Degenerative Spine Disease Research Articles

New-Occurrence of Postoperative Modic Changes and Its Influence on the Surgical Prognosis After Percutaneous Endoscopic Lumbar Disc Discectomy.

Lumbar disc herniation (LDH) is a common degenerative spinal disease in clinical practice. This study aims to investigate the impact of Modic changes (MCs) on postoperative recovery and disease recurrence following percutaneous endoscopic lumbar disc discectomy (PELD), providing important insights for improving the management of chronic low back pain. This study investigates the 1-year progression rate of MCs after PELD and their impact on surgical outcomes and recurrence. This retrospective cohort study analyzed data from 419 patients with single-segment lumbar disc herniation who underwent PELD between January 2019 and December 2022. Lumbar MRI assessed preoperative and postoperative MCs. Pain levels and surgical outcomes were evaluated using the visual analog scale, Oswestry Disability Index, and Macnab criteria. Univariate analysis explored the relationship between postoperative MCs and pain, while subgroups investigated the associations between postoperative efficacy, recurrence, and MCs type and area. One-year follow-up revealed that the probability of MCs postsurgery was 24.8%. Patients with postoperative MCs had significantly lower pain scores compared with the control group (p < 0.05). Univariate analysis indicated that the type and area of postoperative MCs were risk factors for poor outcomes in PELD patients (p < 0.05). During the 1-year follow-up, recurrence rates in the no-MCs and MCs groups were 3.8% and 9.6%, respectively (p < 0.05). Univariate analysis concluded that the area of postoperative MCs was a risk factor for PELD recurrence. The postoperative MCs, as a risk factor, may have a detrimental effect on the surgical efficacy and short-term recurrence of LDH following PELD based on a large sample. Furthermore, the harmful effect is affected by the area and type of the postoperative MCs.

Efficacy and Safety of Acupuncture in the Treatment of Radicular Cervical Spondylosis: A Systematic Review and Meta-Analysis.

Cervical spondylotic radiculopathy is a serious and common degenerative disease of the cervical spine due to irritation and compression of the nerve roots of the cervical spine, resulting in a series of clinical symptoms based on sensory, motor and reflex disorders, such as numbness and pain in the neck, shoulders, upper limbs and fingers. Acupuncture is highly effective in treating CSR and has become a common treatment accepted by patients. This study aims to systematically review and analyze existing randomized controlled trials (RCTs) to evaluate the efficacy and safety of acupuncture in the treatment of CSR. We used the following eight databases for literature data search: PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Biology Medicine Disc ( CBMdisc), Wanfang Database and China Science and Technology Journal Database (VIP). The search consisted of randomized controlled studies of acupuncture for CSR between 2000 and 2020 and the methodological quality of the included studies was assessed according to the Cochrane Collaboration's "Risk of Bias Assessment Tool."RevMan 5.4 software was used for statistical analysis only. Study screening, data extraction and statistics, and assessment of the risk of bias of the included studies were performed independently by two reviewers. 27 studies with 3124 patients were included. The results of the meta-analysis of the total efficiency index for acupuncture for CSR were [RR = 1.14,95% CI (1.09,1.19)]. The results of the meta-analysis of the PPI index were [MD = -0.35, 95% CI (-0.61,-0. 09)]. The results of META analysis of the total effective rate, VAS score, PRI(A) score, PRI(S) score and PRI(T) score showed heterogeneity in the studies included for each outcome index, and sources of heterogeneity were sought through subgroup analysis and sensitivity analysis to ensure more stable and reliable data results. The results of the combined meta-analysis showed that the treatment group was significantly more effective than the control group and more effective in lowering the nerves to reduce the pain index in patients with CSR, with a statistically significant difference (P<0.05). This indicates that acupuncture treatment is superior to traction for CSR. Acupuncture is significantly more effective than traction therapy in the treatment of cervical spondylosis and can reduce the pain index of patients with CSR.

