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Background context High-grade dysplastic spondylolisthesis (HGDS) is a rare pediatric spinal deformity characterized by severe lumbosacral dysplasia and sagittal malalignment. The optimal surgical strategy for achieving deformity correction while minimizing neurological risk remains controversial. Purpose To evaluate radiographic and clinical outcomes of sacral dome osteotomy combined with complete L5 reduction and single-level posterior L5–S1 fusion in pediatric patients with HGDS, and to explore factors associated with residual postoperative sagittal imbalance. Study design A multicenter retrospective case-series study. Patient sample Thirty-one patients (30 females, 1 male; mean age 9.66 ± 2.27 years) with L5 high-grade dysplastic spondylolisthesis who underwent sacral dome osteotomy, complete L5 reduction, and posterior L5–S1 single-level fusion between 2008 and 2023. Outcome measures The primary outcome was residual sagittal imbalance at the latest follow-up, defined as sagittal vertical axis (SVA) > 5.0 cm or pelvic tilt to sacral slope ratio (PT/SS) > 1. These criteria represented global and regional malalignment, respectively. Methods Clinical and radiographic data were retrospectively reviewed. Patients were categorized according to the presence of residual sagittal imbalance at the final follow-up. Univariable and multivariable logistic regression analyses were performed in an exploratory manner to examine associations between selected clinical and radiographic variables and residual sagittal imbalance. Receiver operating characteristic (ROC) curve analysis was conducted to assess the discriminatory ability of preoperative sagittal vertical axis within this cohort. Results Mean follow-up was 3.05 ± 2.01 years. Slip percentage improved from 61.0 ± 11.0 preoperatively to 13.0 ± 10.0 postoperatively (p < 0.001) and remained stable at 9.0 ± 12.0 at the latest follow-up. Lumbosacral and global sagittal alignment parameters demonstrated significant correction that was largely maintained over time. Seven patients (22.6%) demonstrated residual sagittal imbalance (SVA > 5.0 cm or PT/SS > 1). Greater preoperative SVA values were associated with residual postoperative sagittal imbalance (OR 1.04, 95% CI 1.00–1.08, p = 0.037). Exploratory ROC analysis identified a preoperative SVA value of 4.0 cm with high sensitivity (100%) and moderate specificity (75%) for residual imbalance in this cohort. Transient neurological complications occurred in 12.9% of patients, and radiographic adjacent segment degeneration requiring revision occurred in 9.7%. Conclusions Sacral dome osteotomy with complete L5 reduction and single-level posterior L5–S1 fusion achieved durable radiographic correction of sagittal and coronal deformities in pediatric patients with high-grade dysplastic spondylolisthesis. Exploratory analyses suggested that greater preoperative sagittal vertical axis values were associated with residual postoperative sagittal imbalance, highlighting the importance of careful postoperative follow-up.

PurposeTo develop a model to predict 30-day readmission rates in elective 1–2 level posterior lumbar spine fusion (PSF) patients.MethodsIn this retrospective case control study, patients were identified in the State Inpatient Database using ICD-9 codes. Data were queried for 30-day readmission, as well as demographic and surgical data. Patients were randomly assigned to either the derivation or the validation cohort. Stepwise multivariate analysis was conducted on the derivation cohort to predict 30-day readmission. Readmission after posterior spinal fusion (RAPSF) score was created by including variables with odds ratio (OR) > 1.1 and p < 0.01; value assigned to each variable was based on the OR and calibrated to 100. Linear regression was performed between readmission rate and RAPSF score to test correlation in both cohorts.ResultsThere were 92,262 and 90,257 patients in the derivation and validation cohorts. Thirty-day readmission rates were 10.9% and 11.1%, respectively. Variables in RAPSF included: age, female gender, race, insurance, anterior approach, cerebrovascular disease, chronic pulmonary disease, congestive heart failure, diabetes, hemiplegia/paraplegia, rheumatic disease, drug abuse, electrolyte disorder, osteoporosis, depression, obesity, and morbid obesity. Linear regression between readmission rate and RAPSF fits the derivation cohort and validation cohort with an adjusted r2 of 0.92 and 0.94, respectively, and a coefficient of 0.011 (p < 0.001) in both cohorts.ConclusionThe RAPSF can accurately predict readmission rates in PSF patients and may be used to guide an evidence-based approach to preoperative optimization and risk adjustment within alternative payment models for elective spine surgery.Level of evidence3.Graphical abstractThese slides can be retrieved under Electronic Supplementary Material.

