Methods: The study included patients with OVFs undergoing VP with or without SS from 2017 to 2021. Baseline demographic and patient-reported outcome scores, including Oswestry Disability Index (ODI) and European Quality-of-Life-5 Dimensions (EQ-5D), were collected preoperatively and 1 year postoperatively. Radiographic outcomes, including Cobb angle, sagittal angle reduction, and kyphotic progression, were assessed. Perioperative data were gathered. Propensity-score matching was conducted to compare both groups after adjusting for baseline characteristics. Results: This study included 60 patients. The subsequent analyses included 19 patients in both the SS+VP group and the VP groups after matching patient cohorts across various covariates. The SS+VP group demonstrated better ODI (30.38±17.12 vs. 49.68±19.43, p=0.0025) and EQ-5D scores (0.80±0.19 vs. 0.6±0.31, p=0.0018) at 1 year postoperative. Sagittal angle correction was higher in the SS+VP group (10.63°±6.34° vs. 5.74°±5.91°, p=0.0188). The SS+VP group exhibited higher blood loss and longer operative time. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar between the two groups. Conclusions SS with VP generated superior patient-reported outcomes and sagittal angle correction for OVFs when evaluated one year postoperatively compared to VP alone. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar despite increased blood loss and extended operative time.

Methods: The study included patients with OVFs undergoing VP with or without SS from 2017 to 2021. Baseline demographic and patient-reported outcome scores, including Oswestry Disability Index (ODI) and European Quality-of-Life-5 Dimensions (EQ-5D), were collected preoperatively and 1 year postoperatively. Radiographic outcomes, including Cobb angle, sagittal angle reduction, and kyphotic progression, were assessed. Perioperative data were gathered. Propensity-score matching was conducted to compare both groups after adjusting for baseline characteristics. Results: This study included 60 patients. The subsequent analyses included 19 patients in both the SS+VP group and the VP groups after matching patient cohorts across various covariates. The SS+VP group demonstrated better ODI (30.38±17.12 vs. 49.68±19.43, p=0.0025) and EQ-5D scores (0.80±0.19 vs. 0.6±0.31, p=0.0018) at 1 year postoperative. Sagittal angle correction was higher in the SS+VP group (10.63°±6.34° vs. 5.74°±5.91°, p=0.0188). The SS+VP group exhibited higher blood loss and longer operative time. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar between the two groups. Conclusions SS with VP generated superior patient-reported outcomes and sagittal angle correction for OVFs when evaluated one year postoperatively compared to VP alone. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar despite increased blood loss and extended operative time.

Methods: The study included patients with OVFs undergoing VP with or without SS from 2017 to 2021. Baseline demographic and patient-reported outcome scores, including Oswestry Disability Index (ODI) and European Quality-of-Life-5 Dimensions (EQ-5D), were collected preoperatively and 1 year postoperatively. Radiographic outcomes, including Cobb angle, sagittal angle reduction, and kyphotic progression, were assessed. Perioperative data were gathered. Propensity-score matching was conducted to compare both groups after adjusting for baseline characteristics. Results: This study included 60 patients. The subsequent analyses included 19 patients in both the SS+VP group and the VP groups after matching patient cohorts across various covariates. The SS+VP group demonstrated better ODI (30.38±17.12 vs. 49.68±19.43, p=0.0025) and EQ-5D scores (0.80±0.19 vs. 0.6±0.31, p=0.0018) at 1 year postoperative. Sagittal angle correction was higher in the SS+VP group (10.63°±6.34° vs. 5.74°±5.91°, p=0.0188). The SS+VP group exhibited higher blood loss and longer operative time. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar between the two groups. Conclusions SS with VP generated superior patient-reported outcomes and sagittal angle correction for OVFs when evaluated one year postoperatively compared to VP alone. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar despite increased blood loss and extended operative time.

This study aims to demonstrate the surgical technique of inserting a larger cage, typically used in the oblique lateral interbody fusion (OLIF) approach, through the unilateral biportal endoscopic trans-Kambin triangle lumbar interbody fusion (UBE-KLIF) method to maximize the cage footprint and increase fusion rates with minimal tissue disruption. UBE-KLIF is a minimally invasive alternative to traditional open and other fusion methods, and it is particularly suitable for patients without central spinal stenosis where decompression is unnecessary. In this case, a 68-year-old woman with L4–5 spondylolisthesis and instability, presenting with low back pain radiating to her left lower limb, was treated using the UBE-KLIF approach. A large OLIF cage (50 mm×18 mm×10 mm) was successfully inserted, achieving an endplate-to-cage footprint ratio of 46.8%. The procedure minimized tissue disruption while enabling the use of a larger cage, which could potentially improve the fusion rate. This technique demonstrates the feasibility and effectiveness of inserting a larger OLIF cage via the UBE-KLIF approach in patients without central stenosis, offering a promising minimally invasive option for improving fusion outcomes.

