Kevin Hines, Zachary T. Wilt, Daniel Franco, Aria Mahtabfar, Nicholas Elmer, Glenn A. Gonzalez, Thiago S. Montenegro, Lohit Velagapudi, Parthik D. Patel, Maxwell Detweiler, Umma Fatema, Gregory D. Schroeder, and James Harrop
In this study, the authors proposed a novel indicator, gROM (representing the gap between flexion and extension ranges of motion), for predicting the loss of cervical lordosis after laminoplasty in patients with cervical spondylotic myelopathy and examined its clinical performance. The study results demonstrated that gROM could be a highly useful indicator and that one exceeding 30° was a risk factor for a marked loss of cervical lordosis postoperatively.
Praveen V. Mummaneni, Mohamad Bydon, John J. Knightly, Mohammed Ali Alvi, Yagiz U. Yolcu, Andrew K. Chan, Kevin T. Foley, Jonathan R. Slotkin, Eric A. Potts, Mark E. Shaffrey, Christopher I. Shaffrey, Kai-Ming Fu, Michael Y. Wang, Paul Park, Cheerag D. Upadhyaya, Anthony L. Asher, Luis Tumialan, and Erica F. Bisson
In this study, the authors sought to evaluate factors associated with a nonroutine discharge after surgery for cervical myelopathy by using a national registry. They found that socioeconomic and demographic characteristics including age, race, gender, insurance status, and employment status may be the most significant drivers of a nonroutine discharge. These findings may help care teams identify patients who are likely to require discharge to a rehabilitation facility or another postacute care institution and hence facilitate administrative aspects of patient discharge.
R. Andrew Glennie, Mayilee Canizares, Anthony V. Perruccio, Edward Abraham, Fred Nicholls, Andrew Nataraj, Philippe Phan, Najmedden Attabib, Michael G. Johnson, Eden Richardson, Greg McIntosh, Henry Ahn, Charles G. Fisher, Neil Manson, Kenneth Thomas, and Y. Raja Rampersaud
The objective of this study was to determine whether patient expectations of spine surgery were different depending on their preoperative diagnosis. The authors found that patient-reported symptoms, and not the diagnosis, had a significant impact. Cervical myelopathy patients had lower expectations than patients with other pathoanatomical diagnoses. The results of this study illustrate the importance of focusing preoperative discussions on preoperative symptoms, rather than diagnosis, when speaking about expectations from spine surgery.
Erica F Bisson, Jian Guan, Mohamad Bydon, Mohammed A Alvi, Anshit Goyal, Steven D Glassman, Kevin T Foley, Eric A Potts, Christopher I Shaffrey, Mark E Shaffrey, Domagoj Coric, John J Knightly, Paul Park, Michael Y Wang, Kai-Ming Fu, Jonathan R Slotkin, Anthony L Asher, Michael S Virk, Andrew Y Yew, Regis W Haid, Andrew K Chan, and Praveen V Mummaneni
Using a national registry, the authors compared the relative efficacies of decompression alone and decompression plus fusion in patients with grade I lumbar spondylolisthesis, for which ideal surgical management has not been determined despite extensive investigation. After adjusting for differences between groups, fusion remained independently associated with Oswestry Disability Index (ODI) score improvement and achieving the minimal clinically important difference in ODI score at the 24-month follow-up. The results suggest that decompression plus fusion offers superior outcomes at 24 months posttreatment compared to decompression alone for grade I lumbar spondylolisthesis.
Austin Q. Nguyen, Jackson P. Harvey, Krishn Khanna, Bryce A. Basques, Garrett K. Harada, Frank M. Phillips, Kern Singh, Christopher Dewald, Howard S. An, and Matthew W Colman
This study aimed to evaluate the overall rate, cause, and timing of reoperation procedures following anterior or lateral lumbar interbody fusions without direct posterior decompression. There was a low reoperation rate in this cohort. The majority of same-level reoperations were due to a need for further direct decompression, especially in patients with more severe preoperative stenosis. This study adds to the literature on reoperation rates and failure mechanisms following less invasive interbody procedures.
