Methods: This study included 36 patients with HGS in whom reduction, posterior instrumentation, and fusion were achieved with MIS– TLIF. They were evaluated for lower back pain and radicular pain, scaled by Visual Analog Scale (VAS) score. Erect radiographs were performed to calculate slip angle (SA) and sacropelvic and spinopelvic parameters preoperatively, postoperatively, and at each follow-up until 4 years. Results: This study identified 30 patients with grade III HGS and six patients with grade IV/V HGS. Spinopelvic parameters were unbalanced in 13 patients. Complete reduction was achieved in 24 patients, with end-stage reduction of grade I with adequate spinopelvic balance achieved in 12 patients. Intraoperative neuromonitoring demonstrated no loss of signals throughout the procedure in any of the patients. Excellent functional outcome was achieved with back pain as well as leg pain VAS score improvements postoperatively in all patients. No implant-related complications or pseudoarthrosis incidences were reported at long-term follow-up at 4 years. Conclusions MIS–TLIF for HGS is a specific solution for a complex pathology, enabling one to achieve an excellent clinical as well as radiological outcome.

Methods: This study included 36 patients with HGS in whom reduction, posterior instrumentation, and fusion were achieved with MIS– TLIF. They were evaluated for lower back pain and radicular pain, scaled by Visual Analog Scale (VAS) score. Erect radiographs were performed to calculate slip angle (SA) and sacropelvic and spinopelvic parameters preoperatively, postoperatively, and at each follow-up until 4 years. Results: This study identified 30 patients with grade III HGS and six patients with grade IV/V HGS. Spinopelvic parameters were unbalanced in 13 patients. Complete reduction was achieved in 24 patients, with end-stage reduction of grade I with adequate spinopelvic balance achieved in 12 patients. Intraoperative neuromonitoring demonstrated no loss of signals throughout the procedure in any of the patients. Excellent functional outcome was achieved with back pain as well as leg pain VAS score improvements postoperatively in all patients. No implant-related complications or pseudoarthrosis incidences were reported at long-term follow-up at 4 years. Conclusions MIS–TLIF for HGS is a specific solution for a complex pathology, enabling one to achieve an excellent clinical as well as radiological outcome.

Methods: This study included 36 patients with HGS in whom reduction, posterior instrumentation, and fusion were achieved with MIS– TLIF. They were evaluated for lower back pain and radicular pain, scaled by Visual Analog Scale (VAS) score. Erect radiographs were performed to calculate slip angle (SA) and sacropelvic and spinopelvic parameters preoperatively, postoperatively, and at each follow-up until 4 years. Results: This study identified 30 patients with grade III HGS and six patients with grade IV/V HGS. Spinopelvic parameters were unbalanced in 13 patients. Complete reduction was achieved in 24 patients, with end-stage reduction of grade I with adequate spinopelvic balance achieved in 12 patients. Intraoperative neuromonitoring demonstrated no loss of signals throughout the procedure in any of the patients. Excellent functional outcome was achieved with back pain as well as leg pain VAS score improvements postoperatively in all patients. No implant-related complications or pseudoarthrosis incidences were reported at long-term follow-up at 4 years. Conclusions MIS–TLIF for HGS is a specific solution for a complex pathology, enabling one to achieve an excellent clinical as well as radiological outcome.

Methods: Twenty-four patients with AIS (Cobb >65°) underwent surgery at a single center between January 2014 and December 2021. The first 10 patients underwent surgery using only IOT (T group), whereas the subsequent 14 patients underwent surgery with a combination of IOT and PO (TP group). Results: The mean preoperative Cobb angles in the T and TP groups were 89.35°±6.05° and 92.32°±9.28°, respectively (p=0.59). The mean flexibility index (FI) of the T and TP groups were 0.31±0.016 and 0.36±0.03, respectively (p=0.41). The mean postoperative Cobb angle in the T and TP groups were 40.25°±5.95° and 19.1°±3.20°, respectively (p=0.041). Apical vertebral rotation improved from mean grade 3.2 (2–4) to grade 2.6 (1–3) in the T group and from mean grade 3.6 (2–4) to mean grade 1.8 (1–3) in the TP group. Postoperatively, the mean thoracic kyphosis was 13.84°±2.10° and 21.02°±1.68° in T and TP groups (p=0.044). Transient signal-loss intraoperatively was noted in two patients, one in each group. No episodes of postoperative neurological deficits were reported. No incidences of pseudarthrosis/implant-related complications were reported at the end of 2 years in either group. Conclusions IOT and PO complement one another and can be safely combined without an attributable risk of neurological injury.

Methods: We conceptualized a novel pedicle screw considering vertebral bone morphology and strength differences. A validated FE model was developed and used in conjunction with DoE to determine the screw՚s optimum geometrical parameters. The FE model was validated through simulation and laboratory experiments using the control device. The optimized thread profiles for cortical bone and cancellous bone were determined, with pull-out force as the primary factor for screw design evaluation. Results: FE analysis results for the control device closely matched experimental results, with less than 5% difference. The chosen unique pitch/depth ratio showed maximum pull-out force for cortical bone, while DoE enabled the optimization of design parameters for cancellous bone. The optimized pedicle screw exhibited a 15% increase in pull-out force compared to the control device. Conclusions The study proposes a novel pedicle screw design with better pull-out strength than the control device. Combining FE analysis with DoE is an effective approach for screw design optimization, reducing the need for extensive prototyping tests. A two-variable analysis suffices for optimizing cortical bone design parameters, while a multi-variable analysis is more effective for optimizing cancellous bone design parameters.

