Adjacent segment disease is a controversial process after spine stabilization. The two important factors discussed are natural aging and hypermobility in incidental segmental fusion anomalies; patients have two or more fused vertebrae from birth, which are the results of spinal movement restriction due to the fusion of some spinal units. This article’s main purpose is to determine the degree of relationship of hypermobility and the aging process in the deterioration of the disks adjacent to fusion. In this study, the degenerative process developed by hypermobility in the adjacent segment due to incidental segmental fusion was evaluated. The MRI images of 52 adjacent and nonadjacent disks of 45 patients in total were analyzed according to the Pfirrmann grading systems. The average Pfirrmann rating of the disks just above and below the fused segment and the distant first, second, and third non-neighboring levels were evaluated and calculated, respectively. The highest rate of incidental fusion is determined on the cervical area with 51.9%, followed by the thoracal area with 32.7%, and the lumbar area with 15.4%. Damage to the adjacent segment disks in cases with incidental fusion can still be seen at any age, with fusion, indicating that the hypermobility effect plays a more prominent role. The evidence of hypermobility without aging is that the segments adjacent to fusion undergo more degeneration than the distant disks. Adjacent segment disease is under the influence of many factors. Our findings suggest that its incidence is increasing with the pathological processes initiated by hypermobility. It seems that, at least, it carries equal importance as compared to age. Fusion surgeries damage the adjacent segments under the influence of the passage of time beyond the physiological aging of the patient.

Background: Adult spinal deformities (ASD) present complex challenges in spine surgery. The diverse nature of these deformities requires a comprehensive understanding of their classification and treatment options. Traditional approaches, such as fusion and rigid stabilization are associated with complications, including screw loosening, breakage, proximal junctional kyphosis (PJK), and pseudoarthrosis. Dynamic stabilization techniques have emerged as promising alternatives, to reduce these complications and preserve spinal motion. Objective: This study investigated the effectiveness of dynamic stabilization using the Dynesys system in the surgical treatment of adult degenerative spinal deformities, with a particular emphasis on their classification. Methods: ASDs were classified according to the Berjano–Lamartina (BL) and Silva–Lenke (SL) classifications. We analyzed the efficacy of the Dynesys system in enhancing sagittal balance, radiological parameters, and clinical outcomes in this context. Results: Dynamic stabilization of patients with ASDs using the Dynesys system significantly improved the visual analog scale and Oswestry Disability Index scores and decreased the complication rates. Patients with BL types 2, 3, and 4 experienced a significant improvement in sagittal balance followed by sagittal vertical axis measurements (p = 0.045, p = 0.015, and p < 0.0001, respectively). Conclusion: The SL and BL classifications, which were originally developed for rigid spinal stabilization, can be applied in dynamic stabilization. Furthermore, dynamic stabilization using the Dynesys system can be used as an alternative to rigid stabilization in SL levels 2 and 3, and BL types 1, 2, and 3, and in some patients with type 4 ASDs.

Background: Dynamic lumbar stabilization aims to preserve spinal movement, offering stability and controlled motion. However, screw loosening, especially in patients with osteopenia and osteoporosis, remains challenging. Method: Between 2018 and 2022, a retrospective analysis was conducted on a total of 119 patients diagnosed with osteopenia and osteoporosis who underwent spinal dynamic instrumentation surgery. These patients were categorized into two groups: single-stage surgery (n = 67) and two-stage surgery (n = 52). Over the 48-month follow-up period, the occurrence and percentage of screw loosening were examined at each surgical level per patient, as well as by screw location (pedicular, corpus, tip). Clinical outcomes were evaluated using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. Results: Total screw loosening rates were significantly lower in the two-stage group (2.83%) compared to the single-stage group (14.63%, p < 0.001). Patient-based loosening occurred in 5 patients (9.6%) in the two-stage group and 16 patients (23.9%) in the single-stage group. Loosening rates were lower in the two-stage group at L2 (7.78%, p = 0.040), L3 (5.56%, p < 0.001), L4 (8.89%, p = 0.002), and L5 (10.00%, p = 0.006), but higher at S1 (21.11%, p = 0.964), T12 (15.56%, p = 0.031), and iliac levels (15.56%, p = 0.001). Pedicular section exhibited the highest loosening (37 cases). VAS and ODI scores improved significantly in both groups, with better outcomes in the two-stage group at the 48. months (p < 0.001). Conclusions: The two-stage surgical approach significantly reduces screw loosening in patients with osteopenia and osteoporosis undergoing dynamic stabilization surgery, offering enhanced stability and better clinical outcomes.

