International Journal of Spine Surgery最新文献

{"title":"Efficacy of Epidural Steroid in Controlling Pain After Unilateral Biportal Endoscopic Discectomy for Single-Level Lumbar Disc Herniation: A Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"Rattalerk Arunakul, Thanapat Boonraksa, Punnawit Pinitchanon, Koopong Siribumrungwong, Thongchai Suntharapa, Waroot Pholsawatchai","doi":"10.14444/8655","DOIUrl":"10.14444/8655","url":null,"abstract":"<p><strong>Background: </strong>The effects of epidural steroid (ES) administration following open or minimally invasive surgery lumbar discectomy have been extensively studied. However, no research has investigated the impact of steroids following the unilateral biportal technique endoscopic lumbar discectomy (UBE-D) for lumbar disc herniation. This study aims to evaluate the efficacy of ES administration in controlling postoperative pain and disability scores following UBE-D for single-level lumbar disc herniation.</p><p><strong>Methods: </strong>This double-blind, randomized, placebo-controlled trial was conducted between June 2021 and June 2023. Eighty-two patients were assessed, and 60 were eligible and randomized to receive either ES (<i>n</i> = 30) or saline (placebo; <i>n</i> = 30) after UBE-D. The Outcome measures included visual analog scale scores for pain, Oswestry Disability Index scores, morphine consumption over 24 hours, serum C-reactive protein levels, and the occurrence of complications over a 6-month follow-up period.</p><p><strong>Results: </strong>The baseline characteristics were comparable between the 2 groups, with no significant differences observed. Analysis of visual analog scale scores for back and leg pain, as well as Oswestry Disability Index scores, at various postoperative time points (6 hours, 12 hours, 24 hours, 2 weeks, 6 weeks, 3 months, and 6 months), showed no statistically significant differences between the ES and placebo groups (<i>P</i> values ranged from 0.47-0.94). Additionally, no significant differences were found in morphine consumption within the first 24 hours postoperatively (<i>P</i> = 0.85), length of hospital stay (<i>P</i> = 0.36), or C-reactive protein levels at 24 hours and 3 weeks postoperatively (<i>P</i> values ranged from 0.54-0.79) between the 2 groups. Importantly, no postoperative or steroid-related complications were reported in either group within the 6-month follow-up period.</p><p><strong>Conclusions: </strong>ES administration after UBE-D did not significantly reduce postoperative pain, disability scores, or morphine consumption compared with placebo. The findings suggest that routine use of ESs in this context may not provide additional benefits.</p><p><strong>Clinical relevance: </strong>Clinicians should reconsider the use of epidural steroids as part of standard postoperative management after UBE-D, as the lack of significant improvement in patient outcomes indicates that alternative pain management strategies may be more effective.</p><p><strong>Level of evidence: 1: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"11-18"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142509856","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":"Comparison of Pain and Functional Outcomes Among Geriatric and Nongeriatric Adults Following Full Endoscopic Spine Surgery for Degenerative Lumbar Pathology.","authors":"Alexander A Chernysh, Jannik Leyendecker, Owen P Leary, Rahul A Sastry, Ziya L Gokaslan, Jared S Fridley, Peter Derman, Osama Kashlan, Sanjay Konakondla, John Ogunlade, Christoph P Hofstetter, Albert E Telfeian","doi":"10.14444/8693","DOIUrl":"10.14444/8693","url":null,"abstract":"<p><strong>Background: </strong>Full endoscopic spine surgery (FESS) champions a rapid recovery and a low rate of overall complications. However, its efficacy in geriatric patients that might yield additional benefits from minimized invasiveness remains underexplored.</p><p><strong>Methods: </strong>A multi-institutional prospective cohort study was conducted involving patients undergoing elective lumbar FESS. Participants were categorized into nongeriatric (18-69 years old) and geriatric (≥70 years old) groups. Studied variables included demographics, medical comorbidities, operative details, visual analog scale (VAS) for back and leg pain, and Oswestry Disability Index (ODI). A mobile application was leveraged to collect real-time data pre- and postoperatively.