Search Results (468)

Background: Fractures of the first and second cervical vertebrae are common in both young and elderly patients. Surgical management of C1–C2 fractures in elderly patients is controversial. The aim of this study is to report the rate of fusion in elderly patients who underwent surgery for C1 or C2 fractures. Methods: A retrospective review of all patients over the age of 65 years old who underwent surgical treatment for C1 or C2 fracture was reported. Visual analog scale (VAS) and neck disability index (NDI) were used to assess patients’ clinical outcome at 1 year follow-up. Cervical spine computer tomography (CT) scans were performed in all cases before surgery and at 1 year follow-up to evaluate the long-term postoperative rate of fusion, according to Lenke fusion grade. Results: From 2019 to 2023, 105 patients with cervical craniocervical junction (CCJ) fracture underwent surgical treatment in our Pisana University Hospital. Among all these, 74 patients (70.5%) were over 65 years old. The mean age of the study population was 76.9 years old (12.2% aged 65–70, 51.4% aged 70–79, and 36.5% over 80). According to the AO Spine Upper Cervical Injury Classification System, 6 (8.1%) patients presented a type II fracture and 68 (91.9%) patients presented a type III fracture. At admission, neurological examination resulted in American Spinal Injury Association (ASIA) E in 97.3% of cases. Over 60% of all patients underwent C1–C2 posterior fixation. Postoperative complications occurred in 12.25% of patients. According to the criteria described by Lenke, a good rate of fusion (A-B grade) was obtained in 71.6% of patients. Conclusions: In elderly patients with CCJ fractures, precision medicine can help identify those at higher risk for complications and guide personalized treatment strategies. Surgical treatment of CCJ fractures in elderly patients, although not always associated with bone fusion, can be performed with an acceptable incidence of mortality and morbidity, allowing rapid mobilization and return to pre-trauma levels of independence. Full article

Background: Multilevel posterior spinal fusion to T10 often encounters complications such as screw loosening and proximal junctional kyphosis. Cement augmentation or prophylactic vertebroplasty is used to prevent these, but their biomechanical effects remain unclear. Methods: A validated finite element model (T8–pelvis) from CT data of a 57-year-old male was tested in five configurations: fusion only, fusion with cement augmentation at T10, T10–T11, T10–T11 plus T9 vertebroplasty, and T10–T11 plus T8–T9 vertebroplasty. Range of motion (ROM), intradiscal pressure (IDP), posterior ligament/facet stress, and cement–bone interface stresses were analyzed under a 400 N follower load and 10 N·m moments. Results: Cement augmentation at the upper instrumented vertebra produced <5% changes in ROM, IDP, and posterior ligament/facet stresses compared with fusion only, indicating preserved stability. Prophylactic vertebroplasty redistributed stress proximally, with elevated cement–bone interface stresses localized at T9 when vertebroplasty was performed at a single adjacent level (T9) and distributed to both T8 and T9 when performed at two adjacent levels (T8–9)—with T9 stressed mainly during lateral bending and extension, and T8 during flexion and lateral bending. Conclusion: Cement augmentation alone did not compromise adjacent-level biomechanics, but prophylactic vertebroplasty created abnormal stress concentrations at adjacent interfaces, potentially increasing fracture risk. These findings highlight the need for careful patient selection and further studies in osteoporotic populations. Full article

Background/Objectives: Distal adding-on (DA) is a common postoperative phenomenon in Lenke type 2A adolescent idiopathic scoliosis (AIS). Postoperative shoulder imbalance (PSI) is a clinically significant issue following AIS correction, as it may lead to aesthetic dissatisfaction, functional impairment, and reduced quality of life. This study investigated radiographic changes in DA and shoulder balance in Lenke type 2A AIS, particularly focusing on distal wedge angle (DWA) and radiologic shoulder height (RSH) in patients with right sacral slanting (RSS). Methods: We retrospectively analyzed 120 patients with Lenke type 2A AIS who underwent posterior spinal fusion. Patients were grouped by sacral slanting: right (RSS), left (LSS), or none (NS). Radiographic parameters including proximal thoracic curve angle, main thoracic curve angle, DWA, RSH were assessed at multiple time points. Univariate and multivariate linear regression analyses were used to identify factors associated with DA. Results: The RSS group consistently showed the highest DWA and the greatest incidence of DA. RSH initially exceeded the PSI threshold in all groups but decreased to approximately 10 mm by final follow-up. In the RSS group, the inverse relationship between increasing DWA and decreasing RSH was most pronounced. Univariate regression identified postoperative RSH and sacral slanting angle as significant predictors of DWA, though not in the final multivariate model. Conclusions: In Lenke type 2A AIS with RSS, an increasing DWA and decreasing RSH over time suggest that DA may serve as a compensatory mechanism for PSI. Sacral slanting and postoperative RSH may be relevant predictors of this dynamic alignment change. Full article

