Objective: This study aimed to compare the long-term radiographic incidence of adjacent segment degeneration (ASD) following minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) versus open TLIF (O-TLIF) in a matched cohort, and to identify radiographic parameters associated with the development of kyphosis-type ASD. Methods: A retrospective matched-pair analysis was conducted involving 60 patients (30 MIS-TLIF and 30 O-TLIF) who underwent single-level TLIF between 2004 and 2009 and had a minimum follow-up of 8 years. Patients were matched for age (±3 years), sex, body mass index (±2 kg/m²), and operative level. Radiographic ASD was defined as greater than 50% disc-height loss, greater than 3 mm of listhesis, or greater than 10° of kyphotic change at the adjacent segment. Continuous variables were analyzed using independent-sample t-tests or Mann-Whitney U-tests, as appropriate, and categorical variables were analyzed using chi-square or Fisher exact tests, with statistical significance set at p<0.05. Results: The mean follow-up duration was 8.9±1.2 years. The MIS-TLIF group had a significantly shorter hospital stay than the O-TLIF group (3.4±1.7 days vs 6.0±2.3 days, p<0.001). Radiographic ASD occurred significantly less frequently in the MIS-TLIF group at 2 years (3.3% vs. 23.3%, p=0.023), but no significant difference was observed at ≥8 years of follow-up (43.3% vs. 50.0%, p=0.605). An increased Cobb angle at the superior adjacent level was significantly associated with kyphosis-type ASD (p=0.017). No demographic characteristics or preoperative magnetic resonance imaging parameters were found to predict ASD occurrence. Conclusion MIS-TLIF demonstrated an early radiographic advantage in reducing ASD compared with O-TLIF; however, this advantage diminished over time. Long-term ASD appears to be multifactorial, with sagittal imbalance playing a more prominent role in the progression of kyphosis-type ASD than the surgical approach itself.

Objective: This review aimed to synthesize and critically appraise the existing evidence on endoscopic-assisted anterior odontoid screw fixation, with the objectives of clarifying its current clinical utility and identifying priorities for future optimization of the technique. Methods: A systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and registered with PROSPERO (registration number: CRD420251251051). Searches of PubMed/MEDLINE, Embase, Scopus, Web of Science, and Google Scholar identified studies reporting the use of endoscopic visualization during anterior odontoid screw placement. Eligible study designs included clinical reports and cadaveric investigations. Extracted data encompassed patient demographics, fracture subtype, operative technique, radiological alignment, fusion status, perioperative complications, and risk of bias, which was assessed using the modified Joanna Briggs Institute checklist. Results: Eight studies met the inclusion criteria, comprising 6 clinical reports and 2 cadaveric feasibility studies. The extent of endoscopic assistance ranged from hybrid mini-open approaches to fully endoscopic uniportal techniques. Reported fusion rates ranged from 80% to 100%, with fully endoscopic procedures demonstrating the most consistent radiological consolidation and anatomical reduction. No major neurovascular, aerodigestive, or implant-related complications were reported. Cadaveric evidence confirmed enhanced visualization of the C2 odontoid entry point and validated safe screw entry-point orientation with acceptable screw trajectories. Risk-of-bias assessment indicated low risk in 5 studies and moderate risk in 3. Small sample sizes, heterogeneous fracture morphology, and modest follow-up durations limited the overall quality of the evidence. Conclusion Endoscopic-assisted anterior odontoid screw fixation appears to be a technically feasible and biologically favorable minimally invasive option for selected odontoid fractures. Its potential advantages include improved visualization and reduced approach-related morbidity. Further prospective, multicenter investigations, particularly those integrating navigation systems, are required to define its definitive role in the management of cervical spine trauma.

