Background/Objectives: Hip fractures in elderly patients are associated with high morbidity and mortality, requiring early risk stratification to optimize management. Systemic inflammatory markers such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have emerged as potential prognostic tools. This study aimed to evaluate the predictive value of the NLR and PLR measured at admission for adverse outcomes following hip fracture surgery in elderly patients. Methods: This retrospective, single-center cohort study included patients aged 65 years or older admitted for hip fractures between January 2019 and December 2023. Baseline demographic, clinical, surgical, and laboratory data were collected. Primary outcomes were 30-day, 90-day, and 1-year mortality; secondary outcomes included postoperative ICU admission and prolonged hospitalization (>15 days). Univariable and multivariable Cox regression analyses were performed. Receiver operating characteristic (ROC) curve analysis determined optimal cut-offs for the NLR and PLR. Results: Among 395 included patients (mean age 84 years, 56.4% female), the 30-day, 90-day, and 1-year mortality rates were 4.8%, 10.5%, and 13.9%, respectively. ROC analysis identified cut-offs of 7.2 for the NLR (AUC 0.78, sensitivity 69.7%, specificity 85.4%) and 189.4 for the PLR (AUC 0.73, sensitivity 65.1%, specificity 76.1%). Elevated NLR and PLR were independently associated with increased risk of mortality, ICU admission, and prolonged hospitalization. Conclusions: Elevated NLR and PLR at admission are independent, strong predictors of adverse outcomes in elderly patients with hip fractures. These inexpensive, readily available biomarkers could enhance early risk stratification and inform perioperative management strategies.

Introduction: Chronic low-back pain (CLBP) is a leading cause of disability, often requiring opioid therapy when conservative treatments fail. Transdermal buprenorphine and oral oxycodone/naloxone are commonly used, but their comparative effectiveness and safety remain underexplored. Materials and Methods: In this retrospective cohort study, 173 patients with CLBP treated at our center between June 2022 and May 2024 were analyzed. Group A (n = 88) received transdermal buprenorphine (5–15 μg/h), while Group B (n = 85) was treated with oral oxycodone/naloxone (10/5–20/10 mg/day). Treatment lasted four weeks, with dose titration after one week if pain was uncontrolled. Pain intensity (VAS), functional status (ODI), rescue medication use, and adverse effects were assessed at baseline and during follow-up. Results: Both groups showed significant reductions in VAS and ODI scores. Buprenorphine led to a greater functional improvement (ODI reduction p = 0.04) and a trend toward greater pain reduction (VAS p = 0.08). Rescue drug use was significantly lower in Group A (53.4%) compared to Group B (78.8%, p = 0.003). Adverse events were more frequent in the oxycodone group, particularly nausea and constipation. Conclusions: Transdermal buprenorphine provided comparable or superior analgesia with better tolerability and reduced reliance on rescue medication. It represents a safer, effective alternative for CLBP management in routine clinical practice.

Introduction: Hip fractures in elderly patients are associated with high morbidity and mortality, requiring early risk stratification to optimize management. Systemic inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have emerged as potential prognostic tools. This study aimed to evaluate the predictive value of NLR and PLR measured at admission for adverse outcomes following hip fracture surgery in elderly patients. Materials and Methods: This retrospective, single-center cohort study included patients aged 65 years or older admitted for hip fractures between January 2019 and December 2023. Baseline demographic, clinical, surgical, and laboratory data were collected. Primary outcomes were 30-day, 90-day, and 1-year mortality; secondary outcomes included postoperative ICU admission and prolonged hospitalization (>15 days). Univariable and multivariable Cox regression analyses were performed. Receiver operating characteristic (ROC) curve analysis determined optimal cut-offs for NLR and PLR. Results: Among 395 included patients (mean age 84 years, 56.4% female), the 30-day, 90-day, and 1-year mortality rates were 4.8%, 10.5%, and 13.9%, respectively. ROC analysis identified cut-offs of 7.2 for NLR (AUC 0.78, sensitivity 69.7%, specificity 85.4%) and 189.4 for PLR (AUC 0.73, sensitivity 65.1%, specificity 76.1%). Elevated NLR and PLR were independently associated with increased risks of mortality, ICU admission, and prolonged hospitalization. Conclusions: Elevated NLR and PLR at admission are independent, strong predictors of adverse outcomes in elderly patients with hip fractures. These inexpensive, readily available biomarkers could enhance early risk stratification and inform perioperative management strategies.

