Asian Spine Journal最新文献

{"title":"Proximal junction uninstrumented bone fusion for proximal junctional kyphosis/failure prevention: a retrospective matched cohort study in Korea.","authors":"Seung-Jae Hyun, Ki-Jeong Kim, Howard S An, Sungjae An","doi":"10.31616/asj.2025.0768","DOIUrl":"https://doi.org/10.31616/asj.2025.0768","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective matched cohort study.</p><p><strong>Purpose: </strong>This study aimed to determine the efficacy of proximal junction uninstrumented bone fusion (UBF) to prevent proximal junctional kyphosis/failure (PJK/F) in adult spinal deformity (ASD) surgeries.</p><p><strong>Overview of literature: </strong>PJK/F represents significant complications in ASD surgeries. Despite many preventive strategies being developed, which have been largely categorized as additive surgical procedures and optimal alignment correction, PJK/F still remains a prevalent complication.</p><p><strong>Methods: </strong>This study retrospectively analyzed patients who underwent ASD corrective surgeries incorporating UBF at the proximal junction at a single academic institution. The patients with ASD were individually matched (1:2) for age, gender, osteoporosis status, and uppermost instrumented vertebrae. The demographic, operative, and radiographic parameters were compared, while the complication-free periods for PJK/F and any mechanical failure (MF) were separately assessed. A multivariable survival analysis identified the significant factors for mechanical complications.</p><p><strong>Results: </strong>A total of 21 patients in the UBF group and 42 patients in the non-UBF group were enrolled. No significant differences in the demographic, operative, and radiographic parameters and the patient-reported outcome scores were observed. The median time to PJK/F was longer in the UBF group (11.0 months vs. 3.5 months, p=0.037). In the UBF group, six patients had successful bone mass fusion without any MF. The odds ratio of UBF was 0.55 (p=0.28) for PJK/F and 0.35 (p=0.056) for any MF. The results of the Kaplan-Meier analysis indicated a significantly extended MF-free period in the UBF group (p=0.028), but not for PJK/F (p=0.16).</p><p><strong>Conclusions: </strong>Although proximal junction UBF in ASD surgeries did not show a statistically significant PJK/F reduction, its safety, technical simplicity, and the absence of complications in patients with successful bone mass fusion suggest its potential clinical value and warrant further research.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforaminal microtubular discectomy for extraforaminal disc herniation using a 14-mm retractor.","authors":"Arvind G Kulkarni, Deepika Jain, Priyambada Kumar, Bala Ganeshan T, Prikshit Ohri, Mahalingam","doi":"10.31616/asj.2025.0676","DOIUrl":"https://doi.org/10.31616/asj.2025.0676","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Purpose: </strong>We report our experience with minimally invasive transforaminal (TF) microtubular discectomy using a 14-mm tubular retractor in 20 patients with extraforaminal (EF) disc herniations.</p><p><strong>Overview of literature: </strong>Despite the popularity of the TF approach with an open and endoscopic approach, little is known regarding TF microtubular discectomy using a 14-mm diameter tubular retractor.</p><p><strong>Methods: </strong>A group of 20 patients who failed conservative treatment underwent surgery via the TF approach using a 14-mm tubular retractor from March 2018 to January 2024. Preoperative and postoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were monitored.</p><p><strong>Results: </strong>A 14-mm tube over the METRx system (Medtronic-Sofamor-Danek) was successfully utilized in all patients. The mean intraoperative blood loss was 29.85±7.02 mL, whereas the mean operative time was 30.50±5.38 minutes. The affected levels were L3-L4 (eight patients), L4-L5 (five patients), L5-S1 (four patients), and L2-L3 (three patients). The VAS score for the leg improved from 7.6±0.77 to 2.0±0.56 immediate after surgery (p <0.001), whereas the postoperative VAS score for the back was 1.23±0.83. The mean ODI score improved significantly from 57.20%±9.36% before surgery to 12.60%±3.18% at 1 year after surgery (p <0.001). One patient had L5-S1 EF recurrent herniation.</p><p><strong>Conclusions: </strong>TF microtubular discectomy using a 14-mm tubular retractor offers an adequately sized foraminal working channel for effective decompression of the EF disc herniation while reducing pain, improving functional outcomes, and preserving integrity.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of the Korean version of the Modified Japanese Orthopedic Association Score: a prospective questionnaire study.","authors":"Seungmin Lee, Chang Ju Hwang, Jae Hwan Cho, Han-Dong Lee, Jiwon Park, Mi Young Lee, So Jeong Yoon, Sehan Park","doi":"10.31616/asj.2025.0854","DOIUrl":"https://doi.org/10.31616/asj.2025.0854","url":null,"abstract":"<p><strong>Study design: </strong>A prospective questionnaire-based study.