Asian Spine Journal最新文献

{"title":"Long-term follow-up reveals non-utility of nonsurgical management in moderate adolescent idiopathic scoliosis: a comprehensive meta-analysis.","authors":"Eduardo Hevia, Jesús Burgos, Vicente García, María Teresa de Santos Moreno, Ibrahim Khalil, Gonzalo Mariscal, Carlos Barrios","doi":"10.31616/asj.2024.0358","DOIUrl":"https://doi.org/10.31616/asj.2024.0358","url":null,"abstract":"<p><p>This systematic review and meta-analysis aimed to evaluate the outcomes of conservative management of moderate adolescent idiopathic scoliosis (AIS), focusing on long-term curve behavior, surgical rates, patient-reported outcomes, and the influence of follow-up duration. A comprehensive literature search was conducted adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Statistical analyses, using Review Manager, encompassed mean differences, risk ratios, pooled incidences, and random-effects models. Heterogeneity was assessed using the I2 statistic. The outcome measures were radiographic curve progression, percentage of patients with significant (>5°) progression, surgery rates, sagittal profile changes, back pain rates, quality of life scales, and functional outcomes. Thirteen studies involving 1,492 patients with AIS curves within 30°-45°, treated conservatively, with a minimum 10-year follow-up, were included. At 20+ years of follow-up (mean age, 34.5 years), curves worsened by an average of -5.69° (95% confidence interval [CI], -11.66 to 0.29). At 25+ years of follow-up (mean age, 49.8 years), curves worsened by an average of -14.32° (95% CI, -20.14 to -8.50). The incidence of significant progression was 35.68% (95% CI, 22.85 to 48.50). The surgery rate was 14.20% (95% CI, 0.87 to 27.53). Sagittal alignment (thoracic kyphosis and lumbar lordosis) remained within normal ranges at the final follow-up, with no significant changes from baseline. Back pain rate was 63.35% (95% CI, 38.36 to 88.34). These findings highlight the alarming incidence of curve progression and pain in conservatively managed AIS patients. A critical re-evaluation of conservative versus operative indications is imperative to mitigate long-term impacts and improve outcomes for this population.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473947","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":"Preoperative pars defect length predicts bone union after direct repair for lumbar spondylolysis using the modified smiley face rod technique: a retrospective cohort study.","authors":"Shotaro Teruya, Shun Okuwaki, Hisanori Gamada, Toru Funayama, Masaki Tatsumura","doi":"10.31616/asj.2025.0090","DOIUrl":"https://doi.org/10.31616/asj.2025.0090","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Purpose: </strong>To determine whether the preoperative pars defect length predicts bone union following the modified smiley face rod (mSFR) technique for lumbar spondylolysis and to identify a threshold for clinical decision-making.</p><p><strong>Overview of literature: </strong>Lumbar spondylolysis is a common cause of low back pain in young athletes, often leading to pseudarthrosis that requires surgical intervention. Various techniques, including mSFR, address pseudarthrosis; however, the effect of preoperative pars defect length on bone union remains unclear.</p><p><strong>Methods: </strong>This study analyzed 75 pars defects in 38 patients treated with mSFR between 2014 and 2022. Pre- and postoperative pars defect lengths were measured using computed tomography (CT). Patients were categorized into bone union and nonunion groups based on CT findings up to 24 months postoperatively. Group comparisons of defect lengths were performed using the Mann-Whitney U test. Logistic regression was used to examine the association between preoperative defect length and nonunion. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal threshold for preoperative defect length.</p><p><strong>Results: </strong>Bone union was achieved in 65 of 75 defects (87%). The preoperative pars defect length was significantly shorter in the bone union group than in the nonunion group (3.0 mm vs. 5.6 mm, p <0.001). A strong correlation was observed between pre- and postoperative pars defect lengths (Spearman's rho=0.76). Logistic regression analysis revealed a significant association between a longer preoperative defect and nonunion (odds ratio, 1.89; 95% confidence interval, 1.29-2.72; p =0.001). ROC analysis revealed a cut-off value of 3.8 mm (sensitivity, 89%; specificity, 75%; area under the curve=0.86).</p><p><strong>Conclusions: </strong>Bone union following the mSFR technique may be influenced by the pars defect length, with larger preoperative defects potentially hindering bone union. The technique is most effective when the preoperative defect length is ≤3.8 mm.