International Journal of Spine Surgery最新文献

{"title":"Effective Biportal Endoscopic Spine Surgery Technique With Better Facet Joint Preserving for Lumbar Lateral Recess Stenosis.","authors":"Sub-Ri Park, Namhoo Kim, Ji-Won Kwon, Kyung-Soo Suk, Seong-Hwan Moon, Si-Young Park, Byung Ho Lee, Hak-Sun Kim, Jin-Oh Park","doi":"10.14444/8734","DOIUrl":"10.14444/8734","url":null,"abstract":"<p><strong>Background: </strong>Biportal endoscopic spinal surgery (BESS) for the treatment of spinal stenosis provided favorable clinical outcomes in many studies. They reported that interlaminar BESS decompression achieved favorable effects in patients with central spinal stenosis. However, many patients still experienced radiating pain even after conventional interlaminar BESS decompression. Therefore, a more reliable BESS decompression method for traversing root and lateral recess areas is necessary. Hence, we investigated a method to better decompress both lateral recess areas while preserving both facet joints as much as possible with bilateral radiculopathy.</p><p><strong>Methods: </strong>We retrospectively analyzed the data of 48 patients undergoing interlaminar BESS decompression; 24 patients underwent decompression using the conventional BESS technique (group A), and the other 24 patients underwent a both facet joint preserving BESS technique (group B). The following steps are the characteristics of a better decompression technique: using a 30° endoscope at ipsilateral side decompression, enough decompression through traversing root pathway, and enough removal of fibrotic tissue. Clinical outcomes (visual analog scale scores for pain, pregabalin usage, and modified MacNab criteria) and radiological changes (using magnetic resonance imaging) in the spinal canal expansion, lateral recess angle, and facet joint preservation were evaluated.</p><p><strong>Results: </strong>In radiological outcomes, there were significant differences in ipsilateral facet joint preservation ratio and contralateral lateral recess increasing ratio (ipsilateral facet joint preservation ratio 92.15% ± 2.62% vs 90.96% ± 2.88%, <i>P</i> value 0.041 and contralateral lateral recess increasing ratio 155.22% ± 15.99% vs 165.39% ± 22.07%, <i>P</i> = 0.0136). In clinical outcomes, there were significant differences between the 2 groups over time in leg visual analog scale score and pregabalin medication use.</p><p><strong>Conclusion: </strong>The BESS technique for preserving both facet joints was an effective treatment option in long-term follow-up; it achieved favorable clinical outcomes while preserving both facet joints and making as much decompression space as possible.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"131-138"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732178","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":"Postmyelography Acute Paraplegia in Patients With Spinal Cord Stimulators: Case Series and Review of Literature.","authors":"César Carballo Cuello, Jay Kumar, Gabriel Flores-Milan, Diego Soto Rubio, Bryan Clampitt, Puya Alikhani","doi":"10.14444/8760","DOIUrl":"https://doi.org/10.14444/8760","url":null,"abstract":"<p><strong>Background: </strong>Computed tomography (CT) myelography is an important imaging modality utilized in patients who cannot tolerate magnetic resonance imaging (MRI) due to severe artifact or because of the presence of MRI incompatible medical devices. In the setting of thoracic stenosis and a spinal cord stimulator (SCS), it can predispose patients to develop acute weakness and paraplegia after myelography.</p><p><strong>Case presentation: </strong>We present 2 patients with symptomatic thoracic stenosis who developed acute paraplegia after a CT myelogram. Both patients had SCSs due to a history of back pain and were taken emergently to the operating room for SCS removal and thoracic spine decompression.</p><p><strong>Conclusion: </strong>To our knowledge, these are the first reported cases of acute paraplegia postmyelography in the presence of an SCS in the thoracic spine. This report serves as an important warning and possible emerging contraindication for ordering CT myelography in patients with thoracic stenosis in the presence of an SCS.