Innovations and New Technology in Spine Surgery

Editors

G. Bryan Cornwall

University of San Diego

William Robert Walsh

University of New South Wales

Ralph Jasper Mobbs

University of New South Wales

Impact

The patients undergoing surgical treatment in the prone position. The patients in the traditional position with a horseshoe headrest (A,C) and in the BSPST position with a cervical tong for skull traction and body-shape plaster bed for fixation (B,D) as seen from a vertical and horizontal angle. The BSPST position can provide enough space for managing the anesthesia tube and reliable intraoperative steadiness with the usage of body-shape plaster bed and skull traction.

Original Research

10 March 2022

An Innovative Prone Position Using a Body-Shape Plaster Bed and Skull Traction for Posterior Cervical Spine Fracture Surgeries

Zhiyu Ding

, 5 more and

Jinsong Li

3,936 views

1 citations

Deductive SPM for open spinal surgery at the step level (μ = 4), showing the 5 main surgical steps identified for open spinal surgery: (I) superficial incision, (II) deep incision, (III) implantation of pedicle screws, (IV) rod insertion, and (V) wound closure. Additional pathology-specific steps are depicted in orange and are usually located between steps (IV) and (V).

Original Research

25 January 2022

Surgical Process Modeling for Open Spinal Surgeries

Fabio Carrillo

, 8 more and

Philipp Fürnstahl

3,322 views

2 citations

Pre- and postop imaging of a 42 years old male patient who underwent total en-block sacrectomy and received a Closed-Loop spino-pelvic reconstruction. (A,B) Preop T2, MRI images of a large sacral chordoma [(A) sagittal, (B) axial plane]. The extended tumor mass affected the whole sacrum with significant soft tissue extension to the retroperitoneum and cranially involving the paravertebral muscles. (C,D) Standing X-ray images of the patient at 6-month FU [(C) sagittal, (D) coronal plane]. (E,F) CT scan at 24-month FU period. Signs of bony fusion are visible between the L4 and L5 vertebrae and the iliac bone [(E) posterior view of the 3D rendered CT images; (F) coronal view at the fusion site].

Methods

05 January 2022

A Novel Three-Dimensional Computational Method to Assess Rod Contour Deformation and to Map Bony Fusion in a Lumbopelvic Reconstruction After En-Bloc Sacrectomy

Peter Endre Eltes

, 7 more and

Aron Lazary

3,365 views

2 citations

The diagram of C2 spinous muscle complex graft. (A) the anatomy of C2, C3 and vertebral artery, (B) Cut down the posterior 3/4 of C2 spinous, (C) scratch the cortical of C2 and C3 for bone graft, (D) displace the C2 spinous muscle complex graft into C2-3 posterior arch.

Original Research

26 November 2021

Comparison of C2-3 Pedicle Screw Fixation With C2 Spinous Muscle Complex and Iliac Bone Graft for Instable Hangman Fracture

Dingli Xu

, 3 more and

Weihu Ma

2,893 views

1 citations

A 66 year old female complained of low back pain for 3 months underwent posterior lumbar decompression and instrumented interbody fusion at L4/5. (A) Pre-operative lumbar MRI showed that the nerve roots were redundant above the L4/5 intervertebral disc. (B) Post-operative lumbar MRI obtained 3 days after surgery demonstrated significant relief of RNRs. (C,D) Lumbar radiographs obtained 3 months after surgery demonstrate internal fixation in good position without cage subsidence or migration.

Original Research

01 November 2021

Clinical Features and Efficacy Analysis of Redundant Nerve Roots

Jianzhong Xu

and

Yong Hu

5,132 views

5 citations

A nomogram based on independent risk factors for predicting transfusion risk.

