OBJECTIVE:This cohort study aims to evaluate the impact of obesity on the outcomes of full endoscopic lumbar discectomy (FELD) in patients with lumbar disc herniation. METHODS:We conducted a retrospective analysis of 156 adult patients who underwent FELD for lumbar disc herniation from January 2015 to February 2023. Patients were divided into 3 groups: obese endoscopic (n = 71), obese open surgery (n = 31), and nonobese endoscopic (n = 54). Clinical outcomes were assessed using the visual analog scale for leg and back pain, the Oswestry Disability Index, and patient satisfaction rates. Operative time, hospital stay duration, and complication rates were also analyzed. RESULTS:No significant differences were observed in patient-reported outcome measures, operative time, or complication rates between obese and nonobese patients undergoing FELD. The mean operative time was longer in the endoscopic group compared with the open surgery group (70.2 vs 59.8 minutes), but the hospital stay was significantly shorter for endoscopic patients (1.7 vs 2.4 nights, P = 0.0006). Both obese and nonobese groups showed significant improvements in visual analog scale and Oswestry Disability Index scores at the final follow-up, with satisfaction rates of 85.7% in the endoscopic group reporting good to excellent outcomes. CONCLUSIONS:FELD is a viable and effective alternative to traditional open surgery for obese patients, offering comparable clinical outcomes and the added benefit of a shorter hospital stay. These findings suggest that obesity does not inherently affect surgical outcomes, underscoring the need for further research with larger sample sizes and longer follow-up periods. CLINICAL RELEVANCE:FELD offers a viable and effective surgical option for obese patients, with outcomes comparable to traditional surgery but with the added benefit of shorter hospital stays. LEVEL OF EVIDENCE: 3:

BACKGROUND:Endoscopic spine surgery is a minimally invasive approach that offers several advantages over the traditional open approach, including less tissue trauma, faster recovery, and lower rates of complications. However, the learning curve and the requirement of separate equipment limits the acceptability of this technique for many spine surgeons. Using a short survey, the authors sought to report the current status regarding the use of endoscopy among French spine surgeons and to identify the barriers faced by spine surgeons to adopting endoscopy into their practice. METHODS:A cross-sectional survey was conducted in which a predefined questionnaire was sent as a Google form to 522 members of the Societe Francaise de Chirurgie du Rachisspine. Respondents were asked to respond within 3 months, with reminders sent regularly to nonresponders. Responses were collected and analyzed. RESULTS:Among all 123 survey respondents, 39 practiced endoscopy and 84 did not practice endoscopy. Most of the surgeons acquired skills by visiting other surgeons (74.4%) or attending cadaver-based workshops (56.4%). A substantial portion of respondents were in between 1 and 3 years of experience (48.7%) and performed 5 to 10 endoscopic procedures per month(30.8%). Although 92.1% of respondents observed better outcomes in their patients with endoscopy, lack of training (26%) and high equipment cost (13.8%) were the most limiting factors reported by surgeons. CONCLUSION:The results of this survey contribute to the existing literature and highlight the current trends of endoscopic spine surgery in France. Although the benefits of minimally invasive spine surgery are well documented and were confirmed by surgeons in this survey, lack of training and cost of equipment are major barriers that need to be controlled to expand the adoption of this technique. CLINICAL RELEVANCE:Understanding the factors influencing the adoption of endoscopic spine surgery in France provides valuable insights for surgeons and educators. By identifying key barriers and motivations, this study may help guide strategies for improving training, accessibility, and implementation of endoscopic techniques in spinal surgery. LEVEL OF EVIDENCE: 4:

