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Review Article

Lumbar Spine/Biology

Lumbar Disc Herniation Resorption: When and How Does It Occur?
Carla Cunha, Hanzhi Yang, Zorica Buser, Carola Rojas, Marisa Cunha, Paulo Pereira, In Ho Han, Li Jin, Xudong Li, AO Spine Knowledge Forum Degenerative
Neurospine 2026;23(1):82-93.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551538.769

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Lumbar Disc Herniation Resorption: When and How Does It Occur?
Neurospine. 2026;23(1):82-93.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551538.769
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Lumbar Disc Herniation Resorption: When and How Does It Occur?
Neurospine. 2026;23(1):82-93.   Published online January 31, 2026
DOI: https://doi.org/10.14245/ns.2551538.769
Close
Low back pain is a leading cause of disability worldwide, with intervertebral disc herniation contributing substantially to its burden. Most patients improve with conservative care, often associated with disc resorption. Although increasingly recognized as a major determinant of recovery, the mechanisms underlying resorption remain poorly understood. Herniated disc tissue induces immune cell infiltration and release of cytokines and proteolytic enzymes, yet standard anti-inflammatory treatments may paradoxically impede this process. Outcomes are also influenced by physical therapy, lifestyle, herniation characteristics, and immunological background, but predictive biomarkers are lacking. This review summarizes the current knowledge gap and explores strategies to harness intrinsic healing for personalized management.
  • 2,689 View
  • 193 Download

Original Articles

Pain

Evidence-Based Clinical Practice Guidelines for Patients With Lumbar Disc Herniation With Radiculopathy in South Korea
Jong Joo Lee, Min Cheol Chang, Dong Ah Shin, Jin Hoon Park, Miyoung Choi, Hyung-Youl Park, In Soo Kim, Jung-Kil Lee, Chung-Kee Chough, Seung Hwan Yoon, Seong-Soo Choi, Sung-Woo Choi, The Korean Pain Society, The Korean Spinal Pain Society, The Korean Spinal Neurosurgery Society
Neurospine 2025;22(2):366-383.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550094.047

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Evidence-Based Clinical Practice Guidelines for Patients With Lumbar Disc Herniation With Radiculopathy in South Korea
Neurospine. 2025;22(2):366-383.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550094.047
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Evidence-Based Clinical Practice Guidelines for Patients With Lumbar Disc Herniation With Radiculopathy in South Korea
Neurospine. 2025;22(2):366-383.   Published online June 30, 2025
DOI: https://doi.org/10.14245/ns.2550094.047
Close
Objective
In this study, we aimed to develop evidence-based clinical practice guidelines (CPGs) for the treatment of lumbar disc herniation (LDH) with radiculopathy, tailored to South Korean clinical settings.
Methods
The guideline development process used followed the evidence-based medicine principles. Literature searches were conducted across databases, including MEDLINE (PubMed), Cochrane, Embase, and KoreaMed, using predefined search strategies. Titles and abstracts were reviewed to identify the best research evidence. Data extraction and quality assessment were performed using the Cochrane risk of bias tool and the GRADE method. Quantitative meta-analyses or qualitative synthesis were conducted based on data heterogeneity. Recommendations were assigned strength grades (A, B, C, D, I) reflecting evidence reliability.
Results
In these guidelines, comprehensive recommendations for managing LDH with radiculopathy in clinical settings were provided. International evidence and multidisciplinary expert opinions were integrated. Four key clinical questions were identified and divided into sections: surgical treatment, interventional treatment, and physical treatment/exercise. The recommendations for these questions are summarized in this article.
Conclusion
The aim of establishing these CPGs was to enhance treatment outcomes, reduce healthcare costs, and promote public health. By recognizing limitations in domestic data and the dynamic healthcare circumstances, the need for continuous revision was emphasized in these guidelines. Nonetheless, in future updates, the guidelines will be refined to improve their quality and applicability in clinical practice.

Citations

Citations to this article as recorded by  Crossref logo
  • Bone cement-augmented vs. conventional pedicle screws for osteoporotic lumbar spondylolisthesis: a meta-analysis
    Guoyi Qin, Lihui Hu, Zhaoming Liang, Jinghuai Li, Xiaohang Bao, Shaohu Lin, Yicheng Wang, Yuanming Zhong
    Frontiers in Surgery.2026;[Epub]     CrossRef
  • The Biomechanical Landscape of Lumbar Disc Herniation: Mechanobiological Insights Into Injury and Regeneration
    Gianluca Vadala, Fabrizio Russo, In-Ho Han, Amit Jain, Javad Tavakoli
    Neurospine.2026; 23(1): 159.     CrossRef
  • From the Editor-in-Chief: Featured Articles in the June 2025 Issue
    Inbo Han
    Neurospine.2025; 22(2): 309.     CrossRef
  • 25,476 View
  • 415 Download
  • 3 Crossref

Regular Issue

Clinical and Radiographic Outcomes of Cervical Disc Replacement Versus Posterior Endoscopic Cervical Decompression: A Matched-Pair Comparison Analysis
Vit Kotheeranurak, Khanathip Jitpakdee, Kai-Uwe Lewandrowski, Guang-Xun Lin, Weerasak Singhatanadgige, Worawat Limthongkul, Wicharn Yingsakmongkol, Jin-Sung Kim, Wongthawat Liawrungrueang
Neurospine 2024;21(3):1040-1050.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448582.291

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Clinical and Radiographic Outcomes of Cervical Disc Replacement Versus Posterior Endoscopic Cervical Decompression: A Matched-Pair Comparison Analysis
Neurospine. 2024;21(3):1040-1050.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448582.291
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Clinical and Radiographic Outcomes of Cervical Disc Replacement Versus Posterior Endoscopic Cervical Decompression: A Matched-Pair Comparison Analysis
Neurospine. 2024;21(3):1040-1050.   Published online September 30, 2024
DOI: https://doi.org/10.14245/ns.2448582.291
Close
Objective
To compare clinical and radiographic outcomes between 2 motion preservation surgeries, cervical disc replacement (CDR) and posterior endoscopic cervical decompression (PECD), for unilateral cervical radiculopathy.
Methods
Between February 2018 and December 2020, 60 patients with unilateral cervical radiculopathy who underwent either CDR or PECD were retrospectively recruited as matched pairs. Clinical outcomes included visual analogue scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and satisfaction rates. The radiographic outcome was index level motion. Intraoperative data, complications, and hospital stay were collected. Preoperative and postoperative outcomes were compared.
Results
Patients undergoing CDR or PECD were included, with 30 cases in each group. Matched pairs were compared in terms of demographic data and preoperative measurements. CDR was associated with shorter operative times, whereas PECD resulted in less intraoperative blood loss. The total complication rate was 5%. NDI and VAS for neck and arm were significantly improved in both groups, with no significant differences between the 2 groups. Satisfaction rates of good and excellent exceeded 87% in both groups. CDR was superior to PECD in the restoration of disc height. Early postoperative follow-up showed no significant difference in terms of index level motion. PECD demonstrated significantly shorter hospital stays and quicker return-to-work times (p<0.05).
Conclusion
PECD achieved equivalent clinical and radiologic outcomes compared with CDR when the certain criteria for surgery were met. Both techniques demonstrated the potential to maintain index level motion. Additionally, PECD resulted in less blood loss, shorter hospital stays, and faster return-to-work times. Conversely, CDR offered shorter operative times and better restoration of disc height.

