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Background: This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches. Methods: From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion. Results: There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS(back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups. Conclusion: There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient's financial situation, their ability to tolerate surgery, and the surgeon's expertise. [ABSTRACT FROM AUTHOR]

Hip-spine syndrome (HSS) was first described in 1983 to describe the symptomatology resulting from concomitant lumbar degenerative stenosis and hip osteoarthritis. Numerous studies have sought to understand the underlying pathology and appropriate management of this syndrome. The purpose of this article is to review the literature for the specific imaging characteristics and the optimal surgical treatment of HSS. A systematic review was conducted via an electronic database search through PubMed to identify all publications related to HSS. All publications that contained data on patients who underwent surgical treatment for HSS and reported patient-reported outcome measures or radiographic data were included. Exclusion criteria consisted of publications in a language other than English, review articles, and technique articles. Fifteen articles that focused on the surgical management of HSS were identified. Of these 15 articles, 8 reported radiographic outcomes, with most reporting no significant change in spinopelvic parameters before and after surgery. Thirteen articles reported clinical outcomes, with 8 of those 13 articles identifying patient-reported outcome measures to be significantly improved following surgery. The data on the surgical management of HSS remains sparse. While there is some evidence that total hip arthroplasty in patients who previously underwent spinal fusion may have higher complication rates, there remains debate regarding which surgical problem to address first, the hip or the spine. [ABSTRACT FROM AUTHOR]

Background: To compare the clinical and radiological outcomes of modified mini-open transforaminal lumbar interbody fusion (mMO-TLIF) via posterior midline incision for "targeted limited dissection" versus minimal invasive transforaminal lumbar interbody fusion (MIS-TLIF) via Wiltse approach in lumbar degenerative diseases. Methods: A total of 60 consecutive patients in our center from January 2019 to March 2020 were enrolled, including 30 patients who were treated with mMO-TLIF via posterior midline incision and 30 treated with MIS-TLIF through the Wiltse approach. Perioperative parameters were recorded. The questionnaires of Oswestry Disability Index (ODI) and Visual Analogue Score (VAS) were conducted before the operation and after the operation (3 days, 1 week, and 2 years). CT and MRI radiological outcomes were evaluated before the operation and at a 2-year follow-up. Results: There were no significant differences in the general data, gender, age, and BMI between the two groups. All patients were successfully operated without intraoperative complications. There were significant differences between the two groups in the operation time (p < 0.001) and intraoperative bleeding (p < 0.05). There was no difference in ODI and VAS scores between groups pre- and post-operatively, but they were both significantly improved compared to those before the operation (p < 0.01). At a 2-year follow-up, the paraspinal muscle atrophy and fat infiltration were increased comparing to pre-operation, but the difference was also not statistically significant (p > 0.05). In addition, both the two groups' fusion rates were more than 90% at a 2-year follow-up, however, no difference was detected between the two groups. Conclusion: mMO-TLIF via midline incision for "targeted limited dissection" could achieve similar clinical and radiological outcomes as MIS-TLIF for lumbar degenerative disease. [ABSTRACT FROM AUTHOR]

Abstract Background This study retrospectively compared short-term clinical outcomes and complications of minimally invasive surgery transforaminal lumbar interbody fusion(MIS-TLIF)and endoscopic lumbar interbody fusion(Endo-LIF))for two-segmental lumbar degenerative disease, aiming to guide spine surgeons in selecting surgical approaches. Methods From January 2019 to December 2023, 30 patients were enrolled,15 in the MIS-TLIF group and 15 in the Endo-LIF group. All patients were followed up for more than 3 months after surgery and the following information was recorded: (1)surgery time, difference in hemoglobin between preoperative and postoperative, surgical costs, first time out of bed after operation, postoperative hospitalization time, postoperative complication; (2) ODI score (The Oswestry Disability Index), leg and back VAS score (Visual Analogue Scale), and lumbar vertebra JOA score (Japanese Orthopaedic Association Scores); (3) MacNab score at final follow-up to assess clinical outcome, CT to evaluate lumbar fusion. Results There were significant differences between the two groups regarding operation time and cost, with the MIS-TLIF group performing significantly better. Intraoperative bleeding was considerably less in the Endo-LIF group compared to the MIS-TLIF group. However, there were no significant differences in the time of the first postoperative ambulation, postoperative hospitalization time, and postoperative complications. There was no significant difference in preoperative VAS, ODI, and JOA between the two surgical groups There were no significant differences in VAS(leg), ODI, and JOA scores between the two groups before and at 1 day,7 days, 1 month, 3 months and final follow-up. However, at 1 day postoperatively, the VAS( back)score in the Endo-LIF group was lower than that in the MIS-TLIF group, and the difference was statistically significant. At the final follow-up, all patients achieved grade III and above according to the Bridwell criteria, and there was no significant difference between the two surgical groups compared to each other. According to the MacNab score at the final follow-up, the excellent rate was 80.00% in the Endo-LIF group and 73.33% in the MIS-TLIF group, with no significant difference between the two groups. Conclusion There was no significant difference in short-term efficacy and safety between Endo-LIF and MIS-TLIF for two-segment degenerative lumbar diseases. MIS-TLIF has a shorter operative time and lower costs, while Endo-LIF causes less tissue damage, blood loss, and early postoperative pain, aiding long-term recovery. Both MIS-TLIF and Endo-LIF are promising for treating two-segment lumbar degenerative disease. The choice of a surgical procedure depends on the patient’s financial situation, their ability to tolerate surgery, and the surgeon’s expertise.

BACKGROUND: Stand-alone oblique lateral interbody fusion has a high rate of complications of fusion segment sink. Oblique lateral interbody fusion with posterior fixation can provide stable support, but intraoperative position changes and double incisions weaken the advantages of this technique. Oblique lateral interbody fusion combined with lateral plate fixation can achieve one-stage decompression in the same incision, while the lateral internal fixation provides stable support. OBJECTIVE: To analyze the short-term efficacy of oblique lateral interbody fusion combined with lateral plate fixation in the treatment of single-level lumbar degenerative disease. METHODS: The clinical data of 34 patients with single-level lumbar degenerative disease treated with oblique lateral interbody fusion combined with lateral plate fixation were collected from May 2020 to October 2022. Among them, 14 were males and 20 were females aged from 41 to 72 years at the mean age of (58.6 ±9.9) years. There were 11 cases of lumbar spondylolisthesis (I°), 7 cases of lumbar disc herniation with segmental instability, and 16 cases of lumbar spinal stenosis. Operation time, blood loss, and complications were recorded. Visual analog scale scores of lumbago, radiative pain of both lower limbs, and Oswestry disability index scores were evaluated before surgery, 3 months after surgery, and the last follow-up. Dural sac cross-sectional area, intervertebral height, and intervertebral fusion were measured and observed. RESULTS AND CONCLUSION: (1) The 34 patients were followed up for 14-36 months, with an average of (21.3±5.2) months. (2) The operation time ranged from 50 to 92 minutes, with an average of (68.5±11.1) minutes. Intraoperative blood loss was 50-170 mL, with an average of (71.6±25.3) mL. (3) Compared with the preoperative results, the visual analog scale scores and Oswestry disability index scores were significantly decreased at 3 months after surgery and at the last follow-up (P < 0.001), and the maximum Oswestry disability index scores were improved by nearly 50%. (4) Bone fusion was achieved in all patients during half-year follow-up. The overall complication rate was 21% (7/34), including 1 case of plate displacement, 3 cases of cage subsidence, 1 case of psoas weakness, and 2 cases of anterior thigh pain. (5) It is concluded that oblique lateral interbody fusion combined with lateral plate fixation for the treatment of lumbar degenerative diseases has the characteristics of less blood loss, short operation time, rapid postoperative recovery, and significant short-term clinical efficacy with the stable support to a certain extent. The long-term curative effect needs further follow-up observation. [ABSTRACT FROM AUTHOR]

Abstract Purpose Oblique lumbar interbody fusion (OLIF) still has a steep learning curve that many spinal surgeons who want to develop are hesitant. The purpose of this study is to provide reference for beginners through the comparative analysis of the application of two kinds of retraction devices in the early stage of learning curve. Method We prospectively included the first 60 patients with lumbar degenerative diseases treated with OLIF by a surgeon in our department. According to the application of different retraction devices during the operation, the patients were divided into hook retractor group and tubular retractor group. The clinical effects and complications of the two groups were compared. Result The average age of hook retractor group was 62 years old, the average age of tubular retractor group was 65 years old. There was no significant difference in age, sex, operative segment, follow-up time and blood loss between the two groups. The operation time in hook retractor group was less than that in tubular retractor group. The incidence of complications in hook retractor group (11.8%) was significantly lower than that in tubular retractor group (38.5%). Conclusion The tubular retractor group has a higher risk of neurovascular injury in the initial stage of learning, as well as the risk of vertebral fracture. In contrast, the hook retractor group has the advantages of simple method, high fault tolerance and relatively low incidence of complications. Therefore, we believe that the application of hook retractor in the early stage of OLIF learning curve is easier to increase the operator’s confidence and make OLIF more acceptable.

