A system of predictive scores to evaluate the risk of multilevel noncontiguous spinal fractures in patients with traumatic cervical spine injury.

PURPOSE: To develop a predictive scoring system to identify traumatic cervical spine injury patients at a high risk of having multilevel noncontiguous spinal fractures. METHODS: This 12-year retrospective observational cohort study included 588 traumatic cervical spine-injured patients. Patients were categorized into two groups: patients with multilevel noncontiguous spinal fractures and patients without this remote injury. Potential risk factors were examined using multivariable analysis to derive a predictive risk score from independent predictors. Results are presented as odds ratio with a 95% confidence interval (95% CI). The accuracy of the calculated predicted score was demonstrated by the area under the receiver operating characteristic curve (AuROC). RESULTS: The incidence of noncontiguous fracture among the patients was 17% (100 of 588). The independent risk factors associated with multilevel noncontiguous spinal fractures were motor weakness, intracranial injury, intrathoracic injury, and intraabdominal injury. The AuROC of the prediction score was 0.74 (95% CI 0.69, 0.80). The patients were classified into three groups, low-risk group (score< 1), moderate-risk group (score 1-2.5), and high-risk group (score≥ 3), based on the predicted risk of multilevel noncontiguous spinal fractures. CONCLUSIONS: This tool can potentially help preventing the missed diagnosis of cervical spine injuries with multilevel noncontiguous spinal fractures. CT scans or MRI of the entire spine to investigate remote multilevel noncontiguous spinal fractures may have a role in cervical spine-injured patients who have at least one of the independent risk factors and are strongly suggested for patients with scores in the high-risk group.

Cervical sagittal parameters in degenerative cervical spondylolisthesis versus degenerative cervical kyphosis with myeloradiculopathy treated by anterior cervical discectomy and fusion.

Background: Adult spinal deformity, especially sagittal imbalance, is affecting health-related quality-of-life (HRQOL) scores. There is a lack of emphasis in the comparison of cervical sagittal parameters in patients with degenerative cervical spondylolisthesis and degenerative cervical kyphosis. The aim of study is to determine the preoperative and postoperative cervical sagittal parameters in myeloradiculopathic patients with degenerative cervical spondylolisthesis and degenerative cervical kyphosis treated by anterior cervical discectomy and fusion (ACDF). Methods: A retrospective medical records and radiographic study of 30 adult patients were reviewed. Fifteen patients with degenerative cervical spondylolisthesis and 15 patients with degenerative cervical kyphosis have been performed ACDF from 2010-2020. We measured the preoperative and postoperative cervical sagittal parameters: C0-C2 angle, C1-C2 angle, C2-C7 angle, C2-C7 sagittal vertical axis (SVA), T1 slope, neck tilt angle and thoracic inlet angle. Minimum follow-up period was at least 2 years. Results: Patients in degenerative cervical kyphosis group have C2-C7 angle less than degenerative cervical spondylolisthesis group (-14.88±7.32 vs. 9.60±13.60), leading to increase the mismatch between T1 slope and C2-C7 angle in kyphotic group and hyperlordosis of C0-C2 angle and C1-C2 angle (31.13±7.68, 37.88±5.08) compare with spondylolisthesis group (13±10.20, 24.60±10.70). Whereas patients with degenerative cervical spondylolisthesis have C2-C7 SVA (33.22±13.92) more than kyphosis group (13.70±13.60). After surgery, there is significant increase of the C2-C7 angle in the kyphosis group compare before and after surgery (-14.88±7.32 vs. 4.10±11.80). While the spondylolisthesis group has no significantly different parameters compare to before surgery. However, the postoperative cervical sagittal parameters of all patients are within the normal thresholds (T1-Slope minus C2-C7 lordosis <15° and C2-C7 SVA <40 mm). Conclusions: The study demonstrates the difference of sagittal parameters between degenerative cervical spondylolisthesis and kyphosis before and after surgery. ACDF not only provides neural decompressive procedure, but also corrects the regional cervical sagittal parameters.

