The more the better? Integration of vertebral pelvic angles (VPA) PJK thresholds to existing alignment schemas for prevention of mechanical complications after adult spinal deformity surgery.

PURPOSE: While existing adult spinal deformity (ASD) alignment schemas acknowledge the dynamic relationship between the pelvis and spine, consideration of vertebral pelvic angles (VPA) thresholds for PJK may provide further insight into the relationship of each individual vertebra to the pelvis, which may allow for greater individualization of operative targets. Herein, we examine VPA's utility in preventing mechanical complications and its possible unification with prevalent scoring systems. METHODS: In a retrospective cohort study of a prospectively collected database, operative ASD patients ≥ 18 years with complete baseline (BL) and two-year (Y) operative, radiographic, and health-related quality of life data were included. Descriptive analyses, means comparison, and logistic regression tests were applied to explore demographic and surgical differences, as well as the impact of alignment goals on outcomes. Cohorts were grouped as patients who met VPA non-PJK thresholds, as defined by Duvvuri et al. 2023 alone versus traditional GAP/SAAS alignment matching versus combined VPA + SAAS + GAP. The Non-PJK VPA validated mean for L1PA was 10.4 ± 7.0 and T9PA 8.9 ± 7.5. RESULTS: 398 patients met inclusion criteria (mean age 61 ± 14 years, 78% female, BL BMI 27 ± 6, BL CCI 2 ± 2). At baseline, mean vertebral pelvic angles were as follows: T1PA: 24 ± 14; T4PA 20 ± 13, T9PA 15 ± 12, L1PA 11 ± 10, L4PA 11 ± 6. Mean vertebral pelvic angles at 6 W postoperatively: T1PA 16 ± 10, T4PA 12 ± 10, T9PA 8 ± 9, L1PA 9 ± 8, L4PA 11 ± 5. 240 (60%) patients attained optimal L1PA, while 104 patients (26.1%) reached non-PJK mean for T9PA. 89 patients (22%) were optimal by both VPA standards. VPA-Optimal group demonstrated significantly lower rates of 1Y PJK (17% v 83%, p = 0.042) and PJF by 2Y (7% v. 93%, p = 0.038). When patients attained VPA goals in addition to GAP/SAAS goals at 6 W, they demonstrated significantly lower rates of Y1 PJK (p = 0.026) and Y1 and Y2 PJF. Those with optimal VPA registered greater SRS-22 scores across multiple domains (p < 0.02) as well as a greater rate of normal neurological examination at 6 W (p = 0.048). CONCLUSIONS: Vertebral pelvic angles are a reliable measure of global alignment, and respecting certain targets may help prevent development of PJK/PJF. The value of VPA can be augmented through integration with GAP/SAAS frameworks to prevent complications and improve quality of life.

Development of a core outcome set of clinical research on the integration of traditional Chinese and Western medicine for spinal metastases: a study protocol.

BACKGROUND: In recent years, the incidence of spinal metastasis (SM) has been increasing steadily. In response to this serious public health problem, researchers have made progress by using the integration of traditional Chinese and Western medicine. However, considerable heterogeneity in the definition and measurement of outcomes across clinical research studies, along with the lack of uniform measurement standards for study data, makes it difficult for researchers to compare different treatments. Therefore, it is crucial to accurately evaluate clinical research on the integration of traditional Chinese and Western medicine for SM. METHODS: This study protocol outlines a comprehensive research programme based on the Core Outcome Set Standards Protocol Items. The study consists of four phases: a literature review, semistructured interviews, a two-round modified Delphi survey, a consensus meeting. Phase 1 involves a comprehensive literature review to extract outcomes used in current clinical studies of integrated traditional Chinese and Western medicine or Western medicine for the treatment of SM. A semistructured interview format will be used to survey patients and caregivers in phase 2 to collect suggestions from the patient perspective. Phase 3 involves a two-round modified Delphi survey to complete a prioritisation evaluation of outcomes to generate a candidate list for core outcome set (COS). Finally, phase 4 involves a face-to-face consensus meeting to review and establish the COS. ETHICS AND DISSEMINATION: Conducted in response to the current dilemma of SM, the study was endorsed by the Spine Oncology Group of the Orthopaedic Surgeons Branch of the Chinese Physicians' Association. It will be developed and reported through a rigorous process, with the results of the study to be published in a peer-reviewed journal.Registration: COMET Registry: COMET 2938; https://www.comet-initiative.org/Studies/Details/2938.