</p><p><strong>Results: </strong>One hundred and sixty-four patients were included and divided into nongeriatric (<i>N</i> = 125) and geriatric (<i>N</i> = 39) cohorts. No group differences were observed between sex (<i>P</i> = 0.404), body mass index (<i>P</i> = 0.372), procedure duration (<i>P</i> = 0.350), or blood loss (<i>P</i> = 0.384). Nongeriatric patients received discectomy more frequently (<i>P</i> < 0.001), while older patients underwent more decompressive procedures (<i>P</i> < 0.001). Characterization of pain and functional outcome revealed that nongeriatric and geriatric patients follow a similar recovery trajectory and both appreciate significant improvements from baseline to 3 months postoperatively (<i>P</i> < 0.001 for VAS back, VAS leg, and ODI). There were no differences in the rate of improvement between age groups at any time point (<i>P</i> > 0.05 for VAS back, VAS leg, and ODI).</p><p><strong>Conclusions: </strong>FESS significantly improves pain and function in both geriatric and nongeriatric adults with degenerative lumbar conditions, with no difference in the degree of improvement between groups.</p><p><strong>Clinical relevance: </strong>These findings underscore the efficacy of FESS as a minimally invasive surgical option for elderly patients. Mobile application technology is useful for collecting patient-reported data in spine surgery clinical research.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"27-38"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142847905","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":"Selective Direct Vertebral Rotation Instrumentation for the Correction of Adolescent Idiopathic Scoliosis Lenke 5 Curve.","authors":"Emmanuel Alonge, HongQi Zhang, Chaofeng Guo, Wang Yuxiang","doi":"10.14444/8700","DOIUrl":"10.14444/8700","url":null,"abstract":"<p><strong>Background: </strong>Direct vertebral rotation (DVR) effectiveness in improving scoliosis correction outcomes remains unclear and requires further investigation.</p><p><strong>Purpose: </strong>This study aimed to evaluate the effectiveness of short and extended fusion techniques using en-bloc DVR in correcting adolescent idiopathic scoliosis (AIS) classified as Lenke 5 curve (5C).</p><p><strong>Materials and methods: </strong>This retrospective study included 90 randomly selected AIS patients with Lenke 5C who underwent posterior spinal instrumentation surgery using en-bloc DVR between 2014 and 2021. Patients were divided into 2 groups: (1) extended fusion, Group A (<i>n</i> = 40): upper instrumented vertebra = upper-end vertebra +1 or +2 or (2) short fusion, Group B (<i>n</i> = 50): upper instrumented vertebra = upper-end vertebra. Radiographic parameters were compared preoperatively and at postoperative follow-ups of 6 months, 3 years, and more.</p><p><strong>Results: </strong>The mean follow-up duration was 37.5 ± 6 months for Group A and 40.0 ± 8 months for Group B (<i>P</i> = 0.596). The coronal balance correction rate was comparable between the 2 groups, with no significant differences observed at the final follow-up. Significant differences were noted in the fused segment, with Group A having an average fusion rate of 6.8 ± 0 compared with 6.3 ± 0 in Group B (<i>P</i> = 0.001). TK and lumbar lordosis measurements at the final follow-up did not show significant differences between the groups. However, substantial differences were observed in rib hump correction, with Group A demonstrating a better correction rate than Group B at both 6 months and the last follow-up (<i>P</i> = 0.001 for both time points).</p><p><strong>Conclusion: </strong>Selective DVR spinal instrumentation effectively corrects AIS Lenke 5C. However, extended fusion demonstrates more efficient correction and greater improvement in the patient's cosmetic appearance, including better thoracic curve correction, rib hump correction, and shoulder balance, compared with short-level fusion.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"96-103"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013515","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":"Radiation Exposure Analysis on 274 Patients With Vertebral Augmentation Using the Surgivisio Intraoperative Navigation System.","authors":"Mehdi Boudissa, Gaël Kerschbaumer, Guillaume Cavalié, Jean-François Desrousseaux, Alexis Perrin, Georges Naïm Abi Lahoud, Julien Decaudain, Amélie Léglise, John Sledge, Benjamin Bénac, Jérémy Ouali, Jérôme Tonetti","doi":"10.14444/8701","DOIUrl":"10.14444/8701","url":null,"abstract":"<p><strong>Background: </strong>Surgeons' reliance on intraoperative fluoroscopy during vertebroplasty procedures has raised concerns regarding the level of patient and surgeon radiation. Navigation systems have shown a potential to reduce the overall patient and medical staff exposure during dose exposure studies. The main objective of this study was to determine whether the Surgivisio platform (eCential Robotics, France), a unified imaging and navigation platform, lowers the patient dose during routine clinical usage as compared with published fluoroscopy and other navigation options that are published in the literature.