Objective: While minimally invasive-transforaminal lumbar interbody fusion (MIS-TLIF) has shown superiority in key clinical metrics over the open approach, evidence regarding patient-reported outcomes remains limited. This study compared postoperative recovery trajectories and symptomatic improvement phases between MIS and open TLIF.Methods: This retrospective review included patients who underwent single-level MIS or open TLIF. Oswestry Disability Index (ODI) and Numerical Rating Scale (NRS) for back and leg pain were collected preoperatively and postoperatively. Segmented regression analysis with mixed-effects modeling, allowing for identification of distinct recovery phases, compared symptomatic trends between approaches.Results: Of 324 patients (268 MIS, 56 open), baseline demographics were similar except for greater preoperative leg pain in the MIS group (NRS: 6.0 vs. 5.0, p = 0.027). A segmented regression model identified 4 ODI recovery phases: postoperative disability phase (PDP, day 0 to 13), early improvement phase (day 13 to 28), late improvement phase (day 28 to 110), and plateau phase (later than day 110). The MIS group exhibited significantly lower disability exacerbation during PDP (β = 0.93 vs. 1.42 points per day, p = 0.008). Additionally, the plateau of NRS back occurred significantly earlier in the MIS group than in the open group (MIS, 26.7 ± 2.6 days vs. open, 51.7 ± 6.6 days, p < 0.001).Conclusion: MIS-TLIF resulted in lower postoperative disability during the first 2 weeks compared to the open approach. Furthermore, low back pain achieved an earlier plateau in back pain by about 4 weeks in the MIS approach.

Study Design: Retrospective cohort study. Objectives: Severe neck pain has traditionally been considered a relative contraindication for cervical disc replacement (CDR) due to risk of persistent neck pain from the remaining mobile segment. However, recent studies suggest potential for neck pain improvement with CDR. This study aimed to compare postoperative improvements in neck pain and disability between patients undergoing anterior cervical discectomy and fusion (ACDF) and CDR. Methods: Predominant neck pain was defined as neck pain equal to or greater than arm pain preoperatively (visual analog scale [VAS]) and neck disability index (NDI) > 20. Patients with predominant neck pain who underwent 1- or 2-level ACDF or CDR for radiculopathy between 2017 and 2023 were included. Patient-reported outcomes (NDI, VAS) were assessed up to 1 year postoperatively. Inverse probability of treatment weighting (IPTW) was used to control for confounders. Linear mixed-effect models were applied to compare postoperative outcomes. Results: A total of 179 patients (105 ACDF, 74 CDR) were included. Both groups showed significant improvement in NDI and VAS neck scores from baseline to 1 year (NDI: β = −1.81, P < .001; VAS neck: β = −.26, P < .001). After IPTW, no significant differences were found between ACDF and CDR across all PROMs up to 1 year (NDI: β = −0.44, P = .09; VAS neck: β = −.07, P = .10). Conclusion: CDR was associated with postoperative improvements in neck pain and disability comparable to those observed with ACDF in patients with predominant neck pain and radiculopathy. These findings suggest that CDR may be a reasonable treatment option for selected patients.

Study Design: Retrospective cohort study. Objective: In patients with multilevel degenerative lumbar pathology, the decision to extend fusion across all decompressed levels remains a subject of debate. While fusion provides stability in cases of instability or deformity, its necessity for adjacent levels without specific fusion indications is unclear. This study evaluates whether decompression alone at levels without clear fusion indications can achieve similar outcomes compared to spanning the entire decompression with fusion. Methods: The present study is a retrospective cohort study. Patients who underwent one-level decompression and fusion with 2 level decompression (SLF) were propensity score matched with patients who underwent two-level decompression and fusion (DLF) for degenerative conditions of the lumbar spine. Patient-reported outcome measures (PROMs), complication rates, revision surgeries, and recovery kinetics were compared between the cohorts. Results: After propensity score matching a total of 43 SLF patients were compared with 43 DLF patients. Early follow-up (<6 months) showed significantly higher SF-12 PCS scores in the SLF group ( P = .042) and greater achievement of VAS-leg MCID (88.9% vs 59.4%, P = .012). Long-term outcomes (≥6 months) demonstrated no significant differences in ODI, VAS-back, VAS-leg, or SF-12 PCS scores between groups. There were no differences in intraoperative or perioperative complications. The postoperative complication rate was significantly higher in the DLF group (25.6% vs 7%, P = .019) including 4 DLF patients that underwent revision surgery while no SLF patients required revision during their follow up time. Conclusion: SLF resulted in similar long-term outcomes compared to DLF with fewer revisions and adjacent segment symptoms. These findings suggest that “saving” a fusion level in cases without a specific fusion indication at the adjacent level may be warranted to optimize longevity of the construct. Further research is necessary to refine patient selection for fusion levels in degenerative lumbar disease.

