Aims. The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal complications associated with L4-L5 lateral lumbar interbody fusion (LLIF) undertaken using a standardized preoperative assessment and surgical technique. Methods. This was a multicentre retrospective study involving consecutively enrolled patients who underwent L4-L5 LLIF by seven surgeons at seven institutions in three countries over a five-year period. The demographic details of the patients and the details of the surgery, reoperations and complications, including femoral and non-femoral neuropraxia, thigh pain, weakness of hip flexion, and abdominal complications, were analyzed. Neurological and psoas-related complications attributed to LLIF or posterior instrumentation and persistent symptoms were recorded at one year postoperatively. Results. A total of 517 patients were included in the study. Their mean age was 65.0 years (SD 10.3) and their mean BMI was 29.2 kg/m. 2. (SD 5.5). A mean of 1.2 levels (SD 0.6) were fused with LLIF, and a mean of 1.6 (SD 0.9) posterior levels were fused. Femoral neuropraxia occurred in six patients (1.2%), of which four (0.8%) were LLIF-related and two (0.4%) had persistent symptoms one year postoperatively. Non-femoral neuropraxia occurred in nine patients (1.8%), one (0.2%) was LLIF-related and five (1.0%) were persistent at one year. All LLIF-related neuropraxias resolved by one year. A total of 32 patients (6.2%) had thigh pain, 31 (6.0%) were LLIF-related and three (0.6%) were persistent at one year. Weakness of hip flexion occurred in 14 patients (2.7%), of which eight (1.6%) were LLIF-related and three (0.6%) were persistent at one year. No patients had bowel injury, three (0.6%) had an intraoperative vascular injury (not LLIF-related), and five (1.0%) had ileus. Reoperations occurred in five patients (1.0%) within 30 days, 37 (7.2%) within 90 days, and 41 (7.9%) within one year postoperatively. Conclusion. LLIF involving the L4-L5 disc level has a low rate of persistent neurological, psoas-related, and abdominal complications in patients with the appropriate indications and using a standardized surgical technique. Cite this article: Bone Joint J 2024;106-B(1):53–61

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The aim of this study was to determine whether early surgical treatment results in better neurological recovery 12 months after injury than late surgical treatment in patients with acute traumatic spinal cord injury (tSCI).

Aim. A retrospective review of the management of adjacent level discectomy and fusion using a Zero-P (Synthes) cage and report of ease of technique and outcomes. Method. Surgical approach to adjacent level cervical disc protrusion with previous anterior cervical discectomy and fusion (ACDF) can be difficult. We review 4 patients who had previous ACDF with cage and plate who developed new onset adjacent level cervical disc prolepses causing myelopathy. A retrospective review of demographic data, symptoms, details of surgery, pre and post operative radiology, pre and postoperative ODI and pain score, length of stay, complications and follow-up data were collected in all patients. Results. Previous ACDF with plate was performed in all 4 patients an average of 11.6 years ago. Two patients had bilateral approaches previously and both had previous vascular injuries. The average duration of current symptoms was 9 months with a mean age of 65 years. All patients presented with myelopathy and two also had radiculopathy. Multiple level ACDF were operated in 2 patients previously. Revision surgery and dissection on the disc level was restricted by the previous plate. Screws from the previous plate fusion were removed adjacent to the level of surgery and discectomy was performed using distractor pins through the screw sites. Following discectomy a Zero-P cage was used to fusion with DBX under image intensifier guidance. The advantage was not to remove the previous plate and keep the dissection over the scar tissue to the minimal. All patients improved in their radicular symptoms with improvement of their hand function in the myelopaths. There was no complication and post operative radiographs were satisfactory. Conclusions. Use of the Zero-P cage for adjacent level discectomy and fusion was safe without disturbing the previous cage and plate fusion or stability

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To evaluate the perioperative complications associated with total en bloc spondylectomy (TES) in patients with spinal tumours, based on the extent and level of tumour resection.

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The aim of this study was to explore the prognostic factors for postoperative neurological recovery and survival in patients with complete paralysis due to neoplastic epidural spinal cord compression.

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We present the results of correcting a double or triple curve adolescent idiopathic scoliosis using a convex segmental pedicle screw technique.

We describe three patients with pre-ganglionic (avulsion) injuries of the brachial plexus which caused a partial Brown-Séquard syndrome.