Methods: Twenty-four patients with AIS (Cobb >65°) underwent surgery at a single center between January 2014 and December 2021. The first 10 patients underwent surgery using only IOT (T group), whereas the subsequent 14 patients underwent surgery with a combination of IOT and PO (TP group). Results: The mean preoperative Cobb angles in the T and TP groups were 89.35°±6.05° and 92.32°±9.28°, respectively (p=0.59). The mean flexibility index (FI) of the T and TP groups were 0.31±0.016 and 0.36±0.03, respectively (p=0.41). The mean postoperative Cobb angle in the T and TP groups were 40.25°±5.95° and 19.1°±3.20°, respectively (p=0.041). Apical vertebral rotation improved from mean grade 3.2 (2–4) to grade 2.6 (1–3) in the T group and from mean grade 3.6 (2–4) to mean grade 1.8 (1–3) in the TP group. Postoperatively, the mean thoracic kyphosis was 13.84°±2.10° and 21.02°±1.68° in T and TP groups (p=0.044). Transient signal-loss intraoperatively was noted in two patients, one in each group. No episodes of postoperative neurological deficits were reported. No incidences of pseudarthrosis/implant-related complications were reported at the end of 2 years in either group. Conclusions IOT and PO complement one another and can be safely combined without an attributable risk of neurological injury.

Methods: We conceptualized a novel pedicle screw considering vertebral bone morphology and strength differences. A validated FE model was developed and used in conjunction with DoE to determine the screw՚s optimum geometrical parameters. The FE model was validated through simulation and laboratory experiments using the control device. The optimized thread profiles for cortical bone and cancellous bone were determined, with pull-out force as the primary factor for screw design evaluation. Results: FE analysis results for the control device closely matched experimental results, with less than 5% difference. The chosen unique pitch/depth ratio showed maximum pull-out force for cortical bone, while DoE enabled the optimization of design parameters for cancellous bone. The optimized pedicle screw exhibited a 15% increase in pull-out force compared to the control device. Conclusions The study proposes a novel pedicle screw design with better pull-out strength than the control device. Combining FE analysis with DoE is an effective approach for screw design optimization, reducing the need for extensive prototyping tests. A two-variable analysis suffices for optimizing cortical bone design parameters, while a multi-variable analysis is more effective for optimizing cancellous bone design parameters.

Portal hypertension, a known complication of liver cirrhosis, typically leads to variceal bleeding in the esophagus and stomach. However, ectopic varices can also occur outside the gastroesophageal region and may present with life-threatening massive bleeding. We report a case of bleeding ileal ectopic varices in a patient with cirrhosis that were not detected during routine endoscopy. These varices were ultimately diagnosed with the aid of abdominal computed tomography. A transjugular intrahepatic portosystemic shunt (TIPS) was created to decrease portal pressure, and the TIPS tract was then used to selectively embolize the bleeding ectopic ileal varices.

Portal hypertension, a known complication of liver cirrhosis, typically leads to variceal bleeding in the esophagus and stomach. However, ectopic varices can also occur outside the gastroesophageal region and may present with life-threatening massive bleeding. We report a case of bleeding ileal ectopic varices in a patient with cirrhosis that were not detected during routine endoscopy. These varices were ultimately diagnosed with the aid of abdominal computed tomography. A transjugular intrahepatic portosystemic shunt (TIPS) was created to decrease portal pressure, and the TIPS tract was then used to selectively embolize the bleeding ectopic ileal varices.

Methods: Twenty-four patients with AIS (Cobb >65°) underwent surgery at a single center between January 2014 and December 2021. The first 10 patients underwent surgery using only IOT (T group), whereas the subsequent 14 patients underwent surgery with a combination of IOT and PO (TP group). Results: The mean preoperative Cobb angles in the T and TP groups were 89.35°±6.05° and 92.32°±9.28°, respectively (p=0.59). The mean flexibility index (FI) of the T and TP groups were 0.31±0.016 and 0.36±0.03, respectively (p=0.41). The mean postoperative Cobb angle in the T and TP groups were 40.25°±5.95° and 19.1°±3.20°, respectively (p=0.041). Apical vertebral rotation improved from mean grade 3.2 (2–4) to grade 2.6 (1–3) in the T group and from mean grade 3.6 (2–4) to mean grade 1.8 (1–3) in the TP group. Postoperatively, the mean thoracic kyphosis was 13.84°±2.10° and 21.02°±1.68° in T and TP groups (p=0.044). Transient signal-loss intraoperatively was noted in two patients, one in each group. No episodes of postoperative neurological deficits were reported. No incidences of pseudarthrosis/implant-related complications were reported at the end of 2 years in either group. Conclusions IOT and PO complement one another and can be safely combined without an attributable risk of neurological injury.