Spine Surgery Techniques Research Articles

Disparity in Resource Utilization of motion-sparing Anterior Cervical Spine Surgery: An analysis of NSQIP® and PearlDiver® Database.

Widespread racial, gender-related, socioeconomic and insurance-related disparities have been widely implicated in the utilization of new and improved surgical techniques including various aspects spinal surgery. A comprehensive analysis of such disparities is lacking for motion-preserving techniques in cervical spine surgery. To explore the disparities in resource utilization of motion-sparing technology in cervical spine surgery. Retrospective Review of large database PATIENT SAMPLE: NSQIP® database from 2010-2021 and PearlDiver® database from 2010-2022 were queried. CPT codes for cervical disc arthroplasty (CDA), and anterior cervical discectomy and fusion (ACDF) were utilized to isolate the case records (Table 1 and 3). Pre-operative clinical, racial, and gender data were investigated utilizing NSQIP®. PearlDiver® was used for area-level family income, education, insurance status and unemployment. Chi-square, Kruskal-Wallis and logistic regression were used for univariable categorical, continuous and multivariable analyses, respectively. A total of 5,912 and 32,625 CDA cases and 69,701 and 526,851 ACDF cases were isolated from NSQIP® and PearlDiver®, respectively. 'Younger' age, 'Asian Pacific Islander' race and elective surgery (p<0.001), were associated with undergoing CDA in NSQIP® database. Presence of Type 1 diabetes, smoking and hypertension (HTN) (p<0.001) were associated with undergoing ACDF in NSQIP®. PearlDiver® database showed 'Younger' age, higher area-level 'Family Income', and a higher mean percent of patients with 'private health insurance' (p<0.001) were associated with undergoing CDA. Higher area level unemployment was associated with ACDF. Wide spread racial, gender-related, and socioeconomic disparities have been observed. Identification of these disparities is sentinel for implication of change in health-care policy mitigating issues such as underinsurance leading to establishment of health equity.

Prediction of the upright articulated spine shape in the operating room using conditioned neural kernel fields

Anterior vertebral tethering (AVT) is a non-invasive spine surgery technique, treating severe spine deformations and preserving lower back mobility. However, patient positioning and surgical strategies greatly influences postoperative results. Predicting the upright geometry from pediatric spines is needed to optimize patient positioning in the operating room (OR) and improve surgical outcomes, but remains a complex task due to immature bone properties. We propose a framework used in the OR predicting the upright spine geometry at the first visit following surgery in idiopathic scoliosis patients. The approach first creates a 3D model of the spine while the patient is on the operating table. For this, multiview Transformers that combine images from different viewpoints are used to generate the intraoperative pose. The postoperative upright shape is then predicted on-the-fly using implicit neural fields, which are trained from geometries at different time points and conditioned with surgical parameters. A Signed Distance Function for shape constellations is used to handle the variability in spine appearance, capturing a disentangled latent domain of the articulation vectors, with separate encoding vectors representing both articulation and shape parameters. A regularization criterion based on a pre-trained group-wise trajectory of spine transformations generates complete spine models. A training set of 652 patients with 3D models was used to train the model, tested on a distinct cohort of 83 surgical patients. The framework based on neural kernels predicted upright 3D geometries with a mean 3D error of 1.3±0.5mm in landmarks points, and IoU of 95.9% in vertebral shapes when compared to actual postop models, falling within the acceptable margins of error below 2 mm.

Which Spine Surgery Techniques Are Most Appealing to the Public? A Survey Examining Public Perception of Spine Surgery Techniques and Factors Associated with Procedure Preference

Which Spine Surgery Techniques Are Most Appealing to the Public? A Survey Examining Public Perception of Spine Surgery Techniques and Factors Associated with Procedure Preference

Basics and Surgical Techniques for Adult Spinal Deformity

Adult spinal deformity(ASD) is a condition in which the spinopelvic alignment changes owing to age-related degeneration, making it difficult to maintain a standing position. The goal of surgery for ASD is to correct the spine and obtain normal alignment. Here, we discuss the pathophysiology of ASD, spinopelvic alignment, surgical methods, and complications. Circumferential minimally invasive surgery for ASD comprises an anterior approach using lateral lumbar interbody fusion and a posterior approach using percutaneous pedicle screws. Complications include perioperative and implant-related complications, both of which can be serious. Computer-assisted devices are useful for avoiding these complications. Circumferential minimally invasive surgery requires various spine surgery techniques, most of which are performed daily. Circumferential minimally invasive surgery can be achieved by gaining a solid understanding of the theory and improving the accuracies of the basic procedures.