Incidental durotomy during tubular microdiscectomy does not preclude same-day discharge.

PURPOSE: One of the major advantages of a minimally invasive microdiscectomy is that when CSF leak occurs, there is minimal anatomic dead space for ongoing leakage following removal of the tubular retractor. However, there are no published reports that address the safety and long-term outcomes of same-day discharge for CSF leak after tubular microdiscectomy. METHODS: This is a retrospective compartive study of 30 patients with incidental durotomy during minimally invasive tubular microdiscectomy occurring between January 1, 2009 to August 31, 2023 at our institution. RESULTS: There were 16 patients (53%) admitted to hospital and 14 (47%) patients discharged home the same day following CSF leak. There were no differences in patient demographics between the two groups at baseline. Twenty-nine out of 30 (97%) of the patients had onlay duraplasty, and one (3%) patient was repaired using sutures through the tubular retractor. None were converted to an open approach. The hospitalized group was kept on bed rest overnight or for 24 h. The discharge group was kept on best rest for 2 h or mobilized immediately after surgery. No patients in either group required readmission or revision surgery for CSF leak. The average length of admission for the hospitalized group was 2.4 ± 4.0 days. CONCLUSION: Patients with CSF leak during minimally invasive tubular microdiscectomy can be safely discharged home the same day.

Cauda Equina Cavernoma: A Case Report and Literature Review.

Cavernous hemangiomas (or cavernomas) are benign vasculature malformations that occasionally occur in the central nervous system (CNS). The vast majority is found supratentorial, but cavernomas also appear on the spine, usually intramedullary. Cavernomas in the cauda equina are extremely rare, with only a few cases reported in the literature. We report a case of a cavernoma of the cauda equina in a 69-year-old woman with low back pain and right sciatica for two years. Lumbar MRI showed an intradural mass lesion at the L1-L2 level. She underwent surgery with resection of the lesion, which confirmed the diagnosis of cavernous hemangioma. A good clinical outcome was achieved. In addition to the case report, we present a literature review on all reported cauda equina cavernomas, discussing their clinical presentations, imaging characteristics, histological findings, and surgical management.

Prediction models for risk assessment of surgical site infection after spinal surgery: A systematic review.

Background: Spinal surgeries are a common procedure, but there is significant risk of adverse events following these operations. While the rate of adverse events ranges from 8% to 18%, surgical site infections (SSIs) alone occur in between 1% and 4% of spinal surgeries. Methods: We completed a systematic review addressing factors that contribute to surgical site infection after spinal surgery. From the included studies, we separated the articles into groups based on whether they propose a clinical predictive tool or model. We then compared the prediction variables, model development, model validation, and model performance. Results: About 47 articles were included in this study: 10 proposed a model and 5 validated a model. The models were developed from 7,720 participants in total and 210 participants with SSI. Only one of the proposed models was externally validated by an independent group. The other 4 validation papers examined the performance of the ACS NSQIP surgical risk calculator. Conclusions: While some preoperative risk models have been validated, and even successfully implemented clinically, the significance of postoperative SSIs and the unique susceptibility of spine surgery patients merits the development of a spine-specific preoperative risk model. Additionally, comprehensive and stratified risk modeling for SSI would be of invaluable clinical utility and greatly improve the field of spine surgery.

Comparative analysis of patient-reported outcomes in myelopathy and myeloradiculopathy: a Quality Outcomes Database study.