Citations

Citations to this article as recorded by  Crossref logo
  • Delta large-channel endoscopy versus unilateral biportal endoscopy for cervicothoracic junction disc herniation: a prospective randomized controlled trial
    Huaibin Wang, Hui Li, Rushuo Wei, Hao Yan, Ruzhan Yao, Weiqiang Liu, Ling Li
    Journal of Orthopaedic Surgery and Research.2026;[Epub]     CrossRef
  • Cervical disc arthroplasty versus minimally invasive posterior cervical procedures as motion preserving surgeries for cervical radiculopathy: a systematic review and meta-analysis
    Jia Yi Loh, Xian Jun Ngoh, Zhihong Chew, Yee Gen Lim, Michael Janssen, Jiang Lei
    European Spine Journal.2026;[Epub]     CrossRef
  • Comparison of surgical outcomes between posterior percutaneous endoscopic cervical discectomy and microscope-assisted ACDF in patients with single-level unilateral radicular symptomatology of cervical disc herniation: a single-center retrospective study
    Yin He, Jing Zhang, Dawei Ren, Tianping Xi, Zhilin Li
    European Journal of Orthopaedic Surgery & Traumatology.2026;[Epub]     CrossRef
  • Clinical Outcomes and Patient Perspectives in Full Endoscopic Cervical Surgery: A Systematic Review
    Wongthawat Liawrungrueang, Sung Tan Cho, Ayush Sharma, Watcharaporn Cholamjiak, Meng-Huang Wu, Lo Cho Yau, Hyun-Jin Park, Ho-Jin Lee
    Neurospine.2025; 22(1): 81.     CrossRef
  • Advancing the future of endoscopic spine surgery
    Wongthawat Liawrungrueang
    Asian Spine Journal.2025; 19(2): IX.     CrossRef
  • 12,148 View
  • 172 Download
  • 5 Web of Science
  • 5 Crossref

Special Issue on AI & Robotics

Use of ChatGPT for Determining Clinical and Surgical Treatment of Lumbar Disc Herniation With Radiculopathy: A North American Spine Society Guideline Comparison
Mateo Restrepo Mejia, Juan Sebastian Arroyave, Michael Saturno, Laura Chelsea Mazudie Ndjonko, Bashar Zaidat, Rami Rajjoub, Wasil Ahmed, Ivan Zapolsky, Samuel K. Cho
Neurospine 2024;21(1):149-158.   Published online January 31, 2024
DOI: https://doi.org/10.14245/ns.2347052.526

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Use of ChatGPT for Determining Clinical and Surgical Treatment of Lumbar Disc Herniation With Radiculopathy: A North American Spine Society Guideline Comparison
Neurospine. 2024;21(1):149-158.   Published online January 31, 2024
DOI: https://doi.org/10.14245/ns.2347052.526
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Use of ChatGPT for Determining Clinical and Surgical Treatment of Lumbar Disc Herniation With Radiculopathy: A North American Spine Society Guideline Comparison
Neurospine. 2024;21(1):149-158.   Published online January 31, 2024
DOI: https://doi.org/10.14245/ns.2347052.526
Close
Objective
Large language models like chat generative pre-trained transformer (ChatGPT) have found success in various sectors, but their application in the medical field remains limited. This study aimed to assess the feasibility of using ChatGPT to provide accurate medical information to patients, specifically evaluating how well ChatGPT versions 3.5 and 4 aligned with the 2012 North American Spine Society (NASS) guidelines for lumbar disk herniation with radiculopathy.
Methods
ChatGPT's responses to questions based on the NASS guidelines were analyzed for accuracy. Three new categories—overconclusiveness, supplementary information, and incompleteness—were introduced to deepen the analysis. Overconclusiveness referred to recommendations not mentioned in the NASS guidelines, supplementary information denoted additional relevant details, and incompleteness indicated omitted crucial information from the NASS guidelines.
Results
Out of 29 clinical guidelines evaluated, ChatGPT-3.5 demonstrated accuracy in 15 responses (52%), while ChatGPT-4 achieved accuracy in 17 responses (59%). ChatGPT-3.5 was overconclusive in 14 responses (48%), while ChatGPT-4 exhibited overconclusiveness in 13 responses (45%). Additionally, ChatGPT-3.5 provided supplementary information in 24 responses (83%), and ChatGPT-4 provided supplemental information in 27 responses (93%). In terms of incompleteness, ChatGPT-3.5 displayed this in 11 responses (38%), while ChatGPT-4 showed incompleteness in 8 responses (23%).
Conclusion
ChatGPT shows promise for clinical decision-making, but both patients and healthcare providers should exercise caution to ensure safety and quality of care. While these results are encouraging, further research is necessary to validate the use of large language models in clinical settings.

Citations

Citations to this article as recorded by  Crossref logo
  • Evaluation of retrieval-augmented generation and large language models in clinical guidelines for degenerative spine conditions
    Audrey Y. Su, Ashley Knebel, Andrew Y. Xu, Marco Kaper, Phillip Schmitt, Joseph E. Nassar, Manjot Singh, Michael J. Farias, Jinho Kim, Bassel G. Diebo, Alan H. Daniels
    European Spine Journal.2026; 35(3): 1301.     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
  • A comparative study of ChatGPT 4o and DeepSeek in addressing CIED infection-related questions: Accuracy and readability assessment
    Chang Yu, Jianhua Fan, Yu Chen, Weihua Shen, Yini Zhang, Ling Li, Jiasheng Wen, Xiaoli Chen
    Medicine.2026; 105(5): e47493.     CrossRef
  • Comparative assessment of large language models in diabetic foot infection management: alignment with IWGDF/IDSA guidelines
    Hongxia Wu, Jiayi Deng, Xu Qiu, Li Xu, Lumeng Lu, Mingna Fan, Danni Yu, Chuanbo Liu, Zhaohuan Chen, Kai Wang, Yuyan Wang, Haifang Zhou, Liyang Chang, Hanbin Wang
    Frontiers in Endocrinology.2026;[Epub]     CrossRef
  • Are large language models consistent with the ASPS and AAPS guidelines? A comparison of AI chatbot recommendations and plastic surgery clinical guidance
    Raeesa Kabir, Savannah C. Braud, Chandler S. Hinson, Rahim S. Nazerali
    Journal of Plastic, Reconstructive & Aesthetic Surgery.2026; 116: 215.     CrossRef
  • Accuracy, reliability, readability, and European respiratory society guideline consistency of six generative artificial intelligence chatbots in providing health advice for chronic cough: A cross-sectional comparative assessment
    Zhen-Yun Wu, Bei-Bei Hu, Qiu-Xia Mao, Yan-Xia Han, Qian Zhao
    DIGITAL HEALTH.2026;[Epub]     CrossRef
  • Use of Generative Artificial Intelligence in the Management of Low Back Pain: a Scoping Review
    Renjie Tu, Simon French, Isaac Searant, Jae Woo Chung, Mark Hancock, Farah Magrabi, Aron Downie
    Journal of Medical Systems.2026;[Epub]     CrossRef
  • The Use of Chat-GPT 5.2 by Patients Affected by Rotator Cuff Tears Leads to Inaccurate Diagnosis and Treatment Suggestions: A Study by SICSeG (Italian Society of Shoulder and Elbow Surgery)
    Roberto de Giovanni, Edoardo Gaj, Luciano Mottola, Antonio Benedetto Cecere, Martina Coppola, Raffaele Garofalo, Andrea Cozzolino
    Journal of Clinical Medicine.2026; 15(10): 3878.     CrossRef
  • Diagnosis, treatment, and prevention of ankle sprains: Comparing free chatbot recommendations with clinical guidelines
    Friederike Eva Roch, Franziska Melanie Hahn, Katharina Jäckle, Marc-Pascal Meier, Hartmut Stinus, Wolfgang Lehmann, Ronny Perthel, Paul Jonathan Roch
    Foot and Ankle Surgery.2025; 31(4): 329.     CrossRef
  • ChatGPT and Google Gemini are Clinically Inadequate in Providing Recommendations on Management of Developmental Dysplasia of the Hip Compared to American Academy of Orthopaedic Surgeons Clinical Practice Guidelines
    Patrick P. Nian, Amith Umesh, Ruth H. Jones, Akshitha Adhiyaman, Christopher J. Williams, Christine M. Goodbody, Jessica H. Heyer, Shevaun M. Doyle
    Journal of the Pediatric Orthopaedic Society of North America.2025; 10: 100135.     CrossRef
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    Ara Khoylyan, Jason Salvato, Frank Vazquez, Mina Girgis, Alex Tang, Tan Chen
    North American Spine Society Journal (NASSJ).2025; 21: 100580.     CrossRef
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    Qian Du, Xinxin Shao, Minbo Zhang, Guangru Cao
    DIGITAL HEALTH.2025;[Epub]     CrossRef
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    Giacomo ROSSETTINI, Alvisa PALESE, Federica CORRADI, Paolo PILLASTRINI, Andrea TUROLLA, Chad COOK
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  • The double-edged sword of generative AI: surpassing an expert or a deceptive “false friend”?
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    Kyle N. Kunze, Cameron Gerhold, Udit Dave, Nezar Abunnur, Alexander Mamonov, Benedict U. Nwachukwu, Nikhil N. Verma, Jorge Chahla
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  • Large Language Models in Spine Surgery: A Promising Technology
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    Journal of Medical Internet Research.2025; 27: e64486.     CrossRef
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    npj Digital Medicine.2025;[Epub]     CrossRef
  • Can generative artificial intelligence provide accurate medical advice?: a case of ChatGPT versus Congress of Neurological Surgeons management of acute cervical spine and spinal cord injuries clinical guidelines
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    Asian Spine Journal.2025; 19(3): 432.     CrossRef
  • Evidence-Based Clinical Practice Guidelines for Patients With Lumbar Disc Herniation With Radiculopathy in South Korea
    Jong Joo Lee, Min Cheol Chang, Dong Ah Shin, Jin Hoon Park, Miyoung Choi, Hyung-Youl Park, In Soo Kim, Jung-Kil Lee, Chung-Kee Chough, Seung Hwan Yoon, Seong-Soo Choi, Sung-Woo Choi
    Neurospine.2025; 22(2): 366.     CrossRef
  • Accuracy of ChatGPT-3.5, ChatGPT-4o, Copilot, Gemini, Claude, and Perplexity in advising on lumbosacral radicular pain against clinical practice guidelines: cross-sectional study
    Giacomo Rossettini, Silvia Bargeri, Chad Cook, Stefania Guida, Alvisa Palese, Lia Rodeghiero, Paolo Pillastrini, Andrea Turolla, Greta Castellini, Silvia Gianola
    Frontiers in Digital Health.2025;[Epub]     CrossRef
  • Evaluating ChatGPT and DeepSeek in postdural puncture headache management: a comparative study with international consensus guidelines
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    Hao Li, Cheng Zeng, Lei Miao, Ye Wang, Jiyuan Xia, Da He
    Annals of Medicine & Surgery.2025; 87(8): 4835.     CrossRef
  • The assessment of ChatGPT‐4's performance compared to expert's consensus on chronic lateral ankle instability
    Takuji Yokoe, Giulia Roversi, Nuno Sevivas, Naosuke Kamei, Pedro Diniz, Hélder Pereira
    Journal of Experimental Orthopaedics.2025;[Epub]     CrossRef
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    Vítor Marcelo Soares Campos, Tiago Paiva Prudente, Luana Lemos Leão, Maurício Silva da Costa, Henrique Nunes Pereira Oliva, Renato Sobral Monteiro-Junior
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  • Commentary on “Use of ChatGPT for Determining Clinical and Surgical Treatment of Lumbar Disc Herniation With Radiculopathy: A North American Spine Society Guideline Comparison”
    Andreas Seas, Muhammad M. Abd-El-Barr
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  • From the Editor-in-Chief: Featured Articles in the March 2024 Issue
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  • Enhancing Diagnostic Support for Chiari Malformation and Syringomyelia: A Comparative Study of Contextualized ChatGPT Models
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  • Assessing the accuracy and utility of ChatGPT responses to patient questions regarding posterior lumbar decompression
    Alec M. Giakas, Rajkishen Narayanan, Teeto Ezeonu, Jonathan Dalton, Yunsoo Lee, Tyler Henry, John Mangan, Gregory Schroeder, Alexander Vaccaro, Christopher Kepler
    Artificial Intelligence Surgery.2024; 4(3): 233.     CrossRef
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  • 10,508 View
  • 183 Download
  • 43 Crossref

