Journal of spine surgery最新文献

Background and objective: Augmented reality (AR) is being increasingly integrated into spine surgery. However, most existing reviews predominantly focus on its use in instrumentation-based procedures. The broader role of AR in of non-instrumentation minimally invasive spine surgery (MISS), including decompression, endoscopic, and tubular techniques, has not been fully synthesized. This narrative review aims to bring together the current evidence on AR applications across the full range of MISS, with a particular focus on visualization- and workflow-critical non-instrumentation procedures, an area that has been underrepresented in prior reviews.

Methods: A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane Library for articles published between 2010 and 2025. Search terms included Medical Subject Headings (MeSH) and free-text keywords related to augmented reality, minimally invasive spine surgery, decompression, and navigation. Only peer-reviewed English-language articles were included. Study selection was performed independently by three reviewers, with discrepancies resolved by consensus.

Key content and findings: The review synthesizes AR applications across percutaneous procedures, tubular surgery, endoscopic spine surgery (ESS), microscopic surgery, and lateral approaches. The literature indicates that AR can enhance intraoperative visualization through in-situ image overlays, reduce visual attention shifts and cognitive workload, improve workflow efficiency, and lower radiation exposure. However, current evidence is largely derived from small-sample, single-center feasibility studies (levels IV-V evidence). Comparative analyses suggest AR is most valuable as a complementary visualization layer within multimodal navigation ecosystems rather than a standalone replacement.

Conclusions: AR represents a promising adjunct in MISS, particularly for non-instrumentation procedures in which visualization is limited. To define its definitive clinical value, future research must prioritize workflow standardization, validation of performance metrics, and adequately powered multicenter trials that assess clinically meaningful outcomes. Integration with artificial intelligence (AI) and robotic platforms may further enhance surgical precision and efficiency, shaping the next phase of MISS.

Background: While many large contemporary series have demonstrated safe and accurate sacroiliac joint (SIJ) fusion in revision settings, few have exclusively focused on non-robotic stereotactic navigation in patients with dense legacy pelvic hardware. SIJ fusion operations are challenging due to existing hardware distorting bony landmarks and reducing implant corridors, often requiring robotic surgery to mitigate these challenges. Our consecutive case series is unique in highlighting that high fusion rates (100% at 12 months) and universal same day discharge is achievable with purely navigation-assisted techniques. This report provides practical guidance for surgeons who may not have access to robotic technology, thereby extending minimally invasive surgery sacroiliac joint fusion (MIS SIJF) to a broader hospital population.

Case description: We conducted a retrospective case series of 5 patients who underwent navigation-assisted, MIS SIJF after prior pelvic fixation. All patients underwent successful SIJF with no complications. Operative times averaged 67 minutes for unilateral and 84 minutes for bilateral procedures. All cases achieved same day discharge. At 1-year postoperative follow-up, computed tomography (CT) confirmed fusion in all 5 patients and all patients had complete symptom resolution.

Conclusions: Stereotactic navigation-assisted MIS SIJF is safe and effective in patients with prior instrumentation. This approach showed accurate implant placement in all cases. This case series suggests that navigation-assisted MIS SIJF can be utilized in hospitals without robotic navigation capabilities, extending advanced care to hospitals where robotic navigation is limited.

Background: There has not been universal consensus on the management of traumatic dural tears. This case report and systematic review highlighted the incidence, risk factors, diagnostic clues, surgical management and prognosis of dural rupture in the context of traumatic spinal fractures.

Methods: A total of 3 databases were included in the literature search: PubMed, Cochrane and Scopus. Search terms included "(dural tear OR dural rupture)" AND "(vertebral fracture OR burst fracture)". Primary outcomes included (I) the incidence of dural tears and etiologies; (II) radiological risk factors; (III) time to surgery and preoperative neurology; (IV) dural repair method; (V) surgical stabilisation; (VI) complications; and (VII) postoperative neurological outcomes.

