The spine is a complex structure critical for stability, force transmission, and neural protection, with spinal fractures and spondylolisthesis posing significant challenges to its integrity and function. Spinal fractures arise from trauma, degenerative conditions, or osteoporosis, often affecting transitional zones like the thoracolumbar junction. Spondylolisthesis results from structural defects or degenerative changes, leading to vertebral displacement and potential neurological symptoms. Diagnostic and classification systems, such as AO Spine and TLICS, aid in evaluating instability and guiding treatment strategies. Advances in surgical techniques, including minimally invasive approaches, pedicle screws, interbody cages, and robotic-assisted systems, have improved precision and recovery while reducing morbidity. Vertebral augmentation techniques like vertebroplasty and kyphoplasty offer minimally invasive options for osteoporotic fractures. Despite these innovations, postoperative outcomes vary, with challenges such as persistent pain and hardware complications necessitating tailored interventions. Future directions emphasize predictive analytics and enhanced recovery strategies to optimize surgical outcomes and patient quality of life.

Background: Enhanced recovery pathways and modern fixation systems have shortened admission after lumbar spine surgery, yet the interplay between implant choice, comorbidity, and early morbidity remains incompletely defined. Methods: We undertook a retrospective, single-center cohort study of lumbar procedures performed at SANADOR Clinical Hospital (Bucharest, Romania) between 1 January 2023 and 31 May 2024. Eighty-six adult patients (64 women, 22 men; mean age 64.9 ± 10.8 years) met the inclusion criteria. Outcomes included length of stay (LOS), early postoperative neurological change (Frankel/American Spinal Injury Association (ASIA) Impairment Scale), and unplanned reoperation within 90 days. Analyses were performed in Python 3.11 (pandas, SciPy, statsmodels) and verified in IBM SPSS 28.0; α = 0.05. Results: Spondylolisthesis was the predominant diagnosis (60.5%), followed by lumbar stenosis (17.4%). Instrumentation was used in 75 cases (87.2%). Median LOS was 3 days (mean 3.8 ± 2.1), and most patients were discharged by postoperative day 4. LOS did not differ by interbody cage status (Mann–Whitney p = 0.459; median 3 vs. 3 days). Early postoperative neurological change occurred in 34.9% but improved or resolved in all cases by discharge; no permanent motor deficits were observed. Unplanned reoperation within 90 days occurred in 17.6%. In multivariable logistic regression for prolonged hospitalization (LOS > 4 days), early postoperative neurological change was associated with increased odds of prolonged LOS (OR 4.45, 95% CI 1.29–15.43; p = 0.018), whereas age showed only a borderline association (OR 1.06 per year, 95% CI 1.00–1.14; p = 0.065). Conclusions: In this single-center retrospective cohort, postoperative hospitalization was generally short. Prolonged LOS was more closely associated with early postoperative neurological change than with baseline comorbidity or interbody cage use. These findings should be interpreted as short-term, context-specific observations from a complex, predominantly instrumented referral cohort.