Background/Objectives: Pedicle screw placement is crucial for restoring stability. Emerging robot-assisted technologies may offer enhanced precision and reduced radiation exposure. This study aimed to compare the accuracy and clinical outcomes of robot-assisted versus conventional fluoroscopy-guided pedicle screw placements. Methods: This retrospective cohort study included 218 patients undergoing pedicle screw placement at a single spine center between 2019 and 2023. Of these, 105 patients underwent robot-assisted surgery using the Mazor X™ Stealth Edition (Medtronic, Minneapolis, MN, USA), and 113 underwent conventional fluoroscopy-guided surgery. The primary outcome was screw placement accuracy (Grade 0 = optimal, Grades 1–3 = suboptimal, according to the Gertzbein–Robbins classification). Secondary outcomes included estimated blood loss (EBL), radiation exposure, length of hospital stay (LOS), clinical outcome according to the Macnab classification, postoperative pain, and adverse events. Results: Robot-assisted surgery demonstrated significantly higher accuracy in screw placement, with 93.33% achieving Grade 0 accuracy versus 78.76% in the conventional group (p = 0.002). This corresponded to an odds ratio (OR) of 3.78 (95% CI: 1.55–9.19, p = 0.003). The number needed to treat (NNT) to achieve one additional optimal screw placement was 6.9. Robot-assisted surgery demonstrated significantly higher accuracy in screw placement. Moreover, robot-assisted procedures were associated with reduced estimated blood loss (EBL), shorter length of stay (LOS), and lower radiation exposure times; patient-reported outcomes (VAS and Macnab) were also improved (OR = 3.34, 95% CI: 1.89–5.91). Duration of surgery, adverse events, and revision rates were comparable between the two groups. Conclusions: This study supports the clinical benefits of robot-assisted pedicle screw placement, particularly in achieving higher accuracy and reducing EBL and LOS. Future research should explore long-term outcomes, cost-effectiveness, and the generalizability of these results to a broader patient population. Full article

Background/Objectives: To compare the radiographic, perioperative, and patient-reported outcomes between anterior vertebral body tethering (VBT) and posterior spinal fusion (PSF) in adolescents with idiopathic scoliosis. Methods: A systematic search of PubMed, Scopus, Web of Science, and Google Scholar was performed through May 2025. Studies directly comparing anterior VBT and PSF in skeletally immature patients with adolescent idiopathic scoliosis were included. Data were pooled using random-effects meta-analysis and expressed as mean differences (MDs) or odds ratios (ORs) with 95% confidence intervals (CIs). The NIH quality assessment tool was used to evaluate risk of bias. Results: Ten studies comprising 1168 patients (573 VBT, 595 PSF) were included. At 2 years, VBT showed a significantly greater main thoracic curve (MD = 5.03°; 95% CI: 1.87–8.20) and proximal thoracic curve (MD = 3.27°; 95% CI: 1.16–5.38), but no difference in lumbar or main curve Cobb angles. VBT was associated with significantly reduced thoracic kyphosis (MD = −2.68°), increased T1 tilt (MD = 1.50°), shorter operative time (MD = −99.23 min), less blood loss (MD = −405.44 mL), and shorter hospital stay (MD = −1.34 days). However, VBT had a significantly higher revision rate (OR = 5.54; 95% CI: 2.81–10.94). No significant differences were noted in SRS-22 domains, except for higher mental health scores in the VBT group (MD = 0.56; 95% CI: 0.07–1.06). Conclusions: Anterior VBT offers perioperative advantages and comparable radiographic correction to PSF in selected adolescents with idiopathic scoliosis, but at the cost of higher revision rates. 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

