Visual Analog Scale Back Pain Research Articles

Learning Curve of Uniportal Compared With Biportal Endoscopic Techniques for the Treatment of Lumbar Disc Herniation.

Currently, unilateral biportal endoscopic (UBE) and uniportal full-endoscopic (UFE) techniques for the treatment of lumbar disc herniation (LDH) are gaining popularity. However, studies investigating the number of surgeries needed for surgeons to achieve proficiency in these procedures are lacking. This study aims to compare the early learning curve for UBE and UFE when treating LDH. The learning curve for two fellowship-trained surgeons at our institution was retrospectively assessed for 160 consecutive patients (UFE: n = 100, UBE: n = 60) who underwent procedures between September 2020 and May 2023. Surgeon 1 first learned UBE, followed by UFE (S1BF), while Surgeon 2 first learned UFE and then UBE (S2FB). Operation time was evaluated as the primary outcome for determining the learning curve using cumulative sum (CUSUM) analysis. Secondary outcomes assessing endoscopic prowess include surgical outcomes, such as fluoroscopy usage times, postoperative hospital stays, the incidence of complications, and clinical outcomes, including visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI) score and modified MacNab criteria. The learning curve analysis identified the cutoff point in UBE at 14 cases and 11 cases for S1BF and S2FB, respectively, and in UFE at 31 cases and 27 cases, respectively. Without UFE or UBE experience, at the last follow-up, both the VAS back and leg pain in UFE were significantly higher than that in UBE (p < 0.05). Furthermore, the incidence of complications of UFE was also higher than that of UBE (29.0% vs. 7.1%). When surgeons have previous UFE or UBE experience, there was no significant difference in the clinical outcomes between UFE and UBE, and the complication rates were also similar (p > 0.05). After gaining UBE experience, the UFE performed by S1BF showed significantly better outcomes in fluoroscopy usage times (p = 0.024), surgical complications (p = 0.036), last follow-up VAS back pain (p = 0.003), and leg pain (p < 0.001) compared to S2FB. However, after gaining UFE experience, the S2FB only showed significant improvement in operation time (p = 0.041) during the process of learning UBE compared to S1BF. Regardless of whether UBE or UFE is learned first, both techniques can significantly shorten the learning curve for the other technique. We recommend prioritizing the learning of UBE. Compared with UBE, the learning curve for UFE was significantly steeper and longer with higher incidence of complications in the early stage.

Intraoperative Facet Joint Block Reduces Pain After Oblique Lumbar Interbody Fusion

Background: Oblique lumbar interbody fusion (OLIF) results in less tissue damage than in other surgeries, but immediate postoperative pain occurs. Notably, facet joint widening occurs in the vertebral body after OLIF. We hypothesized that the application of a facet joint block to the area of widening would relieve facet joint pain. The purpose of this study was to evaluate the analgesic effects of such injections on postoperative pain. Methods: This double-blinded, placebo-controlled study randomized patients into 2 groups. Patients assigned to the active group received an intra-articular injection of a compound mixture of bupivacaine and triamcinolone, whereas patients in the placebo group received an equivalent volume of normal saline solution injection. Back and dominant leg pain were evaluated with use of a visual analog scale (VAS) at 12, 24, 48, and 72 hours postoperatively. Clinical outcomes were evaluated preoperatively and at 6 months postoperatively with use of the Oswestry Disability Index (ODI) and VAS for back and dominant leg pain. Results: Of the 61 patients who were included, 31 were randomized to the placebo group and 30 were randomized to the active group. Postoperative fentanyl consumption from patient-controlled analgesia was higher in the placebo group than in the active group at up to 36 hours postoperatively (p &lt; 0.001) and decreased gradually in both groups. VAS back pain scores were significantly higher in the placebo group than in the active group at up to 48 hours postoperatively. On average, patients in the active group had a higher satisfaction score (p = 0.038) and were discharged 1.3 days earlier than those in the placebo group. Conclusions: The use of an intraoperative facet joint block decreased pain perception during OLIF, thereby reducing opioid consumption and the severity of postoperative pain. This effect was also associated with a reduction in the length of the stay. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Static Versus Expandable Cages in Minimally Invasive Lateral Lumbar Interbody Fusion

Study Design: A meta-analysis approach to a systematic review. Objective: Perform a systematic review to identify all reports directly comparing outcomes of lateral lumbar interbody fusion (LLIF) using static versus expandable interbody cages. Specifically focusing on periprocedural complications, intraoperative morbidity, and fusion outcomes. Summary of Background Data: Minimally invasive surgical techniques, particularly LLIF, have gained popularity for their potential to reduce muscle and soft tissue dissection, leading to faster postoperative recovery. LLIF has been associated with fewer complications compared with open posterior approaches. The introduction of expandable lumbar interbody devices aims to further reduce surgical difficulty and potential complications. However, concerns include a small graft window due to the expansion mechanism and higher costs. Methods: The Web of Science, Scopus, and PubMed databases were systematically queried in accordance with PRISMA guidelines to identify articles comparing outcomes following LLIF using static and expandable interbodies. The Newcastle-Ottawa Scale (NOS) was employed to assess the risk of bias (ROB) in the selected studies. Extracted data underwent effect-size meta-analysis with the PyMARE library, using P&lt;0.05 to define statistical significance. Results: Of the 77 identified articles, 4 studies comprising 283 patients (mean age: 67.1 y, 55.8% female) met the inclusion and exclusion criteria. A total of 150 patients (53%) were treated with static interbodies compared with 133 (47%) receiving expandable interbodies. The groups did not differ significantly with respect to operative time (P=0.59), blood loss (P=0.89), length of stay (P=0.78), subsidence (P=0.49), 24-month mean disc height (P=0.11), 24-month mean ODI (P=0.58), or 24-month mean visual analog scale (VAS) back pain (P=0.81). The expandable group saw a trend toward improved fusion rates (97% vs. 92%, P=0.06). Conclusions: The present meta-analysis suggests the use of expandable (vs. static) interbodies in LLIF surgery may result in similar surgical morbidity, subsidence, and decompression. Further prospective comparative studies are merited to validate these results.