Study Design: Retrospective cohort study. Objective: To quantify and compare the carbon footprint (CF) of open and MIS microdiscectomy. Methods: The study included 161 patients undergoing primary 1 level open or minimally invasive surgery (MIS) for lumbar disc herniation between 2018 and 2022. Life cycle assessment (LCA) modeling was used to calculate the CF produced during the distribution, use and waste phases of each item used during surgery. Independent samples t-tests and Chi square or Fischer’s exact tests were used to compare the CF of open and MIS procedures. Results: There were 161 cases (100 MIS, 61 Open). MIS had a significantly higher overall CF (114.67 ± 60.06 kg-CO ₂ e) vs open surgery (95.15 ± 45.45 kg-CO ₂ e, P = 0.021). Key contributors included disposable surgical supplies, energy-intensive OR equipment, and anesthetic gases. Only the waste phase had a significant difference in CF, with MIS producing more waste (MIS: 31.50 ± 25.67; Open: 18.18 ± 10.25; kg-CO ₂ e; P < 0.001) and consuming more energy, especially for heating, ventilation, and air conditioning systems and fluoroscopy. Conclusions: MIS microdiscectomy results in higher CF and environmental costs compared to open procedures, highlighting the need for sustainable practices, especially waste reduction, use of reusable materials and optimized energy use in ORs. A multifaceted approach is crucial to mitigate the environmental impact of spine surgeries and should be applied to both MIS and open techniques.

Study Design: Propensity-matched retrospective cohort. Objective: The objective of this study was to determine whether lumbar disc replacement (LDR) can provide radiographic indirect decompression as effectively as anterior lumbar interbody fusion (ALIF). Summary of Background Data: Isolated lumbar foraminal stenosis can often be treated with indirect decompression via ALIF. More recently, LDR has emerged as a motion-preserving treatment option for lumbar disease; however, its ability to provide indirect decompression has not been studied. Methods: All patients undergoing 1-level ALIF and LDR over a 7-year period were queried. A propensity-matched cohort was then identified utilizing patient-specific factors. This yielded 23 patients undergoing LDR and 44 undergoing ALIF. The primary outcome of this study was the change in radiographic foraminal height (FH) and segmental lordosis (SL) from pre- to postoperatively. All measurements were performed by 2 independent reviewers, and intraclass correlation coefficients (ICC) were calculated. Patient-reported outcome measures, including visual analog scale (VAS) back and leg scores, were collected for comparison at early and late postoperative timepoints. Intercohort comparisons were performed via Mann-Whitney U tests. P -values <0.05 were deemed significant. Results: Patients undergoing LDR had shorter operative time (98.9 vs. 136.7 min, P 0.75) across both reviewers. Preoperatively, ALIF patients had smaller radiographic FH (13.8 vs. 15.6 mm, P =0.01), but no other differences were seen. Both ALIF and LDR provided significant increases in FH (ALIF: 3.5 mm and LDR: 3.7 mm) and SL (ALIF: 8.0 degrees and LDR: 8.0 degrees). There were no differences in the mean ΔFH ( P =0.56) or ΔSL ( P =0.85) between cohorts. Both groups showed significant improvement in postoperative VAS leg scores at early and late time points. Conclusions: LDR can provide indirect decompression and segmental lordosis restoration as effectively as ALIF.

Study Design: Prospective Cohort Study. Objectives: The aim of this study was to assess how sound pressure levels (SPL) change throughout spine procedures and which phases may place surgeons at higher risk of noise induced hearing loss. Methods: SPL was recorded by a microphone attached to the surgeon’s collar beneath the sterile gown for 6 of each: MI-TLIF, microdiscectomy, decompression. dBA was recorded every second. An overall average (ADL) and maximum (MDL) for each phase of the procedure were calculated and compared across procedure type. The ADL and MDL of two electric burrs and one pneumatic burr were collected and compared. Results: ADLs were significantly different for all three procedure types. There was no difference in the mean MDL (mMDL) between phases within each procedure type. The irrigation/closure phase had the lowest ADL and mMDL for all three procedure types. In MI-TLIF, facetectomy had a significantly greater ADL than all other phases; the highest mMDL was during the exposure phase. In microdiscectomy, laminotomy had the greatest mMDL, and ADL and was significantly higher than all other phases except exposure. In decompression, the laminectomy phase had the highest ADL and mMDL. The brand A-e burr had a significantly lower ADL and the lowest MDL. Conclusion: During common spine surgery procedures, phases involving powered instruments such as burrs, electrocautery machines or suction had higher ADL and mMDL. Sound levels in the OR may peak above 85 dBA for short periods despite the average being below dangerous levels. Therefore, while surgeons are not usually at an elevated risk of NIHL, periods of elevated dBA warrant attention for elevated risk.