Abstract Background Sacral screw loosening is a typical complication after internal fixation surgery through the vertebral arch system. Bicortical fixation can successfully prevent screw loosening, and how improving the rate of bicortical fixation is a challenging clinical investigation. Objective To investigate the feasibility of improving the double corticality of sacral screws and the optimal fixation depth to achieve double cortical fixation by combining the torque measurement method with bare hands. Methods Ninety-seven cases of posterior lumbar internal fixation with pedicle root system were included in this study. Based on the tactile feedback of the surgeon indicating the expected penetration of the screw into the contralateral cortex of the sacrum, the screws were further rotated by 180°, 360°, or 720°, categorized into the bicortical 180° group, bicortical 360° group, and bicortical 720° group, respectively. Intraoperatively, the torque during screw insertion was recorded. Postoperatively, the rate of double-cortex engagement was evaluated at 7 days, and screw loosening was assessed at 1 year follow-up. Results The bicortical rates of the 180° group, 360° group, and 720° group were 66.13%, 91.18% and 93.75%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P 0.05).The rates of loosening of sacral screws in the 180° group, 360° group, and 720° group were 20.97%, 7.35% and 7.81%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P 0.05). The bicortical 360° group achieved a relatively satisfactory rate of dual cortical purchase while maintaining a lower rate of screw loosening. Conclusion Manual insertion of sacral screws with the assistance of a torque measurement device can achieve a relatively satisfactory dual cortical purchase rate while reducing patient hospitalization costs.

Abstract Purpose The relationship between delayed ambulation (DA) and postoperative adverse events (AEs) following transforaminal lumbar interbody fusion (TLIF) in elderly patients remains elusive. The aim of our study was to evaluate the effects of DA on the postoperative AEs including complications, readmission and prolonged length of hospital stay (LOS). Methods This was a retrospective analysis of a prospectively established database of elderly patients (aged 65 years and older) who underwent TLIF surgery. The early ambulation (EA) group was defined as patients ambulated within 48 h after surgery, whereas the delayed ambulation (DA) group was patients ambulated at a minimum of 48 h postoperatively. The DA patients were 1:1 propensity-score matched to the EA patients based on age, gender and the number of fused segments. Univariate analysis was used to compare postoperative outcomes between the two groups, and multivariate logistic regression analysis was used to identify risk factors for adverse events and DA. Results After excluding 125 patients for various reasons, 1025 patients (≤ 48 h: N = 659 and > 48 h: N = 366) were included in the final analysis. After propensity score matching, there were 326 matched patients in each group. There were no significant differences in the baseline data and the surgery-related variables between the two groups (p > 0.05). The patients in the DA group had a significant higher incidence of postoperative AEs (46.0% vs. 34.0%, p = 0.002) and longer LOS (p = 0.001). Multivariate logistic regression identified that age, operative time, diabetes, and DA were independently associated with postoperative AEs, whereas greater age, higher international normalized ratio, and intraoperative estimated blood loss were identified as independent risk factors for DA. Conclusions Delayed ambulation was an independent risk factor for postoperative AEs after TLIF in elderly patients. Older age, increased intraoperative blood loss and worse coagulation function were associated with delayed ambulation.

Abstract Background Lumbar degenerative conditions are a major cause of back pain and disability in individuals aged 45 and above. Gait analysis utilizes sensor technology to collect movement data, aiding in the evaluation of various gait aspects like spatiotemporal parameters, joint angles, neuromuscular activity, and joint forces. It is widely used in conditions such as cerebral palsy and knee osteoarthritis. This research aims to assess the effectiveness of 3D gait analysis in evaluating surgical outcomes and postoperative rehabilitation for lumbar degenerative disorders. Methods A prospective self-controlled before-after study (n = 85) carried out at our Hospital (Sep 2018 - Dec 2021) utilized a 3D motion analysis system to analyze gait in patients with lumbar degenerative diseases. The study focused on the multifidus muscle, a crucial spinal muscle, during a minimally invasive lumbar interbody fusion surgery conducted by Shandong Weigao Pharmaceutical Co., Ltd. Pre- and postoperative assessments included time-distance parameters (gait speed, stride frequency, stride length, stance phase), hip flexion angle, and stride angle. Changes in 3D gait parameters post-surgery and during rehabilitation were examined. Pearson correlation coefficient was employed to assess relationships with the visual analog pain scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Patient sagittal alignment was evaluated using “Surgimap” software from two types of lateral radiographs to obtain parameters like pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), intervertebral space height (DH), posterior height of the intervertebral space (PDH) at the operative segment, and anterior height of the intervertebral space (ADH). Results By the 6th week post-operation, significant improvements were observed in the VAS score, JOA score, and ODI score of the patients compared to preoperative values (P

Yan Zhang,1,&ast; Qixing Wu,2,&ast; Mingming Han,2 Chengwei Yang,2 Fang Kang,2 Juan Li,2 Chengwen Hu,1 Xia Chen1 1Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China; 2Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xia Chen; Chengwen Hu, Email chenxiaahslyy@163.com; huchengwen318@126.comObjective: Frailty, representing the physiological reserve and tolerance of the body, serves as a crucial evaluation index of the overall status of the older adults. This study aimed to investigate the prevalence of preoperative frailty and its impact on postoperative outcomes among older adults with lumbar degenerative disease in China.Patients and Methods: In this prospective study, a total of 280 patients aged 60 and above, diagnosed with lumbar degenerative disease and scheduled for surgical intervention were enrolled. The prevalence of frailty pre-surgery was evaluated using the Tilburg Frailty Indicator (TFI) and the modified Frailty Index 11 (mFI-11). The primary outcome was postoperative complication within 30 days post-surgery. The secondary outcomes were the length of hospital stay, hospital costs, reoperation within 30 days post-surgery and unplanned readmission within 30 days post-discharge. Both univariable and multivariable logistic regression were employed to screen and identify the risk factors predisposing patients to postoperative complications.Results: A total of 272 older adults were included in the study ultimately. The frailty detection rates of TFI and mFI-11 were 15.8% (43/272) and 10.7% (29/272) respectively. Thirty-four patients (12.5%) encountered complications. Significantly elevated rates of complications, prolonged hospital stays, increased hospital costs, and heightened readmission rates were observed in the frail group compared to the non-frail group (P< 0.05). Univariable analysis showed that the potential factors related to complications are TFI, mFI-11 and albumin. Multivariable logistic regression revealed that TFI was an independent risk factor for postoperative complications (OR=5.371, 95% CI: 2.338– 12.341, P < 0.001).Conclusion: Frailty was an independent predictor of postoperative complications in older adults undergoing lumbar fusion surgery. Frailty assessment should be performed in such patients to improve preoperative risk stratification and optimize perioperative management strategies.Keywords: lumbar degenerative disease, older adults, frailty, postoperative outcome

Study design: Systematic review; meta-analysis. Purpose: Lumbar degenerative disease is frequent and has a tremendous impact on patients’ disability and quality-of-life. Open and minimally invasive procedures have been used to achieve adequate decompression and fusion. Endoscopic lumbar interbody fusion (Endo-LIF) is emerging as an alternative, trying to reduce morbidity, while achieving comparable to superior clinical outcomes. The aim of this work is to perform a systematic review and meta-analysis to investigate how Endo-LIF compares to open or minimally invasive procedures. Methods: Electronic databases (MEDLINE, Scopus, Web of Science, Cochrane) were systematically reviewed using the query: ‘(percutaneous OR endoscop*) AND (open OR minimal* invasive) AND lumbar AND fusion’. PRISMA guidelines were followed. Results: Twenty-seven articles were included (25 cohort study, 1 quasi-experimental study, and 1 randomized control trial; for meta-analytical results, only observational studies were considered). Endo-LIF conditioned longer operative time, with significantly lower blood loss, bedtime, and hospital length of stay. Early post-operative back pain favored endoscopic techniques. Endo-LIF and non-Endo-LIF minimally invasive surgery displayed comparable results for most back and leg pain or disability outcomes, despite Endo-LIF having been associated with higher disability at late follow-up (versus Open-LIF). No differences were found regarding fusion rates, cage subsidence, or adverse events. Definitive conclusions regarding fusion rate cannot be drawn due to low number of studies and unstandardized fusion definition. Conclusion: Endo-LIF is an effective and safe alternative to conventional lumbar interbody fusion procedures. Evidence shortcomings may be addressed, and future randomized control trials may be performed to compare techniques and to validate results.

