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Background and Objectives: There are few reports describing the radiographic correction of vertebral slippage in lateral interbody fusion and percutaneous pedicle screw fixation for lumbar degenerative spondylolisthesis. [Objectives] We evaluated the intraoperative surgical correction obtained by lateral interbody fusion and percutaneous pedicle screw procedures. Materials and Methods: Fifty patients were included in this study. According to the Meyerding classification, 35 cases were Grade 1 and 15 cases were Grade 2. Mean age was 64.7 ± 6.4 years old. Seventeen cases were male, and 33 cases were female. The mean preoperative % slip was 21.1 ± 7.0%. After lateral interbody fusion, vertebral slippage was corrected using reduction technique by percutaneous pedicle screw. Results: The slippage of vertebra was reduced to 11.5 ± 6.5% after lateral interbody fusion procedure and 4.0 ± 6.0% after percutaneous pedicle screw procedure. One year after surgery, the slippage of vertebra was 4.1 ± 6.6%. The correction rate of lateral interbody fusion was 47.7 ± 25.1%, and that of percutaneous pedicle screw was 33.8 ± 2.6%. The total correction rate was 81.5 ± 27.7%. There was no significant loss of correction one year after surgery. The Japanese Orthopaedic Association Score significantly improved from 14.7 ± 4.2 to 27.7 ± 1.7 points at final follow up. No vascular or organ injury was observed during surgery, and there were no postoperative surgical site infections or systemic complications. Conclusion: Compared with previous reports, the final correction rate and the correction rate of the percutaneous pedicle screw procedure were particularly high in this study. Lateral interbody fusion and percutaneous pedicle screw using reduction technique provide excellent clinical and radiographic outcomes for patients with lumbar degenerative spondylolisthesis.

Following lumbar fusion, adjacent segment degeneration has been frequently reported. Dynamic systems are believed to reduce main fusion drawbacks. We conducted a retrospective study on patients with degenerative lumbar disease treated with posterior dynamic stabilization with monoaxial hinged pedicular screws and lumbar decompression. VAS and ODI were used to compare clinical outcomes. As radiological outcomes, LL and SVA were used. 51 patients were included with an average follow-up of 24 months. 13 patients were revised because of postoperative radiculopathy (n=4), subcutaneous hematoma(n=2), L5 screw malposition (n=1) and adjacent segment disease (n=6). The mean ODI score 41 preoperatively compared to 36 postoperatively. The mean VAS scores for back and leg pain were 5.3 and 4.2, respectively compared to 4.5 and 4.0 post-operatively. The mean SVA was 5.3 cm pre-operatively, and 5.7 cm postoperatively. The mean LL was 47.5° preoperatively and 45.5° postoperatively. From our data, whichfail to show significant improvements andreflect a high revision rate, we cannot generally recommend dynamic stabilization as an alternative to fusion. Comparative trials with longer follow-ups are required.

Background context Clinical guidelines, developed in concordance with the literature, are often used to guide surgeons’ clinical decision making. Recent advancements of large language models and artificial intelligence (AI) in the medical field come with exciting potential. OpenAI’s generative AI model, known as ChatGPT, can quickly synthesize information and generate responses grounded in medical literature, which may prove to be a useful tool in clinical decision-making for spine care. The current literature has yet to investigate the ability of ChatGPT to assist clinical decision making with regard to degenerative spondylolisthesis. Purpose The study aimed to compare ChatGPT’s concordance with the recommendations set forth by The North American Spine Society (NASS) Clinical Guideline for the Diagnosis and Treatment of Degenerative Spondylolisthesis and assess ChatGPT’s accuracy within the context of the most recent literature. Methods ChatGPT-3.5 and 4.0 was prompted with questions from the NASS Clinical Guideline for the Diagnosis and Treatment of Degenerative Spondylolisthesis and graded its recommendations as “concordant” or “nonconcordant” relative to those put forth by NASS. A response was considered “concordant” when ChatGPT generated a recommendation that accurately reproduced all major points made in the NASS recommendation. Any responses with a grading of “nonconcordant” were further stratified into two subcategories: “Insufficient” or “Over-conclusive,” to provide further insight into grading rationale. Responses between GPT-3.5 and 4.0 were compared using Chi-squared tests. Results ChatGPT-3.5 answered 13 of NASS’s 28 total clinical questions in concordance with NASS’s guidelines (46.4%). Categorical breakdown is as follows: Definitions and Natural History (1/1, 100%), Diagnosis and Imaging (1/4, 25%), Outcome Measures for Medical Intervention and Surgical Treatment (0/1, 0%), Medical and Interventional Treatment (4/6, 66.7%), Surgical Treatment (7/14, 50%), and Value of Spine Care (0/2, 0%). When NASS indicated there was sufficient evidence to offer a clear recommendation, ChatGPT-3.5 generated a concordant response 66.7% of the time (6/9). However, ChatGPT-3.5’s concordance dropped to 36.8% when asked clinical questions that NASS did not provide a clear recommendation on (7/19). A further breakdown of ChatGPT-3.5’s nonconcordance with the guidelines revealed that a vast majority of its inaccurate recommendations were due to them being “over-conclusive” (12/15, 80%), rather than “insufficient” (3/15, 20%). ChatGPT-4.0 answered 19 (67.9%) of the 28 total questions in concordance with NASS guidelines ( P  = 0.177). When NASS indicated there was sufficient evidence to offer a clear recommendation, ChatGPT-4.0 generated a concordant response 66.7% of the time (6/9). ChatGPT-4.0’s concordance held up at 68.4% when asked clinical questions that NASS did not provide a clear recommendation on (13/19, P  = 0.104). Conclusions This study sheds light on the duality of LLM applications within clinical settings: one of accuracy and utility in some contexts versus inaccuracy and risk in others. ChatGPT was concordant for most clinical questions NASS offered recommendations for. However, for questions NASS did not offer best practices, ChatGPT generated answers that were either too general or inconsistent with the literature, and even fabricated data/citations. Thus, clinicians should exercise extreme caution when attempting to consult ChatGPT for clinical recommendations, taking care to ensure its reliability within the context of recent literature.

