Asian Spine Journal最新文献

Study design: Retrospective cohort study.

Purpose: To evaluate the clinical efficacy and advantages of integrated optical and electromagnetic navigation-guided biportal endoscopic unilateral laminotomy for bilateral decompression (navigation-guided BE-ULBD, Ng-BE-ULBD) in patients with lumbar spinal stenosis (LSS).

Overview of literature: The use of surgical navigation improves procedural precision and contributes to reduced operative time and fluoroscopy exposure. However, currently available navigation systems have notable limitations: optical navigation is influenced by lineof- sight obstruction, while electromagnetic navigation is easily affected by interference from metallic instruments.

Methods: A retrospective analysis was performed on patients who underwent BE-ULBD for LSS at Beijing Chaoyang Hospital between August 2023 and June 2025. Patients treated using an integrated optical and electromagnetic surgical navigation system were categorized into the Ng-BE-ULBD group (n=84), whereas those treated under conventional C-arm fluoroscopy guidance were included in the Carm- guided BE-ULBD (C-BE-ULBD) group. Baseline demographic and clinical characteristics, operative time, number of fluoroscopy shots, clinical outcomes, and postoperative complications were recorded and compared between the two groups.

Results: The total operative time for both single- and two-level decompressions was significantly shorter in the Ng-BE-ULBD group (81.40 minutes and 144.56 minutes, respectively) than in the C-BE-ULBD group (88.79 minutes and 159.53 minutes, respectively; p <0.05), with the most substantial difference observed in catheter placement time. The total number of fluoroscopy shots was also significantly lower in the Ng-BE-ULBD group (p <0.05). Postoperatively, both groups exhibited significant improvement in pain relief, functional recovery, and patient satisfaction. However, no significant differences were identified between the two groups regarding decompression time, complication rates (Ng-BE-ULBD: 3.6% vs. C-BE-ULBD: 7.3%), postoperative pain or functional improvement, or length of hospital stay (p >0.05).

Conclusions: The integrated optical and electromagnetic surgical navigation system effectively reduces radiation exposure and shortens operative time, thereby improving surgical efficiency and safety. These findings demonstrate strong clinical potential for this technology in minimally invasive spine surgery.

Recurrent lumbar disc herniation (RLDH) occurs in up to 15% of patients after primary discectomy and poses challenges in surgical decision-making. Both revision discectomy (RD) and spinal fusion (SF) is utilized for reoperation, but the optimal treatment strategy remains a topic of debate. Additionally, data on the ideal timing for reoperation are limited. This study systematically reviewed risk factors for RLDH, evaluated surgical timing, and compared outcomes between RD and SF. A systematic review and meta-analysis were conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines (PROSPERO-registered). The PubMed, Scopus, and CINAHL databases were searched through December 2024. Eligible studies included patients undergoing revision surgery for RLDH, with data on surgical technique, timing, and outcomes. The risk of bias was assessed using ROB-2 for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Random-effects meta-analysis was employed to pool 12-month improvements in Visual Analog Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) scores. Additional outcomes included perioperative metrics, complications, recurrence rates, and patient satisfaction. Ten studies (including 939 patients) met the inclusion criteria. Reported risk factors included male sex, obesity, smoking, diabetes, and large annular defects. Surgical timing was inconsistently reported, which limited the pooled analysis. SF was associated with significantly greater intraoperative blood loss ((p=0.039), while operative time and hospitalization duration did not differ significantly. Recurrence rates did not significantly differ ((p=0.262), although open fusion showed a trend toward reduced recurrence. No significant differences in 12-month VAS or ODI scores were found between the groups (p>0.3). Minimally invasive techniques (minimally invasive transforaminal lumbar interbody fusion and percutaneous endoscopic lumbar discectomy) were associated with fewer complications and greater patient satisfaction. Both RD and SF are viable options for RLDH, each presenting distinct risk-benefit profiles. Importantly, this study highlights the inconsistent reporting of surgical timing as a persistent knowledge gap. Further high-quality research utilizing standardized definitions of recurrence and reoperation timeframes, with long-term follow-up, is necessary to clarify optimal surgical timing and guide treatment selection (PROSPERO CRD42024570791).

