While the treatment of adult spinal deformity (ASD) has increasingly favored surgical correction, the incidence of revision surgery remains high. Yet, little has been explored on the association between the etiology of reoperation and patient outcomes.

To assess the impact of the etiology of revision surgery on postoperative outcomes.

Retrospective cohort analysis.

A total of 891 ASD patients.

Complications, radiographic parameters, disability metrics.

Operative ASD patients with at least 1 revision stratified by etiology (mechanical [Mech] -pseudarthrosis, thoracic decompensation without junctional failure, X-ray malalignment, implant failure, implant malposition, PJK ± major malalignment; infection [Infx]-early vs late onset, major vs minor; wound [Wound]; SI pain [SI Pain]). Excluded multiple etiologies, and intraoperative or medical complications. Data from the immediate visit prior to the final revision was used as baseline (rBL). Follow-up based on visits best aligned to time points after final revision. Radiographic parameters SVA, PI-LL, and PT were used to assess alignment postrevision via ANOVA. Multivariate analysis controlling for relevant covariates assessed outcome differences after final revision surgery.

In total, 891 met inclusion (Age: 60.40±14.17, 77% F, BMI: 27.97±5.87 kg/m2, CCI: 1.80±1.73). Etiology groups were as follows: Mech: 432; Infx: 296; Wound: 65; SI Pain: 98. Surgically, Infx had lower rates of osteotomy, interbody fusion, and decompression (p<.05). Infx and SI Pain demonstrated similar correction in radiographics SVA, PI-LL, and PT (p>.05), whereas Mech had significantly less improvement by 2 years (p<.003) that improved by 5 years. Compared to without revision, the odds of MCID in ODI were 48.6% lower across groups (OR: 0.514 [.280, .945], p=.032). Indications of X-ray malalignment were 93.0% less likely to reach MCID (OR: 0.071, [.006, .866], p=.038). Similarly, implant failure negatively impacted rates of MCID (40% vs 15.2%, p=.029). Those with PJK had 57% lower odds of MCID (33% vs 54%, OR: .43, [0.2, 0.9] p= .023), further negated by major malalignment (OR: 0.05, [.07, .97], p=.02). Indications of pseudarthrosis, thoracic decompensation, implant malposition were not significant. Major sepsis had lower rates of MCID compared to minor (6.4% vs 21.2%), and early onset infection improved compared to late (OR: 1.43, [1.17, 2.98], p<.001). In the early follow-up period, the Mech group has significantly worse SRS Pain and Mental Health scores compared to other groups (1-year: Mech 1.56 vs Infx 0.83 vs SI Pain 0.72, p<.001; 2-year: 1.88 vs 0.71 vs 0.76, p=.034). Complication rates increased with the number of revisions and with mechanical indication (all p<.05). At 5 years, patient satisfaction was significantly more likely to improve compared to early follow-up (OR: 1.22, p=.011), along with improved pain score, in Mech group (0.89 vs 0.49 vs 0.56, p=.081).

This study focused on the impact of revision as it varies with etiology and time of occurrence postoperatively. Compared to other etiologies, revision surgery due to mechanical complications had less radiographic improvement and worsening patient-reported scores in the early postoperative period despite stabilization at 5 years. The depth of impact of mechanical complication, particularly with the addition of malalignment, merits greater focus during surgical planning.

III.

Retrospective review of prospectively collected data.

The aim of this study was to investigate what factors predict delayed improvement after surgical treatment of low-grade spondylolisthesis.

Lumbar surgery leads to clinical improvement in the majority of patients with low-grade spondylolisthesis. Most patients improve rapidly after surgery, but some patients demonstrate a delayed clinical course.

The Quality and Outcomes Database (QOD) was queried for grade 1 spondylolisthesis patients who underwent surgery who had patient-reported outcome measures (PROMs) collected at baseline, 3, 6, and 12 months, including back and leg pain Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D). Patients were stratified as "early responders" reaching MCID at 3 months and maintaining improvement through 12 months and "delayed responders" not reaching MCID at 3 months but ultimately reaching MCID at 12 months. These two groups were compared with respect to factors which predicted delayed improvement.

Of 608 patients enrolled, 436 (72%) met inclusion criteria for this study. Overall, 317 patients (72.7%) reached MCID for ODI at 12 months following surgery. Of these patients, 249 (78.5%) exhibited a rapid clinical improvement trajectory and had achieved ODI MCID threshold by the 3-month postoperative follow-up. Sixty-eight patients (21.4%) showed a delayed trajectory, and had not achieved ODI MCID threshold at 3 months, but did ultimately reach MCID at 12-month follow-up. Factors associated with delayed improvement included impaired preoperative ambulatory status, better baseline back and leg pain scores, and worse 3-month leg pain scores ( P <0.01).

The majority of patients undergoing surgery for low-grade spondylolisthesis reach ODI MCID threshold rapidly, within the first 3 months after surgery. Factors associated with a delayed clinical course include impaired preoperative ambulation status, relatively better preoperative back and leg pain, and persistent leg pain at 3 months.

Obesity is increasingly prevalent globally and is associated with various health issues, including spine-related disorders. Previous studies have shown mixed results regarding the impact of obesity on spine surgery outcomes.

This meta-analysis aims to evaluate the effects of obesity on perioperative and postoperative outcomes in spine surgery patients.

We performed a systematic review and meta-analysis of prospective and retrospective studies comparing outcomes between obese and nonobese spine surgery patients.

The meta-analysis included 35,639 patients, of which 9,369 were obese (BMI≥30 kg/m²) and 26,270 were nonobese (BMI<30 kg/m²).

Primary outcomes included patient-reported outcome measures (PROMs) such as the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for leg and back pain. Secondary outcomes involved perioperative measures like estimated blood loss (EBL), operative time, and length of stay (LOS), as well as complication and reoperation rates.

Following PRISMA guidelines, four databases were searched for relevant studies. The quality of included studies was assessed using the Cochrane Risk of Bias tool. Mean differences were used to quantify the differences in PROMs and perioperative outcomes. Odds ratios were used to analyze differences in complication rates.

Obese patients had similar PROMs compared to nonobese patients, with differences not exceeding the minimal clinically important difference (MCID). However, obese patients experienced longer operative times, greater EBL, and extended hospital stays. They also had higher rates of postoperative complications such as Dural tears, infections, and reoperations.

While obesity is associated with certain perioperative challenges, the postoperative recovery in terms of pain and disability appears comparable between obese and nonobese patients. Spine surgeons should be aware of the increased perioperative risks but can reassure obese patients of similar long-term outcomes postsurgery.

