Spinal Disorders Research Articles

Morphologic Patterns of Spinal Degeneration and Trauma in a Nigerian Population: A Retrospective Radio-Anatomic Study.

Understanding the morphologic patterns of degenerative and traumatic spinal conditions is essential for precise diagnosis and management plans. This study evaluates the sequence of structural changes in degenerative spinal disorder patients' discovertebral unit and the traumatic spinal injury patterns in a northwestern Nigerian population. A hospital-based retrospective study reviewed radiologic images of 307 patients with spinal degeneration (n= 269) and trauma (n= 38) at 2 tertiary hospitals in northwest Nigeria. The study presented descriptive and inferential statistics, with a 95% confidence interval and significance level with a P value ≤0.05. The average age of patients with spinal degeneration was 52.5 years, with females (60.6%) and those aged 41 years and older (76.6%) predominant, whereas patients with trauma averaged 36.3 years and were predominantly male (78.9%) and aged 21-40 years (60.5%). Common clinical manifestations included radicular pain (53.9%) in degenerative cases and spinal shock (36.8%) in trauma. Correlation analysis showed significant links between mild/moderate straightening of spinal curvature and clinical manifestations (P= 0.001). Age-influenced osteophyte and intervertebral disc degeneration, especially in the group aged 41-60 years (P= 0.001), with AO/Magerl type A spinal injury, was more common in males (P= 0.022) and the group aged 21-40 years (P= 0.019), indicating notable demographic trends. Intervertebral disc degeneration peaks at L3, L4, and L5, notably grade III (P= 0.001), and Modic II frequencies increase from L1 (n= 16) to L5 (n= 35) without significant association (P= 0.99). This study showed different morphologic patterns in degenerative and traumatic spinal conditions in the study population, with considerable age, gender, and symptom correlations. These findings emphasize the importance of understanding these patterns for effective diagnosis and management strategies of spinal degeneration and trauma.

Are paraspinal muscle morphology and composition associated with lumbar spinal stenosis? A systematic review.

There has been increasing interest in associations between paraspinal muscle phenotypes and common spinal disorders, including lumbar spinal stenosis (LSS). However, the relation of paraspinal muscle morphology and composition with LSS is unclear. To provide a systematic overview and synthesis of current evidence on the association of paraspinal muscle morphology and composition with LSS presence, pain and disability or function. Systematic review METHODS: Relevant studies were identified from a search of EMBASE, PubMed, SPORTDiscuss, Cinahl, Web of Science and PEDro. Relevant studies were selected, data were extracted, and risk of bias was assessed by two independent reviewers prior to conducting a narrative synthesis to summarize evidence using GRADE considerations. The study protocol was prospectively registered (Prospero: CRD42021246492). Of 33 studies included in the review, multifidus (n=22) was most frequently studied, followed by psoas (n=10). Fatty infiltration (20 studies), CSA (n=11) and relative CSA (n=10) were the most studied paraspinal phenotypes. Most studies (n=31) had low risk of bias, with selection and confounding bias (n=13) most common. High variability in approaches used to measure muscle morphology and composition and LSS disability and pain, and variable control of confounding factors, created challenges in synthesizing findings. The only association identified for which there was moderate certainty of evidence was between increased multifidus fatty infiltration and the presence of LSS (4 of 6 studies). All other associations studied with high or moderate strength of evidence demonstrated no association, including no association between multifidus fatty infiltration and pain severity (8 studies), multifidus CSA and LSS disability (7 studies), psoas morphology and LSS anatomical severity (4 studies), or psoas composition and LSS pain severity (4 studies) for which there was high certainty. There was moderate certainty of no association between multifidus morphology and LSS pain severity (5 of 7 studies), and erector spinae morphology and pain severity (3 studies), and erector spinae composition and LSS pain severity (3 studies) and function (3 studies). Other associations remain more unclear. Largely consistent results suggest multifidus fatty infiltration is associated with the presence of LSS. However, other specific associations examined with high or moderate certainty of evidence demonstrated no association, and others remain largely undetermined. Although interest has grown in paraspinal muscle morphology and composition for improved phenotyping, prognosis and treatment of common spinal disorders, the clinical utility of paraspinal muscle imaging in LSS remains unclear.