Comparative Analysis of Full Endoscopic Interlaminar Lumbar Discectomy and Lumbar Microdiscectomy.

Retrospective clinical study. The aim is to assess and contrast the results of full endoscopic lumbar discectomy (FELD) and lumbar microdiscectomy (LMD) for L5-S1 disc herniation, with a specific emphasis on postoperative pain reduction and surgical effectiveness. Although minimally invasive spine operations are becoming more popular, there is still little research on the comparative effectiveness of FELD and LMD. The research had a total of 50 patients who received surgical intervention for L5-S1 disc herniation, with 25 patients getting full endoscopic interlaminar discectomy and the other 25 patients undergoing LMD. Clinical outcomes were assessed using the Visual Analog Scale for low back and leg pain, collected preoperatively and at the end of 1 week, 3 months, and 6 months postsurgery. Patient satisfaction was evaluated using Odoms criteria at the same intervals. The study included 50 patients (26 men, 24 women), with a mean age of 51.11 ± 13.76 years. The groups had no significant differences in demographic data. Back and leg pain Visual Analog Scale scores decreased more significantly in the FELD group after 1 week of surgery (P < 0.001), although the declines at 3 months and 6 months were not significantly different between the two groups. According to Odoms criteria, patient satisfaction was favorable in both groups and significantly better in the FELD group than in the LMD group at 1 week postoperatively [excellent in 20 patients (80%) in the FELD group vs 9 patients (36%) in the LMD group (P = 0.025)]. However, patient satisfaction at 3 months and 6 months did not differ between the groups. This study demonstrates that FELD offers significant early postoperative advantages over LMD at the L5-S1 level when compared with pain and satisfaction scales. Level III.

Clinical Comparison of Endoscopic Posterior Lumbar Interbody Fusion and Open Posterior Lumbar Interbody Fusion for Treating Lumbar Spondylolisthesis.

A retrospective case-control study. To compare the clinical efficacy of endoscopic (Endo) and open posterior lumbar interbody fusion (PLIF) in treating lumbar spondylolisthesis. Endo-PLIF has emerged as a new technique for treating lumbar spondylolisthesis. We propose Endo-PLIF as an alternative method. Sixty-four patients with single-segment lumbar spondylolisthesis underwent Endo-PLIF (n = 39) or open PLIF (n = 25) treatment. Demographic data, perioperative parameters, and radiographic parameters were recorded. Clinical results were evaluated by Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. The fusion rate was evaluated by computed tomography at 12 months postoperatively. In addition, a case-control process was included to ensure unbiased comparisons. The average operation time was longer in the Endo-PLIF group. Endo-PLIF showed advantages in reducing blood loss, shortening hospital stay, and early ambulation, but with a longer x-ray exposure time. Both VAS and ODI scores significantly improved in both groups, but the VAS for back pain was lower in the Endo-PLIF group. The radiographic results were similar in both groups. Three patients in the Endo-PLIF group had minor complications. Two patients in the open PLIF group experienced cerebrospinal fluid leakage. Both VAS and ODI scores significantly improved in both groups compared with preoperative scores, but the Endo-PLIF group showed more significant improvement at early follow-up (P < 0.05). There was no significant difference in interbody fusion rate between the two groups. Both Endo-PLIF and open PLIF are effective for treating single-segment lumbar spondylolisthesis. Endo-PLIF shows advantages in reducing blood loss, shortening hospital stays, and promoting early ambulation, with comparable fusion rates and patient satisfaction to open PLIF. Despite minor complications in the Endo-PLIF group and cerebrospinal fluid leakage in the open PLIF group, both procedures lead to significant improvements in pain and disability scores, with Endo-PLIF demonstrating more significant early improvements.

Romosozumab versus bisphosphonates for preventing subsequent vertebral fractures after balloon kyphoplasty: comparison using data from two prospective multicenter studies.

Preventing subsequent fractures after vertebral augmentation is a critical clinical concern. The purpose of this study was to compare the effect of romosozumab and bisphosphonate administration on the occurrence of subsequent vertebral fractures after balloon kyphoplasty (BKP) and to identify factors associated with the occurrence of subsequent vertebral fractures. The study compared 24 patients who underwent BKP and received romosozumab with 58 control patients who underwent BKP and received bisphosphonates, all within 2 months of acute osteoporotic vertebral fracture and showing unfavorable magnetic resonance imaging prognostic factors. The primary outcome was the occurrence of subsequent fracture, and the secondary outcomes were improvement in back pain visual analog scale (VAS) score. Furthermore, logistic regression analysis was conducted to adjust for confounding factors and assess the effect of osteoporosis treatment type on subsequent vertebral fractures following BKP. Subsequent vertebral fractures occurred in 16 patients in the bisphosphonate group and in 1 patient in the romosozumab group (p = .02). There were no significant differences between the 2 groups in VAS scores and their change from preoperatively to 6months after surgery. The multivariable logistic regression analysis identified the type of osteoporosis treatment as an independent factor associated with the occurrence of subsequent vertebral fractures (Odds ratio, 18.30, p = .02). This prospective, multicenter study demonstrates that romosozumab is more effective than bisphosphonates in preventing subsequent vertebral fractures within 6 months after BKP. Romosozumab's superior efficacy in reducing subsequent vertebral fractures may lead to improved long-term outcomes and quality of life, potentially making it a preferred treatment option over bisphosphonates for patients undergoing BKP.

