Background and Objective:In the aging population, degenerative disc and facet joint disease is a common occurrence, and it frequently results in disability. Anterior lumbar interbody fusion (ALIF) surgeries offer effective treatments by stabilising the segment inducing the painful motion, providing indirect decompression of neural elements, restore lordosis and deformity correction. With direct visualization ALIF allows thorough discectomy and endplate preparation, with large surface area implants without the need for direct neural retraction which offers advantages over other techniques. The purpose of this review is to determine the anatomical and technical considerations required for performing ALIF. Methods:A review of literature relevant to ALIF surgery was conducted up to October 2025. Surgical technique, anatomical and technical considerations for reconstruction of the anterior column by ALIF at the L1-L5 level was investigated. Key Content and Findings:Outlined in this review is indications, surgical anatomy and approach, vascular considerations, complications, potential visceral and sympathetic nerve injuries. Details on avoiding vascular and visceral complications as well as methods of venous and arterial repair are discussed. Conclusions:This study comprehensively reviews the available literature for the considerations for ALIF. Recommendations and guidelines for the indications and complications for ALIF is provided to guide clinicians.

Higher-grade degenerative lumbar spondylolisthesis in the elderly presents a significant management challenge. Standard treatment often involves surgical fusion, which provides stability but carries substantial morbidity in this vulnerable population. Decompression alone is less invasive but lacks strong evidence for these specific grades. This case series reports on facet-sparing uniportal endoscopic decompression as a less invasive alternative in three carefully selected elderly patients (>75 years old) with stable Grade II/III degenerative slips and neurogenic symptoms. All patients experienced rapid postoperative recovery, were discharged the same day and had minimal complications. At 6- to 18-months follow-up, they demonstrated significant symptom relief and functional gains while maintaining radiographic stability without slip progression. These preliminary results suggest uniportal endoscopic decompression alone may be a viable option for selected elderly patients with stable Grade II-III spondylolisthesis and warrants further investigation.

L5-S1 pathologies including foraminal disc herniation, foraminal stenosis and spondylolisthesis are well-recognized causes of radicular pain, functional limitation, and diminished quality of life, with many patients requiring surgical intervention due to refractory symptoms or progressive neurological compromise [1,2]. Traditionally, surgical decompression at L5-S1 has involved interbody fusion procedures, aimed at restoring foraminal height and stabilizing the segment to relieve nerve root impingement [3]. However, these procedures can result in prolonged recovery times, increased surgical morbidity, and the long-term risk of adjacent segment degeneration [4,5]. In recent years, endoscopic techniques have emerged as minimally invasive, motion-preserving alternatives for patients with radiculopathy due to foraminal compression [5,6]. Among these, the translaminar contralateral endoscopic foraminotomy (TCEF) approach allows for direct visualisation and precise neural decompression of the L5 nerve root without compromising segmental stability, offering faster recovery, less postoperative pain, and significant reduction in hospital stay [7-9]. The authors report a video technical note on a TCEF in a 39-year-old male with four years of worsening L5 radiculopathy and low back pain. MRI demonstrated a bilateral pars defect with low-grade spondylolisthesis, severe foraminal stenosis and annular bulging (Fig. 1). Under general anaesthesia, fluoroscopic guidance confirmed the L5-S1 level and contralateral translaminar entry point, and a 10-mm incision was made just lateral to the midline. A dilator was advanced to the L5 lamina (Fig. 2A), followed by placement of a 10-mm working cannula (Fig. 3A and B) and stenosis scope. A small laminotomy under the L5 spinous process and lamina was performed, creating a wider working corridor within the canal and providing access to the epidural space and contralateral L5-S1 foramen (Fig. 2B, C and 3C). A 30° endoscope provided high-definition magnified visualization, facilitating precise discectomy and decompression of the L5 nerve root using endoscopic graspers, rongeurs, and radiofrequency probes (Fig. 3E-G). The incision was closed with a single subcutaneous suture and the procedure was completed in 53 min with estimated blood loss of <1 cc. Postoperative imaging confirmed adequate decompression and preservation of the facet joint. Early clinical outcomes demonstrated the patient had resolution of radicular symptoms and no neurological complications. Across three performed cases, the TCEF technique was associated with rapid recovery, less than 24-h length of stay (two of three patients discharged the same day), and preservation of spinal stability. This highlights the advantages of TCEF as a non-fusion alterative for L5-S1 foraminal decompression as it provides enhanced visualization of the foraminal corridor, enables precise discectomy and minimises the risk of iatrogenic instability [7,11,12]. Furthermore, its versatility makes it suitable for a wide range of herniation morphologies at the L5-S1 level [1,9,10].

