Search Results (227)

Background/Objectives: Adult Spinal Deformity (ASD) is a pathologic malalignment of the spine that can lead to significant reductions in quality of life, functional limitations, and increased morbidity. While poor mental health is commonly observed among patients undergoing ASD surgery, its impact on surgical outcomes remains poorly understood. We conducted a systematic review and meta-analysis to examine the association between preoperative mental health and outcomes following surgical correction for ASD. Methods: A comprehensive search of MEDLINE, Embase, Web of Science, and Scopus was performed from inception to April 2025 to identify studies investigating the relationship between preoperative mental health and postoperative health-related quality of life outcomes or complications. Data was pooled using a restricted maximum likelihood (REML) random-effects model. Heterogeneity was assessed using Cochran’s Q statistic, and between-study variance was reported as τ². Study quality was assessed with the Newcastle–Ottawa Scale, and risk of bias was evaluated using the ROBINS-I tool. Results: Twenty-four studies comprising a total of 248,427 patients met inclusion criteria. In pooled analyses, patients with poor preoperative mental health showed comparable improvements in health-related quality of life measures after surgery (standardized mean difference [SMD] −0.04, 95% CI −0.30 to 0.22; I² = 91.5%, τ² = 0.42) and in pain scores (SMD −0.15, 95% CI −0.42 to 0.11; I² = 71.8%, τ² = 0.09). However, patients with poor mental health had significantly higher odds of postoperative complications (odds ratio [OR] 1.44, 95% CI 1.23 to 1.67; I² = 97.4%, τ² = 0.08). These patients also demonstrated worse preoperative disease severity (SMD –0.94, 95% CI −1.41 to −0.47; I² = 95.5%, τ² = 1.64) and worse postoperative disease severity (SMD –0.34, 95% CI −0.44 to −0.25; I² = 48.9%, τ² = 0.03). Conclusions: While patients with poor preoperative mental health have a greater disease severity both before and after ASD surgery, they appear to experience comparable benefits from surgical intervention compared to those without. Recognizing and managing mental health may be useful in preoperative management of ASD patients. Further prospective studies to further elucidate these associations are necessary. Full article

Background/Objectives: Correction surgery for adult spinal deformity (ASD) reduces disability but may lead to spinal stiffness. Cultural diversity may also influence how this stiffness affects daily life. We aimed to evaluate the impact of correction surgery on Japanese patients with ASD using a newly developed questionnaire and to clarify how these patients adapt to their living environment postoperatively in response to spinal stiffness. Methods: This retrospective study included 74 Japanese patients with operative ASD (mean age: 68.2 ± 7.5 years; fusion involving >5 levels) with a minimum follow-up of 1 year. Difficulties in performing various activities of daily living (ADLs) were assessed using a novel 20-item questionnaire tailored to the Oriental lifestyle. The questionnaire also evaluated lifestyle and environmental changes after surgery. Sagittal and coronal spinal parameters were measured using whole-spine radiographs, and clinical outcomes were assessed using the ODI and SRS-22 scores. Results: Coronal and sagittal alignment significantly improved postoperatively. Although the total ADL score remained unchanged, four trunk-bending activities showed significant deterioration. The lower instrumented vertebrae level and pelvic fusion were associated with lower scores in 11 items closely related to trunk bending or the Oriental lifestyle. After surgery, 61% of patients switched from a Japanese-style mattress to a bed, and 72% swapped their low dining table for one with chairs. Both the ODI and SRS-22 scores showed significant postoperative improvements. Conclusions: Trunk-bending activities worsened postoperatively in Japanese patients with ASD, especially those who underwent pelvic fusion. Additionally, patients often modified their living environment after surgery to accommodate spinal stiffness. Full article

The management of adult spinal deformity (ASD) has evolved dramatically over the past century, transitioning from external bracing and in situ fusion to complex, technology-driven surgical interventions. This review traces the historical development of spinal deformity correction and highlights contemporary enabling technologies that are redefining the surgical landscape. Advances in stereoradiographic imaging now allow for precise, low-dose three-dimensional assessment of spinopelvic parameters and segmental bone density, facilitating individualized surgical planning. Robotic assistance and intraoperative navigation improve the accuracy and safety of instrumentation, while patient-specific rods and interbody implants enhance biomechanical conformity and alignment precision. Machine learning and predictive modeling tools have emerged as valuable adjuncts for risk stratification, surgical planning, and outcome forecasting. Minimally invasive deformity correction strategies, including anterior column realignment and circumferential minimally invasive surgery (cMIS), have demonstrated equivalent clinical and radiographic outcomes to traditional open surgery with reduced perioperative morbidity in select patients. Despite these advancements, complications such as proximal junctional kyphosis and failure remain prevalent. Adjunctive strategies—including ligamentous tethering, modified proximal fixation, and vertebral cement augmentation—offer promising preventive potential. Collectively, these innovations signal a paradigm shift toward precision spine surgery, characterized by data-informed decision-making, individualized construct design, and improved patient-centered outcomes in spinal deformity care. Full article

