Search Results (151)

Background: Sciatic scoliosis is a nonstructural, compensatory spinal deformity secondary to lumbar disc herniation. In adolescents and young adults, sciatic scoliosis is frequently misdiagnosed as adolescent idiopathic scoliosis due to the low prevalence of lumbar disc herniation in this demographic. Early clinical suspicion is essential, as radiographic features, particularly minimal or absent vertebral rotation on standing radiographs, help distinguish sciatic scoliosis from structural curves such as adolescent idiopathic scoliosis. Key differentiating features include painful scoliosis, a highly positive straight leg raise test, and minimal or absent vertebral rotation on standing radiographs. Delayed diagnosis or inappropriate management may result in residual deformity, highlighting the importance of early surgical decompression. Despite recognition for decades, the literature is fragmented, largely composed of case reports, small series, and retrospective studies, with heterogeneous definitions, radiological assessments, and outcome measures. Objective: Provide a comprehensive, up-to-date systematic synthesis of the clinical presentation, radiological characteristics, management strategies, and outcomes of lumbar disc herniation-associated sciatic scoliosis. Methods: Thirteen studies evaluating conventional open discectomy and minimally invasive endoscopic procedures (FEID/PELD) were included. Data on demographics, surgical approach, clinical improvement (VAS, ODI, Macnab), and radiographic correction (Cobb angle, trunk list, sagittal alignment) were extracted and synthesized. Results: Surgical decompression consistently leads to clinical improvement. Trunk list and coronal deformity were rapidly corrected, with resolution rates ≥ 85% within 6 months across most series. Both open and endoscopic approaches were effective, with minimally invasive techniques offering advantages in tissue preservation and recovery. Conclusions: Sciatic Scoliosis is a reversible, nonstructural deformity that responds reliably to surgical decompression. Accurate recognition, particularly in adolescents and young adults, and timely intervention targeting the underlying nerve root compression are critical for optimal outcomes. This review consolidates fragmented evidence, providing a comprehensive synthesis of current knowledge. Full article

Finite element analysis is widely used to study spinal biomechanics and to compare surgical strategies under controlled loading conditions. By allowing variation in alignment, fixation, and implant design, these models provide insight into stress redistribution and motion changes that are difficult to isolate experimentally. This review examines spine surgery-focused finite element studies published between 2018 and 2024, with emphasis on interbody fusion techniques, adjacent segment mechanics, and implant-related stress behavior. Across lumbar fusion models, constructs incorporating anterior column support demonstrate lower posterior instrumentation stress than posterior-only approaches, with lateral lumbar interbody techniques showing reduced rod and screw stresses across multiple loading conditions compared with posterior lumbar interbody or posterolateral fusion constructs. In the cervical spine, comparisons of plated and zero-profile anterior cervical discectomy and fusion devices show smaller increases in adjacent-level motion and intradiscal pressure with zero-profile constructs, alongside higher localized stress at fixation interfaces. More recent studies apply finite element methods to implant optimization, alignment planning, and patient-specific modeling. Together, these findings suggest that finite element analysis is increasingly used to support surgical planning and implant design, with continued advances in validation and patient-specific simulation likely to strengthen its clinical relevance. Full article

Cervical spondylosis is a common cause of spinal cord dysfunction, and anterior cervical discectomy and fusion (ACDF) is widely employed when conservative treatment fails. Conventional implant systems such as the cervical cage with plate (CCP) and zero-profile stand-alone cage (ZPSC) are commonly used to enhance spinal stability and promote fusion, but they are associated with complications including dysphagia and adjacent segment degeneration. To address these limitations, a novel flexible plate cage system (FPCS) has been developed to optimize biomechanical performance while minimizing surgical risk. In this study, a finite element model of the C3–T1 cervical spine was constructed to simulate ACDF at the C5–C6 level using CCP, ZPSC, and FPCS implants. Under standardized loading conditions, von Mises stress was analyzed in the bone, intervertebral disc, endplates, cage, and screws, using the mean of the top 5% stress values to ensure accuracy. All surgical models showed increased stress compared to the intact reference spine. The ZPSC model exhibited the highest stress in the cage and screws, suggesting a more concentrated load path. The CCP model showed a more evenly distributed stress profile, particularly affecting the inferior adjacent segment. The FPCS model demonstrated moderate cage stress, reduced screw stress, and the highest plate stress, indicating a design that effectively redirects mechanical load from the screw-bone interface toward the anterior plate. This may be related to the unique structural configuration of the FPCS, which secures screws horizontally into the anterior vertebral body without penetrating the endplates. These findings suggest that the FPCS may offer a biomechanically favorable alternative to existing ACDF implants. Full article