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.

Surgical Outcomes of Unilateral Biportal Endoscopy Versus Full Endoscopy for Lumbar Canal Stenosis: A Meta-Analysis.

Lumbar canal stenosis (LCS) is a common cause of chronic lower back pain in the elderly. Traditionally, open decompression surgery has a prolonged recovery, higher blood loss, and more complications. As a result, there remains no clear consensus on which of these minimally invasive spine surgery (MISS) techniques, including unilateral biportal endoscopy (UBE) and full endoscopy (FE), is the optimal technique for LCS treatment.A systematic review and meta-analysis were accomplished to compare the surgical results of UBE versus FE for lumbar canal stenosis in regard to surgical success, postoperative pain control, operative times, complication rates, and functional outcomes. Studies from2024 were searched comprehensively in PubMed, Scopus, and other databases. Randomized controlled trials (RCTs) and experimental studies comparing UBE with FE were included. Surgical success rates, pain scores (visual analog scale (VAS)), recovery time, and complications were the key outcomes analyzed. Five studies (sample size: 32-163) were included. High surgical success and no significant difference in pain relief were demonstrated by both UBE and FE. UBE was associated with significantly quicker recovery times (odds ratio (OR): 0.54, 95% confidence interval (CI): 0.35-0.83, P = 0.01). The complication rates were lower with UBE compared with FE. Both techniques improved functional outcomes, but UBE had a slight advantage in recovery time. Both UBE and FE present effective treatments for LCS, and UBE is superior concerning recovery time. The choice of technique should be based on the patient's characteristics, and surgical goals should be tailored to each individual patient.

Robotic vs. Conventional Spinal Fusion Techniques in Spine Surgery: A Systematic Review and Meta-analysis of Accuracy in 3,181 Patients

Robotic vs. Conventional Spinal Fusion Techniques in Spine Surgery: A Systematic Review and Meta-analysis of Accuracy in 3,181 Patients

Predictors of cost of admission for robot-assisted pedicle screw placement.

The authors investigated the predictors of cost of admission (CoA) for robot-assisted pedicle screw placement to assess the value of robotic systems in spine operations. Demographic, operative, and postoperative variables were retrospectively collected from 506 patients undergoing robot-assisted spine surgery utilizing the ExcelsiusGPS robot at two high-volume tertiary care centers from 2017 to 2023. Perioperative parameters were evaluated against total hospital admission cost utilizing the Kruskal-Wallis and Wilcoxon rank-sum tests followed by multivariable linear regression. The majority of patients were female (53.6%), 50-80 years of age (77.7%), and White (73.9%); had at least 1 comorbidity (58.1%); and presented with an average functional preoperative Frankel grade (57.5%). The mean CoA was $69,458 ± $47,910. On univariable analysis, demographic data including sex, age, race, and Frankel grade were not associated with CoA. The presence of a comorbidity, however, was associated with increased CoA (p < 0.001). Intraoperatively, one-third of the operations (31.8%) were revisions from prior operations and were subsequently associated with increased CoA (p = 0.021). Thoracic-level operations constituted roughly one-quarter of the cohort (24.1%) and were also associated with increased CoA (p < 0.001). Intraoperative durotomies occurred in 7.7% of patients, leading to increased CoA (p = 0.003). Extended surgical durations also demonstrated elevated CoA (p < 0.001). Postoperatively, the median length of stay (LOS) was 3 days, and an LOS of greater than 3 days was one of the primary drivers of cost (p < 0.001). Postoperative complications occurred in just 6.3% of the cohort but were also associated with increased CoA (p < 0.001). On multivariable analysis, LOS, number of screws placed, operative duration, and postoperative complications were the primary predictors of increased CoA. Understanding the drivers of cost in robot-assisted pedicle screw placement is crucial to elucidate the value associated with the use of robotic systems in spine surgery. These results indicate that patient and surgical complexity influence cost and that robotic systems may augment management in spine surgery. Further investigation is warranted to determine the long-term benefits and cost-effectiveness of new technologies compared with traditional techniques in spine surgery.

