Search Results (58)

Background: Dysphagia, a common and significant complication of cervical spine surgery, remains challenging to predict. This study aims to examine baseline patient characteristics and intraoperative risk factor influence on the incidence of dysphagia following adult cervical deformity (ACD) surgery. Methods: Retrospective Cohort Study of a Prospectively Enrolled Database. Patients with complete baseline (BL) and 2-year (2Y) follow-up data were analyzed. Dysphagia was defined by postoperative reports or SWAL-QOL scores < 25th percentile. Descriptive statistics, means comparison tests, cross-tabulations, and regression analyses were performed. Results: Of 265 patients included (mean age: 58.2 ± 11.4 years, BL BMI 28.5 ± 7.6 kg/m², CCI: 0.93 ± 1.3, BL frailty: 0.2 ± 0.1, operative time: 348 ± 194.9 min, and levels fused: 5.9 ± 3.6), 82 (30.9%) reported postoperative dysphagia. The dysphagia group demonstrated significantly greater BL frailty score (p < 0.001), BL C2–C7 (p = 0.002), and cSVA (p = 0.001). Longer operative time was associated with higher dysphagia risk (OR 1.004, p < 0.001). Anterior osteotomy at any level from C3–C7 demonstrated greater dysphagia rates (p < 0.02, all). Significant corrections of both C2–C7 and McGregor’s Slope (MGS) predict dysphagia (OR 3.6, p < 0.001; OR 17.0, p = 0.009). Delayed extubation postoperatively significantly increased occurrence (80.0% vs. 20.0%, p = 0.015; OR 9.5, p = 0.047). Dysphagia appeared to be associated with early DJF (p = 0.034) and worse M3 NSR scores (p < 0.001). A multivariable logistic regression showed operative duration to be independently associated with postoperative dysphagia (OR 1.004 per minute, 95% CI 1.002–1.005, p < 0.001). The surgical approach was significant overall (Wald χ² = 6.44, df = 2, p = 0.040). However, compared with the anterior approach, neither the posterior nor the combined approach was found to be significantly associated with dysphagia (OR 0.95, 95% CI 0.40–2.28, p = 0.915; OR 2.11, 95% CI 0.81–5.48, p = 0.125). Conclusions: Dysphagia is associated with greater baseline frailty or deformity, undergoing mid-lower cervical osteotomies, significant correction, operative duration, or delayed extubation. Further investigation is warranted, given the small sample size of patients with delayed extubation. These findings underscore the importance of preoperative planning to mitigate dysphagia risk. Full article

Background: Dislocations and fracture-dislocations of the lower cervical spine represent complex injuries with a high risk of neurological damage. Especially in the presence of a confirmed traumatic disc lesion, an anterior surgical approach is described as favoured in the literature. However, studies show that with sufficient reduction technique, even in the presence of a confirmed disc protrusion, posterior stabilization can be considered a safe therapeutic option. The aim of this study is to analyze anterior and posterior treatment of dislocations and fracture-dislocations of the subaxial cervical spine with regard to neurological and radiological outcomes. Methods: In our monocentric cohort study, we investigated the immediate postoperative radiological and neurological outcome depending on the chosen surgical approach and the presence of a disc protrusion. Patients treated at our centre between January 2005 and June 2025 were included. Patients with preoperative complete spinal cord injury were excluded. Neurological status was assessed using the ASIA score preoperatively at admission and postoperatively at discharge or prior to staged surgery. Results: A total of 92 patients were included in the study. Most patients showed an ASIA score C (33.7%). A total of 49 patients (53.3%) were operated anteriorly and 42 patients (45.6%) posteriorly. One patient was primarily stabilized bilaterally. Nine patients initially treated anteriorly had to be secondarily stabilized additionally from posterior. In both groups, neurological deterioration occurred in one case. All other patients remained stable on the ASIA score or improved by at least one point on the scale. Conclusions: The findings provide evidence in favour of a personalized, pathology-oriented approach to lower cervical spine fracture-dislocations rather than selecting the surgical approach based solely on the presence of traumatic disc protrusion. Further prospective studies are needed to validate these observations. Full article

