Osteoarthritis (OA) is a prevalent degenerative joint disease primarily affecting hip and knee joints, with an estimated 300 million cases globally. This study is crucial as it provides an updated, comprehensive comparison of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) for treating medial knee osteoarthritis, offering valuable insights into their relative effectiveness. The findings aim to inform clinical decision-making and improve patient outcomes by identifying the superior treatment option. A comprehensive search was conducted across PubMed, Cochrane Library, and Google Scholar until August 1, 2024. Statistical analysis used Review Manager 5.4 with a random-effects model, risk ratio (RR), and mean differences (MD) with 95% confidence intervals (CI) for the dichotomous and continuous outcomes, respectively. The Newcastle-Ottawa Scale was used for quality assessment, and funnel plots were used to analyze publication bias. GRADE assessment was done to gauge the certainty of the evidence. Thirty-nine studies, involving a total of 56,686 patients, were evaluated for comparison. UKA significantly reduced the complications (RR = 0.37; 95% CI: [0.25, 0.54]; p < 0.0001; I2 = 30%), revision rates to total knee arthroplasty (TKA) (RR = 0.64; 95% CI: [0.41, 0.99]; p = 0.05; I2 = 72%) and postoperative pain (MD = −0.33; 95% CI: [−0.64, −0.03]; p = 0.03; I2 = 89%) compared to HTO, while range of motion (ROM) (RR = −3.55; 95% CI: [−7.16, 0.52]; p = 0.09; I2 = 98%) and walking speed (MD = 0.02; 95% CI: [−0.04, 0.07]; p = 0.56; I2 = 0%) and surgical site infections(RR = 1.40; 95% CI: [0.30, 6.53]; p = 0.67; I2 = 86%) were comparable. All the functional knee scores are comparable except the Hospital for Special Surgery (HSS) score, which is increased in UKA (MD = 2.63; 95% CI: [0.52, 4.74]; p = 0.01; I2 = 76%). UKA is superior to HTO, offering lower revision rates, reduced postoperative pain, fewer complications, and better functional scores.
Several meta-analyses of surgical versus non-operative treatment of femoroacetabular impingement syndrome (FAIS) have been published, but reliable evidence is still lacking. The aim of this meta-analysis of randomized controlled trials (RCTs) was to assess the outcomes of FAIS patients treated conservatively compared with those treated with hip arthroscopy (HAS). PubMed, CENTRAL of the Cochrane Library, Epistemonikos, and Embase databases were searched up to March 31, 2025. Quality was assessed using the Cochrane Risk of Bias 2 tool, the level of evidence for each outcome parameter was determined using the GRADE system, and publication bias was presented in funnel plots. In a common effect and random effects meta-analysis, mean differences (MDs) between the conservative treatment group and the HAS group were calculated with 95% confidence intervals (CIs) using the Hartung-Knapp-Sidik-Jonkman heterogeneity estimator. A total of 7 RCTs with a total of 489 patients in the conservative treatment group and 484 patients in the HAS group met the inclusion criteria. Of the 7 RCTs included, four were assessed as having a low risk of bias, one as having a moderate risk of bias, and two as having a high risk of bias. The outcomes “post-intervention functional MCID” and “iHOT at ≤ 12 months post-intervention” had a high level of evidence, and the outcome “HOS-ADL at ≤ 8 months post-intervention” had a moderate level of evidence. No significant publication bias was detected for any outcome. The HAS group had a statistically significant 0.85 higher post-intervention functional MCID (common effect model: MD: 0.85 CIs 0.53–1.17; random effects model: MD: 0.85 CIs 0.64–1.06; I2 = 0%; τ2 = 0.02; p = 0.96) and a statistically significant 10.74 higher iHOT at ≤ 12 months post-intervention than the conservative treatment group (common effect model: MD: 10.74 CIs 7.06 to 14.42; random effects model: MD: 10.98 CIs 6.62 to 15.34; I2 = 0%; τ2 = 7.52; p = 0.62). There was no difference between the HAS group and the conservative treatment group in HOS-ADL at ≤ 8 months post-intervention (common effect model: MD: 5.62 CIs 1.76 to 9.48; random effects model: MD: 4.10 CIs −12.31 to 20.50; I2 = 69%; τ2 = 29.88; p = 0.04). This meta-analysis using high-quality statistical methods showed a statistically significant higher post-intervention functional MCID and iHOT at ≤ 12 months post-intervention in favor of the HAS group compared to the conservative treatment group. HOS-ADL at ≤ 8 months post-intervention showed no differences.
Introduction: Robotic total hip arthroplasty (rTHA) is gaining widespread adoption, yet the learning curve (LC) associated with its implementation remains uncertain. Understanding LCs is crucial to optimizing training protocols and improving patient outcomes. This scoping review assesses LCs in rTHA by evaluating operative time, leg length discrepancy (LLD), and acetabular component inclination (ACI).
Methods: A systematic search was conducted across PubMed, MEDLINE, Embase, Scopus, and Web of Science following PRISMA guidelines. Studies assessing the LC of rTHA based on operative efficiency, radiographic accuracy, and surgical outcomes were included.
Results: A total of 12 studies were included. Improvements in operative time were observed at a median of 13 cases, ranging from 7 to 35 cases. Both LLD and ACI findings were inconsistent, with little evidence of a LC found in the literature.
Conclusion: This review highlights the learning curve in rTHA, with proficiency improving after early cases. Standardized benchmarks and training models could enhance learning and enable comparisons across robotic systems. Future research should refine proficiency thresholds, assess system differences, and develop structured training for optimal rTHA adoption.
Objectives: Rotator cuff injuries are a leading cause of shoulder dysfunction, where bio-inductive collagen implants have demonstrated promising results in promoting tendon regeneration and reducing retear rates. However, existing evidence lacks consistent evaluation across varying follow-up durations, while the specific factors influencing their safety and effectiveness remain undetermined. This study aims to evaluate the quality of evidence regarding the safety, efficacy, and impact factors of applying the resorbable bio-inductive collagen implant clinically to repair rotator cuff injuries.
Methods: The study protocol was registered on PROSPERO (CRD42022367522). A systematic literature search of PubMed, Web of Science, Embase, and Cochrane Library (from inception to October 2024) for clinical studies on bio-inductive collagen implants for rotator cuff repair. Two investigators independently screened studies, extracted data, and assessed quality (using RoB1 for RCTs, NOS for cohort studies and JBI critical appraisal tools for case series). Primary outcomes included postoperative tendon thickness, shoulder function scores (ASES/Constant), and re-tear rates. Data were analyzed using random/fixed-effects models to calculate mean differences (MDs) with 95% CIs, with subgroup analyses for tear type, patient age, and postoperative mobilization time. Statistical analyses were performed using Stata 17.0.