OBJECTIVE: Myelopathy in the cervical spine can present with diverse symptoms, many of which can be debilitating for patients. Patients with radiculopathy symptoms demonstrate added complexity because of the overlapping symptoms and treatment considerations. The authors sought to assess outcomes in patients with myelopathy presenting with or without concurrent radiculopathy. METHODS: The Quality Outcomes Database, a prospectively collected multi-institutional database, was used to analyze demographic, clinical, and surgical variables of patients presenting with myelopathy or myeloradiculopathy as a result of degenerative pathology. Outcome measures included arm (VAS-arm) and neck (VAS-neck) visual analog scale (VAS) scores, modified Japanese Orthopaedic Association (mJOA) scale score, EuroQol VAS (EQ-VAS) score, and Neck Disability Index (NDI) at 3, 12, and 24 months compared with baseline. RESULTS: A total of 1015 patients were included in the study: 289 patients with myelopathy alone (M0), 239 with myeloradiculopathy but no arm pain (MRAP-), and 487 patients with myeloradiculopathy and arm pain (MRAP+). M0 patients were older than the myeloradiculopathy cohorts combined (M0 64.2 vs MRAP- + MRAP+ 59.5 years, p < 0.001), whereas MRAP+ patients had higher BMI and a greater incidence of current smoking compared with the other cohorts. There were more anterior approaches used in in MRAP+ patients and more posterior approaches used in M0 patients. In severely myelopathic patients (mJOA scale score ≤ 10), posterior approaches were used more often for M0 (p < 0.0001) and MRAP+ (p < 0.0001) patients. Patients with myelopathy and myeloradiculopathy both exhibited significant improvement at 1 and 2 years across all outcome domains. The amount of improvement did not vary based on surgical approach. In comparing cohort outcomes, postoperative outcome differences were associated with patient-reported scores at baseline. CONCLUSIONS: Patients with myelopathy and those with myeloradiculopathy demonstrated significant and similar improvement in arm and neck pain scores, myelopathy, disability, and quality of life at 3 months that was sustained at 1- and 2-year follow-up intervals. More radicular symptoms and arm pain increased the likelihood of a surgeon choosing an anterior approach, whereas more severe myelopathy increased the likelihood of approaching posteriorly. Surgical approach itself was not an independent predictor of outcome.

The impact of serum albumin levels on postoperative complications in lumbar and cervical spine surgery: an analysis of the Michigan Spine Surgery Improvement Collaborative registry.

OBJECTIVE: Patients with serum albumin levels < 3.5 g/dL are considered malnourished, but there is a paucity of data regarding the outcomes of patients with albumin levels > 3.5 g/dL. The objective of this study was to evaluate the effect of albumin on postoperative outcome in patients undergoing elective cervical and lumbar spine procedures. METHODS: The Michigan Spine Surgery Improvement Collaborative database was queried for lumbar and cervical fusion surgeries between January 2020 and December 2022. Patients were grouped by preoperative serum albumin levels: < 3.5 g/dL, 3.5-3.7 g/dL, 3.8-4.0 g/dL, and > 4.0 g/dL. Primary outcomes included urinary retention, ileus, dysphagia, surgical site infection (SSI), readmission within 30 and 90 days, return to the operating room, and length of stay (LOS) ≥ 4 days. Multivariate analysis was conducted to adjust for potential confounders. RESULTS: This study included 15,629 lumbar cases and 6889 cervical cases. Within the lumbar cohort, an albumin level of 3.5-3.7 g/dL was associated with an increased risk of readmission at 30 days (p = 0.048) and 90 days (p = 0.005) and an LOS ≥ 4 days (p < 0.001). An albumin level of 3.8-4.0 g/dL was associated with an increased risk of an LOS ≥ 4 days (p < 0.001). Within the cervical cohort, an albumin level of 3.5-3.7 g/dL was associated with an increased risk of SSI (p = 0.023), readmission at 30 days (p < 0.002) and 90 days (p < 0.001), return to the operating room (p = 0.002), and an LOS ≥ 4 days (p < 0.001). An albumin level of 3.8-4.0 g/dL was associated with an increased risk of readmission at 30 days (p = 0.012) and 90 days (p = 0.001) and an LOS ≥ 4 days (p < 0.001). CONCLUSIONS: This study maintains that patients with hypoalbunemia undergoing spine surgery are at risk for postoperative adverse events. However, there also exist significant associations between borderline serum albumin levels of 3.5-4.0 g/dL and increased risk of postoperative adverse events.

Percutaneous dilational tracheostomy following anterior cervical spine fixation - a retrospective propensity-matched cohort study.

