Single-center retrospective cohort study. To evaluate tumor control, neurological recovery, perioperative morbidity, and long-term biomechanical stability of unilateral hemilaminectomy (UH) for adult intradural spinal tumors. Total laminectomy disrupts stabilizing posterior elements and may necessitate instrumentation for deformity. UH preserves the contralateral posterior complex, offering comparable resection rates, reduced perioperative morbidity, and shorter hospitalization. However, most studies on UH involve small, methodologically heterogeneous samples, with limited long-term data on neurological recovery and mechanical stability without fusion. Adult patients (≥18 years) undergoing UH for intradural spinal tumors (2015-2025) were retrospectively identified from a prospectively maintained database. Pediatric patients and those with extradural tumors were excluded. Primary endpoints were the extent of resection (gross total resection [GTR] vs. subtotal resection [STR]) and biomechanical stability (segmental instability or delayed fusion). Secondary outcomes included operative time, blood loss, length of stay, transfusion, postoperative complications, and unplanned reoperation. Neurological function (American Spinal Injury Association Impairment Scale [AIS] C/D vs. AIS E) was analyzed using Fisher's exact and McNemar tests. A focused literature review summarized comparative evidence on UH versus total laminectomy. Of the 405 UH procedures screened, 136 adult intradural tumors met the criteria (108 extramedullary; 28 intramedullary). The average operative time, blood loss, and hospital stay were 91.0±13.5 minutes, 58.5±16.6 mL, and 3.97±1.05 days, respectively. One patient developed postoperative complications (cerebrospinal fluid leak requiring duraplasty); no transfusions or instrumented fusion were required. GTR was achieved in 95.6% cases; six intramedullary astrocytomas underwent STR followed by stereotactic radiotherapy. Neurological status improved significantly in extramedullary tumors (p<0.001), and no radiographic recurrence or delayed fusion occurred during follow-up. UH allows high resection rates, neurological improvement, low morbidity, and durable mechanical stability in intradural tumors, supporting its use as a tissue-preserving alternative to wider posterior exposure.

Retrospective, single-center study. This study aimed to evaluate whether active apex correction (APC) enables effective modulation of the apical vertebrae in congenital early-onset scoliosis (EOS). APC is a posterior tethering technique that incorporates guided growth principles for the treatment of EOS. The procedure involves the strategic placement of tethering pedicle screws on the convex side of the apical region to achieve controlled modulation of vertebral growth. This retrospective study included 10 patients with congenital EOS who underwent APC as the primary surgical procedure. Preoperative and final follow-up assessments were performed using EOS imaging to measure concave and convex vertebral heights at the apical region and evaluate growth modulation. Patients were excluded if follow-up was <2 years, if apex modulation data were incomplete, or if APC was not the index procedure. The mean age at surgery was 8.2±2.39 years, and the mean postoperative follow-up was 2.3±0.48 years. The concave-toconvex vertebral height ratio at the apical region showed significant changes. At proximal apical vertebrae (A1), the ratio increased from 0.75 preoperatively to 0.84 at final follow-up (p<0.05). At the middle vertebrae (A2), the ratio improved from 0.71 to 0.78 (p<0.05). At the distal vertebrae (A3), the ratio increased from 0.77 to 0.81, although this change was not statistically significant (p>0.05). In contrast, untethered control vertebrae demonstrated a stable mean concave-to-convex height ratio. APC appears effective in EOS, enabling targeted modulation of the three apical vertebrae through guided growth principles. This technique enables controlled correction of the spinal apex and represents a promising growth-preserving alternative for apical deformity management.

Systematic review and meta-analysis. To investigate the efficacy and safety of intradiscal mesenchymal stem cell (MSC) injection for patients with degenerative disc disease (DDD). DDD is a common cause of chronic low-back pain (CLBP). Studies have shown that MSC therapy may have the potential to reverse the degenerative process. However, the evidence remains inconclusive. A comprehensive search of Europe PMC, Cochrane Library, Scopus, and Medline was conducted up to April 30, 2025, using relevant keywords. Randomized controlled trials (RCTs) comparing intradiscal MSC injections with sham/placebo in patients with DDD were included. Random-effects models were used to calculate the odds ratios and mean differences (MDs). Seven RCTs were included. MSC injection was associated with significantly greater reductions in Visual Analog Scale pain scores (MD, 6.67; 95% confidence interval [CI], -9.31 to -4.02; p<0.00001, I2=29%) and Oswestry Disability Index (ODI) (MD, -4.05%; 95% CI, -5.24 to -2.87; p<0.00001, I2=32%) compared with sham/placebo. The magnitude of improvement increased with longer followup. No significant differences were observed between groups in treatment-emergent adverse events (AEs), serious AEs, treatment discontinuation due to AEs, or mortality. Intradiscal MSC injection appears to be a safe and effective therapy, offering modest improvements in pain and function for patients with CLBP due to DDD who do not respond to conservative treatments.

