Adult acquired flatfoot deformity (AAFD) is a disorder caused by repetitive overloading, which leads to progressive posterior tibialis tendon (PTT) insufficiency. It mainly affects middle-aged women and occurs with foot pain, malalignment, and loss of function. After clinical examination, imaging plays a key role in the diagnosis and management of this pathology. Imaging allows confirmation of the diagnosis, monitoring of the disorder, outcome assessment and complication identification. Weight-bearing radiography of the foot and ankle are gold standard for the diagnosis of AAFD. Magnetic Resonance Imaging (MRI) is not routinely needed for the diagnosis; however, it can be used to evaluate the spring ligament and the degree of PTT damage which can help to guide surgical plans and management in patients with severe deformity. Ultrasonography (US) can be considered another helpful tool to evaluate the condition of the PTT and other soft-tissue structures. Computed Tomography (CT) provides enhanced, detailed visualization of the hindfoot, and it is useful both in the evaluation of bone abnormalities and in the accurate evaluation of measurements useful for diagnosis and post-surgical follow-up. Other state-of-the-art imaging examinations, like multiplanar weight-bearing imaging, are emerging as techniques for diagnosis and preoperative planning but are not yet standardized and their scope of application is not yet well defined. The aim of this review, performed through Pubmed and Web of Science databases, was to analyze the literature relating to the role of imaging in the diagnosis and treatment of AAFD.

Introduction: Minimally invasive spine surgery became the gold standard for the treatment of many spinal diseases. Only a few comparative studies were performed regarding the superiority of robotic-assisted (RA) surgery over fluoroscopic guidance (FG) surgery during percutaneous pedicle screws placement. Therefore, the aim of the present study was to conduct a systematic literature review and meta-analysis to evaluate the accuracy and potential advantages of RA compared with FG. Material and Methods: This study is a systematic literature review conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The review questions were formulated following the PICO scheme. Measured outcomes were presented using Forest plots. Heterogeneity among the included studies was assessed using the χ² test, and the I² statistic was utilized to estimate the proportion of total variation among the studies. A value exceeding 50% was considered indicative of substantial heterogeneity. Results: Seven studies that met inclusion criteria were finally included in this meta-analysis. These seven studies include: 447 patients, 228 patients (931 screws) treated with robotic guide, and 219 patients (767 pedicle screws) using fluoroscopic guide, with a mean age of 55.2. The percentages of clinically acceptable screws were 94.3% in the robot-assisted group and 89% in the fluoroscopic guided group. The percentages of non-acceptable screws were 5.7% in the robot-assisted group and 11% in the fluoroscopic-guided group. Discussion: Significant differences were observed between the two groups in terms of radiographic and clinical outcomes, with the robotic-assisted pedicle screw group exhibiting longer operative times. Robot technology serves as a valuable tool for assisting surgeons in challenging scenarios such as anatomical variants or patients with spinal deformities, ensuring accurate screw placement. Conclusion: The accuracy of pedicle screw placement with robotic technology is higher than with FG. In fact, the robotic approach allows significantly lower complication rates, fewer cases of violation of the proximal articular facet, less intraoperative exposure to radiation, even if it requires longer surgical times than the FG technique.

Purpose: Thoracolumbar burst fractures represent a significant proportion of spinal injuries, with management strategies remaining a subject of debate. While four-screw (4S) short-segment posterior fixation is commonly used, recent biomechanical studies suggest that adding pedicle screws at the fractured level (six-screw, 6S, construct) may improve stability and clinical outcomes. However, the clinical relevance of these findings remains uncertain. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Three databases (Scopus, PubMed/MEDLINE, Cochrane Library) were searched for studies comparing 4S and 6S constructs in thoracolumbar fractures. Inclusion criteria encompassed comparative clinical studies reporting perioperative, functional, and radiological outcomes. Data were extracted and analyzed using Review Manager 5.4.1, applying fixed- or random-effects models based on heterogeneity. Results: Twenty-two studies involving 1595 patients were included. The 6S group showed significantly improved postoperative pain scores (VAS), better short- and long-term sagittal alignment, and a lower implant failure rate. However, this technique was associated with longer operative times, increased intraoperative blood loss, and extended hospital stays. No significant differences in long-term functional disability (ODI) or infection rates were found. Conclusions: The addition of intermediate screws improves radiological outcomes and reduces implant failure but increases surgical burden. Further high-quality studies focusing on patient-reported outcomes and specific fracture subtypes are needed to refine clinical indications.