Three-dimensional-printed guide plate for direct percutaneous pedicle screw implantation in minimally invasive transforaminal lumbar interbody fusion surgery: a retrospective study of 162 patients

BackgroundThis study aimed to investigate the impact of three-dimensional (3D)-printed guide plate-assisted percutaneous pedicle screw implantation on minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) surgery.MethodsOverall, 162 patients who underwent MIS-TLIF at Tai’an City Central Hospital were retrospectively reviewed. The studied variables included operative time, volume of intraoperative blood loss, fluoroscopy time, postoperative drainage volume, visual analogue scale (VAS) score, Oswestry disability Index (ODI) score (preoperatively and at 2 weeks, 3 months, 6 months, and 12 months after surgery), and intervertebral fusion rate at 6 months after surgery.ResultsThe conventional group included 99 patients who underwent a conventional procedure, while the 3D printing group included 63 patients who underwent 3D-printed guide plate-assisted percutaneous pedicle screw implantation. The conventional group required more times of positioning needle punctures than the 3D printing group (22.2 ± 5.9 vs. 16.1 ± 4.9). The operation and fluoroscopy time were also longer in the former group (183.5 ± 51.1 min vs. 148.8 ± 40.3 min and 30.2 ± 5.9 s vs. 24.1 ± 4.9 s, respectively). In 3D printing group, lower back pain VAS scores and ODI scores at 2 weeks and 3 months after surgery were observed. There were no significant differences in terms of the volumes of intraoperative blood loss; postoperative lower limb pain VAS scores; and interbody fusion rate (P > 0.05).ConclusionThe novel 3D-printed guide plate-assisted percutaneous pedicle screw implantation can achieve better amelioration of back pain and recovery of function. It also reduced the times of positioning needle puncture and fluoroscopy time during percutaneous screw placement surgery and reduced the duration of surgery.

Minimally Invasive Transforaminal Versus Lateral Lumbar Interbody Fusion for Degenerative Spinal Pathology: Clinical Outcome Comparison in Patients With Predominant Back Pain.

Retrospective review. To compare perioperative and postoperative clinical outcomes between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and lateral lumbar interbody fusion (LLIF) in patients presenting with predominant back pain. Two popular techniques utilized for lumbar arthrodesis are MIS-TLIF and LLIF. Both techniques have reported high fusion rates and suitable postoperative clinical outcomes. Scarce literature exists, however, comparing these 2 common fusion techniques in a subset population of patients presenting with predominant back pain preoperatively. A retrospective review of lumbar procedures performed between November 2005 and December 2021 was conducted using a prospectively maintained single-surgeon database. Inclusion criteria were set as primary, elective, single, or multilevel MIS-TLIF or LLIF procedures for degenerative spinal pathology in patients with predominant preoperative back pain [visual analog scale (VAS) back pain preoperative score > VAS leg preoperative score]. Patients undergoing a revision procedure, single-level procedure at L5-S1, or surgery indicated for infectious, malignant, or traumatic etiologies were excluded. In addition, patients with VAS leg preoperative scores ≥ to VAS back preoperative scores were excluded. Patient demographics, perioperative characteristics, postoperative complications, and patient-reported outcome measures (PROMs) were collected. PROMs included VAS for back and leg pain, Oswestry Disability Index (ODI), and Short Form-12 (SF-12) Item Survey Mental (MCS) and Physical (PCS) Composite Scores with all values collected at the preoperative, 6-week, 12-week, 6-month, 1-year, and 2-year follow-up time point. Patients were grouped into 2 cohorts, depending on whether a patient underwent a MIS-TLIF or LLIF. Demographic and perioperative characteristics were compared between groups using χ2 and Student t test for categorical and continuous variables, respectively. Mean PROM scores were compared between cohorts at each time point utilizing an unpaired Student t test. Postoperative improvement from preoperative baseline within each cohort was assessed with paired samples t test. Achievement of minimum clinical important difference (MCID) was determined by comparing ΔPROM scores to previously established threshold values. MCID achievement rates were compared between groups with χ2 analysis. Statistical significance was noted as a P value <0.05. Eligible study cohort included 153 patients, split into 106 patients in the MIS-TLIF cohort and 47 patients in the LLIF cohort. The mean age was 55.9 years, the majority (57.5%) of patients were males, the mean body mass index was 30.8kg/m2, and the majority of the included cohort were nondiabetic and nonhypertensive. No significant demographic differences were noted between cohorts. The MIS-TLIF cohort had a significantly greater proportion of patients with preoperative spinal pathology of recurrent herniated nucleus pulposus, whereas a significantly greater proportion of patients in the LLIF cohort demonstrated isthmic spondylolisthesis (P < 0.046, all). No significant differences were noted between cohorts for operative duration, estimated blood loss, 1-year rate of arthrodesis, postoperative length of stay, postoperative VAS pain scores on postoperative day 0 or 1, and postoperative narcotic consumption on postoperative day 0 or 1. Patients in the LLIF cohort showed greater rates of postoperative ileus (4.3% vs 0.0%). No other significant differences were noted between cohorts for postoperative complications. Between cohorts, preoperative PROM scores did not significantly differ. The following significant postoperative mean PROM scores were demonstrated: VAS back at 12 weeks and ODI at 12 weeks with both mean scores favoring the LLIF cohort. The MIS-TLIF cohort reported significant improvement from preoperative baseline to the 2-year time point for all PROMs collected at all individual postoperative time points except SF-12 MCS at 6 weeks (P < 0.0, all). LLIF cohort reported significant improvement from preoperative baseline to the 1-year time point for all PROMs collected at all individual postoperative time points except for ODI at 6 weeks, 1 year, and 2 years, SF-12 MCS at 6 weeks and 2 years, and SF-12 PCS at 2 years(P < 0.042, all). The majority of patients in both cohorts achieved overall MCID for VAS back, VAS leg, ODI, and SF-12 PCS. A significantly greater proportion of patients in the LLIF cohort achieved MCID for SF-12 PCS at 12 weeks (94.4% vs 61.1%; P < 0.008). Patients with predominant back pain undergoing MIS-TLIF or LLIF for degenerative spinal pathology demonstrated similar 2-year mean clinical outcomes for physical function, disability, leg pain, and back pain. At the 12-week time point, mean outcome scores for back pain and disability favored the lateral approach with concurrent higher rates of MCID achievement for physical function at that time point.