Background/Objectives: degenerative cervical myelopathy (DCM) is the leading cause of spinal cord impairment in adults, often resulting in disability and reduced quality of life (QoL). Surgery is recommended for moderate and severe cases, while its role in mild DCM remains debated. Emerging evidence suggests that early surgery may improve outcomes, particularly QoL. Methods: We conducted a retrospective, single-center observational study of a cohort of patients undergoing cervical spine surgery for DCM between January 2020 and August 2023 at a single institution (Policlinico di Monza, Italy). Demographic, clinical, radiological and surgical data, as well as complications and outcomes, were analyzed. Neurological status was assessed using the modified Japanese Orthopedic Association (mJOA) score and QoL was evaluated using the Short Form-36 (SF-36) questionnaire preoperatively, at discharge, and at follow-up. Results: 51 patients were included (mean age 58.1 years; 41% female), with anterior surgery performed in 67%. Mild preoperative mJOA score was observed in 74% of patients. At follow-up, 65% achieved complete recovery, 29% improved, and 6% remained stable. No neurological deterioration was recorded. Univariate analysis identified age, anterior cervical discectomy and fusion (ACDF), and mild preoperative mJOA score as significant predictors of recovery. Multivariate logistic regression analysis identified mild preoperative mJOA score as a strong independent predictor of complete clinical recovery (OR = 240.64, 95% CI: 6.82–8496.22, p = 0.002). SF-36 showed significant improvements in emotional well-being, social functioning, pain, and general health, particularly in mild cases. Complications were low (5.8%) and limited to transient dysphagia. Conclusions: early surgical treatment in selected patients with mild DCM may be associated with favorable neurological and quality-of-life outcomes, although larger prospective studies are needed. Full article

Finite element analysis is widely used to study spinal biomechanics and to compare surgical strategies under controlled loading conditions. By allowing variation in alignment, fixation, and implant design, these models provide insight into stress redistribution and motion changes that are difficult to isolate experimentally. This review examines spine surgery-focused finite element studies published between 2018 and 2024, with emphasis on interbody fusion techniques, adjacent segment mechanics, and implant-related stress behavior. Across lumbar fusion models, constructs incorporating anterior column support demonstrate lower posterior instrumentation stress than posterior-only approaches, with lateral lumbar interbody techniques showing reduced rod and screw stresses across multiple loading conditions compared with posterior lumbar interbody or posterolateral fusion constructs. In the cervical spine, comparisons of plated and zero-profile anterior cervical discectomy and fusion devices show smaller increases in adjacent-level motion and intradiscal pressure with zero-profile constructs, alongside higher localized stress at fixation interfaces. More recent studies apply finite element methods to implant optimization, alignment planning, and patient-specific modeling. Together, these findings suggest that finite element analysis is increasingly used to support surgical planning and implant design, with continued advances in validation and patient-specific simulation likely to strengthen its clinical relevance. Full article

Background/Objectives: Postoperative cervical spine radiographs are routinely obtained during in-hospital and follow-up period. We aim to evaluate the utility of postoperative radiographs for identifying instrumentation failure and the subsequent need for revision surgery in patients with traumatic cervical spine injuries. Materials and Methods: A retrospective chart review of patients who had surgical treatment for traumatic cervical spine injury was conducted. Clinical notes and radiographic reports were evaluated. Postoperative radiographs were obtained prior to discharge from the hospital, and subsequently at 2, 6, 12, 24 weeks, and 1 year. Patients who underwent revision surgery, described as any reoperation, were identified. The patients’ indications for surgery were evaluated. The results of postoperative radiographs that prompted a change in management and reoperation were analyzed. Sensitivity and specificity for postoperative radiographs were calculated. Results: A total of 295 patients were reviewed. The rate of revision surgery was 3.7% (n = 11). All 11 patients presented changes in clinical findings and physical exam, but only 3 patients (1%) were identified to have undergone revision surgery due to instrumentation failure seen on radiographs at 13, 89, and 112 days postoperatively, and none within the inpatient period. Two patients underwent revision surgery due to epidural hematoma, and six patients due to wound infection. The overall sensitivity and specificity of routine postoperative radiographs were 27% and 100%, respectively. Conclusions: Postoperative radiographs after cervical spine trauma have low clinical utility for predicting instrumentation failure in the absence of clinical findings, particularly in the inpatient period. Full article

