OBJECTIVE: Posterior lumbar interbody fusion (PLIF) and/or transforaminal lumbar interbody fusion (TLIF), referred to as \"PLIF/TLIF,\" is a commonly performed operation for lumbar spondylolisthesis. Its long-term cost-effectiveness has not been well described. The aim of this study was to determine the 5-year cost-effectiveness of PLIF/TLIF for grade 1 degenerative lumbar spondylolisthesis using prospective data collected from the multicenter Quality Outcomes Database (QOD).
METHODS: Patients enrolled in the prospective, multicenter QOD grade 1 lumbar spondylolisthesis module were included if they underwent single-stage PLIF/TLIF. EQ-5D scores at baseline, 3 months, 12 months, 24 months, 36 months, and 60 months were used to calculate gains in quality-adjusted life years (QALYs) associated with surgery relative to preoperative baseline. Healthcare-related costs associated with the index surgery and related reoperations were calculated using Medicare reimbursement-based cost estimates and validated using price transparency diagnosis-related group (DRG) charges and Medicare charge-to-cost ratios (CCRs). Cost per QALY gained over 60 months postoperatively was assessed.
RESULTS: Across 12 surgical centers, 385 patients were identified. The mean patient age was 60.2 (95% CI 59.1-61.3) years, and 38% of patients were male. The reoperation rate was 5.7%. DRG 460 cost estimates were stable between our Medicare reimbursement-based models and the CCR-based model, validating the focus on Medicare reimbursement. Across the entire cohort, the mean QALY gain at 60 months postoperatively was 1.07 (95% CI 0.97-1.18), and the mean cost of PLIF/TLIF was $31,634. PLIF/TLIF was associated with a mean 60-month cost per QALY gained of $29,511. Among patients who did not undergo reoperation (n = 363), the mean 60-month QALY gain was 1.10 (95% CI 0.99-1.20), and cost per QALY gained was $27,591. Among those who underwent reoperation (n = 22), the mean 60-month QALY gain was 0.68 (95% CI 0.21-1.15), and the cost per QALY gained was $80,580.
CONCLUSIONS: PLIF/TLIF for degenerative grade 1 lumbar spondylolisthesis was associated with a mean 60-month cost per QALY gained of $29,511 with Medicare fees. This is far below the well-established societal willingness-to-pay threshold of $100,000, suggesting long-term cost-effectiveness. PLIF/TLIF remains cost-effective for patients who undergo reoperation.

UNASSIGNED: The causes of pedicle cleft include congenital dysplasia and stress fractures, both of which are rare conditions. Secondary lumbar spondylolisthesis with combined unilateral pedicle cleft and contralateral spondylolysis is extremely rare and can be easily misdiagnosed. We report two cases with these conditions from different causes and discuss the diagnostic and therapeutic features in the context of the literature review.
UNASSIGNED: Case 1 was a 58-year-old female with a stress fracture change at the left L5 pedicle. Case 2 was a 47-year-old female with a pedicle cleft due to hypoplasia of the left L5 pedicle. Both patients had a combined contralateral spondylolysis and Meyerding grade one lumbar spondylolisthesis, while neither had a clear history of lumbar trauma. After initial conservative treatments failed, both patients underwent a single-segment posterior lumbar interbody fusion with bilateral pedicle screw fixation. Both patients were followed up for more than 1 year postoperatively with clinical symptom relief and bony fusion at the pedicle cleft suggested by a CT scan.
UNASSIGNED: Lumbar spondylolisthesis with unilateral pedicle cleft and contralateral spondylolysis is rarely reported and can be clinically misdiagnosed as simple spondylolisthesis with bilateral spondylolysis. There is no widely accepted surgical option for patients for whom conservative treatment has failed. Our experience suggests that good clinical results may be achieved by single-segment posterior interbody fusion and bilateral pedicle screw fixation. Precise screw placement into the deficient pedicle and sufficient exiting nerve decompression are prerequisites for the success of this surgical option.