OBJECTIVES:This study hypothesizes that the spinopelvic sagittal alignment can influence the development of lumbar disc herniation (LDH). To investigate this relationship, the spinopelvic data of surgical LDH patients was compared to that of a healthy historical control group. METHODS:The spinopelvic data of LDH patients aged 15-45 years, undergoing herniated disc surgery (L4-L5/L5-S1) from 2015 to 2019, was compared to that from healthy controls reported by Roussouly et al. Sacral slope (SS), pelvic incidence (PI), pelvic tilt (PT), and Roussouly classification (spinal curves type 1-4) were assessed with full body radiographs in a standing weight-bearing position (EOS® system) using KEOPS software. The prevalence of spine types (1-4) were evaluated in both groups, with subgroup analysis based on herniation level. Proportions were compared using Fisher's exact tests, means by Student's t-tests, and confidence intervals for odds ratios (OR) using the exact conditional tail interval (ECTI) method. RESULTS:Spinopelvic data from 350 patients (190 LDH/160 healthy controls) showed that LDH patients had a significantly higher prevalence of Roussouly type 2 spines ("flat spine") (27.9% vs. 11.2%, OR 3.04, p = 0.001). The LDH group also exhibited lower mean PI (-3.0°, p = 0.009), significantly lower mean SS (-6.9°, p < 0.001), lower lumbar lordosis angle (-10.6°, p < 0.001), and higher thoracic kyphosis angle (+3.6°, p < 0.001). The ratio of OR (2.73, p = 0.01) indicated that type 2 spines pose a stronger risk for LDH surgery at L5-S1 compared to L4-L5. CONCLUSIONS:Patients <45 years old undergoing surgery at L4-L5/L5-S1 showed a threefold higher prevalence of type 2 Roussouly spines, compared to a healthy control group, suggesting a potential role of "flat spine" and lower PI in the development of LDH. LEVEL OF EVIDENCE:III; case-control study.

OBJECTIVE:To describe and evaluate postoperative care after degenerative cervical spine surgery among spine surgeons in France. HYPOTHESIS:The postoperative management after degenerative cervical spine surgery varies considerably depending on the team caring for the patient. Based on a national survey, we aimed at providing trends and guidelines regarding the following points: 1/ clinical follow-up and postoperative imaging, 2/ the place and role of bracing after surgery, 3/ driving recommendation and 4/ return to sports activities after such surgery. METHODS:Data were collected from spinal surgeons using a practice-based online questionnaire (SurveyMonkey Inc.). The survey comprised 15 questions on the current management following degenerative cervical spine surgery in France, especially single or multilevel anterior cervical discectomy fusion (ACDF). The surgeons were asked to answer several questions on 1) patient clinical follow-up, 2) postoperative imaging, 3) postoperative recommendation (e.g., bracing), and 4) time to return to work and sport practice. RESULTS:A total of 239 surgeons participated in the survey, including 158 (66%) neurosurgeons and 81 (34%) orthopedic surgeons. A total of 218 (96.9%) investigators proposed a face-to-face follow-up consultation within 6 weeks after surgery. A total of 210 (92%) practitioners asked for systematic cervical imaging at the first clinical follow-up. In the latter situation, cervical radiography was requested by 195 (85.2%) surgeons, and cervical CT scans were requested by 15 (6.6%) surgeons. A minority of surgeons recommended bracing after monosegmental cervical surgery (n = 99, 43%), except among orthopedic surgeons (n = 51 (63%), p < 0.0001). 38 (16.6%) surgeons advocated for early postoperative physiotherapy, and 130 (56.8%) for delayed physiotherapy. A prolonged time off work (>1 month) was recommended by 133 (57.8%) practitioners. 139 (62.9%) surgeons agreed on returning to sports without load or constraint during the first postoperative month, although orthopedic surgeons were more conservative than neurosurgeons (p = 0.0019). Conversely, return to sport with load (n = 171, 75.3%) or rotation (n = 219, 98%) was delayed for at least 1 month. CONCLUSION:This nationwide study reflects the status of current postoperative management strategies after elective degenerative cervical spine surgery among the French spine community. Interestingly, the information provided to the patient may vary depending on the surgeon's specialty. Consensus-based recommendations are needed to homogenize practices. LEVEL OF EVIDENCE:V.

ABSTRACT:In this case report, we encountered a pseudocyst as a complication of endoscopic lumbar discectomy in a high-level athlete within 3 months, which is atypical according to the literature. The recurrence of this pathology is even rarer, in this case, the patient presented a recurrence of the pseudocyst after resection. This case report outlines a review of the patient's clinical report, imaging, operative procedure, and complications, together with a literature review on pseudocysts after endoscopic lumbar discectomy.