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052471","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":"A Spine Surgeon's Learning Curve With the Minimally Invasive L5 to S1 Lateral ALIF Surgical Approach: Perioperative Outcomes and Technical Considerations.","authors":"Martin H Pham, Alexander J Schupper, Brian R Hirshman, Timothy Y Kim","doi":"10.14444/8754","DOIUrl":"https://doi.org/10.14444/8754","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Lateral anterior lumbar interbody fusion (L-ALIF), or oblique lumbar interbody fusion at L5 to S1 (OLIF51), is a minimally invasive approach between the iliac vessels that provide indirect decompression, alignment restoration, and lordosis. While supine ALIF exposure has historically been performed by vascular surgeons, minimally invasive L-ALIF can be performed by spine surgeons familiar with lateral approaches. The L-ALIF is a relatively newer approach, and the objective of the present study was to assess the learning curve of the L-ALIF approach by comparing the pre- and postoperative radiographic measurements, patient-reported outcome measures (PROMs), and complications in a surgeon's first 25 L-ALIF patients compared with the subsequent 25 L-ALIF patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective case series includes the first 50 OLIF patients at/or including L5 to S1 by 1 surgeon. Demographics, complications, PROMs, and clinical and radiographic results were collected, and patients were analyzed comparing the surgeon's first 1 to 25 patients (group A) and last 26 to 50 patients (B).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Demographic analysis demonstrated a mean age of 59.7 years and a body mass index of 28.7, and 52% of participants were women. The diagnosis was degenerative disc disease in 36 patients and deformity in 14 patients. Fourteen patients underwent single interbody level fusions at L5 to S1, 21 with 2 levels, and 15 with 3 to 6 levels. Segmental L5 to S1 lordosis increased 9.6° ± 3.9°, final mean lordosis 25.3° ± 8.3°; L5 to S1 disc angle increased 11.5° ± 4.9°, final disc angle 19.7° ± 3.8°; posterior disc height increased 3.6 mm ± 2.1 mm with final mean disc height 7.6 mm ± 1.8 mm. PROMs postoperatively were significantly improved from preoperatively. There were no significant differences in operative times for degenerative 1- or 2-level single-position surgery operations between groups A and B. Two group A patients had incisional hernias requiring repair, and 2 group B patients had postoperative ileus. There were no approach-related injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;With proper patient selection and meticulous technique, the minimally invasive L-ALIF at L5 to S1 can be performed by surgeons experienced with lateral approaches to other spine levels. This study provides level 4 evidence and low-quality evidence in the Grading of Recommendations Assessment, Development, and Evaluation framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;The lateral ALIF is a safe and effective approach at L5 to S1 for spine surgeons and provides good clinical, biomechanical, and radiographic outcomes, especially for those who do not have access surgeons available. Close attention to left common iliac vein anatomy is paramount for this type of approach and similar to other approaches. With increased repetition and numbers of cases, surgeons are able to improve in their technique.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Level o","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038945","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":"Safety and Viability of Anterior Lumbar Interbody Fusion in Complex Revision Lumbar Spine Surgeries: Insights From a Case Series of 135 Patients on Transforaminal Lumbar Interbody Fusion/Posterior Lumbar Interbody Fusion Cage Removal.","authors":"Aécio Rubens Dias Pereira Filho, Matheus Galvão Valadares Bertolini Mussalem, Vinicius Santos Baptista, Vinicius de Meldau Benites, Milton Kiyonory Uehara, Nuno Rodolfo Colaço Aguiar, Arthur Cristiano Baston, Alexandre Vinhal Desideri, Francisco Cialdine Frota Carneiro Júnior","doi":"10.14444/8753","DOIUrl":"https://doi.org/10.14444/8753","url":null,"abstract":"<p><strong>Background: </strong>Anterior lumbar interbody fusion (ALIF) has emerged as a valuable technique for managing lumbar degenerative conditions and revision surgeries, particularly for addressing complications associated with transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) cages. However, there is limited evidence documenting its safety and feasibility in the context of revision procedures involving cage removal.</p><p><strong>Objective: </strong>To evaluate intraoperative outcomes of ALIF for TLIF/PLIF cage removal, focusing on complications, surgical times, and blood loss in a substantial case series.</p><p><strong>Methods: </strong>This case series analyzed data from 135 patients who underwent ALIF for TLIF/PLIF cage removal between January 2019 and May 2023. Surgical indications included pseudarthrosis, cage migration, and infection. Outcomes assessed included intraoperative complications, surgical duration, and estimated blood loss.