Nelson Astur

Study Design: Retrospective-prospective multicenter comparative cohort study. Objectives: Postoperative dysesthesia (POD) is a recognized complication of transforaminal endoscopic lumbar surgery, with reported rates up to 21.5%. Degenerative lumbar deformity may amplify this risk through vertebral rotation displacing the dorsal root ganglion into the transforaminal trajectory. This study compares POD rates and functional outcomes between transforaminal endoscopic lumbar foraminotomy (TELF) and interlaminar contralateral endoscopic lumbar foraminotomy (ICELF) in degenerative lumbar deformity, and explores vertebral rotation as a mechanistic basis for approach selection. Methods: One hundred patients with degenerative lumbar deformity (Cobb ≥10°) and foraminal stenosis underwent single-level endoscopic foraminotomy across 6 centers in Latin America: a retrospective cohort of 46 patients treated with TELF (2021–2023) and a prospective cohort of 54 patients treated with ICELF (2023–2025). Vertebral rotation was measured by CT using the Aaro-Dahlbornmethod. Primary outcome was POD occurrence; secondary outcomes included VAS, ODI, and modified MacNab criteria at 12 months. Results: POD occurred in 8/46 TELF patients (17.4%) versus 1/54 ICELF patients (1.9%; p=0.011, OR=11.16), corresponding to an 89% relative risk reduction (NNT=6.4). Functional outcomes were equivalent at 12 months (MacNab excellent+good: 67.4% vs 70.4%, p=0.376). Within the TELF group, vertebral rotation was significantly higher in POD patients (19.2°±4.7° vs 12.2°±4.3°, p=0.001). ROC analysis identified a 15° threshold (AUC=0.870, sensitivity 88%, specificity 74%). Conclusions: ICELF is associated with substantially lower POD rates compared to TELF in degenerative lumbar deformity, with equivalent functional outcomes. Vertebral rotation appears to be a specific, measurable risk modifier for POD in the transforaminal approach, suggesting its role in approach selection.

Study Design: Literature Review with expert consensus–based clinical practice recommendations. Objectives: To synthesize current evidence on risk factors and preventive strategies for proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following adult spinal deformity (ASD) surgery, and to provide clinically actionable recommendations. Methods: A focused literature review was conducted by the AO Spine Knowledge Forum Deformity, identifying 30 relevant studies on PJK/PJF. Four studies were selected based on relevance to prevention strategies. Each study was critically appraised using a standardized framework. Final recommendations were established through multidisciplinary consensus using predefined criteria. Results: PJK/PJF are multifactorial complications with reported incidence ranging from 20–40%, often occurring within the first two years postoperatively. Evidence suggests that radiographic alignment targets alone have limited predictive value for mechanical complications. Moderate-quality evidence supports the use of combined prophylactic implant strategies and avoidance of sagittal overcorrection to reduce PJF risk. Bone mineral density (BMD) consistently demonstrates a strong association with junctional complications, with lower DEXA T-scores and CT Hounsfield units at the upper instrumented vertebra correlating with increased risk. Low-quality evidence supports ligament augmentation as a junctional protection strategy, demonstrating reductions in proximal junctional angle progression and PJF incidence. Conclusions: Prevention of PJK/PJF requires a multimodal approach integrating patient biology, surgical technique, construct design, and individualized alignment goals. Based on current evidence, we recommend routine assessment and of bone quality, avoidance of sagittal overcorrection, and consideration of prophylactic junctional protection in high-risk patients. These recommendations are primarily conditional, reflecting the predominance of observational data.

To translate, culturally adapt, and semantically validate the Brazilian Portuguese version of the Spine Oncology Study Group Outcomes Questionnaire 2.0 (SOSGOQ 2.0) through cognitive interviews with patients with spinal metastases. Following the guidelines of Beaton et al., the translation process included forward translation by two independent Brazilian translators, back translation by two native English speakers, expert committee review, and reconciliation. The final version underwent semantic validation through cognitive interviews with five patients with spinal metastases at a Brazilian public cancer center. Following Consolidated Criteria for Reporting Qualitative Research guidelines, semi-structured interviews assessed comprehensibility, relevance, and cultural appropriateness. All interviews were recorded, transcribed, and analyzed using thematic content analysis. All participants (mean age 58±12 years, 60% male) completed the questionnaire successfully. Thematic analysis identified three main themes. High comprehensibility was observed, as all items were clearly understood without ambiguity. Cultural relevance emerged because the questions reflected the Brazilian healthcare context appropriately. Clinical applicability was also evident, as participants recognized the relevance of the symptoms addressed in the questionnaire to their condition. The mean completion time was 12±3 min, and no linguistic modifications were required. Participant feedback demonstrated semantic equivalence and acceptability of the translated instrument. The Brazilian Portuguese SOSGOQ 2.0 demonstrated strong semantic validity and cultural appropriateness in this qualitative validation study. The instrument is ready for large-scale psychometric validation studies in Brazilian oncology settings.