Background: Metal pedicle screws, particularly titanium, can cause significant imaging artifacts and may lead to stress shielding. Carbon fibre-reinforced polyetheretherketone (CFR-PEEK) pedicle screws offer radiolucency and a more bone-like modulus of elasticity, potentially improving postoperative imaging and reducing implant-related complications in non-oncologic spinal surgery. Objective: To evaluate the clinical and radiographic outcomes of CFR-PEEK pedicle screws in a series of nononcologic spinal surgeries, covering degenerative disease in the setting of osteoporosis, trauma, and revision for non-union. Methods: We retrospectively reviewed 11 consecutive patients who underwent CFR-PEEK pedicle screw fixation at a single institution for non-oncologic spinal pathology between June 6, 2022, and July 8, 2024. Data included patient demographics, surgical approach, radiographic fusion and complications. Results: Mean age was 60 years, with 4 cases for revision of non-union, 4 cases for degenerative disease, and 3 for spinal cord compression and/or trauma. Postoperative imaging confirmed improved clarity of bony anatomy and neural structures due to the screws' radiolucency, and all patients achieved fusion at final follow-up. There have been no implant-related complications in any patient at the time of this writing. Conclusion: CFR-PEEK pedicle screws provided satisfactory stabilisation in this series of 11 non-oncologic cases, enabling clearer postoperative imaging and offering a theoretical advantage in reducing stress shielding. No patient has required revision to date, although future complications cannot be excluded. If adjacent segment pathology were to necessitate additional fusion, the biomechanical implications of extending constructs with existing carbon-based screws remain uncertain and warrant further study. Larger prospective trials are needed to validate these findings and define optimal patient selection.

Background: Lumbar Interbody Fusion (LIF) is a surgical procedure aimed at addressing a range of pathological conditions affecting the structure and function of the spine. Patient-Specific Interbody Cages (PSICs) are an emerging technology that are used in LIF; however, there is a lack of clinical outcome data, making it difficult to assess the potential risks, benefits, and value of PSICs. The purpose of this present study is to contribute data to the field on this new emerging technology. The aims were to investigate Quality of Life (QoL), pain, and the complications of PSICs in LIF. To provide a comparative cohort, we performed a systematic review of patient-reported outcomes of conventional fusion techniques. Methods: This study reports on a multi-surgeon, multi-centre clinical trial of patients with lumbar degenerative disc disease, necessitating discectomy and fusion. All patients underwent LIF procedures with 3D-printed PSICs. Pain Visual Analogue Scale (VAS) and QoL (EQ-5D) scores were collected pre-operatively and at 6m, 12m, and 24m post-operatively. For comparative purposes, we performed a systematic review of the VAS scores from traditional LIF cages and analysed the Australian Spine Registry QoL data. Results: The literature search yielded 4272 publications. The studies were subdivided into four groups based on the interbody device type. All the groups demonstrated improvements in the VAS (for back pain) scores post-operatively. In total, 78 patients (109 instrumented levels) underwent LIF procedures with 3DP PSICs. There were three reoperations (3.8%) and no revisions of any PSIC. The mean VAS scores improved significantly (p < 0.01) from 7.85 (1.50 SD) pre-operatively to 2.03 (2.13 SD) at 24 months post-operatively. The mean QoL index scores improved significantly (p < 0.01) from a pre-operative 0.257 (0.332 SD) to 0.815 (0.208 SD) at 24 months. Conclusions: The systematic review indicated that device fixation to the interbody space was associated with lower VAS scores. The results from the investigational cohort suggest that PSICs may represent a new progression in implant design for spinal fusion, with an associated clinical benefit for LIF.