Results: Seventeen studies were included. The meta-analysis results showed that postoperative tendon thickness of the patients increased statistically compared with the baseline, at 3 months (MD = 2.22; 95% CI: 1.61, 2.83; p < 0.001), 6 months (MD = 2.30; 95% CI: 1.44, 3.16; p < 0.001), 12 months (MD = 2.15; 95% CI: 1.58, 2.72; p < 0.001), and 24 months (MD = 1.05; 95% CI: 0.02, 2.08; p = 0.045). Postoperative shoulder joint function improved significantly. The ASES score and Constant score of the patients were significantly higher than the baseline at 6 months (ASES: MD = 35.90; 95% CI: 32.97, 38.83; p < 0.001), 12 months (ASES: MD = 40.83; 95% CI: 37.56, 44.10; p < 0.001; Constant: MD = 28.59; 95% CI: 21.44, 35.74; p < 0.001), and 24 months (ASES: MD = 39.80; 95% CI: 31.32, 48.27; p < 0.001; Constant: MD = 32.84; 95% CI: 28.72, 36.97; p < 0.001).
Conclusion: The bio-inductive collagen implant is effective and safe for healing rotator cuff injuries. Patient age may be an important moderator affecting its efficacy. The impact of tear size and postoperative activities on efficacy needs to be further explored through in-depth clinical studies.
Background: Two-dimensional (2D) radiographic methods are suggested for evaluating radiographic outcomes following indirect decompression via extreme lateral interbody fusion (XLIF). Nonetheless, assessing neural decompression in a single imaging plane could potentially lead to an underestimation of the effects on central canal and foraminal volumes.
Objective: This study aims to evaluate the radiographic changes associated with XLIF procedures using three-dimensional (3D) volumetric measurements and to investigate the effect of indirect decompression achieved through this procedure.
Methods: The retrospective clinical and radiological data of 44 patients between June 2019 and June 2022 who underwent single- or multilevel XLIF were analyzed. Preoperative and postoperative computed tomography (CT) scans facilitated 3D reconstructions. The effect of indirect decompression, manifesting as the elevation of the cranial vertebra, was quantified by measuring the volumetric change in the spinal canal, calculated through the subtraction of the spinal canal's geometry from a cylinder predefined both preoperatively and postoperatively. The relationship between these volumetric changes and clinical outcomes was then determined. Correlations between changes in volumetric measurements and clinical outcomes were assessed using Pearson's or Spearman's correlation coefficients, depending on the data distribution.
Results: Change in the spinal canal volume (ΔV) due to the XLIF proved to be significant (mean ΔV = 1629.28 ± 775.43 mm3, n = 44, p < 0.05). A significant, positive correlation was found between ΔV significant association between pain intensity (low back and leg pain) and the magnitude of the volumetric increase of the spinal canal was shown (p < 0.05 for LP and ODI, p = 0.06 for LBP).
Conclusion: The developed method demonstrates accuracy, reproducibility, and applicability for analyzing XLIF, with significant potential for application in other spinal surgical methods. The volumetric changes exhibit predictive capability regarding the extent of indirect spinal canal decompression. A larger ΔV correlates with greater clinical benefits observed in XLIF surgery.
Objective: Aseptic hip revision arthroplasty often results in significant postoperative pain, inflammation, nausea, and vomiting. While perioperative dexamethasone has demonstrated benefits in primary hip arthroplasty, its efficacy and safety in revision procedures remain unclear. This study aims to evaluate the effects of perioperative dexamethasone on postoperative pain, inflammation, postoperative nausea and vomiting (PONV), and safety in aseptic hip revision.
Methods: A retrospective cohort study was conducted on 414 patients undergoing aseptic hip revision arthroplasty between 2008 and 2023. Patients were categorized into two groups: those receiving dexamethasone perioperatively (n = 218) and a control group (n = 196). Outcomes included Visual Analog Scale (VAS) pain scores, inflammation markers including C-reactive protein (CRP) and interleukin-6 (IL-6), PONV incidence, analgesic and antiemetic usage, length of stay (LOS), and postoperative complications. Independent samples t-test or Mann–Whitney U test is applied to continuous variables based on normality, while chi-square test or Fisher's exact test is used for categorical variables according to sample size.
Results: The dexamethasone group (average dose: 12.67 mg) exhibited significantly lower VAS scores (p < 0.001) and reduced morphine use on postoperative days (PODs) 1–3. CRP (POD2: 40.60 mg/L vs. 111.66 mg/L) and IL-6 levels (POD1: 31.85 pg/mL vs. 138.28 pg/mL) were significantly lower in the dexamethasone group (both p < 0.001). PONV incidence (28.4% vs. 40.81%) and antiemetic usage were reduced in the dexamethasone group. No significant differences were observed in LOS or postoperative complications between the two groups.
Conclusion: Perioperative low-dose dexamethasone effectively mitigates pain, inflammation, and PONV in aseptic hip revision arthroplasty without increasing the risk of complications.
Objectives: Numerous studies have reported the manifestations and influencing factors of poor matching of intervertebral fusion devices (IFDs) in patients with cervical and lumbar degenerative diseases. However, there is currently no research addressing the use of IFDs matching in posterior vertebral column resection (PVCR) procedures. The purpose of this retrospective radiographic study was to analyze the risk factors associated with poor matching of IFDs following PVCR.
Methods: Data from 92 patients using IFDs following PVCR between June 2006 and July 2024 were reviewed. IFDs implantation failure, adjacent vertebral fractures, subsidence greater than 5 mm, angle formation exceeding 10°, and malposition (defined as one-third of the IFDs exceeding the outer edge of the matching interface) were used as screening indicators to divide patients into poor matching and matching groups. Potential risk factors of poor matching were assessed through univariate and multivariate logistic regression analysis. The multiple regression model was evaluated by the area under the receiver operating characteristic curve (AUC).
Results: Among the 92 patients, 37 (40.2%) experienced poor matching. Univariate logistic regression analysis revealed that the preoperative and postoperative sagittal Cobb angles, the angle between osteotomy surfaces, total instrumented vertebrae, the number of vertebrae resected, the height of IFDs, and the use of titanium mesh or artificial vertebral bodies were potential risk factors for poor matching. Backward stepwise multivariate logistic regression analysis indicated that the preoperative sagittal Cobb angle (OR = 1.053, p = 0.001), the angle between osteotomy surfaces (OR = 1.152, p = 0.003), and the height of IFDs (OR = 1.058, p = 0.033) were independent risk factors for poor matching. The overall predictive performance of this multiple regression model (AUC = 0.872) for poor matching was deemed satisfactory.
