New Technique for Treatment of Spondylolysis and Contralateral Facet Fracture Using Navigation and Robotics: A Case Report.

Case: A healthy 15-year-old male competitive hockey player presented with acute-on-chronic lower back pain was found to have a bilateral pars defect. After conservative treatment, subsequent computed tomography imaging demonstrated partial healing of the right-sided facet fracture but persistent left-sided pars fracture. A novel technique was performed, using robotic navigation to assist in laminar screw placement and to determine the optimal trajectory for subsequent microscopic surgery and bone grafting.

Comparison of rostral facet joint violations in robotic- and navigation-assisted pedicle screw placement for adult lumbar spine instrumentation.

Background Context: Facet joint violation by pedicle screws may lead to adjacent-segment disease and postoperative pain. Previous studies have reported the incidence of rostral facet joint violation using various pedicle screw insertion techniques. However, the incidence of facet joint violations with robotic guidance has not been determined.

Pediatric post-dural puncture headache and paraplegia.

A cerebrospinal fluid (CSF) leak developed in a 14-year-old girl and a 12-year-old boy following a diagnostic lumbar puncture. Two days and sixteen years later, respectively, paraplegia developed due to a functional disorder. Imaging revealed an extensive extradural CSF collection in both patients and digital subtraction myelography was required to pinpoint the exact site of a ventral dural puncture hole where the lumbar spinal needle had gone "through and through" the dural sac.

Risk Factors for Reoperation Following Single-Level Cervical Disc Arthroplasty as Utilized in a Representative Sample of United States Clinical Practice: A Retrospective PearlDiver Study.

Study Design: Retrospective Cohort.

Objectives: Most data regarding cervical disc arthroplasty (CDA) outcomes are from highly controlled clinical trials with strict inclusion/exclusion criteria. This study aimed to identify risk factors for CDA reoperation, in "real world" clinical practice using a national insurance claims database.

Cluster Analysis reveals Socioeconomic Disparities among Elective Spine Surgery Patients.

This work demonstrates the use of cluster analysis in detecting fair and unbiased novel discoveries. Given a sample population of elective spinal fusion patients, we identify two overarching subgroups driven by insurance type. The Medicare group, associated with lower socioeconomic status, exhibited an over-representation of negative risk factors.

Is single-level cervical disc arthroplasty associated with a lower reoperation rate than anterior cervical discectomy and fusion?

Objective: Long-term meta-analysis of cervical disc arthroplasty (CDA) trials report lower rates of subsequent cervical spine surgical procedures with CDA compared with anterior cervical discectomy and fusion (ACDF). The objective of this study was to compare the rate of subsequent cervical spine surgery in single-level CDA-treated patients to that of a matched cohort of single-level ACDF-treated patients by using records from 2010 to 2021 included in a large national administrative claims database (PearlDiver).

Methods: This retrospective matched-cohort study used a large national insurance claims database; 525,510 patients who had undergone a single-level ACDF or CDA between 2010 and 2021 were identified.

New technique and case report: Robot-assisted intralaminar screw fixation of spondylolysis in an adolescent.

Introduction: Management of spondylolysis in adolescents is generally successful with conservative management. Uncommonly, surgical fixation is necessary for refractory cases. Direct repair with intralaminar screws is one commonly utilized technique.

Complications Have Not Improved With Newer Generation Robots.

Study Design: Retrospective cohort study.

Objective: The purpose of this study was to see whether upgrades in newer generation robots improve safety and clinical outcomes following spine surgery.

Methods: All patients undergoing robotic-assisted spine surgery with the Mazor X Stealth Edition (Medtronic, Minneapolis, MN) from 2019 to 2022 at a combined orthopedic and neurosurgical spine service were retrospectively reviewed.

Reliability of a Novel Classification System for Thoracic Disc Herniations.

Study Design: This is a cross-sectional survey.

Objective: The aim was to assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs).

Summary Of Background Data: TDHs are complex entities varying substantially in many factors, including size, location, and calcification.

Perioperative Complications Following Spine Surgery in Adult Patients with Achondroplasia.

Study Design: Retrospective cohort study.

Objectives: To describe the common types of complications and their risk factors during spine surgery in patients with achondroplasia.

Methods: A retrospective review was performed of medical records of adult achondroplasia patients who underwent spine surgery at our institution between 2007 and 2021.

Surgical treatment of young adults with idiopathic scoliosis.

Objective: In this study, the authors report on their experience with the surgical treatment of young adults with idiopathic scoliosis (YAdISs) who did not have surgical treatment in adolescence but did require intervention after skeletal maturity.

Methods: The medical records of YAdISs between 18 and 40 years of age who had been surgically treated at two institutions between 2009 and 2018 were retrospectively evaluated. Pre- and postoperative clinical and radiographic information was gathered and compared at 2 years after treatment.

