lateral-plif-for-lumbar-spinal-arthrodesis-detailed-step-step

Lateral-PLIF for Lumbar Spinal Arthrodesis: A Detailed Step-By-Step Surgical Technique

Posterior lumbar interbody fusion (PLIF) is widely recognized as an effective surgical approach for treating degenerative lumbar spine conditions. To ...

Humanitas University

IRCCS Humanitas Research Hospital

Intramedullary spinal cord tumors (IMSCTs) are a rare subgroup of neoplasms, encompassing both benign, slow-growing masses, and malignant lesions; radical surgical excision represents the cornerstone of treatment for such pathologies regardless of histopathology, which, on the other hand, is a known predictor of survival and neurologic outcome postsurgery. The present study aims to investigate the relevance of other factors in predicting survival and long-term functional outcomes.

Predictive Factors of Long-Term Neurologic Outcome and Progression-Free Survival in Intramedullary Spinal Cord Tumors: A 10-year Single-Center Cohort Study and Review of the Literature.

: Postoperative cerebrospinal fluid (CSF) fistulas remain a significant concern in spinal neurosurgery, particularly following dural closure. The incidence of dural tears during spinal surgery is estimated between 1.6% and 10%. While direct suturing remains the gold standard, it has a failure rate of 5-10%. Various materials and techniques have been used to enhance dural closure. This study aims to assess the effectiveness of non-penetrating titanium clips (AnastoClip) for dural closure in intradural spinal lesion surgeries. : A prospective analysis was conducted on 272 patients who were operated on for intradural spinal lesions from August 2017 to December 2023. Dural closure was performed using non-penetrating titanium clips with sealant, and, in select cases, autologous grafts. Postoperative care included early mobilization and routine MRI to assess outcomes. A comparative analysis was performed with a cohort of 81 patients treated with traditional sutures. : Among the 272 patients, postoperative CSF leaks occurred in 32 cases (11.76%), requiring various management approaches. Thirteen cases required surgical revision, while others resolved with external lumbar drainage or fluid aspiration. Compared to the suture group, which had a fistula rate of 23.46%, the titanium clip group had a significantly lower fistula rate. Logistic regression analysis did not find statistically significant associations between fistula risk and clinical factors. : Non-penetrating titanium clips provide an effective alternative to sutures for dural closure, reducing CSF leak rates. They preserve dural integrity, reduce operative time, and avoid imaging artifacts, making them a viable advancement in spinal surgery with outcomes comparable to, or better than, traditional techniques.

Cerebrospinal Fluid Leak Prevention in Intradural Spine Surgery: A Long Series Analysis of Closure with Non-Penetrating Titanium Clips.

In Reply to the Letter to the Editor Regarding: "Predictive Factors of Long-Term Neurologic Outcome and Progression-Free Survival in Intramedullary Spinal Cord Tumors: A 10-Year Single-Center Cohort Study and Review of the Literature".

Posterior interbody fusion can be associated with adjacent-segment disease (ASD) some years after surgery. The aim of this study is to confirm the rate of ASD in isthmic spondylolisthesis treated by posterior fusion.

Long-Term Risk of Adjacent-Segment Disease in Isthmic Spondylolisthesis Treated with Posterior Interbody Fusion.

A large variety of spinal meningeal diseases have been described in the literature, and differential diagnosis is often complex, requiring a good knowledge of the different entities and accurate neuroimaging. The purpose of this article was to depict the most relevant diagnostic features on the commonly utilized MRI sequences for the main and most frequent pathologies of the spinal arachnoid and to correlate them with intraoperative findings.

Prediction of MRI in intra-operative findings for spinal meningeal diseases.

Hemangioblastomas (HBs) are benign, highly vascular tumors that can be found intracranially or in the spinal region, representing around 2-15% of primary intramedullary tumors. They can occur sporadically or in association with Von Hipple-Lindau (VHL) disease. Despite recent of advancement of nonsurgical treatments, complete surgical resection remains the gold standard of care for the spinal HBs.

Neurological Outcome of Spinal Hemangioblastomas: An International Observational Multicenter Study About 35 Surgical Cases.