</p><p><strong>Purpose: </strong>This study aimed to translate, adapt, and validate the Korean version of the modified Japanese Orthopedic Association (mJOA) score.</p><p><strong>Overview of literature: </strong>The mJOA score is considered one of the most commonly used instruments for assessing the functional status of patients with cervical myelopathy. However, a Korean version of the mJOA score has not yet been developed, limiting its standardized assessment in Korean-speaking populations.</p><p><strong>Methods: </strong>This prospective, questionnaire-based study adhered to established cross-cultural adaptation guidelines to translate the mJOA score into Korean. One hundred and twenty-two native Korean-speaking patients with cervical myelopathy recruited from a spine outpatient clinic were administered the final version. Test-retest reliability and internal consistency were assessed using the intraclass correlation coefficient (ICC) and Cronbach's alpha. Item-level analyses included the mean, standard deviation, and floor and ceiling effects. Construct validity was assessed by analyzing the correlations between the Korean mJOA scores and other patient-reported outcome measures, including the Visual Analog Scale (VAS) and the adapted Korean version of the Neck Disability Index (AK-NDI).</p><p><strong>Results: </strong>This study investigated a total of 122 patients with cervical myelopathy (74 men and 48 women; mean age, 62.5±11.5 years) who completed the Korean mJOA. Internal consistency was acceptable (Cronbach's α=0.666), and test-retest reliability was moderate to excellent across most domains (ICC=0.478-0.896). The total mJOA score also showed a moderate negative correlation with the AK-NDI (r =-0.497, p <0.001) and a weak negative correlation with the arm pain VAS (r =-0.339, p =0.003).</p><p><strong>Conclusions: </strong>This study successfully developed and validated the Korean version of the mJOA score, making it a reliable tool for assessing functional impairment in Korean-speaking patients with cervical myelopathy. Its clinical and research use could standardize patient assessments and improve the management of cervical myelopathy in Korea.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization of spine surgery outcomes in patients with osteoporosis: a comprehensive narrative review.","authors":"Chang-Nam Kang, Hee Jung Son, Sung Cheol Park, Won Rak Choi","doi":"10.31616/asj.2026.0183","DOIUrl":"https://doi.org/10.31616/asj.2026.0183","url":null,"abstract":"<p><p>Osteoporosis has emerged as a major challenge in spine surgery amid the rapid aging of the global population. Diminished bone quality significantly heightens the risk of postoperative mechanical complications following spinal instrumentation, including screw loosening, proximal junctional kyphosis and failure, cage subsidence, pseudoarthrosis, and loss of surgical correction. These complications often result in poorer clinical outcomes, higher healthcare expenditures, and an increased need for revision surgery. Comprehensive preoperative assessment of bone health represents the initial step in optimizing surgical outcomes in patients with osteoporosis. While dual-energy X-ray absorptiometry remains the gold standard for evaluating bone mineral density, opportunistic computed tomography-based assessments can further refine risk stratification. Secondary causes of osteoporosis should be identified and managed preoperatively. Surgical strategies should prioritize maximizing pedicle screw fixation and minimizing implant-related complications. Key technical considerations include optimization of screw trajectory, diameter, and length; judicious use of cement augmentation; appropriate sacral fixation techniques; and meticulous preservation of vertebral endplates to prevent cage subsidence. In selected cases, the cortical bone trajectory may offer biomechanical advantages for osteoporotic bones, while perioperative pharmacologic optimization further enhances outcomes. Anabolic agents, such as teriparatide, augment bone formation and fusion rates and are recommended as first-line therapy when feasible. Antiresorptive agents typically serve as second-line or maintenance therapy following anabolic treatment. A comprehensive approach integrating systematic bone health assessments, optimized surgical techniques, and appropriate pharmacological management is essential to mitigate implant-related complications and improve surgical outcomes in patients with osteoporosis.