International Journal of Spine Surgery最新文献

{"title":"Circumferential Correction of Severe Thoracolumbar Kyphosis by Utilizing an Articulating Rod and Lateral Interbody Device: A Technical Note.","authors":"Sumedh S Shah, Malek Bashti, Manav Daftari, James Boddu, Nathaniel B Dusseau, Jason Liounakos, Timur Urakov","doi":"10.14444/8723","DOIUrl":"10.14444/8723","url":null,"abstract":"<p><strong>Background: </strong>Surgical management of severe thoracolumbar kyphosis (TLK) is challenging due to the necessity of achieving adequate sagittal realignment without increasing operative risk or compromising hardware integrity. Performing large corrective maneuvers during deformity correction may increase the risk of neurological complications, especially when correcting hyperkyphosis in the distal thoracolumbar spine. The present article describes the first use of a custom-made articulating rod to manipulate a patient's severe TLK into extension in combination with the expandable lateral interbody device to achieve circumferential deformity correction.</p><p><strong>Clinical presentation: </strong>A 38-year-old woman with a history of spinal trauma 10 years ago developed severe TLK (<70° angulation) after failed posterior spinal stabilization. Due to her debilitating neurological symptoms and profound sagittal deformity, we performed a T9 to L2 navigation-assisted posterolateral fusion followed by a circumferential kyphotic correction utilizing a custom-made articulating rod (Globus Medical, Inc., Audubon, PA) with an expandable device placed in prone-lateral position at T11 to T12. The use of an articulating rod enabled us to safely manipulate the thoracolumbar spine into extension prior to permanent rod fixation. We were able to achieve approximately 40° of thoracolumbar correction. No immediate or late (at 2-year follow-up) postoperative medical or hardware-related complications were reported.</p><p><strong>Conclusion: </strong>The use of an articulating rod with prone-lateral placement of an expandable interbody device allowed for a high degree of circumferential thoracolumbar deformity correction in a patient with severe post-traumatic TLK. Our results indicated the technical feasibility and success of utilizing this treatment strategy for high-grade TLK without medical- or hardware-related failure.</p><p><strong>Clinical relevance: </strong>The use of an articulating rod for correction of complex TLKs may benefit patient outcomes and improve safety.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"168-172"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657916","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":"High Uptake Detection for Spinal Degenerative Changes: A Comparison Between Bone Scintigraphy and Single Photon Emission Computed Tomography Combined With High-Resolution Computed Tomography.","authors":"Mara Ioana Dimitriu, Robin Brugger, Nikki Rommers, Martin Jaeger, Victoria Schimmelpenning, Helena Milavec","doi":"10.14444/8729","DOIUrl":"10.14444/8729","url":null,"abstract":"<p><strong>Background: </strong>Nuclear imaging modalities are increasingly advancing spinal diagnostics. This study evaluates the prevalence of high uptake in bone scan and single photon emission computed tomography combined with high-resolution computed tomography (SPECT/CT) in the spine and sacroiliac joint (SIJ) and compares the diagnostic performance of BS to SPECT/CT in detecting metabolic activity linked to neck and back pain.</p><p><strong>Objective: </strong>The primary objective was to assess the sensitivity, specificity, and diagnostic accuracy of BSs compared with SPECT/CT for spine and SIJ evaluation.</p><p><strong>Methods: </strong>This retrospective study evaluated data from patients with spinal complaints who underwent spine-focused SPECT/CT alongside whole-body BS at a tertiary institution.</p><p><strong>Results: </strong>A total of 110 patients were included, with 48 cervical spine, 34 thoracic spine, and 91 lumbar spine and SIJ SPECT/CT scans. For the cervical spine, BS sensitivity, specificity, and accuracy were 41.5%, 100%, and 50%, respectively. For the thoracic spine, these values were 50.0%, 100%, and 73.5%, respectively. For the lumbar spine, they were 72.9%, 100%, and 79.1%. For the SIJ, sensitivity, specificity, and accuracy were 38.2%, 96.5%, and 74.7%, respectively.</p><p><strong>Conclusions: </strong>Bone scans demonstrated reasonable sensitivity and high specificity, particularly for lumbar spine and SIJ evaluation, making them a useful screening tool in resource-constrained settings. However, SPECT/CT showed superior performance in detecting osteometabolic activity and provided more detailed functional and structural insights for diagnosing and managing degenerative spinal conditions.