UNASSIGNED: To evaluate the efficacy of the endoscopic lumbar interbody fusion technique across different types of lumbar spondylolisthesis, specifically Grade I and Grade II, and suggest technical optimizations based on therapeutic outcomes, complications, and patient satisfaction for both grades.
UNASSIGNED: We analyzed data from 57 L4 to 5 spondylolisthesis patients, all categorized as either Grade I or Grade II, comprising 31 males and 26 females. Of these, 36 were diagnosed with Grade I and 21 with Grade II. All subjects underwent the endoscopic lumbar interbody fusion procedure. Primary evaluation metrics included pre and post-operative Vasual Analogue Scale（VAS） pain scores, Osewewtry Disability Index（ODI） functional scores, surgical duration, intraoperative blood loss, degree of spondylolisthesis correction, complications, and patient satisfaction levels.
UNASSIGNED: At a minimum of 6 months post-operation, the VAS score for the Grade I cohort reduced from an initial 7.30 ± 0.69 to 2.97 ± 0.47, while the Grade II cohort saw a decrease from 7.53 ± 0.56 to 3.37 ± 0.62 (P = 0.0194). The ODI score in the Grade I group declined from 66.88 ± 5.15 % pre-operation to 29.88 ± 6.36 % post-operation, and in the Grade II group, it decreased from 69.33 ± 5.27 % to 34.66 ± 6.01 % (P = 0.0092). The average surgical duration for the Grade I group stood at 155.72 ± 17.75 min, compared to 180.38 ± 14.72 min for the Grade II group (P < 0.001). The mean intraoperative blood loss for the Grade I group was 144.58 ± 28.61 ml, whereas the Grade II group registered 188.23 ± 9.41 ml (P < 0.001). Post-surgery, 83 % of the Grade I patients achieved a correction degree exceeding 80 %, and 61 % of the Grade II patients surpassed 50 % (P = 0.0055). Complication rates were recorded at 8 % for Grade I and 16 % for Grade II. Patient satisfaction reached 94 % in the Grade I cohort and 90 % in the Grade II cohort.
UNASSIGNED: Endoscopic lumbar interbody fusion showcases promising therapeutic outcomes for both Grade I and Grade II lumbar spondylolisthesis. However, surgeries for Grade II spondylolisthesis tend to be lengthier, more challenging, involve greater blood loss, and have a heightened complication risk. Tailored technical adjustments and enhancements are essential for addressing the distinct spondylolisthesis types.

UNASSIGNED: To compare the effectiveness of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in the treatment of single-segment degenerative lumbar spinal stenosis with lumbar spondylolisthesis.
UNASSIGNED: Between November 2019 and May 2023, a total of 81 patients with single-segment degenerative lumbar spinal stenosis with lumbar spondylolisthesis who met the selection criteria were enrolled. They were randomly divided into UBE-TLIF group (39 cases) and Endo-TLIF group (42 cases). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, body mass index, surgical segment, and preoperative visual analogue scale (VAS) scores for low back and leg pain, Oswestry Disability Index (ODI), and serum markers including creatine kinase (CK) and C reactive protein (CRP). Total blood loss (TBL), intraoperative blood loss, hidden blood loss (HBL), postoperative drainage volume, and operation time were recorded and compared between the two groups. Serum markers (CK, CRP) levels were compared between the two groups at 1 day before operation and 1, 3, and 5 days after operation. Furthermore, the VAS scores for low back and leg pain, and ODI at 1 day before operation and 1 day, 3 months, 6 months, and 12 months after operation, and intervertebral fusion rate at 12 months after operation were compared between the two groups.
UNASSIGNED: All surgeries were completed successfully without occurrence of incision infection, vascular or nerve injury, epidural hematoma, dural tear, or postoperative paraplegia. The operation time in UBE-TLIF group was significantly shorter than that in Endo-TLIF group, but the intraoperative blood loss, TBL, and HBL in UBE-TLIF group were significantly more than those in Endo-TLIF group ( P<0.05). There was no significant difference in postoperative drainage volume between the two groups ( P>0.05). The levels of CK at 1 day and 3 days after operation and CRP at 1, 3, and 5 days after operation in UBE-TLIF group were slightly higher than those in the Endo-TLIF group ( P<0.05), while there was no significant difference in the levels of CK and CPR between the two groups at other time points ( P>0.05). All patients were followed up 12 months. VAS score of low back and leg pain and ODI at each time point after operation significantly improved when compared with those before operation in the two groups ( P<0.05); there was no significant difference in VAS score of low back and leg pain and ODI between the two groups at each time point after operation ( P>0.05). There was no significant difference in the intervertebral fusion rate between the two groups at 12 months after operation ( P>0.05).
UNASSIGNED: UBE-TLIF and Endo-TLIF are both effective methods for treating degenerative lumbar spinal stenosis with lumbar spondylolisthesis. However, compared to Endo-TLIF, UBE-TLIF requires further improvement in minimally invasive techniques to reduce tissue trauma and blood loss.
UNASSIGNED: 比较单侧双通道脊柱内镜下经椎间孔腰椎椎间融合术（unilateral biportal endoscopic transforaminal lumbar interbody fusion，UBE-TLIF）与单通道脊柱内镜下经椎间孔腰椎椎间融合术（endoscopic transforaminal lumbar interbody fusion，Endo-TLIF）对单节段退行性腰椎管狭窄症伴腰椎滑脱的治疗效果。.
UNASSIGNED: 纳入2019年11月—2023年5月收治且符合选择标准的81例单节段退行性腰椎管狭窄症伴腰椎滑脱患者，随机分为UBE-TLIF组（39例）和Endo-TLIF组（42例）。两组患者性别、年龄、身体质量指数、手术节段及术前腰、腿痛疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、血清学指标肌酸激酶（creatine kinase，CK）和C反应蛋白（C reactive protein，CRP）水平等基线资料比较差异均无统计学意义（ P>0.05）。记录并比较两组患者总失血量（total blood loss，TBL）、术中失血量、隐性失血量（hidden blood loss，HBL）、术后引流量、手术时间；比较两组术前1 d及术后1、3、5 d血清学指标CK、CRP水平，术前1 d及术后1 d、3个月、6个月、12个月腰、腿痛VAS评分、ODI及术后12个月椎间融合率。.
UNASSIGNED: 所有手术均顺利完成，无切口感染、血管神经损伤、硬膜外血肿、硬脑膜撕裂和术后截瘫等情况发生。UBE-TLIF组手术时间少于Endo-TLIF组，但术中失血量、TBL、HBL均多于Endo-TLIF组，差异均有统计学意义（ P<0.05）；两组术后引流量比较差异无统计学意义（ P>0.05）。UBE-TLIF组术后1、3 d CK水平及术后1、3、5 d CRP水平均高于Endo-TLIF组（ P<0.05）；其余时间点两组CK和CPR水平比较差异无统计学意义（ P>0.05）。两组患者均获随访12个月。两组术后各时间点腰、腿痛VAS评分及ODI均较术前显著改善（ P<0.05）；术后各时间点两组间腰、腿痛VAS评分及ODI比较差异均无统计学意义（ P>0.05）。术后12个月两组椎间融合率比较差异亦无统计学意义（ P>0.05）。.
UNASSIGNED: UBE-TLIF与Endo-TLIF均为治疗退行性腰椎管狭窄症伴腰椎滑脱的有效方法，但与Endo-TLIF相比，UBE-TLIF需在微创技术上进一步改进，以减少组织创伤与失血量。.

