Seth C. Ransom, Zach Pennington, Nolan J. Brown, Shane Shahrestani, Jessica Ryvlin, Ali Shoustari, John C. Hagen, Anthony L. Mikula, Nikita Lakomkin, Luis D. Diaz-Aguilar, Benjamin D. Elder, Joseph A. Osorio, Martin H. Pham
Neurospine 2024;21(2):458-473. Published online June 30, 2024
Adult degenerative scoliosis (ADS) is a coronal plane deformity often accompanied by sagittal plane malalignment. Surgical correction may involve the major and/or distally-located fractional curves (FCs). Correction of the FC has been increasingly recognized as key to ameliorating radicular pain localized to the FC levels. The present study aims to summarize the literature on the rationale for FC correction in ADS. Three databases were systematically reviewed to identify all primary studies reporting the rationale for correcting the FC in ADS. Articles were included if they were English full-text studies with primary data from ADS ( ≥ 18 years old) patients. Seventy-four articles were identified, of which 12 were included after full-text review. Findings suggest FC correction with long-segment fusion terminating at L5 increases the risk of distal junctional degeneration as compared to constructs instrumenting the sacrum. Additionally, circumferential fusion offers greater FC correction, lower reoperation risk, and shorter construct length. Minimally invasive surgery (MIS) techniques may offer effective radiographic correction and improve leg pain associated with foraminal stenosis on the FC concavity, though experiences are limited. Open surgery may be necessary to achieve adequate correction of severe, highly rigid deformities. Current data support major curve correction in ASD where the FC concavity and truncal shift are concordant, suggesting that the FC contributes to the patient’s overall deformity. Circumferential fusion and the use of kickstand rods can improve correction and enhance the stability and durability of long constructs. Last, MIS techniques show promise for milder deformities but require further investigation.
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Low bone density at the upper instrumented vertebra, not the residual fractional curve, predicts mechanical failure in adult spinal deformity: a ten-year single-center series Kento Yamanouchi, Takeshi Fujii, Aiyush Bansal, Kenneth Nguyen, Renzo Laynes, Mir Amaan Ali, Venu M. Nemani, Jean-Christophe Leveque, Philip K. Louie Spine Deformity.2026;[Epub] CrossRef
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Spinal robotics have the potential to improve the consistency of outcomes in adult spinal deformity (ASD) surgery. The objective of this paper is to assess the accuracy of pedicle and S2 alar-iliac (S2AI) screws placed with robotic guidance in ASD patients. PubMed Central, Google Scholar, and an institutional library database were queried until May 2023. Articles were included if they described ASD correction via robotic guidance and pedicle and/or S2AI screw accuracy. Articles were excluded if they described pediatric/adolescent spinal deformity or included outcomes for both ASD and non-ASD patients without separating the data. Methodological quality was assessed using the Newcastle-Ottawa scale. Primary endpoints were pedicle screw accuracy based on the Gertzbein-Robbins Scale and self-reported accuracy percentages for S2AI screws. Data were extracted for patient demographics, operative details, and perioperative outcomes and assessed using descriptive statistics. Five studies comprising 138 patients were included (mean age 66.0 years; 85 females). A total of 1,508 screws were inserted using robotic assistance (51 S2AI screws). Two studies assessing pedicle screws reported clinically acceptable trajectory rates of 98.7% and 96.0%, respectively. Another study reported a pedicle screw accuracy rate of 95.5%. Three studies reported 100% accuracy across 51 total S2AI screws. Eight total complications and 4 reoperations were reported. Current evidence supports the application of robotics in ASD surgery as safe and effective for placement of both screw types. However, due to the paucity of data, a comprehensive assessment of its incremental benefit over other techniques cannot be made. Further work using expanded cohorts is merited.
