Phil Bohlen

Background/Objectives: Restoration of anterior column support in the lower thoracic spine and thoracolumbar junction can be challenging in the setting of segmental kyphosis, particularly when endplate integrity is compromised. A conformable mesh interbody implant can be introduced in a collapsed configuration through a transforaminal corridor and expanded in situ to accommodate the geometry of the prepared intervertebral space. This study evaluated early radiographic outcomes following anterior column reconstruction with a conformable mesh interbody implant. Methods: This retrospective single-centre study was conducted with 12 patients who underwent thoracic or thoracolumbar anterior column reconstruction using a conformable mesh interbody implant between April 2024 and March 2026. The heterogeneous cohort included degenerative disease, trauma, infection, hardware failure and pseudarthrosis. Segmental Cobb, anterior disc height and posterior disc height were measured preoperatively, immediately postoperatively and at 3-month follow-up. Paired radiographic changes were analyzed using the Wilcoxon signed-rank test. Results: Median segmental Cobb angle improved significantly from −16.2° preoperatively to −7.9° immediately postoperatively (median change +6.4°, p = 0.003), with correction maintained at 3 months (+5.5° versus baseline, p = 0.008). Anterior disc height increased from 6.0 to 9.2 mm immediately postoperatively (p = 0.004) and remained significantly greater than the baseline at 3 months despite a small early reduction in anterior disc height (+2.3 mm, p = 0.013). Posterior disc height increased from 4.3 to 7.6 mm (p = 0.021) and remained improved at 3 months (+2.1 mm, p = 0.014). Conclusions: Anterior column reconstruction through a posterior surgical corridor using a conformable mesh interbody implant appeared feasible in the lower thoracic spine and thoracolumbar junction. Significant restoration of segmental alignment and disc height was achieved, with most radiographic correction maintained at 3 months. These preliminary findings support the short-term maintenance of radiographic correction achieved with this reconstructive strategy.

BACKGROUND: Thoracic ossification of the ligamentum flavum (T-OLF) is an important cause of progressive thoracic myelopathy and may be particularly debilitating in professional baseball pitchers, in whom surgical treatment must restore neural function while preserving the spinal biomechanics required for elite pitching. Although open laminectomy has traditionally been the standard treatment, extensive muscle dissection and disruption of posterior elements may compromise postoperative stability and return to play. OBSERVATIONS: The authors applied a refined full-endoscopic interlaminar decompression technique for single-level and multilevel T-OLF in professional pitchers. The key surgical strategy involved thinning the ossified lesion to a paper-thin shell and elevating it around a lateral hinge point, thereby minimizing direct vertical compression on the vulnerable thoracic spinal cord. When transient intraoperative neurophysiological monitoring deterioration occurred, staged decompression was performed to reduce neurological risk. LESSONS: Both patients showed marked neurological recovery and returned to professional pitching within 6 months, without evidence of biomechanical compromise. These findings suggest that full-endoscopic decompression, by preserving the posterior tension band and paraspinal musculature, may represent a viable primary surgical option for T-OLF in high-demand athletes requiring preservation of spinal mobility and kinetic chain function. https://thejns.org/doi/10.3171/CASE26537

Background/Objectives: SPINEHealthie is a smartphone-based application enabling remote patient monitoring, care delivery and standardized collection of patient-reported outcome measures (PROMs). This registry-based analysis evaluates patient satisfaction with the platform across a large, heterogeneous spine surgery cohort. Methods: A total of 1729 thoracolumbar spine surgery cases were eligible for analysis. Among these, 881 (50.9%) completed the in-app feedback survey and constituted the primary feedback cohort. The global app experience was categorized as “Very Good” or “Poor”. Clinical outcomes, i.e., the Visual Analogue Scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) were assessed at baseline and in the postoperative period; Δ denotes the change from baseline to two weeks postoperation. Results: Among feedback responders, 800 patients (90.8%) rated their app experience as “Very Good”, while 80.8% of 639 patients with surgical outcome data reported that the surgery met their expectations. However, app experience and surgical outcome expectations were assessed using different items at different postoperative time points. Among patients whose surgery did not meet expectations, 84.6% rated their app experience as “Very Good”. Patients with a “Very Good” app-experience rating demonstrated significantly greater improvement in back pain (ΔVAS Back pain 2.94 vs. 2.13, p = 0.027), leg pain (ΔVAS Leg pain 3.16 vs. 2.14, p = 0.019) and disability (ΔODI 11.00 vs. 2.41, p < 0.001). In the primary model, older age, shorter follow-up duration and smaller ODI improvement were associated with an unfavorable app experience; only the association with age remained consistent across sensitivity analyses. Conclusions: Among feedback responders, SPINEHealthie was associated with a high proportion of favorable global app-experience ratings. Favorable app-experience ratings remained high, even among patients with unmet surgical expectations or failure to achieve the exploratory two-week ODI-improvement threshold, suggesting that perceived platform value is not solely explained by surgical outcome. Older patients and those with limited functional recovery were identified as subgroups that may benefit from targeted onboarding and engagement strategies.