International Journal of Spine Surgery最新文献

{"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}

{"title":"Short- and Mid-Term Outcomes Following ALIF and TLIF in L5-S1 Isthmic Spondylolisthesis Patients.","authors":"Jialun Chi, Kate S Woods, Ved A Vengsarkar, Zhiwen Xu, Hanzhi Yang, Abhishek Kumar, Yi Zhang, Zhichang Zhang, Jesse Wang, Lawal Labaran, Li Jin, Xudong Li","doi":"10.14444/8696","DOIUrl":"10.14444/8696","url":null,"abstract":"<p><strong>Background: </strong>A limited number of studies have compared the outcomes of anterior lumbar interbody fusion (ALIF) to transforaminal lumbar interbody fusion (TLIF) for the treatment of isthmic spondylolisthesis. This study aims to compare postoperative complications between these two surgical approaches.</p><p><strong>Methods: </strong>A retrospective review was performed using a large national database. The study population included all patients older than 18 years who underwent single-level ALIF or TLIF with a diagnosis of L5 to S1 isthmic spondylolisthesis. A 1:2 propensity score was used to match ALIF and TLIF cohorts for age, sex, and relevant comorbidities, including smoking status. Multivariate logistic regression was used to compare 3-month and 2-year medical and surgical complications, including 5-year reoperation rates.</p><p><strong>Results: </strong>Five hundred and seventy-eight ALIF patients were paired with 1,156 TLIF patients following the match. The analysis revealed a higher 3-month ileus rate in ALIF patients (<i>P</i> = 0.009) and a lower, though not significant difference in, reoperation rate for ALIF within 2 years at 7.1% compared with TLIF at 7.7% (<i>P</i> = 0.696). Five-year reoperation rates were comparable (9.5% vs 10.8%; <i>P</i> = 0.612).</p><p><strong>Conclusions: </strong>Aside from the increased rate of ileus in the ALIF group, there was no significant difference in both short- and mid-term complications, including overall reoperation rate, between the 2 techniques. Spine surgeons should select the optimal technique for a given patient.</p><p><strong>Clinical relevance: </strong>ALIF and TLIF offer comparable mid-term postoperative outcomes for treating 1-level L5/S1 isthmic spondylolisthesis.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"81-87"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142979801","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":"Fully Navigated Single-Position Prone Lateral Lumbar Interbody Fusion: A Detailed Technical Report and Description of 15 Cases.","authors":"David E Bauer, Nicolas Lauper, Dennis E Dominguez","doi":"10.14444/8697","DOIUrl":"10.14444/8697","url":null,"abstract":"<p><strong>Background: </strong>Navigation increases the precision and safety of pedicle screw placement and has been used to place interbody cages for lateral lumbar interbody fusion. Single-position surgery shortens its duration and that of anesthesia. The aim of this study was the feasibility of simultaneous cage and screw placement in a single prone position using intraoperative navigation without the need for additional fluoroscopy and a detailed technical description of this procedure.</p><p><strong>Methods: </strong>We retrospectively analyzed 15 patients who underwent simultaneous navigated lateral lumbar interbody fusion and posterior instrumentation in a single prone position. A detailed technical description of the procedure is provided. Surgery duration, blood loss, complications, and radiographic parameters were recorded.</p><p><strong>Results: </strong>A total of 24 cages were placed in 15 patients. The mean time taken for cage placement was 21 ± 6.70 minutes, and there were no major complications. Mean surgery duration and blood loss per case, including posterior instrumentation, were 263 ± 94 minutes and 315 ± 143 mL, respectively. There were significant improvements in pre- to postoperative Oswestry Disability Index scores (51.38 ± 15.93 vs 32.81 ± 17.18, <i>P</i> < 0.001) and segmental lordosis (3.26° ± 8.97° vs 13.09° ± 15.25°, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>The present study's results showed the feasibility of lateral lumbar interbody fusion using simultaneous posterior pedicle screw instrumentation and intraoperative navigation in a single prone position.</p><p><strong>Clinical relevance: </strong>Navigated lateral lumbar interbody fusion and posterior instrumentation in a single prone position possibly reduces operating time and blood loss and reduces exposure of operation room personnel to radiation.