Expandable Technology Improves Clinical and Radiographic Outcomes of Minimally Invasive Lateral Lumbar Interbody Fusion for Degenerative Disc Disease.

Background: Static interbody spacers are standard of care for minimally invasive lateral lumbar interbody fusion (MIS LLIF). However, placement of large static interbody spacers typically requires multiple trialing, endplate preparation, and forceful impaction. A lateral expandable interbody spacer with adjustable lordosis can be inserted at a reduced height, to optimize the endplate-to-endplate fit.

Comparative Effectiveness of Laterally Placed Expandable versus Static Interbody Spacers: A 1-Year Follow-Up Radiographic and Clinical Outcomes Study.

Study Design: Retrospective chart review.

Purpose: This study compared the clinical and radiographic outcomes of patients treated with expandable and static interbody spacers following minimally invasive lateral lumbar interbody fusion (MIS-LLIF) with 12-month follow-up.

Overview Of Literature: A common surgical option for the treatment of degenerative disk disease (DDD) is MIS-LLIF using static or expandable spacers to restore disk height (DH), neuroforaminal height (NH), and segmental lordosis.

Navigated robotic assistance improves pedicle screw accuracy in minimally invasive surgery of the lumbosacral spine: 600 pedicle screws in a single institution.

Background: In the emerging field of robot-assisted spine surgery, radiographic evaluation of pedicle screw accuracy in the surgical setting is of high interest. Advances in medical imaging have improved the accuracy of pedicle screw placement, from fluoroscopy-guided to computer-aided navigation.

Methods: A retrospective, institutional review board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed.

Expandable spacers provide better functional outcomes than static spacers in minimally invasive transforaminal lumbar interbody fusion.

Background: Transforaminal lumbar interbody fusion is an effective and frequently performed surgical treatment of chronic lower back pain. Expandable interbody spacers are designed to create greater disc height through expansion. It remains unclear whether the benefits of expandable technology will translate into clinical benefits.

Navigated robot-guided pedicle screws placed successfully in single-position lateral lumbar interbody fusion.

Minimally invasive lateral interbody fusion has distinct advantages over traditional posterior approaches. When posterior stabilization is needed, percutaneous placement of pedicle screws from the lateral decubitus position may potentially increase safety and improve operative efficiency by precluding the need for repositioning. However, safe placement of pedicle screws in the lateral position remains technically challenging.

Does the accuracy of pedicle screw placement differ between the attending surgeon and resident in navigated robotic-assisted minimally invasive spine surgery?

Robotic assistance with integrated navigation is an area of high interest for improving the accuracy of minimally invasive pedicle screw placement. This study analyzes the accuracy of pedicle screw placement between an attending spine surgeon and a resident by comparing the left and right sides of the first 101 consecutive cases using navigated robotic assistance in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 106 navigated robot-assisted spine surgery cases was performed.

Navigated robotic assistance results in improved screw accuracy and positive clinical outcomes: an evaluation of the first 54 cases.

Computer-aided navigation and robotic guidance systems have become widespread in their utilization for spine surgery. A recent innovation combines these two advances, which theoretically provides accuracy in spinal screw placement. This study describes the cortical and pedicle screw accuracy for the first 54 cases where navigated robotic assistance was used in a surgical setting.

Pedicle screw accuracy in clinical utilization of minimally invasive navigated robot-assisted spine surgery.

In the emerging field of robot-assisted spine surgery, the radiographic evaluation of pedicle screw accuracy in clinical application is an area of high interest. This study describes the pedicle screw accuracy of the first 56 consecutive cases in which navigated robotic assistance was used in a private practice clinical setting. A retrospective, Institutional Review Board-exempt review of the first 56 navigated robot-assisted spine surgery cases was performed.

Robotic-assisted navigated minimally invasive pedicle screw placement in the first 100 cases at a single institution.

Proper pedicle screw placement is an integral part of spine fusion requiring expertly trained spine surgeons. Advances in medical imaging guidance have improved accuracy. There is high interest in the emerging field of robot-assisted spine surgery; however, safety and accuracy studies are needed.

What Are the Indications for Spinal Fusion Surgery in Scheuermann Kyphosis?

Background: Surgical indications for Scheuermann kyphosis are variable. We sought to evaluate the characteristics of patients undergoing operative versus nonoperative treatment of Scheuermann kyphosis to better understand current practices and the factors which contribute to the decision for surgical management.

Methods: Multicenter prospective cohort study.

Oswestry Disability Index: Is Telephone Administration Valid?

Background: The Oswestry Disability Index (ODI) is among the most widely used patient reported outcome measures for the assessment of spinal conditions. Traditionally, the ODI has been administered in outpatient clinics on a face-to-face basis, which can be expensive and time consuming. Furthermore, the percentage of patients lost to clinical follow-up is high, particularly after 2-5 years.

Predictive Value and Interrater Reliability of Radiographic Factors in Neurofibromatosis Patients With Dystrophic Scoliosis.

Background: Scoliosis in patients with neurofibromatosis type I (NF1) can manifest as dystrophic or nondystrophic curves. Dystrophic scoliosis is rapidly progressive, rendering treatment challenging. Radiographic characteristics have been reported to predict dystrophic scoliosis, but their reliability and predictive value have not been well described.

Current Evidence Regarding the Diagnostic Methods for Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee.

Study Design: Structured literature review.

Objectives: The Scoliosis Research Society (SRS) requested an assessment of the current state of peer-reviewed evidence regarding pediatric lumbar spondylolisthesis with the goal of identifying what is known and what gaps remain in further understanding the diagnostic methods for pediatric spondylolisthesis.

