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Rory D. S. Gibson, Ralf Wagner, and J. N. Alastair Gibson

  • In the last five years, surgeons have applied endoscopic transforaminal surgical techniques mastered in the lumbar spine to the treatment of thoracic pathology.

  • The aim of this systematic review was to collate the available literature to determine the place and efficacy of full endoscopic approaches used in the treatment of thoracic disc prolapse and stenosis.

  • An electronic literature search of PubMed, Embase, the Cochrane database and Google Scholar was performed as suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis statements. Included were any full-text articles referring to full endoscopic thoracic surgical procedures in any language.

  • We identified 17 patient series, one cohort study and 13 case reports with single or of up to three patients.

  • Although the majority included disc pathology, 11 papers related cord compression in a proportion of cases to ossification of the ligamentum flavum or posterior longitudinal ligament. Two studies described the treatment of discitis and one reported the use of endoscopy for tumour resection.

  • Where reported, excellent or good outcomes were achieved for full endoscopic procedures in a mean of 81% of patients (range 46–100%) with a complication rate of 8% (range 0–15%), comparing favourably with rates reported after open discectomy (anterior, posterolateral and thoracoscopic) or by endoscopic tubular assisted approaches. Twenty-one of the 31 author groups reported use of local anaesthesia plus sedation rather than general anaesthesia, providing ‘self-neuromonitoring’ by allowing patients to respond to cord and/or nerve stimuli.

Cite this article: EFORT Open Rev 2021;6:50-60. DOI: 10.1302/2058-5241.6.200080

Alpaslan Senkoylu, Rolf B. Riise, Emre Acaroglu, and Ilkka Helenius

  • Management of scoliosis in young children needs a comprehensive approach because of its complexity. There are many debatable points; however, only serial casting, growing rods (including traditional and magnetically controlled) and anterior vertebral body tethering will be discussed in this article.

  • Serial casting is a time-gaining method for postponing surgical interventions in early onset scoliosis, despite the fact that it has some adverse effects which should be considered and discussed with the family beforehand.

  • Use of growing rods is a growth-friendly surgical technique for the treatment of early onset spine deformity which allows chest growth and lung development. Magnetically controlled growing rods are effective in selected cases although they sometimes have a high number of unplanned revisions.

  • Anterior vertebral body tethering seems to be a promising novel technique for the treatment of idiopathic scoliosis in immature cases. It provides substantial correction and continuous curve control while maintaining mobility between spinal segments. However, long-term results, adverse effects and their prevention should be clarified by future studies.

Cite this article: EFORT Open Rev 2020;5:753-762. DOI: 10.1302/2058-5241.5.190087

Jean-Charles Le Huec, Stephane Bourret, Wendy Thompson, Christian Daulouede, and Thibault Cloché

  • The sacroiliac joint (SIJ) is a complex anatomical structure located near the centre of gravity of the body.

  • Micro-traumatic SIJ disorders are very difficult to diagnose and require a complete clinical and radiological examination.

  • To diagnose micro-trauma SIJ pain it is recommended to have at least three positive provocative specific manoeuvres and then a radiologically controlled infiltration test.

  • Conservative treatment combining physiotherapy and steroid injections is the most common therapy but has a low level of efficiency. SIJ thermolysis is the most efficient non-invasive therapy.

  • SIJ fusion using a percutaneous technique is a solution that has yet to be confirmed on a large cohort of patients resistant to other therapies.

Cite this article: EFORT Open Rev 2020;5:691-698. DOI: 10.1302/2058-5241.5.190081

Michaël Moeri, Dominique A. Rothenfluh, Christoph J. Laux, and Dennis E. Dominguez

  • No definite consensus exists for the clearance of the cervical spine (C-spine) after blunt trauma, despite many validated algorithms, recommendations and guidelines. We intend to answer the most relevant questions with which physicians are confronted when clearing C-spines after blunt trauma in emergency departments (EDs). To exclude significant C-spine injuries we designed an algorithm to be compatible with clinical practice, to simplify patient management and avoid unrewarding evaluation.

  • We conducted an exploratory PubMed search including articles published from January 2000 to October 2018. Keywords used were “cervical spine”, “injury”, “clearance”, “Canadian C-spine Rule”, “CCR” and “national emergency x-radiography utilization study”. Clinical and experimental studies were included in a detailed review.