BACKGROUND:There has been a gradual shift from open spine surgery to minimally invasive techniques such as endoscopic spine surgery to reduce approach-related trauma, collateral damage, and complications. While recovery following surgery has been measured using subjective measures including patient-reported outcome measures, the introduction of smart wearable devices now provides both an objective and continuous method of patient assessment. This prospective study compares patient recovery after uniportal endoscopic and open lumbar spine surgery by analyzing mobility and gait metrics captured by a wearable sensor. METHODS:Participants included 24 patients who underwent a single-level uniportal endoscopic lumbar decompression or open posterior lumbar fusion. During the first 48 hours after surgery, patients wore a sensor that continuously monitored position, step count, and gait metrics. RESULTS:In the immediate postoperative period, endoscopic spine surgery patients experienced a quicker return to mobility, with less time lying down, higher step count, faster gait velocity, lower double support percentage, and reduced variability, compared with open spine surgery patients. CONCLUSION:There are key differences in patient mobility and gait following uniportal endoscopic and open spine surgery. Endoscopic spine surgery patients had faster recovery, which can guide resource allocation toward the development of training programs and support the advancement of spine endoscopy to address a broader range of pathologies. This pilot study highlights the potential for wearable devices to be used in further studies to form spine surgery recovery trajectories, allowing targeted rehabilitation and prompt intervention for deviations in patient recovery. CLINICAL RELEVANCE:This study demonstrates the benefits of endoscopic spine surgery for improved postoperative recovery in terms of mobility and gait metrics. Additionally, it highlights the potential for wearable sensor technology to provide an objective and continuous method for assessing postoperative outcomes and for the development of individualized rehabilitation protocols. These findings support the broader adoption of endoscopic techniques and emphasize the value of incorporating wearable devices into postoperative monitoring to optimize patient care. LEVEL OF EVIDENCE: 3:

Endoscopic spine surgery has gained prominence as a minimally invasive alternative to traditional open procedures [1,2,4], particularly in managing thoracic spine pathology. The choice of approach-transforaminal or interlaminar-depends on the pathology, anatomical constraints, and surgical goals [3]. This report outlines a case of endoscopic interlaminar and transforaminal access for thoracic decompression. A 68-year-old retired female presented with a 12-month history of progressive myelopathy due to severe T10/11 spinal stenosis and ligamentum flavum hypertrophy. MRI revealed significant cord compression and cord signal change on T2WI. The patient was placed in the prone position under general anaesthesia. A midline 10-mm skin incision was made at T10/11, and a working cannula was inserted at the interlaminar window, targeting the inferior aspect of the T10 lamina. Under direct endoscopic visualization (10 mm Stenosis Scope, 7.1 mm Working Channel, Elliquence USA) the inferior T10 lamina was drilled to reveal the superior attachment of the ligamentum flavum insertion. The ipsilateral hypertrophic ligamentum flavum was resected using endoscopic Kerrison rongeurs and drill. An "over the top" technique was used to decompress the contralateral side (See Video) Decompression was confirmed by direct visualization of the dura and thecal sac pulsation. The patient experienced significant improvement in lower extremity function during the postoperative phase. She was mobilized on postoperative day 1 and discharged home on day 2 with continued outpatient rehabilitation. At 3-month follow-up, she demonstrated sustained neurological improvement. Thoracic endoscopic techniques minimize tissue disruption, facilitate rapid recovery, and expand the surgical armamentarium for thoracic spine pathology, without the requirement for fixation / stabilization. The authors propose that endoscopic techniques should become the mainstay of thoracic decompression without the need for more invasive techniques such as fixation and fusion.

Objectives: Graft material can impact fusion rates in anterior lumbar interbody fusion (ALIF) procedures. We aimed to evaluate the clinical and radiographic outcomes of patients who underwent ALIF with a novel osteoinductive demineralised bone allograft (DBA) due to the paucity of peer reviewed literature. Methods: Includes 112 consecutive patients from 3 senior spine surgeons (multi-centre) undergoing stand-alone ALIF with osteoinductive DBA (Allovance® Crunch Plus) between January 1, 2019 and January 1, 2022. Patient reported outcome measures included visual analog scale (VAS) back pain, Oswestry disability index (ODI) and 12-Item Short Form Survey (SF-12) measured at preoperative, 6-week, 6-month, 12-month, and 24-month time points. CT imaging conducted postoperative day-2 for instrumentation positioning then at either 6-, 12- or 24-months for interbody fusion status. If fusion was achieved no further CTs were undertaken. Minimum follow-up was 12 months (12–24). Results: Mean age of cohort (51.8 % male) was 51.4 ± 14.1 years. Procedures consisted of; single level (n = 71), double level (n = 20), or quadruple level (n = 2) ALIF, and hybrid procedures (n = 19, disc replacement superior to ALIF). Preoperative mean VAS back (7.5 ± 1.5), and ODI (30.4 ± 7.8) significantly (p < 0.0001) decreased (2.5 ± 2.1, 12.2 ± 8.1); SF-12 physical (29.4 ± 5.7), and SF-12 mental (41.3 ± 12.2) showed improvements (p < 0.05) at 12-months follow-up (47.5 ± 8.8, 52.6 ± 7.6). Fusion was achieved at 6-months in 23.6 %, 12-months in 86.8 %, and 24-months in 93.4 % of patients. Nineteen (30.6 %) patients suffered acute (n = 8) and chronic (>6 months, n = 11) complications. Conclusions: Patients undergoing ALIF with this novel osteoinductive DBA demonstrated significant improvement in pain, disability and function with high fusion rates over 24-month follow-up.

