To evaluate retinal microvascular changes using optical coherence tomography angiography (OCTA) and their prognostic value in patients undergoing transsphenoidal surgery for pituitary adenoma. In this prospective study of 90 patients, we assessed best-corrected visual acuity (BCVA), mean deviation (MD) on visual field (VF), and OCTA parameters at the macular region and peripapillary area. Patients with severe VF defects (VFD; MD <-10 dB) showed greater reductions in vessel densities of superficial capillary plexus (SCP) and radial peripapillary capillaries (RPC) than those with minimal VFD (MD >-3 dB) (p=0.021, 0.047). Higher SCP density, RPC density, peripapillary retinal nerve fibre layer (pRNFL) thickness and ganglion cell complex (GCC) thickness were associated with better postoperative visual acuity (r=-0.33, -0.44, -0.24, -0.30; all p<0.05) and MD (r=0.26, 0.46, 0.45, 0.45; all p<0.05). In patients with mild to moderate VFD (MD between -3 and -10 dB), foveal avascular zone area, foveal SCP and deep capillary plexus densities correlated strongly with BCVA outcome (r=0.61,-0.60, -0.63; all p<0.01). Area under the curves for predicting >50% MD improvement were 0.816 (SCP density), 0.784 (RPC density), 0.887 (pRNFL thickness), 0.816 (GCC thickness) and 0.905 (combined; all p≤0.001). After decompression surgery, retinal vessel densities may further decline at 3 months postoperatively, particularly in patients with severe baseline VFD. Foveal parameters predicted visual acuity in those with mild to moderate VFD, while in severe cases, higher SCP density, RPC density, pRNFL thickness and GCC thickness may serve as prognostic biomarkers for predicting better VF improvement.

Decompressive surgery can be lifesaving in patients with severe cerebral venous thrombosis (CVT) and impending brain herniation. However, data on health-related quality of life (HRQoL) after surgery are limited. DECOMPRESS-2 was a prospective cohort study including adult patients with CVT from 15 centers in 10 countries who underwent decompressive surgery (2011-2019). HRQoL was assessed using EQ5D-3 L utility scores, subdomains, and a visual analogue scale (VAS) at 6 and 12 months post-surgery. Complete case analysis, multiple imputation, best- and worst-case analyses were performed. Predictors of EQ5D-score (Tobit regression) and VAS (linear regression) at 12 months were analyzed. Of 118 patients, 112 were included (median age 38 years [IQR 27-46], 68% female). At 12-months, EQ5D-3 L and VAS were available for 89% and 90% of survivors, respectively. Median EQ5D-3L-score was 0.70 (IQR 0.52-0.85, mean 0.59 [SD 0.38]) and median VAS was 70 (IQR 56-80, mean 69 [SD 18]). Overall, 84% of patients reported problems in ≥1 subdomain of the EQ5D-3L: 68% with usual activities, 59% pain/discomfort, 58% anxiety/depression, 47% with self-care, 43% with mobility. Higher age and residence in a middle-income country (vs. high-income) predicted poorer EQ5D-3 L and VAS. Preoperative coma predicted worse EQ5D-3 L only. Twelve months after decompressive surgery for CVT, over 4 out of 5 survivors reported problems in at least one subdomain of the EQ5D-3 L. Higher age, middle-income country status and preoperative coma were negative predictors of quality of life.

