Purpose
There were few available data regarding the prognosis after the surgical treatment for spinal metastases from non-small cell lung cancer (NSCLC) despite its great frequency. The aim of this study was to investigate the prognostic factors for patients who underwent the surgical treatment for spinal metastases from NSCLC.
Materials and Methods
Eighty-seven patients who underwent surgical treatment for spinal metastases from NSCLC were followed up semi-prospectively. There were 43 patients with metastatic spinal cord compression (MSCC) and 44 patients without MSCC. The prognosis analysis was performed according to 3-categorical variables: patients’ , oncologic, and treatments’ factors. Major complications and mortality rate were recorded. The impact of postoperative chemotherapy was evaluated separately.
Results
The overall survival time was median 6.8 months. Postoperative ECOG-PS (0-2 vs. 3, 4) was shown as a significant prognostic factors in both MSCC and non-MSCC groups with HR (hazards ratio) of 2.46 and 2.54, respectively. Major complications developed in 26 patients and 30-day mortality rate was 8.0%. The presence of major complications was also prognostic factor in both groups with HR of 2.55 and 4.47. Earlier surgery within 72 hours showed better prognosis in MSCC group with HR of 2.46. Patients who underwent postoperative chemotherapy survived longer significantly than those who couldn’t with median survival time of 12.0 vs 2.8 months.
Conclusions
Postoperative ECOG-PS and complications were significant prognostic factors in both groups and earlier surgery in MSCC group. The postoperative chemotherapy was another independent prognostic factor affecting the survival time

Purpose
Despite the increasing prevalence of spinal deformity correction using lateral lumbar interbody fusion (LLIF) for degenerative adult spinal deformity, the amount of sagittal plane correction is reported to be suboptimal. Thus, authors have performed mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segment in adjunct to LLIF to make sufficient lumbar lordosis (LL). This study is performed to demonstrate the feasibility of mini-open anterior lumbar interbody fusion (ALIF) combined with lateral lumbar interbody fusion (LLIF) followed by 2-stage posterior fixation in terms of the correction capacity and complications by comparing with a matched control group undergoing posterior-only surgery.
Materials and Methods
This study was case-control study. Thirty patients who underwent ALIF with LLIF followed by 2-stage posterior fixation (ALIF/LLIF group) for adult spinal deformity were compared to 60 patients who underwent posterior-only surgery (posterior group) and were matched according to age, sex, diagnosis, fusion length, pelvic incidence (PI), and follow-up duration. Spinopelvic parameters, hospitalization data, clinical outcomes, and complications were evaluated and compared between ALIF/LLIF and posterior groups.
Results
In the ALIF/LLIF group, interbody fusions were performed for a mean of 4.0 levels, comprising 1.6 and 2.4 levels for ALIF and LLIF, respectively. Interbody fusion in the posterior group was performed for a mean of 3.3 levels. The mean follow-up duration did not differ between two groups (16.7 mo vs. 19.2 mo, p=0.056). Postoperative LL was greater in the ALIF/LLIF than in the posterior group (52.0° vs. 40.9°, p<0.001). The reduction in the sagittal vertical axis was also greater for the ALIF/LLIF group than the posterior group (62.3 mm vs. 24.7 mm). The operation time of the ALIF/LLIF group was longer than the posterior group (11.2 hr vs. 8.6 hr, p<0.001), while estimated blood loss and red cell transfusion was less in the ALIF/LLIF group. Medical complications developed more frequently in the posterior group, while perioperative surgical complications were not different between groups. Delayed surgical complications were observed more in the posterior group. In the posterior group, there were 7 patients who experienced nonunion and rod breakage and 10 patients who experienced decompensation, while there were no such cases in the ALIF/LLIF group.
Conclusion
Mini-open ALIF combined with LLIF can restore sagittal balance more appropriately with a lower rate of complications compared with posterior-alone surgery for the correction of ASD.

Purpose
To analyze the serial changes of the lumbar sagittal alignment from preop. to final follow-up and to evaluate the role of the posterior spinal instrumentation, especially, short level fusion in correction and maintenance of the lumbar sagittal alignment in degenerative lumbar disease.
Materials and Methods
Various lumbar sagittal profiles such as lumbar lordosis(LL), lordosis above, within and below instrumentation(LAI, LWI, LBI), horizontal vertebra and sacral inclination were serially measured in 54 patients whose radiographs at preop., intraop., immed. postop. postop. 2wks and final follow up(>1 yr) were completely equipped.
Results
Intraop. posture, instrumentation itself and interbody fusion could not increase the LL and LWI sufficiently irrespective of the length of fixation. LWI was decreased compared with preop. values irrespective of length of fixation, while interbody fusion has a great role in maintaining the LWI. Loss of LWI was overcompensated at the segments above instrumentation in 1 or 2 levels fixation while compensation has not occurred in longer fixations.
Conclusions
The longer the fixation, the more correction could be obtained. However, maintenance of this correction is more difficult in longer fixations. Prudent consideration should be taken in restoring sufficient lumbar lordosis and maintenance for favorable long term results.

Introduction
Recently, minimally invasive lateral approach for the lumbar spine is revived and getting popularity under the name of XLIF or DLIF by modification of mini-open method using sequential tubular dilator and special expandable retractor system. Purposes: The purposes of this study were to introduce the mini-open lateral approach for the anterior lumbar interbody fusion (ALIF), and to investigate the advantages, technical pitfalls and complications & to provide basic knowledge on XLIF or DLIF
Materials and Methods
Seventy-four patients who underwent surgery by the mini-open lateral approach from September 2000 to April 2008 with various disease entities were included. Blood loss, operation time, incision size, postoperative time to mobilization, length of hospital stay, technical problems and complications were analyzed.
Results
With this approach, we can reach form T12 to L5 subdiaphragmatically. The blood loss and operation time of patients who underwent simple ALIF were 61.2 ml and 86 minutes for one level, 107 ml and 106 minutes for two levels, 250 ml and 142.8 minutes for three levels, and 400 ml and 190 minutes for four levels of fusion, respectively. The incision sizes were on average 4.5cm for one level, 6.3 cm for two levels, 8.5 cm for three levels and 10.0 cm for four levels of fusion. The complications were retroperitoneal hematoma in two cases, pneumonia in one case and transient lumbosacral plexus palsy in three cases.
Conclusion
The mini-open lateral approach is simpler & safer than XLIF or DLIF with very short learning curve. Trial of mini-open lateral approach would be helpful before trial of XLIF or DLIF. However, special attention is required to complications such as transient lumbosacral plexus palsy.