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cement-augmented endplate-penetrating pedicle screws for osteoporotic vertebral collapse: a technical note.","authors":"Masahiro Kawanishi, Hidekazu Tanaka, Yutaka Ito, Naokado Ikeda, Kunio Yokoyama, Makoto Yamada, Akira Sugie, Daiji Ichihashi","doi":"10.31616/asj.2025.0820","DOIUrl":"https://doi.org/10.31616/asj.2025.0820","url":null,"abstract":"<p><p>Osteoporotic vertebral collapse with a retropulsed posterior wall fragment may present with delayed neurological deficits. Although this condition is managed with short-segment posterior fixation, pedicle screw (PS) pullout is a major concern in patients with severe osteoporosis. Herein, we describe a preliminary salvage technique combining endplate-penetrating hollow PSs and cement augmentation to minimize intradiscal cement leakage. Two elderly women with osteoporotic vertebral fractures at L1/L2 with paraparesis underwent partial laminectomy at the collapsed level and short-segment posterior fixation spanning one level above and below. After the hollow PS's tip slightly penetrated the endplates, the screws were further advanced to draw disc tissue into the screw lumen as a biological \"plug,\" and polymethyl methacrylate cement was injected through the lumen under continuous fluoroscopy. Postoperatively, both patients regained independent ambulation with maintained sagittal alignment. This technique is a feasible salvage option in highly selected patients; however, its safety and long-term efficacy require further investigation.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of a thermosensitive poloxamer-based hydrogel as an anti-adhesive agent in full-endoscopic spine surgery: a randomized controlled trial in Thailand.","authors":"Vit Kotheeranurak, Nattapat Tangchitcharoen, Sompoom Sunpaweravong, Surachat Jaroenwareekul, Worawat Limthongkul, Wicharn Yingsakmongkol, Jin-Sung Kim, Weerasak Singhatanadgige","doi":"10.31616/asj.2025.0711","DOIUrl":"https://doi.org/10.31616/asj.2025.0711","url":null,"abstract":"<p><strong>Study design: </strong>Randomized controlled trial.</p><p><strong>Purpose: </strong>This trial aimed to evaluate the efficacy and safety of a thermosensitive poloxamer-based anti-adhesive hydrogel in patients undergoing full-endoscopic lumbar discectomy for lumbar disc herniation.</p><p><strong>Overview of literature: </strong>Epidural fibrosis is a complication following lumbar discectomy that is characterized by frequent pain generation. Although full-endoscopic discectomy causes minimal tissue trauma, fibrosis remains a cause of unsatisfactory outcomes. Although thermosensitive poloxamer-based anti-adhesive hydrogels have demonstrated anti-adhesive effects in animal models, clinical evidence for the same remains scarce.</p><p><strong>Methods: </strong>A single-center randomized controlled trial was conducted on 71 patients undergoing full-endoscopic interlaminar lumbar discectomy. Patients were randomized to receive either an anti-adhesive agent or methylprednisolone. The primary outcome was leg pain measured using the Visual Analog Scale (VAS)-leg 3 months after surgery. Secondary outcomes included VAS-back and the Oswestry Disability Index (ODI), assessed before and 1, 3, 6, and 12 months after surgery. Epidural fibrosis was graded based on magnetic resonance imaging (MRI) 3 months after surgery.</p><p><strong>Results: </strong>Baseline characteristics were comparable between the groups. Both groups demonstrated significant improvements in VAS and ODI scores from baseline at all timepoints (p <0.001). At 12 months, mean VAS-leg decreased by -5.91 and -5.92 in the antiadhesive and control group, respectively (p =0.995). The antiadhesive and control group showed a -2.17 and -2.06 decrease in VAS-back and -15.13 and -15.15 decrease in the ODI, respectively, with no significant differences between the groups. Extensive epidural fibrosis (grades 3-4) was observed in 8.7% and 32% of the antiadhesive and control group, respectively (p =0.047). Adverse events were rare and comparable.</p><p><strong>Conclusions: </strong>No significant differences in the primary outcome (VAS-leg) at 3 months or in other patient-reported outcomes at 12 months were observed between the groups. MRI 3 months after surgery showed that the thermosensitive poloxamer-based hydrogel reduced extensive epidural fibrosis, although this radiographic benefit did not translate into superior clinical outcomes.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Growth factor-loaded scaffolds for locomotor recovery after traumatic spinal cord injuries: a meta-analysis of preclinical evidence.","authors":"Shayan Roshdi Dizaji, Amirreza Peyrovinasab, Amirmohammad Toloui, Ghazal Tavakoli, Amir Azimi, Nogol Motamedgorji, Nima Azh, Mahmoud Yousefifard, Arash Sarveazad","doi":"10.31616/asj.2025.0557","DOIUrl":"https://doi.org/10.31616/asj.2025.0557","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis of preclinical studies.