Background: With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years. Few studies have focused on the complications associated with the treatment of LSS using percutaneous endoscopic lumbar discectomy (PELD). This study aimed to summarize the complications of PETD and identify the associated risk factors. Methods: Complications in a total of 738 consecutive LSS patients who underwent single-level PETD were retrospectively recorded and analyzed between January 2016 and July 2020. In addition, a matched case-control study was designed, and according to the date of operation, the control group was matched with patients without complications, with a matching ratio of 1:3. Demographic parameters included age, sex, BMI, smoking and drinking status, comorbidity, and surgical level. The radiological parameters included grade of surgical-level disc degeneration, number of degenerative lumbar discs, grade of lumbar spinal stenosis, degenerative lumbar scoliosis, lumbar lordosis, disc angle, and disc height index. Univariate analysis was performed using independent samples t-test and chi-squared test. Results: The incidence of different types of complications was 9.76% (72/738). The complications and occurrence rates were as follows: recurrence of LSS (rLSS), 2.30% (17/738); persistent lumbosacral or lower extremity pain, 3.79% (28/738); dural tear, 1.90% (14/738); incomplete decompression, 0.81% (6/738); surgical site infection, 0.41% (3/738); epidural hematoma, 0.27% (2/738); and intraoperative posterior neck pain, 0.27% (2/738). Univariate analysis demonstrated that age, the grade of surgical-level disc degeneration (P < 0.001) and the number of disc degeneration levels (P = 0.004) were significantly related to the complications. Conclusion: Complications in the treatment of LSS using PELD included rLSS, persistent pain of the lumbosacral or lower extremity, dural tear, incomplete decompression, surgical site infection, epidural hematoma, and intraoperative posterior neck pain. In addition, old age, severe grade of surgical-level disc degeneration and more disc degeneration levels significantly increased the incidence of complications.

Background: Transforaminal percutaneous endoscopic lumbar surgeries (PELS) for lumbar disc herniation and spinal stenosis are growing in popularity. However, there are some problems in the establishment of the working channel and foraminoplasty such as nerve and blood vessel injuries, more radiation exposure, and steeper learning curve. Rapid technological advancements have allowed robotic technology to assist surgeons in improving the accuracy and safety of surgeries. Therefore, the purpose of this study is to develop a robot-assisted system for transforaminal PELS, which can provide navigation and foraminoplasty. Methods: The robot-assisted system consists of three systems: preoperative planning system, navigation system, and foraminoplasty system. In the preoperative planning system, 3D visualization of the surgical segment and surrounding tissues are realized using the multimodal image fusion technique of computed tomography and magnetic resonance imaging, and the working channel planning is carried out to reduce the risk for injury to vital blood vessels and nerves. In the navigation system, the robot can obtain visual perception ability from a visual receptor and automatically adjust the robotic platform and robot arm to the appropriate positions according to the patient’s position and preoperative plan. In addition, the robot can automatically register the surgical levels through intraoperative fluoroscopy. After that, the robot will provide navigation using the 6 degree-of-freedom (DOF) robot arm according to the preoperative planning system and guide the surgeon to complete the establishment of the working channel. In the foraminoplasty system, according to the foraminoplasty planning in the preoperative planning system, the robot performs foraminoplasty automatically using the high speed burr at the end of the robot arm. The system can provide real-time feedback on the working status of the bur through multi-mode sensors such as multidimensional force, position, and acceleration. Finally, a prototype of the system is constructed and performance tests are conducted. Discussion: Our study will develop a robot-assisted system to perform transforaminal PELS, and this robot-assisted system can also be used for other percutaneous endoscopic spinal surgeries such as interlaminar PELS and percutaneous endoscopic cervical and thoracic surgeries through further research. The development of this robot-assisted system can be of great significance. First, the robot can improve the accuracy and efficiency of endoscopic spinal surgeries. In addition, it can avoid multiple intraoperative fluoroscopies, minimize exposure to both patients and the surgical staff, shorten the operative time, and improve the learning curve of beginners, which is beneficial to the popularization of percutaneous endoscopic spinal surgeries.

Background: Smoking has a major influence on the development and worsening of low back pain (LBP). However, the effect of smoking on the burden of LBP has not been thoroughly examined at the global, regional, and national levels. This study aims to analyze the trends in smoking-related LBP from 1990 to 2021. It uses data from the 2021 Global Burden of Disease (GBD), providing scientific evidence for policy-making.Methods: This observational study, based on population data, used epidemiological information on LBP due to smoking from the GBD 2021 study. The study categorized the disability-adjusted life years (DALYs) from smoking-related LBP by year, age, country, and socio-demographic index (SDI). Trends in smoking-related LBP from 1990 to 2021 were assessed using the estimated annual percentage change (EAPC). The GBD frontier analysis was used to monitor and assess progress toward global health goals. Furthermore, the Bayesian age-period-cohort (BAPC) model was applied to predict trends in smoking-related LBP from 2022 to 2036.Results: In 2021, smoking-related LBP was responsible for 8823.84 × 10³ DALYs, a 30.05% increase since 1990. From 1990 to 2021, the age-standardized DALYs rate (ASDR) for smoking-related LBP declined with an EAPC of −1.26%. ASDR dropped in all five SDI regions. Montenegro had the highest DALYs due to smoking-related LBP, while Madagascar saw the greatest decline from 1990 to 2021. Regionally, Central Europe and high-income North America had higher-than-expected LBP burdens, while Western Sub-Saharan Africa, Andean Latin America, Southeast Asia, and Central Latin America had lower-than-expected burdens. Frontier analysis identified countries and regions that need urgent action to lessen smoking-related LBP burden. Finally, it is forecasted that the smoking-related LBP burden will decrease from 2022 to 2036.Conclusion: From 1990 to 2021, the global ASDR of LBP attributable to smoking decreased, and this downward trend is expected to persist. However, regions with high smoking rates and low socio-economic status still face a significant burden from smoking-related LBP. The data from these regions highlight the need for targeted health policies and interventions to further reduce the burden of smoking-related LBP.