Translation, cross-cultural adaptation and validation of the Persian version of the physical workload questionnaire (PWQ)

BackgroundMusculoskeletal disorders in manual workers are often linked to physical workload factors such as heavy lifting, repetitive movements, and awkward postures. These factors can negatively impact health and work efficiency. Simple tools like questionnaires are essential for studying physical workload. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Physical Workload Questionnaire for Persian-speaking populations (PWQ-Pr).MethodsThe study involved 255 participants and followed standard guidelines for translation and cultural adaptation. Various psychometric properties were assessed, including face validity through interviews, construct validity via hypothesis testing and factor analysis, content validity using the Content Validity Index (CVI), convergent validity through Pearson’s correlation with the Spine Functional Index (SFI), internal consistency using Cronbach’s alpha, and test-retest reliability assessed through the intra-class correlation coefficient (ICC) and standard measurement error over a 10-day period.ResultsGood internal consistency (α = 0.89) and high test-retest reliability (ICC = 0.90, 95% confidence interval: 0.81–0.94) were obtained. Convergent validity was indicated by a correlation of r = 0.41 (P < 0.001) with the SFI questionnaire. Content Validity (CVI = 0.93) was approved. Factor analysis identified two distinct factors within the PWQ-Pr, explaining 52.07% of the variance. Hypothesis testing indicated significant differences in physical workload across job types and among individuals with and without spinal musculoskeletal disorders (MSDs), with eight hypotheses confirmed out of twelve tested.ConclusionsThe Persian version of the Physical Workload Questionnaire (PWQ-Pr) is a reliable and valid tool for assessing physical workload among Persian-speaking individuals. It is effective in evaluating workload across various job tasks.

Systematic Review of Surgical Success, Complications, Revision Rates, Radiation Dosage, and Operative Time of 3D-Navigated versus Non-Navigated Spinal Procedures.

Three-dimensional (3D) navigation offers real-time guidance in surgery. However, there is limited and inconsistent data regarding the usability, safety, and efficacy. To address gaps in knowledge about 3D navigation in spinal surgery, we conducted a comprehensive review of success rates, complications, revisions, radiation exposure, and operative time associated with Federal and Drug Administration-approved 3D surgical navigation tools. This study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used a protocol registered on International Prospective Registration of Systematic Reviews (CRD42023404554). Ovid MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched using relevant keywords for 3D surgical navigation and spinal procedures from 1946 to March 02, 2023. Two independent reviewers assessed the studies using inclusion/exclusion criteria and risk of bias tools. Statistical analyses included one-way analysis of variance, weighted-mean difference, and unpaired t-tests with Welch's correction for associations and comparisons between groups, respectively. Of the total 11,324 studies identified and 7198 screened, 62 studies totaling 3170 adult patients were included in this comprehensive review. Complication and surgical success rates have remained constant since 2004, with overall rates of 5.5% and 94.0%, respectively. When segmented by spinal region, complication rates may be moderately positively correlated with frequency of cervical and thoracic procedures (r= 0.25, P= 0.68). The most commonly reported complication was pedicle screw malposition or breach. A subset of 20 studies, totaling 1554 patients, compared the performance of 3D navigation to two-dimensional fluoroscopy or freehand navigation. There was a significant difference of 6.53% between surgical success rates of the 3D-navigated and control groups (P= 0.03). However, there was no significant difference in radiation exposure or operative time. The 3D navigation in spinal procedures has higher surgical success rates than two-dimensional fluoroscopy and freehand navigation. Included studies exhibited varying limitations, including no patient follow-up (n= 1), less than 10 patients (n= 6), various types of spinal disorders (n= 1), and varying comorbidities among participants (n= 2). Improving 3D navigation tools remains imperative to decrease operative time and radiation exposure.

Clinical Outcomes following Elective Lumbar Spine Surgery in Patients Living with Dementia.

