Does posterior longitudinal ligament resection during cervical artificial disc replacement affect the clinical or radiographic outcome?

Background Context: Much controversy exists about whether posterior longitudinal ligament (PLL) resection should be performed during cervical artificial disc replacement (ADR). The PLL can be resected or preserved during the ADR procedure based on the shape and location of the compressive pathology. However, unlike fusion operations, the outcomes of ADR may be affected by PLL resection since segmental motion is preserved with ADR and the PLL restricts flexion of the segment.

Enhanced Recovery After Surgery Protocols in One- or Two-Level Posterior Lumbar Fusion: Improving Postoperative Outcomes.

Enhanced recovery after surgery (ERAS) protocols optimize perioperative care and improve recovery. This study evaluated the effectiveness of ERAS in one- or two-level posterior lumbar fusion surgeries, focusing on perioperative medication use, pain management, and functional outcomes. Eighty-eight patients undergoing lumbar fusion surgery between March 2021 and February 2022 were allocated into pre-ERAS ( = 41) and post-ERAS (n = 47) groups.

Could indirect decompression occur for cord compression by the ligamentum flavum with anterior cervical discectomy and fusion?

Objective: Cord compression by the ligamentum flavum (CCLF) has been reported to adversely affect the clinical outcomes of anterior cervical discectomy and fusion (ACDF). While indirect decompression does occur for foraminal stenosis with ACDF, whether ACDF could improve CCLF with the distraction of disc space remains unclear. This study aimed to identify 1) whether indirect decompression occurs for CCLF with ACDF, and 2) risk factors that hinder the improvement of CCLF.

Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy.

Background Context: Anterior cervical discectomy and fusion (ACDF) combined with uncinate process resection and laminoplasty combined with foraminotomy (LPF) have been used to achieve cervical cord and root decompression in patients with combined cervical myeloradiculopathy (CMR).

Purpose: To compare the clinical and radiographic outcomes of ACDF with those of LPF for the treatment of CMR.

Study Design/setting: Propensity score-matched retrospective cohort study.

Does Spinal Cord-Canal Mismatch Adversely Affect the Clinical Outcomes of Anterior Cervical Discectomy and Fusion for the Treatment of Cervical Myelopathy?

Study Design: Retrospective cohort study.

Objective: To clarify whether clinical outcomes of anterior cervical discectomy and fusion (ACDF), is affected by presence of spinal canal-cord mismatch (SCCM).

Summary Of Background Data: SCCM is considered a factor that would moderately influence surgeons to perform posterior surgery since it could widen the spinal canal, while an anterior approach could only remove degenerative pathologies grown into the spinal canal.

Which interbody device minimized nonunion, subsidence, and reoperation after anterior cervical discectomy and fusion? A systematic review and meta-analysis comparing allograft versus polyetheretherketone cage.

Objective: Nonunion and significant subsidence after anterior cervical discectomy and fusion (ACDF) are associated with poor clinical outcomes, which occasionally lead to revision surgery. Allograft and polyetheretherketone (PEEK) cages are the two most commonly used interbody spacer devices for ACDF. Although studies have been conducted to compare the efficacies of these two interbody materials, the question remains regarding the superiority of one over the other.

The Perioperative Effects of Preoperative Radiotherapy in Metastatic Spinal Tumor Patients.

Objective: Radiotherapy is one of the important treatment options for metastatic spinal tumors but is not the definite intervention in all cases, as there are patients who still require surgical treatment because of severe pain or neurologic events after this treatment. We evaluated the perioperative effects of preoperative radiotherapy in these cases as a future guide for surgeons on critical considerations in this period.

Methods: We included 328 patients in this study who had undergone decompression and fusion surgery for metastatic spinal tumors.

Risk factors of revision operation and early revision for adjacent segment degeneration after lumbar fusion surgery: a case-control study.