Results: A case of a 57-year-old male with accidental fall from height was presented. Despite being neurologically intact on admission, he developed acute cauda equina syndrome with imaging revealing a three-column L3 fracture with cauda equina compression. He subsequently underwent urgent first-stage posterior decompression and instrumented L2-L4 spinal fusion, during which a traumatic dural rupture caused by L3 lamina fracture was identified and primarily repaired. A second-stage anterior L3 corpectomy and anterior column reconstruction with fusion was performed. For the review, twenty-seven articles, including 8 case reports, were included. Incidence of dural tears after traumatic spinal fractures ranged from 2.9% to 94.7%. Interpedicular distance, presence of whole laminar fractures, central canal diameter and posterior element fractures were radiological indicators for dural lacerations. Most patients presented with incomplete neurological deficit and surgical intervention for most cases involved posterior stabilisation of spine with primary suture repair of the dural laceration. Complications included cerebrospinal fluid (CSF) leakage, pseudomeningoceles and nerve entrapment. Postoperative course was generally satisfactory with up to 61% of patients making complete recovery and returning to function.

Conclusions: Dural tears were not uncommon after traumatic spinal injuries, especially in lumbosacral impaction or burst fractures. Radiographic predictors for dural lacerations included interpedicular distance and canal diameter. Current standard of dural repair involves primary suture, while adjunctive techniques (grafts and patches) were only recommended when primary repair was not feasible. The need for immediate surgical treatment is emphasized in patients with incomplete neurological deficits given their recovery potential.

Background: Hanging injuries are primarily associated with hypoxic-ischemic brain damage due to vascular compression, rather than airway obstruction. Spinal cord injury in this context is exceedingly rare, particularly when no bony abnormality is present. Only a limited number of cases of cervical spinal cord injury after hanging have been reported, most without radiographic abnormalities resembling spinal cord injury without radiographic abnormality (SCIWORA). We present an additional rare case of cervical spinal cord injury following near-hanging in an elderly patient, focusing on diagnostic and pathophysiological considerations rather than uniqueness.

Case description: A 70-year-old man with no psychiatric history was found in a near-hanging position in a vinyl greenhouse storage area. Cardiopulmonary resuscitation (CPR) was initiated by his spouse and continued for approximately 10 minutes. Return of spontaneous circulation was achieved after one additional cycle of CPR in the emergency department. On examination, he was semicomatous (Glasgow Coma Scale score 8) with quadriparesis (grade I). Cervical radiographs and computed tomography (CT) were normal. Magnetic resonance imaging (MRI) revealed diffuse T2-hyperintense intramedullary edema of the cervical cord without fracture or ligamentous injury. Conservative management was undertaken; however, no significant neurological recovery occurred.

Conclusions: Cervical spinal cord injury following near-hanging, particularly in the absence of bony injury, is a rare but clinically significant entity. MRI is indispensable for diagnosis in patients with neurological deficits after hanging.

Iliosacral screw fixation is a cornerstone technique for stabilizing posterior pelvic ring injuries, particularly vertical sacral wing fractures and sacroiliac joint disjunctions. Although traditionally performed under fluoroscopic guidance, conventional two-dimensional (2D) imaging exposes both patients and surgical teams to significant radiation and carries a non-negligible risk of screw malposition, with potential injury to neural and vascular structures. The integration of intraoperative three-dimensional (3D) neuronavigation represents a major technological advance that enhances the accuracy, safety, and reproducibility of this demanding procedure. This article describes a simplified, standardized, and reproducible technique for percutaneous iliosacral screw placement using 3D neuronavigation, specifically tailored for spine and trauma surgeons. The navigation system is used to preoperatively and intraoperatively define optimal entry points, safe screw trajectories, and appropriate screw lengths, ensuring preservation of sacral foramina and neural elements. A neuronavigated drill guide or navigated Jamshidi needle is employed to insert K-wires, followed by the placement of two to three partially or fully threaded cannulated screws with washers, depending on fracture morphology and biomechanical objectives. Intraoperative 3D image acquisition is systematically performed to verify final screw positioning before closure, allowing immediate correction if necessary. Close interdisciplinary collaboration with orthopedic surgeons is emphasized to address pelvic ring injuries comprehensively, considering both posterior and anterior stability. An intraoperative video of an illustrative clinical case accompanies this description to demonstrate the step-by-step workflow and technical nuances of the procedure. In conclusion, neuronavigated iliosacral screw fixation provides a safe, reliable, and reproducible solution for posterior pelvic ring stabilization. By improving surgical precision, reducing radiation exposure, and shortening the learning curve, this technique represents a valuable addition to the modern spine surgeon's armamentarium and has the potential to become a new standard of care for complex sacral fractures.

