This article aims to introduce a novel full-endoscopic anterior cervical discectomy and fusion (ACDF) procedure to treat cervical myelopathy. Adoption of endoscopic anterior cervical procedures has been lagging due to safety concerns and the necessity of placing an interbody cage. We have developed novel instrumentation and a modified percutaneous anterior cervical approach that allows a safe and reproducible full-endoscopic ACDF. Specially designed retractor blades facilitate percutaneous placement of a zero-profile cervical interbody cage. A 64-year-old male patient presents with chronic neck pain and bilateral paresthesia in his upper extremities, mild ataxia, and positive Hoffmann sign. He has a history of deep vein thrombosis 5 years prior. Preoperative magnetic resonance imaging and computed tomography scans show a degenerated disk, severe central canal stenosis with cord compression and a hyperintense cord signal at C5–6, compatible with cervical myelopathy. An electromyography of upper extrimities shows suspicion of myelopathy at C5–6. Full-endoscopic ACDF was performed at C5–6 to decompress the canal and restore disk height with a zero-profile interbody cage. Postoperatively the patient showed improvement of his symptoms with reduced pain and disability scores and was discharged from the hospital within 24 hours of the surgery. Outcome is satisfactory at 2-year postoperative follow-up. Full-endoscopic ACDF enables excellent visualization of the posterior endplates and cervical canal with constant irrigation, facilitating treatment of cervical myelopathy. No retraction is required during discectomy and decompression, decreasing the risk of postoperative dysphagia, hoarseness and bleeding. A zero-profile interbody cage can be percutaneously placed with special retractor blades.
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Recent progress in surgical treatment of cervical spine myelopathy – A narrative review Jun Ouchida, Hiroaki Nakashima, Sadayuki Ito, Naoki Segi, Ippei Yamauchi, Shiro Imagama Journal of Clinical Orthopaedics and Trauma.2025; 68: 103074. CrossRef
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Original Article
Spine and Spinal Cord Tumors DSPN-Neurospine Special Issue
Objective Total en bloc spondylectomy (TES) is a curative surgical method for spinal tumors. After resecting the 3 spinal columns, reconstruction is of paramount importance. We present cases of mechanical failure and suggest strategies for salvage surgery.
Methods The medical records of 19 patients who underwent TES (9 for primary tumors and 10 for metastatic tumors) were retrospectively reviewed. Previously reported surgical techniques were used, and the surgical extent was 1 level in 16 patients and 2 levels in 3 patients. A titanium-based mesh-type interbody spacer filled with autologous and cadaveric bone was used for anterior support, and a pedicle screw/rod system was used for posterior support. Radiotherapy was performed in 11 patients (pre-TES, 5; post-TES, 6). They were followed up for 59 ± 38 months (range, 11–133 months).
Results During follow-up, 8 of 9 primary tumor patients (89%) and 5 of 10 metastatic tumor patients (50%) survived (mean survival time, 124 ± 8 months vs. 51 ± 13 months; p = 0.11). Mechanical failure occurred in 3 patients (33%) with primary tumors and 2 patients (20%) with metastatic tumors (p = 0.63). The mechanical failure-free time was 94.4 ± 14 months (primary tumors, 95 ± 18 months; metastatic tumors, 68 ± 16 months; p = 0.90). Revision surgery was performed in 4 of 5 patients, and bilateral broken rods were replaced with dual cobalt-chromium alloy rods. Repeated rod fractures occurred in 1 of 4 patients 2 years later, and the third operation (with multiple cobalt-chromium alloy rods) was successful for over 6 years.
Conclusion Considering the difficulty of reoperation and patients’ suffering, preemptive use of a multiple-rod system may be advisable.
