Background:The aim of the present prospective study is to evaluate whether the touted advantages of minimal invasive-transforaminal lumbar interbody fusion (MI-TLIF) translate into superior, equal, or inferior outcomes as compared to open-transforaminal lumbar interbody fusion (O-TLIF). This is the first study from the Indian subcontinent prospectively comparing the outcomes of MI-TLIF and O-TLIF.Materials and Methods:All consecutive cases of open and MI-TLIF were prospectively followed up. Single-level TLIF procedures for spondylolytic and degenerative conditions (degenerative spondylolisthesis, central disc herniations) operated between January 2011 and January 2013 were included. The pre and postoperative Oswestry Disability Index (ODI) and visual analog scale (VAS) for back pain and leg pain, length of hospital stay, operative time, radiation exposure, quantitative C-reactive protein (QCRP), and blood loss were compared between the two groups. The parameters were statistically analyzed (using IBM® SPSS® Statistics version 17).Results:129 patients underwent TLIF procedure during the study period of which, 71 patients (46 MI-TLIF and 25 O-TLIF) fulfilled the inclusion criteria. Of these, a further 10 patients were excluded on account of insufficient data and/or no followup. The mean followup was 36.5 months (range 18-54 months). The duration of hospital stay (O-TLIF 5.84 days + 2.249, MI-TLIF 4.11 days + 1.8, P < 0.05) was shorter in MI-TLIF cases. There was less blood loss (open 358.8 ml, MI 111.81 ml, P < 0.05) in MI-TLIF cases. The operative time (O-TLIF 2.96 h + 0.57, MI-TLIF 3.40 h + 0.54, P < 0.05) was longer in MI group. On an average, 57.77 fluoroscopic exposures were required in MI-TLIF which was significantly higher than in O-TLIF (8.2). There was no statistically significant difference in the improvement in ODI and VAS scores in MI-TLIF and O-TLIF groups. The change in QCRP values preoperative and postoperative was significantly lower (P < 0.000) in MI-TLIF group than in O-TLIF group, indicating lesser tissue trauma.Conclusion:The results in MI TLIF are comparable with O-TLIF in terms of outcomes. The advantages of MI-TLIF are lesser blood loss, shorter hospital stay, lesser tissue trauma, and early mobilization. The challenges of MI-TLIF lie in the steep learning curve and significant radiation exposure. The ultimate success of TLIF lies in the execution of the procedure, and in this respect the ability to achieve similar results using a minimally invasive technique makes MI-TLIF an attractive alternative.

Purpose Surgery with radiation therapy (RT) is more effective in treating spinal metastases, than RT alone. However, RT when administered in close proximity to surgery may predispose to wound complications. There exist limited guidelines on the optimal timing between RT and surgery. The purpose of this systematic review is to: (1) address whether pre-operative RT (preop-RT) and/or post-operative RT (postop-RT) is associated with wound complications and (2) define the safe interval between RT and surgery or vice versa. Methods PubMed, Embase and Scopus databases were systematically searched for articles dealing with spinal metastases, treated with surgery and RT, and discussing wound status. ResultsWe obtained 2332 articles from all databases, and after applying exclusion criteria, removing duplicates and reading the full text, we identified 27 relevant articles. Fourteen additional articles were identified by hand-search, leading to a total of 41 articles. All 41 mentioned wound complications/healing. Sixteen articles discussed preop-RT, 8 postop-RT, 15 both, and 2 mentioned intraoperative-RT with additional pre/postop-RT. Twenty studies mentioned surgery-RT time interval; one concluded that wound complications were higher when RT-surgery interval was ≤ 7 days. Seven studies reported significant association between preop-RT and wound complications. Conclusions Evidence is insufficient to draw definitive conclusion about optimal RT-surgery interval. However, based on published literature and expert opinions, we conclude that an interval of 2 weeks, the minimum being 7 days, is optimum between RT-surgery or vice versa; this can be reduced further by postop-stereotactic body RT. If RT-surgery window is > 12 months, wound-complications rise. Postop-RT has fewer wound complications versus preop-RT.

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Introduction: Cranio-cervical instability (CCI) is a condition commonly found in patients with connective tissue disorders such as Ehlers-Danlos Syndrome (EDS), leading to various symptoms. Assessing patients for surgical fusion as a treatment for CCI is challenging due to the complex nature of EDS-related symptoms. This study aimed to evaluate the role of pre-fusion Halo traction in alleviating symptoms and determining suitable candidates for fusion surgeries. Methods: A case series of 15 EDS patients with neurological symptoms underwent halo traction between 2019 and 2022. Patients completed a CCI Questionnaire before and after the traction, reporting symptoms related to headache, vision, hearing, equilibrium, and performance. Symptom groups were assigned scores based on patient responses, with one point for each affirmative answer. The scores were statistically analyzed using a paired t-test. Patients experiencing over 50% improvement in the majority of symptoms were considered for fusion surgery, and 7 out of 12 patients subsequently underwent the procedure. Results: The average age of the patients was 38 years, with a female-to-male ratio of 14:1, consistent with existing literature. Significant improvements were observed in various symptom categories after halo traction, including headache (63% improvement, p < 0.001), brainstem functions (72% improvement, p < 0.001), cerebellar functions (59% improvement,p < 0.001), hearing (65% improvement, p < 0.001), motor functions (62% improvement, p < 0.001), vision (53% improvement, p < 0.001), cardiovascular functions (58% improvement, p< 0.05), sensory and pain (56% improvement, p < 0.001), high cortical functions (54% improvement, p < 0.01), GI functions (41% improvement, p < 0.05), bladder functions (55% improvement, p< 0.001), and Modified Karnofsky score (26% improvement, p < 0.05). Conclusion: halo traction proved to be a simple and effective method for both evaluating patients for surgery and providing symptomatic relief in EDS-related CCI cases. It also allows surgeons to monitor patients with stable cranio-cervical junctions before committing to surgery. However, the study's limitations include the small sample size and the absence of a validated questionnaire with a scoring system.