PurposeTo provide an overview of the The Norwegian Degenerative spondylolisthesis and spinal stenosis (NORDSTEN)-study and the organizational structure, and to evaluate the study population.MethodsThe NORDSTEN is a multicentre study with 10 year follow-up, conducted at 18 public hospitals. NORDSTEN includes three studies: (1) The randomized spinal stenosis trial comparing the impact of three different decompression techniques; (2) the randomized degenerative spondylolisthesis trial investigating whether decompression surgery alone is as good as decompression with instrumented fusion; (3) the observational cohort tracking the natural course of LSS in patients without planned surgical treatment. A range of clinical and radiological data are collected at defined time points. To administer, guide, monitor and assist the surgical units and the researchers involved, the NORDSTEN national project organization was established.Corresponding clinical data from the Norwegian Registry for Spine Surgery (NORspine) were used to assess if the randomized NORDSTEN-population at baseline was representative for LSS patients treated in routine surgical practice.ResultsA total of 988 LSS patients with or without spondylolistheses were included from 2014 to 2018. The clinical trials did not find any difference in the efficacy of the surgical methods evaluated. The NORDSTEN patients were similar to those being consecutively operated at the same hospitals and reported to the NORspine during the same time period.ConclusionThe NORDSTEN study provides opportunity to investigate clinical course of LSS with or without surgical interventions. The NORDSTEN-study population were similar to LSS patients treated in routine surgical practice, supporting the external validity of previously published results.Trial registrationClinicalTrials.gov; NCT02007083 10/12/2013, NCT02051374 31/01/2014 and NCT03562936 20/06/2018.

Purpose To review existing classification systems for degenerative spondylolisthesis (DS), propose a novel classification designed to better address clinically relevant radiographic and clinical features of disease, and determine the inter- and intraobserver reliability of this new system for classifying DS. Methods The proposed classification system includes four components: 1) segmental dynamic instability, 2) location of spinal stenosis, 3) sagittal alignment, and 4) primary clinical presentation. To establish the reliability of this system, 12 observers graded 10 premarked test cases twice each. Kappa values were calculated to assess the inter- and intraobserver reliability for each of the four components separately. Results Interobserver reliability for dynamic instability, location of stenosis, sagittal alignment, and clinical presentation was 0.94, 0.80, 0.87, and 1.00, respectively. Intraobserver reliability for dynamic instability, location of stenosis, sagittal alignment, and clinical presentation were 0.91, 0.88, 0.87, and 0.97, respectively. Conclusion The UCSF DS classification system provides a novel framework for assessing DS based on radiographic and clinical parameters with established implications for surgical treatment. The almost perfect interobserver and intraobserver reliability observed for all components of this system demonstrates that it is simple and easy to use. In clinical practice, this classification may allow subclassification of similar patients into groups that may benefit from distinct treatment strategies, leading to the development of algorithms to help guide selection of an optimal surgical approach. Future work will focus on the clinical validation of this system, with the goal of providing for more evidence-based, standardized approaches to treatment and improved outcomes for patients with DS.