Full-endoscopic spinal decompression or discectomy show benefits regarding 30-day readmission rates when compared to other spine surgery techniques: A propensity score matched analysis

Background and contextUnplanned readmission within 30 days following elective spine surgery is a key indicator of quality of care, as readmissions often signal early complications or poor recovery. The Hospital Readmission Reduction Program (HRRP) and the Centers for Medicare and Medicaid Services (CMS) utilizes this metric to assess hospital and surgeon performance. PurposeHere we aim to delineate quality of care metrics for full-endoscopic spine surgery (FESS) compared to traditional spine surgery. DesignThe study was a retrospective multicenter analysis comparing outcomes of propensity matched cohorts. Patient sampleThe study included 908 FESS patients operated between 2014 and 2023 and a matched cohort of 73,906 non-FESS patients. Outcome measuresOur primary outcome measures were postoperative 30-day hospital readmissions and revision surgery. Furthermore, demographic data, hospitalization, surgical details and comorbidities were included. MethodsData were collected from 6 participating institutions. Patients older than 18 years undergoing non-instrumented FESS spine surgeries for degenerative lumbar spinal pathologies from 2016-2023 were included. A matched non-FESS cohort was identified in the ACS-NSQIP database (2015-2019). Propensity-score matching was used to compare the cohorts. ResultsBefore matching, the 30-day readmission rate was significantly lower in the FESS cohort (1.1% vs. 4.4%, p < 0.001), which remained consistent after matching (1.1% vs. 4.5%, p < 0.001). The rate of 30-day surgical revisions was similar between cohorts (1.0% vs. 1.1%, p = 0.63). Multivariate analysis indicated a significant correlation between FESS and reduced 30-day readmissions (odds ratio [OR] 0.28, 95% CI 0.14 to 0.57, p < 0.001). ConclusionThis study is the first to compare 30-day hospital readmissions between FESS and non-endoscopic surgeries in a large, matched multicenter cohort. FESS significantly reduces both the length of postoperative hospital stay and 30-day readmission rates compared to non-endoscopic approaches, underscoring the safety and effectiveness of outpatient FESS. Future studies are needed to define the role of FESS in more complex spine procedures.

Multiple Endoscopic Access Lumbar Interbody Fusion (MALIF): A New Technique for Unilateral Biportal Endoscopic Lumbar Interbody Fusion Using Monoportal Endoscopic Spine Surgery Techniques.

This study aims to present a new endoscopic lumbar interbody fusion technique, multiple endoscopic access lumbar interbody fusion (MALIF), which applies the assisted full-endoscopic spine surgery (AFESS) technique to unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF). AFESS represents an advancement over UBE by utilizing a monoportal scope in the camera portal during biportal endoscopic spine surgery, which enables greater stability, controlled irrigation for muscle preservation, and improved protection of neural structures. We performed MALIF on 15 consecutive patients with symptomatic lumbar spondylolisthesis resistant to conservative treatment and showing radiographic evidence of instability. The technique was performed through a unilateral percutaneous pedicle screw (PPS) incision, minimally exposing the lateral facet joint, followed by superior articular process (SAP) resection and interbody cage placement for indirect decompression and fusion. The mean operative time was 97.4 ± 17.5 minutes (range: 70-129 minutes), with minimal blood loss (mean: 24.3 ± 13.8 ml) and short hospital stay (mean: 15.0 ± 3.5 days). All patients showed symptomatic improvement without major complications, except for one case of transient dysesthesia that resolved within two weeks. MALIF offers three key advantages: (1) multi-angle endoscopic access to the surgical site, (2) precise endoscopic discectomy, and (3) enhanced safety through monoportal sleeve protection of the exiting nerve root. These initial results suggest that MALIF is a promising minimally invasive surgical option for lumbar interbody fusion.

