Introduction: The uncovertebral joint is a potential region for anterior cervical fusion. Currently, there are no clinical trials on human uncovertebral joint fusion (UJF). This study aimed to compare the fusion speed and clinical efficacy of UJF and traditional endplate space fusion (ESF) in anterior cervical surgery. Methods: Patients with single-level cervical spondylosis were recruited and admitted between February 2021 and October 2022 and randomly divided into the UJF and ESF groups. The primary outcome was the early fusion rate 3 months postoperatively. Secondary outcomes included the incidence of complications and patient-reported outcome measures (PROMs). Results: A total of 74 (92.5%) patients completed the trial and were included in the analysis, with an average age of 54.8 (26-65) years. The operation duration (131.3 ± 29.4 min vs. 123.6 ± 26.0 min, p=0.237) and intraoperative blood loss (70.6 ± 50.0 ml vs. 79.2 ± 49.0 ml, p=0.454) were comparable between the two groups. The fusion rate in the UJF group was significantly higher than that in the ESF group at 3 and 6 months after operation (3 months after operation: 66.7% vs. 13.2%, p<0.0001; 6 months after operation: 94.1% vs. 66.7%, p=0.006). No significant difference was found in the fusion rate between the two groups 12 months postoperatively. The JOA, NDI, and VAS scores for the arm and neck significantly improved after surgery in both groups. Conclusions: In anterior cervical fusion surgery, the early fusion rate in UJF is significantly higher than that in ESF.

Introduction - Management strategy and surgical technique of choice are still a debate for thoracolumbar spine injuries. There are very few studies done to show the extent of the decompression following posterior wall subsidence of the vertebral body. Hence, we studied the efficacy of posterior wall subsidence in achieving decompression, spinal canal clearance as well as deformity correction in acute thoracolumbar burst fractures. Methods – 25 patients with acute thoracolumbar burst fractures (AO A3-A4) with neurological injury (ASIA A-D) were prospectively studied. The enrolled patients underwent surgical decompression by subsidence of retropulsed posterior wall and posterior instrumentation. Spinal canal diameter and Kyphotic deformity were measured preoperatively, within a week post-surgery, and at 6 months using CT Scan. Neurological status was assessed according to ASIA scale until final follow-up of 2 years. Results - The mean spinal canal decompression achieved at 6th month radiological follow-up was 6.44 ± 1.64 mm and mean improvement in kyphosis was 12.53 ± 7.06°. Mean blood loss and mean operative duration was 347 ± 56.3 ml and 146 ± 23.1 min respectively. The decompression achieved and the sustenance of these measurements at six months was statistically significant (P <0.001). However, no statistical significance could be established between neurological improvement at final follow-up of 2 years. Conclusion - Subsidence of retropulsed fractured posterior wall is an effective surgical method to achieve adequate spinal canal decompression and deformity correction in acute thoracolumbar burst fractures and can serve as an alternative to corpectomy in the surgeon’s armamentarium.

Background:

Early diagnosis of cauda equina syndrome (CES) is crucial for a favourable outcome. Several studies have reported bladder scan use as an adjunct to assess minimum post-void residual urine volume (mPVR). However, variable mPVR values have been proposed without consensus on a single value in predicting CES patients with relevant symptoms and signs.

Aim:
to perform a meta-analysis and systematic review of published evidence to identify mPVR volume providing the highest diagnostic accuracy in suspected CES.

Material & Methods:
The search strategy used electronic databases (PubMed, Medline, EMBASE and AMED) for publications between January 1996 and November 2021. All studies that reported mPVR in suspected CES patients followed by magnetic resonance imaging (MRI) were included.

Results:
A total of 2115 citations were retrieved from the search. Seven studies fulfilled the inclusion criteria. There were 1083 patients in the included studies, with 734 patients’ data available for meta-analysis. In 125 patients, CES was confirmed by MRI. mPVR reported by each study varied and could be categorised into 100 ml, 200 ml, 300 ml and 500 ml. From meta-analysis, 200 ml had the highest diagnostic accuracy, with 82% sensitivity (95% CI: 0.72-0.90) and 65% specificity (95% CI: 0.70-0.90). When compared using summative receiver operating characteristic (SROC) curves, 200 ml mPVR was superior to other values in predicting a radiological confirmation of suspected CES.

Conclusions:

PVR is a useful tool when assessing suspected CES. Compared to other mPVRs values, 200 ml PVR had superior sensitivity, specificity and positive and negative predictive values.

