Journal of Spine Research and Surgery is an open access peer reviewed journal publishes articles on original research works, perspectives, reviews, case reports, commentaries, letters, letters to editor, editorials, opinions and short communications, etc. The journal aims on research and treatment related to the spine and spine surgery.
Hybrid Thoracic Posterior Spinal Fusion Combined with Posterior Lumbar Vertebral Body Tethering in Adolescent Idiopathic Scoliosis: A Motion- Preserving Strategy
Purpose: Posterior spinal fusion (PSF) provides reliable correction in adolescent idiopathic scoliosis (AIS) but sacrifices lumbar motion when extended distally. Vertebral body tethering (VBT) preserves motion but carries significant mechanical complication rates in thoracic spine. We evaluated a hybrid strategy combining thoracic PSF with posterior lumbar vertebral body tethering (PLVBT) to preserve distal lumbar mobility while maintaining deformity correction. Methods: Seventeen consecutive Lenke 1C, 3C or 6C AIS patients underwent thoracic PSF combined with PLVBT. Primary outcome was lumbar Cobb angle change at 2 years. Secondary outcomes included thoracic Cobb angle, sagittal parameters, perioperative data, and complications. Paired t-tests and Cohen's d effect sizes were calculated. Results: Lumbar Cobb angle improved from 51° (± 7°) to 19° ( ± 8°) at 2 years (p < 0.0001, d = 4.21). Thoracic Cobb angle improved from (59° ± 12°) to (34° ± 8°) (p < 0.0001, d = 2.85). Thoracic kyphosis significantly increased from 14° (± 9°) to 24° (± 9)° (p = 0.01, d = 1.11). Lumbar lordosis didn’t change. No tether rupture occurred. Complication rate was 17.6%. Conclusion: Hybrid thoracic PSF combined with PLVBT achieved large, durable correction while theoricaly preserving lumbar mobility. This approach may represent a rational alternative to extended lumbar fusion in selected AIS patients.
Copyright (c) 2026 Journal of Spine Research and Surgery
Healthcare Access Barriers Among Minority Groups with Low Back Pain
Background: Research on healthcare access barriers among sexual and gender minority (SGM) individuals and racial/ethnic minorities with low back pain (LBP) in the United States remains limited. This study compared cost-related and non-cost–related barriers to care among SGM and non- SGM adults with LBP across racial/ethnic groups. Methods: We conducted a cross-sectional analysis of deidentified healthcare access and utilization survey data from the All of Us Research Program (May 6, 2018–July 1, 2022). Adults aged ≥18 years with LBP were included. Exposures included SGM status and self-reported race/ ethnicity (non-Hispanic Black [NHB], non-Hispanic White [NHW], Hispanic/Latino [HL]). Outcomes were cost-related and non-cost–related barriers to healthcare access. Multivariable logistic regression assessed associations between SGM status, race/ethnicity, and barriers to care. Results: Among 25,597 adults with LBP (2,169 [8.5%] SGM), SGM patients had higher odds of delaying mental health visits (aOR 1.72; 95% CI 1.50–1.97), prescription filling (aOR 1.27; 95% CI 1.13–1.43), and specialist care (aOR 1.18; 95% CI 1.02–1.35) due to cost, as well as reporting inability to take time off work (aOR 1.18; 95% CI 1.03–1.36), transportation barriers (aOR 1.36; 95% CI 1.18–1.56), and perceived disrespect (aOR 1.40; 95% CI 1.27–1.54). Compared with NHW patients, NHB and HL patients more frequently delayed care due to cost and experienced transportation and work-leave barriers. HL SGM patients had over twice the odds of delaying care (aOR 2.41; 95% CI 1.61–3.62) compared with NHW non-SGM patients.LBP (2,169 Conclusion: SGM, HL, and NHB adults with LBP experience disproportionate barriers to healthcare access, underscoring the need for targeted strategies to promote equity in pain-related care
Emerging Biologics in Lumbar Disc Degeneration: PRP, Stem Cell Therapy, and Pharmacotherapy in Mobility Restoration and Rehabilitation
Lumbar disc degeneration is a leading contributor to chronic low back pain and functional limitation worldwide, driven by progressive extracellular matrix breakdown, disc dehydration, inflammation, and cellular senescence. Conventional treatments—including pharmacotherapy, physical rehabilitation, and surgery—primarily address symptoms rather than the underlying degenerative cascade and often fail to restore disc structure or long-term mobility. Emerging biologic therapies have gained attention for their potential to modify disease progression and promote regeneration. This narrative review examines current evidence surrounding platelet-rich plasma, mesenchymal stem cell therapies, peptide analogs, and evolving pharmacologic agents in the management of lumbar disc degeneration, with particular emphasis on mobility restoration and rehabilitation integration. platelet-rich plasma and mesenchymal stem cell-based interventions demonstrate moderate improvements in pain and functional outcomes with generally favorable safety profiles, though durable structural regeneration remains unproven. Peptide analogs and molecular agents show promising preclinical regenerative and anti-inflammatory effects but lack robust human data and regulatory approval. Pharmacologic strategies targeting inflammatory and catabolic pathways may complement biologic therapies but remain largely investigational. The integration of biologics with structured rehabilitation and progressive loading appears critical for optimizing functional recovery. Despite encouraging advances, significant limitations persist, including heterogeneous protocols, limited high-quality randomized trials, and insufficient long-term data. Future research should prioritize standardization, comparative effectiveness studies, and multimodal treatment models to clarify the role of biologic therapies in restoring mobility and function in lumbar disc degeneration.
Plastic Surgery-Assisted Closure of Complex Posterior Spine Surgery Wounds Are Associated with Rate of Readmission and Reimbursement
Objective: The objective of this study is to compare clinical outcomes and reimbursements between plastic surgeon (PS) and spine surgeon (SS) closure of wounds following complex posterior spine reconstruction surgery. Methods: Data was sourced from the PearlDiver Mariner Administrative claims database. The patient cohorts included those who underwent posterior spinal fusion with at least 7 levels fused. Several 30-day postoperative outcomes were examined, including readmission rates, sepsis, myocardial infarction, pneumonia, cerebrovascular accident, deep vein thrombosis, pulmonary embolism, venous thromboembolism, surgical site infections (SSI), and emergency department visits. Mean 30- day reimbursement costs were also analyzed. Statistical analysis involved Chi-square testing for categorical variables and T-tests for continuous variables. Multivariate logistic regression was employed to calculate odds ratios and 95% confidence intervals. Statistical significance was defined as a p-value of less than 0.05. Results: The demographics of the matched cohorts indicated no significant differences in age, gender and Elixhauser Comorbidity Index. The readmission rate for the PS group was 19.6%, compared to 12.1% for the SS group (OR = 1.74, CI 1.35-2.22, p < 0.001). Mean 30-day reimbursement was lower for the PS group at $24,072.94 compared to $31,204.64 in the SS group (p < 0.0001). No significant differences were observed in other 30-day outcomes. Conclusion: No significant difference in the rate of SSI was demonstrated between the two closure teams. However, we found that PS closure correlates with an increased rate of 30-day readmission and decreased reimbursement.