Development of the prone lateral lumbar interbody fusion: a comparison of lateral spine surgery techniques

Development of the prone lateral lumbar interbody fusion: a comparison of lateral spine surgery techniques

Insights on High-Value Procedures From the ISASS 4-Part Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery Based on Surgeon Experience.

The authors conducted a comprehensive review and integration of insights from 4 webinars hosted by the International Society for the Advancement of Spine Surgery (ISASS) to arrive at recommendations for best clinical practices for guideline development for endoscopic spine surgery. This perspective article discusses the limitations of traditional surgical trials and amalgamates surgeons' experience and research on various cutting-edge techniques. Data were extracted from surveys conducted during each webinar session involving 3639 surgeons globally. The polytomous Rasch model was employed to analyze responses, ensuring a robust statistical assessment of surgeon endorsements and educational impacts and focusing on operative nuances and experience-based outcomes. Bias detection was performed using the differential item functioning test. The ISASS webinars provided a dynamic platform for discussing advances in endoscopic spine surgery, identifying a range of high-value procedures from basic discectomies to complex lumbar interbody fusions. Each high-value endoscopic spine surgery was highlighted in separate peer-reviewed publications, which form the basis for this summary document that synthesizes key takeaways from these webinars. High-value clinical applications of endoscopic spine surgery, primarily defined as higher-intensity endorsement transformation from the pre- to postwebinar survey with a shift to higher mean logit locations of test items both with unbiased and orderly threshold progression, were: (a) Percutaneous interlaminar endoscopic decompression for lateral canal stenosis, (b) transforaminal debridement of low-grade degenerative spondylolisthesis, (c) transforaminal full-endoscopic interbody fusion for hard disc herniation, (d) endoscopic standalone lumbar interbody fusion, (e) endoscopic debridement of spondylolytic spondylolisthesis, and (f) posterior cervical foraminotomy for herniated disc and bony stenosis. The ISASS webinar series has significantly impacted surgeons' education and contributed to the identification of high-value endoscopic spine surgery practices that may serve as a cornerstone for surgeon training standards, policy, and guidelines development. Ongoing research on technological advancements and expansions of clinical indications combined with systematic review is expected to refine the recommendations on high-value endoscopic spinal surgeries recommended for enhanced reimbursement. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

When Would Minimally Invasive Spinal Surgery Not Be Preferable for Metastatic Spine Disease?

Metastatic spine tumor surgery (MSTS) is an important treatment modality of metastatic spinal disease (MSD). Open spine surgery (OSS) was previously the gold standard of treatment till the early 2010s. However, advancements in MSTS in recent years have led to the advent of minimally invasive spinal surgery (MISS) techniques for the treatment of MSD. The clear benefits of MISS have resulted in a current paradigm shift toward today's gold standard of MISS and early adjuvant radiotherapy in treating MSD patients. Nonetheless, despite improvements in surgical techniques and the rise of literature supporting MISS for MSD, there are still certain situations whereby MISS is not desirable or even suitable. There has also yet to be any literature describing the considerations of not using MISS in MSD in today's clinical context. A narrative review was conducted for this manuscript. All studies related to OSS and MISS in MSTS were included. A total of 54 studies were included in this review. These studies discussed various advantages of MISS for MSD in today's clinical context, including the patient profile, location of vertebrae involved with metastasis requiring treatment, tumor characteristics, as well as equipment availability. This study establishes situations in which MISS can be less applicable despite the advantages it may confer over traditional OSS. MSTS should be individualized, depending on the experience of the surgeon. OSS is a time-tested approach that still holds weight in MSTS and should be readily utilized depending on the clinical situation.

Age-Related Association Between Unilateral Single-Channel and Double-Channel Surgery and Postoperative Multifidus Muscle Atrophy and Fat Infiltration.

