Faculty Bibliography

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.

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.

BACKGROUND/UNASSIGNED:Thoracic disc herniations are rare and challenging to treat surgically due to their complex regional anatomy, and conventional open approaches are associated with considerable morbidity. While full endoscopic approaches have demonstrated success in the cervical and lumbar spine, their role in the thoracic spine is not as well defined. We performed a systematic review of the literature on full endoscopic surgery for thoracic disc herniations in order to elucidate its safety, efficacy, and potential benefit over conventional open approaches. METHODS/UNASSIGNED:The PubMed, Web of Science, and Embase databases were queried from inception to February 2026. Studies describing endoscopic approaches to thoracic disc herniations in at least 5 adult patients with reported postoperative outcomes were included. Exclusion criteria included exclusive reporting of open/thoracoscopic approaches, cadaveric studies, and non-English studies. Data on patient characteristics, operative variables, and perioperative outcomes were extracted. RESULTS/UNASSIGNED:. 0%) were comparable between cohorts, as were pain and functional outcomes. CONCLUSIONS/UNASSIGNED:Full endoscopic approaches to thoracic disc herniations are safe and effective alternatives to traditional open approaches in carefully selected patients, offering meaningful advantages with comparable postoperative outcomes. High quality, direct comparative, multicenter studies are needed to better define their margin of benefit.

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.

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:Thoracic disc herniations (TDHs) are rare, comprising <1% of all disc herniations, but when symptomatic can cause severe neurological dysfunction. Traditional open and mini-open approaches allow for ventral canal decompression but are associated with high morbidity, including pulmonary complications, chest tube placement, and frequent need for fusion. Full-endoscopic thoracic discectomy has emerged as an ultra-minimally invasive alternative with reduced complications and faster recovery, but its application to midline or calcified thoracic discs remains technically demanding. CASE PRESENTATION/METHODS:We report the case of a 54-year-old man with progressive chest wall pain and lower-extremity hyperreflexia who was found to have a T6 to T7 central disc herniation with mild calcification and spinal cord signal change. The patient underwent an outpatient right-sided full-endoscopic transforaminal discectomy. Complete decompression was achieved without spinal cord retraction or manipulation. The patient had complete resolution of his preoperative pain and was discharged home within 2 hours. DISCUSSION/CONCLUSIONS:Compared with open thoracic discectomy, endoscopic approaches significantly lower complication rates, blood loss, hospital stay, and cost while preserving motion segments. Our case highlights strategies for addressing technically challenging central TDHs, including lateralized access, controlled bony resection, and angled instrumentation. These methods align with growing evidence demonstrating the safety and efficacy of endoscopy in thoracic pathology, though the technique requires advanced endoscopic expertise and careful patient selection. CONCLUSION/CONCLUSIONS:Full-endoscopic transforaminal discectomy provides a safe, effective, and minimally invasive option for central TDHs in selected cases. With proper planning and advanced technical execution, endoscopic surgery can achieve decompression comparable to open surgery while minimizing morbidity and expediting recovery.

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.

BACKGROUND:Lateral lumbar interbody fusion is a widely used technique to address degenerative lumbar conditions but can be associated with injury to the psoas, lumbar plexus, and abdominal wall owing to retractor usage. We describe a minimally invasive endoscopic lateral lumbar interbody fusion (ELLIF) procedure that aims to reduce these complications by avoiding prolonged muscle retraction, preparing the disc space under direct endoscopic vision, and shortening the surgical time. METHODS:Between 2019 and 2024, 35 patients underwent ELLIF at a single center. Discectomy, endplate preparation, and iliac crest harvest were done via a working-channel endoscope without expandable retractors. Neurophysiological monitoring was used to minimize nerve injury. Outcomes included complications, visual analog scale scores for pain, and Oswestry Disability Index (ODI). RESULTS:< 0.001). By the 3-year follow-up in 9 patients, ODI scores remained near normal, and visual analog scale was reduced by 93% from baseline. CLINICAL RELEVANCE/CONCLUSIONS:We present a minimally invasive, ELLIF, and decompression technique that provides patients with minimal complications and excellent functional recovery. CONCLUSION/CONCLUSIONS:ELLIF offers a safe, minimally invasive alternative for patients with lumbar degenerative disease. This technique minimizes direct retraction on the psoas and lumbar plexus, resulting in a low complication rate and substantial functional recovery at short- and medium-term follow-up.