Minimization of the surgical approaches to spinal extradural metastases resection and stabilization was advocated by the 2012 Oncological Guidelines for Spinal Metastases Management. Minimally invasive approaches to spine oncology surgery (MISS) are continually advancing. This paper will describe the evolution of minimally invasive surgical techniques for the resection of metastatic spinal lesions and stabilization in a single institute. A retrospective analysis of patients who underwent minimally invasive extradural spinal metastases resection during the years 2013–2019 by a single surgeon was performed. Medical records, imaging studies, operative reports, rates of screw misplacement, operative time and estimated blood loss were reviewed. Detailed description of the surgical technique is provided. Of 138 patients operated for extradural spinal tumors during the study years, 19 patients were treated in a minimally invasive approach and met the inclusion criteria for this study. The mortality rate was significantly improved over the years with accordance of improve selection criteria to better prognosis patients. The surgical technique has evolved over the study years from fluoroscopy to intraoperative 3D imaging and navigation guidance and from k-wire screw insertion technique to one-step screws. Minimally invasive spinal tumor surgery is an evolving technique. The adoption of assistive devices such as intraoperative 3D imaging and one-step screw insertion systems was safe and efficient. Oncologic patients may particularly benefit from the minimization of surgical decompression and fusion in light of the frailty of this population and the mitigated postoperative outcomes associated with MIS oncological procedures.

Retrospective imaging evaluation using an artificial intelligence (AI)-generated model. To develop novel AI software for early prediction and identification of postoperative airway obstruction based on routine post-operative imaging. Acute postoperative airway obstruction following anterior cervical spine surgery due to edema or hematoma is rare but potentially life-threatening. No automated system currently exists to detect this complication in its early stages. All adult patients who underwent anterior cervical fusion between 2012 and 2019 at a single tertiary care center were retrospectively identified. These cases were used to develop an AI model capable of autonomously distinguishing critical airway narrowing from benign postoperative swelling. Image processing and augmentation techniques were applied to establish a segmentation model incorporating three-dimensional reconstructions for computed tomography (CT) scans and pixel analysis for plain radiographs. The Cat- Boost algorithm was harnessed to refine decision trees and generate precise predictions, which were integrated into a graphical user interface for intuitive interaction. A total of 815 anterior cervical fusion procedures were identified; 795 patients met the inclusion criteria. Respiratory complications occurred in 35 patients (4.4%), with 11 (1.3%) caused by airway obstruction. The model achieved a positive predictive value of 0.98, a negative predictive value of 0.90, a sensitivity of 0.91, and a specificity of 0.99. The AI model developed in this study showed strong potential for predicting airway compromise following anterior cervical discectomy and fusion, despite variability between CT and radiographic environments. This tool may facilitate early detection of patients at risk of postoperative airway obstruction and help distinguish benign postoperative changes from complications. Further studies are warranted to validate these initial findings.

This study utilized the FDA-maintained Manufacturer and User Facility Device Experience (MAUDE) database, an extensive resource capturing medical device reports (MDRs) of adverse events, to perform a cross-sectional analysis of failure mechanisms reported by manufacturers. All thoracolumbar pedicle screw system failures reported in the MAUDE database between January 2014 and December 2023 were identified using FDA product codes. Failures were classified as intraoperative or postoperative and grouped into 9 and 5 clusters, respectively. Following de-identification, the 8 most frequently reported manufacturers were analyzed individually. Reports specifying failed components were categorized as screw, set screw, rod, instrument, system, other, or unknown. The “system failure” category lacked specificity regarding the failed component. Descriptive statistics summarized failure mechanisms. A total of 17,639 MDRs related to thoracolumbar fixation failures were reported over the past decade, with 15,234 postoperative and 2,405 intraoperative events. The most frequent intraoperative issues were positioning problems (27.9%), device-device compatibility (26.4%), and difficulty in separation/removal (11.8%), while the most common postoperative failure mechanisms were breakage (45.2%), migration/detachment (42%), and deformation (10.1%). The distribution of failed components varied by the associated failure mechanism. Among 4,676 reported breakages, screws (20.8%), set screws (15.5%), and rods (11.8%) were most frequently involved. In the 4,871 migration/detachment events, set screws accounted for 31.6%, screws for 21%, and rods for 2.3%. Of 1,325 deformation events, the majority were linked to set screws (76.5%), with fewer attributed to system-level components (11.2%) and screws (6%). Failure profiles for pedicle screw systems vary significantly between manufacturers. The MAUDE database is a useful resource for the evaluation of reporting patterns associated with pedicle screw systems. However, limitations include reporting biases and the absence of total sales data, which prevents the calculation of true failure rates.

Background and Objectives: The recently published Spine Stereotactic Radiosurgery (SSRS) ESTRO guidelines advise against treating spinal metastatic disease with a single dose equal to or smaller than 18 Gy, prioritizing local control over the potential for complications. This study aims to assess the necessity and validity of these higher dose recommendations by evaluating the outcomes and experiences with lower radiation doses. Materials and Methods: A retrospective evaluation of SSRS patients treated at a single institute was conducted. The outcomes and complications of this cohort were compared to the current literature and the data supporting the new ESTRO guidelines. Results: A total of 149 treatment sessions involving 242 spinal levels were evaluated. The overall local control rate was 91.2%. The mean radiation dose for the local control group compared to the local failure group was similar (17.5 vs. 17.6 Gy, not significant). The overall complication rate was 6%. These results are consistent with previous publications evaluating SSRS for metastatic spinal disease. Conclusions: SSRS dose escalation may increase local control efficacy but comes with a higher risk of complications. The evidence supporting the strong recommendations in the recent ESTRO guidelines is not robust enough to justify a universal application. Given the palliative nature of treatment for metastatic patients, dose determination should be individualized based on patient conditions and preferences, with a detailed discussion about the risk–benefit ratio of increased doses and the level of evidence supporting these recommendations.