Introduction: Degenerative lumbar kyphosis (DLK) is a common cause of sagittal imbalance, pain, and functional disability. While three-column osteotomies provide powerful correction, they are associated with substantial morbidity. We evaluated the radiographic and clinical outcomes of a novel posterior-based correction strategy combining Posterior Interpedicular Osteotomy (PIO), bilateral discectomy, and hyperlordotic transforaminal lumbar interbody fusion (TLIF) in patients with DLK. Materials and Methods: A retrospective single-center case series was conducted including 215 consecutive patients with symptomatic DLK and pelvic incidence–lumbar lordosis (PI–LL) mismatch >10° treated between 2019 and 2023. All patients underwent PIO combined with bilateral discectomy and insertion of a 20° hyperlordotic TLIF cage. Radiographic parameters, including lumbar lordosis (LL), pelvic tilt (PT), and sacral slope (SS), were assessed preoperatively and up to 24 months postoperatively. Clinical outcomes were evaluated using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36). Complications were systematically recorded. Results: Mean lumbar lordosis improved from 15.7° ± 8.3° preoperatively to 45.4° ± 11.6° at 24 months, corresponding to a mean correction of 29.7° ± 10.1° and 12.4° ± 2.9° per treated level (p < 0.001). Significant improvements were observed in PT, SS, VAS, ODI, and SF-36 scores (all p < 0.001), with maintenance of correction throughout follow-up. Mean operative time was 218.4 ± 47.3 min and mean blood loss was 483.2 ± 195.7 mL. The overall complication rate was 16.3%, with incidental durotomy being the most common event (14.9%). No cases of cage migration, deep infection, neurological deterioration, or radiographic pseudarthrosis were identified among patients who underwent CT evaluation. Conclusions: PIO combined with bilateral discectomy and hyperlordotic TLIF achieved substantial and durable sagittal correction with significant clinical improvement and an acceptable safety profile. By combining extensive posterior release with preservation of the anterior tension band, this technique may represent an effective intermediate alternative between conventional posterior column osteotomies and more invasive three-column deformity correction procedures.

Background: Short-segment posterior fixation with intermediate pedicle screws is widely used for thoracolumbar junction (TLJ) burst fractures. However, the optimal penetration depth of intermediate screws remains controversial. The aim of this study was to evaluate whether intermediate screw penetration depth influences radiographic alignment and functional outcomes at 12 months following short-segment posterior fixation of AO Spine A3–A4 thoracolumbar burst fractures. Methods: This retrospective cohort study included 105 patients with AO Spine A3–A4 TLJ burst fractures treated between 1 January 2019 and 31 December 2022. All patients underwent short-segment posterior stabilization with intermediate screws at the fracture level. Penetration depth was categorized as either <50% (Group A) or ≥50% (Group B) of vertebral body depth. Radiographic parameters (kyphotic deformity, segmental kyphosis, sagittal index, anterior vertebral body height) and clinical outcomes (Visual Analog Scale and Oswestry Disability Index) were evaluated preoperatively and at 12 months. Results: Both groups demonstrated significant postoperative improvement in radiographic alignment and clinical outcomes. No statistically significant differences were detected between groups in kyphotic correction, loss of correction, pain reduction, disability scores, operative time, length of stay, or complication rates at 12 months. Conclusions: Within the limitations of this retrospective study, intermediate screw penetration depth did not significantly influence radiographic or clinical outcomes at 12 months. Screw length selection may therefore depend on anatomical considerations and surgeon preference rather than expected differences in clinical performance.

Background: Incidental durotomy is a recognized complication of spinal surgery and can cause persistent cerebrospinal fluid (CSF) leakage, wound complications, and reoperation. We describe the 4D repair technique and report postoperative outcomes from a single-center clinical series. Methods: This retrospective descriptive study included 112 patients treated between 2005 and January 2025. The 4D technique combines double-layer continuous dural suturing, fibrin sealant, an autologous dermal-fat graft, and passive subfascial drainage. Clinical characteristics and postoperative outcomes were summarized descriptively without a historical comparator. Results: Mean age was 64.1 ± 9.2 years; 60 patients (53.6%) were male. Persistent CSF leakage occurred in 3 patients (2.7%), symptomatic pseudomeningocele in none, CSF fistula in 1 (0.9%), and wound dehiscence in 2 (1.8%). Nine patients (8.0%) underwent reoperation for any indication. No postoperative meningitis was recorded. Mean hospital stay was 9.1 ± 3.8 days and mean passive drainage duration was 7.5 ± 2.3 days. Conclusions: This illustrated 112-patient experience describes the application and observed postoperative course of a standardized multimodal dural repair technique. The descriptive design does not establish comparative effectiveness or the independent contribution of individual steps.