Search Results (47)

Background and Objectives: Osteoporotic vertebral compression fractures (OVCFs) are a major cause of morbidity, disability, and loss of independence in the elderly population. The optimal management of these fractures remains debated, especially regarding the balance between conservative treatment and minimally invasive surgical techniques such as percutaneous vertebroplasty (VP). This study aimed to compare clinical and radiological outcomes of VP and conservative management in patients with acute OVCFs. Materials and methods: A retrospective observational cohort study was conducted on 120 patients with acute OVCFs treated either conservatively or through percutaneous VP using polymethylmethacrylate (PMMA) cement. Clinical outcomes were assessed using the Visual Analogue Scale (VAS) for pain, Roland–Morris Disability Questionnaire (RMDQ), and Oswestry Disability Index (ODI). Evaluations were performed at baseline and at 1, 3, 6, and 12 months post-treatment. Radiological follow-up assessed fracture healing and new vertebral fractures. Results: Patients treated with VP experienced significantly faster pain relief and functional improvement than those managed conservatively, with marked differences in VAS, RMDQ, and ODI scores within the first month (p < 0.01). By 12 months, outcomes converged between groups, with comparable pain and functional levels. No major complications were reported; cement leakage was asymptomatic, and no neurological or systemic adverse events occurred. Radiological healing was satisfactory in both groups, without increased risk of adjacent fractures in the VP group. Conclusions: Percutaneous vertebroplasty resulted in faster short-term improvement compared with conservative treatment, while functional outcomes converged over time. The retrospective, non-randomized design limits causal inference. Full article

Background/Objectives: Thoracolumbar burst fractures often require surgical stabilization. Although posterolateral fusion (PLF) has been traditionally used, percutaneous posterior fixation (PPF) without fusion has emerged as a less invasive alternative. However, comparative data specifically addressing PPF and PLF are limited. This study aimed to compare the radiological and perioperative outcomes of PPF and PLF for thoracolumbar burst fractures. Methods: This retrospective cohort study analyzed 61 patients with T11–L2 burst fractures (PPF, 28; PLF, 33). Radiological parameters included local and global sagittal alignment and vertebral height ratio. Fracture morphology was assessed using a structured grading system based on anterior height ratios. Perioperative variables were also assessed. Statistical significance was set at p < 0.05. Results: PPF demonstrated significant advantages in operative time (160.7 min vs. 205.8 min, p < 0.01) and blood loss (165 cc vs. 317 cc, p < 0.01), with a shorter hospitalization time. PPF achieved outcomes comparable to PLF in global alignment and anterior height restoration. The PLF group showed greater local kyphotic angle correction (−7.77° vs. −1.53°, p = 0.01), whereas the PPF group showed significantly higher postoperative posterior height ratio (p = 0.02). Changes in morphological grades, assessed using the anterior height ratio-based grading system, showed similar patterns of improvement in both groups. All implant removals were performed due to patient-reported discomfort. Conclusions: PPF yielded radiological outcomes comparable to PLF in the treatment of thoracolumbar burst fractures. The use of a morphological grading system provided a structured descriptive tool to evaluate surgical impact, though its utility remains exploratory and requires further validation. Full article