</p><p><strong>Results: </strong>Of the 135 patients (median age: 47 years, range: 15-78), vascular injuries occurred in only 4 cases, all involving the left iliac vein, and were managed intraoperatively without sequelae. No injuries to retroperitoneal, neural, or organ structures were observed. Median surgical time was 100 minutes (range: 50-210), with most cases resulting in less than 150 mL of blood loss. These findings demonstrate the feasibility of ALIF for managing TLIF/PLIF complications.</p><p><strong>Conclusion: </strong>ALIF is a safe and effective option for revision surgeries involving TLIF/PLIF cage removal, offering a low complication profile and manageable intraoperative challenges. A critical factor contributing to these favorable outcomes is the multidisciplinary approach, where the collaboration between access and spine surgeons ensures meticulous handling of anatomical and vascular challenges.</p><p><strong>Clinical relevance: </strong>This study provides valuable data for further prospective research to explore long-term outcomes and refine surgical 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":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053218","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":"Effects of Body Mass Index on Spondylolisthesis Surgery and Associated Patient-Reported Outcomes: A Retrospective Review.","authors":"Rafael Garcia, Kari Odland, Jonathan Sembrano","doi":"10.14444/8752","DOIUrl":"https://doi.org/10.14444/8752","url":null,"abstract":"<p><strong>Background: </strong>Obesity is often associated with worse outcomes after lumbar fusion surgery, but its impact on patient-reported outcomes in spondylolisthesis remains unclear. This study assesses the effect of body mass index (BMI) on outcomes for degenerative and isthmic spondylolisthesis patients undergoing lumbar fusion.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 86 patients with low-grade lumbar degenerative and isthmic spondylolisthesis, categorized by BMI into nonobese (<30 kg/m²), obesity class I (30.0-34.9 kg/m²), obesity class II (35.0-39.9 kg/m²), and obesity class III (≥40.0 kg/m²). Outcomes were measured using the visual analog scale (VAS) for pain and the Oswestry Disability Index (ODI) at baseline and 12 months postoperatively. Statistical analyses included a 1-way analysis of variance, Bonferroni post hoc comparisons, and Kruskal-Wallis tests.</p><p><strong>Results: </strong>Significant disability improvements (mean ODI improvement: 15.6 points, <i>P</i> < 0.001) were observed across all BMI categories, while pain improvements were less pronounced (mean VAS improvement: 2.1 points, <i>P</i> < 0.001). Nonobese and class II patients maintained improvements at 12 months. Degenerative spondylolisthesis patients showed better ODI outcomes compared with isthmic patients (<i>P</i> = 0.019), while VAS outcomes were similar (<i>P</i> = 0.251).</p><p><strong>Conclusion: </strong>Lumbar fusion results in significant disability reduction across BMI categories, with sustained improvements in nonobese and obesity class II patients. These findings suggest that obesity should not be a contraindication for lumbar fusion in well-selected patients, as meaningful improvements can be achieved, particularly in disability outcomes.</p><p><strong>Clinical relevance: </strong>Clinically, this supports a more individualized approach to surgical candidacy, emphasizing functional goals and symptom burden over BMI alone, thereby promoting equitable access to care and helping guide preoperative counseling and shared decision-making.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037194","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":"Letter to the Editor: Police Enforcement and Policy Impact on Moped-Related Spinal Injuries.","authors":"Niyousha Rahimimovaghar, Vafa Rahimi-Movaghar","doi":"10.14444/8750","DOIUrl":"https://doi.org/10.14444/8750","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990124","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":"Prediction of Postoperative Segmental Lordosis at L5 to S1 After Single-Level Anterior Lumbar Interbody Fusion.","authors":"Gabriella P Williams, Juan P Giraldo, James J Zhou, Anna G U Sawa, Jonathan J Lee, Joseph M Abbatematteo, Brian P Kelly, Jay D Turner, Laura A Snyder, Juan S Uribe","doi":"10.14444/8751","DOIUrl":"https://doi.org/10.14444/8751","url":null,"abstract":"<p><strong>Background: </strong>Anterior lumbar interbody fusion (ALIF) is used to improve spinopelvic alignment, most commonly by increasing segmental lordosis (SL) at L5 to S1. Achieving certain radiographic parameters is critical for good patient outcomes. However, the relationships between pre- and postoperative SL and interbody dimensions are inexact and have not been well studied. This study investigated the relationships between postoperative SL at L5 to S1, ALIF cage angle, and preoperative radiographic measurements to improve the predictability of surgical radiographic outcomes after L5 to S1 ALIF.