This study aimed to analyze the evolving paradigms in spine surgery training driven by technological innovation and ethical imperatives, and to propose an integrated framework for contemporary spine surgical education. A narrative review of the current literature, educational models, and technological advancements was performed, with a focus on advanced training methods such as simulation, augmented reality (AR), virtual reality (VR), robotics, and artificial intelligence (AI). The review critically assessed the ethical landscape and global disparities in training access. Frameworks from leading spine societies and training centers were examined to identify trends and gaps. Technological tools, including high-fidelity simulators, robotic platforms, and AR/VR modules, have demonstrated effectiveness in enhancing trainee performance, reducing intraoperative errors, and supporting ethical learning environments. Nevertheless, significant challenges persist, including high costs, cultural resistance, a lack of curriculum standardization, and unequal global access. Emerging solutions include competency-based progression models, modular continuing professional development pathways, and AI-driven personalized learning. Spine surgery education must shift from traditional apprenticeship models to a technology-enabled, ethically grounded, and competency-based approach. Simulation, robotics, AI, and mixed-reality platforms can offer safe, standardized, and globally scalable solutions for surgical training. Collaborative action among institutions, policymakers, and professional societies is essential to democratize access and establish universal benchmarks for modern spine education.

Objective: Minimally invasive surgery (MIS) has attracted increasing interest for the excision of intradural extramedullary (IDEM) spinal cord tumors. While open surgery is associated with excellent rates of gross total resection (GTR), minimal neurological deficits, and favorable quality of life outcomes, MIS provides potential benefits including reduced morbidity, less postoperative pain, decreased tissue damage, reduced blood loss, and accelerated recovery. This study aimed to evaluate the efficacy of MIS compared to open techniques for IDEM tumor excision by analysing clinical outcomes and procedural advantages. Methods: This retrospective study included 80 patients who underwent surgery for IDEM tumors by a single surgeon between 2012 and 2019. Outcomes between MIS and open surgery were compared. Assessed parameters included intraoperative blood loss, operative duration, tumor location, postoperative visual analogue scale (VAS) scores, length of hospital stay, and time to return to work. The primary outcomes were GTR rates and complications; secondary outcomes comprised symptom relief and tumor recurrence. All patients were followed for at least 3 years. Statistical analysis was performed to evaluate differences between groups. Results: Of the 80 patients, 38 underwent MIS and 42 underwent open surgery. MIS was associated with significantly reduced blood loss (65 mL vs. 240 mL, p<0.01) and shorter hospital stays (4.4 days vs. 6.8 days, p<0.01). Although operative times were initially longer for MIS (160 minutes vs. 130 minutes), this was attributed to the learning curve. GTR rates were similar between the groups (94.6% MIS vs. 96.4% open, p=0.46). There were no significant differences in rates of cerebrospinal fluid leak, infection, or neurological complications (p=0.32). Postoperative VAS scores showed significant improvement at 1 and 3 months in the MIS group, but differences were no longer evident at 1 year. No patient in either group required revision surgery within 3 years (p=0.33). Conclusion MIS for IDEM tumor excision offers distinct advantages over open surgery, including reduced morbidity and faster recovery, while achieving comparable long-term outcomes. With the implementation of advanced MIS techniques, results equal or surpass those of traditional open approaches.

STUDY DESIGN: Retrospective case study by clinical and radiological data analysis. PURPOSE: To analyze different types of vertebral anomalies and the incidence of associated intraspinal anomalies in the Indian population. OVERVIEW OF LITERATURE: This is the largest study of congenital scoliosis and associated intraspinal anomalies in Indian population. Incidence of intraspinal anomaly in this series is 47% which is higher than previous literature. Hemivertebra was the most common anomaly as seen in previous studies. METHODS: A total of 119 patients with congenital scoliosis who underwent surgery between December 2006 and December 2012 were studied. Data was reviewed with medical records, plain radiographs, and magnetic resonance imaging (MRI) scans. RESULTS: Thoracolumbar curve was most common, seen in 43.6% of patients. In addition to scoliotic deformity, kyphosis was seen in 26% of patients. Failure of formation, the most common vertebral anomaly, was seen in 51.2% of patients, failure of segmentation was seen in 19.3% of patients, and there were 29.4% patients having both formation and segmentation anomalies. Hemivertebra was the most common vertebral anomaly seen in 66.3% of patients and for whom 63.2% were in thoracic spine. Intraspinal anomalies were associated with 47% of patients with congenital scoliosis. Tethered cord was the most common intraspinal abnormality and was found in 48.2% patients with intraspinal anomalies. The patients with failure of segmentation and mixed deformities were found to have a significantly higher incidence of intraspinal anomalies (65% and 57%, respectively) than those with failure of formation (34%). Out of 31 patients with kyphotic deformity 29% had intraspinal anomalies, and amongst them tethered cord was the most common anomaly seen in 66% patients. Out of 12 patients with neurocutaneous markers, 83% patients had intraspinal anomaly. CONCLUSIONS: Intraspinal anomalies were seen in 47% of patients with congenital scoliosis in the Indian population. Tethered cord was the most common intraspinal anomaly, seen in 48% cases of congenital scoliosis. Hemivertebra was seen in 66% cases and was the most common vertebral defect. Hence MRI imaging of whole spine should be done in all cases of congenital scoliosis before any surgical intervention. Special attention should be given to physical examination and visualization of any neurocutaneous markers, which are associated with a higher incidence of intraspinal anomalies; absence of a neurocutaneous marker, however, does not rule out intraspinal anomaly.
Congenital Abnormalities ; Humans ; Incidence ; Kyphosis ; Magnetic Resonance Imaging ; Medical Records ; Physical Examination ; Retrospective Studies ; Scoliosis* ; Spine ; Statistics as Topic