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Anterior lumbar interbody fusion (ALIF), traditionally performed supine, allows for significant restoration of lumbar lordosis, disc height, and foraminal height in degenerative spine diseases; however, an iatrogenic injury to the viscera and the great vessels can have devastating consequences. Although lateral lumbar interbody fusion (LLIF) is an acceptable and minimally invasive alternative at the L5-S1 level, this approach is suboptimal because of a narrow surgical corridor limited by the iliac crest, common iliac artery and vein, and psoas. Furthermore, combining supine L5-S1 ALIF and lateral decubitus (LD) LLIF requires time-consuming patient repositioning. 1,2 To maximize the advantages of both procedures in patients with disease spanning the lumbosacral junction, ALIF and LLIF can be performed in a single stage with the patient remaining in an LD position throughout. To improve the efficiency of this single-position procedure, a fluoroscopy-based instrument tracking system (TrackX Technology Inc., Hillsborough, North Carolina, USA) was used to navigate surgical tools during the procedure. We show this technique in a 43-year-old patient with medically intractable back and leg pain secondary to multi-level degenerative lumbar spondylosis. The patient consented to this procedure; all participants consented to publication of their images. This tracking system allowed for accurate and precise virtual projections of surgical instruments, thereby facilitating the identification of midline and proper trajectories to perform discectomy and implant placement, reducing the amount of intraoperative fluoroscopy use, and eliminating intraoperative computed tomography. To our knowledge, this is the first operative video showing a fluoroscopy-based instrument tracking system used in a combined single-position LD-ALIF and LD-LLIF. [ABSTRACT FROM AUTHOR]

This article explores the impact of patient demographics and socioeconomic status on surgical outcomes in endonasal endoscopic pituitary surgery. The study reviewed 187 patients who underwent this surgery between 2017 and 2019. The findings revealed that male patients were more likely to have larger tumors and higher comorbidity scores, while Hispanic patients had smaller tumors and lower comorbidity scores. Black patients experienced longer hospital stays, higher costs, and higher rates of readmission, regardless of income. These results suggest that racial health disparities are not solely due to socioeconomic status and emphasize the importance of considering social determinants of health in clinical practice. [Extracted from the article]