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473948","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":"Clinical outcomes of posterior cervical fusion in the setting of increasing age and medical complexity: an American national database analysis from 2012 to 2022.","authors":"Ryan Le, Ryan Hoang, Joshua Lee, Noah Makaio Ross, Joe Morrissey, Oluwaseun Awosanya, Michael Oh, Hansen Bow, Yu-Po Lee, Nitin Bhatia","doi":"10.31616/asj.2024.0342","DOIUrl":"https://doi.org/10.31616/asj.2024.0342","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>This study aimed to investigate trends in postoperative complications for posterior cervical fusions from 2012 to 2022.</p><p><strong>Overview of literature: </strong>Previous studies analyzing the longitudinal outcomes of posterior cervical fusion from 2003 to 2013 have demonstrated relatively improved postoperative outcomes despite the increasing volume, complexity, and age of the patient population. However, few studies have evaluated these outcomes since 2013.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing posterior cervical fusion between 2006 and 2022. Patients aged >18 years with current procedural terminology code 22600 for posterior cervical fusion were included. Patient demographics and comorbidities were recorded, including age, race, body mass index, diabetes mellitus, and hypertension. Annual 30-day complication rates were reported, including wound infection, readmission, reoperation, length of stay, intraoperative blood transfusions, and mortality.</p><p><strong>Results: </strong>In total, 25,537 patients undergoing posterior cervical fusion from 2012 to 2022 were included. Variations in the rates of urinary tract infection, deep vein thrombosis, sepsis, reoperation, and mortality were not significant. Wound infection rates increased from 2.4% in 2012 to 4.0% in 2022 (p=0.003). Pneumonia rates increased from 1.2% in 2012 to 1.6% in 2022 (p=0.011). Intraoperative blood transfusion rates decreased consistently from 5.6% in 2012 to 2.8% in 2022 (p<0.001). Readmission rates increased from 6.4% in 2012 to 6.7% in 2022 (p<0.001). The average length of stay decreased from 4.18 days in 2012 to 3.97 days in 2019, before increasing between 2020 and 2022 to 4.17 days in 2022.</p><p><strong>Conclusions: </strong>Rates of comorbidities including age, diabetes mellitus, and hypertension have increased among patients undergoing posterior cervical fusion between 2012 and 2022, whereas complication rates have remained relatively similar. The length of stay has shortened despite the higher medical complexity of the patients who underwent surgery.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473942","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":"Iliac screw failures compromise long-term radiographic and clinical outcomes of adult spinal deformity surgery without impeding fusion at the lumbosacral junction: a retrospective study in Korea.","authors":"Se-Jun Park, Kyunghun Jung, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Chong-Suh Lee","doi":"10.31616/asj.2025.0006","DOIUrl":"https://doi.org/10.31616/asj.2025.0006","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective study.</p><p><strong>Purpose: </strong>To investigate the effects of iliac screw failure (ISF) on L5-S1 fusion and long-term radiographic and clinical outcomes in adult spinal deformity (ASD) surgery.</p><p><strong>Overview of literature: </strong>Iliac fixation is crucial for long-segmental fusion in ASD surgery to prevent mechanical failure at the lumbosacral junction. Despite numerous studies on ISF, its impact on surgical outcomes remains unclear.</p><p><strong>Methods: </strong>We included 192 patients (mean age, 69.2 years; mean follow-up, 57.8 months) who underwent ≥5-level fusion with interbody fusion at L5-S1 and pelvic fixation using bilateral iliac screws between 2014 and 2022. Patients were categorized into no-ISF and ISF groups. Fusion status at L5-S1 was evaluated using computed tomography (CT) images at 2 years postoperatively. Mechanical failures (evaluated in terms of rod fractures and related revision surgery), radiographic outcomes, and clinical outcomes were compared between the groups.</p><p><strong>Results: </strong>ISFs developed in 66 patients (34.4%) by 13.4 months post-surgery on average. At 2-year CT follow-up, no significant differences in fusion grades were observed between the two groups. ISF rates did not differ according to mechanical failure development in terms of rod fracture at L5-S1 (p =0.273) or at ≥L4-5 (p =0.432), or revision surgery at L5-S1 (p =0.144) or at ≥L4-5 (p =0.886). However, at the final follow-up, sagittal parameters, including pelvic incidence, were significantly worse in the ISF group than in the no-ISF group. The final clinical outcomes were also poorer in the ISF group.