Degenerative Spine Research Articles

Frailty as a Predictor of Postoperative Morbidity and Mortality in Patients Aged 80 Years and Older Undergoing Instrumented Fusion.

Degenerative spine disease is a leading cause of disability, with increasing prevalence in the older patients. While age has been identified as an independent predictor of outcomes, its predictive value is limited for similar older patients. Here, we aimed to determine the most predictive frailty score of adverse events in patients aged 80 and older undergoing instrumented lumbar fusion. We proceeded with a multisite (3 tertiary academic centers) retrospective review including patients undergoing instrumented fusion aged 80 and older from January 2010 to present. A composite end point encompassing 30-day return to operating room, readmission, and mortality was created. We estimated the area under the receiver operating characteristic curve for frailty scores (Modified Frailty Index-5 [MFI-5], Modified Frailty Index-11 [MFI-11], and Charlson Comorbidity Index [CCI]) in relation to that composite score. In addition, we estimated the association between each score and the composite end point by means of logistic regression. A total of 153 patients with an average age of 85 years at the time of surgery were included. We observed a 30-day readmission rate of 11.1%, reoperation of 3.9%, and mortality of 0.6%. The overall rate of the composite end point at 30 days was 25 (15.1%). The AUC for MFI-5 was 0.597 (0.501-0.693), for MFI-11 was 0.620 (0.518-0.723), and for CCI was 0.564 (0.453-0.675). The association between the scores and composite end point did not reach statistical significance for MFI-5 (odds ratio [OR] = 1.45 [0.98-2.15], P = .061) and CCI (OR = 1.13 [0.97-1.31], P = .113) but was statistically significant for MFI-11 (OR = 1.46 [1.07-2.00], P = .018). This is the largest study comparing frailty index scores in octogenarians undergoing instrumented lumbar fusion. Our findings suggest that while MFI-11 score correlated with adverse events, the predictive ability of existing scores remains limited, highlighting the need for better approaches to identify select patients at age extremes.

The Impact of Posterior Intervertebral Osteophytes on Patient-Reported Outcome Measures After L5-S1 Anterior Lumbar Interbody Fusion and Transforaminal Lumbar Interbody Fusion.

Retrospective cohort study. (1) To develop a reliable grading system to assess the severity of posterior intervertebral osteophytes and (2) to investigate the impact of posterior intervertebral osteophytes on clinical outcomes after L5-S1 decompression and fusion through anterior lumbar interbody fusion (ALIF) and minimally-invasive transforaminal lumbar interbody fusion (MIS-TLIF). There is limited evidence regarding the clinical implications of posterior lumbar vertebral body osteophytes for ALIF and MIS-TLIF surgeries and there are no established grading systems that define the severity of these posterior lumbar intervertebral osteophytes. A retrospective analysis of patients undergoing L5-S1 ALIF or MIS-TLIF was performed. Preoperative and postoperative patient-reported outcome measures of the Oswestry Disability Index (ODI) and leg Visual Analog Scale (VAS) at 2-week, 6-week, 12-week, and 6-month follow-up time points were assessed. Minimal clinically important difference (MCID) for ODI of 14.9 and VAS leg of 2.8 were utilized. Osteophyte grade was based on the ratio of osteophyte length to foraminal width. "High-grade" osteophytes were defined as a maximal osteophyte length >50% of the total foraminal width. A total of 70 consecutive patients (32 ALIF and 38 MIS-TLIF) were included in the study. There were no significant differences between the two cohorts in patient-reported outcome measures or achievement of MCID for Leg VAS or ODI preoperatively or at any follow-ups. On multivariate analysis, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with leg VAS or ODI scores at any follow-up time point. In addition, neither the surgical approach nor the presence of high-grade foraminal osteophytes was associated with the achievement of MCID for leg VAS or ODI at 6 months. ALIF and MIS-TLIF are both valid options for treating degenerative spine conditions and lumbar radiculopathy, even in the presence of high-grade osteophytes that significantly occupy the intervertebral foramen. 3.

Safety and efficacy of autologous bone marrow clot as a multifunctional bioscaffold for instrumental posterior lumbar fusion: a 1-year follow-up pilot study.