BACKGROUND: With the rapid development of minimally invasive spinal surgery and enhanced recovery after surgery, endoscopic intervertebral fusion techniques have gradually emerged and been widely used in clinical practice in recent years. OBJECTIVE: To analyze the early clinical efficacy of uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the treatment of lumbar degenerative diseases. METHODS: 135 patients with lumbar degenerative diseases treated by uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the Suining Central Hospital from October 2020 to December 2021 were enrolled in this study. There were 59 males and 76 females, aged 47-79 years. The lower limb and lumbar pain was evaluated by visual analog scale and lumbar function was assessed by Oswestry disability index before the operation, 1 week, 1, and 6 months after the operation, and at the end of follow-up. The overall pain recovery of patients was evaluated by the scoring criteria for low back pain surgery of Spine Group of Chinese Orthopedic Association and the lumbar physiological curvature and intervertebral fusion were evaluated on lumbar lateral X-ray preoperatively and at the end of follow-up. RESULTS AND CONCLUSION: (1) The 135 patients were followed up for (17.8±3.0) months after surgery. There was 1 case of endplate injury, 1 case of cerebrospinal fluid leakage, 1 case of nerve root injury, 1 case of intervertebral cage subsidence and displacement, 1 case of chronic infection, and 1 case of pedicle screw rupture. The complication rate was 5.2%. (2) The lumbar visual analog scale score and Oswestry disability index significantly decreased in the waist and lower limbs at various time points postoperatively compared with those preoperatively in 135 patients (P < 0.05). The scoring criteria for low back pain surgery of the Spine Group of the Chinese Orthopedic Association were significantly better at the last follow-up than that preoperatively in 135 patients (P < 0.05). (3) At the last follow-up, there was no significant difference in physiological curvature of lumbar vertebra as compared with that preoperatively in 135 patients (P > 0.05), with a fusion rate of 95.8%. (4) It is concluded that uniaxial spinal endoscopic intervertebral fusion combined with posterior percutaneous pedicle screw fixation in the treatment of lumbar degenerative diseases has shown satisfactory early clinical results and is a highly safe minimally invasive spinal surgery mode. [ABSTRACT FROM AUTHOR]

This retrospective study assesses the influence of osteoporosis on the short-term clinical outcomes of lateral lumbar interbody fusion (LLIF) surgery in patients with lumbar degenerative diseases (LDDs), focusing on complications, pain intensity, and quality of life (QOL) improvements. The primary aim of this study is to investigate the impact of osteoporosis on the short-term clinical outcomes following LLIF surgery in LDD patients, with a particular focus on the incidence of cage subsidence (CS) and overall patient well-being postoperatively. A retrospective review was conducted on 73 patients who underwent LLIF for LDD. Patients were categorized into 2 groups based on osteoporosis status determined by dual-energy X-ray absorptiometry scans: those with osteoporosis (n = 20) and those without osteoporosis (n = 53). Data collection included demographics, surgical details, complications, magnetic resonance imaging analysis, pain intensity, and QOL (Japanese Orthopaedic Association Back Pain Evaluation Questionnaire). The groups had no significant differences regarding operative time, estimated blood loss, and hospital stay duration. However, the incidence of CS was 40% in patients with osteoporosis, compared to 17% in nonosteoporotic patients. Despite this, significant improvements in spinal canal dimensions were observed in both groups. Both groups experienced significant reductions in pain intensity, with notable improvements in functional outcomes assessed by the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire, indicating the overall effectiveness of LLIF in enhancing patient well-being and functionality, irrespective of osteoporosis status. Osteoporosis increases the risk of CS in LLIF surgery for LDD patients but does not affect short-term pain relief and QOL improvements. [ABSTRACT FROM AUTHOR]

Objective: The traditional VBQ scoring method may lead to overestimation due to the concentration of intravertebral fat and vascular structures in the posterior half of vertebral bodies, potentially resulting in false-positive outcomes. This study aims to modify the measurement method of VBQ score (Modified-VBQ) and evaluate its effectiveness in evaluating bone quality of lumbar degenerative diseases. Methods: Retrospective analysis was conducted on clinical data from patients undergoing lumbar surgery for degenerative diseases between September 2022 and September 2023. Preoperative lumbar t1-weighted Magnetic resonance imaging was used for both modified and traditional VBQ scoring. Computed tomography (CT) images and dual-energy X-ray absorptiometry (DEXA) data were collected through the picture archiving and communication system. The effectiveness of the modified VBQ score was evaluated, considering P < 0.05 as statistically significant. Results: The study included 212 patients, revealing a significant difference between the modified VBQ and VBQ scores (P < 0.0001). Notably, patients with a history of hyperlipidemia exhibited a significant difference between the two scores (P = 0.0037). The area under the ROC curve (AUC) for the modified VBQ was 0.86, surpassing the VBQ score (AUC = 0.74). Linear regression analysis demonstrated a moderate to strong correlation between the modified VBQ and DEXA T-score (r = − 0.49, P < 0.0001) and a high correlation with CT Hounsfield units (HU) values (r = − 0.60, P < 0.0001). Conclusion: The modified VBQ score provides a simple, effective, and relatively accurate means of assessing bone quality in lumbar degenerative diseases. Preoperative implementation of the modified VBQ score facilitates rapid screening for patients with abnormal bone quality. [ABSTRACT FROM AUTHOR]

Background: Sacral screw loosening is a typical complication after internal fixation surgery through the vertebral arch system. Bicortical fixation can successfully prevent screw loosening, and how improving the rate of bicortical fixation is a challenging clinical investigation. Objective: To investigate the feasibility of improving the double corticality of sacral screws and the optimal fixation depth to achieve double cortical fixation by combining the torque measurement method with bare hands. Methods: Ninety-seven cases of posterior lumbar internal fixation with pedicle root system were included in this study. Based on the tactile feedback of the surgeon indicating the expected penetration of the screw into the contralateral cortex of the sacrum, the screws were further rotated by 180°, 360°, or 720°, categorized into the bicortical 180° group, bicortical 360° group, and bicortical 720° group, respectively. Intraoperatively, the torque during screw insertion was recorded. Postoperatively, the rate of double-cortex engagement was evaluated at 7 days, and screw loosening was assessed at 1 year follow-up. Results: The bicortical rates of the 180° group, 360° group, and 720° group were 66.13%, 91.18% and 93.75%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05).The rates of loosening of sacral screws in the 180° group, 360° group, and 720° group were 20.97%, 7.35% and 7.81%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05). The bicortical 360° group achieved a relatively satisfactory rate of dual cortical purchase while maintaining a lower rate of screw loosening. Conclusion: Manual insertion of sacral screws with the assistance of a torque measurement device can achieve a relatively satisfactory dual cortical purchase rate while reducing patient hospitalization costs. [ABSTRACT FROM AUTHOR]

Purpose: The relationship between delayed ambulation (DA) and postoperative adverse events (AEs) following transforaminal lumbar interbody fusion (TLIF) in elderly patients remains elusive. The aim of our study was to evaluate the effects of DA on the postoperative AEs including complications, readmission and prolonged length of hospital stay (LOS). Methods: This was a retrospective analysis of a prospectively established database of elderly patients (aged 65 years and older) who underwent TLIF surgery. The early ambulation (EA) group was defined as patients ambulated within 48 h after surgery, whereas the delayed ambulation (DA) group was patients ambulated at a minimum of 48 h postoperatively. The DA patients were 1:1 propensity-score matched to the EA patients based on age, gender and the number of fused segments. Univariate analysis was used to compare postoperative outcomes between the two groups, and multivariate logistic regression analysis was used to identify risk factors for adverse events and DA. Results: After excluding 125 patients for various reasons, 1025 patients (≤ 48 h: N = 659 and > 48 h: N = 366) were included in the final analysis. After propensity score matching, there were 326 matched patients in each group. There were no significant differences in the baseline data and the surgery-related variables between the two groups (p > 0.05). The patients in the DA group had a significant higher incidence of postoperative AEs (46.0% vs. 34.0%, p = 0.002) and longer LOS (p = 0.001). Multivariate logistic regression identified that age, operative time, diabetes, and DA were independently associated with postoperative AEs, whereas greater age, higher international normalized ratio, and intraoperative estimated blood loss were identified as independent risk factors for DA. Conclusions: Delayed ambulation was an independent risk factor for postoperative AEs after TLIF in elderly patients. Older age, increased intraoperative blood loss and worse coagulation function were associated with delayed ambulation. [ABSTRACT FROM AUTHOR]

Background: Lumbar degenerative conditions are a major cause of back pain and disability in individuals aged 45 and above. Gait analysis utilizes sensor technology to collect movement data, aiding in the evaluation of various gait aspects like spatiotemporal parameters, joint angles, neuromuscular activity, and joint forces. It is widely used in conditions such as cerebral palsy and knee osteoarthritis. This research aims to assess the effectiveness of 3D gait analysis in evaluating surgical outcomes and postoperative rehabilitation for lumbar degenerative disorders. Methods: A prospective self-controlled before-after study (n = 85) carried out at our Hospital (Sep 2018 - Dec 2021) utilized a 3D motion analysis system to analyze gait in patients with lumbar degenerative diseases. The study focused on the multifidus muscle, a crucial spinal muscle, during a minimally invasive lumbar interbody fusion surgery conducted by Shandong Weigao Pharmaceutical Co., Ltd. Pre- and postoperative assessments included time-distance parameters (gait speed, stride frequency, stride length, stance phase), hip flexion angle, and stride angle. Changes in 3D gait parameters post-surgery and during rehabilitation were examined. Pearson correlation coefficient was employed to assess relationships with the visual analog pain scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association (JOA) scores. Patient sagittal alignment was evaluated using "Surgimap" software from two types of lateral radiographs to obtain parameters like pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), intervertebral space height (DH), posterior height of the intervertebral space (PDH) at the operative segment, and anterior height of the intervertebral space (ADH). Results: By the 6th week post-operation, significant improvements were observed in the VAS score, JOA score, and ODI score of the patients compared to preoperative values (P < 0.05), along with notable enhancements in 3D gait quantification parameters (P < 0.05). Pearson correlation analysis revealed a significant positive correlation between improvements in 3D gait quantification parameters and VAS score, JOA score, and ODI value (all P < 0.001). Conclusion: 3D gait analysis is a valuable tool for evaluating the efficacy of surgery and rehabilitation training in patients. [ABSTRACT FROM AUTHOR]