Unilateral biportal endoscopic laminotomy (UBE) and percutaneous endoscopic laminotomy (PEL) are minimally invasive spinal surgery (MISS) techniques used for unilateral and dual-channel endoscopic laminectomy. However, limited research has been conducted on lumbosacral multifidus muscle injuries in elderly individuals undergoing MISS for lumbar spinal canal stenosis. The objective of this study was to investigate the impact of single-channel and double-channel MISS on the multifidus muscle in elderly patients. A total of 107 patients who underwent MISS were stratified into two cohorts: group A (<65 years) and group B (≥65 years). Preoperative imaging data, including magnetic resonance imaging, were gathered to classify the degree of stenosis based on the nerve root compression. The extent of multifidus muscle atrophy and fat infiltration was assessed by calculating the fat-free cross-sectional area (FCSA)/cross-sectional area (CSA) ratio before and after surgery through measurements of CSA and FCSA. Total cross-sectional area/FCSA were calculated using MRI cross-sectional T2WI. The degree of atrophy and fat infiltration did not change between procedures in group A (P>.05), but changed significantly in group B (P<.05). Unilateral single-channel and double-channel surgery had no significant effect on the degree of multifidus muscle atrophy and fat infiltration in patients younger than 65 years. However, in patients 65 years and older, the degree of multifidus muscle atrophy and fat infiltration significantly increased with the increasing incidence of lateral recess stenosis, which was positively correlated with the duration of surgery. [Orthopedics. 202x;4x(x):xx-xx.].

Multilevel thoracic myelopathy: full-endoscopic solution. Illustrative case.

Thoracic myelopathy is relatively uncommon but, when present, causes significant disability. Early surgical intervention is often recommended for patients with myelopathy with compression at multiple levels. Surgical approaches and techniques for thoracic myelopathy have evolved from traditional open spine surgery to less invasive full-endoscopic spine surgery. This article reports an unusual presentation of a 31-year-old male with thoracic myelopathy due to thoracic disc herniation (TDH) at the T8-9 level and ossification of the ligamentum flavum at the T10-11 level that was managed using full-endoscopic spine surgery techniques in a single sitting. The presence of coexisting spinal disorders, that is, TDH and ossification of the posterior longitudinal ligament at noncontiguous spinal levels, makes surgical decision-making more complicated. Uniportal full-endoscopic spine surgery is a safe and effective surgical technique even for thoracic myelopathy. It is less invasive with minimal tissue and bone damage, better access to and visualization of the pathology, and minimal cord handling and is performed through small windows without destabilizing the spine, thus avoiding fusion. Anterior thoracic pathologies are better addressed through the transforaminal approach, whereas the interlaminar approach is preferred for posterior pathologies. Both of these approaches are complementary to each other with their own indications and advantages. https://thejns.org/doi/10.3171/CASE24413.

Insights From ISASS Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery | Part 3: A Polytomous Rasch Analysis on Surgeons' Endorsement of Multiportal Access, Treatment of Lumbar Facet Cyst, Grade I Spondylolisthesis, and Interbody Fusion.

