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.

This study aims to evaluate the clinical and radiological features, histopathological characteristics, treatment modalities, and their effectiveness, as well as long-term follow-up results of pediatric spinal ependymomas treated at a single institution. In this retrospective study, medical records of 14 pediatric patients (3 females and 11 males) who were surgically treated for spinal ependymoma in our institution between 1995 and 2020 were reviewed. Data regarding age, gender, presenting symptoms and signs, radiological findings, postoperative status, extent of resection, histopathological grading, recurrence, tumor growth, seeding, and adjuvant treatment were collected and analyzed. Six patients had myxopapillary ependymoma, 7 patients had grade II ependymoma, and 1 had grade III ependymoma. Median age at diagnosis was 10.5 (range, 1–15) years. The most common presenting symptoms and signs were axial and radicular pain, paresis, and first motor neuron involvement. In 10 patients, gross total tumor resection was achieved. Five patients underwent additional surgeries for disease progression (recurrence or residual tumor growth). Most of the patients who had no disease progression were treated with gross total resection. Two patients experienced seeding. One patient who had a grade III tumor and did not achieve gross total resection died during follow-up. Pediatric spinal ependymomas are uncommon tumors with relatively benign course. Gross total resection should be the primary goal of surgery since it may prevent disease progression, and in case it fails, progression occurs later than those that were treated with subtotal resection.

SINGLE-SESSION MULTILEVEL VERTEBROPLASTY AND KYPHOPLASTY: EVALUATION OF SAFETY AND EFFICACY IN THE TREATMENT OF SPINAL COMPRESSION FRACTURES - The Journal of Turkish Spinal Surgery