Degenerative disc disease (DDD) is a significant cause of chronic low back pain, often leading to disability and high healthcare costs. Current treatments, including physical therapy, pain management, and surgical interventions such as spinal fusion and total disc replacement, do not reverse degeneration. Bioactive therapies offer a potential alternative by targeting the underlying degenerative process. Cell-based therapies, including the use of mesenchymal stem cells and platelet-rich plasma, aim to restore disc structure and function by promoting extracellular matrix production and reducing inflammation. Early studies show potential benefits in pain relief and disc regeneration, but long-term efficacy remains unclear. Nucleus pulposus augmentation and replacement strategies, such as the use of hydrogel implants and in situ curing polymers, are aimed at restoring disc height and biomechanical function. While these strategies are promising, issues such as implant durability and migration require further study. Total disc replacement preserves motion and avoids adjacent-segment disease, but outcomes depend on patient selection and implant design. Despite encouraging results, bioactive therapies still require research to establish long-term safety and effectiveness. Advancements in biomaterials, patient selection criteria, and clinical trials will determine their role in the future management of DDD.

Background: Mechanomyography (MMG) is a neurodiagnostic technique with a documented ability to evaluate the compression of nerve roots. Its utility in degenerative spine surgery is unknown. Objective: To assess the utility of intraoperative MMG during cervical posterior foraminotomy, minimally invasive transforaminal interbody fusion (MIS-TLIF), and tubular lumbar far lateral discectomy. Methods: A prospective feasibility study was conducted during which MMG was applied during three procedures. Adhesive accelerometers were placed on two muscle groups per procedure. Stimulus threshold in mA was recorded before and after the decompression of the nerve root. Differences in stimulation thresholds were correlated with operative findings. Results: In total, 22 patients were included in this study; 5 patients underwent cervical foraminotomies, 3 underwent MIS-TLIFs, and 14 underwent tubular far lateral discectomies. For the foraminotomies, all cases showed a reduction in stimulation threshold (mean of 3.4 mA) after decompression. For MIS-TLIF cases, there was a limited reduction in the stimulation threshold after decompression (mean 1.7 mA). For far lateral discectomy, there was a mean reduction of 4.3 mA in the stimulation threshold following decompression. Conclusions: MMG is a method that may provide intraoperative feedback on the decompression of nerve roots. In the context of MIS-TLIF, MMG showed a limited decrease in stimulus threshold. This may be due to the identification of the nerve occurring after decompression is already underway. For cervical foraminotomies and far lateral discectomies, MMG showed promising results in determining adequate decompression of the nerve root.

Recurrent lumbar disc herniation (RLDH) is a common complication after discectomy, occurring in 2%–25% of patients and contributing to higher reoperation rates, reduced satisfaction, and substantial direct and indirect costs. This review evaluates the economic consequences of RLDH and the relative cost-effectiveness of available management strategies. A systematic search of OVID, MEDLINE, and the Cochrane Library was performed through August 2025. Peer-reviewed, English-language studies were included if they examined adults (≥18 years) with RLDH and reported economic data. Exclusion criteria were studies limited to primary, cervical, or thoracic herniations; animal or cadaveric models; and abstracts. Extracted variables included study design, sample size, follow-up duration, and cost components. Of 283 records identified, 220 were screened and 35 underwent full-text review. Six studies met inclusion criteria, with 2 added through citation searching. Reported costs varied considerably: repeat discectomy added $6,907 in one analysis, while fusion increased expenses by more than 350%. Across studies, repeat discectomy remained the most cost-efficient option, providing comparable outcomes with reduced perioperative expenditures. Conservative management had the lowest immediate direct costs (≈$2,300) but likely underestimates the overall burden due to unmeasured productivity losses. Annular closure devices demonstrated potential cost savings of $2,000–5,000 over 2–5 years. RLDH imposes a substantial economic burden. Heterogeneity in costing methods remains a major limitation which hinders evidence-based determinations. Greater transparency, methodological standardization, and incorporation of societal perspectives are essential to accurately assess the socioeconomic impact of RLDH.

