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"Ikchan Jeon"

Review Article

Artificial Intelligence

From Pixels to Precision: Generative Artificial Intelligence as a Paradigm Shift in Spine Imaging—Technical Foundations, Clinical Applications, and the Path to Safe Clinical Deployment
Daniyal Ashraf, Vivek Sanker, Linda Liverani, Chelsea Park, Ravi Teja Medikonda, Maria Jose Cavagnaro, Ikchan Jeon, John Ratliff, Atman Desai
Neurospine 2026;23(2):293-313.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.2551862.931

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From Pixels to Precision: Generative Artificial Intelligence as a Paradigm Shift in Spine Imaging—Technical Foundations, Clinical Applications, and the Path to Safe Clinical Deployment
Neurospine. 2026;23(2):293-313.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.2551862.931
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From Pixels to Precision: Generative Artificial Intelligence as a Paradigm Shift in Spine Imaging—Technical Foundations, Clinical Applications, and the Path to Safe Clinical Deployment
Neurospine. 2026;23(2):293-313.   Published online April 30, 2026
DOI: https://doi.org/10.14245/ns.2551862.931
Close
Spine imaging represents a complex diagnostic frontier characterized by anatomical variability, motion artifacts, metallic instrumentation interference, and significant inter-reader diagnostic variability (κ=0.20 across institutions). While conventional discriminative artificial intelligence (AI) models achieve >95% accuracy in detecting degenerative changes, they remain limited by data scarcity, heterogeneous protocols, and poor generalizability. In the spine, these limitations are particularly relevant because clinical decisions can often depend on subtle distinctions (such as differentiating levels of canal or foraminal stenosis, characterizing Modic endplate changes, or assessing pedicle and vertebral morphology), where small inconsistencies can meaningfully alter management or surgical planning. Generative AI (GenAI) systems—including generative adversarial networks (GANs), diffusion models, and vision-language models (VLMs)—offer a paradigm shift by learning underlying data structures to generate high-quality synthetic outputs rather than merely classifying existing data. This narrative review, conducted using SANRA (scale for the assessment of narrative review articles) methodology across PubMed, Scopus, Embase, and Cochrane Library, examined GenAI applications in spine imaging. Eligible studies included observational designs through randomized controlled trials exploring image reconstruction, synthetic computed tomography (CT) generation, segmentation, and surgical planning applications. GAN-generated synthetic magnetic resonance imaging sequences reduce scan times by ~40% while maintaining diagnostic confidence; diffusion models enable radiation-free synthetic CT for preoperative planning; and VLMs generate structured radiology reports with hallucination rates <1.12%. However, critical barriers impede clinical translation: external validation gaps reveal AI performance collapse in real-world cohorts (sensitivity drops to 54.9% in cervical fracture detection); hallucinations and anatomical inaccuracies risk misguiding implant sizing; bias amplification magnifies demographic underrepresentation; and fragmented, small datasets lack standardized benchmarks. Technical fragility, computational demands, clinician trust deficits, and unresolved regulatory frameworks for iteratively-updating systems remain unaddressed. Successful integration requires coordinated development across 5 priorities: (1) multi-institutional datasets with cross-vendor harmonization, (2) federated learning frameworks preserving privacy, (3) uncertainty quantification and explainability tools, (4) outcome-linked clinical validation replacing technical metrics, and (5) workflow-integrated systems with DICOM-native interfaces and provenance tracking.