Background: Charcot-Marie-Tooth (CMT) disease is a hereditary motor and sensory neuropathy that affects foot morphology and gait patterns, potentially leading to abnormal plantar pressure distribution. This systematic review synthesizes the existing literature examining plantar pressure characteristics in CMT patients. Methods: A comprehensive search was conducted across PubMed, Scopus, and Web of Science databases. Risk of bias was assessed using the Newcastle–Ottawa Scale. Results: Six studies comprising 146 patients were included. Four studies employed dynamic baropodometry, and two used in-shoe pressure sensors to evaluate the main plantar pressure parameters. The findings were consistent across different populations and devices, with a characteristic plantar-pressure profile of marked midfoot off-loading with peripheral overload at the forefoot and rearfoot, often accompanied by a lateralized center-of-pressure path and a prolonged pressure–time exposure. These alterations reflect both structural deformities and impaired neuromuscular control. Interventional studies demonstrated a load redistribution of pressure after corrective surgery, though residual lateral overload often persists. Conclusions: Plantar pressure mapping seems to be a valuable tool to identify high-pressure zones of the foot in order to personalize orthotic treatment planning, to objectively monitor disease progression, and to evaluate therapeutic efficacy. Further longitudinal studies with standardized protocols are needed to confirm these results. Full article

Background: Lateral lumbar or thoracic interbody fusion (LLIF) is increasingly considered for anterior column reconstruction and restoring segmental lordosis in degenerative, infectious, or deformity conditions. Reports about using LLIF with expandable interbody spacers for spine trauma are scarce. Methods: In this retrospective, single-center observational cohort study, we reviewed all patients treated by an expandable LLIF interbody spacer (ELSA^® Expandable Integrated LLIF Spacer, Globus Medical Inc) for trauma indication at our spine center between September 2018 and January 2024. The primary outcome measures were fusion rate at 12 months, change in segmental sagittal Cobb angle, and clinical outcome according to the MacNab criteria. Secondary outcomes included adverse events and complications. Results: We identified n = 21 patients with a mean age of 48.3 (standard deviation (SD) 15.7), 47.6% were female. LLIF was mostly performed at T11/12 (n = 4; 19.1%) and T12/L1 (n = 10; 47.5%). Indications were AO Spine type A2 (n = 4, 19.1%), A3 (n = 14; 66.7%) or A4 fractures (n = 3; 14.3%) with ligamentous (B2-type) in eight (38.1%) and hyperextension (B3-type) injury in one patient (4.8%). Surgery included the release of the anterior longitudinal ligament in four cases (19.1%). Intraoperative AEs were noted in n = 1 (4.8%), postoperative AEs in n = 3 (14.3%) at discharge, n = 4 (19.1%) at three, and n = 2 (9.5%) at twelve months. Segmental sagittal Cobb angle changed from 1.3° (preoperative) to 13.3° at twelve months (p < 0.001). Functional outcome was excellent/good in n = 15 (71.4%; four missing) at 12 months. The fusion rate at the LLIF level was 100% at the 12-month follow-up. Conclusions: LLIF with expandable interbody spacers for spine trauma (off-label use) is safe, promotes solid fusion (100% fusion rate at 12 months), and enables correction of sagittal segmental Cobb angle (mean improvement of 12°), with good or excellent clinical outcomes in most patients (71.4%). Full article

Craniofacial deformities, particularly craniosynostosis, present significant surgical challenges due to complex anatomy and the need for individualised, high-precision interventions. Augmented reality (AR) has emerged as a promising tool in craniofacial surgery, offering enhanced spatial visualisation, real-time anatomical referencing, and improved surgical accuracy. This review explores the current and emerging applications of AR in preoperative planning, intraoperative navigation, and surgical education within paediatric craniofacial surgery. Through a literature review of peer-reviewed studies, we examine how AR platforms, such as the VOSTARS system and Microsoft HoloLens, facilitate virtual simulations, precise osteotomies, and collaborative remote guidance. Despite demonstrated benefits in feasibility and accuracy, widespread clinical adoption is limited by technical, ergonomic, financial, and training-related challenges. Future directions include the integration of artificial intelligence, haptic feedback, and robotic assistance to further augment surgical precision and training efficacy. AR holds transformative potential for improving outcomes and efficiency in craniofacial deformity correction, warranting continued research and clinical validation. Full article

