International Journal of Spine Surgery最新文献

{"title":"Predictive Value of MRI-Based Vertebral Bone and Endplate Bone Quality Assessments for Screw Loosening and Cage Subsidence in Degenerative Thoracolumbar Spine Surgery: A Systematic Review and Meta-Analysis.","authors":"Abdulrahim Saleh Alrasheed, Raghad Abdulaziz Almutairi, Rammaz Hussam Khoja, Saleh S Baeesa, Óscar L Alves, Ibrahim A Alhalal, Sultan Othman Alsalmi","doi":"10.14444/8801","DOIUrl":"https://doi.org/10.14444/8801","url":null,"abstract":"<p><strong>Background: </strong>Thoracolumbar spine surgical interventions are often complicated by cage subsidence and screw loosening. The main risk factor for such conditions is poor bone mineral density. Vertebral bone quality (VBQ) and endplate bone quality (EBQ) scores are novel radiation-free magnetic resonance imaging (MRI)-based tools that have shown promise in predicting such conditions. This meta-analysis sought to assess the predictive value of VBQ and EBQ scores in identifying the risk of screw loosening and cage subsidence following thoracolumbar spine surgery.</p><p><strong>Methods: </strong>PubMed, Scopus, Cochrane Library, and Web of Science databases were searched systematically to retrieve articles assessing the predictive potential of VBQ and EBQ scores for evaluating screw loosening and cage subsidence following thoracolumbar spine surgery. The quality assessment of diagnostic accuracy studies 2 (QUADAS-2) tool was utilized to assess the quality of diagnostic accuracy studies. Data were synthesized using a random-effects model, assessing for potential heterogeneity among the included studies.</p><p><strong>Results: </strong>19 studies involving 2768 participants met the inclusion criteria. The cage subsidence and screw loosening groups showed significantly higher VBQ scores than the control group. The cage subsidence group showed significantly higher EBQ scores than the control group.</p><p><strong>Conclusions: </strong>MRI-based VBQ and EBQ scores demonstrate efficacy as predictive indicators of screw loosening and cage subsidence following surgical procedures for thoracolumbar degenerative disease. Consequently, preoperative assessment of bone quality is imperative for optimizing surgical outcomes.</p><p><strong>Level of evidence: 1: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145349032","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":"Total Joint Replacement of the Lumbar Spine: 12-Month Pain and Functional Outcomes From an Investigational Device Exemption Clinical Trial.","authors":"Pierce D Nunley, J Alex Sielatycki, S Craig Humphreys, Scott D Hodges, Jon E Block, Domagoj Coric, Jeffrey A Goldstein","doi":"10.14444/8809","DOIUrl":"https://doi.org/10.14444/8809","url":null,"abstract":"<p><strong>Background: </strong>Lumbar fusion eliminates motion at the operative level and is associated with altered load transfer and adjacent segment degeneration. Total joint replacement (TJR) of the lumbar spine is a motion segment reconstruction procedure performed via a bilateral transforaminal approach that allows direct neural decompression and replacement of both disc and facet function. This prospective investigational device exemption clinical trial compared TJR with a concurrent, propensity-score-weighted real-world evidence cohort treated with either instrumented transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody spine fusion (PLIF).</p><p><strong>Methods: </strong>This multicenter investigational device exemption trial was conducted at 20 US sites. Patient-reported outcomes from 152 TJR subjects implanted with the MOTUS device were compared with 142 propensity score-weighted TLIF/PLIF controls. Lumbar-related disability was measured with the Oswestry Disability Index (ODI) and back and worst leg pain severity by a 100-mm visual analog scale (VAS). Minimal clinically important difference thresholds were ODI ≥ 15 points and VAS ≥ 20 mm; responder analyses were also conducted using ≥30% and substantial clinical benefit (≥50%) thresholds. Effect sizes were calculated using Cohen's <i>d</i> or <i>h</i>.