There are few studies of pharmacotherapy of neuropathic pain in cervical spondylotic radiculopathy (CSR). Miro-Cens aimed to examine the efficacy and safety of mirogabalin for treating pain in patients with CSR on non-steroidal anti-inflammatory drugs (NSAIDs), compared with NSAIDs alone.

Miro-Cens was a 12-week, multicenter, randomized, controlled, open-label, interventional study in Japan. Eligible patients with CSR having upper limb pain (visual analog scale score ≥ 40 mm) were randomly assigned in a 1:1 ratio to the mirogabalin add-on to NSAIDs group and the NSAIDs alone group. The primary endpoint was the change in the weekly average numerical rating scale (NRS) score for upper limb pain from baseline at Week 12.

The mirogabalin add-on group and NSAIDs alone group included 72 and 70 patients, respectively. The mirogabalin add-on group had a significantly greater reduction in the NRS score for upper limb pain than the NSAIDs alone group: estimated changes from baseline at Week 12, - 2.63 [95% confidence interval (CI) - 3.14, - 2.11] in the mirogabalin add-on group; - 1.07 (- 1.62, - 0.53) in the NSAIDs alone group; intergroup difference, - 1.55 (- 2.31, - 0.80; p < 0.001). The responder rate on the NRS score at Week 12 was significantly higher in the mirogabalin add-on group than in the NSAIDs alone group: ≥ 30% improvement, 71.7% vs. 39.6%; ≥ 50% improvement, 58.3% vs. 22.6% (both p < 0.001). The frequent treatment-emergent adverse drug reactions in the mirogabalin add-on group were the known ones (somnolence and dizziness), with most being mild or moderate in severity.

In patients with CSR, combination therapy with mirogabalin and NSAIDs significantly improved neuropathic pain compared with NSAID monotherapy. No new safety concerns were identified, although caution should be exercised regarding somnolence and dizziness. These findings suggest that concomitant use of mirogabalin with NSAIDs could be tolerable and a novel treatment option for CSR patients with insufficient analgesic effects on NSAIDs.

jRCTs031210629.

This scoping review maps chiropractic-specific clinical outcomes registries.

Clinical outcomes registries track patient outcomes to improve evidence-based practice and quality of care; however, their role in chiropractic remains unclear.

This research adhered to Joanna Briggs Institute's scoping review outline and methodology, as well as the PRISMA-ScR guidelines. Five databases were searched on January 9, 2025, with subsequent search of grey literature and citation tracking. Sources were included if they described chiropractic-specific registries that reported clinical outcomes data. Two reviewers independently screened 604 citations, extracting data into Excel. Variables included registry characteristics and clinical outcomes collected.

Only one dedicated chiropractic clinical outcomes registry was identified: Spine IQ, launched in 2016 in the US with approximately 50 chiropractors submitting data on over 2000 low back pain patients. Spine IQ collected patient-reported outcome measures including the Oswestry Disability Index, Bournemouth Questionnaire, and the PROMIS physical function measure. By 2018, Spine IQ had completed its pilot phase and planned expansion to 100 clinics. Three sources were excluded: one spine registry not collecting chiropractic outcomes and two databases that included chiropractic data in publications but did not qualify as registries.

This review identified only Spine IQ as a dedicated chiropractic clinical outcomes registry, revealing a significant gap in registry infrastructure within the profession globally. The profession should explore the development of registries to enhance care quality, societal impact, and opportunities for collaborative research.

Patient-reported outcome measures (PROMs) represent a valuable means of assessing the impact of spine surgery on various aspects of patient function and quality of life. This review highlights the most common and contemporary PROMs used in degenerative cervical and lumbar spine conditions, adolescent idiopathic scoliosis, and adult spinal deformity.

Available PROMs differ in their comprehensiveness, flexibility, and ease of use, as well as their ability to provide prognostic information. Condition-specific PROMs such as the Scoliosis Research Society-22 and Modified Japanese Orthopedic Association offer the benefit of prompts tailored to capture the unique considerations for a particular disease state, while more generalized metrics such as the Short-Form 36 facilitate widespread PROM standardization permitting comparison between disease states and interventions. Newer PROMS such as the Patient Reported Outcomes Measurement Information System and the Patient Generated Index offer benefits due to their generalizable yet adaptable format, conferring them the potential to capture condition-specific factors while still permitting comparison between diseases. However, these instruments require further adaptations and validation prior to widespread implementation to fully realize these advantages. Many PROMs are available for use in the spine surgery population, each with unique benefits and drawbacks, necessitating careful evaluation when selecting PROMs for research use.

Study DesignRetrospective comparative analysis of prospective cohort.ObjectiveTo examine clinical outcomes of patients with preexisting SCS after adult spinal deformity surgery.MethodsA total of 94 patients with and without a previous history of spinal cord stimulator placement undergoing surgery for ASD with minimum 2-year follow-up. Thirty-three patients with SCS undergoing ASD surgery with minimum 2-year follow-up were compared with a matched cohort of 61 ASD patients without SCS.ResultsDespite similar baseline ODI (56 vs 50, P = .11) and back VAS (6.8 vs 6.6, P = .52), SCS patients did worse at all post-op time intervals. At 6 months, the SCS cohort had higher ODI (48 vs 31, P < .001) and VAS (4.8 vs 3.5, P = .01). This difference persisted at 1 year for ODI (46 vs 30, P < .001) but not for VAS (4.7 vs 4.0, P = .19). At 2 years, ODI remained significantly worse in the SCS cohort (49 vs 38, P = .004). Both cohorts had significant improvement at 2 years compared to baseline (SCS: -1.6 VAS, P < .001, -7 ODI, P = .03; Control: -2.5 VAS, P < .001, -13 ODI, P < .001). Radiographic parameters such as curve magnitude, curve correction, and balance were similar between the 2 groups.ConclusionDespite having substantial improvement after ASD surgery, patients with previous SCS placement did significantly worse in both back VAS and ODI postop compared with controls. They also did not experience a decrease in narcotic use at 2 years despite having similar overall radiographic results and complication rates.

Study DesignRetrospective cohort study.ObjectiveDecompression for the treatment of lumbar spinal stenosis (LSS) has shown excellent clinical outcomes. In patients with symptomatic single level stenosis and asymptomatic adjacent level disease, it is unknown whether decompressing only the symptomatic level is sufficient. The objective of this study is to compare outcomes between single level and dual level minimally invasive (MIS) decompression in patients with adjacent level stenosis.MethodsThe current study is a retrospective review of patients undergoing primary single or dual level MIS decompression for LSS. Radiographic stenosis severity was graded using the Schizas grading. Patients undergoing single level decompression (SLD) with moderate stenosis at the adjacent level were compared with patients undergoing dual level decompression (DLD) for multi-level LSS. Clinical outcomes, complications, and reoperations were compared. Subgroup analysis was performed on patients with the same Schizas grade at the adjacent level in the SLD group and the second surgical level in the DLD group.Results148 patients were included (126 SLD, 76 DLD). There were no significant differences in patient reported outcomes between the two groups at any timepoint up to 2 years postoperatively, including in the matched stenosis severity subgroups. Operative time was longer in the DLD cohort (P < 0.001). There were no significant differences in complications or reoperation rates.ConclusionIn patients with single level symptomatic LSS and adjacent level stenosis, decompression of only the symptomatic level provided equivalent clinical outcomes compared to dual level decompression. The additional operative time and potential incremental risk of dual level surgery may not be justified.

