Minimally Invasive Iliac Screw Insertion: Clinical Case Series and Technical Note

Objective To describe the technique of minimally invasive iliac screw insertion by freehand technique and using intraoperative navigation guidance. Methods Bilateral iliac screws were inserted in total of seven patients. Five patients under- went navigation guided iliac screw placement and freehand technique was performed in 2 patients. Results Total of 7 patients underwent minimally invasive iliac screw fixation in our series. The pathology in 4 of the cases was spondylodiscitis, among them 2 cases each at L5-S1 and L4-L5, one with the destruction of L5 vertebral body and the other with the destruction of both L4 and L5 vertebral bodies. Of the remaining cases, two cases , one case of sacral insufficiency fracture and the last case was implant failure after L2-L5 oblique lumbar fusion. None of the cases required conversion to open procedure or had wound or hardware related complications till the last follow-up. All patients had an uneventful post-operative period with improvement in pain scores and were mobilized on the 1st postoperative day. One 50-year-old female patient suffering from L5-S1 tubercular spondylodiscitis died due to underlying chronic kidney disease three months post-surgery. Conclusion Minimal invasive iliac screw placement with or without navigation offers the same biomechanical stability as the open approach but without the need for extensive soft tissue exposure needed for a conventional/open procedure; thereby reducing exposure-related complications , enhancing post-operative recovery and early mobilization. Incorporating intra-operative 3D navigation provides real-time multi-planar images which help in easy planning and safe screw placement whilst reducing radiation exposure

Minimally Invasive Subaxial Cervical Pedicle Screw Placement with Routine Fluoroscopy: Cadaveric Feasibility Study and Report of 6 Clinical Cases

Objective Conventional cervical pedicle screw insertion necessitates extensive paraspinal muscle dissection and retraction in order to achieve the lateral to medial angulation needed to achieve the optimal screw trajectory. Minimally invasive transmuscular approach can comfortably achieve this angulation without significant injury to the midline structures and its musculo-ligamentous attachments. Methods Minimally invasive cervical pedicle screws were inserted in 4 fresh frozen cadaveric specimens. Pre-procedure and post-procedure CT scans were done to assess the pedicle dimensions, suitability for screw insertion and integrity of the screws. The same technique was applied in a clinical cohort of six cases – 3 cases of traumatic subluxation; one case of traumatic vertebral fracture and 2 cases of infective facet destruction (Koch’s). Results Among the 38 screws in the cadaver specimens, a total of 11 screws (28.9%) had breached the pedicle wall(Lateral wall breach–9; Medial wall breach–2). Of the 9 screws (23.6%) that had a lateral breach into the vertebral canal, 4 (10.5%) each had Grade IIa breach and one (2.6%) had Grade III breach. Among the 22 screws inserted in the clinical cohort of 6 cases, 4 screws (18.1%) had breached the pedicle wall. All the identified breaches were in the lateral wall(Grade IIa – 3; Grade IIb–1; Grade III–nil). Conclusion Minimally invasive subaxial pedicle screw insertion provides robust posterior cervical fixation, either in isolation or as an adjunct to anterior surgery, in cases where a direct posterior decompression is not warranted. It is a safe and effective approach which minimizes injury to the paraspinal structures and midline attachments

A 30-Year Worldwide Research Productivity of Scientific Publication in Full-Endoscopic Decompression Spine Surgery: Quantitative and Qualitative Analysis

Objective The ever-growing number of articles related to full-endoscopic spine surgery published in the last few decades presents a challenge which is perplexing and time-consuming in identifying the current research status. The study aims to identify and analyze the most cited works related to full-endoscopic decompression spine surgery, compare the articles published by different publishers and area, and show the current publication status of full-endoscopic research. Methods Using Bibliometrix, CiteSpace, and VOSviewer, we analyzed the bibliometric data selected from the Web of Science database between 1992 and 2022. Spine has the highest H-index with the most-cited journal in the field of full-endoscopic decompression spine surgery. China ranked as the most productive country, whereas the most cited with high H-index papers came from South Korea. For the author analysis, Yeung AT, Ruetten S, Hoogland T, Ahn Y, Choi G, and Mayer HM were the most impactful authors in the global and local citations. The most productive organization is Wooridul Spine Hospital. Conclusion The bibliometric study showed a growing trend of research on full-endoscopic decompression spine surgery over the past 30 years. It has demonstrated that there is a significant increase in the number of authors, institutions, and internationally collaborated countries. However, the quality of studies is still low, and the lack of high-quality clinical evidence and the trend of general journal submissions has somewhat affected the quality of endoscopy journals in recent years

A rare case of “Brown tumor” of the axis with parathyroid adenoma and tertiary hyperparathyroidism

“Brown tumors (BTs)” of the spine are benign rare lesions, seen in about 5%–13% of all patients with chronic hyperparathyroidism (HPT). They are not true neoplasms and are also known as osteitis fibrosa cystica or occasionally osteoclastoma. Radiological presentations are often misleading and may mimic other common lesions such as metastasis. A strong clinical suspicion is therefore necessary, especially in the background of chronic kidney disease with HPT and parathyroid adenoma. Surgical spinal fixation in case of instability due to pathological fracture may be required along with excision of the parathyroid adenoma being the treatment of choice, that maybe usually curative and carries a good prognosis. We would like to report one such rare case of BT involving the axis, or C2 vertebra, presenting with neck pain and weakness that was treated surgically. Only a few cases of spinal BTs have been reported so far in the literature. Involvement of cervical vertebrae and in particular C2 is rarer still with the one in this report only being the fourth such case