Clinical study of isthmic spondylolisthesis treated with Mis-TLIF assisted by preoperative posture reduction and intraoperative lifting reduction

To investigate the clinical effect of minimally invasive transforaminal lumbar interbody fusion(Mis-TLIF) technique combined with preoperative position reduction in the treatment of spondylolisthesis and summarize its advantages. Between July 2016 and July 2022, 60 patients with lumbar isthmic spondylolisthesis were retrospectively analyzed, including 26 males and 34 females, with an average age of (51.32±4.24) years old ranging from 35 to 72 years old. They were divided into observation group and control group according to the operation methods. There were 30 patients in the observation group, including 12 males and 18 females;the age ranged from 35 to 71 years old with an average of(51.80±6.38) years old, the course of disease ranged from 12 to 60 months with an average of (24.17±1.98) months;there were 18 cases of L4 spondylolisthesis and 12 cases of L5 spondylolisthesis;according to Meyerding classification, there were 20 cases of grade Ⅰ spondylolisthesis and 10 cases of gradeⅡ. The observation group was treated with preoperative postural reduction combined with intraoperative reduction assisted minimally invasive transforaminal lumbar fusion via Quadrant channel(Mis-TLIF). There were 30 patients in the control group, including 14 males and 16 females, with an average of (50.00±4.24) years old ranging from 36 to 72 years old;the course of disease ranged from 12 to 60 months with an average of (23.70±1.53) months;there were 16 cases of L4 spondylolisthesis and 14 cases of L5 spondylolisthesis;according to Meyerding classification, there were 19 cases of grade Ⅰ spondylolisthesis and 11 cases of grade Ⅱ. The control group was treated with open transforaminal lumbar interbody fusion(Open-TLIF). The differences of operation time, intraoperative and postoperative blood loss, hospital stay, radiation exposure time and complications between the two groups were analyzed. Visual analogue scale (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association(JOA) score were used to evaluate the clinical effect. X-ray and CT were followed up to evaluate the interbody fusion. All patients were followed up for 12 months. There was no significant difference in operation time, VAS of low back pain, slip angle and slip rate between two groups (P>0.05). The intraoperative and postoperative blood loss in the observation group (165.50±15.56) ml and (59.17±10.59) ml were less than those in the control group (259.33±35.32) ml and (165.33 ±29.56) ml (P<0.05). The length of hospital stay in the observation group (3.53±0.68) days was less than that in the control group (5.20±0.41) days (P<0.05).The intervertebral space height, slip angle, slip rate, ODI, VAS and JOA scores were significantly improved in the two groups at the final follow-up (P<0.05). There were significant differences in ODI [(9.93±1.11)% vs (10.93±1.11)%] and JOA [ (26.07±1.01) points vs (25.43±1.25) points] between the observation group and the control group at the final follow-up (P<0.05). In the treatment of spondylolisthesis, preoperative position reduction combined with intraoperative reduction assisted Mis-Tlif technique has advantages of less trauma, less bleeding and shorter hospitalization period than traditional open surgery. It is a safe and effective technique.

To validate and correlate radiologic grading of central and foraminal stenosis post-surgical decompression on degenerative lumbar canal stenosis

Background: Lumbar canal stenosis (LCS) is characterized as a narrowing of the canal diameter with age, which can lead to degenerative bone and soft-tissue changes. Aims and Objectives: The aim of the study is to validate the radiologic grading of central and foraminal through correlation with outcome after surgical decompression in degenerative LCS. Materials and Methods: A total of 23 patients with degenerative LCS who satisfied inclusion criteria and consented to participate in the study were selected and their Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) for back and leg pain were recorded and their magnetic resonance imaging (MRI) was graded. Results: LCS is the reduction in the dimension of the central or lateral lumbar canal that occurs most frequently as a result of chronic degenerative changes at the lumbar motion segments. In our study, ODI has comparable improvement in all groups and it does not correlate with the severity of stenosis. However, VAS for leg pain has a greater prevalence in the shorter durations group (&lt;60 months) which had an average of 8.0. If VAS for leg pain was more preoperatively, a better outcome was seen postoperatively. Conclusion: Decompression surgery for degenerative LCS shows significant improvement in ODI and VAS for back pain and leg pain irrespective of the severity of the stenosis by MRI grading or the severity of symptoms as assessed by VAS or ODI.

Clinical outcomes of percutaneous transforaminal endoscopic decompression for the treatment of degenerative lumbar scoliosis associated with spinal stenosis in elderly individuals: a matched comparison study.

This retrospective cohort study evaluated the efficacy and safety of percutaneous transforaminal endoscopic decompression (PTED) in elderly patients with degenerative lumbar scoliosis (DLS) associated with lumbar spinal stenosis (LSS). A matched comparison study. In total, 97 patients with DLS associated with LSS who underwent PTED under local anesthesia between 2016 and 2021 were retrospectively analyzed. Using the inclusion and exclusion criteria, 24 patients aged ≥ 80 years were screened and included in the study group. Then, 24 patients aged 50-80 years were matched according to gender, date of surgery, and surgical levels were included in the control group. Clinical outcomes such as the visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, modified MacNab criteria, radiological parameters, and complications were assessed. The independent sample t-test, Pearson's chi-square test and Fisher's exact test were used to compare the parameters between the study and control groups. The study group had significantly higher mean American Society of Anesthesiologists classification and age-adjusted Charlson Comorbidity Index scores than the control group (2.42 ± 0.72) vs. 5.25 ± 1.03 and 1.67 ± 0.76 vs. 3.17 ± 2.10, respectively). The VAS scores for pain in two legs and back and ODI scores significantly improved at two weeks after surgery and at the final followup (p < 0.05). The study group had higher back pain VAS and ODI scores than the control group at the final followup (p < 0.05). In addition, the complication and patient satisfaction rates were similar between the two groups (p > 0.05). The overall radiological parameters were comparable between the two groups, and there was no significant deterioration in coronal imbalance or loss of disc height between the two groups. Elderly patients (aged ≥ 80 years) with DLS associated with LSS are less fit and have a greater number of comorbidities. However, they can achieve satisfactory outcomes with PTED, which are comparable to those of patients < 80 years. PTED under local anesthesia can also be an efficient alternative to conventional open lumbar decompression surgery for treating elderly patients with comorbidities.

Lumbar fusion efficacy with local bone grafting and platelet-rich plasma: a clinical investigation in treating degenerative lumbar spinal stenosis in the elderly.