Background and Objectives: Surgical site infections (SSIs) significantly impact pediatric spinal deformity surgery. Considering the increased risk of Gram-negative infections in neuromuscular scoliosis (NMS), broader antibiotic coverage could be advantageous. Some studies suggest extending this approach to all scoliosis etiologies to reduce SSI rates. This study evaluates whether a dual antibiotic prophylaxis with cephalosporin and aminoglycoside reduces SSI incidence within 90 days postsurgery in adolescent idiopathic scoliosis (AIS), NMS, and syndromic scoliosis (SS) patients. Materials and Methods: This study included pediatric patients with AIS, NMS, or SS curves, treated with posterior spinal fusion between January 2019 and December 2022, with a minimum two-year follow-up. The primary outcome was early SSI incidence and its correlation with dual antibiotic prophylaxis in pediatric scoliosis surgery. Secondary outcomes included operative data, blood loss, hemoglobin levels, hospital stay, complications, pelvic fixation, and radiographic correction and how these factors could be identified as potential risk factors for SSIs. Descriptive and inferential statistics were used to analyze antibiotic regimen, SSI risk, and perioperative variables using chi-square, Mann–Whitney U, ANOVA, and Cox regression. Significance was set at p < 0.05. Results: The study included 296 patients: 222 with AIS, 46 with NMS, and 28 with SS. Ninety days postsurgery, SSI rates were 1.2% in AIS (0.8% deep, 0.4% superficial), 6.5% in NMS (all superficial), and 3.5% in SS (all superficial). Deep SSIs in AIS were associated with methicillin-resistant Staphylococcus aureus (MRSA). None of the cases required implant removal. Univariate Cox regression did not reveal any statistically significant predictors for SSIs. However, older age at surgery showed a protective trend, while higher preoperative ASA scores seemed to be a negative prognostic factor (respectively p = 0.051 and p = 0.08). Conclusions: Dual antibiotic prophylaxis with cefazolin and amikacin was associated with a lower SSI rate after posterior spinal fusion for scoliosis, with no adverse events. Further studies are needed to refine dosage, timing, and duration. Full article

Background/Objectives: Proximal junctional kyphosis (PJK) is one of the most frequently discussed complications following corrective surgery in patients with neuromuscular scoliosis (NMS). Despite its clinical relevance, the etiology of PJK remains incompletely understood and appears to be multifactorial. Biomechanical and limited clinical studies suggest that preoperative hyperkyphosis, resection of the spinous processes with consequent disruption of posterior ligamentous structures, and rod contouring parameters may contribute as risk factors. Methods: To validate these findings, we retrospectively analyzed 99 NMS patients who underwent posterior spinal fusion using a standardized screw-rod system between 2009 and 2017. Radiographic assessments were conducted at three time points: preoperatively (preOP), postoperatively (postOP), and at a mean follow-up (FU) of 29 months. Clinical variables collected included patient age, weight, height, sex, and Risser sign. Radiographic evaluations encompassed Cobb angles, thoracic kyphosis (TK), lumbar lordosis, the levels of the upper (UIV) and lower (LIV) instrumented vertebrae, the total number of fused segments, parameters of sagittal alignment, the rod contour angle (RCA), and the postoperative mismatch between RCA and the proximal junctional angle (PJA). Based on the development of proximal junctional kyphosis, patients were categorized into PJK and non-PJK groups. Results: The overall incidence of PJK was 23.2%. In line with previous biomechanical findings, spinous process resection was significantly associated with PJK development. Furthermore, the PJK group demonstrated significantly higher preoperative TK (59.3° ± 29.04° vs. 34.5° ± 26.76°, p < 0.001), greater RCA (10.2° ± 4.01° vs. 7.7° ± 4.34°, p = 0.021), and a larger postoperative mismatch between PJA and RCA (PJA−RCA: 3.8° ± 6.76° vs. −1.8° ± 6.55°, p < 0.001) compared to the non-PJK group. Conclusions: Spinous process resection, a pronounced mismatch between postoperative PJA and RCA (odds ratio [OR] = 1.19, p = 0.002), excessive rod bending (i.e., high RCA), and severe preoperative thoracic hyperkyphosis with an expected increase in the risk of PJK of approximately 6.5% per degree of increase in preoperative TK are significant risk factors for PJK. These variables should be carefully considered during the surgical planning and execution of deformity correction in NMS patients. Full article

