Mohamed A.R. Soliman, Hendrick Francois, Alexander O. Aguirre, Asham Khan, Waeel Hamouda, Stipe Ćorluka, Zorica Buser, Samuel K. Cho, S. Tim Yoon, AO Spine Knowledge Forum Degenerative
Neurospine 2026;23(1):42-58. Published online January 31, 2026
Objective Lumbar discectomy is one of the most frequently undertaken procedures for the management of lumbar disc herniation. However, it may be complicated by recurrent disc herniation, with reported rates as high as 25%. To the authors’ knowledge, this study is the largest systematic review to date, analyzing the clinical and radiographic risk factors for recurrent disc herniation.
Methods A systematic literature search of Embase and PubMed/Medline, covering the period from inception to October 1, 2025, was conducted to identify case-control or cohort studies reporting risk factors for recurrent disc herniation. Risk factors were classified into baseline, clinical, and radiographic risk factors. Meta-analysis was performed for any reported risk factor with data from 3 or more studies. The assessment included an evaluation of publication bias and heterogeneity.
Results A total of 51 studies published during the search timeframe, comprising 52,479 patients, met the inclusion criteria. Recurrent disc herniation occurred in 6,794 patients (12.9%). Significant risk factors for disc herniation included high body mass index (BMI) (standard mean difference [SMD], 0.48; 95% confidence interval [CI], 0.26–0.70), diabetes (odds ratio [OR], 1.48; 95% CI, 1.23–1.77), increased sagittal range of motion (SMD, 2.15; 95% CI, 0.35–3.94), and Modic changes (OR, 2.97; 95% CI, 2.20–4.01). No other significant predictors for recurrent disc herniation were identified.
Conclusion In conclusion, patients with high BMI, diabetics, increased sagittal range of motion, and presence of Modic changes are at increased risk of recurrent disc herniation. Future prospective studies are needed to validate the risk factors identified in this study associated with recurrent disc herniation.
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Comparison of clinical efficacy and minimal invasiveness between unilateral biportal endoscopic and percutaneous endoscopic lumbar discectomy in the treatment of calcified lumbar disc herniation: a retrospective analysis Zhifeng Cheng, Lei Sun, Tao Tang, Qiang Wu, Likan Liang, Haonan Lu, Hao Xu, Bo Hu BMC Musculoskeletal Disorders.2026;[Epub] CrossRef
Risk factors for residual low back pain at twelve months after low-temperature plasma radiofrequency ablation in lumbar disc herniation: a retrospective cohort study Yingying Lou, Song Zhou, Yonggan Ying International Orthopaedics.2026; 50(7): 1719. CrossRef
Luca Ambrosio, Sathish Muthu, Patrick C. Hsieh, S. Tim Yoon, Jeffrey C. Wang, Gianluca Vadalà, Hans Jörg Meisel, Stipe Ćorluka, Zorica Buser, AO Spine Knowledge Forum Degenerative
Neurospine 2026;23(1):31-39. Published online January 31, 2026
Objective This study aimed to characterize international practice patterns in the surgical management of primary lumbar disc herniation (LDH) among AO Spine surgeons.
Methods A cross-sectional online survey was distributed in September 2024 to AO Spine members. The questionnaire collected detailed information on demographic characteristics, surgical indications, preferred techniques, and approaches for primary LDH treatment. Data on specialty, practice setting, fellowship training, and surgical case volume were analyzed using univariate and multivariate logistic regression to identify significant associations between surgeon characteristics and treatment preferences.
Results A total of 714 surgeons participated, representing diverse regions: North America (9.0%), Latin America (18.7%), Europe & Southern Africa (34.7%), Middle East & Northern Africa (12.8%), and Asia Pacific (24.8%). Neurological status was the most critical factor influencing early operative treatment in nonurgent cases, while bladder/bowel dysfunction and severe motor deficits were the primary indications in urgent scenarios. The majority of respondents (54.2%) preferred a mini-open technique—using either a surgical microscope or loupes—with partial laminotomy (58.1%) and partial discectomy (63.2%) being the most frequently performed procedures. Regional variations and differences in surgeon training were significantly associated with the choice of surgical approach and overall case volume.
Conclusion The findings reveal substantial variability in the surgical management of primary LDH across regions and specialties. This comprehensive dataset underscores the need for standardized, evidence-based guidelines to harmonize treatment strategies and optimize patient outcomes.
Luca Ambrosio, Sathish Muthu, Samuel K. Cho, Micheal S. Virk, Juan P. Cabrera, Patrick C. Hsieh, Andreas K. Demetriades, Stipe Ćorluka, S. Tim Yoon, Gianluca Vadalà, AO Spine Knowledge Forum Degenerative
Neurospine 2025;22(1):40-47. Published online March 31, 2025
Objective This study aims to assess global trends in the use of open surgery versus minimally invasive surgery (MIS) for the treatment of single-level L4–5 degenerative lumbar spondylolisthesis (DLS).
Methods A cross-sectional online survey issued by the AO Spine Knowledge Forum Degenerative was conducted among AO Spine members between July and September 2023. Participants were presented with 3 clinical cases of L4–5 grade 1 DLS, each with varying degrees of stenosis and instability. The survey captured surgeon demographics and preferences for open versus MIS approaches. Statistical analysis, including chi-square tests and logistic regression, was performed to explore associations between surgical choices and surgeon demographics.
