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Introduction: For individuals with lumbar spinal stenosis (LSS), minimally invasive procedures such as an interspinous spacer device without decompression or fusion (ISD) or open surgery (i.e., open decompression or fusion) may relieve symptoms and improve functions when patients fail to respond to conservative therapies. This research compares longitudinal postoperative outcomes and rates of subsequent interventions between LSS patients treated with ISD and those with open decompression or fusion as their first surgical intervention. Methods: This retrospective, comparative claims analysis identified patients age ≥ 50 years with LSS diagnosis and with a qualifying procedure during 2017–2021 in the Medicare database which includes healthcare encounters in inpatient and outpatient settings. Patients were followed from the qualifying procedure until end of data availability. The outcomes assessed during the follow-up included subsequent surgical interventions, including subsequent fusion and lumbar spine surgeries, long-term complications, and short-term life-threatening events. Additionally, the costs to Medicare during a 3-year follow-up were calculated. Cox proportional hazards, logistic regression, and generalized linear models were used to compare outcomes and costs, adjusted for baseline characteristics. Results: A total of 400,685 patients who received a qualifying procedure were identified (mean age 71.5 years, 50.7% male). Compared to ISD patients, patients receiving open surgery (i.e., decompression and/or fusion) were more likely to have a subsequent fusion [hazard ratio (HR), 95% confidence intervals (CI): 1.49 (1.17, 1.89)–2.54 (2.00, 3.23)] or other lumbar spine surgery [HR (CI): 3.05 (2.18, 4.27)–5.72 (4.08, 8.02)]. Short-term life-threatening events [odds ratio (CI): 2.42 (2.03, 2.88)–6.36 (5.33, 7.57)] and long-term complications [HR (CI): 1:31 (1.13, 1.52)–2.38 (2.05, 2.75)] were more likely among the open surgery cohorts. Adjusted mean index costs were lowest for decompression alone (US$7001) and highest for fusion alone ($33,868). ISD patients had significantly lower 1-year complication-related costs than all surgery cohorts and lower 3-year all-cause costs than fusion cohorts. Conclusions: ISD resulted in lower risks of short- and long-term complications and lower long-term costs than open decompression and fusion surgeries as a first surgical intervention for LSS. [ABSTRACT FROM AUTHOR]

Purpose of review: Lumbar spinal stenosis has historically been treated with open decompressive surgery which is associated with significant morbidity and may give rise to various complications. Interspinous spacers (ISS) have been developed as a less invasive strategy which may serve to avoid many of these risks. The two current spacers that are FDA approved and commercially available are the Coflex and Superion devices. The goal is to review these two implants, their indications, and patient selection. Recent findings: The Coflex device has been shown to be analogous to decompression and fusion when treating moderate spinal stenosis. It provides dynamic stability after a decompression is performed, without the rigidity of pedicle-screw instrumentation. Recent results show improved outcomes in Coflex patients at 3 years of follow-up, as compared to decompression and fusion. The Superion implant is placed percutaneously in the interspinous space with minimal disruption of spinal anatomy. When compared to the X-Stop device (which is no longer available), the Superion implant shows improved outcomes at 3 years of follow-up. Summary: ISS are lesser invasive options as compared to formal decompression and fusion for the treatment of lumbar spinal stenosis. [ABSTRACT FROM AUTHOR]

Coccydynia is a term that refers to pain in the region of the coccyx. Most cases are associated with abnormal mobility of the coccyx which may trigger a chronic inflammatory process leading to degeneration of this structure. In some patients this instability may be detected on dynamic radiographs. Nonsurgical management remains the gold standard treatment for coccydynia, consisting of decreased sitting, seat cushioning, coccygeal massage, stretching, manipulation, local injection of steroids or anesthetics, and postural adjustments. Those patients who fail these conservative modalities may potentially benefit from coccygectomy. However, surgical intervention is typically reserved for patients with evidence of advanced coccygeal instability (e.g., subluxation or hypermobility) or spicule formation, as this population appears to exhibit the greatest improvement postoperatively. [ABSTRACT FROM AUTHOR]

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Background: Despite numerous attempts at classifying thoracolumbar spinal injuries, there remains no consensus on a single unifying algorithm of management. The ideal system should provide diagnostic and prognostic information, exhibit adequate reliability and validity and be easily applicable to clinical practice. The purpose of this study is to assess the reliability and validity of two novel classification systems for thoracolumbar fractures - the Thoracolumbar Injury Severity Score (TLISS) and the Thoracolumbar Injury Classification and Severity Score (TLICS) - and also to discuss potential efforts towards research in the future. Matereials and Methods: Seventy-one patients with thoracolumbar fractures were prospectively assessed by surgeons with different levels of training and experience (attending orthopedic surgeon, attending neurosurgeon, spine fellows, senior level and junior level residents) at a single institution. Plain radiographs, CT and MRI imaging were used to classify these injuries using the TLISS system. Seven months later, 25 consecutive injuries were prospectively assessed with the TLISS and TLICS systems. Unweighted Cohen's kappa coefficients and Spearman's correlation values were calculated to assess inter-observer reliability and validity at each point in time. Results: For both the TLISS and TLICS algorithms, the inter-rater kappa statistics for all of the subgroups demonstrated moderate-to-substantial reliability (0.45-0.74), although there were no significant differences among the shared subgroups. The kappa score of the TLISS system was greater than that of the TLICS system for injury mechanism/ morphology. Correlation values were also greater across all subgroups (P≤0.01). Statistically significant improvements in TLISS inter-observer reliability were observed across all TLISS fields (P <0.05). The TLISS and TLICS schemes both demonstrated excellent validity. Conclusion: The TLISS and TLICS scales both exhibited substantial reliability and validity. However, the TLISS system displayed greater inter-observer correlation than did the TLICS and demonstrated significant improvements in reliability over time. [ABSTRACT FROM AUTHOR]