The Value of Rigid Cervical Orthesis After Fixation and Fusion of Degenerative Cervical Spine in Geriatric Patients
Introduction: The use of a cervical orthosis after fixation and fusion of the cervical spine in geriatric patients is still controversial. The aim of this study was to find out whether cervical orthosis had an influence on early postoperative clinical-neurological and radiological outcomes. Methods: We included and analyzed the data of all geriatric patients who were surgically treated at our spine center for symptomatic degenerative cervical spine disease requiring ventral and/or dorsal fixation with fusion. From 2010 to 2012, the patients received a rigid cervical orthosis postoperatively (group 1); from 2012 to 2014, no orthosis was applied (group 2). All patients were evaluated 3 months after surgery as part of their clinical follow-up. Radiographic and clinical scores were recorded before and after the operation. Postoperative complications within 30 days of the initial surgery were analyzed. Results: A total of 84 patients were included, of which 65.5% received postoperative cervical orthosis. Patients with orthosis were significantly younger (p=0.009) and had lower ASA scores (p=0.007) than those in group 2. The clinical and radiologic parameters were similar in both groups but without statistical significance, especially with regard to numeric rating scale (NRS) and neck disability index (NDI) scores. However, it was relevant that the patients with an orthosis did not tolerate it well and developed complications (p <0.001). Conclusions: Postoperative cervical orthosis did not lead to improved early clinical and radiological outcomes but were associated with devicerelated complications.
A Multicenter, Retrospective Evaluation of The Efficacy of a Novel Posterior Sacroiliac Joint Fusion System: Initial Case Series
Background: The advent of minimally invasive techniques has significantly advanced sacroiliac joint (SIJ) fusion procedures. Previous studies have reported improvements in pain and functional improvement using Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) following SIJ fusion. Clinical outcomes have been modest, with some patients not achieving the Minimal Clinically Important Difference (MCID) in pain and functional improvement with respect to certain techniques and approaches. The TiLink-P®, SIJ fusion implant is a novel 3D-printed titanium implant with an advanced surface technology designed to improve patient outcomes in SIJ fusion via a posterior approach. This study aimed to assess the efficacy of the TiLink-P® Minimally Invasive SIJ fusion procedure and implant in a case series. Methods: A multicenter retrospective analysis included four US sites. Patients who were previously treated with TiLink-P® between October 1, 2023 to January 4, 2024, were consecutively screened for eligibility. De-identified demographic data, preoperative pain, disability scores, and postoperative outcomes at approximately one year were collected. The primary outcome measures were changes in pain using NRS (Numeric Rating Scale) or VAS and disability using ODI from preoperative to approximately one-year postoperative. Results: A total of 21 subjects were included for analysis with a mean age of 66.6 years, and a mean BMI of 32.1 . The mean follow-up period was 11.6 months. Compared to the preoperative values, the follow up back pain score (VAS) and ODI values improved 60.3%, from 83.3 to 31.1 (p < 0.0001) and 71.9% from 52.8 to 8.3 (p = 0.001) respectively. Clinical Relevance: There were no device or procedure events during the study period. Pain and ODI scores were statistically improved at approximately 1 year follow-up. Conclusions/Level of Evidence: The TiLink-P® posterior SIJ fusion system demonstrated significant pain reduction and functional improvement scores without procedure or device-related adverse events.
Copyright (c) 2025 Journal of Spine Research and Surgery
Percutaneous Lumbar Disc Radiofrequency Intervention-With a Review of Newer Lumbar Disc Steerable Plasma Coblation Devices
Background: Lumbar disc disease and prolapsed intervertebral discs(PID) are common conditions. They cause debilitating lower back pain, sciatica. Proven surgical treatments includes lumbar microdiscectomy. However, this comes with effects of muscular, soft tissue disruption, and the potential surgical complications. Recently, interventional devices utilising thermal heating energy(eg. IDET®), and radiofrequency plasma coblation nucleoplasty have been introduced. Since 1999, a straight cannula needle probe nucleoplasty device(Nucleoplasty®) has been introduced. Newer navigable decompression device options(eg. Yesdisc®) can directly treat contained disc herniations, and discogenic pain. The RF Coblation tip can be directed accurately to the actual damaged disc site, for targeted decompression. Objectives: To compare the different percutaneous lumbar disc radiofrequency devices and their efficacy. We also assess if the newer navigable plasma coblation devices are more effective. Methods: In our article, we searched PubMed and Medline for relevant studies on Percutaneous Lumbar Disc Thermal Ablation, RF Devices for lower back pain. We searched for studies on the efficacy of newer Navigable Coblation Devices. We also reviewed our personal experience with the above devices. The primary outcome measures were improvement in Visual Analogue Scores(VAS) by 50% at 6 months duration or more. Other indices included the Owestri Disability Index(ODI). Study Results and Discussion: In the treatment of discogenic pain treatment, devices such as IDET® and Biacuplasty® have shown modest improvement results in pain relief. The improvement in VAS ranges from 40% to 57%. For the IDET procedure, cases of complications such as catheter shearing were found to have have occurred. Percutaneous laser disc decompression shows promising results, ranging from 60-70% improvement in 6 month VAS scores. This procedure requires care, as cases of thermal injury to the vertebral end-plates have been reported. For nucleoplasty devices(which can treat both a herniated disc and discogenic pain), we find the results of navigable coblation devices(eg.Yesdisc and L’Disq) were better(VAS improvement ranging from 68.5% to 88%), when compared to the older straight cannula nucleoplasty device(VAS improvement ranging from 53-60% at 12 months). These results are also demonstrated in the author’s personal intervention series of 61 procedures. The incidence of complications such as discitis, neural damage were low(less than 1%). Conclusion: Percutaneous lumbar disc RF intervention has an important role in managing persistent lower back pain. A variety of intervention devices have been introduced. Thermal RF ablation of the annular pain fibres has been shown to be moderately effective in improving discogenic pain. For contained disc herniations, lumbar disc plasma coblation using navigable devices such as Yesdisc® show promising results. Encouraging VAS results are shown, ranging from 70% to 88%, with low procedural risks. This should be considered a good treatment option in selected cases. Further larger scale studies are needed in the future to assess this.
