International Journal of Spine Surgery最新文献

{"title":"S1 Pedicle Screw Loosening: A Systematic Review and Meta-Analysis of Risk Factors and Outcomes.","authors":"Kari Odland, Todd J Pottinger, Peter M Grund, David W Polly","doi":"10.14444/8773","DOIUrl":"10.14444/8773","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in fixation techniques, S1 pedicle screw loosening remains a common complication of lumbosacral fusion surgeries for degenerative lumbar conditions, with reported rates ranging from 15.6% to 41.9%. This complication can compromise fusion success, leading to nonunion, adjacent segment disease, and revision surgeries. Compared with other surgical challenges, less is known about the incidence and predictors of S1 pedicle screw loosening. Given the high prevalence of S1 screw loosening and its associated complications, this systematic review and meta-analysis aim to report the incidence and risk factors contributing to S1 pedicle screw loosening in sacral fixation for degenerative lumbar conditions.</p><p><strong>Methods: </strong>The literature search was conducted across 2 databases: PubMed and OVID. Study inclusion criteria were adults (age >18 years) undergoing lumbar fusion with S1 sacral fixation for degenerative lumbar conditions, with a minimum follow-up of 12 months and radiographic confirmation of screw loosening. Eligible studies included cohort or case-control designs that reported screw loosening rates. Extracted data included patient demographics (age, gender, body mass index, and bone mineral density [BMD]), surgical factors (screw type, length, and number of fusion levels), and complication rates.</p><p><strong>Results: </strong>Of 174 studies queried, 21 met inclusion criteria, comprising 2598 patients who underwent lumbar fusion with sacral fixation with S1 pedicle screws (mean age 62 ± 7.2 years). The overall screw loosening rate in patients was 23.8% (696/2924) but varied from 3.0% to 55.0%. The pooled proportion of S1 pedicle screw loosening in patients after lumbosacral fixation was 27% (relative risk = 0.27, 95% CI 0.22-0.34, <i>P</i> < 0.0001). When assessed per screw, the screw-specific loosening rate was 8.7%. The pooled proportion of individual S1 pedicle screws loosening after lumbosacral fixation is 10% (relative risks = 0.10, 95% CI 0.06-0.17, <i>P</i> < 0.0001). Among included patients, the mean BMD was -0.63 ± 1.5, and the mean vertebral bone quality score was 3.3 ± 0.02.</p><p><strong>Conclusion: </strong>The aggregate rate of S1 pedicle screw loosening after sacral fixation is 23.8%, highlighting a significant complication rate that may compromise surgical success. This complication is associated with adverse outcomes, pseudarthrosis, and adjacent segment disease, which can significantly impact patient quality of life. The high failure rate emphasizes the need for careful surgical planning, including patient-specific considerations such as BMD and vertebral bone quality, as well as the selection of optimal fixation techniques in lumbosacral fusion surgeries.</p><p><strong>Clinical relevance: </strong>While advancements in surgical techniques and hardware design have reduced failure rates, the persistent variability across studies underscores the need for further re","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 4","pages":"426-436"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972592","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":"Commentary on \"The First Grade III Lumbar Spondylolisthesis Treated With the Novel 360° Artificial Disc/Artificial Facet Replacement Solution\".","authors":"Ali Araghi, Lisa Ferrara","doi":"10.14444/8783","DOIUrl":"10.14444/8783","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"374"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761681","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":"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":"375-382"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","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":"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":"392-401"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","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}

{"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":"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":"444-451"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","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":"Impact of Extended Endoscopic Lumbar Foraminotomy on Postoperative Surgical Outcomes: Is Greater Decompression Beneficial?","authors":"Ryota Mio, Fumiaki Makiyama, Hiroshi Kageyama, Saori Soeda, Yuij Nagao, Naoto Ono, Masatoshi Morimoto, Hiroaki Manabe, Fumitake Tezuka, Kazuta Yamashita, Koichi Sairyo","doi":"10.14444/8784","DOIUrl":"10.14444/8784","url":null,"abstract":"<p><strong>Background: </strong>The transforaminal (TF) approach in full endoscopic spine surgery (FESS) is the least invasive spinal surgery, as it can be performed under local anesthesia with only an 8-mm skin incision. Transforaminal FESS-based foraminotomy was first performed in the early 2000s for the decompression of foraminal stenosis. The technique has improved year by year over the past 2 decades. In our hospital, full endoscopic lumbar foraminotomy (FELF) has been performed since 2015. Since our development of the FESS undercutting laminectomy procedures in 2019, the size of the decompressed area achieved by FELF has increased.</p><p><strong>Objective: </strong>To estimate the technical alteration of FELF over time by comparing the pre- and postoperative osseous foraminal areas (FAs) between traditional and advanced FELF techniques.</p><p><strong>Methods: </strong>Fifty-two cases were retrospectively reviewed. In the early phase of FELF before 2019, partial or total resection of the superior articular process (SAP) was performed. Twenty-six of the patients were treated using the traditional FELF procedure (SAP-ectomy group). The remaining 26 underwent advanced FELF procedures, including SAP-ectomy, undercutting laminectomy, and removal of the ligamentum flavum (advanced FELF group). Clinical outcomes were assessed using the modified MacNab score. Pre- and postoperative osseous FAs were measured on sagittal computed tomography, and data were compared between the SAP-ectomy and advanced FELF groups. Paired and unpaired <i>t</i> tests were used for statistical analysis.