</p><p><strong>Conclusions: </strong>ISF occurred in over one-third of patients after long-segment fusion. While ISF did not adversely affect radiographic and clinical fusion achievement at the lumbosacral junction, it was associated with inferior long-term radiographic and clinical outcomes.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 3-kilogram weight-lifting flexion radiograph: a new diagnostic method for segmental sagittal lumbar instability: a cross-sectional study.","authors":"Koopong Siribumrungwong, Warunyoo Suttikadsanee, Waroot Pholsawatchai, Sorrawich Singhatanadgige, Thongchai Suntharapa","doi":"10.31616/asj.2025.0065","DOIUrl":"https://doi.org/10.31616/asj.2025.0065","url":null,"abstract":"<p><strong>Study design: </strong>A cross-sectional study.</p><p><strong>Purpose: </strong>To evaluate the diagnostic performance of a novel 3-kg weight-lifting flexion radiograph for detecting lumbar instability.</p><p><strong>Overview of literature: </strong>Conventional flexion-extension radiographs have limited sensitivity for detecting lumbar instability, while magnetic resonance imaging (MRI) is a reliable standard. This study compares the performance of a novel weight-lifting radiograph to conventional flexion radiographs, using MRI as the reference standard.</p><p><strong>Methods: </strong>Forty-six patients with a diagnosis of lumbar instability were enrolled. Participants underwent lateral flexion, lateral extension, and 3-kg weight-lifting flexion lumbosacral spine radiographs. MRI was also performed on all participants. Diagnostic parameters, including sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and likelihood ratios, were calculated for each lumbar level. Reliability was assessed using intraclass correlation coefficients (ICCs).</p><p><strong>Results: </strong>The 3-kg weight-lifting flexion radiograph showed higher sensitivity for detecting spinal instability at the L3/4 and L4/5 levels (88% vs. 36% and 83.3% vs. 44.44%, respectively) but lower specificity (61.9% vs. 76.19% and 70% vs. 80%, respectively) compared to the conventional flexion radiograph. McNemar tests revealed no significant differences between the 3-kg weight-lifting flexion radiograph and MRI at these levels (p >0.05). Reliability assessments demonstrated excellent intra- and interobserver agreement (ICC ≥0.99). Furthermore, this technique was safe, with no adverse effects reported.</p><p><strong>Conclusions: </strong>The 3-kg weight-lifting flexion radiograph enhances diagnostic sensitivity and accuracy for lumbar instability, particularly at the L3/4 and L4/5 levels, offering a reliable screening alternative.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of fixed segment length on the surgical outcomes of single-segment lumbar burst fractures: shorter segments are more prone to the formation of local stable osteophytes: a retrospective observational study.","authors":"Haoliang Chen, Wen Peng, Xiangyang Liu, Bin Liu","doi":"10.31616/asj.2024.0477","DOIUrl":"https://doi.org/10.31616/asj.2024.0477","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Purpose: </strong>This study investigated the impact of long-segment and short-segment pedicle screw fixation on degeneration indicators, particularly stable osteophytes, in the treatment of single-segment lumbar burst fractures.</p><p><strong>Overview of literature: </strong>Current research mainly focuses on clinical indicators such as operation time, Visual Analog Scale (VAS) pain scores, and imaging indicators like the Cobb angle correction rate. However, there is a paucity of research on the indicators of intervertebral disc degeneration at fixed segments (such as bone spur formation, vacuum phenomenon in the disc, and Modic changes). As the health status of the intervertebral disc is closely related to spinal stability, this study provides a comprehensive evaluation of the efficacy of two surgical techniques, providing a more precise basis for clinical treatment.</p><p><strong>Methods: </strong>This was a retrospective analysis of a cohort of 64 patients with single-segment lumbar burst fractures. Among them, 38 patients underwent posterior long-segment pedicle screw-rod fixation (long-segment group), while 26 cases received posterior shortsegment pedicle screw fixation (short-segment group). Changes in degeneration indicators within the fixation area, including osteophyte formation, intervertebral disc vacuum sign, and intervertebral height, were examined.</p><p><strong>Results: </strong>All 64 patients completed surgery and were followed up for at least 24 months. At the final follow-up at 24 months, the shortsegment fixation group exhibited a higher osteophyte formation score than the long-segment fixation group. However, no significant between-group differences were observed in the incidence of intervertebral disc vacuum sign or intervertebral height loss rate.