Bone marrow aspirate (BMA), when combined with graft substitutes, has long been introduced as a promising alternative to iliac crest bone graft in spinal fusion. However, the use of BMA is limited by the absence of a standardized procedure, a structural texture, and the potential for diffusion away from the implant site. Recently, the potential use of a new formulation of BMA, named BMA clot, has been preclinically described. In this report, we present the results of a prospective pilot clinical study aimed at evaluating the safety and efficacy of autologous vertebral BMA (vBMA) clot as a three-dimensional and multifunctional bioscaffold in instrumented posterior lumbar fusion. Ten consecutive patients with an indication of multilevel (≤5) posterior spinal fusion due to lumbar spine degenerative diseases were included in the study and treated with vBMA. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and EuroQoL-5L (EQ-5L) preoperatively and at 3 months and 12 months after spinal fusion. Bone fusion quality was evaluated at the 12-month follow-up using the Brantigan classification on radiography (XR) imaging. Bone density was measured on computed tomography (CT) scans at 6 and 12 months of follow-up visits at the intervertebral arches and intervertebral joint areas and expressed in Hounsfield unit (HU). The results indicate a successful posterolateral fusion rate of approximately 100% (considering levels with C, D, and E grades according to the Brantigan classification) at the 12-month follow-up, along with an increase in bone density from 6 to 12 months of follow-up. An improvement in the quality of life and health status following surgery, as assessed by clinical scores (ODI, VAS, and EQ-5L), was also observed as early as 3 months postsurgery. No adverse events related to the vBMA clot were reported. This prospective pilot study demonstrates the effectiveness and safety profile of vBMA clot as an advanced bioscaffold capable of achieving posterior lumbar fusion in the treatment of degenerative spine diseases. This lays the groundwork for a larger randomized clinical study.

Cross-cultural adaptation, validation and establishment of the minimal clinically important change score of the European Portuguese core outcome measures index in patients with lumbar degenerative spine disease.

The core outcome measures index (COMI) for the back is a questionnaire that evaluates five domains and has been translated into several languages and validated for different populations. We aimed to translate, cross-culturally adapt and validate it in European Portuguese for use in patients with degenerative lumbar disease. Additionally, we aimed to establish the minimal clinically important change score (MCIC). The translation and cultural adaptation were done according to published guidelines. Patients awaiting surgery at a neurosurgical center completed the COMI, Oswestry Disability Index (ODI), EQ-5D questionnaires and a pain visual analog scale (VAS). To evaluate COMI's reproducibility, patients completed the questionnaire twice within two weeks, preoperatively, in addition to answering a transition question. The MCIC was determined by analysis of postoperative changes in total COMI score, using the anchor method, with a question ascertaining surgical outcome as perceived by the patient. The first set of questionnaires was answered by 108 patients and the second, by 98 patients. COMI's construct validity was confirmed by demonstrating the hypothesized correlation between each domain's score (Spearman Rho > 0.4) and the corresponding questionnaire score (ODI, EQ-5D and VAS) and through adequate correlation (Spearman > 0.6) between COMI's total score and ODI and EQ-5D total scores. Intraclass correlation coefficients between each domain and COMI's total score were > 0.8. The MCIC was calculated as 2.1. The cross-culturally adapted COMI questionnaire is a valid clinical assessment tool for European Portuguese-speaking patients with degenerative lumbar disease, with an MCIC of 2.1 points.

Cerebrospinal Fluid Lysophosphatidylcholine Species for Distinguishing Narrowing of the Lumbar Spine

ContextReoperation, sometimes multiple, is common with progressively worse outcomes in patients with degenerative lumbar spine diseases. Lysophosphatidylcholine (LPC), a precursor of lysophosphatidic acid, in the cerebrospinal fluid (CSF) is a possible biomarker for neuropathic pain and discriminating neuropathic pain caused by lumbar spinal canal stenosis (LSCS) from other etiologies. This study aimed to explore this possible use of LPC species in the CSF. DesignUsing liquid chromatography-tandem mass spectrometry, we measured six LPC species, (16:0), (18:0), (18:1), (18:2), (20:4), and (22:6), in the CSF. Setting[Multi-site observational study] ParticipantsPatients with LSCS (n=137) and persistent spinal pain syndrome (PSPS, n=22). InterventionsCSF collection using lumbar puncture. Outcome MeasuresWe compared the LPC values between the groups and determined the cutoff levels that could efficiently discriminate the groups with high accuracy. ResultsThe levels of all measured LPC species were significantly higher in the LSCS group than the PSPS group. Four LPC species demonstrated more than 0.80 area under the curve obtained from the receiver operating characteristic curve analysis. Although the specificity of cutoff levels for the six LPC species was low to moderate, their sensitivity was consistently high. ConclusionThe existing diagnostic protocols combining physical examinations and morphological imaging studies for lumbar spinal pain have limited sensitivity. Measuring LPC species in the CSF is a promising objective laboratory test and could be suitable for detecting the presence of lumbar spinal stenosis and can help indications for surgery.