Original Research

30 August 2021

Establishment and Verification of a Perioperative Blood Transfusion Model After Posterior Lumbar Interbody Fusion: A Retrospective Study Based on Data From a Local Hospital

Bo Liu

, 2 more and

Zhijie Wang

2,256 views

9 citations

Review

23 February 2021

Robotics in Spine Surgery: A Technical Overview and Review of Key Concepts

S. Harrison Farber

, 5 more and

Juan S. Uribe

The use of robotic systems to aid in surgical procedures has greatly increased over the past decade. Fields such as general surgery, urology, and gynecology have widely adopted robotic surgery as part of everyday practice. The use of robotic systems in the field of spine surgery has recently begun to be explored. Surgical procedures involving the spine often require fixation via pedicle screw placement, which is a task that may be augmented by the use of robotic technology. There is little margin for error with pedicle screw placement, because screw malposition may lead to serious complications, such as neurologic or vascular injury. Robotic systems must provide a degree of accuracy comparable to that of already-established methods of screw placement, including free-hand, fluoroscopically assisted, and computed tomography–assisted screw placement. In the past several years, reports have cataloged early results that show the robotic systems are associated with equivalent accuracy and decreased radiation exposure compared with other methods of screw placement. However, the literature is still lacking with regard to long-term outcomes with these systems. This report provides a technical overview of robotics in spine surgery based on experience at a single institution using the ExcelsiusGPS (Globus Medical; Audobon, PA, USA) robotic system for pedicle screw fixation. The current state of the field with regard to salient issues in robotics and future directions for robotics in spinal surgery are also discussed.

27,590 views

36 citations

A representative case. (A) Place the working channel; (B) Lateral X-ray fluoroscopy confirms that the channel is facing the intervertebral space; (C) Positive X-ray fluoroscopy confirms that the channel is located inside the facet joint; (D) Clean up the soft tissue on the surface of the lamina, confirm the lamina space and upper and lower lamina; E. Remove the lamina and expose the ligamentum flavum; (F) Decompression of the nerve root on the same side, ranging from the initial segment of the nerve root, down to the inner edge of the pedicle, explore the Ipsilateral nerve root canal to achieve at least 270° decompression of the nerve root canal; (G) Decompression of the contralateral nerve root; (H) After the decompression, the dural sac and bilateral nerve roots are visible.

Original Research

18 June 2021

Therapeutic Effect of Large Channel Endoscopic Decompression in Lumbar Spinal Stenosis

Fei-Long Wei

, 10 more and

Cheng-Pei Zhou

2,705 views

7 citations

Methods

25 January 2021

Development of a Computer-Aided Design and Finite Element Analysis Combined Method for Affordable Spine Surgical Navigation With 3D-Printed Customized Template

Peter Endre Eltes

, 6 more and

Aron Lazary

7,060 views

25 citations

Unique properties of discogenic cells. (A) The morphology of the cells change from the beginning to the end of the process, where the Discogenic Cell phenotype is attained (Scale bar is 200 μM; one representative set of images shown from n = 10). (B) Flow cytometry of Discogenic Cells shows a lack of co-stimulatory markers CD40, CD80, and CD86, which if expressed could induce T-cell activation and rejection. Ten Discogenic Cell samples tested; one representative dataset shown. Control cells show positive expression of the markers, validating the method. The quantitative result for the percentage of stained cells positive for each marker is shown in bold next to the histograms. (C) Measurement of proliferation of CD3/CD28 stimulated T-Cells from two different donors, with or without Discogenic Cell co-culture. Proliferation was measured by BrdU assay. Overall this indicates the ability of IDCT to inhibit T-cell proliferation thus indicating it has potential immunomodulatory capabilities (n = 5 technical replicates, *p < 0.05 by Student's T-Test).

Perspective

16 December 2020

Perspectives on the Treatment of Lumbar Disc Degeneration: The Value Proposition for a Cell-Based Therapy, Immunomodulatory Properties of Discogenic Cells and the Associated Clinical Evaluation Strategy

Lara Ionescu Silverman

, 6 more and

Kevin T. Foley

5,039 views

9 citations

(A) EIT cervical cage. (B) Retrieved cervical cage specimen. The red line indicates the intersection line from which the histological sections were cut.

Original Research

26 November 2020

Complete Osseointegration of a Retrieved 3-D Printed Porous Titanium Cervical Cage

Wimar van den Brink

and

Nancy Lamerigts

4,969 views

9 citations

Intellectual Property assessment over time with number of US and EP patents issued for the period (1970–2019).

Mini Review

24 November 2020

Innovation and New Technologies in Spine Surgery, Circa 2020: A Fifty-Year Review

G. Bryan Cornwall

, 3 more and

Alexander Vaccaro

6,746 views

8 citations

Use of the starBox system along the patient care continuum.