We aimed to develop and validate a deep convolutional neural network (DCNN) model capable of accurately identifying spondylolysis or spondylolisthesis on lateral or dynamic X-ray images. A total of 2449 lumbar lateral and dynamic X-ray images were collected from two tertiary hospitals. These images were categorized into lumbar spondylolysis (LS), degenerative lumbar spondylolisthesis (DLS), and normal lumbar in a proportional manner. Subsequently, the images were randomly divided into training, validation, and test sets to establish a classification recognition network. The model training and validation process utilized the EfficientNetV2-M network. The model\'s ability to generalize was assessed by conducting a rigorous evaluation on an entirely independent test set and comparing its performance with the diagnoses made by three orthopedists and three radiologists. The evaluation metrics employed to assess the model\'s performance included accuracy, sensitivity, specificity, and F1 score. Additionally, the weight distribution of the network was visualized using gradient-weighted class activation mapping (Grad-CAM). For the doctor group, accuracy ranged from 87.9 to 90.0% (mean, 89.0%), precision ranged from 87.2 to 90.5% (mean, 89.0%), sensitivity ranged from 87.1 to 91.0% (mean, 89.2%), specificity ranged from 93.7 to 94.7% (mean, 94.3%), and F1 score ranged from 88.2 to 89.9% (mean, 89.1%). The DCNN model had accuracy of 92.0%, precision of 91.9%, sensitivity of 92.2%, specificity of 95.7%, and F1 score of 92.0%. Grad-CAM exhibited concentrations of highlighted areas in the intervertebral foraminal region. We developed a DCNN model that intelligently distinguished spondylolysis or spondylolisthesis on lumbar lateral or lumbar dynamic radiographs.

