Study Design: Systematic review and meta-analysis. Objective: Although uniportal and biportal endoscopic decompression have emerged as promising minimally invasive options for the management of lumbar spinal stenosis (LSS), their relative advantages remain debated. This systematic review and meta-analysis aims to evaluate the efficacy and safety of both approaches in LSS treatment. Methods: In adherence to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines, we systematically searched PubMed, Embase, Cochrane Library, and Web of science for randomized controlled trials and observational studies comparing the outcomes of uniportal and biportal endoscopic techniques for LSS treatment. Meta-analysis was performed using a random-effects model. Results: A total of 11 studies were included, comprising 1199 patients. Biportal endoscopy was associated with a significantly lower operation time ( P < .01), Oswestry Disability Index (ODI) at 12 months ( P < .01), and higher postoperative dural sac area ( P < .01) and dural sac area expansion ( P = .02). There were no significant differences between groups in intraoperative blood loss, hospitalization time, back pain, leg pain, or ODI at other timepoints, ipsilateral facetectomy angle, and overall complications, including dural tear, infection, postoperative hematoma, lower limb numbness, and nerve root injury. Conclusion: In this meta-analysis, biportal endoscopic decompression demonstrated significantly lower operation time, ODI at 12 months, and higher postoperative dural sac area and dural sac area expansion, although both techniques showed similar safety profiles and complication rates. Further high-quality studies are needed to better assess the advantages of both techniques for LSS treatment.

This meta-analysis compares clinical outcomes of minimally invasive decompression (MID) versus open laminectomy surgery (OLS) for multilevel lumbar spinal stenosis. A systematic search was conducted in PubMed, Embase, and the Cochrane Central databases to identify studies comparing MID to OLS in patients with multilevel lumbar spinal stenosis. Primary outcomes were length of hospital stay (LHS), operative time (OT), complication rate (CR), intraoperative blood loss (IBL), reoperation due to recurrence (RDR), and low back pain 1 year after surgery (LBP). Of 3695 articles screened, 4 studies and 618 patients were included, of whom 291 (47%) were treated with MID and 327 (53%) were treated with OLS. There were no significant differences between the groups in OT (Mean Difference (MD)) = 7.68; 95% CI [-20.53, 35.88]; p = 0.59, I² = 96%), CR (Odds Ratio (OR)) = 0.72; 95% CI [0.04, 14.73]; p = 0.83; I² = 80%), RDR, LBP and LHS. However, IBL was reduced in MID compared to OLS (MD = -55.20; 95% CI [-105.73, -4.67]; p = 0.03; I² = 95%), decreasing the need for transfusions and complications. Only the RDR presented a low heterogeneity, while the rest of the outcomes conferred a high heterogeneity. Our study showed important statistical differences between the groups analyzed, likely attributable to inconsistencies in standardized approaches and decompression techniques across studies. Notably, MID demonstrated an advantage over OLS regarding intraoperative blood management.

Study design.: Systematic review and network meta-analysis (NMA). Objective.: This NMA evaluates the clinical efficacy and safety of various doses of Tranexamic acid (TXA) for adolescent idiopathic scoliosis (AIS) instrumentation. Summary of background data.: TXA is an antifibrinolytic agent widely used in spine surgery. However, the optimal TXA dose remains unclear, especially for younger patients. Methods.: We performed a systematic search across PubMed, Scopus, Web of Science, and the Cochrane Library up to March 2025. We included studies that compared different TXA doses or patients without TXA in AIS surgery. We evaluated five TXA doses: TXA 0 (control without TXA); TXA 1 (10 mg/kg bolus + 1 mg/kg/hr infusion); TXA 2 (15–20 mg/kg bolus + 1–10 mg/kg/hr infusion); TXA 3 (30–50 mg/kg bolus of TXA + 5–10 mg/kg/hr infusion); and TXA 4 (100 mg/kg bolus of TXA + 10 mg/kg/hr infusion). This meta-analysis compared bleeding volume, surgical time, transfusion rates, length of hospital stay, and complications. Random-effects frequentist NMA was employed. Treatments were ranked with P-scores. Results.: A total of 1,523 patients, mainly aged 13 to 18 years from 16 studies were included in this analysis (eight retrospective studies). TXA 4 outperformed other doses in reducing intraoperative bleeding, operation time, and cell saver volume. TXA 3 also showed significant benefits but was less effective than TXA 4. There was no difference in complication rates, although these data were not uniformly reported in the studies. No evidence of publication bias was found. Quality concerns were observed. Conclusion.: The tranexamic acid dose of 100 mg/kg bolus + 10 mg/kg/hr infusion (TXA 4) was the most effective in bleeding control during AIS instrumentation in teenagers. While these results are promising, more randomized trials are needed to directly compare various TXA doses.

Introduction: Spinal surgery involves different techniques and treatment strategies. Intraoperative navigation by 3D tomography (IoCT) is used to facilitate the insertion of pedicular screws. Better accuracy has been demonstrated by several studies when using navigation compared to fluoroscopy. However, no study as far as we know, investigated the operative outcomes of navigation during single-level transforaminal interbody fusion (SL-TLIF). Objectives: Our goal was to evaluate the impact of Computer Assisted Navigation during SL-TLIF in terms of operative time, hospitalization, blood loss and number of surgical revisions up to 6 months postoperatively when compared to fluoroscopic guidance. Methods: This is a retrospective, single center, case-control study. Patients submitted to SL-TLIF between 2016 and 2020 with fluoroscopy (Fluoro) or loCT navigation (Nav) were evaluated. We excluded traumatic, oncological, infectious, minimally invasive cases, anterior and lateral cases and all those performed on more than one level. Demographic, clinical, and surgical data were collected. Results: One hundred and seventy-six patients were included, 54 (30.68%) in the Nav group and 122 (69.32%) in the Fluoro group. A statistically significant difference in operative time (OT) was reported (Nav 185.93 Vs. Fluoro 163.24, p=0.003), with an average OT of 170 min. The revision rate was also significantly different, with 8 revisions of surgery in the Fluoro group and none in the Nav group (6.6% of GF patients, p=0.050). No statistically significant difference was found for blood loss (Nav 270.83 ml vs. Fluoro 277.28 ml p=0.827) and hospitalization time (days) (4.31 for Nav vs. 4.65 for Fluoro p=0.302). Discussion: Despite the increase in operative time in the Nav group, navigation does not involve increased blood loss or longer hospital stay. We observed a lower rate of reoperation in the Nav group during the first 6 months postoperatively. Conclusions: The use of IoCT navigation is safe, effective, and provides advantages even when used to perform single level TLIF.