The International Society for the Advancement of Spine Surgery hosted the third in a series of webinars focused on innovative endoscopic spine surgery techniques. This session aimed to discuss and evaluate advanced treatments for lumbar spinal stenosis and related conditions utilizing multiportal endoscopic approaches; articulating instruments; unilateral biportal endoscopy; transforaminal techniques for facet cysts, herniated disc, and spinal stenosis; as well as percutaneous endoscopic lumbar interbody fusion (PELIF). To analyze the level of surgeon endorsement for the presented endoscopic spine surgery techniques before and after the webinar, utilizing polytomous Rasch analysis, and to evaluate the potential for these insights to inform clinical guideline recommendations. An online survey was administered to 868 surgeons during a sponsored webinar hosted by the International Society for the Advancement of Spine Surgery. The survey used Likert-scale ratings to evaluate 5 main topics and additional surgical experiences and was distributed before and after the webinar. Survey responses were analyzed using descriptive statistics and Polytomous Rasch analysis to evaluate shifts in acceptance and perception. Of the 793 surgeons who attended the webinar, 229 accessed the prewebinar survey, 154 began it, and 119 completed it, yielding a completion rate of 77.3%. The respondents included 52.9% orthopedic surgeons, 37.0% neurosurgeons, 1.7% fellows, 0.8% residents, and 0.8% medical students. In the postwebinar phase, engagement remained high, with 298 accessing the survey, 169 starting it, and 128 completing it, resulting in a 75.7% completion rate. The postwebinar participant demographics closely resembled the initial distribution, consisting of 53.1% orthopedic surgeons, 35.9% neurosurgeons, 6.2% residents, 3.1% fellows, and 1.6% medical students. The confidence in various endoscopic techniques saw notable changes, particularly for procedures involving transforaminal lateral canal decompression for stenosis, herniated disc, and low-grade spondylolisthesis. Unilateral biportal endoscopy facet joint decompression and PELIF saw an increase in high-level endorsements after the webinar. Polytomous Rasch analysis provided insights into procedural techniques. The study showed consensus on the effectiveness of percutaneous endoscopic decompression of low-grade spondylolisthesis, reflecting evolving surgeon preferences and consensus on best practices. Infit and outfit statistics from the Rasch analysis suggested a good fit between the survey responses and the Rasch model both before and after the webinar, indicating minimal data distortion due to bias except for transforaminal decompression for posterolateral and central herniated nucleus pulposus. Differential item functioning analysis showed no significant bias in item responses between orthopedic surgeons and neurosurgeons in the prewebinar survey but identified potential bias for 1 item postwebinar in PELIF and articulating instruments. The webinar influenced surgeon perceptions and endorsements of advanced endoscopic techniques, substantially impacting professional practice. Continued use of Rasch analysis in evaluating educational interventions offered a nuanced understanding of changes in surgical practice toward more complex and controversial issues such as central and migrated herniated nucleus pulposus, facet cyst, low-grade spondylolisthesis, and fusion while potentially guiding future clinical guidelines and training programs to align with evolving endoscopic techniques. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

Key Takeaways From the ISASS Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery | Part 2: Polytomous Rasch Analysis of Learning Curve and Surgeon Endorsement of Biportal, Interlaminar, and Transforaminal Endoscopic Stenosis Decompression, Discectomy, and Laminectomy in Combination With Interspinous Process Spacers.

The International Society for the Advancement of Spine Surgery hosted the second of a series of 4 webinars on endoscopic spine surgery techniques. The second webinar focused on the application of unilateral biportal endoscopy for discectomy and laminectomy in combination with interbody fusion and interspinous process spacers. This series was intended to identify current trends with contemporary modern endoscopic spine surgery techniques. To analyze the level of surgeon endorsement for the presented endoscopic spine surgery techniques before and after the webinar utilizing polytomous Rasch analysis, as well as to evaluate the potential for these insights to inform clinical guideline recommendations. A survey was available to 667 potential respondents during the Zoom webinar, collecting data on surgeon endorsements using a Likert scale. The polytomous Rasch model was employed to analyze responses while considering the complexity of decisions against surgeon expertise, developing a logarithmic measurement scale, allowing objective statistical analysis of categorical variables, highlighting incongruent or out of order items vs congruent and in order items, and driving improvement in clinical guidelines. Of the 667 surgeons who participated in the webinar, 224 accessed, 122 started, and 61 completed the prewebinar survey, achieving a 50.0% completion rate. Respondents comprised primarily orthopedic surgeons (70.5%) and neurosurgeons (24.6%), with fellows and medical students each making up 1.6%. These surgeons estimated that mastering the learning curve of endoscopic spine surgery required an average of 18.08 cases corroborated by postwebinar responses averaging 15.78 cases. Descriptive statistics revealed an acknowledgment of a learning curve in mastering endoscopic spine surgery, with a slight increase in recognition postwebinar (81.8% up from 80.3%). The data underscored the importance of cadaver courses and high-volume surgical practice before the webinar and highlighted the value of mentorship afterward, indicating a preference shift toward more interactive learning. The confidence in various endoscopic techniques saw notable changes, particularly for procedures involving interlaminar lateral canal decompression and the combined use of transforaminal endoscopic decompression with interspinous process spacers, which saw an increase in high-level endorsements postwebinar. Polytomous Rasch analysis provided insights into training methods and procedural techniques, with mentorship and cadaver courses emerging as key elements for mastering the learning curve. The analysis also highlighted a general consensus on the effectiveness of percutaneous endoscopic interlaminar decompression for lateral canal stenosis, reflecting evolving surgeon preferences and consensus on best practices. Infit and outfit statistics from the Rasch analysis suggested a good fit between the survey responses and the Rasch model both before and after the webinar, indicating minimal data distortion due to bias. Differential item functioning analysis showed no significant bias in item responses between orthopedic surgeons and neurosurgeons in the prewebinar survey, but it identified potential bias for one item postwebinar-unilateral biportal endoscopic laminectomy for central stenosis. This webinar highlighted the importance of hands-on training methods such as cadaver courses and mentorship in mastering the complex spinal endoscopy procedures. The application of polytomous Rasch analysis provided a detailed understanding of surgeons' current preferences and perceptions, as well as the evolving consensus on best practices in endoscopic spine surgery, displaying wide acceptance of the percutaneous interlaminar endoscopic decompression for lateral canal stenosis decompression and a growing interest in integrating endoscopic techniques for more comprehensive spinal care, including wide decompression and spinal stabilization. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