Conclusion: The use of IFDs in PVCR was associated with a high rate of immediate poor matching. The preoperative sagittal Cobb angle, the angle between osteotomy surfaces, and the height of IFDs are independent risk factors for poor matching.
Objective: Operation for thoracic spinal stenosis (TSS) is considered a high-risk surgery. Because of the frailty of elderly patients, the prediction for postoperative complications is crucial. This study investigated the relationship between frailty, as measured by the modified frailty index-11 (mFI-11), and postoperative complications in elderly patients with thoracic myelopathy secondary to TSS.
Methods: A retrospective review was conducted of 391 patients aged 65 years or older, with 209 males and 182 females, who underwent surgery for TSS at Peking University Third Hospital from 2012 to 2023. Patients were stratified into subgroups based on mFI-11 score. Data on perioperative complications, including systemic and local events, were collected. Univariate and multivariate analyses were performed to determine the association between frailty and perioperative complications and to identify independent risk factors.
Results: A total of 391 elderly patients undergoing decompression and fusion for TSS were included and categorized by mFI-11 score: 0 (n = 73), 0.09 (n = 159), 0.18 (n = 98), and ≥ 0.27 (n = 61). Multivariate analysis identified the mFI-11 as an independent risk factor for surgical site infection (SSI) (OR = 7.250, p = 0.022), gastrointestinal complications (OR = 2.461, p = 0.029), urologic complications (OR = 4.855, p = 0.001), respiratory complications (OR = 13.968, p = 0.033), postoperative fever (OR = 2.256, p < 0.001), and postoperative transfusion (OR = 1.962, p = 0.014). Moreover, mFI ≥ 0.27 is a threshold for severe complications (OR = 15.886, p = 0.017), and mFI ≥ 0.18 is a threshold for any postoperative complications (OR = 6.338, p < 0.001) and minor complications (OR = 5.915, p < 0.001).
Conclusions: The mFI-11 score is an effective predictor of the risk of surgical site infection, gastrointestinal complications, urologic complications, respiratory complications, postoperative fever, and postoperative transfusion in elderly patients undergoing TSS surgery. Patients with mFI scores ≥ 0.18 are at a significantly higher risk of any postoperative complications or minor complications, with mFI scores ≥ 0.27 indicating severe complications. Frailty, as assessed by mFI-11, and non-neurological complications did not significantly impact the long-term recovery rate.
Objective: A higher risk of dislocation was still found in patients with spinopelvic disorders, despite the acetabular cup was placed within the classical “Lewinnek safe zone.” This study aimed to reveal the risk factors of acetabular cup placement during total hip arthroplasty (THA) in patients with spinopelvic pathology, construct and validate a novel “Personalized Safe Zone” based on the Hip-Spine Classification System (HSCS) to reduce the prosthetic impingement and dislocation in these patients.
Methods: One retrospective study was conducted on patients with spinopelvic pathologies underwent the primary THA admitted to the First Affiliated Hospital of Kunming Medical University from January 2017 and May 2023. According to the inclusion and exclusion criteria, the general information (Age, gender, Primary disease, Side, BMI) and radiological parameters of patients were collected, including spinal parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], lumbar lordosis angle [LL], sagittal vertical axis, thoracic kyphosis angle, cobb angle), pelvic parameters (cup inclination [CI], cup anteversion [CA], disparity in bilateral femoral offset), and spinopelvic parameters (absolute value of PI minus LL [|PI-LL|], change of sacral slope [ΔSS], combined sagittal index [CSI]). The correlation between the above parameters and prosthesis dislocation after THA was assessed and a clinical prediction model was constructed by R language. Subsequently, the ranges of “Personalized Safe Zone” for the acetabular cup placement in the four subgroups classified by the HSCS, were defined as the mean ± standard deviation of CA and CI in each nondislocation subgroup, and were validated by a cohort study.
Results: There were correlations between ΔSS, |PI-LL|, CA, standing CSI and anterior dislocation, ΔSS, |PI-LL|, CA, sitting CSI and posterior dislocation. The ranges of “Personalized Safe Zone” in each subgroup were as follows: 1A (CA = 14.11° ± 4.57°, CI = 38.65° ± 6.32°), 1B (CA = 17.23° ± 3.15°, CI = 38.19° ± 5.45°), 2A (CA = 15.76° ± 4.08°, CI = 38.95° ± 6.21°), 2B (CA = 19.50° ± 3.73°, CI = 39.50° ± 6.48°). Moreover, a significant reduction in prosthesis dislocation and impingement was investigated, when the acetabular cup was placed according to the “Personalized Safe Zone.”
Conclusions: These parameters, including ΔSS, |PI-LL|, CA, CSI should be fully considered when placing acetabular cup during THA and the novel “Personalized Safe Zone” could reduce the dislocation and prosthetic impingement after THA in patients with spinopelvic pathology.
Objective: The synovial chondromatosis is an exceptionally rare benign condition, predominantly found in the knee joint, and can result in pain, restricted mobility, and potential irreversible damage to the joint and cartilage. Despite the utilization of arthroscopic techniques in the surgical management of synovial chondromatosis, there remains a paucity of long-term assessment regarding its efficacy. The main objectives of this study include: (i) investigating the long-term efficacy of arthroscopic surgery in patients with knee synovial chondromatosis;(ii) identifying factors influencing functional improvement in patients post-surgery function.
Methods: We conducted a retrospective analysis of all patients with synovial chondromatosis of the knee who underwent arthroscopic synovectomy and loose body removal at our institution between June 2009 and January 2020. The follow-up period for all cases exceeded 5 years. Data collection included demographic details, clinical efficacy indicators(VAS, KOOS, WOMAC, etc.), imaging findings, and subjective satisfaction of patients with surgical outcomes. Data analysis selected t-tests, ANOVA, non-parametric tests, and correlation methods based on normality test results.
Results: We enrolled a total of 13 patients, including 4 men and 9 women, with a mean follow-up of 113.15 ± 30.45 months (range 61–145). There were no postoperative complications, recurrence, or malignant transformation in all patients, and the VAS scores, KOOS scores, WOMAC scores, and Lysholm scores of all patients were significantly improved at 3 months, 6 months, 1 year, 5 years, and the last follow-up (p < 0.05). However, one patient experienced osteoarthritis progression, necessitating arthroplasty.
Conclusion: This retrospective study demonstrated that arthroscopic treatment for knee synovial chondromatosis is effective and safe. It leads to immediate post-intervention improvement in symptoms and function, with sustained long-term benefits.
