Evaluating the Feasibility and Outcomes of a Scoliosis Surgical Camp in a Resource-Limited Setting in Sub-Saharan Africa.

BACKGROUND: In sub-Saharan Africa, the estimated prevalence of scoliosis ranges from 3.3% to 5.5%. The management of these deformities is restricted due to lack of infrastructure and access to deformity spine surgeons. Utilizing surgical camps has been demonstrated to be efficient in transferring skills to low-resource environments; however, this has not been documented concerning deformity surgery. METHODS: We conducted a cross-sectional study. The scoliosis camp was held at a major referral spine center in East Africa. We documented information about the organization of the course. We also collected clinical and demographic patient data. Finally, we assessed the knowledge and confidence among surgeon participants on the management scoliosis. RESULTS: The camp lasted 5 days and consisted of lectures and case discussions, followed by casting and surgical sessions. Five patients were operated during the camp. All the patients in the study were diagnosed with AIS, except one with a congenital deformity. The primary curve in the spine was in the thoracic region for all patients. Six months postoperative Scoliosis Research Society-22R Scoring System (SRS-22R) score ranged from 3.3-4.5/5. 87.5% of the participants found the course content satisfactory. CONCLUSIONS: To the best of our knowledge, this is the first time an African scoliosis camp has been established. The study highlights the difficulty of conducting such a course and illustrates the feasibility of executing these complex surgeries in a resource-limited environment.

Telemedical Support Using Smartphones for Spine Surgery in Low- and Middle-Income Countries.

Objective: Low- and middle-income countries (LMICs) face many challenges compared to industrialized nations, most notably in regard to the health care system. Patients often have to travel long distances to receive medical care with few reliable transportation mechanisms. In time-critical emergencies, this is a significant disadvantage. One specialty that is particularly affected by this is spine surgery. Within this field, traumatic injuries and acutely compressive pathologies are often time-critical. Increasing global networking capabilities through internet access offers the possibility for telemedical support in remote regions. Recently, high-performance cameras and processors became available in commercially available smartphones. Due to their wide availability and ease of use, this could provide a unique opportunity to offer telemedical support in LMICs. Methods: We conducted a feasibility study with a neurosurgical institution in east Africa. To ensure telemedical support, a commercially available smartphone was selected as the experimental hardware. Preoperatively, resolution, contrast, brightness, and color reproduction were assessed under theoretical conditions using a test chart. Intraoperatively, the image quality was assessed under different conditions. In the first step, the instrumentation table was displayed, and the mentor surgeon marked an instrument that the mentee surgeon should recognize correctly. In the next evaluation step, the surgical field was shown on film and the mentor surgeon marked an anatomical structure, and in the last evaluation step, the screen of the X-ray machine was captured, and the mentor surgeon again marked an anatomical structure. Subjective image quality was rated by two independent reviewers using the similar modified Likert scale as before on a scale of 1-5, with 1 indicating inadequate quality and 5 indicating excellent quality. Results: The image quality during the video calls was rated as sufficient overall. When evaluating the test charts, a quality of 97% ± 5 on average was found for the chart with the white background and a quality of 84% ± 5 on average for the chart with the black background. The color reproduction, the contrast, and the reproduction of brightness were rated excellent. Intraoperatively, the visualization of the instrument table was also rated excellent. Visualization of the operative site was rated 1.5 ± 0.5 on average and it was not possible to recognize relevant anatomical structures with the required confidence for surgical procedures. Image quality of the X-ray screen was rated 1.5 ± 0.9 on average. Conclusion: Current generation smartphones have high imaging performance, high computing power, and excellent connectivity. However, relevant anatomical structures during spine surgery procedures and on the X-ray screen in the operating room could not be identified with reliability to provide adequate surgical support. Nevertheless, our study showed the potential in smartphones supporting surgical procedures in LMICs, which could be helpful in other surgical fields.

Vertebral body tethering: An alternative to posterior spinal fusion in idiopathic scoliosis?

