Minimally Invasive Surgery for Traumatic Thoracolumbar Fractures: A Cross-Sectional Study of Spine Surgeons.

OBJECTIVE: To describe the perceived feasibility of minimally invasive surgical treatment of thoracolumbar fractures among spine surgeons in Latin American centers. METHODS: This is a cross-sectional study on minimally invasive surgical treatment for unstable thoracolumbar fractures. We conducted an online survey of spine surgeons working in Latin American centers, administered between December 16, 2022 and January 15, 2023. A nonprobabilistic sample was selected (snowball sampling). A questionnaire was sent by email and other messaging applications. RESULTS: Data were extracted from 134 surgeons. The majority of the respondents were from Brazil (n = 30, 22.4%), Mexico (n = 24, 17.9%), Argentina (n = 22, 16.4%), and Chile (n = 15, 11.2%). Their mean age was 46.53 years (standard deviation, 9.7; range 31-67) and almost all were males (n = 128, 95.5%). Most respondents were orthopedists (n = 85, 63.4%) or neurosurgeons (n = 49, 36.9%). Most of the respondents (n = 110, 82.1%) reported at least some difficulty using minimally invasive techniques for thoracolumbar fractures. It should be noted that there were significant regional differences between the surgeons' responses (P = 0.017). Chilean surgeons reported better results than others. CONCLUSION: Spinal surgeons from Latin American centers have identified challenges and obstacles to performing minimally invasive surgery for thoracolumbar trauma. The survey found that a majority of respondents experienced some level of difficulty, with regional variations. The most frequently reported difficulties were the high cost of the procedure, patient insurance restrictions, and long insurance approval times.

Transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon.

Background: Transforaminal endoscopic lumbar discectomy (TELD) has well-recognized advantages and disadvantages in the literature. Some of the mentioned disadvantages are insufficient discectomy, higher recurrence rate and long learning curve (LC). The objective of this study is to describe the LC and analyze the survival rate of patients operated through TELD. Methods: Retrospective study of 41 cases operated through TELD by the same surgeon from June 2013 to January 2020, with a minimum follow-up of 6 months. Demographic data and information on operative time (OT), complications, hospital stay, hernia recurrence and reoperations were collected. LC of the TELD was analyzed using a cumulative sum (CUSUM) test for parameter stability for linear regression coefficients, using the CUSUM from recursive residuals. Results: Thirty-nine patients, 24 men (61.54%) and 15 women (38.46%), were included in the present cohort, and a total of 41 TELD were performed. The average OT was 96 minutes (SD =30) and the CUSUM of the recursive residuals shows learning of the TELD in the case 20. The mean OT in the first 20 cases was 114 minutes (SD =30) versus 80 minutes (SD =17) in the last 21 cases (P=0.0001). The rates of recurrent Dh were 17%, and 12% need reoperation. Conclusions: We consider that the LC of TELD requires operating 20 cases to perform the procedure with a significant reduction in OT, with minimal rates of reoperation and complications.

Spino-pelvic radiological parameters: Comparison of measurements obtained by radiologists using the traditional method versus spine surgeons using a semi-automated software (Surgimap).

Background: Spinopelvic balance measurement is a key point to get an appropriate diagnosis and treatment in a group of spine pathologies; thus, it seems necessary the evaluation of different methods for obtaining the most reliable values. For that reason, different automatic and semi-automatic computer-assisted tools have been developed, and one example of them is Surgimap. Purpose: To demonstrate that the sagittal balance measurements with Surgimap are equal and more time-efficient than with Agfa-Enterprise. Material and Methods: Retrospective-prospective study. Biased comparative analysis of radiographic measurements performed on two different occasions (96 h interval), between two spine surgeons using Surgimap and two radiologists using the traditional Cobb method (TCM) with the Agfa-Enterprise program in 36 full spine lateral X-ray, determining inter- and intra-observer reliability and the mean time required to obtain the measurements. Results: Measurements with both methods demonstrated an excellent intra-observer correlation (Surgimap: PCC 0.95 [0.85-0.99]; TCM: PCC 0.90 [0.81-0.99]). Inter-observer correlation also demonstrated an excellent relationship (PCC >0.95). Thoracic kyphosis (TK) demonstrated the lowest levels of inter-observer correlation (PCC: 0.75). The average time in seconds with TCM was 154.6, while with the Surgimap it was 41.8 s. Conclusion: Surgimap proved to be equally reliable and 3.5 times faster. Therefore, in consistency with the available literature, our results would allow us to promote the use of Surgimap as a clinical diagnostic tool considering precision and efficiency.