Asian Spine Journal最新文献

{"title":"Comparison of surgical outcomes between unilateral biportal endoscopic technique and open microdiscectomy in patients with single-level lumbar disc herniation: a single-center retrospective study in China.","authors":"Tianyao Ke, Qiulin He, Qiying Wang, Long Li, Changgui Shi, Jiaxue Zeng, Qing Li","doi":"10.31616/asj.2024.0002","DOIUrl":"https://doi.org/10.31616/asj.2024.0002","url":null,"abstract":"<p><strong>Study design: </strong>Single-center retrospective cohort analysis.</p><p><strong>Purpose: </strong>To compare surgical outcomes between the unilateral biportal endoscopic (UBE) and open microdiscectomy for the treatment of single-level lumbar disc herniation (LDH).</p><p><strong>Overview of literature: </strong>Open microdiscectomy remains the gold standard for LDH, while UBE has emerged as a minimally invasive alternative. However, comparative evidence on efficacy, safety, and recovery profiles remains limited.</p><p><strong>Methods: </strong>This was a single-center retrospective analysis of 46 patients with single-level LDH who underwent either the UBE surgery (n=22) or open microdiscectomy (n=24) between January 2020 and December 2022. Demographic information, perioperative data, and radiographic measurements were reviewed. Pain intensity, patient satisfaction, and quality of life were assessed using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) at 1-week, 3-month, and 12-month follow-ups.</p><p><strong>Results: </strong>The mean operative time in the UBE group (86.1±11.4 minutes) was significantly longer than in the open microdiscectomy group (72.3±8.0 minutes, p=0.032). UBE was associated with significantly lower estimated blood loss (54.1±13.7 mL vs. 92.5±11.6 mL, p=0.001) and shorter hospital stay (3.7±1.2 days vs. 6.6±1.4 days, p=0.001). The mean VAS score for back pain at 1 week was significantly better in the UBE group (1.88±0.60 vs. 3.59±0.72, p=0.004). However, both surgical techniques showed similar long-term results regarding disc height, disc angle changes, and patient-reported outcomes.</p><p><strong>Conclusions: </strong>Despite the longer operative time, UBE is associated with reduced estimated blood loss and shorter hospital stays, offering a minimally invasive alternative with early postoperative pain relief. Conversely, open microdiscectomy, the conventional treatment approach, demonstrates comparable efficacy in long-term clinical outcomes despite its more invasive nature. Both methods show similar rates of complications and recurrent disc herniation. UBE is a viable alternative to open microdiscectomy, depending on individual patient considerations and surgical preferences.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961511","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":"Carbon-fiber-reinforced polyetheretherketone instrumentation in metastatic spine tumor surgery: technical considerations and potential pitfalls to avoid.","authors":"Naresh Kumar, Si Jian Hui, Priyambada Kumar, Leow Zihui Gabriel, Rohan Parihar, Jiong Hao Tan, Youheng Ou Yang, Yu-Mi Ryang","doi":"10.31616/asj.2025.0040","DOIUrl":"https://doi.org/10.31616/asj.2025.0040","url":null,"abstract":"<p><p>Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation has been reported in recent years for metastatic spine tumor surgery (MSTS). The benefits of CFR-PEEK include imaging artifact reduction, which enables more efficient follow-up and adjuvant radiotherapy (RT) planning compared with traditional titanium implants. Despite the increase in CFR-PEEK application in the literature, technical guides or considerations in terms of CFR-PEEK usage in MSTS are currently unavailable. This study aimed to highlight various important technical considerations and potential pitfalls for surgeons when applying CFR-PEEK instrumentation in MSTS. This narrative review was conducted using PubMed, Medical Literature Analysis and Retrieval System Online, The Cochrane Library, and Scopus databases through December 31, 2024. This review included all studies related to CFR-PEEK instrumentation in MSTS. The vast personal experiences of the senior authors with the CFR-PEEK instrumentation circumstantiated the concepts emphasized in this paper. This review included 36 articles and discussed various considerations when planning for CFR-PEEK instrumentation in patients undergoing MSTS. Factors include preoperative construct planning, intraoperative CFR-PEEK system handling, and postoperative considerations such as the requirement for RT planning. This review is the first to highlight various considerations for MSTS surgeons when applying CFR-PEEK instrumentation. This serves as an important guide for surgeons performing MSTS, with the continuous evolution of our treatment capacity in metastatic spinal disease (Level of evidence: IV).</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972248","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":"Inhibitory effect of MLC901 on axonal demyelination in experimental animals undergoing circumferential lumbal stenosis by increasing transforming growth factor-β1 levels.","authors":"Kevin Jonathan Sjukur, Willy Adhimarta, Andi Asadul Islam, Bambang Priyanto, Andriany Qanitha","doi":"10.31616/asj.2024.0364","DOIUrl":"https://doi.org/10.31616/asj.2024.0364","url":null,"abstract":"<p><strong>Study design: </strong>Experimental study using circumferential lumbar stenosis (CLS) rat model.