Compensatory mechanisms in adult degenerative thoracolumbar spinal deformity - Radiographic patterns, their reversibility after corrective surgery, and the influence of pelvic morphology

Scoping review of robotics technology in spinal surgery with highlights of the Annual Seattle Science Foundation Course

Background

Robotic assistance has become increasingly prevalent in spinal surgery in recent years, emerging as a tool to increase accuracy and precision and lower complication rates and radiation exposure. The 7th and 8th Annual Seattle Science Foundation (SSF) Robotics Courses showcased presentations and demonstrations from some of the field's most experiences leaders on latest topics in robotics and spinal surgery, including cutting-edge preoperative planning technologies, augmented reality (AR) in the operating room, cervical fusion with transpedicular screws, and neuro-oncologic management. We provide a scoping review of the use of robotics technology in spinal surgery featuring highlights from the 7th and 8th Annual SSF Robotics Courses.

Methods

A scoping review of the literature was conducted (last search conducted in July 2024). Key search terms included "robotic assistance", "spine surgery", and "robotic technology" on the PubMed database. Additionally, highlights are included from the 7th and 8th Annual SSF Robotics Courses.

Results

Applications of navigation robotics span subspecialties of spine surgery including deformity correction, minimally invasive approaches, lateral single position operations, spinal oncology, and cervical fusion. Tips on overcoming traditional obstacles of robotics integration such as streamlining staff workflow and adoption while financing robotic-assisted technology are shared. Future directions of robotics enhanced with AR may further guide surgeon decision-making, assist in more practical fashion intraoperatively, and optimize patient outcomes.

Conclusions

While improved precision and accuracy, less radiation, and standardization of procedures represent current advantages of robotic-assistance across spine surgery, robotics in spine surgery will usher more transformative changes to patient care and operative skill in coming years.

Relationship between paravertebral muscle function, pelvic incidence, and health-related quality of life in patients with degenerative spinal deformity

BACKGROUND

Patients with degenerative spinal deformity often experience symptoms that seriously affect their quality of life, such as low back pain and dysfunction. This study aimed to investigate the relationship between paravertebral muscle function and pelvic incidence (PI) and their effect on health-related quality of life (HRQL) in patients with degenerative spinal deformity.

METHODS

A total of 112 patients with degenerative spinal deformity in Southwest Hospital (Chongqing, China) were enrolled. They were divided into groups according to PI angle: high (PI > 60°, n = 37), normal (PI 50°-60°, n = 31), and low (PI < 50°, n = 44). Paravertebral muscle strength and endurance were assessed using the prone external fixation test frame. The sagittal vertical axis (SVA) was measured on X-rays of the spine in an anterolateral position, and all subjects were assessed with the Oswestry Disability Index (ODI), Roland-Morris questionnaire (RMQ), and 36-Item Short Form Health Survey (SF-36). Pearson or Spearman coefficients were used to assess the relationship of paravertebral muscle function with SVA, PI, and health-related quality of life.

RESULTS

Maximal voluntary exercise (MVE) in the high-PI group was significantly lower than the MVE of both the normal- and low-PI groups (p < 0.05). There was no significant difference in MVE between the normal- and low-PI groups (p > 0.05). There was no significant difference in endurance time, SVA, ODI, RMQ, and SF-36 among the three groups. Paravertebral muscle MVE was negatively correlated with PI, SVA, ODI, and RMQ (r = - 0.193, - 0.210, - 0.283, - 0.277, p < 0.05). Endurance time of paravertebral muscle was also negatively correlated with SVA, ODI, and RMQ (r =  - 0.200, - 0.420, - 0.348, p < 0.05) and positively correlated with SF-36 (r = 0.245, p < 0.05). In addition, paravertebral muscle MVE was positively correlated with the physical functioning score of the SF-36 (r = 0.251, p < 0.05), and the endurance time of paravertebral muscle was positively correlated with the physical functioning, physical role, bodily pain, and social function scores of the SF-36 (r = 0.342, 0.230, 0.209, 0.256, p < 0.05).

CONCLUSIONS

High PI may serve as a risk factor for decreased paraspinal muscle strength in patients with degenerative spinal deformities. Early and targeted exercises focusing on paraspinal muscle strength and endurance could potentially be of positive significance in slowing down the progression of sagittal imbalance, alleviating functional disorders, and increasing health-related quality of life in patients with degenerative spinal deformity.