Sacral slanting—defined as the oblique tilt of the upper sacral endplate measurable on standing anteroposterior whole-spine radiographs—is a distinctive and clinically underappreciated finding in adolescent idiopathic scoliosis (AIS). Its etiology is multifactorial and incidence among AIS patients reaches 40%. The direction and degree of sacral slanting interact with the distal lumbar curve type (L4-left vs. L4-right) to influence the pattern of postoperative radiographic changes at the distal spine and shoulder. In patients with L4-left curves and left-sided slanting, stopping fusion at L3 generally prevents coronal decompensation. Furthermore, 5-year data show that the disc wedge angle below the lowermost instrumented vertebra (LIV) does not progress when LIV is L3, and patient-reported outcomes are preserved without revision surgery. When fusion extends to L4 in patients with high sacral slanting, coronal decompensation is more frequent, yet functional outcomes remain comparable and no revision has been required in published series to date, indicating that the decompensation observed is radiographically significant but clinically tolerable within the medium term. In Lenke 1A patients with right-sided sacral slanting (L4-right type), the slanting lowers the last touching vertebra and may facilitate distal adding-on. In Lenke 2A patients with right-sided slanting, distal adding-on serves as a natural shoulder-rebalancing mechanism and may be reasonably monitored conservatively rather than reflexively treated, pending further validation in independent cohorts, unless progressive or symptomatic. Across all scenarios, the optimal distal fusion level remains an unresolved dilemma requiring further long-term prospective study. This review synthesizes the available literature to characterize sacral slanting as a promising radiographic parameter that may serve as a potentially useful adjunct in distal fusion level planning, while highlighting the need for prospective multicenter validation before its routine incorporation into surgical decision-making in AIS.
Objective Full endoscopic cervical surgery (FECS) is an evolving minimally invasive approach for treating cervical spine disorders. This systematic review synthesizes current evidence on the clinical outcomes and patient perspectives associated with FECS, specifically evaluating its safety, efficacy, and overall patient satisfaction.
Methods A systematic search of the PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies published between January 2000 and September 2024 that reported on clinical outcomes or patient perspectives related to FECS were included. Risk of bias was assessed using the ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) tool and the Cochrane Risk of Bias tool. Inclusion criteria encompassed randomized controlled trials, prospective cohort studies, retrospective studies, and observational studies focused on adult populations undergoing FECS for cervical spine surgery.
Results The final synthesis included 30 studies. FECS was associated with significant reductions in both cervical and radicular pain, as well as meaningful functional improvements, measured by standardized clinical scales such as the Neck Disability Index and visual analogue scale. Patient satisfaction rates were consistently high, with most studies reporting satisfaction exceeding 85%. Complication rates were low, primarily involving transient neurological deficits that were typically resolved without the need for further intervention. Nonrandomized studies generally presented a moderate risk of bias due to confounding and selection, whereas randomized controlled trials exhibited a low risk of bias.
Conclusion FECS is a safe and effective minimally invasive surgical option for cervical spine disorders associated with substantial pain relief, functional improvement and high levels of patient satisfaction.
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Objective This retrospective cohort study has been aimed at evaluating the incidence of complications after vertebral body sliding osteotomy (VBSO) and analyzing some cases. Furthermore, the complications of VBSO were compared with those of anterior cervical corpectomy and fusion (ACCF).
Methods This study included 154 patients who underwent VBSO (n = 109) or ACCF (n = 45) for cervical myelopathy and were followed up for > 2 years. Surgical complications, clinical and radiological outcomes were analyzed.
Results The most common surgical complications after VBSO were dysphagia (n = 8, 7.3%) and significant subsidence (n = 6, 5.5%). There were 5 cases of C5 palsy (4.6%), followed by dysphonia (n = 4, 3.7%), implant failure (n = 3, 2.8%), pseudoarthrosis (n = 3, 2.8%), dural tears (n = 2, 1.8%), and reoperation (n = 2, 1.8%). C5 palsy and dysphagia did not require additional treatment and spontaneously resolved. The rates of reoperation (VBSO, 1.8%; ACCF, 11.1%; p = 0.02) and subsidence (VBSO, 5.5%; ACCF, 40%; p < 0.01) were significantly lower in VBSO than in ACCF. VBSO restored more C2–7 lordosis (VBSO, 13.9° ± 7.5°; ACCF, 10.1° ± 8.0°; p = 0.02) and segmental lordosis (VBSO, 15.7° ± 7.1°; ACCF, 6.6° ± 10.2°; p < 0.01) than ACCF. The clinical outcomes did not significantly differ between both groups.
Conclusion VBSO has advantages over ACCF in terms of low rate of surgical complications related to reoperation and significant subsidence. However, dural tears may still occur despite the lessened need for ossified posterior longitudinal ligament lesion manipulation in VBSO; hence, caution is warranted.
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