Background/Objective: The anterior vertebral body tethering (AVBT) technique, which preserves spinal mobility and avoids possible fusion problems in adolescent idiopathic scoliosis (AIS) patients, continues to be increasingly used in spine surgery. The study aims to report the early-to-early-mid postoperative radiological results of thoracolumbar/lumbar AVBT on sagittal alignment, and the second aim is to compare AVBT with selective thoracic fusion (STF) and non-selective fusion (NSF) groups in AIS patients. Methods: Patients with a diagnosis of AIS were retrospectively evaluated in the study. All patients were categorized into three groups based on the surgical technique performed: AVBT (n = 17), NSF (n = 19), and STF (n = 15). The major curvature degree, coracoid height difference (CHD), sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), thoracic kyphosis (TK), cervical lordosis (CL), C7 tilt, sagittal vertical axis (SVA), T1 pelvic angle (TPA), and T1 spinopelvic inclination (T1SPI) were measured for radiological comparison. Scoliosis Research Society-22 (SRS-22) and Oswestry Disability Index (ODI) scores were used at the final follow-up for functional evaluation. Results: The T1SPI value of the NSF group was significantly higher than the STF group in the final follow-up (p = 0.033). The mean decrease of 8.85 ± 7.85 units in the final follow-up value compared to the postoperative CHD value of the patients in the AVBT group was found to be significant (p = 0.028). Statistically significant differences were found between preoperative and the first postoperative CL and TPA measurements (p = 0.001 and p = 0.042, respectively), as well as between preoperative and final follow-up CL measurements in the AVBT group (p = 0.001). No statistically significant differences were observed between the groups in CHD, SS, PT, PI, LL, TK, CL, C7 tilt, SVA, and TPA values (p > 0.05); similarly, the SRS-22 and ODI scores did not differ significantly among the groups (p > 0.05). Conclusions: Thoracolumbar/lumbar AVBT surgery led to significant improvements in shoulder asymmetry and cervical lordosis of AIS patients in the early to early-mid postoperative period. However, compared with spinal fusion techniques, thoracolumbar/lumbar AVBT did not demonstrate superiority in functional scores or sagittal parameters. The mid- to long-term benefits of thoracolumbar/lumbar AVBT remain uncertain and require further investigation. Full article

Dural tear (DT) and cerebrospinal fluid (CSF) leakage, though uncommon complications, represent a potentially serious risk of anterior cervical spine surgery, particularly in patients with ossification of the posterior longitudinal ligament (OPLL). While the incidence in routine anterior cervical discectomy and fusion (ACDF) or corpectomy (ACCF) is typically below 0.5%, it rises sharply to 4–32% in OPLL cases. Furthermore, it exceeds 60% when dural ossification (DO) is present. Adhesion and ossification obliterate the normal epidural plane, creating a fragile osteofibrotic interface that is highly susceptible to tearing during decompression. This review synthesizes current evidence on the pathophysiology of DT and CSF leakage in anterior cervical spine surgery, provides a framework for risk stratification, and outlines evolving techniques for successful repair and management. Intraoperative management has shifted from direct resection toward dura-preserving floating decompression and biologically reinforced multilayer repair using fascia, collagen matrix, fibrin adhesives, and polyethylene glycol (PEG) hydrogel sealants. Postoperative care emphasizes controlled CSF pressure regulation, sterile wound management, and early ambulation. Most DTs achieve successful closure with timely recognition and standardized treatment. However, persistent leakage may require escalation to composite reconstruction, epidural blood patch, or vascularized flap reinforcement. Emerging technologies such as bioactive hydrogels, 3D-printed dural scaffolds, and artificial intelligence–assisted imaging offer potential future improvements, although clinical adoption remains limited. This review summarizes current evidence on the mechanisms, risk factors, diagnostic predictors, repair strategies, and postoperative management of DT and CSF leakage, with specific attention to OPLL-related DO. A more apparent distinction between established clinical practice and emerging investigational technologies is provided to guide evidence-based decision-making. Full article