CSRS Special Issue

Defining Cervical Sagittal Plane Deformity – When Are Sagittal Realignment Procedures Necessary in Patients Presenting Primarily With Radiculopathy or Myelopathy?
Venu M. Nemani, Philip K. Louie, Caroline E. Drolet, John M. Rhee
Neurospine 2022;19(4):876-882.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244924.462

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Defining Cervical Sagittal Plane Deformity – When Are Sagittal Realignment Procedures Necessary in Patients Presenting Primarily With Radiculopathy or Myelopathy?
Neurospine. 2022;19(4):876-882.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244924.462
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Defining Cervical Sagittal Plane Deformity – When Are Sagittal Realignment Procedures Necessary in Patients Presenting Primarily With Radiculopathy or Myelopathy?
Neurospine. 2022;19(4):876-882.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244924.462
Close
Objective
It remains unclear whether cervical sagittal deformity (CSD) should be defined by radiographic parameters alone versus both clinical and radiographic factors, and whether radiographic malalignment by itself warrants a CSD corrective surgery in patients who present primarily with neurologic symptoms.
Methods
We administered a survey to a group of expert surgeons to evaluate whether radiographic parameters alone were sufficient to diagnose CSD, and in which scenarios surgeons recommend a CSD realignment procedure versus addressing the neurologic symptoms alone.
Results
No single radiographic criteria reached a 50% threshold as being sufficient to establish the diagnosis of CSD. When asymptomatic radiographic malalignment was present, a sagittal deformity correction was more likely to be recommended in patients with myelopathy versus those with radiculopathy alone. The majority of surgeons recommended deformity correction when symptoms of cervical deformity were present in addition to radiographic malalignment (85% with deformity symptoms and radiculopathy, 93% with deformity symptoms and myelopathy).
Conclusion
There is no consensus on which radiographic and/or clinical criteria are necessary to define the presence of CSD. We recommend that symptoms of cervical deformity, in addition to radiographic parameters, be considered when deciding whether to perform deformity correction in patients who present primarily with myelopathy or radiculopathy.

Citations

Citations to this article as recorded by  Crossref logo
  • Current Concepts of Sagittal Alignment in Adult Cervical Deformity
    Zeeshan M. Sardar, Justin L. Reyes, Josephine R. Coury, K. Daniel Riew
    Journal of the American Academy of Orthopaedic Surgeons.2026; 34(2): e176.     CrossRef
  • C2–C7 sagittal alignment on lateral cervical X-rays and its correlation with neck pain, disability, and neurological symptoms
    Hoon Sub Han, Won Kyu Kim, Yong Seok Nam
    Journal of Back and Musculoskeletal Rehabilitation.2026;[Epub]     CrossRef
  • Analysis of the factors associated with sexual health improvement in patients who underwent surgical management for adult spine deformity
    David van Schaik, Alice Baroncini, Louis Boissiere, Daniel Larrieu, Lisa Goudman, Javier Pizones, Ferrán Pellise, Ahmet Alanay, Frank Kleinstück, Anouar Bourghli, Ibrahim Obeid
    European Spine Journal.2025; 34(5): 1801.     CrossRef
  • Risk factors associated with distal junctional kyphosis and failure after surgical management of adult cervical deformity: a systematic review
    Davin C. Gong, Anthony N. Baumann, Zhaorui Wang, Omkar S. Anaspure, Muhammad Waheed, Evan J. Beck, Rakesh D. Patel, Ilyas S. Aleem
    European Spine Journal.2025; 34(8): 3430.     CrossRef
  • Reducing Chronic Spine Pain in an Adult Male by Decreasing Lumbar Scoliosis and Increasing Cervical Lordosis Using Chiropractic BioPhysics® Protocols: A 26-Month Follow-Up Case Report
    Jason W Haas, Miles O Fortner, Thomas J Woodham, Deed E Harrison
    Cureus.2024;[Epub]     CrossRef
  • From the Spinopelvic Parameters to Global Alignment and Proportion Scores in Adult Spinal Deformity
    Yongjae Cho, Dae Jean Jo, Seung-Jae Hyun, Jin Hoon Park, Na Rae Yang
    Neurospine.2023; 20(2): 467.     CrossRef
  • Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning
    Chang-Hyun Lee, Dae-Jean Jo, Jae Keun Oh, Seung-Jae Hyun, Jin Hoon Park, Kyung Hyun Kim, Jun Seok Bae, Bong Ju Moon, Chang-Kyu Lee, Myoung Hoon Shin, Hyun Jun Jang, Moon-Soo Han, Chi Heon Kim, Chun Kee Chung, Seung-Myung Moon
    Neurospine.2023; 20(4): 1272.     CrossRef
  • 6,076 View
  • 188 Download
  • 8 Web of Science
  • 7 Crossref