</p><p><strong>Results: </strong>Baseline characteristics were well balanced, and there were no statistically significant differences between study groups. At 12 months, mean ODI decreased by 45 points (71%) with TJR and 37 points (59%) with TLIF/PLIF. The adjusted between-group difference was 8.1 points (95% CI, 2.5-13.7; <i>P</i> = 0.005; Cohen's <i>d</i> = 0.39, small). VAS back and leg pain decreases were similar between groups, with no significant between-group differences. Minimal clinically important difference responder rates were high (>85%) for both procedures; the ≥30% ODI threshold favored TJR (90% vs 80%; <i>P</i> = 0.04).</p><p><strong>Conclusions: </strong>Substantial decreases in back impairment and pain severity were realized in both study groups. However, longitudinal improvement in ODI significantly favored patients treated with TJR.</p><p><strong>Clinical relevance: </strong>Lumbar TJR combines decompression with motion preservation in a single procedure, potentially offering an alternative to fusion in selected patients. The advantage of utilizing a standard posterior operative approach with TJR is that it allows for direct decompression of the neural elements prior to implant placement.</p><p><strong>Level of evidence: </strong>2b.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145348952","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":"Outcomes Comparison Between Oblique Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Low-Grade Spondylolisthesis: A Randomized Clinical Trial.","authors":"Weerasak Singhatanadgige, Wantanun Lorwatthanakitchai, Teerachat Tanasansomboon, Stephen J Kerr, Wicharn Yingsakmongkol, Vit Kotheeranurak, Worawat Limthongkul","doi":"10.14444/8795","DOIUrl":"10.14444/8795","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and oblique lumbar interbody fusion (OLIF) are widely used for treating spondylolisthesis patients, but there is no randomized controlled trial study that directly compared OLIF and MIS-TLIF.</p><p><strong>Methods: </strong>Sixty patients who underwent single-level surgery at L4 to L5 were randomly allocated to the MIS-TLIF or OLIF group. Primary clinical outcomes were visual analog scale (VAS) of back and leg pain, Oswestry Disability Index (ODI) scores, and EQ-5D-5L. Secondary outcomes were radiological outcomes including disc height (DH), foraminal height (FH), foraminal area (FA), cross-sectional area of spinal canal, spinal canal diameter, and fusion rates.</p><p><strong>Results: </strong>Both groups showed significant improvements in clinical outcomes from baseline to each subsequent postoperative period. Predicted mean change (95% CI) in VAS back, VAS leg, ODI scores, and EQ-5D-5L were -3.9 (-4.6 to -3.1), -5.6 (-6.2 to -5.1), -15.7 (-19.0 to -12.5), and 25.4 (21.3-29.6), respectively. Clinical differences in both groups over total follow-up were not statistically significant: VAS back -0.38 (-0.87 to 0.11); <i>P</i> = 0.18, VAS leg: -0.40 (-0.81 to 0.02); <i>P</i> = 0.08, ODI: 0.4 (-1.9 to 2.8); <i>P</i> = 0.7 and EQ-5D-5L: 0.1 (-1.9 to 2.2); <i>P</i> = 0.9. Radiological parameters significantly improved from baseline to early postoperation in both groups. Changes in DH, FH, and FA were lower in MIS-TLIF compared with OLIF. The cross-sectional area of spinal canal change was higher in MIS-TLIF compared with OLIF. Spinal canal diameter change was not different between groups. Fusion rates were similar in both groups.</p><p><strong>Conclusions: </strong>Patient-reported outcomes were significantly improved in both MIS-TLIF and OLIF groups without significant differences between both procedures. OLIF demonstrated advantages in restoration of DH, FH, FA, and lower intraoperative blood loss compared with MIS-TLIF.</p><p><strong>Clinical relevance: </strong>Both MIS-TLIF and OLIF offer comparable clinical benefits for patients with single-level degenerative spondylolisthesis. However, OLIF may be preferred in cases where greater restoration of disc and foraminal dimensions and reduced intraoperative blood loss are desired.