Background/Objectives: Paraspinal muscles are important for maintaining cervical spine function and stability; however, the degeneration of these muscles is common in patients with degenerative disk disease. Such muscular changes may affect recovery trajectories and long-term functional outcomes after cervical spine surgery. This systematic review explores the existing literature on the relationship between the degree of paraspinal muscle degradation and functional outcomes following anterior cervical spine surgery in patients with cervical degenerative disk disease. Methods: A systematic review of the MEDLINE/Pubmed, Web of Science, and Embase databases was conducted according to the PRISMA guidelines up to June 2025. The inclusion criteria were patients who underwent surgery for cervical degenerative disk disease and assessments of the paraspinal muscles with magnetic resonance imaging. The methodological quality of the included studies was assessed using the Modified Newcastle–Ottawa Scale. Results: Following deduplication, a total of 3643 articles were screened, of which 6 met the inclusion criteria and were included in the review. Across these studies, a total of 515 patients were followed for at least one year. Two studies reported a negative association between paraspinal muscle degeneration and functional outcomes, three reported no association, and one reported a positive association. Conclusions: The available evidence on this topic is inconclusive. These mixed results highlight the need for further well-designed, adequately powered studies to clarify the relationship between paraspinal muscle degeneration and functional outcomes. Full article

Background: Primary cervical spine infection is a rare but rapidly progressive disease that can cause early neurological damage, leading to increased morbidity and mortality. Despite its rising incidence, optimal treatment remains controversial. This study compared clinical, hematological, microbiological, and radiological outcomes among such patients treated with different methods. Methods: This retrospective comparative study is a secondary analysis of a previously reported cohort of 59 patients with primary cervical spine infection between 1992 and 2018 at a single institution. Patients were stratified into conservative (Group C, n = 14), surgery with instrumentation (Group S + I, n = 32), and surgery without instrumentation (Group S, n = 13) groups. Outcome measures included neurological status, antibiotic duration, hematological markers, radiological parameters (segmental angle, C2–C7 angle, segmental height, fusion rate), and complications. Results: The mean age and follow-up period were 61.4 years and 19.4 months, respectively. Group S + I demonstrated significantly better neurological outcomes at the last follow-up (p = 0.047) and shorter antibiotic treatment duration (p < 0.001). Radiological outcomes were superior in Group S + I, with greater improvements in segmental angle (p < 0.001), C2-C7 angle (p < 0.001), mean segmental height (p < 0.001), and fusion rate (84.4% vs. 14.3% and 46.2% in Group C and Group S, respectively; p < 0.001). Group S had significantly higher complication (46.2%, p = 0.011) and mortality (30.8%, p = 0.001). Hematological and microbiological results were not significantly different among groups. Conclusions: Surgical debridement with anterior instrumentation provided superior outcomes compared with conservative treatment or surgery without instrumentation. Early surgery with appropriate stabilization should be considered to optimize prognosis and minimize complications. Full article

