Academic Stress Assessment Using Virtual Reality as an Educational Tool in Spine Surgery

Introduction: The evaluation of academic stress in medical students and residents is a topic of significant interest, given the considerable challenges they face during their learning process with traditional teaching methods. The use of technologies like virtual reality presents an opportunity to enhance their skills through simulations and training. The main objective of this study is to qualitatively assess the stress levels experienced by medical students and residents by integrating virtual reality into their current learning methods, aiming to improve their ability to manage stressors in their practice. Material and Methods: A questionnaire was conducted with 12 medical students and 12 Traumatology and orthopedics residents. The purpose of the questionnaire was to evaluate the levels of academic stress using the SISCO inventory. The stress levels were calculated by transforming average values into percentages, and the following criteria were assigned: 0 to 33% for Mild Stress, 34 to 66% for Moderate Stress, and 67 to 100% for Deep Stress. Then, a virtual reality class focused on spine surgery was provided. Both medical students and residents were trained using the Non Nocere SharpSurgeon software platform and Oculus Quest 2 virtual reality glasses. At the end of the session, a second questionnaire related to the practice with virtual reality was conducted with the same evaluation criteria and a comparative analysis was carried out. Results: 12 undergraduate students from Hospital Angeles Mexico, CDMX and 12 traumatology and orthopedics residents at Hospital Santa Fe, Bogota were evaluated. The students in CDMX reported an average qualitative stress of 28.50% during habitual practices, which decreased to an average of 14.67% after virtual reality practice. Residents in Bogotá experienced an average qualitative stress of 30.50% with their current learning methods but this reduced to an average of 13.92% after using virtual reality. These findings indicate that the use of virtual reality has a positive impact on reducing stress levels qualitatively. Conclusions: The use of virtual reality as a learning method for medical students and residents qualitatively improves stress levels. Further studies are required to define the potential uses of Virtual Reality to improve learning methods and emotional state in medical students and residents and for a quantitative assessment to validate the training as certified learning methods.

Background,techniques,applications,current trends,and future directions of minimally invasive endoscopic spine surgery:A review of literature

Across many of the surgical specialties,the use of minimally invasive techniques that utilize indirect visualization has been increasingly replacing traditional techniques which utilize direct visualization.Arthroscopic surgery of the appendicular skeleton has evolved dramatically and become an integral part of musculoskeletal surgery over the last several decades,allowing surgeons to achieve similar or better outcomes,while reducing cost and recovery time.However,to date,the axial skeleton,with its close proximity to critical neural and vascular structures,has not adopted endoscopic techniques at as rapid of a rate.Over the past decade,increased patient demand for less invasive spine surgery combined with surgeon desire to meet these demands has driven significant evolution and innovation in endoscopic spine surgery.In addition,there has been an enormous advancement in technologies that assist in navigation and automation that help surgeons circumvent limitations of direct visualization inherent to less invasive techniques.There are currently a multitude of endoscopic techniques and approaches that can be utilized in the treatment of spine disorders,many of which are evolving rapidly.Here we present a review of the field of endoscopic spine surgery,including the background,techniques,applications,current trends,and future directions,to help providers gain a better understanding of this growing modality in spine surgery.

Erector spinae plane block at lower thoracic level for analgesia in lumbar spine surgery: A randomized controlled trial

BACKGROUND Patients undergoing lumbar spine surgery usually suffer severe pain in the postoperative period.The erector spinae plane block(ESPB),first published in 2016,can anesthetize the ventral and dorsal rami of thoracic nerves and produce an extensive multi-dermatomal sensory block.AIM To assess whether bilateral ultrasound-guided ESPB at a lower thoracic level could improve pain control and quality of recovery in patients undergoing lumbar spine surgery.METHODS A total of 60 patients aged 18-80 years scheduled to undergo lumbar spine surgery with general anesthesia were randomly assigned to two groups:ESPB group(preoperative bilateral ultrasound-guided ESPB at T10 vertebral level)and control group(no preoperative ESPB).Both groups received standard general anesthesia.The main indicator was the duration to the first patient controlled intravenous analgesia(PCIA)bolus.RESULTS In the ESPB group,the duration to the first PCIA bolus was significantly longer than that in the control group(h)[8.0(4.5,17.0)vs 1.0(0.5,6),P<0.01],and resting and coughing numerical rating scale(NRS)scores at 48 h post operation were significantly lower than those in the control group(P<0.05).There was no significant difference between the two groups regarding resting and coughing NRS scores at 24 h post operation.Sufentanil consumption during the operation was significantly lower in the ESPB group than in the control group(P<0.01),while there was no significant difference between the two groups regarding morphine consumption at 24 or 48 h post operation.In the ESPB group,Modified Observer’s Assessment of Alertness/Sedation score within 20 min after extubation was higher and duration in the post-anesthesia care unit was shorter than those in the control group(P<0.01).CONCLUSION In patients undergoing lumbar spine surgery,ultrasound-guided ESPB at a lower thoracic level improves the analgesic effect,reduces opioid consumption,and improves postoperative recovery.