Endoscopic spine surgery (ESS) has traditionally been employed for lumbar disc herniation (LDH). Recent innovations in surgical methods and technologies have expanded its range to address other spinal pathologies, providing minimally invasive solutions with potential clinical benefits. Our review aims to summarize the applications, clinical outcomes, and limitations of ESS beyond LDH, focusing on its role in complex spinal conditions such as stenosis, thoracic disc herniation, spinal tumors, synovial cysts, and failed back surgery syndrome. A thorough review of the literature was conducted to assess and summarize the current evidence regarding ESS applications for spinal conditions beyond LDH surgery. Areas of focus included innovations in technology and technique, as well as comparisons with conventional open surgical methods. ESS shows notable potential across different spinal conditions by providing minimally invasive alternatives to traditional open surgery. Its use could be associated with reduced surgical morbidity, shorter recovery times, and improved patient outcomes. In particular, ESS is versatile in addressing both degenerative and neoplastic conditions of the spine. Despite this, challenges such as technical complexity, steep learning curves, and limited indications for certain pathologies remain as barriers to wider adoption. ESS is evolving in spine surgery, extending its utility beyond LDH surgery. While the current evidence largely supports its clinical efficacy, further studies are needed to address the present limitations and optimize its application. Future developments in surgical training and technology will likely enhance its adoption and broaden its clinical indications.

Advancements in Spinal Endoscopic Surgery: Comprehensive Techniques and Pathologies Addressed by Full Endoscopy Beyond Lumbar Disc Herniation.

Recurrent laryngeal nerve palsy (RLNP) is a well-recognized complication of anterior cervical discectomy and fusion (ACDF). This meta-analysis aims to evaluate whether the laterality of the surgical approach (right vs. left) influences the incidence of RLNP. A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD420250650589). MEDLINE, Embase, and Scopus were searched for comparative studies assessing RLNP incidence between right- and left-sided ACDF approaches. Eligible studies included randomized controlled trials, prospective or retrospective cohort studies, and case-control studies. A random-effects model was used to pool odds ratios (ORs), and heterogeneity was explored through sensitivity analyses, subgroup analyses, and meta-regression. Eight studies involving 1,592 patients were included. Of these, 946 underwent right-sided ACDF and 632 underwent left-sided ACDF. Across all studies, 119 cases of RLNP were reported, with 80 (67.2%) occurring after right-sided approaches and 39 (32.8%) after left-sided approaches. The pooled OR for RLNP was 1.74 (95% CI: 0.86-3.52; p = 0.1232), indicating no statistically significant difference between approaches. Moderate heterogeneity was observed (I² = 33%). Sensitivity analyses confirmed the stability of results. Meta-regression identified country of origin as a significant source of heterogeneity (R^2 = 100%) and a significant predictor (p = 0.026). Surgical laterality in ACDF does not appear to significantly influence the risk of RLNP. These findings support that the choice of surgical approach may be guided by surgeon preference and patient-specific anatomical considerations rather than concerns about RLNP risk.

The impact of surgical laterality on recurrent laryngeal nerve palsy in anterior cervical discectomy and fusion: A meta-analysis.

Sclerosing epithelioid fibrosarcoma (SEF) is a rare soft tissue sarcoma with high rates of local recurrence and distant metastasis. Primary spinal involvement is exceedingly uncommon and often misdiagnosed due to radiological and histopathological resemblance to more frequent spinal tumors. The objective of this study is to present a rare case of thoracic spinal SEF and to contextualize it within the available literature.

Thoracic Spinal Sclerosing Epithelioid Fibrosarcoma Mimicking Schwannoma: Case Report and Literature Review.

 Giant sacral schwannomas present a significant surgical challenge, often requiring extensive resections that compromise neurological function and sacropelvic biomechanics. Conventional approaches frequently necessitate sacral bone sacrifice, resulting in the deafferentation of key pelvic stabilizers and subsequent long-term functional deficits. This study introduces the novel single-posterior "Sacral Frame Technique," designed to preserve the lateral sacral bone margin and optimize functional reconstruction.  We describe the surgical technique and report on a case of a 55-year-old female with a giant sacral schwannoma extending into the spinal canal and presacral space. The resection was performed via a combined trans-sacral and extrasacral approach, employing an intralesional piecemeal strategy to maintain the lateral sacral bone margin. The gluteus maximus muscles, along with the sacrotuberous and sacrospinous ligaments, were meticulously reattached to their natural insertion sites on the preserved bone. Clinical and radiological outcomes were evaluated at six months post-operatively.  Complete tumor resection was achieved without post-operative neurological deficits or sphincter dysfunction. The patient achieved early mobilization, returned to pre-operative activity levels, and showed no evidence of sacropelvic instability at the six-month follow-up. Post-operative imaging confirmed complete tumor clearance and the structural integrity of the preserved sacral bone margin.  The "Sacral Frame Technique" offers a potential strategy for the safe and effective resection of giant sacral schwannomas. By prioritizing the preservation of the lateral sacral bone margin, the technique facilitates the anatomical reattachment of pelvic stabilizers, potentially mitigating long-term biomechanical deficits. Further studies with larger cohorts are warranted to fully validate these findings and establish the broader applicability of this bone-preserving approach.