Background: Contained lumbar disc herniation is a prevalent cause of chronic low back pain and functional impairment. The Disc-FX system, a minimally invasive, percutaneous technique integrating nucleotomy, nucleus ablation, and annuloplasty, offers a multimodal approach to managing early degenerative disc disease. Despite promising short-term outcomes, evidence regarding long-term effectiveness remains limited. Methods: This single-center cohort study evaluated 197 patients (median age: 48 years; 56.85% female) who underwent the Disc-FX procedure between 2017 and 2024. Patients were followed for up to 84 months. Pain and disability were assessed using a Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI), respectively, while satisfaction was measured by the MacNab criteria. Multivariable models, including cumulative link models and linear mixed-effects models, were used to identify predictors of outcomes. Results: The Disc-FX procedure resulted in significant and sustained improvements in pain and function. Mean VAS scores decreased from 7.79 preoperatively to 4.31 at 12 months and remained below baseline at 84 months (5.05). ODI scores improved from 15.43 preoperatively to 9.62 at 36 months, rising slightly to 12.75 at 84 months. Good or excellent outcomes were reported in 66.9% of patients according to MacNab criteria. Male sex (OR = 0.41), longer symptom duration (OR = 0.85), and presence of radicular symptoms (OR = 0.39) were significantly associated with less favorable outcomes. Reoperation occurred in 26.4% of cases, predominantly within the first year and most frequently at L4/L5. Complications were rare (3.08%). Conclusions: This study provides robust evidence supporting the long-term clinical efficacy of the Disc-FX procedure in selected patients with contained lumbar disc herniation. While overall outcomes are favorable, optimal results depend on early intervention and careful patient selection, particularly in relation to symptom chronicity and the presence of radicular signs. Full article

With continued improvements in systemic cancer therapies, there has been an increase in the survivorship of patients with spinal metastases. However, many patients with spinal metastases are frail and may not be able to tolerate the morbidity of open surgery. For these patients, percutaneous ablation techniques offer a minimally invasive approach that can facilitate local tumor control and pain relief. Here we describe the currently employed modalities—radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, and laser interstitial thermal therapy (LITT)—summarize the clinical support for their use, and overview the relative risks and benefits for each. All these technologies offer to help improve local tumor control and improve oncologic pain associated with vertebral metastases, and they have become a staple of multidisciplinary spine metastasis care at many centers. As clinical experience with these technologies continues to grow, their use will likely become more widely adopted, and so understanding of their indications, risks, and benefits will become increasingly important to the practicing spine oncologist. Full article

Background/Objectives: Minimally invasive spine surgery (MISS) is complex and requires proficiency with a variety of technological and robotic modalities. Acquiring these skills is a long and involved process, often with a steep learning curve. This paper seeks to characterize the state of MISS training in neurosurgical and orthopedic residency programs, focusing on their effectiveness at minimizing substantial learning curves in the field, as well as highlighting potential areas for future growth. Methods: We conducted a scoping review of the PubMed, Scopus, and Embase databases utilizing the PRISMA extension for scoping reviews. Results: Of the 100 studies initially identified, 16 were included in our final analysis. MISS training types could be broadly grouped into four categories: virtual simulation (including AR and VR), physical models, hybrid didactic and simulation, and mentored training. Training with these modalities led to improvements in resident performance across multiple different MISS techniques, including percutaneous pedicle screw fixation, MIS dural repair, MIS-TLIF, MIS-LLIF, MIS-ULBD, microscopic discectomy/disk herniation repair, percutaneous needle placement, and surgical navigation. Specific improvements included reduced error rate, operation time, and fluoroscopy exposure, as well as increased procedural knowledge, accuracy, and confidence. Conclusions: The incorporation of MISS training modalities in spine surgery residency leads to increases in simulated performance and could serve as a means of overcoming significant learning curves in the field. Full article