As the population ages and surgical techniques improve, more elderly patients with dementia are being considered for treatment of spinal disorders. However, the combined impact of procedural intensity and anesthesia exposure can exacerbate surgical risks, leading to more complex recoveries and post-operative morbidity. To compare post-surgical outcomes of patients living with dementia who received elective lumbar spine surgery with a comparable group of patients without dementia. Retrospective analysis using national Medicare claims. We identified Medicare beneficiaries living with dementia who underwent elective lumbar spine surgery between 2017-2018. This cohort was compared to Medicare beneficiaries who received comparable surgeries but without a diagnosis of dementia. The primary outcome was any adverse event (AAE) within 180 days of surgery, with post-operative intensive interventions considered in parallel with other clinical outcomes. We employed inverse probability of treatment weights to adjust for confounding. We compared outcomes between cohorts using adjusted hazard ratios (aHR) from Cox-proportional hazard models and Fine-and-Gray models considering death as a competing risk. We included 101,313 patients. Within 180 days of surgery, patients with dementia had an increased hazard of AAE than those without dementia (aHR 1.30; 95% CI 1.21,1.40). Patients with dementia also demonstrated a greater hazard of mortality (aHR 1.75, 95%CI 1.33, 2.29) and post-operative intensive interventions (aHR 1.64, 95% CI 1.08, 2.49) over the same time frame. We found a significantly increased risk of adverse events among patients living with dementia undergoing lumbar spine surgery. We believe these risks were previously underappreciated because of the focus on urgent procedures (e.g. hip and odontoid fractures) in prior research evaluating post-operative outcomes for patients with dementia. Our results suggest the need for greater caution when recommending elective, high-intensity, surgical interventions for patients living with dementia.

Trends and Considerations in Annulus Fibrosus In Vitro Model Design.

Annulus Fibrosus (AF) tissue integrity maintains intervertebral disc (IVD) structure, essential to spine mobility and shock absorption. However, this tissue, which confines nucleus pulposus (NP), has been poorly investigated, partially due to the lack of appropriate study models. This review provides a comprehensive analysis of AF in vitro models. By critically assessing the current AF in vitro models, this works thoroughly identifies key gaps in replicating the tissue's complex microenvironment. Finally, we outline the essential criteria for developing more accurate and reliable AF models, emphasizing the importance of biomaterial composition, architecture, and microenvironmental cues. By advancing in vitro models, we aim to deepen the understanding of AF failure mechanisms and support the development of novel therapeutic strategies for IVD herniation. Insights gained from this review may also have broader applications in regenerative medicine, particularly in the study and treatment of other connective tissue disorders. STATEMENT OF SIGNIFICANCE: This review evaluates the current in vitro models of the annulus fibrosus (AF), a key component of the intervertebral disc (IVD). By identifying gaps in these models, particularly in replicating tissue's complex microenvironment, we propose essential criteria for the development of more accurate AF models, to better understand the pathomechanisms and potentially aid the development of therapeutic approaches for spinal disorders. The findings also extend to broader studies of musculoskeletal tissue disorders in the context of regenerative medicine, appealing to a diverse biomedical research readership.

Preoperative determinants of postoperative expectation fulfillment following elective lumbar spine surgery: an observational study from the Canadian Spine Outcome Research Network (CSORN).

Preoperative patient factors determining expectation fulfillment from elective lumbar surgeries are poorly defined. To identify preoperative factors associated with the levels of expectation fulfillment following elective lumbar spine surgery. This retrospective cohort study used the Canadian Spine Outcome Research Network (CSORN) registry data with participants enrolled between January 2015 and December 2020. The registry prospectively enrolled surgical patients to treat spinal disorders from twenty-three sites. Participating patients completed preoperative and follow-up questionnaires, including information on surgery expectations. Patients recorded their levels of expectation fulfillment on a Likert scale of 1-5, with responses ranging from Completely met (5) to Not applicable (1) in seven expectation dimensions. Consecutive patients with four lumbar conditions (spinal stenosis, disc herniation, degenerative disc disease, or degenerative spondylolisthesis) and those with complete one-year follow-up questionnaires were included. Patients treated for thoracic or cervical pathologies and non-elective lumbar conditions were excluded. A total of 5389 patients who underwent surgery and completed one-year follow-up questionnaires out of 6971 eligible patients were included. Patients' socio-demographics, lifestyle, health status, and clinical factors were examined. The primary outcome was the association between expectation fulfillment and preoperative patient factors. Patient factors were described for the expectation fulfillment categories using descriptive statistics. Bivariable and multivariable associations between patient factors and expectation fulfillment were estimated with ordinal logistic regression models. Point estimates represented as odd ratios, and 95% CIs were reported. The mean age of the participants was 59.5 years, with 49.8% (2683) of them being women. Unmet expectations ranged from 6.7% to 25.7%, with improvement in general physical capacity being the most important expectation fulfilled from surgery for 20% of patients. Factors such as longer symptom duration (OR: 0.74; 95% CI: 0.63-0.86), previous lumbar spine surgery (OR: 0.63; 95% CI: 0.46, 0.89), and reoperations (OR: 0.36; 95% CI: 0.2, 0.63) were associated with higher unmet expectations in the leg pain reduction dimension. Similar results were noted across all other expectation dimensions. Utilizing information on the preoperative factors in presurgical consultations can improve patient satisfaction and expectations from surgery.