Citations

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  • A Commentary on “From Pixels to Precision: Generative Artificial Intelligence as a Paradigm Shift in Spine Imaging—Technical Foundations, Clinical Applications, and the Path to Safe Clinical Deployment”
    Fabrizio Russo, Luca Ambrosio, Gianluca Vadalà, Vincenzo Denaro
    Neurospine.2026; 23(2): 314.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the April 2026 Issue
    Inbo Han
    Neurospine.2026; 23(2): 227.     CrossRef
  • 1,771 View
  • 34 Download
  • 2 Crossref

Original Articles

Minimally Invasive Surgery

Real-Time Water Pressure Monitoring in Unilateral Biportal Endoscopic Spine Surgery
Dongwoo Yu, Ikchan Jeon, Sang Woo Kim
Neurospine 2025;22(3):812-818.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550648.324

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Real-Time Water Pressure Monitoring in Unilateral Biportal Endoscopic Spine Surgery
Neurospine. 2025;22(3):812-818.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550648.324
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Real-Time Water Pressure Monitoring in Unilateral Biportal Endoscopic Spine Surgery
Neurospine. 2025;22(3):812-818.   Published online September 30, 2025
DOI: https://doi.org/10.14245/ns.2550648.324
Close
Objective
Unilateral biportal endoscopic (UBE) spine surgery is a minimally invasive technique that uses continuous irrigation to improve visualization and control bleeding. Effective water pressure management is crucial for patient safety, particularly at the cervical and thoracic levels where spinal cord injury risk is higher. However, real-time pressure monitoring remains underexplored. This study evaluates the impact of real-time water pressure monitoring on safety during UBE surgery.
Methods
A prospective study was conducted involving 20 patients undergoing UBE lumbar spine surgery. Patients were divided into 2 groups based on the irrigation system: gravity-based or infusion pump. Real-time water pressure was monitored using a digital sensor throughout surgery. Each procedure was categorized into 3 phases: phase I, working space preparation; phase II, laminectomy; phase III, flavectomy, dura exposure, and discectomy. Data was analyzed according to the type of irrigation system and surgical phase.
Results
The mean water pressure in the surgical field during UBE spine surgery was 17.98± 8.07 mmHg, with no significant differences between surgical phases. However, the infusion pump system maintained significantly lower mean pressure (12.10±3.51 mmHg) compared to the gravity-based system (23.86±6.97 mmHg, p=0.001). The infusion pump system consistently maintained a significantly lower mean water pressure compared to the gravity-based system.
Conclusion
Real-time water pressure monitoring during UBE surgery enhances safety by enabling improved control of pressure within the surgical field. Both the gravity-based and infusion pump systems safely maintained working space pressure, with the pump system showing significantly lower pressure levels.

Citations

Citations to this article as recorded by  Crossref logo
  • Case Report: Spinal epidural lipomatosis with incomplete cauda equina syndrome treated with unilateral biportal endoscopic technique
    Zaiyin Deng, Yujin Wang, Mohammed Saud Shaik, Duanyang Li, Rongjing Di, Zhourui Wu, Bin Ma
    Frontiers in Surgery.2026;[Epub]     CrossRef
  • Epidemiology of spinal cord hypertension syndrome in water-mediated uniportal full endoscopic thoracolumbar surgery: a single-center experience
    Haiyang Wu, Luyang Wang, Yiping Zheng, Xizhong Zhu, Wanqi Ren, Ziheng Li, Shoule Ma, Mingwang Zhao, Xingchen Li, Yusheng Xu
    European Spine Journal.2026;[Epub]     CrossRef
  • Controlled versus gravity-based irrigation in endoscopic spine surgery: pressure stability, thresholds, and safety implications
    Rajendra Singh, Thomas Cha, Alexander Vaccaro, Alan Hilibrand, Gregory Schroeder, Gregory Kepler, Afshin Razi, Mitchell Ng
    European Spine Journal.2026;[Epub]     CrossRef
  • 7,412 View
  • 121 Download
  • 3 Web of Science
  • 3 Crossref
Using Machine Learning Models to Identify Factors Associated With 30-Day Readmissions After Posterior Cervical Fusions: A Longitudinal Cohort Study
Aneysis D. Gonzalez-Suarez, Paymon G. Rezaii, Daniel Herrick, Seth Stravers Tigchelaar, John K. Ratliff, Mirabela Rusu, David Scheinker, Ikchan Jeon, Atman M. Desai
Neurospine 2024;21(2):620-632.   Published online May 20, 2024
DOI: https://doi.org/10.14245/ns.2347340.670

