Search Results (14)

Background: Vertebral column resection (VCR) has historically been recognized as the most efficacious corrective intervention for severe rigid spinal deformities. Nevertheless, advancements in preoperative optimization, staged corrective methodologies, osteotomies, and contemporary instrumentation have broadened the spectrum of therapeutic options available. The definitive role of VCR in the modern management of rigid congenital spinal deformities remains a topic of ongoing scholarly discourse. Methods: This study presents two illustrative cases of severe congenital spinal deformities that were addressed employing various surgical methodologies, alongside a comprehensive review of the current literature pertaining to VCR and less invasive alternatives, including halo-gravity traction (HGT), temporary internal distraction techniques, pedicle subtraction osteotomy (PSO), asymmetric pedicle subtraction osteotomy (APSO), and multi-rod constructs. Results: The cases elucidated herein underscore the necessity for treatment strategies to be tailored specifically to the characteristics of the deformity, its flexibility, the neurological risks involved, and the individual patient’s specific attributes. In one case, significant deformity correction achieved via preoperative HGT facilitated successful management through multilevel Ponte osteotomies and posterior spinal fusion, thereby obviating the need for VCR. In other patient suffering from severe rigid congenital kyphotic deformity with pronounced anterior column deficiencies, VCR was deemed essential to realize adequate correction and neural decompression. All patients exhibited substantial radiographic correction, enhancements in health-related quality-of-life metrics, diminished disability and pain, while maintaining correction without neurological complications or implant failure at the final follow-up evaluation. Conclusions: VCR continues to be a vital element within the surgical repertoire for the treatment of severe rigid spinal deformities; however, it should not be deemed obligatory in every instance. Diligent preoperative evaluation, staged correction methodologies, and less invasive osteotomy techniques may permit satisfactory correction while mitigating surgical morbidity in suitably selected patients. Treatment approaches should be customized, favoring the least invasive procedure capable of achieving safe and lasting correction whenever practicable. Full article

Background: Three-dimensional (3D)-printed vertebral body replacement (VBR) and artificial vertebral body (AVB) implants are increasingly used for anterior column reconstruction after spinal tumor resection. However, the available evidence on complications remains limited, heterogeneous, and methodologically inconsistent. This systematic review aimed to synthesize reported complications, revision patterns, and mechanical outcomes of 3D-printed VBR/AVB implants in spinal oncology and to critically appraise the quality of the available clinical literature. Methods: This systematic review was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Embase, and the Cochrane Library were searched from 1 January 1980 to 26 February 2026. Eligible studies included clinical series and cohort studies reporting extractable complication and/or revision data in patients who underwent spinal tumor resection followed by reconstruction with a 3D-printed VBR/AVB implant. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Series. Due to substantial clinical and methodological heterogeneity, a structured narrative synthesis was performed. Results: Eleven studies comprising 217 analyzable 3D-printed reconstructions were included. Most were retrospective single-center series and showed marked heterogeneity in tumor histology, spinal level, implant strategy, follow-up duration, and complication definitions. Because adverse-event reporting was inconsistent across studies, no pooled overall complication rate was calculated. Reported perioperative non-mechanical complications included neurological deterioration, cerebrospinal fluid- or dural-related events, wound infection, pleural effusion, pneumonia, and vascular injury. Mechanical implant failure appeared relatively uncommon, although radiographic subsidence was variably defined and inconsistently reported. Implant mismatch and hardware-related problems were infrequent but clinically relevant, particularly with prefabricated or off-the-shelf devices. Revision procedures were most commonly associated with wound complications, clinically significant subsidence, hardware failure, or tumor recurrence. Overall study quality was limited by retrospective designs, small sample sizes, and non-standardized outcome reporting. Conclusions: Current evidence suggests that 3D-printed VBR/AVB implants are a feasible option with encouraging mechanical performance for spinal reconstruction after tumor resection. Most reported adverse events appear to reflect the complexity of oncologic spine surgery rather than device-specific failure alone. However, the available evidence remains low level and heterogeneous. Larger multicenter comparative studies with standardized outcome definitions and longer follow-up are needed to better define the clinical value and durability of 3D-printed vertebral reconstruction in spinal oncology. Full article