Introduction This study aimed to evaluate the clinical outcomes of transforaminal full-endoscopic lumbar discectomy (FELD) for treating lateral lumbar disc herniation. Methods A retrospective single-center study was conducted at Centre Orthopédique Santy, Lyon, France, including 58 adult patients with foraminal or extraforaminal lumbar disc herniations who underwent surgery between October 2020 and January 2023. Inclusion criteria were patients with significant functional impairment due to unilateral radicular pain unresponsive to conservative treatment for over six weeks. Data on demographics, clinical characteristics, and outcomes were collected, evaluated preoperatively and at 12 months postoperatively using Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), and Macnab criteria. Results The cohort had a mean age of 56.5 years and consisted predominantly of males, with 35 men (60%). Most herniations were at the L4-L5 level (29 patients, 50%). Significant improvements were observed in lumbar VAS (mean reduction of 1.9 points, p < 0.001), radicular VAS (mean reduction of 4.9 points, p < 0.001), and ODI (mean reduction of 41.9 points, p < 0.001) scores. Patient satisfaction was high, with 91% (53 patients) reporting excellent or good outcomes. The reoperation rate was 6.9% (4 patients). Linear regression analysis indicated that longer symptom duration and higher preoperative radicular VAS scores predicted greater satisfaction. Conclusions Transforaminal FELD is a safe and effective technique for treating lateral lumbar disc herniation, offering high patient satisfaction. Symptom duration and preoperative radicular VAS scores are key predictors of positive outcomes. Further studies with larger sample sizes and longer follow-up periods are necessary to confirm these findings.

Les impactions de la cage (IC) d’OLIF semblent une complication mécanique fréquente au potentiel impact fonctionnel. Déterminer le taux de survenue d’une IC, ses facteurs de risques et son impact clinique en cas d’arthrodèse combinée à un niveau. Une analyse rétrospective des données collectées prospectivement a été réalisée. Tous nos patients atteints d’un spondylolisthésis dégénératif ont reçu un premier temps d’OLIF complété d’un vissage pédiculaire (APL). Le contrôle peropératoire à l’amplificateur de brillance et la une radiographie standard en postopératoire immédiat permettait d’évaluer la survenue d’une IC, en fonction de la position de l’implant. Un enfoncement secondaire était recherché sur les télérachis au cours du suivi. Les paramètres pelviens étaient analysés, puis la survenue d’une fusion osseuse. L’évaluation clinique était faite à au moins 1 an, par l’Oswestry disability Index (ODI), le périmètre de marche (PM) et l’Échelle visuelle analogique (EVA). Au total, 130 patients sur les 131 inclus ont été analysés. Une IC est survenue dans 25,3 % (n = 33) des cas et pour 94 % (n = 32) en peropératoire. Les femmes ménopausées présentaient plus d’IC avec un OR à 5,8 (p = 0,034). Le groupe « IC » avait un score ODI inférieur de 9,5 % au groupe « non-IC » (p = 0,0040), mais tout deux permettaient un excellent gain d’ODI de 30,8 ± 16 et 32,9 ± 15,5 % (p = 0,0001). Une position « antérieure » de l’implant permettait un gain plus important de lordose lombaire (p < 0,001) mais associée à une survenue plus importante d’IC (p < 0,001), avec un OR à 6,75 (p = 0,0018). La survenue d’une impaction de la cage peropératoire est un évènement fréquent lors de la réalisation de l’OLIF. Les femmes ménopausées ont un risque d’impaction environ 6 fois plus élevé que les hommes et les patients avec un positionnement « antérieur » de l’implant ont 7 fois plus de risque qu’en cas de positionnement centré. L’impact négatif des impactions de la cage sur le score clinique (ODI) était significatif après un an de suivi. IV, étude de cohorte non comparative.