This is a retrospective study that was done according to clinical and radiological evaluation. We analyzed the clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody single level fusion. Minimally invasive transforaminal lumbar interbody fusion is effective surgical method for treating degenerative lumbar disease. The study was conducted on 56 patients who were available for longer than 2 years (range, 24 to 45 months) follow-up after undergoing minimally invasive transforminal lumbar interbody single level fusion. Clinical evaluation was performed by the analysis of the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) and the Kirkaldy-Willis score. For the radiological evaluation, the disc space height, the segmental lumbar lordotic angle and the whole lumbar lordotic angle were analyzed. At the final follow-up after operation, the fusion rate was analyzed according to Bridwell's anterior fusion grade. For the evaluation of clinical outcomes, the VAS score was reduced from an average of 6.7 prior to surgery to an average of 1.8 at the final follow-up. The ODI was decreased from an average of 36.5 prior to surgery to an average of 12.8 at the final follow-up. In regard to the clinical outcomes evaluated by the Kirkaldy-Willis score, better than good results were obtained in 52 cases (92.9%). For the radiological evaluation, the disc space height (p = 0.002), and the whole lumbar lordotic angle (p = 0.001) were increased at the final follow-up. At the final follow-up, regarding the interbody fusion, radiological union was obtained in 54 cases (95.4%). We think that if surgeons become familiar with the surgical techniques, this is a useful method for minimally invasive spinal surgery.

Purpose To investigate the influence of slippage reduction and correction of lumbosacral kyphosis by L5–S1 single-level posterior lumbar interbody fusion (PLIF) on spinal alignment and clinical outcomes including postoperative complications in patients with dysplastic spondylolisthesis (DS). Methods Twenty consecutive patients with symptomatic and severe DS who underwent L5–S1 single-level PLIF with a minimum of 2 years of follow-up after surgery were included. Clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) and visual analog scale (VAS) scores for low back and leg pain obtained on preoperative and postoperative examinations. Postoperative instrumentation failure and L5 radiculopathy were also evaluated. The preoperative and postoperative spinopelvic parameters were measured. Results The JOA score significantly improved from 21.5 ± 4.8 (preoperative) to 27.0 ± 2.5 (postoperative), with a mean recovery rate of 75.0% ± 30.4%. The VAS score for low back pain significantly improved from 44.5 ± 30.1 (preoperative) to 11.5 ± 15.9 (postoperative), and that for leg pain significantly improved from 31.0 ± 33.2 (preoperative) to 5.0 ± 10.2 (postoperative). The slip percentage (% slip) significantly improved from 59.6% ± 13.5% (preoperative) to 25.2% ± 15.0% (postoperative). The lumbosacral angle (LSA) significantly improved from 12.3° ± 9.5° (preoperative) to 1.0° ± 4.9° (postoperative). L5–S1 PLIF led to significant improvement of lumbar lordosis (from 52.0° ± 15.9° to 59.7° ± 8.0°) and pelvic incidence − lumbar lordosis mismatch (from 23.9° ± 20.6° to 13.3° ± 10.0°). Correction of lumbosacral kyphosis had a significant positive correlation with postoperative pelvic tilt (PT) (r = 0.50, P  = 0.02), while postoperative % slip did not have a significant correlation with postoperative PT. Conclusions L5–S1 PLIF for DS provided good clinical outcomes. Correction of lumbosacral kyphosis had a positive impact on regaining ideal spinopelvic balance and may be beneficial in the setting of treating DS. Level of evidence IV.

Background Although anterior cervical discectomy and fusion (ACDF) is the gold standard for treating cervical spondylotic myelopathy (CSM), it still has several disadvantages in spite the used of microscope. Unilateral biportal endoscopy is a newly developed minimally invasive spine surgery and has many advantages. The study aimed to compare the feasibility, technical advantages and short-term clinical efficacy of mini-open endoscope assisted ACDF (MOEA-ACDF) versus microscopic ACDF and traditional ACDF for the treatment of single-level CSM accompanied by osteophyte formation at the posterior edge of the vertebral body or ossification of posterior longitudinal ligament. Methods Thirty-three patients who treated with MOEA-ACDF (Group A), microscopic ACDF (Group B) and traditional ACDF (Group C) were included. Before surgery, at 1 month after surgery and the last follow-up, imaging indicators (cervical Cobb angle, Cobb angle of fused segment, intervertebral space height of fused segment, intervertebral fusion status), and clinical indicators, including visual analogue scale (VAS) scores for neck and upper extremity pain, Japanese orthopedic association (JOA) score, and neck disability index (NDI) were analyzed. Results The operations were successfully completed in all groups. The mean follow-up time was 20.5 ± 2.8, 20.2 ± 4.3, and 20.3 ± 3.7 months in Groups A, B, C, respectively. Group A had longer operation time and shorter length of skin incision than Groups B and C (all P <  0.05). All patients in each group had achieved bony fusion during the follow-up period, no significant difference in the time taken for bony fusion was noted between the three groups. Imaging and clinical indicators both improved significantly at 1 month after surgery and the last follow-up compared with before surgery in all groups (all P <  0.05). There was no significant difference in imaging and clinical indicators, JOA recovery rate, and the complication rates among the three group after surgery. Conclusions For the treatment of CSM accompanied by osteophyte formation at the posterior edge of the vertebral body or OPLL, MOEA-ACDF can achieve satisfactory short-term clinical outcomes, with the advantages of high overall surgical safety, good operation accuracy, less cervical soft tissue damage, low complication rate, and fast postoperative recovery.

