Disc Height Research Articles

Clinical and radiological outcomes of lumbar endoscopic decompression for treating lumbar spinal stenosis and degenerative lumbar scoliosis: a retrospective study at mean 4.4 years follow-up

PurposeTo assess the clinical and radiological outcomes of lumbar endoscopic decompression for the treatment of lumbar spinal stenosis (LSS) with concurrent degenerative lumbar scoliosis (DLS).MethodsThis study retrospectively reviewed 97 patients with LSS and DLS who underwent lumbar endoscopic decompression between 2016 and 2021. The average follow-up duration was 52.9 months. Another 97 LSS patients without DLS were selected as the control group. The pre- and postoperative visual analog score (VAS) and the Oswestry disability index (ODI) were recorded and analyzed to compare clinical outcomes. Radiological findings, such as coronal balance and intervertebral disc height, have also been reported.ResultsBoth groups' mean VAS scores for back pain, leg pain, and ODI were significantly improved two weeks after surgery and at the final follow-up (p < 0.001). There was no significant difference in the prevalence of surgical complications or patient satisfaction rates. However, patients in the DLS group reported more severe back pain at the final follow-up than those in the LSS group (p = 0.039). Radiological follow-up revealed no significant deterioration in coronal imbalance or loss of disc height in either group.ConclusionLumbar endoscopic decompression can be a safe and effective surgical technique for treating LSS with DLS, particularly in elderly patients with poor general conditions.

Aspergillus fumigatus spondylitis in an immunocompetent patient with annular high signal around the intervertebral disks: a case report and literature review

Aspergillus fumigatus spondylitis is a rare fungal infection, primarily occurring in immunocompromised patients, although cases in immunocompetent individuals have also been reported. While Aspergillus fumigatus is commonly associated with pulmonary infections, it can also cause spondylitis. Patients typically present with back pain, limb numbness, and neurological compression symptoms. Imaging findings often show vertebral destruction, reduced disk height, and paraspinal abscesses, potentially accompanied by characteristic ring-enhancing lesions. MRI findings can help distinguish Aspergillus fumigatus spondylitis from other conditions such as tuberculous spondylitis. This case involves an immunocompetent patient with Aspergillus fumigatus spondylitis, whose non-specific clinical manifestations can easily be confused with other types of spinal infections, leading to a potential misdiagnosis. Diagnosis requires tissue biopsy and microbiological culture. Voriconazole is the first-line antifungal agent, and studies have shown that it improves patient response and survival rates. For patients with significant spinal compression or neurological symptoms, surgical intervention combined with antifungal treatment should be considered if antifungal therapy alone is ineffective. Although Aspergillus fumigatus spondylitis is rare, it can occur in immunocompetent individuals. Early diagnosis through imaging and biopsy is crucial, and a combination of surgery and antifungal therapy can help improve prognosis.

Awake, endoscopic lumbar interbody spinal fusion: 10 years of experience with the first 400 cases.

Awake, endoscopic spinal fusion has been utilized as an ultra-minimally invasive surgery technique to accomplish the goals of spinal fixation, fusion, and disc height restoration. While many techniques exist for this approach, this series represents a single institution's experience with a large cohort and the evolution of this method. The medical records of a consecutive series of 400 patients treated over a 10-year period were retrospectively reviewed. Endoscopic decompression, expandable intervertebral spacer deployment, and percutaneous screws were combined with liposomal bupivacaine to allow for the surgery to be performed without general endotracheal anesthesia (GETA) in the vast majority of cases. Clinical and radiographic postoperative results were reviewed with special attention to surgical complications, in particular dorsal root ganglion (DRG) irritation. All patients underwent surgery successfully without conversion to an open operation. Their mean age was 69.1 ± 10.4 years, and 42% of the patients were male. A total of 509 levels were fused, with the most common indication being spondylolisthesis (67.5%). The mean operative time was 84.6 ± 31.4 minutes, the mean intraoperative blood loss was 98 ± 63 ml, and the mean hospital length of stay was 1.93 ± 1.1 nights. Overall, 4.3% of the patients underwent planned GETA due to comorbidities, and 2% were converted to GETA intraoperatively. Eighty percent of the patients experienced > 75% improvement in leg pain, and 52% experienced > 75% improvement in axial back pain. Complications included transient DRG irritation (23%), adjacent-level disease requiring reoperation (3.5%), inadequate decompression (2.3%), and nonunion (1.8%). This large case series demonstrates that awake, endoscopic spinal fusion is a viable option with acceptable clinical and radiographic results in a select patient population. Meticulous attention to detail is required to limit the rate of DRG irritation, achieve interbody height restoration, and mitigate nonunions.

