Comparative Analysis of Microendoscopic and Open Laminectomy for Single-Level Lumbar Spinal Stenosis at L1-L2 or L2-L3.

BACKGROUND: Several reports have highlighted comparable surgical outcomes between microendoscopic laminectomy (MEL) and open laminectomy (open) for lumbar spinal stenosis. However, the unilateral approach in MEL may present challenges for the upper lumbar levels, where facet joints are located deeper inside. Our objective was to compare surgical outcomes and radiographic evaluations for single-level decompression cases at L1-L2 or L2-L3 between MEL and open laminectomy. METHODS: We analyzed patients who underwent single-level decompression for upper lumbar spinal stenosis at 12 distinguished spine centers from April 2017 to September 2021. Baseline demographics, preoperative, and 1-year postoperative patient-reported outcomes, along with imaging parameters, were compared between the MEL and open groups. To account for potential confounding, patients' backgrounds were adjusted using the inverse probability weighting method based on propensity scores. RESULTS: Among the 2487 patients undergoing decompression surgery, 118 patients (4.7%) underwent single-level decompression at L1-L2 or L2-L3. Finally, 80 patients (51 in the MEL group, 29 in the open group) with postoperative data were deemed eligible for analysis. The MEL group exhibited significantly improved postoperative EuroQol 5-Dimension values compared to the open group. Additionally, the MEL group showed a lower facet preservation rate according to computed tomography examination, whereas the open group had a higher incidence of retrolisthesis. CONCLUSIONS: Although overall surgical outcomes were similar, the MEL group demonstrated potential advantages in enhancing EuroQol 5-Dimension scores. The MEL group's lower facet preservation rate did not translate into a higher postoperative instability rate.

A Case of Remote Cerebellar Hemorrhage in Spinal Surgery without Dural Injury: Case Report.

Introduction: Remote cerebellar hemorrhage (RCH) has been reported as a serious complication of spine surgery and is considered to be caused by dural injury. However, we have experienced a case in which intracranial hemorrhage occurred immediately after lumbar spine surgery without dural tear. There were no reports of RCH in spinal surgery without dural injury as far as we could find. Case Report: We described a rare presentation of an 80-year-old male who suffered a loss of consciousness after lumbar surgery. He was diagnosed with impaired consciousness due to chronic and acute intracranial hemorrhage. He went through two hematoma removal surgeries and his consciousness improved. Conclusion: RCH can occur in spinal surgery in patients with predicted cerebrovascular fragility, even in the absence of dural injury. Pre-operative imaging evaluation could be useful in assessing cerebrovascular fragility.

Quality of Life and Postoperative Satisfaction in Patients with Benign Extramedullary Spinal Tumors: A Multicenter Study.

STUDY DESIGN: Retrospective cohort study using prospectively collected registry data. OBJECTIVE: The purpose of this study is to evaluate health-related quality of life (HRQOL) and postoperative satisfaction in patients with different histotypes of benign extramedullary spinal tumors (ESTs). BACKGROUND: Little is known about how different histotypes influence HRQOL and postoperative satisfaction in EST patients. MATERIALS AND METHODS: Patients undergoing primary benign EST surgery at 11 tertiary referral hospitals between 2017 and 2021 who completed preoperative and 1-year postoperative questionnaires were included. HRQOL assessment included the Physical Component Summary and Mental Component Summary (MCS) of Short Form-12, EuroQol 5-dimension, Oswestry/Neck Disability Index (ODI/NDI), and Numeric Rating Scales (NRS) for upper/lower extremities (UEP/LEP) and back pain (BP). Patients who answered "very satisfied," "satisfied," or "somewhat satisfied" on a seven-point Likert scale were considered to be satisfied with treatment. Student t -tests or Welch's t -test were used to compare continuous variables between two groups, and one-way analysis of variance was used to compare outcomes between the three groups of EST histotypes (schwannoma, meningioma, atypical). Categorical variables were compared using the χ 2 test or Fisher exact test. RESULTS: A total of 140 consecutive EST patients were evaluated; 100 (72%) had schwannomas, 30 (21%) had meningiomas, and 10 (7%) had other ESTs. Baseline Physical Component Summary was significantly worse in patients with meningiomas ( P =0.04), and baseline NRS-LEP was significantly worse in patients with schwannomas ( P =0.03). However, there were no significant differences in overall postoperative HRQOL or patient satisfaction between histology types. Overall, 121 (86%) patients were satisfied with surgery. In a subgroup analysis comparing intradural schwannomas and meningiomas adjusted for patient demographics and tumor location with inverse probability weighting, schwannoma patients had worse baseline MCS ( P =0.03), ODI ( P =0.03), NRS-BP ( P <.001), and NRS-LEP ( P =0.001). Schwannoma patients also had worse postoperative MCS ( P =0.03) and NRS-BP ( P =0.001), with no significant difference in the percentage of satisfied patients ( P =0.30). CONCLUSIONS: Patients who underwent primary benign EST resection had a significant improvement in HRQOL postoperatively, and ~90% of these patients reported being satisfied with their treatment outcomes one year after surgery. EST patients may exhibit a relatively lower threshold for postoperative satisfaction compared with patients undergoing surgery for degenerative spine conditions.

Skipping Pedicle Screw Insertion Into Infected Vertebra is a Risk Factor for Revision Surgery for Pyogenic Spondylitis in the Lower Thoracic and Lumbar Spine.

BACKGROUND: Surgical intervention for pyogenic spondylitis is indicated when conservative treatment fails and biomechanical instability persists. Whether to insert pedicle screws into all vertebrae, including the most erosive vertebrae, or whether to skip 1 vertebra in pedicle screw insertion remains controversial. METHODS: A single-institution retrospective cohort study was conducted in consecutive patients with pyogenic spondylitis in the lower thoracic and lumbar spine (T9-S1) between January 2008 and December 2016. The patients were treated with interbody fusion plus posterior stabilization using pedicle screws and were divided into 2 groups as follows: (1) patients in whom 1 vertebra, usually the most erosive, was skipped in pedicle screw insertion (Group Skipping) and (2) pedicle screw insertion into all vertebrae (Group All). Patients' operation data were evaluated, and clinical outcomes were compared between the 2 groups. There were no significant differences between the 2 groups in terms of age, sex, past histories, blood loss, operation time, the presence of abscesses, or operative approach. RESULTS: The length of fixation was greater by 1 vertebral level in the Group Skipping than in the Group All, and the rate of revision surgery for pseudarthrosis was higher in the Group Skipping than in the Group All (P = .02). There was no statistically significant difference between the 2 groups in terms of the mean segmental lordotic angle or Barthel Index. CONCLUSIONS: Skipping pedicle screw insertion for pyogenic spondylitis in posterior fixation led to an increased number of fixed vertebrae and may be a risk factor for revision surgery for pseudarthrosis. LEVEL OF EVIDENCE: 4. CLINICAL RELEVANCE: The insertion of short pedicle screws at the infected vertebra can prevent early treatment failure and increase the biomechanical stability of construct.