Background: Spinal deformity correction surgery, particularly in scoliosis, often necessitates long fusion constructs and complex osteotomies that create significant structural bone defects. These defects threaten the integrity of spinal fusion, potentially compromising surgical outcomes. Bone grafting remains the cornerstone of addressing these defects, traditionally relying on autologous bone. However, limitations such as donor site morbidity and insufficient graft volume have made urgent the development and adoption of biologic substitutes and synthetic alternatives. Additionally, innovations in three-dimensional (3D) printing offer emerging solutions for graft customization and improved osseointegration. Objective: This scoping review maps the evidence of the effectiveness of the use of biologic and synthetic bone grafts in scoliosis surgery. It focusses on the role of novel technologies, particularly osteobiologics in combination with 3D-printed scaffolds, in enhancing graft performance and surgical outcomes. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and the Cochrane Library to identify studies published within the last 15 years. Inclusion criteria focused on clinical and preclinical research involving biologic grafts (e.g., allografts, demineralized bone matrix-DBM, bone morphogenetic proteins-BMPs), synthetic substitutes (e.g., ceramics, polymers), and 3D-printed grafts in the context of scoliosis surgery. Data were extracted on graft type, clinical application, outcome measures, and complications. The review followed PRISMA-ScR guidelines and employed the Arksey and O’Malley methodological framework. Results: The included studies revealed diverse grafting strategies across pediatric and adult populations, with varying degrees of fusion success, incorporation rates, and complication profiles. It also included some anime studies. Emerging 3D technologies demonstrated promising preliminary results but require further validation. Conclusions: Osteobiologic and synthetic bone grafts, including those enhanced with 3D technologies, represent a growing area of interest in scoliosis surgery. Despite promising outcomes, more high-quality comparative clinical studies are needed to guide clinical decision-making and standardize practice. Full article

Introduction: Cervical disc disease is a common cause of disability worldwide. Two surgical options for refractory CDD are anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA). While ACDF is well established, CDA offers motion preservation and has shown promising outcomes. This study compared utilization trends, patient characteristics, and hospitalization outcomes of ACDF and CDA using a large national dataset. Methods: We analyzed patients in the Nationwide Inpatient Sample (2016–2019) undergoing ACDF or CDA, identified using ICD-10 codes. After exclusions, 97,999 patients were included. Propensity score matching yielded 11,415 pairs, enabling balanced comparisons of demographics, comorbidities, complications, length of stay (LOS), and hospital charges. Results: CDA utilization increased during the study period. Compared with ACDF, CDA patients were younger and more likely to have private insurance. Following matching, both groups were demographically similar. CDA was associated with a slightly shorter LOS (1.32 vs. 1.39 days) but significantly higher charges (USD 82,431 vs. USD 58,472). In terms of complications, dysphagia was more frequent after ACDF, whereas cervical spinal cord injury and urinary tract infections were slightly more common after CDA, though rare overall. Conclusions: CDA is increasingly adopted in younger, privately insured patients and demonstrates comparable safety with ACDF. Its advantages include motion preservation, shorter hospitalization, and lower dysphagia rates, though at the expense of higher costs. These findings support the selective use of CDA as a viable alternative to ACDF in appropriately chosen patients. Full article

Background: Spinal solitary fibrous tumors (SFTs) are a rare oncological entity, almost anecdotal in the pediatric population. They have a high relapse rate and represent an ongoing oncological challenge. Methods: In this article, we conducted a systematic review starting from a case report to highlight the current state of the art in managing these tumors. Results: Spinal solitary fibrous tumors (SFTs) are rare, slow-growing neoplasms that can be either intra- or extramedullary. Only a limited number of studies focus on primary pediatric spinal cord localization. Five pediatric cases of spinal SFT have been documented in the literature. On MRI, they typically present as highly vascularized, contrast-enhancing masses. Histologically, they are composed of spindle-shaped cells within a collagenous stroma featuring staghorn-shaped blood vessels. More aggressive subtypes, such as dedifferentiated SFTs, resemble high-grade sarcomas. The NAB2–STAT6 fusion is a key marker, driving EGFR signaling, collagen production, and fibrosis. Additional diagnostic markers include CD34, CD99, and Bcl-2. Surgical resection remains the primary treatment. In metastatic cases, chemotherapy—mainly with anthracyclines, dacarbazine, or temozolomide—is employed, although no standardized pediatric protocols exist. Anti-angiogenic agents, including tyrosine kinase inhibitors, have shown promise. Radiotherapy is used postoperatively for local disease control, but its impact on survival is still under investigation. Conclusions: Surgery remains the cornerstone of treatment, significantly impacting the natural history of the disease and symptom control. While clinical trials exploring radiotherapy and chemotherapy are ongoing in adults, no specific treatment protocol has been established for pediatric patients. Full article