Introduction: Gait analysis is a vital tool in the assessment of human movement and has been widely used in clinical settings to identify potential abnormalities in individuals. However, there is a lack of consensus on the normative values for gait metrics in large populations. The primary objective of this study is to establish a normative database of spatiotemporal gait metrics across various age groups, contributing to a broader understanding of human gait dynamics. By doing so, we aim to enhance the clinical utility of gait analysis in diagnosing and managing health conditions. Methods: We conducted an observational case–control study involving 313 healthy participants. The MetaMotionC IMU by Mbientlab Inc., equipped with a triaxial accelerometer, gyroscope, and magnetometer, was used to capture gait data. The IMU was placed at the sternal angle of each participant to ensure optimal data capture during a 50 m walk along a flat, unobstructed pathway. Data were collected through a Bluetooth connection to a smartphone running a custom-developed application and subsequently analysed using IMUGaitPY, a specialised version of the GaitPY Python package. Results: The data showed that gait speeds decrease with ageing for males and females. The fastest gait speed is observed in the 41–50 age group at 1.35 ± 0.23 m/s. Males consistently exhibit faster gait speeds than females across all age groups. Step length and cadence do not have clear trends with ageing. Gait speed and step length increase consistently with height, with the tallest group (191–200 cm) walking at an average speed of 1.49 ± 0.12 m/s, with an average step length of 0.91 ± 0.05 m. Cadence, however, decreases with increasing height, with the tallest group taking 103.52 ± 5.04 steps/min on average. Conclusions: This study has established a comprehensive normative database for the spatiotemporal gait metrics of gait speed, step length, and cadence, highlighting the complexities of gait dynamics across age and sex groups and the influence of height. Our findings offer valuable reference points for clinicians to distinguish between healthy and pathological gait patterns, facilitating early detection and intervention for gait-related disorders. Moreover, this database enhances the clinical utility of gait analysis, supporting more objective diagnoses and assessments of therapeutic interventions. The normative database provides a valuable reference future research and clinical practice. It enables a more nuanced understanding of how gait evolves with age, gender, and physical stature, thus informing the development of targeted interventions to maintain mobility and prevent falls in older adults. Despite potential selection bias and the cross-sectional nature of the study, the insights gained provide a solid foundation for further longitudinal studies and diverse sampling to validate and expand upon these findings.

Background: Gait analysis is a vital tool for evaluating overall health and predicting outcomes such as mortality and cognitive decline. This study explores how normal and obese BMI categories impact gait dynamics, addressing gaps in understanding the effect of body composition on specific gait parameters. Research Question: The primary objective is to investigate differences in spatiotemporal gait parameters—specifically, gait speed, step length, cadence, and double support time—between normal and obese BMI groups to understand the effects of obesity on gait. Methods: This observational case-control study analyzed spatiotemporal gait metrics from 163 participants, using inertial measurement units (IMUs) to collect data on various gait parameters. Statistical analyses explored the relationship between BMI categories and these metrics. Results: No significant differences were found in gait speed, cadence, stride duration, or double support time between the normal and obese groups. However, significant differences were identified in age, hypertension prevalence, balance problems, and the incidence of falls, emphasizing the complex effects of obesity on factors influencing gait stability. Significance: This study contributes to our understanding of obesity’s impact on gait by highlighting the need to consider associated health and stability parameters. These findings prompt a re-evaluation of how BMI is integrated into clinical gait assessments and emphasize the necessity for personalized healthcare strategies. This research highlights the importance of future studies with larger, more diverse populations and a wider array of biomechanical measures to dissect the relationship between BMI, body composition, and gait dynamics.

