ABSTRACT Postoperative cervical kyphotic deformity (KD) is a recognized complication after laminoplasty for degenerative cervical myelopathy (DCM). This review identified predictors of KD to improve preoperative risk stratification, pooling studies of DCM patients using a random-effects model, with sensitivity and publication bias analyses. Thirty-nine studies (4423 patients) were included, with KD in 20.9% of cases. Age and sex were not significantly associated with KD. Higher body mass index and smoking history showed modest but significant associations. 5-level laminoplasty constructs were associated with increased KD risk, whereas operative time, blood loss, and most construct-related variables were not predictive. Radiographic parameters reflecting sagittal balance and alignment demand demonstrated the strongest associations with KD. Increased T1 slope, greater T1S–cervical lordosis (TS–CL) mismatch, and larger sagittal vertical axis (SVA) measurements (Center of Gravity of Head–C7 SVA and C2–C7 SVA) were significantly associated with KD. Dynamic motion analysis revealed that reduced extension reserve and increased flexion excursion, rather than total range of motion (ROM), characterized higher-risk patients. Magnetic resonance imaging-related factors and thoracolumbar spinopelvic parameters were not significantly associated with KD. Threshold analysis identified CGH–C7 SVA >30.6 mm and extension ROM <11.4° as the most discriminative predictors. Postoperative KD after laminoplasty is primarily determined by preoperative sagittal alignment demand and dynamic motion reserve rather than by general demographics or most comorbidities. Incorporating radiographic and functional parameters – particularly TS–CL mismatch, anterior head translation, and extension reserve – into preoperative evaluation may enhance risk stratification in patients undergoing laminoplasty for DCM.
ABSTRACT Background: The value of crosslink augmentation in posterior thoracolumbar instrumentation for traumatic fractures remains uncertain. Although biomechanical studies suggest improved rotational stability, clinical evidence is limited. Objective: To compare mechanical failure and sagittal alignment in posterior pedicle-screw constructs with and without crosslink augmentation for traumatic thoracic, thoracolumbar, and lumbar fractures. Methods: A retrospective single-center comparative cohort study included patients treated between January 2018 and March 2026 for traumatic thoracic, thoracolumbar, or lumbar fractures. Patients were grouped according to crosslink use. The primary outcome was construct-related mechanical failure, including rod fracture, screw loosening, implant disconnection, crosslink failure, progressive loss of correction, or revision for deformity. Local kyphosis was measured preoperatively, postoperatively, and at final follow-up. Results: Twenty-eight patients were analyzed: 13 with crosslink augmentation and 15 without crosslinks. Crosslink constructs were longer, with more instrumented levels (4.9 vs. 3.9; P = 0.008) and screws (8.2 vs. 6.7; P = 0.013). Index-level screw omission was more frequent with crosslinks (61.5% vs. 20.0%; P = 0.051), as was neurological deficit (84.6% vs. 0%; P < 0.001). AO type B/C morphology and confirmed or suspected posterior ligamentous complex injury were similarly distributed. No mechanical failures occurred in the crosslink group, whereas one noncrosslink patient developed screw loosening associated with chronic infection/fistula. Sagittal differences were not statistically significant, although final kyphosis and late kyphotic progression numerically favored crosslink augmentation. Conclusion: Crosslink-augmented constructs showed no mechanical failures despite greater baseline complexity. These findings suggest potential mechanical benefit, but larger studies are required.