Orthognathic surgery is a successful surgical method for correcting facial deformities, and the piezoelectric system can be used in place of or in addition to traditional tools like the reciprocating saw to perform osteotomies. This study assesses how using a reciprocating saw or a piezoelectric device exclusively affects neurosensory impairment. A review was performed following the PRISMA-ScR recommendations. A search was conducted until December 2024 in PubMed, Embase, and Web of Science. Clinical trials and quasi-experimental studies in English and Spanish were included. A total of nine articles were obtained for full-text review using inclusion and exclusion criteria. The selected articles included a total of 731 subjects. The age range of the studies included was between 18 and 49 years. Three of the six analyzed state that piezoelectric surgery positively correlates with neurosensory recovery, showing less surgical time and a less painful and faster postoperative recovery than the use of a saw. However, only two reported no significant statistical difference in sensitivity recovery between the saw and piezoelectric instruments. Despite the methodological heterogeneity among the studies included, the sample size, and the variability of factors, using a piezoelectric system typically shows a better postoperative recovery of sensitivity compared to using a saw. Full article

Background: Rhinoplasty is a leading cosmetic surgery, with the crooked nose being one of the most complex challenges due to its combination of functional and aesthetic issues. Involving multiple nasal components, a crooked nose remains difficult to correct, with a high recurrence rate. The aim of this study was to analyze the long-term outcomes and stability of the nasal pyramid after surgery through a nasal grid analysis. Methods: A retrospective study was conducted on 360 patients (20 men and 16 women) treated for moderate to severe nasal deviation between January 2014 and January 2020. All patients underwent surgery by the same expert surgeon, with follow-ups extending to at least 24 months. Medical records, physical exams, and standardized photographic evaluations were used to assess outcomes. A nasal grid was adapted to analyze the long-term stability of nasal corrections, focusing on individual post-operative changes. Results: The study involved 360 patients, mostly men aged 22 to 65, with the majority having nasal deviations caused by extrinsic trauma (e.g., sports injuries). Nasal deviations affected various parts of the nose, and all patients underwent follow-up evaluations using a nasal grid to compare pre- and post-operative measurements. The results showed long-term stability in nasal corrections, with minimal changes observed between 1 month and 24 months post-surgery. Only one case had partial recurrence, requiring revision surgery, which was successful. Conclusions: The surgical correction of a crooked nose is complex and requires a personalized approach, particularly for severe septal deviations. Complete anatomical reconstruction, using advanced techniques like extracorporeal septal reconstruction and laser osteotomies, provides stable long-term results. The adapted nasal grid proved to be not only an effective post-operative assessment tool but also shows potential for the pre-operative classification of nasal deformity complexity. Although this study focused on a standardized surgical technique, future comparative analyses with alternative approaches are recommended to further validate the outcomes. Full article

Background: Complex hindfoot pathologies involving critical-sized bone defects of the talus are difficult to manage. The current management involves arthrodesis and bone grafting with the defective talus, which have limitations in restoring structural integrity and functional goals. The advancement of 3D-printed scaffolds has opened new avenues to address such complex hindfoot pathologies, which may potentially improve treatment outcomes. The addition of platelet-rich fibrin further enhances healing potential. Method: This is a retrospective study involving six patients with severe talar bone loss secondary to osteomyelitis or avascular necrosis, where 3D-printed scaffolds coated with PRF were implemented in salvage surgery performed from 2023 to 2024. We intended to investigate the clinical outcomes in terms of healing time and union rate. Additionally, we evaluated the degree of deformity corrections and the patients’ clinical outcomes. Results: This study reports six complex reconstructions which achieved CT-confirmed union after a mean duration of 20.2 weeks. All patients were able to ambulate with full weight bearing after an average duration of 23.3 weeks. The patients demonstrated improved radiological parameters, VAS scores from 7.5 ± 1.4 points to 2.3 ± 1.2, and functional scores in all domains for AOFAS, FFI and SF-36. Conclusion: This study demonstrates the benefits of PRF-coated 3D-printed scaffolds in managing complex hindfoot cases, especially in the presence of significant bony defects. This modality has the potential to achieve a good union rate, near-anatomical correction and good functional outcomes. Full article

Numerous studies exist on medial opening wedge supramalleolar osteotomy (SMO), ever since its introduction by Takakura et al., as a joint-preserving surgical option for treating varus ankle osteoarthritis (OA). Although SMO can induce lateral translation of the talus—which is medially translated in varus ankle OA—it has only minimal effects on the correction of the varus tilt of the talus. Particularly, SMO alone does not effectively neutralize the talar position. The primary reason for this limitation is that varus tilting of the talus is not merely a two-dimensional deformity in the coronal plane, but rather a three-dimensional deformity involving internal rotation and anterior subluxation. Therefore, this study aimed to explore the key considerations for achieving effective correction of varus talar tilt in joint-preserving surgery for treating degenerative varus ankle OA with large talar tilting. Further, we have discussed the relevant studies and included the lessons learned from our clinical experience, categorizing the key surgical considerations into preoperative, intraoperative, and postoperative phases. Full article