Background: Outcome measurement in lumbar surgery is traditionally performed using patient questionnaires that may be limited by subjectivity. Objective gait analysis may supplement patient assessment but must be clinically viable. We assessed gait metrics in lumbar spine patients pre- and postoperatively using a small and lightweight wearable sensor. Methods: This was a prospective observational study with intervention including 12 patients undergoing lumbar spine surgery and 24 healthy controls matched based on age and sex. All the subjects underwent gait analysis using the single-point wearable MetaMotionC sensor. The lumbar spine patients also completed traditional patient questionnaires including the Oswestry Disability Index (ODI). Results: The ODI score significantly improved in the patients from the baseline to six weeks postoperatively (42.4 to 22.8; p = 0.01). Simultaneously, the patients demonstrated significant improvements in gait asymmetry (asymmetry in step length, swing time, single support time, and double support time, by 17.4–60.3%; p ≤ 0.039) and variability (variability in gait velocity, step time, step length, stance time, swing time, single support time, and double support time, by 21.0–65.8%; p ≤ 0.023). After surgery, changes in most spatiotemporal (gait velocity, step length, stance time, swing time, and single limb support time) and asymmetry (asymmetry in step time, stance time, swing time, and single limb support time) metrics correlated strongly (magnitude of r = 0.581–0.914) and significantly (p ≤ 0.037) with changes in the ODI. Conclusions: Gait analysis using a single-point wearable sensor can demonstrate objective evidence of recovery in lumbar spine patients after surgery. This may be used as a routine pre- and postoperative assessment during scheduled visits to the clinic.

BACKGROUND:Degenerative Cervical Myelopathy (DCM) is the most common cause of non-traumatic, chronic spinal cord dysfunction worldwide, causing debilitating disability with a diminishing quality of life. The natural history of DCM is poorly understood. This is a preliminary report of the first 60 patients recruited to the MYelopathy NAtural History (MYNAH) Registry. METHODS:MYNAH Registry is an investigator-initiated, multicenter, prospective, non-interventional, longitudinal, national observational study (Registry ID ACSQHC-ARCR-258). Given the observational nature of the Registry, participants' clinical management plan is neither changed nor affected. Participants are recruited via an opt-in approach. A patient with DCM diagnosed by a spine/neurosurgeon after 1st January 2018 onwards is eligible to participate regardless of their surgical status. The Patient-Reported Outcome Measures (PROMs) are NDI, EQ5D5L and EQ-VAS; and the Practitioner-Reported Outcome Measures (PrROMs) are mJOA Score and Nurick Grade. RESULTS:Sixty participants (n = 60) have now been recruited of which male participants 34 (56.7%) and females are 26 (43.3%), with a mean age of 62.3 years (SD 14.1) and biospecimens for Proteomics have been collected from 33 (66%) participants. The median mJOA Score was 16.5 (8-18), with myelopathy severity recorded as mild in 42 (70%), moderate in 13 (21.7%) and severe in 5 (8.3%) participants. Median Nurick Grade 0 (0-5), NDI 14 (0-45), EQ5D5L Score 0.850 (-0.288-1) and EQ-VAS 70 (10-96). CONCLUSIONS:The MYNAH National DCM Registry in Australia is a novel spinal surgical initiative, that will inform the decision(s) to proceed with the scientific, evidence-based and personalised management of DCM globally in the future.

Background:Three-dimensional printing (3DP) is increasingly used to individualise surgery and may be an effective tool for representing patient anatomy. Current literature on patient-specific anatomical models (biomodels) for minimally invasive spinal surgery is a limited number of case series and cohort studies. However, studies investigating 3DP in other specialties have reported multiple benefits.Methods:This prospective study considered a series of patients (n=33) undergoing elective endoscopic spinal surgery, including combinations of microdiscectomy (n=27), foraminotomy (n=7), and laminectomy (n=3). These surgeries were conducted at vertebral levels ranging from L2/3 to L5/S1. The surgeon then recorded the impact on preoperational planning, intraoperative decision-making and accelerating the learning curve with a qualitative questionnaire.Results:There were benefits to planning in 54.5% of cases (n=18), improved intraoperative decision-making in 60.6% of cases (n=20). These benefits were reported more frequently earlier in the cases, with improvements to learning reported in 60% of the first five cases and not in subsequent cases. The surgeon commented that the biomodels were more useful on.Conclusions:The rates of preoperative and intraoperative benefits are consistent with existing studies, and the early benefit to the learning curve may be suitable for applications to surgical training. Additional research is required to determine the practicality of biomodels and their impact on patient outcomes for endoscopic spinal surgery.