Search Results (132)

Background/Objectives: Minimally invasive spine surgery (MISS) is complex and requires proficiency with a variety of technological and robotic modalities. Acquiring these skills is a long and involved process, often with a steep learning curve. This paper seeks to characterize the state of MISS training in neurosurgical and orthopedic residency programs, focusing on their effectiveness at minimizing substantial learning curves in the field, as well as highlighting potential areas for future growth. Methods: We conducted a scoping review of the PubMed, Scopus, and Embase databases utilizing the PRISMA extension for scoping reviews. Results: Of the 100 studies initially identified, 16 were included in our final analysis. MISS training types could be broadly grouped into four categories: virtual simulation (including AR and VR), physical models, hybrid didactic and simulation, and mentored training. Training with these modalities led to improvements in resident performance across multiple different MISS techniques, including percutaneous pedicle screw fixation, MIS dural repair, MIS-TLIF, MIS-LLIF, MIS-ULBD, microscopic discectomy/disk herniation repair, percutaneous needle placement, and surgical navigation. Specific improvements included reduced error rate, operation time, and fluoroscopy exposure, as well as increased procedural knowledge, accuracy, and confidence. Conclusions: The incorporation of MISS training modalities in spine surgery residency leads to increases in simulated performance and could serve as a means of overcoming significant learning curves in the field. Full article

The management of adult spinal deformity (ASD) has evolved dramatically over the past century, transitioning from external bracing and in situ fusion to complex, technology-driven surgical interventions. This review traces the historical development of spinal deformity correction and highlights contemporary enabling technologies that are redefining the surgical landscape. Advances in stereoradiographic imaging now allow for precise, low-dose three-dimensional assessment of spinopelvic parameters and segmental bone density, facilitating individualized surgical planning. Robotic assistance and intraoperative navigation improve the accuracy and safety of instrumentation, while patient-specific rods and interbody implants enhance biomechanical conformity and alignment precision. Machine learning and predictive modeling tools have emerged as valuable adjuncts for risk stratification, surgical planning, and outcome forecasting. Minimally invasive deformity correction strategies, including anterior column realignment and circumferential minimally invasive surgery (cMIS), have demonstrated equivalent clinical and radiographic outcomes to traditional open surgery with reduced perioperative morbidity in select patients. Despite these advancements, complications such as proximal junctional kyphosis and failure remain prevalent. Adjunctive strategies—including ligamentous tethering, modified proximal fixation, and vertebral cement augmentation—offer promising preventive potential. Collectively, these innovations signal a paradigm shift toward precision spine surgery, characterized by data-informed decision-making, individualized construct design, and improved patient-centered outcomes in spinal deformity care. Full article

Background: The atlanto-axial segment is highly mobile and, therefore, prone to instability in the setting of inflammatory disease, infection, tumor or trauma. While minimally invasive surgical (MIS) techniques have gained acceptance in the thoracolumbar spine due to their advantages over traditional approaches, their use at the atlanto-axial segment is controversial due to the surgical risk associated with its complex anatomy. To evaluate the current evidence on MIS atlanto-axial fixation, we carried out a systematic review of the literature and compared the reported results with those of open procedures. Methods: This systematic review follows PRISMA-DTA 2020 guidelines. A comprehensive search was conducted in November 2023 across PubMed/Medline, Google Scholar and clinicaltrials.gov using specific keywords related to minimally invasive atlanto-axial fixation. Data regarding study characteristics, patient demographics, surgical techniques, and outcomes were extracted from included studies. Results: This systematic review included 13 articles reporting on the results of surgery in 305 patients, in whom a total of 683 screws were inserted through a posterior MIS approach. N = 162 screws were inserted using the Harms–Goel technique, while N = 521 were placed using the Magerl technique. N = 40 screws were inserted using navigation guidance, while N = 643 were introduced with fluoroscopy assistance. Eight screws were misplaced. A Vertebral Artery (VA) injury was reported in three patients. With a mean value of 26.2 ± 15.3 months, the rate of fusion ranged between 80% and 100%. Conclusions: This study highlights the potential of MIS for posterior atlanto-axial fixation, which was achieved using Magerl transarticular screws in a large majority of cases. Despite technical challenges, MIS approaches appear to achieve satisfactory clinical and radiological outcomes with complication rates similar to those of open techniques. Future studies may help refine the indications for MIS and identify those cases better suited for open approaches. Full article