Background/Objectives: Postoperative cervical spine radiographs are routinely obtained during in-hospital and follow-up period. We aim to evaluate the utility of postoperative radiographs for identifying instrumentation failure and the subsequent need for revision surgery in patients with traumatic cervical spine injuries. Materials and Methods: A retrospective chart review of patients who had surgical treatment for traumatic cervical spine injury was conducted. Clinical notes and radiographic reports were evaluated. Postoperative radiographs were obtained prior to discharge from the hospital, and subsequently at 2, 6, 12, 24 weeks, and 1 year. Patients who underwent revision surgery, described as any reoperation, were identified. The patients’ indications for surgery were evaluated. The results of postoperative radiographs that prompted a change in management and reoperation were analyzed. Sensitivity and specificity for postoperative radiographs were calculated. Results: A total of 295 patients were reviewed. The rate of revision surgery was 3.7% (n = 11). All 11 patients presented changes in clinical findings and physical exam, but only 3 patients (1%) were identified to have undergone revision surgery due to instrumentation failure seen on radiographs at 13, 89, and 112 days postoperatively, and none within the inpatient period. Two patients underwent revision surgery due to epidural hematoma, and six patients due to wound infection. The overall sensitivity and specificity of routine postoperative radiographs were 27% and 100%, respectively. Conclusions: Postoperative radiographs after cervical spine trauma have low clinical utility for predicting instrumentation failure in the absence of clinical findings, particularly in the inpatient period. Full article

Background: Effective pain control after lumbar disc surgery is a key determinant of recovery. Therefore, we aimed to compare the effects of modified thoracolumbar interfascial plane block (M-TLIP) and erector spinae plane block (ESP) on postoperative pain control and opioid consumption. Methods: This prospective observational comparative cohort study included 96 patients aged 18–70 years with American Society of Anesthesiologists (ASA) physical status I–III who underwent elective single-level lumbar discectomy. Patients received either an M-TLIP block (Group M-TLIP, n = 49) or an ESP block (Group ESP, n = 47). Postoperative pain was assessed using visual analog scale (VAS) scores at 1, 2, 4, 8, and 24 h as the primary outcome. Secondary outcomes included opioid consumption, postoperative nausea and vomiting, Riker’s Agitation Sedation Scale (RSAS) scores, and patient satisfaction. Repeated pain measurements were analyzed using a linear mixed-effects model. Results: Postoperative pain scores were lower in the M-TLIP group compared with the ESP group, particularly during the early postoperative period. Linear mixed-effects modeling demonstrated a significant main effect of group and time, with the analgesic advantage of M-TLIP being most pronounced in the early postoperative hours and diminishing by 24 h. Total tramadol consumption within the first 24 h was significantly lower in the M-TLIP group (p = 0.039). Postoperative agitation, nausea and vomiting, and patient satisfaction scores were comparable between groups. Conclusions: These findings suggest that M-TLIP block may represent a clinically useful alternative to ESP block for postoperative analgesia in lumbar discectomy. Full article