Effect of occlusion on range of motion of spinal alignment during trunk flexion varies depending on exercise habits
The purpose of this study was to clarify the differences in the effects of occlusion on the range of motion of spinal alignment during trunk flexion based on the participants’ exercise habits. Participants were 16 healthy men, 14 trampoline gymnasts and 15 rugby players. Using a spinal shape analyzer, the lumbar range of motion, hip joint range of motion (HJM), and spinal range of motion (SM) during trunk flexion were measured. Differences in the range of motion of spinal alignment due to participant group and occlusion condition were analyzed using two-way ANOVA. In addition, the difference in the reduction rate in range of motion for each alignment due to clenching was analyzed using the Friedman test. Differences in the range of motion of spinal alignment among participants were noted in all measurement items, with the trampoline gymnasts showing the highest values regardless of occlusion conditions. Differences due to occlusal conditions were observed at all levels except for the SM in healthy men, and the range of motion of spinal alignment was greater when the mandibular rest position than when the clenching. The reduction rate in HJM due to clenching in rugby players was significantly greater than that of SM. The results of this study showed that the effect of occlusion on spinal alignment range of motion during trunk flexion exercise was greater in participants with exercise habits, and trunk stabilization was more pronounced. Furthermore, it became clear that rugby players tend to rely on hip joint movement during trunk flexion.
Correlation Between Personality Traits and Patient Outcomes Following Elective Spine Surgery: A Pre-Post Interventional Study
Background: Patient outcomes following elective spine surgery can be influenced by a variety of factors, including the patient's psychological state and personality traits. Understanding the relationship between personality traits and surgical outcomes could improve patient care and enhance recovery. Objectives: To assess the correlation between personality traits and patient outcomes following elective spine surgery, utilizing pre- and post-surgical evaluations. Study Design: A pre-post interventional study design was used to evaluate the impact of personality traits on patient recovery after elective spine surgery. Methods: A total of 40 patients undergoing elective spine surgery at the Department of Orthopaedics, JSS Hospital, Mysuru, were included in the study using purposive sampling. The Big Five Personality Traits (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness) were measured pre-operatively. Outcomes, including functional status, pain levels, and quality of life, were assessed post-operatively. Data were analyzed using SPSS software, and a p-value < 0.05 was considered statistically significant. Results: The study identified significant correlations between specific personality traits and patient outcomes. High levels of conscientiousness were associated with better recovery and improved functional outcomes, while high neuroticism was correlated with delayed recovery and lower satisfaction levels post-surgery. Conclusion: Personality traits can significantly influence patient outcomes following elective spine surgery. Incorporating psychological evaluations into pre-surgical planning may help improve recovery and patient satisfaction.
Evaluating the Effectiveness of Vancomycin in Preventing Infections in Spinal Fixation Surgeries
Objective: This study aimed to evaluate the efficacy of topical vancomycin in preventing surgical site infections (SSI) following spinal fixation surgeries. Methodology: This retrospective cohort study was conducted at the Bangladesh Spine & Orthopaedic Hospital, Dhaka, Bangladesh. Participants were divided into two groups: treatment and control. In the treatment group, topical vancomycin powder was applied immediately after spinal surgery. Two-thirds of the powder was applied directly to the bones and muscles at the end of the surgery, while the remaining powder was applied between the fascia and fat layer after fascia closure. The vancomycin dose ranged from 0.5 to 2 grams, depending on wound size and surgery type; 75% of patients received 1 gram of vancomycin. Results: A total of 456 patients underwent spinal surgeries in this study. Among them, 81 patients were treated with vancomycin powder, and 375 were assigned to the control group. In total, 28 cases of SSIs were observed across both groups: 8 cases in the vancomycin group and 20 in the control group. The SSI incidence rate was higher in the treatment group (9.9%) compared to the control group (5.3%), with infections typically occurring within 14 days post-surgery. Of the reported SSIs, 43% were superficial, while 57% were classified as deep infections. Conclusion: In conclusion, this study did not find evidence supporting the efficacy of topical vancomycin powder in preventing SSIs following spinal fixation surgeries. However, no adverse effects were observed during the study period.
Surgical Domain-Specific LLM Concordance with NASS Guidelines for Adult Neoplastic Vertebral Fractures: A Comparison of Prompt Engineering Approaches
In spine care, large language models offer promising potential for interpreting complex North American Spine Society (NASS) clinical guidelines. Clinical practice guidelines (CPGs) represent the cornerstone of evidence-based medicine, yet their interpretation and consistent application remain challenging due to complexity, evolving evidence bases, and contextual variability. Standard large language models (sLLMs) demonstrate unreliable performance when interpreting clinical practice guidelines, particularly with zero-shot prompting, due to frequent hallucinations that limit their utility in evidence-based medical decision-making. Domain-Specific Large Language Models (dLLMs) incorporating Retrieval-Augmented Generation (RAG) technology offer a promising solution by integrating external medical knowledge. When combined with Knowledge-Infused (KI) prompting—which concatenates relevant recommendation knowledge with specific guideline questions as contextual prompt—these systems can anchor model responses and reduce hallucinations. This study compares hallucination rates between KI and ZS prompt engineering using Verif.ai, a medical-based, RAG-embedded, dLLM. The goal was to generate low-hallucination recommendations aligned with NASS guidelines for diagnosing and treating adults with neoplastic vertebral fractures. Twenty-two guideline questions were reformulated using both prompting strategies and statistically evaluated. The results show that KI prompting achieved a higher overall concordance (95%) compared to ZS prompting (73%). Performance differences were most notable in Definition and Natural History (100% vs. 50%), Interventional Treatment (88% vs. 50%), and Surgical Treatment (100% vs. 75%) categories. KI prompting excelled with clear guidelines (80% vs. 40%) and maintained superiority in scenarios with evidence limitations (100% vs. 82%). The outperformance of KI over ZS is attributed to several factors: KI's incorporation of specific clinical evidence and terminology provides contextual anchoring and aligns with specialized medical language, thereby reducing the model's tendency to generate inaccurate or "hallucinated" information. Additionally, KI effectively narrows the hypothesis space by constraining the range of possible responses the model can generate. This focused approach enhances the model's ability to accurately communicate evidentiary limitations, particularly in complex and ambiguous clinical scenarios. Thus, integrating Verif.ai’s RAG capabilities with KI prompting significantly improves guideline efficacy over ZS prompting through its robustness in minimizing errors in language model-assisted clinical decision-making, a factor pivotal for spine care.