Novel MRI semiquantitative scores for vertebral fat-water assessment in aging and spinal disorders

Novel MRI semiquantitative scores for vertebral fat-water assessment in aging and spinal disorders

Holistic efficacy of ayurvedic treatment modalities for spinal disorders: An observational study

This research investigates the effectiveness of Ayurvedic treatments for spinal disorders using a holistic, non-invasive approach. Conducted on 49 patients, the study incorporates five integrated modalities: external therapies, internal therapies, diet management, lifestyle modifications, and stress management. The results demonstrate significant symptom resolution rates, with up to 32.65% of patients achieving 90% improvement and 12.24% attaining complete relief. The findings underscore the value of Ayurveda in addressing spinal health through personalized, energy-focused care.

Effect of Rheumatoid Arthritis on Postoperative Outcomes in Patients with Lumbar Spinal Disorders: A Systematic Review and Meta-Analysis.

A systematic review and meta-analysis. This study aimed to determine whether rheumatoid arthritis (RA) is associated with clinical outcomes following spinal surgery for lumbar spinal disorders. MEDLINE, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform were comprehensively searched for observational studies comparing clinical outcomes after lumbar spine surgery in patients with and without RA (>18years). Quality assessment was conducted using the Quality in Prognosis Studies assessment tool. Pooled odds ratios (ORs) and hazard ratios were calculated for reoperation and surgical site infection by using a random effects model. Subgroup analyses were conducted to examine the effect of surgery type. Seven studies with 72,969 patients, including 7518 patients with RA, were analyzed. All studies had a moderate risk of bias. Patients with RA had a significantly higher odds of reoperation (OR: 5.57; 95% confidence interval [CI]: 1.10-28.26; I2 = 92%; P = 0.04) and higher odds of surgical site infection (OR: 1.47; 95% CI: 1.28-1.69; I2 = 2%; P < 0.01). No statistically significant difference was found in reoperation-free survival between patients with RA and those without RA (hazard ratio: 1.15; 95% CI: 0.94-1.40; I2 = 100%; P = 0.16). Patients with RA had higher complication rates, with incidence rates ranging from 13.5% to 57%, compared with those without RA. Compared with patients without RA, patients with RA may be more likely to undergo reoperations and suffer from complications following surgery for lumbar spine lesions.

Instrumented Facet Fusion in the Lumbosacral Spine: Long-Term Clinical and Radiographic Results.

Surgical treatments for degenerative lumbar spinal disorders involve decompression of neural structures and arthrodesis to address pain from unstable intervertebral segments. Lumbar instrumented facet fusion (IFF), a less invasive technique, has shown positive short-term outcomes, but reports on its long-term outcomes are scarce. This study aims to report its long-term biomechanical stability and clinical outcomes. This single-center retrospective observational case-series included patients who underwent single or two-level IFF for degenerative lumbar spinal disorders from January 1996 to January 2021. Patient demographics, Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores, and radiographic fusion were assessed using flexion-extension radiographs and CT scans. Instrument failures and fusion segment angles were measured. A total of 494 patients underwent instrumented facet fusion during the studied period. Of those, 208 were followed up for more than 24 months (mean follow-up of 89.96 +/- 55.59 months). The overall fusion rate was 92.05%. Revision surgery due to adjacent segmental disease was done in 11.06% of patients. Screw loosening was observed in 6 patients, of whom 2 underwent revision surgery. Significant improvements in ODI and VAS were observed. Instrumented facet fusion is a safe and less invasive alternative method of lumbar spinal arthrodesis with comparable fusion rate and clinical outcome. This method show relatively low revision rate.

Prevalence and breed predisposition for spinal diseases in pugs and French bulldogs.