</p><p><strong>Methods: </strong>To accomplish this, we evaluated the radiation exposure dose during routine vertebroplasty procedures in which the surgeon was not trying to limit radiation and then compared the results to best-case dose assessment studies. Since a decreased radiation dose can lead to decreased image quality, we also quantified the surgeon's perception of image quality and ease of use. Two hundred and seventy-four Surgivisio-assisted vertebral augmentations were pooled from a broader 1694-patient protocol (not focusing on radiation outcomes) and analyzed.</p><p><strong>Results: </strong>We measured a median dose-area product and effective dose equal to 3.47 Gy.cm² and 0.81 mSv. The 3-dimensional image acquisitions contributed to 56.3% of the total dose-area product. When screening the literature, fluoroscopy dose levels (8.37-15.1 Gy.cm²) and navigation dose levels (9.12-9.83 Gy.cm²) were generally higher than those delivered with the Surgivisio protocol. Surgeon satisfaction for image quality and overall system experience was 95.8% and 85% for ease of use.</p><p><strong>Conclusions: </strong>The Surgivisio platform provided surgeons with high-quality images and ease of use. Since the surgeon is out of the room during the 3-dimensional image acquisition, this also substantially decreased their radiation exposure. This study demonstrates the efficiency of the Surgivisio platform to assist surgeons during vertebral augmentations, as the reported radiation levels are reduced in routine cases compared with published scenarios reported for other guidance methods.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"88-95"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053268/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013513","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":"Novel Instruments for Full Endoscopic Trans-Kambin Triangle Lumbar Interbody Fusion With Reverse Oblique Lateral Cage Insertion: A Case Report and Technical Note.","authors":"Wei-Lun Chang, Jou-Hua Wang, Ming-Long Yeh, Jui-Ming Yang","doi":"10.14444/8695","DOIUrl":"10.14444/8695","url":null,"abstract":"<p><strong>Background: </strong>Lumbar interbody fusion with screw fixation is a standard treatment for lumbar degenerative diseases. While full-endoscopic lumbar interbody fusion is minimally invasive, it utilizes smaller cages compared with the oblique lateral interbody fusion (OLIF) technique, which offers superior biomechanical support. To merge full-endoscopic lumbar interbody fusion minimal invasiveness with OLIF's advantages, we developed a novel instrument, the Single Beak Adjustable Cage Glider, to facilitate OLIF cage insertion via the full-endoscopic trans-Kambin triangle approach. This note and case report introduce this alternative solution.</p><p><strong>Case presentation: </strong>In a case of L4 to L5 spondylolisthesis, we performed fluoroscopy-guided uniportal facet-preserving trans-Kambin endoscopic fusion surgery. We initially installed percutaneous pedicle screws and rods to correct the anterolisthesis, then established the endoscopic trans-Kambin approach. After releasing the disc-endplate junction, the nerve root was mobilized and protected by the beak of the cage glider. The disc space was cleared, and a 22 × 40 × 12 mm interbody device was inserted through the cage glider under fluoroscopic guidance. The integrity of the exiting nerve root was confirmed with an endoscope.</p><p><strong>Results: </strong>Postoperatively, the patient experienced significant improvements in both low back pain and bilateral lower limb numbness. Muscle strength in both lower limbs returned to baseline, and the patient was able to walk independently without assistive devices. Follow-up radiographs and computed tomography scans showed a well-reduced regional lordotic angle, and the axial computed tomography view confirmed adequate decompression of the spinal canal while preserving the facet joints.</p><p><strong>Conclusions: </strong>The Single Beak Adjustable Cage Glider enables precise positioning of the OLIF cage through the Kambin triangle lumbar interbody fusion approach, avoiding nerve root injury and preserving facet joints. This technique reduces surgical trauma and maintains spine biomechanics, potentially improving patient outcomes.