Journal of Spine Practice (JSP)

Are Self-Drilling, Self-Tapping Screws Effective in Anterior Cervical Fusion Surgery? One Surgeon’s Experience with 50 Consecutive Patients

2025-03-13T11:35:36+00:00

Purpose

Even though plate and screw designs in anterior cervical discectomy and fusion (ACDF) have evolved to improve fusion stability and enhance patient outcomes, some argue that pre-tapping remained the best option. The purpose of this study is to evaluate the outcomes and complications of self-drilling, self-tapping screws and evaluate their efficacy in maintaining instrumentation position in plated ACDFs.

Methods

In this retrospective case series, patients who underwent ACDF with plating and selfdrilling, self-tapping screws from February 2021 to May 2023 were consecutively included. Demographic, radiographic, intraoperative, and postoperative data were collected. Odds ratios (ORs) were also utilized to determine factors associated with abnormal C2-C7 Cobb angles and C2-C7 sagittal vertical axes (SVAs) postoperatively.

Results

A total of 50 patients (26M, 24F, mean age: 56.7 ± 10.4) were included. At the final postoperative radiographic follow-up (251.1 ± 226.5 days), the C2-C7 Cobb angle increased by 21.03%, with the C2-C7 SVA increasing by 3.25%. OR assessment found an association with the American Society of Anesthesiologists (ASA) physical status classification score of ≥ 3 and abnormal postoperative C2-C7 SVA (5.667, 95% CI: 1.067 to 30.086, p=0.042). Longer operative times (≥91.5 minutes) were less likely to be associated with abnormal postoperative C2-C7 Cobb angles when compared to shorter operative times (0.175, 95% CI: 0.032 to 0.952, p=0.044). No fixation system complications or evidence of radiographic or clinical pseudoarthrosis were noted.

Conclusion

Patients undergoing ACDF with self-drilling, self-tapping screws had excellent postoperative outcomes and no evidence of instrumentation complications, including pseudoarthrosis. This case series demonstrates the safety of ACDF with this screw design. However, future studies should include a larger cohort of patients to provide more accurate guidelines and recommendations.

The Impact of Lumbosacral Transitional Vertebra on Long-Term Surgical Outcome of Adjacent Single-Level Lumbar Discectomy

2025-03-13T11:35:36+00:00

Introduction

The lumbosacral transitional vertebra (LSTV) theoretically offloads the inferior intervertebral disc and may reciprocally load up the relevant adjacent disc. In this study, we evaluate the influence of LSTV on clinical outcomes of adjacent discectomy in young adults with lumbar disc herniation (LDH).

Methods

This retrospective study included two groups. Group A consisted of 32 LDH patients with LSTV (16 males and 16 females), and Group B included 167 LDH patients without LSTV (89 males and 78 females). All patients underwent single-level discectomy at the adjacent level to LSTV and were followed for a minimum of 24 months post-surgery. The diagnosis of LSTV was based on radiography and computed tomography (CT) scanning performed preoperatively for all patients. Outcome measurements were performed with pain assessment at each follow-up visit using a visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and recurrence rate.

Results

At 24 months after discectomy, the mean VAS scores for low back pain (LBP) and leg pain and ODI scores showed no significant differences between the two groups. Recurrence occurred in 25 patients (15%) in Group A and in 4 patients (12.5%) in Group B.

Conclusions

In the patients with LDH who underwent microlumbar discectomy, after a mean follow-up period of 48.4 ± 13.7 months, we could not find any significant difference in terms of pain, disability, patient satisfaction, or recurrence rate between the group with versus without LSTV.

Systematic Literature Review of the Efficacy and Safety of Khan Kinetic Treatment for Neck and Back Pain

2025-03-13T11:35:36+00:00

Introduction

Khan Kinetic Treatment (KKT) utilizes high-frequency, small-amplitude sinusoidal waves to activate neuromuscular structures to treat neck and back pain. It integrates biomechanics, physical therapy, and neurophysiology. Despite its global use, KKT is not included in clinical guidelines for neck and back pain due to limited data on its safety and efficacy. This study aims to evaluate the available literature on KKT’s current practice in spinal pain management.

