A prospective pilot study on navigation-guided unilateral biportal endoscopic spine surgery: feasibility, workflow, and early outcomes.

ObjectiveWe investigate the cost-effectiveness of adding robotic technology in spine surgery to an active neurosurgical practice. MethodsThe time of operative procedures, infection rates, revision rates, length of stay, and possible conversion of open to minimally invasive spine surgery (MIS) secondary to robotic image guidance technology were calculated using a combination of institution-specific and national data points. This cost matrix was subsequently applied to 1 year of elective clinical case volume at an academic practice with regard to payor mix, procedural mix, and procedural revenue. ResultsA total of 1,985 elective cases were analyzed over a 1-year period; of these, 557 thoracolumbar cases (28%) were analyzed. Fifty-eight (10.4%) were MIS fusions. Independent review determined an additional ~10% cases (50) to be candidates for MIS fusion. Furthermore, 41.4% patients had governmental insurance, while 58.6% had commercial insurance. The weighted average diagnosis-related group reimbursement for thoracolumbar procedures for the hospital system was calculated to be $25,057 for Medicare and $42,096 for commercial insurance. Time savings averaged 3.4 minutes per 1-level MIS procedure with robotic technology, resulting in annual savings of $5,713. Improved pedicle screw accuracy secondary to robotic technology would have resulted in 9.47 revisions being avoided, with cost savings of $314,661. Under appropriate payor mix components, robotic technology would have converted 31 Medicare and 18 commercial patients from open to MIS. This would have resulted in 140 fewer total hospital admission days ($251,860) and avoided 2.3 infections ($36,312). Robotic surgery resulted in immediate conservative savings estimate of $608,546 during a 1-year period at an academic center performing 557 elective thoracolumbar instrumentation cases. ConclusionApplication of robotic spine surgery is cost-effective, resulting in lesser revision surgery, lower infection rates, reduced length of stay, and shorter operative time. Further research is warranted, evaluating the financial impact of robotic spine surgery.

What's New in Spine Surgery.

Magnetically controlled growing rod systems have been introduced over recent years as an alternative to traditional growing rods for management of early onset scoliosis. The purpose of this paper is to report our early experience of a magnetically controlled growing rod system (MAGEC, Ellipse). Review of pre-operative, postoperative and follow-up Cobb angles and spinal growth in case series of eight patients with a minimum 23 months' follow-up (23-36 months). A total of six patients had dual rod constructs implanted and two patients received single-rod constructs. Four patients had MAGEC rods as a primary procedure. Four were revisions from other systems. Mean age at surgery in the primary group was 4.5 years (range 3.9-6.9). In patients who had MAGEC as a primary procedure, mean pre-operative Cobb angle was 74° (63-94), with postoperative Cobb angle of 42° (32-56) p ≤ 0.001 (43% correction). Mean Cobb angle at follow-up was 42° (35-50). Spinal growth rate was 6 mm/year. One sustained proximal screw pull out. A final patient sustained a rod fracture. Mean age at surgery in the revision group was 10.9 years (range 9-12.6). Mean pre-operative Cobb angle was 45° (34-69). Postoperative Cobb angle was 42° (33-63) (2% correction). Mean Cobb angle at follow-up was 44° (28-67). Mean spinal growth rate was 12 mm/year. Two patients developed loss of distraction. MAGEC growing rod system effectively controls early onset scoliosis when used as either a primary or revision procedure. Although implant-related complications are not uncommon, the avoidance of multiple surgeries following implantation is beneficial compared with traditional growing rod systems.

RISC-V has emerged as a compelling alternative to proprietary instruction set architectures, distinguished by its openness, extensibility, and modularity. As the ecosystem matures, attention has turned to building confidential computing foundations, notably Trusted Execution Environments (TEEs) and secure enclaves, to support sensitive workloads. These efforts explore a variety of design directions, yet reveal important trade-offs. Some approaches achieve strong isolation guarantees, but fall short in scalability or broad adoption. Others introduce defenses, such as memory protection or side-channel resistance, although often with significant performance costs that limit deployment in constrained systems. Lightweight enclaves address embedded contexts, but lack the advanced security features demanded by complex applications. In addition, early-stage development, complex programming models, and limited real-world validation hinder their usability. This survey reviews the current landscape of RISC-V TEEs and secure enclaves, analyzing their architectural principles, strengths, and weaknesses. To the best of our knowledge, this is the first work to present such a consolidated view. Finally, we highlight open challenges and research opportunities, aiming toward establishing a cohesive and trustworthy RISC-V trusted computing ecosystem.