Background/Objectives: Thoracic minimally invasive spine surgery (MISS) offers reduced tissue trauma and faster recovery compared with open approaches, but its adoption remains limited due to technical complexity and uncertainty regarding complication rates. This study aimed to synthesize the available evidence on overall and approach-specific complications of thoracic MISS using tubular, uniportal endoscopic, and biportal endoscopic techniques. Methods: Following PRISMA guidelines (PROSPERO CRD42024594316), PubMed, Medline, Embase, and Cochrane Library were searched from January 2013 to March 2024 for studies reporting complication rates after thoracic MISS in adults. Eligible studies included tubular, uniportal, or biportal approaches. Study quality was assessed using the Newcastle–Ottawa Scale. Complication data were extracted and summarized descriptively, with reported rates stratified by surgical approach. Results: Nine studies (234 patients) were included, all retrospective with moderate risk of bias. Across included studies, reported overall complication rates following thoracic MISS ranged from 0% to 42.9%. Stratified by surgical approach, reported complication rates ranged from 0% to 11.8% across six tubular studies, 9.7% to 20.0% across two uniportal endoscopic studies, and 42.9% in a single small biportal endoscopic study. Neural injuries and dural tears were the most frequently reported complications, with reported rates ranging from 0% to 14.3% and 0% to 3.6%, respectively. Symptomatic cerebrospinal fluid leaks and revision surgeries were less common, with reported rates ranging from 0% to 11.8% and 0% to 3.2%, respectively. Conclusions: Thoracic MISS demonstrates a low overall complication rate, particularly for tubular approaches. However, findings should be interpreted with caution given the small number of included studies, retrospective designs, and clinical heterogeneity. Larger comparative investigations are needed to better define safety profiles and support broader adoption of thoracic MISS techniques.

Background/Objectives: Adult degenerative scoliosis (ADS) is a spinal disease causing pain and reduced mobility, often occurring with degenerative lumbar spinal stenosis (DLSS). While fusion stabilizes the spine, it has drawbacks like loss of motion and adjacent segment degeneration. Minimally invasive techniques, such as tubular unilateral laminotomy for bilateral decompression (tULBD), provide a less invasive alternative, but their impact on ADS with DLSS is underexplored. This study examines the short-term effects of navigated tULBD on radiological and clinical outcomes in this patient population. Methods: This retrospective single-center study analyzed patients aged ≥18 years with DLSS and ADS (Cobb angle ≥ 10°), with or without grade I spondylolisthesis, who underwent navigated tULBD between June 2019 and October 2022. Radiological parameters were assessed pre- and post-operatively using AI-powered FXA™ Version 1.33, Raylytic Software GmbH, Leipzig, Germany, while clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for back and leg pain. Statistical analyses were conducted with R Studio. Results: This study included 20 patients (mean age 74.6 ± 7.6 years, body mass index [BMI] 26.08 ± 3.7 kg/m²), with a median follow-up of 2 months. Most underwent single-level decompression (45%), with a median of 2 surgical levels (IQR: 1–3). Radiological parameters showed no significant changes (p > 0.05). Clinically, the median NRS back improved from 5 (IQR: 3–9) preoperatively to 2 (IQR: 0–2) postoperatively (p = 0.009) and 1 (IQR: 0–4.5) at follow-up (p = 0.004). NRS leg scores dropped from 3.5 (IQR: 0–5) to 0 postoperatively and at follow-up (p = 0.02, p = 0.04). ODI improved from 37.8 (IQR: 29–42.5) preoperatively to 17.5 (IQR: 5–24) at follow-up (p = 0.04). There were no neurological complications. Conclusions: Navigated tULBD is a promising, minimally invasive option for mild ADS and DLSS. It provides significant pain and disability relief without adversely affecting stability and alignment. Long-term studies are needed to confirm durability and efficacy, particularly in severe cases.