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Alvin Y. Chan, Brian V. Lien, Elliot H. Choi, Andrew K. Chan, George Hanna, Alexander M. Lopez, Nolan J. Brown, Sandra Gattas, Lydia Kirillova, David Horton, Gianna Fote, Brian Hanst, Ryan Perry, Yu-Po Lee, Kiarash Golshani, Frank P. K. Hsu, and Michael Y. Oh

ALIF (e.g., disc degeneration, spondylolisthesis, disc herniation, scoliosis, pseudoarthrosis, etc.). Fourth, there was heterogeneity in terms of technique (e.g., laparoscopic vs mini-open) that also made standardization of results challenging. These limitations should be considered when drawing conclusions from our study. Conclusions We presented a systematic review of back pain outcomes following MIS ALIF, which included mini-open and laparoscopic techniques. There was a reliable reduction in back pain postoperatively across all included studies. The complication

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John Y. K. Lee, John T. Pierce, Sukhmeet K. Sandhu, Dmitriy Petrov, and Andrew I. Yang

endoscopic procedure. 3 , 5 , 13 , 19 , 22 , 41 , 47 A direct comparison of E-MVD with microscopic MVD (M-MVD) involving validated outcome tools such as the Penn Facial Pain Scale (PFPS, formerly known as Brief Pain Inventory [BPI]–Facial) has not been reported. 9 , 24 , 39 This study is the first direct comparison of bimanual microdissection techniques using either an endoscope or a microscope and involving modern pain-outcome assessment tools. Methods Study Design The present investigation was a single-center, single-surgeon (J.Y.K.L.), institutional review board

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Luigi Albano, Lina Raffaella Barzaghi, and Pietro Mortini

TO THE EDITOR: We read with great interest the multicenter retrospective study by Mureb et al. 1 on radiosurgery for type 1 trigeminal neuralgia (TN) published in the Journal of Neurosurgery in July 2020 ( Mureb M, Golub D, Benjamin C, et al. Earlier radiosurgery leads to better pain relief and less medication usage for trigeminal neuralgia patients: an international multicenter study. J Neurosurg . Published online July 3, 2020. doi:10.3171/2020.4.JNS192780 ). In this study the authors concentrated on analyzing pain outcomes, focusing on the time interval

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Kunal P. Raygor, Doris D. Wang, Mariann M. Ward, Nicholas M. Barbaro, and Edward F. Chang

17.9 ± 18.7 38.4 ± 39.7 0.09 Preprocedure sensory disturbance 0 (0%) 0 (0%) 1.00 Mean age at 2nd procedure in yrs 63.3 ± 17.0 75.8 ± 13.9 0.04 * Vascular compression on preop MRI 9 (60%) 4 (26.7%) 0.06 Mean FU in mos 44.9 ± 33.6 48.3 ± 45.3 0.09 FU = follow-up. Values are presented as the number (%) of patients unless otherwise noted. Mean values are presented ± SD. * Denotes statistical significance. Pain Outcomes After MVD or SRS Patients who underwent MVD as a second-line treatment had a longer pain-free duration than patients who underwent repeat SRS. All

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Matthew J. McGirt, Mohamad Bydon, Kristin R. Archer, Clinton J. Devin, Silky Chotai, Scott L. Parker, Hui Nian, Frank E. Harrell Jr., Theodore Speroff, Robert S. Dittus, Sharon E. Philips, Christopher I. Shaffrey, Kevin T. Foley, and Anthony L. Asher

potential to assist providers during the preoperative assessment of patients and to improve patient engagement in shared decision-making concerning treatment planning. Using a prospective, multicenter, longitudinal registry, we developed 4 predictive models for 12-month PROs after elective surgery for degenerative lumbar spine pathology. In descending order of importance, the most important predictors of overall disability, QOL, and pain outcomes following lumbar spine surgery were patient employment status, baseline NRS-BP scores, psychological distress, baseline ODI

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Harel Deutsch

literature have been mainly focused on neurological outcome. Pain outcomes were reported in a categorical fashion. Patients either have pain or they do not have pain. In this series numerical pain scores were used to evaluate patient-expressed pain. The results indicate that while 4 of 5 patients had persistent long-term axial pain, patients felt pain was improved at 1 year. Pain improved from NPS score of 8.6 to 3.7 at 1-year follow-up. Some of the long-term pain complaints are related to dysesthetic pain mediated by permanent posterior-column loss of function

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Kunal P. Raygor, Anthony T. Lee, Noah Nichols, Doris D. Wang, Mariann M. Ward, Nicholas M. Barbaro, and Edward F. Chang

comorbidities and frailty, leading to excellent pain outcomes with reasonable adverse event profiles. Recent work has suggested that higher preoperative frailty can predict morbidity and mortality in patients undergoing cranial 16 or oncological 22 neurosurgery. Thus, such indices should be further evaluated, as they may aid in counseling patients on treatment options. Pain Outcomes In our series, multivariate modeling showed that procedure type and the presence of postprocedure sensory changes in patients were associated with a longer duration of a favorable outcome. In

