Journal of spine surgery最新文献

Anterior lumbar interbody fusion (ALIF) is an anterior surgical approach for interbody fusion in the lumbar spine which affords the surgeon unfettered access to the disc space and allows for release of the anterior longitudinal ligament and insertion of a large, lordotic interbody graft. Despite the benefits associated with ALIF when compared with other lumbar interbody fusion techniques, the ALIF approach is associated with a number of unique complications, and certain patient-specific criteria (e.g., vascular anatomy) are important considerations when selecting patients for an ALIF. This review article summarizes the authors' own patient selection criteria for ALIF and describes the items required for pre-operative workup. Notable criteria to consider when planning an ALIF include: patient age, sex, bone density, body mass index, nicotine usage history, the presence-and severity of-medical comorbidities, anatomy of the distal iliac vein/abdominal aorta/iliac bifurcation/iliocaval confluence, history of prior abdominal surgery/infection/radiotherapy, surgical goals, operative level and availability of approach co-surgeons. Pre-operative workup for ALIF procedures should at a minimum consist of magnetic resonance imaging of the lumbar spine, standing X-rays of the lumbar spine with flexion/extension views, scoliosis or long-cassette spinal X-rays and a computed tomography of the lumbar spine without contrast as well as a dual-energy X-ray absorptiometry scan.

Background: Surgical treatment of therapy-resistant radiculopathy associated with lumbar herniated discs in patients with extreme obesity is a challenge for neurosurgeons. In addition to technical problems in surgery due to the abundant subcutaneous adipose tissue and perioperative risks, there are significant anesthetic risks when anesthesia is performed with a patient in the prone position. A surgical procedure should preferably be minimally traumatic and quick with minimal risks of complications. Large studies show good results with minimally invasive techniques, namely microsurgical and endoscopic ones. However, in the case of surgeries in patients with extreme obesity, an endoscopic approach seems to be preferable because the spinal canal is quickly reached through a small skin incision using this approach.

Case description: We describe in detail the successful surgical treatment of a 48-year-old patient with extreme obesity (body mass index 54.3 kg/m²) and therapy-resistant immobilizing radiculopathy at the L4 level on the left by minimally invasive endoscopic sequestrectomy. Following the surgery, the patient was rapidly mobilized and discharged on the 4th postoperative day. No complications were reported in the early and late postoperative periods.

Conclusions: The endoscopic approach can be successfully used for the treatment of therapy-resistant radiculopathy in patients with extreme obesity and can be considered as the main technique of surgical treatment, being both quick and minimally traumatic.

Atlantoaxial rotatory subluxation (AARS) in the adult population is primarily trauma-induced. Conservative and surgical treatments have both been used successfully in treating AARS. In cases where AARS cannot be reduced by conservative measures, open reduction and fusion is the conventional treatment approach. This report details a novel approach for treating adult AARS, where an open reduction was performed without instrumentation or fusion. The patient, a 48-year-old female involved in a high-speed vehicular collision, initially underwent conservative treatment with Gardner Wells Tongs and manual traction. Despite these efforts, X-ray and computed tomography (CT) scans indicated persistent subluxation. Subsequently, the patient was taken to the operating room, where successful open reduction was achieved without the need for fusion or instrumentation. Preoperative imaging revealed rotatory subluxation of C1-2 with a comminuted and displaced fracture of the right C1-2 facet joint and a nondisplaced fracture of the base of the occiput. The surgical technique involved precise manual manipulation using a Cloward spreader and real-time assessment with O-arm 3D X-ray tomography to ensure successful reduction. The absence of significant laxity or instability during intraoperative testing led to the conclusion that fusion was unnecessary. This approach minimizes invasive tissue dissection and preserves natural cervical range of motion (ROM). Postoperatively, the patient was asymptomatic with no joint instability and demonstrated satisfactory alignment at follow-up.

Background: Electromagnetic navigation (EMN) is an advanced technology increasingly utilized in orthopedic surgery for its ability to provide real-time intraoperative guidance. Its application in spinal surgery is evolving rapidly, particularly for complex cases like tumor lesions. Spinal osteoblastomas, characterized by their benign nature, primarily affect the posterior elements of the spine. They present treatment challenges due to their potential for recurrence and proximity to critical structures. EMN-guided surgery offers a promising approach to achieve precise tumor localization and tailored resection in such cases. Therefore, reporting cases of spinal osteoblastomas treated with EMN guidance significantly contributes to understanding the efficacy and potential advantages of this innovative surgical approach.