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Preoperative Robotics Planning Facilitates Complex Construct Design in Robot-Assisted Minimally Invasive Adult Spinal Deformity Surgery—A Preliminary Experience Martin H. Pham, Nicholas S. Hernandez, Lauren E. Stone Journal of Clinical Medicine.2024; 13(7): 1829. CrossRef
Accuracy and postoperative assessment of robot-assisted placement of pedicle screws during scoliosis surgery compared with conventional freehand technique: a systematic review and meta-analysis Wei Cui, Xinglin Liu, Zhiheng Zhao, Zihe Feng, Xianglong Meng Journal of Orthopaedic Surgery and Research.2024;[Epub] CrossRef
The Importance of Planning Ahead: A Three-Dimensional Analysis of the Novel Trans-Facet Corridor for Posterior Lumbar Interbody Fusion Using Segmentation Technology Troy Q. Tabarestani, Peter N. Drossopoulos, Chuan-Ching Huang, Alyssa M. Bartlett, Mounica R. Paturu, Christopher I. Shaffrey, John H. Chi, Wilson Z. Ray, C. Rory Goodwin, Timothy J. Amrhein, Muhammad M. Abd-El-Barr World Neurosurgery.2024; 188: e247. CrossRef
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Neal A. Patel, Sinead O’Bryant, Christopher D. Rogers, Candler K. Boyett, Sachiv Chakravarti, Julian Gendreau, Nolan J. Brown, Zach A. Pennington, Neill B. Hatcher, Cathleen Kuo, Luis Daniel Diaz-Aguilar, Martin H. Pham
Neurospine 2023;20(2):451-463. Published online June 30, 2023
Interbody fusion is a workhorse technique in lumbar spine surgery that facilities indirect decompression, sagittal plane realignment, and successful bony fusion. The 2 most commonly employed cage materials are titanium (Ti) alloy and polyetheretherketone (PEEK). While Ti alloy implants have superior osteoinductive properties they more poorly match the biomechanical properties of cancellous bones. Newly developed 3-dimensional (3D)-printed porous titanium (3D-pTi) address this disadvantage and are proposed as a new standard for lumbar interbody fusion (LIF) devices. In the present study, the literature directly comparing 3D-pTi and PEEK interbody devices is systematically reviewed with a focus on fusion outcomes and subsidence rates reported in the in vitro, animal, and human literature. A systematic review directly comparing outcomes of PEEK and 3D-pTi interbody spinal cages was performed. PubMed, Embase, and Cochrane Library databases were searched according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Mean Newcastle-Ottawa Scale score for cohort studies was 6.4. A total of 7 eligible studies were included, comprising a combination of clinical series, ovine animal data, and in vitro biomechanical studies. There was a total population of 299 human and 59 ovine subjects, with 134 human (44.8%) and 38 (64.4%) ovine models implanted with 3D-pTi cages. Of the 7 studies, 6 reported overall outcomes in favor of 3D-pTi compared to PEEK, including subsidence and osseointegration, while 1 study reported neutral outcomes for device related revision and reoperation rate. Though limited data are available, the current literature supports 3D-pTi interbodies as offering superior fusion outcomes relative to PEEK interbodies for LIF without increasing subsidence or reoperation risk. Histologic evidence suggests 3D-Ti to have superior osteoinductive properties that may underlie these superior outcomes, but additional clinical investigation is merited.
