Alberto Ofenhejm Gotfryd

Lumbar fusion has evolved from open transforaminal lumbar interbody fusion (TLIF) to minimally invasive TLIF (MIS-TLIF), the current minimally invasive benchmark. Endoscopic techniques, proven in discectomy and decompression, have been extended to fusion (uniportal endoscopic TLIF and biportal endoscopic TLIF), offering an alternative to MIS-TLIF. This structured debate-style review critically compares both techniques across 7 domains to clarify their respective roles in lumbar degenerative disease. It combined independent advocacy drafts with an international survey of 106 respondents across 35 countries, capturing procedural preferences and case-based reasoning. Using a prespecified 70% agreement threshold, domains were classified as domains with ≥70% panel agreement, whereas domains falling below this threshold were categorized as domains below the prespecified agreement threshold. This represents structured international survey agreement, not a formal Delphi process. Endoscopic fusion offers advantages in decreased blood loss, soft-tissue preservation, early postoperative back pain, and early recovery, with comparable mid-term clinical outcomes (long-term insufficiently established) to MIS-TLIF, which remains more reproducible and familiar. Complication rates are similar but technique-sensitive for endoscopic fusion. Panel responses favored endoscopic approaches for morbidity-related domains (soft-tissue preservation 89.6%, visualization 81.1%, recovery 74.5%), while fusion stability, short- to mid-term clinical outcomes, complications, and revision remained context-dependent without clear agreement. Endoscopic fusion is a credible option for selected single-level lumbar degenerative disease, offering perioperative advantages with comparable mid-term outcomes to MIS-TLIF; core endpoints, including fusion rate and revision rate, did not reach 70% panel agreement, even among endoscopy-favorable panelists. MIS-TLIF retains reproducibility advantages. The debate has shifted from feasibility to implementation, training standardization, cost-effectiveness, and long-term durability.

Objective: To describe the clinical profile and postoperative outcomes of patients undergoing instrumented spinal arthrodesis under a preemptive antibiotic therapy protocol with vancomycin and ciprofloxacin. Methods: A retrospective, consecutive, and single-center case series was conducted involving 88 patients operated on between January 2021 and December 2022. The protocol consisted of intravenous vancomycin (1 g) and ciprofloxacin (400 mg) administered 60 minutes before incision, with postoperative maintenance for five days. The minimum clinical follow-up was 24 months. Results: The mean age was 45.2 years, with a male predominance (60.2%). Trauma was the most frequent surgical indication (38.9%), followed by neoplasms (25%). The overall arthrodesis infection rate was 4.5% (4/88 patients), with 75% of these cases occurring in patients with oncological etiology. Only one adverse event (1.1%) related to vancomycin was recorded. Conclusions: The preemptive antibiotic therapy protocol showed favorable infection rates (4.5%) and good pharmacological tolerability in the studied sample, suggesting it is a viable strategy for high-complexity spine surgeries. Level of Evidence IV; Case series.

Objective: To create and implement a structured database for patients treated by the spine surgery team at Santa Casa de Misericórdia de São Paulo, analyzing the epidemiological profile, therapeutic strategies, and clinical outcomes. Methods: Retrospective observational study including 5,085 patients treated between 2016 and 2024, comprising 4,192 outpatient consultations and 893 surgical procedures. Data were prospectively collected and recorded on the REDCap platform, including demographic information, diagnoses, treatments, clinical evolution, and standardized questionnaires. Statistical analyses were performed using R software. Results: The mean age was 46.2 ± 20.6 years, with a male predominance in outpatient care (57.8%). Low back pain and degenerative diseases were the most frequent diagnoses (26.2%), followed by lumbar disc herniation (7.6%) and thoracolumbar fractures (7.3%). In the surgical group, metastases (12.3%) and fractures (10.6%) stood out. Conservative treatment was recommended in 71.4% of outpatient cases. Among surgical patients, 47.6% underwent instrumentation, mostly via posterior approach (84.9%). The mean Oswestry Disability Index (ODI) was 31.0. Women reported higher pain intensity but showed better neurological outcomes. The surgical complication rate was 9.2%, with satisfactory evolution in 90.8% of operated cases. Conclusion: This study highlights the predominance of degenerative diseases and low back pain in outpatient settings and underscores the essential role of surgery in complex cases. The implementation of the REDCap database proved effective for clinical monitoring, contributing to the improvement of therapeutic practices and future research in spine surgery. Level of Evidence IV; Retrospective observational study.

Objective: To map obstacles in the diagnosis and treatment of early-onset scoliosis in patients treated through the Brazilian Public Health System (SUS) at a tertiary hospital in São Paulo, supporting action plans to improve treatment access. Methods: Descriptive epidemiological study with 24 patients treated between June and November 2024. Demographic variables, referral process, time to specialist consultation, and proposed treatment were analyzed. Statistical analysis included descriptive statistics for continuous and categorical variables. Normality was tested using Shapiro-Wilk, with p ≤ 0.05. This is a descriptive epidemiological study with retrospective analysis, presenting level II evidence according to the Oxford classification Results: Most patients were female, with a median age of 24 months at the initial evaluation. The most common etiology was congenital (41.7%). The mean referral time to a specialized center was 61.9 months, with 70.8% arriving via direct medical referral, without official regulation. At data collection, 37.5% were still awaiting treatment, with an average wait time of 57.4 months. Conclusion: The study highlights delays in the diagnosis and treatment of early-onset scoliosis within the public health system, impacting patient access to care. Improvements in screening, referral, and specialized resources are essential to optimize care. Level of evidence II; retrospective study.