PURPOSE: In patients with traumatic, infectious, degenerative, and neoplastic surgical indications in the cervical spine, commonly the anterior approach is used. Often these patients require a tracheostomy necessary due to prolonged mechanical ventilation. The limited spinal mobility and proximity to the surgical site of anterior cervical spine fixation (ACSF) could pose an increased risk for complications of percutaneous dilational tracheostomy (PDT.) Importantly, PDT might raise wound infection rates of the cervical spine approach. The aim of this study is to prove safety of PDT after ACSF. METHODS: We performed a retrospective, single-center study comparing patients with and without ACSF who underwent Ciaglia-single step PDT. After propensity score matching using logistic regression, we compared intra- and postprocedural complication rates. Furthermore, surgical site infections were evaluated. Putensen's definitions of complications and Clavien-Dindo's classification were used. RESULTS: A total of 1175 patients underwent PDT between 2009 and 2021. Fifty-seven patients underwent PDT following ACSF and were matched to fifty-seven patients without ACSF. The mean interval between ACSF and PDT was 11.3 days. The overall complication rate was 19.3% in the ACSF group and 21.1% in the non-ACSF group. The mean follow-up was 388 days (± 791) in the ACSF group and 424 days (± 819) in the non-ACSF group. Life-threatening complications (Clavien-Dindo IV to V) were found in 1.8% of ACSF patients and 3.5% of non-ACSF patients. There were no significant differences in complication rates. No surgical site infection of the anterior spine access was detected. CONCLUSION: PDT is a feasible and safe procedure in patients after ACSF. Complication rates are comparable to patients without ACSF. Surgical site infections of ACSF are very rare.

Disparities in the clinical profile of spinal tuberculosis in Africa: a scoping review of management and outcome.

BACKGROUND: Spinal tuberculosis (STB) is a significant contributor to non-traumatic myelopathy. There is a rising burden in Africa, in parallel with the high prevalence of human immunodeficiency virus. We conducted a scoping review to highlight the disparities in the management and outcomes of STB in Africa. METHODS: This study was conducted using the preferred reporting systems for systematic review and meta-analysis extension for scoping review guidelines. AJOL, Embase, MEDLINE, Google Scholar, and Cochrane CENTRAL databases were searched to identify all relevant peer-reviewed articles published on the management of STB in African centres, excluding abstract-only articles, literature reviews, and meta-analyses. RESULTS: 60 studies were eligible for inclusion, comprising data from 3416 patients aged eight months to 89 years (median, 32 years). Thoracic and lumbar segments were the most commonly affected vertebral regions (Thoracic = 42.7%; Lumbar = 35.9%). The most common clinical features were back pain and neurological deficits. Lack of essential laboratory and imaging diagnostic infrastructure was a common problem. Patients received antitubercular therapy (ATT) for varying durations and only 18.3% underwent surgery. A favourable outcome was achieved in 51.6% of patients, 20.3% developed a permanent disability, and the mortality rate was 2.1%. Treatment outcome was adversely affected by a high rate of late presentation and treatment default. CONCLUSIONS: ATT remains the mainstay of treatment, however, the duration of treatment varied widely among studies. Further research is required to explore the feasibility and efficacy of short-course ATT in treating STB in the African population.

Use of Subfascial Passive Bile Bag Drainage for the Management of Durotomies in Spine Surgery.

INTRODUCTION: Historically, the use of subfascial drains for the management of durotomies was avoided due to concerns about the creation of cerebrospinal fluid (CSF) fistulas. Currently, there are limited series utilizing subfascial drainage for CSF leak management, many of which utilize suction drainage. We report our experience with the use of subfascial passive drainage in the management of such leaks. OBJECTIVE: To demonstrate the efficacy of a passive subfascial bile bag for diversion of CSF post-operatively in concert with a post-operative head of bed (HOB) protocol for the management of durotomies in spine surgery. METHODS: We performed a retrospective chart review of patients who underwent spinal surgery at a single institution performed by one surgeon. Cases utilizing a passive subfascial bile bag for durotomies were identified. A total of 1,882 consecutive surgeries were reviewed, and 108 met the inclusion criteria. The primary outcome was return to the operating room (OR) and/or the need for lumbar drain placement. Patient sociodemographic information and pre-, intra-, and post-operative clinical characteristics were reviewed. RESULTS: A total of 108 patients underwent subfascial bile bag CSF diversion after intra-operative durotomy. Four patients (3.7%) experienced post-operative CSF leakage requiring lumbar drain placement, while only two (1.9%) patients required a return to the OR. One patient returned to the OR for symptomatic pseudomeningocele and the other for ongoing CSF drainage from their wound. CONCLUSION:  Durotomies are known to increase complication rates, including reoperation. The use of subfascial passive bile bag drainage in concert with a post-operative HOB protocol is a safe and effective manner to manage durotomies while minimizing the need for reoperation.