Introduction: Skeletally immature patient with adolescent idiopathic scoliosis (AIS) whose curves continue to progress despite bracing should be treated surgically. Vertebral body tethering (VBT) is a non-fusion, compression-based, growth preserving alternative to posterior spinal fusion (PSF) based on the concept of 'growth modulation' to prevent possible functional complications secondary to fusion while correcting scoliotic deformity. This review aims to shed light on the indications of VBT, short- and medium-term outcomes, describe the surgical technique and associated complications, and to compare its efficacy to that of PSF. Methods: A review of peer-reviewed literature on VBT as a surgical technique, its indications, outcomes, complications, and comparison with other surgical interventions to correct AIS was conducted in December 2022. Results: Indications remain controversial and mainly include stage of skeletal maturity based on radiographic markers, curve location, magnitude and flexibility, and presence of secondary curve. Assessment of VBT clinical success should not be restricted to improvement in radiographic parameters but should include functional results and patient-centered outcomes, improved body image and pain, and durability of outcomes. In contrast to fusion, VBT seems to be associated with preserved spinal growth, shorter recovery, potentially better functional outcomes, less motion loss but possibly less curve correction. Discussion: Yet still, with VBT there exists a risk of overcorrection, construct breakage or failure of procedure which require revision and at times conversion to PSF. Patient and family preferences must be accounted for acknowledging gaps in knowledge, attributes and drawbacks of each intervention.

The Efficacy of Blended Learning in a Pediatric Spine Deformity Management Program in Sub-Saharan Africa.

INTRODUCTION: Our study assessed the efficacy of blended learning, which combines in-person learning and e-learning, in a pediatric scoliosis training program through an international collaborative effort. METHODS: The course comprised two parts: the online portion, where participants reviewed educational materials for 3 weeks and met with faculty once/week for discussion, and the in-person session, where participants reviewed cases in a team-based approach and came to a consensus on treatment strategy, followed by discussion with an international expert. All participants completed a needs assessment (NA) and clinical quiz at three points: before the course, after the online session, and after the in-person session, which covered various topics in pediatric spine deformity. RESULTS: Thirty-six surgeons enrolled in the course from 13 College of Surgeons of East, Central and Southern Africa countries. The NA assessment scores improved significantly over the course of the surveys from 67.3, to 90.9, to 94.0 (P = 0.02). The clinical quiz scores also improved from 9.91, to 11.9, to 12.3 (P = 0.002). CONCLUSION: The blended learning approach in a pediatric spine deformity program is effective and feasible and shows a statistically significant change in participants' confidence and knowledge base in these complex pathologies. This approach should be explored further with larger numbers and/or other spinal pathologies.

Posterior spine fusion in a Jehovah's Witness patient with severe rigid idiopathic scoliosis - A case report.

Introduction: Early onset scoliosis (EOS) represent a challenge for spine surgeons. The selection of the best treatment is complex. Some patients, such as Jehovah's Witnesses who refuse blood transfusions, are at high risk of complication when surgical treatment is required because blood loss is a major cause of morbidity and postoperative transfusion rates. Research question: Describe blood-saving techniques that allowed an extensive and invasive surgical procedure in a Jehovah's Witness patient. Material and method: 17-year-old Jehovah's Witness girl with severe 120° Cobb Lenke 1A idiopathic scoliosis started as EOS was prepared with 4 cycles of recombinant human erythropoietin, iron and folic acid supplementation that brought her hemoglobin level from 13.6 g/dl to 16.2 g/dl. In the first surgical time, a temporary rod was implanted. Spine dissection using bipolar sealer and a special electrocautery that operates at lower temperatures than traditional ones was performed. Facetectomies and multilevel Ponte osteotomies was performed using an ultrasonic bone scalpel. The second surgical time, the definitive rods were placed, and the correction of the deformity was achieved using the rod link reducer technique. Results: A good correction of the main curve in the coronal plane is achieve. The Hb nadir was 7.2 g/dl four days after the second operation. The postoperative course was uneventful. Discussion and conclusion: The integration of modern and traditional preoperative, intraoperative, and postoperative blood sparing techniques allowed us to perform an extensive and invasive surgical procedure in a Jehovah's Witness girl with a severe idiopathic scoliosis.

Feasibility of smart glasses in supporting spinal surgical procedures in low- and middle-income countries: experiences from East Africa.

