Innovative method for efficient placement of a working cannula in uniportal transarticular full-endoscopic lumbar interbody fusion: transarticular trephonic plasty (TTP).

To compare the complications and clinical scores of posterior lumbar intervertebral fusion (PLIF) in middle-aged and older patients of different ages, and to assess the risk of complications of PLIF in different ages, providing a reference for clinical treatment. The clinical data of 1 136 patients, who were more than 55 years old and underwent PLIF between June 2013 and June 2016, were retrospectively analyzed. According to the age of patients undergoing surgery, they were divided into 3 groups as 55-64 years old, 65-74 years old, and ≥75 years old. The general characteristics, comorbidities, and surgical data of the three groups were compared, with comparison the morbidity of complications. According to the minimal clinical important difference (MCID), the improvement of patient's pain visual analogue scale (VAS) score and the Oswestry disability index (ODI) score were compared. Univariate logistic regression analysis was used to analyze the difference of complications and the improvement of VAS and ODI scores. Multivariate logistic regression analysis was performed for the risk factors of complications. There were significant differences in the number of surgical fusion segments and osteoporosis between groups ( P<0.05); there was no significant difference in gender, body mass index, operation time, preoperative American Society of Anesthesiologists (ASA) classification, and comorbidities between groups ( P>0.05). All patients were followed up 6-62 months with an average of 27.4 months. Among the results of postoperative complications, there were significant differences in the total incidence of intraoperative complications, systemic complications, minor complications, and the percentage of improvement of ODI score to MCID between groups ( P<0.05); but there was no significant difference in the total incidence of complications at the end of long-term follow-up and the percentage of improvement of VAS score to MCID between groups ( P>0.05). Univariate logistic regression analysis showed that after adjusting the confounding factors, there were significant differences in intraoperative complications and the percentage of improvement of ODI score to MCID between 55-64 and 65-74 years old groups ( P<0.05); systemic complications, minor complications, complications at the end of long-term follow-up, and the percentage of improvement of ODI score to MCID in ≥75 years old group were significantly different from those in the other two groups ( P<0.05). Multivariate logistic regression analysis showed that age was a risk factor for systemic complications, minor complications, and complications at the end of long-term follow-up. Except for age, long operation time was a risk factor for intraoperative complications, increased number of fusion segments was a risk factor for systemic complications, the number of comorbidities was a risk factor for minor complications, and osteoporosis was a risk factor for complications at the end of long-term follow-up. The risk of surgical complications is higher in the elderly patients (≥75 years) with lumbar degenerative diseases than in the middle-aged and older patients (<75 years), while the improvements of postoperative VAS and ODI scores were similar. Under the premise of fully assessing surgical indications, PLIF has a positive effect on improving the elderly patients' quality of life.

Preoperative neutrophil-lymphocyte ratio (NLR) has been described in various fields to predict pain outcomes, but its prognostic utility for pain/functional outcomes after spine surgery is unclear. To determine the relationship between preoperative NLR and pain/functional outcomes at 12 months after lumbar fusion. We performed a single-center retrospective study of 53 patients who underwent lumbar fusion and collected demographic data including age, sex, body mass index, smoking status, spinal levels operated, and preoperative NLR. Visual analog scale (VAS) for back and leg pain and Oswestry Disability Index (ODI) at baseline and 12 months after lumbar fusion were also collected. The outcome measures were the occurrence of a clinically important improvement in VAS and ODI scores at 12 months. Binary logistic regression was used to estimate the associations of demographic factors and NLR with improvement in VAS and ODI scores. A P value of <0.05 was considered statistically significant. There were no statistically significant associations between preoperative NLR and improvement in VAS or ODI scores. A unit increase in baseline VAS back pain score was associated with a 56% increase in the odds of improvement in back pain (OR: 1.56, 95% CI: 1.04-2.35, P = 0.03). Compared to male patients, female patients had 12 times greater odds of an improvement in leg pain (OR: 12.0, 95% CI: 1.3-110, P = 0.03). Preoperative NLR does not predict patient-reported pain/functional outcomes at 12 months after lumbar fusion. Large-scale prospective multicenter studies are warranted to confirm our findings.