Regular Issue

Full Endoscopic Ligamentum Flavum Sparing Unilateral Laminotomy for Bilateral Recess Decompression: Surgical Technique and Clinical Results
Woo-Keun Kwon, Katherine A. Kelly, Malia McAvoy, Sananthan Sivakanthan, John Ogunlade, Natalie Kai Yi Yap, Sharon Durfy, Christoph P. Hofstetter
Neurospine 2022;19(4):1028-1038.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244344.172

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Full Endoscopic Ligamentum Flavum Sparing Unilateral Laminotomy for Bilateral Recess Decompression: Surgical Technique and Clinical Results
Neurospine. 2022;19(4):1028-1038.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244344.172
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Full Endoscopic Ligamentum Flavum Sparing Unilateral Laminotomy for Bilateral Recess Decompression: Surgical Technique and Clinical Results
Neurospine. 2022;19(4):1028-1038.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244344.172
Close
Objective
Interlaminar endoscopic spine surgery has been introduced and utilized for lumbar lateral recess decompression. We modified this technique and utilized it for bilateral lateral recess stenoses without significant central stenosis. Here we present the surgical details and clinical outcome of ligamentum flavum sparing unilateral laminotomy for bilateral recess decompression (ULBRD).
Methods
Prospectively collected registry for full-endoscopic surgeries was reviewed retrospectively. One hundred eighty-two consecutive cases from a single center between September 2015 and March 2021 were reviewed and 57 of them whom underwent ULBRD were enrolled for analysis. Basic patient demographic data, perioperative details, surgeryrelated complications, and clinical outcome were reviewed. The detailed surgical technique is presented as well.
Results
Among the 57 patients enrolled, 37 were males while the other 20 were females. The mean age was 58.53 ± 14.51 years, and a bimodal age distribution at the age of mid-fifties and mid-sixties or older was noted. The later age-peak was related to coexistence of degenerative scoliosis. The average operative time per lamina was 70.34 ± 20.51 minutes and mean length of stay was 0.56 ± 0.85 days. Four perioperative complications were reported (7.0%) and the overall reoperation rate at the index level within 1 year was 8.8%. The preoperative back/leg visual analogue scale scores and functional outcome scales including EuroQol-5 dimension questionnaire, Oswestry Disability Index presented significant improvement immediately after surgery and were maintained until final follow-up.
Conclusion
ULBRD for bilateral lateral recess stenoses without significant central stenosis resulted in good clinical outcomes with acceptably low perioperative complications rates. Sufficient decompression was achieved with the central ligamentum flavum being preserved.

Citations

Citations to this article as recorded by  Crossref logo
  • Uniportal non-coaxial endoscopic posterior cervical discectomy with annular suture repair for C6/C7 disc herniation: a case report
    Yaoyu Xiang, Xin Zhang, Fei Sun, Xianguang Yang, Xidan Hu, Jing Yang, Weiqing Ge, Tao Zhou, Yixiao Wang, En Song
    Frontiers in Surgery.2026;[Epub]     CrossRef
  • Percutaneous Endoscopic Lumbar Decompression for Lumbar Lateral Recess Stenosis: A Systematic Review
    Shanxi Wang, Jianbin Guan, Kaitan Yang, Haohao Liang
    Journal of Investigative Surgery.2026;[Epub]     CrossRef
  • Clinical and Radiological Predictors of Surgical Ease in Interlaminar Endoscopic Lumbar Decompression: A Prospective Observational Study
    Vemula Venkata Ramesh Chandra, Papasani Anil Kumar Reddy, Middina Mahesh, Kanduri Prithvi, Chigurupalli Chandra Sekhar, Bodapati Chandramouliswara Prasad
    Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(1): 14.     CrossRef
  • Ligamentum flavum preservation via unilateral biportal endoscopy in lumbar discectomy: a “Door-Opening” technique and its clinical outcomes
    Ze Gao, Zijian Cheng, Yiyi Chen, Yuxuan Wu, Zhuolong Xiong, Zhenbin Cai, Jing Wang
    European Spine Journal.2026;[Epub]     CrossRef
  • Surgical Outcomes of Full‐Endoscopic Degenerative Lumbar Lateral Recess Stenosis Decompression Through an Interlaminar Approach
    Chengqian Huang, Yingying Qin, Yizhu Huang, Xijiang Wei, Jing Zhuo, Shaofeng Wu, Jiarui Chen, Jichong Zhu, Tianyou Chen, Bin Zhang, Sitan Feng, Chenxing Zhou, Jiang Xue, Xinli Zhan, Chong Liu
    Orthopaedic Surgery.2025; 17(4): 1181.     CrossRef
  • Uni-portal non-coaxial spinal endoscopic surgery combined with annulus fibrosus suture technique for lumbar disc herniation: Case series
    Yongneng Li, Lihui Fu, Yongqiang Yang, Shuwen Kan, En Song
    Journal of International Medical Research.2025;[Epub]     CrossRef
  • Comparative biomechanical analysis of Endo-LOVE and C-endo LFD techniques for bi-segmental cervical spondylotic radiculopathy in normal and osteoporotic patients: a finite element study
    Lei Ke, Jie Lan, Zepei Zhang, Shengrui Chu, Jun Miao, Xiaohui Li
    Computer Methods in Biomechanics and Biomedical Engineering.2025; : 1.     CrossRef
  • Arthroscopic-assisted uniportal spinal surgery with annular repair for lumbar disc herniation in hemophilia: A case report
    Yaoyu Xiang, Jizheng Li, Xianguang Yang, Fei Sun, Xidan Hu, Tuhaopeng Shen, Jing Yang, Weiqing Ge, Tao Zhou, En Song
    Medicine.2025; 104(29): e42223.     CrossRef
  • Efficacy analysis of ligamentum flavum preservation technique under unilateral biportal endoscopic in the treatment of lumbar disc herniation
    Wen-Bo Wei, Sha-Jie Dang, Ling Wei, Da-Peng Duan
    Frontiers in Surgery.2025;[Epub]     CrossRef
  • Full endoscopic surgery for calcium pyrophosphate deposition disease (CPPD) in the cervical ligamentum flavum: report of two cervical myelopathy cases
    Seung Jin Choi, Dong Wan D. Kang, Chang Hwa Ham, Joo Han Kim, Woo-Keun Kwon
    Acta Neurochirurgica.2024;[Epub]     CrossRef
  • Finite element analysis of endoscopic cross-overtop decompression for single-segment lumbar spinal stenosis based on real clinical cases
    Yiwei Ding, Hanshuo Zhang, Qiang Jiang, Tusheng Li, Jiang Liu, Zhengcao Lu, Guangnan Yang, Hongpeng Cui, Fengtong Lou, Zhifeng Dong, Mei Shuai, Yu Ding
    Frontiers in Bioengineering and Biotechnology.2024;[Epub]     CrossRef
  • Why Endoscopic Spine Surgery?
    Woo-Keun Kwon, Se-Hoon Kim
    Neurospine.2023; 20(1): 7.     CrossRef
  • Perioperative Management for Full-Endoscopic Lumbar Discectomy: Consideration From the Perspective of Preventing Complication
    Takeshi Hara, Yukoh Ohara
    Neurospine.2023; 20(1): 28.     CrossRef
  • Radiological Outcomes of Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis With and Without Discectomy
    Hyun-Seo Cho, Se-Hoon Kim, Jeong Su Han, Bum-Joon Kim
    World Neurosurgery.2023; 175: e1307.     CrossRef
  • Saving Stabilizing Structure Treatment With Bilateral-Contralateral Decompression for Spinal Stenosis in Degenerative Spondylolisthesis Using Unilateral Biportal Endoscopy
    Dong Hyun Lee, Dong-Geun Lee, Choon Keun Park, Jae-Won Jang, Jin Sub Hwang, Jun Yong Kim, Yong-Eun Cho, Sang Won Lee, Dong Chan Lee, Bang Sang Han, Sang Yeop Han
    Neurospine.2023; 20(3): 931.     CrossRef
  • Overview and Prevention of Complications During Fully Endoscopic Lumbar Spine Surgery
    Woo-Keun Kwon, Junseok W Hur
    Journal of Minimally Invasive Spine Surgery and Technique.2023; 8(2): 136.     CrossRef
  • A Modified Laminotomy for Interlaminar Endoscopic Lumbar Discectomy: Technical Report and Preliminary Results
    Zhiyun Feng, Yuxu Wu, Honghao Wu, Tae Gyong Jon, Ying Yuan, Zhong Chen, Yue Wang
    Neurospine.2023; 20(4): 1513.     CrossRef
  • 7,978 View
  • 252 Download
  • 17 Web of Science
  • 17 Crossref

