Background: Minimally invasive transforaminal lumbar interbody fusion (TLIF) using percutaneous screws is commonly performed; however, data on mini-open TLIF (MO-TLIF) remain sparse. We aimed to assess the radiological and functional outcomes of single-level MO-TLIF for degenerative disc disease. Materials and Methods: Fifty seven patients underwent MO-TLIF between March 2022 and February 2024; Baseline demographics, clinical, and radiological data were recorded. The Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) were obtained preoperatively, at 1 month and 1 year. Radiographs were obtained immediate post-op, at 6 weeks, 3 months, 6 months, and at 1 year. Results: The study included 57 patients (30 males, mean age: 51.2 ± 14.8 years). Comorbidities were present in 50% of patients (33.3% had hypertension; 21% had diabetes). Most surgeries were performed at L4–L5 (n = 26) and L5–S1 (n = 23). The average surgical duration was 80 ± 8 min, with an average blood loss of 88 ± 10 mL. ODI scores significantly improved from 77.6 ± 5.3 preoperatively to 47.8 ± 4.7 at 1 month, and to 12.7 ± 3.2 at 12 months (P < 0.001). VAS scores improved from 8.1 ± 0.7 preoperatively to 2.9 ± 0.7 at 1 month, and 1.0 ± 0.7 at 12 months (P < 0.001). The average hospital stay was 2.8 ± 0.7 days. No patient had misplaced pedicle screw requiring implant revision. One patient required revision surgery for residual foraminal stenosis. Conclusion: MO-TLIF is a safe and effective procedure for treating patients with degenerative disc disease and lumbar stenosis requiring lumbar fusion.
Thoracolumbar kyphosis (TLK) is a common manifestation of mucopolysaccharidosis (MPS) requiring surgical intervention to prevent neurological compromise and deformity progression. The optimal surgical strategy remains a subject of debate, particularly regarding the choice between circumferential and posterior-only approaches. Here, we report the case of the long-term outcomes of two pediatric patients treated with posterior-only instrumented fusion with over 5 years of follow-up. Case 1 (MPS I, Hurler syndrome) presented at the age of 16 years with an 80° T12–L3 Cobb angle; at 62 months postoperatively, kyphosis improved to 18°, and the vertebral wedge angle decreased from 60° to 7°. Notably, the postoperative pelvic incidence (PI) of 81° exposed the preoperative value (6°) as physiologically implausible; this discrepancy arose because severe hip dislocation prevented the identification of the anatomical femoral head centers, thereby invalidating the spinopelvic reference geometry. A definitive and reproducible PI assessment was only achievable following the restoration of anatomical hip centers through subsequent bilateral arthroplasty. Case 2 (MPS II, Hunter syndrome) involved a 14-year-old male with a 52° T12–L2 Cobb angle; at 67 months, kyphosis corrected to 13°, despite worsened sagittal balance due to progressive hip stiffness. Both patients showed improved quality of life scores with no perioperative or implant-related complications. In conclusion, posterior-only correction appears to be a feasible and relatively safe option for TLK in MPS, achieving satisfactory deformity correction in selected cases.
Background: Pedicle screw fixation is widely used in spinal surgery to achieve mechanical stability. However, in osteoporotic bone, reduced bone mineral density compromises screw anchorage, increasing the risk of loosening and failure. The main objective of the study was to compare the biomechanical performance, including pull-out force, torque, and displacement, of two polymethylmethacrylate (PMMA) augmentation techniques versus non-augmented pedicle screw fixation in osteoporotic vertebrae. Materials and Methods: A cadaveric biomechanical study was conducted on thoracolumbar vertebrae (D10–L3) from nine osteoporotic cadavers (>55 years). Each cadaver served as its own control across three groups: (i) solid screws without augmentation; (ii) fenestrated screws with PMMA injection; (iii) kyphoplasty-assisted PMMA augmentation. Pull-out strength, torque, and vertical displacement were measured using a calibrated apparatus. Repeated-measures analysis of variance was applied. Results: Mean pull-out strength was highest in Group 3 (1167 N), followed by Group 2 (828 N) and Group 1 (428 N). Mean torque values were 5838.3 ± 79.2 N mm, 4141.1 ± 145.9 N mm, and 2144.4 ± 146.1 N mm for Groups 3, 2, and 1, respectively (P < 0.05). Kyphoplasty augmentation significantly had reduced vertical displacement. Conclusion: Cement augmentation substantially improves pedicle screw fixation in osteoporotic spines. Kyphoplasty-assisted PMMA augmentation demonstrated superior biomechanical stability compared to fenestrated screw injection and non-augmented fixation.
Backgroud: Adolescent Idiopathic scoliosis affects quality of life in domains of function, self image and mental health. The Scoliosis Research Society-22r (SRS-22r) is a widely validated instrument, but no malayalam version has existed. The study is a descriptive validation and reliability assessment of the Malayalam version of SRS-22r questionnaire. Materials and Methods: The English version of the SRS-22r was translated, back-translated, and culturally adapted into Malayalam. The instrument was administered to 100 patients (pre-operative, post-operative, and brace-treatment groups). Reliability was assessed by Cronbach’s α and test–retest reliability (intraclass correlation coefficient [ICC]). Validity was assessed by exploratory factor analysis and correlation analysis. Results: The Malayalam SRS-22r demonstrated satisfactory reliability across most domains (Cronbach’s α: 0.63–0.88). The satisfaction domain showed poor reliability (α: 0.32–0.57; ICC: 0.28–0.53). Factor analysis confirmed the five-domain structure, explaining >70% variance. Discriminant validity was supported by expected domain correlations. Self-image scores were lowest, while function and mental health showed higher scores with notable ceiling effects. Conclusion: The Malayalam version of the SRS-22r is a reliable and valid tool for assessing health-related quality of life in adolescents with idiopathic scoliosis. Limitations persist in the satisfaction domain, which is consistent with international experience.
