International Journal of Spine Surgery最新文献

{"title":"Retiring CPT 62380: Why Endoscopic Lumbar Decompression Should Be Defined by Surgical Work, Not Optics.","authors":"Morgan P Lorio, Kai-Uwe Lewandrowski","doi":"10.14444/8776","DOIUrl":"https://doi.org/10.14444/8776","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ninety-Day Complication and Revision Surgery Rates Using Navigated Robotics in Thoracolumbar Spine Surgery: A PRoGRSS Interim Analysis.","authors":"Lindsay D Orosz, Nathan J Lee, Jeffery L Gum, Ronald A Lehman, Tamer R Hage, Jack Katz, Tyler Amell-Angst, Rita T Roy, Gregory T Poulter, Colin M Haines, Ehsan Jazini, Christopher R Good","doi":"10.14444/8777","DOIUrl":"https://doi.org/10.14444/8777","url":null,"abstract":"<p><strong>Background: </strong>Individually, robotic guidance and 3-dimensional navigation assistance have been shown to improve surgical outcomes and accuracy in spine surgery. The pairing of these technologies may further improve outcomes; however, data are needed to support this theory. In the Prospective Robotic-Guided Registry of Spine Surgery (PRoGRSS), outcomes were tracked for cases using a bone-mounted integrated robotic-assisted navigation system. This interim analysis reports on 90-day complications and revisions.</p><p><strong>Methods: </strong>Adults undergoing navigated robotic thoracolumbar surgery from 2020 to 2022 were prospectively enrolled by 6 surgeons at 4 distinct centers. Medical, surgical, and robot-related complications and revision surgeries were collected postoperatively for up to 90 days and analyzed.</p><p><strong>Results: </strong>Of 411 surgeries, 3469 screws were implanted. The mean number of levels fused was 4.4 ± 3.7. Intraoperative adverse events occurred in 4.1% of cases, and 0.5% were robot related. The frequency of patients with at least 1 postoperative surgical complication was 6.6%, none being robot related. The frequency of patients with at least 1 postoperative medical complication was 18.2%. The revision surgery rate at 90 days was 1.5%, none of which were robot related.</p><p><strong>Conclusion: </strong>This first-of-its-kind study of an integrated navigation and robotic spine platform demonstrates low complication and revision surgery rates for thoracolumbar fusion. This interim analysis of PRoGRSS showed 4.1% intraoperative complications, 6.6% postoperative surgical complications, and 1.5% revision surgeries. With advancements in technology and increased surgical expertise, navigated robotics continues to demonstrate consistently low rates of 90-day complications and revision surgeries, supporting its reliability.</p><p><strong>Clinical relevance: </strong>The interim analysis of PRoGRSS suggests that the integration of robotic guidance with 3-dimensional navigation is reproducibly effective in the surgical setting.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rates of Osteolysis for Commercially Available Cervical Disc Arthroplasty Devices in the United States: A Manufacturer and User Facility Device Experience Database Analysis.","authors":"Pierce Nunley, Andrew Meyers, Danny Mangual-Perez, Emily Young, Henry Googe, Ian Armstrong, Stacie Tran, Marcus Stone","doi":"10.14444/8772","DOIUrl":"https://doi.org/10.14444/8772","url":null,"abstract":"<p><strong>Background: </strong>Cervical disc arthroplasty (CDA) represents a promising alternative to anterior cervical discectomy and fusion for the treatment of symptomatic degenerative disc disease in appropriately selected patients. It offers the potential benefits of motion preservation and reduced adjacent segment degeneration. However, like any surgical procedure, CDA has associated risks and complications. Among these, postoperative osteolysis, although rare, warrants further investigation to fully understand its incidence, causes, and optimal management strategies. This study's purpose is to elucidate the current incidence of osteolysis following CDA.</p><p><strong>Methods: </strong>The Manufacturer and User Facility Device Experience (MAUDE) database was queried using the \"Brand Name\" function for: \"Mobi C,\" \"Mobi-C,\" \"Prodisc -C,\" \"Prodisc C,\" \"Bryan,\" \"PCM,\" \"Secure-C,\" \"Secure C,\" \"Prestige,\" \"M6,\" and \"Simplify\" from 1 January 2005 to 30 September 2024. Search results were further queried for the word \"osteolysis.\" Osteolysis percentage was calculated as a proportion of a total number of valid reports. The findings from this study were compared with published literature.