</p><p><strong>Methods: </strong>A single-center database was retrospectively reviewed for patients who underwent L5 to S1 ALIF from January 2017 to December 2022. Patients with posterior percutaneous instrumentation were included in the study, but patients with posterior decompression or facetectomies at L5 to S1 were excluded. Pre- and postoperative scoliosis films and patient surgical data were analyzed. A multilinear regression analysis was performed to create a predictive model of postoperative L5 to S1 SL.</p><p><strong>Results: </strong>This study evaluated 46 single-level L5 to S1 ALIFs. Using mixed-effects linear regression analysis, postoperative L5 to S1 SL can be predicted with statistical significance (<i>P</i> < 0.001) and power of 0.98 if the cage angle and preoperative L5 to S1 SL are known using the following formula: SL_post = 8.741 + (0.454 × <i>C</i>) + (0.595 × SL_pre), where SL_post is postoperative L5 to S1 SL in degrees, <i>C</i> is cage angle in degrees, and SL_pre is preoperative L5 to S1 SL in degrees.</p><p><strong>Conclusions: </strong>Cage angle and preoperative L5 to S1 SL were predictive of postoperative SL after L5 to S1 ALIF. The ability to predict postoperative radiographic values is critically important for good patient outcomes, and efforts should be made to develop more sophisticated mathematical models.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062566","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: The Future of Motion Preservation.","authors":"Jeffrey A Goldstein, Pierce D Nunley, Ahilan Sivaganesan, J Alex Sielatycki, Anton Y Jorgensen, Armen Khachatryan, S Craig Humphreys, Jon E Block, Scott D Hodges, Louis J Nel, Domagoj Coric","doi":"10.14444/8746","DOIUrl":"10.14444/8746","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S45-S48"},"PeriodicalIF":1.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"REPRINT: Surgical Treatment for Discogenic Low-Back Pain: Lumbar Arthroplasty Results in Superior Pain Reduction and Disability Level Improvement Compared With Lumbar Fusion.","authors":"Fred H Geisler","doi":"10.14444/8744","DOIUrl":"10.14444/8744","url":null,"abstract":"<p><p>This article is a reprint of a previously published article. For citation purposes, please use the original publication details: <i>SAS J</i> 2007;1(1):12-19. https://doi.org/10.1016/SASJ-2006-0002-RR) BACKGROUND: The US Food and Drug Administration approved the Charité artificial disc on October 26, 2004. This approval was based on an extensive analysis and review process; 20 years of disc usage worldwide; and the results of a prospective, randomized, controlled clinical trial that compared lumbar artificial disc replacement to fusion. The results of the investigational device exemption (IDE) study led to a conclusion that clinical outcomes following lumbar arthroplasty were at least as good as outcomes from fusion.</p><p><strong>Methods: </strong>The author performed a new analysis of the Visual Analog Scale pain scores and the Oswestry Disability Index scores from the Charité artificial disc IDE study and used a nonparametric statistical test, because observed data distributions were not normal. The analysis included all of the enrolled subjects in both the nonrandomized and randomized phases of the study.</p><p><strong>Results: </strong>Subjects from both the treatment and control groups improved from the baseline situation (<i>P</i>< .001) at all follow-up times (6 weeks to 24 months). Additionally, these pain and disability levels with artificial disc replacement were superior (<i>P</i>< .05) to the fusion treatment at all follow-up times including 2 years.</p><p><strong>Conclusions: </strong>The a priori statistical plan for an IDE study may not adequately address the final distribution of the data. Therefore, statistical analyses more appropriate to the distribution may be necessary to develop meaningful statistical conclusions from the study. A nonparametric statistical analysis of the Charité artificial disc IDE outcomes scores demonstrates superiority for lumbar arthroplasty versus fusion at all follow-up time points to 24 months.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 S2","pages":"S38-S44"},"PeriodicalIF":1.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editor's Introduction: Recollections From the Past and Visions of the Future in Arthroplasty: The ISASS 25th Anniversary Special Issue.","authors":"Charles L Branch","doi":"10.14444/8745","DOIUrl":"10.14444/8745","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S8-S9"},"PeriodicalIF":1.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12050374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}