Case description: We present the case of a 17-year-old female with persistent sacral pain initially diagnosed as an osteoid osteoma based on imaging findings. This led to gamma probe-assisted resection. However, subsequent histopathological analysis revealed the lesion to be an osteoblastoma. Upon recurrence, EMN-guided surgery was employed to achieve precise tumor localization and tailored resection of the osteoblastoma in S1 vertebra. The surgical intervention resulted in complete tumor removal, leading to symptom resolution during a 2-year follow-up period.

Conclusions: This case highlights the emerging role of EMN in the treatment of spinal tumors, demonstrating its potential to improve precision and patient outcomes. The effectiveness of EMN-guided surgery suggests its potential as a valuable tool in tumor resection procedures. Further research and reporting will help confirm the efficacy of EMN and its integration into routine practice for the treatment of spinal tumors.

Background: The objective of this report is to present a case of two cervical spine artificial discs (Bryan Cervical Disk) that completely disappeared within 6 months as a result of a high-energy trauma more than 10 years after the initial surgery. Implant dislocation is a known complication in artificial cervical disc replacement. However, this report presents the case of an exceptional migration path with esophageal ingrowth and rectal excretion, not only for one artificial disc but for two at different times It highlights the need for long-term follow-up examinations after artificial cervical disc arthroplasty (ACDA).

Case description: The patient was seen in a Swiss outpatient spine center. He presented with a history of chronic laryngitis, which led to multiple ear, nose, and throat (ENT) diagnostic examinations without any cause being found. Migration of two cervical artificial discs was discovered incidentally in a cervical spine magnet resonance imaging (MRI), which was performed due to chronic myofascial pain in the lower extremities. The MRI showed anterior/retropharyngeal migration of one cervical disc. The second one could not be seen on the whole spine MRI. The complete patient history and radiographic findings were collected and reviewed. In addition, a whole-body computer tomography (CT) scan was done, and the patient was sent to an ENT center to rule out esophagus perforation and to verify the location of the two BRYAN © Cervical Disc.

Conclusions: This case highlights the importance of considering the possibility of migration of an artificial disc in patients who have undergone cervical disc replacement surgery, even if it has been years since the surgery. In particular, patients presenting with symptoms of hoarseness, dysphagia, or globus sensation and a history of cervical disc replacement surgery should receive at least one low-threshold conventional X-ray of the affected segments.

Background and objective: As the global population ages, degenerative spinal disorders are on the rise, leading to an increased focus on optimizing spinal fusion therapies. Despite the high success rate of iliac crest bone autografts, their usage is hampered by donor site morbidity and limited supply. The objective of this review is to assess the viability of ceramic-based synthetic materials as alternatives in spinal fusion surgeries.

Methods: A review of national databases was performed using key terms "allograft", "nanosynthetic", "spine", and "surgery" for literature from 1900 to 2024. Studies that aimed to describe the utility of ceramic allografts, associated outcomes, limitations, and future directions were included. Studies that were not in English were excluded.

Key content and findings: Successful spinal fusion relies on osteoconductivity, osteoinductivity, osteogenesis, and osteointegration. Ceramic-based materials, primarily calcium sulfates, phosphates, hydroxyapatites (HAs), and silicon nitrides, are recognized for their osteoconductive properties. Recent studies suggest the efficacy of ceramics as graft extenders and highlight both their compatibility and cost-effectiveness. Innovations like nanosynthetic bone grafts have shown potential in preclinical trials, offering enhanced bone formation and resorption properties. The narrative review details comparative outcomes of various synthetic grafts against autografts and allografts, indicating similar fusion rates with potentially lower complication rates.

Conclusions: Ceramic-based synthetic materials represent a significant advancement in spinal fusion procedures, with properties that can potentially match those of autografts. Nanosynthetic grafts, in particular, exhibit promising results in animal studies and initial clinical trials. The continuous development and evaluation of these materials could optimize fusion rates and reduce the morbidity associated with autograft harvesting. However, further research is required to assess long-term outcomes and determine the best practices for their use in spinal surgeries.

Background: Aneurysmal bone cysts (ABCs) are benign, blood-filled neoplasms causing bone destruction, often requiring en bloc resection. However, challenges arise, especially at the cranio-cervical junction, where proximity to critical structures limits en bloc removal. Non-surgical options include selective arterial embolization (SAE) as main treatment, while Denosumab and centrifugated bone marrow emerge as experimental alternatives. We report a case of C2 ABC in a young woman successfully treated with a single injection of biphasic ceramic bone substitute (BCBS) containing hydroxyapatite (HA) and calcium sulfate.