Background: Peripheral nerve stimulation (PNS) has been employed as a therapeutic modality for managing chronic pain across diverse etiologies and neural targets. Nevertheless, its application in treating chronic axial neck pain remains markedly underexplored. Accordingly, this study aimed to both review the existing literature and present a retrospective single-center case series of patients who underwent temporary PNS targeting the cervical medial branch nerves (CMBNs) for chronic axial neck pain. Methods: This investigation comprises a narrative literature review alongside a single-center, retrospective case series evaluating percutaneous, temporary PNS for the management of cervical spondylosis facet arthropathy in the absence of myelopathy or radiculopathy. The primary outcomes were pain reduction, as measured by the numeric rating scale, and improvements in functional disability, with assessments conducted at baseline and at 60 days post-intervention. Results: PNS represents a neuromodulatory, nondestructive intervention that targets the CMBN to alleviate chronic axial neck pain, in contrast to the destructive mechanisms inherent in cervical radiofrequency ablation (CRFA). Although PNS has been applied to other neural targets, its use in the cervical region is sparsely documented, with limited case studies available. Notably, this case series is the first to report pain and disability outcomes specifically associated with CMBN PNS. At the 60-day follow-up, 66% of subjects achieved the minimal clinically important difference (MCID) for pain reduction, while 77% met the MCID for disability reduction. Moreover, our analysis uniquely examined the impact of previous CRFA and a history of cervical spine surgery on treatment outcomes, revealing that patients with such interventions experienced more modest improvements compared to their surgery- and CRFA-naive counterparts. Conclusions: The current literature reveals a significant gap regarding the use of CMBN PNS, underscoring an unmet need in the treatment algorithm for chronic axial neck pain beyond conservative modalities. Our findings suggest that CMBN PNS may offer a promising adjunctive therapy for carefully selected patients with refractory chronic axial neck pain who have not improved after medications, physical therapy, or injections. Additionally, the comparative analysis of outcomes in patients with a history of CRFA or cervical surgery underscores potential advantages of PNS prior to destructive therapies. Future research, ideally in the form of prospective studies with larger cohorts and extended follow-up durations, is warranted to further evaluate long-term outcomes and refine the place of PNS in the treatment algorithm. Full article

Objective: The aim of this study is to present the initiation of robotic-guided (RG) spine surgery into routine clinical care at a single center with the use of intraoperative CT (iCT) automatic registration-based navigation. The workflow included iCT with automatic registration, fusion with preoperative imaging, verification of preplanned screw trajectories, RG introduction of K-wires, and the insertion of pedicle screws (PSs), followed by a control iCT scan. Methods: All patients who underwent RG implantation of pedicle screws using the Cirq^® robotic arm (BrainLab, Munich, Germany) in the thoracolumbar spine at our department were included in the study. The accuracy of the pedicles screws was assessed using the Gertzbein–Robbins scale (GRS). Results: In total, 108 patients (60 female, mean age 68.7 ± 11.4 years) in 109 surgeries underwent RG PS placement. Indications included degenerative spinal disorders (n = 30 patients), spondylodiscitis (n = 24), tumor (n = 33), and fracture (n = 22), with a mean follow-up period of 7.7 ± 9 months. Thirty-seven cases (33.9%) were performed percutaneously, and all others were performed openly. Thirty-three operations were performed on the thoracic spine, forty-four on the lumbar and lumbosacral spine, thirty on the thoracolumbar, one on the cervicothoracic spine, and one on the thoracolumbosacral spine. The screws were inserted using a fluoroscopic (first 12 operations) or navigated technique (latter operations). The mean operation time was 228.8 ± 106 min, and the mean robotic time was 31.5 ± 18.4 min. The mean time per K-wire was 5.35 ± 3.98 min. The operation time was lower in the percutaneous group, while the robot time did not differ between the two groups. Robot time and the time per K-wire improved over time. Out of 688 screws, 592 were GRS A screws (86.1%), 54 B (7.8%), 22 C (3.2%), 12 D (1.7%), and 8 E (1.2%). Seven screws were revised intraoperatively, and after revision, all were GRS A. E screws were either revised or removed. In the case of D screws, screws located at the end of the construct were revised, while so-called in-out-in screws in the middle of the construct were not revised. Conclusions: Brainlab’s Cirq^® Robotic Alignment Module feature enables placement of pedicle screws in the thoracolumbar spine with high accuracy. A learning curve is shown through improvements in robotic time and time per K-wire. Full article