</p><p><strong>Purpose: </strong>To investigate the effect of MLC901 administration on transforming growth factor (TGF)-β1 level and the degree of axonal demyelination in the CLS rat model.</p><p><strong>Overview of literature: </strong>CLS is common in older adults, causing neuropathic pain that impairs daily functioning. TGF-β1 plays an essential role in nerve regeneration and reducing axonal demyelination in CLS. MLC901, a traditional therapeutic formula, has shown promise in preclinical studies, including modulating proinflammatory cytokines. While MLC901's effect on serum TGF-β1 levels in the CLS rat model has been explored, its impact on tissue TGF-β1 expression remains understudied.</p><p><strong>Methods: </strong>Rats were randomly allocated into one of six groups: no CLS (baseline), CLS only (pretreatment), short treatment (1 day) with MLC901, short treatment with placebo, longer treatment (7 days) with MLC901, and longer treatment with placebo. The CLS model was induced by laminectomy at the lumbar 5th vertebra, followed by teflon insertion around the dura mater. Serum TGF-β1 levels were measured using enzyme-linked immunosorbent assay. Tissue TGF-β1 expression and the degree of axonal demyelination were assessed by immunohistochemistry and histopathology, respectively.</p><p><strong>Results: </strong>Long treatment MLC901 group had significantly higher serum TGF-β1 levels than the pretreatment group (p<0.001). Long treatment MLC901 group also exhibited the highest TGF-β1 tissue expression among all treatment groups, including the baseline group (p=0.013). Axonal demyelination was lowest in the long treatment MLC901 group, indicated by the highest number of Schwann cells (p<0.001), the fewest inflammatory cells (except versus baseline) (p=0.001), and the fewest vacuoles (except versus baseline) (p=0.015).</p><p><strong>Conclusions: </strong>MLC901 can inhibit axonal demyelination in experimental animals undergoing CLS surgery by upregulating TGF-β1 levels. MLC901 has the potential to be used as an adjuvant therapy in CLS surgery.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975256","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":"Two-year follow-up of unilateral biportal endoscopy assisted extraforaminal lumbar interbody fusion: how to perform indirect decompression and fusion under endoscopy: a retrospective study in Japan.","authors":"Takaki Yoshimizu, Sanshiro Saito, Teruaki Miyake, Tetsutaro Mizuno, Ushio Nosaka, Keisuke Ishii, Mizuki Watanabe, Kanji Sasaki","doi":"10.31616/asj.2025.0071","DOIUrl":"10.31616/asj.2025.0071","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Purpose: </strong>To compare the clinical and radiographic outcomes of unilateral biportal endoscopy-assisted extraforaminal lumbar interbody fusion (BE-ELIF) and oblique lateral interbody fusion (OLIF).</p><p><strong>Overview of literature: </strong>OLIF is widely recognized for its strong realignment capability, achieved through placing a large interbody cage, and its favorable clinical outcomes with indirect decompression. ELIF, similar to OLIF, does not entail exposure of the spinal canal. At our hospital, BE-ELIF involves removing the superior articular processes on both sides, inserting two expandable cages, and performing indirect canal decompression. BE-ELIF is a lumbar interbody fusion technique that provides indirect decompression similar to OLIF. However, no studies have compared the efficacy of ELIF performed under unilateral biportal endoscopy with that of OLIF.</p><p><strong>Methods: </strong>Forty-nine adults who underwent single-level L4/5 interbody fusion for degenerative spondylolisthesis were divided into BE-ELIF (n=27) and OLIF (n=22) groups based on the surgical approach used. Clinical outcomes were assessed using the Visual Analog Scale and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Radiographic parameters, including distance of spondylolisthesis, disc height, segmental lordosis, lumbar lordosis, pelvic tilt, and sagittal vertical axis, were evaluated preoperatively and at final follow-up.</p><p><strong>Results: </strong>OLIF provided significantly better relief of pain in lower limbs and buttocks at 1-year follow-up. No significant between-group differences were observed in JOABPEQ domains. BE-ELIF resulted in greater improvements in spondylolisthesis distance and disc height, while other parameters did not differ significantly between the two groups.</p><p><strong>Conclusions: </strong>For L4/5 degenerative spondylolisthesis, BE-ELIF demonstrated superior spondylolisthesis reduction and disc height improvement than OLIF. Although BE-ELIF was associated with some inferior clinical outcomes, it provided satisfactory results, effective realignment, and a low complication risk.