Background/Objectives: Hallux valgus, or a bunion, is a prevalent foot deformity associated with pain, limited mobility, and reduced quality of life. Surgical treatments include minimally invasive and traditional open techniques, but the optimal approach remains debated. This systematic review evaluates long-term outcomes, patient satisfaction, cost-effectiveness, the influence of patient-specific factors, rehabilitation protocols, and complication rates for these methods. Methods: A comprehensive search of PubMed, Medline, EMBASE, and Cochrane databases identified 22 studies published within the last 15 years, each with a minimum follow-up of 2 years. The systematic review adhered to PRISMA-ScR guidelines. Eligible studies reported on at least one of six key outcomes, and data were extracted on radiographic and clinical results, patient satisfaction, costs, rehabilitation timelines, and adverse events. Results: Minimally invasive bunion surgery (MIBS) showed faster recovery, higher patient satisfaction, and improved quality of life compared to open surgery. Radiographic outcomes, including hallux valgus and intermetatarsal angle correction, were durable, though outcomes were less consistent for severe deformities. MIBS was more cost-effective over time, owing to shorter operating times and faster recovery. Rehabilitation was accelerated, and wound complications were fewer with MIBS. However, open techniques remained preferable for severe deformities due to their reliability in complex corrections. Conclusions: MIBS offers substantial advantages for most patients undergoing bunion surgery, including faster recovery and fewer complications. However, open techniques may be better suited for severe deformities. Further research is needed to refine patient selection criteria and evaluate long-term outcomes in diverse populations. Full article

Background/Objectives: Adult spinal deformity (ASD) affects sit-to-stand (STS) transitions due to abnormal spinal alignment, influencing muscle function. This study investigated lower-extremity electromyographic activity and kinematic parameters during STS transitions in ASD patients. Methods: A cross-sectional study was conducted with ASD patients scheduled for corrective surgery. The STS task was divided into three phases, and electromyographic activity, temporal parameters, and joint kinematics were compared between ASD patients and controls. Surface electromyography measured muscle activity, and a high-speed camera recorded phase durations and joint movements. Results: Compared to 17 controls, 17 ASD patients exhibited significantly increased %MVIC (ASD, controls, p-value) in the biceps femoris during the flexion momentum phase (23.7 ± 26.5, 12.3 ± 8.6, p = 0.048) and extension phase (48.6 ± 25.8, 32.8 ± 40.5, p = 0.011), and in the soleus during the flexion momentum phase (16.2 ± 7.5, 8.5 ± 2.9, p = 0.001). The ASD group also showed greater joint motion and longer phase durations during STS transitions. Conclusions: ASD patients display increased lower limb muscle activation, prolonged phase durations, and more joint motion during STS transitions. These findings highlight neuromuscular and biomechanical differences, though whether these are pathological, adaptive, or compensatory remains unclear. Full article

Background and Objectives: Rheumatoid arthritis (RA) is a chronic autoimmune disease that frequently causes foot deformities, decreasing mobility and quality of life. Although surgical interventions seek to alleviate these alterations, the long-term experiences of patients have not been deeply explored. The aim of this study was to describe the experiences of patients with RA undergoing osteoarticular surgery to correct acquired foot deformities. Materials and Method: A qualitative study design was used with structured interviews including 19 patients with RA treated in a specialised rheumatology service. The thematic analysis was carried out using the Braun and Clarke thematic analysis, ensuring compliance with ethical standards and the anonymity of the participants. Results: Five main themes were identified: experience with pain before and after surgery; impact on functional capacity; complications and need for additional surgeries; emotional impact and quality of life; overall satisfaction with the surgery. While many patients reported significant pain reduction and functional improvements, others faced recurrences of the deformities, persistent pain, and post-surgical complications. Emotional responses ranged from well-being to frustration, depending on surgical outcomes. The five-year follow-up period allowed for a comprehensive assessment of the long-term impact of surgery. The recurrence rate of deformities was notable, and the emotional impact of these recurrences was significant, with patients expressing frustration and distress in some cases. Conclusions: The patients’ experiences were heterogeneous, with both positive and negative outcomes. These findings underscore the importance of individualized management and comprehensive follow-up that consider the clinical outcomes, expectations, and emotional well-being of RA patients undergoing foot surgery. Full article