Background For Grade I degenerative lumbar spondylolisthesis (DLS), both decompression alone and decompression with fusion are effective surgical treatments. Which of the two techniques is superior is still under debate. The purpose of this study was to compare clinical outcomes after decompression alone versus decompression with fusion for Grade I DLS Materials and Methods 139 patients who underwent surgery for Grade I DLS at L4–L5 were prospectively enrolled. Decompression alone was used to treat 74 patients, and decompression with fusion was used to treat 65 patients. Six patients in the first group and four patients in the second group were lost during the 2-year followup. Demographic data were recorded. Operation time, perioperative blood loss, total blood transfusion volume, and length of hospital stay were compared between the two groups. Back pain and functional outcomes were evaluated using the visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively Results Baseline demographic data were not different between the two groups. Operation time, blood loss, total blood transfusion volume, and length of hospital stay were all significantly greater in the fusion group than in the decompression group. This would be expected because fusion is the more invasive procedure. VAS scores were not different up until 6 months postoperatively. Twelve months after surgery, however, VAS scores were significantly lower in the fusion group. The same results were shown in terms of ODI. Although ODI decreased in both groups over time, the fusion group showed better functional outcomes than did the decompression group Conclusions Although both decompression alone and decompression with fusion improved functional outcomes for Grade I DLS, fusion surgery resulted in better results compared to decompression alone. Therefore, fusion should be considered as the treatment of choice for Grade I DLS

Lumbar spinal stenosis (LSS) frequently coexists with degenerative spondylolisthesis (DS) in the elderly population, and the standard treatment commonly involves decompression with fusion. However, fusion procedures are associated with increased morbidity and may not always be necessary, particularly in Grade I DS. Full-endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has gained attention as a motion-preserving alternative, yet its impact on postoperative stability remains insufficiently studied. Primary objective was to evaluate 12-month improvements in patient-reported outcomes (leg-pain VAS, ODI) after LE-ULBD; radiographic stability was assessed as a key secondary endpoint. This retrospective cohort study included 32 patients with Meyerding stable Grade I DS and symptomatic LSS who underwent single-level lumbar LE-ULBD between January 2023 and October 2024. Pre- and 12-month postoperative radiographs were analyzed for segmental instability, defined as sagittal translation > 4 mm or angular motion > 10°. Clinical outcomes were assessed using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Macnab’s criteria. Subgroup analysis was performed based on slip progression. Mean vertebral slip percentage showed no significant change postoperatively (13.4% ± 3.1 vs. 13.8% ± 3.4; p  = 0.27). Only one patient (3.1%) developed new radiographic instability. VAS improved from 7.1 ± 1.2 to 1.4 ± 0.8 and ODI from 64.3% ± 9.1 to 18.5% ± 4.7 ( p  < 0.001 for both). According to Macnab’s criteria, 90.6% of patients reported Excellent or Good outcomes. Slip progression was observed in 9 patients (28.1%), but this was not associated with inferior clinical results. Complications occurred in 2/32 (6.3%) one incidental durotomy and one epidural hematoma with reoperation in 1/32 (3.1%); new radiographic instability in 1/32 (3.1%). LE-ULBD appears to be a safe and effective treatment option for selected patients with Grade I DS and LSS, achieving significant symptomatic relief while preserving segmental stability in the majority of cases. These findings support its consideration as an alternative to fusion in carefully selected individuals. LE-ULBD short-term (12-month) radiographic stability and clinically meaningful improvement in patients with stable grade-I degenerative spondylolisthesis; longer-term follow-up is required to determine durability and late instability risk.

Purpose To compare the clinical effectiveness of reduction and fusion with in situ fusion in the management of patients with degenerative lumbar spondylolisthesis (DLS). Methods The systematic review was conducted following the PRISMA guidelines. Relevant studies were identified from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrials.gov, and Google Scholar. The inclusion criteria were: (1) comparative studies of reduction and fusion versus in situ fusion for DLS patients, (2) outcomes reported as VAS/NRS, ODI, JOA score, operating time, blood loss, complication rate, fusion rate, or reoperation rate, (3) randomized controlled trials and observational studies published in English from the inception of the databases to January 2023. The exclusion criteria included: (1) reviews, case series, case reports, letters, and conference reports, (2) in vitro biomechanical studies and computational modeling studies, (3) no report on study outcomes. The risk of bias 2 (RoB2) tool and the Newcastle–Ottawa scale was conducted to assess the risk of bias of RCTs and observational studies, respectively. Results Five studies with a total of 704 patients were included (375 reduction and fusion, 329 in situ fusion). Operating time was significantly longer in the reduction and fusion group compared to in situ fusion group (weighted mean difference 7.20; 95% confidence interval 0.19, 14.21; P  = 0.04). No additional significant intergroup differences were noted in terms of other outcomes analyzed. Conclusion While the reduction and fusion group demonstrated a statistically longer operating time compared to the in situ fusion group, the clinical significance of this difference was minimal. The findings suggest no substantial superiority of lumbar fusion with reduction over without reduction for the management of DLS.