The focus of this study was to comprehensively assess the clinical outcomes of lumbar fusion utilizing autogenous bone grafting and platelet-rich plasma (PRP) for the management of degenerative lumbar spinal stenosis (DLSS) in elderly individuals. A cohort of 40 senior individuals diagnosed with DLSS, who underwent treatment at our hospital between January 2020 and March 2022. The control group consisted of 20 participants who underwent local bone grafting for intervertebral fusion, while the observation group comprised 20 individuals who received a combination of local bone grafting and PRP for lumbar fusion. MRI imaging was employed for a comprehensive assessment of spinal structure. The efficacy of spinal fusion was evaluated through MRI imaging. Clinical treatment outcomes were assessed using the Japanese Orthopaedic Association (JOA) and Oswestry Disability Index (ODI) scoring systems. Postoperative low back pain was quantified using a Visual Analog Scale (VAS). During the final follow-up, the observation group demonstrated a significant increase in the inner diameter of the spinal canal and the height of the disc space compared to the control group (P < 0.05).Moreover, the observation group displayed a larger spinal canal than the control group (P < 0.05).A reduced lesion score in the bone grafting region was observed in the observation group compared to the control group during the final follow-up (P < 0.05). Furthermore, the observation group displayed a higher intervertebral fusion continuity score than the control group (P < 0.05).The JOA score in the observation group was significantly higher than in the control group (P < 0.05), while the ODI score was significantly lower (P < 0.05). Of note, the back pain VAS score in the observation group was lower than in the control group at both the three months post-surgery mark and the final follow-up (P < 0.05).The satisfaction rate and overall satisfaction rate in the observation group were significantly higher than those in the control group (P < 0.05), while the dissatisfaction rate in the observation group was evidently lower than in the control group (P < 0.05). In the management of DLSS in elderly individuals, the utilization of local bone grafting and PRP in lumbar spinal fusion yields notable outcomes.

Do obese patients undergoing surgery for grade 1 spondylolisthesis have worse outcomes at 5 years' follow-up? A QOD study.

The long-term effects of increased body mass index (BMI) on surgical outcomes are unknown for patients who undergo surgery for low-grade lumbar spondylolisthesis. The goal of this study was to assess long-term outcomes in obese versus nonobese patients after surgery for grade 1 spondylolisthesis. Patients who underwent surgery for grade 1 spondylolisthesis at the Quality Outcomes Database's 12 highest enrolling sites (SpineCORe group) were identified. Long-term (5-year) outcomes were compared for patients with BMI ≥ 35 versus BMI < 35. In total, 608 patients (57.6% female) were included. Follow-up was 81% (excluding patients who had died) at 5 years. The BMI ≥ 35 cohort (130 patients, 21.4%) was compared to the BMI < 35 cohort (478 patients, 78.6%). At baseline, patients with BMI ≥ 35 were more likely to be younger (58.5 ± 11.4 vs 63.2 ± 12.0 years old, p < 0.001), to present with both back and leg pain (53.8% vs 37.0%, p = 0.002), and to require ambulation assistance (20.8% vs 9.2%, p < 0.001). Furthermore, the cohort with BMI ≥ 35 had worse baseline patient-reported outcomes including visual analog scale (VAS) back (7.6 ± 2.3 vs 6.5 ± 2.8, p < 0.001) and leg (7.1 ± 2.6 vs 6.4 ± 2.9, p = 0.031) pain, disability measured by the Oswestry Disability Index (ODI) (53.7 ± 15.7 vs 44.8 ± 17.0, p < 0.001), and quality of life on EuroQol-5D (EQ-5D) questionnaire (0.47 ± 0.22 vs 0.56 ± 0.22, p < 0.001). Patients with BMI ≥ 35 were more likely to undergo fusion (85.4% vs 74.7%, p = 0.01). There were no significant differences in 30- and 90-day readmission rates (p > 0.05). Five years postoperatively, there were no differences in reoperation rates or the development of adjacent-segment disease for patients in either BMI < 35 or ≥ 35 cohorts who underwent fusion (p > 0.05). On multivariate analysis, BMI ≥ 35 was a significant risk factor for not achieving minimal clinically important differences (MCIDs) for VAS leg pain (OR 0.429, 95% CI 0.209-0.876, p = 0.020), but BMI ≥ 35 was not a predictor for achieving MCID for VAS back pain, ODI, or EQ-5D at 5 years postoperatively. Both obese and nonobese patients benefit from surgery for grade 1 spondylolisthesis. At the 5-year time point, patients with BMI ≥ 35 have similarly low reoperation rates and achieve rates of satisfaction and MCID for back pain (but not leg pain), disability (ODI), and quality of life (EQ-5D) that are similar to those in patients with a BMI < 35.

Effectiveness of Interspinous Process Devices in Managing Adjacent Segment Degeneration Following Lumbar Spinal Fusion: A Systematic Review and Meta-Analysis.

Background: Adjacent segment degeneration (ASD) is a significant complication following lumbar spinal fusion, often necessitating further surgical interventions and impairing patient outcomes. Interspinous process devices were introduced as an alternative treatment for spinal stenosis and degenerative spondylolisthesis and can potentially reduce the incidence of ASDd. This systematic review and meta-analysis aims to evaluate the effectiveness of interspinous process devices or IPDs in managing ASD following a previous spinal fusion compared to traditional fusion techniques. Methods: Electronic databases, including PubMed, Embase, and the Cochrane Library, were queried for studies assessing IPDs against traditional lumbar fusion methods for managing ASD after previous lumbar fusion, which had been published between January 2014 and the present. Statistical analysis was conducted using Review Manager 5.4. Results: Seven retrospective cohort studies involving 546 patients met the inclusion criteria. The analysis revealed that IPDs were associated with a statistically significant reduction in the incidence of ASD (OR = 0.28, 95% CI: 0.16 to 0.51, p < 0.0001, and I2 = 0% after excluding outliers). The ODI demonstrated a non-significant trend towards improved outcomes with IPDs at the 2-year follow-up (SMD = -3.94; 95% CI: -11.72 to 3.85). Range of motion (ROM) was better preserved with IPDs compared to fusion (SMD = 0.00, 95% CI: -0.41 to 0.41, p = 1.00, I2 = 60%). The visual analogue scale or VAS lower back pain scores were significantly reduced at the 2-year follow-up (SMD = -0.69, 95% CI: -1.18 to -0.19, p = 0.006, and I2 = 74%). VAS leg pain showed consistent improvements (SMD = -0.29; 95% CI: -0.63 to 0.04). Intraoperative blood loss was significantly lower with IPDs (SMD = -2.07; 95% CI: -3.27 to -0.87, p = 0.0007, and I2 = 95%), and operation times were shorter (SMD = -2.22, 95% CI: -3.31 to -1.12, p < 0.0001, and I2 = 94%). Conclusions: The judicious use of IPDs might benefit a subset of patients, particularly those who are not suitable candidates for major corrective surgery.