  • We based our literature review on 33 articles. While answering fundamental triage questions from daily clinical practice, the current literature is discussed in detail. We designed an algorithm for the C-spine clearance suitable for any trauma centre with a high-quality multiplanar reconstruction computerized tomography (CT) scan continuously available.

  • The high sensitivity of the Canadian C-spine Rule (CCR) prevents missing C-spine injuries while limiting the amount of unnecessary radiologic examinations. Plain radiographs were fully abandoned for C-spine clearance. A negative CT scan is sufficient to clear the majority of C-spine injuries and allows for collar removal. In case of motor symptoms or radio-clinical discrepancy, the advice of a specialized spine surgeon must be requested. Magnetic resonance imaging must not be routinely used. Neck pain despite negative imaging is not a reason to delay removal of stiff cervical collars.

Cite this article: EFORT Open Rev 2020;5:253-259. DOI: 10.1302/2058-5241.5.190047

Mirza Biscevic, Aida Sehic, and Ferid Krupic

  • In spine deformity surgery, iatrogenic neurologic injuries might occur due to the mechanical force applied to the spinal cord from implants, instruments, and bony structures, or due to ischemic changes from vessel ligation during exposure and cord distraction/compression during corrective manoeuvres.

  • Prompt reaction within the reversible phase (reducing of compressive/distractive forces) usually restores functionality of the spinal cord, but if those forces continue to persist, a permanent neurological deficit might be expected.

  • With monitoring of sensory pathways (dorsal column–medial lemniscus) by somatosensory-evoked potentials (SSEPs), such events are detected with a sensitivity of up to 92%, and a specificity of up to 100%.

  • The monitoring of motor pathways by transcranial electric motor-evoked potentials (TceMEPs) has a sensitivity and a specificity of up to 100%, but it requires avoidance of halogenated anaesthetics and neuromuscular blockades.

  • Different modalities of intraoperative neuromonitoring (IONM: SSEP, TceMEP, or combined) can be performed by the neurophysiologist, the technician or the surgeon. Combined SSEP/TceMEP performed by the neurophysiologist in the operating room is the preferable method of IONM, but it might be impractical or unaffordable in many institutions. Still, many spine deformity surgeries worldwide are performed without any type of IONM. Medicolegal aspects of IONM are different worldwide and in many cases some vagueness remains.

  • The type of IONM that a spinal surgeon employs should be reliable, affordable, practical, and recognized by the medicolegal guidelines.

Cite this article: EFORT Open Rev 2020;5:9-16. DOI: 10.1302/2058-5241.5.180032

Nick Evans and Michael McCarthy

  • Degenerative low-grade lumbar spondylolisthesis is the most common form of spondylolisthesis.

  • The majority of patients are asymptomatic and do not require surgical intervention.

  • Symptomatic patients present with a combination of lower back pain, radiculopathy and/or neurogenic claudication and may warrant surgery if non-operative measures fail.

  • There is widespread controversy regarding the indications for surgery and appropriate treatment strategies for patients with this type of spondylolisthesis.

  • This article provides a comprehensive evidence-based review of the available literature to support the management of degenerative low-grade spondylolisthesis.

Cite this article: EFORT Open Rev 2018;3:620-631. DOI: 10.1302/2058-5241.3.180020.

Amer Sebaaly, Maroun Rizkallah, Guillaume Riouallon, Zhi Wang, Pierre Emmanuel Moreau, Falah Bachour, and Ghassan Maalouf

  • Surgical treatment of patients with thoracolumbar vertebral fracture without neurological deficit is still controversial.

  • Management of vertebral fracture with percutaneous fixation was first reported in 2004.

  • Advantages of percutaneous fixation are: less tissue dissection; decreased post-operative pain; decreased bleeding and operative time (depending on the steep learning curve); better screw positioning with fluoroscopy compared with an open freehand technique; and a decreased infection rate.

  • The limitations of percutaneous fixation of vertebral fractures include increased radiation exposure to the patient and the surgeon, together with the steep learning curve for this technique.

  • Adding a screw at the level of the fractured vertebra has the advantages of incorporating fewer motion segments with less operative time and bleeding. This also increases the axial, sagittal and torsional stiffness of the construct.