Objective This study aimed to evaluate preoperative (pre-op) radiographic characteristics and specific surgical interventions in patients with degenerative lumbar spondylolisthesis (DLS) who underwent lumbar fusion surgery (LFS), with a focus on analyzing predictors of postoperative restoration of segmental lumbar lordosis (SLL). Methods A retrospective review at a single center identified consecutive single-level DLS patients who underwent LFS between 2016 and 2022. Radiographic measures included disc angle (DA), SLL, lumbar lordosis (LL), anterior/posterior disc height (ADH/PDH), spondylolisthesis percentage (SP), intervertebral disc degeneration, and paraspinal muscle quality. Surgery-related measures included cage position, screw insertion depth, spondylolisthesis reduction rate, and disc height restoration rate. A change in SLL ≥ 4° indicated increased segmental lumbar lordosis (ISLL), and unincreased segmental lumbar lordosis (UISLL) < 4°. Propensity score matching was employed for a 1:1 match between ISLL and UISLL patients based on age, gender, body mass index, smoking status, and osteoporosis condition. Results A total of 192 patients with an average follow-up of 20.9 months were enrolled. Compared to UISLL patients, ISLL patients had significantly lower pre-op DA (6.78° vs. 11.84°), SLL (10.73° vs. 18.24°), LL (42.59° vs. 45.75°), and ADH (10.09 mm vs. 12.21 mm) (all, P  < 0.05). ISLL patients were predisposed to more severe intervertebral disc degeneration ( P  = 0.047) and higher SP (21.30% vs. 19.39%, P  = 0.019). The cage was positioned more anteriorly in ISLL patients (67.00% vs. 60.08%, P  = 0.000), with more extensive reduction of spondylolisthesis (− 73.70% vs. − 56.16%, P  = 0.000) and higher restoration of ADH (33.34% vs. 8.11%, P  = 0.000). Multivariate regression showed that lower pre-op SLL (OR 0.750, P  = 0.000), more anterior cage position (OR 1.269, P  = 0.000), and a greater spondylolisthesis reduction rate (OR 0.965, P  = 0.000) significantly impacted SLL restoration. Conclusions Pre-op SLL, cage position, and spondylolisthesis reduction rate were identified as significant predictors of SLL restoration after LFS for DLS. Surgeons are advised to meticulously select patients based on pre-op SLL and strive to position the cage more anteriorly while minimizing spondylolisthesis to maximize SLL restoration.

To performed classification based on global alignment and segmental balance, to better characterize single-segment Meyerding Grade I degenerative spondylolisthesis of lumbar spine (DSLS). A multicenter retrospective cohort study was performed, where 278 and 92 DSLS composed derivation and validation cohorts. Radiographical parameters contained lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and sagittal vertical axis (SVA) and inflected and apical vertebrae. The quality-of life scales contained visual analog scales of low back pain (VAS-LBP) and leg pain (VAS-LP) and Oswestry Disability Index (ODI). The classification system was based on global alignment type and PI-LL: Type 1 and 2 with PI < 50°, while inflection < L2 in Type 1, Type 3 and 4 with PI ≥ 50°, while SS < 45° in Type 3; Subtype 2 A and 3 A with ideal PI-LL while 2B and 3B with unideal PI-LL. In derivation cohort, all DSLS acquired reduction and quality-of-life scales improved. At baseline, ODI and VAS-LBP was the highest in type 4, higher than type 3 and 1 ( P  = 0.030 and P  = 0.041) but not for VAS-LP. In PI-LL subtype, ODI was worse in PI-LL mismatch subgroup in type 2 and 3 and VAS-LBP was worse in PI-LL mismatch subgroup in type 3 compared to match subgroup. All quality-of life scales were comparable among types. In validation cohort, there was 2 A-2B and 3 A-3B difference on ODI but comparable after surgery. The DSLS classification based on global shape (type 1–4) and PI-LL (A and B) was developed, where type 4 was linked to poor quality-of-life. This process broaden comprehensive analysis for DSLS.