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Single stage combined approach total en-bloc spondylectomy of L1 and L2 vertebrae for primary spinal and paraspinal synovial sarcoma Gurushankari Balakrishnan, Narayanaswamy Kathiresan, Chandra Kumar Krishnan, Vijay Sundar Ilangovan, Dileep Damodaran, Suresh Bapu Kandallu, Vijay Sankaran, Krishna Suresh, Anand Raja British Journal of Neurosurgery.2026; 40(2): 357. CrossRef
The impact of pedicle screw transitional segment and thread distribution on postoperative rod-screw system failure Wen Peng, Weichao Wang, Jie Zhang, Yami Liu, Peiliang Yu, Haoling Huo, Jianzeng Ren, Zhongfa Mao, Xiaojian Wang, Yiguo Yan, Cheng Wang Bone & Joint Research.2026; 15(4): 383. CrossRef
Reconstruction of posterior elements of the spine with femoral shaft allograft after spondylectomy for En bloc resection of tumor Alberto Benato, Pavlos Texakalidis, Jean-Paul Wolinsky European Spine Journal.2025;[Epub] CrossRef
Biomechanical Impact of Titanium Cage Tilt in the Sagittal Plane in Lumbar Total Spondylectomy: a Finite Element Analysis Ye Han, Xuehong Ren, Siyuan Wang, Liqi Luo, Yijie Liang, Shaosong Sun, Xinghai Guan, Xinying Zhang, Xiaodong Wang Annals of Biomedical Engineering.2025;[Epub] CrossRef
Case Report: Does the misplaced titanium mesh cage after total spondylectomy causing cervicothoracic cord compression need to be removed during revision surgery? Xin Wang, XiaoFei Cheng, Jie Zhao, ChangQing Zhao Frontiers in Surgery.2024;[Epub] CrossRef
Biomechanical effects of transverse connectors on total en bloc spondylectomy of the lumbar spine: a finite element analysis Ye Han, Xuehong Ren, Yijie Liang, Xiaoyong Ma, Xiaodong Wang Journal of Orthopaedic Surgery and Research.2023;[Epub] CrossRef
Revisiting En Bloc Resection Versus Piecemeal Resection for the Treatment of Giant Cell Tumor of the Spine Sungjoon Lee, Sun-Ho Lee, Joon Ho Yoon, Chi Heon Kim, Jin Hoon Park, Sang Hyub Lee, Chang-Hyun Lee, Seung-Jae Hyun, Sang Ryong Jeon, Ki-Jeong Kim, Eun-Sang Kim, Chun Kee Chung World Neurosurgery.2023; 178: e165. CrossRef
Robert M. Koffie, Alexandra M. Giantini Larsen, Benjamin L. Grannan, Muhamed Hadzipasic, Vijay Yanamadala, Laura Van Beaver, Ganesh M. Shankar, John H. Shin
Neurospine 2020;17(3):659-665. Published online February 2, 2020
Objective Conventional techniques for atlantoaxial fixation and fusion typically pass cables or wires underneath C1 lamina to secure the bone graft between the posterior elements of C1–2, which leads to complications such as cerebrospinal fluid (CSF) leak and neurological injury. With the evolution of fixation hardware, we propose a novel C1–2 fixation technique that avoids the morbidity and complications associated with sublaminar cables and wires.
Methods This technique entails wedging and anchoring a structural iliac crest graft between C1 and C2 for interlaminar arthrodesis and securing it using a 0-Prolene suture at the time of C1 lateral mass and C2 pars interarticularis screw fixation.
Results We identified 32 patients who underwent surgery for atlantoaxial with our technique. A 60% improvement in pain-related disability from preoperative baseline was demonstrated by Neck Disability Index (p < 0.001). There were no neurologic deficits. Complications included 2 patients CSF leaks related to presenting trauma, 1 patient with surgical site infection, and 1 patient with transient dysphagia. The rate of radiographic atlantoaxial fusion was 96.8% at 6 months, with no evidence of instrumentation failure, graft dislodgement, or graft related complications.
Conclusion We demonstrate a novel technique for C1–2 arthrodesis that is a safe and effective option for atlantoaxial fusion.
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Radiographic confirmation of fusion after anterior cervical discectomy and fusion (ACDF) surgery is a critical aspect of determining surgical success. However, there is a lack of established diagnostic radiographic parameters for pseudoarthrosis. The purpose of this study is to summarize the findings of previous studies, review the advantages and disadvantages of frequently employed diagnostic criteria, and present our recommended protocol of fusion assessment. This study identified randomized controlled trials, case-control studies, and prospective and retrospective cohort studies reporting on spinal fusion and how successful fusion after ACDF. Among the 39 articles reviewed, bridging bone across the operated levels on static radiographs was the most commonly used criteria to confirm fusion (31 of 39, 79%). Dynamic flexion-extension radiographs were used to assess for interspinous movement (ISM) (22 of 39, 56.4%) and change in Cobb angle (12 of 39, 30.8%). Computed tomography (CT) based findings (21 of 39, 53.8%) were employed in ambiguous cases with improved sensitivity and specificity. Reconstructed CT scans were used to assess for intragraft bridging bone and extragraft bridging bone (ExGBB). ExGBB were proved to have the highest diagnostic sensitivity and specificity for pseudoarthrosis detection when compared to all other radiographic criteria. The ISM <1 mm on dynamic flexion-extension radiographs had high diagnostic sensitivity and specificity as well. After our reviewing, we recommend using dynamic lateral flexion-extension cervical spine radiographs at 150% magnificationin which the interspinous motion <1 mm and superjacent interspinous motion ≥4 mm confirms fusion. In ambiguous cases, we recommend using reconstructed CT scans to evaluate for ExGBB.