This study aims to compare the efficacy of two endoscopic instruments powered osteotome and powered drill in treating single-segment degenerative lumbar spinal stenosis via unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF). We retrospectively analyzed clinical data from 127 patients treated at Qilu Hospital of Shandong University between January 2021 and December 2022. Patients were divided into two groups: the bone-drill (BD) group (71 cases) and the bone-osteotome (BO) group (56 cases). Various surgical indicators were assessed, including operation time, intraoperative blood loss, postoperative drainage volume, length of hospital stay, and complication rates. Clinical efficacy was evaluated using the visual analog scale (VAS) for lower back and limb pain, the Oswestry Disability Index (ODI), modified MacNab criteria, and the Brantigan and Steffee method for interbody fusion assessment. Results showed that the BD group had an average operation time of 151.41 ± 19.03 min, whereas the BO group completed the procedure significantly faster, averaging 128.48 ± 16.92 min. Intraoperative blood loss was comparable between groups (BD: 102.11 ± 34.26 ml; BO: 120.70 ± 32.89 ml). The BO group showed higher postoperative drainage volume (85.47 ± 19.01 ml) than the BD group (71.25 ± 14.55 ml). Hospitalization durations were similar (BD: 8.92 ± 1.22 days; BO: 9.16 ± 1.12 days). Both groups showed significant improvement in VAS and ODI scores at 3 and 12 months post-surgery ( P  < 0.05), with no significant differences between groups ( P  > 0.05). Notably, the BO group exhibited superior intervertebral fusion quality at 3 months compared to the BD group ( P  < 0.05), with no differences observed at 12 months. In conclusion, the UBE-TLIF technique employing a powered osteotome significantly reduces operation time and enhances intervertebral fusion compared to the powered drill method.

This paper proposes a detector that focuses on multi-scale detection problems and effectively enhances the detection performance to solve the problem that is hard to detect minor traffic signs. This detector, called YOLOF-F (you only look one-level feature fusion), is a single-stage detector that extracts multi-scale feature information from a single layer of fusion feature. First, we propose FFM (feature fusion module) to fuse different scales. Next, we offer a new encoder CDE (corner dilated encoder) to enhance the angular point information in the feature map, improve position regression accuracy, and maintain a faster detection speed. Finally, YOLOF-F achieved 74.57% and 77.23% of the AP on the GTSDB and CTSD datasets and reached 32 FPS. Extensive experiments validate that YOLOF-F is faster and more effective than most traffic sign detection methods.

Background The clinical outcomes of single-level anterior cervical discectomy and fusion (ACDF) with the Zero-profile (Zero-p) were evaluated in comparison with the anterior cervical cage–plate construct (CPC). Methods We performed a systematic search covering PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, Medline, China National Knowledge Infrastructure (NCKI), Wan Fang Database, and Wei Pu Database. Articles focused on single-level ACDF or data of the single - level that can be extracted were included, and articles that did not directly compare Zero-p and CPC were excluded. Twenty-seven studies were included with a total of 1866 patients, 931 in the Zero-p group and 935 in the CPC group. All outcomes were analyzed using Review Manager 5.4. Results The meta-analysis outcomes indicated that operative time (WMD = − 12.47, 95% CI (− 16.89, − 8.05), P  < 0.00001), intraoperative blood loss (WMD = − 13.30, 95% CI (− 18.83, − 7.78), P  < 0.00001), risk of adjacent segment degeneration (ASD) (OR 0.31, 95% CI (0.20, 0.48), P  < 0.0001), risk of dysphagia of short-term (OR 0.40, 95% CI (0.30, 0.54), P  < 0.0001), medium-term (OR 0.31, 95% CI (0.20, 0.49), P  < 0.0001), and long-term (OR 0.29, 95% CI (0.17, 0.51), P  < 0.0001) of Zero-p group were significantly lower. The JOA score of Zero-p group at the final follow-up was significantly higher (WMD = − 0.17, 95% CI (− 0.32, − 0.03), P  = 0.02). There were no significant differences in length of stay (LOS), Neck Disability Index (NDI), Visual Analogue Score (VAS), fusion rate, segmental Cobb angle, cervical Cobb angle, prevertebral soft tissue thickness (PSTT), SF-36, subsidence, implant failure, and hoarseness between the two groups. This study was registered with PROSPERO, CRD42022347146. Conclusion Zero-p group reduced operative time, intraoperative blood loss, JOA score at follow-up and reduced the incidence of dysphagia and postoperative ASD, but the two devices had the same efficacy in restoring the cervical curvature, preventing the cage subsidence, and in postoperative VAS, NDI, LOS, PSTT, SF-36, fusion rate, implant failure, and hoarseness in single-level ACDF. The use of Zero-p in single-level ACDF was recommended.

