Seminars in Spine Surgery最新文献

With the ongoing development of Unilateral Biportal Endoscopic (UBE) spine surgery, it has become standard of care at many centers across the globe for lumbar decompressions and discectomies due to minimal muscle damage, minimal postoperative back pain and early recovery. In UBE, the separation of viewing portal and working portal allows greater freedom of movement for the surgical instruments as the camera and instruments move independently providing unrestricted vision. Moreover, the continuous irrigation fluid pressure decreases bleeding and helps to irrigate out the bone debris. Hence, UBE spine surgery has become quite popular and has expanded its indications to lumbar spinal fusion. The adoption of UBE for conventional spine surgeons into their routine practice is relatively easier than uniportal endoscopy because of use of standard arthroscopic lenses, familiar view of anatomy, and use of conventional open spinal instruments. In this article, we review the current literature and discuss the indications, contraindications, clinical outcomes, complications and compare it with existing minimally invasive transforaminal lumbar interbody fusion.

Surgical treatment for adult spinal deformity is associated with improved surgical alignment and improved outcome measures. Unfortunately, complications are a common consequence following surgery for adult spinal deformity. This article reviews the current concepts in complications including trends in complication profile over the past decade, classification of complications and risk calculators to help with complication stratification. The goal of this article is to identify the current best practices and to provide the reader with objective information to identify risk factors for complications and their prevention.

Outcomes following adult spinal deformity (ASD) surgery vary, despite technical advances and improved patient selection. Current prediction models, comprised of clinical and radiographic parameters, do not fully explain observed variation in patient outcomes. Objective biomarkers have fundamentally improved prediction, prognostication, and risk-stratification in other disease states and warrant further exploration in the care of ASD patients. In this review, we provide an overview of the need for objective biomarkers in the management of ASD. We detail advances in biomarker development for patient frailty, biological age, sarcopenia, bone quality, and nutritional status and consider how these biomarkers might be integrated into the management of ASD patients.

Three-Column Osteotomies (3CO's) refer to osteotomies that involve surgical removal of parts or all of the posterior, middle and anterior columns of the spine. The indications for using a 3CO in the surgical treatment of Adult Spinal Deformity (ASD) have slowly evolved over time but remains idiosyncratic for surgeons treating complex ASD patients. This manuscript will focus on the past and present use of 3CO's to highlight the changes over time in the indications, techniques, surgical results, complications and outcomes to place these procedures in the proper context to then discuss their probable use among ASD patients in the future.

Long-segment adult spinal deformity (ASD) constructs carry a high risk of mechanical complications. Pelvic fixation was introduced to improve distal construct mechanics and has since become the standard for long constructs spanning the lumbosacral junction. Pelvic fixation strategies have evolved substantially over the years. Numerous techniques now use a variety of entry points, screw trajectories, and construct configurations. We review the various strategies for pelvic fixation in ASD in a systematic review of the literature and update the techniques employed in the International Spine Study Group Complex Adult Deformity Surgery database.

Minimally invasive surgery (MIS) for correction of adult spinal deformity was developed to address the high rate of medical and surgical complications rate in open surgical treatment of increasingly aging and frail patient population. In the past decade, MIS group within the International Spine Study Group (ISSG) has been in the forefront of the application of MIS techniques to fulfill the well-established principles of ASD surgery. These efforts have resulted in landmark studies. Here, we review these studies that encompass all aspects of MIS surgical treatment of ASD including patient selection with Minimally Invasive Spinal Deformity Surgery (MISDEF) and MISDEF-2 algorithms, surgical planning with anterior column realignment classification and the Minimally Invasive Interbody Selection Algorithm (MIISA), and surgical execution with Spinal Deformity Complexity Checklist (SDCC). We will highlight that with careful selection, diligent planning and meticulous execution the MIS techniques can treat patients with ASD, abiding to correction principles and radiographic parameters.

Integrating functional evaluation of adult spinal deformity (ASD) patients is an integral component of clinical evaluation. While the spine community has acknowledged its significance, functional assessment is often absent in academic research due to standardization challenges. This review aims to outline diverse modalities for ASD functional assessment, ranging from simple to complex methods available only in dedicated laboratories. Addressing this gap will enhance our understanding of ASD's functional impact and guides improved research and patient care.

Operative treatment for adult spinal deformity (ASD) commonly involves long posterior instrumented fusions with primary rods spanning from the base of the construct to the upper instrumented vertebra. Over the past decade, additional supplemental rods have been increasingly utilized to bolster the primary instrumentation and mitigate risk of primary rod fracture/pseudarthrosis at areas of high biomechanical stress (e.g., 3-column osteotomy [3CO], multiple posterior column osteotomies [PCOs], lumbosacral junction). Supplemental rods for 3CO include satellite rods (4-rod technique with 2 deeply recessed short rods independently attached to pedicle screws across the 3CO), accessory rods (attached to primary rods via side-to-side connectors), and delta rods (accessory rods contoured only at the proximal and distal attachments to primary rods). Utilizing more than 4 rods across a 3CO may increase posterior construct stability; however, diminished load transfer to the anterior vertebral column may increase risk of nonunion and instrumentation failure. Similar supplemental rod constructs can be utilized to support multiple PCOs and/or the lumbosacral junction. We generally recommend using bilateral accessory rods for a total of 4 rods to support the lumbosacral junction (2 accessory rods and 2 primary rods). The novel “kickstand rod” can help facilitate coronal correction and/or function as an accessory rod distally anchored to an independent iliac screw; appropriate nomenclature is “iliac accessory rod” in cases without true kickstand distraction. In this narrative review, we aim to (1) provide a brief historical overview of supplemental rod constructs, (2) describe current indications for supplemental rods, and (3) report our results from a longitudinal analysis (2008–2020) of supplemental rod constructs used by International Spine Study Group (ISSG) surgeons.