</p><p><strong>Clinical relevance: </strong>This technique potentially reduces the cage subsidence rate.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":"19 1","pages":"63-69"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574167","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":"Incidence of Traumatic Spinal Injury Following Public Policy Update on Moped Usage in South Carolina.","authors":"Samuel Wood, Danielle Harpen, Chase Gauthier, Richard Bidwell, Gregory Grabowski","doi":"10.14444/8704","DOIUrl":"10.14444/8704","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Electric scooters and mopeds have become prevalent modes of transportation for many Americans. On 19 November 2018, South Carolina implemented a law mandating the registration of these vehicles with the South Carolina Department of Motor Vehicles, enabling better regulation of moped and scooter drivers on the roads. This study aims to investigate whether the incidence of vertebral fractures and spinal cord injuries related to moped and scooter accidents decreased after the passage of this 2018 South Carolina law.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Retrospective data from a cohort of 350 patients, 239 before (\"prelaw\") and 111 after the law (\"postlaw\") was implemented, seeking care at a level 1 trauma center for moped or scooter-related spinal injuries between January 2014 and December 2022 were analyzed. Differences in the incidence of vertebral fractures and spinal cord injuries before and after the passage of the South Carolina law were calculated. Vertebral fractures were categorized by location on the spine pre- and postlaw. &lt;i&gt;χ&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt;, Wilcoxon rank sum, and Shapiro-Wilk tests were employed to compare variables between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 60 traumatic vertebral fractures (47 prelaw and 13 postlaw) and 7 spinal cord injuries involved moped accidents. There was no significant difference in the incidence rate of vertebral fractures (19.7% vs 11.7%, &lt;i&gt;P&lt;/i&gt; = 0.09) or spinal cord injuries (2.9% vs 0%, &lt;i&gt;P&lt;/i&gt; = 0.1) between those injured prelaw and postlaw, although there were significant differences between the groups in age (43.2 vs 47.4, &lt;i&gt;P&lt;/i&gt; &lt; 0.01) and incidence of men injured (87.9% vs 95.5%, &lt;i&gt;P&lt;/i&gt; = 0.03). Multivariable logistic regression demonstrated suffering a moped-related traumatic injury before the implementation of the 2018 South Carolina law (OR = 2.08, 95% CI: 1.09-4.23, &lt;i&gt;P&lt;/i&gt; = 0.03) and an increase in age at the time of injury (OR = 1.03, 95% CI: 1.01-1.05, &lt;i&gt;P&lt;/i&gt; = 0.01) were independently associated with an increase in the odds ratio of suffering traumatic vertebral fractures following a moped accident when controlling for multiple confounding factors.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Before the implementation of a 2018 South Carolina law that increased moped regulations, moped drivers had a significantly higher odds ratio for suffering a traumatic vertebral fracture compared with after the implementation of the law when controlling for confounding factors. These findings suggest that public policy surrounding moped use may contribute to a decrease in the overall odds of suffering vertebral fractures resulting from moped use and emphasize the need for continual updates to public policy with public safety in mind. This is not only important from a standpoint of patient safety, but it also helps to decrease the amount of health care resources and dollars used.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;Implementation of public policy surroun","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"104-109"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371255","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":"Augmenting Endoscopic Transforaminal Spinal Decompression Surgery (Full Endoscopic Spine Surgery) Using Stimulated Electromyography Neuromonitoring Dilators.","authors":"Dickson Hong Him Chau, Dhivakaran Gengatharan, Walter-Soon-Yaw Wong","doi":"10.14444/8692","DOIUrl":"10.14444/8692","url":null,"abstract":"<p><strong>Background: </strong>Full endoscopic spine surgery via a transforaminal approach (FESS-TFA) offers a minimally invasive approach for spinal decompression. However, it carries a risk of nerve root irritation or injury. Existing intraoperative neuromonitoring primarily provides retrospective warnings of potential nerve disturbance.</p><p><strong>Objective: </strong>To introduce the use of stimulated electromyography neuromonitoring dilators in FESS-TFA for proactive nerve protection, enhanced localization, and potential reduction in radiation exposure.