Regular Issue

Reliability and Diagnostic Accuracy of Standard Dermatomes and Myotomes for Determining the Pathologic Level in Surgically Verified Patients With Cervical Radiculopathy
Chul Gie Hong, Woo Dong Nam
Neurospine 2022;19(4):1006-1012.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244194.097

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Reliability and Diagnostic Accuracy of Standard Dermatomes and Myotomes for Determining the Pathologic Level in Surgically Verified Patients With Cervical Radiculopathy
Neurospine. 2022;19(4):1006-1012.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244194.097
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Reliability and Diagnostic Accuracy of Standard Dermatomes and Myotomes for Determining the Pathologic Level in Surgically Verified Patients With Cervical Radiculopathy
Neurospine. 2022;19(4):1006-1012.   Published online December 31, 2022
DOI: https://doi.org/10.14245/ns.2244194.097
Close
Objective
This study aimed to investigate the reliability and diagnostic accuracy of typical dermatomes and myotomes for determining the pathologic level in surgically verified patients with cervical radiculopathy.
Methods
Patients who underwent single-level surgery due to cervical radiculopathy with at least a 60% reduction in preoperative symptoms or recovery of muscle power after surgery were included. The observed clinical symptoms (pain, paresthesia, motor weakness) were compared to those of typical cervical dermatomes and myotomes.
Results
Among the 227 patients reviewed, 142 (62.6%) had a standard dermatomal pattern, and 74 of 110 (67.3%) had a standard myotomal pattern. The myotome of C5/6 radiculopathy showed much more variance than those of other cervical segments. Among the patients with severe motor weakness (muscle strength ≤ grade 3 or obvious muscle atrophy), all those with involvement of root C5, C7, and C8 showed a typical pattern (C4/5: 13 of 13 patients, C6/7: 5 of 5 patients, C7/T1: 3 of 3 patients), while only 2 of the 6 patients (33.3%) with severe motor weakness caused by C5/6 radiculopathy fit the typical pattern.
Conclusion
Among various symptoms, cervical myotome is of great value in determining the pathological level. However, it should be noted that there is high variability in human dermatomes and myotomes, especially for motor weakness due to C6 root compression, which is more variable than others.

Citations

Citations to this article as recorded by  Crossref logo
  • Functional myotome mapping via triggered electromyography during intraoperative cervical rootlet stimulation
    Hangeul Park, Woojin Kim, Jungbo Sim, Ho Sung Myeong, Jun-Hoe Kim, Young Doo Choi, Gilho Kwak, Bo Eun Kim, Jeongeum Park, Sung-Min Kim, Keewon Kim, John M. Rhee, Woo-Young Jo, Hyongmin Oh, Hee-Pyoung Park, Chang-Hyun Lee, Chi Heon Kim
    Medicine.2026; 105(9): e47668.     CrossRef
  • Strength vs. endurance in myotome assessment—a case for (further studies on) repeated measurements
    Alexia Coulombe-Lévêque, Nicolas Dehors, René Pelletier, François Cabana, Jean-Pierre Dumas, Guillaume Léonard
    Frontiers in Rehabilitation Sciences.2026;[Epub]     CrossRef
  • Treatment Guidelines and Decision Tree for Dry Needling Musculoskeletal Conditions: A Consensus Statement
    Tyler Waterway, Jonathon Beougher, Robert Butler, Kelby Church, Gray Cook, Susan Falsone, Brian Hortz, Tyler Opitz, Phillip J. Plisky, Edo Zylstra, RobRoy Martin
    International Journal of Sports Physical Therapy.2026;[Epub]     CrossRef
  • Estudio de la columna cervical
    S. Grosdent, P. Pesesse, D. Colman, M. Vanderthommen, C. Demoulin
    EMC - Kinesiterapia - Medicina Física.2025; 46(1): 1.     CrossRef
  • C7 Myotome: Muscles and Their Actions
    Jee Eun Kim, Jong Seok Bae
    Journal of the Korean Neurological Association.2025; 43(1): 69.     CrossRef
  • Bilancio del rachide cervicale
    S. Grosdent, P. Pesesse, D. Colman, M. Vanderthommen, C. Demoulin
    EMC - Medicina Riabilitativa.2025; 32(1): 1.     CrossRef
  • Neurological examination for cervical radiculopathy: a scoping review
    Marzia Stella Yousif, Giuseppe Occhipinti, Filippo Bianchini, Daniel Feller, Annina B. Schmid, Firas Mourad
    BMC Musculoskeletal Disorders.2025;[Epub]     CrossRef
  • The resisted levator scapulae test: a clinical test for C4 radiculopathy
    William Roger Peters, James Thomas Ernest Smith, Mario Giuseppe Zotti
    European Spine Journal.2025; 34(8): 3205.     CrossRef
  • A Brief Review on Cervical Spondylosis
    Shivanjali S. Lakhapate, Omkar A. Devade, Vivekkumar K. Redasani
    Journal of Drug Delivery and Therapeutics.2025; 15(7): 144.     CrossRef
  • Does residual foraminal stenosis at levels not covered by anterior cervical discectomy and fusion aggravate postoperative outcomes in cervical radiculopathy?
    Sehan Park, Dong-Ho Lee, San Kim, Chang Ju Hwang, Jae Hwan Cho
    Asian Spine Journal.2025; 19(6): 978.     CrossRef
  • Bilan du rachis cervical
    S. Grosdent, P. Pesesse, D. Colman, M. Vanderthommen, C. Demoulin
    EMC - Kinésithérapie - Médecine physique - Réadaptation.2024; 37(4): 1.     CrossRef
  • Integrating jigsaw puzzle thinking into practice: the assessment of cervical spine radiculopathy
    Michael Mansfield, Mick Thacker
    Current Opinion in Supportive & Palliative Care.2023; 17(3): 135.     CrossRef
  • Regional Sensorimotor Effects of Chiropractic Spinal Manipulation: Preliminary Results From an Experimental Study
    Carlos Gevers-Montoro, Zoha Deldar, Arantxa Ortega-De Mues
    Journal of Manipulative and Physiological Therapeutics.2023; 46(5-9): 280.     CrossRef
  • 27,123 View
  • 773 Download
  • 9 Web of Science
  • 13 Crossref

Minimally Invasive Spinal Surgery SMISS-Neurospine Special Issue

Comparative Analysis With Modified Inclined Technique for Posterior Endoscopic Cervical Foraminotomy in Treating Cervical Osseous Foraminal Stenosis: Radiological and Midterm Clinical Outcomes
Ji Yeon Kim, Dong Hwa Heo, Dong Chan Lee, Tae Hyun Kim, Choon Keun Park
Neurospine 2022;19(3):603-615.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244268.134

