While glucagon-like peptides 1 receptor agonists (GLP-1RAs) grow in popularity, their potential for presurgical weight optimization in spine surgery remains unclear. We examined the influence of semaglutide prescription on one- to three-level transforaminal lumbar interbody fusion (TLIF) outcomes. Retrospective analysis of obese, non-diabetic patients was conducted from 2018 to 2022. A 1:1 exact match paired semaglutide users with non-users based on age, gender, surgical levels, and comorbidities. The primary outcome were the rates of surgical and medical complications at 30 days following TLIF. A sub analysis assessed outcomes after stratifying by prescription duration (greater or less than nine months). Kaplan-Meier survival analyses evaluated the need for additional lumbar fusion. The alpha was set to 0.05, but with the Bonferroni correction the significance threshold was set to 0.0045. 471 semaglutide users were matched with 471 non-users with no baseline differences. Semaglutide users had higher rates of pneumonia (2.97 % vs 0.85 %, p < 0.05) compared to nonusers. When stratified by prescription duration, patients with longer semaglutide use had a higher incidence of urinary tract infection (4.03 % vs 1.27 %, p < 0.05) and acute kidney injury (3.18 % vs 0.85 %, p < 0.05). The need for additional lumbar fusion was associated with both semaglutide use (17.0 % vs. 6.4 %, p < 0.0001) and duration (28.3 % vs. 4.8 %, p < 0.0001). Semaglutide may adversely affect lumbar fusion outcomes and necessitate additional surgery, possibly secondary to its systemic effects on bone metabolism and weight loss patterns. Further research into optimal drug formulation, dosage, and weight loss protocols will be required before mainstream use.

Study Design: Systematic Review. Objective: Endoscopic cervical spine surgery (ECSS) has emerged as a minimally invasive alternative to traditional open surgery for certain cervical spine disorders. ECSS may offer potential advantages such as reduced tissue trauma, shorter hospital stays, and accelerated functional recovery. Technological advancements have further enhanced its feasibility. The purpose of this article is to review current ECSS approaches, systematically review ECSS for cervical stenosis, and explore future directions of ECSS. Methods: The PubMed, Embase, and Google Scholar databases were searched systematically until October 20, 2024, adhering to PRISMA guidelines. We searched keywords associated with cervical stenosis, including “endoscopic cervical surgery”, “endoscopic cervical discectomy”, “endoscopic cervical foraminotomy”, “cervical endoscopic unilateral laminotomy for bilateral decompression”, and “unilateral bilateral endoscopy”. We excluded duplicate publications, review articles, preprints, and studies without clinical outcomes or incomplete information. Clinical outcomes and complications were collected. Results: A total of 12 studies were included with 2 studies being reported twice for having two different ECSS approaches. Each study reported postoperative improvement in clinical outcomes compared to preoperative measurements. The most common complications included dural tears, transient hypesthesia, and CSF leakage. Conclusion: ECSS is an emerging alternative for treating select cases of symptomatic cervical stenosis and other cervical conditions. Complications differed depending on the approach. Advancements in endoscopic instruments, navigational technologies, and artificial intelligence hold promise for improving preoperative planning, surgical precision, and patient outcomes. The true value of ECSS will require carefully conducted prospective, controlled studies with rigorous assessment of outcomes and complications.

Endoscopic lumbar discectomy has gained popularity as a minimally invasive alternative to microdiscectomy, yet large-scale comparative data evaluating postoperative durability remain limited. This study assessed short-term complications and 2-year reoperation rates between endoscopic and microdiscectomy cohorts using a large multicenter database. A retrospective cohort analysis was performed using the TriNetX US Collaborative Network. Adult patients undergoing endoscopic discectomy or microdiscectomy for lumbar disc herniation were identified using Current Procedural Terminology codes. A 1:1 propensity score matching was performed for demographics and baseline comorbidities. Ninety-day medical and surgical complications, hospital readmission, and emergency department utilization were evaluated using risk ratios (RRs). Two-year repeat lumbar decompression, subsequent lumbar fusion, and postlaminectomy syndrome were analyzed using Cox proportional hazards models. At 90 days, composite medical complications were significantly lower following endoscopic discectomy compared with microdiscectomy (2.3% vs. 3.7%; RR 0.61, 95% confidence interval (CI) 0.41-0.93; P=0.020), as were composite surgical complications (0.9% vs. 2.5%; RR 0.37, 95% CI 0.20-0.68; P=0.001). Hospital readmission and emergency department visits were not significantly different (P>0.05). At two years, endoscopic discectomy was associated with a higher risk of repeat lumbar decompression (8.3% vs. 4.3%; hazard ratio 2.03, 95% CI 1.45-2.83; P<0.001) and postlaminectomy syndrome (4.5% vs. 3.1%; hazard ratio 1.58, 95% CI 1.08-2.30; P=0.018). Subsequent lumbar fusion rates were low and comparable between groups (3.5% vs. 3.3%; P=0.595). Endoscopic lumbar discectomy offers improved perioperative safety but reduced 2-year durability compared with microdiscectomy, highlighting the need to balance short-term advantages with long-term reoperation risk.

