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Purpose To investigate the influence of apical vertebrae difference (AVD) on surgical decision-making and clinical outcomes of single- and two-level osteotomy in ankylosing spondylitis (AS) thoracolumbar kyphoscoliosis with sagittal and coronal imbalance. Methods A total of 27 AS patients with thoracolumbar kyphoscoliosis were enrolled in the study. Patients were divided into single- and two-level osteotomy groups based on the number of osteotomy levels. Coronal, sagittal, and clinical parameters were measured preoperatively, postoperatively, and at the last follow-up. AVD, operation time, blood loss, fused segments and complications were recorded between the two groups. Results Among 27 patients, 11 underwent single-level osteotomy and 16 underwent two-level osteotomy. The operation time, blood loss and number of fused segments were lower in single-level group compared to the two-level group ( P  < 0.001). Coronal, sagittal, and clinical parameters improved significantly after surgery ( P  < 0.05), with only osteotomized vertebral angle (OVA) showing a significant difference between the two groups ( P  < 0.05). The average AVD was 1.50 segments in single-level group and 3.30 segments in two-level group. Additionally, single- and two-level osteotomy accounted for 80% and 20% in group A, 77.8% and 22.2% in group B, and 0% and 100% in group C, respectively. Conclusion AVD was a crucial parameter in determining whether single- or two-level osteotomy was appropriate for AS patients with thoracolumbar kyphoscoliosis. If the AVD was < 3 segments, single-level osteotomy should be considered. If the AVD was ≥ 3 segments, two-level osteotomy was recommended.

This study aims to compare the efficacy of two endoscopic instruments powered osteotome and powered drill in treating single-segment degenerative lumbar spinal stenosis via unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF). We retrospectively analyzed clinical data from 127 patients treated at Qilu Hospital of Shandong University between January 2021 and December 2022. Patients were divided into two groups: the bone-drill (BD) group (71 cases) and the bone-osteotome (BO) group (56 cases). Various surgical indicators were assessed, including operation time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and complication rates. Clinical efficacy was evaluated using the visual analog scale (VAS) for lower back and limb pain, the Oswestry Disability Index (ODI), modified MacNab criteria, and the Brantigan and Steffee method for interbody fusion assessment. Results showed that the BD group had an average operation time of 151.41 ± 19.03 min, whereas the BO group completed the procedure significantly faster, averaging 128.48 ± 16.92 min. Intraoperative blood loss was comparable between groups (BD: 102.11 ± 34.26 ml; BO: 120.70 ± 32.89 ml). The BO group showed higher postoperative drainage volume (85.47 ± 19.01 ml) than the BD group (71.25 ± 14.55 ml). Hospitalization durations were similar (BD: 8.92 ± 1.22 days; BO: 9.16 ± 1.12 days). Both groups showed significant improvement in VAS and ODI scores at 3 and 12 months post-surgery ( P  < 0.05), with no significant differences between groups ( P  > 0.05). Notably, the BO group exhibited superior intervertebral fusion quality at 3 months compared to the BD group ( P  < 0.05), with no differences observed at 12 months. In conclusion, the UBE-TLIF technique employing a powered osteotome significantly reduces operation time and enhances intervertebral fusion compared to the powered drill method.

Background context High-grade dysplastic spondylolisthesis (HGDS) is a rare pediatric spinal deformity characterized by severe lumbosacral dysplasia and sagittal malalignment. The optimal surgical strategy for achieving deformity correction while minimizing neurological risk remains controversial. Purpose To evaluate radiographic and clinical outcomes of sacral dome osteotomy combined with complete L5 reduction and single-level posterior L5–S1 fusion in pediatric patients with HGDS, and to explore factors associated with residual postoperative sagittal imbalance. Study design A multicenter retrospective case-series study. Patient sample Thirty-one patients (30 females, 1 male; mean age 9.66 ± 2.27 years) with L5 high-grade dysplastic spondylolisthesis who underwent sacral dome osteotomy, complete L5 reduction, and posterior L5–S1 single-level fusion between 2008 and 2023. Outcome measures The primary outcome was residual sagittal imbalance at the latest follow-up, defined as sagittal vertical axis (SVA) > 5.0 cm or pelvic tilt to sacral slope ratio (PT/SS) > 1. These criteria represented global and regional malalignment, respectively. Methods Clinical and radiographic data were retrospectively reviewed. Patients were categorized according to the presence of residual sagittal imbalance at the final follow-up. Univariable and multivariable logistic regression analyses were performed in an exploratory manner to examine associations between selected clinical and radiographic variables and residual sagittal imbalance. Receiver operating characteristic (ROC) curve analysis was conducted to assess the discriminatory ability of preoperative sagittal vertical axis within this cohort. Results Mean follow-up was 3.05 ± 2.01 years. Slip percentage improved from 61.0 ± 11.0 preoperatively to 13.0 ± 10.0 postoperatively (p < 0.001) and remained stable at 9.0 ± 12.0 at the latest follow-up. Lumbosacral and global sagittal alignment parameters demonstrated significant correction that was largely maintained over time. Seven patients (22.6%) demonstrated residual sagittal imbalance (SVA > 5.0 cm or PT/SS > 1). Greater preoperative SVA values were associated with residual postoperative sagittal imbalance (OR 1.04, 95% CI 1.00–1.08, p = 0.037). Exploratory ROC analysis identified a preoperative SVA value of 4.0 cm with high sensitivity (100%) and moderate specificity (75%) for residual imbalance in this cohort. Transient neurological complications occurred in 12.9% of patients, and radiographic adjacent segment degeneration requiring revision occurred in 9.7%. Conclusions Sacral dome osteotomy with complete L5 reduction and single-level posterior L5–S1 fusion achieved durable radiographic correction of sagittal and coronal deformities in pediatric patients with high-grade dysplastic spondylolisthesis. Exploratory analyses suggested that greater preoperative sagittal vertical axis values were associated with residual postoperative sagittal imbalance, highlighting the importance of careful postoperative follow-up.