Background: Although percutaneous laser disc decompression (PLDD) has been proposed as an alternative to conventional surgery for lumbar disc herniation (LDH), we specifically propose it for patients with contained herniations where standard surgical intervention is not the first option. This study evaluates PLDD compared to conservative therapy as an early treatment alternative. Methods: This retrospective observational study compared PLDD to conservative treatment in adult patients with contained LDH. All patients underwent 3 months of standard conservative therapy. Those who remained dissatisfied according to the Visual Analog Scale (VAS) and/or Macnab criteria were then treated with PLDD. We analyzed outcomes from both treatment phases using the Wilcoxon signed-rank test and the Mann–Whitney U test. Results: 121 patients underwent outpatient evaluation for LDH and received an average of 90 days of conservative therapy. Of these 103 patients, dissatisfied with the outcomes of conservative treatment, subsequently underwent PLDD. Following conservative treatment, the average VAS score reduction was 4.1%. Six months after PLDD, the VAS scores demonstrated a significant reduction, with an average decrease of 30% (p < 0.0001). In terms of functional outcomes assessed by the Macnab criteria, 39.8% of patients treated with PLDD achieved ‘Excellent’ or ‘Good’ outcomes, compared to only 11.4% after conservative treatment. Conclusions: PLDD appears to be a viable alternative to conservative therapy for this subgroup of patients with contained LDH. It may be beneficial to propose PLDD early in the therapeutic regimen to accelerate short term clinical improvement. Further studies are required to evaluate the long term efficacy of this treatment approach. Full article

Background/Objectives: Thoracolumbar fractures are a significant health burden, commonly caused by trauma, osteoporosis, or degenerative conditions, and can severely reduce quality of life and survival. These fractures, classified by the AO Spine Classification System, range from stable to unstable and require tailored management strategies. This study aims to evaluate clinical outcomes and survival probabilities in patients aged 50+ with AO A1–A4 fractures, comparing conservative treatment, percutaneous vertebroplasty (PVP), and surgical stabilization, including minimally invasive spine surgery (MISS). Methods: This retrospective study analyzed 1356 patients treated for thoracolumbar fractures at Hungary’s largest trauma center (2014–2019). Patients aged 50+ with low-impact trauma-induced AO A1–A4 fractures were included. Fractures were categorized into stable (A1–A2) and unstable (A3–A4) groups. Treatments included conservative management, PVP, and surgical stabilization. Survival probabilities were analyzed using Cox proportional hazards models, and outcomes between open and MISS techniques were compared. Results: Spine stability is a crucial factor in determining patient outcomes. MISS enabled stabilization in older patients, reducing hospital stays compared to open surgery (median 6 vs. 10 days). Minimally invasive techniques increased surgical likelihood for unstable fractures, especially in patients over 70 years. Older age and male sex were associated with higher mortality. Conclusions: MISS offers reduced recovery time and broader surgical eligibility, making it effective for managing unstable thoracolumbar fractures in older patients. Tailored management strategies are essential for improving survival outcomes, particularly in elderly and frail populations. Full article