Objective This study aimed to systematically review the literature for comparative and non-comparative studies reporting on clinical outcomes of patients with lumbar foraminal stenosis treated by either endoscopic foraminotomy or fusion. Methods In adherence with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a literature search was done on January 17, 2022, using Medline and Embase. Clinical studies were eligible if they reported outcomes following fusion or endoscopic foraminotomy, in patients with primary lumbar foraminal stenosis. Two independent reviewers screened titles, abstracts, and full-texts to determine eligibility; performed data extraction; and assessed the quality of eligible studies according to the Joanna Briggs Institute (JBI) checklist. Results The search returned 827 records; 266 were duplicates, 538 were excluded after title/abstract/full-text screening, and 23 were eligible, with 16 case series reporting on endoscopic foraminotomy, 7 case series reporting on fusion, and no comparative studies. The JBI checklist indicated that 21 studies scored ≥4 points. When comparing endoscopic foraminotomy to fusion, pooled data revealed reduced operative time (69 vs 119 min, P < 0.01) but similar Oswestry disability index (19 vs 20, P = 0.67), lower back pain (2 vs 2, P = 0.11), leg pain (2 vs 2, P = 0.15), complication rates (10% vs 5%, P = 0.22), and reoperation rates (5% vs 0%, P = 0.16). The proportions of patients with good/excellent MacNab criteria were similar for endoscopic foraminotomy and fusion (82–91% vs 85–91%). Conclusions There were high heterogeneity and no significant differences in clinical outcomes, complication rates, and reoperation rates between endoscopic foraminotomy and fusion for the treatment of lumbar foraminal stenosis; although endoscopic foraminotomy has reduced operative time.

Purpose:To report accuracy, repeatability, and agreement of Cobb angle measurements on radiographs and/or stereo-radiographs (EOS) compared against one another or against other imaging modalities. Methods:This review follows Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A literature search was conducted on 21 July 2021 using Medline, Embase, and Cochrane. Two researchers independently performed title/abstract/full-text screening and data extraction. Studies were eligible if they reported Cobb angles, and/or their repeatability and agreement, measured on radiographs and/or EOS compared against one another or against other imaging modalities. Results:Of the 2993 records identified, 845 were duplicates and 2212 were excluded during title/abstract/full-text screening. Two more relevant studies were identified from references of eligible studies, leaving 14 studies for inclusion. Two studies compared Cobb angles from EOS vs CT, while 12 compared radiographs vs other imaging modalities: EOS, CT, MRI, digital fluoroscopy, or dual-energy x-ray absorptiometry. Angles from standing radiographs tended to be higher than those from supine MRI and CT, and angles from standing EOS tended to be higher than those from supine or prone CT. Correlations across modalities were strong (R = 0.78-0.97). Inter-observer agreement was excellent for all studies (ICC = 0.77-1.00), except one (ICC = 0.13 radiographs and ICC = 0.68 for MRI). Conclusion:Differences of up to 11º were found when comparing Cobb angles across combinations of imaging modalities and patient positions. It is not possible, however, to determine whether the differences observed are due to the change of modality, position, or both. Therefore, clinicians should be careful when utilizing the thresholds for standing radiographs across other modalities and positions for diagnosis and assessment of scoliosis.

Introduction: Circumferential fusion by the anterior (ALIF) or transforaminal (TLIF) approach combined with posterior instrumentation is currently used for the surgical treatment of low-grade isthmic spondy-lolisthesis. But few studies have compared the clinical and radiological outcomes of various interbody fusion techniques. The objective of this study was to compare the clinical and radiological results at 2 years postoperative of two fusion techniques-TLIF versus ALIF plus posterior instrumentation-for low-grade isthmic spondylolisthesis in adults.Materials and methods: This was an observational multicenter study done at nine French healthcare facilities specialized in spine surgery. The inclusion criteria were minimum age of 18 years, grade 1-3 isthmic spondylolisthesis, ALIF + posterior fixation (ALIF + PS) or TLIF, minimum follow-up of 2 years. Clinical and radiological evaluations were done preoperatively and at 2 years of follow-up. A lumbar CT scan was done at 1 year postoperative to evaluate fusion. Results: The cohort consisted of 89 patients (50 women, 39 men) with a mean age of 47.7 +/- 12.3 (18-79) years. The patients in the ALIF groups (n = 71) had a significantly longer hospital stay than those in the TLIF group (n = 18): 5.7 days versus 4.6 days (p = .04). However, their medical leave from work was significantly shorter: 31.0 weeks versus 40.7 (p = .003). Lumbar pain VAS diminished faster in the ALIF groups, with a significantly larger drop than the TLIF group in the first 3 months postoperative. Only the increase in lumbar disc lordosis was larger in the ALIF group: 11.7 degrees +/- 12.0 degrees versus 6.0 degrees +/- 11.7 degrees (p = .036). There was a significant correlation between the increase in global lordosis and reduction in lumbar VAS at 2 years postoperative (p= - 0.3295; p = .021).Conclusion: ALIF + PS provides a faster relief of postoperative low back pain than TLIF but there are no significant clinical differences between techniques at 2 years of follow-up. Despite better restoration of disc lordosis in the ALIF + PS group, there was no difference in the restoration of global lordosis. Level of evidence: III; multicenter comparative study.(c) 2023 Elsevier Masson SAS. All rights reserved.

