Introduction:
Failed Back Surgery Syndrome is the primordial deterrent to a Spine Surgeon in the process of achieving his or her Holy Grail
Material and Methods:
We analyzed the clinical and functional outcomes of patients treated by us for Failed Back Surgery Syndrome for the last 30+ years between 1991 to 2024. A total of 228 patients were analyzed as a part of this study. Patients were divided into 3 categories. We included patients where the index surgery was performed by us as well as patients where the index surgery was performed elsewhere.
The minimum follow-up was 18 months and the maximum follow up was 30+ years
Category 1: Implant related FBSS: 90 patients
Category 2: Surgery related FBSS: 72 patients
Category 3: Non-Specific FBSS: 66 patients
Results:
We used the Oswestry Disability Index to evaluate the functional outcomes of patients. As per Clinical Evaluation Questionnaires to evaluate the outcomes:
94% of patients in Category 1 had excellent clinical outcomes & 92 % had excellent functional outcomes.
78% of patients in Category 2 had excellent clinical outcomes but only 68 % had excellent functional outcomes.
63 % of patients in Category 3 had excellent clinical outcomes but only 56% had excellent functional outcomes.
Conclusion:
We concluded that Implant related FBSS has the best outcome following treatment whereas Non-Specific FBSS had the worst clinical and functional outcomes.

Introduction: craniocervical sagittal alignment plays a crucial role in maintaining the physiological function of the cervical spine and could affect patient surgical outcomes. This study aimed to explore the relationship between craniocervical sagittal balance and clinical and radiological outcomes of cervical disc replacement (CDR). Methods. Patients who underwent 1-level and 2-level CDR were retrospectively analyzed. Clinical outcomes were evaluated using scores on the Japanese Orthopaedic Association (JOA), Visual Analogue Scale (VAS), and Neck Disability Index (NDI). The craniocervical sagittal alignment parameters, including the C2-C7 Cobb angle, C2 slope, T1 slope, C2- C7 sagittal vertical axis (SVA), C1-C7 SVA, the center of gravity of the head (CGH)-C7 SVA were measured. Results. A total of 169 patients were involved. Both the pre- and postoperative C2 slope were significantly higher in the less mobile group than in the more mobile group. Analogously, the CGH- C7 SVA before and after surgery was significantly larger in the less mobile group. Patients with a higher preoperative C2 slope and CGH-C7 SVA had lower cervical lordosis and ROM after surgery. There were no significant differences in the clinical outcomes between patients with different sagittal balance statuses. Patients with radiographic adjacent segment pathology (rASP) had significantly higher preoperative CGH-C7 SVA and C2- C7 SVA. Conclusion. Craniocervical sagittal balance is associated with cervical lordosis and ROM at the index level after CDR. A higher preoperative SVA is related to the presence and progression of rASP. A relationship between sagittal alignment and clinical outcomes was not observed.

Objective: To investigate the prolonged impact of lumbar spinal stenosis (LSS) on the loss of independence in basic activities of daily living, the progression to dementia, and overall lifespan.

Methods: Subjects aged over sixty-five from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS), classified by LSS status via 2008 self-administered questionnaire, were observed until March 2016. Key outcomes were the loss of independence in basic activities of daily living, dementia onset, and mortality. Independence loss was defined as scoring "A" or higher on Japanese long-term care insurance physician's opinion form, with dementia identified at level "II" or above. Analysis utilized Cox regression, adjusting for age, gender, chronic conditions, depression (via the Mental Health Inventory), and grip strength.

Results: The cohort included 1220 participants (451 men, 769 women, mean age 72). Eight years event rates in the LSS (-) group/LSS (+) group were 3.0%/6.1% for independence loss, 6.3%/15.8% for dementia, and 8.8%/11.9% for mortality. After adjustment using Cox regression, LSS was a significant risk factor for dementia onset (HR 1.80; 95% CI: 1.22-2.64) but not for decreased independence (HR 1.40; 95% CI: 0.78-2.52) or mortality HR 1.08; 95% CI: 0.73-1.58).

Conclusion: LSS significantly escalates the risk of dementia, while having a limited effect on the loss of independence in basic activities of daily living and mortality. These results suggest that orthopedic interventions targeting LSS could act as a preventative measure against dementia, emphasizing the need for specific healthcare strategies.

Introduction: Bone loss (BL) is a common phenomenon after cervical disc replacement (CDR). BL was also observed in patients who underwent anterior cervical discectomy and fusion (ACDF). This study aimed to compare the incidence, clinical outcomes, and risk factors for BL between single-level CDR and ACDF. Methods: This is a single-center retrospective cohort study of 212 patients. 113 patients treated with CDR and 99 patients treated with ACDF were retrospectively reviewed. Cervical sagittal alignment parameters, including cervical lordosis (CL), C2-C7 sagittal vertical axis (cSVA), T1 slope, disc angle, and surgical level slope, were evaluated. Results: BL was identified in 75 (66.4%) patients in the CDR group and 57 (57.6%) patients in the ACDF group. There were no significant differences in the incidence, severity, and location of BL between the ACDF and CDR groups. For patients who underwent ACDF, the proportion of females was significantly higher in BL group (P=0.002), while the BMI was significantly lower in the BL group compared to non-BL group (22.72±3.09 vs. 24.60±3.04, P=0.002). The effect of BL on the clinical outcomes of ACDF and CDR was not observed. In the ACDF group, patients with BL had significantly smaller postoperative CL, T1 slope, cSVA, and surgical level slope. BL after CDR was less correlated to the cervical sagittal alignment. Conclusion: BL is common after both CDR and ACDF with comparable incidence and severity. Cervical sagittal alignment was closely related to BL after ACDF yet had less influence on BL after CDR.