Objectives: Scaphoid fractures are the most common carpal fractures with a relatively high incidence of nonunion and avascular necrosis. Previous autopsy studies have shown that proximal ischemia after a fracture is related to the fracture site and retrograde blood supply within the scaphoid, but actual changes in blood flow after fractures have not been thoroughly studied. The purpose of this study was to analyze the influencing factors of blood supply after scaphoid fractures.
Methods: This was a prospective study. Between 2022 and 2023, contrast-enhanced magnetic resonance angiography and gadolinium-enhanced magnetic resonance imaging were performed in 32 patients (28 males and 4 females) with scaphoid fractures. The average age was 35 years (ranges: 15–74 years). We observed the accumulation and filling time of contrast media, and measured the diameters of extraosseous arteries as well as the signal intensity of intraosseous perfusion. The Mann–Whitney U-test, student's t-test, and Friedman test were used, respectively.
Results: 31 of 32 patients showed contrast media accumulation in the wrist joints on the affected sides. The filling time of contrast media on the affected sides was 5.6 (6.05–1) s quicker than on the healthy sides. The diameters of the radial arteries on the affected side increased by 12.8% (SD, 18.4%) compared to those on the healthy side (p = 0.002). All the patients had visible scaphoid nutrient arteries originating from the radial arteries on the affected side. The number of visible arteries on the healthy side was lower. Blood supply to the scaphoid was not related to the patient's sex, injury side, or fracture site. The increase in blood supply at the proximal fragment in older patients was less than that in young individuals (p = 0.015). Blood supply to the proximal and distal fragments of the scaphoid increased after fracture (p < 0.05). Within 1 month after the fracture, the increase in blood supply at the proximal fragment was less than that at the distal fragment, and it increased significantly after 1 month (p = 0.014). However, long-term nonunion (more than 4 years) leads to a decrease in proximal blood supply.
Conclusions: The unique blood supply pattern of the scaphoid and fracture sites might not be the cause of ischemia after a fracture. This could be due to prolonged nonhealing, which leads to proximal ischemia.
Objective: Hinge fracture is a known complication of lateral open wedge distal femoral osteotomy (LOWDFO). However, few studies have differentiated between intraoperative hinge fractures (IHF) and postoperative hinge fractures (PHF). This study aims to investigate the causes of these two types of fractures to help reduce complication rates and improve surgical outcomes.
Methods: We retrospectively analyzed data from 100 patients with genu valgum deformity and lateral unicompartmental osteoarthritis who underwent distal femoral osteotomy at our hospital between January 1st, 2022, and January 1st, 2024, in our hospital. Clinical parameters, radiological data, and the associated factors influencing IHF and PHF were analyzed. Radiological data such as mechanical axis deviation (MAD) and mechanical lateral distal femur angle (mLDFA) were collected. Clinical outcomes such as osteoarthritis index and time of healing were evaluated. Based on fracture morphology, IHF and PHF were further classified into Type 1 (extension), Type 2 (distal) and Type 3 (proximal) for detailed analysis. Statistical analyses included t-tests, Chi-square tests, and regression models to identify factors associated with IHF and PHF.
Results: A total of 87 patients were included in this study. The mean healing time of patients with all kinds of hinge fractures (3.4 ± 1.2 months) was longer than that of patients with no hinge fractures (2.8 ± 0.7 months), which was significant, p = 0.013. The MAD correction, mLDFA correction, and mLDFA correction ratio were related to hinge fractures (p = 0.010, 0.002, and 0.002 respectively). The body weight was higher in all types of hinge fractures group (IHF and PHF together) than the no hinge fractures group. The IHF group had a longer time of healing than the no IHF group. In the IHF group, the mLDFA correction (p = 0.005), mLDFA correction ratio (p = 0.005), and BMI (p = 0.031) were higher than the no IHF group. The PHF was related to hinge position. The group of hinge localized proximal to the adductor tubercle (AT) had a higher rate of PHF than the group of hinge localized in the adductor tubercle (p = 0.001). The healing time in the IHF group (3.9 ± 1.4 months) was significantly longer than the healing time in the PHF group (2.7 ± 0.4 months) (p = 0.002).
Conclusion: In patients with genu valgum undergoing LOWDFO, IHF and PHF represent distinct clinical entities. IHF is associated with greater mLDFA correction, higher mLDFA correction ratios, and increased body weight. In contrast, PHF is primarily associated with hinge position, with a higher incidence observed when the hinge is located proximal to the adductor tubercle. Among the two, IHF has a more pronounced impact on delayed bone healing.
Level of Evidence: Retrospective study Level IV.
Objective: The first step of interlaminar endoscopic lumbar discectomy (IELD) is puncture localization, which lacks standardized protocols and requires a significant learning curve. To address this, we developed a modified corner approach targeting the junction of the S1 superior endplate and facet joint. This study aims to characterize the radiographic anatomy and assess the clinical utility of this modified approach.
Method: Computed tomography (CT) and magnetic resonance imaging (MRI) data from 100 patients were analyzed to measure distances between the target and adjacent structures (dura sac, pedicle, L5 nerve, and S1 nerve). The learning curve of interlaminar endoscopic lumbar discectomy (IELD) surgery based on the modified corner approach was determined by prospectively collecting data from 80 patients.
Results: The mean distance between the target and the dura sac was 4.59 ± 1.74 mm. The mean distance between the target and the inferior border of the L5 nerve was 10.14 ± 1.72 mm, rang from 7.52 to 13.54 mm. The mean distance between the target and the outer edge of the S1 nerve was 0.51 ± 0.91 mm, rang from −0.12 to 2 mm. The mean distance between the target and the inner edge of the S1 pedicle was 3.77 ± 1.04 mm. The distance between the target and the dura sac and the inner edge of the pedicle is mainly affected by the patient's age.
Conclusion: The modified corner approach is a simple, safe, and repeatable surgical approach with the intersection of the superior endplate and facet joint as the puncture target. For patients without or with mild facet joint degeneration, the puncture target can be appropriately moved inward by 2 mm.
Objectives: Congenital dislocation of patella (CDP) is a rare condition and surgery is needed to treat CDP once a diagnosis is made. The 4in1 procedure includes lateral release, correction of quadriceps, Roux-Goldthwait procedure, and medial patello-femoral ligament (MPFL) reconstruction. This study was aimed at evaluating the efficacy and outcome of the 4in1 procedure in the operative treatment of CDP.
