Introdation: Improving surgical outcomes reducing the risk of recurrence after microdiscectomy is still actual. Methods: A total of 1200 patients with single-level lumbar disc herniation were included, with 600 patients undergoing standart microdiscectomy (MD) and 600 undergoing microdiscectomy with novel disc cavity curettage technique (MDC). Preoperative and postoperative data, including visual analog scale (VAS) scores for pain, modified Suezawa and Schreiber Clinical Scoring System (MSS) scores, and evaluation based on the MacNab criteria, were collected and analyzed. MDC incorporates a new technique of disc cavity curettage, utilizing a special instrument with double-sharp edges and a unique petal-shaped design. This instrument facilitates quick and effective removal of part of the nucleus pulposus, potentially reducing the likelihood of future relapse by addressing underlying causes. Both groups demonstrated comparable demographics and distribution of disc herniation levels. Results:The average operative time was slightly shorter for MD compared to MD (75 minutes vs. 85 minutes, p<0.05). Postoperative complications, primarily dura mater injury, were slightly lower in the MD group but did not reach statistical significance (p>0.05). Notably, the recurrence rate of disc herniation was substantially lower in the MDC group (2%) compared to MD (8%), indicating a significant advantage for the novel technique (p<0.05). Conclusion, both MD and MDC are effective surgical techniques for lumbar disc herniation, providing similar outcomes in terms of pain relief and functional improvement. MDC offers the advantage of a potentially lower rates of postoperative complications in reducing recurrence rate.

Introduction:
Aortic injury are infrequent but a life-threatening complications of spinal surgery. The aim of this study was to explore the feasibility of endovascular management of pathology of the thoracic aorta in patients undergoing spine surgery.
Methods:
A review of literature was performed using the Medline database. Clinical studies on spine surgery with related TEVAR-interventions were included. Data on indications, treatment strategy, timing of surgery and outcome were extracted and compared.
Results:
A total of 122 studies have been identified, of whom 12 articles reported on the utilization of concurrent TEVAR and spinal surgery. Five studies on 16 patients reported on the treatment of iatrogenic intra-operative aortic lesions, one study described the utilization of TEVAR for traumatic aortic compression due to a Chance fracture. An additional study on 5 patients describes the successful simultaneous treatment of spinal and vascular pathology. Furthermore, 5 studies focused on endovascular treatment of post-surgical pseudoaneurysm. Both interventions in prone and supine positions were performed and no mortality has been described.
Conclusion:
This systematic literature review demonstrates that endovascular aortic repair is a safe treatment option for aortic pathologies related to spine surgery. Both post-traumatic aortic pathologies and iatrogenic aortic lesions were successfully treated be TEVAR. Future studies should focus on the development of guidelines for the treatment of vascular injuries during spine surgery. Endovascular techniques should be included

Introduction:
The most common cause of spinal dislocations is high-energy trauma - motor vehicle trauma, fall from a height, and blunt trauma. The importance of these injuries comes from numerous of cases with spinal cord injury (SCI). Because of the instability of these injuries, surgical stabilization is required.
Material and methods:
A retrospective review of the surgically treated spinal dislocations during the 5-year period (49 patients) in the Department of Spine Surgery of the University Clinical Center of Serbia.
Results:
The most common levels of injury were C6/7 – 12 patients (24.5%), and Th12/L1 – 7 patients (14.3%). In 23 patients (46.9%) the cause of injury was motor vehicle trauma, in 22 (44.9%) falls from a height, and in 4 (8.2%) patients blunt trauma. In 35 (71.4%) patients, there were neurological deficits and in 14 (28,6%) patients neurological findings were normal (ASIA E). Of the patients with neurological deficits, 11 (31.4%) patients showed neurological improvement and 24 (68.6%) didn’t. Our experience has shown that surgically treated patients had no neurological deterioration. There were 35 (71.4%) male patients and 14 (28.6%) female patients. The age distribution was as follows: <19 (4), 19-24 (4), 24-44 (23), 44-65 (15), 65-80 (2), >80 (1). Seven patients (14.2%) died during the initial hospitalization.
Conclusion:
Because of the high mortality rate during the initial hospitalization and the small number of patients with neurological improvement, these injuries have a significant socio-economic influence.