Objective: This prospective observational follow-up study aimed to examine the surgical outcomes predictive factors in patients with lumbar spinal stenosis (LSS) 10 years after surgery.
Methods: At the baseline, 102 patients with LSS underwent decompressive surgery, and 72 of the original study sample participated in a 10-year follow-up study. Study patients filled out a questionnaire preoperatively, and follow-up data were collected at 10 years postoperatively. Surgical outcomes were evaluated in terms of disability with the Oswestry Disability Index (ODI) and pain with the visual analog scale (VAS) and the patients self-evaluated satisfaction for surgery and re-operations during the follow-up time. Predictors in the models were nonsmoking status, absence of previous lumbar surgery, self-rated health, regular use of painkillers for symptom alleviation, and BMI. Statistical analyses included longitudinal associations, subgroup analyses, and cross-sectional analyses.
Results: In overall the patient were satisfied for the surgery although looking for ODI disability scores there were almost increased at the level of before the surgery. 25% of patients needed a new decompressive surgery during follow-up time. Using multivariate analysis, statistically significant predictors for lower ODI and VAS scores at 10 years were nonsmoking status, absence of previous lumbar surgery, better self-rated health, and regular use of painkillers for <12 months. Patients who smoked preoperatively or had previous lumbar surgery experienced more pain and disability at follow-up.
Conclusion: These study results can enhance informed decision-making processes for patients considering surgical treatment for LSS by showing preoperative predictors for surgical outcomes up to 10 years after surgery.

Introduction: Hirayama disease (HD) is a rare type of cervical myelopathy in young males due to forward displacement of the cord during neck flexion causing cervical cord atrophy with preferential involvement of anterior horn cells of the spinal cord. The etiology and the exact cause of HD largely remain debatable. The natural history of this disease reaches a plateau in terms of neurological involvement and is considered a self-remitting disorder. Material and Methods: We present our series of 17 HD patients managed at our centre from 2016 to 2022, either with conservative or surgical means. Conservative management consisted of bracing of cervical spine with collar to prevent flexion movement. The surgical procedures include either anterior cervical discectomy (single or multiple levels) or posterior stabilisation without decompression. Results:The progression of symptoms had stopped in 10 of the 14 patients managed conservatively with 5 showing improvement in hand grip and strength and the remaining 5 patients plateaued without improvement . Surgical management was refused by 4 patients who had progressive worsening despite adequate conservative management. The 3 patients who were managed surgically had progressive rapid deterioration in the last few months despite adequate conservative management. In all 3, the worsening of symptoms stopped immediately after surgery and gradual improvement of function was noticed. At final follow-up they had good muscle power (grade 4-5) and had return of all activities.Conclusion: While conservative management with cervical collar has been used traditionally, recent literature suggests improved outcome with surgical management in refractory cases.

Background. Metastatic spinal cord compression (MSCC) can occur in advanced stages of neoplastic diseases, causing painful and neurological symptoms that have a serious impact on the quality of life. The study aims to evaluate the effectiveness of a surgical treatment of MSCC. Materials & methods. We retrospectively analyzed 49 patients (29 men, 20 women) with a mean age of 64 years (min 35-max 85 years), surgically treated for MSCC from 2014 to 2021. Forty patients were treated with vertebral stabilization and decompression (8 with partial debulking) whereas 9 decompressed without stabilization. A kyphoplasty was performed in 7 cases, vertebroplasty in 1 and one patient was treated with anterior somatectomy after posterior stabilization. Frankel grade, pain, onset of complications and survival were analyzed. Results. Lesions were located at the thoracic level (59%) and lumbar level (39%). The three most frequent histotypes were multiple myeloma (11), lung cancer (9) and breast cancer (8). 89% of patients had further metastases at the time of MSCC. In 37 cases (75%) an improvement in Frankel Grade and pain was noted (p <0.05); 63% regained the ability to walk. Complication rate was low (9%). At a mean follow-up of 19 months, survival was 77%. Conclusions: An early diagnosis and timely appropriate surgical treatment can significantly decrease the patient's neurological and pain symptoms, with a consequent improvement in the quality of life. The perioperative mortality and the percentage of complications detected are not sufficient to justify a conservative treatment of these patients.

Introduction.
Abnormalities of cervical spine belong to embryopathies of a very heterogeneous group. The hypothesis of the study was that patients with congenital and genetic cervical abnormalities and deformities could be divided on the basis of main pathological syndrome determination. The abnormalities clearance was based on the special clinic algorithm.
Materials. The case histories of 80 patients with cervical spine congenital abnormalities were analyzed as a clinical material for the algorithm working out. Computer tomography, magnetic resonance imaging (MRI) and selective angiography were used to specify the abnormality structure and to make preoperative planning.
Various techniques of surgical treatment such as halo, anterior and posterior fusion, decompression of the brain, spinal cord and cervical vertebral arteries, revision of the spinal canal, neurolysis, and meningolysis were used in 64 patients aged 8 month to 47 years old.
Results. All patients were divided due to the leading pathological syndromes. They were instability, stenosis and brain ischemia. Each group had its own important subgroup.
Conclusions. The selection of main pathological syndrome or combination of syndromes is a simple and effective way for making the right decision when treating patients with congenital and genetic cervical spine abnormalities and deformities. Syndromic approach can be used for prognosis as well. The treatment roadmap can be useful in high volume spine centers with very experienced multi specialities team. The basic surgical skills and tricks in genetic and congenital cervical spine deformities management are the same.

