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Henri d'Astorg, Stephane Bourret, Sonia Ramos-Pascual, Marc Szadkowski, and Jean-Charles Le Huec


  • To report accuracy, repeatability, and agreement of Cobb angle measurements on radiographs and/or stereo-radiographs (EOS) compared against one another or against other imaging modalities.


  • This review follows Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A literature search was conducted on 21 July 2021 using Medline, Embase, and Cochrane. Two researchers independently performed title/abstract/full-text screening and data extraction. Studies were eligible if they reported Cobb angles, and/or their repeatability and agreement, measured on radiographs and/or EOS compared against one another or against other imaging modalities.


  • Of the 2993 records identified, 845 were duplicates and 2212 were excluded during title/abstract/full-text screening. Two more relevant studies were identified from references of eligible studies, leaving 14 studies for inclusion. Two studies compared Cobb angles from EOS vs CT, while 12 compared radiographs vs other imaging modalities: EOS, CT, MRI, digital fluoroscopy, or dual-energy x-ray absorptiometry. Angles from standing radiographs tended to be higher than those from supine MRI and CT, and angles from standing EOS tended to be higher than those from supine or prone CT. Correlations across modalities were strong (R = 0.78–0.97). Inter-observer agreement was excellent for all studies (ICC = 0.77–1.00), except one (ICC = 0.13 radiographs and ICC = 0.68 for MRI).


  • Differences of up to 11º were found when comparing Cobb angles across combinations of imaging modalities and patient positions. It is not possible, however, to determine whether the differences observed are due to the change of modality, position, or both. Therefore, clinicians should be careful when utilizing the thresholds for standing radiographs across other modalities and positions for diagnosis and assessment of scoliosis.

Hua Luo, Chaojun Shen, Tongyou Qu, Lin Chen, Yue Sun, and Yu Ren

  • Convulsions are a neurological illness that has complexity. In clinical treatment, drug-induced convulsions appear from time to time. Drug-induced convulsions often begin as isolated acute seizures but may progress to persistent seizures. In orthopedics, topical administration of tranexamic acid is commonly used in conjunction with intravenous drip to achieve hemostasis during artificial joint replacement surgery. However, side effects induced by tranexamic acid accidental spinal administration should be taken seriously.

  • We report a case of a middle-aged male treated with tranexamic acid locally in combination with intravenous drip for intraoperative hemostasis when undergoing spinal surgery. The patient had involuntary convulsions in both lower limbs after the operation. After symptomatic administration, the symptoms of convulsions gradually resolved. During the follow-up, the convulsions never occurred again. We reviewed the literature on cases with side effects of local tranexamic acid application in spinal surgery and discussed the mechanism of tranexamic acid-induced convulsions.

  • Tranexamic acid is associated with an increased incidence of postoperative seizures. However, many clinicians are unaware that tranexamic acid causes seizures. This rare case summarized the risk factors and clinical features of these seizures. Moreover, it highlights several clinical and preclinical studies that offer mechanistic insights into the potential causes and treatments for tranexamic acid-associated seizures. A clear understanding of tranexamic acid-induced convulsions-related adverse reactions can help the first-line clinical screening of causes and adjustment of drug treatment. This review will aid the medical community by increasing awareness about tranexamic acid-associated seizures and translating scientific findings into therapeutic interventions for patients.

Charles Court, Leonard Chatelain, Barthelemy Valteau, and Charlie Bouthors

  • In young patients, lumbosacral fractures result primarily from high-energy traumas. Life-threatening lesions (e.g. visceral organs) are frequently associated with these fractures. Management consists of medical intensive care for adequate resuscitation and specialized surgical input.

  • Lumbosacral junction represents a frontier between the spine and pelvic ring. Any injury in this area implies a thorough examination of both spine and pelvis through clinical examinations and CT scans. Patients must be assessed specifically for neurological and bladder/bowel symptoms. Several surgical classifications may be required to describe the entire fracture pattern.

  • In unstable fracture with large displacements, definitive surgical fixation is often recommended. Various pelvic and spine surgery techniques can be used depending on the fracture pattern, surgeon’s experience, and available equipment. The use of intraoperative navigation may enhance placement of instrumentation, especially in cases of complex fractures, percutaneous fixations, and/or atypical patients’ anatomy.

  • The fracture itself can cause debilitating complications with long-term consequences such as pain, neurological deficits, and bladder/bowel impairments. Wound infection remains the most common postoperative complication and prominent posterior instrumentation is frequently a source of pain. Irrespective of the treatment, leg discrepancy can be problematic in the case of malunion.