Background and Objectives: Spinal (SA) and general anesthesia (GA) are both available for lumbar disc hernia (LDH) surgery. Patient satisfaction with anesthesia service is under-investigated and may help identify areas requiring improvement, leading to better care. Materials and Methods: A prospective, non-randomized, survey-based study was performed in patients who underwent LDH surgeries under SA or GA. Patients rated perioperative pain (preoperative and postoperative days (PODs) 0, 1, and 2) and satisfaction with perioperative care (10 questions) on a numeric rating scale (NRS) from 0 to 10, and an overall satisfaction score (OSS) was calculated; a patient discomfort questionnaire was also used. Study outcomes were pain scores, satisfaction with care, and discomfort reported by SA and GA patients. Results: In total, 209 completed questionnaires in the GA and SA groups (114 vs. 95) were available for final analysis. Baseline characteristics did not differ significantly between the two groups. The proportion of patients with severe pain decreased from >80% preoperatively to 6% on POD2, and pain scores did not differ significantly between groups. Mean overall satisfaction scores (OSSs) were high: 9.71 (maximum OSS: 57% of cases) in the GA group, and 9.75 (maximum OSS: 53.7% of cases) in the SA group (p = 0.95). The ceiling effect of the patient satisfaction questionnaire had to be addressed. There was no association between the type of anesthesia and OSS. Sources of discomfort were similar between groups, except for oropharyngeal discomfort being more prevalent in the GA group (p < 0.05). Postoperative pain was reported as a source of discomfort by >50% of patients in both the SA and GA groups. Regression analysis identified anxiety and nude body exposure as preoperative factors associated with decreased satisfaction with anesthesia. Postoperative factors associated with submaximal satisfaction were PONV, cold, mouth dryness, and pain. Pain on POD 0 did not influence overall patient satisfaction. An association was only found when pain persisted on POD 1 and POD 2. Conclusions: No significant differences between the two anesthesia methods were found. Patient information, anxiety management, and privacy protection are important for patient satisfaction. In the postoperative period, pain and PONV management must be equally addressed, irrespective of the anesthesia method used. Further efforts to develop optimal tools for patient satisfaction assessment are necessary. Full article

Intervertebral disk pathology, including disk herniation and degeneration, is a major contributor to chronic low back pain, and when conservative treatment fails, surgical management often involves discectomy-based procedures that leave residual annulus fibrosus (AF) defects associated with reherniation and progressive degeneration. These limitations have motivated interest in regenerative strategies using biomaterial scaffolds; however, reproducing the hierarchical, angle-ply architecture of the AF remains challenging. Here, we present a single-step extrusion-based 3D-printing approach to fabricate polycaprolactone (PCL) scaffolds with aligned microscale surface grooves that promote AF-like organization. Patterned nozzles with circumferential peaks generated uniaxial concave microgrooves (10–17 µm wide) directly during printing, enabling formation of multilamellar angle-ply constructs. Human bone marrow-derived mesenchymal stem cells cultured on patterned scaffolds aligned longitudinally within concave grooves, forming end-to-end arrays that guided extracellular matrix deposition. Gene expression analysis showed that topographical cues governed cellular organization without significantly altering gene expression profiles, while TGF-β3 supplementation upregulated outer AF-associated markers, including COL1, COL12, SFRP2, MKX, MCAM, and SCX. TAGLN expression increased specifically on patterned scaffolds in the absence of TGF-β3, indicating an association between microgroove-guided cellular organization and TAGLN expression, warranting further investigation into potential tension-related mechanisms. This novel single-step extrusion-printing approach leverages custom nozzle geometry to impart concave microgrooves, facilitating scalable fabrication of multilamellar angle-ply scaffolds that induce aligned cellular organization and support potential applications in annulus fibrosus repair, as well as mechanobiological studies of anisotropic musculoskeletal tissues. Full article

