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Objective Surgical site infection (SSI), a common serious complication within 1 month after transforaminal lumbar interbody fusion (TLIF), usually leads to poor prognosis and even death. The objective of this study is to investigate the factors related to SSI within 1 month after TLIF. We have developed a dynamic nomogram to change treatment or prevent infection based on accurate predictions. Materials and methods We retrospectively analyzed 383 patients who received TLIF at our institution from January 1, 2019, to June 30, 2022. The outcome variable in the current study was the occurrence of SSI within 1 month after surgery. Univariate logistic regression analysis was first performed to assess risk factors for SSI within 1 month after surgery, followed by inclusion of significant variables at P < 0.05 in multivariate logistic regression analysis. The independent risk variables were subsequently utilized to build a nomogram model. The consistency index (C-index), calibration curve and receiver operating characteristic curve were used to evaluate the performance of the model. And the decision curve analysis (DCA) was used to analyze the clinical value of the nomogram. Results The multivariate logistic regression models further screened for three independent influences on the occurrence of SSI after TLIF, including lumbar paraspinal (multifidus and erector spinae) muscles (LPM) fat infiltration, diabetes and surgery duration. Based on the three independent factors, a nomogram prediction model was built. The area under the curve for the nomogram including these predictors was 0.929 in both the training and validation samples. Both the training and validation samples had high levels of agreement on the calibration curves, and the nomograms C-index was 0.929 and 0.955, respectively. DCA showed that if the threshold probability was less than 0.74, it was beneficial to use this nomograph to predict the risk of SSI after TLIF. In addition, the nomogram was converted to a web-based calculator that provides a graphical representation of the probability of SSI occurring within 1 month after TLIF. Conclusion A nomogram including LPM fat infiltration, surgery duration and diabetes is a promising model for predicting the risk of SSI within 1 month after TLIF. This nomogram assists clinicians in stratifying patients, hence boosting decision-making based on evidence and personalizing the best appropriate treatment.

OBJECTIVE: To introduce a novel visualized foraminoplasty technique in patients with lumbar disc herniation with lumbar foraminal stenosis.METHODS: We retrospectively analyzed patients who had undergone surgery in our hospital for lumbar disc herniation with foraminal stenosis. We enrolled 35 patients who received the traditional TESSYS technique and 70 who received the new technique. We compared the foraminalplasty time, fluoroscopy times, intraoperative blood loss, intraoperative dural and nerve root injuries, length of postoperative hospital stay, clinical outcome according with modified MacNab criteria, Visual Analog Scale (VAS) and Oswestry Disability Index (ODI)between the new technique group and the traditional TESSYS technique group.RESULTS: The intraoperative VAS score(1.84±0.96) and fluoroscopic times(13.30±3.79) in the new technique group were significantly lower than those in the traditional TESSYS group (intraoperative VAS score,3.60±1.09,P=0.000;fluoroscopic times,20.00±4.24,P=0.000).The foraminalplasty time in the TESSYS group(17.60±3.46) was significantly shorter than that in the new technique group (22.81±4.86)(P=0.000).There were no significant differences in length of hospital stay after surge, postoperative VAS score and postoperative ODI score between the two groups (P=0.835, P=0.779, P=0.350). In addition, the amount of blood loss during foraminoplasty could not be calculated due to the presence of continuous saline irrigation in the new technique group. In the conventional TESSYS technique group, there was 1 patient with exiting nerve root injury who developed significant leg pain after surgery.CONCLUTIONS: The novel visualized foraminoplasty technique is a safe and effective surgical method. Compared with traditional surgical methods, it has obvious advantages in reducing intraoperative pain and radiation exposure.

Study design: Retrospective cohort analysis. Objective: Our study aimed to investigate the effect of preoperative lumbar muscle quality (including muscle cross-sectional area (CSA) and muscle fatty infiltration rate (FIR) on L5-S1 foraminal stenosis degeneration after L4-5 TLIF. Summary of Background Data: Adjacent segment degeneration (ASD) was a major spinal fusion complication. The paraspinal muscle had been proven to be an essential factor influencing the happening of ASD. However, few studies had investigated the association between paraspinal muscle and adjacent segment foraminal stenosis degeneration (ASD-FS). Methods: One hundred-thirteen patients diagnosed with lumbar spinal stenosis at L4-5 were involved. Paraspinal muscle measurements were obtained preoperatively and bilaterally from axial T2-weighted MR images. The parameters included the, psoas cross-sectional area (p-CSA), erector spinae cross-sectional area (es-CSA), multifidus cross-sectional area (m-CSA), psoas fatty infiltration rate (p-FIR), erector spinae fatty infiltration rate (es-FIR), and multifidus fatty infiltration rate(m-FIR). The foraminal parameters were obtained in the Computed Tomography system bilaterally, including posterior disc height (PDH), disc-to-facet distance (D-F), foraminal height (FH), and foraminal area (FA). The association between muscle quality and ASD-FS had also been studied. Results: At the last follow-up, the DF, FH, and FA were significantly decreased compared to pre-operation, and the decrease in FA was significantly positively related to es-FIR and m-FIR. Conclusion: FIR for lumbar muscles preoperative was a predictor for L5-S1 ASD-FS after TLIF surgery, and patients who had higher es-FIR and higher m-FIR were more inclined to develop L5-S1 ASD-FS.

Objective: To investigate the incidence of preoperative deep vein thrombosis (DVT) progression after spine surgery and identify the risk factors which predict DVT progression. Methods: 204 patients with preoperative DVT underwent spine surgery were included in this study (50 cases of DVT progression postoperatively while 154 cases of no progression). Extensional demographic data, biochemical analyses data and surgery associated data of these patients were recorded and compared between DVT progression group and no progression group. Multivariate analysis was adopted to identify the predictors of DVT progression after spine surgery. Results: The incidence of DVT progression after spine surgery was 24.5%. Symptomatic pulmonary embolism (PE) was detected in 0.98% of cases but not life-threatening. Comparing with no progression group, the DVT progression group has significantly higher percentage of high energy trauma, higher preoperative D-dimer level, more blood loss, higher percentage of intraoperative blood transfusion and longer operating time. D-dimer ≥ 1.605 mg/L and operating time ≥ 175 min were significantly associated with DVT progression after spine surgery based on the multivariate analysis. Conclusions: For the patients with DVT before spine surgery, the incidence of DVT progression after surgery is not low. It is still safe for these patients receiving spine surgery when postoperative anticoagulant treatment and DVT surveillance with ultrasonography can be timely applied. Preoperative D-dimer ≥ 1.605 mg/L and operating time ≥ 175 min are predictors for DVT progression after spine surgery.