Lateral Transpsoas Interbody Fusion.

The lateral transpsoas approach to lumbar interbody fusion has gained widespread adoption for a variety of indications. This approach to the interbody space allows for a favorable fusion environment, disc and neuroforaminal height restoration, and powerful alignment correction. Despite its minimally invasive nature, this procedure carries unique risks, the most severe of which include bowel injury, major vascular injury, and lumbosacral plexopathy. This poses a marked learning curve and requires rigorous attention to detail in technique. In this review, we provide a detailed description of our approach to preoperative imaging, patient positioning, and surgical technique, with an emphasis on patient safety and evidence-based decision-making. A brief description of intraoperative neuromonitoring techniques follows. The lateral transpsoas approach to interbody fusion has demonstrated reliable outcomes in regard to fusion rates, pain and function, and deformity correction, all across a widespread variety of lumbar spine pathologies. Here, we depict techniques, pearls, and pitfalls that are critical for any surgeon considering whether to add this technique to their practice.

Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum Flavectomy

Objective: Uniportal full-endoscopic transforaminal lumbar interbody fusion (FE-TLIF) carries a unique risk of nerve traction and abrasion injury during cage insertion. This study aims to evaluate the clinical efficacy of the GUARD technique and delayed ligamentum flavectomy in reducing postoperative radicular pain and neurapraxia in patients undergoing uniportal FE-TLIF.Methods: A retrospective analysis was conducted on 45 patients with an average age of 53.9±12.4 years who underwent either FE facet-sparing TLIF (FE fs-TLIF) or FE facet-resecting TLIF (FE fr-TLIF). Patients were divided into 2 groups: the sentinel group (21 patients) using traditional sentinel pin techniques, and the GUARD group (24 patients) using the GUARD technique with delayed ligamentum flavectomy. Patient-reported outcomes included the visual analogue scale (VAS) for leg and back pain, and Oswestry Disability Index. Complication rates, including incidental durotomy, postoperative neurapraxia, and hematoma, were also documented.Results: Postoperative radicular pain in the legs was significantly reduced at 6 weeks in the GUARD group compared to the sentinel group (VAS: 2.201 vs. 3.267, p=0.021). The incidence of postoperative neurapraxia was markedly lower in the GUARD group (0% vs. 19%, p=0.047). Both groups showed similar improvements in disc height, segmental lordosis, and lumbar lordosis at the 1-year follow-up, with no significant differences in endplate injury or fusion rates.Conclusion: The GUARD technique and delayed ligamentum flavectomy significantly enhance patient safety by reducing postoperative radicular pain and neurapraxia without incurring additional costs. These techniques are easy to learn and integrate into existing surgical workflows, offering a valuable improvement for surgeons performing FE-TLIF procedures.

Full-Endoscopic Anterior Cervical Decompression and Fusion for Cervical Myelopathy

