Background Failure to achieve a proper form fitting connection between pedicle screwheads (tulips) and rods is a common phenomenon after thoracolumbar fusion. It indicates that the implant components were fixed under considerable mechanical stress. Force Control is a surgical technology that goes beyond common practice in its efforts to control and minimize intraoperative loads. The study objective is to investigate the rate of form fitting connections and to describe associated outcomes when following the force control principles. Methods In this retrospective study, patients with degenerative and traumatic pathologies underwent fusion surgery with a pedicle screw system that supports the principle of force control. Form fit (yes/no) is measured as the angle between two parallel lines on either side of each pedicle screwhead and a line laterally along the rod; angles 90° ± 0.3° are considered form fitting. It is investigated whether form fit affects revision rate and pain. Results Only form fitting connections were found in 53/62 patients (85.5%). The overall revision rate was 6.5%, and the mean postoperative pain was 1.9 at a mean follow-up of 1.6 years. No implant failures occurred. If the intended form fit was achieved for all screws, revision rate (1.9% vs. 33.3%) and median pain (1.8 vs. 3.8) were significantly lower compared to cases with misalignments. Conclusions Form fitting connections between pedicle screwheads and rods are associated with fewer revisions and less pain. This underlines the importance of further investigating the impact of form fitting connections and of controlling mechanical stress during surgery.
The presence of air within the spinal canal, whether extradural or intradural in location, is known as pneumorrhachis. Traumatic Pneumorrhachis (tPR) may be caused by direct or indirect trauma to the spine, and the intradural type is often associated with severe underlying injuries [1]. It is usually asymptomatic; however, it may present clinically as compressive myelopathy [2] and is prone to be missed in the absence of overt spinal cord injury. In a recent systematic review, sensory-motor deficits were directly attributed to tPR in 9% of patients; of these, myelopathy contributed 6% [3]. I present two cases of tPR patients with contrasting clinical findings and radiology. Interestingly, one patient with a small amount of air presented clinically with myelopathy. In contrast, the other patient, with a larger amount of air, was asymptomatic. These cases suggest that the amount of air is not directly proportional to the clinical symptomatology, and occasionally, small air foci may cause significant cord compression.
Osteoporotic vertebral compression fractures (OVCFs) are a major source of morbidity in patients with osteoporosis. Vertebral augmentation procedures (VAPs), including vertebroplasty and kyphoplasty, provide effective pain relief and stabilization when conservative management fails, but carry risks such as cement leakage, adjacent vertebral fractures, recollapse, and radiation exposure. This narrative review summarizes recent innovations intended to improve the safety, precision, and outcomes of VAPs, based on a non-systematic search of PubMed/MEDLINE, Embase, and Google Scholar for articles published between January 2010 and December 2025. The technologies are organized according to the clinical workflow of OVCF treatment, and the maturity of the supporting evidence is graded. Artificial intelligence and radiomics may improve risk stratification by predicting cement leakage, recollapse, adjacent fractures, and residual back pain, although most models are retrospective and internally validated. Finite element analysis supports planning of cement volume, distribution, and height restoration, but remains largely computational. Augmented reality and robotic platforms may improve puncture accuracy and reduce radiation exposure, at the cost of a learning curve and high expense. Remote-controlled injection of high-viscosity cement may limit leakage and operator exposure. Expandable implants may improve height maintenance, whereas bioactive cements remain mostly preclinical. Early anabolic therapy complements augmentation by reducing subsequent fractures. Overall, these technologies are complementary, but the evidence supporting them varies considerably, and multicenter prospective studies with standardized outcomes and long-term follow-up are needed before their routine clinical adoption.
Minimally invasive oblique lateral lumbar interbody fusion (OLIF) is one of the mainstream minimally invasive surgical procedures commonly used to treat degenerative lumbar disorders. This technique is associated with limited surgical trauma, reduced intraoperative blood loss, minimal impact on intrinsic spinal stability, and faster postoperative recovery, and it has therefore been increasingly adopted in clinical spinal surgery. OLIF is performed through a relatively safe corridor within the retroperitoneal space, anterior to the psoas major muscle and between the psoas major and the major abdominal vessels. Although this surgical approach is considered relatively safe, the operative field lies in close proximity to the lumbar sympathetic chain and lumbar plexus. Intraoperative traction, retraction, electrocautery, and postoperative compression caused by local hematoma may all induce sympathetic nerve dysfunction, thereby leading to sympathetic abdominal distension. Once sympathetic abdominal distension occurs, it may prolong postoperative recovery, increase patient discomfort and hospitalization costs, and reduce patient satisfaction. This article systematically summarizes the anatomical basis, pathogenesis, key points of clinical assessment, and differential diagnosis of sympathetic abdominal distension after OLIF. It also reviews relevant strategies, including perioperative predictive nursing interventions based on pathogenic mechanisms, traditional Chinese medicine nursing techniques, multidisciplinary collaborative management, and intraoperative nerve protection. In addition, current limitations in existing research and future directions are discussed, with the aim of providing a reference for developing standardized, precise, and evidence-based nursing protocols, reducing the incidence of this complication, and promoting the practical implementation of enhanced recovery concepts in spinal surgery.
