by 2.3 mm, and posterior disc height by 1.9 mm. Foraminal height increased by 2 mm; however, this change was not statistically significant. Cervical sagittal alignment parameters remained unchanged. Fusion was achieved in 23 of 25 patients (92%). Mean operative duration was 34.2 min for single-level procedures and 49.3 min for two-level procedures. One superficial wound infection occurred and resolved with debridement and antibiotic therapy. Two patients required revision surgery because of recurrent symptoms.</p><p><strong>Conclusion: </strong>Percutaneous cervical facet cage stabilization with indirect decompression is a minimally invasive and effective treatment option in selected patients with cervical spondylotic radiculopathy and myelopathy. The technique provides satisfactory clinical and radiological outcomes with low morbidity and short operative duration.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"441-445"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820298","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":"Percutaneous vertebroplasty in the surgical treatment of osteoporotic vertebral compression fractures: A retrospective study of 93 patients.","authors":"S S Etibarli, Rovshan S Khalilzada, S A Etibarli, N P Ahmadov, Ibragimov Akobir, Bipin Chaurasia","doi":"10.4103/jcvjs.jcvjs_132_26","DOIUrl":"10.4103/jcvjs.jcvjs_132_26","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous vertebroplasty is a minimally invasive surgical technique used to stabilize and reinforce vertebral bodies affected by osteoporotic fractures, hemangiomas, primary spinal tumors, metastatic lesions, and other pathological conditions.</p><p><strong>Objective: </strong>The objective of this study is to evaluate the clinical effectiveness of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures.</p><p><strong>Materials and methods: </strong>This retrospective study analyzed the medical records of 93 patients who underwent surgical treatment for osteoporotic vertebral fractures between 2015 and 2024 at the Educational Surgery Clinic of Azerbaijan Medical University and Baku Health Center. The cohort included 73 women and 20 men. The mean age was 62.5 ± 1.1 years in women and 68 ± 2.3 years in men. All patients underwent clinical and neurological examination and the diagnosis was confirmed using spondylography, densitometry, computed tomography (CT), and magnetic resonance imaging. Percutaneous vertebroplasty was performed in 76 patients (81.7%). Cement augmentation was carried out at one vertebral level in 46 patients (60.5%), two levels in 25 patients (26%), four levels in 1 patient (1.3%), and five levels in 2 patients (2.6%).</p><p><strong>Results: </strong>Complete pain relief after surgery was observed in 93% of patients, while significant pain reduction occurred in 7%. Minor complications were reported in 5 patients (6.6%) and did not require additional surgical intervention.</p><p><strong>Conclusion: </strong>Percutaneous vertebroplasty is a safe, effective, and minimally invasive method for the surgical treatment of osteoporotic vertebral fractures. The procedure provides rapid pain relief, facilitates early restoration of mobility, and significantly reduces the need for analgesic medications.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"429-433"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819690","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":"Four- and five-level anterior cervical discectomy and fusion with iliac crest autologous bone graft and plate-screw fixation: Radiographic and clinical outcomes with minimum 2-year follow-up.","authors":"Tony Tannoury, Hayley Denwood, Sung Jun Son, Megan Berube, Rehan R Khan, Daman P Dhunna, Jeongeun Kim, Yifei Wang, Chadi Tannoury","doi":"10.4103/jcvjs.jcvjs_24_26","DOIUrl":"10.4103/jcvjs.jcvjs_24_26","url":null,"abstract":"<p><strong>Background: </strong>In multilevel disease, the risks and benefits of performing anterior versus posterior surgical approaches to the cervical spine remain debated. We sought to evaluate the radiographic and clinical outcomes of patients with multilevel cervical spondylotic myelopathy (CSM) treated with four- and five-level anterior cervical discectomy and fusion (ACDF), using tricortical iliac crest autograft and anterior plate fixation.</p><p><strong>Materials and methods: </strong>Between 2009 and 2021, 1428 patients who underwent cervical fusion were reviewed. Inclusion required four- or five-level ACDF fusion with a 2-year clinical follow-up. Exclusions required fusions <4 levels; corpectomies; additional posterior fixation; and surgeries for infection, trauma, or malignancy. Demographics, preoperative and postoperative Nurick grades, Visual Analog Scale (VAS) pain scores, radiographic alignment (C2-C7 Cobb angle, T1 slope [T1S]), and fusion status were collected. Postoperative complications were categorized as early (0-3 months), intermediate (3-12 months), and late (13-24 months).</p><p><strong>Results: </strong>Twenty-seven patients (63% of males), age 59.7 ± 8.6 years, were included. Twenty-two patients underwent four-level and 5 underwent five-level ACDF. Significant improvements were observed in Nurick grade (2.78-1.15, <i>P</i> < 0.001), VAS score for neck and arm pain (both <i>P</i> < 0.001), Cobb angle (8.45°-13.39°, <i>P</i> = 0.001), and T1S (28.81°-32.36°, <i>P</i> < 0.001). Dysphagia was the most common early complication (29.6%), decreasing to 7.4% at late follow-up. Three patients (11.1%) developed adjacent segment disease. All patients achieved radiographic fusion.</p><p><strong>Conclusion: </strong>Four- and five-level ACDF with tricortical iliac crest autograft yields excellent clinical and radiographic outcomes in patients with multilevel CSM, with high fusion rates and low complication profile over a 2-year follow-up.</p><p><strong>Level of evidence: </strong>IV (retrospective case series).</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"367-373"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820283","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":"Partial C2 corpectomy with iliac/fibula bone graft and posterior instrumented fusion for C2 vertebral body lesions: An innovative approach.","authors":"Charan Makkina, Tony Varghese Panicker, Baylis Vivek Joseph","doi":"10.4103/jcvjs.jcvjs_93_26","DOIUrl":"10.4103/jcvjs.jcvjs_93_26","url":null,"abstract":"<p><strong>Introduction: </strong>Lesions of the C2 vertebral body represent a distinct and demanding subset of spinal pathology. The intricate anatomy of the upper cervical spine, characterized by its proximity to critical neurovascular structures, limited surgical corridors, and complex biomechanical demands, renders surgical intervention at this level particularly challenging.</p><p><strong>Anatomical consideration and surgical rationale: </strong>The odontoid process (dens) of C2 plays a pivotal role in the stability of the craniovertebral junction. When the tip of the odontoid is preserved despite partial vertebral body destruction, it remains a reliable anchor point for spinal fusion. Exploiting this anatomical advantage allows for anterior uninstrumented bone graft placement, thereby minimizing surgical morbidity.</p><p><strong>Study objective and surgical technique: </strong>This article presents a retrospective review of six patients who presented with partial destruction of the C2 vertebral body and were managed surgically. The operative strategy employed consisted of three key components: Anterior median C2 corpectomy-targeted resection of the diseased vertebral body while preserving viable bony structuresReconstruction with autologous bone graft-restoration of anterior column integrity using iliac crest or fibular graft, using the osteogenic and biomechanical properties of autologous materialPosterior stabilization - supplementary fixation to ensure construct stability.</p><p><strong>Significance and conclusion: </strong>The findings of this review underscore the viability, safety, and clinical effectiveness of this surgical strategy (anterior corpectomy with uninstrumented fusion and posterior supplementary instrumented fusion) across a spectrum of pathological conditions affecting the C2 vertebra. By demonstrating its applicability in varied clinical scenarios, this technique offers a reproducible and practical framework for surgeons managing this challenging anatomical region.</p>","PeriodicalId":51721,"journal":{"name":"Journal of Craniovertebral Junction and Spine","volume":"17 4","pages":"399-407"},"PeriodicalIF":1.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13506115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820237","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}