Type 2 diabetes mellitus (T2DM) is a well-established risk factor for adverse surgical outcomes, but the impact of prediabetes on spine surgery remains unexplored. This study evaluated the influence of prediabetes on postoperative complications in patients undergoing short-segment (≤3 levels) transforaminal lumbar interbody fusion (TLIF). We retrospectively reviewed patients undergoing 1-3 level TLIF in a national administrative database. Patients were categorized into 3 groups: no diabetes, prediabetes, and T2DM. Patients with type 1 diabetes were excluded. A 1:1:1 exact match was performed to balance demographics, comorbidities, and the number of spinal levels fused. Thirty-day postoperative medical and surgical complications were analyzed. A total of 17,796 patients (5,932 per group) were included. Patients with T2DM demonstrated a significantly higher incidence of urinary tract infection (OR, 1.49; 97.5% CI, 1.19–1.86), pneumonia (OR, 1.59; 97.5% CI, 1.10–2.31), acute kidney injury (OR, 2.32; 97.5% CI, 1.70–3.18), surgical site infection (OR, 1.34; 97.5% CI, 1.04–1.74), overall medical complications (OR, 1.50; 97.5% CI, 1.28–1.75), and surgical complications (OR, 1.29; 97.5% CI, 1.05–1.58). In contrast, patients with prediabetes did not demonstrate a statistically significant increase in postoperative complications. T2DM is associated with a higher risk of medical and surgical complications following short-segment TLIF. However, prediabetes does not appear to affect postoperative complication rates. These findings suggest enhanced perioperative management is warranted for patients with T2DM, while standard protocols may be sufficient for patients with prediabetes.

Osteoporosis increases the risk of postoperative complications and reoperation following spinal fusion due to reduced bone quality. Bone-strengthening medications are frequently employed to mitigate these risks. This study evaluates the impact of osteoporosis and osteoporosis medications on the incidence of additional spine surgeries and postoperative complications following lumbar fusion. We conducted a retrospective cohort study using a national database of patients who underwent transforaminal lumbar interbody fusion between 2010 and April 2023. Patients were exactly matched 1:1 for age, gender, and comorbidities. Osteoporosis medications included bisphosphonates (alendronate, ibandronate, and risedronate), parathyroid hormone analogs (teriparatide and abaloparatide), and monoclonal antibodies (denosumab and romosozumab). Logistic regression and Kaplan-Meier survival compared rates of additional spine surgeries and postoperative complications and assessed the effect of osteoporosis medications. After matching, 24,145 patients with and without osteoporosis were identified. Osteoporosis patients had a higher incidence of all-cause need for additional spine surgery (odds ratio [OR] = 1.40; 95% confidence interval [CI]: 1.28-1.53). Although medication effects did not reach statistical significance, teriparatide (OR = 1.06; 95% CI: 0.41-2.21), abaloparatide (OR = 3.04; 95% CI: 0.71-8.95), and denosumab (OR = 1.35; 95% CI: 0.33-3.70) demonstrated moderate change in risk for reoperation. Osteoporosis patients had higher rates of urinary tract infections (OR = 1.18; 95% CI: 1.08-1.29), pneumonia (OR = 1.25; 95% CI: 1.07-1.45), and deep vein thrombosis (OR = 1.40; 95% CI: 1.16-1.69). Osteoporosis is linked to higher reoperation and medical complications following lumbar fusion. Although osteoporosis medications did not significantly alter reoperation risk, their potential role in perioperative optimization requires further investigation.