The aim of this study was to compare the efficacy and safety of biportal endoscopic discectomy (BED) with microdiscectomy (MD) in patients with a single-level lumbar disc herniation, and to determine whether BED gives similar clinical outcomes to MD but with potential additional benefits.

Included in this multicentre, prospective, assessor-blind, randomized controlled trial were patients with a single-level lumbar disc herniation requiring surgical intervention. These were recruited from six hospitals between 13 July 2021 and 16 September 2022, and followed up for 12 months. The interventions were either BED (n = 50) or MD (n = 50). The primary outcome was the Oswestry Disability Index (ODI) at 12 months postoperatively.

In total, 100 patients were randomized into the BED and MD groups based on computer-generated allocation. The analysis included 41 and 46 patients from the MD and BED groups, respectively. At 12 months, the mean ODI scores were comparable between the BED (10.92; SD 12.93) and MD (10.32; SD 12.55) groups (mean difference 0.61 (95% CI -4.47 to 5.68); p = 0.816). No serious adverse event was seen in either group. Compared to the MD group, the BED group showed slightly lower surgical site pain at 24 (p = 0.004) and 48 hours postoperatively (p = 0.014), lower serum creatine phosphokinase (CPK) (p = 0.003), better scar quality at three (p = 0.002) and six months (p = 0.007), and a significantly lower rate of wound dehiscence (p = 0.018).

BED is as effective as MD in treating single-level lumbar disc herniation but has distinct advantages in terms of postoperative wound complications. Additionally, BED may offer potential benefits in terms of early postoperative surgical site pain, scar aesthetics, and muscle preservation as indicated by CPK levels. These findings suggest that BED is a safe and effective alternative to MD, offering the benefits of minimal invasiveness while maintaining clinical efficacy.

Study DesignRetrospective cohort study.ObjectivesThe impact of delayed access to operative treatment on patient reported outcomes (PROs) for lumbar degenerative conditions remains unclear. The goal of this study is to evaluate the association between wait times for elective lumbar spine surgery and post-operative PROs.MethodsThis study is a retrospective analysis of patients surgically treated for a degenerative lumbar conditions. Wait times were calculated from primary care referral to surgery, termed the cumulative wait time (CWT). CWT benchmarks were created at 3, 6 and 12 months. A multivariable logistic regression model was used to measure the associations between CWT and meeting the minimally clinically important difference (MCID) for the Oswestry Disability Index (ODI) score at 12 months post-operatively.ResultsA total of 2281 patients were included in the study cohort. The average age was 59.4 years (SD 14.8). The median CWT was 43.1 weeks (IQR 17.8 - 60.6) and only 30.9% had treatment within 6 months. Patients were more likely achieve the MCID for the ODI at 12 months post-operatively if they had surgery within 6 months of referral from primary care (OR 1.22; 95% CI 1.11 - 1.34). This relationship was also found at a benchmark CWT time of 3 months (OR 1.33; 95% CI 1.15 - 1.54) though not at 12 months (OR 1.08; 95% CI 0.97 - 1.20).ConclusionsPatients who received operative treatment within a 3- and 6-month benchmark between referral and surgery were more likely to experience noticeable improvement in post-operative function.

Outcomes following radial extracorporeal shockwave therapy (rESWT) in patients with chronic noninsertional Achilles tendinopathy are investigated.

Patients with chronic noninsertional Achilles tendinopathy were recruited from a single National Health Services clinic, randomized equally to either "therapeutic" or "minimal-dose" ("presumed sham") rESWT (3 sessions at weekly intervals). Both groups had an identical structured home rehabilitation program of progressive loading, balance, and stretching exercises.

Fifty-seven patients were recruited; mean age 49.7±7.2 years, 60% female, symptom duration: 22.2±19.5 months. No between-group differences were identified at the final or any interim time points. Clinically and statistically significant within-group improvements were identified in pain/local function patient-reported outcome measures for both groups, with "average pain" improving by 34% at 6 months. No consistent benefits were seen in global function, activity levels, or mood.

"Recommended-dose" rESWT is not superior to "minimal-dose" rESWT and may be ineffective for patients with chronic noninsertional Achilles tendinopathy.

Exploring gender differences in outcomes after spinal surgery is essential. We aimed to assess gender differences in patients treated for thoracolumbar burst fractures without neurological deficit regarding Oswestry Disability Index (ODI) improvement. Secondarily, we assessed baseline characteristics, treatment selection, and other patient-reported outcomes.

Data were prospectively collected. The primary end point was defined as time to achieve minimal clinically important difference (MCID) in ODI. In an exploratory analysis, we defined improvement in ODI as reaching minimal disability.

Genders had similar baseline characteristics, injury characteristics, and treatment selection and timing.Surgically treated women showed a faster achievement of MCID in ODI (14 days, 95% CI 14.0-28.0 vs 28 days, 95% CI 15.0-34.0, P = .009). On multivariable modeling, nonoperatively treated women had a lower chance of achieving improvement in the ODI than nonoperatively treated men (hazard ratio 0.55, 95% CI: 0.32-0.96, P = .036).Women had a longer median time to achieve minimal disability (102.0 days, 95% CI: 76.0; 131.0 vs 62.0 days, 95% CI: 51.0; 72.0, P = .008). Nonoperative women had a longer median time to achieve minimal disability (130.0 days, 95% CI: 82.0-185.0 vs 61.0 days, 95% CI: 47.0-76.0, P = .048). On multivariable modeling, nonoperative women had a lower chance for achieving minimal disability than nonoperatively treated men (hazard ratio 0.55, 95% CI 0.31-0.98 P = .042).

This novel study reports gender differences in thoracolumbar burst fractures in neurologically intact patient. Women do worse with nonoperative management than men. In addition, women do better with operative than nonoperative management in achieving MCID, whereas this was not observed in men. Thus, women benefit to a greater extent from surgical management than do men. These results highlight the importance of personalized treatment that incorporates gender. Future studies should assess gender differences in other traumatic spinal pathologies.