Full-endoscopic spine surgery treatment of lumbar foraminal stenosis after osteoporotic vertebral compression fractures:A case report

BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.

Demineralized Bone Matrix Fibers plus Allograft Bone for Multilevel Posterolateral Spine Fusion: A Game Changer?

Introduction: While autograft bone is the gold standard for multilevel posterolateral lumbar fusion, bone substitutes and graft extenders such as allograft bone, ceramics and demineralized bone matrix (DBM) have been used to avoid the morbidity and insufficient quantity associated with harvesting autologous bone. The primary objective of this retrospective study was to determine whether, in patients with increased risk of operative nonunion related to multilevel fusion, adding DBM fibers to mineralized bone allograft resulted in better fusion than using allograft alone. The secondary objectives were to evaluate how adding DBM fibers affects functional disability, low back pain, intraoperative blood loss and the nonunion rate. Methods: This retrospective study involved a chart review of consecutive patients who underwent multilevel lumbar spinal fusion and were operated on by a single surgeon. The patients were divided into two groups: 14 patients received mineralized bone allograft (control group) and 14 patients received a combination of mineralized bone allograft and DBM (experimental group). Patients were reviewed at a mean of 16.4 ± 2.2 months after surgery at which point CT scans were analyzed to determine whether fusion had occurred;Oswestry disability index (ODI) and pain were also evaluated. Results: A mean of 5 levels [min 2, max 13] were fused in these patients. Posterolateral fusion as defined by the Lenke classification was not significantly different between groups. The experimental DBM group had a significantly better composite fusion score than the control group (P Discussion: Adding DBM fibers to allograft bone during multilevel posterolateral spinal fusion was safe and produced better composite fusion than using allograft only as an autograft extender.

Pedicle screw accuracy assessment in ExcelsiusGPS?robotic spine surgery:evaluation of deviation from pre-planned trajectory

Background: The ExcelsiusGPS?(Globus Medical, Inc., Audubon, PA) is a next-generation spine surgery robotic system recently approved for use in the United States. The objective of the current study is to assess pedicle screw accuracy and clinical outcomes among two of the first operative cases utilizing the ExcelsiusGPS?robotic system and describe a novel metric to quantify screw deviation. Methods: Two patients who underwent lumbar fusion at a single institution with the ExcelsiusGPS?surgical robot were included. Pre-operative trajectory planning was performed from an intra-operative CT scan using the O-arm (Medtronic, Inc., Minneapolis, MN). After robotic-assisted screw implantation, a post-operative CT scan was obtained to confirm ideal screw placement and accuracy with the planned trajectory. A novel pedicle screw accuracy algorithm was devised to measure screw tip/tail deviation distance and angular offset on axial and sagittal planes. Screw accuracy was concurrently determined by a blinded neuroradiologist using the traditional Gertzbein-Robbins method. Clinical variables such as symptomatology, operative data, and post-operative follow-up were also collected. Results: Eight pedicle screws were placed in two L4-L5 fusion cases. Mean screw tip deviation was 2.1 mm (range 0.8-5.2 mm), mean tail deviation was 3.2 mm (range 0.9-5.4 mm), and mean angular offset was 2.4 degrees (range 0.7-3.8 degrees). All eight screws were accurately placed based on the Gertzbein-Robbins scale (88% Grade A and 12% Grade B). There were no cases of screw revision or new post-operative deficit. Both patients experienced improvement in Frankel grade and Karnofsky Performance Status (KPS) score by 6 weeks post-op. Conclusion: The ExcelsiusGPS? robot allows for precise execution of an intended pre-planned trajectory and accurate screw placement in the first patients to undergo robotic-assisted fusion with this technology.

