Faculty Bibliography

BACKGROUND:Posterior decompression for degenerative lumbar spinal stenosis (DLSS) carries approach-related morbidity. In this study, we hypothesized that multilevel lateral lumbar interbody fusion (LLIF) achieves effective indirect decompression with acceptable safety and patient-reported improvement among DLSS patients without scoliosis. METHODS:tests for parametric variables and Wilcoxon signed-rank tests otherwise. RESULTS:= 17). Overall complication rate was 40% with no major events; postoperative neurological complications included transient proximal lower-extremity weakness in 4% and persistent sensory symptoms in 12%. CONCLUSIONS:In carefully selected DLSS patients without scoliosis, multilevel LLIF achieved meaningful indirect decompression, substantial pain and disability improvement, and high early fusion rates with no major complications. The findings support LLIF as a viable alternative to posterior approaches. CLINICAL RELEVANCE/CONCLUSIONS:Multilevel LLIF can facilitate multilevel indirect decompression with favorable radiographic and clinical outcomes while avoiding posterior soft-tissue disruption. Routine posterior instrumentation at the index surgery may support fusion and reduce returns to the OR.

Residual giant thoracic disc herniations after open decompression are uncommon and present a significant surgical challenge, particularly in the setting of prior instrumentation and distorted anatomy. Here, the authors present a case of salvage full-endoscopic resection of a residual giant, centrally calcified thoracic disc herniation causing persistent spinal cord compression following prior transpedicular decompression and instrumented fusion. A 37-year-old woman presented with persistent thoracic pain, gait disturbance, and myelopathic symptoms after partial improvement from an initial open T6 to T7 transpedicular decompression with T6 to T8 fusion. Magnetic resonance imaging and computed tomography demonstrated a residual giant calcified disc herniation at T6 to T7 with severe spinal cord compression and signal change. The patient underwent revision right-sided full-endoscopic thoracic discectomy using preoperative trajectory planning, docking on preserved osseous landmarks, ventral cavity creation, and controlled disc mobilization. The patient experienced rapid postoperative recovery with immediate resolution of thoracic pain and sustained improvement in gait and balance. This case demonstrates that full-endoscopic thoracic discectomy can be safely and effectively applied as a salvage technique to achieve spinal cord decompression in complex revision settings following failed open thoracic disc surgery.

BACKGROUND/UNASSIGNED:Frailty indices are established tools for estimating long-term survival in oncology, yet their utility for predicting short-term surgical outcomes remains less defined. This study evaluates several frailty, comorbidity, and risk indices for predicting postoperative care needs and other short-term outcomes in patients undergoing spinal metastasis resection. METHODS/UNASSIGNED:A retrospective cohort study was performed on patients undergoing surgery for spinal metastasis at a tertiary spine center. Preoperative risk was assessed using the modified 5-item frailty index (mFI-5), Metastatic Spinal Tumor Frailty Index (MSTFI), modified Charlson Comorbidity Index (CCI), New England Spinal Metastasis Score (NESMS), modified Bauer score (mBauer), and Spinal Instability Neoplastic Score (SINS). Multivariate logistic regression evaluated associations between indices and nonroutine discharge, prolonged length of stay (LOS), and reoperation, as well as other secondary outcomes. RESULTS/UNASSIGNED:Among 114 patients (mean age 65.6±10.7 years; 57.9% male), 57.0% were discharged to nonroutine settings, 16.7% underwent reoperation, and the mean length of stay was 11.1±10.8 days. MSTFI was independently associated with nonroutine discharge (OR=2.81, 95% CI [1.64-4.84], p<.001) but not prolonged LOS (OR=1.51 [0.99-2.30], p=.055). NESMS was also associated with nonroutine discharge (OR=0.49 [0.28-0.87], p=.015). Secondary analyses identified associations of NESMS spine-related complications (OR=0.46 [0.24-0.87], p=.017) and 90-day mortality (OR=0.48 [0.23-0.98], p=.045). No index significantly predicted reoperation. ROC analysis demonstrated that MSTFI and NESMS outperformed other indices for nonroutine discharge and prolonged LOS; DeLong's were equivocal. CONCLUSIONS/UNASSIGNED:In this single-center surgical cohort, MSTFI and NESMS were the most consistent risk-stratification tools for short-term outcomes, particularly discharge disposition and LOS. Secondary analyses suggested additional associations of NESMS with spine-related complications and 90-day mortality, whereas no index reliably predicted reoperation. Incorporating MSTFI and/or NESMS into preoperative assessment may improve risk stratification and perioperative planning.