Introduction: Low-grade isthmic spondylolisthesis (ISPL) is generally treated by circumferential fusion with interbody graft, although there is no consensus on technique.Hypothesis: The various interbody fusion strategies provide satisfactory fusion rates and clinical results. Methods: A multicenter retrospective study analyzed lumbar interbody fusion for low-grade ISPL per-formed between March 2016 and March 2019. Techniques comprised: circumferential fusion on a posterior or a transforaminal approach (PLIF, TLIF: n = 57), combined anterior (ALIF) + posterolateral fusion (ALIF + PLF: n = 60), and ALIF + percutaneous posterior fixation (ALIF + PPF: n = 55). Function was assessed on a lumbar and a radicular visual analog scale (AVS-L, VAS-R), Oswestry Disability Index (ODI) and Short Form 12 (SF12).Results: Among the 129 patients, 85.3% showed fusion (Lenke 1 or 2), with no significant differences between the ALIF-PLF or ALIF-PPF groups and the PLIF or TLIF groups (p = 0.3). Likewise, there was no difference in fusion rates between the ALIF-PPF and ALIF-PLF subgroups (p = 0.28). VAS-L (p < 0.001) and VAS-R (p < 0.0001), ODI (p < 0.001) and SF12 physical (PCS) (p < 0.01) and mental component sores (MCS) (p < 0.001) all showed significant improvement at 12 months. Combined approaches provided greater clinical efficacy than TLIF or PLIF for lumbar (p < 0.0001) and radicular pain (p < 0.05), ODI (p < 0.0001) and SF12 PCS (p < 0.01). At 12 months, there was no clinical difference between the ALIF-PPF and ALIF-PLF subgroups. However, patents with interbody non-union (Lenke 3 or 4) had lower SF12 PCS scores (p < 0.004) and VAS-L ratings (p < 0.001) than Lenke 1-2 patients.Conclusion: Low-grade ISPL treated by circumferential arthrodesis and interbody graft showed 85.3% consolidation at 2 years, with equivalent outcomes between anterior and posterior techniques. Successful fusion was associated with better clinical results. Level of evidence: IV.(c) 2022 Published by Elsevier Masson SAS.

Les fusions circonférentielles par voie antérieure (ALIF) ou transforaminale (TLIF) associées à une ostéosynthèse postérieure sont des techniques couramment utilisées dans le traitement chirurgical des spondylolisthésis par lyse isthmique de bas grade. Mais il n’existe que peu d’études comparant les résultats cliniques et radiologiques des différentes techniques de fusions intersomatiques. L’objectif de cette étude était de comparer les résultats cliniques et radiologiques de deux techniques d’arthrodèse : TLIF versus ALIF associée à une instrumentation postérieure à deux ans postopératoires d’un spondylolisthésis par lyse isthmique de l’adulte. Il s’agit d’une étude observationnelle multicentrique réalisée en France dans 9 centres spécialisés en chirurgie du rachis. Les critères d’inclusion étaient : âge minimum 18 ans, spondylolisthésis par lyse isthmique de grade 1 à 3, arthrodèse type ALIF + fixation postérieure (ALIF + PS) ou TLIF, suivi minimal de 2 ans. Une évaluation clinique et radiologique étaient réalisées en préopératoire et à 2 ans postopératoire, un TDM du rachis lombaire réalisé à 1 an postopératoire évaluait la fusion osseuse. La cohorte comportait 89 patients (50 femmes, 39 hommes) avec un âge moyen de 47,7 ± 12,3 (18–79) ans. Les patients du groupe ALIF (n = 71) avaient une durée d’hospitalisation significativement supérieure à ceux du groupe TLIF (n = 18) : 5,7 jours versus 4,6 jours (p = 0,04), mais ils présentaient une durée moyenne d’arrêt de travail inférieure : 31,0 semaines versus 40,7 (p = 0,003). L’EVA lombaire diminuait plus rapidement dans le groupe ALIF avec une décroissance significativement plus importante que dans le groupe TLIF dans les trois premiers mois postopératoires. Seule l’augmentation de lordose discale était significativement plus importante dans le groupe ALIF 11,7 ± 12,0 ° versus 6,0 ± 11,7 ° (p = 0,036). On retrouvait une corrélation significative entre l’augmentation de lordose globale et la diminution de l’EVA lombaire à 2 ans postopératoire (ρ = −0,3295 ; p = 0,021). L’ALIF + PS permet une diminution plus rapide des lombalgies postopératoire sans différence clinique à 2 ans postopératoire. Malgré une meilleure restauration de lordose discale dans le groupe ALIF + PS, il n’existait pas de différence de restauration de lordose globale. III ; étude multicentrique comparative.

