Robotic-assisted spine surgery-a narrative review.

Background and Objective: Emerging technologies have increasingly been adopted in spine surgery in the attempt to increase precision and improve outcomes. Robotic assistance is an area of significant interest, with proposed benefits including increased accuracy, decreased complication rates, and decreased radiation exposure. The purpose of this review is to provide an overview of the currently available robotic assistance systems and their associated outcomes and limitations. Methods: A review of national databases was performed using key terms "robotic", "spine", and "surgery" for literature from 2014 to 2023. Studies that aimed to describe the utilities of endoscopic surgeries, associated outcomes, limitations, and future directions were included. Studies that were not in English were excluded. Key Content and Findings: This review includes a brief overview of the history of robotic spine surgery as well as its clinical outcomes, limitations, and future directions. Conclusions: Robotic-assisted spine surgery has seen increasing use in the attempt to increase precision and improve outcomes and has been associated with increased accuracy in pedicle screw placement and decreased complication rates. Barriers to its adoption include a significant learning curve, possibly longer operative cases, and significant associated costs. As robotic assistance continues to become increasingly popular in spine surgery, it is critical for surgeons to understand the technology available and the associated outcomes to make informed decisions when considering which system to incorporate into their practice.

Improving Applicant Satisfaction in Orthopaedic Surgery Residency Matching: The Role of Preference Signaling.

Background: The orthopaedic surgery residency match is becoming increasingly more competitive with a disproportionate number of applicants to positions. As the residency application process has become more competitive, applicants have resorted to applying broadly to improve their chance of a successful match. Preference signaling was implemented for orthopaedic surgery for the 2022-2023 match cycle which allowed applicants to "signal" 30 programs of their choosing. Methods: The purpose of this study was to assess the impact of preference signaling on orthopaedic surgery applicant experiences and outcomes in the 2023 residency application cycle and match. An anonymous electronically based survey study developed using Research Electronic Data Capture (REDCap) was send to 895 applicants to a single orthopedic residency program. 148 applicants filled out some portion of the survey for a 16.5% response rate. Results: 51% of applicants applied to 61-100 programs. Applicants received more interview offers from programs they signaled compared to programs they did not signal. 50% of applicants responded that the number of allotted signals was "just right", with more applicants responding that the number of signals allotted was "too many" rather than "too few". 62% of applicants agreed that signaling increased his/her chances of receiving an interview offer at a signaled program, 66% were satisfied with the results of the match, and 50% thought signaling had a positive impact on the application process. Conclusion: Overall, preference signaling was well received by applicants and may help to connect applicants with residency programs they are specifically interested in. Level of Evidence: III.

A narrative review of endoscopic spine surgery: history, indications, uses, and future directions.

Background and Objective: The concept of endoscopic surgery began in the 1930s and has since undergone numerous advancements in both technology and surgical indications. Its main benefit is providing the opportunity to perform surgery while minimizing disruption to surrounding structures. The purpose of this review is to summarize the history, uses, and future directions for spine endoscopic surgery. Methods: A review of national databases was performing using key terms "endoscopic", "spine" and "surgery" for literature from 1900 to 2023. Studies that aimed to describe the utilities of endoscopic surgeries, associated outcomes, limitations, and future directions were included. Studies that were not in English were excluded. Key Content and Findings: This review includes a brief overview of the history of endoscopic surgery and its current two main approaches, transforaminal and interlaminar approaches. It then summarizes the main indications and utilization of endoscopic surgery in the lumbar, cervical and thoracic spine, as well as expansion in managing spine tumors, infections, and outpatient surgical cases. Conclusions: There are many rising indications and uses for endoscopic spine surgery in nearly every aspect of the spine. Compared to conventional spine surgery, there is early evidence showing endoscopic surgery is associated with less post-operative pain, shorter hospital stays, and possibly quicker recovery times. As current trends in spine surgery move towards minimally invasive techniques, it is anticipated that the use of endoscopic surgery will continue to expand.