62. The use of primary sacroiliac joint fusion for lower back pain due to sacroiliac joint pathology: a systematic review and meta-analysis

To investigate the early clinical efficacy, safety, and application value of one-hole split endoscopy (OSE)-assisted transforaminal lumbar interbody fusion(TLIF) in the treatment of lumbar degenerative diseases. A retrospective analysis was conducted on 17 patients with lumbar degenerative diseases who underwent OSE-assisted TLIF between June 2023 and June 2024. There were 10 males and 7 females, with a mean of (55.30±6.52) years old ranging 43 to 65 years. The disease duration ranged from 3 to 36 months with a mean of(12.4±13.3) months. The disease distribution was as follows:lumbar disc herniation (7 cases), lumbar spinal stenosis (5 cases), and lumbar spondylolisthesis (2 cases). Operative time, incision length, intraoperative blood loss, number of intraoperative fluoroscopic exposures, time to ambulation, postoperative hospital stay, and complications were recorded. The dural sac area at the affected segment, visual analogue scale (VAS) for low back pain and leg pain, and Oswestry disability index (ODI) were recorded preoperatively and postoperatively. The modified MacNab criteria were used to evaluate the surgical outcome at the final follow-up. All 17 patients successfully underwent surgery and were followed up for 3 to 15 months with a mean of (8.4±3.3) months. The operative time was 120 to 200 minutes with a mean of (143.2±22.0) minutes, the incision length on the decompression side was 1.80 to 4.00 cm with a mean of (2.56±0.65) cm, intraoperative blood loss was 50 to 300 ml with a mean of (161.2±72.5) ml, the number of fluoroscopic exposures was 15 to 38 with a mean of (23.4±6.5), time to ambulation was 24 to 72 hours with a mean of (49.2±11.9) hours, and postoperative hospital stay was 3 to 9 days with a mean of (4.9±1.5) days. Two patients developed transient lower limb pain and numbness, which completely resolved with conservative treatment. The postoperative dural sac area was (121.47±14.90) mm2, which was significantly larger than the preoperative area (51.47±7.69) mm2(P<0.001). The VAS for low back pain were (6.23±1.64), (2.94±1.43), and (1.94±0.75) at preoperation, 3 days postoperation, and final follow-up, respectively;the VAS for leg pain were (7.06±1.43), (2.35±1.17), and (2.06±0.90) at the same time points. The VAS at all postoperative time points were significantly lower than preoperative scores (P<0.001). The ODI at final follow-up was (25.29±8.15)%, which was significantly better than the preoperative ODI of(82.35±5.16)%(P<0.001). At the final follow-up, the MacNab surgical outcome was excellent in 11 cases, good in 4 cases, and fair in 2 cases. OSE-assisted TLIF is an effective, safe, and minimally invasive technique with a gentle learning curve for the treatment of lumbar degenerative diseases, capable of effectively relieving symptoms and improving function.

Objective To investigate the operation key points and clinical efficacy of oblique lateral interbody fusion (OLIF) for the treatment of degenerative lumbar disease. Methods The clinical data of 22 patients with degenerative lumbar disease treated with OLIF at the Department of Neurosurgery, Sichuan Provincial People’s Hospital from December 2014 to October 2015 were analyzed retrospectively. Eight patients were treated with the combined posterior percutaneous pedicle screw fixation, 11 were treated with the combined anterior percutaneous pedicle screw fixation, and 3 did not treated with the screw-rod system fixation. The visual analogue scale (VAS) score, Oswestry disability index (ODI) score, and imaging findings before and after procedure were compared. The clinical efficacy of the surgical method was evaluated. The follow-up time ranged from 3 to 9 months (mean, 6.6 months). Results Postoperative VAS score (2.73±0.84) and ODI score (20.97±3.83) were significantly decreased compared with before procedure (VAS score: 7.10±0.97; ODI score: 60.86±6.88; all P<0.05). The average operation time was 92.5±14.8 min, the average blood loss was 78.4±29.6 ml, and the average length of stay was 8.2±2.4 d. Compared with before procedure, the postoperative intervertebral space height was increased (after procedure: 9.12±1.09 mm, before procedure: 5.24±1.07 mm, P<0.001) and the intervertebral foramen area was increased in 22 cases (after procedure: 1.81±0.25 cm2, before procedure: 0.83±0.10 cm2, P<0.001). None of them had severe complications, such as vascular injury, lumbar plexus nerve injury, ureteral injury and infection. Conclusions OLIF is a safe, effective, and minimally invasive surgical method for the treatment of lumbar degenerative disease. Its clinical efficacy is reliable in the near future. It has the advantages of short operation time, less intraoperative blood loss, less trauma, and quick recovery. Strict selection of patients and grasping the technical details are the keys to the success of surgery. Key words: Lumbar vertebrae; Intervertebral disc degeneration; Surgical procedures, minimally invasive; Oblique lateral interbody fusion