Background Context: Adjacent segment degeneration (ASD) following lumbar fusion operation is common and can occur at varying timepoints after index surgery. An early revision operation for ASD, however, signifies a short symptom-free period and might increase the risk of successive surgeries.

Purpose: We aimed to elucidate the overall risk factors associated with revision surgeries for ASD with distinct attention to early revisions.

Reoperation Rates According to Surgical Approach After Operation for Degenerative Cervical Pathology in Patients With Athetoid Cerebral Palsy: A Nationwide Cohort Study.

Study Design: National population-based cohort study.

Objective: The overall complication rate for patients with athetoid cerebral palsy (CP) undergoing cervical surgery is significantly higher than that of patients without CP. The study was conducted to compare the reoperation and complication rates of anterior fusion, posterior fusion, combined fusion, and laminoplasty for degenerative cervical myelopathy/radiculopathy in patients with athetoid cerebral palsy.

Does Preoperative Radiation Therapy Performed for Metastatic Spine Cancer at the Cervical Spine Increase Perioperative Complications of Anterior Cervical Surgery?

Background: Radiation therapy (RT) performed before anterior cervical spine surgery (ACSS) may cause fascial plane fibrosis, decreased soft-tissue vascularity, and vertebral body weakness, which could increase the risk of esophageal and major vessel injuries, wound complications, and construct subsidence. Therefore, this study aimed to evaluate whether preoperative RT performed for metastatic spine cancer (MSC) at the cervical spine increases perioperative morbidity for ACSS.

Methods: Forty-nine patients who underwent ACSS for treatment of MSC at the cervical spine were retrospectively reviewed.

Shoulder balance in Lenke type 2 adolescent idiopathic scoliosis: correlations among radiological indices, cosmetic indices, and patient-reported outcomes.

Objective: The aim of this study was to investigate the correlation between radiological indices of shoulder balance (SB) and cosmetic indices of shoulder deformity in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) and to determine the extent to which patient-reported outcomes (PROs) correlate with these measurements. Current management decisions and outcomes for SB in AIS are primarily based on radiological measurements. It is crucial to understand how these radiological parameters and cosmetic indices relate to patient satisfaction.

Novel Screw Placement Method for Extremely Small Lumbar Pedicles in Scoliosis.

Consecutive case series. To propose a screw placement method in patients with extremely small lumbar pedicles (ESLPs) (<2 mm) to maintain screw density and correction power, without relying on the O-arm navigation system. In scoliosis surgery, ESLPs can hinder probe passage, resulting in exclusion or substitution of the pedicle screws with a hook.

Comparison of preemptive and preventive intravenous acetaminophen on opioid consumption in pediatrics undergoing posterior spinal fusion surgery: a randomized controlled trial.

Background: Posterior spinal fusion (PSF), commonly used for adolescent idiopathic scoliosis (AIS), causes severe postoperative pain. Intravenous (IV) administration of acetaminophen has shown promise for opioid-sparing analgesia; however, its analgesic effect and optimal timing for its standard use remain unclear. Our study aimed to evaluate the analgesic effect and optimal timing of IV acetaminophen administration in pediatric and adolescent patients undergoing PSF and requiring adequate pain control.

Does Sacral Slanting Affect Postoperative Shoulder Balance in Patients With Lenke Type 2A Adolescent Idiopathic Scoliosis?

Objective: Even minor sacral slanting can influence T1 tilt and shoulder balance. Yet, the relationship between sacral slanting and postoperative shoulder imbalance (PSI) has not been previously explored. To determine risk factors for PSI in Lenke 2A adolescent idiopathic scoliosis (AIS) patients, with an emphasis on sacral slanting.

Exploring the impact of mild-to-moderate foraminal stenosis at L5-S1 on clinical outcomes following L4-5 posterior lumbar interbody fusion.

