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OBJECTIVE:Spinal alignment has become a focal point of spine deformity surgery amid an increased emphasis on global balance. Following a strong focus on thoracolumbar alignment, the cervical spine has recently emerged as a key area for further investigations. We applied formal bibliographic analytic techniques to assess trends regarding cervical sagittal alignment over time. METHODS:Data was collected from the Clarivate Web of Science, PubMed, and Scopus databases on 08/02/2025 utilizing the keyword search ("cervical" OR "cervical spine") AND ("sagittal imbalance" OR "sagittal balance" OR "sagittal alignment" OR "sagittal malalignment"). Excel was used to create the publication years, citations per year, publishing journals, countries, author figures. VosViewer was used to create the network visualizations of keyword co-occurrence, cocitation, country copublication, and coauthorship analyses. RESULTS:We identified an over ten-fold increase every fifteen years in cervical sagittal alignment-related publications, starting with one study published in 1994 rising to 161 published in 2023. This trend outpaces global increases in spine publications by over sixfold. Notable jumps occurred from both 2012-2013 and 2016-2017, with over 50% increases in publications year over year. In the last five years, there has been an increasing focus on deformity, laminectomy, and motion. CONCLUSIONS:Cervical sagittal alignment has received a rapid and disproportionate increase in publications in the last ten years which may reflect increased interest in personalized surgery through deformity correction and motion preservation. Our study provides a graphic perspective on this topic and reflects the importance of spinal alignment in all sections of the spinal column.
OBJECTIVE:Lateral lumbar interbody fusion (LLIF) is based on a less-invasive access corridor through the retroperitoneum and psoas muscle, though concerns persist over postoperative weakness and neuropathy on the surgical side. This study investigates if the trans-psoas LLIF approach is associated with long-term changes in psoas morphology, hip flexor weakness, and lower extremity dysesthesia. METHODS:The authors retrospectively reviewed all LLIF cases at a single institution from January 2016 to June 2024. Inclusion required the availability of preoperative and postoperative magnetic resonance imaging. Psoas cross-sectional area was measured at the L4 upper endplate and the level of surgery. Clinical outcomes were analyzed through standardized Oxford motor examinations, standardized sensory examinations, and patient-reported symptoms as documented and reviewed by the attending surgeon. RESULTS:Eight hundred sixty-five patients underwent LLIF, of which 108 patients met inclusion criteria for imaging and indication (48 male, 60 female). The mean follow-up for included patients was 2.8 years (range 3.8 months-7.3 years). We observed a statistically significant mean decrease of 6.3% in psoas size on the surgical side (P < 0.001, Cohen's d = 0.19) and no significant change on the non-surgical side (P = 0.20, d = 0.07), both reflecting inconsequential effect sizes. Average hip flexor strength decreased by ≥ 1 grade in 8 (14.5%) patients on the surgical side and 5 patients (9.1%) on the nonsurgical side, with no significant difference between groups (P = 0.85). CONCLUSIONS:Our study found that LLIF was associated with minor long-term decreases in psoas size and quality on the surgical side, small mean bilateral strength losses, and no side-specific sensory deficits.
The diagnosis and management of spondylodiscitis (SD) remain challenging for clinicians due to its insidious onset and nonspecific clinical presentation. Patients often have multiple comorbidities, requiring a multidisciplinary approach that may involve both nonsurgical and surgical interventions. This bibliometric study aims to analyze global research output on SD, exploring publication trends, citation patterns, contributing countries and journals, and commonly associated keywords. Data were collected from the Clarivate Analytics Web of Science (WoS) database on July 22, 2024, using the search terms "Spondylodiscitis" OR "Spondylodiskitis" OR "vertebral osteomyelitis" OR "spine osteomyelitis" OR "spinal osteomyelitis" OR "osteodiscitis" OR "osteodiskitis" OR "discitis" OR "diskitis". A total of 4,363 relevant publications were identified, spanning the years 1982 to 2023. Descriptive and quantitative analyses were conducted, including keyword network visualizations. There was an almost 15-fold increase in publication volume, from 18 publications in 1982 to 269 in 2023. Citation frequency followed a similar trajectory, rising from a single citation in 1982 to 7,148 in 2023. The United States, Germany, and France accounted for over 50% of the total research output, with Spine identified as the most prolific journal. Commonly co-occurring keywords included "endocarditis" and "staphylococcus aureus," as revealed by network visualization analysis. In conclusion, SD is a complex condition requiring multidisciplinary care. This bibliometric review demonstrates significant growth in both research volume and citation impact, particularly from high-income countries. Notably, keyword mapping revealed an underrepresentation of comorbidity-related terms in recent literature, indicating a potential gap in current academic discourse.
ObjectivePosterior inferior cerebellar artery (PICA) aneurysms are uncommon and may be challenging to treat, especially if they are very small saccular or dissecting pseudoaneurysms at proximal and mid-PICA locations. They are usually technically difficult to treat with conventional reconstructive endovascular methods. We present our experience with PICA aneurysms treated by a stand-alone small, low-profile stent with a moderate flow-diverting effect (low-profile visualized intraluminal support junior (LVIS Jr)) compared to conventional endovascular methods.MethodsSingle institution cases of treated unruptured PICA aneurysms from 2015 to May 2022 were retrospectively reviewed. Patient characteristics, pre-and postoperative images, and last clinical and radiological outcomes were analyzed. Comparative statistical analysis was used.ResultsNine cases of unruptured PICA aneurysms treated with stand-alone LVIS Jr (group 1) and seven cases treated with other conventional methods (group 2) were identified. The mean age was 56 versus 61.43 years, sex was female in 7 versus 6 cases, and the left side was involved in 7 versus 4 cases in group 1 and group 2, respectively. All aneurysms were in the proximal PICA segment except for one case in the mid-PICA segment aneurysm in each group. There was a difference in aneurysm type in both groups (p = 0.008). All aneurysms were of saccular type except for five dissecting types in group 1 and 2 in group 2. The mean aneurysm size was 1.91 ± 0.62 in group 1 and 9.04 ± 5.82 mm in group 2 (p < 0.0002). In group 2, treatment was with PICA sacrifice (one case), primary aneurysm coiling (three cases), stent-assisted coiling (one case), and flow diverter (two cases). Complications were only puncture site-related that occurred once in each group. There were no differences in mean clinical or radiological follow-up. Aneurysm recurrence with retreatment occurred in two cases in each group. All patients had an mRS 0-2 at the last follow-up.ConclusionIn selected cases, unruptured small or dissecting PICA aneurysms may be treated safely and effectively using single stand-alone LVIS Jr. Prospective studies are needed to validate safety and efficacy.
Degenerative spondylolisthesis and spinal canal stenosis are some of the more common clinical conditions associated with low back pain, with various surgical techniques available, ranging from standalone decompression to fusion. Interspinous spacer devices (ISD) have emerged as an intermediary surgical option. The aim was to compare 90-day all-cause readmission rates between techniques, with secondary outcomes including total hospital charges and postoperative complications. Utilizing the 2020 Nationwide Readmissions Database (NRD), adult patients (> 18 years) were selected by primary diagnosis ICD-10 code for spondylolisthesis and/or spinal stenosis. Patients were categorized by surgical treatment: ISD, decompression, or single-level posterior fusion. Treatment techniques were compared using a multivariable logistic and linear regression while adjusting for potential confounding factors. Propensity score adjustments were performed as a sensitivity analysis. In total 37,503 patients met our inclusion criteria, with (81.2