Lumbar decompression and short-segment lumbar fusion are standard procedures for short-segment lumbar canal stenosis, even in patients with moderate Cobb angles. Adult degenerative scoliosis is diagnosed at a threshold of 10°, and patients with coronal Cobb angles over 30° are recommended for long fusion due to global spinal deformity. However, there is a lack of research on clinical outcomes in patients with moderate coronal deformity, such as Cobb angles between 20° and 30°.

This study aims to investigate the radiographic and clinical outcome differences between isolated decompression and short-segment interbody fusion for lumbar spinal canal stenosis in patients with moderate coronal deformity.

A retrospective analysis of a prospectively collected registry.

Patients with Cobb angle exceeding 20° who underwent 1- or 2- levels of lumbar surgery for lumbar canal stenosis. Patients diagnosed as spinal deformity were excluded.

Patient-reported outcomes included Oswestry Disability Index (ODI), VAS back, VAS leg, Short form 12 physical component score (SF-12 PCS) and Mental Component Score (SF-12 MCS), and patient-reported outcomes measurement information system physical function (PROMIS-PF) at preoperative, 12-week postoperative, and 1-year postoperative timepoints. Preoperative and postoperative spinopelvic alignment was assessed using Cobb angle, pelvic tilt, sacral slope, pelvic incidence, lumbar lordosis and PI minus LL.

A propensity score-matched analysis with the overlap weighting was utilized to investigate patient-reported outcomes at 12-week and 1-year postoperatively between the surgery groups. Spinopelvic alignments were compared between preoperative and 1-year postoperative timepoint using a linear mixed-effect model.

Before overlap weighting, the two surgery groups showed significant differences in age and diagnosis. No obvious sagittal malalignment was observed (PI minus LL: decompression, 7.4° vs fusion, 11.5°). After propensity score weighting, the fusion groups exhibited significantly better ODI and VAS back at the 1-year timepoint (ODI: fusion, 16.6 vs decompression, 28.1, p=.013; VAS back: fusion, 1.5±2.1 vs decompression, 3.7±1.9, p<.001). Radiographic assessment showed that the fusion group achieved better PI minus LL compared to decompression group (15° vs 10°, p=.008).

In patients with degenerative scoliosis and a Cobb angle greater than 20°, short-segment lumbar fusion surgery may result in enhanced improvement for short-segment lumbar pathology compared to isolated decompression.

To assess the early clinical and radiological outcomes of the midline lumbar interbody fusion (MIDLIF) approach with the use of robotic assistance and expandable spacers.

A retrospective case series was performed on patients who underwent MIDLIF procedures for the treatment of degenerative spinal diseases, with a minimum of three months postoperative follow-up. Demographic (age, gender, body mass index [BMI], comorbidities, and diagnoses), surgical data (operative time, blood loss, hospital stay, intraoperative complications), patient-reported outcomes (PROs) (visual analogue scale [VAS] back pain and disability (Oswestry disability index [ODI]), and radiographic data were collected.

In total, 42 patients were included, with an average age of 53.6 years and a BMI of 28 kg/m². Surgical data showed the mean total operative time was 98.8 minutes, and the mean blood loss was 17.1 mL with no intraoperative complications. At three-month follow-up, all mean PROs showed statistically significant improvement (p<0.05) when compared with baseline. VAS back pain improved from 7.5 (standard deviation (stdev) 7.5±0.7) preoperatively to 3.0 (stdev 1.0) at three months postoperative, while ODI improved from 58.7 (stdev 7.2) to 26.3 (stdev 10.3) at the same time points. Radiographic data showed that using robotic assistance for planning and placing cortical screws yielded high accuracy, as evidenced by a mean tip deviation of 1.2 mm (stdev 0.6 mm), mean tail deviation of 1.1 mm (stdev 0.4 mm) and a mean angular offset of 1.4 mm (stdev 0.7). Two (4.8%) patients had postoperative complications at three-month follow-up, including a wound infection and one report of wound dehiscence.

MIDLIF is an efficient, reproducible surgical procedure with a low complication rate that resulted in significant improvements in early PROs. Robotic assistance for planning and placing cortical screws in MIDLIF was highly accurate. These initial findings suggest that using robotic assistance adds value to MIDLIF procedures and is a viable alternative to traditional posterior fusion procedures.

There is a paucity of data comparing patient-reported outcomes across surgeon age. Prior work has focused on adverse event rates for surgeon age across a variety of surgical procedures.

To compare patient-reported outcomes, expectation fulfillment, and satisfaction measures after spine surgery across surgeon age categories.

This retrospective cohort study was conducted at multicentered tertiary referral centers across Canada. Patients with degenerative conditions of the spine were enrolled in a national research network from January 2015 to August 2020. Patients were linked to a demographic survey distributed to spine surgeons who enrolled the patients. Elective surgery for degenerative spine conditions were followed up for a minimum of 1 year after operation. The data were analyzed in January 2024.

Surgeons were classified according to their age: younger (age 35-44 years), middle age (45-59 years), and older (≥60 years).

The primary outcomes were the Ostwestry Disability Index (ODI) and Neck Disability Index (NDI), numerical pain scores, expectation fulfillment, and overall satisfaction with spine surgery. Baseline demographic and clinical data and surgical procedure complexity were collected. Multivariate logistic regression models were employed, using generalized estimating equations to account for clustering within surgeons, to compare patient outcomes, expectation fulfillment, and satisfaction by surgeon age.

A total of 3421 patients (1236 [36.1%] aged 65 years or older; 1603 female [46.9%]) were included in the study for analysis, with 811 (23.7%) treated by younger surgeons, 1643 (48.0%) by middle-age surgeons, and 967 (28.3%) by older surgeons. There were 2857 procedures of the lumbar spine (83.5%). After accounting for patient demographic, clinical, surgical, and surgeon characteristics, there were no significant differences in disability and pain (ODI and NDI or pain score) at 12 months among younger (mean ODI and NDI score, 25.6; 95% CI, 24.3-26.9; mean pain score, 3.4; 95% CI, 3.2-3.6), middle-age (mean ODI and NDI score, 25.8; 95% CI, 24.9-26.8; mean pain score, 3.3; 95% CI, 3.2-3.4), and older (mean ODI and NDI score, 24.6; 95% CI, 23.4-25.8; mean pain score, 3.4; 95% CI, 3.2-3.6) surgeons. Patients treated by younger (adjusted odds ratio [aOR], 1.57; 95% CI, 1.02-2.40) and middle-age (aOR, 1.41; 95% CI, 1.06-1.86) surgeons reported having all their expectations fulfilled compared with older surgeons. Additionally, patients treated by younger surgeons reported higher satisfaction levels (aOR, 1.29; 95% CI, 1.01-1.69) compared with middle-aged and older surgeons.