ObjectiveTo compare the long-term clinical outcomes and radiographic changes between the Topping-off technique and lumbar fusion surgery for lumbar degenerative diseases, and to evaluate their effects on Adjacent Segment Degeneration (ASD).MethodsA retrospective analysis was conducted on 97 patients who underwent lumbar fusion surgery at Dongzhimen Hospital of Beijing University of Chinese Medicine from January 2010 to October 2013, with a minimum of 8 years of follow-up data. Patients were divided into the Topping-off group and the Fusion group based on whether a Wallis interspinous device was implanted at the adjacent upper segment. Clinical outcomes were assessed using the Visual Analogue Scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), and reoperation rate. Radiographic progression of ASD was evaluated by range of motion (ROM) of the adjacent upper segment, intervertebral disc height (IDH), intervertebral foramen height (IFH), ligamentum flavum thickness, dural sac sagittal diameter, University of California at Los Angeles (UCLA) grading of intervertebral space degeneration, Pfirrmann classification of disc degeneration, and Pathria-CT grading of facet joint degeneration.ResultsThe mean follow-up duration for the 97 patients was 107.4 ± 13.0 months. At the final follow-up, all patients showed significant improvement in VAS, JOA, and ODI scores compared to preoperative values. Between groups, the Topping-off group had better ODI and VAS scores than the Fusion group (P < 0.05). At the final follow-up, ROM, IDH, IFH, and dural sac sagittal diameter at the adjacent upper segment decreased in all patients compared to preoperative measurements. However, the Topping-off group showed significantly smaller ROM (P < 0.05) and greater IDH, IFH, and dural sac sagittal diameter (P < 0.05) compared to the Fusion group. The ligamentum flavum thickness did not increase significantly in the Topping-off group (P = 0.078), while it increased significantly in the Fusion group (P < 0.05). The Topping-off group demonstrated significantly less radiographic degeneration in UCLA grading of intervertebral space, Pfirrmann classification of disc degeneration, and Pathria-CT grading of facet joint degeneration (P < 0.001). The incidence of ASD in the Topping-off group (31.1%) was lower than in the Fusion group (59.6%) (P < 0.05). The reoperation rate was also lower in the Topping-off group compared to the Fusion group (15.6% vs. 23.1%, respectively).ConclusionBoth the Topping-off technique and lumbar fusion surgery achieved satisfactory clinical outcomes in treating lumbar degenerative diseases. Although the Wallis-implanted segment showed decreased ROM, IDH, IFH, and dural sac sagittal diameter, the implantation of Wallis effectively delayed the progression of ASD compared to the adjacent upper segment in conventional lumbar fusion surgery.