Background: Degenerative disc disease may be due to compression of a cervical nerve root or the cord resulting in radiculopathy or cervical myelopathy. Diagnosis is achieved by clinical assessment, plain radiography, MRI and CT scan. Surgical management depends on neural decompression followed by reconstruction of the motion segment.
Aim of the Work: To compare the results of anterior cervical discectomy and fusion using standalone cages versus cages with anterior plating with one-year follow up.
Patients and Methods: fifty consecutive patients diagnosed with multi-level cervical disc disease (two or more) underwent anterior cervical discectomy and fusion in Kasr Al Ainy hospital, Cairo University between August 2021 and June 2022; 25 patients (group A) using stand alone cages (PEEK cages) & the other 25 patients (group B) using (PEEK cages) with additional anterior plating. Randomization was done by operating patients in blocks, the first 4 went to group A & the next 4 to group B and so on.Results: Comparing the pre and post operative VAS for both neck pain and brachialgia and neck disability index in both groups were statistically significant. There was no significant statistical difference between the two groups regarding the post operative clinical outcomes or in the fused segment lordotic angle after 12-month follow up.Conclusion: The use of stand alone cages in 2-level ACDF or more in our study had a shorter operative time and hospital stay when compared to ACDF with anterior plating, but with no difference in clinical or radiological outcomes for 1 year follow up.

Introduction: Intraspinal anomalies like syringomyelia, split cord malformations and low-lying tethered cord may lead to neurologic deficits if not detected and addressed before corrective surgery for scoliosis. The aim of the study was to determine the incidence and predictive factors of occurrence of intraspinal anomalies in scoliosis patients. Methods: A cross-sectional observational study analyzing retrospective data of 320 patients who underwent surgical deformity correction between 2014 and 2020 was done. Neural axis MRI from brain stem to sacrum to screen the intraspinal abnormities was done for all patients. Results: Intraspinal anomalies were detected in 33.5% patients with congenital scoliosis. The most common anomaly reported was tethered cord (n=42,22.7%%) followed by diastematomyelia (n=23,12.4%%), syringomyelia/ syringohydromyelia (n=7,3.8%), meningocele (n=5,2.7%). In patients with idiopathic scoliosis, intraspinal anomalies were detected in 8.4% (n=9) patients. Tethered cord was the most common intraspinal anomaly seen in 4 patients. There was no significant difference in the incidence of intraspinal anomalies between right sided curves and left sided curves under both groups. There was no correlation between the magnitude of scoliosis and the presence of intraspinal anomalies.
Conclusion: This study highlights the importance of a preoperative MRI in all patients with congenital scoliosis before corrective surgery and describes the factors associated with the occurrence of intraspinal anomalies in scoliosis patients.

Purpose: This study aims to compare the clinical and radiological outcome of cortical bone trajectory screws (CBTS) to traditional trajectory screws (TTS) in osteoporotic patients in short structure fusion surgeries.
Methods: A retrospective cohort study was done on 59 osteoporotic patients indicated for lumbar spine fusion: 27 patients in group A treated using CBTS and 32 patients in group B were treated with TTS. Patients were followed for at least one year clinically and radiologically. Dynamic X-rays to assess fusion and VAS and ODI for clinical assessment.
Results: In terms of fusion rate, implant failure, operational time, incisional length, hospital stay, the incidence of complications, and clinical outcome, there was no significant difference between the two study groups (VAS, ODI). It was accompanied by decreased intraoperative blood loss than the TTS group (P=0.012), but with greater radiation exposure (P <0.001).
Conclusion: In osteoporotic patients receiving short-structure lumbar fusion surgery, CBTS revealed comparable clinical and radiological outcomes to TTS. So, CBTS could safely replace TTS in short-structure spine fusion surgery in osteoporotic patients

Background-Tranexamic acid (TXA) is an anti-fibrinolytic drug that reduces blood loss by inhibiting the plasmin-mediated degradation of fibrin. This is the first study in the United Kingdom looking at the effectiveness of TXA in surgically managed isolated spine trauma. The primary aim was to evaluate if TXA is safe to be used for isolated spine trauma. The secondary aims were to assess whether TXA use impacts the need for perioperative blood transfusion and the incidence of postoperative complications.Methods-This prospective observational study across two Major Trauma Centres in England looked at all patients aged 17 and above with isolated spine trauma requiring surgical intervention from 1st January 2022 to 31st June 2022. Results-We identified 67 patients. 26 (39%) received TXA, and 41 (61%) did not. Both groups were matched in age, gender, ASA grade, and mechanism of injury. All patients in the TXA group had an open approach with a mean of 5 spinal levels involved and a mean operative time of 203 minutes, compared to 24 patients (58%) in the non-TXA group having an open approach with a mean of 3 spinal levels involved and mean operative time of 159 minutes. In patients that received TXA, blood loss was less than 150ml in 8 patients (31%), 150-300ml in 15 patients (58%) and 300-500ml in 3 patients (11%). There were no cases of thromboembolic events in any patients that received TXA.Conclusion -TXA is safe for isolated spine trauma. We found no increased risk of blood transfusion or VTE in either group.