  • Management of lumbosacral fractures requires a thorough understanding of both lumbar spine and pelvic injuries. Surgical treatment may involve a combination of spine and pelvic surgery techniques. Therefore, this implies for the surgeon to be trained specifically for these fractures, or else a close cooperation between the pelvic surgeon and the spine surgeon in managing the patients.

Minghe Yao, Tingkui Wu, and Beiyu Wang

  • Mesenchymal stromal cells (MSCs) are important potential candidates for regenerative therapy for intervertebral disc degeneration (IDD). This scientometric study aimed to summarize the main research trends, identify current research hotspots, and measure the networks of the contributors and their scientific productivity.

  • A total of 1102 publications regarding MSC in IDD were recognized from January 2000 to April 2022. The number of records every year followed an overall uptrend with fluctuations.

  • The main trend of research demonstrated the practice of gradually applying MSC-based therapy to IDD with the assistance of advances in biomaterials and IDD pathology. A recent focus on MSC-derived exosomes and notochordal cells was detected.

  • The basic studies in this field were mainly contributed to by Japan, the USA, and European countries, while China dominated in the number of recent publications. Tokai University with Daisuke Sakai was the most productive contributor.

  • Cell biology, tissue engineering, and biomaterials were the categories with deep engagement in research of this field.

Paulo Diogo Cunha, Tiago P Barbosa, Guilherme Correia, Rafaela Silva, Nuno Cruz Oliveira, Pedro Varanda, and Bruno Direito-Santos

  • Patient positioning on the surgical table is a critical step in every spine surgery. The most common surgical positions in spine surgery are supine, prone and lateral decubitus.

  • There are countless lesions that can occur during spine surgery due to patient mispositioning. Ulnar nerve and brachial plexus injuries are the most common nerve lesions seen in malpositioned patients. Devastating complications due to increased intraocular pressure or excessive abdominal pressure can also occur in prone decubitus and are real concerns that the surgical team must be aware of.

  • All members of the surgical team (including surgeons, anesthesiologists and nurses) should know how to correctly position the patient, identify possible positioning errors and know how to avoid them in order to prevent postoperative morbidity.

  • This work pretends to do a review of the most common positions during spine surgery, alert to errors that can happen during the procedure and how to avoid them.

Michiel Vande Kerckhove, Henri d'Astorg, Sonia Ramos-Pascual, Mo Saffarini, Vincent Fiere, and Marc Szadkowski


  • This study aimed to systematically review the literature for comparative and non-comparative studies reporting on clinical outcomes of patients with lumbar foraminal stenosis treated by either endoscopic foraminotomy or fusion.


  • In adherence with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a literature search was done on January 17, 2022, using Medline and Embase. Clinical studies were eligible if they reported outcomes following fusion or endoscopic foraminotomy, in patients with primary lumbar foraminal stenosis. Two independent reviewers screened titles, abstracts, and full-texts to determine eligibility; performed data extraction; and assessed the quality of eligible studies according to the Joanna Briggs Institute (JBI) checklist.


  • The search returned 827 records; 266 were duplicates, 538 were excluded after title/abstract/full-text screening, and 23 were eligible, with 16 case series reporting on endoscopic foraminotomy, 7 case series reporting on fusion, and no comparative studies. The JBI checklist indicated that 21 studies scored ≥4 points. When comparing endoscopic foraminotomy to fusion, pooled data revealed reduced operative time (69 vs 119 min, P < 0.01) but similar Oswestry disability index (19 vs 20, P = 0.67), lower back pain (2 vs 2, P = 0.11), leg pain (2 vs 2, P = 0.15), complication rates (10% vs 5%, P = 0.22), and reoperation rates (5% vs 0%, P = 0.16). The proportions of patients with good/excellent MacNab criteria were similar for endoscopic foraminotomy and fusion (82–91% vs 85–91%).


  • There were high heterogeneity and no significant differences in clinical outcomes, complication rates, and reoperation rates between endoscopic foraminotomy and fusion for the treatment of lumbar foraminal stenosis; although endoscopic foraminotomy has reduced operative time.

Amer Sebaaly, Sarah Farjallah, Khalil Kharrat, Gaby Kreichati, and Mohammad Daher

  • Scheuermann’s Kyphosis (SK) is a rigid spinal kyphosis. Several theories have been proposed concerning its pathogenesis, but it is, to this day, still unknown.