To explore the relationship between modic changes (MCs) and endplate sclerosis in patients with lumbar degenerative disease. This network meta-analysis was performed on the basis of Preffered Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement. This study was registered at the International Prospective Register of Systematic Reviews (CRD42024497370). We performed a systematic search of the PubMed, Web of Science, Embase, China national knowledge infrastructure, China Science and Technology Journal Database, and Wanfang databases from inception to December 22, 2023. STATA13.0 and RevMan 5.3 were applied to perform the meta-analysis. Seven studies with a total of 1510 endplates were divided into 6 groups according to the type of MCs. The endplate sclerosis rate in the single-type group was significantly lower than that in the mixed-type group. The endplate sclerosis rate in the type I MC (MC1) was significantly lower than that in the type II MC (MC2). The endplate sclerosis rate in the MC2 was significantly lower than that in the type III MC (MC3). The endplate sclerosis rate in the MC1/2 was significantly lower than that in the MC2/3. No significant difference was detected between MC1/2 and MC1/3 or between MC2/3 and MC1/3. For decreasing the endplate sclerosis rate, the order of the different types of MCs was MC1>MC2>MC1/2>MC2/3≈MC1/3>MC3. Endplate sclerosis occurs in all kinds of MCs. With increasing grade of MCs, the incidence of endplate sclerosis gradually increased. The endplate sclerosis rate in mixed-type MCs was significantly greater than that in MC2 and significantly lower than that in MC3. The endplate sclerosis rate in the mixed-type, including MC3 (MC1/3 and MC2/3), was significantly greater than that in the MC1/2. [ABSTRACT FROM AUTHOR]

Study Design: Prospective randomized controlled trial. Objectives: No prospective studies have directly compared clinical and radiographic outcomes of unilateral vs bilateral instrumented lateral lumbar interbody fusion (LLIF) for lumbar degenerative disease (LDD). We compared the short-term radiographic, clinical outcomes, and some complications of the unilateral percutaneous pedicle screw (PPS) (UPS) vs bilateral PPS (BPS) fixation in short-level spinal fusion with LLIF for LDD. Methods: This was a prospective randomized controlled study of 33 patients who underwent UPS or BPS fixation after LLIF for LDD; 18 patients were assigned to the UPS group and 15 patients to the BPS group. Clinical outcomes, complication rates, and fusion rates were assessed. Results: The two groups were similar in age, sex, preoperative diagnosis, and level of surgery. Blood loss, length of hospital stay, and numeric rating scale score one year after surgery did not differ between groups. The operative time was longer in the BPS than UPS group (120.2 vs 88.8 min, respectively; P =.029). Both groups showed improvement in disc height and dural sac in the immediate postoperative computed tomography and magnetic resonance imaging, which did not differ significantly between groups. The subsidence grade and fusion rate did not differ, but cage subsidence was more severe in the UPS than BPS group. Conclusion: Unilateral and bilateral PPS fixation after LLIF yielded similar short-term clinical and radiological outcomes. However, severe cage subsidence was more common in the UPS group, which suggests that BPS fixation after LLIF may be a better choice over the long term. [ABSTRACT FROM AUTHOR]

BackgroundObesity accelerates the development of lumbar disease and increase the risk during surgery. Unilateral biportal endoscopic discectomy (UBE) is a newly developed minimally invasive technique, which refers to the spinal surgery under unilateral double-channel endoscopic surgery. Therefore, the purpose of this study is whether UBE decompression alone can bring good clinical results to young obese patients with lumbar degenerative diseases.MethodsThe patients with lumbar diseases who underwent UBE and open surgery (open discectomy) in our hospital from February 2020 to February 2022 were selected as young (age ≤ 44 years old) and obesity (BMI ≥ 30 kg/m2). The patients were evaluated with VAS, ODI, JOA and modified Macnab score before operation, 1 month, 6 months and 12 months after operation. Nerve root function sensation, muscle strength and tendon reflex were evaluated. The operation time, estimated blood loss, postoperative hospital stay, incidence of postoperative complications and reoperation rate were recorded. MRI quantitative lumbar multifidus muscle (LMM) comparison was performed 12 months after operation.Results77 patients were included, and the scores of VAS, ODI and JOA were similar in the two groups during the last follow-up. There were no difference in nerve root function sensation, muscle strength or tendon reflex. However, one month after operation, the VAS back score and ODI improvement in the UBE group were significantly better than those in the open group, which were 2.44 ± 0.97, 33.10 ± 6.78 and 2.93 ± 0.79 and 36.13 ± 5.84, respectively, with a statistically significant difference (p = 0.020 and 0.038). According to the modified Macnab criteria, UBE group, the excellent and good rate was 97.2%. The excellent and good rate of open group was 97.6%. The estimated blood loss and postoperative hospital stay in UBE group (36.81 ± 17.81, 3.92 ± 1.32) were significantly better than those in open group (104.88 ± 31.41, 6.41 ± 1.94), with a statistically significant difference (p = 0.010). There was no significant difference in operation time between the two groups (p = 0.070). The number of complications in UBE group was 2 (5.6%) and open group was 4 (9.8%). The fat infiltration rate of 19.3%+11.0% in UBE group was significantly lower than that of 27.0%±13.9% in open group (p = 0.010).ConclusionUBE has the advantage of early recovery in the treatment of lumbar degenerative diseases in young obese patients, and reduces the damage to LMM, so it has a good clinical effect.

Abstract Intravenous application of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF) can effectively reduce blood loss without affecting coagulation function. However, it has not been reported whether preoperative use of anticoagulants may affect the efficacy of TXA in PLIF. The purpose of this study is to observe the effect of preoperative use of anticoagulants on coagulation indicators and blood loss after PLIF receiving intravenous unit dose TXA. A retrospective analysis was conducted on data from 53 patients with PLIF between 2020.11 and 2022.9, who received intravenous application of a unit dose of TXA (1 g/100 mL) 15 min before the skin incision after general anesthesia. Those who used anticoagulants within one week before surgery were recorded as the observation group, while those who did not use anticoagulants were recorded as the control group. The main observation indicators include surgical time, intraoperative blood loss, postoperative drainage volume, blood transfusion, and red blood cell (RBC), hemoglobin (HB), and hematocrit (HCT) measured on the 1st, 4th, 7th, and last-test postoperative days. Secondary observation indicators included postoperative incision healing, deep vein thrombosis of lower limbs, postoperative hospital stay, and activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), and platelets (PLT) on the 1st and 4th days after surgery. The operation was successfully completed in both groups, the incision healed well after operation, and no lower limb deep vein thrombosis occurred. There was no significant difference in surgical time, intraoperative blood loss, postoperative drainage volume, and blood transfusion between the two groups (p > 0.05). There was no significant difference in the RBC, HB, and HCT measured on the 1st, 4th, 7th, and last-test postoperative days between the two groups (p > 0.05). There was no statistically significant difference in APTT, PT, TT, FIB and PLT between the two groups on the 1st and 4th postoperative days (p > 0.05). There was no significant difference in postoperative hospital stay between the two groups (p > 0.05). The use of anticoagulants within one week before surgery does not affect the hemostatic effect of intravenous unit dose TXA in PLIF.

Abstract The Waveflex semi-rigid-dynamic-internal-fixation system shows good short-term effects in the treatment of lumbar degenerative diseases, but there are few long-term follow-up studies, especially for recovery of sagittal balance. Fifty patients with lumbar degenerative diseases treated from January 2016 to October 2017 were retrospectively analysed: 25 patients treated with Waveflex semi-rigid-dynamic-internal-fixation system (Waveflex group) and 25 patients treated with double-segment PLIF (PLIF group). Clinical efficacy was evaluated by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Imaging data before surgery and at 3 months, 1 year, and 5 years postoperatively was used for imaging indicator assessment. Local disc degeneration of the cephalic adjacent segment (including disc height index (DHI), intervertebral foramen height (IFH), and range of motion (ROM)) and overall spinal motor function (including lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and |PI-LL|) were analysed. Regarding clinical efficacy, comparison of VAS and ODI scores between the Waveflex and PLIF groups showed no significant preoperative or postoperative differences. The comparison of the objective imaging indicators showed no significant differences in the DHI, IFH, LL, |PI-LL|, and SS values between the Waveflex and PLIF groups preoperatively and 3 months postoperatively (P > 0.05). These values were significantly different at 1 and 5 years postoperatively (P

Background The occurrence of postoperative complications in lumbar degenerative disease (LDD) is closely related to malnutrition, and currently there is a lack of nutritional evaluation methods that can effectively, objectively, and comprehensively assess the nutritional status of LDD patients and predict the occurrence of postoperative complications. Objective To compare the predictive value of four nutritional evaluation methods of Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT), Naples Prognostic Score (NPS) and High-sensitivity Modified Glasgow Prognostic Score (HS-mGPS) for postoperative complications in patients with LDD, so as to formulate a precise nutritional intervention plan and effectively prevent complications. Methods A total of 201 patients diagnosed with LDD and underwent open surgery in Spine Surgery Department of Xiangya Hospital of Central South University from December 2021 to July 2022 were selected as the study subjects, four nutritional evaluation methods of PNI, CONUT, NPS and HS-mGPS were applied to assess the preoperative nutritional status of the patients, respectively, and occurrence of postoperative complications from postoperative period to hospital discharge were observed. The patients were divided into the complication group and non-complication group according to the occurrence of postoperative complications to analyze and compare the difference in clinical characteristics between the two groups; the optimal cut-off values of different nutritional evaluation methods were calculated by plotting the receiver operating characteristic (ROC) curve, and the prediction efficiency of different evaluation methods was compared, the area under curve (AUC) was compared by using MedCalc software. Multivariate Logistic regression model was used to analyze the correlation between different nutritional evaluation methods and postoperative complications. Results Postoperative complications occurred in 60 patients with an incidence rate of 29.8%. The comparison of clinical characteristics data showed statistically significant differences in age, gender, intraoperative bleeding, surgical segment, PNI, CONUT, and NPS scores between the complication group and non-complication group (P