Current Trends in Artificial Intelligence-Assisted Spine Surgery: A Systematic Review.

This systematic review summarizes existing evidence and outlines the benefits of artificial intelligence-assisted spine surgery. The popularity of artificial intelligence has grown significantly, demonstrating its benefits in computer-assisted surgery and advancements in spinal treatment. This study adhered to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a set of reporting guidelines specifically designed for systematic reviews and meta-analyses. The search strategy used Medical Subject Headings (MeSH) terms, including "MeSH (Artificial intelligence)," "Spine" AND "Spinal" filters, in the last 10 years, and English- from January 1, 2013, to October 31, 2023. In total, 442 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 220 that matched the criteria, of which 11 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. In total, 11 studies met the eligibility criteria. Analysis of these studies revealed the types of artificial intelligence-assisted spine surgery. No evidence suggests the superiority of assisted spine surgery with or without artificial intelligence in terms of outcomes. In terms of feasibility, accuracy, safety, and facilitating lower patient radiation exposure compared with standard fluoroscopic guidance, artificial intelligence-assisted spine surgery produced satisfactory and superior outcomes. The incorporation of artificial intelligence with augmented and virtual reality appears promising, with the potential to enhance surgeon proficiency and overall surgical safety.

Endoscopic carpal surgery in carpal tunnel syndrome: A systematic review.

Objective: Endoscopic carpal tunnel release has become increasingly popular and has shown the advantage of early recovery of hand function with minimal morbidity. In this systematic review, we aimed to summarize the currently available data and describe the reported advantages and disadvantages of endoscopic carpal tunnel surgery for treating carpal tunnel syndrome. Methods: In this study, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, which is a set of reporting requirements for systematic reviews and meta-analyses. The search strategy with MeSH terms was "MeSH (carpal tunnel syndrome) AND (endoscopic)" Filters: in the last 5 years, English-on February 27th, 2022. A total of 131 articles fulfilled the first screening criteria. A detailed analysis of those articles identified 39 that matched the criteria, of which 14 were considered appropriate for this analysis after applying the complete inclusion and exclusion criteria. Results: A total of 14 studies met the eligibility criteria. Analysis of those studies found that all types of portals in endoscopic carpal tunnel release reduced postoperative pain at a short-term follow-up. There was no evidence to suggest the superiority of the single- or two-portal techniques in terms of outcomes. In terms of pain relief, symptom resolution, patient satisfaction, duration to return to work, and adverse events, this early use of endoscopic carpal tunnel release produced satisfactory outcomes. Further studies comparing the number of portals are needed. Conclusion: Endoscopic carpal tunnel surgery for treating carpal tunnel syndrome is effective and both single- and dual-portal techniques provide advantages in terms of early recovery and minimal morbidity.

An invasive squamous cell carcinoma of the ankle: a case report.

One to ten percent of all squamous carcinomas are invasive squamous cell carcinomas (ISCC), a rare variation of the disease. According to a recent literature review, less than 25 cases have been reported in the foot and ankle, making it especially uncommon in those areas. Case presentation: The authors present the case of a male patient, 60 years old, who presented with a progressive mass on his left ankle for 2 years with a history of healed burns in that area. The ISCC was diagnosed using histopathology after which he underwent a marginal excision biopsy and split-thickness skin grafting. Wide-marginal excision and split-thickness skin grafting were done. It was noted that the graft had taken well and that there were clear tumour margins postoperatively. The skin graft was almost completely incorporated. No tumour cells were reported on the margins during the postoperative histopathology. Clinical discussion: This case highlights a successful outcome of the patient improved at the 12-month follow-up, and he expressed a high degree of satisfaction with the treatment. Conclusion: ISCC of the lower extremities is a rare disease that almost never affects the ankle and is frequently treated inappropriately since it mimics chronic wounds. It is important to have an index of suspicion in patients with a history of chronic irritation to the area of interest. Surgery is the primary option if ICCS is detected. Clear tumour margins are important, and, if done well, excision should be curative.