Cerebrospinal fluid (CSF) leaks of spinal origin present unique diagnostic and therapeutic challenges. Ventral leaks in particular are technically demanding due to limited exposure, proximity to the spinal cord, and the need for precise dural repair. Traditional management strategies, ranging from laminectomy-based approaches to thoracotomy, carry significant morbidity. Recent advances in full endoscopic spine surgery provide a minimally invasive alternative that allows surgeons to access ventral pathology, remove osteophytes, and perform direct dural closure under continuous irrigation. This article reviews treatment challenges, highlights conventional and emerging strategies, and discusses the role of full endoscopic repair of spinal CSF leaks. Technical considerations unique to endoscopic repair of Type 1 CSF leaks in the thoracic spine are described.

BACKGROUND:Travel distance can serve as an objective, behavioral measure of patient preference in health care. Endoscopic spine surgery is the least invasive surgical option for treating spinal pathology, yet access is limited due to the relatively small number of trained surgeons. This study evaluates travel patterns of patients seeking care at the Endoscopic Spine Institute of New York, a specialized center staffed by 3 fellowship-trained endoscopic spine surgeons. METHODS:We conducted a retrospective analysis of the first 100 consecutive patients undergoing endoscopic spine surgery at Endoscopic Spine Institute of New York. The primary objective was to quantify patient travel distance as a behavioral proxy for preference for specialized, minimally invasive care. Secondary objectives were to characterize spinal pathology, determine revision surgery frequency, and compare travel distances by pathology type and revision status. Travel distances were calculated as straight-line distances from the patient's city of residence to the institute. Descriptive and comparative statistics were performed. RESULTS:< 0.05). Lumbar pathology cases were associated with slightly longer travel distances compared with cervical and thoracic cases, though differences were not statistically significant. CONCLUSIONS:Patients are willing to travel substantial distances to access specialized, minimally invasive spine surgery. Travel distance serves as a behavioral measure of patient preference, distinct from conventional quality metrics, providing insight into patient priorities in health care utilization and informing the centralization of specialized surgical services. CLINICAL RELEVANCE/CONCLUSIONS:Understanding how far patients will travel for endoscopic spine surgery provides insight into the growing demand for minimally invasive approaches and the regionalization of specialized spine care. This information can help guide resource allocation, referral patterns, and the develpment of centers of excellence. LEVEL OF EVIDIENCE/UNASSIGNED:4.

INTRODUCTION/UNASSIGNED:Full-endoscopic spine surgery (FESS) is increasingly utilized for the treatment of degenerative lumbar spinal disorders, with the aim of minimizing tissue disruption and facilitating recovery. Concurrently, postoperative follow-up is shifting toward digital platforms, enabling high-frequency collection of patient-reported outcome measures (PROMs). The characteristics of postoperative recovery trajectories and the determinants of long-term follow-up adherence in this setting remain incompletely defined. RESEARCH QUESTION/UNASSIGNED:Do postoperative PROM trajectories and follow-up retention differ between full-endoscopic lumbar discectomy and decompression, and does early postoperative engagement predict long-term follow-up compliance? MATERIAL AND METHODS/UNASSIGNED:This prospective multicenter cohort study included adult patients undergoing lumbar full-endoscopic discectomy or decompression for degenerative pathology between 2018 and 2025. Postoperative PROMs were collected using a smartphone-based application on a daily basis during the first postoperative week and at predefined intervals up to six months. Outcomes included visual analog scale (VAS) scores for back and leg pain and the Oswestry Disability Index (ODI). Longitudinal PROM trajectories were analyzed, and follow-up retention was assessed using Kaplan-Meier analysis and Cox proportional hazards regression in a baseline-engaged cohort. Early postoperative PROM adherence was evaluated as a predictor of long-term retention. RESULTS/UNASSIGNED:A total of 478 patients were analyzed (279 discectomy, 199 decompression). Both cohorts demonstrated significant and sustained reductions in back and leg pain beginning on postoperative day one and persisting through six months (all p < 0.001). Functional recovery, as measured by ODI, followed a delayed course and exhibited a transient early postoperative increase in the decompression cohort. Six-month complete PROM datasets were available in 31.6% of discectomy patients and 48.4% of decompression patients. Follow-up retention differed significantly between procedures, with decompression associated with a lower hazard of dropout (adjusted HR 0.60, 95% CI 0.50-0.72). Higher PROM completion during the first postoperative week was independently associated with long-term follow-up compliance. DISCUSSION/UNASSIGNED:High-frequency app-based PROM assessment allows detailed evaluation of early and mid-term recovery following FESS. However, long-term outcome interpretation is constrained by follow-up attrition, which varies by procedure type. CONCLUSION/UNASSIGNED:Early postoperative engagement appears to be a key determinant of durable follow-up and represents a potential target for improving longitudinal outcome assessment.

