ABSTRACT Objective: To compare posterior decompression techniques in degenerative cervical myelopathy (DCM) and evaluate their clinical outcomes. Methods: A retrospective observational study was conducted on patients with DCM who underwent posterior cervical decompression surgery between 2012 and 2022. Variables analyzed included surgical time, intraoperative blood loss, and hospital stay. Results: A total of 32 patients were included. Open surgery had a surgical time of 176.6 ± 45.3 minutes, blood loss of 300.5 ± 236.3 ml, and a hospital stay of 4.5 ± 4.4 days. Minimally invasive surgery had a surgical time of 161.5 ± 72 minutes, blood loss of 93.8 ± 69.5 ml, and a hospital stay of 1.8 ± 1 day. Conclusions: Minimally invasive decompression resulted in shorter surgical time, reduced blood loss, and shorter hospital stay compared to open surgery. Further research is needed to determine its impact on functional outcomes. Level of Evidence II; Retrospectivef Study.

ABSTRACT Objective: To evaluate the cost-effectiveness of combining sacral epidural block with foraminal block in the treatment of degenerative lumbar spine diseases and compare it with patient age. Materials and Methods: This is a retrospective cohort study. A total of 47 patients with degenerative lumbar spine disease associated with radiating leg pain were included. Low back pain and leg pain were assessed using the visual analog scale (VAS), applied during the consultation before the procedure and one week after. Data were compared preand postoperatively using the paired Student’s t-test. Cost-effectiveness and the cost required for a one-point improvement in VAS to age were calculated using the sum, division, and the rule of three. For inferential analysis, the paired Welch’s t-test with Bootstrap and the robust median test were used. Results: For low back pain, scores ranged from 2 to 10, with a mean of 7.5±2.14 (95% CI: 6.8-8.1) before the procedure, and from 0 to 10, with a mean of 3.1±2.8 (95% CI: 2.3-4.0) one week after (p<0.0001). For leg pain, scores ranged from 1 to 10, with a mean of 6.8±2.5 (95% CI: 6.1-7.4) before the intervention, and from 0 to 9, with a mean of 2.4±2.5 (95% CI: 1.8-3.1) one week after (p<0.0001). The cost of materials used for each procedure was 214.72 reais. Patients over 60 years old showed better cost-effectiveness compared to younger patients in lumbar infiltrations, with Welch’s t-test with Bootstrap 56.0 [21.5;90.2] (p=0.006). Regarding leg pain, there was no significant difference, with Welch’s t-test with Bootstrap -32.4 [-70.9;7.00] (p=0.12). Conclusion: The combination of sacral epidural block and foraminal block in patients over 60 years old for lumbar pain demonstrated better cost-effectiveness, while for leg pain, there was no significant difference in the cost-effectiveness of the procedure. Level of Evidence III; Retrospective Cohort Study.

ABSTRACT Objective: To evaluate the spinopelvic alignment in patients with thoracolumbar junction fractures surgically treated with Schanz screws and to conduct an epidemiological assessment of these patients. Methods: A longitudinal and retrospective study was conducted, analyzing the electronic medical records and imaging files of patients who suffered thoracolumbar junction fractures (T11-L2) and underwent surgery using the Schanz screw technique between January 2017 and January 2021. Spinopelvic balance measurements (PI; LL; PT; SS; PI-LL; L4S1) and epidemiological data such as age, sex, fracture type, and trauma mechanism were analyzed. Radiographic assessments were performed at the initial postoperative period (POI) and 12 months postoperatively (PO 12m) using the Surgimap® system. Results: A total of 35 patients were analyzed. The most prevalent fracture type was AO A4, with a fall from height being the primary trauma mechanism. There was a significant increase in lower lumbar lordosis (L4S1) between POI and PO 12m (8.5°), as well as in PI-LL (8.9°), both with statistical significance. Conclusion: The fixation of thoracolumbar junction fractures with Schanz screws restored normal spinopelvic balance 12 months postoperatively. Males were the most prevalent group, and a fall from height was the main trauma mechanism. Burst fractures were the most common among these injuries. Level of Evidence II; Longitudinal and Retrospective Study.