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Comparative Analysis With Modified Inclined Technique for Posterior Endoscopic Cervical Foraminotomy in Treating Cervical Osseous Foraminal Stenosis: Radiological and Midterm Clinical Outcomes
Neurospine. 2022;19(3):603-615.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244268.134
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Comparative Analysis With Modified Inclined Technique for Posterior Endoscopic Cervical Foraminotomy in Treating Cervical Osseous Foraminal Stenosis: Radiological and Midterm Clinical Outcomes
Neurospine. 2022;19(3):603-615.   Published online September 30, 2022
DOI: https://doi.org/10.14245/ns.2244268.134
Close
Objective
We compared the midterm clinical and radiological outcomes between 2 types of full endoscopic posterior cervical foraminotomy, including conventional posterior endoscopic cervical foraminotomy (PECF) and modified inclined technique for PECF.
Methods
One of the 2 types of PECF surgery was performed for defined cervical foraminal stenosis. The foraminal expansion ratio and facet resection rate and foraminal stenosis grade were measured using magnetic resonance imaging. Visual analogue scale (VAS) scores for neck and arm pain, neck disability index, MacNab criteria, operation time, hospital stay, and complications, including postoperative dysesthesia, were assessed. Clinical and radiological parameters were compared between the 2 surgical groups.
Results
There were 49 and 46 patients in the PECF and modified-PECF groups, respectively. The modified-PECF group showed significantly higher expansion of distal foraminal diameter and foraminal height, and a lower facet resection rate compared to PECF group (in all, p < 0.001). The modified-PECF group displayed significantly lower VAS score for neck pain at 1 day and 1 week after surgery and lower arm pain VAS score after 6-month follow-up (p = 0.002, p = 0.001, p = 0.002, respectively).
Conclusion
Compared with the PECF, the modified inclined technique has radiologic benefits, including enhanced facet joint preservation, restoration of the natural course of nerve roots, and prevention of restenosis by expanding the superior articular process base, especially in grade 2 foraminal stenosis. Furthermore, the modified inclined technique significantly improved the postoperative VAS score for neck pain within the 1-week follow-up and that of arm pain after 6-month follow-up.

Citations

Citations to this article as recorded by  Crossref logo
  • Full-endoscopic posterior cervical foraminotomy: Case-series and technical nuances
    Sameer Nazeeruddin, Jean-Yves Fournier, Alexandre Simonin
    World Neurosurgery: X.2026; 29: 100559.     CrossRef
  • Clinical Outcomes and Future Directions of Endoscopic Cervical Spine Surgery: A Systematic Review With Narrative Insights
    Ryan Wang, Satheeshram Tamilselvan, Ji Soo Ha, Aditya Vedantam, Courtney Rory Goodwin, Nathan Evaniew, Uzondu F. Agochukwu, Konstantinos Margetis, Yoon Ha, Michael Fehlings, Jefferson R. Wilson, Ankit I. Mehta
    Global Spine Journal.2026;[Epub]     CrossRef
  • Algorithmic Approach to Combined Standard and Inclinatory Foraminotomy via Unilateral Biportal Endoscopy for Cervical Foraminal Stenosis Using Sagittal-Oblique Computed Tomography
    Malcolm Darayes Pestonji, Sharvari Rajendra Gunjotikar, Sucheta Tirpude, Kai-Uwe Lewandrowski
    Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(Suppl 1): S177.     CrossRef
  • CLINICAL AND SURGICAL OUTCOMES OF POSTERIOR ENDOSCOPIC SURGERY ON THE CERVICAL SPINE IN THE TREATMENT OF CERVICAL PATHOLOGIES
    Lina Marcia de Araujo Herval, Kelsen de Oliveira Teixeira, Fernando Flores de Araújo, Edgar Takao Utino, Rangel Roberto de Assis, André Luis Rousselet Lafratta, Diogo Sales Archangel dos Santos, Jorge Luis Garcia Ferrabone, Victor da Silva Pereira, Wilson
    Coluna/Columna.2026;[Epub]     CrossRef
  • Transforaminal Endoscopic Thoracic Discectomy Is More Cost-Effective Than Microdiscectomy for Symptomatic Disc Herniations
    Junseok Bae, Pratyush Shahi, Sang-Ho Lee, Han-Joong Keum, Ju-Wan Seok, Yong-Soo Choi, Jin-Sung Kim
    Neurospine.2025; 22(1): 118.     CrossRef
  • Surgical Outcomes of Full Endoscopic Posterior Cervical Foraminotomy for Proximal Cervical Spondylotic Amyotrophy
    Deokcheol Lee, Kazuo Ohmori, Reiko Yoneyama, Takuro Endo, Yasuhiro Endo
    Asian Spine Journal.2024; 18(1): 32.     CrossRef
  • Biportal endoscopic transforaminal thoracic interbody fusion for the treatment of thoracic myelopathy
    Ji Yeon Kim, Su Yong Choi, Kyoung Mo Kim
    Acta Neurochirurgica.2024;[Epub]     CrossRef
  • Machine-learning-based models for the optimization of post-cervical spinal laminoplasty outpatient follow-up schedules
    Yechan Seo, Seoi Jeong, Siyoung Lee, Tae-Shin Kim, Jun-Hoe Kim, Chun Kee Chung, Chang-Hyun Lee, John M. Rhee, Hyoun-Joong Kong, Chi Heon Kim
    BMC Medical Informatics and Decision Making.2024;[Epub]     CrossRef
  • Posterior Endoscopic Cervical Discectomy
    Hyeun Sung Kim, Yoon Ha Hwang
    Journal of Minimally Invasive Spine Surgery and Technique.2024; 9(2): 180.     CrossRef
  • New Paradigm of Endoscopic Spine Surgery: Unilateral Biportal Endoscopic Spinal Surgery
    Dong Hwa Heo, Jin Hwa Eum
    Journal of Minimally Invasive Spine Surgery and Technique.2024; 9(2): 81.     CrossRef
  • Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes
    Ji Yeon Kim, Ji Soo Ha, Chang Kyu Lee, Dong Chan Lee, Hyun Jin Hong, Su Yong Choi, Choon Keun Park
    Neurospine.2023; 20(1): 129.     CrossRef
  • Biportal Endoscopic Posterior Cervical Foraminotomy for Adjacent 2-Level Foraminal Lesions Using a Single Approach (Sliding Technique)
    Dong Hwa Heo, Ji Soo Ha, Jae Won Jang
    Neurospine.2023; 20(1): 92.     CrossRef
  • Overview and Prevention of Complications During Full-Endoscopic Cervical Spine Surgery
    Young-Rak Kim, Jun-Hoe Kim, Tae-Hwan Park, Hangeul Park, Sum Kim, Chang-Hyun Lee, Kyoung-Tae Kim, Chun Kee Chung, Chi Heon Kim
    Journal of Minimally Invasive Spine Surgery and Technique.2023; 8(2): 153.     CrossRef
  • Future of Endoscopic Spine Surgery: Insights from Cutting-Edge Technology in the Industrial Field
    Woon-Tak Yuh, You-Sang Lee, Il Choi
    Bioengineering.2023; 10(12): 1363.     CrossRef
  • 8,176 View
  • 293 Download
  • 15 Web of Science
  • 14 Crossref
Comparative Analysis of 3 Types of Minimally Invasive Posterior Cervical Foraminotomy for Foraminal Stenosis, Uniportal-, Biportal Endoscopy, and Microsurgery: Radiologic and Midterm Clinical Outcomes
Ji Yeon Kim, Hyun Jin Hong, Dong Chan Lee, Tae Hyun Kim, Jin Seob Hwang, Choon Keun Park
Neurospine 2022;19(1):212-223.   Published online February 2, 2022
DOI: https://doi.org/10.14245/ns.2142942.471