Background: Interbody implants have evolved to reduce the risk of nonunion with polyetheretherketone (PEEK) and subsidence with titanium devices. Two novel anterior lumbar interbody fusion (ALIF) implants, hydroxyapatite (HA) infused PEEK (HA PEEK) and titanium alloy with microtextured HA infused surface [titanium hydroxyapatite (TiHA)] may overcome these inherent risks. The primary objective of this study was to compare subsidence and fusion rates between HA PEEK and TiHA implants. Secondarily, reoperation rates and changes in patient reported outcomes were compared.

Methods: In this multicenter retrospective analysis, data was extracted for adult circumferential ALIF ≤3 levels using HA PEEK or TiHA implants. Primary outcomes included rates of subsidence at 12 months and fusion at 6 and 12 months. Secondary outcomes included reoperation rates up to 12 months and changes in ODI and VAS back pain scores at 12 months. Fusion and subsidence were evaluated using an automated, computer vision-based analysis of radiographs. Fusion was defined as <3° of angular motion and subsidence was defined as ≥2 mm of disc space height loss. Analysis compared outcomes between implant groups to test for differences.

Results: Of 181 patients (48.1% HA PEEK, 51.9% TiHA), 273 levels were treated, 47.8% of patients were males, and the median age was 55 years. At 6 months, the majority of levels were fused in both groups (94.2% HA PEEK, 99.3% TiHA, P=0.04). Fusion at 6 months was strongly predictive of 12-month fusion (92% HA PEEK, 98% TiHA, P=0.02). At 12 months, subsidence was minimal in both groups (4.1% HA PEEK, 0.7% TiHA, P=0.10). No difference was found in reoperation rates between implant groups (9% HA PEEK, 11% TiHA, P=0.10). Reduction in ODI scores (-29.0 HA PEEK, -22.7 TiHA, P=0.049) and VAS back pain scores (-40 HA PEEK, -25 TiHA, P=0.02) trended better in the HA PEEK group at 12 months.

Conclusions: Surface-enhanced PEEK and titanium ALIF implants demonstrated high fusion rates, low rates of subsidence and reoperation, and clinically meaningful improvements in disability and back pain at 12 months. These results suggest that modern surface-enhanced interbody implants may mitigate the historical nonunion risk of untreated PEEK and subsidence risk of untreated titanium, allowing implant selection to be guided by surgeon preference and case-specific factors rather than performance.

Background: Unstable C1 (atlas) fractures pose a substantial surgical challenge due to their proximity to critical neurovascular structures and the unique biomechanical role of the atlantoaxial complex. Disruption of the transverse atlantal ligament (TAL) destabilizes the C1 ring, and traditional fusion constructs sacrifice substantial cervical motion. C1-ring osteosynthesis with a rod and lateral mass screw construct offers a motion-preserving alternative, though screw placement can be technically demanding. In this report, we present the use of stereotactic navigation-assisted open reduction and internal fixation (ORIF) of the C1 ring to stabilize an unstable C1 fracture.

Case description: A 34-year-old man sustained a ring-expanding C1 fracture with TAL disruption after diving into a shallow pool. Imaging confirmed right-sided anterior and posterior arch fractures with lateral mass displacement and intrasubstance TAL tear. Given the unstable fracture pattern, surgical fixation was pursued to restore anatomic alignment and preserve motion. The patient underwent prone positioning, closed reduction with fluoroscopic guidance, and stereotactic navigation-assisted C1-ring osteosynthesis via a posterior approach. Intraoperative O-arm imaging confirmed accurate screw placement and anatomic reduction. Postoperatively, the patient demonstrated excellent recovery with maintained bony alignment, fracture healings, and near-complete return of cervical motion at 6.5 months.

Conclusions: Navigation-assisted ORIF of unstable C1 fractures is a safe, effective, and motion-preserving strategy that achieves reliable reduction and stabilization. It represents a valuable alternative to fusion procedures in young patients in whom fusion carries very high morbidity. Stereotactic navigation enhances the accuracy and safety of lateral mass screw placement and may reduce complication risk. This case adds to the growing literature supporting posterior C1-ring osteosynthesis as a safe approach for select unstable atlas fractures.

Background: Ankylosing spinal disorders (ASD), including ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, markedly increase spinal rigidity and susceptibility to highly unstable thoracolumbar fractures. These injuries often require long-segment posterior fixation, which conventionally relies on C-arm fluoroscopy and exposes operating staff to cumulative radiation. O-arm-based intraoperative navigation may reduce radiation exposure while maintaining pedicle screw accuracy; however, evidence in ASD-related fractures remains limited. The aim of this study was to compare intraoperative radiation exposure and pedicle screw placement accuracy between O-arm navigation and C-arm fluoroscopy during percutaneous pedicle screw (PPS) fixation in patients with ASD.