The impact of paraspinal muscle morphology on functional outcome in patients with degenerative lumbar spine disease undergoing surgery - A prospective observational study

IntroductionParaspinal muscle atrophy has been implicated in low back pain (LBP) as well as degenerative disc disease, lumbar spinal stenosis, and disc herniation. The objective of the study was to determine the association of paraspinal muscle morphology with functional outcomes in patients undergoing spine surgery in degenerative spine diseases. Research questionCan the degree of paraspinal muscle atrophy be a reliable prognostic indicator of post-operative functional outcome in patients undergoing surgery for degenerative lumbar spine disease? Materials and methodsForty-one patients with degenerative lumbar spine disease planned for surgery were included. Pre-operative and postoperative MRI-based muscle morphology including total cross-sectional area (TCSA) and muscle atrophy were recorded. Association between muscle parameters and functional status as indicated from the visual analogue scale (VAS), and Oswestry Disability Index (ODI) were assessed, and compared between prior and after surgery. ResultsThe MF and ES cross-sectional area on MRI was in proportion to the functional status. (higher ODI and VAS). Preoperative MF TCSA was positively correlated with preoperative ODI ((r = −0.441, p = = 0.032), preoperative VAS (r = −0.338, p = 0.048) and was negatively correlated with change in ODI (r = −0.268, p = 0.016) while preoperative ES TCSA was negatively correlated with preoperative ODI (r = −0.420, p = 0.003). Preoperative ODI, change in ODI and preoperative VAS had significant correlation with muscle atrophy (p < 0.05). There was a positive correlation between preoperative ODI with Grade 2 (r = 0.332, p = 0.016) and Grade 3 (r = 0.299, p = 0.048) MF muscle; and Grade 2 (r = 0.308, p = 0.067) and Grade 3 (r = 0.202, p = 0.018) ES muscles atrophy. The change in ODI, negatively correlated with Grade 3 MF and ES atrophy (r = −0.332, p = 0.018 and r = −0.286, P = 0.011 respectively). Linear regression analysis showed duration of symptom (p = 0.005) was positively associated with preoperative ODI. Age and BMI were negatively associated with improvement in ODI. (p = 0.073, 0.098 respectively). Discussion and conclusionPreoperative paraspinal muscle area is an independent variable that affects preoperative functional status. The grade of paraspinal muscle atrophy is a good predictor of preoperative, postoperative and improvement in functional status.

Substance P Level in Patients with Degenerative Lumbar Spine Disorder undergoing Decompressive Surgery: An Observational Study

Introduction: Patients with degenerative lumbar spine disorders experience Chronic Low Back Pain (CLBP) for which they undergo decompressive surgery. Substance P (SP), a neurotransmitter which acts as a modulator of pain perception and transmits nociceptive signals via primary afferent fibers to the spinal cord and brainstem. In chronic painful conditions, SP level can be associated with the severity of pain and gets altered; however, this correlation is not present in acute pain. Aim: To evaluate serum SP level in CLBP patients undergoing decompressive spine surgery. Materials and Methods: The present study was a prospective observational study, in which 30 patients with CLBP undergoing decompressive spine surgery were enrolled. Along with them, one first-degree relative of each patient and an equal number of healthy volunteers were included in the study group. Patients were followed-up on the 5th postoperative day and at two months after surgery for the evaluation of SP levels and Visual Analogue Scale (VAS) scores. Statistical data analysis was carried out using IBM PASW Statistics (SPSS) 25.0 version software. SP levels followed a non normal distribution and were compared by Mann-Whitney U or Kruskal Wallis test (for 2 or more groups, respectively) and correlated using Spearman rank correlation. Results: Patients undergoing decompressive spine surgery had a significantly higher SP level (97.5 picogram/mL (pg/mL)) than healthy volunteers (23.22 pg/mL), p-value &lt;0.001. The serum SP levels in patients were found to be significantly reduced on the 5th postoperative day (31.7 pg/mL) and at two months after surgery (48.5 pg/mL), p-value=0.043. In contrast, there was no discernible change in the VAS score, which did not correlate with the fall in SP levels on the 5th postoperative day. Conclusion: SP level was elevated in subjects with degenerative lumbar spine disorders undergoing decompressive surgery. Higher levels of SP can be attributed to CLBP in those patients. SP can be contemplated as a biomarker of pain due to degenerative lumbar spine pathology. However, further studies are warranted to substantiate this.