Background: Iliopsoas impingement (IPI) is an increasingly recognized cause of persistent groin pain following total hip arthroplasty (THA), often resulting from mechanical conflict between the iliopsoas tendon and the anterior rim of the acetabular component. Despite its clinical relevance, risk factors contributing to IPI remain poorly defined. Methods: A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted according to PRISMA guidelines. Studies were eligible if they evaluated adult patients undergoing primary THA and reported at least one risk factor associated with IPI. Only studies with a clearly defined clinical diagnosis of IPI were included. Data extraction and risk of bias assessments were performed independently by two reviewers. Risk of bias in each study was assessed through the Newcastle-Ottawa Scale. Results: Twelve observational studies met the inclusion criteria. Diagnosis of IPI was based on clinical symptoms of anterior groin pain exacerbated by hip flexion; 9 studies confirmed diagnosis with anesthetic injections. Key surgical risk factors included anterior cup prominence (ORs 1.16–35.20), oversized cups (cup-to-head ratio > 1.2, OR = 5.39, or ≥6 mm difference, OR = 26.00), decreased cup inclination, collared stem protrusion (OR = 13.89), and acetabular screw protrusion > 6.4 mm. Patient-specific risk factors included female sex (ORs 2.56, 2.79), higher BMI (OR = 1.07), younger age, previous hip arthroscopy (OR = 9.60) and spinal fusion (OR = 4.60). The anterolateral approach was also associated with higher IPI risk when compared to the posterior approach (OR = 4.20). Conclusions: IPI after THA is a multifactorial complication influenced by modifiable surgical variables and patient-specific anatomy. Careful preoperative planning, precise implant positioning, and attention to individual risk factors are essential to reduce IPI incidence and improve outcomes. Full article

Successful arthrodesis is a crucial factor in spinal fusion surgery, maximizing the likelihood of improved quality of life. The incorporation of metals into bone grafts has been demonstrated to enhance fusion rates through various osteoinductive and osteoconductive pathways. A systematic review was conducted to investigate the utility of metal composite bone grafts in promoting arthrodesis in spinal fusion preclinical studies. PubMed/MEDLINE was queried to identify studies investigating metal composite bone grafts in animal models of spinal fusion. Non-spinal fusion animal models were excluded. Risk of bias was assessed using the SYRCLE risk of bias tool. After screening a total of 1554 articles, 17 articles were included in our review. Metal composite bone grafts with bioactive agents had significantly greater fusion rates than metal composite only bone grafts (p < 0.001) and similar fusion rates compared to non-metal comparator bone grafts (p = 0.172). Bone grafts containing strontium and magnesium had the greatest fusion rates compared to other metals and had significantly greater fusion rates than those of silicon-containing bone grafts (p = 0.02 and p = 0.04, respectively). Bone quality and bone volume percentages of fusion masses formed by metal composite bone grafts were enhanced via the addition of bioactive agents such as stem cells, rhBMP-2, autograft, and poly (lactic-co-glycolic acid). The adverse event rate was 3.0% in all animal surgeries. Metal composite bone grafts show promise as osteoinductive agents to promote arthrodesis in spinal fusion, and their osteoinductive capability is enhanced with the synergistic addition of osteogenic factors such as stem cells and autograft. Full article

Aim of the study: This paper focuses on the correlation of nicotine use with chronic lumbar back pain (CLBP). Methods: This is a cross-sectional observational study involving smoker and non-smoker patients with a diagnosis of chronic low back pain (CLBP), recruited during their initial neurosurgical consultation at the Neurosurgery Clinic over a period of 6 months. All patients were followed for a minimum of 3 months after the start of conservative therapy. Age, sex, smoking habits, and the presence of any comorbidities were noted. Pain severity and discomfort were evaluated using the Numeric Rating Scale (NRS), the DN4 questionnaire, and the Oswestry Disability Index (ODI). Based on imaging (MRI of the lumbosacral spine), diagnoses of disc herniation or vertebral lumbar stenosis were documented. Statistical analysis was performed using IBM SPSS Statistics software (Version 30). A p-value of less than 0.05 was considered statistically significant. Results: Improvement on the CLBP, NRS, and DN4 scales after the same conservative therapy was better in Patients with non-smoking habits improved more on the CLBP, NRS and DN4 scales when compared to smokers (NRS scale 0.001 and DN4 scale 0.027). Conclusions: Patients with smoking habitudes affected by lumbar disk her-niation and stenosis and undergoing conservative therapy had worse pain scores Full article

