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Volume 11(1); June 2021

Original Articles

Objective
This study aimed to compare the efficacy of unilateral biportal endoscopic decompression (UBE) and percutaneous endoscopic lumbar discectomy (PELD) in reducing muscle injury by measuring serum levels of creatine phosphokinase (CK) and lactate dehydrogenase (LDH).
Materials and Methods
Thirty patients with degenerative lumbar stenosis or a herniated lumbar disc underwent decompression surgery. Among them, 12 patients underwent UBE (experimental group, n=12) and 18 underwent PELD (control group, n=18). CK and LDH were determined at admission and 1, 3, and 5 days after surgery. Pain was measured with a visual analogue scale (VAS).
Results
The mean age was significantly higher in the UBE group than the PELD group (63.33±13.50 vs. 49.94±14.79, p<0.035). Mean CK levels were not significantly different at admission. However, at both 3 and 5 days after surgery, CK levels were higher in the UBE group (308.44±153.93 vs. 70.43±40.15, p=0.002; 157.11±91.41 vs. 47.62±23.13, p=0.007). The mean LDH level was higher in the PELD group at 1 day after surgery (152.55±34.69 vs. 199.87±53.78, p=0.027). The operation time was significantly shorter in the PELD group (90.67±39.59 vs. 49.43±14.11, p=0.003).
Conclusions
The UBE group had higher CK levels at 3 and 5 days after surgery. The PELD group had a higher LDH level at 1 day after surgery. Therefore, neither procedure is clearly superior in terms of muscle damage.
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Indication and Application of Minimally Invasive Lateral Lumbar Interbody Fusion (LLIF)
Jae-Wan Soh, Chang-Hyun Kim, Jae Chul Lee
J Adv Spine Surg 2021;11(1):9-19.   Published online June 30, 2021
Purpose
Spinal fusion is useful method of treatment of degenerative lumbar diseases, and is divided into anterior and posterior surgery. Each approach has advangages and disadvantages. Recently, minimally invasive lateral lumbar interbody fusion (LLIF) supplemented disadvantages of anterior and posterior surgery is interested. We introduce LLIF and present about application and indication of LLIF.
Materials and Methods
A 76-year-old female was diagnosed by degenerative disc disease on L2-3. A 66-year-old male was diagnosed by central spinal stenosis on L2-3-4-5. A 86-year-old female was diagnosed by foraminal stenosis on L3-4-5 and degenerative scoliosis. A 73-year-old male was diagnosed by spinal stenosis on L3-4-5 and spondylolisthesis. A 70-year-old male was diagnosed nonunion on L4-5. On past history, the patient was operated by fusion because of L2 burst fracture. A 75-year-old female was diagnosed by infective spondylodiscitis on L3-4.
Results
Degenerative disc disease, severe central and foraminal spinal stenosis, degenerative scoliosis, spondylolisthesis and infective spondylodiscitis were application and indication of LLIF.
Conclusions
LLIF merges the advantages and covers the disadvantages of anterior and posterior surgery. However, approach-related lumbar plexus injury and L5-S1 approach were remained obstacles.
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Biportal Endoscopic Posterior Cervical Foraminotomy for Unilateral Cervical Foraminal Disc Disease
Min-Seok Kang, Jun-Young Choi, Ki-Han You, Jin-Ho Hwang, Hoon-Jae Chung, Hyun-Jin Park
J Adv Spine Surg 2021;11(1):20-29.   Published online June 30, 2021
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Three Consecutive Selective Nerve Root Block for Herniation and Stenosis of the Lumbar Spine: Risk Factors of Surgery
Young-Cheol Park, Ho-Jin Lee, Jae-Sung Ahn, Sang-Bum Kim, Eugene J. Park, Jae-Woo Shin
J Adv Spine Surg 2021;11(1):30-37.   Published online June 30, 2021
Purpose
The current study aims to report the results of analyzed factors that ultimately undergo surgical treatment after selective nerve root block in patients with spinal structural pathology that cause lower back pain and radiating pain in the lower extremities. Material and methods: A retrospective study was performed on 537 patients diagnosed with spinal canal stenosis or disc herniation among patients who underwent selective nerve root block at our hospital for five years from May 2015 to December 2017. The patients were divided into Group A (patients with an only selective spinal nerve root, n=99) and Group B (patients with surgical treatment, n=20). We evaluated the primary demographic factors, including age, sex, onset, symptom duration, diabetes mellitus, hypertension, angina, osteoporosis. The clinical variables included in the analysis were the preoperative visual analog scale (VAS) pain score, the Korean version of the Oswestry Disability Index (K-ODI), and the Roland-Morris disability questionnaire (RMDQ).
Results
The average symptom duration was 22.6±1.2 weeks in group A, and 35.7±0.9 in group B. Of a total of 20 patients (16.8%), four males (20%) and 16 females (80%) were underwent surgical procedures because there was no improvement in symptoms. Group B had a significantly higher proportion of female patients and longer symptom duration than group A. And there were no statistically significant differences between groups in other variables.
Conclusions
Although the frequency of surgical treatment decreased after selective nerve root block, the longer symptom duration and the female gender might be related to the risk factors for surgical treatment.
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Case Report
Surgical Technique for Simultaneous Oblique Lumbar Interbody Fusion with O-arm Based Spinal Navigation (OLIF-360) and Percutaneous Pedicle Screw Fixation in Patients with Spondylolisthesis Grade II
Young San Ko, Young IL Won, Chi Heon Kim, Seung Heon Yang, Chun Kee Chung
J Adv Spine Surg 2021;11(1):38-44.   Published online June 30, 2021
Oblique lumbar interbody fusion (OLIF) is one of surgical techniques for patients with spondylolisthesis, but an insertion of cage at an ideal location (anterior 1/3 of disc space) is challenging for patient with high grade spondylolisthesis, because vertebra are not aligned. Recently, a technique of simultaneous insertion of pedicle screw and rod system from the back of patient and insertion of cage via retroperitoneal route from the front of patient is possible by using spinal navigation system (OLIF-360). The author present a case and surgical technique of simultaneous re-alignment of high-grade spondylolisthesis at L4-5 and insertion of interbody cage by using OLIF-360. An intervertebral cage was inserted at the ideal location after re-alignment of spondylolisthesis with OLIF-360. Postoperative images showed re-aligned vertebra and successful decompression. The specific utilization of OLIF-360 has not been underscored yet.
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