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"70-80"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142898838","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":"Patient Recovery Following Uniportal Endoscopic Vs Open Lumbar Spine Surgery: Objective Analysis of Postoperative Mobility and Gait Patterns Using Wearable Sensors.","authors":"Alison Ma, Ralph J Mobbs, Monish M Maharaj","doi":"10.14444/8718","DOIUrl":"10.14444/8718","url":null,"abstract":"<p><strong>Background: </strong>There has been a gradual shift from open spine surgery to minimally invasive techniques such as endoscopic spine surgery to reduce approach-related trauma, collateral damage, and complications. While recovery following surgery has been measured using subjective measures including patient-reported outcome measures, the introduction of smart wearable devices now provides both an objective and continuous method of patient assessment. This prospective study compares patient recovery after uniportal endoscopic and open lumbar spine surgery by analyzing mobility and gait metrics captured by a wearable sensor.</p><p><strong>Methods: </strong>Participants included 24 patients who underwent a single-level uniportal endoscopic lumbar decompression or open posterior lumbar fusion. During the first 48 hours after surgery, patients wore a sensor that continuously monitored position, step count, and gait metrics.</p><p><strong>Results: </strong>In the immediate postoperative period, endoscopic spine surgery patients experienced a quicker return to mobility, with less time lying down, higher step count, faster gait velocity, lower double support percentage, and reduced variability, compared with open spine surgery patients.</p><p><strong>Conclusion: </strong>There are key differences in patient mobility and gait following uniportal endoscopic and open spine surgery. Endoscopic spine surgery patients had faster recovery, which can guide resource allocation toward the development of training programs and support the advancement of spine endoscopy to address a broader range of pathologies. This pilot study highlights the potential for wearable devices to be used in further studies to form spine surgery recovery trajectories, allowing targeted rehabilitation and prompt intervention for deviations in patient recovery.</p><p><strong>Clinical relevance: </strong>This study demonstrates the benefits of endoscopic spine surgery for improved postoperative recovery in terms of mobility and gait metrics. Additionally, it highlights the potential for wearable sensor technology to provide an objective and continuous method for assessing postoperative outcomes and for the development of individualized rehabilitation protocols. These findings support the broader adoption of endoscopic techniques and emphasize the value of incorporating wearable devices into postoperative monitoring to optimize patient care.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"39-48"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075671","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":"Clinical Outcomes Following Treatment of Cervical Spondylotic Radiculopathy With Cervical Posterior Decompression Using Unilateral Biportal Endoscopic Technique: A Single Center Retrospective Series of 20 Patients.","authors":"Keyur K Akbari, Teo Hong Lee Terry, Umesh Kanade, John Choi","doi":"10.14444/8690","DOIUrl":"10.14444/8690","url":null,"abstract":"<p><strong>Background: </strong>Unilateral biportal endoscopy (UBE) is a minimally invasive approach to treat cervical spondylotic radiculopathy (CSR), which is a common condition caused secondary to disc herniation, disc degeneration, uncal osteophytes, and other conditions manifesting as neuropathic radicular pain. Anterior cervical discectomy and fusion (ACDF) is the gold standard surgical technique for treating CSR. However, it has several disadvantages, including loss of mobile segment, adjacent segment degeneration (ASD), implant- and approach-related complications, and high hospitalization costs.</p><p><strong>Objective: </strong>The current study aimed to evaluate the safety and efficacy of UBE decompression for CSR.</p><p><strong>Methods: </strong>After obtaining IRB approval, a single-center retrospective study was undertaken. Included patients underwent UBE decompression for CSR with a minimum of 6 months of follow-up. Patient demographics, perioperative data, and length of hospital stay were reviewed. Clinical outcomes were assessed using VAS scores for neck and arm pain, and NDI scores were measure preoperatively and at 1 and 6 months after UBE decompression. A repeated analysis of variance test was performed to measure the difference between VAS and NDI scores.