Spine surgery has evolved tremendously over the last 2 decades, moving from conventional open spine surgery to minimally invasive spine surgery. Minimally invasive spine surgery prevents damage to the paraspinal muscles, reduces intraoperative blood loss, shortens the surgical time, and avoids traditional open surgery. Thus, in the majority of cases, recovery is much quicker and patients have less back pain after surgery. Previous literature has proven the advantages of uniportal full-endoscopic spine procedures and unilateral biportal endoscopy (UBE) procedures. However, a steep learning curve is a critical barrier for most endoscopic procedures. Recently, biportal endoscopic spine surgical methods have been developed to make it easier for aspiring spine surgeons to learn and implement. UBE utilizes 2 portals—namely, a working portal and a viewing portal—to perform spinal decompression. A right-handed surgeon stands on the left side of a prone and anesthesia induced patient to plan the working and viewing portals under C -arm fluoroscopy. The working portal is marked caudally on the medial pedicle line (caudal pedicle) targeting the spinolaminar junction of the cranial vertebra of the involved level, and the viewing portal is marked cranially, targeting the same spot on the same line on the cranial pedicle. A problem arises when the spinal pathology is located on the right side of the patient’s spine. Therefore, the authors describe a technique through which a right-handed surgeon can tackle a right-sided spinal pathology through a right-sided approach.

Objective: Older patients undergoing spine surgery present unique challenges due to age-related physiological changes and comorbidities. The choice of anesthetic plays a pivotal role in perioperative outcomes, yet limited data exist on optimal approaches in this vulnerable population. This study compared the safety and efficacy of general anesthesia (GA) versus spinal anesthesia (SA) in patients over 65 years of age undergoing lumbar spine surgery. Methods: A retrospective analysis was conducted on 150 patients over 65 years of age undergoing lumbar spine surgery between January 2021 and December 2023. Patients were equally divided into GA (n=75) and SA (n=75) groups. Demographics, surgical parameters, intraoperative data, and postoperative outcomes, including visual analogue scale (VAS), Oswestry Disability Index (ODI), time to analgesic requirement, length of hospital stay, and complication rates, were analyzed. Results: Baseline demographics and surgical parameters were comparable between groups. SA was associated with significantly lower VAS scores at 48 hours (3.02±0.60 vs. 4.65±0.68, p<0.001) and better ODI scores (38.94±4.12 vs. 43.25±4.75, p<0.001) compared to GA. Time to first analgesic requirement postoperatively was significantly delayed in SA (151.73±12.45 minutes vs. 61.25±5.82 minutes, p<0.001), along with shorter hospital stay (2.74±0.68 days vs. 3.24±0.74 days, p<0.001). Complication rates were comparable, though nausea/vomiting was significantly lower in patients who received SA (6.7% vs. 16%, p=0.04). Long-term VAS and ODI scores at 1 year were similar between groups. Conclusion SA offers significant early postoperative advantages in lumbar spine surgery in older patients, including superior pain control, faster recovery, and shorter hospitalization, without affecting long-term outcomes. It represents a safe and effective alternative to GA in older spine surgery patients.

Objective: Awake spine surgery has improved patient outcomes in common orthopaedic procedures. Integrating it into spine surgery is of interest to surgeons since it may reduce the difficulties and complications associated with general anaesthesia. The demand for safe spine surgery is rising due to healthcare improvements and increasing ageing population. This study aimed to assess the safety and feasibility of spine surgery under spinal anesthesia for elderly patients aged 65 and older. Methods: In a retrospective review, 83 lower lumbar spine surgeries performed under spinal anesthesia by a single surgeon at a single hospital from 2015 to 2019 were examined. All procedure-related data was collected prospectively for analysis. This study explored demographic characteristics, surgical features, perioperative concerns, and anesthesia-related obstacles in spine surgery under spinal anaesthesia. Results: This study included 83 patients aged 65 years and older. Following follow-up, visual analogue scale and Oswestry Disability Index scores considerably improved (p<0.05). Patients in the American Society of Anesthesiologists physical characteristics classification grade II had the highest count. The most common level was L4–5. About 7.2% of patients needed multiple spinal procedures. The average induction time was 20.2±9.6 minutes. The average intraoperative operation lasted 84.0±17.20 minutes. The shifting-out process took 7.95±2.10 minutes to start. The mean intraoperative arterial blood pressure was 70.7±10.8 mmHg, and the mean heart rate was 69.0±7.2 beats per minute. The average postoperative analgesia initiation time was 79.9±7.7 minutes. The average postoperative stay was 3.02±0.83 days. In 10.8% of individuals, cerebrospinal fluid was found. 1.2% of patients experienced postoperative hypotension, 12% experienced nausea and vomiting. Infection occurred in 2.4% of patients, and 14.5% experienced post-operative urinary retention. Conclusion This case series shows that older patients can undergo lumbar fusion, decompression surgeries under spinal anesthesia with a skilled anaesthesia team. Additionally, spinal anaesthesia substantially minimised dangers and concerns related with general aanaesthesia.

Objective: Kyphoscoliosis is the most common deformity seen in patients with neurofibromatosis type 1 (NF1), occurring in 10%–60% of cases. These dystrophic curves often exhibit severe deformities that require surgical intervention. Various procedures have been evaluated and studied; however, there is no consensus, and these are also associated with a higher rate of morbidity. Therefore, this study aimed to evaluate the clinical and radiological outcomes of apical spinal osteotomy (ASO) in NF1 patients with dystrophic curves who exhibited thoracic, thoracolumbar, or lumbar kyphoscoliosis. Methods: We conducted a retrospective analysis of prospectively collected data involving 21 children with dystrophic NF1 curves who underwent ASO at a single tertiary care center from November 2009 to June 2017. The efficacy of ASO for correcting coronal and sagittal deformities was assessed. Clinical outcomes (visual analogue scale [VAS], Oswestry Disability Index [ODI], and Frankel grade) and radiological outcomes (Cobb angle correction, fusion, and complications) were evaluated. Results: The study included 21 patients (11 males, 10 females) with a mean age at surgery of 9.33 years. The mean kyphotic Cobb angle improved significantly from 98.33° to 36.52°. The mean sagittal vertical axis also improved significantly from 7.40 cm to 4.21 cm, along with significant improvements in VAS and ODI scores. Conclusion This study describes a technique using a posterior approach for single-level ASO in the treatment of severe dystrophic NF1 curves. The technique can be effective in children with mild to moderate curves, yielding good clinicoradiological outcomes and satisfactory correction rates.