Background: Achondroplasia, the most common genetic dwarfism caused by the FGFR3 mutation (autosomal dominant, 80% de novo), results in a disproportionately short stature. Thoracolumbar kyphosis (TLK), combined with characteristic spinal canal stenosis, increases the risk of symptomatic compression, yet the literature lacks clear thresholds for symptom onset or progressive deformity angles. Methods: A 16-year-old female with achondroplasia presented with rapidly progressive kyphosis despite conservative management (bracing and therapy). Over six months, she developed neurogenic claudication; bilateral leg pain; weakness; and paresthesia that worsened with standing/walking, which was relieved by flexion/sitting. Imaging demonstrated surgical-threshold kyphosis with progressive spinal misalignment. Her symptoms indicated compressive myeloradiculopathy from lumbar stenosis, critical given achondroplasia’s congenitally narrowed canal and heightened neurologic vulnerability. Results: Staged surgery planned: Posterior fusion T6-L4 with pedicle screws and then extensive decompression (laminectomy/foraminotomy T11-L3), L1 corpectomy with expandable titanium cage, and Ponte osteotomies. Intraoperative complications included a malpositioned left T10 screw breaching the anterior/lateral cortex near the aorta, requiring urgent revision. Postoperatively: Neurogenic bladder, wound leakage, and E. coli urinary tract infection (UTI) with fever (treated with IV antibiotics). After infection resolution, definitive surgery removed the malpositioned screw and completed decompression, corpectomy, cage placement, bone grafting, and osteotomies, successfully resolving neurological symptoms. However, 13 cm trunk lengthening caused severe functional impairment—disproportionately short arms prevented independent toileting and dressing. Left arm lengthening via external fixation restored partial function. At 2.5-year follow-up, there was solid fusion, no neurological deficits, and improved quality of life. Conclusions: Surgery addresses severe TLK, vertebral wedging, and neurogenic claudication in achondroplasia. Vertebral column resection effectively corrects TLK and neurological deficits but carries a high complication risk. This should be reserved for severe TLK with hypoplastic vertebrae, performed by experienced surgeons. Critically, correction magnitude must preserve limb–trunk proportions to prevent functional disability, as excessive lengthening may necessitate additional limb procedures for independence restoration. Full article

Congenital scoliosis is a complex spinal deformity caused by abnormal vertebral development during embryogenesis, occurring in roughly 0.5–1.0 per 1000 live births. It encompasses a wide spectrum of anomalies that arise from failures in vertebral formation or segmentation, or mixed defects during the fourth to sixth weeks of gestation. Managing this condition requires careful consideration of growth dynamics, associated systemic anomalies, and individualized decisions regarding surgical timing. In this review, current evidence on the epidemiology, pathophysiology, diagnostic strategies, and treatment of congenital scoliosis is synthesized, with special attention to surgical decision-making between hemivertebrectomy and growth-preserving methods such as growing rods. Recent surgical techniques—including magnetically controlled growing rods and posterior vertebral column resection—have expanded therapeutic options, while greater recognition of the psychosocial impacts has underscored the importance of family-centered care. Successful management relies on striking a balance between early deformity correction and preserving long-term spinal and thoracic growth. Multidisciplinary collaboration and thorough family counseling remain central to optimizing both structural and psychosocial outcomes. Full article

