BACKGROUND: Morphometric analysis of the psoas major muscle has shown utility in predicting postoperative morbidity in various surgical fields, but its usefulness in predicting complications in elderly patients undergoing multilevel lumbar fusion surgery has not been studied. The study aimed to investigate if psoas major parameters are independent risk factors of early postoperative complication among elderly patients.
METHODS: Patients who underwent multilevel lumbar fusion for degenerative lumbar spinal stenosis (DLSS) were included. The psoas major was measured at the lumbar 3/4 intervertebral disc level in three ways on computed tomography image: psoas muscle mass index, mean muscle attenuation, and morphologic change of the psoas major. Early complications were graded using the Clavien-Dindo classification system and the Comprehensive complication index (CCI). A CCI ≥ 26.2 indicated severe complications. Logistic regression was performed to identify independent risk factors.
RESULTS: This retrospective study reviewed 108 patients (mean age 70.9 years, female to male ratio 1.8:1). Complications were observed in 72.2% of patients, with allogeneic blood transfusion being the most frequent (66.7%), followed by wound infection, acute heart failure (2.8% each). Severe complications occurred in 13.9% of patients. After multivariable regression analysis, those in the lowest psoas muscle attenuation tertile had higher odds of experiencing early postoperative complications (OR: 3.327, 95% CI 1.134-9.763, p = 0.029) and severe complications (OR: 6.964, 95% CI 1.928-25.160, p = 0.003).
CONCLUSIONS: The psoas muscle attenuation can be used as a predictor of early postoperative complications in elderly patients undergoing multilevel lumbar fusion surgery for DLSS.

UNASSIGNED: Postoperative visual loss (POVL) is a relatively rare but devastating complication. We reported a case of POVL after spine surgery caused by ischemia of retina and optic nerve, and firstly introduced the possibility of cavernous sinus thrombosis in POVL development.
METHODS: A 67-year-old woman diagnosed with \"lumbar spinal stenosis\" was admitted to undergo posterior lumbar spinal canal decompression surgery because of the persistent lumbago and numbness. The operation was performed in the prone position under general anesthesia uneventfully. On the second day, the visual acuity of her right eye suddenly decreased to no light perception. The ophthalmic examination indicated edematous eyelid, chemosis, ptosis, ophthalmoplegia, relative afferent pupillary defect and higher orbital pressure in her affected eye, and funduscopic examination revealed pale optic disc, diffuse retinal welling and attenuated arteries. Cerebral magnetic resonance angiography implied the stenosis of cavernous sinus segment of right internal carotid artery. Aseptic cavernous sinus thrombosis and the secondary combined occlusion of central retinal and optic nerve vessels were suspected. Therefore, anticoagulation, vasodilation, oxygen and anti-inflammation treatment were timely administrated. One month after the treatment, swelling eyelid and ocular motion had markedly improved. However, there was no remarkable improvement in the patient\'s visual acuity.
UNASSIGNED: Postoperative visual loss (POVL) after spine surgery is regarded as a serious complication with irreversible vision damage. It was alarming that cavernous sinus thrombosis might be a possible cause of POVL. High-volume fluid replacement, unstable hemodynamic parameters, prone position and prolonged surgical duration might bring about microvascular diseases and hypercoagulable state, contributing to the occurrence of POVL.
CONCLUSIONS: Our study firstly implied the possibility of cavernous sinus thrombosis in the POVL development. Detailed assessment, fluids management, hemodynamic stabilizing and duration optimization were proposed for POVL prevention.

BACKGROUND: Tandem spinal stenosis (TSS) is a condition characterized by the narrowing of the spinal canal in multiple segments of the spine. Predominantly observed in the cervical and lumbar regions, TSS also manifests in the conjunction of the cervical and thoracic spine. The simultaneous occurrence of cervical and thoracic spinal stenosis engenders intricate symptoms, potentially leading to missed and delayed diagnosis. Furthermore, the presence of tandem cervical and thoracic stenosis (TCTS) introduces a notable impact on the decision-making calculus of surgeons when contemplating either one-staged or two-staged surgery. Currently, there is no agreed-upon strategy for surgical intervention of TCTS in the literature.