Full-Endoscopic Lumbar Discectomy Approach Selection: A Systematic Review and Proposed Algorithm.

STUDY DESIGN: A systematic review of the literature to develop an algorithm formulated by key opinion leaders. OBJECTIVE: This study aimed to analyze currently available data and propose a decision-making algorithm for full-endoscopic lumbar discectomy for treating lumbar disc herniation (LDH) to help surgeons choose the most appropriate approach [transforaminal endoscopic lumbar discectomy (TELD) or interlaminar endoscopic lumbar discectomy (IELD)] for patients. SUMMARY OF BACKGROUND DATA: Full-endoscopic discectomy has gained popularity in recent decades. To our knowledge, an algorithm for choosing the proper surgical approach has never been proposed. MATERIALS AND METHODS: A systematic review of the literature using PubMed and MeSH terms was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient samples included patients with LDH treated with full-endoscopic discectomy. The inclusion criteria were interventional research (randomized and nonrandomized trials) and observation research (cohort, case-control, case series). Exclusion criteria were case series and technical reports. The criteria used for selecting patients were grouped and analyzed. Then, an algorithm was generated based on these findings with support and reconfirmation from key expert opinions. Data on overall complications were collected. Outcome measures included zone of herniation, level of herniation, and approach (TELD or IELD). RESULTS: In total, 474 articles met the initial screening criteria. The detailed analysis identified the 80 best-matching articles; after applying the inclusion and exclusion criteria, 53 articles remained for this review. CONCLUSIONS: The proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.

Automatic Detection, Classification, and Grading of Lumbar Intervertebral Disc Degeneration Using an Artificial Neural Network Model.

BACKGROUND AND OBJECTIVES: Intervertebral disc degeneration (IDD) is a common cause of symptomatic axial low back pain. Magnetic resonance imaging (MRI) is currently the standard for the investigation and diagnosis of IDD. Deep learning artificial intelligence models represent a potential tool for rapidly and automatically detecting and visualizing IDD. This study investigated the use of deep convolutional neural networks (CNNs) for the detection, classification, and grading of IDD. METHODS: Sagittal images of 1000 IDD T2-weighted MRI images from 515 adult patients with symptomatic low back pain were separated into 800 MRI images using annotation techniques to create a training dataset (80%) and 200 MRI images to create a test dataset (20%). The training dataset was cleaned, labeled, and annotated by a radiologist. All lumbar discs were classified for disc degeneration based on the Pfirrmann grading system. The deep learning CNN model was used for training in detecting and grading IDD. The results of the training with the CNN model were verified by testing the grading of the dataset using an automatic model. RESULTS: The training dataset of the sagittal intervertebral disc lumbar MRI images found 220 IDDs of grade I, 530 of grade II, 170 of grade III, 160 of grade IV, and 20 of grade V. The deep CNN model was able to detect and classify lumbar IDD with an accuracy of more than 95%. CONCLUSION: The deep CNN model can reliably automatically grade routine T2-weighted MRIs using the Pfirrmann grading system, providing a quick and efficient method for lumbar IDD classification.

Minimally invasive carpal tunnel release: A clinical case study and surgical technique.

Introduction and importance: Carpal tunnel syndrome (CTS) is the most prevalent type of median nerve entrapment neuropathy. CTR surgery with a single limited incision is becoming more widely accepted. A better recovery, less pillar pain, less scarring, and an earlier return to work are the key benefits of single limited incision. This study provides an inquiry report on the surgical method, surgical advice, and outcomes of single limited incision minimally invasive carpal tunnel release for CTS. Case presentation: A 60-year-old female developed carpal tunnel syndrome (CTS). Patient received minimally invasive carpal tunnel release using single limited incision following the failure non operative treatment and the patient was able to return to work with excellent 1-year outcomes. The patient was extremely satisfied with this operative technique. Clinical discussion: This case highlights a successful outcome of a minimal invasive surgery in CTS. Visual efficiency during surgery and full transverse carpal ligament release are both improved with this technique which requires only a single limited incision. The transverse carpal ligament is totally released with this approach. During the operation, median nerves and superficial palmar arches are not injured. Conclusion: This technique has been shown to be effective and safe for minimal invasive surgery. This technique could be of interest to surgeons performing minimal invasive surgery who treat CTS.

