Effectiveness of 6 surgical approaches for minimally invasive lumbar interbody fusion: 1-year follow-up results from a global multicentre study

Background: Minimally invasive lumbar interbody fusion (MI-LIF) procedures are an effective treatment for patients with degenerative lumbar disease (DLD). However, consensus does not exist among surgeons for selecting 1 approach over another. The objectives were to collect patientreported, surgical and fusion outcome data at 1 year after surgery for patients receiving either anterior lumbar interbody fusion (ALIF), direct lateral interbody fusion (DLIF), oblique lumbar interbody fusion (OLIF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF) or midline lumbar interbody fusion (MIDLF) for DLD. Methods: A total of 340 patients with DLD were consecutively enrolled in a prospective, global, multicentre cohort study (MASTERS-D2;NCT02617563). Patients were treated according to the surgeon's choice with 1 of 6 MI-LIF procedures. Outcome data for disability (Oswestry Disability Index), back and leg pain (Visual Analogue Scale), quality of life (EQ-5D) were collected at baseline, 4 weeks, 3 months and 12 months. Demographic, surgical and safety data were also recorded. Fusion status was assessed by using computed tomography or x-rays at 1 year (plus or minus 6 mo) after surgery. Paired sample t tests were used to test for improvement from baseline. Results: One year after surgery, patients attained clinically significant improvements on all patient-reported outcome measures regardless of approach used. Patients who were selected to receive an ALIF comprised the highest proportion of smokers, were the youngest and had the longest operating time, but low fluoroscopy exposure. Anterolateral (ALIF, DLIF, OLIF) compared with posterior (MIDLF, PLIF, TLIF) approaches had the least amount of blood loss, despite similar or longer surgical times. Within 1 year of follow-up, 7 device-related and 7 surgery-related serious adverse events (SAEs) had been recorded. Assessment of fusion was hindered by the effects of COVID-19. In total, 196 out of 340 (57.6%) patients were assessed. The aggregate fusion rate for anterolateral approaches was 88.1% and for posterior approaches 85.1% at 12 months of follow-up. Conclusion: All 6 approaches for MI-LIF surgery demonstrate favourable patient-reported and surgical outcomes for patients with DLD. Continuing data collection up to 5 years after surgery will yield information on long-term effectiveness, safety, health economics and revision surgery and on the long-term impact of surgeons' choice of approach.

SPINE20 recommendations 2021: spine care for people's health and prosperity.

PURPOSE: The focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability. METHODS: On September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments. RESULTS: In total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes. CONCLUSIONS: SPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe.

Successful Treatment of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19 (PIMS-TS) with Split Doses of Immunoglobulin G and Estimation of PIMS-TS Incidence in a County District in Southern Germany.

Pediatric inflammatory multisystem syndrome temporally associated with SARS Cov2 (PIMS-TS) is a newly encountered disease in children sharing clinical features with Kawasaki disease, toxic shock syndrome, or macrophage-activating syndrome. Pathogenically, it is associated with immune-mediated post-infectious hyperinflammation leading to short-term myocardial injury with yet unknown long-term outcome. We herein present three cases of PIMS-TS treated in our institution with divided doses of immunoglobulins and high dose acetyl salicylic acid, according to existing Kawasaki disease guidelines. Due to greater weight in adolescents affected and concerns of rheological sequelae following possible hyperviscosity, doses of immunoglobulins were divided and given 24 h apart with good tolerability. All patients recovered rapidly with normalization of previously encountered cardiac manifestations. As diagnosis of PIMS-TS should be made promptly, timing of therapy is of paramount importance for a favorable outcome. To date, no randomized controlled trial data exist concerning treatment recommendations. 1.8% (95% CI: 1.7% to 2.0%) of all children and adolescents in the county district of Ostallgäu were tested positive for SARS CoV-2, incidence of PIMS-TS was 1.7% (95% CI: 0.9% to 3.1%) among SARS CoV-2 positive tested earlier. As the pandemic is still ongoing, rising numbers of PIMS-TS in children might be expected.