Objective: To evaluate the safety and efficacy of knotless barbed sutures for wound closure in elective degenerative short-segment posterior lumbar surgery. Methods: This is a prospective randomized controlled trial study. Patients who met the inclusion and exclusion criteria undergoing elective posterior lumbar surgery at the Department of Orthopedics,Peking University Third Hospital from March 2024 to May 2025 were enrolled and randomly assigned to either the trial group or the control group using a random number table. Wound closure in the trial group was performed using barbed sutures for the deep fascia, subcutaneous, and intradermal layers; while the control group received conventional sutures. The incision length, deep fascia, subcutaneous, and intradermal wound closure times, and total wound closure time were compared between the two groups, and the suturing speed per unit length was calculated. Postoperative drainage volume, drainage tube removal time, weight of soiled dressings at the first dressing change, total length of hospital stays (LOS), postoperative LOS, wound healing status, and incidence of incision-related complications were recorded. Functional outcomes were assessed using the Japanese Orthopaedic Association (JOA) score, Oswestry disability index (ODI), and visual analog scale (VAS) for pain at the 3-month postoperative follow-up. Data analysis was taken by independent sample t test or Mann-Whitney U test, Chi-square test or Fisher exact test. Results: A total of 114 patients were included in this study. There were 51 males and 63 females,aged (61.1±9.0)years(range:27 to 79 years). There were 57 patients in each group. No significant difference was found in incision length between the two groups ((11.0±1.8) cm vs. (11.1±1.8) cm, t=-0.399, P=0.690). The suturing speed was significantly faster in the trial group than in the control group ((1.1±0.3) min/cm vs. (1.7±0.4) min/cm, t=-7.200, P<0.01). The trial group demonstrated significantly shorter closure times for the deep fascia, subcutaneous, intradermal layer, and total wound closure time compared to the control group (all P<0.01). No significant differences were found between the two groups in terms of total operative time, total operating room time, postoperative drainage volume, drainage tube removal time, total LOS, or 3-month postoperative JOA, VAS, and ODI scores (all P>0.05). However, the trial group had a significantly shorter postoperative LOS than the control group ((6.0±1.9) d vs. (6.8±2.9) d, t=-2.391 P=0.017). Conclusion: For short-segment posterior lumbar surgery, barbed sutures significantly reduce layered and total wound closure times and decrease postoperative hospitalization, while demonstrating non-inferiority to conventional sutures in operative duration, drainage management, complication rates, and functional outcomes.

Calcium Pyrophosphate Dihydrate (CPPD) deposition disease, also known as pseudogout, is a crystal-induced arthropathy that primarily affects larger, weight-bearing joints such as the knees, hips, and shoulders. CPPD can present with a wide spectrum of clinical manifestations, ranging from asymptomatic chondrocalcinosis to acute inflammatory arthritis. CPPD in the spine is rare and can lead to calcification of the ligamentum flavum, potentially causing spinal cord compression, myelopathy, and significant neurological impairment. The absence of chondrocalcinosis on imaging does not rule out the diagnosis of spinal CPPD. On microscopy, CPPD is characterised by rhomboid-shaped, positively birefringent crystals, in contrast to the needle-shaped, negatively birefringent crystals observed in gout. The present case report of a 78-year-old female highlights a rare and isolated clinical presentation of CPPD causing lumbar spine myelopathy, which was discovered incidentally on histopathology after spinal decompression and discectomy surgery. Although imaging modalities may raise suspicion for CPPD by revealing chondrocalcinosis, they often lack the specificity to differentiate it from other degenerative or inflammatory conditions. Histopathological analysis and polarised microscopic examination remain the cornerstones in diagnosing CPPD, even in atypical clinical presentations or ambiguous imaging findings. This underscores the importance of including pseudogout in the differential diagnosis of lumbar myelopathy, particularly in elderly patients, to provide early, targeted treatment and prevent severe irreversible neurological deficits.

Balanced orbital decompression for thyroid-associated orbitopathy and the role of stereotactic navigation in infraorbital nerve preservation.

Adopting Keyhole Strategies in Microvascular Decompression Surgery for Vascular Compression Syndromes in Early Career Academic Practice: Outcomes, Technical Nuances and Complication Avoidance

Hypertension and Diabetes are Significantly Associated with Increased Risk of Pain Recurrence Following Microvascular Decompression Surgery for Single-Vessel Compression of the Trigeminal Nerve