Summary Of Background Data: Spondylolisthesis in the lumbar spine is common among children and adolescents and no formal synthesis of the published literature regarding diagnostic methods has been previously performed.

Tranexamic Acid Reduced the Percent of Total Blood Volume Lost During Adolescent Idiopathic Scoliosis Surgery.

Background: Multilevel posterior spine fusion is associated with significant intraoperative blood loss. Tranexamic acid is an antifibrinolytic agent that reduces intraoperative blood loss. The goal of this study was to compare the percent of total blood volume lost during posterior spinal fusion (PSF) with or without tranexamic acid in patients with adolescent idiopathic scoliosis (AIS).

Implant Density at the Apex Is More Important Than Overall Implant Density for 3D Correction in Thoracic Adolescent Idiopathic Scoliosis Using Rod Derotation and En Bloc Vertebral Derotation Technique.

Study Design: Biomechanical analysis of 3D correction and bone-screw forces through numerical simulations of scoliosis instrumentation with different pedicle screw patterns.

Objective: To analyze the effect of different screw densities and distributions on 3D correction and bone-screw forces in adolescent idiopathic scoliosis (AIS) instrumentation.

Summary Of Background Data: Instrumentation constructs with various numbers of pedicle screws and patterns have been proposed for thoracic AIS instrumentation.

Current Evidence Regarding the Treatment of Pediatric Lumbar Spondylolisthesis: A Report From the Scoliosis Research Society Evidence Based Medicine Committee.

Study Design: Structured literature review.

Objectives: The Scoliosis Research Society requested an assessment of the current state of peer-reviewed evidence regarding pediatric lumbar spondylolisthesis to identify what is known and what research remains essential to further understanding.

Summary Of Background Data: Pediatric lumbar spondylolisthesis is common, yet no formal synthesis of the published literature regarding treatment has been previously performed.

Biomechanical effect of pedicle screw distribution in AIS instrumentation using a segmental translation technique: computer modeling and simulation.

Background: Efforts to select the appropriate number of implants in adolescent idiopathic scoliosis (AIS) instrumentation are hampered by a lack of biomechanical studies. The objective was to biomechanically evaluate screw density at different regions in the curve for AIS correction to test the hypothesis that alternative screw patterns do not compromise anticipated correction in AIS when using a segmental translation technique.

Methods: Instrumentation simulations were computationally performed for 10 AIS cases.

Current Evidence Regarding Diagnostic Imaging Methods for Pediatric Lumbar Spondylolysis: A Report From the Scoliosis Research Society Evidence-Based Medicine Committee.

Background: Spondylolysis is common among the pediatric population, yet no formal systematic literature review regarding diagnostic imaging has been performed. The Scoliosis Research Society (SRS) requested an assessment of the current state of peer reviewed evidence regarding pediatric spondylolysis.

Methods: Literature was searched professionally and citations retrieved.

Reliability of the Planned Pedicle Screw Trajectory versus the Actual Pedicle Screw Trajectory using Intra-operative 3D CT and Image Guidance.

Background: Technological advances, including navigation, have been made to improve safety and accuracy of pedicle screw fixation. We evaluated the accuracy of the virtual screw placement (Stealth projection) compared to actual screw placement (intra-operative O-Arm) and examined for differences based on the distance from the reference frame.

Methods: A retrospective evaluation of prospectively collected data was conducted from January 2013 to September 2013.

Sacral bone mineral density (BMD) assessment using opportunistic CT scans.

This study seeks to establish a method for opportunistic evaluation of sacral bone mineral density. This is a retrospective review of 109 scans from 109 patients who had renal-protocol computed tomography (CT) scans performed for any indication during a 3-month period at a single academic institution in 2014. In the collected CT scans, sacral CT-attenuation in multiple regions of interest (ROI) was compared to the L1 CT-attenuation, an internal reference standard, to determine if a correlation existed.

Pulmonary function tests correlated with thoracic volumes in adolescent idiopathic scoliosis.

Scoliosis deformity has been linked with deleterious changes in the thoracic cavity that affect pulmonary function. The causal relationship between spinal deformity and pulmonary function has yet to be fully defined. It has been hypothesized that deformity correction improves pulmonary function by restoring both respiratory muscle efficiency and increasing the space available to the lungs.

Which Malpositioned Pedicle Screws Should Be Revised?

Background: Up to 10% of free-hand pedicle screws are malpositioned, and 1 in 300 patients may undergo return to surgery for revision of malpositioned screws. The indications for revision of asymptomatic malpositioned screws have not been carefully examined in the literature. We sought to evaluate the threshold among spinal deformity surgeons for revision of malpositioned screws.

Accuracy of Pedicle Screw Placement in Children 10 Years or Younger Using Navigation and Intraoperative CT.

Study Design: A consecutive case series.

Objective: To determine the revision rate for pedicle screws placed using intraoperative CT and image-guided navigation in children 10 years or younger.

Summary Of Background Data: Screws are frequently used for spinal instrumentation in young children, although this is only by physician-directed use.

Adolescent Idiopathic Scoliosis Thoracic Volume Modeling: The Effect of Surgical Correction.

Background: Scoliosis has been shown to have detrimental effects on pulmonary function, traditionally measured by pulmonary function tests, which is theorized to be correlated to the distortion of the spine and thorax. The changes in thoracic volume with surgical correction have not been well quantified. This study seeks to define the effect of surgical correction on thoracic volume in patients with adolescent idiopathic scoliosis.