Pugs and French bulldogs (FBDs) are commonly presented for spinal disease. The aim of this study was to define the most common spinal diseases in both breeds. This was a monocentric retrospective study including pugs and FBDs presenting with clinical signs consistent with spinal disease between 2010 and 2022. The information collected included signalment, onset of clinical signs, presence of spinal pain, progression of clinical signs, presence of urinary or faecal incontinence and neurological examination findings. A total of 439 FBDs with 448 diagnoses and 106 pugs with 125 diagnoses were included in the study. A total of 272 (62.0%) FBDs had an acute onset of clinical signs, and 79 pugs (74.5%) had a chronic onset. The most common disease in the FBD population was acute intervertebral disc extrusion, with 377 diagnoses (84.3%). The most common diagnoses among pugs were spinal arachnoid diverticula (SADs) (n = 30, 24.0%) and chronic intervertebral disc protrusion (n = 30, 24.0%). This study was limited by its retrospective nature, meaning that there was not a standardised diagnostic protocol. This study confirms that FBDs and pugs are affected by different spinal disorders. While FBDs are mostly affected by acute intervertebral disc extrusions, pugs are more often affected by SADs and chronic intervertebral disc protrusions.

Clinical application of visual minimally invasive acupotomy

Visual minimally invasive acupotomy is applicable for the diseases with the pathological characteristics of soft tissue injury, including disorders of spine, four limbs and joints, peripheral nerve compression and chronic soft tissues. The diseases with superior effect obtained are cervicogenic headache, lumbar disc herniation, carpal tunnel syndrome and flexor tendon stenosing tenosynovitis. Under the guidance with ultrasound, visual minimally invasive acupotomy is advantaged at preoperative diagnosis, intraoperative guidance and postoperative evaluation in clinical practice so that it is precise, safe and reliable in clinical treatment. Visual minimally invasive acupotomy is essentially a kind of "ultra-minimally invasive" technique in treatment, focusing on the self-rehabilitation of the body induced by external treatment measures. It is highly complementary to the repair and reconstruction of minimally invasive surgery of modern medicine in clinical application.

Diagnostic Dilemmas in Carpal Tunnel Syndrome and Cervical Spine Disorders: A Comprehensive Review.

Carpal tunnel syndrome (CTS) and cervical spondylosis (CS) are both common diseases, yet differentiation between the two is sometimes necessary. However, there are few evidence-based reviews on the differentiation of these conditions. This review examined the literature on the diagnosis of CTS and CS, focusing on how to distinguish between them. The analysis is divided into four categories: clinical symptoms, physical examination, diagnostic imaging, and electrodiagnosis. A total of 281 studies are reviewed, revealing a major issue: the inclusion criteria for defining each disease varies widely across studies. Understanding this limitation, the conclusion drawn is that no single clinical symptom, test, or imaging evaluation can be deemed uniquely reliable for diagnosing CTS or CS. Therefore, it is essential to apply the most up-to-date knowledge, conduct thorough examinations, and perform necessary tests for each patient to achieve a confident and accurate diagnosis.

Association between occupational exposure to pesticides and ototoxicity in farmers of Pontal do Paranapanema-SP, Brazil

The scope of this study was to assess the ototoxic effects and general health of farmers exposed to pesticides in the Pontal do Paranapanema region, SP, Brazil. Participants of both sexes aged 18-40, 40-60 and >60 years were allocated into two groups: Non-Exposed Group (NEG) and Occupationally Exposed Group (OEG). A questionnaire of exposure and health, meatoscopy, pure tone audiometry, logoaudiometry and immittanciometry were assessed. Cypermethrin, chlorpyrifos and glyphosate were the most reported pesticides. The most frequently reported exposure times were 0-10, 31-40 and 51-60 years. Headaches, visual and spinal disorders were the most common complaints, as well as hypertension and gastric and renal disorders. Only 35% (18-40) and 30% (40-60) of the OEG had good hearing perception. Rotational dizziness, ear infection, tinnitus and otalgia were reported. There was an increase in conventional and high frequency hearing thresholds in EWGs, at almost all frequencies and ages, as well as an alteration in the stapedial reflex. It was concluded that occupational exposure to pesticides has ototoxic potential and can harm general health.

Unveiling and Validating a Modified Method to Assess Cervical Sagittal Alignment as an Effective Substitute for Conventional C2-7 Cobb Angle.