Methods: CDP patients were retrospectively collected from two operative centers from January 2013 to December 2024. For all patients, patellae on both sides were examined by x-ray, CT, and MR bilaterally. Ten patients (14 patellae) underwent 4in1 procedure. Gradual passive and active exercises of knee motion and quadriceps were begun as tolerated. Kujala Score was collected before and after the operation.
Results: This cohort included 10 patients (4 males, 6 females), with 4 cases of bilateral involvement and 6 unilateral cases (total 14 limbs). The mean age at surgery was 8.36 years (4–14 years), with an average surgical duration of 157.7 min and intraoperative blood loss of 35.6 mL. Kujala scores improved from 39.9 preoperatively to 82.9 postoperatively (p < 0.001). All patients were followed up for at least 1 year. All patellae were centerized on the groove postoperatively with no recurrence.
Conclusion: CDP is a rare lower limb skeletal disorder requiring thorough evaluation. Early diagnosis and 4in1 procedure optimize patellar stability and knee function, preventing long-term complications.
Objectives: Given the critical biomechanical role of the calcar femorale in load transmission and fracture stability, understanding its relationship with postoperative complications is essential for optimizing surgical outcomes. Therefore, this study aimed to explore the relationship between calcar femorale injury and postoperative complications of femoral neck fracture in young and middle-aged patients.
Methods: A retrospective analysis was conducted on 350 femoral neck fracture patients (aged 18–65 years) treated with closed reduction and three cannulated screws fixation at a single institution from 2015 to 2020. Evaluate the clinical and imaging information of patients such as sex, age, body mass index, Garden classification, calcar femorale injury situation, computed tomography Hounsfield units (CT HUs), comorbidities (e.g., diabetes, hypertension etc.) and complications (femoral neck shortening, nonunion, and femoral head necrosis). CT-based 3D reconstruction was used to analyze calcar femorale morphology. Statistical analyses included univariate and multivariate logistic regression to identify independent risk factors.
Results: A total of 284 patients were included for analysis according to the inclusion and exclusion criteria. The results showed that Garden classification with displaced type (p < 0.001, OR = 4.615, 95% CI: 2.479–8.593), calcar femorale injury (p = 0.026, OR = 1.990, 95% CI: 1.087–3.645) and lower CT HUs (p = 0.002, OR = 0.989, 95% CI: 0.982–0.996) were independent risk factors for femoral neck shortening. Whether the patient has diabetes (p = 0.005, OR = 10.069, 95% CI: 2.043–49.628) was an independent risk factor for femoral neck nonunion. BMI (p = 0.030, OR = 1.154, 95% CI: 1.014–1.313) and Garden classification with displaced type (p < 0.001, OR = 10.000, 95% CI: 2.950–33.903) were independent risk factors for femoral head necrosis.
Conclusion: This study found that older patients with displaced type femoral neck fractures with calcar femorale injury are more likely to experience femoral neck shortening. Clinicians should pay close attention to the above risk factors to reduce the incidence of postoperative complications in young and middle-aged patients with femoral neck fractures.
Purpose: Although subtalar arthroereisis (SA) with HyProCure is increasingly utilized for progressive collapsing foot deformity (PCFD), evidence regarding risk factors for complications remains limited. This study aimed to analyze the influencing factors and correlations of sinus tarsi pain and implant removal in PCFD patients after SA utilizing the HyProCure device.
Methods: A retrospective study was conducted involving 223 patients (236 ft) diagnosed with PCFD who underwent SA from June 2015 to June 2023. General data and surgical data such as patient gender, age, body mass index (BMI), surgical side, any adjunctive surgeries, length of stay, HyProCure size, and HyProCure depth were collected. Complications were also recorded. Statistical analysis included normality assessment, inter-group comparisons (t-tests for normal quantitative data, Mann–Whitney U for non-normal data, and chi-square for categorical variables). Spearman correlation analyzed factors associated with sinus tarsi pain and implant removal. Binary logistic regression identified risk factors.
Results: From 2015 to 2023, a total of 60 cases with sinus tarsi pain, with an incidence rate of 25.42%. Spearman correlation analysis showed that sinus tarsi pain was positively correlated with BMI (r = 0.159, p = 0.014), length of stay (r = 0.165, p = 0.011), and HyProCure depth (r = 0.501, p < 0.01). HyProCure removal was positively correlated with HyProCure depth (r = 0.521, p < 0.01) and sinus tarsi pain (r = 0.700, p < 0.01). In the analysis of sinus tarsi pain, the primary risk factor in patients with PCFD was identified as length of stay (OR = 1.456, 95% CI 1.113–1.904) and HyProCure depth (OR = 2.156, 95% CI 1.690–2.750), both of which were statistically significant (p < 0.05). Among the cases of sinus tarsi pain, 36 patients underwent HyProCure removal, leading to an incidence rate of 15.25%. Regarding the removal of HyProCure, the primary risk factor identified was HyProCure depth (OR = 2.531, 95% CI 1.849–3.463), which was statistically significant (p < 0.05). In particular, no significant correlation was observed between HyProCure size and sinus tarsi pain or implant removal (p > 0.05).
Conclusion: In patients with PCFD, length of stay was correlated with the incidence of sinus tarsi pain. Additionally, HyProCure depth was linked to both the incidence of sinus tarsi pain and HyProCure removal. Our research suggests that the prognosis is better for PCFD patients with a shorter length of stay and a reduced HyProCure depth.
Level of Evidence: Level III, Retrospective Comparative Study.
Objective: For atlantoaxial joint disorders, traditional surgical approaches often presented challenges such as significant trauma and prolonged recovery. Therefore, it was crucial to explore safer and more effective surgical alternatives. The primary aim of this study was to investigate the anatomical safety and feasibility of artificial atlanto-odontoid joint (AAOJ) replacement via a transoral pharyngeal approach, through simulated surgical procedures and postoperative anatomical and radiological studies.
Methods: The novel AAOJ replacement surgery was simulated on 18 fresh adult cadaveric head and neck specimens, and relevant anatomical parameters were measured. Postoperatively, the specimens underwent X-ray and CT scans, and software was used to measure the relevant parameters of the fixation screws. The spatial relationships between the atlantoaxial components, fixation screws, and critical anatomical structures were also examined. The comparison of parameters between the left and right sides was conducted using paired-sample t-tests.