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Using Machine Learning Models to Identify Factors Associated With 30-Day Readmissions After Posterior Cervical Fusions: A Longitudinal Cohort Study
Neurospine. 2024;21(2):620-632.   Published online May 20, 2024
DOI: https://doi.org/10.14245/ns.2347340.670
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Using Machine Learning Models to Identify Factors Associated With 30-Day Readmissions After Posterior Cervical Fusions: A Longitudinal Cohort Study
Neurospine. 2024;21(2):620-632.   Published online May 20, 2024
DOI: https://doi.org/10.14245/ns.2347340.670
Close
Objective
Readmission rates after posterior cervical fusion (PCF) significantly impact patients and healthcare, with complication rates at 15%–25% and up to 12% 90-day readmission rates. In this study, we aim to test whether machine learning (ML) models that capture interfactorial interactions outperform traditional logistic regression (LR) in identifying readmission-associated factors.
Methods
The Optum Clinformatics Data Mart database was used to identify patients who underwent PCF between 2004–2017. To determine factors associated with 30-day readmissions, 5 ML models were generated and evaluated, including a multivariate LR (MLR) model. Then, the best-performing model, Gradient Boosting Machine (GBM), was compared to the LACE (Length patient stay in the hospital, Acuity of admission of patient in the hospital, Comorbidity, and Emergency visit) index regarding potential cost savings from algorithm implementation.
Results
This study included 4,130 patients, 874 of which were readmitted within 30 days. When analyzed and scaled, we found that patient discharge status, comorbidities, and number of procedure codes were factors that influenced MLR, while patient discharge status, billed admission charge, and length of stay influenced the GBM model. The GBM model significantly outperformed MLR in predicting unplanned readmissions (mean area under the receiver operating characteristic curve, 0.846 vs. 0.829; p < 0.001), while also projecting an average cost savings of 50% more than the LACE index.
Conclusion
Five models (GBM, XGBoost [extreme gradient boosting], RF [random forest], LASSO [least absolute shrinkage and selection operator], and MLR) were evaluated, among which, the GBM model exhibited superior predictive performance, robustness, and accuracy. Factors associated with readmissions impact LR and GBM models differently, suggesting that these models can be used complementarily. When analyzing PCF procedures, the GBM model resulted in greater predictive performance and was associated with higher theoretical cost savings for readmissions associated with PCF complications.

Citations

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  • Predicting Healthcare Utilization Outcomes With Artificial Intelligence: A Large Scoping Review
    Carlos Gallego-Moll, Lucía A. Carrasco-Ribelles, Marc Casajuana, Laia Maynou, Pablo Arocena, Concepción Violán, Edurne Zabaleta-del-Olmo
    Value in Health.2026; 29(1): 159.     CrossRef
  • Artificial intelligence in spine surgery: a scoping review
    Anis Choucha, Morgane Evin, Matteo de Simone, Guillaume Dannhoff, Henry Dufour, Valentin Avinens, Kaissar Farah, Florian Saby, Stephane Fuentes
    Neurochirurgie.2026; 72(1): 101764.     CrossRef
  • Artificial intelligence in spine surgery
    Cheng Zhang, Shanshan Liu, Jialin Shi, Xingyu Zhou, Peter Passias, Nanfang Xu, Weishi Li
    Spine Research.2025; 1(1): 13.     CrossRef
  • 5,927 View
  • 145 Download
  • 2 Web of Science
  • 3 Crossref
Comparison of the Clinical Efficacy of Anabolic Agents and Bisphosphonates in the Patients With Osteoporotic Vertebral Fracture: Systematic Review and Meta-analysis of Randomized Controlled Trials
Ikchan Jeon, Sung Bae Park, Bong Ju Moon, Miyoung Choi, Sung Uk Kuh, Jongtae Kim
Neurospine 2024;21(2):416-429.   Published online May 2, 2024
DOI: https://doi.org/10.14245/ns.2347256.628