This article aims to introduce a novel full-endoscopic anterior cervical discectomy and fusion (ACDF) procedure to treat cervical myelopathy. Adoption of endoscopic anterior cervical procedures has been lagging due to safety concerns and the necessity of placing an interbody cage. We have developed novel instrumentation and a modified percutaneous anterior cervical approach that allows a safe and reproducible full-endoscopic ACDF. Specially designed retractor blades facilitate percutaneous placement of a zero-profile cervical interbody cage. A 64-year-old male patient presents with chronic neck pain and bilateral paresthesia in his upper extremities, mild ataxia, and positive Hoffmann sign. He has a history of deep vein thrombosis 5 years prior. Preoperative magnetic resonance imaging and computed tomography scans show a degenerated disk, severe central canal stenosis with cord compression and a hyperintense cord signal at C5–6, compatible with cervical myelopathy. An electromyography of upper extrimities shows suspicion of myelopathy at C5–6. Full-endoscopic ACDF was performed at C5–6 to decompress the canal and restore disk height with a zero-profile interbody cage. Postoperatively the patient showed improvement of his symptoms with reduced pain and disability scores and was discharged from the hospital within 24 hours of the surgery. Outcome is satisfactory at 2-year postoperative follow-up. Full-endoscopic ACDF enables excellent visualization of the posterior endplates and cervical canal with constant irrigation, facilitating treatment of cervical myelopathy. No retraction is required during discectomy and decompression, decreasing the risk of postoperative dysphagia, hoarseness and bleeding. A zero-profile interbody cage can be percutaneously placed with special retractor blades.

Can unilateral-transforaminal lumbar interbody fusion replace the traditional transforaminal lumbar interbody fusion procedure for lumbar degenerative disc diseases?: a single center matched case-control mid-term outcome study.

Matched case-control study. To evaluate the midterm outcomes of unilateral pedicle screw fixation (UPSF) versus bilateral pedicle screw fixation (BPSF) in transforaminal lumbar interbody fusion (TLIF) procedure, ascertain efficacy of UPSF in adequately decompressing contralateral foramen+spinal canal and reducing rate of adjacent segment degeneration (ASD) at 4-8-year follow-up (FU). Previous meta-analyses found no significant differences between UPSF and BPSF regarding fusion rates, clinical and radiological outcomes; however, few studies have reported higher rates of cage migration/subsidence and pseudoarthrosis in the UPSF. No study has evaluated the impact of UPSF on indirect decompression and ASD. Retrospective analysis of 319 patients treated with UPSF vs. 331 patients treated with BPSF between 2012 to 2020. Clinical and radiological outcomes were evaluated at 6 months, 1 year, 2 years, and 4 years postoperatively. X-rays were used to assess fusion+ASD and computed tomography scans in doubtful cases. Magnetic resonance imaging was used at last FU to determine cross-sectional area of cord (CSA), foraminal height (FH), and width (FW) restoration. The mean FU duration was 50 months (range, 44-140 months). In UPSF, CSA increased by 2.3 times from preoperative values; FH and FW increased by 25% and 17.5%, respectively, at last FU (p<0.001); fusion rate was 94.3%, comparable to BPSF (similar CSA, FW, FH, 96.4% fusion rate). In UPSF, adjacent disc height remained stable, from preoperative 11.39±2.03 to 10.97±1.93 postoperatively at 4 years and 10.03±1.88 at 8 years. BPSF showed ASD in 14 (4.47%) vs. three patients (1.06%) in UPSF (p<0.04). Complication rates were similar (6.58% UPSF vs. 6.04% BPSF, p>0.05). UPSF-TLIF is comparable to BPSF in terms of patient-reported clinical outcomes, fusion rates, and complication rates while being superior in terms of lesser ASD. UPSF enables radiologically and clinically significant contralateral indirect neural foraminal decompression and canal decompression without disturbing the contralateral side anatomy, unlike BPSF.

Hueter-Volkmann Law; How It Influences the Correction of Scoliosis Curves with Braces

Background: According to the Hueter-Volkmann law, there is asymmetry in the loads applied to the spinal structure on the convex and concave sides, which can increase the severity of scoliosis and its progression. The purpose of this review was to examine the asymmetry of vertebrae in subjects with scoliosis and explore how this theory can be utilized to enhance the effectiveness of braces in controlling and reducing scoliosis curves. A search was conducted in databases such as Google Scholar, PubMed, and ISI Web of Knowledge using keywords like Hueter-Volkmann law and asymmetry in relation to scoliosis. While there were limited studies on the asymmetry of vertebrae in individuals with scoliosis, the findings indicated significant differences in the height of vertebrae and discs between the concave and convex sides. Additionally, the degree of asymmetry was found to be correlated with the severity of scoliosis. It appears that the design of scoliotic braces is influenced by the Hueter-Volkmann law. It is recommended that new brace designs be developed based on the principles of this law to minimize the impact of gravity on the spine.