Lateral interbody fusion for adjacent segment disease: a narrative review.

Background and Objective: Adjacent segment disease (ASD) is a late complication of lumbar fusion characterized by persistent symptoms correlating to radiographic changes in the levels immediately above or below the prior fusion. Lateral interbody fusion (LIF) through a direct lateral approach is a minimally invasive and effective surgical treatment for ASD. Biomechanically, LIF for ASD provides significantly decreased motion in multiple planes. While hardware failure and injury to the lumbar plexus are potential complications, these risks may be outweighed by decreased blood loss, shorter operating room (OR) times, and possibly superior patient reported visual analog scale (VAS) scores compared to traditional posterior spinal fusion (PSF) alone. The purpose of this review is to summarize the history, uses, outcomes, and future directions of LIF for ASD. Methods: A review of national databases (PubMed and SCOPUS) was performed using literature from 1900 to 2022. Keywords included terms "LATERAL" and "LUMBAR" and "INTERBODY" and "FUSION" and "ADJACENT" and "SEGMENT" and "DISEASE". Studies that aimed to describe the biomechanical, clinical course and complications, radiological outcomes, biomechanical aspects, need for revision surgery, and/or patient reported outcomes of the XLIF/LIF technique were included. Key Content and Findings: This review includes a brief overview of the natural history of ASD and current approaches to address it. It then summarizes the main indications and utilization of LIF to address ASD, summarizing reported outcomes in regard to biomechanical, clinical, and radiographic outcomes. Conclusions: LIF has emerged as a minimally invasive and effective surgical treatment for ASD. This mini-review suggests that LIF provides a solid foundational biomechanical construct that has been paired with good patient-reported, clinical, and radiographic outcomes. While further research is required, current literature suggests that LIF for ASD results in fewer complications, decreased morbidity, and decreased need for subsequent surgery compared to other commonly utilized techniques.

Clinical Outcomes of Prone Transpsoas Lumbar Interbody Fusion: A 1-Year Follow-Up.

BACKGROUND: Lateral lumbar interbody fusion (LLIF) is commonly used to address various lumbar pathologies. LLIF using the prone transpsoas (PTP) approach has several potential advantages, allowing simultaneous access to the anterior and posterior columns of the spine. The aim of this study was to report the 1-year outcomes of LLIF via PTP. METHODS: This is a retrospective review of 97 consecutive patients who underwent LLIF via PTP. Radiographic parameters, including lumbar-lordosis, segmental-lordosis, anterior disc height, and posterior disc height, were measured on preoperative, initial-postoperative, and 1-year postoperative imaging. Patient-reported outcomes measures, including Oswestry Disability Index, visual analog scale (VAS), pain EQ5D, and postoperative complications, were reviewed. RESULTS: Ninety-seven consecutive patients underwent 161 levels of LLIF. Fifty-seven percent underwent 1-level LLIF, 30% 2-level LLIF, 6% 3-level LLIF, and 7% 4-level LLIF. The most common level was L4 to L5 (35%), followed by L3 to L4 (33%), L2 to L3 (21%), and L1 to L2 (11%). Significant improvements were noted at initial and 1-year postoperative periods in lumbar-lordosis (2° ± 10°, P = 0.049; 3° ± 9°, P = 0.005), segmental-lordosis (6° ± 5°, P < 0.001; 5° ± 5°, P < 0.001), anterior disc height (8 mm ± 4 mm, P < 0.001; 7 mm ± 4 mm, P < 0.001), and posterior disc height (3 mm ± 2 mm, P < 0.001; 3 mm ± 2 mm, P < 0.001). Significant improvements were seen in Oswestry Disability Index at 6 weeks (P = 0.002), 6 months (P < 0.001), and 1 year (P < 0.001) postoperatively; pain EQ5D at 6 weeks (P < 0.001), 6 months (P < 0.001), and 1 year (P < 0.001) postoperatively; and leg and back visual analog scale at 2 weeks (P < 0.001), 6 months (P < 0.001), and 1 year (P < 0.001) postoperatively. The average length of stay was 2.5 days, and the most common complications were ipsilateral hip flexor pain (46%), weakness (59%), and contralateral hip flexor pain (29%). CONCLUSION: PTP is a novel way of performing LLIF. These 1-year data support that PTP is an effective, safe, and viable approach with similar patient-reported outcome measures and complications profiles as LLIF performed in the lateral decubitus position.