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Comparison of the Clinical Efficacy of Anabolic Agents and Bisphosphonates in the Patients With Osteoporotic Vertebral Fracture: Systematic Review and Meta-analysis of Randomized Controlled Trials
Neurospine. 2024;21(2):416-429.   Published online May 2, 2024
DOI: https://doi.org/10.14245/ns.2347256.628
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Comparison of the Clinical Efficacy of Anabolic Agents and Bisphosphonates in the Patients With Osteoporotic Vertebral Fracture: Systematic Review and Meta-analysis of Randomized Controlled Trials
Neurospine. 2024;21(2):416-429.   Published online May 2, 2024
DOI: https://doi.org/10.14245/ns.2347256.628
Close
Objective
We investigated the clinical efficacy of anabolic agents compared with bisphosphonates (BPs) for the incidence of new osteoporotic vertebral fracture (OVF) and fracture healing of OVF in the patients with OVF via meta-analyses of randomized controlled trials (RCTs).
Methods
Electronic databases, including PubMed, Embase, and Cochrane Library were searched for published RCTs till December 2022. The RCTs that recruited participants with osteoporosis at high-/very high-risk of fracture (a history of osteoporotic vertebral or hip fracture) or fresh OVF were included in this study. We assessed the risk of bias on every included RCTs, estimated relative risk (RR) for the incidence of new OVF and fracture healing of OVF, and overall certainty of evidence. Meta-analyses were performed by Cochrane review manager (RevMan) ver. 5.3. Cochrane risk of bias 2.0 and GRADEpro/GDT were applied for evaluating methodological quality and overall certainty of evidence, respectively.
Results
Five hundred eighteen studies were screened, and finally 6 eligible RCTs were included in the analysis. In the patients with prevalent OVF, anabolic agents significantly reduced the incidence of new OVF (teriparatide and romosozumab vs. alendronate and risedronate [RR, 0.57; 95% confidence interval, 0.45–0.71; p < 0.00001; high-certainty of evidence]; teriparatide vs. risedronate [RR, 0.50; 95% confidence interval, 0.37–0.68; p < 0.0001; high-certainty of evidence]). However, there was no evidence of teriparatide compared to alendronate in fracture healing of OVF (RR, 1.23; 95% confidence interval, 0.95–1.60; p = 0.12; low-certainty of evidence).
Conclusion
In the patients with prevalent OVF, anabolic agents showed a significant superiority for preventing new OVF than BPs, with no significant evidence for promoting fracture healing of OVF. However, considering small number of RCTs in this study, additional studies with large-scale data are required to obtain more robust evidences.