Robotic navigation has been shown to increase precision, accuracy, and safety during spinal reconstructive procedures. There is a paucity of literature describing the best techniques for robotic-assisted spine surgery for complex, multilevel cases or in cases of significant deformity correction. We present a case series of 100 consecutive multilevel posterior spinal fusion procedures performed for multilevel spinal disease and/or deformity correction. 100 consecutive posterior spinal fusions were performed for multilevel disease and/or deformity correction utilizing robotic-assisted placement of pedicle screws. The primary outcome was surgery-related failure, which was defined as hardware breakage or reoperation with removal of hardware. A total of 100 consecutive patients met inclusion criteria. Among cases included, 31 were revision surgeries with existing hardware in place. The mean number of levels fused was 5.6, the mean operative time was 303min, and the mean estimated blood loss was 469mL. 28 cases included robotic-assisted placement of S2 alar-iliac (S2AI) screws. In total, 1043 pedicle screws and 53 S2AI screws were placed with robotic-assistance. The failure rate using survivorship analysis was 18/1043 (1.7%) and the failure rate of S2AI screws using survivorship analysis was 3/53 (5.7%). Four patients developed postoperative wound infections requiring irrigation and debridement procedures. None of the 1043 pedicle screws nor the 53 S2AI screws required reoperation due to malpositioning or suboptimal placement. This case series of 100 multilevel posterior spinal fusion procedures demonstrates promising results with low failure rates. With 1043 pedicle screws and 53 S2AI screws, we report low failure rates of 1.7% and 5.7%, respectively with zero cases of screw malpositioning. Robotic screw placement allows for accurate screw placement with no increased rate of postoperative infection compared to historical controls. Level of evidence: IV, Retrospective review.

Preliminary clinical experience with polyetheretherketone cages filled with synthetic crystallic semihydrate form of calcium sulfate for anterior cervical discectomy and fusion

Endoscopy of the lumbar spine has traditionally found much broader adoption than those endoscopic procedures of other areas of the spine. Initially, a herniated disc was the target of endoscopic spine surgery techniques. Stenosis indications were later identified as technological advancements permitted. Many endoscopic spinal surgeries commenced in the domain of interventional pain management. Lasers and radiofrequency were applied to some of the procedures that nowadays are aided by direct videoendsocopic visualization of the painful pathology. In this chapter, the authors briefly reviewed the history of spinal endoscopy and its key opinion leaders. Giving credit to the most prominent pioneers of this fast-moving field sets the stage for what the reader is about to discover in this most-up-to-date publication: Contemporary Spinal Endoscopy: Lumbar Spine.<br>

Pseudarthrosis following transforaminal interbody fusion (TLIF) is not infrequent. Although cage migration and subsidence are commonly regarded as evidence of the absence of solid fusion, there is still no evidence of the influence of cage migration and subsidence on fusion. This study aimed to evaluate cage migration and subsidence using computed tomography (CT) DICOM data following lumbar interbody fusion. The effects of cage migration and subsidence on fusion and clinical outcomes were also assessed. A postoperative CT data set of 67 patients treated with monosegmental TLIF was analyzed in terms of cage position. To assess the effects of cage migration and subsidence on fusion, 12-month postoperative CT scans were used to assess fusion status. Clinical evaluation included the visual analog scale for pain and the Oswestry Disability Index. Postoperative cage migration occurred in 85.1% of all patients, and cage subsidence was observed in 58.2%. Radiological signs of pseudarthrosis was observed in 7.5% of the patients Neither cage migration nor subsidence affected the clinical or radiographic outcomes. No correlation was found between clinical and radiographic outcomes. The incidence of cage migration was considerable. However, as cage migration and subsidence were not associated with bony fusion, their clinical significance was considered limited.