Associated pathologies due to lumbar spine disorders continue to be one of the most common clinical problems encountered by spine surgeons. Over the past year, several new studies have updated the understanding of certain aspects of the field. How to Reduce Blood Loss One study evaluated the effect of the use of antifibrinolytic solvents, such as tranexamic acid and aminocaproic acid, on intraoperative blood loss during posterior long-segment spinal fusion for adult spinal deformities. One prospective, double-blind study compared intraoperative blood loss with intraoperative tranexamic acid (19 patients), aminocaproic acid (19 patients), and placebo (14 patients), with the mean age of the patients in the three groups being 60, 47, and 45 years, respectively. For patients 55 years of age and older, intraoperative blood loss was less in both the tranexamic acid and aminocaproic acid treatment groups than in the control group. In patients under 55 years of age, there was no significant difference in blood loss between the three groups. Moreover, the rate of postoperative blood transfusion was significantly lower in patients in the aminocaproic acid treatment group compared with the placebo group. One patient in each of the three groups developed pulmonary embolism. Therefore, the above findings support the use of antifibrinolytic agents in adult patients over 55 years of age undergoing surgery for spinal deformities. NONOPERATIVE TREATMENT Interest in the nonoperative management of lumbar spine disorders has remained strong over the past year. In a prospective study, some authors compared the effectiveness and cost-benefit analysis of surgical versus nonsurgical treatment of postoperative degenerative lumbar spine disease in elderly patients. Ninety-five elderly patients (>65 years of age) with degenerative lumbar spine pathologies, including lumbar spinal stenosis, lumbar spondylolisthesis, and lumbar disc herniation, who had previously undergone lumbar spine surgery, were included in the prospective study. Follow-up of efficacy outcomes for both surgical and nonsurgical treatments was done by a single center. Of these 95 patients, 55 patients were re-treated surgically, while 45 patients received only non-surgical treatment. From the two-year postoperative follow-up, the surgical treatment was superior to the non-surgical treatment in terms of all clinical function scores, including: the VAS pain score, the ODI score, the EuroQol 5D score, and the quality-adjusted life year (QALY). The quality-adjusted life year (QALY) two years after surgery was significantly higher in the surgical treatment group (0.67) than in the non-surgical treatment group (0.18). The total cost over the two years was significantly higher in the surgical treatment group ($41,500) than in the non-surgical treatment group ($14,000), whereas the savings per quality-adjusted life year in the surgical treatment group compared to the non-surgical group was approximately$56,437 on average. Thus, from a value-based aspect as well as from the patient’s point of view, nonsurgical treatment is not the preferred treatment option for older patients with postoperative degenerative disorders of the lumbar spine. Lower Back Pain Lower back pain continues to be an important clinical problem. One author analyzed and evaluated the relationship between physical activity, obesity, and lower back pain. The study was a population-based, cross-sectional study of 6,796 adult patients from the National Health and Nutrition Examination Survey (NHANES), which was conducted by the U.S. Department of Health and the National Center for Health Statistics of the Centers for Disease Control and Prevention, between 2003 and 2004. The authors found that the incidence of lower back pain was positively correlated with body mass index (BMI), with a prevalence of 2.9% in the normal range of body weights (BMI of 20-25 kg/m2), 5.2% in those who were overweight (BMI of 26-30 kg/m2), 7.7% in the obese (BMI of 31-35 kg/m2) and 7.7% in the highly obese ( The prevalence among the highly obese (BMI of 36 kg/m2 or above) was 11.6%. Smoking was the highest risk factor for lower back pain in all BMI groups, while physical activity was negatively associated with the development of lower back pain, especially in overweight and obese people. Another study analyzed the correlation between incipient lower back pain and MRI findings. This was a prospective imaging and clinical study that included 248 clinically asymptomatic subjects, all of whom had no prior history of lower back pain episodes. MRI of the lumbar spine was first performed on all subjects, and then all subjects were followed up for at least two years, and the MRI findings prior to the onset of lower back pain were analyzed in patients who had a clinical presentation of lower back pain. The prevalence of disc degeneration, intervertebral space narrowing, and bulging and/or herniated discs shown on MRI in the entire population was 60.5%, 19.0%, and 34.3%, respectively. The mean follow-up time was 4.3 years. The incidence of first lower back pain during the follow-up period was 34.7%, and the mean age at first lower back pain was 44.8 years. The incidence of lower back pain was significantly higher in the presence of bulging and/or herniated discs and in the presence of increased scores for degenerative disc disease (especially in the mid-lumbar spine). Moreover, the level of the degenerative disc disease score and the severity of bulging and/or herniated discs were positively correlated with the severity of lower back pain, the severity of dysfunction, and the frequency of lower back pain in the future.