Intravenous application of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF) can effectively reduce blood loss without affecting coagulation function. However, it has not been reported whether preoperative use of anticoagulants may affect the efficacy of TXA in PLIF. The purpose of this study is to observe the effect of preoperative use of anticoagulants on coagulation indicators and blood loss after PLIF receiving intravenous unit dose TXA. A retrospective analysis was conducted on data from 53 patients with PLIF between 2020.11 and 2022.9, who received intravenous application of a unit dose of TXA (1 g/100 mL) 15 min before the skin incision after general anesthesia. Those who used anticoagulants within one week before surgery were recorded as the observation group, while those who did not use anticoagulants were recorded as the control group. The main observation indicators include surgical time, intraoperative blood loss, postoperative drainage volume, blood transfusion, and red blood cell (RBC), hemoglobin (HB), and hematocrit (HCT) measured on the 1st, 4th, 7th, and last-test postoperative days. Secondary observation indicators included postoperative incision healing, deep vein thrombosis of lower limbs, postoperative hospital stay, and activated partial thrombin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), and platelets (PLT) on the 1st and 4th days after surgery. The operation was successfully completed in both groups, the incision healed well after operation, and no lower limb deep vein thrombosis occurred. There was no significant difference in surgical time, intraoperative blood loss, postoperative drainage volume, and blood transfusion between the two groups (p > 0.05). There was no significant difference in the RBC, HB, and HCT measured on the 1st, 4th, 7th, and last-test postoperative days between the two groups (p > 0.05). There was no statistically significant difference in APTT, PT, TT, FIB and PLT between the two groups on the 1st and 4th postoperative days (p > 0.05). There was no significant difference in postoperative hospital stay between the two groups (p > 0.05). The use of anticoagulants within one week before surgery does not affect the hemostatic effect of intravenous unit dose TXA in PLIF. [ABSTRACT FROM AUTHOR]

BACKGROUND: Minimally invasive surgery is developing rapidly. Robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are important posterior minimally invasive surgical approaches to treat lumbar degenerative diseases. However, it is worth discussing which operation method is more advantageous. OBJECTIVE: To compare the clinical efficacy and imaging examination between different operation groups, and discuss the clinical application value of robotassisted minimally invasive lumbar posterior fusion technology to treat lumbar degenerative diseases. METHODS: Clinical data of 83 patients with lumbar degenerative diseases from January 2018 to June 2022 at the Department of Orthopedics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital were retrospectively analyzed. Of them, 27 patients received robot-assisted minimally invasive transforaminal lumbar interbody fusion treatment (group A); 30 patients received robot-assisted unilateral biportal endoscopic transforaminal/ posterior lumbar interbody fusion treatment (group B), and 26 traditional minimally invasive transforaminal lumbar interbody fusion patients were selected as the control group (group C). There were no significant differences in gender, age, body mass index, surgical segment, preoperative visual analog scale score and Oswestry Disability Index among the three groups (P > 0.05). The operation time, intraoperative blood loss, complications, fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency were compared among the three groups. Gertzbein-Robbins’ classification was used to evaluate the accuracy of percutaneous pedicle screw. Visual analog scale and Oswestry Disability Index scores were evaluated after surgery. The excellent and good rate of the three surgical options was evaluated using Macnab’s criteria. RESULTS AND CONCLUSION: (1) The operation time of group A was significantly shorter than that of groups B and C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). The intraoperative blood loss in group B was significantly less than that in group A, and that in group A was significantly less than that in group C (P < 0.05). (2) The fluoroscopic dose, fluoroscopic time, and fluoroscopic frequency of group C were significantly higher than those of groups A and B (P < 0.05). (3) Visual analog scale score and Oswestry Disability Index in the three groups significantly improved after operation when compared with that before operation (P < 0.05), but there was no significant difference among the three groups 1 day and 6 months after surgery (P > 0.05). (4) Postoperative imaging showed that the accuracy of percutaneous pedicle screw placement in groups A and B was better than that in group C (P < 0.05). (5) There was no significant difference in the excellent and good rate of MacNab criteria among the three groups (P > 0.05). (6) There was no significant difference in complications among the three groups (P > 0.05). (7) The results indicated that robot-assisted minimally invasive transforaminal lumbar interbody fusion and robot-assisted unilateral biportal endoscopic transforaminal/posterior lumbar interbody fusion are effective surgery methods for lumbar degenerative diseases. Compared with traditional minimally invasive transforaminal lumbar interbody fusion, robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery has higher efficiency, less intraoperative radiation and higher internal fixation accuracy, which has a good clinical application value. [ABSTRACT FROM AUTHOR]

The aim of this study is to analyze the biomechanical stability of a newly proposed surgical combination (minimally invasive surgery of screw-rod system for indirect decompression + interspinous fusion system for long term spinal stability) in treatment of lumbar degenerative diseases. The three-dimensional (3D) computed tomography (CT) image data of an adult healthy male volunteer were selected. An intact model of L4/5 was further established and validated by using Mimic and 3-matic, 3D slicer, abaqus, Python. Four surgical models were constructed. The biomechanical stability among these surgical modes was compared and analyzed using finite element analysis. The maximum von mises on fixation system in surgical models 2 and 3 exhibited comparable values. This finding suggested that the increase in interspinous fusion did not result in a significant elevation in maximum von mises on fixation system. Compared with the third surgical model, the fourth model, which received less average von mises experienced by the screw in contact with both cancellous and cortical bone. The findings indicated that the inclusion of facet joint fusion in surgical procedures might not be necessary to increase the average von Mises stress experienced by the screw in contact with both cancellous and cortical bone. The biomechanical stability of the newly proposed surgical combination (MIS screw-rod for indirect decompression + interspinous fusion for long term spinal stability technique) was not lower than that of the other surgical combination groups, and it might not be necessary to perform facet joint fusion during the surgery. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the efficacy of the lateral approach and posterior approach in the treatment of lumbar degenerative diseases. Through a systematic search of relevant articles published on or before July 20, 2023, in the Embase, PubMed, and Cochrane libraries, the 2 authors independently extracted data and used the Newcastle‒Ottawa scale to evaluate the quality of the included studies. Using Stata16 software, the continuous variables were presented as the standard mean deviation, and the bipartite variables were analyzed using the pooled odds ratio with 95% confidence interval. A total of 13,892 articles were screened and 10,908 studies were identified after deleting duplicates, of which 41 met the criteria and were included in the meta-analysis. The meta-analysis showed that the lateral approach was superior to the posterior approach in reducing blood loss, operation time, and hospital stay. At the same time, compared with the posterior approach, the lateral approach has more advantages in the long-term Japanese Orthopaedic Association score and Oswestry Disability Index score, adjusting mid- and long-term LL and short- and long-term disc height. Lateral and posterior surgery have similar clinical effects in the treatment of lumbar degenerative diseases and can significantly reduce pain and improve postoperative SL. At the same time, the lateral approach has more advantages in improving long-term quality of life, reducing the long-term disability index, adjusting mid- and long-term LL and short- and long-term disc height. [ABSTRACT FROM AUTHOR]

BACKGROUND: Interspinous distraction fusion device BacFuse was used for the management of lumbar degenerative disease and obtained good clinical efficacy in recent years. However, the related biomechanical study was lacking. OBJECTIVE: To explore the related biomechanical characteristics of BacFuse, a novel interspinous distraction fusion device, which was used in lumbar degenerative disease. METHODS: After constructing the goat spinal models (L1-L6), they were grouped into four groups based on different simulated surgeries: the control group, the BacFuse group (L3/4), the screw-rod fixation group (L3/4) and the Topping-off group (L3/4 screw-rod fixation + L2/3 BacFuse fixation). The goat lumbar spine surgical model was assembled into a biomechanical testing system. A biomechanical machine was used for mechanical loading, simulating lumbar spine movement of flexion, extension, lateral flexion and rotation with a 4 Nm moment. A visual tracking system was used for positioning and capturing. Finally, mechanical and optical calibration was completed to calculate the range of motion of the L2/3, L3/4 and L4/5 segments. RESULTS AND CONCLUSION: (1) Compared with the control group, the range of motion of the L3/4 segment in the BacFuse group decreased 27.27%, 70%, 38.1% and 23.08% in the flexion, extension, lateral bending and rotation directions, respectively (P < 0.05). The range of motion of L3/4 segment in the screwrod fixation group decreased 72.73%, 80%, 71.43% and 73.08% in the flexion, extension, lateral bending and rotation directions, respectively (P < 0.05). (2) Compared with the control group, the range of motion of the adjacent segment L2/3 increased by 33.33%, 25% and 23.81% in the extension, lateral bending and rotation directions, respectively in the BacFuse group (P < 0.05), with no significant change in flexion. In the screw-rod fixation group, there was a 50%, 44.44%, 50% and 58.96% increase in the adjacent segment L2/3 in the flexion, extension, lateral calibration and rotation directions, respectively (P < 0.05). (3) Compared with the control group, the BacFuse group showed an increase in range of motion in proximal segment L4/5 in the extension and rotation directions by 27.3% and 17.39% (P < 0.05) respectively, with no significant change in flexion or lateral bending. In the screw-rob fixation group, the proximal segment L4/5 demonstrated 38.89%, 22.73% and 26.09% (P < 0.05) increases in range of motion in the flexion, extension and rotation directions, respectively, with no significant change in lateral bending. (4) In the Topping-off group, the range of motion of L2/3 was reduced by 37.04%, 73.08%, 56.67% and 38.46% in flexion, extension, lateral flexion and rotation, respectively, compared to the screw-rob fixation group (P < 0.05). Compared with the screw-rob fixation group, the Topping-off group showed a 20% reduction in the range of motion of the L4/5 in the flexion direction (P < 0.05), with no significant differences seen in extension, lateral bending and rotation. (5) It is concluded that the interspinous distraction fusion device BacFuse significantly reduces the range of motion of the implanted segment and provides some stability. It still retains more mobility and reduces the impact on the adjacent segment compared to screw-rob fixation, while the Topping-off tip, which can be used for intervertebral fusion fixation, significantly reduces the range of motion of the adjacent segment and reduces the risk of adjacent segment degeneration. [ABSTRACT FROM AUTHOR]