ABSTRACT Ewing sarcoma (ES) is a highly aggressive primary bone tumor that poses significant diagnostic and therapeutic challenges when affecting the spinal column. This review synthesizes current literature on spinal ES, covering its epidemiology, clinical manifestations, diagnostic methods, differential diagnoses, and multimodal treatment strategies. The focus is for spinal surgeons, highlighting the balance between oncological control and neurological preservation. Early recognition and a rigorous multidisciplinary approach are key for optimizing oncological efficacy and neurological outcomes. Systemic chemotherapy is fundamental, while surgical resection is vital for local control, neurological decompression, and spinal stability. En bloc resection, when feasible, shows advantages in local control and disease-free survival. Radiation therapy is an important adjuvant or primary local treatment. This review clarifies managing spinal ES, emphasizing specialized, integrated care to improve patient prognosis and quality of life. Level of Evidence III; Review Article.

ABSTRACT This review aims to update the cervical laminoplasty techniques described in the literature and perform a systematic review of the open-door (ODL) and French-door (FDL) laminoplasties. A literature review was conducted on the Pubmed and Scielo platforms. This study was separated into two phases. The first section reviewed the laminoplasty techniques described in the literature. In this phase, a literature review was carried out using the descriptor “cervical laminoplasty”, employing “clinical trial”, “meta-analysis”, “review,” and “systematic review” as filters. The second section was a systematic review of the two most-studied techniques, the open-door and French-door laminoplasties. In this phase, a review was carried out using the descriptors “cervical laminoplasty”, “open-door” and “French-door” or “double-door”, employing “meta-analysis” and “review” as filters. In both phases, no limits were defined on the period. The first laminoplasty was described in 1973 and, since then, there have been, at least, six more techniques described that involve opening the spinal canal. Other studies report slight modifications in the type of spine access or details related to the osteotomy technique. Five systematic reviews were performed comparing the ODL and FDL. Only two of them analyzed common variables, and their results were divergent. Both ODL and FDL achieve favorable clinical and radiological results for the patient, and it is not yet possible to say whether one is better than the other. Level of Evidence II; Therapeutic Studies.

ABSTRACT Objective: To evaluate whether prolonged preoperative halo gravity traction (HGT) influences spinopelvic parameters in patients with severe spinal deformities. Methods: This retrospective observational study included patients treated with preoperative HGT between 2017 and 2023 at a spine deformity referral center. Inclusion criteria comprised curves >100°, and a minimum of two weeks of preoperative traction. Pre- and post-HGT radiographs were analyzed to assess changes in coronal and sagittal Cobb angles, sagittal vertical axis (SVA), and spinopelvic parameters—pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL). Statistical significance was set at p ≤ 0.05. Results: Fifteen patients met the inclusion criteria. HGT resulted in significant preoperative reductions in proximal thoracic, main thoracic, and thoracolumbar/lumbar Cobb angles. Sagittal Cobb angle and T5–T12 kyphosis significantly improved, while T2–T5 kyphosis remained unchanged. Spinopelvic parameters (PI, PT, SS, LL) and SVA did not show statistically significant changes after HGT. Individual LL variations were noted, but not at the group level. Conclusion: While HGT remains an important tool for the management of severe spinal deformities, its influence on spinopelvic parameters is negligible. Level of Evidence IV; Therapeutic Study.