In this retrospective cohort study of patients who underwent elective spine surgery, there was no difference in outcomes by surgeon age at 1 year, but patients treated by younger surgeons reported higher levels of satisfaction and expectation fulfillment. These findings suggest that spine surgeons of all ages are a valuable resource given similar patient outcomes for all groups.

There has been no recent updated comprehensive review of measurement properties focused on the 5-repetition sit-to-stand test (5R-STS) in patients with lumbar degenerative disorders (LDD) that could aid in better understanding of its clinical and research applicability.

The aim of this systematic review was to summarize evidence on measurement properties of the 5R-STS in patients with LDD according to COnsensus Based Standards for the Selection of Health Measurement INstruments (COSMIN) guidelines.

Systematic review and meta-analysis.

In Step 1 and 2, 3,363 and 1,287 adult patients with suspected or diagnosed either clinically and/or radiologically LDD were included, respectively. Step 2 involved screening studies from Step 1 that passed the full text-stage and including only those that assessed at least 1 COSMIN measurement property.

Functional Measures (5R-STS, Timed Up and Go Test). Self-report Measures (including Oswestry Disability Index (ODI), Roland Morris Disability Questionnaire, pain scores eg, Visual Analogue Scale) and healthcare quality of life questionnaires (eg, EQ-5D-3L)).

In December 2022 Embase, PubMed/Medline, Web of Science and Scopus were searched for studies of 5R-STS of patients with LDD (PROSPERO: CRD42022383095). Quality of evidence was assessed using GRADE and COSMIN Checklist. Results for measurement error were pooled using the weighted mean method. Random effect meta-analysis was performed for studies on reliability and criterion validity.

Thirty-eight full-text articles were included in Step 1 and 19 in Step 2. The overall intraclass correlation coefficient (ICC) of test-retest reliability and inter-rater reliability of the 5R-STS was 0.93 (95% CI 0.37-1.00) and 0.99 (95% CI 0.83-1.00), respectively. The weighted standard error of measurement (SEM) mean value was 2.8s. Estimated r of 5R-STS and ODI, reflecting insufficient criterion validity (since r <0.70), was 0.53 (95% CI 0.17-0.88). Hypothesis testing for construct validity was confirmed for 40% of predefined hypothesis (graded as insufficient since overall, not >70% hypothesis confirmed). Accounting for limited evidence, responsiveness of the test was adequate.

This COSMIN systematic review summarizes 5R-STS measurement properties in patients with LDD, including pooled estimates of ICC for reliability, SEM, and correlation between 5R-STS and ODI. The 5R-STS is a reliable and responsive instrument reflecting a new dimension of functional impairment in patients with LDD.

There is lack of evidence regarding the impact of class 2/3 obesity (body mass index [BMI] ≥35) on outcomes following minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

To analyze clinical outcomes, return to activities, fusion rates, and complication/reoperation rates following MI-TLIF in class 2/3 obese patients and compare them with other BMI groups.

Retrospective cohort.

Patients who underwent primary single-level tubular MI-TLIF for degenerative conditions of lumbar spine and had a minimum of 1-year follow-up were included. Patients were divided into 4 cohorts based on their BMI: normal (BMI 18.5 to <25), overweight (25 to <30), class 1 obesity (30 to <35), and class 2/3 obesity (BMI ≥35).

(1) operative variables: operative time, estimated blood loss (EBL), postoperative length of stay (LOS); (2) patient reported outcome measures (PROMs) (Oswestry Disability Index [ODI]; Visual Analog Scale [VAS] back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); (3) global rating change (GRC), minimal clinically important difference (MCID), and patient acceptable symptom state (PASS) achievement rates; (4) return to activities; (5) fusion rates; and (6) complication and reoperation rates. Two postoperative timepoints were defined: early (<6 months) and late (≥6 months).

Differences between the 4 BMI cohorts in demographics and outcome measures were analyzed with appropriate statistical tests. Subgroup analyses were performed to compare outcomes between (1) class 2 and class 3 obesity groups and (2) patients with and without metabolic syndrome. Regression analyses were performed to analyze the relationship of BMI groups and metabolic syndrome with PASS achievement.

Three hundred and ninety patients were included (119 normal, 160 overweight, 67 class 1 obesity, 44 class 2/3 obesity). There was no significant difference in intraoperative variables. Although no significant difference was seen between the groups in PROMs at <6 months, class 2/3 obesity group had significantly worse PROMs, lower PASS achievement rates, and lower MCID achievement rates in VAS leg and SF-12 PCS at ≥6 months. There were no significant differences in the MCID achievement rates in ODI and VAS back and responses on the GRC scale. Although class 2/3 obesity group had a lower fusion rate (67% vs. >87% in other groups), this difference was not statistically significant. Class 2/3 obesity group had significantly higher postoperative LOS (62 hours vs. <50 hours in other groups) and took significantly greater number of days to return to driving (74 days vs. <40 days in other groups). No significant difference was found in return to work and discontinuation of narcotics. The groups had similar complication and reoperation rates. On subgroup analysis, postoperative PROMs did not show any difference between (1) class 2 and class 3 obesity groups and (2) patients with and without metabolic syndrome. On regression analysis, class 2 and class 3 obesity groups showed a significant negative relationship with PASS achievement. Class 2 obese patients were 3.7 times and class 3 obese groups were 5 times less likely to achieve PASS.

Class 2/3 obese patients undergoing MI-TLIF had significantly worse PROMs and lower MCID and PASS achievement rates at ≥6 months. They took longer to be discharged from the hospital and return to driving following surgery. Class 2 obese patients were 3.7 times and class 3 obese groups were 5 times less likely to achieve an acceptable symptom state after surgery.

Carbon-fiber-reinforced polyether ether ketone (CF-PEEK) is a radiolucent, non-metallic implant material used for instrumented lumbar spondylodesis. Clinical studies of pedicle screw systems employing this material, especially for degenerative indications, are scant.

We conducted a multicenter, prospective clinical study to assess clinical and radiographic outcomes in patients with symptomatic degenerative lumbar disk disease, including degenerative spondylolisthesis treated with a CF-PEEK pedicle screw and a transforaminal lumbar interbody fusion (TLIF) cage system. We followed up the participants for two years postoperatively to collect clinical data (via the Oswestry Disability Index, Core Outcome Measures Index, and Visual Analog Scale), radiographic parameters (functional X-rays) to assess fusion status, and any complications.