Objective This retrospective study aimed to compare the clinical and radiological outcomes of transforaminal lumbar interbody fusion (TLIF) through the Wiltse approach (W‐TLIF) vs minimally invasive microendoscopy‐assisted transforaminal lumbar interbody fusion (ME‐TLIF) in single‐segment lumbar disc herniation (LDH). Methods A retrospective study was conducted to study the differences in specific clinical outcomes between single‐segment LDH patients receiving W‐TLIF and ME‐TLIF. Single‐segment LDH patients admitted to the Fujian Medical University Union Hospital from March 2015 to June 2018 were included. All the participants were divided into the ME‐TLIF group or the W‐TLIF group according to their TLIF surgery types. Demographic characteristics, the visual analog score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scale, blood loss volume, postoperative drainage, ambulated time, initial postoperative back pain, hospitalization duration, expenses, and improvement rates of patients in the two groups were collected for analysis. Radiographic fusion was ultimately assessed via the Bridwell interbody fusion grading system. All selected patients with TLIF were followed up for 1 year. Results Fifty‐seven patients were selected, with 26 in the ME‐TLIF group and 31 in the W‐TLIF group, both of whom were followed up for 1 year. The mean age of the included patients was 53.75 ± 9.313 years, and the sex ratio was indiscrimination. There was no significant difference in demographic data or operating time between the two groups prior to surgery. The blood loss volume (ME‐TLIF: 228.5 vs W‐TLIF: 681.3), postoperative drainage (ME‐TLIF:82.1 ± 23.5 vs W‐TLIF: 345.8 ± 65.2), initial postoperative back pain (ME‐TLIF: VAS_3 days: 1.96 ± 0.60 VAS_7 days: 1.73 ± 0.53, W‐TLIF: VAS_3 days: 2.48 ± 0.51 VAS_7 days: 1.87 ± 0.43), and hospitalization duration (ME‐TLIF: 9.04 vs. W‐TLIF: 11.29) were all significantly lower in the ME‐TILF group (p < 0.05). However, there were no statistical differences between the two groups in VAS, ODI, and JOA at 1 month, 3 months, 6 months, and 1 year postoperatively (p > 0.05). The fusion rates of the two groups showed no notable difference (p > 0.05), while the X‐ray exposure time in the ME‐TLIF group was significantly longer than in the W‐TLIF group (p < 0.05). Conclusions ME‐TLIF surgery was an effective and satisfactory surgical technique to manage LDH. Although ME‐TLIF increased the operation time and intraoperative fluoroscopic irradiation volume, it could effectively relieve low back pain from early postoperative onset and promote early postoperative recovery compared with W‐TLIF. Minimally invasive surgical instruments for the MET‐Rx Microsightoscopy System (Medtronic) and a brief description of surgery procedure.

Study Design Retrospective analysis. Objectives To evaluate resolution of radiculopathy in one-level lumbar fusion with indirect or direct decompression techniques. Methods Patients ≥18 years of age with preoperative radiculopathy undergoing single-level lumbar fusion with up to 2-year follow-up were grouped by indirect and direct decompression. Direct decompression (DD) group included ALIF and LLIF with posterior DD procedure as well as all TLIF. Indirect decompression (ID) group included ALIF and LLIF without posterior DD procedure. Propensity score matching was used to control for intergroup differences in age. Intergroup outcomes were compared using means comparison tests. Logistic regressions were used to correlate decompression type with symptom resolution over time. Significance set at P < .05. Results 116 patients were included: 58 direct decompression (DD) (mean 53.9y, 67.2% female) and 58 indirect decompression (ID) (mean 54.6y, 61.4% female). DD patients experienced greater blood loss than ID. Additionally, DD patients were 4.7 times more likely than ID patients to experience full resolution of radiculopathy at 3 months post-op. By 6 months, DD patients demonstrated larger reductions in VAS score. With regard to motor function, DD patients had improved motor score associated with the L5 dermatome at 6 months relative to ID patients. Conclusions Direct decompression was associated with greater resolution of radiculopathy in the near post-operative term, with no differences at long term follow-up when compared with indirect decompression. In particularly debilitated patients, these findings may influence surgeons to perform a direct decompression to achieve more rapid resolution of radiculopathy symptoms.