Objective To investigate clinical efficacy of dynamic interspinous assisted motion(D1-AM)system in treatment of degenerative lumbar disease.Methods Eight cases with lumbar vertebral insta-bility were treated with the DIAM system at Peking Union Medical College Hospital from June 2006 to Jan-uary 2008.There were 6 female and 2 male cases,with a mean age of 46.9 years ranging from 40 to 52years.Radiographs and scores on outcome measures including the visual analogue scale(VAS)for pain and Oswestry Disability Index(ODI)were recorded before surgery and at 3-month,6-month,1-year intervals and final follow-up after surgery.Results The follow-up time ranged from 12 to 31 months,with the mean of20.6 months.The ODI scores before surgery and at 3-month,6-month,1-year intervals and final follow-up af-ter surgery were 67.75±12.12,22.25±15.76,19.75±17.12,20.00±18.48 and 23.00±19.09,while VAS seores were 8.44±1.35,2.88±3.41,2.63±3.51,2.50±3.78 and 3.50±4.15,respectively.There were significant differ-ence between preoperative ODI and VAS scores and postoperative ones(P＜0.05); however no difference was found at the different postoperative follow-up time(P＞0.05).The L4,5 segment activity were 10.38°±5.13°,4.25°±2.19°,2.63°±0.92°,2.00°±0.86°and 2.13°±1.55°,respectively.There were significant difference be-tween preoperative L4,5 segment activity and postoperative ones(P＜0.05); however no difference was found at the different postoperative follow-up time(P＞0.05).The ODI and VAS score improvements were directly cor-related with segment activity(r＞0.7,P＜0.05).Conclusion The DIAM system appears to be a useful and ef-fective alternative in the surgical management of degenerative lumbar disease if the patients are correctly selected.However long-term follow-up is needed to evaluate clinical outcomes of the device. Key words: Lumbar vertebrae; Low back pain; Prostheses and implants; Treatment outcome

Friday, September 28, 2018 1:00 PM–2:30 PM abstracts: achieving lumbar interbody fusion: 194. The Effect of preoperative symptom duration on postoperative outcomes following transforaminal lumbar interbody fusion

Objective To observe the mid-and long-term clinical efficacy of minimally invasive transforaminal lumbar interbody fusion for the treatment of single-segment lumbar degenerative diseases. Methods Retrospective analysis of the clinical data of 832 patients with lumbar degenerative disease treated with single-segment MIS-TLIF surgery from 2007 to 2013, 443 males and 389 females; aged 23-82 years, mean 56.4±18.7 years old. All cases were divided into revision surgery group, severe lumbar spinal stenosis group, moderate to severe lumbar spondylolisthesis group and general case groups (as a control) for comparative analysis. Efficacy evaluation indicators include Oswestry disability index (ODI), visual analog scale (VAS), intervertebral fusion rate, and complications. Results All patients were followed up for 62 to 93 months, with an average of 79.2±18.6 months. One month after operation, the VAS score of low back pain in the severe spinal stenosis group 2.9±0.5 and the moderate to severe spondylolisthesis group 3.8±1.1 were both significantly higher than the general case group 1.6±0.6, and the difference was statistically significant. The VAS score of leg pain was high in the moderate to severe slip group 2.6±0.7, but the difference was not statistically significant. The ODI value was significantly higher in the moderate to severe spoiler group 28.8±6.9% than in the general case group 22.1±6.4%. In the 2 years after the operation, the vas of lower back pain was divided into 2.4±0.9, compared with the general case group 1.7±0.5, and the difference was statistically significant; the ODI group of severe spinal stenosis and moderate-severe spondylolisthesis were 17.9%±3.4% and 19.4%±4.9%, respectively, which was higher than the general case group 11.3%±3.3%, and the difference was statistically significant. In the last follow-up, the VAS scores 2.3±0.8 and 2.6±1.1 of the severe vertebral canal stenosis group and the moderate-severe spondylolisthesis group were respectively higher than that of the general case group 1.6±0.7, and the difference was statistically significant; the ODI group of severe vertebral canal stenosis and moderate-severe spondylolisthesis were 18.3%±11.1% and 19.6%±12.1, higher than the general case group 11.8%±9.7%, the difference was statistically significant. The incidence of mid- and long-term complications (intervertebral non-fusion, adjacent segment disease) was not statistically significant among the four groups. Conclusion MIS-TLIF treatment of lumbar degenerative diseases can obtain good medium and long-term clinically effect. For complex diseases such as revision, severe degeneration and moderate to severe spondylolisthesis, MIS-TLIF did not increase the incidence of medium and long-term complications. Key words: Lumbar vertebrae; Surgical procedures, minimally invasive; Spinal fusion