METHODS: Medical databases in English (Pubmed, Web of Science, Embase, the Cochrane Database of Systematic Reviews) and Chinese (CNKI, Wanfang Data, VIP CMJD) were searched using Medical Subject Heading queries for the terms \"tandem cervical and thoracic stenosis\", \"cervical stenosis AND thoracic stenosis\", \"tandem spinal stenosis\" and \"concomitant spinal stenosis\" from January 1980 to March 2023. We included studies involving adult individuals with TCTS. Articles exclusively focused on disorders within a single spine region or devoid of any mention of spinal disorders were excluded.
RESULTS: Initially, a total of 1625 literatures underwent consideration for inclusion in the study. Following the elimination of the duplicates through the utilization of EndNote, and a meticulous screening process involving scrutiny of abstracts and full-texts, 23 clinical studies met the predefined inclusion criteria. Of these, 2 studies solely focused on missed diagnosis, 19 studies exclusively discussed surgical strategy for TCTS, and 2 articles evaluated both surgical strategy and missed diagnosis.
CONCLUSIONS: Our study revealed a missed diagnosis rate of 7.2% in TCTS, with the thoracic stenosis emerging as the predominant area susceptible to oversight. Therefore, the meticulous identification of TCTS assumes paramount significance as the inaugural step in its effective management. While both one-staged and two-staged surgeries have exhibited efficacy in addressing TCTS, the selection of the optimal surgical plan should be contingent upon the individualized circumstances of the patients.

To investigate the early efficacy and safety of unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of cervical stenosis (CS). The clinical data of 28 patients with CS treated by unilateral biportal endoscopic posterior total laminectomy decompression from January 2021 to October 2022 in the Henan NO.3 Provincial People\'s Hospital were retrospectively analyzed. Of the patients, 16 were male and 12 were female, the mean age was (55.6±9.6) years. The CS occurred at C3-4 level in 1 cases, at C4-5 level in 3 cases, at C5-6 level in 16 cases and at C6-7 level in 8 cases. Each case was compared at the moment of pre-operation and final follow-up by the Japanese Orthopedic Association (JOA) score. The postoperative complications were recorded. The JOA improvement rate was computed at the final follow-up. As a result, all patients underwent successful surgery and were followed up for (11.6±4.7) months. The operation time was (43.0±5.3) min. Intraoperative blood loss (7.9±2.8) ml; Postoperative drainage volume (8.1±2.3) ml. The JOA score increased from 7.9±1.2 before surgery to 13.5±1.3 six months after surgery, and it was 13.7±1.2 at the last follow-up, the differences between postoperative and preoperative were both statistically significant (both P<0.001). No complications occurred, such as cerebrospinal fluid leakage, nerve injury and intraspinal hematoma. At the last follow-up, cervical spine X-ray or CT evaluation showed no instability in the operative segment. The overall curative effect was evaluated according to JOA score at the last follow-up: 16 cases got excellent outcome, 7 cases got good and 2 cases got medium outcome, with an excellent and good rate of 89.3% (25/28). This study shows that unilateral biportal endoscopic posterior total laminectomy decompression in the treatment of single-level cervical stenosis can achieve satisfactory efficacy, has no impact on spinal stability, and has a high safety.