Background: Transcutaneous Randomized Pulsed Radiofrequency (TCPRF-STP) is a non-invasive therapeutic approach increasingly explored for managing spine-related pain, particularly in cases involving disc herniations and degenerative spine conditions. Objectives: To evaluate the use of transcutaneous PRF-STP in the treatment of spine pathologies and its evolution in short-term follow-up. Methods: This case series examines the outcomes of three patients treated with TCPRF-STP for varying spine pathologies, including lumbar and cervical disc herniations, lumbar stenosis, and radiculopathy. All patients had previously undergone conventional conservative therapies without a satisfactory improvement and were unwilling or unable to undergo invasive procedures. The treatment involved the application of electromagnetic fields through adhesive skin patches at targeted sites. Patients underwent three sessions of TCPRF-STP, with follow-up assessments evaluating pain and MRI. Results: Transcutaneous PRF-STP showed notable reductions in pain (VAS 0 in most cases), improvements in movement, and the restoration of normal daily activities. Follow-up MRI scans demonstrated positive structural changes in the treated discs. Although long-term recurrence occurred in one case, the patient remained active without functional limitations. Conclusions: Transcutaneous PRF-STP offers a promising, minimally invasive alternative for patients seeking to avoid surgery, though further studies with larger cohorts and longer follow-up periods are necessary to establish more robust evidence of its efficacy. This technique could become an important adjunct in managing chronic spinal pain conditions, offering patients an option with minimal risk and hospital demands. Full article

Background: Although percutaneous laser disc decompression (PLDD) has been proposed as an alternative to conventional surgery for lumbar disc herniation (LDH), we specifically propose it for patients with contained herniations where standard surgical intervention is not the first option. This study evaluates PLDD compared to conservative therapy as an early treatment alternative. Methods: This retrospective observational study compared PLDD to conservative treatment in adult patients with contained LDH. All patients underwent 3 months of standard conservative therapy. Those who remained dissatisfied according to the Visual Analog Scale (VAS) and/or Macnab criteria were then treated with PLDD. We analyzed outcomes from both treatment phases using the Wilcoxon signed-rank test and the Mann–Whitney U test. Results: 121 patients underwent outpatient evaluation for LDH and received an average of 90 days of conservative therapy. Of these 103 patients, dissatisfied with the outcomes of conservative treatment, subsequently underwent PLDD. Following conservative treatment, the average VAS score reduction was 4.1%. Six months after PLDD, the VAS scores demonstrated a significant reduction, with an average decrease of 30% (p < 0.0001). In terms of functional outcomes assessed by the Macnab criteria, 39.8% of patients treated with PLDD achieved ‘Excellent’ or ‘Good’ outcomes, compared to only 11.4% after conservative treatment. Conclusions: PLDD appears to be a viable alternative to conservative therapy for this subgroup of patients with contained LDH. It may be beneficial to propose PLDD early in the therapeutic regimen to accelerate short term clinical improvement. Further studies are required to evaluate the long term efficacy of this treatment approach. Full article