Objective: Cervical spine surgery presents unique technical challenges because of the small and complex anatomy of the cervical vertebrae and the high risk of neurovascular complications. Recent advances in 3-dimensional (3D) printing and navigation technologies have been introduced to improve screw placement accuracy, reduce surgical risk, and potentially shorten operative time. In this systematic review, we aimed to summarize currently available evidence and to describe selected studies evaluating 3D-printed navigation templates and intraoperative computer-assisted navigation systems for cervical pedicle screw placement. Methods: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A literature search was performed for publications published between 2019 and 2024 using the following search terms: (“cervical spine” OR “navigation-assisted system”) OR (“3D printing template” OR “computer-assisted system”). A total of 130 articles met the initial screening criteria, of which 8 studies were included in the final analysis after application of predefined inclusion and exclusion criteria. Results: Eight studies were included in the final systematic review and network meta-analysis. The findings indicated that 3D-printed templates demonstrated higher accuracy, reaching up to 95.8% (risk ratio [RR], 1.17), and fewer deviations compared with computer-assisted navigation (RR, 1.05) and traditional techniques (RR, 1.0). Computer-assisted navigation showed greater heterogeneity across studies. However, no statistically significant difference in outcomes was observed between 3D-printed templates and computer-assisted navigation systems. Conclusion Navigation-assisted cervical pedicle screw fixation is effective, and both 3D-printed templates and computer-assisted navigation techniques provide advantages in terms of accuracy and procedural safety.

Objective: Full endoscopic cervical surgery (FECS) is an evolving minimally invasive approach for treating cervical spine disorders. This systematic review synthesizes current evidence on the clinical outcomes and patient perspectives associated with FECS, specifically evaluating its safety, efficacy, and overall patient satisfaction. Methods: A systematic search of the PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies published between January 2000 and September 2024 that reported on clinical outcomes or patient perspectives related to FECS were included. Risk of bias was assessed using the ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) tool and the Cochrane Risk of Bias tool. Inclusion criteria encompassed randomized controlled trials, prospective cohort studies, retrospective studies, and observational studies focused on adult populations undergoing FECS for cervical spine surgery. Results: The final synthesis included 30 studies. FECS was associated with significant reductions in both cervical and radicular pain, as well as meaningful functional improvements, measured by standardized clinical scales such as the Neck Disability Index and visual analogue scale. Patient satisfaction rates were consistently high, with most studies reporting satisfaction exceeding 85%. Complication rates were low, primarily involving transient neurological deficits that were typically resolved without the need for further intervention. Nonrandomized studies generally presented a moderate risk of bias due to confounding and selection, whereas randomized controlled trials exhibited a low risk of bias. Conclusion FECS is a safe and effective minimally invasive surgical option for cervical spine disorders associated with substantial pain relief, functional improvement and high levels of patient satisfaction.

Obesity presents significant challenges in spinal surgery, including higher rates of perioperative complications, prolonged operative times, and delayed recovery. Traditional open spine surgery often exacerbates these risks, particularly in patients with obesity, because of extensive tissue dissection and larger incisions. Endoscopic spine surgery (ESS) has emerged as a promising minimally invasive alternative, offering advantages such as reduced tissue trauma, minimal blood loss, lower infection rates, and faster recovery. This systematic review and meta-analysis aimed to evaluate the safety, efficacy, and outcomes of ESS techniques, including fully endoscopic and biportal endoscopic lumbar discectomy and decompression, in patients with obesity and lumbar spine pathologies. A comprehensive literature search of the PubMed/Medline, Embase, and Scopus databases yielded 2,975 studies published between 2000 and 2024, of which 10 met the inclusion criteria. The meta-analysis revealed significant improvements in pain relief (Visual Analog Scale) and functional outcomes (Oswestry Disability Index), with comparable results between patients with and without obesity. Patients who are obese experienced longer operative times and have a slightly higher risk of symptom recurrence; however, ESS demonstrated lower rates of wound infections, shorter hospital stays, and faster recovery than traditional surgery. These findings position ESS as a viable and effective option for managing lumbar spine conditions in patients with obesity, addressing obesity-related surgical challenges while maintaining favorable clinical outcomes. However, limitations such as study heterogeneity and the lack of randomized controlled trials highlight the need for further high-quality research to refine ESS techniques and optimize patient care in this high-risk population.