Chordomas are primary tumors of the skull base and vertebral column typically derived from the notochord. Treatment options consist of surgical resection, radiotherapy, and chemotherapy. This study reviews clinical trials focused on radiotherapy techniques, such as photon therapy and carbon ion radiotherapy, as well as the concomitant use of radia-tion sensitizers. We completed a literature review on all published clinical trials on the usage of photon, proton, and carbon ion radiotherapy (CIRT) for chordoma in adults and all published literature on radiation sensitizers used for treatment in chordoma from 2000 to 2025. We reviewed all nine current clinical trials on radiotherapy for chordoma in adults. All clinical trials were able to achieve an overall survival rate above 50% at 3-year follow-up. Seven publications were found on the use of radiation sensitizers for chordomas, both in vitro and in vivo. The completed clinical trials evaluate the effectiveness of proton, photon, and CIRT for treatment of the skull base, spine, and sacral chordoma. Current trials continue these efforts and compare the different radiotherapies and determine appropriate doses. Research on radiation sensitizers for chordomas shows various therapies, ranging from hyperthermia to pharmaceutical options, that require further study. Full article

The aim of this work is to analyse the effectiveness of the medical use of the Cavitron Ultrasonic Surgical Aspirator (CUSA) in microsurgical treatment of Intramedullary Spinal Cord Tumors (IMSCTs), with a focus on the thermo-mechanical effects on neighbouring tissues to assess any potential damage. Indeed, CUSA emerges as an innovative solution, minimally invasive tumor excision technique, enabling controlled and focused operations. This study employs a Finite Element Analysis (FEA) to simulate the vibratory and thermal interactions occurring during CUSA application. A computational model of a vertebral column segment affected by an IMSCT was developed and analysed using ANSYS 2024 software. The simulations examined strain distribution, heat generation, and temperature propagation within the biological tissues. The FEA results demonstrate that the vibratory-induced strain remains highly localised to the application site, and thermal effects, though measurable, do not exceed the critical safety threshold of 46 °C established in the literature. These findings suggest that CUSA can be safely used within defined operational parameters, provided that energy settings and exposure times are carefully managed to mitigate excessive thermal accumulation. These conclusions contribute to the understanding of the thermo-mechanical interactions in ultrasonic tumour resection and aim to assist medical professionals in optimising surgical protocols. Full article

Background/Objectives: Surgery for adolescent idiopathic deformities is often aimed at improving aesthetic appearance, striving for the best possible correction. However, severe and rigid scoliotic curves not only present aesthetic issues but can also compromise cardiopulmonary health and cause early neurological impairment due to spinal cord compression, posing significant risks of morbidity and mortality if untreated. Conservative treatments are ineffective for severe curves, defined by scoliotic angles over 70° and flexibility below 30% on lateral bending X-rays. Treatment often requires invasive interventions, such as osteotomies and vertebral resections. In particular, posterior vertebral column resection (PVCR) has shown effectiveness in realigning vertebral structures in complex cases. This study describes the efficacy and risks of PVCR through a series of cases treated at our institution. Methods: This case series was conducted at the Rizzoli Orthopedic Institute in Bologna, involving eight pediatric patients with severe, rigid spinal deformities, operated upon between 2018 and 2023. The underlying pathologies included idiopathic kyphoscoliosis, neurofibromatosis type 1, Pott’s disease, and other congenital anomalies. Preoperative assessment included standard radiographs, magnetic resonance imaging, and computed tomography. During PVCR, motor and sensory evoked potentials were monitored to minimize neurological injury risk. Postoperative management included blood transfusions, antibiotic support, and early physiotherapy. Results: PVCR resulted in an average reduction in the Cobb angle from 86.3° preoperatively to 22.4° postoperatively, with a mean correction of 64%. The mean duration of the procedures was 337.4 min. Three patients had an uneventful postoperative course, while five developed complications, including infections and temporary neurological deficits, which were successfully managed. One patient developed an epidural hemorrhage that required emergency surgery for hematoma evacuation, with partial recovery. This study demonstrates the potential of PVCR for correcting rigid spinal deformities, highlighting the importance of postoperative management to minimize the associated risks. Conclusions: Posterior vertebral resection techniques offer significant promise in the correction of pediatric spinal deformities. Although ours is a small case series, it can provide important data for such treatment. Long-term monitoring is needed to fully understand the impact of these procedures and to further refine surgical techniques. Full article

