Objective: Kyphoscoliosis is the most common deformity seen in patients with neurofibromatosis type 1 (NF1), occurring in 10%–60% of cases. These dystrophic curves often exhibit severe deformities that require surgical intervention. Various procedures have been evaluated and studied; however, there is no consensus, and these are also associated with a higher rate of morbidity. Therefore, this study aimed to evaluate the clinical and radiological outcomes of apical spinal osteotomy (ASO) in NF1 patients with dystrophic curves who exhibited thoracic, thoracolumbar, or lumbar kyphoscoliosis. Methods: We conducted a retrospective analysis of prospectively collected data involving 21 children with dystrophic NF1 curves who underwent ASO at a single tertiary care center from November 2009 to June 2017. The efficacy of ASO for correcting coronal and sagittal deformities was assessed. Clinical outcomes (visual analogue scale [VAS], Oswestry Disability Index [ODI], and Frankel grade) and radiological outcomes (Cobb angle correction, fusion, and complications) were evaluated. Results: The study included 21 patients (11 males, 10 females) with a mean age at surgery of 9.33 years. The mean kyphotic Cobb angle improved significantly from 98.33° to 36.52°. The mean sagittal vertical axis also improved significantly from 7.40 cm to 4.21 cm, along with significant improvements in VAS and ODI scores. Conclusion This study describes a technique using a posterior approach for single-level ASO in the treatment of severe dystrophic NF1 curves. The technique can be effective in children with mild to moderate curves, yielding good clinicoradiological outcomes and satisfactory correction rates.

Methods: This retrospective pilot study was performed at single center on 858 spine surgery patients. The patients were divided into the following two groups: the study group (after implementation of the checklist [2016–2017]) and the control group (before the implementation of the checklist [2015–2016]). The incidence of common preventable human errors and major perioperative complications in spine surgeries were recorded and compared between the two groups. Results: The prevalence of wrong-level surgeries was 0%, and the overall prevalence of the preventable errors was 1.63% (7/428). The rate of adverse, near-miss, and no-harm events was 0.23% (1/428), 0.70% (3/428) and 0.70% (3/428), respectively. The preoperative, intraoperative, and postoperative errors were 0.70% (3/428), 0.23% (1/428), and 0.70 (3/428), respectively. The reoperation rate related to preventable errors reduced after the checklist was used. There were significant differences in the total preventable errors related to complications, such as infections, prolonged hospital stays, and unplanned hospital readmission/revision surgeries (p=0.001) Conclusions The authors propose the first-of-its kind spine surgery-specific checklist that is comprehensive and involves perioperative parameters. The checklist is easy to use, safe, and effective for reducing the unforgiving errors and perioperative complications. However, its broader implementation would require validation in large, multi-center, randomized control studies.

Retrospective cohort.

Retrospective cohort.

Methods: The study included 200 patients (164 females, 36 males) undergoing primary TKR. Follow-up was performed at 4 weeks, 3, 6, 12, and 24 months. Lumbar spine and knee symptom improvements were assessed using the Oswestry Disability Index (ODI) and Oxford Knee Score, respectively. Results: All 200 patients undergoing bilateral TKR presented with radiographic lumbar spine degenerative pathology; 60% (n=120) of the patients presented with moderate to severe clinical symptoms of lumbar spondylosis, including 54% (n=108) with degenerative lumbar spondylosis and lumbar canal stenosis and 6% (n=12) with degenerative spondylolisthesis. Of the 120 patients who presented with lumbar spine problems, 90% (n=108) reported improvement in their symptoms; the ODI score improved from 42.5%±4.1% preoperative score to 15.6%±2.3% postoperative score (p -value<0.001). Of the 12 patients with no improvement, 10 patients underwent percutaneous procedures for their lumbar spine pathology with good results, one patient underwent surgery, and one declined any intervention. Conclusions A significant number of patients (60%) undergoing bilateral TKR also present with symptomatic lumbar spine problems. Patients with mild to moderate lumbar spine degenerative symptoms and no associated severe radiating pain on activity are more likely to experience relief of their symptoms post-TKR.

Methods: In total, 225 cases (450 top screws; MIS-TIFL, 120; OPEN-TILF, 105) undergoing single-level lower lumbar fusion were included in the study. Postoperative computed tomography grading system was used to evaluate iatrogenic SFV. Patient and surgical factors such as age, body mass index, top-screw level, side of the top screw, depth of the spine, and superior facet joint angle (SFA) were analyzed in iatrogenic SFV and non-violation groups to determine their influence on iatrogenic SFV. The clinical outcomes in both groups were assessed preoperatively and postoperatively. Results: The overall incidence of iatrogenic SFV and high-grade violations was higher in MIS-TLIF (41.25%) than in OPEN-TLIF (30.4%). In both groups, bivariate analysis showed a significantly greater incidence of the iatrogenic SFV in patients aged <60 years and those with obesity, top pedicle screws at L4, right-sided top screws, SFA >35°, and depth of the spine >50 mm. Conclusions This study demonstrated that the incidence of iatrogenic SFV is greater in MIS-TLIF than in OPEN-TLIF at a single lower lumbar level. MIS-TLIF is effective for lumbar degenerative disease; however, the incidence of iatrogenic SFV was higher. Patient and surgical factors must be considered to protect the facet joints in both TLIF methods to avoid ASD.