Background/Objectives: Stand-alone lateral lumbar interbody fusion (LLIF) remains a debated approach in spinal surgery, with limited published evidence supporting its efficacy without supplemental fixation. This prospective study presents the institutional case series on single-level L3-L4 stand-alone LLIF, using next-generation 3D-printed titanium cages, as treatment for degenerative disc disease (DDD). Methods: A cohort of 49 patients with symptomatic DDD, unresponsive to conservative therapy, underwent stand-alone LLIF at L3-L4 (neither posterior pedicle screws nor lateral plating). Clinical outcomes (VAS and ODI) and radiological parameters (disc height, segmental/lumbar lordosis) were collected preoperatively and at 1, 6, and 12 months. Repeated-measures ANOVA with Bonferroni correction was adopted for statistical analysis. Results: Significant improvements were observed in pain and disability scores at all time points, with the mean VAS score decreasing from 6.53 to 0.29, and ODI from 27.6% to 3.84% at one year (p < 0.001). Radiographic analysis confirmed durable increases in disc height and segmental lordosis. Solid fusion was achieved in 97.9% of cases. No patient required posterior revision; transient neurological symptoms were mild and self-limiting. Conclusions: This study demonstrates that stand-alone LLIF at L3-L4 is safe and effective in achieving stable fusion and clinical–radiological improvement. These results challenge the necessity of supplemental fixation and support the broader adoption of a less invasive fusion paradigm. Full article

Background/Objectives: Biportal endoscopic spine surgery (BESS) is one of the minimally invasive spine surgery techniques. BESS has several advantages, such as better visualization, less muscle injury, early rehabilitation, etc. Due to its clear visualization, delicate intraoperative hemostasis of the bleeding foci, including cancellous bone and small epidural vessels, can be achieved. Therefore, some authors have reported that BESS resulted in less intraoperative visible blood loss (VBL) compared to conventional open surgery. However, it is difficult to analyze the exact amount of intraoperative blood loss because of the continuous normal saline irrigation. In addition, hidden blood loss (HBL) tends to be overlooked, and the amount of HBL might be larger than expected. We aim to calculate the amount of HBL during BESS and to compare our findings with convention open surgery. Methods: We retrospectively obtained the clinical data of patients that underwent lumbar central decompression from July 2021 to June 2024. Patients were divided into two groups: the BESS group that underwent biportal endoscopic lumbar decompression, and the open surgery group that underwent open decompression. Both groups used unilateral laminotomy and bilateral decompression techniques. Total blood loss (TBL) using preoperative and postoperative change in hematocrit (Hct) was measured using Gross’s formula and the Nadler equation. Since TBL consists of VBL and HBL, HBL was calculated by subtracting the VBL measured intraoperatively from TBL. Results: A total of sixty-six patients in the BESS group and seventeen patients in the open surgery group were included in the study. The TBL was 247.16 ± 346.88 mL in the BESS group and 298.71 ± 256.65 mL in the open surgery group, without significant difference (p = 0.569). The calculated HBL values were 149.44 ± 344.08 mL in the BESS group and 171.42 ± 243.93 mL in the open surgery group. The HBL in the BESS group was lower than the HBL in the open surgery group, without significant difference (p = 0.764). Conclusions: The TBL and HBL during lumbar central decompression were smaller in patients who underwent BESS compared to those who underwent open surgery. While TBL was significantly lower in BESS, HBL did not show statistical significance between the two groups. HBL during BESS should not be neglected, and related hemodynamics should be considered postoperatively. Full article

Full endoscopic spine surgery (FESS) offers an ultra-minimally invasive solution for addressing many different degenerative spine pathologies. While FESS has demonstrated strong evidence for faster recovery, reduced hospital stays, fewer complications, and potentially lower overall costs, FESS remains underutilized in low-income countries (LICs). This narrative review synthesizes the existing literature to evaluate access to FESS in LICs, highlighting challenges such as a lack of trained neurosurgeons and orthopedic surgeons, insufficient access to specialized equipment, capital costs, and limited representation in research. A systematic literature search identified only a handful of relevant studies, underscoring the scarcity of data on FESS in LICs. Findings reveal stark disparities in training opportunities and equipment availability, with less than 25% of LIC facilities equipped with the essential tools. This review advocates for international collaboration, increased funding, cost reduction, and targeted research to bridge these gaps. Innovative solutions such as virtual training platforms may help overcome current limitations. Addressing these challenges is essential to leveraging FESS’s potential to mitigate the burden of spinal disorders in LICs and advance global health equity. Full article