</p><p><strong>Purpose: </strong>To evaluate the efficacy of biomaterial scaffolds incorporating neurotrophic growth factors in promoting locomotor recovery after traumatic spinal cord injury (SCI).</p><p><strong>Overview of literature: </strong>SCI results in severe neurological deficits and limited regenerative capacity. Biomaterial scaffolds provide structural support and, when combined with neurotrophic growth factors, may enhance axonal regeneration and functional recovery. However, despite numerous preclinical studies, the pooled efficacy of these strategies has not been comprehensively quantified.</p><p><strong>Methods: </strong>Comprehensive searches of Medline, Embase, Scopus, and Web of Science were conducted through May 2025. Two independent researchers conducted the screening process and extracted data as per the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Eligible studies assessed functional recovery in rodent SCI models treated with scaffolds containing neurotrophic factors. A random-effects meta-analysis was performed to calculate standardized mean differences (SMDs) and 95% confidence intervals (95% CI). Risk of bias (ROB) was evaluated using SYRCLE's ROB tool. The certainty of evidence was reported using the GRADE framework.</p><p><strong>Results: </strong>Analysis of 56 articles revealed that brain-derived neurotrophic factor (BDNF) (SMD, 3.35; 95% CI, 1.71-5.00; p <0.001), nerve growth factor (NGF) (SMD, 4.51; 95% CI, 1.57-7.45; p <0.001), neurotrophin-3 (NT-3) (SMD, 2.57; 95% CI, 1.29-3.84; p <0.001), basic fibroblast growth factor (bFGF) (SMD, 3.23; 95% CI, 1.84-4.62; p <0.001), and insulin-like growth factor 1 (IGF-1) (SMD, 2.39; 95% CI, 1.35-3.43; p <0.001) were associated with significant improvements in locomotion. NGF demonstrated sex-specific differences favoring females (p =0.026), while bFGF was most effective in transection models (SMD, 4.60; p <0.001). Both bioactive and non-bioactive scaffolds effectively delivered BDNF and NGF.</p><p><strong>Conclusions: </strong>Growth factor-loaded scaffolds, especially those incorporating BDNF, NGF, and NT-3, demonstrate substantial potential for the treatment of SCI. These findings highlight the significance of selecting appropriate scaffold materials and delivery strategies tailored to specific injury types.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brain activation is correlated with patient-reported outcomes in patients with chronic lower back pain: a prospective observational study in Japan.","authors":"Shinji Tanishima, Yasunori Kotani, Eijiro Yamashita, Tokumitsu Mihara, Chikako Takeda, Hideki Nagashima","doi":"10.31616/asj.2025.0440","DOIUrl":"https://doi.org/10.31616/asj.2025.0440","url":null,"abstract":"<p><strong>Study design: </strong>This was a prospective observational study.</p><p><strong>Purpose: </strong>This study aimed to investigate the relationship between brain activity and self-reported outcomes in patients with chronic lower back pain (CLBP).</p><p><strong>Overview of literature: </strong>Previous research has shown that emotional brain regions, including the amygdala, are activated in patients with CLBP in response to pain-related stimuli. However, their association with patient-reported outcomes has been unclear.</p><p><strong>Methods: </strong>In this study, 20 patients with CLBP and 20 age- and sex-matched healthy controls underwent functional magnetic resonance imaging during verbal stimulation involving pain-related and neutral words. Brain activation was analyzed in predefined regions of interest, including the amygdala. The associations between brain activity and clinical outcome measures (e.g., the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire [JOABPEQ], Oswestry Disability Index [ODI], Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale) were assessed.</p><p><strong>Results: </strong>Under the pain-related versus neutral verbal contrast condition, the patients with CLBP showed a significantly greater left amygdala activation than the controls (p =0.012). In the CLBP group, left amygdala activation was positively correlated with selected JOABPEQ domain scores, including lumbar spine dysfunction, gait dysfunction, social life disorder, and psychological disorder (r =0.49-0.61), and negatively correlated with the ODI score (r =-0.49).</p><p><strong>Conclusions: </strong>These findings suggest that amygdala activity reflects the emotional aspects of CLBP and is associated with patient-reported functional status.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous endoscopic lumbar discectomy combined with sinuvertebral nerve ablation for lumbar disc herniation with Modic type I endplate changes: a retrospective case-control study.","authors":"Lei Liu, Meng Han","doi":"10.31616/asj.2025.0752","DOIUrl":"https://doi.org/10.31616/asj.2025.0752","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective case-control study.