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Comparative Analysis of 3 Types of Minimally Invasive Posterior Cervical Foraminotomy for Foraminal Stenosis, Uniportal-, Biportal Endoscopy, and Microsurgery: Radiologic and Midterm Clinical Outcomes
Neurospine. 2022;19(1):212-223.   Published online February 2, 2022
DOI: https://doi.org/10.14245/ns.2142942.471
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Comparative Analysis of 3 Types of Minimally Invasive Posterior Cervical Foraminotomy for Foraminal Stenosis, Uniportal-, Biportal Endoscopy, and Microsurgery: Radiologic and Midterm Clinical Outcomes
Neurospine. 2022;19(1):212-223.   Published online February 2, 2022
DOI: https://doi.org/10.14245/ns.2142942.471
Close
Objective
The aim of this study was to compare the clinical and radiologic outcomes of 3 types of minimally invasive posterior cervical foraminotomy (PCF): uniportal endoscopic surgery, biportal endoscopic surgery, and microsurgery.
Methods
Between January 2019 to January 2020, PCF was performed using 3 different approaches to treat foraminal stenosis. The foraminal expansion rate, facet resection rate, and surgical foraminal approach angle were measured using magnetic resonance imaging. Visual analogue scale (VAS) scores for neck and arm pain, neck disability index (NDI), MacNab criteria, operation time, hospital stay, and complications were assessed. Clinical and radiologic parameters were compared among the 3 surgical groups.
Results
There were 38, 30, and 50 patients in the uniportal endoscopy, biportal endoscopy, and microscopy groups, respectively. Microscopy group displayed significantly higher foraminal expansion compared to uniportal endoscopy group (p = 0.001). Facet resection rates and inclination angle for facet joint undercutting were significantly different among the 3 groups. Uniportal endoscopy group had the highest inclination angle and the least facet resection. On the 6 months and final follow-up, VAS scores and NDI were significantly lower in the uniportal endoscopy group than in the microscopy group (p = 0.000).
Conclusion
All 3 types of PCF displayed favorable clinical outcomes and sufficient expansion of the midforaminal area. Two endoscopy groups showed a significantly higher inclination angle for undercutting the facet joint and a lower facet resection rate than the microscopy group. Reduced facet joint resection using an inclinatory approach did not interfere with sufficient foraminal expansion and enhanced the clinical result after 6 months of follow-up.

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Synthetic Cages Associated With Increased Rates of Revision Surgery and Higher Costs Compared to Allograft in ACDF in the Nonelderly Patient
Majd Marrache, Rachel Bronheim, Andrew B. Harris, Varun Puvanesarajah, Micheal Raad, Sang Lee, Richard Skolasky, Amit Jain
Neurospine 2020;17(4):896-901.   Published online December 31, 2020
DOI: https://doi.org/10.14245/ns.2040216.108

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Synthetic Cages Associated With Increased Rates of Revision Surgery and Higher Costs Compared to Allograft in ACDF in the Nonelderly Patient
Neurospine. 2020;17(4):896-901.   Published online December 31, 2020
DOI: https://doi.org/10.14245/ns.2040216.108
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Synthetic Cages Associated With Increased Rates of Revision Surgery and Higher Costs Compared to Allograft in ACDF in the Nonelderly Patient
Neurospine. 2020;17(4):896-901.   Published online December 31, 2020
DOI: https://doi.org/10.14245/ns.2040216.108
Close
Objective
The aim of this study was to compare all-cause reoperation rates and costs in nonelderly patients treated with anterior cervical discectomy and fusion (ACDF) with structural allograft versus synthetic cages for degenerative pathology.
Methods
We queried a private claims database to identify adult patients ( ≤ 65 years) who underwent single-level ACDF in a hospital setting using either structural allograft or a synthetic cage (polyetheretherketone, metal, or hybrid device), from 2010 to 2016. The rate of all-cause reoperations at 2 years were compared between the 2 groups. Index hospitalization costs and 90-day complication rates were also compared. Significance was set at p < 0.05.
Results
A total of 26,754 patients were included in the study. 11,514 patients (43%) underwent ACDF with structural allograft and 15,240 (57%) underwent ACDF with a synthetic cage. The patients in the allograft group were younger and more likely to be male. There was no significant difference between the 2 groups with respect to 90-day complications including: wound dehiscence, dysphagia, dysphonia, and hematoma/seroma. In the 2-year postoperative period, the synthetic cage group had a significantly higher rate of allcause reoperation compared to the allograft group (9.1% vs. 8.0%, p = 0.002). Index hospitalization costs were significantly higher in the synthetic cage group compared to those in the allograft group ($23,475 vs. $20,836, p < 0.001).
Conclusion
Structural allograft is associated with lower all-cause reoperation rates and lower index costs in nonelderly patients undergoing ACDF surgery for degenerative pathology. It is important to understand this data as we transition toward value-based care.

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    Akiro H. Duey, Christopher Gonzalez, Eric A. Geng, Pierce J. Ferriter Jr, Ashley M. Rosenberg, Ula N. Isleem, Bashar Zaidat, Paul M. Al-Attar, Jonathan S. Markowitz, Jun S. Kim, Samuel K. Cho
    Neurospine.2022; 19(4): 927.     CrossRef
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  • 118 Download
  • 11 Web of Science
  • 14 Crossref

Case Report: Technical Note

The Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy for Cervical Radiculopathy: Technical Report and Preliminary Results
Kwan-Su Song, Chul-Woo Lee
Neurospine 2020;17(Suppl 1):S145-S153.   Published online July 31, 2020
DOI: https://doi.org/10.14245/ns.2040228.114

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The Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy for Cervical Radiculopathy: Technical Report and Preliminary Results
Neurospine. 2020;17(Suppl 1):S145-S153.   Published online July 31, 2020
DOI: https://doi.org/10.14245/ns.2040228.114
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The Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy for Cervical Radiculopathy: Technical Report and Preliminary Results
Neurospine. 2020;17(Suppl 1):S145-S153.   Published online July 31, 2020
DOI: https://doi.org/10.14245/ns.2040228.114
Close
The purpose of the current study was to introduce a surgical technique for posterior cervical inclinatory foraminotomy (PCIF) using a percutaneous biportal endoscopic (BE) approach. Consecutive 7 patients underwent BE-PCIF for their cervical radiculopathy. Postoperative radiologic images (x-rays, computed tomography [CT], and magnetic resonance imaging [MRI]) were evaluated postoperatively for optimal neural decompression status and stability. A visual analogue scale (VAS) for the arm pain and the Neck Disability Index were used to evaluate clinical results in the preoperative and postoperative periods. Mean follow-up periods were 6.42 ± 2.99 months. The mean operative time was 101.42 ± 49.30 minutes. Postoperative MRI and CT revealed complete removal of herniated discs and ideal neural decompression of the treated segments in all patients. Disc height and stability were preserved on postoperative x-rays. Preoperative VAS and Oswestry Disability Index scores improved significantly after the surgery. BE-PCIF may be an effective surgical treatment of the cervical radiculopathic lesions, which provides successful surgical decompression as far as distal part of foramen with better operative view and more easy surgical manipulation. This approach may also minimize iatrogenic damages of the posterior cervical musculo-ligamentous structures and help to maximize the preservation of the facet joint.

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    Malcolm Darayes Pestonji, Sharvari Rajendra Gunjotikar, Sucheta Tirpude, Kai-Uwe Lewandrowski
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Original Article

Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort
Andre M. Samuel, Harold G. Moore, Avani S. Vaishnav, Steven McAnany, Todd Albert, Sravisht Iyer, Yoshihiro Katsuura, Catherine Himo Gang, Sheeraz A. Qureshi
Neurospine 2019;16(3):563-573.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938220.110

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Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort
Neurospine. 2019;16(3):563-573.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938220.110
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Effect of Myelopathy on Early Clinical Improvement After Cervical Disc Replacement: A Study of a Local Patient Cohort and a Large National Cohort
Neurospine. 2019;16(3):563-573.   Published online September 30, 2019
DOI: https://doi.org/10.14245/ns.1938220.110
Close
Objective
Cervical disc replacement (CDR) is an effective long-term treatment for both cervical radiculopathy and myelopathy. However, there may be unique differences in the early postoperative clinical improvement for patients with and without myelopathy. In addition, previous studies using CDR to treat cervical myelopathy were underpowered to determine risk factors for relatively postoperative medical complications.
Methods
Two different cohorts were studied. A local cohort of patients undergoing CDR by a single surgeon was utilized to study the early postoperative course of clinical improvement. In addition, a national cohort of patients undergoing CDR in the 2015 and 2016 National Surgical Quality Improvement Program database was utilized to study differences in postoperative medical complications after CDR. Patients with a preoperative diagnosis of cervical myelopathy were identified in both cohorts, and perioperative outcomes and complications were compared to patients without myelopathy.
Results
A total of 43 patients undergoing CDR were included in the institutional cohort, of those 16 patients (37% of cohort) had a preoperative diagnosis of cervical myelopathy. A total of 3,023 patients undergoing CDR were included in the national cohort, of those 411 (13% of cohort) had a preoperative diagnosis of cervical myelopathy. In the institutional cohort, the nonmyelopathy group had a lower initial Neck Disability Index (NDI) and saw a faster improvement in NDI by 2 weeks postoperative. However, at 24 weeks there was no significant difference between groups in terms of NDI. Interestingly, only the nonmyelopathy cohort had a significant improvement in modified Japanese Orthopaedic Association score by 6 weeks (p<0.05). In the national cohort, myelopathy was associated with longer operative time and length of stay (p<0.05). However, there was no significant difference in perioperative complications (p>0.05) between myelopathy and nonmyelopathy patients.
Conclusion
Significant improvements in NDI, visual analogue scale (VAS)-arm pain, and VAS-neck pain are seen in both myelopathy and nonmyelopathy populations undergoing CDR by 6 weeks postoperatively. However, nonmyelopathy populations improve faster by 2 weeks postoperatively. In the national cohort analysis, medical complications were similarly low in both myelopathy and nonmyelopathy groups.