Original Research

23 October 2020

Innovative Technology System to Prevent Wrong Site Surgery and Capture Near Misses: A Multi-Center Review of 487 Cases

David M. Gloystein

, 3 more and

Deborah Spratt

9,935 views

5 citations

Mini Review

23 October 2020

mHealth Apps for Enhanced Management of Spinal Surgery Patients: A Review

Michael Y. Bai

, 2 more and

Callum Betteridge

3,569 views

15 citations

Review

21 August 2020

The Role of Machine Learning in Spine Surgery: The Future Is Now

Michael Chang

, 3 more and

Alexander R. Vaccaro

The recent influx of machine learning centered investigations in the spine surgery literature has led to increased enthusiasm as to the prospect of using artificial intelligence to create clinical decision support tools, optimize postoperative outcomes, and improve technologies used in the operating room. However, the methodology underlying machine learning in spine research is often overlooked as the subject matter is quite novel and may be foreign to practicing spine surgeons. Improper application of machine learning is a significant bioethics challenge, given the potential consequences of over- or underestimating the results of such studies for clinical decision-making processes. Proper peer review of these publications requires a baseline familiarity of the language associated with machine learning, and how it differs from classical statistical analyses. This narrative review first introduces the overall field of machine learning and its role in artificial intelligence, and defines basic terminology. In addition, common modalities for applying machine learning, including classification and regression decision trees, support vector machines, and artificial neural networks are examined in the context of examples gathered from the spine literature. Lastly, the ethical challenges associated with adapting machine learning for research related to patient care, as well as future perspectives on the potential use of machine learning in spine surgery, are discussed specifically.

17,665 views

87 citations

Representative radiographs of each group at 4-weeks post-op (A–G), and a representative time 0 radiograph taken immediately post-implantation, which was similar for all groups (H).

Original Research

20 March 2020

In-vivo Performance of Seven Commercially Available Demineralized Bone Matrix Fiber and Putty Products in a Rat Posterolateral Fusion Model

Nicholas Russell

, 5 more and

Frank Vizesi

Introduction: Demineralized bone matrix (DBM) is a widely used bone graft in spinal fusion. Most commercial DBMs are composed of demineralized bone particles (~125–800 microns) suspended in a carrier that provides improved handling but dilutes the osteoinductive component. DBM fibers (DBF) provide improved osteoconductivity and do not require a carrier. It has been suggested that 100% DBF may offer improved performance over particulate-based DBMs with carrier.

Study Design: Seven commercially available DBM products were tested in an athymic rat posterolateral fusion model. There were four 100% DBFs, two DBFs containing a carrier, and one particulate-based DBM containing carrier.

Objective: The study objectives were to evaluate the in vivo performance: (1) compare fusion rate and fusion maturity of six commercially available DBFs and one particulate-based DBM, and (2) assess the effect of carrier on fusion outcomes for DBFs in a posterolateral fusion model.

Methods: The DBF/DBM products evaluated were: Strand^TM Family, Propel® DBM Fibers, Vesuvius® Demineralized Fibers, Optium® DBM Putty, Grafton® DBF, Grafton Flex, and DBX® Putty. Single-level posterolateral fusion was performed in 69 athymic rats. Fusion was assessed bilaterally after 4 weeks by manual palpation, radiograph and CT for bridging bone. Fusion mass maturity was assessed with a CT maturity grading scale and by histology. Statistical analysis was performed using Fishers Exact Test for categorical data and Kruskal-Wallis Test for non-parametric data.

Results: Strand Family achieved 100% fusion (18/18) by manual palpation, radiographic and CT evaluation, significantly higher than Propel Fibers, Vesuvius Fibers, Optium Putty, and DBX Putty, and not statistically higher than Grafton DBF and Grafton Flex. Strand Family provided the highest fusion maturity, with CT maturity grade of 2.3/3.0 and 89% mature fusion rate. Fusion results suggest a detrimental effect of carrier on fusion performance.

Conclusions: There were large variations in fusion performance for seven commercially available DBM products in an established preclinical fusion model. There were even significant differences between different 100% DBF products, suggesting that composition alone does not guarantee in vivo performance. In the absence of definitive clinical evidence, surgeons should carefully consider available data in valid animal models when selecting demineralized allograft options.

14,258 views

24 citations