</p><p><strong>Level of evidence: 1: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259565","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":"Beyond Pain Relief: Preventing Recurrence and Preserving Function After Lumbar Discectomy.","authors":"Parker Babington, Jason Zook, K Brandon Strenge, Pierce Nunley, Juliette Beristain, Marcus Stone, Laura C Shum, Michael Musacchio","doi":"10.14444/8803","DOIUrl":"https://doi.org/10.14444/8803","url":null,"abstract":"<p><p>Lumbar discectomy remains the most common surgical treatment for lumbar disc herniation, potentially providing quick pain relief for patients. However, while pain resolution is a key measure of short-term success, it does not guarantee long-term recovery. In patients with large annular defects (≥6 mm), the structural vulnerability left by discectomy predisposes patients to recurrent herniation, which can trigger a return of severe pain, diminished function, and the need for additional surgery. Revision surgeries for recurrent herniations are costly and are associated with a lower chance of positive patient outcomes compared with primary procedures.Bone-anchored annular closure devices aim to address the root structural cause of recurrent herniation by sealing the annular defect during discectomy to preserve disc integrity. Adding a bone-anchored annular closure device to discectomy reduces symptomatic reherniation and reoperation rates by more than 50%, prolonging pain-free intervals and improving quality of life. Patients treated with bone-anchored annular closure devices report low pain scores over long-term follow-up, faster return to work, and reduced opioid requirements.Cost-effectiveness analyses demonstrate that in patients with a large annular defect, bone-anchored annular closure devices achieve cost neutrality, or savings, within 2 to 5 years, with incremental cost-effectiveness ratios below accepted thresholds. By preventing the recurrence of lumbar herniation and the need for reoperation, bone-anchored annular closure technologies offer a clinically validated, economically prudent solution aligned with value-based care principles and durable, patient-centered success.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293754","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":"Sexual Dysfunction and Retrograde Ejaculation After Primary Anterior Lumbar Interbody Fusion in Male Patients: A Survey on 98 Patients.","authors":"Timo Dennier, Emin Aghayev, Yael Rachamin, Peter Diel, Lorin Michael Benneker, Lukas Kouba, Paul Ferdinand Heini","doi":"10.14444/8799","DOIUrl":"https://doi.org/10.14444/8799","url":null,"abstract":"<p><strong>Background: </strong>Anterior lumbar interbody fusion (ALIF) is a well-established procedure for the treatment of spondylosis, spondylolisthesis, and degenerative disc disease but can cause sexual dysfunction and retrograde ejaculation (RE).</p><p><strong>Objective: </strong>We assessed the occurrence of sexual dysfunction and RE and explored associations between patient and surgical characteristics with sexual dysfunction, RE, and patient satisfaction with the outcome of surgery.</p><p><strong>Methods: </strong>This is a retrospective survey study. A short questionnaire on changes in sexual function, RE, and patient satisfaction was sent to 170 male patients aged 18 to 60 years who underwent a primary ALIF at L5/S1, L4/L5, or both via retroperitoneal approach between 2015 and 2020 in a high-volume spine centre in Switzerland. Factors associated with changes in sexual function and with RE were examined in univariable and multivariable logistic regressions. The multivariable logistic regression model was adjusted for age at surgery, time since surgery, level of surgery, and fusion material. The associations between satisfaction with the outcome of surgery and time since surgery and changes in sexual function were also assessed using univariable logistic regression.</p><p><strong>Results: </strong>Of the 170 patients contacted, 98 (58%) agreed to participate. The most frequent fusion level was L5/S1 (<i>n</i> = 74, 76% of respondents), and InductOs was generally used (<i>n</i> = 69, 70%). Overall, 21 patients (21%) reported changes in sexual function, and 11 (11%) felt signs of RE. The majority of patients were satisfied with the surgical outcome (<i>n</i> = 83, 85%) and would undergo the surgery again (<i>n</i> = 83, 85%). In all regression models, changes in sexual function and RE were not associated with any of the studied factors. The odds of being satisfied with the surgery were 4× higher for patients who did not observe changes in sexual function than those who did (95% CI, 1.24-12.86).</p><p><strong>Conclusions: </strong>The risk of sexual dysfunction and RE after ALIF is relevant, and patients need to be adequately informed about these complications, especially if they want to have children. At the same time, the ALIF procedure remains a successful treatment option with high patient satisfaction.