Posterior Endoscopic Cervical Decompression in Metastatic Cervical Spine Tumors: An Alternative to Palliative Surgery.

Metastatic spinal cord compression of the cervical spine is a well-known consequence of cancer that generally manifests as an oncological emergency. This study presents and describes an alternative to the minimally invasive posterior full-endoscopic approach for direct decompression and tumor debulking from the metastasis of hepatocellular carcinoma (HCC) in the cervical spine. A 54-year-old man presented with progressive cervical radiculopathy that had persisted for 3 months. The underlying disease was HCC. Radiographic examination revealed evidence of metastatic spinal cord compression with an epidural mass at the C4-C5 levels, which compressed the C4-C5 spinal cord without bony destruction. The modified Tomita score was 6 to 8 points based on palliative surgery. A posterior full-endoscopic approach to remove the tumor from the metastasis of HCC in the cervical spine was done. A postoperative radiographic study revealed adequate tumor mass resection and spinal decompression. The patient was extremely satisfied with this alternative treatment and achieved complete neurologic recovery at 1 month and no recurrent symptoms at the 6-month follow-up. The technique of posterior full-endoscopic decompression of cervical metastasis causing unilateral radiculopathy, presented in this study, is feasible. This surgical intervention seems to be optional minimally invasive and acts as an alternative to palliative surgery.

Acute traumatic lateral atlantoaxial dislocation associated with locked atlas lateral mass and odontoid process fracture: A clinical case study and literature review.

Background: Traumatic atlantoaxial dislocation combined with locked atlas lateral mass and odontoid process fracture is a complex injury and is extremely rare. We describe the surgical technique by presenting a clinical case study in managing a traumatic lateral atlantoaxial dislocation combined with a locked atlas lateral mass and a type II odontoid fracture (Grauer type IIB). Case description: This is a clinical case study of a 38-year-old female patient who presented with severe neck pain without neurological deficit following a traffic accident. Computed tomography showed a type IIB odontoid fracture and a lateral C1-C2 dislocation with a laterally locked left lateral mass at the C1-C2 level. Emergency management included protecting the cervical spine and applying gradually increasing skull traction. The locked lateral mass and laterally-dislocated C1-C2 facet joints were partially reduced. An intraoperative joint reduction operation with leverage technique was then performed. Posterior C1-C2 fixation (a modified Harms-Goel technique) and fusion with iliac bone graft were then executed. Outcome: Postoperatively, neck pain improved significantly. The atlantoaxial joint was successfully reduced and stabilized. Solid bony fusion was confirmed by a radiographic study at the 1-year follow-up. Conclusions: Based on a review of current literature, traumatic lateral atlantoaxial dislocation combined with a locked atlas lateral mass and type IIB odontoid fracture is rarely seen. It is an extremely unstable injury. Our proposed leverage technique used in conjunction with a modified Harms-Goel technique is an effective alternative treatment. This approach can assist surgeons in the management of these difficult cases.

Atlas (C1) lateral mass screw placement using the intersection between lateral mass and inferomedial edge of the posterior arch: a cadaveric study.