</p><p><strong>Results: </strong>The total number of osteolysis events reported in the MAUDE database for each disc was 2 Mobi-C, 1 Prodisc-C, 3 Bryan, 0 PCM, 0 Secure-C, 2 Prestige, 138 M6, and 16 Simplify. The highest rate of osteolysis was found in the M6 (36.2%) and Simplify discs (25.8%). Results from the MAUDE database were consistent with previously published literature.</p><p><strong>Conclusion: </strong>While acknowledging the limitations of the MAUDE database, the data presented give rise to substantial concerns regarding the association of osteolysis with the M6 implant. While the reports on the Simplify disc are recent, the current findings indicate a necessity for careful monitoring. Although surgeon participation in the MAUDE database is optional, it is imperative to promptly report any issues with recent technology to ensure fellow surgeons and the public are well informed.</p><p><strong>Clinical relevance: </strong>This report brings to light a clinical concern of osteolysis in cervical TDR surgeries that was not previously discussed. Using these findings, surgeons can look out for signs of osteolysis in earlier follow-up to provide early treatment.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence: The Prevalent Coauthor Among Early-Career Surgeons.","authors":"Franziska C S Altorfer, Giuseppe Loggia, Fedan Avrumova, Darren R Lebl","doi":"10.14444/8778","DOIUrl":"https://doi.org/10.14444/8778","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional survey study BACKGROUND: Artificial intelligence (AI) tools are increasingly integrated into various aspects of medicine, including medical research. However, the scope and manner in which early-career surgeons utilize AI tools in their research remain inadequately understood.</p><p><strong>Objective: </strong>This study aimed to investigate the frequency and specific applications of AI tools in medical research among early-career surgeons, including their perceptions, concerns, and outlook regarding AI in research.</p><p><strong>Methods: </strong>A survey comprising 25 questions was distributed among members of an international club of early-career spine surgeons (<10 years of experience). The survey assessed demographics, AI tool utilization, access to AI training resources, and perceptions of AI benefits and concerns in research.</p><p><strong>Results: </strong>Sixty early-career surgeons participated, with 86.7% reporting AI tool use in their research. ChatGPT was the most frequently utilized tool, with a usage rate of 93.1%. AI tools were primarily used for grammatical proofreading (69.6%) and rephrasing (64.3%), while 26.8% of participants used AI for statistical analysis. While 80.4% perceived improved efficiency as a key benefit, 70.0% expressed concerns about reliability. None of the participants had received formal AI training, and only 15.0% had access to AI mentors. Despite these challenges, 91.6% anticipated a positive long-term impact of AI on research.</p><p><strong>Conclusion: </strong>AI tools are widely adopted among early-career surgeons for various research tasks, extending from text generation to data analysis. However, the absence of formal training and concerns regarding the reliability of AI tools underscore the necessity of training for AI integration in medical research.</p><p><strong>Clinical relevance: </strong>This study provides timely insights into AI adoption patterns among early-career surgeons, highlighting the urgent need for formal AI training programs to ensure responsible research practices.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opioid-Induced Hyperalgesia and Inflammaging in the Management of Spine Pain: The Case for Genetically Directed Dopamine Homeostasis.","authors":"Kai-Uwe Lewandrowski, Rossano Kepler Alvim Fiorelli, Sergio Schmidt, Alireza Sharafshah, David Baron, Mark S Gold, Panayotis K Thanos, Igor Elman, Debasis Bagchi, Abdalla Bowirrat, Albert Pinhasov, Morgan P Lorio, Kenneth Blum","doi":"10.14444/8756","DOIUrl":"https://doi.org/10.14444/8756","url":null,"abstract":"<p><strong>Background: </strong>The management of spine-related pain with narcotics, both before and after surgery, poses major challenges, including drug diversion, limited effectiveness, and worsening of pain symptoms over time. Chronic opioid use is associated with hypodopaminergia-induced hyperalgesia, whereby dopamine depletion increases pain sensitivity. Patients with inherently low dopaminergic function are particularly predisposed to hyperalgesia and reduced pain tolerance.</p><p><strong>Methods: </strong>An alternative therapeutic strategy centers on genetically guided pro-dopamine regulation, which aims to transmodulate dopaminergic signaling to mitigate hyperalgesia. Early identification of predisposition through genetic testing, combined with pharmacogenetic and pharmacogenomic monitoring, is proposed to optimize treatment approaches.