C5 palsy is a common and clinically significant complication following cervical decompression surgery. However, the relationship between this complication and the novel surgical technique, anterior controllable antedisplacement and fusion (ACAF), remains underexplored. This study aimed to investigate the incidence and independent risk factors of C5 palsy in patients with cervical ossification of the posterior longitudinal ligament (C-OPLL) after ACAF, with the goal of facilitating early prevention and improving clinical outcomes. We conducted a retrospective review of all patients with C-OPLL who underwent ACAF at our institution between June 2018 and December 2020. Independent risk factors for postoperative C5 palsy were identified using binary logistic regression analysis. Cutoff values for significant predictors were determined via receiver operating characteristic (ROC) curve analysis to support clinical diagnosis. Among the 275 included patients, 12 (4.36%) developed C5 palsy. The median age was 51.0years in the non-C5 palsy group and 56.5years in the C5 palsy group. Significant differences (P < 0.05) were observed in the maximum stenosis rate at the C4-5 spinal canal (MSRSC), preoperative spinal cord rotation angle (SCRA), left/right narrowest distance between the vertebral body and articular process at C5 (NDVA), and postoperative distance of dura mater beyond the facet joint (DDF). Binary logistic regression identified preoperative SCRA, NDVA, and postoperative DDF as independent risk factors for C5 palsy (P < 0.05). The combined diagnostic model showed the largest area under the curve (AUC), with sensitivity and specificity both exceeding 90%, demonstrating strong predictive performance. A nomogram was developed based on these independent predictors. This study established preoperative SCRA, NDVA, and postoperative DDF as independent risk factors for C5 palsy following ACAF and proposed a clinically applicable nomogram for risk prediction. To reduce the incidence of C5 palsy, we recommend performing slow and symmetric antedisplacement of the vertebral-OPLL complex combined with appropriate foraminotomy during ACAF. Future studies should assess the generalizability of these risk factors to other decompressive techniques for C-OPLL.

Background: Spinal subdural hematomas (SSDHs) are rare and potentially disabling complications of neuraxial anesthesia. Cephalic migration of spinal hematomas from the lumbar puncture site extending to the cervical or thoracic regions is even less frequently encountered, especially in postpartum patients. Case Description: A 28-year-old postpartum female developed acute spastic paraparesis 1 day following spinal anesthesia for an emergency cesarean section. The spinal puncture was attempted twice at the L3-L4 interspace. The magnetic resonance imaging of the lumbar spine revealed hemorrhagic fluid-fluid levels at both the L5-S1 and S1-S2 levels, while the cervicodorsal imaging demonstrated a C6-D5 subdural hematoma resulting in significant cord compression and hyperintense cord signal changes. The patient underwent an emergent decompressive laminectomy for hematoma evacuation from C7 to D4 after which she made a progressive and complete recovery over 6 postoperative months. Conclusion: Cephalic migration of SSDH following spinal anesthesia is rare. It is critical to obtain complete spinal imaging in postpartum patients presenting with new neurological deficits following spinal anesthesia and to immediately perform operative decompression to maximize neurological recovery.

Obesity is linked to increased spinal degenerative pathology and higher perioperative risks in spinal surgery. As the global obesity rates continue to rise, spine surgeons increasingly turn to minimally invasive approaches to theoretically minimize risk, but its outcomes are unclear. To evaluate the impact of obesity on perioperative outcomes in minimally invasive surgery (MIS) for the lumbar spine. A systematic review and meta-analysis were conducted using the MEDLINE, Embase, and Cochrane databases to examine the effects of obesity on MIS lumbar spine surgeries. Perioperative outcomes were categorized by surgical procedures, specifically lumbar fusion and decompression surgeries. Patients with obesity were further stratified into 2 groups: (1) obese (all classes) vs nonobese, and (2) class II/III obese vs nonobese. Twenty-six cohort studies met the inclusion criteria. In MIS lumbar fusion procedures, patients with obesity experienced higher blood loss (14 studies, n = 3128; mean difference [MD] 21.54; 95% CI 4.29-38.78), longer surgical times (16 studies, n = 3353; MD 19.41, 95% CI 8.12-30.70), and increased length of hospital stay (13 studies, n = 3222; MD 0.36, 95% CI 0.14-0.58). Similarly, for MIS lumbar decompression surgeries, patients with obesity had higher blood loss (6 studies, n = 1318; MD 17.02, 95% CI 1.23-32.80), longer operative times (8 studies, n = 1294; MD 17.80, 95% CI 4.36-31.25), and extended hospital stays (10 studies, n = 1892; MD 0.41, 95% CI 0.06-0.76). There was an increased rate of revision surgery in patients with obesity undergoing decompression procedures (7 studies, n = 1397; relative risk 1.43, 95% CI 1.04-1.96). Obesity was not associated with increased risks of short-to-mid-term surgical complications, infections, pseudarthrosis, or higher opioid use. While MIS for obese lumbar spine patients may mitigate perioperative risk, it does not eliminate it. Obesity remains associated with increased blood loss, longer operative times, extended hospital stays, and higher revision rates. Future research should investigate mid- to long-term consequences, including complications, pseudarthrosis, and rates of revision surgery, in patients with obesity undergoing MIS lumbar interventions. Patients should be counseled about the risks associated with obesity, and preoperative weight optimization is recommended to improve outcomes.

