This study was designed to systematically review and meta-analyze the functional and radiological outcomes between lateral and posterior approaches in adult degenerative scoliosis (ADS). Both lateral (lumbar, extreme, and oblique) and posterior interbody fusion (posterior lumbar and transforaminal) are used for deformity correction in patients with ADS with unclear comparison in this cohort of patients in the existing literature. A literature search using three electronic databases was performed to identify studies that reported outcomes of lateral (group L) and posterior interbody fusion (group P) in patients with ADS with curves of 10°–40°. Group P was further subdivided into minimally invasive surgery (MIS-P) and open posterior (Op-P) subgroups. Data on functional, radiological, and operative outcomes, length of hospital stay (LOHS), fusion rates, and complications were extracted and meta-analyzed using the random-effects model. A total of 18 studies (732 patients) met the inclusion criteria. No significant difference was found in functional and radiological outcomes between the two groups on data pooling. Total operative time in the MIS-P subgroup was less than that of group L (233.86 minutes vs. 401 minutes, p <0.05). The total blood loss in group L was less than that in the Op-P subgroup(477 mL vs. 1,325.6 mL, p <0.05). Group L had significantly less LOHS than the Op-P subgroup (4.15 days vs. 13.5 days, p <0.05). No significant difference was seen in fusion rates, but complications were seen except for transient sensorimotor weakness (group L: 24.3%, group P: 5.6%; p <0.05). Complications, such as postoperative thigh pain (7.7%), visceral injuries (2%), and retrograde ejaculation (3.7%), were seen only in group L while adjacent segment degeneration was seen only in group P (8.6%). Lateral approach has an advantage in blood loss and LOHS over the Op-P subgroup. The MIS-P subgroup has less operative time than group L, but with comparable blood loss and LOHS. No significant difference was found in functional, radiological, fusion rates, pseudoarthrosis, and complications, except for transient sensorimotor deficits. Few complications were approach-specific in each group.

Background: Identifying the risk factors for the neurological deficit in spine tuberculosis would help surgeons in deciding on early surgery, thus reducing the morbidity related to neurological deficit. The main objective of our study was to predict the risk of neurological deficit in patients with spinal tuberculosis (TB). Methods: The demographic, clinical, radiological (X-ray and MRI) data of 105 patients with active spine TB were retrospectively analyzed. Patients were divided into two groups – with a neurological deficit (n = 52) as Group A and those without deficit (n = 53) as Group B. Univariate and multivariate logistic regression analysis was used to predict the risk factors for the neurological deficit. Results: The mean age of the patients was 38.1 years. The most common location of disease was dorsal region (35.2%). Paradiscal (77%) was the most common type of involvement. A statistically significant difference (p < 0.05) was noted in the location of disease, presence of cord compression, kyphosis, cord oedema, loss of CSF anterior to the cord, and degree of canal compromise or canal encroachment between two groups. Multivariate analysis revealed kyphosis > 30° (OR – 3.92, CI – 1.21–12.7, p – 0.023), canal encroachment > 50% (OR – 7.34, CI – 2.32–23.17, p – 0.001), and cord oedema (OR – 11.93, CI – 1.24–114.05, p – 0.03) as independent risk factors for predicting the risk of neurological deficit. Conclusion: Kyphosis > 30°, cord oedema, and canal encroachment (>50%) significantly predicted neurological deficit in patients with spine TB. Early surgery should be considered with all these risk factors to prevent a neurological deficit.

Background: Cervical spondylotic myelopathy (CSM) is a common cause of progressive neurological decline in elderly patients, often necessitating surgical decompression. Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are commonly used procedures. However, there is no consensus on the superior approach, particularly in cases involving 2-level CSM. Methods: A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, Cochrane, Scopus, and Embase databases were searched for studies comparing perioperative, clinical, and radiological outcomes of ACDF and ACCF in 2-level CSM. Fourteen studies with 4,449 patients (ACDF: 2,265, ACCF: 2,184) met the inclusion criteria. Outcomes analyzed included operating (OR) time, blood loss, hospital stay, patient-reported outcomes (Neck Disability Index [NDI], Visual Analog Scale [VAS], modified Japanese Orthopaedic Association [mJOA], Odom criteria), radiological parameters, complications, and fusion rates. Statistical analysis was performed using Review Manager 5.4, with heterogeneity assessed using I² statistics. Results: ACDF was associated with significantly shorter OR time, reduced blood loss, shorter hospital stays, and lower overall complication rates compared with ACCF. Both procedures showed comparable improvements in NDI, VAS, and mJOA scores. ACDF demonstrated superior postoperative cervical alignment, with greater improvements in global and segmental lordosis. Complication rates, including implant-related issues, were higher in the ACCF group, while reoperation and fusion rates were similar. Conclusion: Both ACDF and ACCF significantly improve functional outcomes in 2-level CSM. However, ACDF demonstrated advantages in perioperative outcomes, complications, and cervical alignment. While ACDF is associated with shorter OR time and fewer complications, ACCF may be necessary in cases with extensive disk herniation or other pathologies requiring direct decompression posterior to the vertebral body. Surgical decisions should be individualized based on patient-specific pathology. Level of Evidence: Level II. See Instructions for Authors for a complete description of levels of evidence.