Justin S. Smith, Michael P. Kelly, Elizabeth L. Yanik, Christine R. Baldus, Thomas J. Buell, Jon D. Lurie, Charles Edwards, Steven D. Glassman, Lawrence G. Lenke, Oheneba Boachie-Adjei, Jacob M. Buchowski, Leah Y. Carreon, Charles H. Crawford III, Thomas J. Errico, Stephen J. Lewis, Tyler Koski, Stefan Parent, Virginie Lafage, Han Jo Kim, Christopher P. Ames, Shay Bess, Frank J. Schwab, Christopher I Shaffrey, and Keith H Bridwell
Although short-term adult symptomatic lumbar scoliosis studies favor operative over nonoperative treatment, longer outcomes are critical because the majority of instrumentation failures occur 2–5 years after surgery. The objective of this study was to assess the durability of adult symptomatic lumbar scoliosis treatment. The findings demonstrate that the greater improvement of operative versus nonoperative treatment for adult symptomatic lumbar scoliosis at 2 years was durably maintained at the 5-year follow-up. These findings have important implications for patient counseling and cost-effectiveness assessments.
Corey T. Walker, David S. Xu, Tyler S. Cole, Lea M. Alhilali, Jakub Godzik, Santiago Angel Estrada, Juan Pedro Giraldo, Joshua T. Wewel, Clinton D. Morgan, James J. Zhou, Alexander C. Whiting, S. Harrison Farber, Nikolay L. Martirosyan, Jay D. Turner, and Juan S. Uribe
The authors performed quantitative assessments of indirect decompression on consecutively treated patients with transpsoas lateral interbody fusion using volumetric reconstructions of MRI. The authors found that tall preoperative disc height was predictive of clinical failure with indirect decompression alone, whereas decreased disc height, body mass index, and increased anterolisthesis correlated to radiographic increases in central canal dimensions. These results may provide surgeons with predictive preoperative variables to determine whether indirect decompression alone will be successful.
Mohamed Macki, Travis Hamilton, Seokchun Lim, Edvin Telemi, Michael Bazydlo, David R. Nerenz, Hesham Mostafa Zakaria, Lonni Schultz, Jad G. Khalil, Miguelangelo J. Perez-Cruet, Ilyas S. Aleem, Paul Park, Jason M. Schwalb, Muwaffak M. Abdulhak, and Victor Chang
The objective of this study was to characterize any racial disparities in elective spinal surgery utilizing the Michigan Spine Surgery Improvement Collaborative. The authors’ key finding was that patients who self-identified as African American had greater risk of dissatisfaction with elective spine surgery after adjusting for confounding factors on multivariate analysis. This study illustrates the potential interactions between race and outcome.
Joshua T. Wewel, Alp Ozpinar, Corey T. Walker, David O. Okonkwo, Adam S. Kanter, and Juan S. Uribe
Researchers created a novel method of using clinical photographs to assess spinal alignment in patients with deformity. Photographic measurements of deformity are found to be highly correlated with radiographic equivalents and can be used instead of radiographs or when full-spine images are unavailable.
Devon J. Ryan, Nicholas D. Stekas, Ethan W. Ayres, Mohamed A. Moawad, Eaman Balouch, Dennis Vasquez-Montes, Charla R. Fischer, Aaron J. Buckland, Thomas J. Errico, and Themistocles S. Protopsaltis
This is the largest retrospective analysis of access to the concave side of the coronal curve in adult degenerative scoliosis and associated morbidity. This study illustrates the safety of concave access in a large, retrospective, multi-institutional cohort.
Francis Lovecchio, Renaud Lafage, Jonathan Charles Elysee, Alex Huang, Bryan Ang, Mathieu Bannwarth, Han Jo Kim, Frank Schwab, and Virginie Lafage
Preoperative radiographs were compared to determine thoracic flexibility, which is defined as the change in thoracic alignment between supine and standing radiographs. Thoracic flexibility was associated with proximal junctional kyphosis at 1 year. Patients with a large amount of thoracic flexibility may be at risk for thoracic flattening induced by intraoperative positioning, leading to an increased risk of proximal junctional kyphosis.
Srujan Kopparapu, Daniel Lubelski, Zach Pennington, Majid Khan, Nicholas Theodore, and Daniel Sciubba
The authors investigated whether radiation exposure during percutaneous vertebroplasty (PV) or balloon kyphoplasty (BK) exceeds safety limits for patients and operators. Exposures were lower for PV than BK for both operators and patients, but both procedures were unlikely to exceed safety limits when standard radiation protection equipment was used. However, radiation to the hand may limit the number of procedures an operator can safely perform. Additional high-quality data are necessary to definitively establish exposure differences between procedures and evaluate impacts of newer techniques, such as CT-guided procedures.