Advantages to interspace-level analyses over person-level analyses when studying relationships between lumbar spinal degeneration findings : a cross-sectional study.

To examine associations between lumbar intervertebral disc degeneration (LDD) and type II Modic changes (MC) when retaining information at each interspace ("interspace-level analysis"), as compared to aggregating information across interspaces as is typically done in spine research ("person-level analysis") . The study compared results from (1) interspace-level analyses assuming a common relationship across interspaces (the "interspace-level, common-relationship" approach), (2) interspace-level analyses allowing for interspace-specific associations (an "interspace-level, interspace-specific" approach), and (3) a conventional person-level analytic approach. Adults in primary care (n=147) received lumbar spine magnetic resonance imaging (MRI) and neuroradiologist-evaluated assessments of prevalent disc height narrowing (DHN), type II MC, and other LDD parameters. Analyses examined associations between DHN and type II MC in interspace-level, common-relationship analyses, interspace-level, interspace-specific analyses, and conventional person-level analyses. Cross-sectional, interspace-level, common-relationship analyses found large-magnitude DHN-type II MC associations (adjusted OR [aOR]=6.5, 95% confidence intervals (CIs) 3.3-13; p<0.001). The magnitude of this association was larger and more precise than that yielded by person-level analyses (aOR=2.9 [95% CI 1.2-7]), and substantially more precise than interspace-level, interspace-specific analyses which allowed the association between DHN and type II MC to vary across levels. Across exploratory analyses of disc signal intensity and other MC types, interspace-level, common-relationship analyses produced larger-magnitude and more precise associations than person-level analyses in most situations, and were more precise than interspace-level, interspace-specific analyses. Interspace-level analytic approaches offer some advantages to person-level analyses that may be useful in understanding relationships between spinal degeneration findings.

Constraining the Galactic Structure Using Time Domain Gravitational Wave Signal from Double White Dwarfs Detected by Space Gravitational Wave Detectors

The gravitational wave (GW) signals from a large number of double white dwarfs (DWDs) in the Galaxy are expected to be detected by space GW detectors, e.g., the Laser Interferometer Space Antenna (LISA), Taiji, and Tianqin in the millihertz band. In this paper, we present an alternative method by directly using the time-domain GW signal detected by space GW detectors to constrain the anisotropic structure of the Galaxy. The information of anisotropic distribution of DWDs is naturally encoded in the time-domain GW signal because of the variation of the detectors’ directions and consequently the pattern functions due to their annual motion around the Sun. The direct use of the time-domain GW signal enables simple calculations, such as utilizing an analytical method to assess the noise arising from the superposition of random phases of DWDs and using appropriate weights to improve the constraints. We investigate the possible constraints on the scale of the Galactic thin disk and bulge that may be obtained from LISA and Taiji by using this method with mock signals obtained from population synthesis models. We further show the different constraining capabilities of the low-frequency signal (foreground) and the high-frequency signal (resolvable sources) via the Markov Chain Monte Carlo method, and find that the scale height and length of the Galactic thin disk and the scale radius of the bulge can be constrained to a fractional accuracy of ∼30%, 30%, 40% (or 20%, 10%, 40%) by using the low-frequency (or high-frequency) signal detected by LISA or Taiji.

Protective effects of cannabinoid receptor 2 on annulus fibrosus degeneration by upregulating autophagy via AKT-mTOR-p70S6K signal pathway.