Guidelines for navigation-assisted spine surgery

Spinal surgery is a technically demanding and challenging procedure because of the complicated anatomical structures of the spine and its proximity to several important tissues.Surgical landmarks and fluoroscopy have been used for pedicle screw insertion but are found to produce inaccuracies in placement.Improving the safety and accuracy of spinal surgery has increasingly become a clinical concern.Computerassisted navigation is an extension and application of precision medicine in orthopaedic surgery and has significantly improved the accuracy of spinal surgery.However,no clinical guidelines have been published for this relatively new and fast-growing technique,thus potentially limiting its adoption.In accordance with the consensus of consultant specialists,literature reviews,and our local experience,these guidelines include the basic concepts of the navigation system,workflow of navigation-assisted spinal surgery,some common pitfalls,and recommended solutions.This work helps to standardize navigation-assisted spinal surgery,improve its clinical efficiency and precision,and shorten the clinical learning curve.

Cost-effectiveness of robotic-assisted spinal surgery:A single-center retrospective study

Objective:Robotic-assisted spine surgeries(RASS)have been shown to enhance precision,reduce operative time,prevent complications,facilitate minimally invasive spinal surgery,and decrease revision surgery rates,leading to improved patient outco mes This study aimed to compare the cost-effectiveness of RAs's and non-robotic-assisted surgery for degenerative spine disease at a single center.Me thods:This retrospective study,including 122 patients,was conducted at a single center from March 2015 to February 2022.Patients who underwent ro bot-assisted surgery were assigned to the robotgroup,and patients who underwent non-robotic-assisted surgery were assigned to the non-mmbot group.Various data,indluding demographic information,surgical details,outcomes,and cost-effectiveness,were colected for both groups.The cost-effectiveness was determined using the incremental cost-effectiveness ratio(ICER),and subgroup analysis was conducted for patients with 1 or 2 levels of spi-nal instrumentation.The analysis was performed using STATA SE version 15 and Tree.Age Pro 2020,with Monte Caro simulations for the cost-effectiveness acceptability curve.Results The owerallICER was$22,572,but it decreased to$16,980 when considering cases with only 1or 2 levels of instrumentation.RASS is deemed cost-effective when the willi ingness to pay is$3000-$4000 if less than 2 levels of the spine are instrumented.Conchsions:The cost-effectiveness of robot icassistance be comes apparent whenthere isa reduced need for open surgeries,leading to decreased d revision rates caused by complications such as misplaced screwsor infctions.Therefore,it is advisable to allocate healthcare budget resou Irces to spine robots,as RASS PIDves to be cost-effective,partic cularly when only two or Ewer spinal levels require instrumentation.

TINAVI robot-assisted one-stage anteroposterior surgery in lateral position for severe thoracolumbar fracture dislocation:A case report

BACKGROUND The combined anterior/posterior approach appears to be capable of reconstructing spinal stability,correcting thoracolumbar deformity,and promoting neural recovery in severe thoracolumbar fracture dislocation.However,this type of operation requires changing the body position during the procedure,resulting in a lengthy operation time.As a universal surgical robot,TINAVI robot has achieved good surgical results in clinical surgery.But to our knowledge,no reports describing TINAVI robot-assisted single lateral position anteroposterior surgery for thoracolumbar fracture dislocation.CASE SUMMARY We describe a case of a 16-year-old female patient with severe thoracolumbar fracture and dislocation underwent surgery assisted by the TINAVI robot.A onestage combined anterior and posterior operation was performed on a severe thoracolumbar fracture dislocation using the TINAVI robot,and the operation was completed in right lateral position.CONCLUSION The TINAVI robot-assisted one-stage anterior and posterior surgery in right lateral position for severe thoracolumbar fracture and dislocation is both safe and effective.