Unpacking the Tibial Tubercle-Trochlear Groove Distance: Evaluation of Rotational Factors, Trochlear Groove and Tibial Tubercle Position, and Role of Trochlear Dysplasia.

BACKGROUND: The tibial tubercle to trochlear groove (TT-TG) distance is often utilized for determining the surgical treatment for patients with patellar instability (PI). It is thought to directly represent the position of the TT on the tibia. Recent work has shown that the measurement of the TT-TG distance is multifactorial. PURPOSE: To investigate the relationship between relative tibial external rotation (rTER) and trochlear dysplasia (TD), as well as the location of the TG and TT in patients with and without PI, and to correlate these and other anatomic measurements with the TT-TG distance. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 89 patients with PI who underwent magnetic resonance imaging were identified with 92 matched control patients. A standardized measurement protocol on axial magnetic resonance imaging determined rTER, the proximal and distal TG lateralization (pTGL and dTGL, respectively) ratios, and the TT lateralization (TTL) ratio. Other measures of interest included the lateral trochlear inclination angle, sulcus angle, and lateral patellar inclination angle. Univariate regression was used to determine the associations of TD (lateral trochlear inclination angle, sulcus angle) with rTER and the TG position, and multivariate regression was used to model associations among all the variables with the proximal and distal TT-TG distances. RESULTS: rTER was significantly higher in the study group (P < .001), and univariate regression showed a significant association between dysplasia measures and rTER (P < .001). The pTGL ratio was lower in the study group (P = .025), but there was no difference in the dTGL ratio (P = .090) or the TTL ratio (P = .098) between the groups. There were no associations between dysplasia measures and the pTGL and dTGL ratios (P > .05). Multivariate regression showed that the proximal TT-TG distance is predicted by the sulcus angle, pTGL ratio, rTER, and TTL ratio (P < .05) and that the distal TT-TG distance is predicted by the lateral patellar inclination angle, dTGL ratio, sulcus angle, rTER, and TTL ratio (P < .05). CONCLUSION: rTER had a significant association with TD. The position of the proximal TG was more medial in patients with PI. There was no significant difference in the TTL ratio between patients with and without PI. The TT-TG distance was associated with multiple anatomic measures and was not solely predicated on the position of the TT.

Role of simultaneous bilateral transforaminal epidural steroid injections in patients with prior lumbar fusions or laminectomies: A retrospective case series.

Objective: The goal of this study is to assess the clinical effectiveness and prognostic potential of simultaneous bilateral lumbar transforaminal epidural steroid injections (TFESIs) in patients with bilateral radicular back pain with previous history of lumbar laminectomy and/or fusion surgery. Design: Retrospective case series. Setting: Single physiatrist in an academic setting. Subjects: 23 patients with previous lumbar surgery who received bilateral TFESIs. Methods: Cumulative bilateral radicular back pain was assessed with a pain numerical rating scale (NRS, 0-10) prior to receiving bilateral TFESI and at minimum 2 weeks follow-up. Responders included patients who experienced any NRS pain reduction post-procedure and non-responders were patients who reported no change in pain. A minimal clinically important difference (MCID) was defined as NRS change ≥2.0 to identify the proportion of responders who experienced a clinically significant reduction in pain. Other outcome measures included subsequent repeat bilateral TFESI, operations at the level of injections, and operative outcomes of these patients. Results: There was a statistically significant (P â€‹< â€‹0.0001) reduction of 2.2 in mean NRS at average 3.7 weeks follow-up. With the MCID defined as NRS pain reduction ≥2, 13 of 16 responders (56%; CI 36.8-74.4%) achieved a clinically significant reduction in pain. Nine patients (39.1%) went on to receive repeat bilateral TFESIs and 9 patients (39.1%) underwent surgical interventions involving the same spinal level as the injections. Eight of the 9 patients who underwent repeat bilateral TFESIs met follow-up criteria and each responded to repeat injections with an average NRS pain reduction of 2.2. Of the 9 surgical patients, 5 responded to the previous injections and each reported improvements in pain and function after their operations (PPV â€‹= â€‹100%). Of the 4 surgical patients who were non-responders to the injections, 2 reported improvements in pain and function post-operatively and the remaining 2 reported no change or worsening outcomes (NPV â€‹= â€‹50%). Conclusion: This study suggests bilateral TFESIs are clinically effective in short-term management of bilateral radicular back pain in patients with previous lumbar surgery, and they reveal potential prognostic information for subsequent surgical intervention.

