Tuberculosis is endemic in many parts of the world. With increasing immigration, we can state that it is prevalent throughout the globe. Tuberculosis of the spine is the most common form of bone and joint tuberculosis; the principles of treatment are different; biology, mechanics, and neurology are affected. Management strategies have changed significantly over the years, from watchful observations to aggressive debridement, to selective surgical indications based on well-formed principles. This has been possible due to the development of various diagnostic tests for early detection of the disease, effective anti-tubercular therapy, and associated research, which have revolutionized treatment. This picture is rapidly changing with the advent of minimally invasive spine surgery and its application in treating spinal infections. This review article focuses on the past, present, and future principles of surgical management of tuberculosis of the spine.

Minimally invasive posterior or transforaminal lumbar interbody fusion (MI-PLIF/TLIF) are widely accepted procedures for lumbar instability due to degenerative or traumatic diseases. Oblique lateral interbody fusion (OLIF) is currently receiving considerable attention because of the reductions in damage to the back muscles and neural tissue. The aim of this study was to compare clinical and radiographic outcomes of simultaneous single-position OLIF and percutaneous pedicle screw (PPS) fixation with MI-PLIF/TLIF. This retrospective comparative study included 98 patients, comprising 63 patients with single-position OLIF (Group SO) and 35 patients with MI-PLIF/TLIF (Group P/T). Cases with more than 1 year of follow-up were included in this study. Mean follow-up was 32.9 ± 7.0 months for Group SO and 33.7 ± 7.5 months for Group P/T. Clinical and radiological evaluations were performed. Comparing Group SO to Group P/T, surgical time and blood loss were 118 versus 172 min (p < 0.01) and 139 versus 374 mL (p < 0.01), respectively. Cage height, change in disk height, and postoperative foraminal height were significantly higher in Group SO than in Group P/T. The fusion rate was 96.8% in Group SO, similar to the 94.2% in Group P/T (p = 0.985). The complication rate was 6.3% in Group SO and 14.1% in Group P/T (p = 0.191). Simultaneous single position O-arm-navigated OLIF reduces the surgical time, blood loss, and time to ambulation after surgery. Good indirect decompression can be achieved with this method.

Intraoperative neuromonitoring using motor evoked potentials (MEP) satisfactorily detects motor tract integrity changes during spinal surgery. However, monitoring is affected by “anesthetic fade,” in which the stimulation threshold increases because the waveform amplitude decreases with the accumulation of propofol. Therefore, the purpose of this study was to clarify the effect of anesthetic fade on transcranial MEPs by investigating the time-dependent changes of amplitude during spinal deformity surgeries. We retrospectively reviewed medical records of 142 spinal deformity patients (66 patients with idiopathic scoliosis, 28 with adult spinal deformities, 19 with neuromuscular scoliosis, 17 with syndromic scoliosis, and 12 with congenital scoliosis). The average age was 28 years (range, 5 to 81 years). MEPs were recorded bilaterally from the abductor digiti minimi (ADM) and abductor hallucis (AH) muscles during spinal deformity surgeries. The Wilcoxon signed-rank test was used to investigate the time-dependent changes of amplitude after propofol infusion to evaluate anesthetic fade effects. The average time to baseline from initial propofol infusion was 113 min (range, 45 to 182 min). In the ADM, the amplitude was 52% at 1 h after initial propofol infusion, 102% at 2 h, 105% at 3 h, 101% at 4 h, 86% at 5 h, and 81% at 6 h. Compared to the 2-h time point, MEP decreased significantly by 16% at 5 h (P < 0.0005) and by 21% at 6 h (P < 0.05). In the AH, the amplitude was 49% at 1 h after initial infusion of propofol, 102% at 2 h, 102% at 3 h, 92% at 4 h, 71% at 5 h, and 63% at 6 h. Compared to the 2-h time point, MEP decreased significantly by 10% at 4 h (P < 0.005), by 31% at 5 h (P < 0.0000005), and by 39% at 6 h (P < 0.05). MEP amplitude significantly decreased in the upper limbs at 5 and 6 h and in the lower limbs at 4, 5, and 6 h after the initial infusion of propofol, respectively. The influence of anesthetic fade could influence false positive MEPs during long spinal surgeries.

Objectives: Early sarcopenia detection using screening tools, such as SARC-F and SARC-CalF, has been proven reliable. However, the relationship between chronic musculoskeletal pain with sarcopenia is unknown. This study assessed sarcopenia morbidity as well as the reliability of sarcopenia screening with SARC-F and SARC-CalF in patients with chronic musculoskeletal pain. Methods: Overall, 172 patients with chronic musculoskeletal pain were included in this cross-sectional study. All participants completed the SARC-F, SARC-CalF, numeric rating scale (NRS), and pain disability assessment scale (PDAS) assessments. Sarcopenia was diagnosed using the Asian Working Group for Sarcopenia criteria 2019. Correlations between SARC-F and SARC-CalF scores and each measured variable were evaluated using univariate and multiple linear regression analyses. A receiver operating characteristic curve analysis was conducted, and reliabilities of SARC-F and SARC-CalF scores for diagnosing sarcopenia were compared. Results: Thirty-nine patients were diagnosed with sarcopenia. Among these, 10 patients were 65 years old. Both SARC-F and SARC-CalF scores significantly correlated with grip power, gait speed, skeletal mass index, numeric rating scale score, and PDAS score. In multiple linear regression analysis, SALC-F and SALC-CalF scores significantly correlated with PDAS score, skeletal mass index, and gait speed. The area under the curve were 0.70 for SARC-F and 0.88 for SARC-CalF; SARC-CalF had a significantly higher area under the curve than SARC-F. Discussion: Sarcopenia was diagnosed in patients aged <65 years with chronic musculoskeletal pain. SALC-F and SARC-CalF scores showed a significant correlation with disability due to pain and were reliable sarcopenia screening tools for chronic musculoskeletal pain. SARC-CalF was more reliable than SARC-F.

Background and Objectives: The thoracolumbar burst fracture is one of the most common spinal injuries. If the patient has severe symptoms, corpectomy is indicated. Currently, minimally invasive corpectomy with a navigated expandable vertebral cage is available thanks to spinal surgical technology. The aim of this study is to retrospectively compare clinical and radiographic outcomes of conventional and navigational minimally invasive corpectomy techniques. Materials and Methods: We retrospectively evaluated 21 patients who underwent thoracolumbar minimally invasive corpectomy between October 2016 and January 2021. Eleven patients had a navigated expandable cage (group N) and 10 patients had a conventional expandable cage (group C). Mean follow-up period was 31.9 months for group N and 34.7 months for group C, ranging from 12 to 42 months in both groups. Clinical and radiographic outcomes are assessed using values including visual analogue scale (VAS) for back pain and Oswestry disability index (ODI). This data was collected preoperatively and at 6, 12, and 24 months postoperatively. Results: Surgical time and intraoperative blood loss of both groups were not significantly different (234 min vs. 267 min, 656 mL vs. 786 mL). Changes in VAS and ODI were similar in both groups. However, lateral cage mal-position ratio in group N was lower than that of group C (relative risk 1.64, Odds ratio 4.5) and postoperative cage sinking was significantly lower in group N (p = 0.033). Conclusions: Clinical outcomes are not significantly different, but radiographic outcomes of lateral cage mal-position and postoperative cage sinking were significantly lower in the navigation group.