Developing and validating a modified parameter, the SYS-G angle (the angle between the lower endplate of the C2 and the upper endplate of C7 vertebrae), as a feasible substitute for the C2-C7 Cobb method in assessing cervical sagittal alignment and exploring its reference range through a large-scale retrospective study. The visibility of the C6, C7 upper, and C7 lower endplates was graded and compared. Baseline data such as height, weight, body mass index (BMI), age, and sex were analyzed for their impact on the visibility of the C7 lower endplate. Values of C2-6 Cobb angle, SYS-G angle, and C2-7 Cobb angle were measured. The intra- and interobserver reliability, differences, and efficacy of evaluation on cervical lordosis of the parameters were compared, and the correlations among the parameters were analyzed. Furthermore, reference ranges for the SYS-G angle were established based on lateral cervical spine x-rays of 825 asymptomatic Chinese adults across different age groups and sexes. The visibility of the C7 lower endplates was significantly reduced compared to the C6 lower and C7 upper endplates. Age, weight, BMI, and male sex were identified as factors negatively influencing the visibility of the C7 lower endplate. Both intraobserver and interobserver reliability demonstrated excellence for all tested parameters. The linear regression model unveiled a stronger association of the SYS-G angle with the C2-7 Cobb angle compared to the C2-6 Cobb angle. Furthermore, the SYS-G angle exhibited excellent efficacy in evaluating cervical lordosis. Age displayed a positive correlation with the SYS-G angle, and across every age bracket from 20 to 69 years, men exhibited a higher mean SYS-G angle compared to women. The visibility of the C7 lower endplate diminishes with increasing age, weight, BMI, and male sex. In cases where the C7 lower endplate is unclear, the SYS-G angle emerges as a reliable method for estimating cervical sagittal morphology. Reference ranges for the SYS-G angle were established across various age groups and sexes among asymptomatic Chinese adults, offering a valuable resource to guide therapeutic interventions for cervical spine disorders and deformities.

Cervical Spondylosis: Innovative Techniques for Physical Therapy-An Updated Review

Cervical spondylosis is a degenerative disorder of the cervical spine affecting intervertebral discs, facet joints, and ligaments. It is commonly seen in individuals over 50 years old and presents with neck pain, stiffness, and potential neurological symptoms. The condition significantly impacts quality of life and contributes to increased healthcare costs and disability rates. Aim: This review explores innovative physical therapy techniques for managing cervical spondylosis, aiming to enhance symptom relief and functional recovery. Methods: A systematic review of recent literature was conducted to identify non-invasive, evidence-based physical therapy interventions. The review included randomized controlled trials, cohort studies, and meta-analyses published in peer-reviewed journals. The primary focus was on therapeutic exercises, manual therapy, neuromuscular re-education, and technology-assisted rehabilitation methods. Results: Innovative techniques such as cervical proprioceptive training, deep tissue mobilization, and neuromuscular electrical stimulation demonstrated significant improvements in pain reduction and functional mobility. Studies also highlighted the benefits of virtual reality-based rehabilitation and biomechanical feedback interventions in enhancing patient adherence and outcomes. Traditional methods, including cervical traction and postural correction exercises, remained effective but showed greater efficacy when combined with newer therapeutic approaches. Conclusion: Physical therapy plays a crucial role in managing cervical spondylosis. Combining traditional methods with innovative techniques leads to better pain control, improved mobility, and enhanced patient engagement. The integration of technology-based rehabilitation strategies may further optimize treatment outcomes. Future research should focus on long-term efficacy and cost-effectiveness of these approaches.

Evaluating the Outcomes of Minimally Invasive Techniques in Spinal Surgery

Background: There may be benefits to minimally invasive spine surgery (MISS) versus open surgeries. The results of MISS are assessed in this research in terms of safety, quality of life, pain alleviation, and functional improvement. Methods: Data from 136 patients who had MISS procedures performed at Peshawar's Khyber Teaching Hospital (KTH) between April 2022 and March 2024 were examined. Data from pre-, during-, and post-operation were gathered. The Oswestry Disability Index (ODI) was used to measure functional status, the Visual Analog Scale (VAS) was used to measure pain, and the SF-36 Health Survey was used to measure quality of life. SPSS version 25 was used for the statistical analysis, with a significance level of p &lt; 0.05. Results: The mean VAS ratings of the patients decreased from 7.8 preoperatively to 2.2 after 12 months (p &lt; 0.001), indicating considerable pain alleviation. There was a significant improvement in function as well; within the same time period, ODI scores decreased from 48% to 15% (p &lt; 0.001). The SF-36 physical and mental component scores increased from 32 and 40 preoperatively to 54 and 53 at 12 months, respectively (p &lt; 0.001), indicating a significant improvement in quality of life. 10% of patients had postoperative problems; there were no long-term neurological impairments, and 5% of cases returned. Conclusion: MISS successfully reduces pain, improves function, and improves quality of life while retaining a low incidence of problems and recurrences. These findings support the wider use of MISS for spinal disorders and point to the need of further studies with bigger sample numbers and longer follow-up periods.

