Carolina Ramírez Martínez

Purpose: To characterize baseline spinal multimorbidity, we investigated sex-associated differences in disability, and the temporal distribution of patients aged 80 years or older presenting to a tertiary spine center over three decades. Methods: We performed a retrospective single-center study (1994–2024). Of 3199 screened unique patient medical records evaluated for low back pain, 193 unique patients were age-eligible; 71 were excluded for prespecified record-quality criteria, leaving 122 patients in the analytical cohort. Baseline Visual Analog Scale (VAS) scores were available for all 122 patients and Oswestry Disability Index (ODI) scores for 99. Diagnoses required clinical-imaging concordance. A Lumbar Pathology Count (LPC) summarized seven coexisting degenerative diagnosis categories. Temporal distributions across study periods (D1: 1994–2004, D2: 2005–2014, D3: 2015–2024) were examined descriptively. Multivariable robust linear regression evaluated the association between sex and ODI. Results: Mean age was 84.2 years, and median VAS was 8/10. Among 99 patients with ODI data, mean ODI was 47.6%. Women with complete sex and ODI data had higher disability than men (51.5% vs. 39.8%; p = 0.002; Cohen d = 0.66). In the adjusted model (n = 98), female sex remained associated with a 12.3-point higher ODI (95% CI 4.5–20.2; p = 0.002). Most patients (76.2%) had more than one lumbar diagnosis (mean LPC, 1.99), but LPC was not significantly correlated with VAS or ODI. From D2 to D3, facet arthrosis increased from 31.3% to 65.3% and central disc herniation decreased from 37.5% to 9.9%; both remained significant after Benjamini–Hochberg correction (q = 0.039). The analytical cohort comprised five patients in D1, 16 in D2, and 101 in D3. Conclusions: In this selected referral-center cohort, advanced-age patients presented with severe baseline pain, disability, and frequent coexisting lumbar degeneration. Female sex was independently associated with higher baseline disability. Temporal patient distributions reflect complete-record inclusion criteria rather than population epidemiology. These findings emphasize the necessity of explicit functional phenotyping in late-life spine care.

Introducción: Colombia enfrenta una acelerada transición epidemiológica hacia una población envejecida; esto plantea importantes retos sobre el sistema de salud. El dolor lumbar crónico es una de las enfermedades de mayor impacto en la funcionalidad y en la pérdida de autonomía en pacientes de vejez avanzada. La cirugía mínimamente invasiva de columna (CMIC) es una alternativa que permite recuperar la capacidad funcional en esta población frágil. El propósito de este trabajo es evaluar los resultados del tratamiento mínimamente invasivo, el impacto funcional y su seguridad en pacientes por encima de los 80 años de edad.Materiales y métodos: Estudio observacional descriptivo de 122 pacientes entre 80 y 99 años tratados en un centro de referencia con técnicas quirúrgicas mínimamente invasivas de columna. Se analizaron variables demográficas, comorbilidades y escalas de dolor y discapacidad.Resultados: La mediana de la edad fue de 84 años (RIC: 81-86,25). Un 91,8% de los pacientes geriátricos reportó alguna comorbilidad; la HTA fue la más frecuente con un 72%. Se realizaron un total de 223 procedimientos. Uno de los más comunes fue la rizólisis facetaria percutánea (31%). La CMIC redujo la EVA significativamente de 8 a 2 puntos (p<0,001) y la mediana del índice de funcionalidad ODI se redujo de 46% a 14% (p<0,001). La tasa de complicaciones fue de 5% con una satisfacción global al cuestionario Macnab del 60,7%.Conclusión: La CMIC usando anestesia regional es una alternativa segura y efectiva que permite la restauración funcional en pacientes de longevidad extrema en los que el mantenimiento de la autonomía es un factor importante en la calidad de vida.

Objective: To report the clinical outcomes obtained using AECF for cervical spondylarthrosis treatment. Methods: A retrospective study evaluated the patient-reported outcome measures (PROM) and complications of patients with radiating cervical pain and imaging findings of spondylarthrosis and foraminal stenosis treated with awake outpatient AECF. Results: AECF was performed in 18 patients. A satisfaction rate between excellent and good was obtained in 82.4% of the patients. Neck Disability Index significantly decreased 37.4% ± 14.3 (95% CI 29.8 – 45.0) to 11.5% ± 9.7 (95% CI 5.54 17.4) (P<0.001). VAS scores showed a statistically significant variation from a preoperative pain of 7.83 ±1.38 (95% CI 7.15 – 8.52) and then, at the 24-month follow-up, a score of 2.20 ± 1.79 (95% CI 1.31 – 3.09). There were two complications and two reoperations. Conclusion: This case series demonstrated favorable clinical outcomes using the anterior endoscopic technique for radiculopathy due to cervical spondylosis, supporting AECF as a feasible surgical alternative. Although current evidence suggests endoscopic treatment as an alternative for lateral stenosis, further high-quality studies are needed to strengthen the level of evidence. Level of Evidence IV; Case Series.

Objective: To evaluate the clinical outcomes achieved with the combined surgical management of Transforaminal Endoscopic Lumbar Foraminoplasty (TELF) with an Interspinous Spacer Device (ISD) in patients with DS grades I and II and LSS. Methods: A retrospective observational study was conducted using clinical records of patients who underwent a TELF procedure plus the placement of an ISD for LSS and DS. Demographic variables and Patient-Reported Outcome Measures (PROMs), including the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), were analyzed to evaluate the clinical outcomes of the combined procedures. A total of 37 patients (54.05% women, 45.95% men) were evaluated. The mean age was 59.59 ± 15.89 years (95% CI 55.29 – 64.89); 43.24% (n=16) of the sample were women aged 60 or older and 32.43% of the patients were “pensioner-retired.” The most common presenting symptom was radicular pain: 30.30% on the right side and 48.48% on the left side. A total of 49 TELF procedures were performed, and 45 ISD were placed in the 37 patients. The average procedure duration was 85.77 ± 28.54 minutes, and the average blood loss was 23.28 ± 21.96 ml. The most frequently operated level was L4-L5. Results: The VAS and ODI scores improved significantly differences (p <0.001) before and after the procedure. Two complications were observed (5.4%). The overall reoperation rate was 10.81% (n=4). Conclusion: Transforaminal endoscopic decompression with ISD represents a feasible and safe outpatient alternative for patients with low-grade spondylolisthesis and stenosis. This combined minimally invasive technique provides significant clinical improvement with a low reoperation rate and offers a compelling alternative to more invasive surgery. Level of Evidence IV; Case Series.