Results: The transoral pharyngeal approach provided adequate exposure, clear surgical visualization, and sufficient working space. Anatomical measurements showed that the width of the anterior arch bone window of the atlas was (13.8 ± 0.7) mm; the width of the vertebral body bone window of the axis was (11.0 ± 0.4) mm; the distance between the insertion points for the atlas screws was (28.2 ± 4.0) mm; the distance from the atlas insertion points to the lateral joint edge of the atlanto-axial joint was (5.2 ± 0.9) mm; the distance between the insertion points for the axis screws was (16.8 ± 1.6) mm; and the distance from the axis insertion points to the lateral joint edge of the atlanto-axial joint was (7.7 ± 0.9) mm. Radiological measurements showed that the screw trajectory length of the lateral mass screw in the atlas was (21.5 ± 2.8) mm, the outward insertion angle was (13.2 ± 2.5)°, and the caudal insertion angle was (3.5 ± 1.1)°; for the pedicle screw of the axis, the screw trajectory length was (29.8 ± 2.8) mm, the outward insertion angle was (20.7 ± 2.8)°, and the caudal insertion angle was (16.6 ± 2.7)°. The prosthesis was precisely fitted to the upper cervical spine, with adequate safety distances between the atlantoaxial components, fixation screws, and critical anatomical structures such as the foramen transversarium, vertebral artery groove, and spinal canal.
Conclusions: The transoral pharyngeal approach for novel AAOJ replacement is anatomically safe and feasible.
Objective: The posterior tibial slope (PTS) is essential in the assessment of ankle alignment. However, its standardized reference value has not been adequately investigated. This study aims to compare the PTS of the ankle joint on virtual radiographs and CT images and determine the effect of participants' demographic characteristics on the PTS.
Methods: A retrospective analysis was conducted in healthy populations who underwent CT scans of the ankle joint. A total of 106 participants (53 males and 53 females) were included in our study. The three-dimensional model of the ankle joint was reconstructed by CT images, and the standard coronal and sagittal planes were produced using the anatomical coordinate system. The PTS was measured on different CT sagittal planes and virtual radiographs. All measurements were performed using three reference axes, including the anterior cortex axis, the anatomical axis, and the posterior cortex axis of the tibial shaft. Subgroup and correlation analyses were performed to investigate the effect of participants' demographic characteristics (the age, height, gender, and BMI) on the PTS. Statistical comparisons between two groups were performed using independent t-tests, while variations across sagittal planes and reference axes were analyzed through one-way analysis of variance.
Results: The mean values of PTS varied from 76.7° to 83.4° on different sagittal planes of CT images, and there was an increasing trend for PTS from the medial to lateral CT images. The mean values of PTS on the virtual radiograph were 81.6°, 82.3°, and 80.8° for the anterior cortex, anatomical, and posterior cortex axes, respectively. Significant differences in PTS measurements were found between CT images and virtual radiographs (p < 0.05). However, no differences were found while using different reference axes on PTS measurements (p < 0.05). Subgroup analysis showed females had a greater PTS than males, indicating a gender-based difference in the anatomy of the PTS.
Conclusion: The PTS varied on CT images and radiographs, and the anterior cortex, anatomical, and posterior cortex axes do not significantly influence the PTS measurements. The observed gender-based differences highlight the need for individualized surgical planning and the development of sex-specific implants.
Objective: Creating a 3D lumbar model and planning a personalized puncture trajectory has an advantage in establishing the working channel for percutaneous endoscopic lumbar discectomy (PELD). However, existing 3D lumbar models, which seldom include lumbar nerves and dural sac reconstructions, primarily depend on CT images for preoperative trajectory planning. Therefore, our study aims to further investigate the relationship between different virtual working channels and the 3D lumbar model, which includes automated MR image segmentation of lumbar bone, nerves, and dural sac at the L4/L5 level.
Methods: Preoperative lumbar MR images of 50 patients with L4/L5 lumbar disc herniation were collected from a teaching hospital between March 2020 and July 2020. Automated MR image segmentation was initially used to create a 3D model of the lumbar spine, including the L4 vertebrae, L5 vertebrae, intervertebral disc, L4 nerves, dural sac, and skin. Thirty were then randomly chosen from the segmentation results to clarify the relationship between various virtual working channels and the lumbar 3D model. A bivariate Spearman's rank correlation analysis was used in this study.
Results: Preoperative MR images of 50 patients (34 males, mean age 45.6 ± 6 years) were used to train and validate the automated segmentation model, which had mean Dice scores of 0.906, 0.891, 0.896, 0.695, 0.892, and 0.892 for the L4 vertebrae, L5 vertebrae, intervertebral disc, L4 nerves, dural sac, and skin, respectively. With an increase in the coronal plane angle (CPA), there was a reduction in the intersection volume involving the L4 nerves and atypical structures. Conversely, the intersection volume encompassing the dural sac, L4 inferior articular process, and L5 superior articular process increased; the total intersection volume showed a fluctuating pattern: it initially decreased, followed by an increase, and then decreased once more. As the cross-section angle (CSA) increased, there was a rise in the intersection volume of both the L4 nerves and the dural sac; the intersection volume involving the L4 inferior articular process grew while that of the L5 superior articular process diminished; the overall intersection volume and the intersection volume of atypical structures initially decreased, followed by an increase.
Conclusion: In terms of regularity, the optimal angles for L4/L5 PELD are a CSA of 15° and a CPA of 15°–20°, minimizing harm to the vertebral bones, facet joint, spinal nerves, and dural sac. Additionally, our 3D preoperative planning method could enhance puncture trajectories for individual patients, potentially advancing surgical navigation, robots, and artificial intelligence in PELD procedures.
Objective: Unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression (UBE-ULBD) is a widely utilized minimally invasive surgical technique for treating lumbar spinal stenosis (LSS). This study aimed to evaluate the effectiveness of the enhanced recovery after surgery (ERAS) clinical pathway in improving perioperative and short-term clinical outcomes for patients undergoing UBE-ULBD for LSS.
Methods: A retrospective cohort study was conducted on the clinical data of patients who underwent UBE-ULBD surgery for LSS from May 2022 to April 2024. Since the implementation of the ERAS clinical pathway in our department in May 2023, all eligible patients were divided into the ERAS group (May 2023–April 2024) and the traditional group (May 2022–April 2023). The two groups were analyzed for Visual Analog Scale (VAS) scores for lower extremities at preoperative, 6, 24, and 48 h postoperatively and on the day of discharge. In addition, the Oswestry Disability Index (ODI) and walking distances were assessed preoperatively, at 3 months postoperatively, and at 6 months postoperatively. Other parameters evaluated included the time to first ambulation after surgery, total length of hospital stay (LOS), postoperative LOS, perioperative opioid consumption, postoperative rehydration volume, and the incidence of postoperative complications.