Results A total of 943 surgeons responded, with 479 completing the survey. Open surgery was the preferred approach in all 3 cases (58.8%, 57.3%, and 42.4%, respectively), particularly in cases involving central and bilateral foraminal stenosis. MIS was the second most common choice, particularly for unilateral foraminal stenosis with mild instability (38.8%). Surgeons’ preferences varied significantly by region, age, and fellowship training, with younger and fellowship-trained surgeons more likely to prefer MIS.
Conclusion The study highlights the continued predominance of open surgery for DLS, especially in complex cases, despite the growing acceptance of MIS. Significant regional and demographic variations in surgical preferences suggest the need for tailored guidelines and standardized training protocols to optimize patient outcomes. Future research should focus on the long-term efficacy of these approaches and the impact of evolving technologies on surgical decision-making.
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Minimally Invasive Options for Spondylolisthesis Chibuikem A. Ikwuegbuenyi, Mousa Hamad, Ibrahim Hussain, Roger Härtl Neurosurgery Clinics of North America.2026; 37(1): 39. CrossRef
Long-term comparative study of Open-TLIF, MIS-TLIF, and UBE-TLIF in single-level degenerative lumbar spondylolisthesis Jian Luo, Lihua Shen, Changshen Bao, Zhichao Gao European Journal of Medical Research.2026;[Epub] CrossRef
Clinical Efficacy Of Sodium Heptasaponin Combined With Diosmin In Postoperative Patients Undergoing Posterior Open Surgery For Degenerative Diseases Of The Spine: A Retrospective Study Canglu Wu Pakistan Journal of Pharmaceutical Sciences.2026;[Epub] CrossRef
Awake full-endoscopic transforaminal lumbar interbody fusion via the trans-Kambin approach under local anaesthesia in a nonagenarian Maria Auron, Win Boonsirikamchai, Borriwat Santipas, Jin-Sung Kim BMJ Case Reports.2026; 19(9): e269723. CrossRef
Current Trends and Future Directions in Lumbar Spine Surgery: A Review of Emerging Techniques and Evolving Management Paradigms Gianluca Galieri, Vittorio Orlando, Roberto Altieri, Manlio Barbarisi, Alessandro Olivi, Giovanni Sabatino, Giuseppe La Rocca Journal of Clinical Medicine.2025; 14(10): 3390. CrossRef
Luca Ambrosio, Gianluca Vadalà, Javad Tavakoli, Laura Scaramuzzo, Giovanni Barbanti Brodano, Stephen J. Lewis, So Kato, Samuel K. Cho, S. Tim Yoon, Ho-Joong Kim, Matthew F. Gary, Vincenzo Denaro, AO Spine Knowledge Forum Degenerative
Neurospine 2024;21(1):204-211. Published online March 31, 2024
Objective To evaluate the global practice pattern of wound dressing use after lumbar fusion for degenerative conditions.
Methods A survey issued by AO Spine Knowledge Forums Deformity and Degenerative was sent out to AO Spine members. The type of postoperative dressing employed, timing of initial dressing removal, and type of subsequent dressing applied were investigated. Differences in the type of surgery and regional distribution of surgeons’ preferences were analyzed.
Results Right following surgery, 60.6% utilized a dry dressing, 23.2% a plastic occlusive dressing, 5.7% glue, 6% a combination of glue and polyester mesh, 2.6% a wound vacuum, and 1.2% other dressings. The initial dressing was removed on postoperative day 1 (11.6%), 2 (39.2%), 3 (20.3%), 4 (1.7%), 5 (4.3%), 6 (0.4%), 7 or later (12.5%), or depending on drain removal (9.9%). Following initial dressing removal, 75.9% applied a dry dressing, 17.7% a plastic occlusive dressing, and 1.3% glue, while 12.1% used no dressing. The use of no additional coverage after initial dressing removal was significantly associated with a later dressing change (p < 0.001). Significant differences emerged after comparing dressing management among different AO Spine regions (p < 0.001).
Conclusion Most spine surgeons utilized a dry or plastic occlusive dressing initially applied after surgery. The first dressing was more frequently changed during the first 3 postoperative days and replaced with the same type of dressing. While dressing policies tended not to vary according to the type of surgery, regional differences suggest that actual practice may be based on personal experience rather than available evidence.
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Duration of Wound Coverage for the Prevention of Surgical Site Infections After Surgery: A Systematic Review of Current Evidence With Meta‐Analysis of Randomised Controlled Trials Moira D. Cruickshank, Kirsty Loudon, Paul D. Manson, George Ramsay, Miriam G. Brazzelli International Wound Journal.2026;[Epub] CrossRef
The AO Spine Knowledge Forums: A Decade of Impactful Spine Research Klaus John Schnake, Michael G. Fehlings, Niccole Germscheid, Shekar Kurpad, Ilya Laufer, Stephen J. Lewis, Gregory D. Schroeder, S. Tim Yoon, Charles G. Fisher Global Spine Journal.2025; 15(7): 3039. CrossRef
Two-week post-operative dressing: balancing cost and surgical site infection risk in orthopaedic procedures Musa Muhammad, Aliyu M. Maigoro, Lamidi Jimoh, Rabiu A. Rufai, Oni N. Salawu, Shamsuddeen Muhammad, Sani A. Giade, Kabir B. Jatto, Shem B. Yilleng International Journal of Research in Orthopaedics.2025; 12(1): 30. CrossRef
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