Background: Severe spinal deformity manifests as a pronounced deviation from the normal curvature of the spine in the frontal, sagittal, and horizontal planes, where the coronal plane curvature exceeds 90 degrees and may coincide with hyperkyphotic deformity. The most severe deformities exhibit rigidity, with flexibility below 30%. If left untreated or improperly treated, these deformities can result in serious complications associated with progression of the curvature. A combination of surgical techniques is frequently employed to attain optimal outcomes and minimize the risk of complications. The overall medical condition of the patient, their capacity to endure extensive procedures, the expertise of the surgeon, and the resources available all play significant roles in determining the course of management. A systematic and thorough review of the relevant literature was conducted utilizing a variety of electronic databases. The primary objective of this study was to scrutinize the surgical techniques commonly employed in complex spine surgeries for the management of severe scoliosis without resection vertebral body techniques, with higher potential risk of major complications, including permanent neurological deficit. Conclusions: Halo-gravity traction, halo femoral traction, and all techniques for releases of the spine (anterior, posterior, or combine), as well as thoracoplasty, have demonstrated significant effectiveness in managing severe and rigid idiopathic scoliosis. The combination of several of these methods can lead to optimal alignment correction without the need to perform high-risk techniques involving three-column osteotomies. Surgeons must customize the indications based on factors such as available resources, characteristics of the deformity, and the patient’s individual profile. Surgical correction of severe scoliosis without vertebral body resection surgeries decreases the potential risks related to neurological and pulmonary complications while providing significant clinical improvement outcomes. The powerful Ponte osteotomy is indicated for severe scoliosis, curves with poor flexibility, for better restoration of hypokyphosis, and decrease of hyperkyphosis. These corrective techniques combined with HGT or temporary internal distraction rods are recommended as viable options for managing individuals with severe rigid spine deformity characteristics. Therefore, they also should be considered and performed by a proficient surgical team. The presence of neuromonitoring is crucial throughout these procedures. Full article

Background: Congenital kyphosis is a spinal deformity that arises from the inadequate anterior development or segmentation of the vertebrae in the sagittal plane during the initial embryonic stage. Consequently, this condition triggers atypical spinal growth, leading to the manifestation of deformity. Concurrently, other congenital abnormalities like renal or cardiac defects within the gastrointestinal tract may co-occur with spinal deformities due to their shared formation timeline. In light of the specific characteristics of the deformity, the age range of the patient, deformity sizes, and neurological conditions, surgical intervention emerges as the optimal course of action for such cases. The selection of the appropriate surgical approach is contingent upon the specific characteristics of the anomaly. Case Presentation: This investigation illustrates the utilization of a surgical posterior-only strategy for correcting pediatric congenital kyphoscoliosis through the implementation of a vertebral column resection method along with spine reconstruction employing a mesh cage. The individual in question, a 16-year-old female, exhibited symptoms such as a progressive rib hump, shoulder asymmetry, and back discomfort. Non-invasive interventions like bracing proved ineffective, leading to the progression of the spinal curvature. After the surgical procedure, diagnostic imaging displayed a marked enhancement across all three spatial dimensions. After a postoperative physical assessment, it was noted that the patient experienced significant enhancements in shoulder alignment and rib hump prominence, with no discernible neurological or other adverse effects. Conclusions: Surgical intervention is considered the optimal approach for addressing such congenital anomalies. Typically, timely surgical intervention leads to favorable results and has the potential to halt the advancement of deformity and curvature enlargement. Full article