Methods: LSS patients with predominant NIC symptoms for ≥3 months were randomized (1:1:1) to receive GBA (1,800 mg/day), PGB (300 mg/day), or placebo in addition to standard conservative management, including physical therapy and naproxen. GBA and PGB were both titrated to the effective dose over 14 days. The primary outcome was NIC pain measured by Visual Analog Scale (VAS). Secondary outcomes included the Swiss Spinal Stenosis Score (SSS), self-paced shuttle walk test (SPSWT; time to NIC symptoms and walking distance), Euro-QoL Group’s 5-Dimension, 5-Level (EQ-5D-5L), and adverse effects. All outcomes were assessed monthly over 4 months. Results: Ninety patients (mean age, 63.14 years; symptoms duration, 19.38 months) were included. All groups demonstrated significant improvements in VAS, SSS, SPSWT, and EQ-5D-5L at 4 months. At 1 and 2 months, PGB showed greater EQ-5D-5L improvement compared to GBA (mean differences: 0.07 [p=0.045] and 0.08 [p=0.001], respectively). No significant differences in other outcomes were observed between groups at any time point. Adverse effects, including dizziness and sedation, were more common in the GBA and PGB groups compared to placebo (p<0.001). Conclusions GBA and PGB did not demonstrate superior efficacy over placebo in reducing NIC and improving functional outcomes in LSS. Moreover, their use was associated with a higher incidence of adverse effects. These findings suggest limited utility for gabapentinoids as adjunctive treatments for LSS.

Methods: A registry of patients who underwent surgery (instrumentation, decompression, or fusion) for spinal metastases between 2004 and 2018 was used. The outcome measure was survival at postoperative days 90, 180, and 365. Preoperative variables were used to develop machine-learning algorithms to predict survival chance in each period. The performance of the algorithms was measured using the area under the receiver operating characteristic curve (AUC). Results: A total of 389 patients were identified, with 90-, 180-, and 365-day mortality rates of 18%, 41%, and 45% postoperatively, respectively. The XGBoost algorithm showed the best performance for predicting 180-day and 365-day survival (AUCs of 0.744 and 0.693, respectively). The CatBoost algorithm demonstrated the best performance for predicting 90-day survival (AUC of 0.758). Serum albumin had the highest positive correlation with survival after surgery. Conclusions These machine-learning algorithms showed promising results in predicting survival in patients who underwent spinal palliative surgery for spinal metastasis, which may assist surgeons in choosing appropriate treatment and increasing awareness of mortality-related factors before surgery.

Ossification of the ligamentum flavum (OLF) in the thoracic spine is a cause of thoracic myelopathy that is more commonly found in East Asian populations (Koreans, Japanese, Chinese) than in others. Early diagnosis and sufficient surgical decompression can improve the functional prognosis for thoracic OLF. Surgical decompression is necessary and should be done as soon as the symptoms develop. There is a wide range of possible treatments, from standard open laminectomy to endoscopic decompression surgery. This video demonstrates the least invasive technique of decompressive laminectomy with bilateral decompression and removal of thoracic OLF through unilateral biportal endoscopic spinal surgery. The authors present the case of an 81-year-old male patient who presented with bilateral lower extremity weakness, numbness, pain, and ataxia. Magnetic resonance imaging and computed tomography scans of the whole spine showed the presence of OLF with severe spinal canal stenosis and a cord signal change at the T9–10 level. He underwent biportal endoscopic decompression and removal of thoracic OLF at T9–10. On the discharge day (postoperative day 7), motor power and pain had significantly improved. He could stand and independently ambulate with a walker.

Methods: This retrospective study included patients who underwent spinal metastasis at a university-based medical center in Thailand between January 2009 and November 2021. Collected data included preoperative parameters and ambulatory status 90 and 180 days following surgery. Thirteen machine-learning algorithms, namely, artificial neural network, logistic regression, CatBoost classifier, linear discriminant analysis, extreme gradient boosting, extra trees classifier, random forest classifier, gradient boosting classifier, light gradient boosting machine, naïve Bayes, K-neighbor classifier, Ada boost classifier, and decision tree classifier were developed to predict ambulatory status 90 and 180 days following surgery. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and F1-score. Results: In total, 167 patients were enrolled. The number of patients classified as ambulatory 90 and 180 days following surgery was 140 (81.9%) and 137 (82.0%), respectively. The extreme gradient boosting algorithm was found to most accurately predict 180-day ambulatory outcome (AUC, 0.85; F1-score, 0.90), and the decision tree algorithm most accurately predicted 90-day ambulatory outcome (AUC, 0.94; F1-score, 0.88). Conclusions Machine-learning algorithms were effective in predicting ambulatory status following surgery for spinal metastasis. Based on our data, the extreme gradient boosting and decision tree best predicted postoperative ambulatory status 180 and 90 days after spinal metastasis surgery, respectively.