Controversy exists surrounding timing and benefits of surgery versus nonsurgical treatment when motor weakness occurs in spinal disorders. We sought to study relationship between duration of preoperative motor weakness and motor recovery. Study includes 22 patients who underwent surgery for weakness between 2018 and 2022 at single institution. Cases with causes other than lumbar spinal stenosis were excluded. Extent of recovery was assessed by comparing difference between preoperative muscle weakness and muscular strength at last follow-up, categorized as complete recovery, some improvement, no change, and deterioration. Total of 22 cases were identified, 10 patients experienced complete recovery, 4 showed improvement, and 8 exhibited no change in muscle strength. Among 22 patients, 15 patients had preoperative MRC grade 4 and the other 7 patients were below grade 4. 10 of 14 patients with weakness duration for less than 2 years made complete recovery, 4 patients made partial recovery and 1 patient made no recovery. However, all patients with symptoms for more than 2 years made no recovery. Mean duration of weakness in patients with complete recovery was 9.4 months(±7.82) and with no recovery was 44.62months(±19.85). Among 8 patients who made no recovery postoperatively, 5 patients had both MRC grade 4 weakness and weakness duration more than 2 years. In multiple, simple regression analysis, only duration of motor weakness was found to be associated with motor recovery(p=.002, p<.001). Even in cases with mild motor deficits, surgical treatment of stenosis as soon as possible can improve the outcome.

Objective：To compare the accuracy between TINAVI orthopaedic robot-assisted and free-hand pedicle screw placement in the treatment of lumbar spondylolysis in adolescents. Methods：The clinical data of 65 adolescents with lumbar spondylolysis who underwent surgery were analyzed retrospectively. All patients were treated with double segmental pedicle screw reduction and autogenous iliac bone graft. According to different screw placement methods, they were divided into TINAVI orthopedic robot-assisted screw placement group (robot group, n = 32) and free-hand screw placement group (free-hand group, n = 33). The satisfactory rate of pedicle screw placement and cortical penetration rate were calculated according to Neo standard, and the superior articular process invasion rate of screw was calculated by Babu standard. Results：All patients completed the operation successfully. A total of 128 screws were implanted in the robot group, and the rate of the screw placement satisfaction, cortical penetration and articular process invasion were 98.2%, 3.1% and 2.3%, respectively, while 132 screws were implanted in the free-hand group. The rate of screw placement satisfaction, cortical penetration and articular process invasion were 90.9%, 21.1% and 7.6％ respectively, and there were significant differences between the two groups (P < 0.05). Conclusion：Compared with free-hand screw placement, TINAVI orthopedic robot assisted screw placement can improve the accuracy of pedicle screw placement.

Introduction: Sacroiliac joint dysfunction can be successfully treated through sacroiliac joint fusion (SIFJ). One of the considerations of SIJF is motion through the sacroiliac joint. This motion is reflected in the spinopelvic radiographic parameter known as pelvic incidence (PI), a measurement integral to the assessment and treatment of spinal deformity. Traditionally viewed as fixed, recent analyses suggest variability in PI. Changes in PI have not been examined in patients undergoing SIJF. Our study aims to investigate PI changes in patients undergoing primary SIJF and identify those with >5° change to control for interobserver variability.
Methods: Retrospective analysis included patients aged 18-85 undergoing primary SIJF, excluding revision, trauma, cancer, or infection cases. Pelvic parameters were measured by two independent evaluators before and after surgery. Results: Among 104 eligible patients, 11 (10.6%) experienced >5° PI change post-SIJF, unrelated to preoperative demographic factors. Discussion: PI significantly changed by >5° in 10.6% of patients after primary SIJF. This would suggest that PI is not a static parameter. Our observed change is consistent with other studies that have demonstrated PI can change with flexion/extension of the spine or those undergoing long-construct adult spinal deformity surgery. Additional investigations are needed to identify preoperative demographic factors that may predict change in PI as well as the clinical significance of those who experience change. Surgeons performing SIJF should consider fusion positioning's impact on PI, potentially influencing overall spinopelvic alignment and concurrent lumbar fusion planning or exacerbating new/existing spinal deformity.

