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Surgical treatment of high-grade spondylolisthesis is controversial and aims at restoring the spinopelvic sagittal balance through complete or partial reduction of the listhesis. Nerve decompression and interbody fusion are necessary for patients presenting with neurological deficit, severe pain, lower limb asymmetry, or deformities. We present the case and the results of a patient with high-grade spondylolisthesis, in whom minimally invasive management was performed. A narrative review in this topic is also provided. We performed a literature review of high-grade spondylolisthesis to compare our technique to current surgical alternatives. We included articles from PubMed, Embase, Scopus, Ovid, and Science Direct published between 1963 and 2022 that were written in English, German, and Spanish. The terms used were the following: "high grade spondylolisthesis," "spondyloptosis," "surgical management," "interbody fusion," and "arthrodesis." In all, 485 articles were displayed, from which we filtered 112 by title and abstract. At the end, 75 references were selected for the review. Different interbody fusion techniques can be used to correct the lumbosacral kyphosis and restore the spinopelvic parameters. A complete reduction of the listhesis is not always required. The surgical procedure carried out in our patient corresponds to the first known case of minimally invasive circumferential arthrodesis with iliac screws and sacral fixation in a high-grade dysplastic spondylolisthesis. This approach guarantees the correction of the lumbosacral kyphosis and a complete reduction of the listhesis. Further studies are required to determine whether the results of this case can be extrapolated to other patients with high-grade spondylolisthesis.

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STUDY DESIGN: Cross-sectional survey. OBJECTIVE: Although literature does not recommend routine wound drain utilization, there is a disconnect between the evidence and clinical practice. This study aims to explore into this controversy and analyze the surgeon preferences related to drain utilization, and the factors influencing drain use and criterion for removal. METHODS: A survey was distributed to AO Spine members worldwide. Surgeon demographics and factors related to peri-operative drain use in 1 or 2-level open fusion surgery for lumbar degenerative pathologies were collected. Multivariate analyses by drain utilization, and criterion of removal were conducted. RESULTS: 231 surgeons participated, including 220 males (95.2%), orthopedics (178, 77.1%), and academic/university-affiliated (114, 49.4%). Most surgeons preferred drain use (186, 80.5%) and subfascial drains (169, 73.2%). Drains were removed based on duration by 52.87% of the surgeons, but 27.7% removed drains based on outputs. On multivariable analysis, significant predictors of drain use were surgeon's aged 35-44 (OR = 11.9, 95% CI = 1.2-117.2, P = .034), 45-54 (29.1, 3.1-269.6, P = .003), 55-64 (8.9, 1.4-56.5, .019), and wound closure using coaptive films (6.0, 1.2-29.0, P = .025). Additionally, surgeons from Asia Pacific (OR = 5.19, 95% CI = 1.65-16.38, P = .005), Europe (3.55, 1.22-10.31, P = .020), and Latin America (4.40, 1.09-17.83, .038) were more likely to remove drain based on time duration, but surgeons <5 years of experience (10.23, 1.75-59.71, P = .010) were more likely to remove drains based on outputs. CONCLUSIONS: Most spine surgeons worldwide prefer to place a subfascial wound drain for degenerative open lumbar surgery. The choice for drain placement is associated with the surgeon's age and use of coaptive films for wound closure, while the criterion for drain removal is associated with the surgeons' region of practice and experience.

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INTRODUCTION: Lumbar interbody fusion is a standard method to treat certain degenerative conditions that are refractory to conservative treatments. LLIF reduces posterior muscle damage, can relieve neurological symptoms through indirect decompression, provides increased stability with its wider cages, and promotes more significant segmental lordosis than standard posterior techniques. However, the technique possesses its issues, such as unusual positioning, possible plexus-related symptoms, and median segmental lordosis correction. Trying to ease those issues, the idea of a prone transpsoas technique occurred. METHODS: Retrospective, single-centric, comparative, and non-randomized study. The authors paired patients receiving lateral lumbar interbody fusion (LLIF) or prone transpsoas (PTP) to evaluate the technique's impact on the segmental lordosis correction. A correlation test selected the covariates for the matching. p-Values inferior to 0.05 were deemed significant. RESULTS: Seventy-one patients were included in the analysis, 53 in the LLIF group and 18 in the PTP group. The significant covariates to the segmental lordosis correction were technique, preoperative segmental lordosis, cage position, and preoperative pelvic tilt. After the paring model, PTP showed significant segmental lordosis correction potential regarding the LLIF. CONCLUSION: The prone transpsoas approach can significantly enhance the correction of segmental lordosis proportionated to the traditional LLIF approach.