  • It has a prevalence of 0.4–8.3% in the population with a higher incidence in females.

  • Clinical examination with x-rays is needed to differentiate and confirm this diagnosis.

  • Non-surgical management is reserved for smaller deformities and in skeletally immature patients, whereas surgery is recommended for higher deformities.

  • Combined anterior and posterior approach was considered the gold standard for the surgical treatment of this disease, but there is an increasing trend toward posterior-only approaches especially with use of segmental fixation.

  • This study reviews the pathophysiology of SK while proposing a treatment algorithm for its management.

Wen-xi Sun, Hao-nan Liu, Meng-tong Chen, Yong-peng Lin, Hong-shen Wang, and Bo-lai Chen


  • The aim of this study was to comprehensively evaluate the efficacy of oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of degenerative lumbar spondylolisthesis by meta-analysis.


  • A computer-based search of PubMed, Cochrane Library, Embase, Web of Science Core Collection databases, the China National Knowledge Infrastructure, China Biology Medicine, and Wanfang Digital Periodicals was conducted from the time of inception of each database to December 2021. The review process was conducted according to the PRISMA guidelines and registered in the PROSPERO database. Meta-analysis was performed using RevMan 5.4 software provided by the Cochrane Library.


  • Thirteen studies were included in the statistical analysis. One randomized controlled study and 12 cohort studies with 954 patients were included. In terms of operation time, intraoperative blood loss, Oswestry disability index score, intervertebral height, and complications, the OLIF group was better than the TLIF group, and the difference was statistically significant (P < 0.05). There was no significant difference between the two groups in terms of visual analogue scale score, lumbar lordosis or fused segment lordosis (P > 0.05).


  • Both OLIF and TLIF are effective surgical modalities in the treatment of degenerative lumbar spondylolisthesis. They achieve similar therapeutic effects, but OLIF is superior to TLIF in restoring intervertebral height. At the same time, OLIF has the advantages of short operation time and less intraoperative blood loss.

Qiushi Bai, Yuanyi Wang, Jiliang Zhai, Jigong Wu, Yan Zhang, and Yu Zhao

  • Tandem spinal stenosis (TSS) is defined as the concomitant occurrence of stenosis in at least two or more distinct regions (cervical, thoracic, or lumbar) of the spine and may present with a constellation of signs and symptoms. It has four subtypes, including cervico-lumbar, cervico-thoracic, thoraco-lumbar, and cervico-thoraco-lumbar TSS. The prevalence of TSS varies depending on the different subtypes and cohorts.

  • The main aetiologies of TSS are spinal degenerative changes and heterotopic ossification, and patients with developmental spinal stenosis, ligament ossification, and spinal stenosis at any region are at an increased risk of developing TSS.

  • The diagnosis of TSS is challenging. The clinical presentation of TSS could be complex, concealed, or severe, and these features may be confusing to clinicians, resulting in an incomplete or delayed diagnosis. Additionally, a consolidated diagnostic criterion for TSS is urgently required to improve consistency across studies and form a basis for establishing treatment guidelines.

  • The optimal treatment option for TSS is still under debate; areas of controversies include choice of the decompression range, choice between simultaneous or staged surgical patterns, and the order of the surgeries.

  • The present study reviews publications on TSS, consolidates current awareness on prevalence, aetiologies, potential risk factors, diagnostic dilemmas and criteria, and surgical strategies based on TSS subtypes. This is the first review to include thoracic spinal stenosis as a candidate disorder in TSS and aims at providing the readers with a comprehensive overview of TSS.

Geovanny Ruiz, Norberto J Torres-Lugo, Pablo Marrero-Ortiz, Humberto Guzmán, Gerardo Olivella, and Norman Ramírez

  • Early-onset scoliosis (EOS) is defined as any spinal deformity that is present before 10 years old, regardless of etiology.

  • Deformity must be evaluated based on the intercorrelation between the lungs, spine, and thorax.

  • Curvatures of early-onset have increased risk of progression, cardiorespiratory problems, and increased morbidity and mortality.

  • Progression of the deformity may produce thoracic insufficiency syndrome, where a distorted thorax is unable to support normal respiratory function or lung growth.

  • Management and treatment of EOS should pursue a holistic approach in which the psychological impact and quality of life of the patient are also taken into consideration.

  • Growth-friendly surgical techniques have not met the initial expectations of correcting scoliotic deformity, promoting thoracic growth, and improving pulmonary function.