Can minimally invasive transforaminal lumbar interbody fusion achieve a better clinical and radiological outcome than traditional open technique in isthmic spondylolisthesis?

BackgroundSpondylolisthesis is a prevalent condition in the lumbar spine that can cause low back pain, leg pain, neurogenic claudication, and impact health-related quality of life in symptomatic individuals.Aimto assess the results of minimally invasive TLIF (MIS-TLIF) versus open-TLIF and the impact of correcting spino-pelvic parameters on the Health-Related Quality of Life (HRQoL) in patients with low-grade isthmic spondylolisthesis. The primary objective was to compare the effectiveness of both methods in correcting spinopelvic parameters. The secondary objectives involved comparing clinical improvement, operating time, blood loss, complications, and postoperative hospital stays between the two procedures.Patients and methodsSeventy-two patients with low-grade isthmic spondylolisthesis were enrolled in this retrospective cohort-control study, with a minimum follow-up period of 18 months. Disability was assessed using the Oswestry Disability Index (ODI), while back and leg discomfort were rated using the Visual Analogue Scale (VAS) for each patient. The measurements comprised the sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and Meyerding slip grades. We measured lumbar lordosis (LL), and segmental lordosis.ResultsThe seventy-two patients were 60 female and 12 males. There was no statistically significant difference in the duration of operation between the two groups. In the MIS group, there was a notable reduction in blood loss, higher radiation exposure, and a shorter hospital stay (P < 0.001). The back VAS showed more favorable outcomes in the MIS-TLIF, while the leg VAS showed better results in the Open-TLIF in the early outcome. Both procedures significantly reduced leg and back pain VAS scores and ODI, with no notable difference between the two groups at the final follow-up. Post-surgery, the pelvic incidence (PI) and lumbar lordosis (LL) matched properly in all patients, showing a rise in LL and sacral slope along with a decrease in pelvic tilt.ConclusionBoth open-TLIF and MIS-TLIF are effective methods for correcting spino-pelvic parameters and improving HRQoL in patients with low-grade isthmic spondylolisthesis. The rapid improvement in back pain experienced by these patients favored the use of MIS-TLIF. However, the cost-effectiveness of this approach must be carefully evaluated.

Study on related influencing factors on the occurrence of redundant sign in the cauda equina in lumbar spinal stenosis

To analyze the relational factors influencing the formation of cauda equina redundant nerve roots (RNRs) of the lumbar spinal stenosis. Clinical data of 116 patients with lumbar spinal stenosis treated from January 2016 to June 2019 were retrospectively analyzed. The patients were divided into redundant nerve roots(RNRs) group and non-RNRs group based on the presence or absence of RNRs on sagittal T2-weighted MRI. In the non-RNRs group, there were 74 patients, including 38 males and 36 females with an average age of (62.00±10.41) years old, the body mass index (BMI) was (23.09±2.22) kg·m-2;the maximum stenosis segment was L2-L3 in 12 cases, L3-L4 in 38, L4-L5 in 20, and L5S1 in 4, respectively. In the RNRs group, there were 42 patients, including 18 males and 24 females with an average age of (63.36±8.73) years old, the BMI was (22.63±2.60) kg·m-2;the maximum stenosis segment was L2-L3 in 3 cases, L3-L4 in 9, L4-L5 in 27 and L5S1 in 3, respectively. MRI was performed in the supine position to observe the conshape and morphology of the redundant nerve in the sagittal position. The preoperative low back and leg pain visual analogue scale(VAS), and preoperative Oswestry disability index(ODI) were analyzed, and the rate of spondylolisthesis and ligamentum flavum hypertrophy were compared. Simultaneously, the inter-vertebral height, intervertebral foramen height, inter-vertebral height+vertebral height, median sagittal diameter at the inter-vertebral space level(DIW-MSD), median sagittal diameter at the pedicel level(DV-MSD), range of motion(ROM) of the stenotic segment were measured and analyzed. Among the 116 patients with lumbar spinal stenosis, 42 patients developed RNRs, with an incidence of 36.2%. There were no significant differences in gender, age, BMI, preoperative VAS for lumbar and leg pain and ODI between two groups(P>0.05). There were statistically significant differences regard to the duration of symptoms and the rate of spondylolisthesis and ligamentum flavum hypertrophy (P<0.05);the inter-vertebral height, intervertebral foramen height, inter-vertebral height+vertebral height, DIW-MSD, ROM of the stenotic segment were also significantly different between two groups(P<0.05). However, there was no significant difference in DV-MSD between two groups(P>0.05). The inter-vertebral height, inter-vertebral foramen height, inter-vertebral height+vertebral height, DIW-MSD and ROM of the stenotic segment were the crucial factors related to RNRs in lumbar spinal stenosis.