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Lumbar Fusion With Micro- & Nano-Textured, 3D Printed Porous Titanium Versus PEEK Interbody Cages in TLIF: A Single-Blinded, Randomized Controlled Trial Joshua H. Weinberg, Nathan Ritchey, Witty Kwok, Shravani Khisti, Bryan Ladd, Stephanus Viljoen, Siri S. Khalsa, David S. Xu, Andrew J. Grossbach Global Spine Journal.2026; 16(1): 434. CrossRef
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Oblique lateral interbody fusion: role of the elastic modulus of the cage material in mechanically induced osteogenesis Teng Lu, Zhongwei Sun, Xijing He Computer Methods and Programs in Biomedicine.2026; 276: 109242. CrossRef
Unilateral Biportal Endoscopic Transforaminal Lumbar Interbody Fusion (TLIF) Using 3-Dimensional-Printed Titanium Cages Compared With Open TLIF: A Comparison of Clinical Outcomes and Fusion Rates Sang Hyub Lee, Junghan Seo, Dain Jeong, Sang Youp Han, Dong Hyun Lee, Jae-Won Jang, Dong-Geun Lee, Choon Keun Park Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(Suppl 1): S28. CrossRef
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Interbody Cages: Surface Technologies in Spinal Implants Joseph E. Nassar, Lama A. Ammar, Trevor L. Toavs, Jinseong Kim, Ashley Knebel, Mohammad Daher, Christopher I. Shaffrey, Alan H. Daniels Journal of Bone and Joint Surgery.2026; 108(13): 969. CrossRef
Clinical and radiographic outcomes of anterior lumbar interbody fusion (ALIF) with a 3D-printed porous titanium intervertebral cage J. Alex Thomas, Neil A. Tayyab, Kaveh Khajavi, R. Alden Milam, Jeremy Smith Journal of Orthopaedic Surgery and Research.2026;[Epub] CrossRef
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The Importance of Planning Ahead: A Three-Dimensional Analysis of the Novel Trans-Facet Corridor for Posterior Lumbar Interbody Fusion Using Segmentation Technology Troy Q. Tabarestani, Peter N. Drossopoulos, Chuan-Ching Huang, Alyssa M. Bartlett, Mounica R. Paturu, Christopher I. Shaffrey, John H. Chi, Wilson Z. Ray, C. Rory Goodwin, Timothy J. Amrhein, Muhammad M. Abd-El-Barr World Neurosurgery.2024; 188: e247. CrossRef
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Endoscopic Anterior Lumbar Interbody Fusion: Systematic Review and Meta-Analysis Nolan J. Brown, Zach Pennington, Cathleen C. Kuo, Alexander M. Lopez, Bryce Picton, Sean Solomon, Oanh T. Nguyen, Chenyi Yang, Evelyne K. Tantry, Hania Shahin, Julian Gendreau, Stephen Albano, Martin H. Pham, Michael Y. Oh Asian Spine Journal.2023; 17(6): 1139. CrossRef
Omar Al Jammal, Julian Gendreau, Bejan Alvandi, Neal A. Patel, Nolan J. Brown, Shane Shahrestani, Brian V. Lien, Arash Delavar, Katelynn Tran, Ronald Sahyouni, Luis Daniel Diaz-Aguilar, Kevin Gilbert, Martin H. Pham
Neurospine 2021;18(4):725-732. Published online December 31, 2021
Objective To study the impact of demographic factors on management of traumatic injury to the lumbar spine and postoperative complication rates.
Methods Data was obtained from the National Inpatient Sample (NIS) between 2010–2014. International Classification of Diseases, 9th revision, Clinical Modification codes identified patients diagnosed with lumbar fractures or dislocations due to trauma. A series of multivariate regression models determined whether demographic variables predicted rates of complication and revision surgery.
Results A total of 38,249 patients were identified. Female patients were less likely to receive surgery and to receive a fusion when undergoing surgery, had higher complication rates, and more likely to undergo revision surgery. Medicare and Medicaid patients were less likely to receive surgical management for lumbar spine trauma and less likely to receive a fusion when operated on. Additionally, we found significant differences in surgical management and postoperative complication rates based on race, insurance type, hospital teaching status, and geography.
Conclusion Substantial differences in the surgical management of traumatic injury to the lumbar spine, including postoperative complications, among individuals of demographic factors such as age, sex, race, primary insurance, hospital teaching status, and geographic region suggest the need for further studies to understand how patient demographics influence management and complications for traumatic injury to the lumbar spine.
