Search Results (1,178)

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/Objectives: Open thoracoabdominal aortic aneurysm (TAAA) repair remains essential despite expanded endovascular options, yet the contemporary open-surgery case-mix has shifted as minimally invasive therapies became widespread. The objective was to evaluate temporal changes in patient demographics, pathology, and perioperative outcomes of open TAAA repair across two decades. Methods: Retrospective, cross border cohort of all open TAAA repairs performed at two high-volume tertiary centers (Aachen, Germany; Maastricht, Netherlands) from 2000–2024. Patients were stratified into Early Era (2004–2013) and Late Era (2014–2024). Primary endpoints were shifts in demographics and perioperative mortality/morbidity; secondary endpoints included major complications (spinal cord ischemia, acute kidney injury, pulmonary and cardiac events). Results: Among 577 open repairs, 376 (65.2%) occurred in the Early Era and 201 (34.8%) in the Late Era, with annual volumes declining to <12 cases/year after 2020. Late Era patients were younger (median 55.9 vs. 63.0 years, $p<0.001$) and had more genetic aortopathy (Marfan 26.9% vs. 11.7%, $p<0.01$) and post-dissection pathology (64.7% vs. 43.1%, $p<0.01$), alongside more prior aortic surgery (59.2% vs. 43.4%, $p<0.01$). Massive transfusion and incidental splenectomy decreased (37.8% vs. 54.5%, $p<0.01$; 5.0% vs. 14.9%, $p<0.01$). In-hospital mortality was similar (18.4% Late vs. 21.8% Early, $p=0.34$); spinal cord ischemia showed a non-significant reduction (5.5% vs. 8.0%, $p=0.26$); myocardial infarction decreased (1.0% vs. 4.3%, $p=0.03$); and ARDS increased (15.9% vs. 5.1%, $p<0.01)$. Conclusions: Despite the shift towards endovascular repair and the changing demographics of patients selected for open TAAA repair, specialized centers can maintain stable outcomes through standardized protocols and concentrated expertise. The preservation of open surgical capabilities remains crucial for specific patient populations, emphasizing the need for a balanced approach that integrates both open and endovascular techniques to provide optimal, individualized care. Full article

Surgical site infections (SSIs) remain a significant complication in spine surgery, especially in instrumented procedures with long operative times. Although guidelines recommend cefazolin as the first-line agent due to its efficacy against Staphylococcus aureus, predictable pharmacokinetics, and safety, its real-world practice is highly variable, with inappropriate and prolonged regimens reported across Europe. Vancomycin is often used as the first choice of therapy empirically and without screening, exposing patients to risks such as delayed infusion, nephrotoxicity, and the emergence of vancomycin-resistant enterococci (VRE).This review assesses the present function of vancomycin in relation to cefazolin for spinal prophylaxis and examines wider trends in the misuse of surgical antibiotic prophylaxis, which were identified through PubMed and Scopus searches. Evidence from randomized and prospective studies consistently supports cefazolin as the preferred prophylactic agent in clean spinal surgery. Observational data suggest that adjunctive or topical vancomycin may reduce infection rates in selected high-risk or revision cases, though the results are inconsistent and frequently limited by retrospective designs and heterogeneous outcome reporting. Importantly, the most rigorous randomized controlled trial found no benefit of intrawound vancomycin over the placebo. A small number of available investigations in vancomycin use with major design limitations have resulted in no significant VRE emergency. Unexpectedly, widespread use of vancomycin was followed by a notable transition toward Gram-negative and opportunistic organisms. In summary, vancomycin may only be considered in patients with documented MRSA colonization, β-lactam allergy, or selected revision procedures, but its widespread empirical use as a first-choice therapy is not supported. Full article

Background and Objectives: Spinal anesthesia is increasingly preferred in pediatric surgeries due to its rapid onset, high success rate, and low risk of systemic complications. However, the influence of age and body mass index (BMI) on block characteristics in adolescents remains insufficiently studied. Materials and Methods: This retrospective study evaluated 190 pediatric patients (aged 9–18 years; 154 male, 36 female) undergoing elective surgery with spinal anesthesia. Patients were stratified by age (Group 1: 9–14 years; Group 2: 15–18 years) and BMI (Group A: 16.00–19.65 kg/m²; Group B: 19.66–23.31 kg/m²). The primary outcome was sensory block duration. Secondary outcomes included sedation requirements, complications, analgesic requirement times, and Visual Analog Scale (VAS) scores. Results: Group 2 had significantly longer sensory block duration and lower postoperative VAS scores at 3 and 12 h compared to Group 1 (p < 0.001). Lower BMI was associated with greater sedation requirements (p < 0.001) and a higher incidence of intraoperative nausea and vomiting (p = 0.013). Complications were infrequent (hypotension 6.3%, bradycardia 2.1%, PONV 7.1%, postoperative headache 3.1%) and managed conservatively. Conclusions: Age and BMI meaningfully influence spinal anesthesia characteristics in pediatric patients. Older adolescents achieved longer sensory block durations and better postoperative analgesia, whereas younger and lower-BMI patients required more sedation and had higher nausea rates. Individualized spinal anesthesia planning, considering age, BMI, and developmental stage, may optimize clinical outcomes. Prospective studies are warranted to validate these findings. Full article