Joel A. Finkelstein, Roland B. Stark, James Lee, and Carolyn E. Schwartz
Machine learning was used to examine the value of clinical and demographic variables in conjunction with expectations and quality-of-life appraisal in predicting outcomes following spine surgery. Different expectations and appraisal processes played a role in long- versus short-term predictions, suggesting that cognitive adaptation is important and relevant to pain relief outcomes after spine surgery. These results underscore the importance of addressing how patients think about quality of life and surgery outcomes to maximize the benefits of surgery.
Survival scoring systems for spine metastasis (SPM) allow one to determine the most suitable treatment according to survival estimation. In this multicenter study of 739 patients treated and followed for SPM, the authors determined that prognosis scoring systems used to estimate survival are obsolete and underestimate survival. Surgical treatment decisions should not be based only on survival estimations.
The authors investigated the prevalence, postoperative pathologies, and relation with radiological parameters of early-onset adjacent-segment disease (ASD) occurring within 3 years after primary posterior lumbar interbody fusion (PLIF). Important findings were that lumbar disc herniation was significantly more common in early-onset ASD and that a major risk factor for ASD, especially early-onset ASD, is a change in segmental lordosis, which is also the only parameter that can be adjusted by the surgeon.
The objective was to determine how focal apex angle and C2–7 angle affect spinal cord decompression status and neurological recovery in patients after cervical laminoplasty. Patients with both focal apex angle > 32.1° and C2–7 angle < 12.4° may have poor spinal cord decompression status and neurological recovery after surgery. To ensure successful decompression with cervical laminoplasty, surgeons should evaluate not only the C2–7 angle but also focal apex angle.
The aim of this study was to elucidate factors affecting patient satisfaction after thoracopelvic corrective fusion surgery for patients with adult spinal deformity (ASD). Achievement of Scoliosis Research Society–22r (SRS-22r) self-image and function minimal clinically important differences (MCIDs) was significantly associated with postoperative satisfaction in corrective fusion surgery for ASD. Given that patients with poor preoperative health-related quality of life are more likely to achieve SRS-22r MCIDs, surgeons should carefully consider whether to operate on patients with a relatively good baseline HRQOL when making surgical decisions.
The present study evaluated the effect of accessory supplemental rod (ASR) implantation on postoperative occurrence of primary rod fracture (RF) in 114 patients who underwent long-segment spinal instrumentation for adult spinal deformity. Patients treated with ASR were 76.9% less likely to experience RF than patients managed with dual-rod construct. The statistically significant improvement in RF rates among patients treated with ASR suggests a potential benefit to using this technique to prevent RF.
This study investigated the benefits and limitations of minimally invasive surgery (MIS) approaches to posterior lumbar surgery compared with open surgery in obese and nonobese patients and the effect of obesity on MIS outcomes. MIS reduced blood loss, operative time, hospital length of stay, and surgical site infections in obese patients. This study has been the largest to date investigating posterior lumbar MIS outcomes in obese patients, which will continue to be an important area of consideration as the prevalence of obesity increases.
The authors review the literature on retrograde ejaculation following anterior lumbar surgery and identify limitations in the published accounts. They pool data from published literature and report an overall low incidence. They subsequently surmise how the risk of retrograde ejaculation may be inflated in the literature due to perpetuation of data unrepresentative of the current landscape of spine surgery, and they encourage surgeons not to dismiss an anterior approach as a viable option in men with child-siring potential.
The authors aimed to evaluate the role of perioperative antibiotic prophylaxis in noninstrumented spine surgery (NISS), both in postoperative infections and the impact on the selection of resistant bacteria. Results confirmed that a single dose of preoperative cefazolin was effective and mandatory in preventing surgical site infections in NISS. Single-dose antibiotic prophylaxis has an immediate impact on cutaneous flora by increasing cefazolin-resistant bacteria.
The authors aimed to identify associations between radiological parameters and neurological findings in degenerative cervical myelopathy. The spinal cord signal intensity on T2-weighted MR images was associated with a positive Hoffmann reflex, severe spinal cord compression during neck flexion was associated with a positive Babinski sign, and the position sense of the great toe was associated with large cervical lordosis. These imaging features can help us understand the characteristics of the neurological findings.