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"217-227"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802429","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":"Response to the Letter to the Editor: Effect of core stabilization exercises on cervical sagittal balance parameters in patients with forward head posture: a randomized controlled trial in Egypt.","authors":"Ahmed Mahmoud Mohamed Shabana, Abeer Farag Hanafy, Ahmad Salamah Yamany, Reda Sayed Ashour","doi":"10.31616/asj.2025.0130.r2","DOIUrl":"10.31616/asj.2025.0130.r2","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"19 2","pages":"328-329"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967184","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":"Letter to Editor: Effect of furosemide on prevertebral soft tissue swelling after anterior cervical fusion: a comparative study with dexamethasone.","authors":"Sneha Sharma, Sanjay Singh Rawat, Udit Kumar Jayant, Ravikiran Vanapalli, Venkatesh Kumar S, Sujit Kumar Singh","doi":"10.31616/asj.2025.0022.r1","DOIUrl":"https://doi.org/10.31616/asj.2025.0022.r1","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"19 2","pages":"330-331"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960582","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":"Biportal endoscopic lumbar interbody fusion using a large polyetheretherketone cage: preliminary results.","authors":"Sang-Min Park, Hyun-Jin Park, Ki-Han You, Ho-Joong Kim, Jin S Yeom","doi":"10.31616/asj.2025.0010","DOIUrl":"10.31616/asj.2025.0010","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Purpose: </strong>This study aimed to introduce biportal endoscopic lumbar interbody fusion (BELIF) using a large polyetheretherketone (PEEK) cage, describe the surgical technique, and evaluate its clinical and radiological outcomes.</p><p><strong>Overview of literature: </strong>Biportal endoscopic techniques have emerged as a promising approach in spine surgery, and BELIF is reported to have good surgical outcomes. The use of large PEEK cage in lumbar interbody fusion has gained attention owing to their potential biomechanical advantages. Despite the potential benefits of BELIF with large PEEK cages, studies on its effectiveness and safety are lacking.</p><p><strong>Methods: </strong>Twelve consecutive patients underwent single-level BELIF for lumbar degenerative disease. The technique involves two small portals, one each for endoscopy and instruments. A large PEEK cage was inserted through a posterolateral approach. Clinical outcomes, including a Visual Analog Scale for back and leg pain, the Oswestry Disability Index, and the European Quality of Life-5 Dimensions, were assessed preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was evaluated using computed tomography (CT) at 12 months.</p><p><strong>Results: </strong>The mean patient age was 69.1±7.2 years, with operations predominantly at the L4-5 level (83%). The mean operation time was 149.7±37.4 minutes, and the average surgical drainage was 201.4±59.7 mL. All clinical outcome measures showed significant improvement at 12 months (p<0.05). Fusion was achieved in 83.3% of patients. Cage subsidence (>1 mm) occurred in one patient (8.3%). Complications included one case each of incidental durotomy, wrong-site surgery, and wound dehiscence and three cases of asymptomatic hematoma.</p><p><strong>Conclusions: </strong>BELIF using a large PEEK cage demonstrated promising clinical outcomes and fusion rates. The technique offers enhanced visualization and enables direct neural decompression while minimizing tissue trauma. The use of a large PEEK cage may contribute to improved stability and reduced subsidence risk.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"252-258"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802419","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":"The unilateral biportal endoscopy journey: proposing a 10-tier difficulty progression framework for unilateral biportal endoscopy.","authors":"Xavier Augusto Santander Espinoza, Elsa González Pérez, Dae-Jung Choi","doi":"10.31616/asj.2025.0064","DOIUrl":"10.31616/asj.2025.0064","url":null,"abstract":"<p><p>Unilateral biportal endoscopy (UBE) has revolutionized minimally invasive spinal surgery, offering enhanced visualization and reduced recovery times. However, the steep learning curve and technical complexity require a structured training framework. This narrative review proposes a 10-tier difficulty progression framework for UBE designed to guide novice surgeons through incremental skill acquisition. Each tier corresponds to specific procedures with escalating challenges spanning lumbar, cervical, and thoracic pathologies. The proposed framework begins with foundational lumbar procedures, such as ipsilateral recess decompression and discectomy, and advances to more intricate techniques, such as transforaminal lumbar interbody fusion. Transitioning to the cervical and thoracic regions requires mastery of earlier tiers, emphasizing precision in handling delicate anatomical structures. These challenges include achieving proficiency in mobilizing nerve roots, minimizing spinal cord manipulation, and mastering advanced decompression techniques. Evidence from learning curve analyses, including cumulative sum methodologies, underscores the importance of tailored training to reduce complications and optimize outcomes. By standardizing the progression of UBE procedures, this framework aims to enhance surgical safety, improve patient outcomes, and facilitate their widespread adoption. Future research should focus on validating this framework by using clinical trials, training feedback, and long-term patient data. Ultimately, this 10-tiered approach provides a roadmap for mastering UBE, addressing the growing demand for minimally invasive spinal surgery with precision and confidence.