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OBJECTIVE The purpose of this study is to investigate the efficacy of the local bone graft from laminectomy and facetectomy in one level lumbar posterolateral arthrodesis. METHODS Sixty six patients who underwent one level lumbar posterolateral arthrodesis for degenerative lumbar diseases between January 2005 and June 2008 were evaluated retrospectively. Arthrodesis was performed by transpedicular screw fixation and grafting with autologous local bone chips from laminectomy and facetectomy instead of autologous iliac bone, allograft bone or biosynthetic composite bone grafts.
Postoperative radiographs were obtained to review the evidence of fusion. A modified Lenke score was used to assess the status of the fusion. RESULTS Sixty six patients consist of 29 males and 37 females with mean age 60.7 years old and 22.5 months mean follow-up period. A mean amount of the local bone chips from laminectomy and facetectomy was 13.4g. At 12 months after operation, the average Lenke score was 1.5 and spinal bone fusion rate was 95.4%. There were three patients with failed fusion and all of them were heavy smokers. CONCLUSION The local bone graft from laminectomy and facetectomy in the one level lumbar posterolateral arthrodesis is reliable and effective enough to replace the graft from autologous iliac bone, allograft bone or biosynthetic composite bone grafts.
Since 1966 the first metal ball shape implant was inserted into the cervical and lumbar areas by Dr. Fernstrom, numerous attempts and prostheses have been tried to maintain physiologic range of motion and prevent adjacent segment degeneration (ASD) after surgery. However fusion itself is not a single causative factor of ASD and other biologic factors including natural progression of degenerative process and mechanical factors also contribute in the development of ASD. Several well designed prospective randomized control studies for Bryan disc and Prodisc C have been recently documented preservation of spinal motion, superior or, at least, equivalent clinical outcome in comparing with anterior cervical arthrodesis, and less adverse postoperative events both in frequency and severity.
Still remained or undetermined problems in cervical arthroplasty are heterotopic ossifications, segmental kyphosis of implanted levels, MR imaging compatibility, vertebral body fracture by keeled prostheses and long term wear properties. In spite of these unsolved problems and incompleteness of prosthetic design, cervical arthroplasty is now considered as one of standard methods in surgical management of one or two level cervical disc diseases and its indication may be broader in near future.
OBJECTIVE The incidence of symptomatic adjacent segment disease appears to occur at a rate of 2% to 3% per year, following anterior cervical discectomy and fusion. Recently, cervical arthroplasty is a preferred procedure to arthrodesis. METHODS We performed 16 arthropalsties form January 2005 to December 2006 in the Samsung medical center, using the BRYAN artificial disc and 16 anterior cervical interbody fusions.
Radiographic evaluation included flexion and extension roentgenogram images of cervical spine. In the former group, the pre- and postoperative segmental sagittal range of motion(ROM) in the arthroplasty level and the adjacent level were measured. In the later group, the pre- and postoperative segmental sagittal ROM in the adjacent level to the fusion level was measured and the Cobb angles at C2-7(or 6) to ascertain overall cervical alignment was measured in both groups. RESULTS There was minimal change in sagittal ROM of whole cervical spine in all patients in the two groups. Sagittal ROM of arthroplaty level were increased 7.581+/-4.222 to 11.512+/-5.398(p<0.05) ROM of adjacent level to arthroplasty level were no significant change pre- and postoperatively.
But ROM of adjacent level to arthrodesis level were increased 7.160+/-3.609 to 11.260+/-4.832(p<0.05). CONCLUSIONS Artificial disc could maintain ROM of pathologic level and adjacent level to fusion level should replace ROM of pathologic level but adjacent level to arthroplasty level should not replace additional ROM postoperatively. Long-term follow up studies are required to prove its efficacy and its ability to prevent adjacent segment disease.
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