Expandable pedicle screw instrumentation plus cement augmentation in surgery for severely osteoporotic spine

Objective To evaluate short-teerm clinical and radiographic results of a novel expandable pedicle screw instrumentation combined with cement augmentation in surgery for severely osteoporotic spine.Methods From October 2006 to October

Application Research of PETD Combined with MRI Nerve Root Water Imaging in the Minimally Invasive Treatment of LDH

Objective: This study aims to evaluate the safety and efficacy of PETD combined with nerve root water imaging of MRI for the treatment of lumbar disc herniation. Methods: A retrospective review was performed on 62 patients with lumbar disc herniation from March 2019 to March 2021. The study included an experimental group of 30 patients and a control group of 32 patients. The experimental group underwent PETD combined with nerve root water imaging of MRI, while the control group received traditional PETD treatment. The visual analogue scoring method (VAS score), and JOA lumbar spine function score before and after surgery were compared between the two groups, and efficacy was assessed and compared using the MacNab score. Results: The mean operation time was significantly reduced in the experimental group (56.43 &#177;10.40 minutes) compared to the control group (65.69 &#177;14.12 minutes). The VAS score was compared between the two groups with preoperative (p = 0.624), one month after surgery (p = 0.325), three months after surgery (p = 0.676), one year after surgery (p = 0.341);The JOA score was compared between the two groups with preoperative (p = 0.961), one month after the surgery (p = 0.266), three months after surgery (p = 0.185), one year after surgery (p = 0.870), they were no significant statistical difference;The efficacy evaluation of the last follow-up Macnab showed that all the 30 patients in the experimental group were excellent, 31 of 32 patients in the control group were excellent, 1 case was good;There was no statistical difference in the comparison between the two groups (p > 0.05). Conclusion: The study concludes that the combined approach of PETD with nerve root water imaging of MRI is a safe, effective, and more efficient alternative to conventional PETD for treating lumbar disc herniation.

Massively prolapsed intervertebral disc herniation with interlaminar endoscopic spine system Delta endoscope: A case series

BACKGROUND Surgery is often indicated for patients with massively prolapsed intervertebral disc herniation.The interlaminar endoscopic spine system(iLESSYS)Delta 6-mm working channel endoscope has advantages over other systems.The aim of this study was to explore the benefits and complications of using the iLESSYS Delta for the treatment of massively prolapsed intervertebral disc herniation.AIM To explore the clinical benefits of treating massively prolapsed lumbar intervertebral disc herniation with the iLESSYS Delta endoscope.METHODS In this study,the data of 37 patients who underwent surgery with the iLESSYS Delta endoscope at The Affiliated Hospital of Qingdao University were retrospectively analyzed.Intraoperative blood loss,operation time,and complications were collected.The visual analog scale(VAS),oswestry disability index(ODI),and modified MacNab criteria were determined before and at 1 d,3 mo,and 6 mo after surgery.RESULTS The mean intraoperative blood loss was 20.4±1.2 mL.The mean operation time was 97.3±12.4 min.The VAS scores for leg and back pain decreased from 68.0±7.3,34.4±8.5 before operation to 2.5±1.7,5.5±1.9 at 6 mo after surgery,respectively.The ODI also decreased from 60.2±7.3 to 17.9±3.4 at 6 mo after surgery.The improvement rate of the MacNab score was 86.4%,which was considered excellent.No spinal dural injury,nerve root injury,secondary protrusion of intervertebral disc,or myeloid hypertension was found during follow-up.CONCLUSION The iLESSYS Delta 6-mm working channel endoscope has several advantages in terms of clinical and functional benefits,complications,and low risk of residual vertebral pulp in treating patients with massively prolapsed intervertebral disc herniation.

Atypical osteochondroma of the lumbar spine associated with suprasellar pineal germinoma:A case report

BACKGROUND Osteochondromas are the most common benign bone tumor,accounting for 36%of benign bone tumors.Often found within the appendicular skeleton,osteochondromas of the spine are rare,comprising 4%to 7%of primary benign spinal tumors.CASE SUMMARY We report a case of a solitary lumbar osteochondroma in an 18-year-old male with a history of a suprasellar pineal germinoma treated with combined chemotherapy and radiation.He underwent mass excision and partial laminectomy with the ultrasonic bone scalpel(Misonix,Farmingdale,NY,United States)at the L5 Level without the use of adjuvants.The patient returned to work and full activities without back pain at 3 mo postoperatively.CONCLUSION Osteochondromas are common tumors of the appendicular skeleton but rarely occur within the spine.This case discussion supplements current osteochondroma literature by describing an unusual presentation of this tumor.

Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery:A case report and review of literature

BACKGROUND Deep venous thrombosis(DVT)is a serious complication of lumbar spine surgery.Current guidelines recommend pharmacomechanical prophylaxis for patients at high risk of DVT after spine surgery.May-Thurner syndrome(MTS),a venous anatomical variation that may require invasive intervention,is an often overlooked cause of DVT.To date,no case reports of symptomatic MTS caused by isthmic spondylolisthesis or subsequent acute DVT after posterior lumbar surgery have been published.CASE SUMMARY We here present a case of a patient who developed acute DVT 4 h after spondylolisthesis surgery,and MTS was only considered after surgery,during a review of a gynecological enhanced computed tomography image taken before the procedure.CONCLUSION In conclusion,clinicians should consider MTS in the presence of a dangerous triad:spondylolisthesis,elevated D-dimer levels,and sonographically indicated unilateral deep vein dilation.Consultation with a vascular surgeon is also essential to MTS management.

Surgical strategy used in multilevel cervical disc replacement and cervical hybrid surgery:Four case reports

BACKGROUND Multilevel artificial cervical disc replacement and anterior hybrid surgery have been introduced as reliable treatments for multilevel cervical degenerative disc disease.Surgical techniques are important for resolving patients’symptoms and maintaining the normal functioning of cervical implants.However,the use of inappropriate surgical strategies could lead to complications such as implant migration and neurological deficit.In this paper,we summarize our surgical strategies used in multilevel cervical disc replacement and hybrid surgery into five major notes.CASE SUMMARY We share the key notes and our surgical procedures in the form of four typical case presentations.All patients were diagnosed with cervical degenerative disc disease with myelopathy or radiculopathy and needed multilevel cervical spine surgery.The first case demonstrated that index levels indicating the presence of highly serious spinal cord compression required a prioritized decompression.The second case demonstrated that the disc replacement should be performed before fusion in cervical hybrid surgery.The third and forth cases demonstrated that a top-down implantation sequence was needed in continuous two-level cervical disc replacement.The symptoms of all patients were significantly relieved after surgery.CONCLUSION We hope that our surgical strategies can help improve the performance and outcomes of multilevel cervical spine surgery.

COVID-19 pandemic:An update on the reaction attitude of the spine societies and their members worldwide

BACKGROUND All surgical specialties have been influenced by the coronavirus disease 2019(COVID-19)pandemic,and substantial changes have been determined in medical assistance,especially in elective surgery.Several spine societies have published recommendations to provide optimal care during this unique situation.AIM To discuss the recommendations by many spine societies for the management of spinal diseases during the COVID-19 pandemic.METHODS The present study was performed according to the PRISMA guidelines.A review of the MEDLINE database(PubMed–National Library of Medicine),Google,and Google Scholar was performed from March 2020 to date for articles published in the English Language.RESULTS Spine associations and societies worldwide were divided into three groups:Continental,specialty and country-based societies.A total of 27 spine associations were included in this review.There were eight major continental associations,but only one-third of these had published guidelines and recommendations on this topic.On the other hand,the specialty-based societies have not addressed the topic,except in two cases.CONCLUSION The national spine societies showed the deepest concern on this topic with several publications in scientific journals influenced by the local epidemiological severity.Contrarily,continental and specialty-based societies showed less interest in this topic.

Evolution of evidence in spinal surgery–past,present and future Scientometric analysis of randomized controlled trials in spinal surgery

BACKGROUND Spine surgery is evolving and in the due course of its evolution,it is useful to have a comprehensive summary of the process to have a greater understanding to refine our future directives.With the multiple domains of research in the spine,it has become difficult for a surgeon to find the potential hotspots in research or identify the emerging research frontiers.AIM To analyze RCTs(1990–2019)for potential research domains along with their research networks and identify the hot topics for future research.METHODS A comprehensive and systematic analysis of all the RCTs published on spinal surgery from 1990 to 2019 retrieved from the Web of Science Core Collection database.Scientometric and visual analysis of their characteristics,cooperation networks,keywords,and citations were made using CiteSpace software.Journal and article impact index were retrieved from Reference Citation Analysis(RCA)Database.RESULTS A total of 696 RCTs were published on spinal surgery from 1990 to 2019;of which,the United States(n=263)and China(n=71)made a significant contribution.Thomas Jefferson University(n=16)was the leading contributor to RCTs on spinal surgery.Weinstein JN was the most cited author in the field followed by Deyo RA.Spine(n=559)remained the top-cited journal for RCTs on spinal surgery.On literature co-citation analysis,spinal stenosis,anterior cervical discectomy and fusion,degenerative disc disease,and minimally invasive decompression were identified as the hotspots and potential research frontiers.CONCLUSION The identified hotspots that extending the frontiers in the management of degenerative disorders of the spine through further research holds the potential for advancement in spinal care.

Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Background: Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. Aim: The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. Case presentation: A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation. The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. Conclusion: Fracture-dislocations of the thoracolumbar spine are caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.

Case Series of 11 Patients Operated with Axial-LIF Technique in a Single Center in Mexico

Introduction: Since the earliest description of spinal fusion in 1911 and later by Dr. Fred H. Albee, it has become one of the most commonly performed procedures by orthopedist and neurosurgeons. The spinal fusion is now used to treat a variety of indications, such as traumatic injuries, deformities, primary and secondary tumors, infections and degenerative conditions of the spine. The risk of iatrogenic injury during traditional anterior, posterior, and transforaminal open fusion surgery is significant. The axial lumbar interbody fusion (Axia-LIF) is a minimal invasive technique which uses the retroperitoneumpresacral anatomical corridor to fuse the lumbar vertebral bodies L4-L5-S1 avoiding manipulation of the annular ligament, paravertebral muscles and facet joints. Methods: In this retrospective series, we report all the cases made in the Centro Medico Naval in México City in two years. A total of eleven patients with degenerative disc disease and spondylolisthesis underwent Axia-LIF one or two level systems with a 36 months clinical and radiographic follow-up. The outcomes included Oswestry Disability Index (ODI) score and leg/back pain severity. Radiographic outcome was evaluated with dynamics and orthogonal x-ray, as well as lumbosacral tomography scan to evaluate fusion status. Results: Nine patients underwent Axia-LIF one level system (L5-S1) and the rest two levels system (L4-S1). Ten patients were fixated with transpedicular percutaneous screws and one with facets joints screws. No intraoperative complications were reported. The mean back pain severity improved 57% in 12 months, and the mean leg pain severity improved 50% in the same time (P < 0.001). Mean ODI scores improved 58%, from 60% ± 16% at baseline to 25% ± 8% at twelve months (P < 0.001). At one year, a patient developed pseudoarthrosis that required posterolateral arthrodesis with transpedicular percutaneous screws. At 36 months monitoring, 100% patients presented a total interbody fusion in the tomography scans. At final follow-up, mean ODI score improved 73% (16% ± 5%;P < 0.001). Conclusion: The Axial Lumbar Interbody Fusion has demonstrated to be a safe treatment for the degenerative disc disease L5-S1 and L4-S1. The patients who underwent one or two level Axia-LIF showed an improvement in ODI and back/leg pain severity scores, with no intraoperative complications. The use of this technique and its indications are still in controversy;nevertheless, its use has increased as for pathologies such as spondylitis, scoliosis, patients with residual pain with previous surgeries. We recommended complementary pedicular fixation to avoid complications and improved interbody fusion.

颈椎内固定术后咽食管憩室1例

1临床资料患者,男,65岁,因“咽部不适1年余,进行性加重2周”入院。患者1年前出现咽部不适,无咽痛、声嘶,近2周出现饮食饮水呛咳,遂至潍坊市人民医院耳鼻咽喉科行钡餐检查示(图1A):食管上端前部有一较大的囊袋样憩室充盈,压迫局部食管变窄,钡剂通过受阻、部分造影剂逆行向前上方反流进入喉及气管和支气管内。后为求进一步治疗就诊于我院胸外科门诊,以“食管憩室”收治入院。患者既往白癜风病史20年余,自发病以来偶有呛咳和食管反流症状,曾于2015年7月因外伤于当地医院行颈部钢板固定术,钢板未取出。其余无特殊。经胸外科联系我科、脊柱外科、消化内科进行多学科会诊,讨论结果为:患者钡餐考虑食管憩室,诊断明确。消化内科建议因食管憩室较高,行食管支架手术后支架存在脱落可能性较大,暂不考虑行支架治疗。我科会诊建议:患者目前咽喉反流严重,考虑为憩室压迫所致,可转我科行手术治疗,术中请脊柱外科医师同台手术取出脊柱钢板。后患者及家属同意转至我科进一步手术治疗,术前再次行颈部增强CT及MRI检查明确颈部情况(图1B,图1C)。排除手术禁忌后,联合脊柱外科、麻醉科于2021-01-19全麻下行“食管憩室切除术+颈椎内固定取出术”。