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Shelby Sabourin, Justin Tram, Breanna L. Sheldon, and Julie G. Pilitsis

of patients with FBSS. Analysis of global pain levels, as quantified with NRS in this study and VAS in a previous study, resulted in similar MCID thresholds in both studies. The MCID range of 0.9–2.7 established for NRS by this study is consistent with the previously defined range of 1.2–2.7 for VAS. 17 In another study of SCS for patients with type 1 CRPS, pain outcomes recorded at 3, 6, 9, and 12 months were not significantly different. 22 Other studies have further shown that pain-related outcomes after SCS do not diminish until 5 years postoperatively. 23

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K. Anthony Kim, Matthew McDonald, Justin H. T. Pik, Paul Khoueir, and Michael Y. Wang


To assess the safety and efficacy of the DIAM implant, the authors compared the mean 12-month outcomes in patients who underwent lumbar surgery with DIAM placement and in those who underwent lumbar surgery only.


Of 62 patients who underwent simple lumbar surgery (laminectomy and/or microdiscectomy) in a 24-month period, 31 underwent concomitant surgical placement of a DIAM interspinous process spacer (33 devices total). Radiographic imaging, pain scores, and clinical assessments were obtained postoperatively to a mean of 12 months (range 8–25 months). Patients who did not undergo implantation of an interspinous process spacer (Group C) were compared with and stratified against patients who underwent placement of a DIAM implant (Group D).

In Group D, no statistically significant differences were noted in anterior or posterior disc height when comparing patients pre- and postoperatively. Compared with Group C, a relative kyphosis of less than 2° was noted on postoperative images obtained in Group D. No statistically significant differences in visual analog scale (VAS) pain scores or MacNab outcomes were noted between Groups C and D at a mean of 12 months of follow up. Complications in Group D included three intraoperative spinous process fractures and one infection.


After simple lumbar surgery, the placement of a DIAM interspinous process spacer did not alter disc height or sagittal alignment at the mean 12-month follow-up interval. No adverse local or systemic reaction to the DIAM was noted. No difference in VAS or MacNab outcome scores was noted between the groups treated with or without the DIAM implants, particularly when the DIAM was used to alleviate low-back pain.

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Johanna Wibault, Birgitta Öberg, Åsa Dedering, Håkan Löfgren, Peter Zsigmond, and Anneli Peolsson


Structured physiotherapy has been suggested as treatment before as well as after surgery to improve clinical outcomes in patients with cervical radiculopathy (CR), but randomized clinical trials to inform evidence-based clinical guidelines for the treatment of patients with CR after surgery are lacking. The aim of this study was to compare the results of structured postoperative physiotherapy combining neck-specific exercises with a behavioral approach to a standard postoperative approach in patients who had undergone surgery for cervical disc disease with CR at 6 months after surgery.


Patients with cervical disc disease and persistent CR who were scheduled for surgery were randomized preoperatively to structured postoperative physiotherapy (n = 101) or a standard postoperative approach (n = 100). The latter included pragmatic physiotherapy in accordance with the usual Swedish postoperative care. Outcome measures included patient-reported neck disability as measured with the Neck Disability Index (NDI), intensity and frequency of neck and arm pain, global outcome of treatment, and expectation fulfillment, as well as enablement.


Patients who received structured postoperative physiotherapy reported greater expectation fulfillment (p = 0.01), and those who attended at least 50% of the treatment sessions reported less neck pain frequency (p = 0.05), greater expectation fulfillment (p = 0.001), and greater enablement (p = 0.04) compared with patients who received the standard postoperative approach. No other difference between treatment groups was found (p > 0.15). The NDI and neck and arm pain intensity were improved in both groups at 6 months after surgery (p < 0.001). Additional use of postoperative physiotherapy was reported by 61% of the patients who received the standard postoperative approach.


The results from this first randomized clinical trial of postoperative physiotherapy showed only minor additional benefit of structured postoperative physiotherapy compared with standard postoperative approach 6 months postoperatively in patients who underwent surgery for cervical disc disease with CR. Patients who received structured postoperative physiotherapy reported higher expectation fulfillment, and many patients in the standard postoperative approach group perceived a need for additional treatments after surgery, suggesting that patients with CR are in need of further postoperative support. The results confirm that neck-specific exercises are tolerated postoperatively by patients with CR, but more studies of postoperative physiotherapy are needed to inform clinical guidelines for this patient group.

Clinical trial registration no.: NCT01547611 (