Transforaminal lumbar interbody fusion (TLIF) is a commonly employed surgical technique for managing lumbar degenerative disease and spinal instability. While it offers advantages over posterior lumbar interbody fusion (PLIF), traditional TLIF often involves prolonged recovery and morbidity due to muscle retraction. To improve outcomes, several alternative techniques have emerged, including minimally invasive TLIF (MIS-TLIF), trans-Kambin percutaneous TLIF (PE-TLIF), and transfacet TLIF (TF-TLIF). Each approach presents distinct anatomical and technical advantages, yet no standardized framework exists to guide their selection based on individual patient anatomy. In this study, we review the evolution of TLIF techniques and propose a novel algorithm that integrates patient-specific imaging, anatomical variability, and segmentation data to guide surgical decision-making. By analyzing the surgical corridors, indications, and limitations of each approach, and presenting representative clinical cases, we demonstrate how this algorithm can be applied in practice. For instance, TF-TLIF may be optimal in patients requiring direct decompression without major deformity, while PE-TLIF may be appropriate for those with Kambin’s triangles measuring ≥ 9 mm, allowing for indirect decompression. This tailored framework aims to optimize outcomes and reduce complications. Further prospective validation and incorporation of AI-driven segmentation tools are needed to support broader clinical implementation.

Low back pain is the world's most prevalent disability and lumbar disc degeneration is implicated as a pain driver. The discs are large avascular tissues and consequently fluid transport from adjacent vertebrae is required to perfuse the disc tissues with the necessary nutrients to maintain disc health. Deficiencies in disc transport may be predictive of spine disease and low back pain. Positron emission tomography (PET) using ¹⁸Fluorine - Fluorodeoxyglucose (FDG) is one method to measure metabolism of glucose, a key nutrient, and there is evidence of altered FDG uptake in the lumbar vertebrae with age, with degenerative disc/facet joint disease, and with disc/vertebrae infection. Prior studies demonstrate that transport depends on age and spinal level, decreasing from cranial to caudal, and we hypothesize that the transport of glucose also depends on age and spinal level. Our primary objective was to determine how FDG uptake in the lumbar discs and vertebrae is affected by age and spinal level. Our secondary objective was to validate FDG PET as a diagnostic imaging tool for spine disease. We identified patients in the Duke electronic health record (EHR) aged 18-70 years who received FDG PET CT imaging for any medical indication over a 10-year period, excluding patients with history of spine surgery or congenital disease, systemic rheumatic disease, or primary or metastatic malignancies of the spine. We further excluded individuals with severe comorbidities and poor-quality scans, leaving N=102 for analysis. Using custom 3D segmentation tools, we measured FDG uptake in vertebral bodies and discs across the lumbar spine, and subsequently evaluated relationships between FDG uptake, spinal level, age, and low back pain. Mean FDG uptake was greater in the vertebral bodies than the discs (mean/std. dev.: vertebral body SUV, 1.74±0.48; disc SUV, 1.02±0.33). Vertebral body FDG uptake was marginally associated with spinal level and was not associated with age. Disc FDG uptake was significantly affected by spinal level, where peak FDG uptake occurred at the T12-L1 and L5-S1 discs and was minimum at the L3-L4 and L5-S1 discs. Furthermore, lower lumbar discs demonstrated increased FDG uptake with age, and in a preliminary analysis of low back pain severity, disc and vertebral body FDG uptake were associated with severe pain at older ages. BMI was associated with vertebral body and disc FDG uptake as well. Lumbar disc FDG uptake is associated with age, spinal level, and higher BMI, where discs are more metabolically active at lower lumbar levels and with age. We propose the disc FDG uptake is a biomarker for abnormal metabolism and warrants further investigation as a biomarker of pain.

Objective: This scoping review evaluated the impact of social determinants of health (SDOH) on health care delivery and access for US children with cerebral palsy (CP). Method: A comprehensive literature search was conducted using Medline, Embase, CINAHL Complete, and Scopus. Studies lacking extractable data or published before 2010 or outside the United States were excluded. Two independent investigators screened abstracts and a third resolved disagreements. Selected manuscripts underwent full-text review and data extraction for thematic and comparative analysis. Descriptive statistics were calculated in Excel. Results: In total, 6482 articles were identified and 146 underwent full-text review. Ultimately, 9 studies were included. The 3 main themes discussed were race (n = 6), economic standing (n = 5), and insurance status (n = 3). Three articles examined multiple themes. Black and multiracial individuals had significantly higher postoperative complication rates and unmet care coordination needs, and lower rates of receiving special services (e.g., physical therapy). Higher economic status was associated with greater health care expenses and service access. Public insurance was associated with insufficient care coordination, decreased special service utilization, and increased rates of readmission and inpatient complications. Conclusion: Included articles demonstrate that race, insurance status, and economic standing are significantly associated with unequal health care access and outcomes for US children with CP. Future efforts should prioritize standardization of reported metrics for SDOH and investigation into systemic inequalities in health care access.