BACKGROUND Vertebral compression fractures (VCFs) are common, particularly in elderly patients. VCFs are often associated with significant pain, functional impairment, and spinal deformity. The aim of this study was to compare the outcomes of early balloon kyphoplasty across age groups. METHODS This retrospective study analyzed patients treated with early balloon kyphoplasty for VCFs at a tertiary hospital from 2015 to 2024. Early balloon kyphoplasty was defined as surgical treatment performed within 7 days of radiological diagnosis of an acute osteoporotic VCF. Patients were divided into 2 age groups: those younger than 80 years (group A) and those 80 years or older (group B). Data collected included time to diagnosis, time to surgery, total hospital stay, American Society of Anesthesiologists score, complication rates, and visual analog scale score. Radiological outcomes were assessed using the Beck Index. Rates of cement leakage, re-fracture, and adjacent fracture were also evaluated. RESULTS Ninety-eight patients were included (53 in group A; 45 in group B). Both groups showed significant improvement in visual analog scale scores and Beck Index following kyphoplasty (P < 0.0001). Cement leakage, re-fracture, and adjacent fracture rates were comparable between the 2 groups. Minor complications differed between groups. CONCLUSIONS In this retrospective cohort, early balloon kyphoplasty was associated with significant improvements in pain and vertebral body restoration in elderly patients with osteoporotic VCFs, with similar short-term trajectories in patients aged <80 and ≥80 years. CLINICAL RELEVANCE Comparable short-term clinical and radiographic outcomes were observed between patients <80 and ≥80 years, suggesting that advanced age alone may not preclude consideration of early balloon kyphoplasty in appropriately selected patients. LEVEL OF EVIDENCE: 3
BACKGROUND Lumbar disc herniation (LDH) is a leading cause of radiculopathy and disability worldwide. Open microdiscectomy remains the criterion standard, but it requires paraspinal muscle stripping, which may delay recovery. Microscope-assisted tubular discectomy, which combines reusable tubular retractors with a standard operating microscope, is useful in resource-limited settings where endoscopic platforms are unavailable, yet prospective data from such settings are scarce. OBJECTIVE To determine whether microscope-assisted tubular discectomy is associated with a more favorable perioperative and early recovery profile, with no statistically significant difference in long-term clinical outcomes, compared with open microdiscectomy for single-level LDH. METHODS In this prospective comparative study, 150 patients with single-level LDH were enrolled at a tertiary care neurosurgical center (January 2020 to December 2024) and allocated on a nonrandomized basis, determined by operative list scheduling and surgeon availability, to tubular (n = 75) or open microdiscectomy (n = 75). After loss to follow-up, 71 and 72 patients, respectively, were analyzed. All procedures in both arms were performed or directly supervised by a single senior neurosurgeon. Primary outcomes were visual analog scale leg and back pain and Oswestry Disability Index at baseline, 2 weeks, and 3, 6, and 12 months. Secondary outcomes included operative time, blood loss, hospital stay, time to ambulation, and return to work among employed patients. Longitudinal primary outcomes were analyzed with linear mixed-effects models (patient as random intercept; group, time, and group by time as fixed effects). Multivariable regression was adjusted for baseline covariates, and a propensity-score-matched sensitivity analysis was performed to further address confounding from nonrandomized allocation. RESULTS Tubular discectomy was associated with shorter operative time (48.5 vs 72.3 minutes), less blood loss (32.4 vs 78.6 mL), shorter hospital stay (1.2 vs 1.8 days), earlier ambulation (0.8 vs 1.2 days), and faster return to work among employed patients (18.0 vs 28.0 days; n = 60 vs 57; all P < 0.001). Linear mixed-effects models showed significantly lower visual analog scale and Oswestry Disability Index scores in the tubular group at 2 weeks and at 3 and 6 months; between-group differences did not exceed established minimum clinically important difference thresholds, and the difference was not statistically significant at 12 months. Complication (11.3% vs 16.7%, P = 0.39) and recurrence rates were comparable; dural tears occurred in 9.9% vs 4.2% (P = 0.19). A propensity-score-matched sensitivity analysis (58 pairs) reproduced the direction and approximate magnitude of these findings. CONCLUSIONS Microscope-assisted tubular discectomy offered meaningful perioperative advantages and faster early recovery, with long-term outcomes not significantly different from open microdiscectomy at 12 months. Given the nonrandomized design and the observational nature of the comparison, these findings should be interpreted as evidence of a favorable perioperative profile rather than a demonstration of long-term superiority. CLINICAL RELEVANCE Microscope-assisted tubular discectomy using reusable retractors and a standard operating microscope is a safe and efficient alternative to open microdiscectomy, particularly in resource-constrained environments where endoscopic infrastructure is unavailable. LEVEL OF EVIDENCE: 2
BACKGROUND Full-endoscopic pars crisscross decompression has recently been introduced as a local-anesthesia procedure for foraminal stenosis associated with stable L5 isthmic spondylolisthesis. Although transforaminal endoscopic foraminoplasty combined with discectomy has been described in patients with spondylolisthesis, the pars crisscross technique may provide a distinct working corridor for simultaneous treatment of bony foraminal stenosis and concomitant lateral disc pathology. We present 2 cases treated with single-stage pars crisscross decompression and discectomy under local anesthesia. CASE PRESENTATION Two patients, a 51-year-old woman and a 60-year-old man, presented with unilateral L5 radiculopathy refractory to conservative treatment. Imaging demonstrated L5 isthmic spondylolisthesis, ipsilateral L5/S1 foraminal stenosis, and concomitant lateral disc herniation without significant segmental instability. CASE MANAGEMENT Both patients underwent single-stage full-endoscopic pars crisscross decompression and endoscopic discectomy under local anesthesia. Adequate decompression of the exiting L5 nerve root was achieved by sequential resection of the bony components of the pars defect, followed by removal of the herniated disc. Leg pain improved immediately after surgery in both patients. Postoperative imaging confirmed adequate foraminal decompression. No perioperative complications occurred. At 18 months in case 1 and 12 months in case 2, neither patient demonstrated recurrence of radicular symptoms, progression of low back pain, or radiographic evidence of segmental instability. CONCLUSION Transforaminal full-endoscopic spine surgery using the pars crisscross technique provided effective decompression of both bony and discal pathology in carefully selected patients with stable L5 isthmic spondylolisthesis and concomitant lateral disc herniation. Larger studies with longer follow-up are required before its role relative to fusion surgery can be established. CLINICAL RELEVANCE The pars crisscross technique may offer a minimally invasive, motion-preserving surgical option for selected patients with stable isthmic spondylolisthesis and concomitant foraminal stenosis and lateral disc herniation, potentially avoiding fusion surgery while allowing treatment under local anesthesia. LEVEL OF EVIDENCE: 5