Defining role of atlantoaxial and subaxial spinal instability in the pathogenesis of cervical spinal degeneration: Experience with "only-fixation" without any decompression as treatment in 374 cases over 10 years.

The authors analyze their published work and update their experience with 374 cases of cervical radiculopathy and/or myelopathy related to spinal degeneration that includes ossification of the posterior longitudinal ligament (OPLL). The role of atlantoaxial and subaxial spinal instability as the nodal point of pathogenesis and focused target of surgical treatment is analyzed. During the period from June 2012 to November 2022, 374 patients presented with acute or chronic symptoms related to radiculopathy and/or myelopathy that were attributed to degenerative cervical spondylotic changes or due to OPLL. There were 339 males and 35 females, and their ages ranged from 39 to 77 years (average 62 years). All patients were treated for subaxial spinal stabilization by Camille's transarticular technique with the aim of arthrodesis of the treated segments. Atlantoaxial stabilization was done in 128 cases by adopting direct atlantoaxial fixation in 55 cases or a modified technique of indirect atlantoaxial fixation in 73 patients. Decompression by laminectomy, laminoplasty, corpectomy, discoidectomy, osteophyte resection, or manipulation of OPLL was not done in any case. Standard monitoring parameters, video recordings, and patient self-assessment scores formed the basis of clinical evaluation. During the follow-up period that ranged from 3 to 125 months (average: 59 months), all patients had clinical improvement. Of 130 patients who had clinical evidences of severe myelopathy and were either wheelchair or bed bound, 116 patients walked aided (23 patients), or unaided (93 patients) at the last follow-up. One patient in the series was operated on 24 months after the first surgery by anterior cervical route for "adjacent segment" disc herniation. No other patient in the entire series needed any kind of repeat or additional surgery for persistent, recurrent, increased, or additional related symptoms. None of the screws at any level backed out or broke. There were no implant-related infections. Spontaneous regression of the size of osteophytes was observed in 259 patients where a postoperative imaging was possible after at least 12 months of surgery. Our successful experience with only spinal fixation without any kind of "decompression" identifies the defining role of "instability" in the pathogenesis of spinal degeneration and its related symptoms. OPLL appears to be a secondary manifestation of chronic or longstanding spinal instability.

The relationship between osteoporotic vertebral fractures and spine degeneration on the occurrence of complications: A systematic review

The relationship between osteoporotic vertebral fractures and spine degeneration on the occurrence of complications: A systematic review

Late presenting dural tears after surgery for degenerative lumbar spine disease

Late presenting dural tears after surgery for degenerative lumbar spine disease

ARTRODESE CERVICAL VIA ANTERIOR: ENXERTO AUTÓLOGO OU SINTÉTICO?

ABSTRACT Objective: To compare patients who underwent anterior cervical arthrodesis with autologous iliac crest graft and those who used synthetic graft. Methods: Analysis of 38 patients aged between 18 and 100 years with anterior cervical spondylosis of 1 or 2 levels in a spine surgery service. Results: degenerative cervical spine changes associated with cervicalgia and cervicobrachialgia. Excluded: previous cervical spine surgeries, fractures, or surgery above two levels. Two groups were formed with 19 patients, one using autologous graft and the other using synthetic tricalcium phosphate - a questionnaire assessed satisfaction (Oswestry and VAS) pre- and postoperatively. Bone consolidation was evaluated by tomography at nine months. Results: Mean ODI (Group 1) was 68.5% ± 4.6% preoperatively and 27.2% ± 3.8% postoperatively, being statistically relevant (p&lt;0.001). VAS performed to evaluate the cervical region, Group 1 pre and post-op was considered statistically relevant (p&lt;0.001). No significant difference was observed when comparing the mean values found in the postoperative period between Group 1 and Group 2 (p=0.463). Only two patients complained of chronic pain, representing 10% of the total. In nine-month tomography, 100% of patients in Group 1 and 100% of Group 2 showed bone consolidation, with no statistically relevant difference (p=0.676) between the groups. Conclusion: Similar functional and osteointegration outcomes were observed in both types of grafts. Synthetic graft minimizes the risks and complications of using allografts. Level of Evidence III; Retrospective comparative study.