Diagnosing early lumbar spondylolisthesis is challenging for many doctors because of the lack of obvious symptoms. Using deep learning (DL) models to improve the accuracy of X-ray diagnoses can effectively reduce missed and misdiagnoses in clinical practice. This study aimed to use a two-stage deep learning model, the Res-SE-Net model with the YOLOv8 algorithm, to facilitate efficient and reliable diagnosis of early lumbar spondylolisthesis based on lateral X-ray image identification.
A total of 2424 lumbar lateral radiographs of patients treated in the Beijing Tongren Hospital between January 2021 and September 2023 were obtained. The data were labeled and mutually identified by 3 orthopedic surgeons after reshuffling in a random order and divided into a training set, validation set, and test set in a ratio of 7:2:1. We trained 2 models for automatic detection of spondylolisthesis. YOLOv8 model was used to detect the position of lumbar spondylolisthesis, and the Res-SE-Net classification method was designed to classify the clipped area and determine whether it was lumbar spondylolisthesis. The model performance was evaluated using a test set and an external dataset from Beijing Haidian Hospital. Finally, we compared model validation results with professional clinicians\' evaluation.
The model achieved promising results, with a high diagnostic accuracy of 92.3%, precision of 93.5%, and recall of 93.1% for spondylolisthesis detection on the test set, the area under the curve (AUC) value was 0.934.
Our two-stage deep learning model provides doctors with a reference basis for the better diagnosis and treatment of early lumbar spondylolisthesis.

OBJECTIVE: The Isobar TTL dynamic fixation system has demonstrated favorable outcomes in the short-term treatment of lumbar degenerative disc diseases (LDDs). However, there is a paucity of extensive research on the long-term effects of this system on LDDs. This study aimed to evaluate the long-term clinical and radiological outcomes of patients with LDDs who underwent treatment utilizing the Isobar TTL dynamic fixation system.
METHODS: The study analyzed the outcomes of 40 patients with LDDs who underwent posterior lumbar decompression and received single-segment Isobar TTL dynamic internal fixation at our hospital between June 2010 and December 2016. The evaluation of clinical therapeutic effect involved assessing postoperative pain levels using the visual analogue scale (VAS) and Oswestry disability index (ODI), both before surgery, 3 months after, and the final follow-up. To determine the preservation of functional motion in dynamically stable segments, we measured the range of motion (ROM) and disc height of stabilized and adjacent segments preoperatively and during the final follow-up. Additionally, we investigated the occurrence of adjacent segment degeneration (ASD).
RESULTS: Forty patients were evaluated, with an average age of 44.65 years and an average follow-up period of 79.37 months. Fourteen patients belonged to the spondylolisthesis group, while the remaining 26 were categorized under the stenosis or herniated disc group. The preoperative ROM of the stabilized segment exhibited a significant reduction from 8.15° ± 2.77° to 5.00° ± 1.82° at the final follow-up (p < 0.001). In contrast, there was a slight elevation in the ROM of the adjacent segment during the final follow-up, increasing from 7.68° ± 2.25° before surgery to 9.36° ± 1.98° (p < 0.001). The intervertebral space height (IH) in the stabilized segment exhibited a significant increase from 10.56 ± 1.99 mm before surgery to 11.39 ± 1.90 mm at the one-week postoperative follow-up (p < 0.001). Conversely, there was a notable decrease in the IH of the adjacent segment from 11.09 ± 1.82 mm preoperatively to 10.86 ± 1.79 mm at the one-week follow-up after surgery (p < 0.001). The incidence of ASD was 15% (6/40) after an average follow-up period of 79.37 months, with a rate of 15.38% (4/26) in the stenosis or herniated disc group and 14.29% (2/14) in the spondylolisthesis group; however, no statistically significant difference was observed in the occurrence of ASD among these groups (p > 0.05).
CONCLUSIONS: The Isobar TTL dynamic fixation system is an effective treatment for LDDs, improving pain relief, quality of life (QoL) and maintaining stabilized segmental motion. It has demonstrated excellent long-term clinical and radiographic results.

UNASSIGNED: This study aimed to explore the risk factors of Modic changes in lumbar spondylolisthesis.
UNASSIGNED: The distribution of Modic changes in different types of lumbar spondylolisthesis, degree of spondylolisthesis, and degree of intervertebral disc degeneration in patients with lumbar spondylolisthesis was observed and analyzed. Statistical analysis was conducted to assess whether intervertebral disc degeneration, local mechanical changes, etc. affect the occurrence of Modic changes. The risk factors of Modic changes in lumbar spondylolisthesis were further illustrated.
UNASSIGNED: The age in the lumbar spondylolisthesis with Modic changes group was younger than that in the lumbar spondylolisthesis without Modic changes group, and the bone mineral density was better in the lumbar spondylolisthesis with Modic changes group than that in the lumbar spondylolisthesis without Modic changes group, P < 0.05. The two groups statistically differed in intervertebral disc height (IDH) and disc angle on magnetic resonance imaging (MRI). In the classification of Modic changes, the incidence of type II was the highest. The incidence of Modic changes is higher in isthmic spondylolisthesis than in degenerative spondylolisthesis. With the aggravation of lumbar spondylolisthesis and intervertebral disc degeneration, the incidence of Modic changes gradually increased. Modic changes are most commonly seen in both the upper and lower endplates. Logistic regression analysis showed that the occurrence of Modic changes in lumbar spondylolisthesis was significantly correlated with IDH, disc angle on MRI, type of spondylolisthesis, degree of spondylolisthesis, and degree of intervertebral disc degeneration, P < 0.05.
UNASSIGNED: The occurrence of Modic changes is related to the type of spondylolisthesis, the degree of spondylolisthesis, the degree of disc degeneration, the decrease of intervertebral disc height, and local stress angulation.

