Study Design.: Heterogeneous data collection through a mix of prospective, retrospective, and ambispective methods. Objective.: To evaluate the effect of biological sex on patient-reported outcomes after spinal fusion surgery for lumbar degenerative disease. Summary of Background Data.: Current literature suggests sex differences regarding clinical outcome after spine surgery may exist. Substantial methodological heterogeneity and limited comparability of studies warrants further investigation of sex-related differences in treatment outcomes. Materials and Methods.: We analyzed patients who underwent spinal fusion with or without pedicle screw insertion for lumbar degenerative disease included within a multinational study, comprising patients from 11 centers in seven countries. Absolute values and change scores (change from preoperative baseline to postoperative follow-up) for 12-month functional impairment [Oswestry disability index (ODI)] and back and leg pain severity [numeric rating scale (NRS)] were compared between male and female patients. Minimum clinically important difference (MCID) was defined as >30% improvement. Results.: Six-hundred sixty (59%) of 1115 included patients were female. Female patients presented with significantly baseline ODI (51.5±17.2 vs. 47.8±17.9, P<0.001), back pain (6.96±2.32 vs. 6.60±2.30, P=0.010) and leg pain (6.49±2.76 vs. 6.01±2.76, P=0.005). At 12 months, female patients still reported significantly higher ODI (22.76±16.97 vs. 20.50±16.10, P=0.025), but not higher back (3.13±2.38 vs. 3.00±2.40, P=0.355) or leg pain (2.62±2.55 vs. 2.34±2.43, P=0.060). Change scores at 12 months did not differ significantly among male and female patients in ODI (∆1.31, 95% CI: -3.88 to 1.25, P=0.315), back (∆0.22, 95% CI: -0.57 to 0.12, P=0.197), and leg pain (∆0.16, 95% CI: -0.56 to 0.24, P=0.439). MCID at 12 months was achieved in 330 (77.5%) male patients and 481 (76.3%) female patients (P=0.729) for ODI. Conclusion.: Both sexes experienced a similar benefit from surgery in terms of relative improvement in scores for functional impairment and pain. Although female patients reported a higher degree of functional impairment and pain preoperatively, at 12 months only their average scores for functional impairment remained higher than those for their male counterparts, while absolute pain scores were similar for female and male patients.

Introduction: The age of patients requiring surgery for spinal metastasis, primarily those over 65, has risen due to improved cancer treatments. Surgical intervention targets acute neurological deficits and instability. Anticoagulants are increasingly used, especially in the elderly, but pose challenges in managing bleeding complications. The study examines the correlation between preoperative anticoagulant/antiplatelet use and bleeding risks in spinal metastasis surgery, which is crucial for optimizing patient outcomes. Material and Methods: In a retrospective study at our department from 2010 to 2023, spinal tumor surgery patients were analyzed. Data included demographics, neurological status, surgical procedure, preoperative anticoagulant/antiplatelet use, intra-/postoperative coagulation management, and the incidence of rebleeding. Coagulation management involved blood loss assessment, coagulation factor administration, and fluid balance monitoring post-surgery. Lab parameters were documented at admission, preop, postop, and discharge. Results: A cohort of 290 patients underwent surgical treatment for spinal metastases, predominantly males (63.8%, n = 185) with a median age of 65 years. Preoperatively, 24.1% (n = 70) were on oral anticoagulants or antiplatelet therapy. Within 30 days, a rebleeding rate of 4.5% (n = 9) occurred, unrelated to preoperative anticoagulation status (p > 0.05). A correlation was found between preoperative neurologic deficits (p = 0.004) and rebleeding risk and the number of levels treated surgically, with fewer levels associated with a higher incidence of postoperative bleeding (p < 0.01). Conclusions: Surgical intervention for spinal metastatic cancer appears to be safe regardless of the patient’s preoperative anticoagulation status. However, it remains imperative to customize preoperative planning and preparation for each patient, emphasizing meticulous risk–benefit analysis and optimizing perioperative care.