Objective: To evaluate the radiographic fusion rate and safety of a deproteinized bovine-derived xenograft as an adjunct in spinal arthrodesis. Methods: A prospective case series study (n=35) was conducted on adult patients undergoing instrumented spinal fusion. Radiographic fusion was assessed at 6 months using the Molinari classification. Descriptive and inferential statistical analyses (Fisher’s Exact Test, Mann-Whitney U, Kruskal-Wallis) were performed to investigate associations between demographics, etiology, and the outcomes of fusion and complications. Results: The overall fusion rate (Molinari grade I or II) was 88.6% (31/35). There was no statistically significant association between etiology, sex, or age and the fusion outcome (p > 0.05). The complication rate was 11.4% (4/35), consisting of superficial wound infections. The occurrence of complications was significantly associated with deformity patient group (p < 0.001). Conclusion: The deproteinized bovine xenograft proved to be a safe and effective adjunct for spinal arthrodesis, with a high and consistent radiographic fusion rate (88.6%) across different pathologies. Complications were associated with the surgical magnitude of the underlying disease rather than the graft material itself. Level of Evidence IV; cross-sectional study.

Introduction: Chronic low back pain is one of the most prevalent health conditions, with significant social and economic impact. Its increasing incidence has driven the demand for new, effective therapeutic alternatives. This study compared the efficacy of platelet-rich plasma (PRP) and corticosteroid injections in the treatment of chronic low back pain of facet joint origin. Methods: This was a randomized clinical trial involving patients with chronic low back pain of facet joint origin, selected through a positive response to medial branch block. Epidemiological data and clinical outcomes were analyzed, including disability questionnaires (Roland-Morris Disability Questionnaire) and the visual analog scale (VAS) for pain. Assessments were conducted at baseline, one month, and three months post-procedure. Results: A total of 59 patients were included, with 32 in the corticosteroid group and 27 in the PRP group. No significant differences were found between the treatments in terms of disability scores or the Roland-Morris Questionnaire. However, a significant interaction between treatment and time was observed (p = 0.038). Regarding pain scores, no significant differences were found between groups at any of the assessed time points. Conclusion: The study found no evidence of superiority of platelet-rich plasma over corticosteroid injections in terms of pain reduction and functional outcomes for the treatment of lumbar facet syndrome. Level of evidence: I; Randomized clinical trial.

Objectives: This study aimed to analyze predictive factors for postoperative complications in patients with lymphoproliferative disease in the spine.

Resumo: Objetivo Analisar associações entre ansiedade e desfecho clínico pós-cirúrgico em pacientes que realizaram a cirurgia de descompressão lombar minimamente invasiva, além de comparar sintomas de ansiedade e depressão antes e após a cirurgia. Métodos Trata-se de um estudo de coorte prospectiva de pacientes que realizaram a cirurgia de descompressão lombar minimamente invasiva. Os desfechos clínicos foram mensurados antes e 6 meses após a cirurgia, utilizando a escala visual analógica de dor (EVA); Global Perceived Effect of Change (GPE); Hospital Anxiety and Depression Scale (HADS) e o Oswestry Disability Index (ODI). A partir do escore de ansiedade pré-cirúrgico, os pacientes foram categorizados em pacientes ansiosos e não ansiosos e os desfechos comparados. Resultados Os pacientes de ambos os grupos obtiveram resultados similares em relação aos desfechos clínicos avaliados. Os escores HADS pré-operatório diminuíram significantemente 6 meses após a cirurgia, tanto em ansiedade (8,70 ± 3,48 vs. 5,75 ± 3,91) quanto em depressão (6,95 ± 3,54 vs. 5,50 ± 2,99). Houve redução da dor na escala EVA das costas (-2,8 ± 3,64) e das pernas (-5,5 ± 3,5). Conclusão A cirurgia de descompressão lombar minimamente invasiva promoveu melhora clínica e funcional, não sendo afetada por sintomas pré-operatórios de ansiedade. Os indicadores de saúde mental evidenciaram redução significativa dos sintomas 6 meses após a cirurgia.

Introduction: Minimally invasive tubular surgeries are an option for neural decompression in the spine. Despite its advantages described in the literature, controversy persists regarding its safety in reducing the length of hospital stay. Objective: To evaluate the readmission rate and hospital costs of patients discharged within 24 hours after minimally invasive tubular decompression. Methods: Retrospective comparative analysis of patients undergoing tubular decompression of the spine between 2017 and 2023 who had no perioperative complications. One group was made up of patients who were discharged from hospital within 24 hours after the end of the surgery, and the other was made up of patients who were discharged after this period. Data regarding costs and readmissions/reoperations within 180 days after hospital discharge were compared. Results: The sample consisted of 179 patients, 167 of whom were discharged early. There were 18 cases of readmission/reoperation within 180 days, and all were cases from the group that received early discharge. The main reason for readmission was recurrence (61.1%). Total hospital costs were higher in the “non-early” group, with an average of R$30,756.00, representing a 40.39% higher percentage expense when compared to the “early discharge” group. Conclusion: Microsurgical tubular decompression of the spine is a technique that enables safe early discharge and does not increase the risk of readmission within 180 days. Patients who were discharged early had lower hospital costs related to hospitalization. Level of evidence III; Retrospective Comparative Study.