Exploring Flexibility vs. Stability: A Biomechanical Study on Stand-Alone Cages vs. Unilateral and Bilateral Pedicle Screw Fixation in Multilevel Lateral Lumbar Interbody Fusion and the Impact on Slope Variations
Background Context: Lateral lumbar interbody fusion (LLIF) is utilized to treat various lumbar spine conditions, including degenerative disc disease, spondylolisthesis, and spinal instability. Although pedicle screws and rods are commonly added for fusion stability, they pose risks such as adjacent facet joint issues and guidewire-related vascular problems. Previous research has identified a direct link between the level of instrumentation and a reduction in spinal flexibility, prompting a critical question: What's the ideal balance between spinal flexibility and stability for successful fusion, challenging the idea of completely restricting natural spinal motion? Methods: Eight human cadaveric L1-L5 specimens were utilized, affixed to a universal testing machine (MTS 30/G) and subjected to optical motion-tracking technology for threedimensional range of motion assessment. The specimens underwent testing under four conditions: 1) intact, 2) 26 mm lateral interbody stand-alone cages (stand-alone LLIF), 3) 26 mm lateral interbody cages with unilateral rod fixation at L1-L5 (LLIF + unilateral rod), and 4) 26 mm lateral interbody cages with bilateral rods fixation at L1-L5 (LLIF + bilateral rods). Results: From the intact condition, stand-alone LLIF decreased the slope of flexion by 0.29, extension by 0.89, left lateral bending by 0.93, and right lateral bending by 0.18. Compared to the stand-alone cages, LLIF with unilateral rod and pedicle screw fixation further decreased the slope of flexion by 0.08-0.30. Conversely, the implementation of bilateral rods and pedicle screws decreased slope by an additional 0.24-0.42 compared to the stand-alone cages. Conclusions: Our study found that the differences in ROM between stand-alone LLIF and using additional instrumentation amount to changes in slope below 1. This raises the question: Is the incremental decrease in ROM, often expressed in fractions, genuinely pivotal in the larger context of patient outcomes and overall well-being?
Clinical Characteristics and Post-surgical Outcomes in Patients with ACIS™ -Anterior Cervical Interbody Spacer (ACIS) Placement in Anterior Cervical Discectomy and Fusion Surgery
Introduction: The ACIS™ -Anterior Cervical Interbody Spacer (ACIS, Johnson & Johnson MedTech, Raynham, MA) is a polyetheretherketone (PEEK) cervical cage and is intended for use as intervertebral body fusion device in skeletally mature patients with degenerative disease of the cervical spine (C2–C7). Supplemental fixation is recommended in multi-segmental fusions. Narrowing of the intervertebral height (IH) is an important pathological change in degenerative spinal disease. This study aims to study clinical characteristics, surgical measures and adverse events in patients that received ACIS and VECTRA anterior cervical plate (VECTRA, Johnson & Johnson MedTech, Raynham, MA). It also aims to provide a better understanding of the role that IH plays in clinical outcomes following anterior cervical discectomy and fusion (ACDF). Methods: In this retrospective cohort study, patients with degenerative disease of the cervical spine were obtained from the hospital electronic medical records of Carilion Medical Center between 2016 to 2020. Patients that received treatment with ACIS and VECTRA and allograft bone grafting were selected. Information on patient demographics, clinical characteristics, and surgical characteristics was collected. Plain film radiographs were reviewed to evaluate changes in anterior and posterior IH at pre-operative, immediate post-operative, 6-month follow-up visit, and 12-month follow-up visit. A two-tailed T-test was used to identify if there was a statically significant difference in preoperative IH compared to post-operative IH. Radiographic assessment to look for bridging bone was done in order to confirm successful fusion. Results: This study included 106 patients. There are 55 males and 51 females. The mean age is 54.4 years and median age is 53 years-old ranging from 26 to 84 years-old . The average body mass index of the population is 31 (95% confidence interval of 18-45). Thirty-one patients never smoked, 35 patients quit over 3 months ago, and 40 patients were current smokers (28%, 32%, and 37%, respectively). Overall, the mean anterior and posterior IH at each post-op visit was significantly greater than pre-op mean anterior and posterior IH (P<0.05). After surgery, a few patients had persistent symptoms of neck pain and swallowing difficulties. In general, the number of patients with swallowing difficulties improved with time; however, the number of patients experiencing neck pain remained constant (Figure 2). Five patients underwent a reoperation procedure, four of which were revision procedures in which supplemental posterior fixation was added to the index vertebral levels. One patient underwent reoperation adjacent to the index levels for treatment of adjacent level disease. Fifty-two of the 56 patients were fused by the 6 month post-op visit and the remaining four patients were fused by the 12 month post-op visit. Conclusion: This single center, retrospective cohort study is the first study to look at clinical and surgical factors in patients with degenerative spine disease that were surgically treated with ACIS and VECTRA in single and multilevel ACDF procedures. This study showed that patients received satisfactory fusion as exemplified by radiographic imaging. This study revealed that IH significantly increased post-operatively. Additionally, this difference was sustained throughout all follow-up visits for at least 1 year after surgery.
Open Spinal Fusion versus Minimally Invasive Spine Surgery: A Literature Review
Background: Spinal fusion remains a foundational intervention for degenerative disc disease, spondylolisthesis, and scoliosis. While open spinal fusion (OSF) has been the gold standard for decades, minimally invasive spine surgery (MISS) has gained prominence for its reduced perioperative burden and potential to enhance recovery. A comprehensive comparison of these techniques is necessary to evaluate their relative efficacy, safety, and adaptability across patient populations. Objectives: To critically compare open spinal fusion and MISS techniques from 2014 to 2024 in terms of clinical outcomes, surgical innovations, patient-specific factors, and economic viability, focusing on quantitative metrics such as fusion success, complication rates, revision frequency, operative parameters, and quality-of-life indices. Methodology: A systematic review of peer-reviewed literature (2014– 2024) was conducted across PubMed, Scopus, and Web of Science using predefined MeSH terms and Boolean logic. Inclusion criteria required comparative studies (RCTs, meta-analyses, systematic reviews) involving ≥50 patients with degenerative disc disease, spondylolisthesis, or scoliosis. Outcome variables included fusion rates, Visual Analog Scale (VAS) pain scores, Oswestry Disability Index (ODI), operative time, blood loss, complications, length of stay (LOS), and revision surgery rates. Results: MISS demonstrated significantly lower complication rates (5%–10%) compared to OSF (20%–30%) (p < 0.05), with reduced blood loss (100–200 mL vs. 400–600 mL), shorter LOS (2–3 vs. 5–7 days), and faster ambulation (up to 3.5 days earlier). Fusion rates were comparable across techniques: 80.5%–98% for MISS and 91.1%–98% for OSF (p > 0.05). MISS reduced opioid use by 30%, and in obese patients (BMI > 30), complication rates fell from 15% (OSF) to 6% (MISS, p < 0.01). Revision surgery rates were halved in MISS (14% vs. 28%, p = 0.001), although early learning curve risks were noted (OR 2.59, p = 0.003). In scoliosis, MISS achieved equivalent Cobb angle correction (≈70%) with 50% less blood loss. Quality-of-life outcomes (ODI, EQ-5D, VAS) converged by 2–5 years across all conditions (p > 0.05). Conclusion: MISS provides equivalent long-term efficacy to OSF in spinal fusion while conferring significant perioperative advantages, reduced revision rates, and enhanced recovery—particularly in paediatric, elderly, and obese populations. Despite initial technical challenges and reliance on advanced technology, its integration of endoscopic, robotic, and awake techniques positions MISS as a leading strategy for modern spinal care. Further long-term, condition-specific RCTs are warranted to optimize patient stratification and refine adoption.
