Objectives
We report the new minimally invasive technique and its clinical results of oblique lumbar interbody fusion (OLIF) combined with central decompression using biportal endoscopic spinal surgery (BESS). Summary of Literature Review: The OLIF procedure is one of the minimally invasive spine surgeries and is being frequently attempted recently to treat lumbar degenerative disease. It has been reported that it effectively decompresses foraminal stenotic lesions indirectly by inserting a large cage anteriorly, which reduces spondylolisthesis and widens the disc space. However, OLIF has limited effect for severe central canal stenosis, since it cannot achieve direct decompression. Therefore, authors report a new minimally invasive technique of OLIF combined with direct central decompression using BESS for severe central stenosis along with its clinical results as a pilot study.
Materials and Methods
For patients who were candidate for fusion surgery due to spondylolisthesis (more than one segment) or foraminal stenosis, authors performed OLIF and central decompression using BESS simultaneously, when the patients had concomitant severe central canal stenosis. From June to December, 2017, 8 patients (16 levels) were enrolled, the operative time, blood loss, complications and clinical results have been evaluated. The clinical results were analyzed by Visual analog scale (VAS) scores, Oswestry disability index (ODI) and Roland Morris Disability Questionnaire (RMDQ) of preoperative, 1month, 3month postoperative and final follow-up.
Results
Mean operative time and blood loss were 238.4 minutes and 173.3ml, respectively. In all cases, there were no operative complications, and mean follow-up period was 7.1 months. The mean back VAS, lower extremity VAS, ODI, and RMDQ at the final follow-up were improved from 5.4±2.4 to 2.0±0.9, 7.0±1.1 to 1.6±1.7, 64.2±11.8 to 44.2±10.6, and from 17.5±4.2 to 12.9±4.0.
Conclusion
A new combination technique of OLIF and BESS for direct decompression can be regarded as effective alternative procedure to treat the foraminal and central stenotic lesions of lumbar degenerative disease.

Objectives
To evaluate the effectiveness of a prototype plate and cage device (PCB) in cervical spine disease.
Summary of Background
Data: Several Cage-Screw implants have recently been developed to avoid cervical platerelated complications.
Methods
A total of 34 patients with cervical disc protrusion who underwent PCB implantation between 2004 and 2007 were included in the study. There were 22 males and 12 females with a mean age of 49.9 years (range: 30 to 62 years). Odom’s Criteria were evaluated in all patients for a minimum follow-up period of 1 year (mean 24.6 months). Radiographic evaluation was performed to assess the status of fusion, intervertebral disc height, cervical lordosis and segmental kyphosis.
Results
In general, there were 20 excellent cases, 10 good cases and 4 fair cases according to Odom’s Criteria. In terms of radiological results, the height of intervertebral disc space was measured three different times, as follows: pre-operation, mean 6.07 mm; post-operation, mean 9.52 mm; last follow-up, mean 8.74 mm. No patients showed segmental instability on flexion-extension view at the last follow-up appointment. There were no cases of screw back out or device failure and no donor site morbidity.
Conclusion
PCB implant for degenerative cervical disease may restore intervertebral disc space and lordotic angle of the cervical spine without significant complications.

Intraoperative blood loss volume increases due to soft tissue injury or excessive traction generated by extensive approach including posterior fusion or posterior lumbar interbody fusion, leading to the occurrence of complication and delay in postoperative recovery, On the other hand, MI-TLIF minimizes injuries in soft tissue and surrounding muscle by approaching between multifidus muscles and longissimus dorsi after separating them, and reaching intervertebral disc from lateral vertebral foramen. The advantages of this surgical procedure are minimization of muscle or soft tissue injuries incurred by lateral approach, reduction of surgically related muscle damage, and decrease of postoperative blood loss. However, The size of cages are limited by transforaminal approach in MI-TLIF, eventually it could be difficult to maintain the correction of deformity(disc height, segmental and lumbar lordosis). Recently, DLIF(Direct lateral interbody fusion) is developed to improve the disadvantages of TLIF. DLIF allows to insert larger cage than TLIF, as a result larger cage have a advantage to maintain correction of disc height and lordosis because it can support both apophyseal rings of endplates. However, Transpsoas approach is essential for DLIF, so we need to understand the anatomy lumbosacral plexus in psoas, because nerve injury during the transpsoas approach is the most common and potentially the most devastating complication of the DLIF procedure. And many authors reported that various frequency of nerve injury according to surgeon’s skill. Therefore, surgeon’s skill and accurate understanding about the procedure are important factors to prevent the complications of DLIF.

Purpose
Anterior lumbar interbody fusion (ALIF) is widely accepted surgical technique in the treatment of lumbar degenerative disc disease, especially with foraminal stenosis. But many surgeons suspect the effectiveness of ALIF in one or multi-level lumbar degenerative disease. The aim of this study is to evaluate the effectiveness of the two-level ALIF in lumbar degenerative disease.
Materials and Methods
Included were the patients who had foraminal stenosis or spinal stenosis with segmental instability (e.g. spondylolisthesis). All patients were studied with plain radiographs and MRI before surgery and plain radiographs at 1 week, 6, 12 and 24 months after surgery. Radiographic measurements included disc height, global lumbar lordosis and existence of lateral fusion mass. To investigate the changes in lumbar global lordosis, the Cobb angle was evaluated on pre- and postoperative standing lateral radiographs from L1 superior endplate to S1 endplate. Union was defined as the presence of trabecular osseous continuity and/or less than 4° mobility between the segments on a flexion and extension radiograph. Details of blood loss, operative time, transfusions during hospitalization, hospital day, and perioperative complications were evaluated. Clinical outcomes were assessed using Visual Analogue Scale (VAS) scores for leg and back pain and Oswestry disability index (ODI) before surgery and at 6, 12 and 24 months after surgery. Paired t-test was used for statistical analysis.
Results
37 patients (10 men and 27 women; age 33-76 years, mean 61.1 years) who had undergone ALIF combined with PLF or percutaneous pedicle screw fixation (PPF) during January 2007 and January 2009 were studied retrospectively. The mean follow-up period was 34.2 months (48-25 months). The affected levels were L3-4-5 in 14 cases and L4-5-S1 in 23 cases. The average hospital days are 10.7 days, showing no difference between PLF and PPF surgery. The average operation time is 286 minutes. Blood loss was variable from 130 mL to 1200 mL (average 621.2 mL). But Blood loss during the ALIF operation was minimal. (220 mL ; range 120-540 mL). Global lumbar lordosis was improved from 29.2 to 37.8. Postoperatively all patients had relief of sciatic pain, and there were no techniqueassociated complications. Complications included sensory deficit (hypo/dysesthesia) in 4 patients, DVT in one patient, ileus in one patient and transient sympathetic symptom in 11 patients. Two patients had wound problem but were treated easily. The VAS score in leg pain was improved from 6.9 to 2.3 with statistical significance at 24 months after surgery. Also, ODI score was decreased from 30.8 to 9.2 significantly at 24 months after surgery. Radiologic evidence of solid fusion was observed in all patients on the basis of motion and screw loosening. The lateral bone mass was observed bilaterally in 26 of the 28 patients (92%). Radiologic ASD was found in 10/37(27%), but only one patient showed symptom and had minor surgery.
Conclusion
ALIF is an effective surgical strategy for the treatment of two-level lumbar degenerative disease and could be a useful alternative to posterior fusion surgery.