Citations

Citations to this article as recorded by  Crossref logo
  • Development of an explainable machine learning model to reproduce and interpret expert pharmacological decisions in osteoporosis treatment
    Yutaro Sugawara, Tomohiro Shimizu, Hotaka Ishizu, Kosuke Arita, Yusuke Ohashi, Shu Yamazaki, Terufumi Kokabu, Katsuhisa Yamada, Norimasa Iwasaki
    Bone.2026; 204: 117745.     CrossRef
  • Disuse Bone Loss in Fusion Constructs After Multilevel Lumbar Fusion: A Computed Tomography Hounsfield Unit Analysis
    Hyun-Jun Jang, Dongkyu Kim, Bong-Ju Moon, Kyung-Hyun Kim, Jeong-Yoon Park, Sung-Uk Kuh, Keun-Su Kim, Dong-Kyu Chin
    Neurospine.2026; 23(1): 176.     CrossRef
  • Under-prescribed and underutilized: National trends in osteoporosis medication use after fragility fracture
    Harsh Wadhwa, Katelin J. Isakoff, Nicole S. Pham, L. Henry Goodnough, Julius A. Bishop, Michael J. Gardner
    Bone.2026; 206: 117835.     CrossRef
  • Comparative Radiologic Outcomes of Romosozumab and Teriparatide in Osteoporotic Vertebral Fractures
    Jun-Seok Lee, Geon-U Kim, Ho-Young Jung, Young-Hoon Kim, Sang-Il Kim, Sangjun Park, Young-Yul Kim, Hyung-Youl Park
    Journal of Clinical Medicine.2026; 15(6): 2349.     CrossRef
  • A Comparison Between Bisphosphonates and Teriparatide in the Treatment of Postmenopausal Osteoporosis: A Systematic Review
    Russaal S Mann, Isha Chopra, Abdullah Kilic, Ayushi Saxena, Bilal Khan, Rupanshu Rupanshu, Paolo S Chavez Cavalie
    Cureus.2026;[Epub]     CrossRef
  • Sequential Versus Step-Therapy Approaches for Osteoporosis Management in Orthopedic Subspecialties
    Samer G. Salman, Rohan Phadke, James Burnett, Jonathan Walsh
    Current Osteoporosis Reports.2026;[Epub]     CrossRef
  • Effectiveness of Posterior Long-Segment Fixation for Thoracolumbar Osteoporotic Compression Fractures: A Retrospective Study
    Jong-Hwan Hong, Jong-Hoon Jung, Ji-Ho Jung, Moon-Soo Han, Jung-Kil Lee
    World Neurosurgery.2025; 194: 123433.     CrossRef
  • A Real-Life Study in Sequential Therapy for Severe Menopausal Osteoporosis
    Oana-Claudia Sima, Mihai Costachescu, Mihaela Stanciu, Claudiu Nistor, Mara Carsote, Denisa Tanasescu, Florina Ligia Popa, Ana Valea
    Journal of Clinical Medicine.2025; 14(2): 627.     CrossRef
  • Comparative Analysis of Romosozumab Versus Vertebroplasty With Denosumab: Efficacy, Safety, and Secondary Bone Mineral Density Outcomes
    Hyun Woong Mun, Jong Joo Lee, Hyun Chul Shin, Tae-Hwan Kim, Seok Woo Kim, Jae Keun Oh
    Neurospine.2025; 22(1): 69.     CrossRef
  • A Commentary on “Comparative Analysis of Romosozumab Versus Vertebroplasty With Denosumab: Efficacy, Safety, and Secondary Bone Mineral Density Outcomes”
    Toshihiko Inui
    Neurospine.2025; 22(1): 78.     CrossRef
  • Clinical Outcomes and Risk Factors Associated with Spinal Kyphotic Deformity Following Osteoporotic Vertebral Fracture
    Hayato Oishi, Keishi Maruo, Tomoyuki Kusukawa, Tetsuto Yamaura, Kazuma Nagao, Masakazu Toi, Masaru Hatano, Fumihiro Arizumi, Norichika Yoshie, Toshiya Tachibana
    Journal of Clinical Medicine.2025; 14(8): 2769.     CrossRef
  • Revisiting Cement Augmentation in Osteoporotic Vertebral Fractures: A Narrative Review
    Gilbert Bungay Dimacali, Byung Ho Lee
    Journal of Korean Society of Spine Surgery.2025; 32(4): 144.     CrossRef
  • The Effects of Longer Use of Teriparatide on Clinical and Radiographic Outcomes after Spinal Fusion in Geriatric Patients
    Young-Hoon Kim, Kee-Yong Ha, Hyun W. Bae, Hyung-Youl Park, Young-Il Ko, Myung-Sup Ko, Sang-Il Kim
    Medicina.2024; 60(6): 946.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the June 2024 Issue
    Inbo Han
    Neurospine.2024; 21(2): 373.     CrossRef
  • Commentary on “Comparison of the Clinical Efficacy of Anabolic Agents and Bisphosphonates in the Patients With Osteoporotic Vertebral Fracture: Systematic Review and Meta-analysis of Randomized Controlled Trials”
    Dae-Chul Cho
    Neurospine.2024; 21(2): 430.     CrossRef
  • 16,968 View
  • 361 Download
  • 13 Web of Science
  • 15 Crossref