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BACKGROUND: To describe success and failure (S&F) after lumbar spine surgery in terms equally understandable across the entire health ecosystem. METHODS: Back and leg pain and disability were prospectively recorded before and up to 12 months after the procedure. Satisfaction was recorded using a Likert scale. Initially, patients were classified as satisfied or unsatisfied. Optimal satisfaction/unsatisfaction cutoff values for disability and pain were estimated with ROC curves. Satisfied and unsatisfied groups underwent a second subdivision into four subcategories: success (satisfied AND pain and disability concordant with cutoff values), incomplete success (satisfied AND pain and disability nonconformant with cutoff values), incomplete failure (unsatisfied AND pain and disability nonconformant with cutoff values), and failure (unsatisfied AND pain and disability concordant with cutoff values). RESULTS: A total of 486 consecutive patients were recruited from 2019-2021. The mean values of preoperative PROMs were ODI 42.2 (+ 16.4), NPRS back 6.6 (+ 2.6) and NPRS leg 6.2 points (+ 2.9). Of the total, 80.7% were classified as satisfied, and 19.3% were classified as unsatisfactory. The optimal disability and pain cutoff values for satisfaction/unsatisfaction (NPRS = 6, AND ODI = 27) defined a subdivision: 59.6% were classified as success, 20.4% as incomplete success, 7.1% as incomplete failure and 12.4% as failure. The descriptions of each group were translated to the following: success-all patients were satisfied and presented no or only mild to tolerable pain and no or borderline disability; incomplete success - all patients were satisfied despite levels of pain and/or disability worse than ideal for success; incomplete failure - all patients were not satisfied despite levels of pain and/or disability better than expected for failure; failure - all patients were unsatisfied and presented moderate to severe pain and disability. CONCLUSION: It is possible to report S&F after surgery for DDL with precise and meaningful operational definitions focused on the experience of the patient.

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Resumen: Introducción: Estudio prospectivo en pacientes afectos de hernia discal lumbar L5 S1 tratados mediante la U-Force interespinosa N6. El espaciador interespinoso denominado "U" está realizado en titanio y es colocado entre las apófisis interespinosas. Material y métodos: 50 pacientes operados de hernia discal lumbar fueron evaluados; 25 pertenecían al grupo U-N6 y 25 sólo fueron tratados con microcirugía. Se les realizó valoración clínica y estudios radiológicos seriados. Todos los individuos tuvieron un seguimiento durante dos años (2013-2014). Resultados: Nuestro estudio revela que el uso del dispositivo fue más efectivo (estadísticamente significativo) para el retraso de la inestabilidad que sólo la técnica quirúrgica (p < 0.01). Permitió su colocación en 90% de los sujetos. Conclusión: El uso de este dispositivo retrasa el colapso vertebral y, por ende, la inestabilidad del segmento operado. Noventa por ciento de los casos del grupo N6 presentan el dispositivo a nivel de L5 S1 versus 60% del grupo histórico con otros dispositivos (2004-2011).

Abstract: Introduction: We conducted a retrospective study in patients with disc herniation and compared the results obtained in individuals treated with the U device N6 with those acquired in patients treated without any device. The U device is a titanium alloy implant that is placed between the spinous processes. Material and methods: In a cohort of 50 patients with degenerative lumbar disc, 25 underwent surgical treatment in which the U device was placed and 25 control individuals were treated with discectomy alone. Patients underwent serial follow-up evaluations, and radiographic assessment was used to determine the outcome. Up to two years of follow-up data were obtained in all patients (2013-2014). Results: Statistically significant improvement was seen in patients treated with the coflex device in the management of lumbar disc degeneration to avoid lumbar instability in the future (p < 0.01). It allowed its placement in 90% of the patients. Conclusions: Our study shows that the coflex device was more effective than the discectomy group in the management of lumbar instability. Ninety percent of the cases of the N6 group present the device at L5 S1 versus 60% of the historical group with other devices (2004-2011).

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INTRODUCTION: We conducted a retrospective study in patients with disc herniation and compared the results obtained in individuals treated with the U device N6 with those acquired in patients treated without any device. The U device is a titanium alloy implant that is placed between the spinous processes. MATERIAL AND METHODS: In a cohort of 50 patients with degenerative lumbar disc, 25 underwent surgical treatment in which the U device was placed and 25 control individuals were treated with discectomy alone. Patients underwent serial follow-up evaluations, and radiographic assessment was used to determine the outcome. Up to two years of follow-up data were obtained in all patients (2013-2014). RESULTS: Statistically significant improvement was seen in patients treated with the coflex device in the management of lumbar disc degeneration to avoid lumbar instability in the future (p 0.01). It allowed its placement in 90% of the patients. CONCLUSIONS: Our study shows that the coflex device was more effective than the discectomy group in the management of lumbar instability. Ninety percent of the cases of the N6 group present the device at L5 S1 versus 60% of the historical group with other devices (2004-2011).