Insights From the ISASS Webinar Series on Current and Emerging Techniques in Endoscopic Spine Surgery | Part 1: Polytomous Rasch Analysis of Surgeon Endorsement of Endoscopic Discectomy/Foraminotomy, Interbody Fusion, and Importance of Patient Feedback During Surgery.

The International Society for the Advancement of Spine Surgery hosted the first of a series of 4 webinars on endoscopic spine surgery techniques, focusing on end§oscopic discectomy, foraminotomy, instrumented endoscopic fusion, standalone lumbar interbody fusion with innovative materials, and the role of patient feedback in awake procedures. This series aims to share knowledge and discuss the complexities and clinical evidence of modern endoscopic spine surgery. To analyze the level of surgeon endorsement for the presented endoscopic spine surgery techniques before and after the webinar, utilizing polytomous Rasch analysis, and to evaluate the potential for these insights to inform clinical guideline recommendations. A survey was available to 1311 potential respondents during the Zoom webinar, collecting data on surgeon endorsements using a Likert scale. The polytomous Rasch model was employed to analyze responses, considering the complexity of decisions against surgeon expertise, developing a logarithmic measurement scale, allowing objective statistical analysis of categorical variables, highlighting incongruent or out-of-order items vs congruent and in-order items, and driving improvement in clinical guidelines. All 4 topics received higher confidence ratings demonstrated by descriptive statistics, highlighting the webinar's effective role in surgeon education and in identifying ongoing trends in spine surgery. The logarithmic transformation of these data during Rasch analysis showed noticeable shifts in surgeon confidence levels postwebinar, with increased endorsement for transforaminal full-endoscopic thoracolumbar interbody fusion for hard disc herniation and standalone endoscopic lumbar interbody fusion. The Wright plot and person-item map analyses demonstrated that the webinar effectively targeted areas of initial low confidence, significantly impacting surgeons' perceptions. Disordered endorsement thresholds remained in the topics of uniportal transforaminal discectomy/foraminotomy and patient feedback during endoscopic spine surgery, indicating issues in response category discrimination or confounding factors not captured by the survey. Ongoing controversies were highlighted by the influence of confounding factors, stemming from preconceived notions and limited familiarity with high-grade evidence. The first in the 4-part webinar series effectively shifted professional confidence and acceptance of innovative surgical approaches among spine surgeons. Observations indicated a high level of interest in applying the endoscopic surgery platform with other advanced technologies. The polytomous Rasch analysis provided nuanced insights into ongoing trends and areas in need of further clarification. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.