Case Report

Intradural Extramedullary Capillary Hemangioma In the Upper Thoracic Spine with Simultaneous Extensive Arachnoiditis
Jae Ho Lee, Ikchan Jeon, Sang Woo Kim
Korean J Spine 2017;14(2):57-60.   Published online June 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.2.57

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Intradural Extramedullary Capillary Hemangioma In the Upper Thoracic Spine with Simultaneous Extensive Arachnoiditis
Korean J Spine. 2017;14(2):57-60.   Published online June 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.2.57
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Intradural Extramedullary Capillary Hemangioma In the Upper Thoracic Spine with Simultaneous Extensive Arachnoiditis
Korean J Spine. 2017;14(2):57-60.   Published online June 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.2.57
Close
Capillary hemangiomas are common benign vascular tumors on skin and soft tissues, but developing as an intradural and extramedullary (IDEM) tumor in spine is extremely rare. In this report, we present IDEM tumor compressing thoracic cord in T2-3 level with extensive arachnoiditis below the tumor level in a 60-year-old man. The lesion was removed and histological diagnosis was capillary hemangioma. Prompt diagnosis and resection are important to avoid neurological deterioration from acute hemorrhagic condition. Simultaneous arachnoiditis may be originated from old subarachnoid hemorrhage associated tumor before diagnosis, and we suggest it as a helpful diagnostic feature to suspect vascular tumors such as capillary hemangioma.

Citations

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  • Intradural spinal capillary hemangioma mimicking thoracic meningioma
    Katherine H Belanger, Carol P Geer, Tyler P Grande, E Andrew Stevens
    Radiology Case Reports.2026; 21(2): 505.     CrossRef
  • MRI Features of Spinal Capillary Hemangiomas: A Retrospective Case Series
    Jiyeong Lee, Hyun Su Kim, Young Cheol Yoon, Sungjoon Lee, Sun-Ho Lee, Ji Hyun Lee
    Investigative Magnetic Resonance Imaging.2026; 30(2): 135.     CrossRef
  • Intradural Extra medullary Spinal Metastasis From Breast Carcinoma: A Rare Occurrence
    Boutaleb Joud, Chahboun Ouafae, Messari Loubna, Ouijdane Zamani ; Rachida Saouab; Jamal El Fenni
    MedPeer publisher.2025;[Epub]     CrossRef
  • Microsurgical treatment of spinal intradural capillary hemangioma: A consecutive case series of 18 patients and literature review
    Zheng Cai, Xinjie Hong, Zhengwei Zhang, Xuehua Ding, Wei Sun, Guohan Hu
    Clinical Neurology and Neurosurgery.2024; 246: 108527.     CrossRef
  • The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)
    Carol S. Palackdkharry, Stephanie Wottrich, Erin Dienes, Mohamad Bydon, Michael P. Steinmetz, Vincent C. Traynelis, Panagiotis Kerezoudis
    PLOS ONE.2022; 17(9): e0274634.     CrossRef
  • Spinal intradural extramedullary capillary hemangioma with coexistent spinal edema and syringomyelia successfully treated by tumor removal and cervical laminoplasty
    Motohiro Takayama, Yoshinori Maki
    Asian Journal of Neurosurgery.2021; 16(04): 854.     CrossRef
  • Biomechanical Evaluation of an Anterior Upper Thoracic Plate Fixation System: An In Vitro Human Cadaveric Study
    Chunxiang Xiong, Juli Luo, Dong Yin, Xinli Zhan, Huijiang Liu
    World Neurosurgery.2019; 124: e503.     CrossRef
  • Intradural-Extramedullary Capillary Hemangioma with Acute Bleeding: Case Report and Literature Review
    Irene Panero, Carla Eiriz, Alfonso Lagares, Oscar Toldos, Alberto Panero, Igor Paredes
    World Neurosurgery.2017; 108: 988.e7.     CrossRef
  • 11,337 View
  • 146 Download
  • 8 Crossref