</p><p><strong>Conclusions: </strong>After a 2-year follow-up, the short-segment fixation group demonstrated a similar intervertebral height loss rate and intervertebral disc vacuum sign incidence compared to the long-segment fixation group, but a higher rate of stable osteophyte formation.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473950","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":"Duraplasty with laminoplasty for Hirayama disease: a technical note with a case series.","authors":"Fadlyansyah Farid, Toshio Nakamae, Yoshinori Fujimoto, Kiyotaka Yamada, Yasushi Fujiwara, Hiroki Fukui, Nobuo Adachi","doi":"10.31616/asj.2024.0451","DOIUrl":"https://doi.org/10.31616/asj.2024.0451","url":null,"abstract":"<p><p>Hirayama disease, a form of cervical myelopathy predominantly affecting young males, is characterized primarily by distal muscle atrophy in the upper limbs. We investigated the surgical outcomes of duraplasty with laminoplasty for Hirayama disease. Five male patients with an average age of 17.4 years with Hirayama disease who had preoperative muscle atrophy and numbness in the upper extremities underwent duraplasty with laminoplasty. The severity of disability in activities of daily living was classified using the Tokumaru classification. Following cervical duraplasty with laminoplasty, all patients experienced significantly improved upper extremity performance. Hirayama disease is characterized by an inelastic dura that constricts and compresses the cervical spinal cord when the neck is flexed. Duraplasty with laminoplasty is proposed as an effective treatment for Hirayama disease.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473944","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":"Comparison of topical and intravenous tranexamic acid for reducing postoperative blood loss in single-level posterior lumbar interbody fusion: a retrospective study from Japan.","authors":"Kazuma Kitaguchi, Kunihiko Hashimoto, Takashi Kaito, Kazuya Oshima, Eiji Wada","doi":"10.31616/asj.2024.0463","DOIUrl":"https://doi.org/10.31616/asj.2024.0463","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Purpose: </strong>This study aimed to compare the efficacy and safety of topical and relatively high-dose intravenous tranexamic acid (TXA) in minimizing postoperative blood loss in patients undergoing single-level posterior lumbar interbody fusion (PLIF).</p><p><strong>Overview of literature: </strong>Topical TXA demonstrates a similar hemostatic efficacy to intravenous TXA. However, whether intravenous or topical TXA is more effective in minimizing postoperative bleeding in spine surgery remains unclear.</p><p><strong>Methods: </strong>In total, 140 patients who underwent single-level PLIF were retrospectively enrolled and assigned to the (1) control group (n=58), which did not receive TXA; (2) TXA (iv) group (n=39), which was administered intravenously with a relatively high-dose (2 g) of TXA immediately before wound closure; and (3) TXA (t) group (n=43), which received topical application of TXA (1 g in 100 mL of saline solution) to the wound immediately before wound closure.</p><p><strong>Results: </strong>No significant differences in age, body mass index, sex, preoperative hematological parameters, or intraoperative blood loss were found among the three groups. The total postoperative blood loss was significantly lower in the TXA (t) group than in the TXA (iv) and control groups (389.6±137.5 vs. 543.6±175.4 vs. 700.3±231.4, respectively; both p<0.01). Analysis of blood loss over time revealed significantly less blood loss throughout the postoperative period in the TXA (t) group than in the control group (p<0.01). In contrast, the TXA (iv) group showed less blood loss than the control group in 2-6 hours and 6-12 hours postoperatively (p<0.05). No complications, such as thromboembolic events, were associated with the use of either TXA formulation.</p><p><strong>Conclusions: </strong>Following single-level PLIF, topical TXA exerts rapid and long-lasting effects on minimizing postoperative blood loss compared with twice the amount of intravenous TXA.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473943","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":"Laminectomy with fusion for cervical spondylotic myelopathy is associated with higher early morbidity and risk of perioperative complications compared with laminectomy alone: a retrospective study in the United States.","authors":"Abhinav Sharma, Paramveer Birring, Nischal Acharya, Manaav Mehta, Nicole Goldenhersh, Michael Steinhaus, Zorica Buser, Hao-Hua Wu, Sohaib Hashmi, Don Young Park, Yu-Po Lee, Nitin Bhatia","doi":"10.31616/asj.2024.0350","DOIUrl":"https://doi.org/10.31616/asj.2024.0350","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study.