Reasons and strategies of reoperation after oblique lateral interbody fusion

To summarize the reasons and management strategies of reoperation after oblique lateral interbody fusion (OLIF), and put forward preventive measures. From October 2015 to December 2019, 23 patients who underwent reoperation after OLIF in four spine surgery centers were retrospectively analyzed. There were 9 males and 14 females with an average age of (61.89±8.80) years old ranging from 44 to 81 years old. The index diagnosis was degenerative lumbar intervertebral dics diseases in 3 cases, discogenic low back pain in 1 case, degenerative lumbar spondylolisthesis in 6 cases, lumbar spinal stenosis in 9 cases and degenerative lumbar spinal kyphoscoliosis in 4 cases. Sixteen patients were primarily treated with Stand-alone OLIF procedures and 7 cases were primarily treated with OLIF combined with posterior pedicle screw fixation. There were 17 cases of single fusion segment, 2 of 2 fusion segments, 4 of 3 fusion segments. All the cases underwent reoperation within 3 months after the initial surgery. The strategies of reoperation included supplementary posterior pedicle screw instrumentation in 16 cases;posterior laminectomy, cage adjustment and neurolysis in 2 cases, arthroplasty and neurolysis under endoscope in 1 case, posterior laminectomy and neurolysis in 1 case, pedicle screw adjustment in 1 case, exploration and decompression under percutaneous endoscopic in 1 case, interbody fusion cage and pedicle screw revision in 1 case. Visual analogue scale (VAS) and Oswestry disability index (ODI) index were used to evaluate and compare the recovery of low back pain and lumbar function before reoperation and at the last follow-up. During the follow-up process, the phenomenon of fusion cage settlement or re-displacement, as well as the condition of intervertebral fusion, were observed. The changes in intervertebral space height before the first operation, after the first operation, before the second operation, 3 to 5 days after the second operation, 6 months after the second operation, and at the latest follow-up were measured and compared. There was no skin necrosis and infection. All patients were followed up from 12 to 48 months with an average of (28.1±7.3) months. Nerve root injury symptoms were relieved within 3 to 6 months. No cage transverse shifting and no dislodgement, loosening or breakage of the instrumentation was observed in any patient during the follow-up period. Though the intervertebral disc height was obviously increased at the first postoperative, there was a rapid loss in the early stage, and still partially lost after reoperation. The VAS for back pain recovered from (6.20±1.69) points preoperatively to (1.60±0.71) points postoperatively(P<0.05). The ODI recovered from (40.60±7.01)% preoperatively to (9.14±2.66)% postoperatively(P<0.05). There is a risk of reoperation due to failure after OLIF surgery. The reasons for reoperation include preoperative bone loss or osteoporosis the initial surgery was performed by Stand-alone, intraoperative endplate injury, significant subsidence of the fusion cage after surgery, postoperative fusion cage displacement, nerve damage, etc. As long as it is discovered in a timely manner and handled properly, further surgery after OLIF surgery can achieve better clinical results, but prevention still needs to be strengthened.

Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) in treatment of degenerative diseases of lumbosacral spine compared to modified open TLIF: a prospective randomised controlled study.

The aim of this study was to determine the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) compared to modified open TLIF via the Wiltse approach for treatment of degenerative diseases of the lumbosacral region. The results were evaluated over a post-operative period of 48 months. Radiological data and medical records of patients who underwent MIS TLIF and modified open TLIF between May 2017 and May 2021 were reviewed. Parameters monitored to evaluate the surgical results were: clinical status, operation time, blood loss, radiation dose to patient, day of discharge, analgesic consumption, fusion, and complications rate. For functional assessment, the Visual Analogue Scale for back pain (VAS-BP), VAS for leg pain (VAS-LP), Oswestry Disability Index (ODI), Patient Satisfaction Rate (PSR), and the complication rate were used. This study included 57 patients randomly divided into two groups: 30 operated on using the MIS TLIF technique, and 27 operated on using the modified open TLIF technique via the Wiltse approach. 48-month follow-up rates were similar for the two cohorts. Patients did not differ significantly at baseline in terms of ODI, VAS-BP, or VAS-LP. Perioperatively, MIS TLIF was associated with significantly less blood loss (167.3 ± 80.0 vs. 297.9 ± 81.5 ml, p = 1.1E-05), slightly longer procedures (185.7 ± 45.2 vs. 183.1 ± 66.4 minutes, p = 0.76), a lower radiation dose (MIS 16.9 ± 7.1 vs. 22.0 ± 9.7 mGy OPEN p = 0.012), and shorter hospitalisations (MIS 5.9 ± 1.8 vs. 7.7 ± 1.6 days OPEN). The most common complication was radiculitis, which accounted for 33% and 37% in the MIS and the TLIF groups, respectively. The second most common complication was malposition of the fixation material, which accounted for 18.5% in the TLIF group and 20% in the MIS group. The level of fusion achieved was 92.6% in the MIS group versus 92.3% in the TLIF group. There was lower consumption of analgesics in MIS. Patient Satisfaction Rate (PSR) was 90%. Clinical and radiological outcomes after MIS TLIF in patients with degenerative disease of the lumbosacral region are generally favourable. MIS TLIF was associated with decreased blood loss perioperatively, a lower radiation dose and an earlier discharge, but there was no difference between MIS TLIF and modified open TLIF in 48-month outcomes in terms of disability, back pain, leg pain, quality of life, or patient satisfaction rate or complication rate. Although the differences taper off over time, MIS TLIF has undeniable advantages in the perioperative and early postoperative periods.

Surgical Innovation: Comparative Efficacy of Navigation-Assisted Modified Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) and Traditional MIS-TLIF in Treating Low-Grade Isthmic Spondylolisthesis in the Elderly