Result: Compared to the traditional group, patients in the ERAS group demonstrated significantly lower pain scores at 6 and 24 h postoperatively, earlier ambulation, shorter total LOS and postoperative LOS, reduced postoperative rehydration volume, and perioperative opioid application (p < 0.05). No statistically significant differences were observed between the two groups in terms of lower extremities VAS scores before surgery, at 48 h postoperatively, and on the day of discharge. No statistically significant differences were observed in ODI scores before surgery, at 3 months postoperatively, and at 6 months postoperatively, as well as walking distances (p > 0.05). Furthermore, the incidence of complications was comparable between the two groups (p > 0.05).
Conclusion: The UBE-ULBD surgery under the guidance of the ERAS program, through multidisciplinary collaboration and comprehensive measures, can significantly optimize perioperative management, improve postoperative recovery quality, and achieve satisfactory perioperative and short-term clinical outcomes.
Objective: Diabetic foot is a serious complication of diabetes, often leading to poor prognosis and increased risk of amputation. Transverse tibial bone transport (TTT) has emerged as a promising limb salvage technique. However, some patients still experience adverse postoperative outcomes. This study aimed to analyze the influencing factors for poor prognosis after TTT and explore the correlations and clinical significance of key risk factors.
Methods: A retrospective analysis was conducted on the clinical data of 120 diabetic foot patients treated with TTT at the Department of Hand and Foot Surgery, our hospital, from January 2016 to May 2024. The incidence and types of adverse outcomes were recorded. Independent sample t-tests were employed for comparing continuous variables between two groups. Univariate and multivariate logistic regression analyses were used to identify significant prognostic factors. Pearson or Spearman correlation analysis was applied depending on data distribution, and Receiver Operating Characteristic (ROC) curves were constructed to assess diagnostic performance.
Results: Among the patients, 95% retained their feet, 81.67% maintained functional feet, and 5% underwent amputation. Complications included osteotomy margin necrosis (8.33%), lower limb venous thrombosis (5.83%), and pin tract infection (2.5%). A total of 26 patients experienced adverse outcomes. Univariate analysis showed significant differences in foot temperature, VAS score, resting pain, transcutaneous oxygen pressure, blood glucose, calcium, and CRP levels (p < 0.05). Multivariate analysis identified foot temperature, transcutaneous oxygen pressure, blood glucose, and CRP as independent risk factors. Correlation analysis revealed that foot temperature was positively correlated with transcutaneous oxygen pressure and negatively correlated with blood glucose and CRP. Blood glucose was positively correlated with CRP. ROC analysis showed good diagnostic performance for foot temperature (AUC = 0.891), transcutaneous oxygen pressure (AUC = 0.954), blood glucose (AUC = 0.850), and CRP (AUC = 0.908), with a combined AUC of 0.998 (Sensitivity = 100.00%, Specificity = 96.81%).
Conclusion: This study suggests that foot temperature, transcutaneous oxygen pressure, blood glucose, and CRP are significant risk factors for poor postoperative prognosis in diabetic foot patients undergoing tibial transverse osteotomy. These factors are interrelated and have high diagnostic value for predicting adverse outcomes, especially when used in combination. Clinically, monitoring changes in these factors can help predict the occurrence of poor postoperative outcomes in diabetic foot patients, thereby supporting the development of personalized treatment plans.
Background: Osteoarthritis (OA) is the most prevalent joint disease in the elderly population, and primary computer-assisted navigation total knee arthroplasty (CA-TKA) remains a critical therapeutic intervention for OA. The presence of physiologic radiolucent lines (RLLs) beneath the tibial base plate following CA-TKA carries significant long-term clinical implications and is regarded as a potential indicator of prosthetic loosening. However, the specific risk factors for RLL development in CA-TKA, despite its theoretical precision advantages, remain poorly understood. This study aimed to characterize the clinical features of physiologic RLLs and identify associated risk factors.
Methods: A retrospective nested case-control study was conducted using a cohort of OA patients who underwent primary CA-TKA between January 2021 and September 2024. Physiologic RLLs were diagnosed according to the 1989 Knee Society Total Knee Arthroplasty Roentgenographic Evaluation and Scoring System. Patients with physiologic RLLs under the tibial base plate at follow-up were assigned to the RLLs group, while controls were matched 1:1 from the cohort based on follow-up time (±14 days). Covariates included age, gender, body mass index, smoking, alcohol consumption, hypertension, diabetes, surgical side, hospital stay duration, operative time, anesthesia type, continuous passive motion use, periprosthetic joint infection, total perioperative blood loss, preoperative/postoperative hip-knee-ankle angle (HKA), tibial cement mantle quality, cement penetration, and perioperative medial proximal tibial angle. Univariate and multivariate analyses were performed to identify risk factors.
Results: The cohort comprised 407 patients, of whom 113 developed physiologic RLLs under the tibial base plate. Univariate analysis identified age, preoperative HKA, tibial cement mantle defects, and cement penetration as statistically significant risk factors (all p < 0.05). Multivariate logistic regression analysis revealed that preoperative HKA (OR = 0.919, 95% CI = 0.876–0.963, p < 0.001), tibial cement mantle defects (OR = 2.638, 95% CI = 1.043–6.668, p = 0.040), and cement penetration (OR = 0.205, 95% CI = 0.126–0.332, p < 0.001) were independent risk factors for physiologic RLLs under the tibial base plate after primary CA-TKA in OA patients. Age was not an independent risk factor.
Conclusions: The overall incidence and clinical characteristics of physiologic RLLs under the tibial base plate after primary CA-TKA were comparable to those reported for conventional TKA techniques. This nested case-control study identified preoperative HKA, tibial cement mantle defects, and cement penetration as independent risk factors for physiologic RLLs, whereas age was not.
Objective: About 7%–34% of the femur fracture contributes to subtrochanteric fracture, and only very little research is available about these fractures when compared to common hip fractures. Hence, the aim of this study was to develop a clinically relevant and reproducible open fracture model in rabbits at the subtrochanteric region to understand the fracture healing mechanism at this site and to explore treatment effects of biophysical intervention in future studies.
Methods: An open osteotomy was created in 32 adult New Zealand white rabbits at the subtrochanteric region, followed by customized titanium internal fixations. The internal fixator consists of a 3D printed titanium compression plate with cortical screws for locking. The fracture healing was monitored for 6 weeks, and the corresponding radiography, MicroCT, and histomorphometry analysis were performed at regular intervals.
Results: Four rabbits were excluded due to complications (4/32), including bone dislocation one week post-surgery (3/32). Fracture healing progression was observed in radiographic images. MicroCT analysis showed increased callus volume after 42 days. Histomorphometry revealed remodeled bone area with a higher number of osteocyte cells.