OBJECTIVE:Although patients often report improvements in pain and functional capacity after endoscopic lumbar spine surgery, objectively measured real-life physical activity may differ from that reported. This multicenter prospective study aimed to assess the correlations between physical activity and patient-reported outcomes (PROs). METHODS:All adult patients undergoing endoscopic lumbar spine surgery were offered enrollment in the SPINEhealthie smartphone app to assess physical activity. Estimated daily step counts (SCs) and serial PROs, including visual analog scale (VAS) leg pain, VAS back pain, and Oswestry Disability Index (ODI) scores, were collected. RESULTS:Of the 289 patients with pre- and postoperative SC data (mean follow-up 11.4 months), > 70% of patients achieved minimal clinically important difference (MCID) for VAS back and leg pain at 2 weeks and remained stable at 1 year (p < 0.05). Although patients demonstrated substantial improvement in VAS leg (-3.4, p < 0.001) and VAS back (-3.1, p < 0.001) pain scores at 2 weeks, the mean SC decreased significantly at 2 weeks (-632.4, p < 0.001). SC began to increase at 3 months (+265.7, p = 0.004). VAS scores demonstrated minimal further improvement beyond 2 weeks, but SCs continued to improve at all subsequent time points (p < 0.001), as did ODI (-12.2 at 3 months and -13.6 at 1 year, p < 0.001 for both). Preoperative SC was highly predictive of 1-year SC (r = 0.86, p < 0.001) and mildly predictive of ODI at 1 year (r = -0.31, p = 0.006). No preoperative PRO was correlated with PROs or SC at 1 year (r ≤ 0.10, p > 0.2 for all). Quartile analysis of SC revealed that pain scores did not correlate with functional measures. The patient quartiles' recovery patterns remained distinct (p < 0.05 between quartiles at 1 year). ODI improvement was greater in patients with higher baseline SCs (-15.6 vs -13.8 in the lowest quartile at 1 year, p = 0.047). Stratification of patients by baseline scores did not distinguish improvement in SC, or ODI, VAS leg pain, or VAS back pain (p > 0.05 for all) scores, indicative that baseline scores did not predict outcomes. CONCLUSIONS:Patients demonstrated immediate reduction in pain but delayed improvement in SC and ODI score. Among preoperative assessments, only SCs were predictive of postoperative outcomes. Furthermore, pain scores did not correlate with disability or activity. SC demonstrated interquartile stability, suggesting that SC may provide a reliable and independent perspective and may be predictive of outcomes.

OBJECTIVES:Approximately 20-50% of patients develop biochemical recurrence (BCR) of prostate cancer within 10 years following radical prostatectomy (RP). The accurate identification of recurrent disease is crucial for guiding salvage treatment decisions. While multiparametric MRI (mpMRI) and prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) are both utilized for detecting local recurrence, their combined diagnostic benefits remain unclear. This study seeks to evaluate the diagnostic performance of both modalities alone and in conjunction for detecting local recurrence following RP in patients with BCR. METHODS:A retrospective single-institution analysis included 37 post-RP patients with BCR who received mpMRI and PSMA PET/CT. Five board-certified radiologists reviewed images in three phases: mpMRI only, PSMA PET/CT only, and both modalities combined. Multidisciplinary tumor board consensus served as the reference standard. Diagnostic performance, inter-reader agreement, and radiologist confidence with each modality was examined. RESULTS:MpMRI outperformed PSMA PET/CT, yielding a higher sensitivity (73.0% vs. 65.2%) and specificity (77.1% vs. 75.7%). Interpretation of mpMRI and PSMA PET/CT together achieved the highest diagnostic accuracy (77.8%), representing a statistically-significant increase over PSMA PET/CT (p = 0.026) but a non-statistically-significant increase over mpMRI (p = 0.441). Combined imaging also resulted in greater specificity (90.0%) and inter-rater reliability (κ = 0.622). However, in some cases performance decreased with both modalities due to interpretive pitfalls. CONCLUSION:While mpMRI remains the preferred imaging modality for post-RP local recurrence surveillance, the integration of PSMA PET/CT may lead to improved specificity and inter-rater reliability. However, radiologists must understand each modality's limitations to avoid interpretive pitfalls.