Navigation-Guided C-arm-Free Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Comparative Study of Cage Orientation and Screw Insertion Accuracy Against the Conventional C-arm-Assisted Technique.

BACKGROUND: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is a widely utilized technique in spine surgery. This study compares the efficacy and safety of MIS-TLIF performed with traditional C-arm fluoroscopy and C-arm-free O-arm navigation. To the best of our knowledge, our study is the first to compare cage positioning between C-arm-free and C-arm techniques for MIS- TLIF. METHODS: A retrospective, comparative analysis was conducted on 43 patients undergoing MIS-TLIF. The group was divided based on the utilization of C-arm fluoroscopy or C-arm-free O-arm navigation. Key parameters analyzed included cage orientation, screw insertion accuracy, operative efficiency, and postoperative recovery. Radiographic measurements were used to assess surgical precision and perioperative complications were documented. RESULTS: The study encompassed 43 patients, with no significant differences in demographic characteristics between the two groups. Surgical time and blood loss were comparable between C-arm-free and C-arm groups. O-arm navigation significantly reduced pedicle screw misplacement (p=0.024). Cage positioning differed between groups (p=0.0063): O-arm cages were mostly mid-center, while C-arm cages were more anterior-center. Such differences in the cage location did not cause any impact on clinical outcome. No significant differences were observed in postoperative complications (screw loosenings, dural tears, surgical site infections) between groups. The Oswestry Disability Index scores at the final follow-up showed no significant difference between the O-arm and C-arm groups, indicating similar levels of postoperative disability. CONCLUSION: Despite the clinically insignificant difference in cage placement between C-arm-free and C-arm dependent, C-arm-free MIS-TLIF significantly improves screw placement accuracy and reduces radiation exposure to operating stuff. This suggests its potential as a valuable tool for safer and more precise spinal fusion surgery.

Strategic Surgical Intervention in a Rare Presentation of Hip-Spine Syndrome With Lumbosacral Malunion: A Case Report.

The hip and lumbar spine are closely related and can create similar patterns of pain and dysfunction. Furthermore, diagnosing and treating hip and spine conditions can be challenging due to the overlap of symptoms. This report describes the successful treatment of a 54-year-old male with hip-spine syndrome following multiple surgeries for spondylolytic spondylolisthesis. The patient presented with low back pain (LBP) and bilateral hip pain, with radiological findings indicating spinal deformity and hip joint synovitis. Two years after two-stage corrective surgery, including pedicle subtraction osteotomy (PSO), the hip synovitis resolved and the symptoms improved. This case emphasizes the need to consider hip-spine syndrome as a possible complication of lumbosacral spine fusion surgery and demonstrates the efficacy of two-stage corrective surgery with pedicle subtraction osteotomy in treating this condition.

Quantifying value loss due to presenteeism and absenteeism in workers' compensation spinal patients.

Background: Recent studies suggest that better outcomes in work productivity following spine surgery eventually offset the higher cost of treatment. By analyzing preoperative and postoperative changes in work productivity, studies can determine if surgery is cost-effective and give patients valuable information about treatment. Prior studies reviewing outcomes in work performance after spine surgery have largely excluded patients on workers' compensation from the overall cost analysis. Methods: A retrospective review of 92 eligible patients was conducted. Evaluation of the EHR identified presenteeism and absenteeism from designated work restrictions. Statistical analyses were conducted using JMP Pro 17. Results: About 84 (83%) spinal surgery cases were able to return to work, 60 (59%) were able to return to work with no restrictions, 26 (26%) received permanent work restrictions, and 12 (12%) were still undergoing treatment. 86 (85%) experienced presenteeism and 99 (98%) experienced absenteeism. Of the cases that were able to return to work without permanent work restrictions, the mean presenteeism length postoperatively was 287.4 days (median 191 days) and the mean absenteeism length postoperatively was 232.5 days (median 142 days). 72 patients were identified as having sedentary or nonsedentary labor. After excluding outliers, the average return-to-work length was 988.62 days for patients with sedentary employment types and 952.15 days for patients with nonsedentary employment types (p=.116). Conclusion: Following spinal surgery, our worker's compensation patient population's return-to-work rate was at an average of 232.5 days (median of 142 days) for 83% of patients included in this study. This exhibited worse outcomes than a previous study's measurement excluding worker's compensation patients. Presenteeism length within our population contributed more to decreased work productivity postoperatively than absenteeism length. Our results found no significant difference in return-to-work length between patients with sedentary and nonsedentary employment types.