Technical Note

Application of Lateral Approach for the Removal of Migrated Interbody Cage: Taphole and Fixing Technique
Jae Sung Eom, Ikchan Jeon, Sang Woo Kim
Korean J Spine 2017;14(1):23-26.   Published online March 31, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.1.23

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Application of Lateral Approach for the Removal of Migrated Interbody Cage: Taphole and Fixing Technique
Korean J Spine. 2017;14(1):23-26.   Published online March 31, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.1.23
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Application of Lateral Approach for the Removal of Migrated Interbody Cage: Taphole and Fixing Technique
Korean J Spine. 2017;14(1):23-26.   Published online March 31, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.1.23
Close
When a revision surgery related with removal of failed interbody cage is required, going through the previous passage can lead to a higher risk of neurological deficits or incidental dural injuries. Recently, the lateral approach has become a popular method instead of the conventional anterior or posterior approaches. The lateral approach is also useful method to remove failed interbody cage previously placed and re-do interbody fusion with lower risks compared to revision surgery via previous passage. However, there is still some difficulty in retrieving the interbody cage from the intervertebral space because of no spacious passage, subsidence, and uncontrolled movable cage. In this study, we introduce our experience that we removed failed interbody cage more easily with only the simple additional steps of making a taphole and fixing the cage using a thread-tipped stick.

Citations

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  • Revision surgical treatments and classification system for cage retropulsion in degenerative lumbar disease
    Weiming Zhao, Shuxin Zheng, Yawen Su, Xi Yang, Chunguang Zhou, Yueming Song
    BMC Musculoskeletal Disorders.2026;[Epub]     CrossRef
  • The role of XLIF in spinal revision surgery involving failed interbody implants: a review of technique, outcomes, and indications
    Yusuf-Zain Ansari, Arwa Jader, Abdul Hameed Kidwai, Dia R. Halalmeh
    Acta Neurochirurgica.2025;[Epub]     CrossRef
  • Intraoperative Anteropulsion of an Interbody Fusion Cage During Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Case Report
    Ameya Rangnekar, Ayush Sharma, Atif Naseem, Harsh Agrawal, Komalchand Gajbhiye, Nandan Marathe
    Journal of Minimally Invasive Spine Surgery and Technique.2023; 8(2): 224.     CrossRef
  • Using an Extreme Lateral Interbody Fusion (XLIF) in Revising Failed Transforaminal Lumbar Interbody Fusion (TLIF) With Exchange of Cage
    Anwar M Al-Rabiah, Zahraa I Alghafli, Ibrahim Almazrua
    Cureus.2021;[Epub]     CrossRef
  • Delayed asymptomatic retroperitoneal dislodgement into the pouch of Douglas of a TLIF cage: A case report and review of the literature
    Manoj Kumar, Deepak Kaucha, Nitin Adsul, R. S. Chahal, K. L. Kalra, Shankar Acharya
    Surgical Neurology International.2021; 12: 360.     CrossRef
  • Surgical Strategies for the Treatment of Lumbar Pseudarthrosis in Degenerative Spine Surgery: A Literature Review and Case Study
    Peter B. Derman, Kern Singh
    HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery.2020; 16(2): 183.     CrossRef
  • Technical Consideration for TLIF Cage Retrieval and Deformity Correction With Anterior Interbody Fusion in Lumbar Revision Surgeries
    M. Burhan Janjua, Nissim Ackshota, Vincent Arlet
    Spine Deformity.2019; 7(4): 633.     CrossRef
  • Mimickers in Spine: Migrated Cages Causing Radiculopathy
    Saurav Narayan Nanda, Mantu Jain, Sudarsan Behera, Manisha Gaikwad
    Case Reports in Orthopedic Research.2019; 2(1-3): 21.     CrossRef
  • 8,904 View
  • 174 Download
  • 8 Crossref