(1) Background: The three-dimensional printing (3DP) technique has been reported to be of great utility in spine surgery. The purpose of this study is to report the clinical application of personalized preoperative digital planning and a 3DP guidance template in the treatment of severe and complex adult spinal deformity. (2) Methods: eight adult patients with severe rigid kyphoscoliosis were given personalized surgical simulation based on the preoperative radiological data. Guidance templates for screw insertion and osteotomy were designed and manufactured according to the planning protocol and used during the correction surgery. The perioperative, and radiological parameters and complications, including surgery duration, estimated blood loss, pre- and post-operative cobb angle, trunk balance, and precision of osteotomy operation with screw implantation were collected retrospectively and analyzed to evaluate the clinical efficacy and safety of this technique. (3) Results: Of the eight patients, the primary pathology of scoliosis included two adult idiopathic scoliosis (ADIS), four congenital scoliosis (CS), one ankylosing spondylitis (AS), and one tuberculosis (TB). Two patients had a previous history of spinal surgery. Three pedicle subtraction osteotomies (PSOs) and five vertebral column resection (VCR) osteotomies were successfully performed with the application of the guide templates. The main cobb angle was corrected from 99.33° to 34.17°, and the kyphosis was corrected from 110.00° to 42.00°. The ratio of osteotomy execution and simulation was 97.02%. In the cohort, the average screw accuracy was 93.04%. (4) Conclusions: The clinical application of personalized digital surgical planning and precise execution via 3D printing guidance templates in the treatment of severe adult rigid deformity is feasible, effective, and easily generalizable. The preoperative osteotomy simulation was executed with high precision, utilizing personalized designed guidance templates. This technique can be used to reduce the surgical risk and difficulty of screw placement and high-level osteotomy. Full article

Background: Horner’s syndrome (HS) classically consists of the symptom triad of miosis, ptosis, and anhidrosis. It is caused by impairment of a certain pathway in the sympathetic nervous system. It may also appear as part of the clinical signs of other diseases and syndromes, including Pancoast tumors, intradural and/or epidural tumors, thoracic outlet syndrome, syringomyelia, brachial plexus injury, and aortic dissection. Here, we report a very rare complication of vertebral column resection in children, and we present the clinical findings of a case of Horner’s syndrome with a current literature review. Case presentation: A five-year-old child with severe congenital kyphoscoliosis qualified for surgical treatment of the spinal deformity via a posterior approach, with three-column osteotomy and fusion. Results: After successful surgery, the patient presented with HS due to distraction of the sympathetic nerve trunk and, thus, innervation to the left eye. At the 4-year follow-up, the child had fully recovered. Conclusions: Pediatric HS after posterior instrumented scoliosis correction surgery with posterior vertebral column resection of the thoracic spine is very rare. This is the first reported case of HS after posterior vertebral column resection and spinal fusion for congenital kyphoscoliosis without the use of epidural analgesia. Symptom resolution may be variable and, in some cases, delayed. Full article

Background and Objectives: Benign osseous tumors of the spinal column comprise about 10% of all spinal tumors and are rare cause for surgery. However, these tumors pose various management challenges and conventional surgery may be associated with significant morbidity. Previous reports on minimally invasive resection of these lesions are rare. We report a series of patients managed by total resection of benign osseous spine tumors using MIS techniques. Surgical decisions and technical considerations are discussed. Materials and Methods: A retrospective evaluation of prospectively collected data of patients who underwent minimally invasive surgery for removal of benign osseous vertebral tumors. Demographic, clinical and radiographic features, operative details and final pathological reports were summarized. Primary outcomes were completeness of tumor resection and pain relief assessed by VAS for back and leg pain. Secondary outcome measures were recurrence of tumor on repeat post-operative MRI and postoperative unstable deformity on standing scoliosis X-rays. Results: This series included 32 cases of primary osseous spine tumors resected by minimally invasive techniques. There were 17 males and 15 females aged 5–68 years (mean 23.3). The follow-up period was 8–90 months (mean 32 months) and the preoperative symptoms duration was 9–96 months. Axial spinal pain was the presenting symptom in all the patients. Five patients also complained about radicular pain and four patients had antalgic scoliosis. The tumor involved the thoracic spine in 12 cases, the lumbar segment in 11, the cervical in 5 and the sacral area in 4 cases. Complete tumor removal was performed in all patients. No procedure-related complications were encountered. Histopathology showed osteoid osteoma in 24 patients, osteoblastoma in 5 patients, and fibrous dysplasia, fibroadenoma and eosinophilic granuloma in one case each. All patients experienced significant pain relief after surgery, and had stopped pain medications by 12 months postoperatively. No patient suffered from tumor recurrence or spinal deformity. Conclusions: Minimally invasive surgery is feasible for total removal of selected benign vertebral tumors and may have some advantages over conventional surgical techniques. Full article