Case description: En bloc resection was deemed unnecessary due to the absence of neurological deficits or deformities, as reported throughout literature evidences. Denosumab administration showed interval tumor change, while SAE was hindered by arterial anastomosis, limiting the possibility of obtaining complete embolization, while significantly increasing cerebral ischemic risks. Repeated intralesional iliac crest bone marrow injection proved ineffective. Subsequently, a single BCBS injection was attempted. A 6-month follow-up computed tomography (CT) scan revealed complete cyst ossification, cortical bone remodeling without artifacts, and spinal canal restoration.

Conclusions: HA and calcium sulfate BCBS vertebroplasty emerges as a promising alternative to SAE and denosumab when surgery is not indicated or feasible. Its benefits include effectiveness after a single injection, complete ossification, cortical bone restoration, and artifact-free imaging. These features make it valuable also in cases of pathological fractures.

Lumbar spinal surgery relies on palpation of anatomical landmarks and X-ray imaging confirmation to identify the correct spinal level, therefore exposing patients and staff to radiation, and increasing intraoperative time and cost. Ultrasound (US) assistance is being used to visualise spinal anatomy by many specialities, such as neurology and anaesthetics, and can be used intraoperatively in selected spinal surgery cases. However, its potential use to check spinal levels prior to surgery remains understudied. This prospective, pilot study screened all patients requiring a primary elective or emergency lumbar discectomy, under the supervision of a single consultant neurosurgeon, over an 8-month period at a single neurosurgical unit. US assistance was used to identify and mark the proposed spinal level prior to skin incision. The resemblance of the parasagittal lumbar US images to the back of the dinosaur Stegosaurus aided users in identifying the relevant anatomical structures necessary to mark the desired spinal level, (e.g., lumbar laminae, intervertebral spaces, sacrum). This inspired our description of the US images of the lumbar spine as 'The Stegosaurus Appearance'. The spinal level marked by US was then confirmed in the standard fashion using intraoperative X-ray imaging. In 100% of cases (12/12), the desired spinal level was correctly identified using US, confirmed by the subsequent intraoperative X-ray images. US assistance appears to be a safe, quick, and accurate tool for identifying the correct lumbar spinal level prior to skin incision, and could therefore represent a useful adjunct to supplement level checking in lumbar spinal surgery.

Background: Interspinous devices were introduced in the field of spine surgery as an alternative to traditional pedicle screw fixation in selected patients for treatment of spinal stenosis and fixation. These devices designs have evolved from non-fixated extension blocks to sophisticated interspinous fixation devices (IFDs). There is an absence of literature comparing the biomechanical fixation strength of different IFD plate designs and the role of set screw locking systems. The aim of this study was to evaluate fixation strengths by bench testing static disassembly and pullout strength of two dissimilar IFD designs and locking mechanisms. We hypothesized that the InSpan (InSpan LLC, Burlington, MA, USA) dual-locking symmetrically IFD plate designed will have stronger fixation than the Aspen (ZimVie, Parsippany, NJ, USA) single-locking asymmetric IFD plate design.

Methods: We conducted two biomechanical bench tests to evaluate the load to failure locking characteristics of symmetrical InSpan and asymmetrical Aspen IFD designs. Static pullout testing involved locking each IFD to the stainless steel and 40 pcf cellular polyurethane foam and measuring pullout load and displacement six times. Seven InSpan and two Aspen IFDs (including the "used" IFDs from the pullout testing) underwent static disassembly tests using a pair of disassembly fixtures positioned between the IFD plates to measure disassembly force and displacement. All tests were performed under ambient conditions using an INSTRON 8874 Bi-Axial Tabletop Servohydraulic Dynamic Testing System (INSTRON, Norwood, MA, USA), and data was collected at a 0.2 mm/s displacement control rate until the test was stopped when there was a drop in the continuously increasing force against resistance (gross failure).

Results: The InSpan IFD experienced 94.81% higher resistance to pullout compared to the Aspen IFD in static pullout testing (P<0.05), owing to its notably larger footprint area of 69.8%. Gross failure for both IFD implant designs occurred at the foam block-block interface. In static disassembly testing, pristine InSpan required 60.7% higher force over pristine Aspen and 401.3% for "used" IFDs. Gross failure was characterized by the gradual distraction of the plates and material removal at the set screw contact points. Implant failure at the block-implant interface emphasized the pivotal role of teeth design and the contact surface area of the plates in ensuring stability.

Conclusions: The dual-locking symmetrical InSpan IFD outperformed single-locking asymmetric Aspen IFD in both static disassembly and pullout bench tests. This highlights the benefits of InSpan's improved design and its potential for enhanced long-term stability in spinal fixation applications.