To compare the efficacy of navigation-assisted modified MIS-TLIF (Minimally invasive transforaminal lumbar interbody fusion) and MIS-TILF in the treatment of low-grade isthmic spondylolisthesis in the elderly. We retrospectively included elderly patients with low-grade isthmic spondylolisthesis who underwent surgical treatment at our hospital from January 2019 to January 2022. Based on the surgical method chosen according to the patient's personal preference, the patients were divided into the modified MIS-TLIF group and the MIS-TLIF group. The modified MIS-TLIF group underwent navigation-assisted MIS-TLIF, while the MIS-TLIF group underwent conventional MIS-TLIF. A total of 54 patients (34 males and 20 females) were included in this study, with 26 cases in the modified MIS-TLIF group and 28 cases in the MIS-TLIF group. Relevant data for this study were collected by an independent observer. The demographic characteristics, including age, gender, BMI, comorbidities, surgical level, Meyerding grade, and duration of symptoms before admission, were recorded and compared between the two groups. Perioperative parameters, such as operative time, intraoperative blood loss, postoperative drainage volume, bed rest time, and hospital stay, were also recorded and compared. The lumbar pain visual analog scale (BP-VAS), Oswestry Disability Index (ODI), and lumbar JOA scores were recorded preoperatively and at 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively to evaluate functional recovery in both groups. At 12 months postoperatively, patient satisfaction was assessed using the Macnab criteria (with satisfaction defined as the number of excellent and good outcomes divided by the total number in the group × 100%). The rate of vertebral slippage was recorded preoperatively, at 1 week postoperatively, and at 12 months postoperatively. The accuracy of screw placement was evaluated by CT scan at 1 week postoperatively, and interbody fusion was assessed by CT scan at 12 months postoperatively. Surgical complications were recorded, and their incidence was calculated. The intraoperative blood loss, postoperative drainage volume, bed rest time and hospital stay in the modified MIS-TLIF group were less than those in the MIS-TLIF group (P< 0.05). The BP-VAS (Back Pain Visual Analogue Scale), ODI (Oswestry Disability Index), and JOA (Japanese Orthopaedic Association) modified MIS-TLIF groups improved significantly compared with the MIS-TLIF group at 1 week, 1 month, 3 months, and 6 months after surgery, and the differences between groups were statistically significant (P<0.05). The excellent and good rate of modified MIS-TLIF group was higher than that of MIS-TLIF group, and the difference had statistical significance (P<0.05). The accuracy of screw placement in the modified MIS-TLIF group was higher than that in the MIS-TLIF group, and the difference was statistically significant (P<0.05). The fusion rate in the modified MIS-TLIF group was higher than that in the MIS-TLIF group at 12 months after surgery, and the difference was statistically significant (P<0.05). No statistical difference in the incidence rate of complications between the two groups. Compared with MIS-TLIF, navigation-assisted modified MIS-TLIF has the advantages of less trauma, rapid recovery, accurate screw placement, high fusion rate, high surgical satisfaction and good safety.

Application of polyetheretherketone rod semi-rigid pedicle screw internal fixation in lumbar non-fusion surgery

To investigate the effect of Polyetheretherketone (PEEK) rod semi-rigid pedicle screw fixation system in lumbar spine non-fusion surgery. A total of 74 patients with tow-level lumbar degenerative diseases who underwent surgery from March 2017 to December 2019 were divided into PEEK rod group and titanium rod group. In the PEEK rod group, there were 34 patients, including 13 males and 21 females, aged from 51 to 79 years old with an average of (62.4±6.8) years old;There were 1 patient of L1-L3 segments, 7 patients of L2-L4 segments, 20 patients of L3-L5 segments and 6 patients of L4-S1 segments. In the titanium rod group, there were 40 patients, including 17 males and 23 females, aged from 52 to 81 years old with an average of (65.2±7.3) years old;There were 3 patient of L1-L3 segments, 11 patients of L2-L4 segments, 19 patients of L3-L5 segments and 7 patients of L4-S1 segments. The general conditions of operation, such as operation time, intraoperative blood loss, postoperative drainage was recorded. The visual analogue scale (VAS) for low back pain and Oswestry disability index (ODI) were compared in preoperatively and postoperatively(3 months, 12 months and last follow-up) between two groups. The change of range of motion (ROM) was observed by flexion and extension x-ray of lumbar. All patients successfully completed the operation. The follow-up time ranged from 22 to 34 months with an average of(26.8±5.6) months. The operative time (142.2±44.7) min and intraoperative blood loss(166.5±67.4)ml in PEEK group were lower than those in titanium group [(160.7±57.3) min、(212.8±85.4) ml](P<0.05). There was no significant differences in postoperative drainage between the two groups (P>0.05). At the final follow-up visit, in PEEK group and titanium group VAS of low back pain[(0.8±0.4) points vs (1.0±0.5) points], VAS for leg pain [ (0.7±0.4) points vs (0.8±0.5) points] and ODI [(9.8±1.6)% vs (12.1±1.5)%] were compared with preoperative [ (5.8±1.1) points vs (6.0±1.1)points], [ (7.2±1.7) points vs (7.0±1.6) points], [(68.5±8.9)% vs(66.3±8.2)%] were significantly different(P<0.05). There was no significant difference in VAS scores between the two groups at each postoperative time point (P>0.05). At 3 months after surgery, there was no difference in ODI between the two groups (P>0.05). There were significant differences in ODI between PEEK group and titanium rod group at 12 months [(15.5±2.1)% vs (18.4±2.4)%] and at the last follow-up [(9.8±1.6)% vs (12.1±1.5)%] (P<0.05). The total range of motion (ROM) of lumbar decreased in both groups after surgery. At 12 months after surgery and the last follow-up, the PEEK group compared with the titanium rod group, the total range of motion of lumbar was statistically significant (P<0.05). The range of motion (ROM) of the fixed segments decreased in both groups after surgery. The ROM of the fixed segments in PEEK group decreased from (9.5±4.6)° to (4.1±1.9)° at the last follow-up (P<0.05), which in the titanium rod group was decreased from (9.8±4.3)°to (0.9±0.5)° at the last follow-up (P<0.05). The range of motion (ROM) of upper adjacent segment increased in both groups, there was statistical significance in the ROM of upper adjacent segment between the two groups at 12 months after surgery and the last follow-up, (P<0.05). There was no screw loosening and broken rods in both groups during the follow-up period. The PEEK rod semi-rigid pedicle screw internal fixation system used in lumbar non-fusion surgery can retain part of the mobility of the fixed segment, showing comparable short-term clinical efficacy to titanium rod fusion. PEEK rod semi-rigid pedicle screw internal fixation system is a feasible choice for the treatment of lumbar spine degenerative diseases, and its long-term efficacy needs further follow-up observation.