Cervical Intradural Fungal Infection Masquerading as a Meningioma in an Immunocompetent Patient: A Case report and Systematic Review.

BACKGROUND: Intradural spinal fungal infection is a rare phenomenon that can carry a significant increase in morbidity and mortality. In this systematic review and case report presentation of a 75-year-old male with an intradural cervical mass that was diagnosed as a fungal infection intraoperatively. The objective of this paper is to analyze and report on intradural spinal fungal infections in immunocompetent patients. METHOD: We performed a systematic literature review following the PRISMA protocol for studies of intradural fungal infections published in the past 25 years. Original articles with a description of treatment outcomes of such patients were included. RESULTS: 8 studies were included in this review with the addition of the present case. There were 5 males and 4 females with the average age of patients was 45.6-year-old (range 24-75). Aspergillus and Candida species being the most isolated fungal organism. The origin of the lesions was identified and iatrogenic in four cases. Most patients underwent decompressive laminectomy with biopsy, abscess drainage, or resection of the identified lesion. There were two instances of cervical lesions, but most of the lesions were in the thoracic and lumbar spine. Half of the cases reported symptoms improvement, but two patients died from the infection or complications from the infections. CONCLUSION: Intradural fungal infections are rare with only ten total cases reported in the past 25 years. Nonetheless, they can be associated with significant mortality and morbidity. Thus, the timeline from presentation to intervention should be evaluated and determined carefully.

Biportal Endoscopic Resection of Intradural Meningioma in the Cervical Spine: A Case Report.

Cervical intradural meningioma are rare central nervous system neoplasms. Surgical resection is the primary treatment due to the tumor's benign nature and clear demarcation from the spinal cord, although the posterior surgical approach can result in complications such as neurological deficits and cerebrospinal fluid leaks. We present a case of a 78-year-old woman with progressive clumsiness, gait disturbance, and weakness. She was diagnosed with an intradural extramedullary meningioma at the C2 to C3 level through magnetic resonance imaging. The tumor was excised using a cervical biportal endoscopic spine surgery approach, a minimally invasive technique that utilizes 2 small portals for endoscope and instrument access. The procedure, performed under general anesthesia, involved a hemilaminectomy and partial laminectomy to access and remove the tumor. Postoperative assessments indicated significant neurological recovery, with the patient regaining independent mobility and fine motor skills. Follow-up magnetic resonance images at 18 months confirmed the absence of tumor recurrence. This case demonstrates the efficacy of cervical biportal endoscopic spine surgery in managing high cervical intradural tumors, highlighting its potential for reducing surgical complications and promoting rapid patient recovery.

Minimally invasive robot-assisted direct pars repair: illustrative cases.

BACKGROUND: Robot-assisted techniques are increasingly integrated into the field of spine surgery, with the potential benefits of increased accuracy and reduced radiation exposure. The objective of this study was to describe the technique of minimally invasive robot-assisted direct pars repair with 2 case illustrations. OBSERVATIONS: An 18-year-old male and a 42-year-old male, both with bilateral L5 spondylolysis, underwent successful minimally invasive L5 direct pars repairs with robotic assistance after conservative measures failed, and their cases are presented herein. LESSONS: A robot-assisted direct pars repair is a safe and effective technique for treating bilateral lumbar spondylolysis. The integration of robot-assisted techniques in spine surgery has the potential to improve outcomes, decrease surgical time, and reduce the amount of radiation exposure to operating room staff. https://thejns.org/doi/10.3171/CASE2415.