Background/Objectives: Cervical spine disease requiring surgical intervention is a major cause of disability. Anterior cervical discectomy and fusion (ACDF) is a well-established procedure for treating cervical pathology; however, there remains no consensus on whether 1-level versus 2-level ACDF yields comparable outcomes. This study compares 1-level versus 2-level ACDF by evaluating surgery-related and postoperative outcomes, radiographic parameters, and patient-reported outcome measures (PROMs). Methods: PubMed, Embase, Scopus, and Cochrane Library were searched through 10 July 2024. Studies comparing 1-level with 2-level ACDF were included. Data on operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), complications, and PROMs, including Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, were extracted. Results: Thirteen studies met our inclusion criteria, comprising 2091 patients (1078 undergoing 1-level and 1013 2-level ACDF). No statistically significant differences were observed in EBL or LOS between the cohorts. However, the 2-level ACDF group showed significantly longer OR times (p-value < 0.001) and higher odds of developing dysphagia (p-value = 0.05). Patients undergoing 2-level ACDF showed greater correction in cervical lordosis. Both cohorts reported similar statistically and clinically significant improvements in VAS neck and NDI scores at final follow-up. There was no difference in adjacent segment disease or revision surgery at final follow-up. Conclusions: Both 1-level and 2-level ACDF improve clinical and radiographic outcomes. The choice should be tailored to the patient’s pathology and anatomy while considering the higher dysphagia risk with additional fusion levels. This study highlights the importance of individualized surgical planning to optimize postoperative outcomes while minimizing complications. Full article

Background: Opioid use disorder (OUD) has emerged as a growing public health challenge, increasingly affecting surgical populations. While anterior cervical discectomy and fusion (ACDF) is a common spinal procedure with known perioperative risks, the specific impact of preoperative OUD on anesthesia-related complications in ACDF remains poorly studied. Methods: We analyzed adult patients undergoing elective single-level ACDF between 2016 and 2022 using the Nationwide Inpatient Sample (NIS) database. Patients with and without OUD were identified using ICD-10 codes. Propensity score matching was applied to adjust for baseline differences. Primary outcomes included prolonged ventilation, central line placement, and major anesthesiology complications. Secondary outcomes included total charges, length of stay, and number of procedures. A cost-effectiveness analysis of universal preoperative urine drug screening was also performed. Results: Among 178,215 patients undergoing ACDF, 1.5% had documented OUD. Following propensity matching, OUD patients had a significantly increased risk of prolonged ventilation (>24 h and >96 h), central line placement, blood transfusion, feeding tube insertion, and major anesthesiology complications. OUD patients experienced longer hospital stays (7.9 vs. 2.7 days), more procedures (4.2 vs. 3.0), and higher total charges ($139,207 vs. $82,179; all p < 0.01). The estimated excess cost attributable to OUD per surgical patient was $855, compared to a $75 screening cost. Conclusions: Preoperative OUD is associated with significantly increased perioperative risk, ICU-level intervention, and healthcare costs in ACDF patients. These findings support systematic preoperative screening and multidisciplinary management for patients with OUD undergoing spine surgery. Full article

The internal branch of the superior laryngeal nerve (IbSLN) plays a critical role in the sensory innervation of the supraglottic larynx. It is essential for protective reflexes such as coughing and swallowing. This nerve is frequently at risk during surgeries involving the cervical region, including thyroidectomy, carotid endarterectomy, and anterior cervical spine procedures. Injury to the IbSLN may lead to postoperative complications. A comprehensive review of the morphological and topographic characteristics of the IbSLN is presented, focusing on its anatomical course, relationships with key vascular structures, branching patterns, and clinically significant variations. Full article

Retrospective Cohort Study. Objectives: The objectives of this study are to (1) compare post-operative patient-reported outcome measures (PROMs) between non-diabetic (non-DM) and diabetic (DM) patients undergoing Anterior Cervical Discectomy and Fusion (ADCF), (2) characterize the clinical trajectory, and (3) compare the rate of post-operative complications. Methods: A total of 261 non-DM and 52 DM patients were included. Patient demographics, Neck Disability Index (NDI) and Patient-Recorded Outcomes Measurement Information System (PROMIS) scores were collected up to one year after operation. Maximum medical improvement (MMI) was defined as the timepoint where more than 90% of the cohort achieved a minimal clinically important difference (MCID) in survey scores. Post-operative complications were collected. Descriptive and inferential statistics were performed. Results: Non-DM patients achieve MMI significantly more quickly than DM patients (non-DM: 6 months; DM: 1 year, p < 0.010). No difference in ∆NDI (non-DM: 24.9; DM: 23.0; p = 0.824) or ∆PROMIS-Physical Function (non-DM: 7.1; DM: 9.1; p = 0.373) was found between the two cohorts. In diabetic patients undergoing single-level fusion ACDF, a pre-operative HbA1c of ≥7.3% demonstrates 100% sensitivity and 25% specificity in detecting failure to achieve 1-year PROMIS MCID (AUC = 0.833, p = 0.009). There was no association between diabetic status and post-operative complication rate. Conclusions: Diabetic patients may demonstrate a slower rate of achieving maximum medical improvement despite equal subjective and clinical outcomes. Pre-operative HbA1c ≥ 7.3% demonstrates a significant correlation with worse subjective outcomes following single-level ACDF. Full article