Assessment of MIR3142HG genetic polymorphisms and the susceptibility of lumbar disc herniation in the Chinese population

Lumbar disc herniation (LDH) is a common degenerative disease of the lumbar spine, which is related to host genetic factors. Our study aimed to explore the association between MIR3142HG polymorphisms and LDH susceptibility. Six SNPs in MIR3142HG from 504 LDH patients and 500 healthy individuals were genotyped by the Agena MassARRAY platform. The relationship between SNPs and LDH susceptibility was evaluated with logistic regression analysis by calculating odds ratios (ORs) and 95% confidence intervals (CIs). The interactions between SNP and SNP were analyzed using the multifactor dimensionality reduction (MDR) method. Our study showed that rs7727115 was related to a decreased susceptibility to LDH. Rs2961920 and rs58747524 were significantly associated with an increased risk of LDH. Stratified analysis showed that rs7727115 reduced the risk of LDH in patients aged > 49 years. Rs17057846, rs2961920, and rs58747524 had a risk-increasing influence on patients aged > 49 years and women. Besides, rs7727115 decreased susceptibility in cases of disc prolapse, while rs2961920 and rs58747524 increased the risk. Rs2431689 increased susceptibility in patients with a single hernia, and rs58747524 correlated with an increased risk in cases of multiple hernias. Moreover, MDR analysis indicated that the combination of rs1582417, rs2431689, rs7727115, rs17057846, rs2961920, and rs58747524 was the best predictive model for LDH. Our study showed that MIR3142HG polymorphisms were significantly associated with LDH risk, which suggests that MIR3142HG polymorphisms play some potential roles in diagnosing LDH.

Unveiling therapeutic targets for spinal stenosis from genetic insights: a Mendelian randomization analysis

Spinal stenosis is a commonly chronic spinal degenerative disease, which is a major cause of pain and dysfunction in the elderly. Mendelian randomization (MR) has been widely applied to repurpose licensed drugs and identify novel therapeutic targets. Consequently, we intended to identify new therapeutic targets for spinal stenosis and to analyze their possible mechanisms and potential side effects.We conducted the Mendelian randomization analysis to identify potential drug targets for the management of spinal stenosis. Cis-expressed quantitative trait loci (cis-eQTL) data as genetic instrumental variables were acquired from the eQTLGen consortium. The summary statistics for single nucleotide polymorphism (SNP) associations of spinal stenosis were obtained from the FinnGen study(20,807 cases and 294,770 controls). Co-localization analysis was performed to determine whether there was shared causal variation between the SNPs associated with spinal stenosis as well as the eQTL. Multiple external validations were performed to reinforce the reliability and stability of the findings utilizing the cis-eQTL from the GTEx portal, the Ferkingstad et al. pQTL dataset, and the Sun et al. pQTL dataset. The viability of the identified drug targets for future clinical applications was elucidated through the phenome-wide association study and drug candidate prediction. Three drug targets (BMP6, DLK1, and GFPT1) exhibited significant causal associations with spinal stenosis in the eQTLGen cohort by MR analysis, which was strongly supported by the results of the co-localization analysis. The causal association of DLK1 and GFPT1 with spinal stenosis remained remarkable with multiple external validations. Multivariate MR and phenome-wide association study analysis indicated that both targets were not associated with other traits. In addition, phenome-wide association study analysis and drug prediction analysis demonstrated the potential of these two targets for future clinical applications. In this study, DLK1 and GFPT1 were identified as promising novel therapeutic targets for spinal stenosis, providing initial genetic insights for drug development in spinal stenosis.

The use of the psoas-to-lumbar vertebrae index and modified frailty index in predicting postoperative complications in degenerative spine surgery: can sarcopenia or frailty be underestimated?