探讨单侧双通道内镜（UBE）下颈椎后路全椎板切除减压术治疗颈椎管狭窄症的早期疗效及安全性。回顾性分析2021年1月至2022年10月在河南省直第三人民医院采用UBE下颈椎后路全椎板切除减压治疗的28例单节段颈椎管狭窄症患者的临床资料。其中男16例，女12例，年龄（55.6±9.6）岁；C3~4节段1例，C4~5节段3例，C5~6节段16例，C6~7节段8例。比较术前和术后随访时患者日本骨科协会（JOA）评分；记录术后并发症发生情况；计算末次随访时JOA评分改善优良率。所有患者手术顺利并获得随访，手术时间（43.0±5.3）min，术中出血量（7.9±2.8）ml，术后引流量（8.1±2.3）ml，随访时间（11.6±4.7）个月。JOA评分由术前的（7.9±1.2）分升至术后6个月的（13.5±1.3）分，末次随访则为（13.7±1.2）分，术后与术前差异均有统计学意义（均P<0.001）。术后无脑脊液漏、神经损伤、椎管内血肿等并发症发生；末次随访时通过颈椎X线片或CT评估，手术节段无失稳情况。末次随访时综合疗效：优16例，良7例，中2例，优良率89.3%（25/28）。UBE下颈椎后路全椎板切除减压术治疗单节段颈椎管狭窄症可取得满意疗效，对脊柱稳定性无影响，并具有较高的安全性。.

METHODS: A systematic review and Bayesian network meta-analysis (NMA).
OBJECTIVE: To compare the effectiveness and safety of different posterior decompression techniques for LSS. Lumbar spinal stenosis (LSS) is one of the most common degenerative spinal diseases that result in claudication, back and leg pain, and disability. Currently, posterior decompression techniques are widely used as an effective treatment for LSS.
METHODS: An electronic literature search was performed using the EMBASE, Web of Science, PubMed, and Cochrane Library databases. Two authors independently performed data extraction and quality assessment. A Bayesian random effects model was constructed to incorporate the estimates of direct and indirect treatment comparisons and rank the interventions in order.
RESULTS: In all, 14 eligible studies comprising 1,260 patients with LSS were included. Five interventions were identified, namely, spinal processes osteotomy (SPO), conventional laminotomy/laminectomy (CL), unilateral laminotomy/laminectomy (UL), bilateral laminotomy/ laminectomy (BL), and spinous process-splitting laminotomy/laminectomy (SPSL). Among these, SPO was the most promising surgical option for decreasing back and leg pain and for lowering the Oswestry Disability Index (ODI). SSPL had the shortest operation time, while SPSL was associated with maximum blood loss. SPO and UL were superior to other posterior decompression techniques concerning lesser blood loss and shorter length of hospital stay, respectively. Patients who underwent BL had the lowest postoperative complication rates.
CONCLUSIONS: Overall, SPO was found to be a good surgical choice for patients with LSS.

UNASSIGNED: To investigate the short-term effectiveness of unilateral biportal endoscopy (UBE) in treatment of lumbar lateral saphenous fossa combined with intervertebral foramina stenosis via contralateral sublaminar approach.
UNASSIGNED: A clinical data of 15 patients with lumbar lateral saphenous fossa combined with intervertebral foramina stenosis, who were admitted between September 2021 and December 2023 and met selective criteria, was retrospectively analyzed. There were 5 males and 10 females with an average age of 70.3 years (range, 46-83 years). Surgical segment was L 4, 5 in 12 cases and L 5, S 1 in 3 cases. The disease duration was 12-30 months (mean, 18.7 months). All patients were treated by UBE via contralateral sublaminar approach. The operation time, intraoperative blood loss, postoperative hospital stay, and the occurrence of complications were recorded. The visual analogue scale (VAS) score was used to evaluate the degree of lower back and leg pain before and after operation; the Japanese Orthopaedic Association (JOA) score and the Oswestry disability index (ODI) were used to evaluate the lumbar function; and the clinical outcome was evaluated using the MacNab criteria at 6 months after operation. Postoperative MRI and CT were taken to observe whether the lateral saphenous fossa and intervertebral foramen stenosis were removed or not, and the cross-sectional area of the spinal canal (CSA-SC), cross-sectional area of the intervertebral foramen (CSA-IVF), and cross-sectional area of the facet joint (CSA-FJ) were measured.