Hip-spine syndrome: Diagnostic difficulties

Introduction. Hip-spine syndrome (HSS) is a combination of coexisting hip osteoarthritis (OA) and degenerative lumbar spine stenosis (LSS). Main difficulties in treating patients with HSS are in early diagnostics and in choosing right surgery, because mistakes lead to pain maintenance. Existing diagnostic algorithms show right surgery choosing failure in 15–20%. We present results of examination patients with HSS in our survey.The aim – to present clinical and instrumental results of examination of patients with hip-spine syndrome.Materials and methods. We have examined 378 patients with typical pain pattern (buttocks, low back spine, groin and lateral hip) and difficulties in pain source definition. We performed hip X-rays and low back spine MRI.Due to results we divided patients into three groups – patients with HSS (n=100), with hip OA (n=172) and patients with LSS (n=106). We used Harris Hip Score, Oswestry Disability Index and Visual Analogue Score to determine hip and lumbar spine functional status and pain level.Results. Patients with HSS had higher (p&lt;0.05) pain levels (76.5±9.1 mm) than patients with hip (68.3±7.9 mm) or lumbar spine pathology (67.4±7.9 mm). Harris Hip Score in patients wirh HSS (52.7±8.1 points) was same as in patients with hip OA (55.5±9.1 points), Oswestry Disability Index in these patients (44.2±7.6%) was same as in patients with LSS (43.2±7.8%).Conclusion. High pain level and low Harris Hip Score and Oswestry index, along with clinical examination, on first visit can help suspect hip-spine syndrome and recommend both hip and lumbar spine imaging.

Reduced mortality in patients over 65 years old that undergo surgery for degenerative spine disease

Reduced mortality in patients over 65 years old that undergo surgery for degenerative spine disease

Traction treatment, underwater traction therapy, weight bath cabin

Thermal waters are important and multifunctional natural resources for renewable energy, recreation, health-tourism and their use in balneotherapy is particularly well known. Many degenerative spine diseases can be successfully treated with traction treatments. As a result of traction, the height of the discs adjusts, the disc protrusions retract, and canals of the nerve roots expand. Compared to dry traction treatment, underwater traction treatment has many advantages. Due to the effect of warm water, we do not have to count on muscle protection. Thanks to the buoyant force, a very careful traction can be achieved. Thanks to this, this treatment can be considered the safest and most effective traction treatment. With our innovative weight bath cabin, you can carry out an individualized, safe and successful weight bath treatment. In our weight bath cabin, we can effectively combine traction treatment and medicinal water treatment.

Standardizing physical activity monitoring in patients with degenerative spine disorder

Standardizing physical activity monitoring in patients with degenerative spine disorder

A comparative study of perioperative pain, blood loss, and hospital stay in an Indian population undergoing mini-open oblique lumbar interbody fusion versus open transforaminal lumbar interbody fusion.