Surgical Treatment of Pediatric Scoliosis: Historical Origins and Review of Current Techniques.

The treatment of scoliosis has been explored and debated in medicine since the first recorded texts. Scoliosis treatment has shifted over time from external modalities, such as traction and bracing, to internal stabilization techniques that leverage surgical advances. Surgical fixation constructs can generally be separated into two different modalities: dynamic vs. static constructs. For skeletally immature individuals with progressive deformities, surgical options range from traditional or magnetically controlled growing rods to vertebral body staples or tethering. For individuals who have reached skeletal maturity, many devices have been developed that provide static length constructs. Understanding the surgical options available is critical for the appropriate management of this varied patient population. With this article, we sought to provide a summary of past and present techniques and devices used in the treatment of scoliosis.

Late Flexor Entrapment in Neocortex After Pediatric Forearm Fracture: A Case Report.

CASE: A pediatric patient sustained an open Monteggia-equivalent fracture treated operatively. Despite uneventful fracture healing, late-onset extrinsic flexor tightness of the index finger occurred. A neocortex developed about the torn ulnar periosteum, entrapping the index flexor digitorum profundus muscle belly. Despite being 5 years postinjury, motion was improved after proximal muscle release. CONCLUSION: Acute flexor entrapment is well-reported in forearm fractures; however, late-onset entrapment inside a neocortex is not. Although early recognition of restricted motion is ideal, even long-standing contractures may be amenable to improvement with appropriate treatment guided by the physical examination.

Bilateral sciatic hernias in an elderly woman successfully managed with robotic surgery: A case report and literature review.

INTRODUCTION: Sciatic hernias are the rarest form of pelvic floor hernias as well as an uncommon cause of sciatica. A high index of suspicion is required to make the diagnosis due to its variable clinical presentation. This is the first case describing bilateral intestinal sciatic hernia, diagnosis, and robotic surgical repair. PRESENTATION OF CASE: A 77-year-old female with history of chronic back pain and diverticulitis presented with three weeks of abdominal pain, radiating down her legs bilaterally. Computed tomography (CT) revealed bilateral sciatic notch hernias without evidence of bowel obstruction. Magnetic resonance imaging (MRI) confirmed compression of the sciatic nerves within the sciatic notch bilaterally. She underwent robotic bilateral retroperitoneal sciatic notch hernia repair successfully. DISCUSSION: There are several independent causes of abdominal pain and bilateral radiating leg pain. Sciatic hernias are an unusual cause of both. Aside from bowel, the hernia can involve other structures, such as the bladder, ureters, or ovaries, potentially creating drastically different clinical pictures. Laparoscopic or robotic repair have been proven superior to open surgery in the literature. CONCLUSION: This case demonstrates that bilateral sciatic hernias can present as uncomplicated sciatica in an elderly patient, but the addition of seemingly unrelated abdominal pain should warrant further investigation. Minimally invasive robotic repair can successfully treat sciatic hernias.