In total, 86 patients were recruited. During the study, 21 patients (24.4%) dropped out, including 5 (5.8%) who underwent explantation of the study device(s). At the final follow-up, the fusion rate was 98.6% (95% confidence interval, 92.7-100.0%). All clinical parameters improved significantly. There were no complications potentially attributed to the implant material.

The results demonstrate a fusion rate similar to that of metallic implant systems with the use of a CF-PEEK pedicle screw and a TLIF cage system. Further studies with larger samples are needed to substantiate this finding.

The study was registered at ClinicalTrials.gov (NCT02087267). Date of registration: March 12, 2014.

The impact of surgical interventions on lumbar disc herniation (LDH) is often assessed using objective functional impairment (OFI) tests like the five-repetition sit-to-stand (5R-STS) test. This study calculates the minimum clinically important difference (MCID) for 5R-STS improvement in patients with LDH one year after surgery.

Adult patients with LDH scheduled for surgery were prospectively recruited from a Dutch short-stay spinal clinic. The 5R-STS time, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), Numeric Rating Scale for back and leg pain, EQ-5D-3L health-related quality of life questionnaire and EQ5D-VAS were recorded preoperatively, at 6-weeks and 1-year post-operatively. The MCID was calculated using anchor-based methods (within-patient change; between-patient change; and receiver-operating characteristic approaches) and distribution-based methods (0.5 standard deviation (SD); effect size; standard error of measurement; standardized response mean; and 95% minimum detectable change (MDC)). The final MCID value was based on the "gold standard": an averaging of the anchor-based methods using ODI and RMDQ as the closest available anchors.

We prospectively recruited 134 patients. One-year follow-up was completed by 103 (76.8%) of patients. The MCID values derived using different methods varied from 0.7 to 5.1 s (s). The final, averaged, anchor-based MCID for improvement was 3.6 s. Within distribution-based methods, 95% MDC and 0.5SD approach, yielded an MCID of 3.0 and 3.8 s, respectively, aligning closely with the overall anchor-derived MCID for 5R-STS.

In a patient with LDH, an improvement in 5R-STS performance of at least 3.6 s can be regarded as a clinically relevant improvement.

Retrospective review of prospective data.

Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) may be beneficial for elderly patients due to decreased surgical morbidity and faster postoperative recovery. This study compared the clinical and radiological outcomes of MIS-TLIF in elderly patients and younger controls at minimum 5-year follow-up.

There were 120 patients who underwent single-level MIS-TLIF for degenerative spondylolisthesis. Elderly patients (≥70 years; n = 30) and controls (<70 years; n = 90) were matched 1:3 for demographics, comorbidities and preoperative patient-reported outcomes (PROs). The Oswestry Disability Index (ODI), 36-Item Short-Form Physical (SF-36 PCS) and Mental Component Summary (SF-36 MCS), Visual Analogue Scale (VAS) back pain, and VAS leg pain were compared at 6 months, 2 years and 5 years. Radiographic fusion, adjacent segment degeneration (ASD) and revision rates were assessed at mean 7.2 ± 2.0 years.

Elderly patients had longer length of stay (4.7 ± 5.8 vs 3.3 ± 1.4 days, P = .035) and more readmissions (10% vs 1%, P = .019), but there was no difference in operative time, transfusions, complications or discharge disposition. All PROs were comparable at 5 years and satisfaction rates were similar (93% elderly vs 91% controls, P = .703). The rates of radiographic fusion in the control group and elderly group were similar (94% vs 97%, P = .605), as were the rates of ASD (40% vs 33%, P = .503). There were 3 revisions (3.3%) in the control group (2 for ASD, 1 for screw loosening) but none in the elderly group (P = .311).

Elderly patients undergoing MIS-TLIF achieved similar improvements in pain, disability and quality of life that were sustained at 5 years.Level of Evidence: Level III, retrospective cohort study.

Retrospective cohort.

To study the impact of class 2/3 obesity (body mass index, BMI ≥35) on outcomes following minimally invasive decompression.

No previous study has analyzed the impact of class 2/3 obesity on outcomes following minimally invasive decompression.

Patients who underwent primary minimally invasive decompression were divided into four cohorts based on their BMI: normal (BMI: 18.5-<25), overweight (25-<30), class 1 obesity (30-<35), and class 2/3 obesity (BMI ≥35). Outcome measures were: 1) intraoperative variables: operative time, estimated blood loss (EBL); 2) patient-reported outcome measures (PROMs) (Oswestry disability index, ODI; visual analog scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); 3) global rating change (GRC), minimal clinically important difference (MCID), and patient acceptable symptom state (PASS) achievement rates; 4) return to activities; and 5) complication and reoperation rates.

Totally, 838 patients were included (226 normal, 357 overweight, 179 class 1 obesity, and 76 class 2/3 obesity). Class 1 and 2/3 obesity groups had significantly greater operative times compared with the other groups. Class 2/3 obesity group had worse ODI, VAS back and SF-12 PCS preoperatively, worse ODI, VAS back, VAS leg and SF-12 PCS at below six months, and worse ODI and SF-12 PCS at above six months. However, they had significant improvement in all PROMs at both postoperative timepoints and the magnitude of improvement was similar to other groups. No significant differences were found in MCID and PASS achievement rates, likelihood of betterment on the GRC scale, return to activities, and complication/reoperation rates.

Class 2/3 obese patients have worse PROMs preoperatively and postoperatively. However, they show similar improvement in PROMs, MCID and PASS achievement rates, likelihood of betterment, recovery kinetics, and complication/reoperation rates as other BMI groups following minimally invasive decompression.

To investigate patient-reported outcomes following lumbar discectomy in patients with lateral lumbar disc herniation (LDH) compared with patients with paramedian LDH.

Data on patients with lateral and paramedian LDH operated on between 2017 and 2020 at a single public spine unit were extracted from the National Danish Spine Registry, DaneSpine. A propensity score-matched, case-control analysis was conducted to compare the 2 groups. Subgroup analysis was done by further dividing the lateral LDH group into foraminal and extraforaminal groups. Patient demographics, Oswestry Disability Index visual analog scale (VAS) leg and back pain (0-100), EuroQol-5D questionnaire, and measures of patient improvement and satisfaction were collected at baseline and 1 year postoperatively.

Of 887 eligible patients, baseline and 1-year follow-up data were available for 525 patients with paramedian LDH and 68 patients with lateral LDH. Following propensity score matching, the 2 groups were similar in terms of all baseline characteristics (P > 0.05). There were no significant differences between groups in Oswestry Disability Index, VAS leg pain, VAS back pain, and EuroQol-5D 1 year postoperatively. Both groups improved in all outcomes from inclusion to follow-up (P < 0.001). Subgroup analysis showed that patients with foraminal LDH compared with extraforaminal LDH had a significantly greater improvement in VAS leg pain (P = 0.016) with a larger number of patients with clinically significant leg pain improvement (P = 0.03).