</p><p><strong>Results: </strong>Pro-dopamine regulators have demonstrated promising results across 43 clinical studies, showing potential to reduce stress, craving, and relapse rates, while improving emotional well-being and attenuating pain sensitivity. These findings suggest that pro-dopamine regulation may serve as a viable frontline therapy for managing chronic pain and associated Reward Deficiency Syndrome behaviors, offering a significant reduction in the adverse effects commonly observed with chronic opioid therapy.</p><p><strong>Conclusions: </strong>Given the limitations of dopaminergic blockade through chronic opioid agonist therapy, there is a critical need to reevaluate current pain management practices. The induction of dopamine homeostasis via pro-dopamine regulation represents a novel and potentially transformative strategy. Spine surgeons, pain specialists, and addiction medicine practitioners are urged to consider this approach as a promising alternative for improving long-term outcomes in patients suffering from chronic pain.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144620757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of 2D Sagittal Radiological Analysis vs 3D Templating for Pedicle Screw Fixation of C2 Vertebral Body.","authors":"Adarsh Suresh, Takashi Hirase, Scott A Buhler, Rex A W Marco","doi":"10.14444/8775","DOIUrl":"https://doi.org/10.14444/8775","url":null,"abstract":"<p><strong>Background: </strong>There are currently no studies that directly compare the previously established 2-dimensional (2D) sagittal technique with 3-dimensional (3D) templating for C2 pedicle screw.</p><p><strong>Objective: </strong>To verify the accuracy of sagittal radiological analysis for safe placement of a C2 pedicle screw by performing a direct comparison between 2D planning with 3D templating methods.</p><p><strong>Methods: </strong>In this retrospective analysis, forty-six sets of computed tomography scans that contained 2-mm bony cuts and 2D reconstructions in the axial, sagittal, and coronal planes of skeletally mature patients were analyzed. StealthStation S7 (Medtronic Surgical Navigation, Minneapolis, Minnesota, United States) trajectory planning was used to plan the ideal placement, maximum diameter pedicle screw into the C2 pedicle. Based on the parameters of ≤3 mm screw diameter as high risk, >3 mm and <5 mm as moderate risk, and ≥5 mm as low risk, frequency and percentage values were calculated for the left, right, and bilateral pedicle screws.</p><p><strong>Results: </strong>Out of the 46 patients analyzed in this study, only 1 patient (2.2%) was classified as low risk (≥5 mm) bilaterally, 5 were classified as high risk (≤3 mm) bilaterally (10.8%), and 25 patients (54.3%) showed variability in pedicle width between the left and right sides. With analysis of both left and right pedicle, 7 out of 92 pedicles (7.6%) analyzed were classified as low risk (≥5 mm), 67 out of 92 (72.8%) were at moderate risk (>3 mm and <5 mm), and 18 out of 92 (19.6%) were at high risk (≤3 mm).</p><p><strong>Conclusion: </strong>Both the previously described 2D sagittal planning method and the current 3D templating method allow for accurate preoperative planning for the placement of ≤4 mm C2 pedicle screws, which is important given the limited availability and amount of resources utilized for the 3D templating model. However, the 3D templating method more precisely identifies C2 pedicles where 3.0 to 4.5 mm screws can feasibly be placed.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Anterior Lumbar Interbody Fusion Reduce Mechanical Complication and Pseudarthrosis Rate at the Lumbosacral Junction in Adult Spinal Deformity Surgery in Comparison to Posterior Lumbar Interbody Fusion?","authors":"Mohamed Kamal A Mohamed, Michael Rauschmann, Andrei Slavici, Marcus Rickert, Sebastian Walter, Nikolaus Kernich, Krishnan Sircar, Peer Eysel, Vincent J Heck","doi":"10.14444/8774","DOIUrl":"https://doi.org/10.14444/8774","url":null,"abstract":"<p><strong>Background: </strong>To evaluate the impact of anterior lumbar interbody fusion (ALIF) vs posterior lumbar interbody fusion (PLIF) at the lumbosacral junction on mechanical complications and fusion rate at the caudal lumbar segments in adult spinal deformity (ASD) surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included ASD patients with coronal or sagittal imbalance who underwent thoracolumbar to pelvic fusion with ALIF or PLIF technique at the lumbosacral junction and a minimum follow-up of 2 years. The primary focus was on mechanical complications, including material failure and sacral fracture, implant-related pain, pseudarthrosis, and reoperation. Patient-specific and perioperative characteristics were also analyzed at the 2-year follow-up. The primary focus was on mechanical complications, including material failure and sacral fracture, implant-related pain, pseudarthrosis, and reoperation. Patient-specific and perioperative characteristics were also analyzed.