Les spondylolisthésis par lyse isthmique (ISPL) de bas grades sont régulièrement traités par arthrodèses circonférentielles comprenant un temps de greffe intersomatique sans qu’un consensus technique ne soit établi. Les différentes stratégies d’arthrodèses intersomatiques permettent d’obtenir des taux de fusion et des résultats cliniques satisfaisants. Une étude rétrospective multicentrique concernant des arthrodèses lombosacrées réalisées pour ISPL de bas grades a été menée entre Mars 2016 et Mars 2019. Les techniques comprenaient des arthrodèses circonférentielles réalisées par abord postérieur ou transforaminal (PLIF, TLIF) (n = 57), des arthrodèses combinées antérieures (ALIF) + postérolatérales (ALIF + PLF) (n = 60) et des ALIF + fixations percutanées postérieures (ALIF + PPF) (n = 55). La fusion a été évaluée sur scanner selon les 4 grades de Lenke à 2 ans de recul minimal postopératoire. La fonction était évaluée par l’Echelle Visuelle Analogique lombaire (EVA L) et radiculaire (EVA R), l’Oswestry Disability Index (ODI) et le score Short Form 12 (SF12). La fusion était observée (Grade 1 et 2 de Lenke) chez 85,3 % des 129 sujets évalués. Il n’y avait pas de différence significative entre le groupe ALIF + fixation postérieure (PPF ou PLF) et le groupe PLIF/TLIF sur ce critère (p = 0,3). De même, il n’apparaissait pas de différence de taux de fusion entre les sous-groupes ALIF + PPF et ALIF + PLF (p = 0,28). L’EVA lombaire (p < 0,001) et radiculaire (p < 0,0001), l’ODI (p < 0,001) et le SF12 PCS (p < 0,01), MCS (p < 0,001) étaient significativement améliorés à 12 mois de recul. Les chirurgies par voies combinées apportaient une meilleure efficacité clinique que les stratégies TLIF/PLIF en terme d’EVA lombaire (p < 0,0001) et radiculaire (p < 0,05), d’ODI (p < 0,0001) et de SF12 PCS (p < 0,01). À 12 mois de recul, Il n’apparaissait pas de différence clinique entre les sous-groupes ALIF + PPF et ALIF + PLF. En revanche, les patients présentant une pseudarthrose intersomatique (Lenke 3-4) présentaient des scores inférieurs SF12 PCS (p < 0,004) et EVA L (p < 0,001) par rapport aux groupe Lenke 1-2. Les ISPL de bas grades traités par arthrodèses circonférentielles avec greffe intersomatique présentent un taux de consolidation de 85,3 % à 2 ans de recul avec des résultats équivalents pour les techniques d’arthrodèse antérieure et postérieure. L’obtention de la fusion aboutit à de meilleurs résultats cliniques. IV.