Objective: The purpose of the study is as follows: to characterize bone resorption around the annular closure device (ACD). Methods: One hundred thirty-three patients underwent ACD implantation after microdiscectomy, and 107 of them were followed up for 8 years after surgery (ODI, VAS). Lumbar CT scans helped characterize the bone resorption area around the ACD. Results: The median of follow-up was 85 [74; 93] months (from 73 to 105 months). The prevalence of bone resorption around the ACD was up to 63.6%, and it was mainly around the polymer mesh of the ACD (70.6%). The resorbed bone volume increased with time and reached its maximum of 5.2 cm3 (12% of the vertebral body volume) once a sclerotic rim developed around the bone resorption area. No differences in VAS pain intensity or in ODI were found between patients with resorption and patients without it (p > 0.05). The volume of the intervertebral disc before surgery is a predictor of bone resorption (OR = 0.79, p = 0.009): if it is less than 13.2 cm3, the risk of bone resorption increases significantly (p < 0.05). Conclusion: The majority of patients (up to 63.6%) with implanted ACDs have vertebral bone resorption around them. The bone resorption area around the ACD mesh increases with time to up to 12% of the vertebral body volume, with no clinical evidence, though. If the volume of the intervertebral disc before surgery is less than 13.2 cm3, the risk of bone resorption increases significantly.

Background:
Dysplastic (or hypoplastic) vertebrae, commonly associated with spina bifida occulta, are increasingly recognized developmental variants that cause disruptions in normal spine biomechanics, leading to degenerative spine changes and back pain. They are very common in the developing world, where many patients present with early-onset low back pain.

Methods
The study was conducted between January 2023 and December 2023. The requisite radiological materials included plain radiographs and MRI's of the lumbar spine. CT scans were rarely used. Patients were divided into two groups: those with dysplastic LV5 and those without. Key measurements were spinopelvic measurements, L5 vertebral body heights, and the wedge angle. Recorded observations were disc degeneration, pars fracture and vertebral slippage.
Results
Of the 217 patients with low back pain, 112 ineligible cases were excluded. Among the remaining, 51 had dysplastic L5 vertebrae, and 54 were normal. The dysplastic group revealed an increased frequency of sciatica (p = 0.007), increased disc degeneration, pars fractures and slippage in the dysplastic group as compared to controls (p < 0.001). There were also differences in the wedge angle, lumbar lordosis, sacral slope and pelvic index in the dysplastic group compared to the control group (p < 0.05). A significant correlation existed between those with dysplastic vertebrae and lumbar lordosis (R = 67).
Conclusion
Dysplastic LV5 vertebrae significantly impact the stability of the lumbosacral junction. Instability leads to disc disease, spondylolysis, and later facet joint disease. Early onset of low back pain and nervous tissue compression are common complications.

Introduction: Heterotopic ossification (HO) is a common complication after cervical disc replacement (CDR) and may limit the range of motion of the artificial disc. As HO usually progresses slowly, long-term follow-up is required to better understand its incidence. This systematic review and meta-analysis aimed to assess the incidence of HO at 10 years postoperatively.
Methods: We searched PubMed, Medline, Embase, and Cochrane Library databases to identify eligible studies. The pooled incidence and 95% confidence intervals (CI) of HO were calculated according to study design, severe or mild HO, prosthesis type, and funding source. In addition, meta-regression analyses were conducted to identify factors contributing to heterogeneity.
Results: Eleven studies with at least 10 years of follow-up comprising 1,140 patients who underwent CDR were included. The pooled incidence of overall HO was 70% (95% CI: 60–81%) at 10 years postoperatively. The pooled incidence of severe HO (grade 3 or 4) was 37% (95% CI: 29–45%), and mild HO (grade 1 to 2) was 30% (95% CI: 17–44%) at 10-year follow-up. Pooled ROM decreased from 8.59˚ before surgery to 7.40˚ 10-year after surgery. Subgroup analysis showed that HO incidence differed according to the prosthesis type and funding source. Earlier publication was associated with a higher pooled incidence of severe HO in the meta-regression analysis.
Conclusion: This is the first meta-analysis providing detailed information on the pooled 10 years incidence of HO after CDR and showed that HO incidence increased with the extension of follow-up time.

