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To report the development of the technique for minimally invasive lumbar decompression using robotic-assisted navigation.

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The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on complications and costs.

Aims. Lumbar spinal stenosis (LSS) is a common skeletal system disease that has been partly attributed to genetic variation. However, the correlation between genetic variation and pathological changes in LSS is insufficient, and it is difficult to provide a reference for the early diagnosis and treatment of the disease. Methods. We conducted a transcriptome-wide association study (TWAS) of spinal canal stenosis by integrating genome-wide association study summary statistics (including 661 cases and 178,065 controls) derived from Biobank Japan, and pre-computed gene expression weights of skeletal muscle and whole blood implemented in FUSION software. To verify the TWAS results, the candidate genes were furthered compared with messenger RNA (mRNA) expression profiles of LSS to screen for common genes. Finally, Metascape software was used to perform enrichment analysis of the candidate genes and common genes. Results. TWAS identified 295 genes with permutation p-values < 0.05 for skeletal muscle and 79 genes associated for the whole blood, such as RCHY1 (PTWAS = 0.001). Those genes were enriched in 112 gene ontology (GO) terms and five Kyoto Encyclopedia of Genes and Genomes pathways, such as ‘chemical carcinogenesis - reactive oxygen species’ (LogP value = −2.139). Further comparing the TWAS significant genes with the differentially expressed genes identified by mRNA expression profiles of LSS found 18 overlapped genes, such as interleukin 15 receptor subunit alpha (IL15RA) (PTWAS = 0.040, PmRNA = 0.010). Moreover, 71 common GO terms were detected for the enrichment results of TWAS and mRNA expression profiles, such as negative regulation of cell differentiation (LogP value = −2.811). Conclusion. This study revealed the genetic mechanism behind the pathological changes in LSS, and may provide novel insights for the early diagnosis and intervention of LSS. Cite this article: Bone Joint Res 2023;12(6):387–396

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The aim of this study was to assess the accuracy of pedicle screw placement, as well as intraoperative factors, radiation exposure, and complication rates in adult patients with degenerative disorders of the thoracic and lumbar spines who have undergone robotic-navigated spinal surgery using a contemporary system.

Initial treatment of traumatic spinal cord injury remains as controversial in 2023 as it was in the early 19th century, when Sir Astley Cooper and Sir Charles Bell debated the merits or otherwise of surgery to relieve cord compression. There has been a lack of high-class evidence for early surgery, despite which expeditious intervention has become the surgical norm. This evidence deficit has been progressively addressed in the last decade and more modern statistical methods have been used to clarify some of the issues, which is demonstrated by the results of the SCI-POEM trial. However, there has never been a properly conducted trial of surgery versus active conservative care. As a result, it is still not known whether early surgery or active physiological management of the unstable injured spinal cord offers the better chance for recovery. Surgeons who care for patients with traumatic spinal cord injuries in the acute setting should be aware of the arguments on all sides of the debate, a summary of which this annotation presents.

Cite this article: Bone Joint J 2023;105-B(4):347–355.

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Although lumbosacral transitional vertebrae (LSTV) are well-documented, few large-scale studies have investigated thoracolumbar transitional vertebrae (TLTV) and spinal numerical variants. This study sought to establish the prevalence of numerical variants and to evaluate their relationship with clinical problems.

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This study, using a surgeon-maintained database, aimed to explore the risk factors for surgery-related complications in patients undergoing primary cervical spine surgery for degenerative diseases.

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The aim of this study was to explore risk factors for complications associated with dural tear (DT), including the types of DT, and the intra- and postoperative management of DT.

