Background Context. Different minimally invasive approaches to the lumbar spine have been proposed but they can be associated with increased risk of complications, steep learning curve and longer operative time. Purpose. To report the complications associated with a minimally invasive technique of retroperitoneal anterolateral approach to the lumbar spine. Study design. Retrospective study of 179 patients who underwent anterior oblique lumbar interbody fusion (OLIF). Methods. A total of 179 patients with previous posterior instrumented fusion undergoing OLIF were included. This muscle-splitting approach consists in anterolateral exposure through a 4 cm incision followed by placement of a PEEK cage filled with bone graft and/or substitute. Results. Patients were aged 54.110.6 years with BMI of 24.84.1 kg/m2. Length of follow-up was (0.90.7 years), including 17 patients with a minimum follow-up of 2 years. A left-sided approach was done in 174 patients. The procedure was performed at L1–2 in 4, L2–3 in 54, L3–4 in 120, L4–5 in 134 and L5-S1 in 6 patients. It was done at 1 level in 56, 2 levels in 107, and 3 levels in 16 patients. Operative time and blood loss were respectively 32.513.2 min and 57131 cc per level fused. There were 19 patients with single complication and one with two complications, including two patients with postoperative radiculopathy after L3–5 OLIF. There was no abdominal weakness or herniation. Conclusion. Minimally invasive OLIF can be performed easily and safely from L2 to L5, and at L1–2 and L5-S1 for selected cases. Up to 3 levels can be addressed through a “sliding window”. It is associated with minimal blood loss and short operative time. The risk of complications is similar to that reported for traditional anterior approaches, with the advantage of decreasing the risk of abdominal wall weakness or herniation

There is limited long term evidence to support instrumented fusion as an adjunct to decompression for foraminal stenosis in the presence of single level degenerative disc disease. We report the long term outcome of a prospective randomised controlled trial. Forty-four patients with single-level disc disease were randomly assigned to three groups (spinal decompression (Group 1), decompression and instrumented posterolateral fusion (Group 2), or decompression and instrumented posterolateral fusion plus transforaminal interbody fusion (Group 3). Spinal disability (Dallas, Roland Morris, and Lower Back Outcome Score [LBOS]), and quality of life (EuroQol (EQ) and short form (SF-) 36 questionnaires) were assessed before and at after surgery by independent researchers. At mean of 15 years follow up 33 (75%) patients were available for assessment. All groups observed a significant improvement in the EQ-5D at final follow up. Group 1 demonstrated significantly better functional outcome at final follow up according to the Dallas, Roland Morris, LBOS, and EQ-5D (3L and VAS) scores when compared to the other two groups (p<0.01). The SF-36 score demonstrated that group 1 had significantly better generic health scores compared to groups 2 and 3. Regression analysis was used to adjust for the differences in general health between the groups and demonstrated no significant difference between the groups in the spine specific scores: Dallas (p>0.15), Roland Morris (p>0.37), or the LBOS (p>0.32). Fusion in combination with decompression for the treatment of foraminal stenosis and single level degenerative disc disease offers no long term functional benefit over decompression in isolation

We have reviewed our experience in managing 11 patients who sustained an indirect sternal fracture in combination with an upper thoracic spinal injury between 2003 and 2006. These fractures have previously been described as ‘associated’ fractures, but since the upper thorax is an anatomical entity composed of the upper thoracic spine, ribs and sternum joined together, we feel that the term ‘fractures of the upper transthoracic cage’ is a better description. These injuries are a challenge because they are unusual and easily overlooked. They require a systematic clinical and radiological examination to identify both lesions. This high-energy trauma gives severe devastating concomitant injuries and CT with contrast and reconstruction is essential after resuscitation to confirm the presence of all the lesions. The injury level occurs principally at T4–T5 and at the manubriosternal joint. These unstable fractures need early posterior stabilisation and fusion or, if treated conservatively, a very close follow-up.