As an important pathological process, annulus fibrosus (AF) degeneration contributes greatly to intervertebral disc degeneration (IVDD). Moreover, extracellular matrix (ECM) degradation and AF cell (AFC) autophagy are of utmost importance. The involvement of cannabinoid receptor type 2 (CB2) in the pathological mechanisms underlying different diseases has been demonstrated dueto its capacity toregulateautophagy. The objective of this study was to explore the impact of CB2-induced autophagy on AF degeneration and its underlying mechanism. First, the expression of CB2 in human degenerative AF tissues decreased with increasing degeneration degree, whereas its expression in rat AFCs increased in a concentration- and time-dependent manner following H2O2 intervention. Activation of CB2 increased collagen Ⅰ and Ⅱ expression while decreasing MMP3 and MMP13 expression. In addition, p62 expression decreased, whereas beclin-1 and LC3-Ⅱ/LC3-Ⅰ expression increased after JWH133 intervention. After CB2 activation, the addition of 3-MA impeded the synthesis of collagen Ⅰ and Ⅱ while preserving the elevated levels of MMP3 and MMP13. The activation of CB2 greatly suppressed the protein levels of the AKT/mTOR/p70S6K signaling pathway. In vivo, the JWH133 group exhibited elevated disk height index (DHI) and MRI signals, along with a comparatively intact structure of the intervertebral disc in contrast to the vehicle group. In general, CB2 activation could modulate apoptosis and autophagy in rat AFCs, thereby mitigating the advancement of IVDD. Moreover, the AKT/mTOR/p70S6K signaling pathway plays a role in the development of AF degeneration through the regulation of autophagy. The findings suggest that CB2 is a potentially effective therapeutic target for IVDD.

Comparative efficacy and fusion outcomes of unilateral bi-portal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in treating single-segment degenerative lumbar spondylolisthesis with lumbar spinal stenosis: a two-year retrospective study

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.

Does Position of Pedicle Screws Correlate With Adjacent Segment Degeneration? An Average 6-Year Follow-Up Retrospective Study.

Retrospective case serie. Assess the correlation between pedicle screw (PS) position of the first instrumented vertebra (FIV) with proximal adjacent segment degeneration (ASD) development or progression. Patients ≥55years who have undergone lumbar fusion with a minimum 2-year follow-up were included. Radiographic PS position was assessed by the angle between the first PS and the upper vertebral endplate (VE) and by the PS tip-VE distance. Radiographic parameters of ASD included: disc height, disc angle, and vertebral listhesis. ASD magnetic resonance imaging (MRI) parameters included: disc degeneration and lumbar stenosis. ROC curve analysis was performed to identify the best cut-off points in correlation with lumbar stenosis. Forty-eight patients were included with an average follow-up of 6years. All 48 included patients developed some degree of ASD whether on radiographic or MRI parameters. PS tip-VE distance and PS-VE angle were both positively correlated with: (1) Delta (Δ) lumbar stenosis; (2) Δ Disc degeneration; and (3) Δ Disc height. ROC curve analysis correlating PS tip-VE distance and PS-VE angle with an increase in the canal stenosis severity ≥2° resulted in a cut-off point of 36% and 9.5°, respectively. The cranial orientation (PS-VE angle) of the pedicle screw in the first instrumented vertebra, along with a shorter pedicle screw tip-vertebral endplate distance (PS tip-VE), positively correlated with ASD progression at an average 6-year follow-up. Protective values against lumbar stenosis were identified as a PS tip-VE distance ≥36% of the first instrumented vertebra height and a PS-VE angle ≤9.5° relative to the upper vertebral endplate.

Long-Term Outcomes of Modified Expansive Open-Door Laminoplasty Combined with Short-Level Anterior Cervical Fusion in Multilevel Cervical Spondylotic Myelopathy.

Background and Objectives: Multilevel cervical spondylotic myelopathy (MCSM) presents complex challenges for surgical management, particularly in patients with kyphosis or significant anterior pathology. This study aimed to assess the long-term efficacy of modified expansive open-door laminoplasty (MEOLP) combined with short-level anterior cervical fusion (ACF) in providing decompression, preserving alignment, and maintaining range of motion (ROM) over a nine-year follow-up. Materials and Methods: A retrospective analysis was conducted on 124 MCSM patients treated with MEOLP combined with ACF between 2011 and 2015. MEOLP, a muscle-sparing posterior approach, was combined with ACF to correct sagittal misalignment and address anterior compression. Key outcome measures included the Pavlov ratio, C2-C7 angle, Japanese Orthopedic Association (JOA) score, and Visual Analog Scale (VAS) for neck pain. Patients were monitored for adjacent segment degeneration (ASD) and other postoperative changes over the long-term follow-up. Results: At nine years post-surgery, patients demonstrated significant improvements in decompression and cervical alignment. The mean C2-C7 angle increased, reflecting enhanced lordotic curvature, while the Pavlov ratio showed maintained canal expansion. JOA scores improved significantly, indicating reduced myelopathy symptoms, and VAS scores for neck pain decreased, reflecting symptom relief. Despite these positive outcomes, ASD was noted, especially in patients with reduced preoperative disk height, highlighting the need for strategies to mitigate degeneration at adjacent segments. Conclusions: MEOLP combined with short-level ACF is a viable and durable option for managing complex MCSM cases, offering effective decompression, alignment correction, and ROM preservation. The limitations of this study, including its retrospective, single-center design and the lack of quality-of-life assessments, underscore the need for future multi-center studies with broader outcome measures. These findings support MEOLP with ACF as an alternative approach in cases where traditional laminoplasty may be insufficient.