Citations

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Review Article

The Option of Motion Preservation in Cervical Spondylosis: Cervical Disc Arthroplasty Update
Chih-Chang Chang, Wen-Cheng Huang, Jau-Ching Wu, Praveen V. Mummaneni
Neurospine 2018;15(4):296-305.   Published online December 14, 2018
DOI: https://doi.org/10.14245/ns.1836186.093

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The Option of Motion Preservation in Cervical Spondylosis: Cervical Disc Arthroplasty Update
Neurospine. 2018;15(4):296-305.   Published online December 14, 2018
DOI: https://doi.org/10.14245/ns.1836186.093
Download Citation

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The Option of Motion Preservation in Cervical Spondylosis: Cervical Disc Arthroplasty Update
Neurospine. 2018;15(4):296-305.   Published online December 14, 2018
DOI: https://doi.org/10.14245/ns.1836186.093
Close
Cervical disc arthroplasty (CDA), or total disc replacement, has emerged as an option in the past two decades for the management of 1- and 2-level cervical disc herniation and spondylosis causing radiculopathy, myelopathy, or both. Multiple prospective randomized controlled trials have demonstrated CDA to be as safe and effective as anterior cervical discectomy and fusion, which has been the standard of care for decades. Moreover, CDA successfully preserved segmental mobility in the majority of surgical levels for 5–10 years. Although CDA has been suggested to have long-term efficacy for the reduction of adjacent segment disease in some studies, more data are needed on this topic. Surgery for CDA is more demanding for decompression, because indirect decompression by placement of a tall bone graft is not possible in CDA. The artificial discs should be properly sized, centered, and installed to allow movement of the vertebrae, and are commonly 6 mm high or less in most patients. The key to successful CDA surgery includes strict patient selection, generous decompression of the neural elements, accurate sizing of the device, and appropriately centered implant placement.

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Case Report

Tophaceous Gout in the Lumbar Spinal Canal Mimicking Epidural Spinal Tumor
Taeshin Kim, Bum-Joon Kim, Se-Hoon Kim, Seung-Hwan Lee
Korean J Spine 2017;14(2):50-52.   Published online June 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.2.50

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Tophaceous Gout in the Lumbar Spinal Canal Mimicking Epidural Spinal Tumor
Korean J Spine. 2017;14(2):50-52.   Published online June 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.2.50
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Tophaceous Gout in the Lumbar Spinal Canal Mimicking Epidural Spinal Tumor
Korean J Spine. 2017;14(2):50-52.   Published online June 30, 2017
DOI: https://doi.org/10.14245/kjs.2017.14.2.50
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Gout is an inflammatory arthritis characterized by deposition of monosodium urate crystals in joints. Though gout frequently involves the big toe or other extremities, it rarely occurs in the spinal canal. A 35-year-old man presented with left L5 radiculopathy. He had leg pain for 8 months and received several epidural steroid injections. Magnetic resonance imaging revealed a 1.7×1.1-cm ovoid contrast-enhancing mass, causing pressure erosion of the left L5 pedicle. Microscopic laminotomy was performed at the left L5 lamina. White chalky materials, identified at the left lateral recess of the spinal canal, were removed in a piecemeal manner. The histopathologic diagnosis was tophaceous gout. Although the patient’s radiating pain did not resolve postoperatively, it was dramatically relieved with uric acid-lowering medications. If a mass effect is suspected, surgical removal of gouty tophi might aid in symptom release and definite diagnosis. Medical treatment after rheumatology consultation is crucial.

Citations

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  • A Rare Case Report of an Adult With Intraspinal Gouty Stones and Concurrent Knee Joint Involvement
    Bo Cao, Jinlong Wang
    Clinical Case Reports.2025;[Epub]     CrossRef
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    Journal of Craniovertebral Junction and Spine.2024; 15(2): 133.     CrossRef
  • Chronic pyogenic spondylitis in patients with spinal gout: a case series and literature review
    Arkadiy A. Vishnevskiy, Denis G. Naumov, Mikhail M. Shchelkunov, Tatiana A. Novitskaya
    Traumatology and Orthopedics of Russia.2024; 30(2): 168.     CrossRef
  • A unique presentation of acute tophaceous gout in the lumbar spine causing cauda equina syndrome
    Esther Tan Wan Xian, Shawn Kok Shi Xian, Yeap Phey Ming
    Radiology Case Reports.2023; 18(9): 3341.     CrossRef
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    Anne Cotten, Simon Henry, Laura Scarciolla, Ralph Abou Diwan, Xavier Demondion, Sammy Badr
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    Fangke Hu, Lu Xue, Dong Zhao, Chao Chen, Gang Liu, Qiang Yang
    Experimental and Therapeutic Medicine.2023;[Epub]     CrossRef
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  • Percutaneous transforaminal endoscopic decompression for the treatment of intraspinal tophaceous gout
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    Medicine.2020; 99(21): e20125.     CrossRef
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Clinical Article

Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy
Jang Ho Ahn, Moon Sun Park, Seong Min Kim, Seung Young Chung, Do Sung Lee, Ki Seok Park
Korean J Spine 2016;13(3):134-138.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.134

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Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy
Korean J Spine. 2016;13(3):134-138.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.134
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Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy
Korean J Spine. 2016;13(3):134-138.   Published online September 30, 2016
DOI: https://doi.org/10.14245/kjs.2016.13.3.134
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Objective

Anterior cervical microforaminotomy (ACMF) is a motion-preserving surgical procedure. The purpose of this study is to assess radiologic changes of operated and adjacent segments after ACMF.

Methods

We retrospectively reviewed 52 patients who underwent ACMF between 1998 and 2008. From X-ray film-based changes, disc height and sagittal range of motion (ROM) of operated and adjacent segments were compared at preoperative and last follow-up periods. Radiological degeneration of both segments was analyzed as well.

Results

The mean follow-up period was 48.2 months. There were 78 operated, 52 upper adjacent, and 38 lower adjacent segments. There were statistically significant differences in the ROM and disc height of operated segment between preoperative and last follow-up periods. However, there were no statistically significant differences in the ROM and disc height of adjacent segment between both periods. Radiological degenerative changes of operated segments were observed in 30%. That of adjacent segments was observed in 11 and 11% at upper and lower segments, respectively.

Conclusion

After mean 4-year follow-up periods, there were degenerative changes of operated segments. However, ACMF preserved motion and prevented degenerative changes of adjacent segments.

Citations

Citations to this article as recorded by  Crossref logo
  • Clinical and radiological outcomes of anterior cervical foraminotomy: Insights from a pioneering Australian case series and systematic review
    Jiahua Huang, Daniel Liu, Keshan Murugananthan, Saeed Kohan
    Journal of Clinical Neuroscience.2025; 142: 111698.     CrossRef
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    Yong Ahn
    Neurospine.2023; 20(1): 11.     CrossRef
  • Long-term Radiological Evidence of Affected and Adjacent Segment Disease after Anterior Cervical Foraminotomy
    Yasufumi OHTAKE, Junya HANAKITA, Toshiyuki TAKAHASHI, Manabu MINAMI, Hirohiko NAKAMURA, Taigo KAWAOKA
    Neurologia medico-chirurgica.2020; 60(10): 492.     CrossRef
  • 9,611 View
  • 109 Download
  • 3 Crossref
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