OBJECTIVE: Telemedicine technology has been developed to allow surgeons in countries with limited resources to access expert technical guidance during surgical procedures. The authors report their initial experience using state-of-the-art wearable smart glasses with wireless capability to transmit intraoperative video content during spine surgery from sub-Saharan Africa to experts in the US. METHODS: A novel smart glasses system with integrated camera and microphone was worn by a spine surgeon in Dar es Salaam, Tanzania, during 3 scoliosis correction surgeries. The images were transmitted wirelessly through a compatible software system to a computer viewed by a group of fellowship-trained spine surgeons in New York City. Visual clarity was determined using a modified Snellen chart, and a percentage score was determined on the smallest line that could be read from the 8-line chart on white and black backgrounds. A 1- to 5-point scale (from 1 = unrecognizable to 5 = optimal clarity) was used to score other visual metrics assessed using a color test card including hue, contrast, and brightness. The same scoring system was used by the group to reach a consensus on visual quality of 3 intraoperative points including instruments, radiographs (ability to see pedicle screws relative to bony anatomy), and intraoperative surgical field (ability to identify bony landmarks such as transverse processes, pedicle screw starting point, laminar edge). RESULTS: All surgeries accomplished the defined goals safely with no intraoperative complications. The average download and upload connection speeds achieved in Dar es Salaam were 45.21 and 58.89 Mbps, respectively. Visual clarity with the modified white and black Snellen chart was 70.8% and 62.5%, respectively. The average scores for hue, contrast, and brightness were 2.67, 3.33, and 2.67, respectively. Visualization quality of instruments, radiographs, and intraoperative surgical field were 3.67, 1, and 1, respectively. CONCLUSIONS: Application of smart glasses for telemedicine offers a promising tool for surgical education and remote training, especially in low- and middle-income countries. However, this study highlights some limitations of this technology, including optical resolution, intraoperative lighting, and internet connection challenges. With continued collaboration between clinicians and industry, future iterations of smart glasses technology will need to address these issues to stimulate robust clinical utilization.

Rod Link Reducer system in adolescent idiopathic scoliosis: a retrospective observational trial.

PURPOSE: The Rod Link Reducer (RLR) (Globus Medical, PA, USA) allows direct three-dimensional correction of the spine deformity follows the direct vertebral rotation (DVR) theories. The purpose of this retrospective study is to compare RLR with traditional correction technique (TCT) in two cohorts of patients with adolescent idiopathic scoliosis (AIS). METHODS: Fifty-four patients (M:F = 1:8) between 2018 and 2020 were included. The first group (n = 22) was treated by RLR while the second one (n = 32) by TCT. All spines were classified as per the Lenke system. Length of hospitalization, days in intensive care unit (ICU), operative time, and blood loss were recorded. SRS-30 and SF-36 questionnaires were administered pre-operative and post-operative. We collected radiological data: pre-operative and post-operative Cobb angles, coronal and sagittal balance, trunk and thoracic height. RESULTS: RLR and TCT groups are homogeneous in age (p = 0.317), sex ratio (p = 0.347), and Risser stage (p = 0.222). Between both groups there was no significant statistical difference in haemoglobin value, hospitalization length, days in ICU, operative times, SF-36, SRS-30, NRS, and perceived satisfaction. RLR group shows a better improvement of correction of main thoracic (MT) curve (RLR 54.2% ± 15.9%/TCT 38.1% ± 20.4%, p = 0.031). Nevertheless, RLR group shows a worse thoracic kyphosis correction (RLR 16.82° ± 9.13°/27.12° ± 12.13°, p = 0.015). CONCLUSION: RLR system allows a more effective MT curve correction than TCT systems, but it seems to give a hypokyphosis effect.

SPINE20 recommendations 2021: spine care for people's health and prosperity.

PURPOSE: The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. METHODS: On September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments. RESULTS: In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes. CONCLUSIONS: SPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe.

Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Cervical Spine: Technical Nuances and Outcome of a Multicenter Experience.