Researchers examined how a recent state-level opioid reform impacted postoperative opioid prescribing, patient-reported outcomes (PROs), and healthcare utilization following elective lumbar decompression surgery. In the year after the reform was introduced, patients received significantly less postoperative opioid medication compared with the year prior without having a change in PROs, emergency department visits, or hospital readmissions. These results demonstrate that state-level reforms placing reasonable limits on opioid prescriptions may decrease opioid exposure to patients without negatively impacting patient outcomes.
The objective of this paper was to evaluate with long-term follow-up whether transforaminal lumbar interbody fusion (TLIF) induces kyphosis or lordosis in the spine. The key finding was that a TLIF will induce either kyphosis or lordosis of the spine based on the preoperative disc angle and cage position. This information may help surgeons decide if TLIF is the best operation for the patient if lordosis needs to be induced with surgery.
The authors investigated the effect of predominant location of preoperative pain on patient-reported outcomes following 1- or 2-level anterior cervical discectomy and fusion (ACDF) for degenerative spine disease. Predominant neck pain was associated with lower rates of patient satisfaction and worse Neck Disability Index scores compared with predominant arm pain and equal arm and neck pain at the 1-year follow-up. This study underlines the role of predominant pain location in predicting outcomes after ACDF and provides potential targets for improving patient management.
The authors systematically reviewed the literature on the management of instrumentation after surgical site infection. Studies were mostly low-quality and heterogeneous, and no clear consensus on whether to leave or remove instrumentation was identified. However, the most common findings supported retaining hardware in patients with early infection and potential removal for later infections. This review reinforces the need for higher-quality evidence from larger studies to determine optimal treatment of patients with instrumentation who experience wound infection.
Prior to embarking on a human trial, it is imperative to demonstrate that the surgical technique itself does not harm the individual. The data reported in this article provided the final demonstration of safety in a large-animal model comparable to the human spinal cord dimensions, thereby enabling proceeding with the first trial of administering stem cells in humans directly into the injured human spinal cord.
L3 is most often selected as the lowest instrumented vertebra (LIV) to conserve mobile segments. This study aimed to know whether LIV selection as L3 for cases with the lowest end vertebra (LEV) at L4 could have a risk of coronal decompensation. The results showed that these cases showed postoperative main thoracic and thoracolumbar or lumbar curve progression, although no significant differences were observed in global alignment. Therefore, surgeons should pay attention to determining the LIV level as L3, especially for cases with the LEV at L4.
The authors investigated radiographic findings of proximal junctional failures with late neurological deficits and clinical outcomes after revision surgery. Perioperative complications were common and neurological outcomes after surgery were not favorable. To the authors' knowledge, this is the first study demonstrating detailed radiographic findings of proximal junctional failures with late neurological deficits and clinical outcomes after revision surgery.
This study compared the biomechanical profile of advanced surgical techniques in deformity reconstruction, including anterior column realignment and pedicle subtraction osteotomy. Both techniques are significantly destabilizing and prone to failure; however, with appropriate construct design, stability can be restored, with no significant difference between the two techniques. No prior rigorous biomechanical testing has been performed to compare these techniques; the results can help guide patient-specific surgical decision-making for spinal deformity surgeons in the future.
The authors compared patient characteristics associated with the utilization of a posterior lumbar interbody device between patients with degenerative spondylolisthesis and those with isthmic spondylolisthesis. Similar proportions of patients received a posterior interbody device and had similar postoperative outcomes. However, these cohorts showed significant variations in demographic and patient characteristics associated with the use of an interbody fusion device. These baseline differences should be considered when designing studies of lumbar spondylolisthesis and suggest that the two pathologies should be analyzed separately.
The authors retrospectively studied the effectiveness of systemic therapy on survival after surgery for renal cell spine metastases. Starting therapy was associated with a median survival benefit of 28 versus 12 months compared with surgery alone. This is the first paper demonstrating a survival advantage independent of sarcopenia and frailty. This may help surgeons adjudicate the role of surgery for patients with poor nutrition, limited survival, and an uncertain likelihood of starting or continuing systemic therapies.
Lateral lumbar interbody fusion (LLIF) has become a familiar, successful technique for minimally invasive spine surgeons. However, an increasing number of reported complications in the literature prompted the authors to investigate the feasibility of an endoscope-assisted LLIF to provide direct visualization of critical retroperitoneal structures (e.g., ureter, iliac vessels, genitofemoral nerve). The authors describe the endoscope-assisted LLIF with a step-by-step operative video and report favorable feasibility for clinical practice.