Background/Objectives: Degenerative lumbar spine disease (DLSD) is increasingly managed with minimally invasive surgery (MIS) and evolving anesthesia methods. While general anesthesia (GA) remains standard, spinal anesthesia (SA) may offer faster recovery and fewer side effects. This study compares the clinical and economic outcomes of GA versus SA in transforaminal lumbar interbody fusion (TLIF). Methods: A retrospective review of 18 TLIF patients (2018–2022) was performed, with 9 patients in each cohort. Patients were matched by demographics and procedure type. Data collected included operative time, blood loss, complications, postoperative opioid utilization, and 30-day readmissions. Costs were analyzed in categories: anesthesia, implants, inpatient care, operating room (OR) supplies, OR time, and PACU fees, using Wilcoxon Rank T-tests and Pearson Chi-Squared tests. Results: Clinical outcomes such as blood loss, and operative time were similar between groups. However, SA patients had significantly shorter LOS compared to GA (SA: 12 h vs. GA: 84 h, % difference: −150%, p = 0.04). Additionally, SA patients had lower total direct costs ($27,881.85 vs. $35,669.01; p = 0.027). Significant cost reductions with SA were noted in OR supplies/medications ($7367.93 vs. $10,879.46; p = 0.039) and inpatient costs ($621.65 vs. $3092.66; p = 0.027). Within these categories, reductions were observed for intravenous solutions, sedatives/anesthetics, pressure management, labs, imaging, evaluations, hospital care, and medications. Although costs for implants, anesthesia care, OR time, and PACU fees were lower with SA, these differences did not reach statistical significance. Conclusions: In TLIF for DLSD, SA provides significant economic advantages over GA while yielding comparable clinical outcomes. These results support SA as a cost-effective alternative, warranting further prospective studies to confirm these findings. Full article

Introduction: Robotic-assisted (RA) spine surgery enhances pedicle screw placement accuracy through real-time navigation and trajectory guidance. However, the absence of traditional direct haptic feedback by freehand instrumentation remains a concern for some, particularly in minimally invasive (MIS) procedures where direct visual confirmation is limited. During RA spine surgery, navigation systems display three-dimensional data, but factors such as registration errors, intraoperative motion, and anatomical variability may compromise accuracy. This technical note describes a visuohaptic intraoperative phenomenon observed during RA spine surgery, its underlying mechanical principles, and its utility. During pedicle screw insertion with a slow-speed automated drill in RA spine procedures, a subtle and rhythmic variation in resistance has been observed both visually on the navigation interface and haptically through the handheld drill. This intraoperative pattern is referred to in this report as a cyclical insertional torque (CIT) pattern and has been noted across multiple cases. The CIT pattern is hypothesized to result from localized stick–slip dynamics, where alternating phases of resistance and release at the bone–screw interface generate periodic torque fluctuations. The pattern is most pronounced at low insertion speeds and diminishes with increasing drill velocity. CIT is a newly described intraoperative observation that may provide visuohaptic feedback during pedicle screw insertion in RA spine surgery. Through slow-speed automated drilling, CIT offers a cue for bone engagement, which could support intraoperative awareness in scenarios where tactile feedback is reduced or visual confirmation is indirect. While CIT may enhance surgeon confidence during screw advancement, its clinical relevance, reproducibility, and impact on placement accuracy have yet to be validated. Full article