</p><p><strong>Clinical relevance: </strong>The study emphasizes the need to provide patients with adequate information regarding ALIF surgery.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145293924","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":"Anterior Debridement and Fusion With Plating for Cervical Spondylodiscitis: Retrospective Assessment of Clinical Efficacy.","authors":"Yu-Dong Liao, Chen Tu, Jia-Wen Gao, Rui-Feng Ao, Yu-Shen Huang, Ying-Tao Hu, Si-Yuan Zhu, Jian Jin, Zhao-Ming Zhong","doi":"10.14444/8798","DOIUrl":"https://doi.org/10.14444/8798","url":null,"abstract":"<p><strong>Background: </strong>Cervical spondylodiscitis is a rare condition that easily causes neurological deficits. This study aimed to evaluate the safety and efficacy of anterior debridement and fusion (ADF) with plating for cervical spondylodiscitis.</p><p><strong>Method: </strong>We retrospectively analyzed the medical records of 24 patients who underwent ADF with plating and antibiotics for cervical spondylodiscitis at our institution from June 2005 to June 2023. The neurologic status was evaluated using the Japanese Orthopedic Association scoring system and Hirabayashi recovery rate. Radiological parameters were assessed, including C2 to C7 angle, angle and height of the fused segment, and fusion status.</p><p><strong>Results: </strong>Mean follow-up time was 50.1 (range 12-162) months. The Japanese Orthopedic Association score increased from 13.2 preoperatively to 15.8 at the final follow-up, with a mean Hirabayashi recovery rate of 79.3%. Recovery outcomes were excellent in 17 (70.8%) cases, good in 3 (12.5%), acceptable in 1 (4.2%), and unchanged in 3 (12.5%). Postoperative C2 to C7 angles and the angle and height of the fused segment were significantly improved compared with preoperative measures. However, height loss of the fused segments occurred in all cases during the follow-up period, especially in ADF with titanium mesh. One patient received revision with posterior fixation because of a pathological fracture in the cephalic vertebral body of the fused segment in the early postoperative phase. Infection resolution and solid bony fusion were achieved in all patients.</p><p><strong>Conclusion: </strong>ADF with plating can achieve satisfactory clinical outcomes for cervical spondylodiscitis.</p><p><strong>Clinical relevance: </strong>Poor bone quality secondary to infection, excessive intraoperative cervical distraction, and the choice of fusion material may be associated with the loss of fused segmental height and angle, as well as potential instrumentation failure, after ADF with plating.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240113","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":"Advantages of 12° Endoscope in Unilateral Biportal Endoscopic Surgery for Lumbar Disc Herniation.","authors":"Wenbo Wu, Yanqiu Xie, Yinkai Xue, Min Cui, Xianlin Zeng, Yukun Zhang, Cao Yang, Yongchao Wu","doi":"10.14444/8771","DOIUrl":"https://doi.org/10.14444/8771","url":null,"abstract":"<p><strong>Objective: </strong>This study introduces the application of a 12° endoscope in unilateral biportal endoscopic (UBE) decompression surgery for lumbar disc herniation and discusses its advantages in UBE procedures.</p><p><strong>Methods: </strong>From December 2019 to December 2020, 75 patients (33 men and 42 women) were treated with UBE decompression using a 12° endoscope. Patient ages ranged from 26 to 78 years (mean 53.2). Pre- and postoperative visual analog scale (VAS) scores for low back and leg pain were recorded. Surgical outcomes were evaluated using MacNab criteria, with operative time and complications documented.</p><p><strong>Results: </strong>The 12° endoscope demonstrated superior maneuverability with a distortion-free visual field. Compared with 30° endoscopes, it showed better applicability within the anatomical working triangle while providing broader visualization than 0° endoscopes. This enabled effective decompression of the superior articular process medial edge, nerve root canal, and lateral recess. Low back pain VAS scores decreased from 7.3 ± 1.3 to 1.9 ± 1.2 (<i>P</i> < 0.001), while leg pain scores improved from 8.1 ± 1.8 to 1.6 ± 1.0 (<i>P</i> < 0.001). At the 12-month follow-up, MacNab criteria outcomes were excellent in 65.3%, good in 25.3%, and unsatisfactory in 9.3% of cases (<i>χ</i> ² test, <i>P</i> = 0.002).