Background Context: Patients scheduled for L4-5 PLIF often have FS at L5-S1. However, data on the clinical and radiographic outcomes of cases with mild-to-moderate L5-S1 FS are lacking, which may affect clinical outcomes or require additional surgery after L4-5 fusion.

Purpose: To evaluate the clinical and radiographic outcomes of L4-5 PLIF in patients with and without mild-to-moderate L5-S1 FS, with a primary focus on the association between L5-S1 FS and postoperative clinical outcomes including back pain, leg pain, and scores on the oswestry disability index (ODI) and EuroQol 5-dimension (EQ-5D).

Connecting the S2 alar-iliac screw head to the satellite rod for surgical correction of degenerative sagittal imbalance.

Purpose: The S2AI screw technique has several advantages over the conventional iliac screw fixation technique. However, connecting the S2AI screw head to the main rod is difficult due to its medial entry point. We introduce a new technique for connecting the S2AI screw head to a satellite rod and compare it with the conventional method of connecting the S2AI screw to the main rod.

Can We Control Lateral Shoulder Balance Through Proximal Thoracic Curve Correction in Lenke Type 2 Adolescent Idiopathic Scoliosis?

Background: Proximal thoracic curve (PTC) correction has been considered to prevent lateral shoulder imbalance in Lenke Type 2 adolescent idiopathic scoliosis (AIS) patients; however, postoperative shoulder imbalance (PSI) commonly occurs despite these strategies with PTC correction. We investigated the hypothesis that PTC correction would not directly affect PSI in the majority of Lenke type 2 AIS cases. Furthermore, we investigated the risk factors for lateral PSI after corrective surgery.

Risk Factors for Postoperative Loss of Lordosis, Cervical Kyphosis, and Sagittal Imbalance After Cervical Laminoplasty.

Objective: A retrospective cohort study was undertaken to elucidate the risk factors of loss of cervical lordosis (LCL), kyphotic deformity, and sagittal imbalance after cervical laminoplasty.

Methods: A total of 108 patients who underwent laminoplasty to treat cervical myelopathy and were followed for ≥2 years were included. Logistic regression analysis and multiple regression analysis were performed to identify preoperative risk factors of LCL, kyphotic deformity (cervical lordosis <0°), and sagittal imbalance (sagittal vertical axis >40 mm) at postoperative 2 years.

Meta-Analysis on Efficacy and Complications of Bone Morphogenetic Protein-2 for Posterior Fusion of Cervical Spine.

Objective: Recombinant human bone morphogenetic protein-2 (rhBMP-2) is effective for promoting robust fusion for long-level cervical deformity and revision surgeries. However, only a few studies have reported its efficacy and complications in posterior cervical fusion (PCF).

Methods: Therefore we evaluated the efficacy and complications of rhBMP-2 application in PCF surgery by searching 3 electronic databases (PubMed, Cochrane Database, and EMBASE) for studies that evaluated the use of rhBMP-2 in PCF.

Atrophy of the Posterior Cricoarytenoid Muscle as an Indicator of a Recurrent Laryngeal Nerve Injury History Before Revision Anterior Cervical Spine Surgery.

Study Design: Retrospective study.

Objectives: In our recent study, we observed some cases of symptomatic normal vocal cord motility instead of asymptomatic vocal cord palsy (VCP) in preoperative laryngoscopy of a revision anterior cervical spine surgery (ACSS) cohort. We assumed the intrinsic muscle atrophy caused by recurrent laryngeal nerve injury could cause vocal cord-related symptoms.

Does Posterior Cord Compression From the Ligamentum Flavum Influence Clinical Outcomes After Anterior Cervical Discectomy and Fusion?

Study Design: Retrospective cohort study.

Objective: To clarify whether outcomes of anterior cervical discectomy and fusion (ACDF) differ according to the presence of posterior cord compression from the ligamentum flavum (CCLF).

Summary Of Background Data: Although ACDF effectively addresses anterior cord compression from disc material and bone spurs, it cannot address posterior compression.