Purpose
To evaluate whether the contralateral radiating pain improved after unilateral decompression and minimally invasive transforaminal lumbar interbody fusion (TLIF) in the patients with bilateral radiating pain due to degenerative lumbar disease.
Materials and Methods
Patients with the degenerative lumbar disease who underwent unilateral minimally invasive TLIF and were followed for more than 1 year were included. Clinically, low back pain and radiating pain on the dominant symptom side and the contralateral side were evaluated by the visual analogue score (VAS), and the Oswestry disability index (ODI) score was also evaluated.
Results
ODI and VAS of low back pain and radiating pain were effectively reduced in a total of 57 cases. Thirty cases having bilateral radiating pain, among these patients, unilateral decompression was performed in 15 cases and bilateral decompression thru unilateral approach in 15 patients. In unilateral decompression group, radiating pain on the dominant symptom side, and radiating pain on the contralateral side were also improved at the final followup. In 15 cases who underwent bilateral decompression, radiating pain on the dominant symptom side and the contralateral side were improved at the final follow-up. There was no significant difference between the two groups in terms of preoperative ODI, VAS of low back and radiating pain.
Conclusions
Minimally invasive TLIF via unilateral approach with or without contralateral decompression showed good clinical results in patients having unilateral or bilateral radiating pain. Minimally invasive TLIF could be an useful option even if there is bilateral radiating pain in degenerative lumbar disease.

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.

Lumbar fusion surgery for lumbar degenerative diseases has increased in the past several decades and many techniques for fusion surgery have been introduced. Recently lateral lumbar interbody fusion with minimally invasive technique was introduced and accepted as a useful method for various lumbar degenerative disease. It can produce good correction for sagittal and coronal imbalance with relatively decreased morbidity. The advantage of lateral lumbar interbody fusion is that it can avoid injury to the abdominal large vessels and neural structures which is more common during posterior approaches. However various complications had been reported. Complications related with lateral lumbar interbody fusion include neurologic complications including thigh pain and numbness, vascular complications including arterial injury, cage related complication such as cage subsidence and vertebral body fractures. Therefore special care should be taken to avoid possible complications in lateral lumbar interbody fusion surgery.

A 77-year-old female suffering from severe degenerative scoliosis, spinal stenosis and lumbar disc herniation underwent Direct lateral lumbar interbody fusion (DLIF) at L2-4. On the 3rd postoperative day, she complained of severe back pain without any trauma history. Simple radiograph revealed L3 vertebral fracture and cage subsidence. Pain was subsided after conservative treatment including TLSO and medication. Radiographic union was achieved at fractured vertebra after 3 months. Solid fusion was observed at operated level after 6 months. Patient has visited our clinic without any pain. DLIF is one of novel minimally invasive spine procedures available today. It is designed to maximize benefits and minimize risks of other traditional techniques such as anterior approach and posterior approach. However, there can be some risk of cage subsidence and vertebral fracture after DLIF. Therefore, care should be taken to avoid cage subsidence during the operation.

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.