UNASSIGNED: The operation time was 55-200 minutes (mean, 127.5 minutes); the intraoperative blood loss was 10-50 mL (mean, 27.3 mL); the length of postoperative hospital stay was 3-12 days (mean, 6.8 days). All patients were followed up 6-12 months (mean, 8.9 months). At 1 day, 1 month, 3 months, and 6 months after operation, the VAS scores of low back and leg pain and ODI scores after operation were significantly lower than preoperative scores and showed a gradual decrease with time; the JOA scores showed a gradual increase with time; the differences in the above indexes between different time points were significant ( P<0.05). The clinical outcome was rated as excellent in 10 cases, good in 4 cases, and poor in 1 case according to the MacNab criteria at 6 months after operation, with an excellent and good rate of 93.33%. Imaging review showed that the compression on the lateral saphenous fossa and intervertebral foramina had been significantly relieved, and the affected articular process joint was preserved to the maximum extent; the CSA-SC and CSA-IVF at 3 days after operation significantly increased compared to the preoperative values ( P<0.05), and the CSA-FJ significantly reduced ( P<0.05).
UNASSIGNED: The UBE via contralateral sublaminar approach can effectively reduce pressure in the lateral saphenous fossa and the intervertebral foramina of the same segment while preserving the bilateral articular process joints. The short-term effectiveness is good and it is expected to avoid fusion surgery caused by iatrogenic instability of the lumbar spine. However, further follow-up is needed to clarify the mid- and long-term effectiveness.
UNASSIGNED: 探讨单侧双通道脊柱内镜技术（unilateral biportal endoscopy，UBE）对侧椎板下入路治疗腰椎侧隐窝狭窄合并同节段椎间孔狭窄的早期疗效。.
UNASSIGNED: 回顾分析2021年9月—2023年12月收治且符合选择标准的15例腰椎侧隐窝狭窄合并同节段椎间孔狭窄患者临床资料。男5例，女10例；年龄46～83岁，平均70.3岁。手术节段：L 4、5 12例，L 5、S 1 3例。病程12～30个月，平均18.7个月。所有患者均接受UBE对侧椎板下入路手术治疗。记录手术时间、术中出血量、术后住院时间以及并发症发生情况。手术前后采用疼痛视觉模拟评分（VAS）评价腰腿痛程度，日本骨科协会（JOA）评分以及Oswestry功能障碍指数（ODI）评价腰部功能，术后6个月采用 MacNab 标准对患者疗效进行评价。术后复查MRI和CT，观察侧隐窝和椎间孔狭窄是否去除，测量椎管横截面积（cross-sectional area of the spinal canal，CSA-SC）、椎间孔横截面积（cross-sectional area of the intervertebral foramen，CSA-IVF）和小关节横截面积（cross-sectional area of the facet joint，CSA-FJ）。.
UNASSIGNED: 手术时间 55～200 min，平均127.5 min；术中出血量10～50 mL，平均27.3 mL；术后住院时间3～12 d，平均6.8 d。患者均获随访，随访时间6～12个月，平均8.9个月。术后1 d及1、3、6个月腰、腿痛VAS评分以及ODI均较术前降低，且随时间延长呈逐渐下降趋势；JOA评分则呈逐渐增高趋势；上述指标各时间点间差异均有统计学意义（ P<0.05）。术后6个月根据MacNab标准评估手术疗效：优10例、良4例、可1例，优良率93.33%。影像学复查示侧隐窝及椎间孔所受压迫已明显解除，最大程度保留患侧关节突关节；术后3 d CSA-SC及CSA-IVF较术前增加、CSA-FJ较术前减小，差异均有统计学意义（ P<0.05）。.
UNASSIGNED: UBE对侧椎板下入路能在保留双侧关节突关节同时，对侧隐窝及同节段椎间孔进行充分减压，早期疗效较好，有望避免腰椎医源性不稳所致的融合手术，但中、远期疗效有待进一步随访明确。.