PURPOSE: To compare the Atlas (C1) lateral mass screw placement between screw trajectories of 0° and 15° medial angulation while using the intersection between lateral mass and inferomedial edge of the posterior arch. METHODS: Forty-eight Atlas lateral masses were prepared and divided into 2 groups: Group 1; screws inserted at 3 mm lateral to the reference point with screw trajectory of 0° angulation(N = 24) and Group 2; those inserted with screw trajectory of 15° medial angulation(N = 24). We evaluated the atlas anatomy, screw purchase and the presence of any breaches using CT scan. RESULTS: The radiographic parameters for Groups 1 and 2 were found statistically different (p-value < 0.05): bilateral intraosseous screw lengths (17.92 ± 1.47 mm. vs. 20.71 ± 2.4 mm.), bilateral screw length (29.92 ± 1.72 mm. vs. 33.13 ± 1.78 mm.), left screw medial angulation (x°) (0.67° ± 0.78° vs.14.17° ± 3.51°), right screw medial angulation (y°) (0.83° ± 1.03° vs.14.25° ± 2.53°) and bilateral screw medial angulation (0.75° ± 0.9° vs. 14.21° ± 2.99°). Twenty-two screws (91.67%) using the 0° medial angulation and nineteen screws (79.17%) using the 15° medial angulation had no cortical violations (Grade 0). However, two screws (8.33%) with 0° medial angulation and five screws (20.83%) with 15° medial angulation had breach less than 2 mm (Grade 1). There were no screws with breach between 2 and 4 mm (Grade 2) or greater than 4 mm. (Grade 3). CONCLUSION: A starting point of 3-mm lateral to the intersection between lateral mass and inferomedial edge of the Atlas posterior arch can be safely and effectively used to insert C1 lateral mass using both 0° and 15° medial angulation.

An Unusual Chordoma of the Odontoid Process: A Case Report and Literature Review.

The aim of this study is to present a rare case of chordoma in the odontoid process in which the tumor involved the odontoid process and compressed the spinal cord at the craniocervical junction. We report on the effectiveness and successful outcome of anterior microscopic tumor resection combined with posterior occipitocervical fixation and review the current standard treatment. A 39-year-old man presented with sudden dyspnea and quadriparesis caused by an unknown tumor compression at C2. Radiographic examination revealed a large destructive mass at C2 and heterogeneous enhancement. The patient received urgent surgical intervention by microscopic-assisted anterior tumor resection and posterior spinal fixation from the occiput to the C5 level. The pathohistologic reports for cytokeratins, epithelial membrane antigen, and S-100 protein were positive. The final diagnosis was chordoma of the odontoid process. At the 2-year follow-up, the patient's condition had improved, and a postoperative MRI showed no indication of tumor regrowth. Chordoma of the odontoid process or C2 body is very rare. The current standard management is wide tumor resection to prevent recurrence. The combined approach of anterior tumor resection with microscopic assistance and posterior stabilization of the occiput to C5 is the optimal treatment for this condition.

Spinal nerve compression after malunion of vertical sacrum fractures.

INTRODUCTION AND IMPORTANCE: Unstable pelvic ring injuries often occur in high energy traumas. Vertical sacrum fracture is an associated injury. This report describes a late spinal nerve compression that occurred following surgical reduction and fixation of pelvic ring injuries caused by traumatic L5-S1 disc herniation and malposition of the sacral fracture. CASE PRESENTATION: A 61-year-old female presented with radiculopathy in her right leg after surgical reduction and fixation of a sacral and pelvic fracture. Physical examination revealed numbness and weakness of the right leg. Radiographic studies showed spinal compression caused by a fracture spike from the malunion of the sacrum and protruding disc from the L5/S1 level. The fracture spikes were removed by laminectomy and discectomy after which the patient's condition had improved and she had no recurrent symptoms at the one-year follow-up. CLINICAL DISCUSSION: Malunion of a posterior pelvic ring fracture and a herniated adjacent intervertebral disc can cause sacral nerve root compression. This complication can be managed and satisfactory results achieved by surgical intervention. CONCLUSION: Traumatic L5-S1 disc herniation and malposition following surgical reduction and fixation of a sacrum fracture can be avoided. Posterior decompression by laminectomy and discectomy is an effective alternative treatment for patients with this condition.

An unusual presentation of thoracic diffuse idiopathic skeletal hyperostosis (DISH) and video-assisted thoracoscopic surgery (VATS).