Two-stage surgery with oblique lateral interbody fusion and posterior fixation in degenerative scoliosis with lumbosacral curve-driven degenerative lumbar scoliosis: a feasible option to prevent postoperative coronal decompensation

ObjectiveThis study aims to introduce a two-stage surgical procedure, namely oblique lateral interbody fusion (OLIF), for spinal disorders treatment. Furthermore, clinical outcomes and imaging results are analyzed between OLIF with posterior fixation and posterior lumbar interbody fusion (PLIF) with fixation for lumbosacral curve-driven degenerative lumbar scoliosis (DLS).Methods146 patients with type 2 DLS who underwent OLIF or PLIF between January 2019 and November 2023 were included. Spinal and pelvic parameters were measured using X-ray imaging before and after surgery. Clinical symptoms were assessed using Oswestry Disability Index (ODI) and visual analog scale (VAS). Operation time, intraoperative blood loss, surgical fixation segments, drainage tube indwelling time, and drainage volume were recorded.Results70 patients underwent OLIF and 76 underwent PLIF. Preoperative and postoperative clinical symptoms remain the same (p > 0.05). OLIF group exhibited significantly less intraoperative blood loss, fewer fixation segments, shorter drainage tube retention time, and reduced drainage volume (p < 0.01). Additionally, improvements in coronal parameters, including coronal balance distance, were more pronounced in OLIF group with less potential postoperative coronal imbalance (p < 0.05).ConclusionFor type 2 DLS, two-stage surgery of OLIF with posterior fixation represents a more efficient surgical approach, reducing surgical fusion segments, causing less trauma and bleeding, and effectively avoiding postoperative coronal plane decompensation than traditional posterior surgery.

The Potential Elimination of Blood Transfusions in Lumbar Spine Fusion Surgery: Clinical Case Series of 620 Consecutive Minimally Invasive TLIF Surgeries and Review of the Literature

Background Lumbar spine fusion is one of the most common surgical procedures performed in the operative management of adult degenerative spine disorders. The dual incision, mini-open TLIF surgery uses a minimally invasive surgical technique that decompresses neural elements through placement of an anterior interbody disc spacer and posterior stabilization with pedicle screws. It is well established that this approach results in significantly less muscle dissection than the open technique used in conventional TLIF, however a quantitative assessment of the need for blood transfusions during this procedure has been limited to relatively small case series. The aim of this study was to assess the incidence of blood transfusion amongst a large group of patients undergoing a mini-open dual incision TLIF procedure over an extended amount of time. A retrospective study was completed of 620 consecutive patients surgically treated with the Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF) procedure, the largest such study completed by a single surgeon at multiple institutions from 2004 to 2020. Methods The study sample comprises 620 patients who underwent a mini-open TLIF procedure through a dual incision technique for treatment of lumbar degenerative diseases from January 2004 to October 2020. No patients who underwent the procedure were excluded from the series. Surgical and medical record review was conducted to determine whether patients required blood transfusions during their hospitalization. No patients were lost to three-month follow up. Results The study group consisted of 620 patients, 332 women and 288 men. Ages ranged from 20 to 88 years old with a mean age of 54 years. No patients in the series required a blood transfusion during their surgery, hospitalization, or 3-month postoperative period. Conclusions The dual incision MIS Mini-open transforaminal lumbar interbody fusion allows for decompression of neural elements, pedicle screw instrumentation, and placement of an anterior interbody cage while potentially eliminating the need for blood transfusions. While previous studies have shown the potential for reduced blood loss with the mini-open technique compared to the open technique, this study adds a significant volume of data-driven evidence to support this conclusion. As such, this study represents the largest single-surgeon case series to show consistent absence of blood transfusions with a mini-open TLIF technique over sixteen years.