Patient-specific technologies within the field of adult spinal deformity (ASD) aid surgeons in pre-surgical planning, accurately help identify anatomical landmarks, and can project optimal post-surgical sagittal alignment. This narrative review aims to discuss the current uses of patient-specific technologies in ASD and identify new innovations that may very soon be integrated into patient care. Pre-operatively, machine learning or artificial intelligence helps surgeons to simulate post-operative alignment and provide information for the 3D-printing of pre-contoured rods and patient-specific cages. Intraoperatively, robotic surgery and intraoperative guides allow for more accurate positioning of implants. Implant materials are being developed to allow for better osseointegration and patient outcome monitoring. Despite the significant promise of these technologies, work still needs to be performed to ensure their accuracy, safety, and cost efficacy. Full article

Background: Robotic hysterectomy and Enhanced Recovery After Surgery (ERAS) are two significant improvements in gynecologic surgery, both associated with decreased postoperative pain and faster recovery. Spinal analgesia guarantees excellent pain coverage; however, its appropriateness in robotic procedures is still controversial. The aim of the study was to compare postoperative pain control after robotic hysterectomy in patients receiving spinal analgesia versus intravenous low-dose oxycodone. Methods: Consecutive patients undergoing robotic hysterectomy from January 2022 to July 2023 were included in the analysis. Until August 2022, patients received spinal analgesia, while from September 2022, low-dose oxycodone was administered intraoperatively. All patients were managed following the ERAS protocol. Primary outcomes were the VAS pain score and opioid rescue use, while secondary outcomes included postoperative nausea and vomiting (PONV), mobilization, oral intake, and length of hospital stay (LOS). Results: Of 114 patients, 67 (58.8%) received spinal analgesia and 47 (41.2%) received intravenous low-dose oxycodone. No differences were reported in the VAS pain score at day 0 (1.5 ± 1.6 vs. 1.6 ± 2.2, p = 0.78) and day 1 (2.0 ± 2.1 vs. 1.3 ± 1.8, p = 0.07). At day 2, the VAS pain score was 1.4 ± 1.6 in the spinal analgesia group and 0.7 ± 1.0 in the oxycodone group (p = 0.01). No differences were reported in the need for opioid rescue at days 1 and 2 (p = 1.00). At day 0, 26 patients (38.8%) experienced PONV in the spinal analgesia group versus 8 (17.0%) in the oxycodone group (p = 0.01). Conclusions: Patients receiving intraoperative low-dose oxycodone experienced comparable satisfactory postoperative pain control with a lower incidence of PONV when compared to the spinal analgesia group. Full article

Background: Temporary internal distraction is a safe surgical technique that has been shown to improve correction of severe scoliosis. The traditional surgical adjunct for scoliosis treatment in the perioperative period is halo gravity traction, but there are several known disadvantages of this technique. We describe the technical nuances of temporary internal distraction using the construct-to-construct technique, a surgical adjunct that utilizes two rods joined by lateral domino connectors to enact powerful internal distraction or compression forces on the spine for achieving spinal deformity correction. Methods: This study was designed as a retrospective review and illustrative surgical technique report. The primary aim was to describe the construct-to-construct internal distraction and compression technique for scoliosis correction, with illustrative models and representative clinical cases. Results: Internal distraction using the construct-to-construct configuration is performed early in the surgery to take advantage of the viscoelastic properties of the spine as gradually increasing distraction forces are applied. The surgical technique for applying internal distraction and compression using the construct-to-construct configuration is discussed in detail. Conclusions: Construct-to-construct internal distraction and compression techniques are powerful methods to correct severe scoliosis curves, serially distract traditional growing rod constructs, and close three-column osteotomies. Full article