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"311-323"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802427","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":"Three types of ligamentum flavum resections for the treatment of lumbar central canal stenosis: BUTTERFLY retrospective study.","authors":"Ariel Kaen, Santiago Rocha Romero, María Jesús Correa Romero, Fernando Durand, Ignacio Martin","doi":"10.31616/asj.2025.0014","DOIUrl":"10.31616/asj.2025.0014","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective analysis of a prospective study.</p><p><strong>Purpose: </strong>The study aimed to evaluate and compare the clinical results of three surgical techniques for the resection of the hypertrophic ligamentum flavum in patients with lumbar stenosis.</p><p><strong>Overview of literature: </strong>Lumbar spinal stenosis is a common degenerative condition. Biportal endoscopic surgery is a modern technique that has gained popularity in recent years. Although various techniques have been proposed for resecting the ligament, no studies have identified the most superior method.</p><p><strong>Methods: </strong>This retrospective study enrolled patients with severe lumbar canal stenosis who underwent biportal endoscopic \"Z\" technique decompression between 2021 and 2023. Patients with any clinical or radiological signs of spondylolisthesis were excluded. The resection of the ligamentum flavum was classified into piecemeal resection, one-piece \"butterfly\" resection, and the novel variant \"two-wings\" or two-piece resection. Several demographic and clinical statistical variables were collected, with a specific focus on surgical time, postoperative complications, and clinical outcomes.</p><p><strong>Results: </strong>Ninety lumbar decompression surgeries were performed on 70 patients. The patients were divided into the butterfly group (en bloc) with 27 levels, \"two-wings\" group with 35 levels, and \"piecemeal\" group with 28 levels. No significant differences in demographics or clinical variables were found among the three groups. However, piecemeal resection was associated with a higher incidence of dural tears and a longer surgical time (p<0.05). In contrast, en bloc resection, particularly in the two-wing group, demonstrated the best surgical times without an increase in complication rates.</p><p><strong>Conclusions: </strong>The results revealed that removing the ligamentum flavum en bloc (either in two pieces or one) may reduce the surgical time and incidence of dural tears. Randomized and prospective studies are warranted to establish definitive conclusions.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"176-182"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802428","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":"A systematic review of biportal endoscopic spinal surgery with interbody fusion.","authors":"Wongthawat Liawrungrueang, Ho-Jin Lee, Sang Bum Kim, Sang-Min Park, Watcharaporn Cholamjiak, Hyun-Jin Park","doi":"10.31616/asj.2024.0425","DOIUrl":"10.31616/asj.2024.0425","url":null,"abstract":"<p><p>Biportal endoscopic spinal surgery (BESS) with interbody fusion is a relatively novel minimally invasive technique that was developed to reduce soft tissue trauma and intraoperative blood loss and shorten recovery time while achieving comparable clinical outcomes for lumbar degenerative diseases. Despite the growing interest in BESS, a comprehensive analysis of its effectiveness, complication rates, and long-term outcomes remains lacking. This systematic review evaluated the clinical outcomes, surgical efficacy, and complication rates of BESS with interbody fusion for lumbar degenerative diseases. Recent literature on endoscopic lumbar interbody fusion was included to expand the scope and gain new perspectives, thereby, providing a comparative analysis that highlighted the advantages, limitations, and emerging trends in minimally invasive spine surgery. This review synthesized current evidence to guide future research and clinical applications. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a combination of MeSH (Medical Subject Headings) terms and relevant keywords, PubMed/Medline and Scopus databases were systematically searched for studies published between January 2000 and September 2024. The studies were assessed using the ROBINS-I (Risk of Bias in Nonrandomized Studies of Interventions) tool to determine the risk of bias. From the 12 studies that provided clinical evidence, the data extracted were patient demographics; operative time; blood loss; clinical outcomes, such as Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores and fusion rates; and complications. The mean operative time ranged from 98 to 206 minutes, with fusion rates between 70% and 95%. Most studies reported significant improvements in VAS scores for back and leg pain and ODI scores. Complications, including dural tears (2.9%-6.4%) and hematomas (1.4%-4.3%), were infrequent but notable. BESS with interbody fusion demonstrated excellent clinical outcomes, high fusion rates, and few complications. Although these results are promising, more randomized controlled trials and long-term studies are required to confirm the broader applicability, particularly in more complex or multilevel spinal pathologies.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"275-291"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802415","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}