Posterior lumbar interbody fusion (PLIF) with cortical bone trajectory (CBT) screw fixation (CBT-PLIF) shows potential for reducing adjacent segmental disease. Previously, our investigations revealed a relatively lower fusion rate with the use of carbon fiber-reinforced polyetheretherketone (CP) cages in CBT-PLIF compared with traditional pedicle screw fixation (PS-PLIF) using CP cages. This study aims to evaluate whether the implementation of titanium-coated polyetheretherketone (TP) cages can enhance fusion outcomes in CBT-PLIF. A retrospective analysis was conducted on 68 consecutive patients who underwent CBT-PLIF with TP cages (TP group) and 89 patients who underwent CBT-PLIF with CP cages (CP group). Fusion status was assessed using computed tomography at 1 year postoperatively and dynamic plain radiographs at 2 years postoperatively. No statistically significant differences in fusion rates were observed at 1 and 2 years postoperatively between the TP group (86.8% and 89.7%, respectively) and the CP group (77.5% and 88.8%, respectively). Notably, the CP group exhibited a significant improvement in fusion rate from 1 to 2 years postoperatively (P = 0.002), while no significant improvement was observed in the TP group. Examination of temporal changes in fusion rates reveals that only the TP group achieved a peak fusion rate 1 year postoperatively. This implies that TP cages may enhance the fusion process even after CBT-PLIF. Nevertheless, the definitive efficacy of TP cages for CBT-PLIF remains uncertain in the context of overall fusion rates. [ABSTRACT FROM AUTHOR]

IntroductionPolyetheretherketone (PEEK) lumbar fusion rods have been successfully used in short-segment posterior instrumentation to prevent adjacent segment degeneration. However, limited studies have reported their application in lumbar long-segment instrumentation. This study aimed to compare the biomechanical performances of PEEK rods and titanium rods in lumbar long-segment instrumentation using finite element (FE) models, with the expectation of providing clinical guidance.MethodsA lumbar FE model (A) and four lumbar fixation FE models (BI, CI, BII, CII) of the L1–S1 vertebral body were developed using CT image segmentation (A: intact model; BI: intact model with L2–S1 PEEK rod internal fixation; CI: intact model with L2–S1 titanium rod internal fixation; BII: intact model with L3–S1 PEEK rod internal fixation; CII: intact model with L3–S1 titanium rod internal fixation). A 150-N preload was applied to the top surface of L1, similar to the intact model. The stresses on the lumbar intervertebral disc, facet joint, pedicle screws, and rods were calculated to evaluate the biomechanical effect of the different fixation procedures in lumbar long-segment instrumented surgery.ResultsUnder the four physiological motion states, the average stresses on the adjacent segment intervertebral disc and facet joint in all fixation models were greater than those in the intact model. Furthermore, the average stresses on the adjacent segment intervertebral disc and facet joint were greater in models CI and CII than in models BI and BII, respectively. The average stresses on the pedicle screws and rods were decreased in models BI and BII compared with models CI and CII under the four physiological motion states, respectively.DiscussionThe PEEK rod internal fixation system may have better biomechanical properties than the titanium rod internal fixation system in delaying adjacent segment degeneration, improving the lumbar function of postoperative patients, and reducing the risk of screw loosening and breakage in lumbar long-segment instrumentation.

Abstract Background To compare the early clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) and modified posterior lumbar interbody fusion (MPLIF) in the treatment of lumbar degenerative disease (LDD). Methods A total of 37 patients who underwent PE-PLIF and 58 patients who underwent MPLIF from March 2019 to January 2022 were retrospectively reviewed. The operation time, intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were recorded. The visual analogue scale (VAS) scores of leg pain and low back pain, Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI) scores were evaluated and compared before the operation, 3 days after the operation, 1 week after the operation, 1 month after the operation, 6 months after the operation and at the last follow-up. The modified MacNab’s criteria were applied at the last follow-up. The fusion rate and surgical-related complications during follow-up were recorded. Results The average operation time in the PE-PLIF group was highly significant longer than that in the MPLIF group (P

BACKGROUND: Patients with severe lumbar degenerative disease may have their bone mineral density incorrectly raised by dual-energy X-ray absorptiometry. While lumbar cancellous bone Hounsfield unit value can assist dual-energy X-ray absorptiometry in reducing osteoporosis misdiagnosis. OBJECTIVE: To identify osteoporosis in woman patients with lumbar degenerative diseases using lumbar CT scans. METHODS: Bone mineral density test results and lumbar CT data of 192 women patients who were treated at the Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University were retrospectively reviewed. All patients were divided into a degeneration group (n=107) and a control group (n=85) according to the criteria of severity of vertebral degeneration as assessed on CT of the lumbar spine. The CT value of axial cancellous bone of L1 vertebral body was measured in the two groups. The T score and bone mineral density of the hip and L2-L4 were recorded. According to previously published studies, osteoporosis was diagnosed at L1 vertebral CT values ≤110. The prevalence of osteoporosis diagnosed by dual-energy X-ray absorptiometry and CT values was compared between the two groups. RESULTS AND CONCLUSION: (1) CT values were significantly and positively correlated with T scores and mean bone mineral density of the L2-L4 vertebrae in both groups (P < 0.001), while the correlation was higher in the control group. (2) Lumbar T scores and bone mineral density values were significantly higher in the degeneration group than those in the control group (P < 0.05) and CT values were significantly lower in the degeneration group than that in the control group (P = 0.001). Hip T scores and bone mineral density were not significantly different in the two groups. (3) The prevalence of osteoporosis diagnosed by CT thresholds was higher in all patients than that diagnosed by T values (51.0% and 42.7%). (4) The prevalence of osteoporosis diagnosed by CT values was as high as 23.6% in the 110 patients diagnosed with non-osteoporosis by dual energy X-ray absorptiometry in both groups, and was higher in the degeneration group than that in the control group (31.7% and 14.0%, respectively). (5) The prevalence of missed osteoporosis was as high as 38.6% (27/70) of non-osteoporosis patients diagnosed by dual-energy X-ray absorptiometry of the lumbar spine in the degeneration group compared to 19.6% (11/56) in the control group. (6) It is concluded that osteoporosis is common in female patients with lumbar degenerative diseases aged ≥50 years. Measurement of lumbar cancellous bone CT values may be a useful complementary method for diagnosing osteoporosis in patients with lumbar degenerative diseases, especially in patients with severe degenerative lumbar degenerative diseases where more missed osteoporosis patients can be identified. [ABSTRACT FROM AUTHOR]

The adequacy of screw anchorage is a critical factor in achieving successful spinal fusion. This study aimed to use machine learning algorithms to identify critical variables and predict pedicle screw loosening after degenerative lumbar fusion surgery. A total of 552 patients who underwent primary transpedicular lumbar fixation for lumbar degenerative disease were included. The LASSO method identified key features associated with pedicle screw loosening. Patient clinical characteristics, intraoperative variables, and radiographic parameters were collected and used to construct eight machine learning models, including a training set (80% of participants) and a test set (20% of participants). The XGBoost model exhibited the best performance, with an AUC of 0.884 (95% CI: 0.825-0.944) in the test set, along with the lowest Brier score. Ten crucial variables, including age, disease diagnosis: degenerative scoliosis, number of fused levels, fixation to S1, HU value, preoperative PT, preoperative PI-LL, postoperative LL, postoperative PT, and postoperative PI-LL were selected. In the prospective cohort, the XGBoost model demonstrated substantial performance with an accuracy of 83.32%. This study identified crucial variables associated with pedicle screw loosening after degenerative lumbar fusion surgery and successfully developed a machine learning model to predict pedicle screw loosening. The findings of this study may provide valuable information for clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: Accurate identification of pain generators in the context of low back and spine-related pain is crucial for effective treatment. This review aims to evaluate the potential usefulness of single photon emission computed tomography with computed tomography (SPECT/CT) as an imaging modality in guiding clinical decision-making. Methods: A broad scoping literature review was conducted to identify relevant studies evaluating the use of SPECT/CT in patients with spine-related pain. Studies were reviewed for their methodology and results. Results: SPECT/CT appears to have advantages over traditional modalities, such as magnetic resonance imaging and CT, in certain clinical scenarios. It may offer additional information to clinicians and improve the specificity of diagnosis. However, further studies are needed to fully assess its diagnostic accuracy and clinical utility. Conclusions: SPECT/CT is a promising imaging modality in the evaluation of low back pain, particularly in cases where magnetic resonance imaging and CT are inconclusive or equivocal. However, the current level of evidence is limited, and additional research is needed to determine its overall clinical relevance. Clinical Relevance: SPECT/CT may have a significant impact on clinical decision-making, particularly in cases in which traditional imaging modalities fail to provide a clear diagnosis. Its ability to improve specificity could lead to more targeted and effective treatment for patients with spinal pathology. Level of Evidence: 4. New Technology. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The objective of this study is to conduct a bibliometric analysis to examine the current condition, areas of interest, and rising trends of transforaminal lumbar interbody fusion in lumbar spine surgery (TLIF), as well as its importance in associated research domains. MATERIALS AND METHODS: An extensive collection of academic papers on the use of TLIF was obtained from the Web of Science between January 1, 2000, and November 5, 2023. Then, using a variety of tools like HisCite, VOSviewer, CiteSpace, and the bibliometrix package, a bibliometric study was carried out. This study included the collection of information on country, institution, author, journal, and keywords. RESULTS: A comprehensive analysis was undertaken on a total of 1,907 publications obtained from 181 journals, encompassing the contributions of 7,232 authors affiliated with 1,775 institutes spanning 57 countries/regions. Notably, the USA exhibited the highest number of publications, with 763 (40.03%) articles on TLIF. The most productive institution was Rush University, with 96 (5.03%) publications. The author with the highest publication output was Singh, Kern with 75 (3.93%) publications. World Neurosurgery demonstrated the highest level of productivity, having published a total of 211 (11.06%) articles. The most frequently used keywords were "TLIF", "spondylolisthesis" and "complication". Meanwhile, "workflow", "technical note" and "hidden blood loss" have been identified as the research frontiers for the forthcoming years. CONCLUSIONS: This paper provides a thorough evaluation of current research trends and advancements in TLIF. It includes relevant research findings and emphasizes collaborative efforts among authors, institutions, and countries. [ABSTRACT FROM AUTHOR]