Background: Lumbar spinal stenosis (LSS) remains a predominant cause of debilitating back and leg pain, affecting many aging populations. Traditional decompression surgeries can be invasive and pose significant risks and recovery time. This study elucidates the techniques and preliminary outcomes of endoscopic transfacet decompression in treating severe LSS. Methods: A retrospective review was performed on 65 patients with severe LSS who underwent endoscopic transfacet decompression. The patient outcomes were analyzed using the VAS for leg pain and the modified Macnab criteria. Pre-operative and post-operative scores were compared, and any complications were analyzed. An online survey was administered to 868 surgeons using Likert-scale ratings to evaluate surgeons’ experience with endoscopic decompression in patients with painful spondylolisthesis. The survey responses were analyzed using descriptive statistics and Polytomous Rasch analysis to evaluate surgeon endorsement. Results: The study included 65 patients, of which 29 (44.6%) were female and 36 (55.4%) were male, with a mean age of 65.79 ranging from 38 to 84 years. The available mean post-operative follow-up period was 31.44 months, ranging from 24 to 39 months. The VAS score for leg pain reduced significantly from pre-operative 7.54 ± 1.67 to 2.20 ± 1.45 by 5.34 ± 2.03 (p < 0.001) with a large effect size (Cohen’s d = 2.626). At the final follow-up, functional Macnab outcomes were reported as excellent by 20 (30.8%), good by 37 (56.9%), fair by 5 (7.7%), and poor by 3 (4.6%) of patients. There were no incidental durotomies, nerve root injuries, wound complications, or instances of post-operative instability. Only five patients (7.7%) developed post-operative dysesthesia. Incomplete decompression led to fair and poor outcomes in 8 (12.3%) patients. No revision surgeries were performed. post-operative instability was not observed. The surgeon survey corroborated these observations, where the polytomous Rasch analysis showed consensus on the effectiveness of the percutaneous endoscopic decompression of low-grade spondylolisthesis. Differential item functioning (DIF) analysis showed no significant bias in item responses between orthopaedic and neurosurgeons. Conclusions: The endoscopic transfacet decompression technique delineated herein showcased excellent Macnab outcomes in managing severe LSS, with a combined success rate of 87.7%. Patients also experienced a statistically significant reduction in leg pain. Dysesthesia rates were lower than with the transforaminal approach, likely because of limited exiting and traversing nerve root manipulation. This technique might represent a viable, less invasive alternative to open microsurgical dissection and decompression for patients with severe LSS, where fusion may be required. This approach was found to be highly accepted among endoscopic spine surgeons. Full article

This review aims to explore the evolution, techniques, and outcomes of minimally invasive spine surgery (MISS) within the field of neurosurgery. We sought to address the increasing burden of spine degeneration in a rapidly aging population and the need for optimizing surgical management. This review explores various techniques in MISS, drawing upon evidence from retrospective studies, case series, systematic reviews, and technological advancements in neurosurgical spine treatment. Various approaches, including endonasal cervical, transoral cervical, transcervical, mini-open/percutaneous, tubular, and endoscopic techniques, provide alternatives for current approaches to a range of spinal pathologies. The main findings of this review highlight potential advantages of MISS over traditional open surgery, including reduced complications, shorter hospital stays, and improved patient outcomes. Our research underscores the importance of adopting MISS techniques to optimize patient care in neurosurgical spine treatment. Full article

Background: The accurate identification of intraoperative levels is of paramount importance in spinal surgery, particularly in cases of obesity or anatomical anomalies affecting the thoracic spine. The aim of this work was to clarify whether the preoperative percutaneous placement of fiducial markers under local anesthesia only, with minimal discomfort to the patient, can be performed safely and efficiently. Methods: Patients treated at our institution between June 2019 and June 2020 for thoracic intraspinal lesions with preoperative percutaneous gold fiducial placement were analyzed. A total of 10 patients underwent CT-guided gold fiducial placement 2–48 h prior to surgery on an outpatient or inpatient basis. Patient characteristics, CT intervention time, and perioperative complications were recorded. Results: In all cases, the gold markers were placed under local anesthesia alone and were easily visualized intraoperatively with fluoroscopy. There was no preoperative dislocation or malposition. The procedure was performed without X-ray exposure to the neuroradiology interventionalist. The average CT intervention time from the planning scout to the final control time was 14.3 min. The percentage of anatomical norm variants in our observation group was high, as 2 of the 10 patients had lumbarization of the first sacral vertebra, resulting in a six-link lumbar spine. Conclusions: Preoperative CT-guided transcutaneous submuscular placement of gold markers under local anesthesia is a practical and safe method for rapid and accurate intraoperative level determination in thoracic spine surgery in a time-saving minimally invasive manner. The virtually painless procedure can be performed either preoperatively on an outpatient basis or as an inpatient procedure. Full article