Patients with lateral and paramedian LDH reported similar postsurgical outcomes. Spine surgeons should be less hesitant to operate on patients with lateral LDH. Patients with extraforaminal LDH experienced the least relief of leg pain.

Objectives: To detect differences between individualized homeopathic medicinal products (IHMPs) and placebo after 4 months of intervention in patients with chronic low-back pain (LBP). Design: Four-month, double-blind, randomized (1:1), placebo-controlled, two parallel arms trial. Setting: PG3 and research outpatient department of D. N. De Homoeopathic Medical College & Hospital. Subjects: Sixty participants with chronic LBP. Interventions: Verum (n = 30; IHMPs plus concomitant care) versus control (n = 30; placebos plus concomitant care). Outcome Measures: Primary-Oswestry LBP Disability Questionnaire (ODQ); Secondary-Roland Morris Pain and Disability Questionnaire (RMPDQ); McGill Pain Questionnaire-Short Form (SF-MPQ); measured at baseline, and every month, up to 4 months. Results: Group differences achieved significance or near significance in all the specified outcomes-ODQ score (F1, 58 = 4.331, p = 0.042), RMPDQ score (F1, 58 = 2.939, p = 0.092), and SF-MPQ total score (F1, 58 = 6.666, p = 0.012). Rhus toxicodendron (n = 13), Bryonia alba (n = 8), Hypericum perforatum, and Nux vomica (n = 5 each) were the most frequently prescribed medicines. Different repertories were used as per the need of the cases-Kent, Synthesis, Murphy, Pulford, Boericke, Boger Boenninghausen's Characteristics and Repertory, and Complete. Minor adverse events were reported from either group. Conclusions: Thus, homeopathic medicines worked significantly better than placebos in reducing chronic LBP. Independent replications are warranted to substantiate the findings. Clinical Trial Registration Number: CTRI/2022/04/041878.

 While the rates of lumbar spinal stenosis (LSS) surgery have increased continuously internationally, the role of fusion surgery in the treatment of LSS has been under debate. We aimed to assess the outcome of LSS surgery at 1 year postoperatively and to compare decompression surgery with or without fusion based on the Finnish national spine register FinSpine data.

 FinSpine data of surgically treated LSS from 2015 to 2022 was included. The primary outcome was Oswestry Disability Index (ODI), and secondary ones were Visual Analogue Scale for leg and back pain. Predetermined minimal clinically important difference (MCID) for all outcome measures was used to assess the clinical significance of differences in outcomes. Propensity score matching was utilized to ensure that the treatment groups were comparable.

 There were 8,647 LSS patients in the data, of whom 6,751 (77%) were the subject of decompression surgery. Over 90% of patients without spondylolisthesis received decompression alone. At 1-year follow-up, ODI was on average 20.6 (95% confidence interval [CI] 19.3-21.9]) for the fusion group and 23.3 (CI 22.5-24.0) for the decompression group. Differences in ODI, VAS leg pain, or VAS back pain were below the MCID. The share of patients reaching ODI percentage change score ≥ 30% was 74% (CI 71-78) in the fusion group and 66% (CI 63-68) in the decompression group.

 Most of the LSS patients experienced significant improvement after LSS surgery. We found no clinical differences between decompression surgery with and without fusion.

Although a few recent studies showed good outcomes in back pain-predominant patients following decompression alone, none of the studies had a comparative fusion group.

We sought to compare outcomes of minimally invasive decompression alone versus fusion in patients with predominant back pain.

This retrospective cohort study included patients who underwent minimally invasive decompression alone or fusion and had preoperative back pain > leg pain. Outcome measures were (1) patient-reported outcome measures (PROMs), (2) minimal clinically important difference (MCID) achievement, (3) patient acceptable symptom state (PASS) achievement, and (4) global rating change (GRC). As a subgroup analysis, MCID, PASS, and GRC rates were also compared between the decompression and fusion groups for patients with preoperative back pain < leg pain.

Of 510 patients included, there were statistically significant improvements in all PROMs in both groups at <6 and >6 months with no significant difference in the magnitude of improvement. The fusion group showed significantly higher MCID achievement rates for Visual Analog Scale (VAS) back at <6 months (85% vs 70%) and Oswestry Disability Index (ODI) at >6 months (67% vs 51%). Proportion of patients achieving PASS and feeling better after surgery based on response to GRC showed no difference between the groups. The subgroup analysis for decompression versus fusion in patients with preoperative back pain < leg pain showed no differences in MCID, PASS, or GRC rates.

This retrospective cohort study found that in patients with predominant back pain, minimally invasive decompression alone had significantly less MCID achievement rates in VAS back at <6 months and ODI at >6 months. However, it did lead to an overall significant improvement in PROMs, similar PASS achievement rates, and similar responses on the GRC scale.

Retrospective cohort.

To identify the predictors of slower and nonimprovement after surgical treatment of L4-5 degenerative lumbar spondylolisthesis (DLS).

There is limited evidence regarding clinical and radiologic predictors of slower and nonimprovement following surgery for L4-5 DLS.

Patients who underwent minimally invasive decompression or fusion for L4-5 DLS and had a minimum of 1-year follow-up were included. Outcome measures were: (1) minimal clinically important difference (MCID), (2) patient acceptable symptom state (PASS), and (3) global rating change (GRC). Clinical variables analyzed for predictors were age, gender, body mass index (BMI), surgery type, comorbidities, anxiety, depression, smoking, osteoporosis, and preoperative patient-reported outcome measures (PROMs) (Oswestry disability index, ODI; visual analog scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS). Radiologic variables analyzed were slip percentage, translational and angular motion, facet diastasis/cyst/orientation, laterolisthesis, disc height, scoliosis, main and fractional curve Cobb angles, and spinopelvic parameters.

Two hundred thirty-three patients (37% decompression and 63% fusion) were included. At less than three months, high pelvic tilt (PT) (OR: 0.92, P= 0.02) and depression (OR: 0.28, P= 0.02) were predictors of MCID nonachievement and GRC nonbetterment, respectively. Neither retained significance at above six months and hence, were identified as predictors of slower improvement. At above six months, low preoperative VAS leg (OR: 1.26, P= 0.01) and high facet orientation (OR: 0.95, P= 0.03) were predictors of MCID nonachievement, high L4-5 slip percentage (OR: 0.86, P= 0.03) and L5-S1 angular motion (OR: 0.78, P= 0.01) were predictors of GRC nonbetterment, and high preoperative ODI (OR: 0.96, P= 0.04) was a predictor of PASS nonachievement.