ABSTRACT Objectives: This study aims to report and analyze two cases of tension hemothorax in patients with neurofibromatosis type 1 (NF1) undergoing scoliosis surgery, highlighting the incidence, etiology, and optimal treatment strategies. Methods: We present two detailed cases of tension hemothorax in NF1 patients who underwent scoliosis surgery. Clinical presentations, diagnostic findings, treatment interventions, and outcomes were meticulously documented. A literature review was conducted to contextualize these cases within the broader spectrum of tension hemothorax in NF1 patients undergoing similar surgeries. Results: Both cases involved severe complications requiring immediate surgical interventions. The first patient experienced arterial bleeding necessitating endovascular embolization, while the second patient required open thoracotomy. Postoperative management included intensive monitoring and multidisciplinary care. The literature review supported these findings, indicating that surgical interventions such as chest tube insertion, thoracoscopy, and angiography with endovascular embolization are common in such cases. Conclusion: These cases underscore the critical need for vigilance and prompt intervention in managing tension hemothorax in NF1 patients undergoing scoliosis surgery. A multidisciplinary approach is essential for optimizing treatment outcomes and improving understanding of this rare but life-threatening complication in this specific surgical context. Level of Evidence IV; Case Report.

ABSTRACT Contralateral radiculopathy due to disc herniation (DH) is a rare and challenging condition. Contralateral symptoms may result from nerve root traction or local inflammation, complicating surgical decision-making. This case report describes the endoscopic treatment of a recurrent lumbar DH with contralateral symptoms. A 48-year-old woman with low back pain radiating to the left lower limb (LLL) was diagnosed with L4-L5 DH. After conservative treatment failure, endoscopic discectomy was performed with significant improvement. Five months later, the patient presented with recurrent DH and intense pain in the right lower limb (RLL). A new left extra-foraminal endoscopic procedure was performed, resulting in symptom resolution and functional recovery. Contralateral DH may result from preexisting stenosis or inflammation. The endoscopic approach offers a less invasive and effective treatment option with rapid recovery. Endoscopic surgery was effective in treating recurrent DH with contralateral symptoms, but further studies are needed to determine the best approach. Level of Evidence IV; Case Report.

ABSTRACT Objective: Evaluate and compare sagittal parameters of the spine in different morphological types of cervical curves. Method: ten lateral radiographs of the cervical spine of each morphological type of cervical curvature (lordotic, straightened, sigmoid and kyphotic) were used to measure the C1-C2 angle, C2-C7 angle using the Cobb method, T1 inclination, T1-lordosis inclination C2-C7 cervical and axial sagittal cervical axis. Parameter measurements were compared in the different morphological types of cervical spine curvature. Results: a statistical difference was observed in the C2-C7 angle, T1 inclination and T1 inclination-C2-C7 cervical lordosis in the different morphological types of cervical curvature. No statistical difference was observed in the C1-C2 angle and axial sagittal cervical axis in the different morphological types of cervical curvature.Conclusion: sagittal parameters (C2-C7 angle by Cobb method, T1 inclination, T1 inclination-C2-C7 cervical lordosis) present differences in the different morphological types of cervical curvatures and must be considered in the evaluation and therapeutic development. Evidence level III, retrospective comparative study.

ABSTRACT Objective: To predict lumbar spine flexibility by analyzing the difference in lumbar lordosis between orthostatic and supine positions. Methods: A retrospective analysis was conducted on patients undergoing interbody fusion and posterior fixation surgery between 2013 and 2019 due to degenerative diseases of the lumbar spine. All patients were over 18 years old, and preand post-operative weight-bearing X-rays and pre-operative magnetic resonance imaging were obtained. The difference between lumbar lordosis in standing X-rays and magnetic resonance imaging was calculated as lordosis delta and compared to post-operative radiographic outcomes. Results: The study involved 49 patients, with the most approached level being L4-L5 (49.0%). The Roussouly type 3 of lumbar lordosis was the most common (53.1%). Disc degeneration syndrome (DDS) was the predominant diagnosis (83.7%). The Pearson correlation between lordosis delta and post-operative lumbar lordosis was significantly positive. Conclusion: This study establishes a correlation between lumbar lordosis delta and post-operative radiographic outcomes, suggesting its utility in the pre-operative assessment of lumbar spine flexibility. Level of Evidence IV; Retrospective Observational Study.