3D printed PGCL@PLA/10CSPL composite scaffolds loaded with fibronectin 1 for intervertebral disc degeneration treatment

Restoration of disc height and biomechanical function is essential for intervertebral disc degeneration (IDD) treatment. Removing abnormal nucleus pulposus (NP) tissue is an important step to facilitate bony fusion during the healing process. We analyzed publicly available single-cell transcriptome data for human normal and degenerative NP to identify genes associated with NP degeneration. A novel poly(glycolide-co-caprolactone)@polylactide (PLA)-b-aniline pentamer (AP)-b-PLA/chitosan-ϵ-polylysine (PGCL@1PAP/10CSPL) scaffold with good biocompatibility and electroactivity was designed and fabricated as an implant for IDD treatment using 3D printing technology. The PGCL@1PAP/10CSPL scaffold exhibited superior hydrophilicity, mechanical properties, cytocompatibility, and antibacterial activity compared to PGCL. Fibronectin 1 (FN1), identified from single-cell transcriptome analysis, was loaded into the PGCL@1PAP/10CSPL scaffold to accelerate the abnormal NP degeneration.In vitroandin vivoexperiments indicated that the PGCL@1PAP/10CSPL-FN1 scaffold enhanced osteogenic differentiation, promoted angiogenesis, and facilitated the removal of damaged disc tissue. This study introduces a novel implant system with desirable mechanical strength and unique bone-promoting and vascularizing properties for lumbar interbody fusion in IDD treatment.

A new hernia blocking system to prevent recurrent lumbar disc herniation: surgical technique, intraoperative findings and six-months post-operative outcomes.

The aim of this study was to evaluate the performance and safety of a new hernia blocking system (HBS), implanted after a limited discectomy, to prevent recurrence of lumbar disc herniation. Prospective, multicenter (6 sites), cohort clinical investigation. Thirty patients with a postero-lateral disc herniation between L4-S1 and large annular defects (> 6mm wide), who underwent a limited discectomy and were treated with a new HBS (DISC care, NEOS Surgery S.L.), were included. This article presents details about the investigational device, its surgical technique, intraoperative parameters, and up to 6months follow-up outcomes. The primary endpoint of the study was to assess the incidence of early symptomatic reherniation. In addition, disc height, leg and back pain (NRS 0-10), Oswestry Disability Index (ODI), quality of life (EQ-5D-5L) and device safety, were evaluated. gov: NCT04188236; date: 27th November 2019. Thirty patients (43.3% female, 41.7 ± 10.9years) were implanted with the device under evaluation in a mean of 16 ± 9.6min. Six months after surgery, no symptomatic reherniation was detected and disc height was maintained in all patients included. All patients had a significant reduction in leg pain (> 2 points in the NRS), 92.9% improved > 15 points in the ODI and 82.6% significantly improved their quality of life (≥ 12 points in EQ VAS score). No product-related serious adverse events nor reoperations occurred. The implantation of an HBS is a feasible and safe procedure that prevents early disc herniation recurrence in patients at high risk of reherniation.