Conclusion: The rabbit fracture model of an open femoral osteotomy at the subtrochanteric region has been successfully established, with the facilitation of an internal fixator consisting of a 3D printed titanium compression plate with cortical screws for locking. Applications of this model are being investigated, including different biophysical stimulation methods for accelerating fracture healing.
Objective: In thoracic posterior decompression surgery, the traditional pedicle-to-pedicle (PTP) approach may have limitations in achieving complete decompression and may also pose potential risks of injury to the spinal cord. Through comparative analysis with the PTP method, the study explored the safety of posterior thoracic decompression via the pedicle-ossification tunnel (POT), aiming to provide a more scientific and safer clinical surgical pathway selection.
Methods: Combined with preoperative image data and intraoperative operation images, the POT decompression method was deeply analyzed. In this study, the thoracic vertebrae of sheep were taken as experimental specimens. The water sac was placed close to the joint level of the articular process to simulate the spinal cord, and the experiment was carried out by the surgical methods of PTP and POT respectively with a high-speed bur. The laser displacement sensor (LDS) was used to monitor the vibration displacement of the water sac, and the collected vibration data was divided into 0.1 s/frame (500 vibration signal data points), which were used to calculate the curvature change of the vibration displacement curve. The Wilcoxon rank sum test was used for statistical analysis. Milling parameters for the high-speed bur were set to: milling depth 0.5 mm, milling speed 0.5 mm/s, milling angle 45°, and spherical bit size 4 mm.
Results: Combining the detailed preoperative image data and intraoperative images of key operations, the study first provides a detailed description of the surgical steps for safe posterior thoracic decompression via the POT. Then, based on Euler–Bernoulli beam theory, the vibration of the “spinal cord” under different surgery pathways (POT and PTP) in posterior thoracic decompression was further studied. The statistical analysis showed that the vibration amplitude and curvature value of the vibration curve of POT and PTP were significantly different (p < 0.05). As the milling position approached POT, the amplitude and curvature values also decreased gradually.
Conclusion: Through theoretical analysis and experimental verification, the safety and effectiveness of posterior thoracic decompression via POT was thoroughly investigated. The milling pathway via POT could not only achieve the surgical purpose of complete decompression, but also avoid the contact area between OLF and dura as much as possible, thus reducing the irritation to the spinal cord.
Objective: The objective of this study is to achieve distinct visualization of juxta-articular intraosseous microvessels, a novel nanoimaging methodology in which superparamagnetic iron oxide nanoparticles and meglumine diatrizoate (MD) are used cooperatively was implemented.
Methods: A newly created composite of MD and Fe3O4 nanoparticles (MD-Fe3O4 NPs) was prepared as a contrast agent to achieve efficacious imaging of the juxta-articular intraosseous vasculature-canal complex (JIVCC). Scanning electron microscopy (SEM) and energy dispersive spectrum (EDS) were employed to observe the structural characteristics and binding stability of the MD-Fe3O4 NPs. In 20 rabbits that received an injection of MD-Fe3O4 NPs, 1-mm-thick computed tomography (CT) scanning was performed for radiographic assessment. Hematoxylin–eosin- and potassium ferrocyanide-stained sections from 10 sacrificed rabbits were used to observe the histological characteristics of JIVCC with MD-Fe3O4 NPs, and the remaining 10 rabbits were utilized for a systemic safety evaluation. After a healthy volunteer received an MD-Fe3O4 NP injection, we also performed CT scanning and related safety evaluations.
Results: When the MD nanoparticles and amino-Fe3O4 nanoparticles were mixed together, they aggregated into a stable compound structure according to microscopic observations and SEM–EDS verification. In 20 rabbits receiving MD-Fe3O4 injections, 1-mm slice CT imaging demonstrated significantly enhanced visualization of the JIVCCs in magnet-placed knees compared to contralateral limbs (tibial JIVCC: p < 0.001; femoral JIVCC: p < 0.001), confirming MD-Fe3O4 NPs as the efficacious magnetic contrast enhancer. The histological characteristics of MD-Fe3O4 NPs in JIVCC were revealed. The levels of serum iron before and 4 and 72 h after MD-Fe3O4 NP injection were 23.9 ± 2.13 μmol/L, 26.2 ± 2.30 μmol/L, and 24.9 ± 2.33 μmol/L, respectively, indicating that there was no significant difference in safety (p = 0.092). After a volunteer received MD-Fe3O4 NPs via intravenous administration, the JIVCC was clearly visualized, laboratory tests of serum iron levels were normal, and no injection-related complications occurred.
Conclusions: A novel compound nanoparticle, which achieved satisfactory overall outcomes, was implemented as an appropriate alternative for the discernible visualization of juxta-articular intraosseous microvessels. The nanotechnology utilized in this study may augment the clinical imaging methodology for the osseous vascular system.
Objective: This study aims to propose and evaluate the clinical efficacy of a novel non-coaxial endoscopic-assisted technique for establishing the “Shelter Space” in Anterior Controllable Antedisplacement and Fusion (ACAF) for treating high-level (C2-involved) cervical ossification of the posterior longitudinal ligament (COPLL).
Methods: Sixteen patients diagnosed with high-level OPLL (involving C2) who underwent AUSS (Arthroscopic-Assisted Uni-Portal Spinal Surgery) assisted ACAF treatment were enrolled, and their outcomes were analyzed. The OPLL below C2 was managed via ACAF, including discectomy at involved levels, appropriately removing the anterior part of the affected vertebrae below C2, placement of intervertebral cages, fixation with anterior cervical plates, and isolation of the vertebrae–OPLL complex (VOC). For C2-level OPLL, after achieving hemostasis, the posteroinferior portion of the C2 vertebral body was ground under non-coaxial endoscopic assistance based on the thickness of C2-OPLL to create a “shelter” facilitating anterior displacement of the ossified mass posterior to C2. Finally, the C2 OPLL and the VOC from lower segments were elevated. Preoperative and postoperative clinical and radiological parameters, along with surgical complications, were documented.
Results: Postoperative CT and MRI confirmed adequate spinal cord decompression using the AUSS assisted ACAF technique. Significant improvements were observed in the Reserve Space for the Cord at the Edge (RSCE) and the occupying rate (OR) of the spinal canal. No specific complications were observed postoperatively. At the final follow-up of 12 months, all patients exhibited marked neurological recovery.
Conclusion: The AUSS assisted ACAF technique effectively circumvents the technical challenges and complications associated with traditional open Shelter techniques, enhancing surgical precision and feasibility. This method is a viable, user-friendly, and effective approach for managing high-level COPLL with myelopathy. However, large-scale studies with control groups are warranted to further validate the universality and safety of this technique.