The footprint mismatch of cervical disc arthroplasty comes from degenerative factor besides ethnic factor.

A mismatch in footprints of cervical total disc arthroplasty (CTDA) implants occasionally occurred in Asian population and it had been attributed solely to ethnic factor. Yet, cervical degeneration process may play a role. Our purpose was to compare the cervical vertebra morphometric data with and without degeneration. The study included patients with CT scans of cervical spine from our hospital between January, 2019, and September, 2021. The total cervical degenerative index (TCDI) of each patient were collected by adding CDI score for 5 disc-levels. Patients were categorized into normal (TCDI 0-5) and degeneration groups (TCDI 6-60). Various measurements of the C3-C7 vertebral body and endplate were taken. Forty-nine patients in the normal group and 55 in the degeneration group were included. No significant difference was noted in gender, BH, BW, or BMI except age and TCDI (p < .001). During degeneration, disproportional endplate size changes were observed, with an increment ratio of 12-20% in the anteroposterior and 5-17% in the mediolateral plane throughout C3-C7, while vertebral body height remained constant. In conclusion, degeneration process, besides ethnic factor, causes the endplate size and shape mismatch. This information can help spine surgeon choose appropriate implants in CTDA surgery.

Cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine - A case report.

Background: Few studies discuss the complication of pulmonary cement embolism (PCE) due to cement augmented pedicle screw instrumentation (CAPSI) of the thoracolumbar spine. Case Description: A 62 female with a history of multiple myeloma and Sjogren's syndrome on chronic steroids developed an osteoporotic L1 compression fracture and underwent posterior stabilization with a T10-L4 CAPSI. However, postoperatively, the patient developed a surgical site infection and a PCE, resulting in severe respiratory compromise and death 1 month later. Conclusion: When performing a T10-L4 thoracolumbar CAPSI (i.e., augmented pedicle screw instrumentation of the thoracolumbar spine) to address an L1 osteoporotic compression fracture, a 62 year old patient developed a life ending multi organ deficiency due to sepsis together with a PCE.

Intradural extramedullary cervical cavernoma.

Background: Spinal cavernomas (SCs) account for about 5% of all spinal vascular malformations. Intradural SCs occur in just 3% of cases and are typically intramedullary. Case Description: A 58-year-old female presented with progressive left occipital neuralgia, left cervicobrachial neuralgia, and paresthesia of all four extremities. The magnetic resonance imaging (MRI) revealed an intradural extramedullary C2-C4 lesion causing significant spinal cord compression. Gross total tumor excision was accomplished through a midline laminectomy pathologically; the lesion proved to be a cavernoma. The postoperative follow-up MRI obtained 4 months postoperatively showed complete tumor resection. Conclusion: A 58-year-old female successfully underwent gross total excision of a C2-C4 intradural extramedullary SC.

Recent advances of 3D-printing in spine surgery.

Background: The emerging use of three-dimensional printing (3DP) offers improved surgical planning and personalized care. The use of 3DP technology in spinal surgery has several common applications, including models for preoperative planning, biomodels, surgical guides, implants, and teaching tools. Methods: A literature review was conducted to examine the current use of 3DP technology in spinal surgery and identify the challenges and limitations associated with its adoption. Results: The review reveals that while 3DP technology offers the benefits of enhanced stability, improved surgical outcomes, and the feasibility of patient-specific solutions in spinal surgeries, several challenges remain significant impediments to widespread adoption. The obvious expected limitation is the high cost associated with implementing and maintaining a 3DP facility and creating customized patient-specific implants. Technological limitations, including the variability between medical imaging and en vivo surgical anatomy, along with the reproduction of intricate high-fidelity anatomical detail, pose additional challenges. Finally, the lack of comprehensive clinical monitoring, inadequate sample sizes, and high-quality scientific evidence all limit our understanding of the full scope of 3DP's utility in spinal surgery and preclude widespread adoption and implementation. Conclusion: Despite the obvious challenges and limitations, ongoing research and development efforts are expected to address these issues, improving the accessibility and efficacy of 3DP technology in spinal surgeries. With further advancements, 3DP technology has the potential to revolutionize spinal surgery by providing personalized implants and precise surgical planning, ultimately improving patient outcomes and surgical efficiency.