Aim. Spinal implant-associated infections (SIAI) require combined surgical and antimicrobial treatment and prolonged hospital stay. We evaluated the clinical, laboratory, microbiological and radiological characteristics and treatment approaches in patients with SIAI. Method. Consecutive adult patients with SIAI treated between 2015 and 2017 were prosepctively included. SIAI was defined by: (i) significant microbial growth from intraoperative tissue or sonication fluid, (ii) intraoperative purulence, secondary wound dehiscence or implant on view, (iii) radiographic evidence of infection and fever (>38°C) without other recognized cause, increasing back pain or neurologic impairment, (iv) peri-implant tissue inflammation in histopathology. Results. A total of 60 patients were included, median age was 66 years (range, 28–91 years), 29 (48%) were males. The most common reason for spinal stabilization was spinal canal stenosis in 20 patients (33%) followed by vertebral degenerative disease in 14 (23%). 31 patients (52%) had one or more previous spine surgeries (range, 1–4 interventions). The anatomic site of spinal instrumentation was lumbar/sacral in 26 (43%), cervical in 23 patients (38%), thoracic in 11 (18%). The median number of fused segments was 5 (range, 1–14). Clinical manifestations included wound healing disturbance in 41 patients (68%), increasing back pain in 15 (25%), neurologic impairment in 12 patients (20%) and fever in 14 (23%). Serum CRP was abnormal (>10mg/l) in 46/59 patients (78%). Most (n=54) infections were postsurgical, 5 were hematogenous and 1 was contiguous. Imaging showed epidural, intraspinal or paravertebral abscess in 21/42 patients (50%), implant failure in 9 (21%) and implant loosening in 3 cases (7%). Monomicrobial infection was observed in 41 (68%), polymicrobial in 16 (27%) patients and culture-negative infection in 3 episodes (5%). Predominant causative pathogens were S. aureus (n=19), coagulase-negative staphylococci (n=18) and gram-negative rods (n=16). Surgery was performed in all patients including debridement and implant retention in 39 patients (65%), partial implant exchange in 10 (17%) and complete exchange in 11 (18%). Antimicrobial treatment included biofilm-active substances in 52 patients (87%). The median duration of antimicrobial therapy was 11,7 weeks (range, 6–12 weeks). 14 patients (23%) recieved suppressive therapy for a median duration of 9 months (range 3–12 months). Conclusions. Most SIAI were seen in lumbar/sacral segments and wound healing disturbance and increasing back pain were the most common manifestations. In 95% the causative pathogen was isolated, predominantly staphylococci. In half of the episodes, abscesses were present. All patients underwent surgery and biofilm-active antibiotics were administered in 87%

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To address the natural history of severe post-tuberculous (TB) kyphosis, with focus upon the long-term neurological outcome, occurrence of restrictive lung disease, and the effect on life expectancy.

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This study aimed to determine the relationship between pedicle-lengthening distance and bulge-canal volume ratio in cases of lumbar spinal stenosis, to provide a theoretical basis for the extent of lengthening in pedicle-lengthening osteotomies.

We all aware about overuse syndrome, as compensation of other parts of body. Our famous poet Sa'adi: when part of our body sustains become painful, the other parts can't tolerate and reciprocate. Among our patients who underwent total Knee arthroplasty few of them have pain especially in 1st 3 months (Anterior Knee pain, effusion, ….) but almost 15 – 20 percents are not satisfied enough by this Procedure. In a Cohort historic study on 301 TKA with at least 2 years follow up 47 patients had not enough satisfaction in our clinic we tried to visit them to find out why?. Criteria's we chose, were:. Age. Osteopenia. Sarcopenia. Low back pain. Spinal canal stenosis. Shoulders. Unstable blood pressure. Neuropathy. Eyes dysfunction. We exclude those who had problem by their new knees. 11 patients, all have been over age 68 years, and duration of start of symptoms in knee (s) to the surgery were more than 12 years, clearly showed painful arch of shoulder motion or frozen shoulder or established gleno humeral alone or G.H. and A.C. joints OA. Conclusion. Because of abnormal stand up of long lasting knee OA patients, they start to put pressure on their shoulder to climb on their body. Even their cane or crutches use are not in regular and academic rules. So, we nominate this entity: shoulder knee syndrome as a negative criteria that interferes in out come

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The aim of this study was to determine whether chilled irrigation saline decreases the incidence of clinical upper limb palsy (ULP; a reduction of one grade or more on manual muscle testing; MMT), based on the idea that ULP results from thermal damage to the nerve roots by heat generated by friction during bone drilling.