Systematic Review. To systematically review cases of pneumocephalus following spinal procedures and evaluate prognosis and effective treatment options for this pathology. Pneumocephalus is a rare complication of spinal procedures requiring unique strategies for symptom management and treatment. Intracranial air may cause acute decompensation when intracranial pressure rises rapidly, and therefore, early identification of pneumocephalus is crucial for recovery. A systematic review was performed to interrogate PubMed/MEDLINE for clinical and radiologic presentation of cases of pneumocephalus following spinal procedures. A total of 105 articles were included, with 133 cases of pneumocephalus presenting as a complication of spinal procedures. The most common procedures investigated were epidural injections (38.7%) and decompression surgeries (17.0%). Tension pneumocephalus was reported in 17 cases and conveyed no increased risk of mortality (P=0.59), ICU admission (P=0.76), or persistent symptoms (P=0.71). Patients receiving surgical treatment were significantly more likely to have an ICU stay during their hospital course (P=0.005) but had no difference in symptom improvement (P=0.35), radiologic resolution (P=0.34), or mortality (P=0.62) compared with medically managed patients. Patients with additional neurological sequelae were also more likely to receive surgery (P<0.001). Patients with headache were significantly less likely to experience persistent symptoms (P=0.008), persistent imaging findings (P=0.01), ICU care (P<0.001), and mortality (P=0.04), while altered mental status was associated with significantly greater risk of symptom persistence (P=0.04), ICU stay (P<0.001), and mortality (P=0.049). The overall symptom improvement rate was 86%, and the mortality rate was 5%. Overall prognosis for pneumocephalus as a complication of spinal procedures is favorable. Insights concerning symptom presentation can help spine surgeons improve communication regarding expected outcomes. Level IV.

There is limited evidence regarding longitudinal postoperative changes in retinal vascular density in patients with compressive anterior visual pathway lesions. In this study, we aimed to investigate the changes in retinal vasculature after decompression surgery based on optical coherence tomography (OCT) and OCT angiography (OCTA) and the predictive utility of OCT and OCTA parameters for postoperative visual outcomes. This prospective study included 22 eyes (15 patients) with a compressive anterior visual pathway lesion, which were assessed preoperatively as well as at 1, 3, and 6 postoperative months. Preoperative and postoperative visual acuity (VA), mean deviation on standard automated perimetry, and OCT and OCTA parameters (e.g., retinal nerve fiber layer, macular ganglion cell complex [GCC] thickness, vessel densities of radial peripapillary capillaries, parafoveal and perifoveal superficial vessel densities, and deep vessel densities) were evaluated. At 1 month postoperatively, the average VA and mean deviation were significantly improved (P = .001, P < .001, respectively), while the average values of retinal nerve fiber layer, GCC, and vessel densities of the radial peripapillary capillaries were significantly reduced (P = .027, P < .001, P < .001, respectively), with these trends continuing until 6 postoperative months. Moreover, the average parafoveal superficial vessel densities was significantly reduced at 6 postoperative months (P = .016). Preoperative GCC thickness was a significant predictive factor for VA improvement over the follow-up period (P = .008), while an average GCC thickness of < 70 μm was associated with significantly worse visual outcomes (P = .003). Following decompressive surgery, OCT and OCTA can detect further regression of retinal structure and vasculature over 6 months as a result of retrograde degeneration of the compressed optic nerve with subsequent axonal loss and secondary superficial retinal vascular remodeling. Despite these structural changes, functional visual outcomes improved due to restored nerve transmission in surviving axons. Our findings indicate that average GCC thickness may serve as a predictor associated with visual prognosis and thus should be routinely evaluated.