STUDY DESIGN: Retrospective multicenter. OBJECTIVES: diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH. METHODS: Patients with DISH needing for anterior cervical osteophytectomy were collected. Swallow studies and endoscopy supported imaging in targeting bone decompression. Patients characteristics, clinico-radiological presentation, outcome and surgical strategies were recorded. Impact on clinical outcome of duration and time to surgery and different surgical techniques was evaluated through ANOVA. RESULTS: 24 patients underwent surgery. No correlation was noted between specific spinal levels affected by DISH and severity of pre-operative dysphagia. A trend toward a full clinical improvement was noted preferring the chisel (P = 0.12) to the burr (P = 0.65), and whenever C2-C3 was decompressed, whether hyperostosis included that level (P = 0.15). Use of curved chisel reduced the surgical times (P = 0.02) and, together with the nasogastric tube, the risk of complications, while bone removal involving 3 levels or more (P = 0.04) and shorter waiting times for surgery (P < 0.001) positively influenced a complete swallowing recovery. Early decompressions were preferred, resulting in 66.6% of patients reporting disappearance of symptoms within 7 days. One and two recurrences respectively at clinical and radiological follow-up were registered 18-30 months after surgery. CONCLUSION: The "age of DISH" counts more than patients' age with timeliness of decompression being crucial in determining clinical outcome even with a preoperative mild dysphagia. Targeted bone resections could be reasonable in elderly patients, while in younger ones more extended decompressions should be preferred.

Major complications in extreme lateral interbody fusion access: multicentric study by Italian S.O.L.A.S. group.

PURPOSE: The eXtreme Lateral Interbody Fusion (XLIF) approach has gained increasing importance in the last decade. This multicentric retrospective cohort study aims to assess the incidence of major complications in XLIF procedures performed by experienced surgeons and any relationship between the years of experience in XLIF procedures and the surgeon's rate of severe complications. METHODS: Nine Italian members of the Society of Lateral Access Surgery (SOLAS) have taken part in this study. Each surgeon has declared how many major complications have been observed during his surgical experience and how they were managed. A major complication was defined as an injury that required reoperation, or as a complication, whose sequelae caused functional limitations to the patient after one year postoperatively. Each surgeon was finally asked about his years of experience in spine surgery and XLIF approach. Pearson correlation test was used to evaluate the association between the surgeon's years of experience in XLIF and the rate of major complications; a p-value of last than 0.05 was considered significant. RESULTS: We observed 14 major complications in 1813 XLIF procedures, performed in 1526 patients. The major complications rate was 0.7722%. Ten complications out of fourteen needed a second surgery. Neither cardiac nor respiratory nor renal complications were observed. No significant correlation was found between the surgeon's years of experience in the XLIF procedure and the number of major complications observed. CONCLUSION: XLIF revealed a safe and reliable surgical procedure, with a very low rate of major complications, when performed by an expert spine surgeon.

Direct anterior approach versus direct lateral approach in total hip arthroplasty and bipolar hemiarthroplasty for femoral neck fractures: a retrospective comparative study.

BACKGROUND: In the current literature, there is no consensus on the best surgical approach in hip replacement for femoral neck fractures (FNFs). AIM: The aim of this study is to compare the direct anterior approach (DAA) and the direct lateral approach (DLA) in patients treated with bipolar hemiarthroplasty (BHA) and total hip arthroplasty (THA) for FNFs. MATERIALS AND METHODS: Patients with displaced FNFs (Garden type III and IV) treated operatively using BHA and THA were enrolled. The surgical approach techniques DAA and DLA are compared. The analysed variables are: mean surgery time, number of blood units transfused perioperatively, percentage of patients transfused, perioperative complications, pain and functional outcomes at 1 and 6 months and mortality at 1, 3 and 12 months. RESULTS: Between 2015 and 2017, 37 patients underwent BHA by the DAA and 38 patients underwent BHA by the DLA, 69 patients underwent THA by the DAA and 60 patients underwent THA by the DLA. For THA, the DAA compared to the DLA had a higher mean surgery time (100.8 min vs. 97.7 min), a lower mean number of blood units transfused perioperatively (1.4 U vs. 1.9 U), a significantly lower percentage of patients transfused (53.6% vs. 71.7%), a higher rate of perioperative complications (10.1% vs. 1.6%), a lower pain referred and better functional outcomes in the first 6 postoperative months and a significantly lower mortality rate at 12 months (2.9% vs. 16.7%). For BHA, the advantages of the DAA over DLA are not as significant. CONCLUSIONS: The direct anterior approach in THA for FNFs provides significant benefits in the early post-operative period compared to the direct lateral approach in terms of functional recovery, residual pain, blood loss and mortality rate in the elderly active population. LEVEL OF EVIDENCE: Level IV, retrospective cohort study.

Spine Surgery in Italy in the COVID-19 Era: Proposal for Assessing and Responding to the Regional State of Emergency.