</p><p><strong>Results: </strong>A total of 56 patients were included, comprising 32 ALIF and 24 PLIF patients, with a mean age of 79.5 ± 6.6 years. The overall mechanical complication rate was 19.6%, including screw loosening (7.1%), rod breakage (5.4%), sacral fracture (3.6%), and screw breakage (1.8%). Pseudarthrosis and reoperation rates were 10.7% each. ALIF significantly reduced mechanical complications compared with PLIF (9.4% vs 37.5%, <i>P</i> = 0.011). The ALIF group also showed lower rates of pseudarthrosis, implant-related pain, and reoperation (<i>P</i> < 0.05). Regression analysis identified PLIF as an independent risk factor for mechanical complications (<i>P</i> = 0.006). Length of hospital stay, operative time, and pseudarthrosis rate were significantly associated with an increased rate of mechanical complications, but patient demographics had no significant impact.</p><p><strong>Conclusion: </strong>Approximately 1 in 5 patients experiences mechanical complications within 2 years of ASD correction surgery. ALIF at the lumbosacral junction significantly reduces mechanical complications and pseudarthrosis compared with PLIF, resulting in lower reoperation rates. These findings suggest that ALIF should be the preferred technique for lumbosacral fusion in long-segment ASD constructs, provided there is no spondylolisthesis or severe spinal stenosis with L5 nerve root compression requiring simultaneous direct posterior decompression and fusion. This is particularly important in patients at risk for mechanical complications and pseudarthrosis, including those undergoing revision procedures.</p><p><strong>Level of evidence: </strong>3 - Retrospective comparative study.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The First Grade III Lumbar Spondylolisthesis Treated With the Novel 360° Artificial Disc/Artificial Facet Replacement Solution.","authors":"Jared D Ament, Jack Petros, Cooper Gardner, Amir Vokshoor","doi":"10.14444/8769","DOIUrl":"https://doi.org/10.14444/8769","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The incidence of spondylolisthesis increases with age and is more prevalent in women. \"High-grade\" (above grade II) occurs in 10% to 12% of affected individuals. Patients often present with back pain as well as leg pain, numbness, paresthesias, hamstring tightness, radiculopathy, and neurogenic claudication. If conservative therapy fails , the standard of care is fusion. However, despite its effectiveness in stabilizing the spine, fusion causes biomechanical load transfer to adjacent vertebrae, which can increase the risk of adjacent segment disease and reduce range of motion. These drawbacks are especially problematic for younger, more active patients who wish to maintain a high quality of life. In this report, we describe an innovative 360º, motion-preserving surgical approach utilizing 2 FDA-approved devices, the Prodisc L Artificial Disc Replacement and the Total Posterior Spine System, in an \"off-label\" investigational manner for the treatment of high-grade spondylolisthesis and associated disc space collapse.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This case report is part of a multi-institution, Institutional Review Board-approved, prospective cohort trial. Subjective and objective outcomes were collected every 6 to 12 weeks. Patient satisfaction scores as well as patient-reported outcomes included neurologic examination, visual analog scale (VAS) back pain, VAS left leg pain, VAS right leg pain, Patient-Reported Outcomes Measurement Information System (PROMIS), PROMIS physical health, PROMIS mental health, 12-item short form (SF-12), need for repeat surgery, patient's recommendations pertaining to their surgery, and postoperative radiographic dynamic x-ray images. A 36-year-old man presented to the clinic with complaints of progressive 7 to 8/10 low back pain with pain radiating down his legs bilaterally. The patient reported years of symptoms, only mildly managed with conservative therapy. He had been offered fusion by multiple surgeons. Imaging demonstrated progression of his known L5 to S1 grade II spondylolisthesis with severe disc space collapse to now grade III.