There are several approaches for lumbar fusion, although there is yet to be a consensus on which approach is the best. This study aimed to evaluate the intraoperative blood loss and acute postoperative pain in single-level mini-open oblique lumbar interbody fusion (OLIF) versus open transforaminal lumbar interbody fusion (TLIF) surgeries for the degenerative spine. Thirty-two patients were assigned by the surgeon to OLIF or TLIF groups - 16 in mini-open OLIF and 16 in open TLIF groups. The intraoperative blood loss and postoperative hemoglobin, numerical rating scale (NRS) at proposed time intervals for 24 h postoperative, and rescue analgesics used were compared among the groups. The operative duration and hospital stay in both groups were also compared. The OLIF group showed significantly higher postoperative hemoglobin (11.5 vs. 10.5 g %, P = 0.04), lower 24-h postoperative pain scores on movement, (NRS 4 vs. 5.5, P = 0.0001), and shorter hospital stay (4.5 vs. 7 days, P = 0.003) than TLIF group. However, the surgery duration was significantly longer in OLIF than in TLIF (190 vs. 150 min, P = 0.005). Intraoperative hemodynamics, other postoperative pain scores at variable time points, and rescue analgesics given were comparable among groups (P > 0.05). Intraoperative blood loss was lower in OLIF than TLIF (275 vs. 500 mL) but was not statistically significant (P > 0.05). Mini-open OLIF has favorable perioperative outcomes compared to open TLIF. Patients have higher postoperative hemoglobin and lesser pain on movement on the first postoperative day, leading to earlier mobilization and a shorter hospital stay.

Monocentric experience of transforaminal endoscopic lumbar discectomy and foraminotomy outcomes: pushing the indications and avoiding failure. Report of 200 cases.

This paper reports the results of the treatment of our first 200 cases of lumbar disc herniation and foraminal stenosis using full-endoscopic transforaminal lumbar discectomy (FETLD). We analyzed outcomes and radiological parameters to overcome failure and inappropriate indications and also highlighted the red flags for surgeons coming to this field as well as the pathways to success. Data on endoscopic procedures were retrospectively analyzed between October 2018 and March 2023. We abstracted sex, age, leg pain by NPRS, postoperative satisfaction according to the MacNaab score, postoperative surgical complications/adverse events (≤30 days), and history of any previous surgery. Furthermore, we measured different radiological parameters to determine the grade of stenosis or discopathy. Once the learning curve was completed, patients' satisfaction increased to 94%, with only a small percentage (6%) of patients unsatisfied 30 days after the operation. Perioperatively, 33.5% of the patients experienced mild to moderate transitory paresthesia. Univariate analysis showed a tendency toward a higher risk of failure in those patients with degenerative listhesis (odds ratio [OR] 4.8, 95% CI 0.97-23.9, P=0.055) as well as those with severely degenerated discs (OR 8.7, 95% CI 0.96-79.4, P=0.054). Conversely, the chances of failure seemed to be lower in patients with severe foraminal stenosis. FETLD proved its efficacy in treating several degenerative spine conditions or was useful for avoiding previous scarring in patients already operated on to the same extent. Therefore, FETLD can be safely used in patients with comorbidities, the elderly, and when the invasiveness of an open technique is not suitable.

Effectiveness of spinal traction in degenerative spine diseases. (A literature review)

To analyze sources of scientific and technical literature and study materials of meta-analyses, systematic reviews on the issues of evaluation of the spinal traction effectiveness (dry and underwater, horizontal and vertical) in the treatment of patients with degenerative spine diseases. An analysis of 67 sources, including 54 periodical articles, 5 meta-analyses and 8 systematic reviews was conducted. The search depth was 20 years. The ability of the spinal traction method to influence on the pain intensity, functional state, general improvement or return to work in patients with degenerative spine diseases has been identified. There has been a statistically significant regression of lumbar and radicular pain under the influence of «dry» horizontal tractions of the spine (13389 patients with degenerative spine diseases received them), including in combination with physiotherapy (vibration, impulse currents, laser therapy), and there has been an improvement in the motor function of the spine, a decrease in the disability rate in patients with herniated disks. These results were also obvious in short-term observation (up to 3 months after intervention). Underwater traction (5533 patients received it) had a positive impact on pain syndrome at rest and during activity, increased the activity of patients. All registered effects were related to short-term effect for up to 3 months after the intervention. The evidence, based on the materials of meta-analyses and systematic reviews of medium and low quality, that «dry» and underwater spinal traction can be considered as a therapeutic tool for short-term (within 3 months) reducing pain and disability in patients with lumbar pain and lumbar radiculopathy, is presented.

The prevention of infectious complications in degenerative spine surgery with sodium aminodihydrophthalazinedione use

The prevention of infectious complications in degenerative spine surgery with sodium aminodihydrophthalazinedione use

Characteristics of attrition of patients enrolled into the CSORN registry and prospective studies for degenerative spine surgery

Characteristics of attrition of patients enrolled into the CSORN registry and prospective studies for degenerative spine surgery