Introduction: Heterotopic ossification (HO) is an intractable issue after cervical disc replacement (CDR) that may decrease the segmental mobility and even develop to arthrodesis. This study aimed to identify factors in preoperative cervical degeneration that affect the HO formation after surgery and explore the impacts of preoperative degeneration on the occurrence of HO in different locations. Methods: This was a retrospective study of patients who underwent CDR in our center. The degree of preoperative cervical spondylosis was evaluated radiologically, including the intervertebral disc, uncovertebral joints, facet joints and ligaments. The effects of cervical degeneration on the HO formation after CDR were analyzed according to HO location. Multivariate logistic regression was performed to identify independent factors. Results: 149 patients with a total of 196 arthroplasty segments were involved in this study. HO, anterior HO (AHO), and posterior HO (PHO) developed in 59.69%, 22.96%, and 41.84% levels, respectively. The significant factors in univariate analysis for PHO included disc height loss, anterior osteophytes, preoperative uncovertebral joint osteophytes, and facet joint degeneration. The disc height loss in the high-grade HO was significantly more than that in the low-grade group (P=0.039). Multivariate analysis identified disc height loss as the only independent factor for PHO (P=0.009). No significant degenerative factors related to the formation of AHO were found. Conclusion: Preoperative cervical spondylosis predominantly affected the HO formation in the posterior disc space after CDR. In the multiple elements of preoperative cervical degeneration, the disc height loss was an independent risk factor for posterior HO formation.

Purpose: To evaluate the effectiveness of the mathematical model for estimating chances for recurrence of lumbar disc herniation (rLDH). Materials: One-Center Retrospective Study. The study included 514 patients (I group), operated on lumbar disc herniation L4-L5, L5-S1, with a 3-year follow-up period. Before surgery, patients evaluated the radiological parameters of the lumbar spine and determined the risk of rLDH using the mathematical model for estimation of chances. If the risk was less than 50% (Ia group), then the patient underwent microdiscectomy. If the value was more than 50% (Ib group), fusion was performed. Comparison group (II group) - data from 350 patients (300 – without recurrence, 50 - recurrence requiring surgery). Based on the data from these patients, the mathematical model was created. To obtain homogeneous values of the preoperative parameters of both groups, the Propensity Score Matching was used. Results: The preoperative data of groups I and II were aligned for significantly different indicators. After that, the sample size was 37 patients in each group. The number of reoperations in the groups was statistically significantly different: group I - 5% [1%; 18%], group II - 35% [22%; 51%] (p = 0.003). The risk of reoperation in group I at 0.13 [0.03; 0.58] times lower than in group II (p = 0.002). Conclusions: The proposed mathematical model for estimating chances for recurrence of lumbar disc herniation can be used as an option to determine the surgical tactics of treating patients aimed at reducing the frequency of reoperations after microdisectomy.

Background: Because previous studies have not focused on postoperative cervical collapse. Objective: The purpose of the present study was to introduce the overload vertebra body (OVB) phenomenon following multilevel anterior cervical discectomy and fusion (ACDF) as well as to investigate its effects on clinical and radiographic outcomes. Methods: We conducted a retrospective study involving patients who underwent ACDF. A total of 55 patients were included in the analysis, including 110 OVB and 110 non-OVB. The evaluated vertebral parameters included the vertebral cross-sectional area (CSA), wedge angle (WA), vertebral height (anterior [AH] and posterior [PH]) and anterior-posterior vertebral diameter (upper [UD] and lower [LD]). Results: The CSA and WA were significantly lower in the OVB group than in the non-OVB group at 3, 6, and 12 months after surgery as well as at the final follow-up (p<0.01). The AH of the OVB group was significantly lower at 3, 6, and 12 months after surgery as well as at the final follow-up compared to 1 week after surgery (p<0.01). Conclusion: OVB, a new phenomenon following multilevel ACDF, is defined as the cervical vertebral body located in the middle of the surgical segments in multilevel anterior cervical spine surgery. Statistical analysis of vertebral parameters, including CSA, WA, AH, PH, UD, and LD, showed that OVB occurs mainly at the anterior edge of the vertebra and that its largest radiographic manifestation is the loss of height at the anterior edge of the vertebra in the early postoperative period.

Introduction
Surgical treatment of lumbar degenerative disc disease (DDD) and spondylolisthesis with or without segment instability with the implementation of fusion is the "gold standard" of treatment, but is associated with a large number of complications. The use of TiNi as a material for the rods can significantly decrease the rate of complications.