Currently, the primary treatment for ulnar neuropathy at the elbow is open in-situ decompression surgery. The effectiveness of ultrasound localization therapy, especially small-incision surgery using ultrasound combined with SWE, remains unclear. To evaluate the effect of small-incision ulnar nerve release in treating ulnar neuropathy at the elbow by ultrasound combined with shear wave elastography (SWE). A retrospective analysis of 98 patients treated in our hospital for ulnar neuropathy at the elbow was conducted from June 2023 to March 2025. According to the treatment style, these patients were divided into a traditional open in-situ decompression surgery group (n = 51) and an ultrasound combined with SWE small-incision surgery group (n = 47). The maximum proximal Cross-sectional Area (CSA), Sensory Conduction Velocity (SCV), Motor Conduction Velocity (MCV), modified Bishop score, Quick-DASH score, and Visual Analogue Scale(VAS) score were compared between the two groups. Additionally, the amount of intraoperative blood loss, operation duration, hospital stay, patients' satisfaction with postoperative incision aesthetics, the postoperative complications of different operation methods, and the degree of damage to the medial cutaneous nerve of the forearm were studied. All patients underwent surgical treatment, with preoperative ultrasonography confirming no ulnar nerve subluxation. No statistically significant differences in age, preoperative SCV, MCV, CSA, Quick-DASH score, or VAS score were found between the two groups. The postoperative and the last follow-up SCV, MCV, and CSA were similar in the two groups. In addition, the improved Bishop score, Quick-DASH score, VAS score, postoperative hematoma rate, elbow stiffness rate, and postoperative protection of the medial cutaneous nerve of the forearm in the ultrasound combined with SWE surgery group were better than those in the traditional open surgery group. What's more, compared with the traditional open surgery group, the ultrasound combined with SWE surgery reduced the amount of intraoperative blood loss, shortened the operation duration and hospital stay, and the patients were more satisfied with the scar of the incision. For patients with ulnar neuropathy at the elbow who are amenable to in situ decompression, this study highlights the potential of preoperative ultrasound combined with SWE to guide a targeted, minimally invasive surgical approach.

Microvascular decompression (MVD) surgery is traditionally performed via a retrosigmoid craniotomy. Recently, neurosurgeons have increasingly adopted smaller approaches; however, the available evidence has not yet been systematically compiled. This is the first systematic review and meta-analysis on the efficacy and safety of ≤ 2-cm-keyhole retrosigmoid MVD. PubMed and Embase databases were searched for studies involving adults with trigeminal neuralgia (TN), hemifacial spasm (HFS), or glossopharyngeal neuralgia (GPN), who underwent first-time retrosigmoid keyhole MVD (diameter ≤ 2cm). Primary outcomes were symptom relief and complications. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). Pooled estimates were calculated using a random-effects single-arm meta-analysis. 32 publications met the inclusion criteria. 93.7% had a retrospective design. The mean MINORS score was 9.9 ± 1.4 out of 16. Among 5,883 patients, 37.7% had TN, 61.6% HFS, and 0.7% GPN. The complete symptom resolution rate was 89.8% (95% CI [0.855-0.930]) for TN, 91.1% (95% CI [0.871-0.940]) for HFS and 88.7% (95% CI [0.746-0.954]) for GPN. The overall complication rate was 13.9% (95% CI, 0.107-0.180), with a permanent neurological deficit rate of 4.7% (95% CI, 0.030-0.074), all involving cranial nerves (CN). In patients with TN, the most frequent permanent neurological deficit was a sensory CN V deficit, occurring in 2.6% (95% CI, 0.013-0.050), followed by a CN VIII deficit in 1.9% (95% CI, 0.011-0.035). Among HFS patients, the most frequent permanent deficits were CN VIII in 5.0% (95% CI, 0.026-0.094) and CN VII in 2.1% (95% CI, 0.008-0.050). None of the studies described cases requiring conversion from a keyhole approach to a standard craniotomy. The keyhole retrosigmoid approach for MVD appears to be safe and effective. Comparative studies are needed to evaluate potential advantages of a keyhole approach over a standard craniotomy.