Minimally Invasive Retropleural Thoracic Diskectomy: Step-by-Step Operative Planning, Execution, and Results.

Background: Thoracic disk herniation is rare and difficult to treat. The minimally invasive lateral retropleural approach to the thoracic spine enables the surgeon to decompress the neural elements and minimize thecal sac manipulation through direct visualization with less exposure-related morbidity.

Objective: To provide a detailed step-by-step overview of the minimally invasive retropleural approach for thoracic diskectomies, including preoperative planning through postoperative care as practiced at our institution.

Evolution of Bioactive Implants in Lateral Interbody Fusion.

Lateral lumbar interbody fusion (LLIF) is an advantageous approach for spinal arthrodesis for a wide range of spinal disorders including degenerative, genetic, and traumatic conditions. LLIF techniques have evolved over the past 15 years regarding surgical approach, with concomitant improvements in implant material design. Bioactive materials have been a focus in the development of novel methods, which reduce the risk of subsidence and pseudarthrosis.

Kickstand rods and correction of coronal malalignment in patients with adult spinal deformity.

Purpose: Coronal malalignment (CM) is a challenging spinal deformity to treat. The kickstand rod (KR) technique is powerful for correcting truncal shift. This study tested the hypothesis that the KR technique provides superior coronal alignment correction in adult deformity compared with traditional rod techniques.

Predictors of subsidence after lateral lumbar interbody fusion.

Objective: Lateral lumbar interbody fusion (LLIF) facilitates the restoration of disc height and the indirect decompression of neural elements. However, these benefits are lost when the graft subsides into the adjacent endplates. The factors leading to subsidence after LLIF are poorly understood.

Should Somatosensory and Motor Evoked Potential Monitoring Be Used Routinely in All Posterior Cervical Operations for Degenerative Conditions of the Cervical Spine?

Objective: Intraoperative neuromonitoring (IONM) is useful during spinal cord operations, but whether IONM is necessary for posterior cervical surgeries for degenerative conditions is unknown. We evaluated the utility of somatosensory evoked potential (SSEP) and motor evoked potential (MEP) monitoring as a tool for predicting new postoperative neurologic deficits during posterior decompression and fusion for degenerative cervical spine conditions.

Methods: We retrospectively reviewed posterior cervical operations performed at our institute over a 4-year period.

Surgical anatomy of minimally invasive lateral approaches to the thoracolumbar junction.

Objective: The thoracolumbar (TL) junction spanning T11 to L2 is difficult to access because of the convergence of multiple anatomical structures and tissue planes. Earlier studies have described different approaches and anatomical structures relevant to the TL junction. This anatomical study aims to build a conceptual framework for selecting and executing a minimally invasive lateral approach to the spine for interbody fusion at any level of the TL junction with appropriate adjustments for local anatomical variations.

Radiographic comparison of lordotic and hyperlordotic implants in L5-S1 anterior lumbar interbody fusion.

Objective: Anterior lumbar interbody fusion (ALIF) used at the lumbosacral junction provides arthrodesis for several indications. The anterior approach allows restoration of lumbar lordosis, an important goal of surgery. With hyperlordotic ALIF implants, several options may be employed to obtain the desired amount of lordosis.

Accuracy of Subaxial Cervical Pedicle Screw Placement Using Direct Visualization Versus Computed Tomography-Based Navigation.

Study Design: Retrospective analysis of operative data from cadaveric cervical spines.

Objective: To evaluate the accuracy of neuronavigation compared with laminotomy with direct visualization (DV) of the pedicle for placement of subaxial pedicle screws.

Summary Of Background Data: Subaxial pedicle screws provide superior fixation compared with other posterior cervical fixation strategies.

Emerging Technologies in Spinal Surgery: Ultra-Low Radiation Imaging Platforms.

Background: Spine surgery has seen tremendous growth in the past 2 decades. A variety of safety, practical, and market-driven needs have spurred the development of new imaging technologies as necessary tools for modern-day spine surgery. Although current imaging techniques have proven satisfactory for operative needs, it is well-known that these techniques have negative consequences for operators and patients in terms of radiation risk.

Safety of lateral access to the concave side for adult spinal deformity.

Objective: Minimally invasive surgery (MIS) techniques, particularly lateral lumbar interbody fusion (LLIF), have become increasingly popular for adult spinal deformity (ASD) correction. Much discussion has been had regarding theoretical and clinical advantages to addressing coronal curvature from the convex versus concave side of the curve. In this study, the authors aimed to broadly evaluate the clinical outcomes of addressing ASD with circumferential MIS (cMIS) techniques while accessing the lumbar coronal curvature from the concave side.