Factors affecting return to work following endoscopic lumbar foraminal stenosis surgery: A single-center series.

Background: This study evaluates the factors affecting the return to work of endoscopic surgery for lumbar foraminal stenosis (LFS), including symptoms, functional status, complications, and reoperation rates. Methods: The authors' retrospective cohort study included 100 consecutive patients (50 males and 50 females) diagnosed with LFS who underwent endoscopic surgery at Trotsky National Research Center of Surgery between January 2018 and December 2021. Results: There were no significant differences in age and preoperative visual analog scale and Oswestry disability index scores between the male and female groups, time to return to work for different patient groups after undergoing endoscopic lumbar foraminotomy (ELF). However, patients with more severe stenosis and comorbidities may take longer to recover. Confounding factors were patient age, preoperative physical function, and job requirements. Conclusion: This study confirms that study ELF can effectively improve symptoms associated with lumbar radiculopathy, as well as back pain, and improve patients' quality of life. Comorbidity, smoking status, and complications prolong the time to return to work following ELF surgery compared to healthy subjects.

Learning Curve and Minimally Invasive Spine Surgery.

BACKGROUND: Minimally invasive surgery has become popular in recent times and has proved more advantageous than conventional open surgery methods, in terms of maximal preservation of natural anatomy and minimal postoperative complications. However, these advancements require a longer learning curve for inexperienced surgeons. OVERVIEW: The learning curve in minimally invasive spine surgery is complex and difficult to measure, and therefore operating times, conversion to open procedures, visual analog scale, and periods of hospital stay are used. In assessing complications as a measure of the learning curve, it was noted that nearly all the complications had been documented previously and became minimum after the 30th consecutive case. As surgical experience increases, perioperative parameters (e.g., operative time and length of hospitalization) improve. The downside of minimally invasive spine surgery is starting unfamiliar procedures without tactile sensation, working in a narrow restricted surgical field, and using endoscopes via two-dimensional imaging. CONCLUSIONS: Appropriate instruments, a trained team, and an adept radiographer are important assets for a smooth transition during the learning period. Structured training with cadavers and lots of practice, preferably while working under the guidance of experienced surgeons, is helpful. The learning curve can be shortened when a proficient surgeon gains relevant knowledge, understands three-dimensional anatomy, and has surgical aptitude along with manual dexterity.

Conus Medullaris Arachnoid Cyst Presenting as Cauda Equina Syndrome.

Intradural arachnoid cysts are a rare cause of spinal cord and nerve root compression. Primarily, they are present in the thoracic region posteriorly. We report a 25-year-old man who had an intradural arachnoid cyst at the level of conus medullaris presenting with cauda equina syndrome, which is very rare.

Surgically treated spinal metastases: Do prognostic scores have a role?

BACKGROUND: The outcome for patients with metastatic disease in spine is difficult to predict. Multiple scoring systems were utilized in this study to determine their effectiveness in predicting long-term prognoses. METHODS: A retrospective analysis of surgically treated patients of spinal metastasis was performed between 2005 and 2016. Data were collected prospectively during which 8 patients were lost to follow-up. Ultimately, data from 63 patients were reviewed. Treatment and prognoses were analyzed utilizing various scoring systems including the SINS, the Tomita, the modified Tokouhashi and Bauer scores. RESULTS: Records of 63 patients, averaging 54 years of age, were analyzed. The Tomita score was applied in 44 patients, a modified Bauer score was studied in 49 patients, while SINS and modified Tokouhashi scores were calculated in all 63 patients. The hazard ratios for the Tomita score were 1, 0.030, 0.622, and 0.272, respectively. The hazard ratios for the modified Bauer scores were 1, 4.663, and 1.622, respectively. The Tokouhashi ratios were 1, 1.656, and 0.501, respectively. Of interest, the Tomita scores provided the highest statistical significance (P = 0.000) followed by the Bauer (P = 0.002) and Tokuhashi scores (P = 0.003). Notably, the SINS score showed no significant correlation in predicting patient survival. CONCLUSION: For evaluating the metastatic spine disease, this study evaluated the prognostic efficacy of four widely used scores: the Tomita, score, the modified Tokouhashi and Bauer scores, and the SINS scores. The Tomita scores provided the highest statistical significance, followed by the Bauer, and Tokuhashi scores, while the SINS score showed no significant correlation in predicting patient survival.