Methods

A systematic literature search of PubMed and Google Scholar identified articles on KKT for cervical and lumbar pain using specific keywords. Eligibility criteria included English-language articles without publication date restrictions, patients over 18 years of age undergoing KKT for neck or lower back pain, any outcome measure, and no restrictions on study design or publication date, with the latest date being June 2024.

Results

The search yielded 219 articles; 5 studies met the inclusion criteria and quality assessment. The studies included three Randomized controlled trials (RCTs) and two case reports. Sample sizes ranged from 1 to 49 participants, focusing on neck and lower back pain. The RCTs were rated as Level 2 evidence, while other studies were rated as lower evidence. A high risk of bias was observed in the included trials, and significant heterogeneity in design and outcomes precluded meta-analysis.

Conclusion

Current evidence on KKT’s efficacy for spinal pain is sparse and inconsistent. While some studies suggest benefits in pain reduction and functional improvement, methodological limitations and small sample sizes undermine generalizability. Further, well-designed studies are needed to evaluate KKT’s efficacy, safety, and costeffectiveness.

Interdural Spinal Arachnoid Cyst Case Study and Review of Literature with Operative Technical Considerations

2025-03-13T11:35:35+00:00

Introduction

Spinal arachnoid cysts are commonly encountered throughout all age groups and are often managed observantly, but a minority cause symptoms requiring intervention. These cysts can be caused by congenital malformations, trauma, inflammation, or even occur spontaneously. A vast majority of arachnoid cysts in the spine are extradural, and about 10% are intradural. One type of intradural cyst occurs between two leaflets of the dura, described as an interdural cyst.

Case Report

This case report describes a 47-year-old female with an interdural arachnoid cyst spanning the thoracolumbar region (T11-L3). Initially, the patient was asymptomatic but later presented with progressive neurologic symptoms, including intermittent back pressure, heaviness in her legs, paresthesia, urinary hesitancy, and decreased sensation in the perineal area. Surgical intervention via direct lumbar laminectomy was performed from the bottom of T11 to the top of L3, revealing an interdural cyst without communication to the subarachnoid space. Thus, surgical fenestration was performed to establish a pathway between the cyst and the subarachnoid space to alleviate symptoms and prevent recurrence.

Discussion

The absence of communication between the cyst and the subarachnoid space suggests alternative mechanisms, such as a ball valve mechanism, contributing to cyst expansion. A comprehensive review of existing literature on interdural cysts underscores the necessity for revised classification systems, considering both their fluid content and communication with the subarachnoid space.

Conclusions

The proposed classification of interdural cysts based on CSF analysis and connection to the subarachnoid space may guide operative management and provide more information on the etiology. This classification system could refine outcome data in the operative management of interdural spinal cysts.

Correction of Post-Radiotherapy Cervical Kyphotic Deformity by Gradual Halo Traction Followed by Combined Anterior and Posterior Fusion

2025-03-13T11:35:36+00:00

The article presents a case study on the surgical correction of a severe cervical kyphotic deformity that developed as a post-radiotherapy complication in a pediatric patient. This deformity was treated through a two-stage procedure involving gradual halo traction followed by combined anterior and posterior cervical fusion. The patient, a 15-year-old girl with a history of radiation therapy for a posterior fossa tumor, exhibited significant deformities that compromised her quality of life. Initial halo traction improved the curvature by approximately 60%, after which a 180-degree cervical reconstruction was performed to achieve near-complete correction.

The first stage of the surgery involved posterior decompression and occipito-cervical fixation, while the second stage addressed anterior structural support through discectomy and fusion. The multidisciplinary approach led to a stable cervical alignment with notable functional recovery over an 18-month follow-up, including improvements in oral feeding, gaze stability, and motor function. The article discusses the complexities of managing radiation-induced spinal deformities in pediatric patients, emphasizing the importance of early diagnosis and a comprehensive surgical approach to optimize long-term outcomes