</p><p><strong>Methods: </strong>This technical note describes the first use of neuromonitoring dilators in FESS-TFA. A 6-mm dilator tipped with a stimulation electrode is introduced to provide real-time directional feedback regarding nerve proximity, allowing the surgeon to actively avoid accidental injury to the exiting nerve root. With the creation of a safe tract, subsequent introduction of working instruments would theoretically reduce the risk of neural injury.</p><p><strong>Results: </strong>The technique was successfully applied in a case of T11/T12 severe spinal stenosis, facilitating safe instrument passage and nerve localization. We describe the surgical technique and provide illustrative intraoperative details.</p><p><strong>Conclusion: </strong>Neuromonitoring dilators represent a promising innovation in FESS-TFA with the potential to enhance patient safety and possibly streamline the procedure. Larger-scale studies are warranted to quantify the true impact of this technique on complication rates, operative time, and radiation exposure.</p><p><strong>Clinical relevance: </strong>This technique highlights a significant advancement in reducing neural complications during minimally invasive spinal surgeries. By proactively preventing nerve irritation or injury and reducing radiation exposure, it contributes to optimizing surgical workflows and improving patient outcomes.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"57-62"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792514","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":"Evolving Role of Lumbar Decompression: A Narrative Review.","authors":"Sagar Telang, Sahil S Telang, Ryan Palmer, Andy Ton, William J Karakash, Jonathan Ragheb, Siddharth Patel, Jeffrey C Wang, Ram K Alluri, Raymond J Hah","doi":"10.14444/8702","DOIUrl":"10.14444/8702","url":null,"abstract":"<p><p>Traditional open lumbar decompression techniques have long been used to relieve spinal canal pressure caused by lumbar spinal stenosis. However, these procedures are associated with significant postoperative pain and prolonged recovery. Over the past few decades, there has been a shift toward minimally invasive surgical (MIS) techniques designed to minimize tissue trauma, postoperative pain, and recovery time. These advancements represent a major step forward, offering smaller incisions and direct visualization of the spinal canal. Despite the clear benefits of MIS and endoscopic techniques, they also present challenges such as a steep learning curve for surgeons and a risk of incomplete decompression. The present review examines the historical progression from open to MIS and endoscopic lumbar decompression techniques, assessing their clinical outcomes, benefits, and limitations. It highlights the ongoing need for careful application of these methods based on individual patient factors and emphasizes the importance of balancing innovative techniques with evidence-based practices to enhance patient care in spine surgery. The future of lumbar decompression will likely be shaped by further technological advancements, including navigation systems, robotic assistance, and augmented reality, which promise to improve surgical precision and outcomes.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"117-128"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053112/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494009","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":"Preoperative Evaluation of Oswestry Disability Index in Lumbar Spinal Stenosis: New Evidence of Time Independence of Variation Up to 1 Year.","authors":"Juho Hatakka, Katri Pernaa, Joel Kostensalo, Keijo Mäkelä, Inari Laaksonen","doi":"10.14444/8699","DOIUrl":"10.14444/8699","url":null,"abstract":"<p><strong>Background: </strong>The Oswestry Disability Index (ODI) is a well-validated and widely used patient-reported outcome instrument to evaluate lumbar spinal stenosis (LSS) patients' treatment outcomes. The objective of the present study was to determine long the average interval between 2 preoperative measurements can be before a clinically significant difference of 10 points or more might appear.