There is a lack of consensus on the use of postoperative bracing for lumbar degenerative conditions. Spine surgeons typically determine whether to apply postoperative braces based primarily on clinical experience rather than robust, evidence-based medical data. Thus, the present study sought to assess the impact of postoperative bracing on clinical outcomes, complications, and fusion rates following lumbar fusion surgery in patients with degenerative spinal conditions. Only randomized controlled studies published between January 1990 and 20 October 2023 were included in this meta-analysis. The primary outcome measures consisted of pre- and postoperative assessments of the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores. Improvements in VAS and ODI scores were analyzed in the early postoperative period (1 month after operation) and at final follow-up, respectively. The analysis also encompassed fusion rates and complications. Five studies with 362 patients were included in the present meta-analysis. In the early postoperative period, the brace group showed a relatively better improvement in ODI scores compared with the no-brace group (19.47 vs 18.18), although this difference was not statistically significant (P = 0.34). Similarly, during the late postoperative period, the brace group demonstrated a slightly greater improvement in VAS scores in comparison to the no-brace group (4.05 vs 3.84), but this difference did not reach statistical significance (P = 0.30). The complication rate was relatively lower in the brace group compared with the no-brace group (14.9% vs 17.4%), although there was no statistical difference between the 2 groups (P = 0.83). Importantly, there were no substantial differences in fusion rates between patients with or without braces. The present meta-analysis revealed that the implementation of a brace following lumbar fusion surgery did not yield substantial differences in terms of postoperative pain relief, functional recovery, complication rates, or fusion rates when compared with cases where no brace was employed. This meta-analysis provides valuable insights into the clinical impact of postoperative bracing following lumbar fusion surgery for degenerative spinal conditions.

BackgroundMinimally invasive spine surgery has seen rapid development in recent years. The purpose of this study was to evaluate the use of unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive surgery transforaminal interbody fusion (MIS-TLIF) for the treatment of single-segment lumbar degenerative disease (LDD) through a systematic review and meta-analysis.MethodsIn collaboration with various search terms, a comprehensive examination of the scientific literature was carried out using PubMed, China National Knowledge Infrastructure (CNKI), Wanfang, and other databases. A total of 9 studies were included retrospective cohort studies.ResultsWe observed statistically significant differences in intraoperative blood loss, total hospital stay, postoperative hospital stays, and 1-month postoperative Oswestry Disability Index (ODI) scores between the ULIF and MIS-TLIF groups, with the ULIF group being more dominant. MIS-TLIF group was statistically more advantageous in terms of operative time. There were no statistically significant differences in postoperative visual analogue scale (VAS) scores, 3-month postoperative and final ODI scores, excellent and good rate, complications, disc heights, and lumbar lordosis angle between the two groups.ConclusionsTreatment of single-segment LDD with ULIF and MIS-TLIF is both safe and effective. ULIF has the advantage of less intraoperative blood loss, shorter total hospital stay, shorter postoperative hospital stay, and lower ODI scores at 1 month postoperatively compared to MIS-TLIF. There were no significant differences between ULIF and MIS-TLIF in the treatment of LDD in terms of postoperative VAS scores, 3-month postoperative and final ODI scores, satisfaction rates, fusion rates, complications, disc heights, and lumbar lordosis angle. MIS-TLIF has a shorter procedure time than ULIF.