Introduction The S2 alar iliac (S2AI) screw is currently the preferred Zone 3 pelvic anchor in spinopelvic fusions. It offers significant resistance to pull out, is in line with the lumbosacral pedicle screws and due to its recessed entry point, has less rate irritation due to implant prominence. Robotic assistance in spine surgery allows planning and execution of precise trajectories even in the presence of altered anatomy. Methods: Thirty-two robotic assisted S2AI screws were inserted in 15 patients with fusions to the pelvis. All surgeries, conducted by a single surgeon, involved intraoperative robotic registration and image acquisition. All S2AI screws were analyzed using postoperative O-arm scans. The time taken for insertion of the S2AI screws was noted. The mean craniocaudal, and mediolateral angulation during screw insertion was noted. The mean radiation exposure was also noted. Results: The most cranial UIV was T8 and required two sets of O-arm scans and the most caudal UIV was L4 in which a single scan was used. The mean time for S2AI screw insertion was 3.1 minutes. The mean radiation dose to the patient was 48.7mGy. The mean medial angle for insertion on the axial view was 37 degrees and the mean caudal angulation on the sagittal view was 17 degrees. All screws were completely within the bone and had no breaches.
Conclusion: Robotic assistance provides additional safety and lowers risk of misplacement of the S2AI screw with reduced radiation to the surgeon.

Objectives: The type of atlantodental space tissue in patients with atlantoaxial dislocation (AAD) can help doctors understand the possibility of reduction before surgery. However, relevant research on this topic is lacking. In this study, we aimed to summarise the atlantodental space classification of patients with AAD using magnetic resonance imaging (MRI) and explore their clinical characteristics.
Materials and Methods: Preoperative 3T cervical MR images of patients who underwent posterior reduction and fixation surgery for non-traumatic AAD between 1 September 2012 and 31 July 2023 were collected. Two radiologists read and recorded the MRI results based on the standard protocol. The kappa value was used to evaluate intra- and inter-observer agreements. The patient’s age, sex, body mass index, clinical symptoms, Japanese Orthopaedic Association (JOA) score, and visual analogue scale information were obtained from medical records.
Results: A total of 135 patients with AAD (mean age, 51.3 ± 14.0 years, 52 men) were included in the analysis. The inter-observer agreement between the two readers was 0.818 (P<0.0001). The intra-observer consistencies were 0.882 (P<0.0001) and 0.896 (P<0.0001). Patients with hard tissue signs were older and had a higher incidence of abnormal spinal cord signals and JOA scores.
Conclusions: Novel MRI signs exhibited high inter- and intra-observer consistency and were associated with patient age, abnormal spinal cord signals, and symptoms.

Background: Contiguous two-segment cervical disc arthroplasty (CDA) is safe and effective, while post-operative radiographic change is poorly understood. We aimed to clarify the morphological change of the three vertebral bodies operated on. Methods: Patients admitted between 2015 and 2020 underwent contiguous two-level Prestige LP CDA were included. The follow-up was divided into immediate post-operation (≤1 week), early (≤6 months), and last follow-up (≥ 12 months). Clinical outcomes were measured by Japanese Orthopedic Association (JOA) score, visual analogue score (VAS), and neck disability index (NDI). Radiographic parameters on lateral radiographs included sagittal area, anterior-posterior diameters (superior, inferior endplate length, and waist length), and anterior and posterior heights. Sagittal parameters included disc angle, Cobb angle, range of motion, T1 slope, and C2-C7 sagittal vertical axis. Heterotopic ossification (HO) and anterior bone loss (ABL) were recorded. Results: 78 patients were included. Clinical outcomes significantly improved. Of the three operation-related vertebrae, only middle vertebra decreased significantly in sagittal area at early follow-up. The four endplates that directly meet implants experienced significant early loss in length. Sagittal parameters were kept within an acceptable range. Both segments had a higher class of HO at last follow-up. More ABL happened to middle vertebra. The incidence and degree of ABL were higher for the endplates on middle vertebra only at early follow-up. Conclusion: Our findings indicated that after contiguous two-segment CDA, middle vertebra had a distinguishing morphological changing pattern that could be due to ABL, which deserves careful consideration before and during surgery.

Objectives: This study aims to assess clinical and radiologic factors associated with long-term prognosis following single-door cervical laminoplasty (SDCL) by multivariate analysis.