</p><p><strong>Methods: </strong>This was a retrospective observational study utilizing prospectively collected data from a single university hospital database, which was compatible with the national registry. One hundred and four surgically treated LSS patients were included in this observational study using systematic sampling. The preoperative ODI score was obtained at 2 timepoints. The 2-month mark as a potential turning point was of special interest, as the registry in question excludes preoperative data as outdated if the data are older than 2 months. Possible time dependence of the change in ODI scores was explored using a linear mixed-effects model with ODI as the dependent variable and interval length, sex, age, body mass index (BMI), and the presence of a concomitant disease as fixed effects.</p><p><strong>Results: </strong>The mean ODI score was 41.7 points (SD = 16.0) at the first and 41.1 points (SD = 15.5) at the second measurement. Mean time between the ODI scores was 74 days (range 8-361). On average, ODI changed by 9.17 points (SD = 7.16) between the 2 measurements, increasing for 48 patients, remaining unchanged for 9 patients, and decreasing for 47 patients. The arithmetic mean of the changes was -0.60 points and the median was 0.00 points. The estimated change in the population mean was -0.0005 points/day (95% CI [-0.022, 0.022], <i>P</i> = 0.97), meaning that we have strong evidence that the change in the mean is not clinically significant for up to 15 months (95% CI between ±10 points). Furthermore, no evidence was found that age, sex, BMI, or concomitant diseases were associated with the change of ODI score over time. Furthermore, the probability to observe a clinically significant change in a patient did not depend on the number of days between the 2 measurements (OR 1.003, 95% CI [0.997, 1.010], <i>P</i> = 0.30). Variance in ODI change did not grow over time.</p><p><strong>Conclusions: </strong>The probability of observing a clinically significant differences does not depend on the length of the observation interval, and ODI scores can be considered equally reliable for a significantly longer time than 2 months, even up to 1 year.</p><p><strong>Clinical relevance: </strong>Preoperative ODI scores do not lose reliability up to 1 year in patients undergoing operatively treatment for LSS.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"110-116"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068413","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":"Redefining Surgical Boundaries for Obese Patients? Full Endoscopic Lumbar Discectomy Proves Equally Effective With Shorter Hospital Stay in Obese Patients.","authors":"Xavier Castel, Henri d'Astorg, Mohammad Allaji, Vincent Fiere, Marc Szadkowski","doi":"10.14444/8654","DOIUrl":"10.14444/8654","url":null,"abstract":"<p><strong>Objective: </strong>This cohort study aims to evaluate the impact of obesity on the outcomes of full endoscopic lumbar discectomy (FELD) in patients with lumbar disc herniation.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 156 adult patients who underwent FELD for lumbar disc herniation from January 2015 to February 2023. Patients were divided into 3 groups: obese endoscopic (<i>n</i> = 71), obese open surgery (<i>n</i> = 31), and nonobese endoscopic (<i>n</i> = 54). Clinical outcomes were assessed using the visual analog scale for leg and back pain, the Oswestry Disability Index, and patient satisfaction rates. Operative time, hospital stay duration, and complication rates were also analyzed.</p><p><strong>Results: </strong>No significant differences were observed in patient-reported outcome measures, operative time, or complication rates between obese and nonobese patients undergoing FELD. The mean operative time was longer in the endoscopic group compared with the open surgery group (70.2 vs 59.8 minutes), but the hospital stay was significantly shorter for endoscopic patients (1.7 vs 2.4 nights, <i>P</i> = 0.0006). Both obese and nonobese groups showed significant improvements in visual analog scale and Oswestry Disability Index scores at the final follow-up, with satisfaction rates of 85.7% in the endoscopic group reporting good to excellent outcomes.</p><p><strong>Conclusions: </strong>FELD is a viable and effective alternative to traditional open surgery for obese patients, offering comparable clinical outcomes and the added benefit of a shorter hospital stay. These findings suggest that obesity does not inherently affect surgical outcomes, underscoring the need for further research with larger sample sizes and longer follow-up periods.</p><p><strong>Clinical relevance: </strong>FELD offers a viable and effective surgical option for obese patients, with outcomes comparable to traditional surgery but with the added benefit of shorter hospital stays.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"2-10"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366827","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}