</p><p><strong>Results: </strong>Twenty patients (M: 15, F: 5) with a mean age of 56.7 ± 10.2 years were included. The mean follow-up period was 8.4 ± 1.8 months. The mean surgical time was 64.3±10.6 minutes. The average length of hospital stay was 1 day. At the final follow-up, the mean VAS for arm pain improved from 6.4 ± 0.7 to 0.6 ± 0.5 (92% improvement) and the mean VAS for neck pain improved from 3.3 ± 0.4 to 2.0 ± 0.2 (40% improvement). NDI score improved from 23.2 ± 1.95 to 5.7 ± 0.6 at the final follow-up (75% improvement). There were no complications.</p><p><strong>Conclusion: </strong>UBE is a safe and effective surgical treatment option for patients with CSR with excellent clinical outcomes.</p><p><strong>Clinical relevance: </strong>Clinical relevance of this case series study is to demonstrate the safety and efficacy of the novel unilateral biportal endoscopic decompression of cervical spondylotic radiculopathy and its short term clinical outcomes.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"19-26"},"PeriodicalIF":1.7,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640018","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":"Segmental Interbody, Muscle-Preserving, Ligamentotaxis-Enabled Reduction: \"SIMPLER\" Technique for cMIS Correction of ASD.","authors":"Jerry Robinson, David Gendelberg, Andrew Chung, Jose H Jimenez-Almonte, Babak Khandehroo, Neel Anand","doi":"10.14444/8714","DOIUrl":"10.14444/8714","url":null,"abstract":"<p><strong>Background: </strong>Correction of adult spinal deformity (ASD) through minimally invasive techniques is a challenging endeavor and has typically been reserved for experienced surgeons. This publication aims to be the first high-resolution technique guide to demonstrate a reproducible technique for ASD correction utilizing circumferential minimally invasive surgery (cMIS) without an osteotomy. The Segmental Interbody, Muscle-Preserving, Ligamentotaxis-Enabled Reduction (SIMPLER) technique is a novel ligamentotaxis-based scoliosis surgery that represents a paradigm shift from traditional osteotomies toward patient-specific correction.</p><p><strong>Methods: </strong>The senior author's (N.A.) cMIS technique for ASD correction without an osteotomy is described using high-resolution photographs, computer-generated imagery (CGI), and a case example. Step-by-step intraoperative photographs document a novel muscle-preserving posterior spinal exposure, spinal robotic safety protocol for instrumentation, dedicated deformity instrumentation system, rod reduction sequence, and minimally invasive fusion technique. CGI assists to reinforce technical considerations described by intraoperative photographs.</p><p><strong>Results: </strong>The SIMPLER technique is documented from incision to closure with high-resolution pictures including CGI to highlight concepts documented in photographs. Technical considerations were detailed for all aspects involved in the planning and execution of an osteotomy-free deformity correction.</p><p><strong>Conclusion: </strong>This represents the first in-depth technical description of ligamentotaxis-based, osteotomy-free, ASD scoliosis correction. The SIMPLER approach is reproducible and minimally invasive and can be done routinely for appropriately selected deformity candidates. This technique serves as a foundation to externally validate previously described cMIS ASD deformity correction outcomes.</p><p><strong>Clinical relevance: </strong>Circumferential minimally invasive spinal deformity correction is reproducible and can be achieved reliably through the use of the SIMPLER technique, without the use of an osteotomy.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S37-S54"},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967229","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":"Master Techniques in Minimally Invasive Spine Surgery: Lumbar Endoscopic Spine Surgery.","authors":"Choll W Kim","doi":"10.14444/8715","DOIUrl":"10.14444/8715","url":null,"abstract":"<p><p>The difficult learning curve remains the major obstacle to adoption of lumbar endoscopic spine surgery (LESS) techniques. Detailed, step-by-step techniques are described for the uniportal transforaminal technique, as well as uniportal and biportal interlaminar approaches. Special emphasis is placed on specific areas of the learning curve that pose obvious challenges to the completion of successful surgery. Logistical challenges of the first case are addressed with electronic checklists with interactive photographs of key instruments and equipment for easy identification by staff, interactive animations of the room set-up, and interactive animations of the surgical anatomy. This technique guide is part of a comprehensive training program with the goal to \"make the first case go well.\"</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S55-S75"},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400304","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}