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.

Methods: In a 24-month follow-up retrospective study, 191 patients with osteoporotic vertebral compression fractures were randomly assigned to the bisphosphonate group (n=104) or the teriparatide group (n=87), with patients opting for their treatment between January 2016 and October 2020. Demographic data and patient-reported outcomes scores, including the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), union rates, and kyphosis progression, were assessed at baseline, 6 months, 1 year, and 2 years after treatment. Results: Both groups had a significant decrease in VAS, from 8.38±0.74 to 3.15±1.40 in the bisphosphonate group and from 8.49±0.73 to 1.11±0.31 in the teriparatide group. The ODI scores reduced significantly at 2-year follow-ups, recording 25.02±13.94 and 15.11±2.17 in the bisphosphonate and teriparatide groups, respectively. Risks of nonunion development were slightly higher at 11.53% in the bisphosphonate group and 8.63% in the teriparatide group required operative intervention. The kyphosis progression angles were also significantly lower in the teriparatide group (4.97°±0.78°) than in the bisphosphonate group (8.09°±1.25°). Conclusions Over time, numerous studies have demonstrated the efficacy of bisphosphonates and teriparatide in ameliorating pain. In this study, the efficacy of teriparatide surpassed that of bisphosphonates in certain aspects, such as the initial 6-month union rates and reduction in the progression of segmental kyphosis. However, bisphosphonates and teriparatide yield similar and favorable union rates at 1 year and final follow-up.

Retrospective cohort.

Retrospective cohort.

Methods: The study included 200 patients (164 females, 36 males) undergoing primary TKR. Follow-up was performed at 4 weeks, 3, 6, 12, and 24 months. Lumbar spine and knee symptom improvements were assessed using the Oswestry Disability Index (ODI) and Oxford Knee Score, respectively. Results: All 200 patients undergoing bilateral TKR presented with radiographic lumbar spine degenerative pathology; 60% (n=120) of the patients presented with moderate to severe clinical symptoms of lumbar spondylosis, including 54% (n=108) with degenerative lumbar spondylosis and lumbar canal stenosis and 6% (n=12) with degenerative spondylolisthesis. Of the 120 patients who presented with lumbar spine problems, 90% (n=108) reported improvement in their symptoms; the ODI score improved from 42.5%±4.1% preoperative score to 15.6%±2.3% postoperative score (p -value<0.001). Of the 12 patients with no improvement, 10 patients underwent percutaneous procedures for their lumbar spine pathology with good results, one patient underwent surgery, and one declined any intervention. Conclusions A significant number of patients (60%) undergoing bilateral TKR also present with symptomatic lumbar spine problems. Patients with mild to moderate lumbar spine degenerative symptoms and no associated severe radiating pain on activity are more likely to experience relief of their symptoms post-TKR.

Methods: In total, 225 cases (450 top screws; MIS-TIFL, 120; OPEN-TILF, 105) undergoing single-level lower lumbar fusion were included in the study. Postoperative computed tomography grading system was used to evaluate iatrogenic SFV. Patient and surgical factors such as age, body mass index, top-screw level, side of the top screw, depth of the spine, and superior facet joint angle (SFA) were analyzed in iatrogenic SFV and non-violation groups to determine their influence on iatrogenic SFV. The clinical outcomes in both groups were assessed preoperatively and postoperatively. Results: The overall incidence of iatrogenic SFV and high-grade violations was higher in MIS-TLIF (41.25%) than in OPEN-TLIF (30.4%). In both groups, bivariate analysis showed a significantly greater incidence of the iatrogenic SFV in patients aged <60 years and those with obesity, top pedicle screws at L4, right-sided top screws, SFA >35°, and depth of the spine >50 mm. Conclusions This study demonstrated that the incidence of iatrogenic SFV is greater in MIS-TLIF than in OPEN-TLIF at a single lower lumbar level. MIS-TLIF is effective for lumbar degenerative disease; however, the incidence of iatrogenic SFV was higher. Patient and surgical factors must be considered to protect the facet joints in both TLIF methods to avoid ASD.