</p><p><strong>Purpose: </strong>We present data assessing the differences in 30-day morbidity, mortality, and postoperative complications between the two surgical remedy options.</p><p><strong>Overview of literature: </strong>The choice between decompression with fusion or decompression alone for the management of cervical spondylotic myelopathy (CSM) remains controversial.</p><p><strong>Methods: </strong>The American College of Surgeons National Quality Improvement Program database was queried for adults ≥18 years diagnosed with spondylosis with cervical myelopathy (10th revision of the International Classification of Diseases [ICD-10]: M47.12) or spinal stenosis of the cervical region (ICD-10: M48.02) who underwent laminectomy (Current Procedural Terminology [CPT] 63001, 63015, 63045) with or without fusion (CPT 22600) between 2015 and 2020. Patients were stratified into fusion and non-fusion cohorts for comparative review. Estimated 30-day mortality and morbidity, postoperative complications, and American Society of Anesthesiologists (ASA) classification were evaluated using chi-square and analysis of variance tests, and results were further stratified according to ASA classification.</p><p><strong>Results: </strong>Of the 6,412 patients, 3,355 (52%) received laminectomy without fusion, and 3,057 (48%) experienced laminectomy with fusion. Patients undergoing decompression with fusion had higher mean morbidity (estimated probability 0.073 vs. 0.064, p<0.001), unplanned reoperations (4.2% vs. 2.7%, p<0.002), unplanned readmissions (7.6% vs. 6.3%, p<0.014), mean length of stay (5.0±8.9 days vs. 3.4±7.2 days, p<0.001), deep wound infections (0.8% vs. 0.4%, p<0.022), and bleeding risk necessitating transfusion (3.8% vs. 1.6%, p<0.001). Stratification by ASA scores demonstrated an overall higher rate of 30-day postoperative complications with increasing ASA scores in both cohorts, However, the decompression with fusion cohort showed a greater relative increase in complications compared to the decompression-alone cohort with each ASA group.</p><p><strong>Conclusions: </strong>Decompression with fusion is correlated with higher estimated morbidity, unplanned reoperations and readmissions, and 30-day complications postoperatively. Decompression alone is an appealing procedure option for CSM, particularly for patients with higher ASA scores and those at greater risk.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473946","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":"Lumbar spinal stenosis: current concept of management.","authors":"Ji-Won Kwon, Kyung-Soo Suk, Seong-Hwan Moon, Si-Young Park, Namhoo Kim, Sub-Ri Park, Jae-Won Shin, Hak-Sun Kim, Byung Ho Lee","doi":"10.31616/asj.2025.0198","DOIUrl":"https://doi.org/10.31616/asj.2025.0198","url":null,"abstract":"<p><p>Lumbar spinal stenosis (LSS) is a common degenerative spinal condition where spinal canal narrowing causes symptoms such as neurogenic claudication, radiculopathy, and lower back pain. While non-operative and surgical approaches yield similar long-term outcomes, surgical intervention-particularly decompression-can provide earlier symptom relief, functional recovery, and fall prevention in selected patients with refractory symptoms. Recent advancements in surgical technologies and image guidance have brought about a paradigm shift in LSS management. Biportal endoscopic spine surgery (BESS) has gained global traction as a minimally invasive alternative to traditional decompression methods, offering superior visualization, less soft tissue damage, shorter hospital stays, and faster recovery. High-quality studies, including randomized controlled trials, have shown promising outcomes for this technique. Furthermore, the integration of navigation systems, robot-assisted instrumentation, and artificial intelligence (AI)-driven diagnostics and surgical planning tools is transforming spinal surgery by enhancing precision in preoperative evaluation and intraoperative execution. These innovations enable accurate targeting, reduce complications, and improve reproducibility across diverse surgical settings. This review provides an updated overview of LSS, covering its pathophysiology, clinical assessment, diagnosis, and treatment. Special emphasis is placed on the growing role of BESS and the transformative impact of digital technologies such as navigation, robotics, and AI in the evolving landscape of spinal stenosis care.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282244","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}