Severe Ataxia Secondary to Copper Deficiency Myelopathy in a Patient with History of Gastric Bypass Surgery: A Case Report
This is a 46-year-old female with significant past history notable for systemic lupus erythematous, gastric bypass surgery, and anterior cervical diskectomy and fusion at cervical 5-6 who presents to clinic with months of progressive difficulty with ambulation and falls. Patient initially misdiagnosed with severe cervical stenosis and then vitamin B12 deficiency as the cause of her gait ataxia. Subsequent workup later proved patient was suffering from copper deficiency leading to subacute combined degeneration of the spinal cord. Copper deficiency is a rare and often overlooked cause of spinal cord injury especially in the context of gastric bypass and zinc supplementation for wellness in today’s COVID era. More attention should be placed on copper deficiency as a root cause of gait ataxia.
Impact of Sleep Disorders and Sleep Quality on Psychological Well-Being and Quality of Life in Patients with Traumatic Spinal Cord Injury
Background: Many people with traumatic spinal cord injury (TSCI) struggle with bad sleep, which is relationship to a reduced quality of life (QoL). Objective: The study aims to investigate how sleep disorders and the sleep quality influence the psychological well-being and QoL of individuals who have experienced a TSCI. Methods: This is a cross-sectional quantitivae study of TSCI patients patients admitted to Wuhan Hospital, Rehabilitation department, we used Pittsburgh Short form-12, and Sleep Quality Index (PSQI) to assess QoL, and quality of sleep, respectively. Moreover, was used Self-Rating Anxiety, and Depression Scale (SAS, and SDS) To assess anxiety, and depression among of TSCI patients. Results: The Physical Component Summary (PCS-12) score was 16.43 (SD = 1.87) and the Mental Component Summary (MCS-12) score was 23.05 (SD = 1.09). Correlation analysis indicated that the PCS-12 had a negligible correlation with the PSQI (r = 0.04, p = 0.64) and a moderate correlation with SAS (r = 0.34, p = 0.87), while its correlation with SDS was minimal (r = 0.12). In contrast, the MCS-12 showed a significant positive correlation with the PSQI (r = 0.45, p = 0.03) but weak correlations with the SDS (r = 0.24, p = 0.85) and SAS (r = 0.12, p = 0.53). This suggests complex interactions among injury characteristics, gender, and sleep disorders in relation to quality of life measures. Conclusion: Our outcomes emphasize important role that sleep disorders. Furthermore, sleep quality play in the psychological well-being of individuals with TSCI.
Long-Term Outcomes of Minimally Invasive vs. Traditional Open Spinal Fusion: A Comparative Analysis
Spinal fusion is a widely performed surgical intervention for managing degenerative spinal conditions, instability, and deformities. Traditionally, open spinal fusion has been the standard approach, offering direct visualization and access to spinal structures. However, advancements in surgical techniques have led to the development of minimally invasive spinal fusion (MISF) as an alternative, aiming to achieve comparable clinical outcomes while reducing surgical trauma, postoperative pain, and recovery time. Despite these advantages, concerns remain regarding the long-term effectiveness of MISF, particularly in terms of fusion rates, complication risks, and adjacent segment disease (ASD). This review critically examines the long-term outcomes of MISF compared to traditional open fusion, focusing on key factors such as perioperative outcomes, pain relief, functional recovery, fusion success rates, and costeffectiveness. Perioperative data indicate that MISF is associated with reduced blood loss, shorter hospital stays, and lower infection rates but may involve longer surgical times and a steeper learning curve. Long-term clinical outcomes appear comparable between MISF and open fusion, with both techniques achieving high fusion rates and significant improvements in pain and function. However, the impact of MISF on adjacent segment disease remains inconclusive, with conflicting evidence regarding its potential biomechanical advantages. Cost-effectiveness analyses suggest that MISF may offer financial advantages in the long term by reducing hospitalization and rehabilitation expenses, despite higher initial surgical costs. Nonetheless, limitations in current research, including variability in study methodologies, patient selection, and surgeon expertise, necessitate further high-quality, long-term randomized controlled trials. This review synthesizes the current literature on MISF and traditional open fusion, identifies existing research gaps, and outlines future directions for optimizing surgical decision-making and improving patient outcomes.
Lumbar Spinal Stenosis: Pathophysiology, Biomechanics, and Innovations in Diagnosis and Management
Lumbar spinal stenosis (LSS) is a common condition caused by the narrowing of the spinal canal, resulting in compression of neural and vascular structures. This compression leads to symptoms such as claudication, paresthesia, and lower extremity weakness. LSS is the leading cause of low back pain and functional limitations, affecting over 103 million people worldwide. Degenerative changes, including ligamentum flavum hypertrophy, facet joint osteoarthritis, and intervertebral disc degeneration, are the primary contributors to LSS. Additional factors, such as genetic predisposition, congenital abnormalities, and autoimmune conditions, are also emerging as contributors. A major challenge in managing LSS lies in differentiating it from other causes of neurogenic symptoms and low back pain while devising an appropriate treatment plan from the wide array of conservative and surgical options available. Minimally invasive surgical techniques, such as lumbar spinous processsplitting laminoplasty and partial facetectomy, are often compared to the gold standard laminectomy with or without fusion. Surgical interventions offer significant improvements in pain relief, disability, and quality of life within 3–6 months; however, these benefits often diminish after 2–4 years. Contrasting evidence demonstrates that long-term outcomes of non-surgical treatments, such as physical therapy, pharmacological management, and lifestyle modifications, are often comparable to surgical modalities. Emerging therapies, including interspinous devices and stem cell therapy, show promise but require further research. Managing LSS requires a multidisciplinary approach tailored to patient-specific factors, including age, comorbidities, and functional goals. Future research should aim to improve diagnostic accuracy, refine surgical techniques, and explore innovative therapies to enhance outcomes for patients with LSS.