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Identification of an Operative Time Threshold for Substantially Increased Postoperative Complications After Thoracolumbar Spine Surgery: A Nationwide Retrospective Cohort Analysis Bilal Moiz, Khaled M. Taghlabi, Isuru Somawardana, Rijul Nanda, Lokeshwar S. Bhenderu, Jaime R. Guerrero, Aboud Tahanis, Amir H. Faraji World Neurosurgery.2025; 197: 123897. CrossRef
Racial Disparities in Time to Decompression in Central Cord Syndrome: A National Trauma Database Analysis Daniel Deysher, Sam H. Jiang, Harsh Khilwani, Mehul Patnam, Mounika Bhaskara, Syed Khalid, Ryan G. Chiu, Ankit I. Mehta World Neurosurgery.2023; 177: e146. CrossRef
Diagnosis and Management of Thoracolumbar Spinal Disorders Presenting as Cardiac, Gastrointestinal, and Other False Pain Syndromes Nolan J. Brown, Cathleen Kuo, Zach Pennington, Angie Zhang, Ashley E. Choi, Andrew K. Chan, Shane Shahrestani, Nicholas E. Bui, Matthew J. Hatter, Gaston Camino-Willhuber, Martin H. Pham, Michael Y. Oh Clinical Spine Surgery.2025; 38(3): 114. CrossRef
Nolan J. Brown, Brian V. Lien, Shane Shahrestani, Elliot H. Choi, Katelynn Tran, Sandra Gattas, Seth C. Ransom, Ali R. Tafreshi, Ryan Chase Ransom, Ronald Sahyouni, Alvin Chan, Michael Oh
Neurospine 2021;18(1):45-54. Published online March 31, 2021
Objective Cervical spondylotic myelopathy (CSM) is a degenerative disorder leading to progressive decline in spinal cord function. Cervical laminoplasty (CLP) and cervical laminectomy with fusion (CLF) are standard treatments for multilevel CSM. However, it is still unclear whether one procedure over the other provides better outcomes. Here, we performed a comprehensive review of published articles that compare the clinical outcomes and costs between CLP and CLF for CSM.
Methods A literature search was performed using PubMed, Web of Science, and Cochrane databases. Strict exclusion criteria were applied, and included articles were then assessed for publication year, study design, and significant differences in outcome variables.
Results From 519 studies identified with search terms, 38 studies were included for the qualitative analysis. Statistically significant differences in the clinical outcomes and costs were found in 18 studies. Eleven studies were prospective or retrospective, and 8 studies were meta-analyses. For the outcome variables of interest, results were reported by classifying into prospective studies, retrospective studies, and meta-analyses.
Conclusion CLP and CLF are 2 of the most commonly performed surgical procedures for the treatment of CSM. Although CLP and CLF each provide satisfactory clinical outcomes for patients with CMS, CLP may result in better cervical range of motion and less cost, length of stay, operation time, blood loss, paraspinal muscular atrophy, and rate of nerve palsies as compared to CLF. The major limitation of CLP versus CLF comparison studies includes the heterogeneity in techniques and preoperative criteria. Thus, further validation and investigations in larger cohorts will be required.
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Machine-learning-based models for the optimization of post-cervical spinal laminoplasty outpatient follow-up schedules Yechan Seo, Seoi Jeong, Siyoung Lee, Tae-Shin Kim, Jun-Hoe Kim, Chun Kee Chung, Chang-Hyun Lee, John M. Rhee, Hyoun-Joong Kong, Chi Heon Kim BMC Medical Informatics and Decision Making.2024;[Epub] CrossRef
An Observational Study Comparing Laminoplasty versus Lateral Mass Screw Fixation in Multilevel Cervical Compressive Myelopathy R. Partha Sarathy, Sumit Bansal, Arunkumar Sekar, Ashis Patnaik, Rabi Narayan Sahu Journal of Spinal Surgery.2024; 11(4): 134. CrossRef
Anterior and Posterior Approaches for 4-Level Degenerative Cervical Myelopathy: Low-Profile Cage Versus Cervical Pedicle Screws Fixation Peng Zou, Rui Zhang, Jun-Song Yang, Er-Liang Li, Qian Zhang, Yuan-Ting Zhao Journal of Clinical Medicine.2023; 12(2): 564. CrossRef
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