Background: To compare the early clinical efficacy of percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) and modified posterior lumbar interbody fusion (MPLIF) in the treatment of lumbar degenerative disease (LDD). Methods: A total of 37 patients who underwent PE-PLIF and 58 patients who underwent MPLIF from March 2019 to January 2022 were retrospectively reviewed. The operation time, intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were recorded. The visual analogue scale (VAS) scores of leg pain and low back pain, Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI) scores were evaluated and compared before the operation, 3 days after the operation, 1 week after the operation, 1 month after the operation, 6 months after the operation and at the last follow-up. The modified MacNab's criteria were applied at the last follow-up. The fusion rate and surgical-related complications during follow-up were recorded. Results: The average operation time in the PE-PLIF group was highly significant longer than that in the MPLIF group (P < 0.01). The intraoperative blood loss, post-operative hospitalization time, and post-operative bedrest time were significantly less in the PE-PLIF group than those in the MPLIF group (P < 0.01). There were highly significant differences in VAS scores of leg pain, VAS scores of low back pain, JOA scores, ODI scores at the last follow-up compared with those before the operation in the two groups (P < 0.01). Three days after the operation and 1 week after the operation, the VAS scores for low back pain and ODI were highly significant less in the PE-PLIF group than that in the MPLIF group (P < 0.01). Three days after the operation, the JOA scores were highly significant higher in the PE-PLIF group than that in the MPLIF group (P < 0.01). All patients showed intervertebral fusion at 6 months after the operation. Two patients (5.4%) in the PE-PLIF group experienced complications. Conclusion: Both PE-PLIF and MPLIF surgery were clinically effective and safe for patients with single-segment LDD. PE-PLIF surgery is a promising technique that can be used as an alternative treatment for single-segment LDD. [ABSTRACT FROM AUTHOR]

Objectives: Open transforaminal lumbar interbody fusion (O-TLIF) remains the most popular and widely practiced lumbar fusion method even today, providing direct decompression. Oblique lateral interbody fusion (OLIF) is a novel retroperitoneal approach that allows placement of a large interbody cage which provides an indirect neural decompression, and screws can be placed minimal invasively or through the Wiltse OLIF (W-OLIF) approach. We aim to find out the short-term efficacy of W-OLIF to O-TLIF in terms of radiological and clinical outcomes in patients of lumbar degenerative diseases. Materials and Methods: Fifty-two patients were divided equally into two groups (group O-TLIF and group W-OLIF). Several parameters were measured, such as the spinal cord cross-sectional area (SC-CSA), foraminal cross-sectional area (F-CSA), disc height (DH), foraminal height (FH), Schizas grade for stenosis, and Meyerding's grading for olisthesis. Functional scores were measured using the visual analog scale (VAS) for low back pain (LBP) and lower limbs, Oswestry Disability Index. All parameters were repeat measured at 3 months follow-up. Statistical analysis was done using SPSS software. Results: Both groups were similar in composition preoperatively. There was significant improvement in all clinical and radiological parameters postsurgery in either group. However, at 3 months, The DH, FH, FSA, and VAS (LBP) were better in the W-OLIF group than in O-TLIF. Procedure-related complications were seen in both groups (15% in the O-TLIF group and 19% in the W-TLIF group), but only one patient in O-TLIF required revision due to cage migration. Conclusion: Similar improvement occurs in most of the clinical and radiological parameters in the W-OLIF group compared to the O-TLIF group. Few radiological parameters such as the DH, FH, and F-CSA and the VAS (LBP) correction are superior in the W-OLIF group in the short-term follow-up. We conclude that indirect decompression by W-OLIF provides equivalent, if not better, results than the traditional O-TLIF lumbar fusion. [ABSTRACT FROM AUTHOR]

Purpose: To assess clinical, functional and radiographical results of one-level minimally invasive transforaminal interbody fusion with unilateral pedicle screw fixation (UNILIF) in the treatment of stable lumbar degenerative diseases with a minimum of 5 years of follow-up. Material and method: From January 2012 to December 2016, clinical and radiological data of patients with degenerative lumbar disease managed by UNILIF were prospectively collected. Patients with a follow-up that ended before 5 years were excluded. SF-12, Oswestry disability index (ODI) and visual analog scale (VAS) were collected preoperatively, at 2 years and at the last follow-up. A full-spine standing radiograph was performed at each follow-up appointment. Results: Mean operative time was 74.7 (± 19) minutes, mean blood loss was 131.1 (± 207) ml and mean follow-up was 7.5 (± 1.7) years. All functional scores and VAS were significantly improved between the preoperative and the 2 years postoperative. Between the 2 years postoperative and the last follow-up ODI and VAS continued to significantly improved. Fusion rate was 98.6% on radiographic analysis at follow-up. Conclusion: UNILIF method is a safe and effective surgical strategy. It provides a durable improvement in functional score over 7 years of follow-up with a stable radiological correction over time. [ABSTRACT FROM AUTHOR]

Circumferential lumbar fusions (cLFs) are becoming more common with increasing and more minimally invasive anterior access techniques. Staging allows reassessment of indirect decompression and alignment prior to the posterior approach, and optimization of OR time management. Safety of staging has been well documented in deformity surgery but has yet to be delineated in less extensive, degenerative cLFs. The purpose of this study is to compare perioperative complications and outcomes between staged versus single-anesthetic circumferential fusions in the lumbar spine. Propensity-matched comparative observational cohort. Patients who underwent cLFs for lumbar degenerative disease. In-hospital, 30-day, 90-day, and 1-year complications. From 123 patients undergoing single-anesthetic and 154 patients undergoing staged cLF, 95 patients in each group were propensity-matched based on age, sex, BMI, ASA score, smoking, revision, and number of levels. We compared perioperative, 30-day, 90-day, and 1-year complications between the two cohorts. Mean days between stages was 1.58. Single-anesthetic cLF had longer total surgery time (304 vs 240 minutes, p<.001) but shorter total PACU total time (133 vs 196 minutes, p<.001). However, there was no difference in total anesthesia time (368 vs 374 minutes, p=.661) and total EBL (357 vs 320cc, p=.313). Intraoperative complications were nine incidental durotomies in the single-anesthetic and one iliac vein injury in the staged group (9% vs 1%, p=.018). There was no difference of in-hospital (38 vs 31, p=.291), 30-day (16 vs 23, p=.281), 90-day (10 vs 15, p=.391), 1-year complications (9 vs 12, p=.644), and overall cumulative 1-year complications (54 vs 56, p=.883) between the two cohorts. There is a decrease in total surgical time and intraoperative complications during staged compared with single-anesthetic cLF with no difference in in-hospital, 30-day, 90-day, and 1-year complications between approaches. [ABSTRACT FROM AUTHOR]

Study Design: network meta-analysis Objective: To compare the clinical efficacy and safety of endoscopic lumbar interbody fusion (Endo-LIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and open transforaminal lumbar interbody fusion (OTLIF) in the treatment of lumbar degenerative diseases (LDDs). Method: A literature search was conducted in the PubMed, Embase, and Cochrane Library databases. Studies comparing Endo-LIF, MIS-TLIF and OTLIF published from September 2017 to September 2022 for the treatment of LDD were retrieved. Data were extracted from preset clinical outcome measures, including operation time, estimated intraoperative estimated blood loss (EBL), length of hospital stay (LOS), complications, visual analog scale (VAS) score, Oswestry disability index (ODI) score, etc. Result: Thirty-one studies with 3467 patients were included in this study. Network meta-analysis showed that in the comparison of the 3 procedures, Endo-LIF was superior to MIS-TLIF and OTLIF in terms of reducing EBL, LOS, time to ambulation, and VAS score of back pain. MIS-TLIF was superior to Endo-LIF in terms of ODI improvement, and OTLIF required the shortest intraoperative fluoroscopy time. There was no significant difference in operative time, complication rate, fusion rate, VAS score of leg pain, or JOA score among the 3 procedures. Conclusion: Endo-LIF, MIS-TLIF and OTLIF each have their own advantages and disadvantages and show similar results in many respects, except for better early outcomes achieved with the more minimally invasive procedure. [ABSTRACT FROM AUTHOR]