Methods
103 patients underwent surgical treatment using TiNi rods between 2010 and 2012. All patients were divided into three groups depending on the level of intervention and the clinical picture. Consequently, each group was divided into two subgroups - with TiNi and titanium rods. Radiographs, CT, MRI and clinical outcomes were examined preoperatively, at 6, 12, 24 and 42 months.

Results
The mean patient age was 53 years. Minimum follow - up period was 3.5 years. Statistical analysis was performed using SPSS 21.2. Statistically better results (p˂ 0.05) were shown 3.5 years after surgery in all groups with nitinol rods.
One of the main evaluation criteria in our study was the extent of preserved mobility of the spine segments fixed with nitinol rods.
In all patient groups where nitinol rods were used for stabilization, mobility was present at all times throughout the observation (up to 42 months).

Conclusions
The use of nitinol rods in lumbar stabilization surgery showed good results in comparison with titanium rods. Further investigation, including multicenter studies, will allow to more clearly define the indications and contraindications for this type of implants.

Introduction
Scoliosis, thoracic kyphosis, and other deformities are more common in patients with PD. Severe and involuntary forward flexion of the thoracolumbar spine is a disabling process in the course of PD.

Materials and methods
Comparative prospective study. 36 patients with PD and lumbar spine stenosis were enrolled and divided in two groups according to type of surgery. Spinal fusion and decompression surgery using transpedicular constructions was performed in 21 patients (group I), only decompression at the most significant level of stenosis was performed in 15 patients (group II)

Results
Clinical results were satisfactory in 2 patients in group I, the remaining patients noted dissatisfaction with surgical treatment. The mean postoperative VAS was 6.4, while the mean preoperative VAS was 5.9. (P = 0.19). During the first 12 months after the operation, 17 out of 21 patients underwent revision surgery due to instability of the structure (n=7) or fractures of the hardware elements (n=10). In 24 months after the surgery complete removal of the instrumentation was performed in 8 patients.
Group II patients in the early postoperative period showed greater satisfaction with the surgical intervention. Thus, 12 patients were fully satisfied: VAS 6.1 preop and 5.8 postop. Revision interventions were not performed in this group.

Conclusion
The outcomes of surgical treatment of lumbar spine stenosis in patients with Parkinson’s disease (PD) are controversial and might be improved by minimization of surgical activity. Given the progressive natural course of Parkinson's disease, a poor prognosis for surgical treatment is inevitable.

Introduction: Morphology of the lateral atlantoaxial articulation (LAA) seems to contribute to pathological changes in basilar invagination (BI) with atlantoaxial dislocation (AAD). No study has investigated its impact on the outcome of surgical reduction. This study aims. to investigate (1) LAA morphology BI with AAD and healthy individuals (2) its relationship with the severity of dislocation and (3) the effect of the LAA morphology on reduction degree (RD) after surgery.
Methods: In this retrospective propensity score matching case-control study, imaging and baseline data of 62 patients with BI and AAD from 2011 to 2022 were collected. 613 participants without occipitocervical junctional deformity served as controls. Logistic regression analysis and receiver operating characteristic curve was used for analysis.
Results: There were no significant differences in sex, age, and BMI between the two groups after propensity score matching. Sagittal slope angle (SSA) and coronal slope angle (CSA) was lower and greater, respectively, in the patient group than in the control group. Regression analysis revealed a significant negative correlation between SSA and severity of dislocation. However, no relationship was found between CSA and the severity of dislocation. Multivariate logistic regression found minimum-SSA was an independent predictor of satisfactory reduction (RD ≥90%). The area under the curve was 0.844, and the cut-off value was -40.2.
Conclusion: SSA in patients group was significantly smaller and more asymmetric than that in the control group. Dislocation severity was related to SSA but not to CSA. SSA can be used as a predictor of horizontal RD after surgery.

Introduction: there are very few research papers devoted to the study of the effect of halo traction on IONM indicators. There are no reports of the effect of preoperative halo traction on IONM. Methods: a retrospective analysis of the results of surgical treatment of 88 patients with severe spinal deformities using different types of HT and IONM was carried out. The patients were divided into 2 groups. Group I (52 people) received standing or sitting HGT as a preoperative preparation. Group II (36 people) was operated under conditions of intraoperative HT. The modalities of motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP), spontaneous electromyography (EMG), and transpedicular screw test were used. A comparative analysis of signaling criteria with the threat of developing neurological deficit of the lower extremities during surgery (more than 80% when using facilitation) was performed. Results: signaling criteria with the threat of neurological deficit development were registered in 12 patients: 8 in group I, 4 in group II. Of these, a significant decrease in MEP was noted in 5 patients of group I and 1 patient II, while complete loss of MEP was diagnosed in 3 patients in each group. In two patients of group II, the recovery of the MEP indicators of the lower extremities did not occur and permanent neurological deficit could not be avoided. Conclusions: preoperative HGT demonstrates greater safety in the postoperative period. The combined use of IONM with preoperative preparation can significantly reduce the incidence of neurological complications in severe deformities.