Introduction: Cage impactions (CI) of Oblique Lumbar Interbody Fusion (OLIF) appear to be a frequent mechanical complication with a potential functional impact.Objectives: To determine the rate of CI occurrence, their risk factors and clinical implications in the case of combined single-level arthrodesis.Method: A retrospective analysis of prospectively collected data was performed. All our patients with degenerative spondylolisthesis initially underwent OLIF combined with pedicle screw fixation (PSF). Intraoperative control with an image intensifier and a standard radiograph in the immediate postoper-ative period made it possible to assess the occurrence of CI, depending on the position of the implant. Secondary subsidence was sought on the standing radiological examination using EOS biplanar radiog-raphy during follow-up. The pelvic parameters were analyzed, as well as the occurrence of bone fusion. The clinical evaluation was made at >= 1 year, by the Oswestry Disability Index (ODI), the walking distance (WD) and the Visual Analogue Scale (VAS).Results: In all, 130 patients out of the 131 included were analyzed. A CI occurred in 25.3% (n = 33) of cases and of these, 94% (n = 32) occurred intraoperatively. Postmenopausal women had more CI with an odds ratio (OR) of 5.8 (P = 0.034). The "CI" group had a 9.5% lower ODI score than the "non-CI" group (P = 0.0040), but both provided excellent ODI gains of 30.8 +/- 16 and 32.9 +/- 15.5% (P < 0.0001). An "anterior" position of the implant allowed a greater gain in lumbar lordosis (P < 0.001) but was associated with greater CI occurrence (P < 0.001), with an OR of 6.75 (P = 0.0018).Conclusion: The occurrence of intraoperative cage impaction is a frequent event when performing OLIF. Postmenopausal women have an approximately 6 times greater risk of impaction than men, and patients with an "anterior" implant placement have a 7 times greater risk than with central placement. The negative impact of cage impactions on the clinical score (ODI) was significant after one year of follow-up. Level of evidence: IV, non-comparative cohort study. (c) 2022 Published by Elsevier Masson SAS.

Purpose To determine within-patient fusion rates of chambers filled with bioactive glass versus autologous iliac crest bone on computed tomography (CT) following anterior lumbar interbody fusion (ALIF). Methods A consecutive series of 40 patients (58 levels) that underwent single-level (L5-S1 only) or two-level (L5-S1 and L4-L5) ALIF were assessed. Indications for fusion were one or more of the following: degenerative disc disease with or without Modic changes, spondylolisthesis, and stenosis. Each intervertebral cage had a middle beam delimiting two chambers, one of which was filled with bioactive glass and the other with autologous iliac crest bone. CT scans were graded using the Bridwell classification (grade I, best; grade IV, worst). Patients were evaluated using the Oswestry Disability Index (ODI), and by rating pain in the lower back and legs on a Visual Analog Scale (pVAS); complications and reoperations were noted. Results At 15 ± 5 months follow-up, there were no significant differences in fusion across chambers filled with bioactive glass versus chambers filled with autologous bone ( p = 0.416). Two patients with Bridwell grade III at both chambers of the L4-L5 cages required reoperation using posterior instrumentation. Clinical assessment of the 38 remaining patients (54 levels) at 25 ± 2 months, revealed ODI of 15 ± 12, lower back pVAS of 1.4 ± 1.5 and legs pVAS of 1.9 ± 1.6. Conclusions For ALIF at L5-S1 or L4-L5, within-patient fusion rates were equivalent for bioactive glass compared to autologous iliac crest bone; thus, bioactive glass can substitute autologous bone, avoiding increased operative time and blood loss, as well as donor site morbidity.

BACKGROUND A high degree of vigilance is warranted for a spinal infection, particularly in a patient who has undergone an invasive procedure such as a spinal injection. The average delay in diagnosing a spinal infection is 2-4 mo. In our patient, the diagnosis of a spinal infection was delayed by 1.5 mo. CASE SUMMARY A 60-year-old male patient with a 1-year history of right-sided lumbar radicular pain failed conservative treatment. Six weeks to prior to surgery he received a spinal injection, which was followed by increasing lumbar radicular pain, weight loss and chills. This went unnoticed and surgery took place with right-sided L4-L5 combined microdiscectomy and foraminotomy via a posterior approach. The day after surgery, the patient developed left-sided lumbar radicular pain. Blood cultures grew Staphylococcus aureus (S. aureus). Magnetic resonance imaging showed inflammatory aberrations, revealing septic arthritis of the left-sided L4/L5 facet joint as the probable cause. Revision surgery took place and S. aureus was isolated from bacteriological samples. The patient received postoperative antibiotic treatment, which completely eradicated the infection. CONCLUSION The development of postoperative lower back pain and/or lumbar radicular pain can be a sign of a spinal infection. A thorough clinical and laboratory work-up is essential in the preoperative evaluation of patients with spinal pain.