Lumbar intervertebral disc herniation is a common cause of low back and radicular leg pain, traditionally managed with a combination of conservative therapies and, when indicated, surgical discectomy. An intriguing phenomenon observed in many patients is the spontaneous resorption of herniated disc material over time, often correlating with significant symptom improvement. This article is presented as a narrative review synthesizing experimental, imaging, and clinical literature relevant to spontaneous disc resorption and its implications for clinical decision-making. This paper provides a comprehensive overview of spontaneous disc herniation resorption, exploring the underlying pathophysiological mechanisms and the factors that predict which herniations are likely to regress without surgery. Key mechanisms include inflammatory-mediated degradation of disc fragments, neovascularization with macrophage infiltration and phagocytosis of extruded nucleus pulposus tissue, and biological processes such as enzymatic matrix breakdown and cellular apoptosis that collectively lead to shrinkage of the herniated mass. Patient and disc characteristics that favour spontaneous resorption are identified, such as younger age, extruded or sequestered fragment type, larger initial herniation size, and robust inflammatory response on imaging, whereas certain chronic degenerative changes may reduce this likelihood. We also review current clinical guidelines and expert recommendations on when surgical intervention is warranted versus when conservative management and observation are appropriate. Understanding the probability of natural disc fragment resolution is critical in guiding treatment decisions. In the absence of severe neurological deficits or intractable pain, a period of non-operative management can often be pursued safely, given that the majority of patients experience substantial relief within a few months as discs regress. Conversely, timely surgery is advised for those with neurological compromise or refractory symptoms. By synthesizing the latest evidence on spontaneous disc herniation resorption and its predictors, this review aims to assist neurosurgeons and spine specialists in optimizing patient selection for conservative care and identifying the proper timing for surgical intervention to achieve the best clinical outcomes. Given the narrative design, conclusions are based on synthesis of heterogeneous evidence rather than formal comparative analysis. Full article

Background/Objectives: Degenerative cervical myelopathy (DCM) may result from posture-dependent spinal cord compromise not detectable on neutral imaging. Dynamic MRI can uncover clinically relevant mechanisms underlying otherwise unexplained myelopathy and guide management. This report illustrates a dynamic cervical myelopathy phenotype revealed by flexion–extension imaging and its impact on surgical decision-making. Methods: A 49-year-old man presented with progressive bilateral upper-limb paresthesias, intrinsic hand atrophy, and distal weakness. Neutral cervical MRI, standard radiographs, and flexion–extension MRI were performed to investigate a suspected dynamic etiology, including differentiation from Hirayama disease. Surgical treatment consisted of anterior cervical discectomy and fusion (ACDF), with clinical and radiological follow-up. Results: Neutral MRI showed intramedullary T2 hyperintensity from C4 to C6 without static canal stenosis or frank compression, while radiographs demonstrated segmental kyphosis without instability. Flexion MRI revealed reproducible spinal cord contact with a small cranially located osteophyte at C5–C6, concordant with the myelopathic signal. ACDF at C4–C6 led to clinical improvement. One year later, recurrent symptoms from adjacent-segment pathology (C3–C4 myelopathic signal and C6–C7 foraminal disc herniation) required a second ACDF, resulting in durable neurological stability. Conclusions: This case demonstrates flexion-dependent cord–osteophyte conflict causing cervical myelomalacia in the absence of static stenosis. Dynamic MRI resolved a clinical–radiological mismatch and directly informed surgical planning. Recognition of dynamic myelopathy phenotypes and vigilance for adjacent-segment disease after fusion are essential for optimizing outcomes. Full article

Background: Anterior cervical discectomy and fusion (ACDF) is a widely performed procedure for treating degenerative cervical spine conditions. While it effectively addresses neural decompression and restores segmental alignment, the interplay of baseline alignment and implant-specific factors on postoperative segmental alignment remains underexplored. This study evaluates the influence of preoperative cervical alignment and interbody cage design on segmental alignment changes following 1- to 3-level ACDF. Methods: Following institutional review board approval, we identified 258 patients undergoing ACDF for degenerative pathology between 1 January 2010 and 31 December 2023. Preoperative and postoperative radiographs were analyzed for cervical alignment, disc height, and segmental lordosis. Cage dimensions, lordosis, and positioning relative to vertebral landmarks were recorded. Multivariable linear regression models evaluated predictors of postoperative disc height, segmental lordosis, and their respective changes. Results: Postoperative disc height was positively associated with greater cage height (β = 1.13 mm per mm, p < 0.001) and negatively associated with greater cage lordosis (β = −0.10 mm per °, p = 0.001). Segmental lordosis was positively influenced by cage height (β = 0.78° per mm, p = 0.002) and lordosis (β = 0.42° per °, p = 0.002) but was negatively correlated with the distance of the cage from the anterior edge of the cranial vertebra (β = −1.76° per mm, p = 0.004). Greater preoperative segmental kyphosis predicted more significant postoperative lordosis correction (β = −1.07° per °, p < 0.001). Conclusions: This study underscores the importance of preoperative alignment and interbody cage design in achieving optimal segmental correction following ACDF. While cage height primarily drives disc height restoration, surgical technique, particularly anterior placement of the cage, is pivotal for enhancing segmental lordosis. These findings support personalized surgical planning to optimize alignment and patient outcomes. Full article

