Background: Augmentation of soft tissue repairs has been helpful in protecting surgically repaired tissues as they heal. FlexBand (Artelon, Marietta, Georgia) is a synthetic, degradable, polycaprolactone-based polyurethane urea (PUUR) matrix that has been investigated and used for soft tissue repair in a variety of settings. The purpose of this study was to evaluate the safety profile of a PUUR matrix in a large cohort of patients undergoing soft tissue repairs about the foot and ankle. Methods: A retrospective chart review of consecutive patients who underwent surgery using FlexBand to augment a soft tissue repair was performed to evaluate for major and minor complications related to the PUUR matrix. Results . A total of 105 patients with an average >6 months follow-up were included. The most common procedures were spring ligament repair, Achilles tendon repair, and Brostrom. There were 12 complications. Four major complications occurred with only 1 requiring PUUR matrix removal. Patients with wound complications had a higher body mass index (BMI) and rate of smoking. Conclusion: Complication rates involving PUUR matrix in soft tissue foot and ankle reconstruction procedures are low and comparable with historical complication rates. The PUUR matrix is safe for use in a variety of soft tissue procedures about the foot and ankle. Level of Evidence: Level 4, Retrospective case-series

A consensus on grading the complexity of endoscopic spinal procedures is lacking, but urgently needed to guide training, clinical practice, and regulatory concepts. A 2-dimensional classification system was developed, considering both the technical and morphological parameters contributing to the complexity of endoscopic spine procedures. An international survey with 68 questions - including those on demographic data and surgical volumes, suitability of the proposed 2-dimensional classification system, and categories of techniques and morphologies - was completed by spine surgeons with endoscopic experience. A consensus was defined as a difference >/= 10% between the most frequently given grade and the second most given grade. In cases of no clear consensus (ie, agreement of less than 10%), an additional analysis considering only the responses from surgeons with experience of more than 500 endoscopic spine surgeries was performed. 115 survey entries were received, of which 112 were analyzed. The participating spine surgeons (64% orthopedic surgeons, 35% neurosurgeons, 1% other) originated from 27 countries and have performed an average of 509 endoscopic spine surgeries (55,984 total endoscopic procedures). 85.7% of the survey respondents agreed that the proposed 2-dimensional classification system was indeed appropriate for its particular purpose. Thus, a consensus classification system was born, allowing for grading simple procedures (eg, Ia for lumbar interlaminar discectomy of a soft disc herniation) to complex procedures (eg, IIIc for revision posterior endoscopic cervical central decompression). A consensus of 112 endoscopic spine surgeons from 27 countries facilitated the development of a 2-dimensional classification system outlining the complexity of endoscopic spinal procedures, taking into account both technical aspects and morphological parameters. This classification system categorizes different endoscopic spine procedures and the pathologies they are employed to treat based on complexity, thus guiding the endoscopic spine community in medical training, patient education, and regulatory and reimbursement discussion.

Aims: To report the development of the technique for minimally invasive lumbar decompression using robotic-assisted navigation.Methods: Robotic planning software was used to map out bone removal for a laminar decompression after registration of CT scan images of one cadaveric specimen. A specialized acorn-shaped bone removal robotic drill was used to complete a robotic lumbar laminectomy. Post-procedure advanced imaging was obtained to compare actual bony decompression to the surgical plan. After confirming accuracy of the technique, a minimally invasive robotic-assisted laminectomy was performed on one 72-year-old female patient with lumbar spinal stenosis. Postoperative advanced imaging was obtained to confirm the decompression.Results: A workflow for robotic-assisted lumbar laminectomy was successfully developed in a human cadaveric specimen, as excellent decompression was confirmed by postoperative CT imaging. Subsequently, the workflow was applied clinically in a patient with severe spinal stenosis. Excellent decompression was achieved intraoperatively and preservation of the dorsal midline structures was confirmed on postoperative MRI. The patient experienced improvement in symptoms postoperatively and was discharged within 24 hours.Conclusion: Minimally invasive robotic-assisted lumbar decompression utilizing a specialized robotic bone removal instrument was shown to be accurate and effective both in vitro and in vivo. The robotic bone removal technique has the potential for less invasive removal of laminar bone for spinal decompression, all the while preserving the spinous process and the posterior ligamentous complex. Spinal robotic surgery has previously been limited to the insertion of screws and, more recently, cages; however, recent innovations have expanded robotic capabilities to decompression of neurological structures.Cite this article: Bone Jt Open 2024;5(9):809–817.