Background and Objectives: Thoracolumbar kyphosis is one of the most frequent skeletal manifestations in patients with achondroplasia. Few papers have been published on the surgical treatment of this condition, especially in skeletally mature patients. With this study, we presented a retrospective case series of long-term surgical results for achondroplastic patients with severe thoracolumbar kyphosis. This study was conducted to evaluate the outcome of surgical treatment for thoracolumbar kyphosis in patients associated with achondroplasia presenting with paraparesis. Materials and Methods: Three patients with achondroplasia who developed neurologic deficits due to severe thoracolumbar kyphosis and underwent surgical treatment were evaluated (mean age 22.3 years; mean follow-up 9.3 years). All patients were treated with posterior vertebral column resection (p-VCR) of hypoplastic apical vertebrae with a cage and segmental instrumentation. Neurologic outcomes (JOA scores), correction of kyphosis, and operative complications were assessed. Results: All patients had back pain, neurological deficits, and urinary disturbance before surgery. The average preoperative JOA score was 8.3/11 points, which was improved to 10.7/11 points at the final follow-up (mean recovery rate 83%). All patients obtained neurologic improvement after surgery. The mean preoperative kyphotic angle was 117° (range 103°–126°). The postoperative angles averaged 37° (range 14°–57°), resulting in a mean correction rate of 67%. All patients had postoperative complications such as rod breakage and/or surgical site infection. Conclusions: The long-term results of p-VCR were acceptable for treating thoracolumbar kyphosis in patients with achondroplasia. To perform this p-VCR safely, spinal navigation and neuromonitoring are inevitable when resecting non anatomical fused vertebrae and ensuring correct pedicle screw insertion. However, surgical complications such as rod breakage and surgical site infection may occur at a high rate, making informed consent very important when surgery is indicated. Full article

Background and Objectives: In osteoporotic fractures of the spine with resulting kyphosis and threatening compression of neural structures, therapeutic decisions are difficult. The posterior vertebral column resection (pVCR) has been described by different authors as a surgical treatment in a single-stage posterior procedure. The aim of this study is to evaluate midterm outcomes of patients treated by pVCR due to severe osteoporotic fractures. Materials and Methods: Retrospective data analysis of all the patients treated for osteoporotic fractures by pVCR from 2012–2020 at two centers was performed. Demographic data, visual analog scale (VAS), Frankel scale (FS), Karnofsky performance status (KPS), radiological result and spinal fusion rates were evaluated. Results: A total of 17 patients were included. The mean age was 70 ± 10.2 y. The mean VAS decreased significantly from 7.7 ± 2.8 preoperatively to 3.0 ± 1.6 at last follow-up (p < 0.001) and the segmental kyphosis decreased from 29.4 ± 14.1° to 7.9 ± 8.0° (p < 0.001). The neurologic function on the FS did not worsen in any and improved in four of the patients. The median KPS remained stable over the whole observation period (70% vs. 70%). Spinal fusion was observed in nine out of nine patients who received CT follow-up >120 days after index surgery. Conclusions: This study showed that pVCR is a safe surgical technique with few surgical complications and no neurological deterioration considering the cohort. The patients’ segmental kyphosis and VAS improved significantly, while the KPS remained stable. Full article