Background: Spine surgeries present challenges for patients, including postoperative pain and difficulties with mobilization. Studies indicate that fear and anxiety prolong recovery; multidisciplinary care, including psychoeducation, which informs patients about their condition, addresses emotional challenges, and teaches coping strategies have benefits on recovery. Objectives: This study investigated whether preoperative psychoeducation improves outcomes in spinal surgery by reducing postoperative analgesic use and accelerating mobilization, with the hypothesis that it decreases medication needs and shortens recovery time. Methods: Data of 100 patients operated on spinal disease were analysed: 50 of them underwent microscope-assisted discectomy for lumbar disc herniation (LDH), and 50 were treated with transpedicular posterior lumbar interbody fusion (PLIF) for monosegmental instability. Each group was subdivided into a psychoeducation group (N = 25) and a control group (N = 25). All patients completed the Surgical Fear Questionnaire (SFQ). Postoperative analgesic use and time to mobilization were analysed. Results: Patients receiving psychoeducation in both groups reported lower preoperative anxiety, required fewer analgesics, and, in the PLIF group, achieved earlier mobilization. A strong correlation was found between SFQ scores and analgesic consumption (p < 0.01). Discussion: Preoperative psychoeducation reduced anxiety, decreased postoperative analgesic use, and enhanced mobilization, suggesting clinical and economic benefits if integrated into standard care. Full article

Background: Anterior cervical discectomy and fusion (ACDF) is widely performed and has a low incidence of postoperative infection. Anterior cervical abscess is a rare but potentially life-threatening complication, typically caused by skin or oral flora. Identification of atypical pathogens has important implications for diagnostic vigilance and antimicrobial management. Case Presentation: We report a 56-year-old man with degenerative cervical myelopathy and significant respiratory comorbidity who underwent single-level ACDF and developed progressive dysphagia and neck pain in the early postoperative period. Imaging demonstrated a prevertebral abscess requiring urgent surgical drainage. Intraoperative cultures identified Moraxella catarrhalis, a respiratory tract commensal rarely implicated in postoperative spinal infections. No evidence of esophageal perforation or superficial wound contamination was identified. The patient was treated with surgical washout and prolonged culture-directed antibiotic therapy, with full clinical recovery. To contextualize novelty, we performed a focused review of the available literature on M. catarrhalis spinal infections. Conclusions: This case expands the spectrum of pathogens implicated in postoperative cervical spine infections and highlights the need to consider respiratory tract organisms in high-risk patients, particularly those with chronic pulmonary disease or immunosuppression. Early imaging in the presence of dysphagia, prompt source control, and culture-directed antimicrobial therapy are essential to optimizing outcomes. Full article