This study aimed to systematically evaluate the optimal surgical fusion approach for lumbar spondylolisthesis, to provide the latest and most reliable evidence for future clinical practice.
A comprehensive search of the PubMed, Ovid-Embase, Web of Science, Cochrane, and Scopus databases was conducted from inception to September 1, 2023, to identify relevant records. Two independent reviewers performed the literature screening, data extraction, and assessment of study quality.
Fifteen randomized controlled trials involving 892 patients met the inclusion criteria. The network evidence plot showed that posterolateral fusion and posterior lumbar interbody fusion (PLIF) were the most used fusion techniques. The network meta-analysis results revealed that minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) had a significantly greater improvement in the Oswestry Disability Index (ODI) compared to endoscopic-TLIF, while PLIF had a significantly better fusion effect than posterolateral fusion. Furthermore, no statistically significant differences were observed between other fusion surgeries in terms of improving ODI, fusion rate, complications, or the improvement of visual analog scale-low back pain. The surface under the cumulative ranking curve results indicated that MIS-TLIF had the greatest potential for improving ODI, visual analog scale-low back pain, and complications, while PLIF had the greatest potential for increasing fusion rates. However, the existing selection bias, measurement bias, reporting bias, and publication bias may have reduced the reliability of the meta-analysis results.
Among the various fusion surgeries for lumbar spondylolisthesis, MIS-TLIF appears to provide the greatest benefit to patients. However, more high-quality, large-scale studies are needed to further investigate the treatment efficacy of different fusion surgeries for lumbar spondylolisthesis.

BACKGROUND: A previous cost-effectiveness analysis published in 2022 found that the Total Posterior Spine (TOPSTM) system was dominant over transforaminal lumbar interbody fusion (TLIF). This analysis required updating to reflect a more complete dataset and pricing considerations.
OBJECTIVE: To evaluate the cost-effectiveness of TOPSTM system as compared with TLIF based on an updated and complete FDA investigational device exemption (IDE) data set.
METHODS: Cost-utility analysis of the TOPSTM system compared to TLIF.
METHODS: A multicenter, FDA IDE, randomized control trial (RCT) investigated the efficacy of TOPSTM compared to TLIF with a current population of n=305 enrolled and n=168 with complete 2-year follow-up.
METHODS: Cost and quality adjusted life years (QALYs) were calculated to determine our primary outcome measure, the incremental cost-effectiveness ratio. Secondary outcome measures included: net monetary benefit as well at willingness-to-pay (WTP) thresholds.
METHODS: The primary outcome of cost-effectiveness is determined by incremental cost-effectiveness ratio. A Markov model was used to simulate the health outcomes and costs of patients undergoing TOPSTM or TLIF over a 2-year period. alternative scenario sensitivity analysis, one-way sensitivity analysis, and probabilistic sensitivity analysis were conducted to assess the robustness of the model results.
RESULTS: The updated base case result demonstrated that TOPSTM was immediately and longitudinally dominant compared with the control with an incremental cost-effectiveness ratio of -9,637.37 $/QALY. The net monetary benefit was correspondingly $2,237, both from the health system\'s perspective and at a WTP threshold of 50,000 $/QALY at the 2-year time point. This remained true in all scenarios tested. The Alternative Scenario Sensitivity Analysis suggested cost-effectiveness irrespective of payer type and surgical setting. To remain cost-effective, the cost difference between TOPSTM and TLIF should be no greater than $1,875 and $3,750 at WTP thresholds of $50,000 and 100,000 $/QALY, respectively.
CONCLUSIONS: This updated analysis confirms that the TOPSTM device is a cost-effective and economically dominant surgical treatment option for patients with lumbar stenosis and degenerative spondylolisthesis compared to TLIF in all scenarios examined.