Background: Fragility fractures of the pelvis (FFP) are an increasing challenge in aging societies. Among these, FFP type 4B (“H-shaped” sacral fractures) represent the most unstable subtype, characterized by bilateral sacral ala fractures with transverse dissociation. Optimal fixation strategies remain debated, as spinopelvic fixation provides maximal stability but is invasive, while iliosacral screws often fail in osteoporotic bone. Trans-sacral bar (TSB) fixation has been proposed as a less invasive alternative, though evidence for its use in FFP 4B remains limited. Methods: We conducted a retrospective single-center study of 31 elderly patients (mean age 77.9 years; 87.1% female) with CT-confirmed FFP type 4B fractures treated between 2015 and 2022 using navigation-guided TSB constructs. Surgical configurations included hybrid fixation (TSB + bilateral iliosacral screws, n = 25) and dual-bar fixation (n = 6). Outcomes included perioperative complications, implant survival, radiographic healing, pain, and mobility at 3 and 12 months. Opportunistic CT-derived Hounsfield units (HU) were used to assess bone quality. Results: All patients had severe osteoporosis (mean HU 75.8 ± 30.1). Mean operative time was 71 min, and mean hospitalization was 9.1 days. No intraoperative or postoperative complications occurred, and no implant loosening, migration, or revision surgeries were required. At 3 months, mean pain score was 1.9, further decreasing to 1.1 at 12 months; 60.9% of patients reported complete pain resolution. Mobility improved in most cases, with 80.6% discharged with a walker or crutches. Radiographic follow-up confirmed stable healing in all patients. Conclusions: Navigation-guided TSB-based fixation provided stable osteosynthesis with excellent implant survival, significant pain relief, and early mobilization in elderly patients with FFP type 4B fractures. Hybrid and dual-bar constructs both achieved reliable outcomes. TSB fixation thus represents a safe and effective alternative to spinopelvic fixation in this fragile population. Larger multicenter prospective studies are warranted to confirm these findings and refine fixation strategies.

Objectives: Cervical spondylotic myelopathy (CSM) is a progressive neurological disorder caused by spinal cord compression in the cervical spine. The Japanese Orthopaedic Association (JOA) score is commonly used to quantify neurological impairment. Surgical decompression is the main treatment, aiming to relieve pressure on the spinal cord and improve neurological function. Historically, the primary goal was to halt disease progression; however, recent studies suggest an improvement even in cases with mild symptoms. The extent to which the shifting of the spinal cord contributes to clinical improvement remains controversial. Methods: This study included 95 patients who underwent dorsal decompression and instrumentation for cervical myelopathy between 2020–2024. Patients were followed up at 3 and 12 months post surgery. Results: Dorsal decompression resulted in a significant improvement in neurological function as measured by the JOA score at three months and one-year post-operation (0.0004 and 0.006, respectively). The average posterior spinal cord shift (PSS) was 3 mm. The prevalence of C5-palsy was 3.1%. Linear and logistic multivariable regression showed no significant relationship between PSS and JOA score alteration or subjective clinical improvement, but a multivariable regression analysis identified the ASA score as a significant negative predictor of neurological improvement. Conclusions: Dorsal decompression in CSM is a safe procedure concerning neurological complications and does not only stop the worsening of symptoms but indeed improves the JOA score and the subjective clinical situation. Although PSS was observed postoperatively, the extent of PSS showed no statistically significant relationship with JOA score improvement.

Background: H-type sacral fragility fractures are commonly deemed biomechanically unstable and often treated with spinopelvic fixation (SPF). However, elderly osteoporotic patients may benefit from less invasive approaches. Methods: A retrospective cohort of 51 elderly patients with CT-confirmed H-type sacral fractures underwent navigated transsacral bar (TSB) fixation. Radiographic stability and clinical outcomes were evaluated at 3 months. Results: No revision surgeries or implant failures were observed. Most patients regained mobility at discharge. TSB alone provided adequate stabilization, challenging the necessity of routine SPF in this demographic. Conclusion: Navigated TSB fixation offers a stable, less invasive alternative to SPF for selected osteoporotic sacral fractures