Methods: This single-center retrospective cohort study included 24 consecutive adults with ASD who sustained thoracolumbar fractures between 2015 and 2024. Patients underwent PPS fixation using either O-arm navigation (n=11) or C-arm fluoroscopy (n=13). Demographic characteristics, operative variables, radiation time, and screw accuracy-assessed using the Heary and Gertzbein classification systems-were compared. Fluoroscopy time served as a surrogate marker of radiation exposure because actual dosimeter data were unavailable.

Results: Radiation exposure time was significantly shorter in the O-arm group than in the C-arm group (2.5±1.8 vs. 16.9±11.4 min; P<0.001). Pedicle screw accuracy was comparable (acceptable accuracy: 88.3% vs. 87.3%, respectively; P>0.99). Operative time, blood loss, and complication rates did not differ significantly between groups. Time from injury to surgery was longer in the O-arm group, reflecting workflow constraints and the use of C-arm fluoroscopy for urgent after-hours cases.

Conclusions: O-arm navigation markedly reduces intraoperative radiation exposure without compromising pedicle screw accuracy in ASD-related thoracolumbar fractures. Given the substantial occupational radiation risks faced by spine surgeons, O-arm navigation represents a valuable tool for improving radiation safety while maintaining surgical precision. Larger prospective studies are warranted to validate these findings.

Background: Anterior cervical discectomy and fusion (ACDF) is a widely performed surgical procedure for treating cervical spine pathologies, with pseudarthrosis remaining a significant postoperative challenge. While glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated beneficial effects on vascular health and bone metabolism, their impact on cervical fusion outcomes remains unexplored. This study investigates the relationship between perioperative GLP-1 agonist use and pseudarthrosis rates following single-level ACDF procedures.

Methods: We conducted a retrospective propensity-matched cohort study using the TriNetX database. retrospective analysis using the TriNetX Research Network database, examining records from October 2010 to October 2022. The study population included patients who underwent single-level ACDF procedures. One-to-one propensity score matching (PSM) was performed to account for demographic factors, body mass index (BMI), hemoglobin A1c (HbA1c), and relevant comorbidities. Pseudarthrosis rates were evaluated at 6 months, 1 year, and 2 years postoperatively.

Results: Of 28,133 patients who underwent ACDF, 555 were prescribed GLP-1 agonists within 6 months of surgery. After PSM, 546 patients were included in each cohort. The GLP-1 agonist cohort demonstrated significantly lower odds of developing pseudarthrosis at 6 months [odds ratio (OR): 0.60, 95% confidence interval (CI): 0.42-0.87], 1 year (OR: 0.65, 95% CI: 0.46-0.94), and 2 years (OR: 0.62, 95% CI: 0.44-0.86) postoperatively compared to the non-GLP-1 agonist cohort.

Conclusions: GLP-1 agonist use was associated with significantly reduced pseudarthrosis rates following ACDF procedures across all measured time points. These findings suggest potential benefits of GLP-1 agonists in cervical fusion outcomes, independent of their metabolic effects. Further prospective studies are warranted to validate these results and elucidate the underlying biological mechanisms.

Background: Reoperation after lumbar discectomy for recurrent disc herniation can be technically challenging due to surgical scarring and altered anatomy, especially if postoperative complications are present. Iatrogenic pars fractures are a rare but significant post-operative complication that can complicate management with potential to cause persistent back pain, radiculopathy, and progression to instability, particularly in young active patients if not treated appropriately.

Case description: The authors present the case of a 37-year-old female who presented with cauda equina syndrome following recent open lumbar laminectomy and discectomy, with imaging showing giant recurrent disc herniation and iatrogenic pars fracture. Patient underwent endoscopic transforaminal discectomy and temporary percutaneous pedicle screw fixation, with delayed hardware removal following fracture union. At follow-up, she demonstrated complete radiological cauda equina decompression and near-complete clinical recovery, with only minor residual sensory symptoms and preserved motion at that segment following hardware removal.

Conclusions: This case demonstrates that a minimally invasive endoscopic approach to discectomy combined with temporary pedicle screw fixation may be a promising motion-preserving alternative in select cases of recurrent disc herniation and iatrogenic pars fracture in younger patients.