Lumbar degenerative disease was associated with paraspinal muscle atrophy, alterations in spinal alignment and sagittal balance, and narrowing of the spinal canal. This study aimed to evaluate the paraspinal muscle cross-sectional area (CSA), sacral slope (SS), and canal diameter (CD) as predictors of functional outcome improvement measured by the Oswestry Disability Index (ODI) following decompression and fixation for degenerative lumbar stenosis. A retrospective case–control study was conducted involving 40 patients with degenerative lumbar canal stenosis who underwent decompression and fusion surgery. Preoperative radiographic evaluations included sacral slope, multifidus muscle CSA (MFCSA), erector spinae muscle CSA (ESCSA) at the L4–L5 level, and canal diameter at the stenotic level. The ODI was assessed preoperatively and postoperatively on the first, second, fourth, and sixth days, as well as at the eighth postoperative week. Patients with an ESCSA of at least 900 mm² demonstrated a significant improvement in ODI scores at postoperative weeks 2, 4, 6, and 8 (p &lt; 0.005). No significant differences in postoperative ODI improvement were observed between patients with MFCSA below or above 600 mm² or between those with sacral slope below or above 30 degrees (p &gt; 0.05). Preoperative canal diameter showed a significant correlation with postoperative ODI improvement at weeks 2, 4, 6, and 8 (p &lt; 0.05). In conclusion, a larger erector spinae muscle CSA and a narrower preoperative canal diameter were significant predictors of postoperative functional improvement in patients with degenerative lumbar stenosis undergoing decompression and fixation. Multifidus muscle CSA and sacral slope were not significant predictors of ODI improvement in this study. Keywords: Canal Diameter, Degenerative Lumbar Stenosis, Oswestry Disability Index, Paraspinal Muscle Cross-Sectional Area, Sacral Slope

The rising prevalence of obesity has raised concerns about its impact on surgical outcomes. Obesity is a critical risk factor of low back pain and lumbar degeneration diseases, but it is still unclear whether obesity is related to lumbar surgical outcomes in the Chinese population. This study examines the influence of body mass index (BMI) on the clinical effectiveness of lumbar decompression surgery in patients with lumbar canal stenosis (LCS). 465 patients with single-segment LCS treated with lumbar decompression surgery at the LiHuiLi Hospital between April 2018 and August 2023 were enrolled in this study. Patients were divided into obesity (OB, BMI > 30 kg/m²) and non-obesity (NOB, BMI < 24 kg/m²) groups. Baseline data, operation time (OT), hospital stay (HS), Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI), and maximum walking distance (MWD), C-reaction protein (CRP), white blood cell (WBC), complications, and reoperations were evaluated. Of the total participants, 156 were categorized as OB and 309 as NOB. The NOB group exhibited significantly greater improvement in VAS scores at 1 month and ODI scores at 3 and 12 months postoperatively (P < 0.001). The OB group had significantly lower MWD both preoperatively and at the final follow-up compared to the NOB group (P < 0.001). The OB group also had significantly longer OT and HS (P < 0.001), as well as higher rates of complications and reoperations compared to the NOB group (P < 0.05). Linear regression revealed a significant relationship between BMI and MWD (P < 0.001). Obesity maybe associated with poorer functional recovery, increased complications, and prolonged recovery following lumbar decompression surgery.

BackgroundThyroid eye disease (TED) is characterized by inflammation of orbital tissue, proptosis, diplopia, and potential changes in facial appearance. TED has been associated with poor mental health and reduced health-related quality of life (HRQOL) due to the combined impact of impaired visual functioning and changes in facial appearance. The study aims to determine the impact of treatments for TED on patients' HRQOL as a measure of comprehensive well-being.MethodsSystematic searches of literature in MEDLINE, EMBASE and CINAHL databases and grey literature sources were conducted. After de-duplication and screening, the modified Downs-and-Black criteria were used to assess the risk of bias. Baseline characteristics, HRQOL-questionnaire data, and mean HRQOL measurements were extracted.ResultsSearches yielded 313 studies from databases and 9 grey literature studies. 23 studies (2023 patients total) were included for quality assessment and data synthesis. Strabismus surgery yielded the greatest improvement in total HRQOL score. Surgical interventions improved visual function QOL (VF-QOL) and visual appearance QOL scores (Ap-QOL).Other medical therapies, including doxycline and selenium were effective for improving Ap-QOL.ConclusionSurgical interventions, particularly decompression, eyelid, and strabismus surgery, improved appearance-related QOL. Immunosuppressive therapy and doxyxycline contributed to progressive functional improvements over time. Longer follow-up durations were generally associated with greater patient-reported benefit from treatments.