  • Percutaneous fixation alone without grafting is sufficient for treating type A and B1 (AO classification) thoracolumbar fractures with satisfactory results concerning kyphosis reduction when compared with open instrumentation and fusion and with open fixation.

  • Type C and B2 fractures (ligamentous injuries) should undergo fusion since the ligamentous healing is mechanically weak, increasing the risk of instability.

  • This review offers a detailed description of percutaneous screw insertion and discusses the advantages and disadvantages.

Cite this article: EFORT Open Rev 2018;3:604-613. DOI: 10.1302/2058-5241.3.170026.

Emmanuelle Ferrero and Pierre Guigui

  • Degenerative spondylolisthesis (DS) is a common disease of the degenerative spine, often associated with lumbar canal stenosis. However, the choice between the different medical or surgical treatments remains under debate.

  • Preference for surgical strategy is based on the functional symptoms, and when surgical treatment is selected, several questions should be posed and the surgical strategy adapted accordingly.

  • One of the main goals of surgery is to improve neurological symptoms. Therefore, radicular decompression may be necessary. Radicular decompression can be performed indirectly through interbody fusion or interspinous spacer. However, indirect decompression has some limits, and the most frequent technique is a posterior decompression with fusion.

  • Indeed, in cases of DS, associated fusion or dynamic stabilization are recommended to improve functional outcomes and prevent future destabilization. Risk factors for destabilization, such as anteroposterior and angular mobility, and significant disc height, have been discussed in the literature. When fusion is performed, osteosynthesis is often associated. It is essential to choose the length and position of the fusion according to the pelvic incidence and global alignment of the patient. It is possible to add interbody fusion to the posterolateral arthrodesis to improve graft area and stability, increase local lordosis and open foramina.

  • The most common surgical treatment for DS is posterior decompression with instrumented fusion. Nevertheless, some cases are more complicated and it is crucial to consider the patient’s general health status, symptoms and alignment when selecting the surgical strategy.

Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170050

Andreas F. Mavrogenis, Panayiotis D. Megaloikonomos, Vasileios G. Igoumenou, Georgios N. Panagopoulos, Efthymia Giannitsioti, Antonios Papadopoulos, and Panayiotis J. Papagelopoulos

  • Spondylodiscitis may involve the vertebral bodies, intervertebral discs, paravertebral structures and spinal canal, with potentially high morbidity and mortality rates.

  • A rise in the susceptible population and improved diagnosis have increased the reported incidence of the disease in recent years.

  • Blood cultures, appropriate imaging and biopsy are essential for diagnosis and treatment.

  • Most patients are successfully treated by conservative means; however, some patients may require surgical treatment.

  • Surgical indications include doubtful diagnosis, progressive neurological deficits, progressive spinal deformity, failure to respond to treatment, and unresolved pain.

Cite this article: EFORT Open Rev 2017;2:447–461. DOI: 10.1302/2058-5241.2.160062

Scott D. Middleton, Ralf Wagner, and J. N. Alastair Gibson

  • In the last ten years, there has been an exponential increase in endoscopic spinal surgery practice.

  • With improvements in equipment quality and the availability of high definition camera systems, cervical endoscopic disc resection is now a viable alternative to anterior cervical decompression and fusion (ACDF) or disc arthroplasty for the treatment of disc prolapse and low grade stenosis.

  • Based on the current literature, there is now strong evidence to support the use of transforaminal endoscopic approaches for the treatment of thoracic disc prolapse.

  • There is now level I evidence to show that outcomes following transforaminal endoscopic discectomy (TED) are at least equivalent to those after open microdiscectomy, with an expected shorter operating time, lesser requirement for analgesia, reduced duration of post-operative disability, more rapid rehabilitation and lower costs of care. However, it should be recognised that there is a significant learning curve for TED.

  • New endoscopic techniques with interlaminar approaches allow the decompression of central and lateral recess stenosis. Future developments will facilitate vision and access to the spine with 3D imaging and robotics at the forefront.

  • We present a case report of whole spine endoscopic decompression to illustrate the potential of endoscopic surgery at all spinal levels.

Cite this article: EFORT Open Rev 2017;2:317-323. DOI: 10.1302/2058-5241.2.160087