The authors report their technique and early clinical experience with simultaneous posterior and lateral lumbar access utilizing a prone transpsoas lumbar corpectomy. They found that this approach is feasible for difficult clinical scenarios. To their knowledge, this paper is the first in the literature to report this technique.
The authors analyzed the adjacent-level mobility of single-level L3–4 cortical screw–rod (CSR) versus pedicle screw–rod (PSR) fixation with and without interbody support. The use of PSR versus CSR significantly affects mobility at the adjacent level, regardless of the type of interbody support. Biomechanical evaluations of adjacent-level mobility with different screw trajectories have not been previously reported. These findings provide useful insights for clinical decision-making based on cortical bone trajectories and outcomes, as well as for future investigations.
This study analyzed the biomechanical effects of adding a titanium triangular-shaped sacroiliac implant to a long-segment lumbopelvic construct with S2-alar-iliac screws. The analysis showed that the posteriorly placed device improved local stability of the sacroiliac joint without significantly affecting rod and screw strains at the lumbosacral junction. These findings were intended to help clinicians understand the in vitro biomechanical effects of supplementing adult deformity correction constructs with a sacroiliac fusion device.
This study aimed to evaluate the comparative accuracy and safety of navigation-based approaches for cervical pedicle screw placement versus fluoroscopic techniques. It was found that navigation-based techniques confer a statistically significantly more accurate screw placement and resultant lower complication rates. This review adds to the current knowledge of cervical pedicle screws by directly comparing fluoroscopic and navigation-based pedicle screw insertion techniques for their accuracy and safety in a systematic manner.
The incidence of adjacent-segment disease (ASD) necessitating reoperation has been well described following traditional posterior lumbar fusion techniques (2.5%–3.9% per year); however, the incidence of surgical ASD remains poorly characterized following the less invasive stand-alone lateral lumbar interbody fusion (LLIF). The objective of this study was to identify the incidence of ASD following LLIF for degenerative lumbar etiologies, which was noted to be 0.88% per year in this study cohort. Given this relatively lower rate of ASD, LLIF may be preferable for properly selected and appropriately indicated patients.
To investigate whether blood flow of a compressed spinal cord improves after decompressive surgery for cervical spondylotic myelopathy, regional blood flow was measured precisely in a cervical chronic compression model in rats by using a fluorescent microsphere technique. Chronic mechanical compression induced segmental spinal cord blood flow insufficiency and development of myelopathy. Subsequent decompressive surgery brought about sequential blood flow recovery. These results suggest that blood flow alterations may play a significant role in neurological changes.
Long-term changes in sagittal spinopelvic alignment in patients with lumbar spinal stenosis (LSS) after decompression surgery remain unclear. This study revealed that a significant percentage of patients with LSS could obtain normal sagittal balance in the short term and mid- to long term after decompression surgery alone. Preoperative sagittal vertical axis (SVA) and postoperative SVA, pelvic incidence minus lumbar lordosis, and pelvic tilt affected clinical outcomes after decompression alone. The clinical outcomes of patients with persistent postural malalignment tended to deteriorate more than those of other patients.
In this study, the authors analyzed factors associated with an academic career trajectory among fellowship-trained spinal neurosurgeons. Increased protected research time during residency, higher h-index during residency, completing more than one clinical fellowship, and attending any of the top 5 programs that graduated the most fellows in the study cohort were all independently associated with an academic career. The study findings may be useful in developing programs to encourage residents who are interested in academic spinal neurosurgery.
The objective of this study was to assess the cerebral functional and macrostructural changes that occur after surgical decompression in patients with degenerative cervical myelopathy. The key finding was that increased functional connectivity between the cerebellum and primary sensorimotor areas was found to be positively associated with the neurological improvement in patients with degenerative cervical myelopathy (DCM). This study helps us to better understand the importance of supraspinal plasticity in the pathogenesis of DCM and its role in neurological recovery.
Although statistical significance is pertinent to research, p values are extremely sensitive to sample size and often fall short in demonstrating clinical efficacy. Minimal clinical important difference (MCID) values are used to determine the minimum change necessary to achieve meaningful improvement. This was the first study to successfully establish MCID thresholds for several prominent pain assessments after spinal cord stimulation (SCS), resulting in ability to better determine patients' success with and response to SCS therapy.