Degenerative spine disease (DSD) is increasingly prevalent due to aging populations, leading to higher surgical interventions and associated complications. This necessitates a comprehensive preoperative assessment, evaluating frailty through tools such as the modified Frailty Index 5 and modified Frailty Index 11 (mFI-5 and mFI-11). Despite the utility of mFI-5 and mFI-11 in predicting postoperative complications, these indices do not account for sarcopenia, a syndrome related to but distinct from frailty, which is associated with higher complication rates. This paper aims to retrospectively evaluate the influence of sarcopenia and frailty on postoperative adverse events in a cohort of patients who underwent posterior spine fusion for degenerative disease of the lumbar spine. A retrospective review of 286 patients who underwent posterior lumbar spine fusion for DSD was conducted. Frailty was measured using mFI-5 and mFI-11, while sarcopenia was assessed through Psoas to Lumbar Vertebral Index (PLVI) on magnetic resonance images. Primary outcomes included postoperative complications within 30 days. Statistical analysis involved univariate and multivariate models to determine the predictors of complications. Higher frailty scores were significantly associated with increased postoperative complications (p < .05). However, sarcopenia showed no significant correlation with postoperative complications rates, except for pneumological complications (p = .031). Multivariate analysis confirmed frailty as a strong independent predictor of postoperative complications, while sarcopenia had limited impact. Frailty is a robust predictor of postoperative complications in DSD surgeries, while sarcopenia, appears to play a lesser role. The findings suggest that frailty alone provide a more comprehensive assessment of risk than sarcopenia.

Cross-cultural adaptation, validation, and establishment of the minimal clinicallyimportant change score of the European Portuguese Core Outcome Measures Index in patients with cervical degenerative spine disease.

We aimed to validate and cross-culturally adapt the Core Outcome Measures Index (COMI) neck for use in Portuguese patients with cervical spine degenerative disease and define the minimal clinically important change score (MCIC) for this questionnaire and population. The COMI translation and cross-cultural adaptation was done following published guidelines. Patients awaiting surgery in a neurosurgical centre completed the COMI, Neck Disability Index (NDI) and EQ-5D questionnaires, a pain visual analog scale (VAS) twice within a 5-to-15-day period, and a Global Treatment Outcome (GTO) question evaluating whether a clinical status change had occurred during that period. The MCIC was obtained through an anchor method by analysis of changes in pre- to postoperative total COMI scores and GTO dichotomized answers. The COMI first assessment was completed by 101 patients and 72 patients completed both assessments. The questionnaire showed good construct validity (n = 72 patients) as predefined hypotheses were confirmed: scores on each COMI domain correlated with a Spearman ρ > 0.4 with scores for the corresponding domain on other questionnaires and COMI total score displayed good correlation with total NDI score (ρ = 0.67) and EQ-5D total score (ρ = 0.55). Test-retest reliability (n = 72 patients) was confirmed through high intraclass correlation coefficients. The MCIC (n = 76 patients) was calculated as 2 points. The COMI (neck) psychometric qualities were confirmed, such that it can be considered a valid and reliable questionnaire to be applied in the European Portuguese population with surgical cervical spine degenerative disease, with an MCIC of 2 points.

A Comparative Review of Spine Surgeries in Two New Neurosurgery Centres in an Urban and Rural Environment in Southeast Nigeria

Background: The Imo State University Teaching Hospital (IMSUTH) located in a rural setting commenced neurosurgical services in January 2016 with a spine procedure as the first case whereas the Imo State Specialist Hospital (IMSSH) located in an urban setting commenced neurosurgical services in April 2021 and spine procedures in August 2021. The presentation of surgically managed spine pathologies in both hospitals were compared. Aims: The study aimed to descriptively compare the number of spine procedures performed in both hospitals including the age and gender distribution of the surgically managed spine patients, the spine pathologies and their distribution. Methods: The surgical records of all spine patients who had surgical procedures at IMSUTH, Orlu, from January 2016 to May 2020 (42 months), and at IMSSH, Owerri, from August 2021 to July 2024 (36 months) were retrospectively reviewed. Results: During the study periods, in IMSUTH, Orlu, there were 27 spine surgeries, giving an average of 1 spine procedure in 2 months whereas in IMSSH, Owerri, there were 157 spine surgeries giving an average of 4 spine surgeries per month. Interestingly the distribution of spine procedures revealed that the highest frequency of spine surgeries was performed in the lumbar spine (n=7, 26% in IMSUTH; n=43, 27.3% in IMSSH) followed by lumbosacral spine (n=6, 22.2% in IMSUTH; n=42, 26.8% in IMSSH) in both hospitals. And quite interesting also is that trauma (n=15, 55.6%) accounted for the highest number of spine surgeries in the rural environment of IMSUTH, Orlu, while degenerative spine diseases (n=113, 71.9%) accounted for the highest number of spine surgeries in the urban environment of IMSSH, Owerri. Conclusion: The study revealed that spine pathologies are not uncommon in resource poor settings especially in the urban environment. There is a male preponderance for spine surgeries. Lumbar/lumbosacral spine pathologies are common in our resource poor settings but trauma related spine pathologies are more common factors for spine surgeries in rural settings. There is need to improve access to spine care in the rural environments.