Background: Acute kidney injury (AKI) is a critical medical condition characterized by a sudden decline in renal function, often resulting in severe complications and increased mortality. In the context of spine surgery, particularly for adult spine deformities, the risk of AKI is significant due to the complexity and duration of these procedures, as well as the substantial intraoperative blood loss and hemodynamic instability they can entail. Despite advancements in surgical and perioperative care, AKI remains a major concern. This paper presents a case report of AKI following spine deformity surgery and conducts a comprehensive literature review to evaluate the incidence and risk factors associated with AKI in this specific surgical population. Methods: A systematic literature search was conducted across the PubMed, Medline, and Cochrane Library databases, focusing on studies published between January 2000 and December 2023. The inclusion criteria targeted studies reporting on adult patients undergoing spine surgery, specifically detailing the incidence and risk factors of AKI. Exclusion criteria included studies on pediatric patients, non-English publications, and those lacking clear AKI diagnostic criteria. Data from the selected studies were independently extracted by two reviewers and analyzed using descriptive statistics and meta-analysis techniques where applicable. The case report highlights a patient who developed AKI following extensive spine surgery for Adult Spine Deformity (ASD), detailing the clinical course, diagnostic approach, and management strategies employed. Results: The literature review revealed that the incidence of AKI in spine surgery varies widely and is influenced by factors such as patient demographics, type of surgery, and perioperative management. Identified risk factors include significant blood loss, prolonged operative time, intraoperative hypotension, and the use of nephrotoxic drugs. The findings underscore the importance of vigilant perioperative monitoring and proactive management strategies to mitigate the risk of AKI. These strategies include optimizing hemodynamic stability, minimizing blood loss, and careful management of nephrotoxic medications. Conclusions: By integrating a detailed case report with a thorough review of the existing literature, this paper aims to enhance the understanding of AKI in spine surgery and inform clinical practices to improve patient outcomes.

Background: Adolescent idiopathic scoliosis (AIS) is a spinal pathology affecting 0.47–5.2% of the population, often requiring surgical intervention to control deformity progression. Posterior spinal instrumentation and fusion with pedicle screw fixation are standard procedures for AIS curve correction; however, implant failure remains a significant complication, especially in multi-level fusions. This retrospective cohort study aims to compare the failure rates between conventional pedicle screws (CPSs) and fenestrated pedicle screws (FPSs) in AIS treatment, with a focus on investigating potential causes of these failures. Methods: This study, conducted from January 2016 to December 2020, involves a two-center retrospective analysis of AIS patients undergoing posterior instrumented fusion. Results: Data from a total of 162 patients (122 females and 40 males) revealed a mean age of 14.95 years (range: 11–18). The CPS group consisted of 80 patients (56 females and 24 males), whereas the FPS group consisted of 82 patients (66 females and 16 males) stratified by Risser grade and Lenke Classification. Radiological assessments, clinical outcomes, and SRS-22 scores were evaluated pre-operatively, at 6 months, and post-operatively (minimum follow-up of 2 years). Conclusions: Fenestrated pedicle screws (FPSs) pose concerns due to their lower mechanical strength compared to solid screws. Understanding their limitations and optimizing their application in AIS treatment is essential.

Background: Sacral and pelvic insufficiency fractures (SIFs and PIFs) are increasingly recognized yet frequently underdiagnosed complications after adult spinal deformity (ASD) surgery, particularly in patients undergoing long-segment spinal fusion to the sacrum or pelvis. Methods: We present a representative case of sacral and pelvic insufficiency fractures following extensive spinal fusion, highlighting diagnostic and therapeutic challenges. In addition, a systematic review of the literature was performed according to PRISMA guidelines through PubMed, MEDLINE, and Scopus databases, including studies up to December 2024. Data regarding demographics, risk factors, diagnostic modalities, management strategies, and outcomes were extracted and narratively synthesized. Results: A total of 21 studies comprising 89 patients were included. The majority were elderly postmenopausal women with osteoporosis and additional risk factors such as chronic corticosteroid therapy or high body mass index. Diagnosis was frequently delayed due to low sensitivity of plain radiographs, whereas computed tomography was the most reliable modality. Management was surgical in 49 patients (55%)—most commonly extension of fixation to the pelvis or use of S2-alar-iliac screws—with favorable fracture healing reported in most cases. Conservative treatment, employed in 40 patients (45%), included bracing, restricted activity, and bone health optimization, also leading to healing in the majority of cases. Conclusions: Sacral and pelvic insufficiency fractures represent an underrecognized but clinically significant complication after ASD surgery. Early recognition through cross-sectional imaging (CT/MRI) is crucial, and both surgical and conservative approaches can be effective if tailored to patient and fracture characteristics.