BackgroundNeurogenic claudication induced by degenerative lumbar spondylolisthesis (DLS) is a highly prevalent condition. In recent research, oblique lumbar interbody fusion with anterior fixation (OLIF-AF) has emerged as a favored minimally invasive approach for treating DLS. Nevertheless, there have been relatively few investigations that have compared this method with minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), which has long been considered the standard technique.AimTo compare the clinical and radiological outcomes of OLIF-AF and MIS-TLIF in patients suffering from single-level, low-grade degenerative lumbar spondylolisthesis that leads to neurogenic claudication.MethodsWe conducted a retrospective study of 57 patients who presented with neurogenic claudication secondary to single-level degenerative lumbar spondylolisthesis and underwent surgical treatment between May 2018 and December 2022. Of these 57 patients, 31 underwent oblique lumbar interbody fusion with anterior fixation (OLIF-AF) and 26 underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). Every patient had a follow-up period of at least 2 years. The recorded and compared data included the perioperative indicators, follow-up outcomes, and imaging parameters between the two groups.ResultsPreoperatively, the two groups exhibited a comparable baseline in demographic data and clinical characteristics, including visual analog scale (VAS) scores, Oswestry Disability Index (ODI), disc height (DH), intervertebral space angle (ISA), spinal canal cross-sectional area (CSA) and slip percentage (SP). Postoperatively, both groups exhibited significant improvements in VAS and ODI scores. The OLIF-AF group demonstrated superior clinical outcomes in terms of operative time (125.7 ± 46.2 min vs. 202.1 ± 66.4 min, p < 0.001), estimated blood loss (58.6 ± 30.5 mL vs. 143.5 ± 46.8 mL, p < 0.001), and length of hospital stay (8.6 ± 2.5 days vs. 10.7 ± 3.5 days, p = 0.009) compared to the MIS-TLIF group. However, the incidence of perioperative complications did not differ significantly between the two groups (16.1% vs. 19.2%, p > 0.05). Radiographic assessment at the 2-year follow-up revealed significantly greater improvements in DH, ISA and CSA in the OLIF-AF group (p < 0.05). At the 2-year follow-up, there were no significant differences between the two groups in SP (9.6 ± 1.8 % vs. 9.4 ± 1.6 %), interbody fusion rate (93.5% vs. 92.3%), or cage subsidence rate (3.2% vs. 3.8%) (all p > 0.05). Although low back pain VAS, leg pain VAS, and ODI scores improved postoperatively in both groups compared with preoperative values, the OLIF-AF group showed greater improvement in low back pain VAS and ODI scores at 1 week and 3 months postoperatively.ConclusionBoth OLIF-AF and MIS-TLIF are efficient in treating neurogenic claudication resulting from degenerative lumbar spondylolisthesis (DLS). Nevertheless, OLIF-AF is associated with a shorter operation duration, reduced surgical trauma, and faster early recovery, while maintaining long-term effectiveness and safety comparable to those of MIS-TLIF.

Background:Decompression and fusion is considered as the ‘gold standard’ for the treatment of degenerative lumbar diseases, however, many disadvantages have been reported in several studies, recently like donor site pain, pseudoarthrosis, nonunion, screw loosening, instrumentation failure, infection, adjacent segment disease (ASDis) and degeneration. Dynamic neutralization system (Dynesys) avoids many of these disadvantages. This system is made up of pedicle screws, polyethylene terephthalate cords, and polycarbonate urethane spacers to stabilize the functional spinal unit and preserve the adjacent motion after surgeries. This was a retrospective cohort study to compare the effect of Dynesys for treating degenerative lumbar diseases with posterior lumbar interbody fusion (PLIF) based on short term followup.Materials and Methods:Seventy five consecutive patients of lumbar degenerative disease operated between October 2010 and November 2012 were studied with a minimum followup of 2 years. Patients were divided into two groups according to the different surgeries. 30 patients underwent decompression and implantation of Dynesys in two levels (n = 29) or three levels (n = 1) and 45 patients underwent PLIF in two levels (n = 39) or three levels (n = 6). Clinical and radiographic outcomes between two groups were reviewed.Results:Thirty patients (male:17, female:13) with a mean age of 55.96 ± 7.68 years were included in Dynesys group and the PLIF group included 45 patients (male:21, female:24) with a mean age of 54.69 ± 3.26 years. The average followup in Dynesys group and PLIF group was 2.22 ± 0.43 year (range 2-3.5 year) and 2.17 ± 0.76 year (range 2-3 year), respectively. Dynesys group showed a shorter operation time (141.06 ± 11.36 min vs. 176.98 ± 6.72 min, P < 0.001) and less intraoperative blood loss (386.76 ± 19.44 ml vs. 430.11 ± 24.72 ml, P < 0.001). For Dynesys group, visual analogue scale (VAS) for back and leg pain improved from 6.87 ± 0.80 to 2.92 ± 0.18 and 6.99 ± 0.81 to 3.25 ± 0.37, (both P < 0.001) and for PLIF, VAS for back and leg pain also improved significantly (6.97 ± 0.84–3.19 ± 0.19 and 7.26 ± 0.76–3.56 ± 0.38, both P < 0.001). Significant improvement was found at final followup in both groups in Oswestry disability index (ODI) score (both P < 0.001). Besides, Dynesys group showed a greater improvement in ODI and VAS back and leg pain scores compared with the PLIF group (P < 0.001, P = 0.009 and P = 0.031, respectively). For radiological, height of the operated level was found increased in both groups (both P < 0.001), but there was no difference between two groups (P = 0.93). For range of motion (ROM) of operated level, significant decrease was found in both groups (P < 0.001), but Dynesys showed a higher preservation of motion at the operative levels (P < 0.001). However, no significant difference was found in the percentage change of ROM of adjacent levels between Dynesys and PLIF (0.74 ± 8.92% vs. 0.92 ± 4.52%, P = 0.91). Some patients suffered from degeneration of adjacent intervertebral disc at final followup, but there was no significant difference in adjacent intervertebral disc degeneration between two groups (P = 0.71). Moreover, there were no differences in complications between Dynesys and PLIF (P = 0.90), although the incidence of complication in Dynesys was lower than PLIF (16.67% vs. 17.78%).Conclusion:Dynamic stabilization system treating lumbar degenerative disease showed clinical benefits with motion preservation of the operated segments, but does not have the significant advantage on motion preservation at adjacent segments, to avoid the degeneration of adjacent intervertebral disk.