Diagnostic performance of dual-energy CT with electron-density reconstruction for lumbar disc herniation.

Magnetic resonance imaging (MRI) is used for the evaluation of degenerative spinal disease. However, its utility is restricted in routine practice because of contraindications and a lack of widespread availability. Dual-energy computed tomography (DECT) is a newer technique for the evaluation of degenerative spinal disease. This study aimed to evaluate the diagnostic performance of DECT with electron-density (ED) image reconstruction compared to standard CT for the detection of lumbar disc herniation, with MRI as the gold standard. The retrospective study included 84 patients between 01 July 2023 to 31 December 2023 who underwent DECT and 1.5-T MRI within 1 week. Four radiologists, blinded to the clinical and MRI information, independently evaluated the standard CT series and DECT series with ED reconstructions for lumbar disc herniation and spinal nerve root impingement. The gold standard for comparison was lumbar spine MRI, and diagnostic accuracy was measured with sensitivity and specificity. MRI revealed 417 lumbar disc herniations. Dual-energy computed tomography with ED reconstruction showed higher sensitivity (86.36% [532/616] vs. 57.79% [356/616]) and specificity (96.86% [1019/1052] vs. 95.82% [1008/1052]) for the detection of lumbar disc herniation compared to standard CT. Dual-energy computed tomography with ED reconstruction shows better diagnostic performance for the detection of lumbar disc herniation compared to standard CT and can be a useful alternative imaging modality when MRI is contraindicated or unavailable. This study shows the usefulness of DECT as an alternative imaging technique for screening of degenerative spinal disease whenever MRI is contraindicated or unavailable.

Mortality in patients older than 65 years undergoing surgery for degenerative lumbar spine disease: a comparison with the general population

BackgroundThe increased life expectancy and prevalence of spondylarthrosis have led to a growing frequency of spinal surgery in older people. This study aims to assess whether there is an excess mortality concerning that expected in the general population associated with surgical procedures performed in patients over 65 years old for a degenerative disease of the lumbar spine.MethodsAll patients aged 65 years or older undergoing surgery at a single center between 2009 and 2019 for lumbar spine degenerative disease were included. Standardized mortality ratios (SMRs) were estimated to compare the mortality risk with the expected in the Spanish population for the same age, gender, and calendar-period. Multivariable Cox analysis was employed to determine risk factors of mortality.ResultsA total of 411 procedures were analyzed. The mean age was 72.6 years old. SMR was 0.67 (CI 95% 0.54–0.84). That benefit was significant in women after gender stratification. Patients operated on between 65–84 years old had a lower mortality rate than that expected for the general population. For patients aged 85 or older, the observed mortality was not different from that expected in the general population. Multivariable Cox analysis observed an association between higher mortality and the variables age, male, and Charlson comorbidity index score.ConclusionsCompared with the general population, patients over 65 years old who underwent spinal surgery for degenerative disease of the lumbar spine experienced a reduction in mortality. This effect was particularly significant in women and patients aged 65–84 years. Age, male gender, and Charlson comorbidity index score were associated with higher mortality risk.Graphical