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Background: Rugby exposes athletes to high mechanical loads, especially during scrums and tackles, potentially predisposing players to early cervical spine degeneration. This study evaluated the prevalence of degenerative changes in the cervical spine and sagittal alignment alterations in Brazilian rugby athletes, with secondary analyses comparing forwards and backs and examining associations between alignment parameters and pain and disability. Methods: Sixty-four professional rugby athletes underwent cervical spine radiography, and the images were analyzed for degenerative findings and sagittal parameters (cervical lordosis, T1 slope, cervical sagittal vertical axis, and T1–CL mismatch). Pain and disability were assessed using the Visual Analogue Scale (VAS) and Neck Disability Index (NDI). Comparative analyses included Student’s t-test and Fisher’s exact test, while additional exploratory analyses were performed using correlation and multiple linear regression models. Results: Cervical degeneration was present in 20.3% of players. Forwards reported significantly greater pain than backs (VAS: 1.64 ± 1.58 vs. 0.76 ± 0.93; p = 0.007). Deviations in cervical lordosis (>2 SD from normative values) were associated with higher VAS scores (p = 0.024). No significant associations were found between T1 slope or cervical sagittal vertical axis and pain or disability. Conclusions: Forwards demonstrated greater symptom burden and a higher prevalence of cervical degenerative changes, suggesting that positional demands may contribute to early cervical spine alterations. These findings highlight the need for targeted preventive strategies and support future longitudinal investigations to clarify the progression and clinical relevance of cervical misalignment in collision-sport athletes.

Lower back pain and sciatica account for approximately 40% of work-related absences, with management options ranging from conservative measures, such as rest and analgesia, to surgical intervention. Lumbar epidural steroid injections and facet joint blocks are frequently used for both diagnostic and therapeutic purposes. While most complications are minor (2.4%-9.6%), severe events, including infection, hematoma formation, and spinal cord infarction, have been reported. This case presents a perineural hematoma manifesting as acute radiculopathy, necessitating urgent surgical decompression. The patient

Objective: To examine the evolution of degenerative changes in the vertebral plateau of patients with lumbar disc herniation undergoing microdiscectomy, emphasizing the progression of Modic type 1 and 2 changes.

Background To quantify fatty infiltration and degree of paraspinal muscle degeneration in patients submitted to tubular microdiscectomy and conventional open microdiscectomy. Methods A prospective cohort of patients was submitted to microdiscectomy for lumbar disc herniation after failure of conservative treatment. Selection of the technique was based on the surgeon’s preference. Analysis of the multifidus muscle was performed using the Goutallier system and the percentage of fat in the muscle. Preoperative and 1-year postoperative T2-weighted magnetic resonance imaging was used, and statistical analysis was carried out using the Wilcoxon test and Spearman correlation test using a significance level of 5%. Results Thirty-two patients were included in the study. The percentage of fatty infiltration in the muscle increased on both sides of the spine 1 year after surgery, although only the ipsilateral side presented statistical significance in patients submitted to conventional microdiscectomy (43.3% preoperative and 57.8% postoperative). Muscular degeneration increased significantly ipsilateral to the disc herniation according to the Goutallier classification (grades 1–2) for both interventions. No statistically significant difference was found for fatty infiltration scores or for the degree of muscular degeneration of the multifidus in the comparative analysis of the methods. Conclusions Muscular damage resulting from surgery of lumbar disc herniation significantly increases fatty infiltration and degeneration of the multifidus. Muscular degeneration was associated with worsening back pain. Clinical Relevance While no significant difference was found between the techniques, the tubular minimally invasive approach shows a tendency for less muscle damage. These findings highlight the importance of minimizing muscle injury during surgery to improve postoperative recovery and long-term outcomes. Level of Evidence 4.