</p><p><strong>Conclusion: </strong>The 12° endoscope demonstrates clinical value as a feasible, safe, and effective option for UBE surgery in lumbar disc herniation treatment.</p><p><strong>Clinical relevance: </strong>Key clinical advantages of the 12° endoscope include direct visualization of key anatomical structures, minimized bone resection (particularly at the medial spinous process base), and a reduction in instrument crowding. These technical benefits contribute to effective decompression, improved patient outcomes (as measured by VAS and MacNab criteria), and potentially a shorter learning curve for surgeons adopting the UBE technique.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240070","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":"Sensitivity of Lumbar Total Joint Replacement to Axial and Coronal Plane Misalignment Using Computational Modeling.","authors":"Steven A Rundell, Steven M Kurtz, Hannah Spece, Jeffrey A Goldstein, Scott D Hodges, Ron V Yarbrough","doi":"10.14444/8792","DOIUrl":"https://doi.org/10.14444/8792","url":null,"abstract":"<p><strong>Background: </strong>During lumbar total joint replacement (LTJR), component misalignment during implantation may affect the bearing surface interaction. In this study, validated computational models of the lumbar spine were used to investigate a range of clinically relevant misalignment scenarios.</p><p><strong>Methods: </strong>A finite element model (FEM) of the LTJR, exposed to mode I (normal wear) and mode IV (impingement) wear boundary conditions, was previously validated following the ASME V&V 40 standard. The LTJR FEM was virtually implanted into a previously validated FEM of the lumbar spine (L3-L5) at L4 to L5. The model included vertebrae, major spinal ligaments, erector muscle forces, and intervertebral discs. Misalignment was introduced by adjusting the bilateral implant axial plane convergence angle (20°-40°), anterior-posterior offset (0-4 mm), and coronal plane tilt (±20°). Analyses were conducted using LS-DYNA3D (ANSYS) under boundary conditions simulating bending at the waist. Contact pressures and von Mises stresses were evaluated for each misalignment scenario and compared with those developed during mode I and mode IV impingement scenarios.</p><p><strong>Results: </strong>Axial plane convergence angle had minimal impact on contact stress and von Mises stress magnitude and distribution. Increasing anterior-posterior offset led to higher stresses on the anteriorly shifted component but did not significantly alter the overall stress pattern. Coronal tilt had the most substantial effect on both stress magnitude and distribution.</p><p><strong>Conclusion: </strong>Overall, polyethylene stresses in all misalignment scenarios remained below mode IV impingement levels. Contact areas remained within the intended spherical bearing surfaces without signs of impingement. LTJR contact stresses were found to be reasonably insensitive to misalignment under boundary conditions representing bending at the waist.</p><p><strong>Clinical relevance: </strong>This work assesses the impact of clinically relevant implant misalignment scenarios on the polyethylene stresses associated with damage and wear for a novel LTJR and offers best practice guidelines for surgeons.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214072","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":"Full Decompression of Spinal Stenosis in Stable Adult Isthmic Spondylolisthesis With a Combination of Full Endoscopic Spine Surgery and Unilateral Biportal Endoscopic Spine Surgery: A Case Report.","authors":"Chien-Chieh Wang, Kin-Weng Wong, Po-Kuan Wu, Kuan-Ting Chen, Wen-Shuo Chang, Chi-Sheng Chien, Dae-Jung Choi, Tsung-Mu Wu","doi":"10.14444/8800","DOIUrl":"https://doi.org/10.14444/8800","url":null,"abstract":"<p><strong>Background: </strong>Adult isthmic spondylolisthesis often remains stable in adulthood, but progressive neural compression can occur due to scar tissue, bony overgrowth, and disc degeneration. Conventional endoscopic techniques such as the interlaminar or transforaminal approaches may be limited by anatomical constraints in adult isthmic spondylolisthesis, making complete decompression difficult.