</p><p><strong>Clinical relevance: </strong>This study highlights the potential complementary role of bone scans in spinal diagnostics.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"139-144"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732182","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":"Comparative Review of Lateral and Oblique Lumbar Interbody Fusion: Technique, Outcomes, and Complications.","authors":"Jae-Young Hong, Jaewan Soh","doi":"10.14444/8759","DOIUrl":"https://doi.org/10.14444/8759","url":null,"abstract":"<p><p>Minimally invasive spinal surgery has made tremendous progress. The retroperitoneal lateral lumbar interbody fusion and oblique lumbar interbody fusion techniques are increasingly used to treat a variety of lumbar spinal conditions. As with other minimally invasive techniques, the theoretical advantages include reduced blood loss, improved postoperative pain due to less retraction and smaller incisions, faster recovery, and eliminating the need for an approach surgeon. It allows the placement of a large cage that spans the apophyses and enables the achievement of indirect decompression as well as coronal and sagittal deformity correction. As experience grows and the techniques evolve further, indications might be expanded beyond their current limitations. However, as these techniques continue to grow in popularity, evidence-based risk-stratification systems are required. This study reviews the literature about the development and application of lateral lumbar interbody fusion and oblique lumbar interbody fusion, with a discussion of its outcomes, approach-related complications specific to the lateral technique, and areas of new research.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 2","pages":"246-260"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019396","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":"Posttraumatic Spinal Cord Tethering and Syringomyelia: A Retrospective Investigation of Patients With Progressive Disease and Surgical Revisions.","authors":"Crescenzo Capone, Denis Bratelj, Susanne Stalder, Phillip Jaszczuk, Marcel Rudnick, Rajeev K Verma, Tobias Pötzel, Michael Fiechter","doi":"10.14444/8716","DOIUrl":"10.14444/8716","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord tethering and syringomyelia after trauma are well-known pathologies in patients suffering from spinal cord injury (SCI). In symptomatic cases, various surgical options are available, but untethering and expansion duraplasty is the currently preferred treatment strategy. However, patient outcomes are usually limited by rather high rates of surgical revisions. The aim of the present study was to identify risk factors in SCI patients who underwent multiple surgeries for symptomatic spinal cord tethering and syringomyelia.</p><p><strong>Methods: </strong>We retrospectively investigated 25 patients who received at least 2 untethering surgeries of the spinal cord. All patients were treated by untethering and expansion duraplasty and/or clinically followed between 2012 and 2022 at the Swiss Paraplegic Center.</p><p><strong>Results: </strong>A higher location of SCI correlates with a more rapid development of symptomatic spinal cord retethering in need of surgical revision (<i>r</i> = 0.406 and <i>P</i> = 0.044). Interestingly, the extent of spinal cord tethering is lower in those patients who underwent an early surgical intervention (<i>r</i> = 0.462 and <i>P</i> = 0.030), which points toward an increased vulnerability of the spinal cord at higher levels. Ninety-two percent of the patients displayed a potentially chronic inflammatory condition with a mean level of C-reactive protein of 28.4 ± 4.1 mg/L, while the white blood cell count was identified as an independent predictor for surgical interventions in symptomatic cases.</p><p><strong>Conclusions: </strong>Revision surgery in posttraumatic spinal cord tethering and syringomyelia patients is associated with the location of SCI and the extent of spinal cord tethering. It appears that chronic inflammatory conditions might play an important role in promoting spinal cord retethering and thus warrant further investigation.</p><p><strong>Clinical relevance: </strong>SCI patients with chronic inflammatory conditions and SCI at upper levels should be clinically monitored more carefully as they appear to be more susceptible to progressive forms of posttraumatic spinal cord tethering and syringomyelia.