REMEMBER: 30 YEARS SINCE CONSTANTIN ARSENI PASSED AWAY - THE FONDATOR OF ROMANIAN NEUROSURGERY

Introduction The authors will present one of the great personalities of Romanian neurosurgery, Dr Constantin Arseni, who created it in Bucharest, creating the largest university centre of neurosurgery in Europe at that time. Material After the tragic loss of his mentor Prof. Dr Dumitru Bagdasar in 1946, Dr Constantin Arseni, took over the management of the neurosurgery service at the Central Hospital for Mental, Nervous and Endocrinologic Diseases, the only department of this kind in this country; He was able to have the first Clinic of Neurosurgery from Romania. For his merits, Dr Constantin Arseni, became an Associate Professor in 1952 and University Professor in 1963. His neurosurgical activity was complex, but mainly focused on tumoral pathology, cerebral and spinal, and also on spinal degenerative disease. Under Professor C. Arseni, the Neurosurgical Clinic of Bucharest is transformed in 1975 into the “Prof. Dr D. Bagdasar” Clinical Hospital of Neurosurgery, the largest hospital of Neurosurgery in the Europe, with 550 beds and, subsequently, 650 beds. Also, he developed the departments of neurosurgery in each of the biggest university centres in the country; while being the first President of the Romanian Society of Neurosurgery. Scientific Activity Scientific activity of Prof. Dr Constantin Arseni includes the numerous publications (54 treaties and monographies), together with all his collaborators, encompassing all domains of neurosurgery: Tumoral, Neuropathological, Vascular, Paediatric, Spinal Degenerative Pathology, Central Nervous System Malformations, History, etc. with high international visibility. An editorial board under C. Arseni published, with the substantial contribution of the Bucharest Medical Publishing House of the Clinic, the “Treatise of Neurology” in 8 volumes (1979-1981). Conclusions Professor Constantin Arseni was a dedicated surgeon, he practiced his job asking from those around him as much as he offered - the maximum. He was a schoolmaster and a teacher in the true sense of word. Professor Constantin Arseni, Member of the Romanian Academy, was an exemplary professional, a model of conduct, which will forever remain in our memory, of the neurosurgeons, and of the Romanian neurosurgery, leaving behind a legacy hard to match for those who followed him.

Assessment of the Concentration of Transforming Growth Factor Beta 1-3 in Degenerated Intervertebral Discs of the Lumbosacral Region of the Spine.

The purpose of this study was to evaluate the feasibility of using the expression profile of transforming growth factor beta (TGF-β-1-3) to assess the progression of L/S spine degenerative disease. The study group consisted of 113 lumbosacral (L/S) intervertebral disc (IVD) degenerative disease patients from whom IVDs were collected during a microdiscectomy, whereas the control group consisted of 81 participants from whom IVDs were collected during a forensic autopsy or organ harvesting. Hematoxylin and eosin staining was performed to exclude degenerative changes in the IVDs collected from the control group. The molecular analysis consisted of reverse-transcription real-time quantitative polymerase chain reaction (RT-qPCR), an enzyme-linked immunosorbent assay (ELISA), Western blotting, and an immunohistochemical analysis (IHC). In degenerated IVDs, we noted an overexpression of all TGF-β-1-3 mRNA isoforms with the largest changes observed for TGF-β3 isoforms (fold change (FC) = 19.52 ± 2.87) and the smallest for TGF-β2 (FC = 2.26 ± 0.16). Changes in the transcriptional activity of TGF-β-1-3 were statistically significant (p < 0.05). Significantly higher concentrations of TGF-β1 (2797 ± 132 pg/mL vs. 276 ± 19 pg/mL; p < 0.05), TGF-β2 (1918 ± 176 pg/mL vs. 159 ± 17 pg/mL; p < 0.05), and TGF-β3 (2573 ± 102 pg/mL vs. 152 ± 11 pg/mL) were observed in degenerative IVDs compared with the control samples. Determining the concentration profiles of TGF-β1-3 appears to be a promising monitoring tool for the progression of degenerative disease as well as for evaluating its treatment or developing new treatment strategies with molecular targets.

Factors associated with favourable short-term non-operative treatment outcomes among patients with degenerative cervical spine disease at Muhimbili Orthopaedic Institute

Factors associated with favourable short-term non-operative treatment outcomes among patients with degenerative cervical spine disease at Muhimbili Orthopaedic Institute

Unveiling the Gut-Disc Axis: How Microbiome Dysbiosis Accelerates Intervertebral Disc Degeneration.