</p><p><strong>Methods: </strong>A 70-year-old man presented with bilateral leg pain and neurogenic claudication. Imaging revealed bilateral L4 to L5 lateral recess narrowing, L5 foraminal stenosis, and a bulging L5 to S1 disc compressing the extraforaminal nerve roots. A novel craniocaudal interlaminar approach via unilateral biportal endoscopic spine surgery was used to decompress the central and contralateral foraminal regions. The residual ipsilateral extraforaminal lesion was accessed through a separate full endoscopic transforaminal approach. Three incisions of 7 mm each were used.</p><p><strong>Results: </strong>The patient experienced immediate and significant relief of radicular symptoms and improved function and was discharged the next day. At 18-month follow-up, he remained pain-free and without new-onset back pain or signs of instability.</p><p><strong>Conclusions: </strong>This is the first reported case combining unilateral biportal endoscopic spine surgery and full endoscopic spine surgery. The approach enabled full decompression from central to extraforaminal zones with minimal invasiveness. This dual-endoscopic strategy may serve as a model for treating complex spine cases not amenable to single-approach techniques.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145214096","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":"Bilateral Pedicle Screw Fixation Vs Unilateral Pedicle Screw Fixation for Single Level Lateral Lumbar Interbody Fusion: Outcomes, Cost Analysis, and Radiation Exposure.","authors":"Saagar Dhanjani, Timothy Choi, Abdufarrukh Karimov, Kishan S Shah, Micah B Blais, Gregory M Mundis, Ali Bagheri, Behrooz A Akbarnia, Robert K Eastlack","doi":"10.14444/8794","DOIUrl":"https://doi.org/10.14444/8794","url":null,"abstract":"<p><strong>Background: </strong>This study aims to determine whether single-level lateral lumbar interbody fusion (LLIF) with unilateral pedicle screw fixation (UPSF) might offer advantages over bilateral pedicle screw fixation (BPSF) in terms of radiation emission, cost, and outcomes.</p><p><strong>Methods: </strong>The records of 101 patients who underwent single-level LLIF with percutaneous pedicle screw fixation from September 2017 to August 2024 were analyzed. Patients were divided into 2 groups: 42 with UPSF and 59 with BPSF. Demographic data, social history, comorbidities, surgical characteristics, costs (based on manufacturer prices), and radiation metrics (radiation emitted, fluoroscopy time, number of images, and magnification mode used) were collected. Clinical outcomes were assessed using the Numeric Rating Scale (NRS), the Oswestry Disability Index, and procedure satisfaction, while radiographic evaluation employed a novel fusion classification system.</p><p><strong>Results: </strong>There were no significant differences in age, body mass index, social history, comorbidities, or operative level. However, the BPSF group included significantly more women (<i>P</i> = 0.002) and a higher proportion of spondylolisthesis cases (<i>P</i> < 0.001). Oswestry Disability Index and NRS scores were similar, except for greater improvements in NRS back pain at 1 year in the BPSF group (-4.0 vs -1.75, <i>P</i> = 0.008). While the total fluoroscopy time, number of images, and Mag 1 usage were greater in the BPSF group (all <i>P</i> < 0.001), the average radiation emitted did not significantly differ (39.38 milligray for UPSF vs 50.75 milligray for BPSF, <i>P</i> = 0.211). Fusion grades were comparable (<i>P</i> = 0.478), and UPSF costs were 27.7% lower.</p><p><strong>Conclusions: </strong>Our study found that when used according to clinical indications, UPSF results in similar radiation emission and radiographic outcomes, while being 27.7% less expensive than BPSF for single-level LLIF. Additionally, while BPSF was associated with greater improvement in 1 year NRS back scores, no other significant differences in patient-reported outcome measures were observed between the 2 groups.</p><p><strong>Clinical relevance: </strong>This study provides clinically relevant insights for selecting between UPSF and BPSF in single-level LLIF when both are considered appropriate.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151388","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}