This was a retrospective study using the Diagnosis Procedure Combination (DPC) database. Using a large national database, we aimed to investigate the epidemiology, treatment patterns, and outcomes of cervical fracture dislocation (CFD) among adolescents. There have been numerous clinical studies on CFD in adults. However, the current lack of studies on adolescent CFD is a clinically relevant research gap that urgently needs to be addressed. Among 4,653 inpatients who were identified to have a definitive diagnosis of CFD from 2010 to 2021 from the DPC database, we extracted the medical data of 84 adolescent inpatients (aged 11-18 years). CFD in adolescent inpatients was rare, accounting for only 1.8% of all patients with CFD in the DPC database. Complications occurred in 31 patients (36.9%), and mortality rate was 9.5%. Of eight patients who died, four were complicated by traumatic brain injury. Polytrauma was found in 32 patients (38.1%), and its incidence was significantly higher in those with mental disorders (p <0.001). The proportion of patients who were discharged home was significantly lower in those with mental disorders than in those without mental disorders (p =0.01). This epidemiological study provided new insights into adolescent CFD using real-world data. Future research should focus on the evaluation of long-term functional prognosis and development of preventive strategies and improved treatments for CFD in adolescent patients.

Accurate assessment of fusion status following spinal fusion surgery is paramount, as it closely relates to patient outcomes and quality of life. Multiple imaging modalities have been developed to evaluate fusion, each with distinct advantages and limitations. Plain radiography remains the most accessible and practical method, with dynamic flexion-extension radiographs providing reasonably reliable information on segmental motion and stability. Computed tomography offers superior spatial resolution and enables direct visualization of trabecular bone bridging between vertebral segments, making it the most accurate modality for confirming fusion. Magnetic resonance imaging and radionuclide imaging can serve as complementary techniques, particularly when conventional methods are inconclusive or contraindicated. This review summarizes the strengths and limitations of each imaging modality used for assessing spinal fusion. It also highlights recent technological advances and emerging diagnostic approaches that may enhance the objectivity, reliability, and accuracy of fusion assessment in the future.

Lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) is a minimally invasive procedure designed to treat lumbar spinal stenosis. While traditional uniportal endoscopic decompression already reduces tissue damage and promotes faster recovery compared to open surgery, this work introduces standardized terminology and specific endoscope-camera maneuvers to improve visualization and precision during both ipsilateral and contralateral decompression. By describing endoscope ("shaft") and camera head ("optic") rotations in a degree-degree format (e.g., 0-0, 90-0, 135-135, 180-180), the technique allows reproducible, targeted access to key anatomical areas while minimizing unnecessary bone removal. This systematic approach addresses the steep learning curve and technical intricacies of lumbar endoscopy, aiding intraoperative communication and potentially decreasing complications from inadequate decompression or poor visualization. The method aims to improve training, safety, and consistency of outcomes in endoscopic lumbar decompression procedures stenosis.

Retrospective cohort study. This study aimed to investigate bone quality and the trajectories of modified paravertebral foramen screw (mPVFS) on computed tomography (CT) images compared with those of PVFS and lateral mass screw (LMS). With increasing demand for cervical posterior fusion in aging populations, achieving optimal fixation remains challenging. The PVFS offers biomechanical stability with a safer trajectory than traditional pedicle screw and LMS. However, its efficacy in elderly patients with poor bone quality is a concern. We analyzed the cervical CT images of 40 patients (10 patients per group), stratified by age and sex. Bone mineral density was assessed using CT attenuation values of the C5 vertebral body and lateral mass. We compared screw length, insertion area, and CT attenuation values along the screw trajectory across techniques. Bone quality decreased significantly with age, particularly in women. The mPVFS had a significantly longer trajectory than that of the PVFS (2.5-3.0 mm longer) and the LMS (1 mm longer) and a larger screw-bone contact area (1.2× that of PVFS, 1.4× that of LMS). CT attenuation values were higher along the mPVFS trajectory than along the PVFS and LMS trajectories. The differences were not consistently significant. mPVFS provides a biomechanical advantage by increasing screw length and contact area while targeting dense cancellous bone. mPVFS could safely accommodate screws that are 2.5-3.0 mm longer than conventional PVFS, irrespective of patient age or sex, which may be a potential clinical advantage. To validate its efficacy and long-term stability, further biomechanical and clinical studies are required.

Multicenter retrospective cohort study. To evaluate the impact of abscess presence and type on treatment duration and clinical outcomes in patients undergoing minimally invasive posterior fixation for thoracolumbar pyogenic spondylitis. Surgical management is increasingly favored for pyogenic spondylitis. Abscesses, particularly epidural and iliopsoas, have been linked to poorer prognoses, and empyema, though uncommon, tends to be particularly severe. However, the effect of specific abscess types on surgical outcomes remains unclear. This study included 92 patients who underwent minimally invasive posterior fixation across 10 centers between 2014 and 2024. Patients were classified into an abscess group (epidural, iliopsoas, empyema, or other) and a non-abscess group. Clinical outcomes, including total duration of intravenous antibiotics and unplanned additional surgeries, were compared. Subgroup and regression analyses were conducted to assess the impact of specific abscess type. Abscesses were present in 65 patients (71%): epidural (n=51), iliopsoas (n=38), and empyema (n=3), with some overlap. Compared with the non-abscess group (n=27; 29%), there were no significant differences in antibiotic duration or rates of unplanned additional surgery. However, iliopsoas abscess was associated with longer antibiotic duration (8.1 weeks vs. 6.6 weeks, p =0.044), while all empyema cases required additional surgery for poor infection control (p =0.000). Regression analysis identified iliopsoas abscess and age ≥65 years as independent predictors of prolonged antibiotic use, whereas epidural abscess was associated with shorter antibiotic duration. Iliopsoas abscesses were associated with longer antibiotic courses, while empyema was linked to poor infection control and a higher likelihood of additional surgery.