In December 2019, coronavirus disease 2019 (COVID-19) was discovered in Wuhan, Hubei province, from where it spread rapidly worldwide. COVID-19 characteristics (increased infectivity, rapid spread, and general population susceptibility) pose a great challenge to hospitals. Infectious disease, pulmonology, and intensive care units have been strengthened and expanded. All other specialties have been compelled to suspend or reduce clinical and elective surgical activities. The profound effects on spine surgery call for systematic approaches to optimizing the diagnosis and treatment of spinal diseases. Based on the experience of one Italian region, we draw an archetype for assessing the current and predicted level of stress in the health care system, with the aim of enabling hospitals to make better decisions during the pandemic. Further, we provide a framework that may help guide strategies for adapting surgical spine care to the conditions of epidemic surge.

Idiopathic Early-Onset Scoliosis Treated With Magec Rods: What to Do After the Lengthening Period Is Over?

The treatment of early-onset scoliosis with magnetic growing rods has been established, but the management at the end of the lengthening program is still controversial. The options available are removal of rods and observation, removal of rods and immediate fusion, or replacement/maintenance of rods. We present 2 cases of early-onset scoliosis patients treated with Magec rods, up to skeletal maturity. In the first case of a Lenke 3 scoliosis (14 years and 11 months) with a thoracic curve of 50° and lumbar curve of 40°, we removed the rods and kept the patient under observation. After 5 months, the patient showed curve progression, with a thoracic curve of 61° and a lumbar curve of 57°. Consequently, we performed an instrumented T4 to L4 fusion with a correction of the thoracic curve of 66% and lumbar curve of 60%. In the second case of a Lenke 1 scoliosis (15 years and 10 months) with a thoracic curve of 38°, the rods were removed and the patient was kept under observation. After 10 months, following a curve progression, presenting a thoracic curve of 72°, we performed an instrumented fusion T5 to L2 and right thoracoplasty (6th to 11th ribs) with a 40% curve correction. Observing these 2 cases at the end of the treatment with Magec rods, even in case of a good and satisfying final correction, skeletal maturity, and secondary sexual characteristics, we recommend immediate instrumented spine fusion.

Evaluation of the effectiveness of expandable cages for reconstruction of the anterior column of the spine.

PURPOSE: For anterior spine column reconstruction after corpectomy, expandable cages offer solid anterior support and allow correction of deformity, providing excellent primary stability. To provide a larger body of clinical observations concerning the effectiveness of the approach, this retrospective study examines patients treated by corpectomy and reconstruction with an expandable cage for different pathologies. METHODS: Across 5 years, 39 patients underwent vertebral reconstruction with expandable cages after single (n = 34), double (n = 4), or triple (n = 1) corpectomy. Pathologies were tumors (n = 21), fractures, or deformities in traumatic injuries (n = 14), degenerative pathology (n = 2), and infection (n = 2). Levels were cervical (n = 10), thoracic (n = 14), and lumbar (n = 15). All patients were evaluated clinically and radiographically. RESULTS: There were no cases of neurologic deterioration. Nurick grade showed significant improvement at 3 months postoperative versus preoperative (p < 0.01). Visual analog scale significantly improved preoperatively versus 3 and 12 months postoperatively (both p = 0). Regional angulation was significantly corrected, from preoperative to 3 and 12 months postoperative, at cervical, thoracic, and lumbar levels. We achieved reconstruction of the normal local anatomy with full recovery of the height of the vertebral body. Six patients (15.4%) had complications and two (5.1%) underwent revision surgery. CONCLUSIONS: In our experience, expandable cages confer stable anterior support, providing significant improvement of the segmental kyphosis angle and restoration of the original somatic height. Our clinical results are favorable, and the low rate of complications and revision accentuates the expandable cage as a valuable tool to replace the vertebral body in diverse pathologies and different spine levels.

Efficacy and safety of minimally invasive axial presacral L5-S1 interbody fusion in the treatment of lumbosacral spine pathology: a retrospective clinical and radiographic analysis.