Biportal endoscopic spinal surgery (BESS) with interbody fusion is a relatively novel minimally invasive technique that was developed to reduce soft tissue trauma and intraoperative blood loss and shorten recovery time while achieving comparable clinical outcomes for lumbar degenerative diseases. Despite the growing interest in BESS, a comprehensive analysis of its effectiveness, complication rates, and long-term outcomes remains lacking. This systematic review evaluated the clinical outcomes, surgical efficacy, and complication rates of BESS with interbody fusion for lumbar degenerative diseases. Recent literature on endoscopic lumbar interbody fusion was included to expand the scope and gain new perspectives, thereby, providing a comparative analysis that highlighted the advantages, limitations, and emerging trends in minimally invasive spine surgery. This review synthesized current evidence to guide future research and clinical applications. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and using a combination of MeSH (Medical Subject Headings) terms and relevant keywords, PubMed/Medline and Scopus databases were systematically searched for studies published between January 2000 and September 2024. The studies were assessed using the ROBINS-I (Risk of Bias in Nonrandomized Studies of Interventions) tool to determine the risk of bias. From the 12 studies that provided clinical evidence, the data extracted were patient demographics; operative time; blood loss; clinical outcomes, such as Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores and fusion rates; and complications. The mean operative time ranged from 98 to 206 minutes, with fusion rates between 70% and 95%. Most studies reported significant improvements in VAS scores for back and leg pain and ODI scores. Complications, including dural tears (2.9%–6.4%) and hematomas (1.4%–4.3%), were infrequent but notable. BESS with interbody fusion demonstrated excellent clinical outcomes, high fusion rates, and few complications. Although these results are promising, more randomized controlled trials and long-term studies are required to confirm the broader applicability, particularly in more complex or multilevel spinal pathologies.

Methods: This study included 41 patients with single-level grades 1 or 2 LS from February 2023 to February 2024. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI). Bridwell fusion grades were evaluated via lumbar spine computed tomography performed 6 months postoperatively. Results: Over a mean follow-up period of 10.6 months (range, 7–18 months), significant improvements were observed in VAS scores for low back pain (from 7.8±0.8 to 2.1±1.4) and leg pain (from 8.1±1.3 to 1.9±1.5) as well as ODI scores (from 50.4±15.4 to 14.8±10.5). The cohort consisted of patients with grades 1 (73.2%) and 2 LS (26.8%) at L4–L5 (58.6%), L5–S1 (34.1%), and L3–L4 (7.3%) levels. The mean operation time was 182.8±36.4 minutes, with a mean intraoperative blood loss of 190.5±81.3 mL and a mean hospital stay of 7.2±3.6 days. Successful fusion (Bridwell grades I/II) was achieved in 82.9% of the cases, with a 4.9% incidence of cage subsidence. Minor complications included durotomies in two patients (4.9%), whereas no major complications, such as nerve root injury, hardware-related issues, or postoperative infections, were reported. Conclusions The described BE-LIF technique, using HA bone grafts, which are an autologous bone from the preserved IAP, and a TLIF cage, is a viable, safe, and effective option for treating low-grade LS. This approach achieves favorable clinical outcomes and high fusion rates, which provides a cost-effective alternative to advanced surgical implants.

Methods: A total of 68 patients with symptomatic, low-grade DLS and moderate-to-severe central canal stenosis underwent ULBD using BESS. Patients were followed for at least 2 years. Clinical outcomes were measured using the Visual Analog Scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and the modified Macnab criteria for patient satisfaction. Radiological outcomes were assessed on the basis of sagittal translation from dynamic flexion–extension radiographs. Results: The mean VAS score for back pain decreased from 3.8±2.4 preoperatively to 1.9±2.0 at the final follow-up, and the leg pain scores decreased from 6.4±1.8 to 2.3±2.0 (both p<0.05). The ODI score improved significantly from 48.9±15.7 preoperatively to 23.1±17.5 at the final follow-up (p<0.05). According to the modified Macnab criteria, 27.9%, 42.6%, 22.1%, and 7.4% of the patients reported excellent, good, fair, and poor outcomes. Radiological assessments indicated no significant changes in sagittal translation, supporting the preservation of spinal stability. Conclusions BESS with ULBD represents a safe and effective minimally invasive approach for treating low-grade DLS with central canal stenosis. It offers substantial symptom relief and functional improvement without jeopardizing spinal stability, making it a viable alternative to conventional fusion surgery.