To evaluate contrast sensitivity function in patients with thyroid eye disease (TED) associated compressive optic neuropathy (CON) who achieved full recovery of conventional visual function following three-wall orbital decompression and to evaluate its impact on vision-related quality of life. In this prospective matched case-control study, 22 TED eyes (18 TED-CON, 4 TED-non-CON) were compared to 22 healthy eyes matched on age, sex, and refraction. All TED patients had recovered 10/10 best-corrected visual acuity (BCVA), normal visual fields, and no OCT abnormalities after three-wall decompression surgery. CS was assessed using CSV-1000E, and quality of life was measured with the GO-QOL visual function subscale. Despite normal BCVA and visual fields, TED-CON eyes showed significantly reduced CS versus controls (p < 0.01), especially at low spatial frequencies. TED-non-CON eyes also exhibited subnormal CSF, suggesting early or subclinical dysfunction. CS strongly correlated with lower GO-QOL scores (ρ =-1.00,p < 0.001), highlighting its functional relevance beyond standard tests. TED patients with previous compressive optic neuropathy show persistent contrast sensitivity deficits despite complete recovery of visual acuity potentially reflecting irreversible or subclinical optic nerve injury. Even TED eyes without CON may exhibit subtle functional impairment. CS testing could serve as a sensitive functional marker of optic nerve stress in TED, with direct impact on patients' quality of life.

To evaluate the influence of Body Mass Index (BMI) on short- and medium-term outcomes following endoscopic spinal surgery. In this retrospective study, 294 patients who underwent surgery between August 2021 and June 2024 were identified; 189 met inclusion criteria. Outcomes assessed were the Visual Analogue Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and EQ-VAS at 12 weeks and last follow-up (9–12 months). Statistical analyses included Spearman’s correlations, baseline-adjusted multivariable linear regression, and minimal clinically important difference (MCID) assessment. BMI was analysed primarily as a continuous variable and secondarily as a categorical variable. Between-group differences in improvement were visualised using a shared-control estimation plot. Mean BMI was 29.4 kg/m2, with 38% classified as overweight (25–29.9 kg/m²) and 43% as obese (≥ 30.0 kg/m²). At 12 weeks, higher BMI was associated with less improvement in VAS leg pain (ρ = −0.178, p = 0.043) and ODI (ρ = −0.173, p = 0.044), while no significant associations were observed for the remaining outcome measures. By last follow-up, BMI was not associated with improvement in any measure. Estimation plot and multivariable regression indicated no significant BMI-related differences in medium-term improvement. MCID achievement rates were comparable across BMI categories. Higher BMI was associated with modestly reduced short-term improvements, but these differences diminished by last-follow-up. BMI did not strongly predict medium-term outcomes. Endoscopic spinal surgery appears viable across BMI categories, although obesity should be considered a modifiable factor for optimising early postoperative recovery.

Unrealistic or unmet expectations can contribute to lower satisfaction and decisional regret (DR), particularly as shared decision-making becomes more central in elective spine care. Understanding these dynamics in minimally invasive lumbar decompression may guide strategies to optimize preoperative counseling and patient-centered outcomes. Our study aims to evaluate the correlation between patient expectation-actuality differences and DR following minimally invasive lumbar decompression surgery and to identify other patient-reported outcomes associated with DR. This prospective cohort study included adults undergoing elective one-level or two-level minimally invasive lumbar decompression. Patients completed preoperative Musculoskeletal Outcomes Data Evaluation and Management Systems (MODEMS) expectation surveys and postoperative MODEMS actuality surveys at 3 and 6 months, along with the Decisional Regret Scale at both time points. Expectation-outcome mismatch was calculated for each MODEMS domain. Predictors of DR were assessed using univariate linear regression, with significance set at P < .05. Among 104 patients (mean age 64.9 years, 54.5% male), 60% reported no regret and 11% high regret at 3 months, compared with 61% no regret and 6% high regret at 6 months. Across both time points, DR was strongly associated with greater expectation-outcome mismatch. In univariate regression, mismatch in pain relief, daily activity, exercise, sleep, return-to-work, and disability prevention significantly predicted higher regret, with pain relief showing the largest effect. Demographic and clinical factors, including age, sex, comorbidity burden, and preoperative disability, were not associated with regret. MODEMS mismatch remained the most consistent predictor at both follow-ups. DR in minimally invasive lumbar decompression is strongly linked to expectation-actuality differences and reduced satisfaction, with pain relief, activity, and exercise emerging as key drivers. These findings highlight the importance of refining tools to assess expectations and identify unmet needs to reduce regret and improve patient-reported outcomes.