INTRODUCCIÓN: Estudio prospectivo en pacientes afectos de hernia discal lumbar L5 S1 tratados mediante la U-Force interespinosa N6. El espaciador interespinoso denominado «U¼; está realizado en titanio y es colocado entre las apófisis interespinosas. MATERIAL Y MÉTODOS: 50 pacientes operados de hernia discal lumbar fueron evaluados; 25 pertenecían al grupo U-N6 y 25 sólo fueron tratados con microcirugía. Se les realizó valoración clínica y estudios radiológicos seriados. Todos los individuos tuvieron un seguimiento durante dos años (2013-2014). RESULTADOS: Nuestro estudio revela que el uso del dispositivo fue más efectivo (estadísticamente significativo) para el retraso de la inestabilidad que sólo la técnica quirúrgica (p 0.01). Permitió su colocación en 90% de los sujetos. CONCLUSIÓN: El uso de este dispositivo retrasa el colapso vertebral y, por ende, la inestabilidad del segmento operado. Noventa por ciento de los casos del grupo N6 presentan el dispositivo a nivel de L5 S1 versus 60% del grupo histórico con otros dispositivos (2004-2011).

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Objetivos: La presencia de sintomatología secundaria a la fibrosis posquirúrgica tras la cirugía de la Hernia de disco y Estenosis de canal es una de las peores noticias tanto para el paciente como para el cirujano. Se hace necesario una prevención de dicha sintomatología (Entre el 2 y el 18 por ciento de los pacientes la presentan tras dicha cirugía), mediante el desarrollo de una barrera física: matriz de colágeno Tipo IV, con una tripe acción A) Función de Hemostasia, B) barrera física por la porosidad, C) función regeneradora por la matriz. Material y Métodos: Se ha realizado un estudio retrospectivo en un total de 600 pacientes intervenidos de cirugía de raquis con abordaje del Canal; 200 pertenecían al grupo control, 400 al grupo Duragen. Tras la cirugía se coloco el duragen tanto en la zona del defecto óseo, como en la zona de revisión de la raíz: Fenestración de anillo fibroso; foraminotomia y sangrado de vasos epidurales como hemostasia residual, de esta manera se crea una barrera física que impide al fibroblasto del músculo poder atrapar a la raíz tras la cicatrización del músculo .además en caso de fístula de LCR la matriz favorece el paso de fibroblastos entre la dos laminas de la dura a través de la matriz y se produce un sellado completo del orificio. El seguimiento mínimo fue de un año y se realizaron controles clínicos y radiológicos de forma seriada. Resultados: Del total de pacientes del grupo control; un 8 por ciento presentaron sintomatología secundaria a fibrosis que requiero tratamiento mediante: nueva cirugía (Fijación Lumbar: artrodesis) o colocación de un neuroestimulador. En el grupo D no se presentaron pacientes con sintomatonología por fibrosis. 0.6 por ciento vs. 8 por ciento. Discusión: La evolución de los pacientes tratados con Duragen obtuvo un mejor resultado al no presentar sintomatología por fibrosis, además en caso de fístula esta quedo sellada. En los casos en los que hubo que reoperar por otros factores: recidiva...

Objective: The symptomatic appearance of post-operative fibrosis following surgery for lumbar disc herniation is bad news for both the patient and the surgeon. A method of preventing this undesired outcome would be of great utility (between 2 and 18 percent of the patients suffer from it after said surgery). Here we report one approach to achieving this outcome, through the development of a physical barrier: a matrix of Type I collagen, with three main attributes: A) Haemostatic function, B) Physical barrier due to its porosity, C) Regenerating function through the matrix. Method: A retrospective investigation was made of 600 patients whom had undergone spinal surgery with canal approach; 200 took part in the control group and 400 took part in the DuraGen group. These procedures involved fenestration of the fibrous ring, foraminectomy and haemostasis of bleeding of epidural vessels. Prior to wound closure, DuraGen was placed both in the area of the bone defect and in the area of the affected nerve root. Thereby creating a physical barrier that prevents fibro tic entrapment of the nerve root. Further, in the event of CSF leakage (fistula) the matrix accomplished complete closure of the dural defect through the process of fibroblast migration and the formation of a new connective tissue sheet continuous with the existing dura. There was a minimum follow-up of Two year that included a series of clinical and radiological exams. Results: From all the control group patients, 8 percent showed secondary symptomatology of fibrosis that required treatment through: new surgery (lumbar fixation: arthrodesis) or placement of a neurostimulator. There were no patients with symptomatology due to fibrosis in the DuraGen group (0.6 percent vs. 8 percent). Discussion: The progress of patients treated with DuraGen showed a better result since there was no symptomatology due to fibrosis. Further, in the event of fistula, the fistula was closed. When there was a need for new surgery...

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