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The patient's Oswestry Disability Index improved from 16 to 2 (87.5%) at 3 months postoperatively. The patient's VAS score for back, left, and right leg pain was 4.87, 2.41, and 1.51 preoperatively. All VAS scores decreased to 0 by 3 months. The PROMIS physical health score of 14 remained relatively stable at 13 at 3 months. The SF-12 physical and mental component scores improved by 16.7% and 21.23%, respectively. By 6 weeks postoperation, the patient expressed high satisfaction of 8 out of 10, improving to 10 out of 10 by 3 months. Results have been maintained at 9 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This case illustrates encouraging early data in support of a 360º arthroplasty concept in the treatment of high-grade spondylolisthesis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;This cutting-edge motion preservati","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ISASS Recommendations and Coverage Criteria for Bone-Anchored Annular Defect Closure Following Lumbar Discectomy: Coverage Indications, Limitations, and/or Medical Necessity-An ISASS 2025 Policy Update on the Use of Bone-Anchored Annular Closure to Prevent Reherniation in High-Risk Lumbar Discectomy Patients.","authors":"Morgan P Lorio, Richard A Kube, John Ratliff, Anthony DiGiorgio, David A Essig, Kris Radcliff, Kai-Uwe Lewandrowski, Jon E Block","doi":"10.14444/8770","DOIUrl":"https://doi.org/10.14444/8770","url":null,"abstract":"<p><p>Patients with symptomatic lumbar disc herniation with radiculopathy where there is a large residual annular defect following discectomy are at greater risk of reherniation with symptom recurrence and revision surgery. These patients may benefit from primary annular repair. In 2019, the International Society for the Advancement of Spine Surgery published clinical guidelines supporting the use of bone-anchored annular closure in patients with large annular defects who are at greater risk for recurrent disc herniation. This 2025 update is provided to (1) summarize the current, increased clinical evidence for bone-anchored annular closure with greater follow-up durations and (2) update guidance for coding in light of new diagnostic and upcoming current procedural terminology codes. Based on accumulating clinical evidence, the International Society for the Advancement of Spine Surgery reiterates its position that in patients with symptomatic lumbar disc herniation with radiculopathy undergoing primary discectomy with large (≥6 mm wide) annular defects, bone-anchored annular closure may be used to sustain the treatment benefits of discectomy.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Perspectives on Awake Transforaminal Endoscopic Decompression Surgery Outcomes.","authors":"Albert E Telfeian, Rohaid Ali, Sanjay Konakondla, Kai-Uwe Lewandrowski","doi":"10.14444/8763","DOIUrl":"10.14444/8763","url":null,"abstract":"<p><strong>Background: </strong>This study aims to evaluate patient perceptions of the outcomes following awake transforaminal endoscopic lumbar decompression surgery for treating degenerative spine diseases.</p><p><strong>Methods: </strong>Over a 1-year period from 2022 to 2023, awake transforaminal endoscopic spine surgeries were performed on 183 patients using local anesthesia and sedation, allowing patients to communicate with the surgical team throughout the procedure. A follow-up app-based survey was sent to these patients to assess their perceptions and outcomes related to the surgery.</p><p><strong>Results: </strong>Out of 183 recipients, 102 patients completed the survey. At the 1-year follow-up, 89.2% of the respondents reported better outcomes in comparison to traditional spine surgeries, and 98% expressed willingness to recommend the procedure to others with similar conditions.</p><p><strong>Conclusions: </strong>The findings demonstrate notable advancements in minimally invasive spine surgery, with awake transforaminal endoscopic decompression showing high satisfaction rates tied closely to meeting patient expectations. The study also identifies areas for improvement, particularly in managing postoperative pain and aligning patients' expectations with clinical results.</p><p><strong>Clinical relevance: </strong>Effective preoperative communication and consistent pain management practices are critical in enhancing patient satisfaction and postoperative recovery, along with the integration of conservative treatments such as physical therapy and acupuncture to maximize surgical outcomes.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}