This note describes a surgical technique to kinematically align a medial Oxford® UKA. Applying kinematic alignment principles is an alternative, personalised, physiological, and potentially clinically advantageous method for implanting the medial Oxford® UKA. Further investigations are needed to better define the reproducibility and clinical impact of this new surgical technique.

Objective: To evaluate the clinical and radiological outcomes of patients undergoing one-level oblique lumbar interbody fusion (OLIF) combined with posterolateral fusion (PLF) with pedicle screws for the treatment of degenerative lumbar spondylolisthesis (DS) with a minimum follow-up of 1 year. Methods: A retrospective analysis of prospectively collected data was performed. Patients who underwent combined OLIF and PLF between March 2013 and December 2019 were considered for study eligibility. Patients were evaluated using the Oswestry Disability Index (ODI) and the Short Form-12 (SF-12) (physical PCS, mental MCS), self-evaluation of pain with a Visual Analog Scale (VAS) and walking distance. Compensation and sagittal balance were assessed using the Gille classification by full spine stereoradiography (EOS Imaging, Paris, France). Mechanical complications were also collected. Results: A total of 131 patients were included (mean (SD) age: 64.2 +/- 10.4 years), and 127 patients were evaluated after a mean follow-up of 22 +/- 12.3 months. The mean ODI at the last follow-up was 13.8 +/- 12.9% (gain of 32.3 +/- 15.5%; p < 0.0001), the mean PCS was 45.6 +/- 7.7 (gain of 12.6 +/- 9.8) and the mean MCS was 43.9 +/- 11.9 (gain of 5.3 +/- 13.5) (p < 0.0001). Ten patients (7.6%) had adjacent segment syndrome, and there was one vertebral body fracture. Patients with preoperative imbalance (SVA > 40 mm) had a significant improvement in SVA of 19.8 +/- 32 mm (p = 0.025). Sagittal imbalance (Gille type 3) was not associated with a change in postoperative functional score (p = 0.52). Conclusions: OLIF improved functional scores at 1 year, with excellent outcomes in 80% of our patients with a low morbidity. Sagittal imbalance did not adversely affect the clinical outcomes.

Objectives: To assess early clinical outcomes of stand-alone minimally invasive ALIF for patients with DDD at L4-L5 and determine whether the procedure affects spino-pelvic parameters. Methods: The authors reviewed the records of all patients with DDD that underwent stand-alone minimally invasive ALIF at L4-L5 using the self-locking SynFix cage (DePuy Synthes, PA, USA). Patients were evaluated using the Oswestry Disability Index (ODI), Short Form 12, and lower back and legs pain on Visual Analog Scale. Spino-pelvic parameters were measured from whole-spine standing radiographs. Results: From the initial cohort of 48 patients, 3 could not be reached, and 4 were reoperated due to pseudarthrosis using posterior instrumentation with bone graft, leaving 41 for clinical and radiologic evaluation. At a follow-up of 18.2 +/- 7.3 months, all 5 clinical scores improved from pre-operative values. Multi-variable regressions revealed no significant associations between independent variables and ODI. Comparing pre- and postoperative radiographs: global lumbar lordosis increased by 3.6 +/- 7.7 degrees (p = 0.001), L4-L5 lordosis increased by 7.4 +/- 6.1 degrees (p < 0.001), and L5-S1 lordosis decreased by 1.6 +/- 4.5 degrees (p = 0.029). There was a small but significant increase in pelvic incidence (1.8 +/- 3.1 degrees, p = 0.001), as well as small and insignificant increases in pelvic tilt (0.9 +/- 4.9 degrees, p = 0.252) and sacral slope (1.2 +/- 5.2 degrees, p = 0.143). Conclusions: Minimally invasive stand-alone ALIF at L4-L5 grants satisfactory early clinical outcomes, and can improve segmental and global lordosis, with satisfactory fusion rates and minimal complications. The procedure resulted in a small but significant increase in pelvic incidence, as well as small and insignificant increases in pelvic tilt and sacral slope.