Background: Ventriculoperitoneal shunting (VPS) is the mainstay of treatment for most forms of hydrocephalus; VPS infection (VPSI) is a leading cause of shunt-related morbidity and mortality. A meta-analysis of the existing literature on risk factors for VPSI is currently lacking. Herein, the authors performed a systematic review and meta-analysis to evaluate the role of different clinical factors in the development of VPSI. Methods: A systematic search in the PubMed, Scopus, and Cochrane databases was performed to identify studies comparing patients developing VPSI to controls. The following data were extracted where available: number of patients who developed VPSI vs. number of patients with a regular course, demographics (gender, age at VPS insertion, age > 18 years), average length of hospital stay before shunt implant (days), aetiology of hydrocephalus (tumour-associated hydrocephalus; post-haemorrhagic hydrocephalus; congenital hydrocephalus; spinal dysraphism-associated hydrocephalus; post-infectious hydrocephalus; post-traumatic hydrocephalus; post-craniotomy hydrocephalus), and hydrocephalus type (obstructive hydrocephalus, communicating hydrocephalus, normal-pressure hydrocephalus—NPH). Results: Five studies including 2333 patients (225 with VPS infection) were analysed. Tumour-related hydrocephalus was linked to a lower infection risk (OR 0.418; p < 0.001), while congenital hydrocephalus (OR 2.502; p < 0.001) and spinal dysraphism (OR 2.359; p < 0.001) increased the risk. Conclusions: VPSI represents a serious complication after shunt surgery. Our meta-analysis identifies three key factors influencing the risk of VPSI. VPS-centred, large multicentre prospective studies are needed to possibly confirm the role of the factors we identified and to identify additional ones, enabling earlier detection of VPSI and allowing for better patient care. Full article

Background/Objectives: Rates of degenerative spinal pathology are increasing, driving interest in minimally invasive surgical (MIS) techniques that facilitate faster recovery. Full endoscopic lumbar discectomy (FELD) and biportal endoscopic lumbar discectomy (BELD) offer reduced tissue disruption, but comparative outcomes versus non-endoscopic MIS and optimal patient selection remain unclear. This systematic review examines pre-operative characteristics and post-operative outcomes of endoscopic lumbar microdiscectomy (ELMD) compared to MIS and open techniques. Methods: A PRISMA-guided search of PubMed, Embase, Scopus, and hand searches through 31 September 2024 identified studies on lumbar spinal surgery using endoscopic techniques, restricted to level 1a/b and 2a evidence. Articles were subgrouped by surgery type, with this analysis focusing on ELMD. Data extraction included risk-of-bias assessment, and meta-analysis was performed using multivariate mixed-effects regression. Pre-operative patient characteristics and post-operative outcomes for endoscopic lumbar microdiscectomy (ELMD) were directly compared to both open microdiscectomy and minimally invasive non-endoscopic microdiscectomy (MIS) techniques. Within the ELMD cohort, we further analyzed differences between full endoscopic (FELD) and biportal endoscopic (BELD) approaches, as well as between transforaminal and interlaminar access routes. Results: Of 6891 articles, 5469 unique titles/abstracts were screened, yielding 87 studies (3238 patients) for final synthesis. Compared to open microdiscectomy, ELMD patients were more often male, younger, of lower BMI, and had more comorbidities. They typically presented with shorter symptom duration and predominant radiculopathy. ELMD was performed most at L3–L4 and L4–L5. Post-operatively, ELMD patients had significantly lower VAS Leg Pain scores at 1 day and 1 year and reduced recurrence rates. ELMD was associated with lower recurrence rates and correspondingly lower revision surgery rates, with dural tears and wound infections trending lower compared to open surgery. Compared to non-endoscopic MIS, pre- and post-operative characteristics were similar. BELD patients more often had longer symptom duration, motor weakness, and hyporeflexia than FELD patients. Conclusions: ELMD patients demonstrate favorable pain relief and reduced recurrence versus open surgery, with outcomes comparable to MIS. These findings support ELMD as a less invasive alternative within the MIS spectrum. 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: Continuous glucose monitoring (CGM) has changed the clinical practice in diabetes management during pregnancy; however, its application during caesarean section remains understudied. This feasibility study evaluates the performance, reliability, and clinical utility of two CGM systems—FreeStyle Libre 2 and Medtronic Guardian Connect—during caesarean delivery and the early postpartum period in a patient with pregestational diabetes mellitus (PGDM). Methods: A prospective, single-patient study was conducted. A 32-year-old woman with type 1 diabetes underwent elective caesarean section at 38 weeks of gestation. Both CGM systems were applied over 18 h prior to surgery and monitored continuously through the intraoperative and five-day postpartum period. Glucose data, device performance, and usability were assessed. Results: Both CGM systems provided uninterrupted, high-quality glucose data throughout the perioperative period, including during spinal anaesthesia, surgical manipulation, and postoperative recovery. No sensor displacement nor signal loss occurred. Glycaemic readings remained within the normoglycaemic range (90–100 mg/dL) during surgery, with mild elevations observed during anaesthesia initiation. Postoperatively, both systems showed comparable glucose trends, with slightly lower readings from FreeStyle Libre 2. Conclusions: CGM is feasible and reliable during caesarean section in PGDM patients. These findings support the integration of CGM into obstetric surgical care and highlight the need for larger studies to validate clinical benefits. 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