Summary Statement. Tandem stenosis is a prevalent condition in an Asian population with the narrowest cervical canal diameters and risk factors include advanced age and increased levels of lumbar canal stenosis. Introduction. Tandem spinal stenosis (TSS) is defined as patient with concomitant spinal canal stenosis found in both cervical (C) and lumbar (L) spinal region. Few studies have reported the incidence of TSS is ranged from 5–25%, but these are all noncomparative, small cohort studies. To the best of author knowledge this is the 1st study aims to compare the prevalence of TSS and its risk factors of development in a large multiracial Asian population. Methods. A retrospective review of all mid-sagittal T2MRI whole spine image was carried out at a University hospital in year 2007. Patients with spinal tumour, fracture and congenital stenosis were excluded. Spinal stenosis was defined as canal diameter of ≤10mm, measured from the posterior cervical vertebral/disc wall to anterior surface of the corresponding lamina. Patients were divided into 4 groups, no stenosis(NS), lumbar stenosis only(LS), cervical stenosis only(CS) and TSS. Patients’ demographics, race, co-morbidities and lumbar radiological report data were examined. Potential risk factors for the development of TSS were analyzed using SPSS software. Results. 926 (479 male, 447 female) patients with average age 50 (20–96) yrs were studied. Cervical canal diameters (mm) in TSS patients were the narrowest among the 4groups with C2/3 disc: 11.6, C3/4: 9.7, C4/5: 9.4, C5/6: 8.9, C6/7: 10.0 and C7T1: 11.4mm. The incidence of TSS was 26.2%. The prevalence of TSS in Chinese was 30.7%, Indian 12.5%, Malay 22.5%. The TSS prevalence in patients with 1 level lumbar canal stenosis was 12.5%, 2 levels lumbar stenosis was 6.4% and 3 levels was 4.1%. Multivariate analysis showed patients aged between 40–59 yrs (p=0.000, Exp(B):5.8, 95%CI 2.8–12.0), aged > 60yrs (p=0.000, Exp(B): 10.5, 95%CI 4.8–22.9), Chinese race (p=0.008, Exp(B): 2.5, 95%CI 1.3–4.9), patients with 1 level lumbar stenosis (p=0.000, Exp(B): 63.3, 95%CI 29.2–137.3), 2 levels lumbar stenosis (p=0.000, Exp(B): 67.7, 95%CI 29.4–155.7) and 3 levels lumbar stenosis (p=0.000, Exp(B): 106.6, 95%CI 43.6–260.5) are statistical significant risk factors for TSS development. Conclusion. The incidence of TSS was 26.2%. TSS patients have the narrowest cervical canal measurements among the studied groups. The prevalence of TSS in Chinese is the highest (30.7%). Patients advancing in age or have increased levels of lumbar canal stenosis are at risk of developing TSS

Neurogenic claudication is most frequently observed in patients with degenerative lumbar spinal stenosis. We describe a patient with lumbar epidural varices secondary to obstruction of the inferior vena cava by pathological lymph nodes presenting with this syndrome. Following a diagnosis of follicular lymphoma, successful chemotherapy led to the resolution of the varices and the symptoms of neurogenic claudication.

The lumbar epidural venous plexus may have an important role in the pathogenesis of spinal stenosis. Although rare, epidural venous engorgement can induce neurogenic claudication without spinal stenosis. Further investigations should be directed at identifying an underlying cause.

This study evaluates factors related to myelopathic symptoms in patients with ossification of the posterior longitudinal ligament (OPLL). A total of 87 patients with OPLL were included. Of these, 53 (Group I) had no symptoms or presented with neck pain and radiculopathy and 34 (Group II) had myelopathic symptoms. Gender, age, and history of trauma were evaluated in the two groups. The range of movement of the cervical spine was measured using plain radiographs. The number of involved segments, type of OPLL, and maximal compression ratio were analysed using CT and signal change in the spinal cord was evaluated using MRI.

The patients’ age was found to be significant (p = 0.001). No difference was found between gender and the range of movement in the two groups. The maximum compression of the spinal canal showed a difference (p = 0.03). The signal change of the spinal cord was different between the two groups. In patients with OPLL of the cervical spine, myelopathic symptoms are not related to the range of movement or the number of involved segments.