Comparison of Fluoroscopy Reducing OLIF51 and Standard TLIF51 Methods in the Surgical Treatment of Adult Spinal Deformity

Objective: The objective of the study was to evaluate the OLIF51 (L5-S1 Oblique Lumbar Interbody Fusion) and TLIF51 (L5-S1 Transforaminal Lumbar Interbody Fusion) techniques in relation to several key variables, including the duration of the operation, quantity of blood lost, fluoroscopy time used, radiological outcome and complications as regards the management of adult spinal deformity. Materials and Methods: In this retrospective study, a total of 60 patients who underwent surgical treatment for spinal deformities between January 2018 and December 2023 were included in the analysis. Patients were divided into two groups according to OLIF51 and TLIF51 methods. Demographic data, surgical time, blood loss, hospitalization, fluoroscopy time, and complication rates were recorded. VAS (Visual Analog Scale) and ODI (Oswestry Disability Index) were used for clinical evaluation. Radiological parameters were analyzed using disc height and lumbar lordosis angle. Results: The OLIF51 group exhibited a shorter surgical duration (p &lt; 0.001), reduced blood loss (p &lt; 0.001), and a shorter hospital stay (p = 0.002) compared to the control group. Moreover, the OLIF51 procedure demonstrated a notable reduction in the utilization of fluoroscopy, with a statistically significant difference (p &lt; 0.001). In terms of radiological outcomes, the OLIF51 group exhibited superior disc height and lumbar lordosis angle measurements compared to the TLIF51 group, with statistical significance (p &lt; 0.05). No significant difference was observed between the two groups in terms of clinical improvement. Conclusion: The OLIF51 procedure offers several advantages over TLIF51, including a shorter operative time, reduced blood loss, and less fluoroscopy time. Additionally, radiological outcomes are more favorable for OLIF51. For this reason, OLIF51 can be regarded as a secure and effective alternative for the management of spinal deformities.

Sequential Anterior Longitudinal Ligament Release With Expandable Spacers for Lordosis Correction in Anterior-to-Psoas Lumbar Interbody Fusion: A Radiographic and Biomechanical Study.

Anterior column realignment is an attractive minimally invasive treatment for sagittal imbalance. Expandable spacers offer controlled tensioning of the anterior longitudinal ligament (ALL) during release, which could optimize correction and anterior column stability. This study investigated the biomechanical and radiographic effects of single-level anterior-to-psoas lumbar interbody fusion (ATP-LIF) with expandable spacers and sequential ALL release. In vitro range of motion tests were performed on 7 fresh-frozen cadaveric spines (L2-L5) with a ±7.5 Nm load applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). After testing intact spines, single-level (L3-L4) ATP-LIFs were performed and supplemented with posterior screws, rods, and integrated lateral screws and tested after (1) no ALL release (ATP-LIF); (2) resection of 1/3 the ALL's width (1/3 ALL release); (3) resection of 2/3 the ALL's width (2/3 ALL release); and (4) complete ALL resection (3/3 ALL release). Following each partial ALL release, rods were removed, and spacers were expanded until the torque limit was reached. Rods were then reapplied, and lateral radiographs were taken to analyze changes in intervertebral angle (IVA), foraminal height, foraminal area, and posterior and anterior disc height (PDH and ADH). In ATP-LIF constructs, range of motion decreased in FE (18% intact), LB (14% intact), and AR (30% intact), while IVA, PDH, ADH, foraminal height, and foraminal area increased. PDH and ADH increased linearly with sequential ALL release and spacer expansion, while LB and AR remained stable. FE increased slightly (+15%-16% intact, <1°) following 2/3 ALL release but remained stable afterward. IVA increased exponentially with sequential ALL release, gaining 8.8° ± 3.2° with complete release. The present study found improved biomechanics and radiographic parameters following ATP-LIF with intact ALL, minimal biomechanical differences between partial and complete ALL release, and greater correction and height restoration with complete release. Future clinical testing is necessary to determine the impact of this finding on patient outcomes. Controlled tensioning of the ALL before and after ligament release allows for potential optimization between restoring sagittal balance and maximizing construct stability in a minimally invasive approach.

Standalone Anterior Lumbar Interbody Fusion Without Supplementary Posterior Fixation Is Effective for Treatment of Symptomatic Grade 1 Isthmic Spondylolisthesis.