Endoscopic spine surgery (ESS) has traditionally been employed for lumbar disc herniation (LDH). Recent innovations in surgical methods and technologies have expanded its range to address other spinal pathologies, providing minimally invasive solutions with potential clinical benefits. Our review aims to summarize the applications, clinical outcomes, and limitations of ESS beyond LDH, focusing on its role in complex spinal conditions such as stenosis, thoracic disc herniation, spinal tumors, synovial cysts, and failed back surgery syndrome. A thorough review of the literature was conducted to assess and summarize the current evidence regarding ESS applications for spinal conditions beyond LDH surgery. Areas of focus included innovations in technology and technique, as well as comparisons with conventional open surgical methods. ESS shows notable potential across different spinal conditions by providing minimally invasive alternatives to traditional open surgery. Its use could be associated with reduced surgical morbidity, shorter recovery times, and improved patient outcomes. In particular, ESS is versatile in addressing both degenerative and neoplastic conditions of the spine. Despite this, challenges such as technical complexity, steep learning curves, and limited indications for certain pathologies remain as barriers to wider adoption. ESS is evolving in spine surgery, extending its utility beyond LDH surgery. While the current evidence largely supports its clinical efficacy, further studies are needed to address the present limitations and optimize its application. Future developments in surgical training and technology will likely enhance its adoption and broaden its clinical indications. Full article

Background/Objectives: Lumbar spine surgery has undergone significant technological transformation in recent years, driven by the goals of minimizing invasiveness, improving precision, and enhancing clinical outcomes. Emerging tools—including robotics, augmented reality, computer-assisted navigation, and artificial intelligence—have complemented the evolution of minimally invasive surgical (MIS) approaches, such as endoscopic and lateral interbody fusions. Methods: This systematic review evaluates the literature from February 2020 to February 2025 on technological and procedural innovations in LSS. Eligible studies focused on degenerative lumbar pathologies, advanced surgical technologies, and reported clinical or perioperative outcomes. Randomized controlled trials, comparative studies, meta-analyses, and large case series were included. Results: A total of 32 studies met the inclusion criteria. Robotic-assisted surgery demonstrated high accuracy in pedicle screw placement (~92–94%) and reduced intraoperative blood loss and radiation exposure, although long-term clinical outcomes were comparable to conventional techniques. Intraoperative navigation improved instrumentation precision, while AR enhanced ergonomic workflow and reduced surgeon distraction. AI tools showed promise in surgical planning, guidance, and outcome prediction but lacked definitive evidence of clinical superiority. MIS techniques—including endoscopic discectomy and MIS-TLIF—offered reduced blood loss, shorter hospital stays, and faster recovery, with equivalent pain relief, fusion rates, and complication profiles compared to open procedures. Lateral and oblique approaches (XLIF/OLIF) further optimized alignment and indirect decompression, with favorable perioperative metrics. Conclusions: Recent innovations in lumbar spine surgery have enhanced technical precision and perioperative efficiency without compromising patient outcomes. While short-term benefits are clear, long-term clinical advantages and cost-effectiveness require further investigation. Integration of robotics, navigation, AI, and MIS into spine surgery reflects an ongoing shift toward personalized, data-driven, and less invasive care. Full article

Background: Thoracic schwannomas are benign nerve sheath tumors that can cause neurological and respiratory symptoms depending on their location and extension. The optimal surgical approach remains debated, particularly regarding resection extent, complication rates, and postoperative morbidity. Methods: This retrospective multicenter study analyzed 106 patients treated between 2011 and 2024, classifying tumors according to the Eden system and comparing surgical strategies. Surgical variables, including operative time, blood loss, resection extent, recurrence rates, and complications classified by Clavien–Dindo, were analyzed. Results: Eden I and II schwannomas were treated with laminectomy (LCT) or hemilaminectomy (HLCT) and transpedicular approaches (TPD), achieving high gross total resection (GTR) rates with minimal complications. Eden III dumbbell tumors benefited from a combined neurosurgical–thoracic approach (LCT + VATS), which resulted in higher GTR rates (100% vs. 62%, p < 0.01) and lower dural complications compared to neurosurgical resection alone. Eden IV extraforaminal schwannomas were best managed with VATS, which was associated with lower intraoperative blood loss (p = 0.018), shorter surgical duration (p = 0.027), and reduced postoperative complications compared to open thoracotomy. Our findings confirm that minimally invasive techniques, particularly VATS and combined neurosurgical–thoracic approaches, optimize tumor resection while reducing morbidity. However, feasibility depends on institutional resources and multidisciplinary collaboration. Conclusions: This study provides a stratified comparison of surgical approaches tailored to Eden classification, aiming to identify the most effective and least morbid strategies for each lesion type. Future prospective studies should validate these findings, integrating preoperative functional assessments and long-term follow-up to better stratify surgical risk, personalize operative planning, and refine surgical decision making for thoracic schwannomas. Full article

