New Advances in the Surgical Treatment of the Lumbar Spine In the last year, there have been a number of new studies that have made significant advances in the treatment of lumbar spine disorders. Intraoperative antibiotics In a recent study, osteoblasts were extracted from five patients undergoing spinal fusion and then cultured to evaluate the effect of intra-incisional vancomycin on the cells. Osteoblasts were placed in three different concentrations of vancomycin, 3, 6, and 12 mg/cm2, and all five patients showed cell migration on days 3 to 6 of culture. However, after the addition of vancomycin, cell migration could be observed in only one of the five cases. Cell activity was 100% in the lowest vancomycin group, while it was 97% in the higher vancomycin concentrations and only 87% in the highest vancomycin concentration, a significant difference (p less than 0.009). The authors conclude that vancomycin application may affect cell migration, cell differentiation, and cell activity, leading to severe cell morphological changes, and that this effect is dose-dependent. Therefore, when vancomycin is applied topically to the incision, it will likely affect the fusion rate of spinal fusion. Sacroiliac joint A recent study evaluated the incidence of sacroiliac joint degeneration in an asymptomatic population. The authors analyzed the imaging data of 500 patients who underwent CT of the abdominopelvic region for pain other than lower back pain or pelvic region, and 373 patients were included in the study. A total of 746 sacroiliac joints were included. In the whole population, sacroiliac degeneration was present on at least one side in 131 cases (35%), while significant sacroiliac degeneration was present on at least one side in 114 cases (31%). The prevalence increased progressively from the age of 20 to 80 years. The authors concluded that sacroiliac degeneration is more common in the asymptomatic population and increases with age. Imaging manifestations of sacroiliac degeneration do not directly correlate with symptoms. Socioeconomics A recent study evaluated autologous blood transfusion applied to a total of 508 patients with short-segment lumbar laminectomy and fusion of three or fewer segments. Of these patients, 84 patients (16.5%) had intraoperative use of an autologous blood return device, and 65 of these patients (77%) received intraoperative autologous blood return. And also in this group, 57 patients who did not use autologous blood transfusion received allogeneic blood transfusion. The authors finally concluded that the autologous blood transfusion efficacy ratio is not high in lumbar laminectomies and fusions of three or fewer segments. Several authors sought to clarify whether patient demographic characteristics and clinical outcomes affect patient follow-up rates at 1 year after spine surgery. The authors included data from a two-year registry of all patients treated with spinal degeneration surgery. A total of 1484 patients were included in the study, and clinical information included the underlying condition as well as clinical outcomes at three months postoperatively. Of this group, 233 patients (15.7%) were lost to follow-up at the first year postoperatively. Among the patients who were followed up in the first year postoperatively and those who were missed, there were no significant differences in the patients’ underlying conditions or comorbidities, except for age and work status. The mean age of patients in the missed group (51 years) was significantly lower than in the followed group (57.1 years) (p less than 0.001), however, the percentage of patients in the missed group who were working (45.9%) was significantly higher than in the followed group (41.7%) (p=0.04). There was no significant difference between the two groups in terms of preoperative pain, functional impairment, and quality of life (p > 0.05). Moreover, there were no significant differences between the two groups in terms of prevalence, pain level, functional impairment, quality of life, and patient satisfaction at 3 months postoperatively. In the results of the multifactorial analysis, age was the only independent factor leading to missed visits at 1 year postoperatively (p less than 0.001). Thus, for patients actually enrolled in the registry, the 1-year postoperative loss rate was approximately 15%, and the only independent factor predicting postoperative loss was age, not poor clinical outcome or postoperative dissatisfaction.