Background/Objectives: To evaluate the clinical and radiological outcomes of surgical interventions stratified by dynamic K-line status and to identify predictors of neurological recovery in multilevel cervical ossification of the posterior longitudinal ligament (OPLL). Methods: This study analyzed 535 patients with multilevel cervical OPLL who underwent anterior cervical discectomy and fusion (ACDF), laminoplasty (LP), or laminectomy with fusion (LF), with a minimum 24 months of follow-up. Patients were classified based on dynamic K-line status—neutral (NK-line) and flexion (FK-line)—into three groups: Group 1 (NK-line [+]/FK-line [+]), Group 2 (NK-line [+]/FK-line [−]), and Group 3 (NK-line [−]/FK-line [−]). Radiographic parameters, JOA scores, and VAS were compared, and multivariate regression identified predictors of recovery. A multinomial inverse probability of treatment weighting (IPTW) analysis was conducted to reduce treatment selection bias. Results: Progressive dynamic K-line negativity was associated with greater cervical kyphosis, a higher canal-occupying ratio, reduced FK-line distance, and poorer neurological recovery. After IPTW analysis, ACDF showed higher adjusted recovery across subgroups. In Group 1, younger age and fewer operative levels predicted better recovery. In Groups 2 and 3, LF demonstrated significantly greater neurological recovery than LP. A larger preoperative FK-line distance and a greater postoperative FK-line distance increase were independent predictors of favorable outcomes. Conclusions: Dynamic K-line stratification has good prognostic value in multilevel cervical OPLL. ACDF remains the most effective procedure across dynamic K-line status groups, and LF is preferred over LP in patients with latent or fixed FK-line (−). Incorporating dynamic K-line metrics into surgical planning could improve procedure selection and enhance neurological recovery. Full article

Background/Objectives: Postoperative nausea and vomiting (PONV) remains a frequent and clinically relevant complication following open lumbar discectomy (OLD) under general anesthesia. The present study represents a secondary, post hoc analysis of a randomized controlled trial originally designed to investigate the effects of infiltration anesthesia (IA) on postoperative pain perception and opioid consumption. The objective of this analysis was to explore the incidence of PONV in patients undergoing OLD under adequacy of anesthesia (AoA)-guided general anesthesia, with or without IA. Methods: This secondary analysis included 94 patients undergoing OLD under AoA-guided general anesthesia with fentanyl titration based on the surgical pleth index (SPI). Patients were randomized to receive IA with 0.2% ropivacaine (RF) or bupivacaine (BF) plus 50 µg fentanyl, or no IA (control). PONV was assessed as early (in the post-anesthesia care unit), late (in the neurosurgical ward), and overall (within 48 h postoperatively). Opioid consumption and Apfel risk scores were also analyzed. All analyses related to PONV were exploratory. Results: PONV occurred in 12.8% of patients, with no significant differences between study groups. Postoperative morphine consumption was significantly lower in the RF group than in the control group (2.7 ± 5.3 mg vs. 7.1 ± 5.9 mg; p < 0.05). Higher pre-induction SPI values were observed in patients who experienced early PONV (73.1 ± 9.7 vs. 59.5 ± 17.2; p < 0.05); however, this exploratory finding requires confirmation in larger studies. Conclusions: In this secondary, post hoc analysis, no significant differences in PONV incidence were observed between anesthetic groups in patients undergoing OLD under AoA-guided general anesthesia. The observed association between pre-induction SPI values and early PONV should be interpreted cautiously and requires confirmation in adequately powered prospective studies. Full article

Full-endoscopic lumbar discectomy (FELD) has emerged over time as a minimally invasive alternative to conventional microdiscectomy. This narrative review summarizes the available evidence regarding the evolution, indications, techniques, and outcomes of FELD, with a particular focus on how different types of lumbar disc herniations influence the choice of surgical approach. The literature indicates that the transforaminal approach is most suitable for foraminal and upper lumbar disc herniations, whereas the interlaminar approach is preferred for central or migrated L5–S1 herniations due to the larger interlaminar window at this level. Unilateral biportal endoscopy (UBE) provides better flexibility, visualization, and instrument maneuverability, making it particularly useful in certain cases. Reported complication rates remain low overall but vary according to surgical technique and surgeon experience. The learning curve for FELD typically ranges from approximately 20 to over 50 cases, depending on the approach and individual proficiency. Overall, full-endoscopic techniques are redefining the management of lumbar disc herniations by offering less invasive alternatives with favourable clinical outcomes, and their role is expected to expand further as both technology and surgical expertise continue to evolve. Full article