Methods: 115 patients who underwent SDCL with miniplate fixation from November 2008 to June 2018 were analyzed. Postoperative follow-up averaged 17.3 months. Prognosis was evaluated based on the Japanese Orthopedic Association (JOA) recovery rate. The recovery rate of JOA ≤ 50% were classified as poor prognosis group (PP group) whose prognosis is relatively poor, and those> 50% were classified as good prognosis group (GP group) whose have a better prognosis. The clinical factors including gender, age, duration of symptoms, diagnosis type, blood loss, operative time, pre- and post-JOA score, etc. were recorded. The radiologic factors including sagittal canal diameter (SCD), the cervical curvature index (CCI), the range of motion (ROM), the spinal canal area and the increasing of cervical spinal cord area, etc. were collected before and after operation and measured by X-ray plain and computed tomography (CT) scan images. The univariate analysis and multivariate logistic regression analysis were performed.

Results: There were 62 patients in PP group and 53 patients in GP group. The multivariate analysis showed that the preoperative (OR=6.875, P<0.001) and postoperative JOA scores (OR=24.000, P<0.001), preoperative spinal canal area (OR=2.464, P<0.023) and the increasing of cervical spinal cord area (OR=5.438, P<0.001) maybe related factors to the recovery rate of JOA at the final follow-up.

Conclusions: Preoperative spinal canal area, increased cervical spinal cord area, pre- and postoperative JOA scores significantly influence long-term prognosis post-SDCL.

Introduction:A novel Uni-portal Arthroscopic Spinal Surgery (UASS) is a modification of the biportal endoscopic surgery. UASS technique utilizes a single incision, housing both the 30 degree arthroscope and the surgical instruments. This study aims to evaluate the clinical safety and efficacy of UASS technique combined with bone anchoring annular repair for the treatment of lumbar disc herniation with vertebral marginal rupture of annulus fibrosus.Methods: From December 2021 and December 2022 this study recruited 39 patients with lumbar disc herniation, who underwent UASS technique combined with bone anchoring annular repair technique. Bone anchoring annular repair is a novel technique which used annulus fibrosus repair device close the annular defects on the vertebral body edge.The pre/post-operation neurological function and pain status were evaluated by VAS and ODI.The assessment also data including: operation time, the quantity of bleeding and intraoperative and postoperative complications, were recorded. Patients were followed up at intervals of preoperative, postoperative 1 months, 3 months, last follow-up. Results:The procedure was successfully performed in all cases. Average operation time was 55 minutes, Average blood loss was 25.3±6.2mL. The preoperative symptoms were alleviated significantly after surgery. All the standardized measures improved significantly. At the last follow-up, including VAS score (7.9±1.2 to 1.1±0.5; p＜0.001) and ODI (75.3 to 9.6; p＜0.001). There was no postoperative complication and disc reherniation..Conclusion:Early results showed the use of the novel uni-portal arthroscopic spinal surgery combined with bone anchoring annular repair technique are beneficial for short term outcomes demonstrating reduction in symptomatic disc reherniation with low post-operative complication rates.

Background: The pathological changes of basilar invagination (BI) and atlantoaxial dislocation (AAD) include vertical and horizontal dislocations. Current surgical techniques have difficulty accurately controlling the degree of reduction in these two directions and often require preoperative traction, which increases patients’ pain, hospital stay, and medical cost.
Objective: This study aimed to introduce a novel technique for accurately reducing horizontal and vertical dislocation without preoperative traction and report the radiological and clinical outcomes.
Methods: From 2010 to 2022, patients with BI and AAD underwent posterior two-step distraction and reduction (TSDR) and occipitocervical fixation. Radiological examination was used to evaluate the reduction degree (RD) and compression. Japanese Orthopedic Association (JOA) score was used to evaluate clinical outcome.
Results: A total of 62 patients with BI and AAD underwent TSDR and occipitocervical fusion. The clinical symptoms of 96.8% of them improved. JOA score increased significantly after the operation. Appropriate (50%≤RD< 80%) or satisfactory (RD≥80%) horizontal reduction was achieved in 93.5% of patients, and 91.9% obtained appropriate or satisfactory vertical reduction. Thirty-one patients did not undergo preoperative skull traction. There was no significant difference in radiological outcomes or JOA scores between the traction- and non-traction groups. However, the length of hospital stay in the traction group was longer than that in the non-traction group.
Conclusion: TSDR enables horizontal and vertical reduction. It is a safe, simple, and effective technique for patients with BI and AAD. Despite the absence of preoperative skull traction, the degree of reduction and clinical outcomes were satisfactory.