Background/Objectives: Spinal muscular atrophy (SMA) is a progressive neurodegenerative disease resulting in proximal muscle weakness and paralysis. SMA treatment has radically changed in the past 10 years thanks to the development of novel therapies such as nusinersen and onasemnogene abeparvovec. Since the advent of new treatments, the incidence and perioperative risk factors of patients with SMA undergoing longer, higher-risk surgeries are unknown. We hypothesized that patients with SMA would be at an overall elevated risk for postoperative pulmonary complications (PPC) and prolonged length of stay compared to the general population, but that this would be reduced in patients undergoing surgery in the years after the release of new therapies. Methods: Patients who underwent surgery at a continuously enrolled American College of Surgeons National Surgery Quality Improvement Program-Pediatric hospital from 1 January 2012, to 31 December 2021, were included in this study. Cases with missing covariate or primary outcome data were excluded from the analysis. Patients with ages greater than 17 years, preoperative tracheostomy, preoperative mechanical ventilation, missing covariate or primary outcome data were excluded. Patients with SMA were identified by their ICD-9 and 10 codes. A cutoff year of 2018 was chosen for analysis of the primary outcomes as this was a full year after nusinersen received FDA approval. Results: On univariable analysis, the risk for PPC in patients with SMA was reduced in patients undergoing surgery in 2018 or later compared to pre-2018 (pre-2018 OR 4.44, 95% CI 1.56–9.6, p = 0.008; post-2018 OR 3.48, 95% CI 0.84–9.12, p = 0.08). On multivariable analysis, the association between SMA and PPC substantially decreased in 2018 and after but was no longer statistically significant (pre-2018 OR 1.96, 95% CI 0.80–4.80, p = 0.14; post-2018 OR 1.03, 95% CI 0.33–3.26, p = 0.96). SMA was positively associated with LOS in the pre-2018 cohort, with a coefficient from a log linear model of 0.67 (95% CI 0.32–1.01; p < 0.001), and SMA adding an additional 1.93 days in LOS. For data post-2018, the effect of SMA on LOS was no longer statistically significant. Conclusions: Utilizing a large dataset, we found a reduced association between SMA and PPC a year following widespread implementation of SMN antisense oligonucleotide therapy, and a statistically significant reduction in LOS in patients with SMA after 2018. This may reflect improved motor outcomes and respiratory mechanics in the new treatment era. Full article

Background/Objectives: Spinal hydatid disease frequently poses significant surgical challenges and leads to severe neurological complications. Despite the development of various surgical techniques, recurrence remains a common issue. The aim of this study was to evaluate the impacts of radical vertebrectomy on recurrence and long-term follow-up outcomes by comparing total en-bloc spondylectomy with conventional laminectomy, decompression, and posterior stabilisation in patients treated at our centre. Methods: This study included 21 patients who underwent surgery for spinal hydatid cysts at our centre between 2001 and 2021. Twelve patients had cystectomy, laminectomy, decompression, and stabilisation, and nine patients had total en-bloc spondylectomy. A single senior surgeon carried out each procedure, selecting the surgical approach based on the presence of vertebral body involvement. All patients received albendazole treatment for six months following surgery. The surgeon who performed the operations followed up all patients clinically and radiologically for at least three years. Results: Seven out of twelve patients (58.3%) who had conventional surgery experienced recurrences, while total en-bloc spondylectomy produced no recurrences (p = 0.004). The recurrent cases had a mean of 2.8 surgical procedures and manifested within 14 months. Although total en-bloc spondylectomy was associated with a longer operative time and greater blood loss, neurological recovery and overall clinical outcomes were comparable between the two groups. The difference in the recurrence rate was statistically significant. Conclusions: Although technically demanding, radical vertebrectomy is shown to provide complete protection against recurrence in appropriately selected patients with spinal hydatid disease in this study. Furthermore, as conservative approaches often require multiple procedures, total en-bloc spondylectomy can be considered an effective treatment for patients with vertebral body involvement. Full article