Spinal infection (SI) is an infectious disease affecting the vertebral column, spinal cord, and adjacent structures. The infection can occur following interventions or spontaneously. The aim of this study was to highlight the importance of employing a methodological approach for the accurate and rapid diagnosis of SI and to share information on the most effective treatment method, which involves using a diagnostic-treatment algorithm that can help with SI management. This study included 50 patients diagnosed with SI between 2016 and 2020. The treatment follow-up period was limited to six months, and the study was conducted as a retrospective cohort analysis. The sample consisted of 22 female patients and 28 male patients, and the mean age of the patients was 50.2 years. All patients received diagnosis and treatment according to the algorithm described in this article. In the study group, 60% of patients had an infection in the lumbar spine, 4% in the thoracal spine, 12% in the cervical spine, and 8% in the sacral spine. Previously operated patients were diagnosed on the 30.16th day on average. A total of 19 patients (38%) had no history of undergoing surgery. Radiologically, the most common finding was spondylodiscitis/discitis (32%). Osteomyelitis was detected in one (2%) patient. Methicillin-sensitive Staphylococcus aureus (MSSA) was the most commonly isolated organism in culture results and was detected in 13 patients (26%). The culture results of 12 patients (24%) were negative. The number of patients with active SI who were unstable and stabilized at the time of diagnosis was 11 (22%), and stabilization materials were removed in two patients (4%). In the 6th month of control, the patients did not have any complaints, signs of an infection, or unstable vertebral column. We conclude that the combined algorithm we recommend for the diagnosis and treatment of patients with SI can prevent negative deviation and is an effective treatment for this condition.

Background and Objectives: This study aimed to assess if extensive surgical resection enhances outcomes in wild-type Isocitrate Dehydrogenase (IDH) butterfly glioblastoma (B-GBM) patients, despite the presence of Telomerase Reverse Transcriptase (TERT) mutation and Epidermal Growth Factor Receptor (EGFR) amplification. Methods: The study, retrospectively conducted from 2014 to 2022, involved 723 GBM patients, 41 of whom met the criteria for IDH wild-type B-GBM. Exclusion criteria comprised prior diagnoses or treatments for low-grade glial tumors. Surgeons, employing two approaches—partial and extensive surgery—categorized patients based on age, sex, tumor location, corpus callosum involvement, and genetic characteristics. The interval between initial surgery and tumor recurrence/tumor-free period (TR/TFP) and overall survival (OS) were recorded and compared between the partial and extensive resection groups, analyzing the impact of resection width on TR/TFP and OS. Preoperative assessments utilized thin-section cranial computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI). Intraoperatively, tumor excision was guided by sodium fluorescein, and margins were delineated via neuronavigation. Genetic alterations (TERT mutations and EGFR amplifications) were correlated with surgical type, TR/TFP, and OS. Karnofsky Performance Scale (KPS) evaluations were performed pre- and post-operatively and at key intervals, comparing outcomes between surgical groups. Standard radiotherapy and chemotherapy regimens were administered to all patients. Results: Extensive resection yielded significantly longer TR/TFP compared to partial resection, despite TERT gene mutation and EGFR amplification being linked to shorter TR/TFP and OS. Its impact on OS, however, was not significant. KPS scores indicated a superior quality of life after extensive resection, with sustained improvement upon recurrence. Conclusions: Extensive resection of B-GBM, even in the presence of adverse genetic alterations, may prolong TR/TFP, offering patients a period of improved comfort with minimal distress.