Background The surgical treatment of degenerative disc disease L5-S1 is considerably controversial. The purpose of this study was to evaluate the radiographic and clinical results of patients treated with AxiaLif® Technique (AxiaLif®, AMSGroup, Italy) using a minimally invasive pre-sacral approach. Methods From 2013 to 2018 a total of 52 patients have been treated (12 M, 40 F; mean age 46.3 years). Diagnosis included L5 isthmic spondylolisthesis low-grade dysplasia, primary and secondary degenerative disc disease. 43 patients have been followed for at least 2 years. Fusion assessment was based on plain radiographs and Brantigan fusion criteria at 1, 6, 12 and 24 months after surgery. All patients completed the VAS and ODI at baseline through last follow-up. Results Clinical results showed good pain resolution. VAS back demonstrated an average reduction over baseline of 50%, 57%, 71%, 77% at 3, 6, 12 and 24 months, respectively (p<0.001). ODI demonstrated an average reduction over baseline of 38%, 51%, 67%, and 72% at the same time points (p<0.001). Complete fusion was demonstrated in 65% of cases, 30% partial fusion and 5% in the absence of bony bridges visible radiographically. We had two major complications, as 1 retroperitoneal hematoma and 1 spondylodiscitis, and one minor complication, as a superficial infection of the surgical wound. Conclusions The surgical treatment of degenerative disc disease at L5-S1 with minimally invasive technique Axialif showed good radiographic and clinical outcomes with an acceptable rate of complications. Moreover, shorter hospitalization and faster functional recovery are adding factors to choice this technique.

Incomplete, stable-like, peri-prosthetic Vancouver B fracture around an ha-coated stem. Is there a case for strategic thoughtful neglect?

The Periprosthetic fracture of the proximal femur is usually treated by internal fixation of the fracture or revision of the femoral stem depending on the characteristics of the fracture and stability of the implant. This case report shows an early periprosthetic fracture around an uncemented straight stem which is treated conservatively with an excellent clinical radiographic result and explains the biomechanics related to this non-operative choice. A conservative treatment of periprosthetic fracture is possible but only after a careful analysis of the fracture pattern, the characteristics of the prosthetic stem and the time elapsed from implanting the prosthesis to the fracture.

Minimally Invasive Far Lateral Lumbar Interbody Fusion: A Prospective Cohort Study.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To assess rate and degree of interbody bone fusion and evolution in Oswestry Disability index (ODI) and visual analog scale (VAS) of pain after minimally invasive far lateral lumbar interbody fusion. METHODS: Twenty-three patients with single-level lumbar instability or degenerative disc were treated by this method and prospectively included. VAS of pain and ODI were evaluated preoperatively and at last follow-up. Computed tomography scan was performed 6 months after surgery to assess interbody fusion. RESULTS: Between preoperative and 2 years postoperative follow-up, mean VAS decreased by 2.4 points (P < .001); mean ODI improved by 21.8% (P < .001). Computed tomography scan showed fusion in all patients but one. No severe complications were observed. CONCLUSIONS: Minimally invasive far lateral lumbar interbody fusion resulted in satisfactory clinical and radiological results.

Anterior decompression and plate fixation in treatment of cervical myelopathy: A multicentric retrospective review.

OBJECTIVES: The aim of this study was to evaluate the results on anterior decompression and fusion with titanium mesh or expanding cage and plate fixation in patients with cervical myelopathy. METHODS: We conducted a retrospective multicentric review of 114 patients, 75 males and 39 females, with cervical myelopathy who underwent surgical treatment between July 2009 to December 2011. All surgeries were performed via a ventral approach. Based on the type of surgery the patients received, they were divided into 3 groups: group 1 consisted of 49 patients who received multilevel corpectomies and fusion with strut iliac bone graft and plates; group 2 consisted of 26 patients who received multilevel corpectomies and fusion with titanium expanding cage and plating; group 3 consisted of 39 patients who received multilevel corpectomies and fusion using titanium mesh with autologous bone graft and anterior plating. RESULTS: Decompression of the cervical spinal cord and grafting with plate fixation via a ventral approach demonstrated a high rate of improvement in neurological function with minimal complications. Fusion was documented radiologically in all cases. Eighty-three patients experienced a partial improvement and 41 had a complete recovery according to Nurick's myelopathy grading. Sixty-two patients were ranked as excellent, 48 as good, 4 as fair; unsatisfactory outcome was related to donor site complications. CONCLUSION: Spinal decompression and fusion with titanium cages and plates appears to be a safe and effective alternative in patients with cervical spinal myelopathy. LEVEL OF EVIDENCE: Level IV, therapeutic study.