Clinical Article

Three-Years Outcome of Microdiscectomy via Paramedian Approach for Lumbar Foraminal or Extraforaminal Disc Herniations in Elderly Patients over 65 Years Old
Chang Gi Yeo, Ikchan Jeon, Sang Woo Kim, Sam Kyu Ko, Byung Kil Woo, Kwang Chul Song
Korean J Spine 2016;13(3):107-113.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.107

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Three-Years Outcome of Microdiscectomy via Paramedian Approach for Lumbar Foraminal or Extraforaminal Disc Herniations in Elderly Patients over 65 Years Old
Korean J Spine. 2016;13(3):107-113.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.107
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Three-Years Outcome of Microdiscectomy via Paramedian Approach for Lumbar Foraminal or Extraforaminal Disc Herniations in Elderly Patients over 65 Years Old
Korean J Spine. 2016;13(3):107-113.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.107
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Objective

Lumbar foraminal or extraforaminal disc herniations (FEFDH) have unusual clinical features and higher incidence in elderly patients compared to usual intraspinal canal disc herniations. We evaluated the efficacy of microdiscectomy via paramedian approach for lumbar FEFDH in elderly patients over the age of 65.

Methods

Retrospective study was performed in 68 patients over the age of 65 (23 male and 45 female patients; 71.46±3.87 years) who underwent microdiscectomy via paramedian approach for unilateral lumbar FEFDH causing sciatica. The radiological factors including degree of slippage, presence of instability, disc height, and degree of disc degeneration; pain and functional status by the means of visual analogue scale score, Oswestry Disability Index score, and Macnab classification were analyzed preoperatively and during the postoperative follow-up period of 3 years to evaluate the efficacy of the surgical treatment.

Results

Pain and functional status improved according to short- and long-term follow-up evaluations after surgery. Radiological changes following surgery, which can be understood as structural deteriorations and deformations, did not represent patient condition. Nine patients underwent additional surgery due to sustained or recurring leg pain of aggravation of back pain, and fusion surgery was required for 3 patients. Degree of preoperative slippage was the only statistically significant factor related to additional surgery (p<0.05).

Conclusion

Microdiscectomy via paramedian approach for FEFDH may be a good surgical alternative in elderly patients. Radiological changes after surgery did not show a concordance with patients' actual functional status. The excessive preoperative slippage tended to lead to unfavorable result after surgery and was associated with additional surgery.

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  • 11,263 View
  • 153 Download
  • 9 Crossref

Case Report

Delayed or Missed Diagnosis of Cervical Instability after Traumatic Injury: Usefulness of Dynamic Flexion and Extension Radiographs
Chang Gi Yeo, Ikchan Jeon, Sang Woo Kim
Korean J Spine 2015;12(3):146-149.   Published online September 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.3.146

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Delayed or Missed Diagnosis of Cervical Instability after Traumatic Injury: Usefulness of Dynamic Flexion and Extension Radiographs
Korean J Spine. 2015;12(3):146-149.   Published online September 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.3.146
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Delayed or Missed Diagnosis of Cervical Instability after Traumatic Injury: Usefulness of Dynamic Flexion and Extension Radiographs
Korean J Spine. 2015;12(3):146-149.   Published online September 30, 2015
DOI: https://doi.org/10.14245/kjs.2015.12.3.146
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Prompt and accurate diagnosis of cervical spine injury is important to prevent the catastrophic results that can be caused by undetected lesions. Delayed or missed diagnosis of cervical spine injury occurs with an incidence of 5 to 20% according to previous studies. In this study, we report four cases of cervical instability without initial radiologic evidence. These cases demonstrate that dynamic flexion and extension radiographies can be a proper choice of modality to diagnose and exclude the possibility of cervical instability in a patient with a suspicious ligament injury on the static radiographies following acute cervical trauma.

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  • 23,117 View
  • 184 Download
  • 12 Crossref
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