Background/Objectives: Degenerative lumbar spine conditions are a major cause of disability, particularly in elderly patients or those with comorbidities. Surgical treatment often combines decompression and stabilization to address pain and instability. Pedicle screws are the gold standard for stabilization but pose challenges in patients with compromised bone quality. Interspinous devices have emerged as a less invasive alternative, but comparative studies are limited. This study aimed to compare clinical and surgical outcomes of lumbar decompression with stabilization using pedicle screws versus interspinous devices. Methods: A retrospective cohort study was conducted on patients who underwent lumbar decompression with either pedicle screw fixation or interspinous device stabilization at Mater Olbia Hospital between February 2020 and February 2023. Outcomes were evaluated using VAS for back and leg pain, SF-36 for quality of life, EQ-5D, and SCL-90 for psychological factors. Statistical analysis included paired t-tests, chi-square tests, and multivariate regression. Results: A total of 728 patients were included. The interspinous device group consisted of older patients with higher comorbidity burdens (mean age: 68.4 vs. 59.2 years, p < 0.001). Surgical time and incision size were significantly shorter in the interspinous group (p < 0.001), and no postoperative complications were reported, compared to 3.5% in the pedicle screws group (p < 0.05). Both groups demonstrated significant improvements in pain (VAS), quality of life (SF-36, EQ-5D), and psychological outcomes (SCL-90). Somatization and paranoid ideation were significant predictors of worse postoperative pain, particularly in the pedicle screws group. No significant differences in quality-of-life improvements were observed between the groups. Conclusions: Both stabilization techniques are effective for lumbar spine surgery, with interspinous devices offering a safer and less invasive option for high-risk patients. Psychological factors significantly influence pain outcomes, underscoring the need for a comprehensive approach addressing both physical and psychological aspects to optimize patient recovery. Full article

Spinopelvic dissociation is a highly unstable orthopedic injury with a growing incidence worldwide. Operative treatment classically involves an open lumbopelvic fusion and sacroiliac stabilization, which carries high perioperative morbidity and mortality in a frail patient population. Advancements in spinal navigation, robotics, and minimally invasive surgery (MIS) techniques now allow these fracture patterns to be treated entirely percutaneously through small incisions. These incisions are just large enough to accommodate pedicle screw guides and enable the placement of lumbopelvic instrumentation, with rods being passed subfascially across pedicle screws and extending caudally to iliac fixation. This contrasts with the open midline approach, which requires more extensive soft tissue dissection and results in increased blood loss compared to percutaneous techniques. Modern imaging techniques, including CT navigation and robotics, facilitate the precise placement of sacral S2AI screw instrumentation in both open and percutaneous methods, all while safely avoiding previously placed trans-sacral fixation and other existing hardware, such as acetabular screws. Trans-sacral screws are typically percutaneously inserted first by the orthopedic trauma service, utilizing inlet, outlet, and lateral sacral fluoroscopic guidance to navigate the limited available corridor. With the advent of MIS techniques, trauma patients can now benefit from faster postoperative rehabilitation, minimal blood loss, decreased pain, and quicker mobilization. This article will review current concepts on spinopelvic anatomy, fracture patterns, indications for treatment, and current concepts for minimally invasive percutaneous lumbopelvic fixation, and it will present illustrative examples. Full article