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"216-223"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956414","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":"Segmental Lordosis and Disc Height Discrepancies in Lateral Lumbar Interbody Fusion Using Expandable Cages.","authors":"Akihiko Hiyama, Daisuke Sakai, Hiroyuki Katoh, Masato Sato, Masahiko Watanabe","doi":"10.14444/8726","DOIUrl":"10.14444/8726","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated discrepancies between the expected intervertebral disc height (DH) and segmental lordosis (SL), defined as predicted values based on the rotations of the expandable cage driver, and the actual DH and SL achieved postoperatively in lateral lumbar interbody fusion (LLIF) using expandable cages.</p><p><strong>Methods: </strong>A retrospective review was conducted on patients who underwent LLIF with expandable cages between May 2022 and May 2024. The study included 51 patients (28 men and 23 women; mean age: 70.6 ± 11.7 years). Surgical outcomes measured included SL, anterior DH, posterior DH, average DH, canal diameter, and central canal area (CCA). Pre- and postoperative measurements were compared to evaluate cage effectiveness.</p><p><strong>Results: </strong>Postoperative measurements showed significant improvements: SL increased from 3.5° to 4.8° (<i>P</i> = 0.002), anterior DH from 5.9 to 10.7 mm (<i>P</i> < 0.001), PDH from 3.4 to 7.7 mm (<i>P</i> < 0.001), and average DH from 4.6 to 9.2 mm (<i>P</i> < 0.001). Despite these gains, the actual SL (4.8°) was significantly lower than the predicted SL (8.7°, <i>P</i> < 0.001). Canal dimensions also improved, with canal diameter increasing from 5.0 to 8.3 mm and CCA from 55.8 to 89.7 mm² (<i>P</i> < 0.001 for both). A significant correlation was found between changes in posterior DH and CCA (<i>r</i> = 0.272, <i>P</i> = 0.017).</p><p><strong>Conclusion: </strong>Expandable cages in LLIF significantly improved DH, SL, and canal dimensions, contributing to better clinical outcomes. However, achieving the ideal SL remains challenging, highlighting the need for further refinement in surgical techniques and cage design.</p><p><strong>Clinical relevance: </strong>Expandable cages in LLIF significantly enhance DH, SL, and spinal canal dimensions, which contribute to improved clinical outcomes such as pain relief and functional recovery. However, the difficulty in achieving the ideal SL suggests further advancements are needed in surgical techniques and cage design to optimize patient outcomes and long-term spinal alignment.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"188-199"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574140","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":"Recovery Trajectories After Lumbar Fusion Stratified by Baseline Patient-Reported Outcomes Measurement Information System Physical Function Disability Levels.","authors":"Justin J Turcotte, Jane C Brennan, Andrea H Johnson, Chad M Patton","doi":"10.14444/8755","DOIUrl":"https://doi.org/10.14444/8755","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have identified patient and surgical factors associated with patient-reported outcomes measurement information system (PROMIS)-physical function (PF) minimal clinically important difference (MCID) rates after lumbar fusion, but investigation into the timing of MCID achievement remains limited. This study aimed to assess whether time to MCID achievement differed across patients presenting with mild, moderate, or severe disability as measured using the PROMIS-PF instrument.</p><p><strong>Methods: </strong>A retrospective review of 144 patients undergoing 1- to 3-level lumbar fusion from 2020 to 2023 was performed. All patients completed PROMIS-PF surveys at baseline and 1 year postoperatively. Patients were classified as mild (PROMIS-PF > 40), moderate (30-40), or severe (<30) disability based on baseline PROMIS-PF T-scores. MCID achievement rates and time to MCID were compared across groups using univariate and multivariate analyses. Multivariate Cox proportional hazard models were used to assess the relationship between baseline disability and MCID achievement rates over time.</p><p><strong>Results: </strong>Twenty (13.9%) patients presented with mild disability, 92 (63.9%) with moderate disability, and 32 (22.2%) with severe disability. The overall rate of 1-year postoperative MCID achievement was 59%. After adjusting for American Society of Anesthesiologists scores and Charlson Comorbidity Index, severe baseline disability was associated with increased odds of early MCID achievement (<90 days; OR = 2.95, <i>P</i> = 0.015) and shorter days to MCID achievement. In the adjusted Cox models, patients with severe baseline disability demonstrated increased MCID achievement at any time over the 1-year postoperative period when compared with the mild disability (HR = 3.52, <i>P</i> = 0.005) and moderate disability (HR = 1.85, <i>P</i> = 0.020) groups.