Outcome of Prolapse Lumbar Intervertebral Disc (PLID) Surgery: A Study at a District-Level Private Hospital in Bangladesh
Background: Lumbar disc herniation (LDH) is the most common specific cause of low back pain (LBP). It is a degenerative process as well as acute trauma causing annular tear with extrusion of the nucleus pulposus through the posterior midline or posterolateral aspect of the disc, leading to compression of the thecal sac and nerve roots with radicular symptoms. Disc prolapse often affects the lumbar region, typically at L4/L5 or L5/S1. Individuals with occupation of prolonged standing (eg- Traffic Police), prolonged sitting (Desk job) weightlifters, and those with multiple jerking trauma (eg-Bikers) are at higher risk. Initial symptoms include backache and sciatica, with possible muscle weakness, Bowel and Bladder involvement in Cauda Equina compression. Diagnosis based on a typical History of LBP with Radiculopathy, physical tests like straight leg raising, and DRE should be done in Cauda Equina Syndrome. Differential diagnoses include tuberculosis, spinal stenosis, and vertebral tumours. MRI will confirm the diagnosis. Dynamic view X-ray will be required to see the instability. Surgery is reserved for those who are not responding to nonsurgical management for at least 6 weeks, but for Cauda Equina Syndrome, surgery should be done immediately. Surgical management of lumbar intervertebral disc prolapse (PLID) is crucial for alleviating pain and restoring function. In Bangladesh, evaluating surgical outcomes is essential. Aim of the study: The study aimed to explore the various demographic aspects of patients who have undergone PLID surgery, focusing on clinical presentation, complications, and surgical outcomes. Methods: This prospective observational study was conducted in the different private hospitals in Satkhira, Bangladesh, from 2020 to 2021. A total of 112 patients undergoing PLID surgery were enrolled and analyzed in this study. Advanced imaging techniques like MRI confirmed diagnoses, and participants were selected through purposive sampling. Detailed demographic and clinical data were recorded, and patients voluntarily joined a clinical follow-up program, with assessments preoperatively, on day one post-surgery, after one week, at 12 weeks, and after 1 year. Patients with low back pain who are diagnosed with PLID do not respond to conservative treatment or progressive neurological deficits. Patients with disc prolapse other than lumber region, malignancy, tuberculosis, and patients with severe co-morbidity and unfit for surgery, Pain and functional outcomes were measured using VAS scores and Modified Macnab criteria. Result: The study evaluated surgery outcomes for lumbar intervertebral disc prolapse (PLID) among 112 participants. Most participants were aged 31-40 (46.43%) and 21-30 (35.71%). Females comprised 61.61% and 20% of cases of Cauda equina syndrome. PLID primarily affected the left side (58.04%) and commonly occurred at L4-L5 (56.25%) and L5-S1 (36.61%). Pre-surgery, the mean VAS score was 7.4, dropping to 2.8 at 12 weeks post-surgery. Conclusion: The study found that PLID surgery at a district-level private hospital in Bangladesh resulted in significant pain reduction and excellent outcomes for most patients. Among 112 participants, mean VAS scores dropped from 7.4 to 2.8 post-surgery, with 75.89% achieving excellent results. Complications were minimal and well-managed.
Copyright (c) 2024 Journal of Spine Research and Surgery
Clinical Application of Near Infrared Blood Oxygen Monitoring in Cervical Spinal Cord Injury
Background: It has always been a challenge for orthopedic surgeons worldwide, to detect the blood flow after cervical spinal cord injury (CSCI). How to non-invasively, real time, and quantitatively evaluate the blood supply and injury degree of the spinal cord during the operation, and how to guide the selection of laminectomy and durotomy? Objective: To investigate the feasibility of using NIR-SO2 (Near infrared light-Oxygen saturation) monitoring for CSCI and to determine whether NIR can provide a non-invasive, real time, and quantitative assessment of the degree of spinal cord decompression and the need for a durotomy. Methods: This study collected 37 CSCI cases from June 2023 to October 2024. Inclusion criteria: patients aged >18 years; patients with cervical fracture and/or dislocation, ASIA grades A, B, and C; treated with a posterior approach. Exclusion criteria: patients aged <18 years; ASIA grade D or E, no cervical fracture and/or dislocation; SCI treated conservatively; patients with normal MRI and no neurological symptoms; patients with spinal tumors. However, apply NIR-SO2 technology to detect regional SO2 under light-proof conditions. Results: This study collected 37 patients; 23 males (62.2%) and 14 females (37.8%). The patients' ages was 51.4±9.7 years. The admissionto- operation time was 51.9±9.1 hours. The ASIA grades improved during the last follow-up. The NIR-SO2 in 22 patients before laminectomy was 53.7±1.6%, and after laminectomy was 65.1±1.6% (P<0.01). Therefore, in 15 patients before laminectomy, the NIR-SO2 was 39.7±1.6%, improving to 42.3±2.6% after laminectomy and increasing to 62.7±3.1% after durotomy and duroplasty with a statistical difference before and after durotomy (P<0.01). Conclusion: NIR-SO2 technology is safe and feasible and directly reflects the improvement of spinal cord blood supply. NIR-SO2 technology can monitor the regional SO2 of CSCI patients and assess spinal cord perfusion and compression in real time.
C1-Ring Osteosynthesis as a Safe and Effective Method for C1 Fractures
Background: C1 fractures are traditionally treated with C1–2 fixation and fusion because they are thought to provide a better level of stability. However, this surgical treatment is associated with a reduced range of motion. C1 ring osteosynthesis is an alternative technique that provides adequate fracture healing while preserving the range of motion. We aimed to describe the clinical and radiological outcomes of patients with C1 fractures treated with C1 osteosynthesis. Methods: This retrospective single-center study included all patients with C1 fractures who underwent C1-ring osteosynthesis surgery during 2007– 2023. Lateral mass displacement (LMD), atlantodental interval (ADI), hospital stay, surgical duration, and surgical complications were analyzed. Results: Overall, 38 patients were identified. Thirty patients received C1 ring osteosynthesis alone, and eight patients had associated polytrauma and multiple surgeries including other spondylodesis in the cervical spine (17 female, 21 male; age: 57.3 ± 23.7 years). The mean operative duration was 94 ± 17 minutes. The mean hospital stay was 18.2 ± 7.6 days, however, after excluding polytraumatic patients with long intensive care treatment, the mean hospital stay was 9.8 ± 1.4 days. No postoperative neurological deterioration was observed. All patients reported pain relief shortly after surgery. ADI and bi- and unilateral LMD were significantly reduced after surgery. Conclusion: Based on this analysis, C1 ring osteosynthesis is a safe and feasible procedure for treating C1 fractures. Radiographic and clinical parameters were significantly improved, while complication rates were comparable to those of other methods.