The gut microbiome (GM), often referred to as the second genome of the human body, plays a crucial role in various metabolic processes and mediates the development of numerous diseases. Intervertebral disc degeneration (IDD) is an age-related degenerative spinal disease characterized by the loss of disc height, hydration, and integrity, leading to pain and reduced mobility. Although the pathogenesis of IDD is not fully understood, recent studies suggest that dysbiosis of the gut microbiome may accelerate the progression of IDD through multiple mechanisms. This article begins by discussing the potential relationship between GM dysbiosis and human diseases, followed by a comprehensive review of the regulatory mechanisms of GM in skeletal diseases within the gut-disc axis framework. Furthermore, it explores three potential pathways through which GM dysbiosis may mediate the development of IDD: immunomodulation, bacterial translocation and colonization, and the decomposition and absorption of intestinal metabolites. These pathways can disrupt disc cell homeostasis and promote degenerative changes. Finally, this paper summarizes for the first time the potential therapeutic approaches for delaying IDD by targeting the gut-disc axis, providing new insights into the pathogenesis and regenerative repair strategies for IDD.

Risk Factors Analysis and Nomogram Conduction for Major Adverse Events After Lumbar Fusion Surgery in Older Patients: A Prospective Cohort Study

This study aimed to identify risk factors for major adverse events (AEs) after lumbar fusion surgery in patients aged 75 and older and evaluate the role of several common geriatric comprehensive assessment items in predicting postoperative major AEs. This is a prospective cohort study of patients aged ≥75years who underwent open lumbar fusion for degenerative spine disease from August 2019 to August 2022. The primary outcome measure was the incidence of major postoperative AEs within 90days after surgery. Clavien-Dindo III-IV complications and unplanned readmission were defined as major AEs. Patients' characteristics, laboratory tests, assessment results, and surgery-related variables were compared between the major AEs and the nonmajor AEs groups. Multivariable logistic regression analysis was used to identify independent risk factors for major AEs. The logistic regression model was evaluated in another prospective cohort of patients from October 2022 to October2023. A total of 301 patients (mean [SD] age, 79.7 [3.5] years; 60.5% male) were included in the study. Five features, including female (OR 1.99, P=0.040), higher body mass index (OR 1.090, P=0.024), frailty (OR 2.043, P=0.032), hypoalbuminemia (OR 2.489, P=0.040), and higher Charlson comorbidity index (OR 1.397, P=0.024), were independently associated with major AEs and were selected to develop a predictive nomogram of major AEs. The area under the curve values for the development set and validation set were 0.75 and 0.71, respectively. Preoperative frailty, hypoalbuminemia, female sex, greater body mass index, and higher Charlson comorbidity index grade were risk factors for 90-day major AEs after lumbar fusion surgery in older patients. The predictive nomogram that we developed using this data can enhance preoperative risk counseling and optimization for older patients.

Early NRS Leg and Back Thresholds Predict Clinical Recovery after MIS Transforaminal Lumbar Interbody Fusion for Degenerative Spine Disease.

This retrospective study included patients who underwent primary one-level minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spine conditions. To identify early predictors of failing to achieve the Oswestry Disability Index (ODI) minimum clinically important difference (MCID) one-year post-surgery. Early identification of patients at risk of failing to achieve ODI-MCID is crucial for early intervention and improved postoperative counseling. Currently, no specific thresholds guide patient follow-up for optimal recovery. The assessment included demographic information, surgical details, and patient-reported outcome measures (PROMs). PROMs were collected postoperatively at 2-, 6-, and 12-week time points, as well as at 6- and 12-months. The study included 166 patients, with 34% failing to achieve ODI-MCID at one year. Early VAS back and leg scores were found to be significant predictors of ODI-MCID achievement. The optimal thresholds identified were 2.25 for early VAS back and 4.25 for early VAS leg. A rerun regression identified the thresholds as independent predictors of ODI-MCID, with odds ratios of 0.31 for both measures. VAS back and leg score thresholds at 6-12 weeks can predict ODI-MCID achievement one year after MIS TLIF. Patients exceeding the identified thresholds may be at risk of failing ODI-MCID and should be monitored closely. Level 3.