This review article provides a comprehensive evaluation of Infuse^® and InductOs^®, two ground-breaking recombinant human Bone Morphogenetic Protein-2 (rhBMP-2)-based bone graft products, focusing on their tissue-level regenerative responses, clinical applications, and associated costs. Preclinical and clinical studies demonstrate that rhBMP-2 induces strong osteoinductive activity, effectively promoting mesenchymal stem cell differentiation and vascularized bone remodeling. While generally well-tolerated, these osteoinductive effects are dose-dependent, and excessive dosing or off-label use may result in adverse outcomes, such as ectopic bone formation or soft tissue inflammation. Histological and imaging analyses in craniofacial, orthopedic, and spinal fusion models confirm significant bone regeneration, positioning rhBMP-2 as a viable alternative to autologous grafts. Notably, advances in delivery systems and scaffold design have enhanced the stability, bioavailability, and targeted release of rhBMP-2, leading to improved fusion rates and reduced healing times in selected patient populations. These innovations, alongside its proven regenerative efficacy, underscore its potential to expand treatment options in cases where autografts are limited or unsuitable. However, the high initial cost, primarily driven by rhBMP-2, remains a critical limitation. Although some studies suggest overall treatment costs might be comparable to autografts when factoring in reduced complications and operative time, autografts often remain more cost-effective. Infuse^® has not substantially reduced the cost of bone regeneration and presents additional safety concerns due to the rapid (burst) release of growth factors and limited mechanical scaffold support. Despite representing a significant advancement in synthetic bone grafting, further innovation is essential to overcome limitations related to cost, mechanical properties, and controlled growth factor delivery. Full article

Background/Objectives: Upper lumbar spinal stenosis presents unique challenges because vertically oriented facet joints and narrow laminae increase the risk of iatrogenic instability following decompression. Traditional decompression techniques may damage the facet joints, potentially resulting in further instability and degeneration. This study introduces a novel, facet-preserving bilateral–contralateral decompression strategy using unilateral biportal endoscopy (UBE) for upper lumbar stenosis, aiming to defer unnecessary spinal fusion. Methods: This retrospective series of three cases involved patients with upper lumbar stenosis characterized by vertically oriented facets (>60°) and narrow laminae, including cases of adjacent segment stenosis (ASS) and stenosis with grade 1 spondylolisthesis. Patients were selected using the authors’ facet angle–based criteria (>60°) and laminar morphology to identify anatomically vulnerable segments. All patients exhibited vertical facet orientation and narrow laminae, without significant dynamic instability or severe foraminal compromise. Bilateral–contralateral decompression was performed using biportal endoscopy to preserve facet integrity and defer fusion where feasible. Results: This series demonstrated that bilateral–contralateral decompression provided effective neural decompression and symptom relief while preserving facet structures in the upper lumbar spine characterized by vertical facets and narrow laminae. No progression to instability or requirement for additional fusion was observed during the 6-month follow-up, even among patients with ASS and grade 1 spondylolisthesis. Conclusions: The authors propose that bilateral–contralateral decompression may serve as a facet-preserving and fusion-deferral strategy for upper lumbar stenosis with vertically oriented facets and narrow laminae. This approach is particularly applicable in cases such as ASS and spinal stenosis with grade 1 spondylolisthesis, where preserving structural reserve is critical. These preliminary findings highlight the need for prospective validation through carefully designed observational studies and larger case series. Full article

Sheep have been widely used as a model for osteoporosis research. This study aimed to characterise changes in microstructure and composition in lumbar vertebrae L1–L7 and the proximal femur after implementation of a bone loss induction protocol (in this species). A sham control and experimental group (glucocorticoid-treated ovariectomized sheep) were used (n = 6/group), with a study duration up to the 24th postoperative week. Through micro-computed tomography, vertebrae and femoral head trabecular bones from the experimental group presented a consistent decrease in bone volume fraction (BV/TV), trabecular thickness (Tb.Th), and trabecular number (Tb.N) and an increase in trabecular separation (Tb.Sp) and total porosity (p > 0.05). The mineral density of the femoral heads from the experimental group showed a statistically significant decrease (p ˂ 0.05). The entire histomorphometric analysis of the vertebrae in the experimental group showed an increase in cortical porosity (Ct.Po) and a decrease in cortical thickness (Ct.Th) (p ˂ 0.0001 and p ˂ 0.001, respectively). Vertebrae L6 and L7 were the most affected, showing a significant increase in Ct.Po (p < 0.05) and a significant decrease in Ct.Th at the L6 level (p < 0.05). Regarding the trabecular bone at the vertebral level, only L4 showed a significant increase in Tb.Sp (p ˂ 0.05). In the femoral heads’ subchondral cortical layer, the Ct.Po increased significantly and Ct.Th decreased (p < 0.01), and at the trabecular level, the BV/TV, Tb.Th, and Tb.N decreased significantly, while Tb.Sp increased (p < 0.05). In conclusion, the L4, L6 and L7 vertebrae seem the most suitable for further preclinical and translational studies of vertebral augmentation or spinal fusion in this animal model. Full article