The Sacral Frame Technique: A Novel Trans/Extrasacral Approach for Giant Sacral Schwannomas Resection with Sacropelvic Biomechanics Preservation.

: Conventional static magnetic resonance imaging may underestimate the severity of cervical cord compression by failing to account for positional changes in the spinal canal. Dynamic MRI (dMRI) captures cervical motion, allowing evaluation of cord compression under physiological loading. This systematic review aimed to synthesize evidence on how dMRI modifies the assessment of spinal canal narrowing and signal change, and how these findings correlate with impairment and postoperative outcomes in degenerative cervical myelopathy. : A systematic literature search was conducted across PubMed, Scopus, and Embase databases according to PRISMA guidelines. Studies evaluating the role of dMRI (flexion-extension MRI) in diagnosing or predicting outcomes of cervical degenerative pathology were included. Data were extracted on imaging protocols, diagnostic findings, quantitative parameters, and clinical outcomes. : Nineteen studies met the inclusion criteria. dMRI consistently revealed motion-dependent stenosis and intramedullary signal changes not visible on static imaging. Extension imaging frequently demonstrated disease progression, showing altered spinal cord area, cerebrospinal fluid (CSF) reserve, and additional compression levels. Dynamic sequences enhanced sensitivity for pathological segment detection and improved correlation with clinical severity. Preoperative dMRI findings, particularly extension-related compression and T2 hyperintensity, predicted postoperative neurological recovery and influenced surgical planning in up to one third of cases. : Dynamic MRI provides superior diagnostic sensitivity and prognostic information compared with static imaging by revealing motion-induced spinal cord compression and microstructural alterations. It should be considered when clinical findings exceed static MRI severity or when the symptomatic level is uncertain. Standardization of protocols and large prospective studies are needed to define evidence-based clinical indications.

Article	Year
Predictive Factors of Long-Term Neurologic Outcome and Progression-Free Survival in Intramedullary Spinal Cord Tumors: A 10-year Single-Center Cohort Study and Review of the Literature. World neurosurgery\| PubMed ID: 38608817	2024
Cerebrospinal Fluid Leak Prevention in Intradural Spine Surgery: A Long Series Analysis of Closure with Non-Penetrating Titanium Clips. Brain sciences\| PubMed ID: 39766422	2024
In Reply to the Letter to the Editor Regarding: "Predictive Factors of Long-Term Neurologic Outcome and Progression-Free Survival in Intramedullary Spinal Cord Tumors: A 10-Year Single-Cente... World neurosurgery\| PubMed ID: 39814178	2025
Long-Term Risk of Adjacent-Segment Disease in Isthmic Spondylolisthesis Treated with Posterior Interbody Fusion. World neurosurgery\| PubMed ID: 40015678	2025
Prediction of MRI in intra-operative findings for spinal meningeal diseases. Neuro-Chirurgie\| PubMed ID: 40057181	2025
Neurological Outcome of Spinal Hemangioblastomas: An International Observational Multicenter Study About 35 Surgical Cases. Cancers\| PubMed ID: 40361357	2025
Advancements in Spinal Endoscopic Surgery: Comprehensive Techniques and Pathologies Addressed by Full Endoscopy Beyond Lumbar Disc Herniation. Journal of clinical medicine\| PubMed ID: 40507448	2025
The impact of surgical laterality on recurrent laryngeal nerve palsy in anterior cervical discectomy and fusion: A meta-analysis. Neurosurgical review\| PubMed ID: 41193882	2025
Thoracic Spinal Sclerosing Epithelioid Fibrosarcoma Mimicking Schwannoma: Case Report and Literature Review. Current oncology (Toronto, Ont.)\| PubMed ID: 41294690	2025
The Sacral Frame Technique: A Novel Trans/Extrasacral Approach for Giant Sacral Schwannomas Resection with Sacropelvic Biomechanics Preservation. Journal of clinical medicine\| PubMed ID: 41375814	2025
Dynamic MRI in Degenerative Cervical Myelopathy: A Systematic Review of Radiological Markers, Correlations, and Outcomes. Journal of clinical medicine\| PubMed ID: 41517513	2025

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