Effect of cannabis use history on postoperative opioid utilization in lumbar fusion patients: an American retrospective study.

A retrospective cohort study. To examine the effect of cannabis use history on postoperative opioid utilization in patients undergoing one- to three-level lumbar fusion for degenerative spine disease. Strategies to minimize dosing and chronic opioid use are needed for spine surgery given their widespread prescription for postsurgical pain management. In this database study, medical coding was used to identify patients who had undergone one- to three-level lumbar fusions between 2012 and 2021. Propensity score matching was used to create two equal cohorts with respect to cannabis use history. Opioid utilization rates (morphine milligram equivalents [MME]/day) and overuse rates at 6 months post-index procedure were assessed. All pvalues <0.05 were considered statistically significant. Following examination of 153,500 patient records, 1,216 patients were matched into cannabis user and non-cannabis user cohorts. Cannabis users had lower rates of opioid utilization compared to non-cannabis users as early as 2 months after fusion (47.7% vs. 41.1%, p <0.05), a relationship which persisted at 6 months (46.2% vs. 37.7%, p <0.01). Additionally, cannabis users had lower rates of high-dose opioid utilization (≥100 MME per day) during the initial 14-30 days following surgery (6.91% vs. 3.79%, p <0.05). Patients with a history of cannabis use were less likely to be using opioids as early as 2 months postoperatively and had lower rates of high-dose opioid utilization in the immediate postoperative period. Physicians operating on these patients should consider their cannabis use patterns to provide appropriate titration of pain medication over time.

Minimally Invasive Spine Surgery for Lumbar Decompression or Disc Herniation

ABSTRACTMany people experience low back pain caused by degenerative disease of the lumbar spine; this includes spinal stenosis, spondylolisthesis, disc degeneration, and disc herniation. Conservative management of degenerative disease, which includes physical therapy, lifestyle modifications, and medications, is the initial approach. If this approach fails, a surgical procedure may be the next step. Previously, open lumbar surgery would have been the planned procedure; today, minimally invasive spine surgery gives patients another choice. Perioperative nurses should understand how minimally invasive spine surgery differs from the open procedure, the steps involved during a minimally invasive procedure, the benefits of this type of procedure, and nursing considerations for patients undergoing minimally invasive spinal procedures.

Comparative study of clinical effects between oblique lumbar interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) in the treatment of degenerative disc disease of the lumbar spine.

To compare the clinical effects of oblique lumbar interbody fusion (OLIF) and lateral lumbar interbody fusion (LLIF) in the treatment of degenerative disc disease of the lumbar spine. This was a retrospective study. The clinical data of 80 patients with lumbar disc degenerative disease who underwent surgery in Affiliated Hospital of Beihua University from May 2018 to May 2023 were selected. The patients were divided into LLIF group and OLIF group according to surgical methods. Compare the 36-Item Short-Form Health Survey(SF-36), Visual Analog Scale(VAS) scores, Oswesterly Disability Index(ODI), Japanese Orthopedic Association(JOA) scores, Cobb angle, and intervertebral height changes between two groups of patients pre- and posttreatment, and evaluate the differences in clinical efficacy and surgical complications. Postsurgery, the SF-36 score, VAS score, ODI index, and JOA score of two groups were significantly better than presurgery(p<0.05); After three months of treatment, the improvement in OLIF group was better than LLIF group(p<0.05), while there was no statistically significant difference between the two groups at six months postsurgery(p>0.05). Six months postsurgery, the intervertebral space height and Cobb angle of the two groups were significantly improved compared to presurgery (p<0.05), but there was no significant difference between the groups(p>0.05). There was no difference in clinical efficacy and incidence between the two groups(p>0.05). LLIF and OLIF may be both safe and effective minimally invasive surgical methods for the treatment of degenerative disc disease of the lumbar spine.