Study design: This was a retrospective study using the Diagnosis Procedure Combination (DPC) database.

Purpose: Using a large national database, we aimed to investigate the epidemiology, treatment patterns, and outcomes of cervical fracture dislocation (CFD) among adolescents.

Overview of literature: There have been numerous clinical studies on CFD in adults. However, the current lack of studies on adolescent CFD is a clinically relevant research gap that urgently needs to be addressed.

Methods: Among 4,653 inpatients who were identified to have a definitive diagnosis of CFD from 2010 to 2021 from the DPC database, we extracted the medical data of 84 adolescent inpatients (aged 11-18 years).

Results: CFD in adolescent inpatients was rare, accounting for only 1.8% of all patients with CFD in the DPC database. Complications occurred in 31 patients (36.9%), and mortality rate was 9.5%. Of eight patients who died, four were complicated by traumatic brain injury. Polytrauma was found in 32 patients (38.1%), and its incidence was significantly higher in those with mental disorders (p <0.001). The proportion of patients who were discharged home was significantly lower in those with mental disorders than in those without mental disorders (p =0.01).

Conclusions: This epidemiological study provided new insights into adolescent CFD using real-world data. Future research should focus on the evaluation of long-term functional prognosis and development of preventive strategies and improved treatments for CFD in adolescent patients.

Accurate assessment of fusion status following spinal fusion surgery is paramount, as it closely relates to patient outcomes and quality of life. Multiple imaging modalities have been developed to evaluate fusion, each with distinct advantages and limitations. Plain radiography remains the most accessible and practical method, with dynamic flexion-extension radiographs providing reasonably reliable information on segmental motion and stability. Computed tomography offers superior spatial resolution and enables direct visualization of trabecular bone bridging between vertebral segments, making it the most accurate modality for confirming fusion. Magnetic resonance imaging and radionuclide imaging can serve as complementary techniques, particularly when conventional methods are inconclusive or contraindicated. This review summarizes the strengths and limitations of each imaging modality used for assessing spinal fusion. It also highlights recent technological advances and emerging diagnostic approaches that may enhance the objectivity, reliability, and accuracy of fusion assessment in the future.

Recurrent laryngeal nerve (RLN) injury is a recognized complication of anterior cervical spine surgery with potential for significant morbidity. Temporary vocal fold dysfunction is relatively common, whereas permanent deficit is uncommon. Theoretically, right-sided approaches carry a higher risk of RLN injury due to the shorter and more oblique course of the right RLN. This review aimed to determine whether the side of the surgical approach significantly influences the incidence of RLN injury. A comprehensive search of MEDLINE (Ovid), EMBASE, Scopus, and Google Scholar identified studies reporting RLN injury incidence and the surgical approach side. Owing to marked heterogeneity in study design and outcome reporting, a narrative review with limited statistical analysis was performed. Twenty-nine studies involving 13,540 anterior cervical procedures were included. The overall incidence of RLN injury was 2%, with no significant difference between left and right-sided approaches. However, 20 of 29 studies assessed RLN function only in symptomatic patients (reactive laryngoscopy), whereas nine studies performed postoperative laryngoscopy in all patients, regardless of symptoms (routine laryngoscopy). In this latter group, right-sided approaches were associated with a significantly higher incidence of RLN injury (odds ratio, 0.47; 95% confidence interval, 0.28-0.81; p=0.05). This review demonstrates that right-sided approaches are associated with a greater risk of RLN injury, although many injuries are minimally symptomatic or asymptomatic. Left-sided approaches should be preferred when feasible, considering factors such as surgeon handedness, training, and spinal pathology. Pre- and postoperative laryngoscopy are recommended in patients with a history of prior neck surgery.

Minimally invasive lumbar interbody fusion continues to evolve with advancements in navigation and endoscopic technologies aimed at reducing tissue trauma and improving safety. Conventional endoscopic fusion approaches, such as the interlaminar and trans-Kambin techniques, have inherent limitations regarding neural safety and implant positioning. We describe a novel computer-navigated transfacet uniportal endoscopic lumbar interbody fusion technique that leverages advanced navigation and endoscopic visualization to safely access the disc space via a transfacet corridor. We present an initial case series to demonstrate the clinical feasibility, safety, and effectiveness of this technique.