Acupuncture has been widely used for acute low back pain (LBP), yet there remains continued controversy regarding its efficacy. Therefore, we aimed to critically evaluate the evidence for acupuncture as an effective treatment for acute LBP. English and Chinese databases were searched for randomized controlled trials (RCTs) that involved acupuncture for acute LBP published up to May 2020. Data on the outcomes of pain intensity, functional status, and analgesic use were extracted. The meta-analysis was performed using the Cochrane Collaboration's RevMan 5.3, and pooled data were expressed as mean differences (MD) with 95% confidence intervals (CIs). Of the 13 eligible RCTs identified, 11 RCTs (involving 707 patients) provided moderate-quality evidence that acupuncture has a statistically significant association with improvements in VAS (visual analog scale) score [MD: -1.75 (95% CI: -2.39, -1.12)]. Two studies indicated that acupuncture did not influence the RMDQ (Roland-Morris Disability Questionnaire) scores more than the control treatment [MD: -2.34 (95% CI: -5.34, 0.67)]. Three studies suggested that acupuncture influenced the ODI (Oswestry Disability Index) scores more than the control treatment [MD: -12.84 (95% CI: -23.94, -1.74)]. Two studies suggested that acupuncture influenced the number of pills more than the control treatment [MD: -3.19 (95% CI: -3.45, -2.92)]. Acupuncture treatment of acute LBP was associated with modest improvements in the VAS score, ODI score, and the number of pills, but not the RMDQ score. Our findings should be considered with caution due to the low power original studies. High-quality trials are needed to assess further the role of acupuncture in the treatment of acute LBP.

BackgroundDegenerative lumbar spondylolisthesis (DLS) with lumbar spinal stenosis (LSS) is a common condition resulting in substantial lower back pain and disability. Surgical intervention is recommended only when conservative treatment fails. This study compared UBE-TLIF and MIS-TLIF regarding clinical outcomes and fusion rates in patients with single-segment DLS with LSS.MethodsA total of 85 patients who underwent either UBE-TLIF (n = 40) or MIS-TLIF (n = 45) were examined retrospectively. Clinical results were evaluated by the Visual Analog Scale (VAS) for pain and the Oswestry Disability Index (ODI) for functional outcomes. Radiographs and CT were utilized to assess radiological outcomes such as disc height (DH), lumbar lordosis (LL), and interbody fusion rates. The two groups were also compared in terms of perioperative data (operation time, blood loss, hospital stay, and fluoroscopy exposure).ResultsBoth surgical techniques showed similar statistically significant improvements in VAS and ODI scores. Fusion rates at 2 years postoperatively were identical, including 95% for the UBE-TLIF group and 97.7% for the MIS-TLIF group. However, compared with MIS-TLIF, the operative time and fluoroscopy exposure were longer for UBE-TLIF, but intraoperative blood loss and length of hospital stay were reduced.ConclusionsUBE-TLIF and MIS-TLIF can successfully treat single-segment DLS in the presence of LSS, achieving similar clinical and radiological outcomes with low complication rates. Although UBE-TLIF has certain advantages regarding perioperative outcomes (less blood loss and shorter hospital stay), MIS-TLIF is associated with shorter operative times and lower fluoroscopy exposure.