The Decline of Lumbar Artificial Disc Replacement
Lower back pain associated with degenerative disc disease is a common occurrence, with many surgical treatments targeting the degenerated disc to relieve symptoms. Current surgical options for degenerative disc disease primarily consist of a discectomy followed by either spinal fusion or artificial disc replacement, with the former being increasingly more common in the lumbar region despite the risk of adjacent segment disease. Though artificial disc replacement aims to provide an increase in range of motion and decreases risk of adjacent segment disease, surgeons are increasingly opting for spinal fusion in the lumbar region. This review investigates underlying factors that may be contributing to this trend by assessing lumbar artificial disc replacement selection criteria, clinical outcomes, surgical technique, complications, revision burden, and overall cost. While these factors had some role in the physician’s decision, ultimately the narrow selection criteria and lack of cost reimbursement by insurance has primarily led to the decline in lumbar artificial disc replacement.
Sitting With or Without Wedge-Shaped Cushion After Lumbar Spinal Fusion
Introduction: Transition from standing to sitting significantly decreases lumbar lordosis (LL). Fusion of lumbar segments eliminates motion and therefore, adjacent mobile segments are recruited during transition from standing to sitting to compensate. Prescription of a wedge-shaped seat cushion to retain LL while seated is a common practice. However, its effect has not been evaluated before and after posterior lumbar spinal fusion (PSF). Methods: Patients undergoing PSF at a single academic institution between May 2022 and August 2023 were included in the study. Radiographic spinopelvic parameters were measured in the standing, relaxed sitting, and sitting on a wedge-shaped cushion positions before and after surgery. Results: Twenty patients were included for analysis (female to male, 11:9). Mean age was 67 ± 10 years. Mean body mass index was 26.3 ± 3.3 kg/m2. Median LL significantly decreased before the surgery from the standing 43° (33.5-49.5°) to the sitting positions with and without a cushion (24° (13-32°) vs 25° (8.5-34.5°); p<.001). After surgery LL also significantly decreased from the standing 38° (32- 47°) to the sitting positions with and without a cushion (26° (16.5-36°) vs 26° (19-38°); p<.001). But there was no significant difference in LL between the sitting positions without and with a cushion before and after the surgery 1° (-2-4°) and -2 (-4-2°), respectively. Conclusions: Sitting significantly decreases lumbar lordosis and increases pelvic tilt, but use of a wedge-shaped seat cushion does not alter lumbar lordosis compared with regular sitting before or after fusion surgery.
Can Anterior Discectomy and Fusion (ACDF) Surgery be Safely Performed in an Outpatient Setting? A Systematic Review on the Post-operative Complication and Readmission Rates
Background: Anterior Cervical Discectomy and Fusion (ACDF) is a common surgical procedure used to treat cervical spine disorders. The safety and efficacy of outpatient versus inpatient ACDF settings have been debated, with varying findings reported in the literature. This study aims to evaluate and compare post-operative complication reporting frequency, numerical rate and readmission rates and readmission rates between outpatient and inpatient ACDF surgeries. Methods: A systematic review was performed between 1996 and 2024 using PubMed, Medline and Embase. Thirty one studies were included, 22 compared inpatient and outpatient settings directly and nine that focused solely on outpatient settings. Data were analysed on the overall rates of major and minor post-operative complications, frequency of specific complications, and readmission rates. Statistical significance was assessed using p-value of <0.05. Results: Results showed that inpatient ACDF surgeries had a higher interquartile range of overall complication rates compared to outpatient surgeries. Specifically, inpatients reported complication rates ranging from 0% to 31.36%, while outpatients ranged from 0.001% to 34.59%. Sixteen out of twenty two studies demonstrated higher complication rates for inpatients, with statistically significant differences observed in mortality, haematoma, dysphagia, respiratory and dural complications. Conversely, dysphagia was reported at higher rates in outpatients in one statistically significant study. Readmission rates were also higher for inpatients, ranging from 0% to 44.2%, compared to 0% to 24.69% for outpatients. The findings suggest that outpatient ACDF surgeries are associated with lower overall complication rates and readmission rates compared to inpatient procedures. The variability in complication rates and readmission may be influenced by differences in patient selection, procedural complexity, and post-operative monitoring. Conclusion: Outpatient ACDF surgery appears to be as safe and effective as inpatient surgery, with advantages including lower readmission rates and fewer major complications. Despite some discrepancies, particularly concerning dysphagia, the overall evidence supports the efficacy of outpatient ACDF. Further research with standardised definitions and methodologies is needed to confirm these findings and better understand the implications for clinical practice.
Enhancing Surgical Outcomes in Pars Interarticularis Fracture: An Investigation of Treatment Modalities and Variability in Spondylolysis Surgical Approaches
Numerous studies have failed to definitively establish the most stable repair construct for spondylolysis. We seek to clarify this issue through a combination of physical experimentation using SawBones and corresponding finite element analyses (FEA). Using twenty-five SawBones lumbar vertebral body models, we tested four repair techniques: Buck's intralaminar screws, pedicle-screw and hook construct, pars interarticularis plating, and pedicle-screw intralaminar screw construct. Each Sawbones repair construct was secured with a C-clamp to the base of an MTS 858 Bionix test system. The testing frame was programmed to apply axial load to replicate an extension moment on the pars interarticularis and gradually increased until catastrophic failure, gapping of the pars defect exceeded 5 mm, or an obvious yield point was identified on stress-strain curves. The FEA involved creating an L4-L5 vertebrae model from CT scans, simulating fractures, and analyzing stress using SolidWorks and Ansys software. Results showed that while no repair method fully replicated the original stiffness of the intact pars, Buck's technique emerges as the closest approximation. Repair by pedicle screw hook, intralaminar screws, and plates demonstrates enhanced peak load to failure and elastic displacement. In FEA, the Buck technique exhibits superior reliability in comparison to other methods when assessing von Mises stresses, and the novel Implants 1 and 2 showcase the lowest average displacements. While the clinical significance of maintaining greater peak load or elastic displacement remains uncertain, our findings contribute to understanding spondylolysis repair. Additionally, utilizing FEA for novel designs offers promise in enhancing surgical outcomes.