There is a paucity of data examining anterior lumbar interbody fusion (ALIF) with pedicle-screw fixation (ALIF-PSF) or without (standalone, sa-ALIF) for the treatment of low-grade isthmic spondylolisthesis (IS). Treating pathology with sa-ALIF reduces costs, operative times, and posterior access morbidity. This study aimed to investigate the clinical and radiographic outcomes of sa-ALIF for the management of low-grade IS compared with an ALIF-PSF cohort. Retrospective analysis of prospectively collected data. Consecutive patients from 1 senior spine surgeon performing sa-ALIF or ALIF-PSF for management of low-grade IS. Patient-reported outcome measures (PROMs) were collected at baseline, then postoperatively at 6 weeks, 6 months, 12 months, and a final follow-up timepoint. Computed tomography was conducted at 6 months, 12 months, or until interbody fusion was confirmed. Two cohorts comprised 51 patients (sa-ALIF 22 and ALIF-PSF 29). Both cohorts' PROMs improved from baseline to 12 months postoperatively. There were no significant differences (P = 0.05) in PROMs between the 2 cohorts at 6 months postoperatively, 12 months postoperatively, or at a final follow-up timepoint. There were no significant differences in mean fusion rates 12 months postoperatively (sa-ALIF 82% and ALIF-PSF 88%). Compared with preoperative measurements in sa-ALIF and ALIF-PSF cohorts, listhesis and segmental lordosis showed no significant changes, while disc height significantly increased (P = 0.0001). There were no significant differences in disc L5/S1 radiographic measurements between the cohorts at 12 months. There were 12 complications (sa-ALIF 2 and ALIF-PSF 10). Only 1 patient in the ALIF-PSF cohort required revision surgery. In appropriately selected patients with normal bone density, sacral slope <40°, and a body mass index <35, sa-ALIF is a safe and effective treatment option for grade I IS. The additional morbidity and cost of PSF may not be justified given the satisfactory clinical and radiographic outcomes of sa-ALIF for grade I IS. Clinically, this research continues to suggest that sa-ALIF is a safe and effective method of treatment for low grade IS.

What Radiographic and Spinopelvic Parameters do Spine Surgeons Consider in Decision-Making for Treatment of Degenerative Lumbar Spondylolisthesis?

Cross-sectional survey. Surgical treatment of degenerative lumbar spondylolisthesis is remarkably varied due to heterogeneity of clinical-radiological presentations. This study aimed to assess which spinopelvic radiological parameters were considered for decision-making. Survey distributed to International AO Spine members to analyze surgeons' considerations for treatment. Data collected includes demographics, training background, years of experience, and treatment decisions based on various radiographical findings, including segmental and global spinopelvic parameters. From 479 responses, the most frequently radiological parameter considered was slippage on dynamic X-rays (79.1%), followed by disc height (78.9%), global sagittal balance SVA (71.4%), and PI-LL mismatch (69.7%), while the least important was absolute spondylolisthesis on static lateral radiograph (22.8%). Fellowship-trained surgeons were likelier to use SVA (OR = 1.73, 95% CI = 1.02-2.99, P = 0.049), and disc height (2.13, 1.14-3.98, P < 0.05). There was no difference between orthopedics and neurosurgery in applying SVA and PI-LL mismatch. Surgeons from Asia Pacific emphasizes segmental lordosis (2.39, 1.11-5.15, P = 0.026) as from Latin America (2.55, 1.09-5.95, P = 0.030) and Middle East (4.33, 1.66-11.28, P = 0.003). However, surgeons from Latin America and Middle East also significant consider disc height (2.95, 1.07-8.15, P = 0.037) and (3.03, 1.04-8.83, P = 0.043), respectively. Additionally, the surgeons' age was associated with using angular motion on flexion-extension radiographs, and volume of treated cases yearly with consideration for disc height. Treatment of degenerative lumbar spondylolisthesis was influenced by slippage on dynamic radiographs, disc height, global alignment, and PI-LL mismatch. Surgeons' age and Region, fellowship-trained, and volume of treated cases were significantly associated to apply these radiological parameters.