Surgical Treatment of Primary Spinal Tumors

Primary spinal tumors appear to be much less common than metastatic lesions, but their surgical treatment comprises a complex and multifaceted task. Numerous factors influence indications and timing of surgical intervention, including neurological status of the patient, histological characteristics of the tumor, its localization, stability of the spinal column, and comorbidities. Significant spinal cord compression, rapid progression of neurologic deficits, or pronounced instability of the spinal column may require urgent surgical intervention. When the spinal canal is not affected, treatment should start with a biopsy to accurately determine the histology of the tumor. Some tumor types, such as giant cell tumors, osteoblastomas, chordomas, and chondrosarcomas, require complete removal of the tumor. However, performing a wide resection in a single block is often found difficult due to compression of vascular and nerve structures. Current approaches to surgical management of primary spinal tumors involve minimally invasive techniques that significantly improve postoperative recovery and reduce the risk of complications. These techniques were originally used to treat degenerative spinal diseases and trauma; however, they have also demonstrated their effectiveness in tumor surgery. Adapting surgical strategy based on histology and tumor location, as well as integrating minimally invasive techniques, can improve patient survival and quality of life. The present paper describes the latest advances in the surgical treatment of primary spinal tumors, discusses current techniques and strategies, and prospects for further research in this area.

Efficacy comparison of robot-assisted versus freehand fluoroscopy-assisted minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spinal diseases

Objective: To compare the clinical and radiographic outcomes between robot-assisted minimally invasive transforaminal lumbar interbody fusion (RA MIS-TLIF) and fluoroscopy-assisted MIS-TLIF (FA MIS-TLIF) in patients with degenerative lumbar spinal diseases. Methods: The clinical data of 114 patients with lumbar degenerative diseases who underwent MIS-TLIF in Qilu Hospital of Shandong University from January 2019 to March 2022 were analyzed retrospectively. Fifty-eight patients underwent RA MIS-TLIF (robot group) and 56 patients received FA MIS-TLIF (freehand group). There were 16 males and 42 females in the robot group, with a mean age of (56.7±8.1) years. And there were 19 males and 37 females in the freehand group, with a mean age of (57.2±8.6) years. The clinical outcome parameters were the visual analog scale (VAS) of pain, Oswestry Disability Index (ODI) score, operative time, number of intraoperative fluoroscopies, blood loss, postoperative hospital stay and complications. The radiographic change measures were the accuracy of screw placement, facet joint violation (FJV), fusion status, and change in disc height at the proximal adjacent segment. All the patients were followed-up for 2-5 years. Results: There was no significant differences in the VAS and ODI scores, blood loss, or postoperative hospital stay between the two groups (all P>0.05). The operative time was longer in robot group than freehand group [(158.5±12.1) min vs (146.4±15.4) min, P<0.001]. There was no significant difference in the number of intraoperative fluoroscopies for patients between robot group and freehand group (P>0.05). The number of intraoperative fluoroscopies for the surgeon was significantly lower in robot group than freehand group (13.8±3.9 vs 74.7±6.8, P<0.001). The rate of a perfect screw position (grade A) was higher in robot group than freehand group [87.5%(203/232) vs 70.1%(157/224), P<0.001]. However, there was no significant difference in the proportion of clinically acceptable screws (grades A and B) between the two groups [98.3%(228/232) vs 96.9%(217/224), P=0.330]. The FJV grade was significantly higher in freehand group than robot group (0.43±0.68 vs 0.13±0.43, P<0.001). During at 2-year postoperative follow-up, there was no significant difference in the fusion status between the two groups (P>0.05); however, the decrease in disc height at the proximal adjacent segment was significantly less in robot group than freehand group [(0.63±0.38) mm vs (0.92±0.35) mm, P=0.001]. In the robotic group, a pedicle screw penetrated the outer wall of the vertebral pedicle in one patient, which was adjusted during surgery. In the freehand group, two screws were inserted too deeply and penetrated the anterior cortex, resulting in mild abdominal discomfort postoperatively, which resolved by the third day after surgery. Conclusions: Robot-assisted percutaneous pedicle screw placement is a safer and more accurate alternative to conventional freehand fluoroscopy-assisted pedicle screw insertion in MIS-TLIF. Compared with freehand MIS-TLIF, robot-assisted MIS-TLIF increases the operation time, but the accuracy of screw placement is higher, and the intraoperative radiation dose and the degree of adjacent segment degeneration are reduced.