ABSTRACT Background: Anterior cervical discectomy and fusion (ACDF) is widely used for cervical disc disease, primarily for neural decompression. However, its potential vascular effects – particularly on vertebral artery hemodynamics and cervicogenic dizziness – remain underexplored. Objective: The objective of this study was to evaluate whether ACDF improves vertebral artery flow and alleviates dizziness symptoms associated with impaired posterior circulation perfusion. Methodology: A prospective case series of 40 patients with cervical radiculopathy or myelopathy underwent ACDF with polyetheretherketone (PEEK) cages. Vertebral artery peak systolic velocity (PSV) was assessed preoperatively and at 1, 3, 6, and 12 months postoperatively using duplex ultrasonography. Functional outcomes were measured with the Visual Analog Scale for neck and arm pain, the Neck Disability Index, and patient-reported dizziness. Radiographic fusion was confirmed at serial follow-up. Results: PSV decreased significantly, indicating improved vertebral artery flow: right side from 48.85 ± 12.71 to 39.0 ± 7.45 and left side from 48.20 ± 12.02 to 41.54 ± 7.56 (both P < 0.001). Symptomatic dizziness also improved in parallel. Fusion was achieved in 92.5% by 12 months, with minor complications in 12.5%. Conclusion: ACDF may alleviate both neural compression and extrinsic vertebral artery compromise, particularly in younger patients. Given the absence of a control group and reliance on surrogate vascular measures, these results should be considered hypothesis-generating rather than definitive.
ABSTRACT Context: Posterior-only pedicle screw fixation is now the leading surgical treatment for Scheuermann’s kyphosis (SK). However, high-density screw constructs increase the risk of malpositioning complications and elevate overall surgical costs. Aims: To evaluate the safety and clinical efficacy of the low screw density (LSD) technique combined with multiple Ponte osteotomies for the correction of SK. Settings and Design: This prospective case series was conducted at Kasr Al-Aini and Al-Salam International Hospitals. Subjects and Methods: This study was conducted between December 2020 and December 2022 and enrolled 30 patients who underwent posterior-only correction using the LSD approach and multilevel Ponte osteotomies. Results: The cohort (mean age 20.5 years; range 13–37) presented with a mean preoperative maximum kyphosis of 85.9° (range 75°–108°) and a mean pelvic incidence-lumbar lordosis (PI-LL) mismatch of 25.9°. Following surgery, the mean maximum kyphosis improved to 46.2° (range 37°–63°), and the PI-LL mismatch was reduced to 7.7°. These corrections remained stable at the 1- and 2-year follow-ups, with no statistically significant loss of sagittal alignment. Conclusions: The LSD technique, supported by multiple Ponte osteotomies, is a safe and effective surgical strategy for correcting SK, providing stable deformity correction with reduced instrumentation.
ABSTRACT Background: Intradural extramedullary (IDEM) spinal tumors are the most common intradural spinal neoplasms, typically benign and slow-growing. They cause neurological deficits through progressive spinal cord compression. Surgical excision remains the mainstay of treatment, with generally favorable outcomes. Objective: To analyse the clinical profile, surgical management, and functional outcomes of patients with IDEM spinal tumors. Materials and Methods: A retrospective study was conducted on 214 patients who underwent microsurgical excision of IDEM tumors between January 2009 and December 2023. Clinical presentation, radiological findings, surgical details, histopathology, complications, and functional outcomes were evaluated. Neurological status was assessed using the Modified McCormick Scale and American Spinal Injury Association impairment scale with a minimum follow-up of 12 months. Results: The majority of patients were >45 years (40.2%) with a slight female predominance (54.7%). Back pain (80.4%) was the most common presenting symptom, followed by motor deficit (60.3%). The thoracic spine was most frequently involved (45.3%). Gross total resection was achieved in 83.6% of cases. Schwannoma (47.2%) and meningioma (30.8%) were the most common histologies. Mean blood loss and operative time were 172 ± 62 ml and 164 ± 43 min, respectively. Complications were low, with cerebrospinal fluid leak (2.8%) and wound infection (3.3%) being the most frequent. Significant postoperative neurological improvement was observed, with most patients achieving Modified McCormick Grade 1–2 at 2-year follow-up. Conclusion: IDEM tumors have a favorable prognosis when managed surgically. Microsurgical excision allows high rates of complete resection with low morbidity. Early intervention is associated with better neurological recovery.