</p><p><strong>Conclusion: </strong>Patients presenting with severe disability were more likely to achieve clinically significant improvements in function across time points during the 1-year postoperative period. Furthermore, these patients demonstrated higher rates of early MCID achievement and less time to MCID than those with moderate or mild baseline disability. Utilization of PROMIS-PF may assist with preoperative patient selection and expectation setting.</p><p><strong>Clinical relevance: </strong>In the clinical setting, establishing realistic recovery expectations is a critical aspect of the surgeon-patient relationship. The data presented in the current study may be used in preoperative consultations to provide patients with a depiction of their potential improvement in physical function over time based on their baseline level of function. Postoperatively, the data may serve as a benchmark for assessing an individual's recovery trajectory compared to historically similar patients.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 2","pages":"207-215"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014421","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":"Association Between Nonsteroidal Anti-inflammatory Drugs Use and Surgical Outcomes Following Posterior Lumbar Fusion: A Medical Claims Database Analysis.","authors":"Aneysis D Gonzalez-Suarez, Allen Green, María José Cavagnaro, Emily Moya, Corinna Zygourakis, Atman M Desai","doi":"10.14444/8732","DOIUrl":"10.14444/8732","url":null,"abstract":"<p><strong>Background: </strong>Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed for postoperative pain management after spinal fusion surgeries, but their potential impact on fusion outcomes and wound healing remains controversial.</p><p><strong>Objective: </strong>To use a national database and consistent selection criteria to compare the postoperative outcomes of patients who first received NSAIDs ≤ 72 hours, 72 hours to 90 days, and 90 days to 1 year after posterior lumbar fusion (PLF) surgery, to those who never received NSAIDs within the first year of surgery.</p><p><strong>Methods: </strong>Using the Merative Marketscan Research Databases, we analyzed PLF patients aged 18 to 90 years who underwent either single- and multilevel fusions. A subanalysis focused specifically on single-level fusions. Using the inverse probability of treatment weighting to adjust for confounders, we compared the outcomes of patients first administered NSAIDs at 3 different postoperative timeframes (≤72 hours, 72 hours to 90 days, and 90 days to 1 year) to patients who did not receive NSAIDs within 1 year of surgery. The outcomes evaluated included 30-day readmissions, length of stay, pseudoarthrosis, hardware failure, and wound complications up to 1 year after surgery.</p><p><strong>Results: </strong>Single- and multilevel PLF patients who received >90-day courses of NSAIDs 72 hours to 1 year postoperatively had greater odds of pseudoarthrosis, with those receiving short, ≤30-day courses of NSAIDs 72 hours to 90 days postoperatively additionally having greater odds of wound complications. Meanwhile, patients who started≤30-day courses of NSAIDs within 72 hours of surgery experienced reduced length of stay and lower rates of wound complications.</p><p><strong>Conclusion: </strong>Administration of long courses of NSAIDs >72 hours to 1 year after PLF surgery is associated with higher odds of pseudoarthrosis, while short courses of NSAIDs administered 72 hours to 90 days of surgery are additionally associated with higher odds of wound complications. Conversely, patients who received NSAIDs within 72hours of surgery may experience a slightly reduced length of hospital stay, with short courses of NSAIDs protecting against wound complications.</p><p><strong>Clinical relevance: </strong>This study suggests that the timing and duration of postoperative NSAID use after posterior lumbar fusion can significantly affect outcomes, particularly fusion integrity and wound healing. These findings may help guide pain management protocols to balance effective analgesia with minimizing surgical complications.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"224-236"},"PeriodicalIF":1.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732105","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":"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":"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":"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}