BackgroundThere currently exists some controversy about the efficacy of oblique lumbar interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar degenerative diseases.AimThis study compares the application effects of OLIF and TLIF in lumbar degenerative diseases by reviewing the literature and using meta-analysis.MethodsWe included randomized controlled trials and cohort studies comparing TLIF and OLIF in the treatment of lumbar degenerative diseases. We searched for words such as “intervertebral disc degeneration,” “spinal fusion,” and “lumbar vertebrae” in the PubMed, Embase, and Cochrane Library databases. The search date was set from the establishment date of the database to October 2023. Two authors independently conducted document screening, data abstraction, and qualitative assessment. A meta-analysis was performed and adapted to RevMan5.3 software. The odds ratio (OR), weighted mean difference (WMD), and 95% CI were calculated by adopting a fixed-effect model (FEM) or a random-effect model (REM).ResultsA total of 18 cohort studies were included with 1,550 patients, of whom 806 patients underwent TLIF (TLIF group) and 744 patients underwent OLIF (OLIF group). There were no significant differences found in the fusion rate [OR = 1.58 (0.95, 2.64), P = 0.08], complication rate [OR = 1.25 (0.93, 1.68), P = 0.14], and visual analog scale for back pain (VAS-BP) [WMD = 0.00 (−0.13, 0.14), P = 0.96] between the two groups. Compared with the TLIF group, the OLIF group had a lower Oswestry disability index (ODI) [WMD = −0.62 (−1.03, −0.20), P = 0.003], a higher foramen height (FH) [WMD = 2.03 (1.42, 2.46), P

Background: Lumbar articular fusion with the facet wedge (FW) technique is gaining increasing interest among surgeons for the treatment of vertebral instability due to its limited invasiveness and ease of use. Studies on cadavers have reported biomechanical properties similar to pedicle screws. Yet, the evidence supporting their use is still limited and moreover focused only on spinal degenerative disease. Methods: 96 cases of lumbar articular fusion with the FW techniques performed at 3 different centers between 2014 and 2022 were retrospectively analyzed based on the specific surgical indications: 1) degenerative spondylolisthesis/unstable lumbar stenosis; 2) synovial cysts; 3) adjacent segment disease (ASD). Medical records were reviewed to identify rates of complications and measures of functional outcome (ODI, low back pain VAS and modified Macnab scale) were collected both at baseline and at the follow-up visits. Wilcoxon signed-rank test was adopted to test for significant functional improvements. Results: Significative clinical improvements were observed from baseline to follow-up regarding ODI and VAS scores. Overall rate of moderate and severe complications (according to Landriel–Ibañez scale) was 7.9%. Only 3.4% of patients with degenerative disease developed ASD requiring reoperations. Only one case of radicular deficit and one of device mobilization were reported. 2/4 cases of synovial cysts treated with unilateral fusions developed contralateral complications. 9 out of 16 (56.25%) patients who underwent long-term postoperative CT scans presented adequate degree of articular fusion. Conclusion: FW technique is easy, safe, and effective. Its low rate of complications justifies its use for cases of mild lumbar instability.

Abstract Purpose To explore whether combining the Hounsfield unit (HU) values and vertebral bone quality (VBQ) scores can improve the BMD assessment in patients with lumbar degenerative diseases. Methods The HU values were measured by CT image, and VBQ scores were calculated by lumbar MRI image. The correlations of the opportunistic imaging parameters to the lowest T-scores were analyzed. Receiver-operating characteristic curve (ROC) analysis was used to evaluate the accuracy in detecting osteoporosis. Finally, the specificity and sensitivity of different combined methods of the HU values and VBQ scores in the diagnosis of osteoporosis were compared. Results Patients with osteoporosis had the lowest HU values and the highest VBQ scores. The correlation coefficients between the VBQ scores and the T-scores were smaller than HU values (L1 HU value: 0.702; average HU value:0.700; L1 VBQ score: -0.413; VBQ score: -0.386). The areas under the curve (AUCs) of the HU values were greater than those of the VBQ scores, and the AUCs of the L1 VBQ score were similar to the VBQ score (L1 HU value: 0.850; average HU value:0.857; L1 VBQ score: 0.704; VBQ score: 0.673). When combining the two imaging parameters in series, the specificity of the detection of osteoporosis was improved (L1 HU value and L1 VBQ score: 87.3%; Average HU value and VBQ score: 85.9%). When combining the two imaging parameters in parallel, the sensitivity of the detection of osteoporosis was improved (L1 HU value or L1 VBQ score: 88.1%; Average HU value or VBQ score: 91.5%). Conclusions Combinations of the HU values and VBQ scores could improve the diagnostic performance of osteoporosis. In addition, considering the same diagnostic performance but easier measurement, parameters at the single-segment level were recommended to assist in the diagnosis of osteoporosis.

Abstract Background There are few studies about sexual function in the patient with posterior lumbar spinal fusion for degenerative lumbar disease. The aim of this study is to investigate sexual activities in patients with lumbar degenerative disease before and after lumbar fusion surgery. Methods We recruited 35 patients who underwent lumbar spinal fusion at the age of 55 years or younger. They were 17 men and 18 women with a mean age of 47.4 years. After informed consent, the patients were asked to complete anonymous questionnaire concerning sexual desire, activity, and satisfaction before and after surgery. Results In the presick period, 69% of the patients had sexual desire, and 79% achieved satisfaction during sexual activity. Lumbar degenerative disease decreased sexual desire and frequency of sexual activity in 40%, and 74% respectively. Before surgery, satisfaction in sexual activities decreased in 53%, and 55% of the patients felt discomfort during sexual activity. Adjustment in sexual position was required in 44% of man and 54% of woman. After surgery, Sexual desire, frequency of sexual activity and satisfaction did not regain after surgery in 94%, 93% and 92%, respectively. Those who did not feel discomfort after surgery was significantly lower VAS in both low back pain and leg pain than the patients felt discomfort (low back pain; p = 0.024, leg pain; p = 0.046). Conclusion This study demonstrated that lumbar degenerative diseases decreased sexual desire, frequency of sexual activity and satisfaction, and little of the patients regained their sexual activities after posterior lumbar fusion surgery in the middle-aged patients.

Objective At present, the influence of Modic changes (MCs) on postoperative fusion rate of lumbar interbody fusion (LIF) is mainly focused on the medium‐ and long‐term fusion rate, while the short‐term fusion rate has not been reported. The aim of this study was to compare the short‐term fusion rate of lumbar degenerative disease patients with and without MCs after single level transforaminal lumbar interbody fusion (TLIF). Methods In this retrospective and matched‐pair case control study, we included 100 patients who underwent TLIF from January 2017 to January 2020 and had at least two follow‐up visits over a two‐year period. Fifty patients with MCs (MCs group) were matched with 50 patients without MCs (non MCs group) for age, sex, surgical level, diagnosis, operative time, and intraoperative blood loss. We collected the X‐ray and computed tomography (CT) data of patients from 3 months to 2 years after the operation to assess bony fusion and the cage union ratio. According to the type of cage, the MCs group was further divided into the nano‐hydroxyapatite/polyamide 66 (n‐HA/PA66) group and polyetheretherketone (PEEK) group, and the fusion performance between the two groups was compared. Finally, age, sex, body mass index (BMI), smoking and cage type were included in the logistic regression model for risk factor analysis. Results The bony fusion rates in the MCs group at 3 months, 6 months, 1 year and 2 years after surgery were significantly lower than those in the non MCs group (P

Objective To analyze the clinical efficacy of full-visualization single-channel endoscopic lumbar interbody fusion (PE-PLIF) in the treatment of lumbar degenerative diseases, and to explore the application skills and significance of endoscopic spinal canal decompression and interbody fusion. Methods From January 2021 to December 2022, 50 patients who underwent PE-PLIF in The Affiliated Huai ‘an No.1 Hospital of Nanjing Medical University were selected retrospectively. A total of 56 lower lumbar segments were treated with spinal canal decompression and interbody fusion. The expandable cage implantation technique was used for spinal canal decompression, intervertebral fusion, and percutaneous pedicle screw internal fixation. The visual analogue scale (VAS) score of low back pain and lower limb pain, Oswestry disability index (ODI), and modified MacNab scoring system were used to evaluate the clinical efficacy before and after operation. Results The VAS scores of low back pain were 5.2±1.1, 2.2±0.7, 1.5±0.6, 1.3±0.7, 1.0±0.9 before operation, 1 day, 3 months, 6 months after operation and at the last follow-up, respectively. The VAS scores of lower limb pain were 7.2±1.0, 2.0±1.0, 0.5±0.3, 0.3±0.2, 0.3±0.2, respectively. The ODI was 66.3±7.4, 16.6±5.0, 12.4±3.6 and 10.7±3.3 before operation, 3 months, 6 months after operation and at the last follow-up, respectively. The VAS score and ODI score decreased after operation, and the differences were statistically significant compared with those before operation (P