</p><p><strong>Purpose: </strong>This study aimed to evaluate the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) combined with sinuvertebral nerve ablation (SNA) based on the clinical data of patients with lumbar disc herniation (LDH) accompanied by Modic type I changes (MC I).</p><p><strong>Overview of literature: </strong>Modic changes are associated with poorer outcomes following surgery. SNA effectively alleviates low back pain (LBP), and its analgesic effect is primarily mediated through neural ablation.</p><p><strong>Methods: </strong>Clinical data were collected from 136 patients with LDH and combined MC I who underwent PELD. They were divided into two groups based on treatment approaches: the PELD+SNA (PSNA) and PELD groups. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) score for back and leg pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI) for degenerative lumbar diseases at 1, 3, and 12 months postoperatively. The modified MacNab criteria were employed to evaluate efficacy at the final follow-up. Efficacy and adverse events were compared between the two groups.</p><p><strong>Results: </strong>No significant differences in sex, age, LDH segment, and location were observed between the two groups. In addition, no significant differences in the preoperative LBP VAS, leg pain VAS, lumbar JOA, or ODI were found between the two groups. The postoperative symptoms of patients in both groups were significantly relieved; specifically, the LBP and leg pain VAS scores, and the ODI, were significantly lower at all postoperative time points than preoperatively. A significant difference was observed between the PSNA and PELD groups. At the last follow-up, no significant difference in the modified MacNab score was observed between the two groups.</p><p><strong>Conclusions: </strong>SNA improved the efficacy of PELD for the treatment of LDH with MC I. The incorporation of SNA during surgery can lead to better long-term outcomes and reduced residual LBP after PELD.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of index-level reoperation-free survival and complication rates between endoscopic and conventional transforaminal lumbar interbody fusion: a retrospective comparative study in Korea.","authors":"Myung Soo Youn, Yoon Jae Cho, Tae Sik Goh, Jung Sub Lee","doi":"10.31616/asj.2025.0590","DOIUrl":"https://doi.org/10.31616/asj.2025.0590","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective comparative study.</p><p><strong>Purpose: </strong>To compare index-level reoperation-free survival and implant-related complication rates between patients undergoing endoscopic transforaminal lumbar interbody fusion (ETLIF) and conventional open transforaminal lumbar interbody fusion (TLIF) for degenerative lumbar spine disorders.</p><p><strong>Overview of literature: </strong>ETLIF is a popular minimally invasive alternative to conventional TLIF for degenerative lumbar spine disorders; however, there are concerns regarding its long-term durability and the risk of reoperation compared with the established open TLIF.</p><p><strong>Methods: </strong>We retrospectively analyzed clinicodemographic characteristics (including bone mineral density), operative parameters, and implant-related complications of 199 patients who underwent lumbar interbody fusion at two spine centers (ETLIF: n=97; TLIF: n=102). Kaplan-Meier survival analysis and Cox proportional hazards modeling were used to evaluate index-level reoperation rates. Statistical significance was set at p <0.05.</p><p><strong>Results: </strong>The ETLIF group had a significantly higher rate of index-level reoperation (7.2% vs. 1.0%, p =0.017), longer operative time (182 minutes vs. 162 minutes, p =0.014), and shorter follow-up duration (23.5 months vs. 37.2 months, p=0.001) than the open TLIF group. Kaplan-Meier analysis demonstrated a progressive decline in reoperation-free survival in the ETLIF group, whereas the TLIF group maintained 98.9% survival at 24 months. Cox regression revealed a hazard ratio of 8.34 (95% confidence interval, 1.36-22.20) for ETLIF. Although the ETLIF group showed slightly higher rates of screw loosening, infection, and implant breakage, between-group differences were not statistically significant.</p><p><strong>Conclusions: </strong>ETLIF was associated with a higher incidence and risk of early index-level reoperation compared to open TLIF, highlighting the need for careful monitoring of initial construct stability in endoscopic fusion. Further studies are required to verify these observations and their clinical implications.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148418142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}