Study Design.: A biomechanical study of 10 human thoracolumbar (T7–L2) spine specimens was performed. Objective.: To analyze the biomechanical characteristics of a Tether pedicle screw (TPS) in long-segment thoracolumbar instrumentation in terms of proximal junction mechanics and transitional motion patterns. Background.: Adult spinal deformity correction carries a high junctional failure risk. A soft-landing construct at a rigid construct cranial end might reduce the proximal junctional kyphosis and proximal junctional failure risks. Therefore, a novel TPS was designed to mitigate the proximal junctional kyphosis/proximal junctional failure risk. The pedicle screw is characterized by a tether between the threaded shaft and the screw head, enabling motion among parts. Materials and Methods.: For initial flexibility tests, 3 instrumentation patterns were tested. Representing conventional instrumentation, standard thoracolumbar pedicle screw-rod instrumentation at T10 to L2 was used [standard (STD) group]. The TPS was tested at T9 (TPS+1 group), 1 level above the upper instrumented vertebra, and at T9 and T8 (TPS+2 group). Flexibility tests (±5 Nm) in all 3 motion directions were performed and repeated after cyclic loading (250 cycles, 1–10 Nm). Finally, specimens in the STD and TPS groups were subjected to screw pull-out testing at the index level to analyze the TPS stress-shielding effects. Results.: The TPS+2 group demonstrated the largest range of motion decrease at T9 to T10 in the flexibility tests, with a smaller effect in the second adjacent segment at T8 to T9. No significant change in range of motion was observed in the uppermost segment (T7–T8) among all instrumentation pattern studies. Pull-out testing revealed greater mean forces at the T10 end-level in the TPS+2 group than in the STD group. Conclusion.: The TPS effectively distributed the loads across 3 adjacent levels and softened the load transition compared with the rigid construct. The TPS also showed the potential to stress-shield the upper instrumented vertebra (T10) and reduce the end-level screw loosening risk.

Objective: Surgical management of lumbar spinal stenosis remains controversial, as factors qualifying patients for fusion procedures may not be met and decompression alone may carry the risk for the development of secondary lumbar instability (SLI). The aim of this study was to validate a novel scoring system for SLI risk prediction including a 14-point scale, created using the most relevant risk factors selected by the authors’ spine surgery research group with the help of a peer-review process. Methods: Patients treated with lumbar “over-the-top” decompression due to spinal stenosis at the author’s department from January until December 2018 were included. BMI, gender, smoking history, age, previous lumbar surgery, presence of low back pain, presence of spondylolisthesis (> 5 mm), dynamic olisthesis (> 3 mm), segmental kyphosis (> 10°), disc height > 6.5 mm, facet joint angle (> 50°) and fluid-filled facet joints were retrospectively assessed. Clinical deterioration, presented as SLI with requirement for spondylodesis of the previously operated segment during a postoperative 2-year follow-up was defined as the primary outcome value. Results: 107 patients (45 female, 62 male) with a median age of 69 years (inter-quartile range [IQR] 61, 76) were included in this study. Twenty-eight patients (26.2%) had mechanical low back pain with VAS > 4, and 24 patients (22.4%) were already previously operated at the respective segment. The median SLI score was 6/14 (IQR 5, 8). Patients who subsequently required spondylodesis (9/107, 8,4%) had a significantly higher SLI score compared to patients who did not subsequently develop SLI (9 vs. 6, p = 0.013). The most relevant risk factors for development of SLI were disc height > 6.5 mm, BMI as well as the presence of a lumbar olisthesis with a relative risk (RR) of 2.8, 2.3 and 2.8, respectively. Conclusion: Using the novel SLI score, we were able to show a clear difference regarding pre-defined risk factors for patient with and without subsequent fusion surgery after lumbar decompression. Further studies are needed in order to define clear cut-off values for a more efficient distinction and easer decision-making during the preoperative evaluation of patient scheduled for decompression or fusion surgery.