We are presenting a prospective analysis and assessment for the results of the Coflex@ inter-spinous dynamic stabilization device with a 2 year follow up. The purpose of this study is to assess the efficacy and safety of the Coflex@ Posterior Dynamic Stabilization Implant. A prospective analysis was performed on 121 patients (176 devices) treated with the Coflex@ Interspinous Implant. Indication for the treatment was spinal canal foraminal stenosis with nerve root irritation. Pre- and postoperative disability and pain scores were measured using Oswestry disability score, functional assessment a radiological evaluation at pre-operative - three - six twelve and twenty-four month interval. Data analysis revealed a high rate of patient satisfaction 92% of patients are satisfied and will have the surgery again 81% of patients had major improvement of their leg symptoms. 72% of patients reported improvement of their back pain symptoms this was more noted in the decompression group. Two revision surgeries were carried out. One due to implant back-out and the second due to infection. The Coflex@inter-spinous implant is a simple surgical treatment strategy with a low risk. Early results show a good improvement of both clinical and radiological parameters combined with patient satisfaction with better outcome achieved if combined with spinal decompression

To assess radiological fusion rates in posterolateral fusions using SiS-CaP. Retrospective, radiological follow-up study. Single surgeon series of 76 consecutive patients were evaluated, in a regional spinal unit. All patients had clinical and radiological (MRI) spinal canal stenosis secondary to degenerative spondylosis or spondylolisthesis. Surgery consisted of instrumentation, decompression and meticulous preparation of the posterolateral graft bed by removal of all soft tissues posterior to the inter-transverse membrane and decortication of transverse processes (TPs). SiS-CaP putty was injected into this gutter and moulded around the instrumentation. Good quality, well prepared bone chips from the posterior decompression were seeded into the putty. Patient radiographs were reviewed at 3-6 months, 1 year and 2 years. Radiographs were assessed using a protocol to examine granularity, bone formation and evidence of pseudarthrosis, based upon previously reported literature . 1. and our personal experience. Of the 76 patients, 26 were excluded. M:F was 21:29. Mean age was 58yrs. Average number of motion segments fused per case was 2.2. There was one pseudarthrosis with metalwork fracture, and thus a total fusion rate of 98%. In addition, one patient had scanty bridging of TPs, and one patient had lucency around the S1 screws. SiS-CaP, as a bone graft substitute in posterolateral instrumented fusions, gives comparable results to published fusion rates using autologous iliac crest grafting and/or Bone Morphogenic Protein . 2. Moreover, it avoids the associated morbidity of iliac bone harvest

Purpose: The average age of people suffering spinal cord injuries in many countries is shifting toward an older population, with a disproportionate number occurring in the spondylotic cervical spine. These injuries are typically due to low energy impacts, such as a fall from standing height. Since a stenotic spinal canal (a common feature of a spondylotic cervical spine) can cause myelopathy when the spine is flexed or extended, traumatic flexion or extension likely causes the injury during the low energy impact. However, this injury mechanism has not been observed experimentally. Method: To better understand this injury mechanism an in-vitro study, using six whole cervical porcine spines, was conducted. The following techniques were combined to directly observe spinal cord compression in a stenotic spine during physiologic and super-physiologic motion:. A radio-opaque surrogate cord, with material properties matched to in-vivo specimens, replaced the real spinal cord. Sagittal plane X-rays imaged the surrogate cord in the spine during testing. Varying levels of canal stenosis were simulated by a M8 machine cap screw that entered the canal from the anterior by drilling through the C5 vertebral body. Pure moment loading and a compressive follower load were used to replicate physiologic and super-physiologic motion. Results: Initial results show that a stenotic occlusion that removes all extra space in the canal in the neutral posture, without compressing the cord, can lead to spinal cord compression within physiologic ranges of flexion and extension. The spinal cord can also be compressed during slightly super-physiologic flexion and extension with only 25% canal occlusion. Physiologic loads and motions in the same spines did not cause cord compression when canal occlusion was 0%. Conclusion: These results support the hypothesis that cervical spinal canal stenosis increases the risk of spinal cord injury because spinal cord compression was observed during motions and loads that would be safe for a non-stenotic spine. These results are limited primarily due to the use of a porcine spine. However, this new stenosis model and experimental technique will be applied to in-vitro human spine specimens in future work