</p><p><strong>Results: </strong>By the modified MacNab score, the excellent/good rate was 82.6% in the SAP-ectomy group and 95.5% in the advanced FELF group. The improvement was greater in advanced FELF but not significantly. FA prior to surgery was 87.5 ± 27.0 mm² in the SAP-ectomy group and 95.7 ± 34.3 mm² in the advanced FELF group, with postoperative increases to 151.4 ± 45.5 mm² and 195.3 ± 39.1 mm², respectively (<i>P</i> < 0.05). FA increased by 63.9% and 99.6% in the SAP-ectomy and advanced FELF groups, respectively.</p><p><strong>Conclusion: </strong>Full endoscopic foraminotomy techniques have evolved over time. The recently developed advanced FELF technique appears to safely and effectively achieve better clinical outcomes by significantly enlarging FA.</p><p><strong>Clinical relevance: </strong>The advanced FELF technique contributes to improved decompression of the exiting nerve root.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 4","pages":"418-425"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972371","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":"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":"409-417"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","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":"Can Percutaneous Kyphoplasty Be a New Solution for Vertebral Fractures in Patients With Diffuse Idiopathic Skeletal Hyperostosis? Retrospective Study.","authors":"Tian-Yi Wu, Yun Teng, Le-Yu Zhao, Jun-Jie Niu, Da-Wei Song, Jin-Ning Wang, Qi Yan, Xiao Sun, Rui Chen, Xiang-Gu Zhong, Hui-Lin Yang, Jun Zou","doi":"10.14444/8781","DOIUrl":"10.14444/8781","url":null,"abstract":"<p><strong>Background: </strong>Diffuse idiopathic skeletal hyperostosis (DISH) is a metabolic disease that is prevalent in elderly patients and is characterized by spinal ankylosis. Traditional surgical treatment requires open long-segment internal fixation. Percutaneous kyphoplasty (PKP), as a minimally invasive spinal surgery technology, can accurately relieve pain and improve quality of life. The objective of this study was to evaluate the efficacy and reliability of PKP in treating vertebral fractures with DISH.</p><p><strong>Methods: </strong>We retrospectively investigated 209 patients with thoracic or lumbar fractures receiving PKP between January 2019 and December 2020. The patients were divided into 2 groups according to the diagnostic criteria. The anterior and posterior vertebral height restoration ratio and the local kyphotic angle (LKA) were used to evaluate the radiographic results. The visual analog scale score and the Oswestry Disability Index questionnaire were used for the assessment of the clinical function.</p><p><strong>Results: </strong>The average age of the DISH group was significantly older than that of the non-DISH group (<i>P</i> < 0.05). The perioperative prognostic nutritional index measured in the DISH group was significantly worse than that in the non-DISH group (<i>P</i> < 0.05). PKP in DISH patients achieved a significant restoration in the anterior and posterior vertebral height restoration ratio between pre- and postoperative measurements (<i>P</i> < 0.05). The postoperative LKA was significantly corrected at 1 day, 1 month, and the last follow-up (<i>P</i> < 0.05). Significant reductions in visual analog scale and Oswestry Disability Index scores were obtained during follow-up (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>For vertebral fractures in elderly DISH patients, PKP may be effective and feasible, which restores the vertebral height, corrects the LKA, and achieves pain relief and satisfactory functional improvement.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"485-491"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761680","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":"10.14444/8769","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>This case illustrates encouraging early data in support of a 360º arthroplasty concept in the treatment of high-grade spondylolisthesis.</p><p><strong>Clinical relevance: </strong>This cutting-edge motion preservati","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"362-369"},"PeriodicalIF":1.7,"publicationDate":"2025-09-02","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":"Surgeon Skill Level, Experience, and Impact on Patient Outcomes: Rethinking Research Paradigms in Spine Surgery.","authors":"Kai-Uwe Lewandrowski, Morgan P Lorio, Óscar L Alves, Rossano Kepler Alvim Fiorelli, Sergio Luis Schmidt, Hansen A Yuan, Alexander R Vaccaro","doi":"10.14444/8787","DOIUrl":"https://doi.org/10.14444/8787","url":null,"abstract":"<p><p>Spine surgery is a highly skill-dependent specialty, where the surgeon's expertise plays a critical role in determining patient outcomes. Despite the traditional emphasis on randomized controlled trials and meta-analyses as the gold standard for clinical research, these methodologies may fall short in accounting for the variability in surgeon proficiency, which significantly influences success rates in spine surgery. This perspective article examines the limitations of relying solely on randomized controlled trials and meta-analyses in skill-driven fields such as spine surgery and argues for a broader research paradigm that incorporates the role of surgical skill and experience. Alternative methodologies, such as observational studies, surgeon-led outcome tracking, and surgical registries, are proposed to better capture the real-world complexities of spine surgery. This perspective article emphasizes the importance of structured training programs, continuous professional development, and proficiency-based education models in improving surgical outcomes. A call to action is made for policymakers, professional organizations, and academic institutions to shift the focus of spine surgery research toward integrating surgeon expertise alongside traditional evidence-based approaches, ultimately fostering innovation and improving patient care.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972368","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}