INTRODUCTION AND IMPORTANCE: Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease and Forestier and Rotes-Querol disease, is a systemic condition characterized by calcification and ossification of ligaments and entheses which often mainly affects the thoracic spine. Anterior osteophyte compression of the esophagus resulting in dysphagia and dyspepsia is extremely rare in symptomatic thoracic DISH. CASE PRESENTATION: A 72-year-old male presented with dyspepsia and dysphagia for 10 months. A large beak-like anterior osteophyte, detected by a radiographic study and by a Barium esophagogram test at the T9-T10 level of the thoracic spine, was established by gastrointestinal medicine specialists to be the cause of the symptoms. The large anterior osteophyte was removed using video-assisted thoracoscopic surgery (VATS). At the one-year follow-up, the patient's symptoms had significantly improved and there was no recurrence of the osteophyte or the dyspepsia and dysphagia. CLINICAL DISCUSSION: Thoracic DISH rarely presents with dysphagia and dyspepsia due to the greater mobility of the esophagus in the area of the thoracic spine than in the area of the cervical spine. This is the first reported case of symptomatic thoracic DISH treated by anterior thoracic osteophytectomy with VATS. The treatment was effective with no post-operative complications. CONCLUSION: Anterior thoracic osteophytectomy with VATS is an effective surgical treatment option for this condition.

A Preliminary Report on Augmented Reality Assisted Carpal Tunnel Release.

Augmented reality (AR) refers to the use of technology to enhance a real-world environment by computer generated visual, auditory, haptic, somatosensory and/or olfactory stimuli. We developed an augmented reality-assisted surgery (ARAS) for carpal tunnel syndrome (CTS). It generates a virtual image of the operative field that the surgeon can view. This enhances the operative experience. We report the use of ARAS in performing limited open carpal tunnel release. Level of Evidence: Level V (Therapeutic).

Can acute radiculopathy be caused by upper lumbar hemorrhagic synovial cyst spinal compression in the elderly?

INTRODUCTION AND IMPORTANCE: Acute radiculopathy caused by upper lumbar synovial cysts is rare. They generally present with a slow development of symptoms resulting from spinal canal involvement. Intracyst hemorrhagic synovial cysts are extremely uncommon and can manifest as radicular pain, radiculopathy or even cauda equina compression syndrome. CASE PRESENTATION: A 71-year-old woman with acute back and radicular leg pain presented with worsening symptoms after receiving 1 week of therapy to the left lower limb without trauma. Magnetic resonance imaging (MRI) showed a hemorrhagic synovial intracyst at L2-L3 on the front of the left inter-facet joint which was identified as the cause of the acute back pain and radiculopathy which required surgical removal. Post-surgery, the patient followed the rehabilitation program instructions and attended all scheduled follow-up visits. The patient was asymptomatic at the one-year follow-up. CLINICAL DISCUSSION: Synovial cysts are commonly associated with degenerative changes that occur with aging, although the specific cause is unknown. Surgical removal of an upper lumbar synovial cyst gives better results than non-surgical treatments if the symptoms persist or recurrent. CONCLUSION: For recurrent symptomatic upper lumbar spine synovial cysts (L2-L3), surgery is usually the best option. Surgical removal of an upper lumbar synovial cyst can result in full relief of acute symptoms and reduction of neurologic deficits.

Surgeons' Perspective, Learning Curve, Motivation, and Obstacles of Full-Endoscopic Spine Surgery in Thailand: Results From A Nationwide Survey.

Objective: To report a nationwide survey of the endoscopic spine surgeons across Thailand. Furthermore, the survey will be focused on the perspective of experience, learning curve, motivations, and obstacles at the beginning of their practices. Materials and Methods: The online survey consisting of 16 items was distributed to spine surgeons who are performing endoscopic spine surgery in Thailand via the Google forms web-based questionnaire to investigate participants' demographics, backgrounds, experience in endoscopic spine surgery, motivations, obstacles, and future perspectives. The data was recorded from January 7, 2020 to January 21, 2022. Descriptive statistics were used for analysis. Results: A total of 42 surveys were submitted by 6 neurosurgeons (14.3%) and 36 orthopedic surgeons (85.7%). From the surgeons' perspective, the average number of cases that should be performed until one feels confident, consistently good outcomes, and has minimal complications was 27.44 ± 32.46 cases. For surgeons who starting the endoscopic spine practice, at least 3 workshop participation is needed. Personal interest (39 selected responses) and trending marketing or business purpose (25 selected responses) were the primary motivators for endoscopic spine surgery implementation. Lack of support (18 selected responses) and afraid of complications (16 selected responses) were pertinent obstacles to endoscopic spine surgery implementation. Conclusions: The trend of endoscopic spine surgery has continued to grow in Thailand, shown by the rate of implementation of endoscopic spine surgery reported by Thai spine surgeons. The number of appropriate cases until one feels confident was around 28 cases. The primary motivator and obstacles were personal interest and lack of support.