Effects of Suboccipital Release Osteopathic Manipulation on Autonomic Nervous System: Insights from Short-Term QT Interval Measurements in Healthy Young Adults
Introduction: Osteopathic physicians employ the Sub Occipital Release (SOR) manipulation technique to promote wellness and modulate the Autonomic Nervous System (ANS). It has been found that this technique promotes relaxation and balance throughout the body. The principle behind SOR involves targeting mechanoreceptors found within the deep fascia, connective tissue, and muscles of the sub occipital area. By effectively balancing the ANS, SOR techniques are believed to alleviate stress and improve blood flow in the suboccipital region. This could potentially relieve any potential compression on the vagus nerve, enhancing vagal activity in cardiac myocytes. The primary objective of this research is to examine how SOR impacts cardiac control, specifically using QT variability as a surrogate measure. Methods: A crossover design was incorporated with three interventions: a control group with no physical contact, sham treatment, and a SOR group. Data was collected using 12-lead EKG recordings, with intervals for QRS, QT, QTcB, JT, QTa, and QTend. The index of cardiac electrophysiological balance (iCEB) was determined by measuring QTcB and QRS duration. Results: The multiple comparisons showed that there was no significant difference in the QTa measurements between the V2 and aVF leads, as these two leads record the maximum and minimum QTa intervals [F (1.705, 34.11) = 1.294, P = 0.06]. The The mean values (Mean±SEM) for the control, sham, and SOR groups (96.29 ± 4.37msec ,97.14 ± 5.85 msec, and 89.48 ± 4.62msec respectively. This was significantly lower for the SOR group [F (1.705, 34.11) = 1.294, P = 0.05]. The variability in the QTcb was also found to be statistically significant [F (1.410, 28.19) = 0.4429, P=0 .051]. To get a more accurate measurement of relative variation compared to just using QTend alone, we looked at the ratio of QTend to either QT or QTc interval. The mean ratio values (Mean±SEM) for the control, sham, and SOR groups were 0 .26±0 .01, 0.25±0 .01, and O .19±O.01 respectively. A significant decrease was observed in the SOR group when compared to the other two groups. Conclusions: The effects of SOR on QT metrics were diverse, resulting in a moderate increase in both QT and QTcB length. Additionally, there was a decoupling of the QTend and JT intervals, leading to shortened QTend intervals potentially due to increased vagal activity. This could be a result of alterations in repolarization or a temporary decrease in heart rate due to vagal stimulation. This, along with a moderate increase in QTcB, suggests that SOR may improve cardiac function by prolonging the effective refractory period enhancing ventricular relaxation.
Single Neurosurgeon Experience with the ZimVie LDR-C ROI Implant: A Study of 236 Patients with Predictive Outcome Modeling
Study Design: Retrospective Review Objective: The goal of the study is to show the device has acceptable performance and fusion rates with a predictive modeling analysis of poor outcomes. Summary of Background Data: This is one of the larger single-surgeon studies using the same (ZimVie LDR-C ROI) stand-alone device in the treatment of cervical degenerative disease with an Anterior Cervical Diskectomy and Fusion (ACDF). Methods: We reviewed the records of 236 patients over a 4-year period (2016 – 2020) including presentation, diagnosis, risk factors, outcome, Odom’s Criteria, fusion status, and complication rate up to one year. We identified risk factors and performed a predictive modeling analysis for poor outcomes. Results: Patients presented with radiculopathy (72%) or myelopathy (28%). Surgery included one-level (45.3%), two-level (47.8%) and threelevel fusions (6.8%) with a total 384 levels. Three patients (1.2%) developed a wound hematoma; 11 (4.7%) patients had a prior fusion that needed re-exploration for possible pseudoarthrosis, and 13 (5.5%) developed adjacent segment disease. Odom’s Criteria Scores for patients at 2 weeks, 1 month, 3 months and 1 year with an outcome of Excellent to Good were 68%, 74%, 78% and 89% respectively. Fusion rates at 1 month, 3 months, and 1-year were 33%, 69% and 92%. Predictive modeling showed that outcome in the short-term was fair to poor with a pre-operative history of motor deficit or narcotics history for pain. Fair to poor outcome in the long-term one was related to a history or worker’s compensation injury, narcotics history for pain, and emotional lability. Conclusion: The ZimVie LDR-C ROI is a safe device with low complication rate, commensurate fusion rate, and acceptable outcome scores.
Impact of Non-surgical Spinal Decompression Combined Protocol on a Lumbar Disc Herniation Predisposing the Patient to Surgical Intervention - A Case Study
Background: Although conservative treatment is the first choice for patients with lumbar disc herniation symptoms, in the case of sciatica, progressive neurological deficits and confirmation of extensive herniation from MRI, surgical intervention is indicated. Despite the existence of factors predisposing the patient to surgery, around 3% to 43% of patients experience recurrence of their symptoms following lumbar decompressive surgery. Case Report: A 49-year-old female recreational kite surfer doing a sedentary job as a secretary complained of acute sciatic pain after intensive gardening. The initial physical therapy examination revealed a suspicion of a herniated disc in the L5 area, which was confirmed by an MRI. Despite the length of the herniation exceeding 1 cm associated with significant sciatic symptoms predisposing the patient to surgery, a non-invasive approach combining non-surgical spinal decompression with high-intensity repetitive peripheral magnetic stimulation (RPMS) was chosen. The final examination revealed a significant improvement in symptoms and MRI findings after ten combined sessions. Conclusion: The combination of non-surgical spinal decompression and RPMS therapy represents a promise for patients who are indicated for surgical intervention, but prefer an alternative non-invasive treatment without the risk of side effects and the need for post-operative recovery.
Cauda Equina Syndrome During Labour - A Diagnostic Challenge and Proposed Management Algorithm
Aim: The incidence of lumbar disc herniation during pregnancy is rare (1:10,000). Of all lumbar disc herniation’s, only 2% will develop acute Cauda Equina Syndrome (CES). It is a diagnostic challenge to identify CES during labour due to overlapping symptoms that mimic and obscure CES symptoms in a stressful therapeutic environment. We present a case report and brief literature review with a proposed algorithm for management. Method: We reviewed the case of a nulliparous 35 year old woman who developed CES during labour due to an acute extruded disc. CES symptoms developed during labour and were initially attributed to the obstetric process. Baby was delivered via emergency caesarean section for prolonged labour and foetal distress. Post delivery persistent saddle paresthesia, urinary retention and radicular leg pain prompted orthopaedic review. An MRI was performed demonstrating a large disc extrusion at the level of L5/S1. Results: Emergent decompression was performed post partum day 7. Improving pain and neurologic deficits were seen initially but some ongoing perineal parathesia and urinary frequency. Conclusion: Maintaining a high index of suspicion for persistent saddle anaesthesia, urinary retention and radicular pain post partum would aide in early referral for Orthopaedic review and advanced imagining in CES. The hope is this will help prevent persistent neurological deficits in young women and case reporting will aide in understanding what role if any CES has in prolonged labour.
Osteoblastoma-Like Osteosarcoma of the spine: A Case Report and Review of the Literature
Background: OBLOS of the spine is an extremely rare tumor, with 12 cases have been reported in the literature. We present a case of OBLOS affecting the thoracic spine. We also review similar cases in literature. Clinical Presentation: A 19-year-old male patient presented to our center with an incidental T7 lesion with a complain of back pain for 2 weeks with altered sensation starting from T7 dermatomal distribution below. Neuro examination showed no significant neurological deficits. He underwent tumor excisional surgery over 2 occasions. Last follow up images showed tumor recurrence despite treatment. Conclusion: OBLOS in general is an aggressive tumor and yet best modality of treatment is early surgical excision. Future research should be carried out to determine the best method of adjuvant treatment modality for OBLOS.