Postoperative infection following anterior cervical spine surgery, particularly when complicated by esophageal injury, is a rare but serious condition associated with significant morbidity and mortality. This review elucidates the complex interplay between postoperative infection and esophageal injury. We systematically analyzed studies from 2000 to 2025 using PubMed, Scopus, and Web of Science, focusing on infection, esophageal injury, surgical outcomes, and management strategies, with emphasis on recent advances in diagnostics, surgical techniques, and postoperative care. Our findings highlight the multifactorial nature of these complications and the critical role of early recognition, accurate diagnosis, and timely management. Imaging modalities such as CT, MRI, and contrast esophagography, along with flexible esophagoscopy, are indispensable in assessing injury and infection extent. Effective management requires a multidisciplinary approach integrating broad-spectrum antibiotics, surgical debridement, vascularized flap reinforcement, negative pressure wound therapy, and antibiotic-loaded cement beads. Meticulous postoperative care with prolonged antibiotics, nutritional support, and imaging follow-up is vital for optimizing outcomes. Innovative approaches, including vascularized muscle flaps and hyperbaric oxygen therapy, show promise in enhancing healing and reducing infections. Our review underscores the need for future meta-analyses to strengthen evidence and refine protocols. As surgical techniques evolve, so too must our diagnostic, surgical, and postoperative strategies to minimize complications and improve patient outcomes. Full article

Background/Objectives: Many patients evaluated by shoulder specialists suffer from intractable pain, neuropathy, and weakness. The pectoralis minor (PM) remains the only scapula muscle to receive lower trunk (C8-T1) input. We propose a novel syndrome: the Human Disharmony Loop. This model portrays how this unique PM innervation causes scapular dyskinesia, which deranges the anatomy of the upper limb girdle and produces a refractory symptom complex of pain, neuropathy, and weakness. We hypothesize that certain patients with historically intractable symptoms of the upper limb girdle may benefit from PM tenotomy. Methods: Ten patients of diverse etiologies presented with a similar constellation of complaints. The patients included a female athlete, a female with macromastia, a male bodybuilder, and patients with post-radiation breast cancer, post-operative shoulder arthroplasty, interscalene block injury, cervical spine disease, persistent impingement after rotator cuff repair, direct traction injury, and occupational disorder. All patients exhibited coracoid tenderness, scapula protraction with internal rotation and anterior tilt, and pain involving the neck, shoulder, and upper back. The patients demonstrated varying degrees of arm neuropathy, subacromial impingement, and occipital headaches. The patients failed all prior treatments by multiple subspecialists, including surgery. Each patient underwent isolated open PM tenotomy. Results: In all ten patients, PM tenotomy substantially reduced shoulder, upper back, and neck pain, cleared concomitant neuropathy, restored full motion, and eradicated occipital headaches. The response to surgery was rapid, dramatic, and durable. Conclusions: The unique asymmetric neurologic innervation to the sole ventral stabilizer of the scapula, the pectoralis minor, predisposes the human shoulder to neurologic and musculoskeletal imbalance. This produces the Human Disharmony Loop: a clinical syndrome spanning from the neck to the fingertips, with chronic pain, neuropathy, and weakness. These challenging patients may benefit dramatically from isolated PM tenotomy. Full article