Anterior screw fixation for type II odontoid process fractures: A single-center experience with the double Herbert screw fixation technique (Retrospective cohort study).

BACKGROUND: In type II odontoid fractures with intact transverse ligament as classified by the Anderson and D'Alonzo system, anterior screw fixation offers the best anatomical and functional results. The goal of this study is to review the results of the double screw technique in anterior odontoid surgery using a headless 3.0-mm.-diameter cannulated Herbert screw on patients with odontoid process fractures. METHODS: From January 2015 through March 2019, 12 cases of acute traumatic type II odontoid fractures were treated with double anterior screw fixation using 3.0-mm Herbert screws, slightly smaller than the standard size for Caucasian populations. The data collected included radiographic measurements, postoperative complications, union rate and clinical outcomes in follow-up examinations over an average of 24-months. RESULTS: The age of the 12 patients, 8 males and 4 females, ranged from 17 to 68 years (mean, 38.42 ± 20.14). The fracture type was type IIa in 4 patients (33.33%) and type IIb in 8 patients (66.67%). The period of follow-up was 15-64 months (mean, 31.42 ± 17.37). All the patients had good clinical results after surgery with no postoperative complications. Eleven cases (92%) had achieved bone union with 1 case (8%) of nonunion. In the nonunion case, the patient was a chronic smoker who continued smoking both during treatment and follow-up. CONCLUSIONS: This series of satisfactory clinical results demonstrates that double anterior screw fixation of type II odontoid process fractures using 3.0-mm screws is highly effective in the Thai population. Headless cannulated cancellous screws provide significant biomechanical strength which is not inferior to the traditional screws.

The adjustable aiming device for caspar pin insertion in anterior cervical spine surgery.

BACKGROUND: Creating a rectangular disc space is an important step during anterior cervical discectomy and fusion or cervical total disc replacement. The study aims to determine the accuracy of Caspar pin insertion by using a novel Adjustable Caspar Pin Aiming Device in anterior cervical procedures. METHODS: Forty Caspar pins were placed using an Adjustable Caspar Pin Aiming Device in 20 human cadaveric cervical vertebral bodies from C3 to C7 after performing anterior discectomies. Accuracy of pin placement was assessed by lateral fluoroscopy, considering superior endplate slope (SE), inferior endplate slope (IE), Caspar pin slope (CP), and endplate-Caspar pin slope difference (SE/CP, IE/CP). RESULTS: The mean superior endplate slope (SE), inferior endplate slope (IE), and Caspar pin slope (CP) were 10.82 ± 2.3°, 10.32 ± 3.2°, and 15.58 ± 7.9°, respectively. The average superior endplate-Caspar pin slope difference (SE/CP) and inferior endplate-Caspar pin slope difference (IE/CP) were 6.6 ± 0.8° and 7.7 ± 0.8°, respectively. The greatest slope difference was observed at the superior and inferior endplates of C3. No cervical endplate violations occurred. CONCLUSION: Adjustable Caspar Pin Aiming Device allowed for a highly accurate Caspar pin placement with the average endplate-Caspar pin slope difference of less than 7.7°. It results in accurate placement of the superior and inferior Caspar pins parallel to the index vertebral endplates. Furthermore, it appears to facilitate the safe and effective insertion of Caspar pins for anterior cervical procedures.