Thoracic Vertebrae

BackgroundMinimally invasive posterior fixation surgery for pyogenic spondylitis is known to reduce invasiveness and complication rates; however, the outcomes of concomitant insertion of pedicle screws (PS) into the infected vertebrae via the posterior approach are undetermined. This study aimed to assess the safety and efficacy of PS insertion into infected vertebrae in minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis.MethodsThis multicenter retrospective cohort study included 70 patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis across nine institutions. Patients were categorized into insertion and skip groups based on PS insertion into infected vertebrae, and surgical data and postoperative outcomes, particularly unplanned reoperations due to complications, were compared.ResultsThe mean age of the 70 patients was 72.8 years. The insertion group (n = 36) had shorter operative times (146 versus 195 min, p = 0.032) and a reduced range of fixation (5.4 versus 6.9 vertebrae, p = 0.0009) compared to the skip group (n = 34). Unplanned reoperations occurred in 24% (n = 17) due to surgical site infections (SSI) or implant failure; the incidence was comparable between the groups. Poor infection control necessitating additional anterior surgery was reported in four patients in the skip group.ConclusionsPS insertion into infected vertebrae during minimally invasive posterior fixation reduces the operative time and range of fixation without increasing the occurrence of unplanned reoperations due to SSI or implant failure. Judicious PS insertion in patients with minimal bone destruction in thoracolumbar pyogenic spondylitis can minimize surgical invasiveness.

Background and Objectives: Robotic-assisted surgery (RS) has progressively emerged as a promising technology in modern thoracolumbar spinal surgery, offering the potential to enhance accuracy and improve clinical outcomes. To date, the benefits of robot-assisted techniques in thoracolumbar spinal surgery remain controversial. The objective of this study was to assess the efficacy and safety of RS compared to fluoroscopy-assisted surgery (FS) in spinal fusion procedures. Materials and Methods: In accordance with the PRISMA guidelines, a systematic review and meta-analysis was conducted, using REVMAN V5.3 software. The review protocol was registered in the Prospective Register of Systematic Reviews (PROSPERO) website with the following registration number: CRD42024567193. Results: Eighteen studies were included in the meta-analysis with a total of 1566 patients examined. The results demonstrated a worse accuracy in FS in cases with major violations of the peduncular cortex (D-E grades, according to Gertzbein's classification) [(odds ratio (OR) 0.47, 95%-CI 0.28 to 0.80, I2 0%]. In addition, a lower complication rate was shown in the RS group compared to the FS group, specifically regarding the need for surgical revision due to screw mispositioning (OR 0.28-CI 0.17 to 0.48, I2 98%). Conclusions: Advantages of robot-assisted techniques were demonstrated in terms of postoperative complications, revision surgery rates, and the accuracy of screw placement. While RS represents a valuable and promising technological advancement in thoracolumbar spinal surgery, future studies are needed to further explore its advantages in thoracolumbar spinal surgery and to identify which spinal surgical approach has greater advantages when using the robot.

Thoracic disc herniations (TDHs) are rare conditions, comprising 0.1% to 5% of all reported herniation cases, and affecting up to 1 in 1,000,000 individuals. The mid to lower thoracic spine, particularly between the T11 and T12 vertebrae, is most frequently affected and often associated with trauma. Conditions like Scheuermann's disease can predispose patients to TDHs. This study explores the clinical manifestations, diagnostic methods, surgical techniques, and complications associated with TDHs. Diagnosis relies on magnetic resonance imaging and computed tomography myelography to identify the level and nature of the herniation. Various surgical approaches, including posterolateral, lateral, and anterior, have been implemented, each with specific indications, advantages, and pitfalls. Complications range from lung-associated to neurological deterioration to dural breaches. Clinical presentation primarily includes thoracic back pain. Patients can present with significant neurological deficits depending on the herniation's characteristics, namely giant centrally located. Surgical intervention is indicated in cases of failed conservative treatment or acute trauma with significant cord compression. This review aimed to delve into the literature to provide insights into the clinical manifestations of TDHs, diagnosis, surgical techniques, and associated complications.

BackgroundSpinal epidural hemangiomas are rare benign vascular lesions. A dumbbell configuration defined by extension through the neural foramen with both intraspinal and extraspinal components is most commonly associated with schwannomas. Dumbbell-shaped capillary hemangiomas are exceptionally rare and can pose significant diagnostic challenges.Case presentationA 66-year-old woman presented with a one-year history of back pain and progressive bilateral lower-limb weakness that progressed to a bedridden state. Imaging revealed a dumbbell-shaped lesion extending from D3 to D5 with a large paravertebral component measuring 4.3 × 3.6 × 5.7 cm. A combined D3-D5 laminectomy and right posterolateral thoracotomy was performed. The tumor was markedly hypervascular intraoperatively, and gross total resection was achieved. Recent coronary artery bypass grafting and dual antiplatelet therapy increased the operative hemorrhagic risk. Postoperatively, the patient demonstrated neurological improvement with restoration of bladder control and regained ambulation with a walker.ConclusionsDumbbell capillary hemangiomas can mimic schwannomas radiologically yet carry substantial hemorrhagic risk. Multidisciplinary surgical planning is essential for safe management.