The objective of this study was to compare preoperative and postoperative gait posture and ability in elderly patients with adult spinal deformity (ASD) who underwent extensive corrective fusion from the thoracic spine to pelvis according to age. Elderly patients with ASD had improved gait after surgery to the same extent as middle-aged patients. The study results are useful for both elderly patients with ASD and surgeons considering surgical indications for their patients.
The objective of this study was to evaluate the correlation between increasing frailty, outcomes, and complications among patients undergoing single-level transforaminal lumbar interbody fusion. Not surprisingly, it was demonstrated that as modified frailty index scores increased patients experienced longer inpatient hospital stays, a higher probability of discharge to a nursing or rehabilitation facility, and increased complications. These data may help inform physicians in their patient selection for lumbar fusion.
The objective of this study was to evaluate the safety and efficacy of a novel lumbar interbody fusion device. The results demonstrated endplate surface area coverage similar to an anterior lumbar interbody fusion, but via a minimally invasive transforaminal lumbar interbody fusion approach. The device was not only safe but demonstrated itself to be very effective, with a high fusion rate and low failure rate.
The aim of this study was to compare a traditional cervical cage with a zero-profile fixation device in patients who underwent three-level anterior cervical decompression and fusion in terms of clinical and radiological outcomes and complications. Use of zero-profile implants yielded satisfactory long-term outcomes that were similar to those of a standard anterior cage-plate construct. This study could provide a reference for surgeons to choose the appropriate surgical option for patients with multilevel cervical spondylotic myelopathy.
A novel, minimally invasive, anteroposterior combined surgery with lateral lumbar interbody fusion was used to overcome the drawbacks of conventional procedures to treat lumbar spinal canal stenosis associated with osteoporotic vertebral collapse. With tailored placement of interbody cages and pedicle screws according to the morphology of the collapsed vertebra, this procedure avoids corpectomy and achieves neural decompression, correction of local alignment, and reconstruction of anterior support with a rigid, minimally invasive, short-segment fusion construct.
This study compares template-guided (TG) and standard freehand (FH) pedicle screw insertion techniques in a randomized controlled trial (RCT). High accuracy with less intraoperative radiation exposure could be achieved using the TG technique. The pros and cons of the TG technique have been illuminated in one of the first RCTs.
Researchers investigated the reciprocal changes in the cervical spine after lumbar pedicle subtraction osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis. Different patterns of cervical reciprocal changes occurred based on the presence or absence of ossification of the anterior longitudinal ligament in the lower cervical spine. The clinical significance of the relationship between cervical reciprocal changes and osteotomy angle suggested that reciprocal cervical changes should be considered when approximating the osteotomy angle for ankylosing spondylitis patients with thoracolumbar kyphosis preoperatively.
The authors tested the hypothesis that preoperative cerebrospinal fluid (CSF) biomarkers are altered in patients with cervical spondylotic myelopathy and correlate with neurological status and outcome. Biomarkers of glial and axonal damage in CSF biomarkers were increased, while amyloid breakdown products were decreased. Correlations between preoperative neurological picture and outcome were noted. CSF biomarkers can reflect the ongoing pathophysiology of spinal cord compression and damage and may provide prognostic information on surgical outcome.
The authors compared standing and supine radiographs for 73 patients and found that those with bilateral sacroiliac (SI) joint vacuum signs, as identified on CT, had a change in pelvic incidence between the supine and standing positions. This suggests there may be increasing motion across the SI joint with significant joint degeneration.
The objective of this study was to elucidate the efficacy of the cyst-dyeing method in microendoscopic spinal decompression surgery for lumbar spinal stenosis caused by facet cysts. The adjunctive cyst-dyeing method effectively delineated cyst and dural boundaries, facilitating safer and more effective cyst separation and neural decompression, even with microendoscopic surgery. Microendoscopic surgery combined with the authors' novel facet cyst-dyeing method is a safe and effective minimally invasive technique for facet-joint cysts.
The authors aimed to determine which radiological parameters related to the aging spine are associated with curve progression in early degenerative lumbar scoliosis (DLS), in particular which factors predict curve progression. In early DLS patients observed for a mean of 13.7 years, asymmetrical disc degeneration in the lower disc space of the apical vertebra, leading to lower apical vertebral disc wedging angles, was the most important factor in predicting curve progression. Therefore, patients with this finding need to be closely monitored.