Lumbar back pain is one of the main causes of disability around the world. Most patients will complain of back pain at least once in their lifetime. The degenerative spine is considered the main cause and is extremely common in the elderly population. Consequently, treatment-related costs are a major burden to the healthcare system in developed and undeveloped countries. After the failure of conservative treatments or to avoid daily chronic drug intake, invasive treatments should be suggested. In a world where many patients reject surgery and prefer minimally invasive procedures, interventional radiology is pivotal in pain management and could represent a bridge between medical therapy and surgical treatment. We herein report the different image-guided procedures that can be used to manage degenerative spine-related low back pain. Particularly, we will focus on indications, different techniques, and treatment outcomes reported in the literature. This literature review focuses on the different minimally invasive percutaneous treatments currently available, underlining the central role of radiologists having the capability to use high-end imaging technology for diagnosis and subsequent treatment, allowing a global approach, reducing unnecessary surgeries and prolonged pain-reliever drug intake with their consequent related complications, improving patients’ quality of life, and reducing the economic burden. Full article

Background and Objectives: Proximal junctional kyphosis (PJK) and failure (PJF), the most prevalent complications following long-segment thoracolumbar fusions for adult spinal deformity (ASD), remain lacking in defined preventive measures. We studied whether one of the previously reported strategies with successful results—a prophylactic augmentation of the uppermost instrumented vertebra (UIV) and supra-adjacent vertebra to the UIV (UIV + 1) with polymethylmethacrylate (PMMA)—could also serve as a preventive measure of PJK/PJF in minimally invasive surgery (MIS). Materials and Methods: The study included 29 ASD patients who underwent a combination of minimally invasive lateral lumbar interbody fusion (MIS-LLIF) at L1-2 through L4-5, all-pedicle-screw instrumentation from the lower thoracic spine to the sacrum, S2-alar-iliac fixation, and two-level balloon-assisted PMMA vertebroplasty at the UIV and UIV + 1. Results: With a minimum 3-year follow-up, non-PJK/PJF group accounted for fifteen patients (52%), PJK for eight patients (28%), and PJF requiring surgical revision for six patients (21%). We had a total of seven patients with proximal junctional fracture, even though no patients showed implant/bone interface failure with screw pullout, probably through the effect of PMMA. In contrast to the PJK cohort, six PJF patients all had varying degrees of neurologic deficits from modified Frankel grade C to D3, which recovered to grades D3 and to grade D2 in three patients each, after a revision operation of proximal extension of instrumented fusion with or without neural decompression. None of the possible demographic and radiologic risk factors showed statistical differences between the non-PJK/PJF, PJK, and PJF groups. Conclusions: Compared with the traditional open surgical approach used in the previous studies with a positive result for the prophylactic two-level cement augmentation, the MIS procedures with substantial benefits to patients in terms of less access-related morbidity and less blood loss also provide a greater segmental stability, which, however, may have a negative effect on the development of PJK/PJF. Full article

Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As scientific evidence accumulates, the efficacy and safety of cervical endoscopic spine surgery are continually affirmed. Both anterior and posterior endoscopic approaches have surfaced as viable alternative treatments for various cervical spine pathologies. Newer techniques, such as endoscopic-assisted fusion, the anterior transcorporeal approach, and unilateral laminotomy for bilateral decompression, have been developed to enhance clinical outcomes and broaden surgical indications. Despite its advantages, this approach faces challenges, including a steep learning curve, increased radiation exposure for both surgeons and patients, and a relative limitation in addressing multi-level pathologies. However, the future of cervical endoscopic spine surgery is promising, with potential enhancements in clinical outcomes and safety on the horizon. This progress is fueled by integrating advanced imaging and navigation technologies, applying regional anesthesia for improved and facilitated postoperative recovery, and incorporating cutting-edge technologies, such as augmented reality. With these advancements, cervical endoscopic spine surgery is poised to broaden its scope in treating cervical spine pathologies while maintaining the benefits of minimized tissue damage and rapid recovery. Full article