Comparison of Three Surgical Approaches for the Treatment of Lumbar Spinal Stenosis: Total Laminectomy, Unilateral Approach for Bilateral Decompression, and Total Laminectomy with Posterior Transpedicular Screw Fixation

ABSTRACT Introduction: Lumbar spinal stenosis (LSS) is one of the most common diseases for spinal surgery and many surgical techniques are used for treatment. Objective: The aim of this retrospective study was to observe the clinical and radiological results of total laminectomy (TL), unilateral approach for bilateral decompression, and posterior transpedicular fixation–interbody fusion with TL. Materials and Methods: The data of 112 patients who underwent surgical treatment for LSS with different surgical techniques were reviewed retrospectively. The patients were divided into 3 groups according to the surgical technique. In the first group, patients underwent TL, in the second group, patients underwent bilateral decompression via unilateral hemilaminectomy, and in the third group, patients underwent posterior transpedicular fixation–interbody fusion with TL. Preoperative and postoperative evaluations were done by visual analog scale (VAS) and functional back pain scales (FBPSs). Furthermore, three groups were compared in respect of operation time, bleeding, and complications. Results: The difference between preoperative and postoperative VAS and FBPS scores were statistically significant in all groups. Operation time, bleeding, and hospital stay were greater in fusion group than decompression-alone groups. The VAS improvement rate was 66%, 70%, and 62% in Group 1, Group 2, and Group 3, respectively. In addition, improvement of FBPS scores between preoperative and postoperative period was statistically significant for the three groups (P &lt; 0.05). Conclusion: Decompression with fusion surgery had no significant difference compared with decompression alone in patient’s clinical outcome and safety.

Key Takeaways From ISASS Webinar Series on Endoscopic Spine Surgery Techniques | Part 4: Advancing the Curve on Surgeons' Experience With Complex Lumbar Revision Scenarios, Grades 1 to 3 Spondylolytic Spondylolisthesis, Cervical Foraminotomy, and Cervical Spondylotic Myelopathy.

The fourth webinar in a 4-part series hosted by the International Society for the Advancement of Spine Surgery explored contemporary endoscopic spine surgery techniques. This session covered complex revision strategies, endoscopic management of grades 1-3 spondylolytic spondylolisthesis, cervical foraminotomy, and decompression techniques for cervical spondylotic myelopathy (CSM). The aim was to assess surgeon endorsement of the discussed endoscopic spine surgery techniques both before and after the webinar using polytomous Rasch analysis. Additionally, the analysis sought to determine how these insights might shape clinical guideline recommendations. Before the webinar, which was attended by 868 potential participants, a survey was distributed to collect data on the level of support for various techniques using a Likert scale. The polytomous Rasch model analyzed these responses by evaluating decision complexity relative to surgeon expertise. This approach helped develop a logarithmic scale to objectively analyze categorical responses, distinguish between congruent and incongruent items, and contribute to the enhancement of clinical guidelines. Of the 868 surgeons, 263 accessed, 150 started, and 118 completed the prewebinar survey, with a completion rate of 78.7%. The participants were mainly orthopedic surgeons (59.3%) and neurosurgeons (34.7%) but also included residents (2.5%), fellows (1.7%), and interventional radiologists (1.7%). In the postwebinar phase, 298 participants accessed the survey, 169 started it, and 128 completed it, achieving a 75.7% completion rate. The demographics of postwebinar participants closely mirrored the initial group: 66.4% orthopedic surgeons, 23.4% neurosurgeons, 3.6% residents, 2.9% fellows, 0.7% medical students, and 2.9% interventional radiologists. The Rasch analysis confirmed high surgeon confidence for the posterior cervical foraminotomy and endoscopic treatment of spondylolytic spondylolisthesis grades 1 to 3 and posterior endoscopic decompression for CSM. Both pre- and postwebinar responses showed a good fit to the Rasch model for these endoscopic techniques, indicating minimal bias, supported by differential item functioning analysis. The application of the endoscopic surgery platform for procedures such as lumbar revision surgery for adjacent segment disease or failed interbody fusion cages and posterior decompression of CSM saw little shift in endorsement, as evidenced both in descriptive and the logarithmically transformed Rasch statistics. This webinar highlighted the evolving consensus on best practices in endoscopic spine surgery, displaying wide acceptance of endoscopic debridement of spondylolytic spondylolisthesis, cervical foraminotomy for herniated disc and bony stenosis, and posterior endoscopic decompression for CSM. Assessing surgeon confidence and acceptance of endoscopic spinal surgeries using polytomous Rasch analysis. Level 2 (inferential) and 3 (observational) evidence because Rasch analysis provides statistical validation of instruments rather than direct clinical outcomes.