High PT and depression were predictors of slower improvement and low preoperative leg pain, high disability, high facet orientation, high slip percentage, and L5-S1 angular motion were predictors of nonimprovement. However, these are preliminary findings and further studies with homogeneous cohorts are required to establish these findings.

This study investigates the relationship between surgical levels and coronal deformity to identify risk factors for failing to achieve a minimal clinically important difference (MCID) in the Oswestry Disability Index (ODI) following short-segment isolated decompression or fusion surgery in patients with degenerative scoliosis (DS) and concurrent lumbar canal stenosis (LCS), without severe sagittal deformity malalignment.

Patients with degenerative scoliosis who underwent 1- or 2-level lumbar isolated decompression or fusion surgery were included. Surgical level was labeled as "Cobb-related" when decompression or surgical levels spanned or were between end vertebrae, and "outside" when the operative levels did not include the end vertebrae. Logistic regression analysis was conducted to assess the factor associated with MCID achievement in ODI at 1 year postoperatively.

A total of 129 DS patients with LCS and preoperative ODI > 30 were included. At 1-year follow-up, 91 patients (70.5%) achieved MCID in ODI. No significant differences were found in demographics or overall spinal alignment between patients who did and did not achieve MCID. Logistic regression analysis revealed that Cobb-related decompression was independently associated with decreased odds of achieving MCID in ODI (adjusted Odds Ratio 0.18, 95% CI 0.42-0.79, P = 0.025).

In patients with mild to moderate coronal deformity and minimal sagittal deformity, decompression alone at or across end vertebrae significantly lowers the likelihood of achieving the MCID in ODI compared to fusion surgery, with an 84% reduction in odds. No significant difference in MCID achievement was observed between decompression and fusion surgeries outside the Cobb angle.

Many interventional strategies are commonly used to treat chronic low back pain (CLBP), though few are specifically intended to target the distinct underlying pathomechanisms causing low back pain. Restorative neurostimulation has been suggested as a specific treatment for mechanical CLBP resulting from multifidus dysfunction. In this randomized controlled trial, we report outcomes from a cohort of patients with CLBP associated with multifidus dysfunction treated with restorative neurostimulation compared to those randomized to a control group receiving optimal medical management (OMM) over 1 year.

RESTORE is a multicenter, open-label randomized controlled trial. Candidates were assessed for CLBP associated with multifidus dysfunction, with no indication for or history of lumbar spine surgery. Participants were randomized to either restorative neurostimulation with the ReActiv8 system or OMM. The primary endpoint was a comparison of the mean change in the Oswestry Disability Index (ODI) between the treatment and control arms at 1 year, and secondary endpoints included pain (numeric rating scale [NRS]) and health-related quality of life (EuroQol Five-Dimension [EQ-5D-5L]).

A total of 203 patients, average age 47 years, and with an average 11-year history of low back pain, were included in the analysis. The primary endpoint was a statistically significant demonstration of a clinically relevant mean improvement in the Oswestry Disability Index (ODI) between restorative neurostimulation and OMM arms: ODI (-19.7 ± 1.4 vs. -2.9 ± 1.4; p < 0.001). Additionally, improvements in both the numeric rating scale (NRS) (-3.6 ± 0.2 vs. -0.6 ± 0.2; p < 0.001) and EuroQol Five-Dimension (EQ-5D-5L) (0.155 ± 0.012 vs. 0.008 ± 0.012; p < 0.001) were statistically and clinically significant in the restorative neurostimulation arm compared to the OMM arm.

The RESTORE trial demonstrates that restorative neurostimulation is a safe, reversible, clinically effective, and highly durable option for patients suffering with nonoperative CLBP associated with multifidus dysfunction. This demonstration of treatment superiority over OMM through 1 year is a significant milestone in addressing a major health burden and unmet clinical need.

ClinicalTrials.gov Identifier: NCT04803214.

To evaluate the clinical efficacy of large-channel endoscope-assisted posterior lumbar interbody fusion (Endo-PLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open posterior lumbar interbody fusion in treatment of degenerative diseases of the lumbar spine.

Data of 110 patients with degenerative diseases of the lumbar spine were analyzed retrospectively: 31 patients underwent Endo-PLIF, 36 patients underwent MIS-TLIF, and 43 patients underwent modified TLIF. We compared operative duration, intraoperative blood loss, latent blood loss, intraoperative radiation dose, visual analog scale score, Oswestry Disability Index, anterior protrusion angle of the intervertebral space, postoperative ambulatory time, postoperative duration of hospital stay, and complications among the 3 groups. The prevalence of interbody fusion was observed at follow-up.

Operative duration of Endo-PLIF was longer than that of MIS-TLIF and modified TLIF (P < 0.05). In terms of intraoperative blood loss, latent blood loss, and recovery time, Endo-PLIF and MIS-TLIF had clear advantages (P < 0.05). Visual analog scale score and Oswestry Disability Index of the 3 groups were satisfactory, but low back pain of patients in the Endo-PLIF and MIS-TLIF groups was less than that in the modified TLIF group (P < 0.05). In terms of complications and prevalence of interbody fusion, there were no significant differences among the 3 groups (P > 0.05).

All 3 operative methods had satisfactory efficacy. Endo-PLIF can be employed to treat lumbar degenerative diseases more precisely and in a minimally invasive fashion, but a learning curve and improvement in surgical instruments are needed.

Retrospective review of prospectively collected data.

To analyze temporal trends in improvement after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Although several studies have shown that patients improve significantly after MIS TLIF, evidence regarding the temporal trends in improvement is still largely lacking.

Patients who underwent primary single-level MIS TLIF for degenerative conditions of the lumbar spine and had a minimum of 2-year follow-up were included. Outcome measures were: 1) patient reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); 2) global rating change (GRC); 3) minimal clinically important difference (MCID); and 4) return to activities. Timepoints analyzed were preoperative, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years. Trends across these timepoints were plotted on graphs.

236 patients were included. VAS back and VAS leg were found to have statistically significant improvement compared to the previous timepoint up to 3 months after surgery. ODI and SF-12 PCS were found to have statistically significant improvement compared to the previous timepoint up to 6 months after surgery. Beyond these timepoints, there was no significant improvement in PROMs. 80% of patients reported feeling better compared to preoperative by 3 months. >50% of patients achieved MCID in all PROMs by 3 months. Most patients returned to driving, returned to work, and discontinued narcotics at an average of 21, 20, and 10 days, respectively.

Patients are expected to improve up to 6 months after MIS TLIF. Back pain and leg pain improve up to 3 months and disability and physical function improve up to 6 months. Beyond these timepoints, the trends in improvement tend to reach a plateau. 80% of patients feel better compared to preoperative by 3 months after surgery.