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Physical Performance Continues to Improve After Surgery for Sciatica, Exceeding Recovery Periods of Physical Capacity and Patient-Reported Outcomes: Multicenter Prospective Observational Study
Neurospine. 2026;23(2):229-238.   Published online April 30, 2026
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Physical Performance Continues to Improve After Surgery for Sciatica, Exceeding Recovery Periods of Physical Capacity and Patient-Reported Outcomes: Multicenter Prospective Observational Study
Neurospine. 2026;23(2):229-238.   Published online April 30, 2026
Close
Objective
To longitudinally analyze smartphone-based real-life activity data and compare it with established clinical outcome measures in patients undergoing lumbar spine surgery for sciatica, focusing on identifying divergence in recovery trajectories.
Methods
Fifty patients were assessed preoperatively and at 6 weeks (6W), 3 months (3M), and 6 months (6M). Outcomes included smartphone-derived daily Step Count, objective capacity (6-minute walking test [6WT]), and subjective disability (visual analogue scale [VAS] leg/back, Core Outcome Measures Index [COMI] back, and Oswestry Disability Index [ODI]). All metrics were standardized into z-scores relative to baseline. Piecewise linear mixed-effects (LME) models compared recovery slopes across 2 segments: phase I (early: 0–6 weeks) and phase II (late: 6 weeks–6 months).
Results
The cohort (mean age, 50.7 years; 24 females) included 33 patients with lumbar disc herniation and 17 with lateral recess stenosis. All measures improved significantly during phase I (all p<0.05). However, LME modeling revealed a significant interaction between time segment and measurement type in phase II. Daily Step Count was the only metric maintaining a significant, linear upward recovery slope during the late phase (β=0.31 Z/mo). Conversely, slopes for 6WT, ODI, and COMI were significantly flatter (p<0.001 vs. Step Count), indicating a statistical plateau or “ceiling effect.” Spearman correlations between Step Count and traditional metrics weakened from strong at baseline to weak at 6 months.
Conclusion
Smartphone-derived real-life activity data detect continuous functional improvement up 6 months postoperatively, whereas conventional objective and subjective measures plateau by 6 weeks. Real-world activity monitoring provides a more sensitive assessment of long-term surgical success.

Citations

Citations to this article as recorded by  Crossref logo
  • From the Editor-in-Chief: Featured Articles in the April 2026 Issue
    Inbo Han
    Neurospine.2026; 23(2): 227.     CrossRef
  • Real-World Effectiveness Versus Efficacy in a Study Environment: How Smartphones Help Capture Meaningful Patient Recovery Trajectories – A Commentary on “Physical Performance Continues to Improve After Surgery for Sciatica, Exceeding Recovery Periods of P
    Victor E. Staartjes
    Neurospine.2026; 23(2): 239.     CrossRef
  • 1,033 View
  • 52 Download
  • 2 Crossref

Minimally Invasive Spinal Surgery SMISS-Neurospine Special Issue

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Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica
Neurospine. 2022;19(3):594-602.   Published online September 30, 2022
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Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica
Neurospine. 2022;19(3):594-602.   Published online September 30, 2022
Close
Objective
Full-endoscopic spine surgery is gaining interest as a less-invasive alternative to treat sciatica caused by a lumbar disc herniation. Concerns, however, exist with the learning curve as percutaneous transforaminal endoscopic discectomy (PTED) appears to be more difficult to be performed compared to other techniques. In this study, the clinical outcomes during and after the learning curve are presented of 3 surgeons naïve to PTED.
Methods
In the first phase of a randomized controlled, noninferiority trial comparing PTED with microdiscectomy, 3 surgeons were trained in the PTED-procedure by a senior surgeon. After performing up to 20 cases under supervision, they started performing PTED on their own. Results of the early cases were compared to the later cases (>20). Furthermore, complications and reoperations were compared. Finally, differences in clinical outcomes between surgeons were compared.
Results
At 12 months of follow-up, 87% of the patients had follow-up data available. In general, there were no significant differences in patient-reported outcomes between the early and later PTED cases. Furthermore, outcomes of the early PTED cases were comparable to the outcomes of microdiscectomy, while the later PTED cases had small, but more favorable outcomes compared to microdiscectomy. Two learning curve surgeons had substantially higher rates of reoperations within 1 year, compared to the senior surgeon or the microdiscectomy group. Duration of surgery was also longer for all learning curve surgeons. Finally, when comparing clinical outcomes of patients undergoing PTED versus microdiscectomy, there appears to be some statistically significant differences in outcomes compared between the senior and 3 learning curve surgeons.
Conclusion
PTED appears to be safe to be adopted by surgeons naïve to the procedure when they are initially supervised by an experienced senior surgeon. Duration of surgery and risk of repeated surgery are increased during the learning curve, but patient-reported outcomes of the early PTED cases are similar to the outcomes of later PTED cases, and similar to the outcomes of microdiscectomy cases. This study underlines the need for an experienced mentor for surgeons to safely adopt PTED.

Citations

Citations to this article as recorded by  Crossref logo
  • The Initial Learning and Supply Cost Curve of Incorporating Interlaminar and Transforaminal Endoscopy at a Tertiary Academic Medical Center
    Mark M Zaki, Edward S Harake, Varun G Kathawate, Michael J Strong, Rushikesh S Joshi, Joseph R Linzey, Yamaan S Saadeh, Osama N Kashlan
    Cureus.2026;[Epub]     CrossRef
  • Operative time, recurrence, and complications throughout the initial learning curve in transforaminal endoscopic lumbar discectomy
    Michelle D. Poelman, Annegien Boeykens, Biswadjiet S. Harhangi, Marc L. Schröder, Victor E. Staartjes
    Acta Neurochirurgica.2026;[Epub]     CrossRef
  • Endoscopic Spine Surgery: A Scoping Review of the Literature
    Drew Mulhall, Chien Yew Kow, Catherine Veilleux, Anand Oliveira Masson, Steven Casha, Stephan du Plessis, Ken Thomas, Michael M. H. Yang
    Global Spine Journal.2026;[Epub]     CrossRef
  • Simulation training in spinal endoscopic surgery: a systematic review of current status
    Gilberto Perez Rodriguez Garcia, Abdulwhab Alotaibi, Omid Yousefi, Ataollah Shahbandi, Pegah Ghamasaee, Abdul Mounnem Yassin Kassab, Rakan Bokhari, Muhammad Abd-El-Barr, Saman Shabani, Mohamad Bakhaidar
    Neurosurgical Review.2026;[Epub]     CrossRef
  • Percutaneous Endoscopic Debridement and Drainage for Infectious Spondylodiscitis Under Local Anesthesia
    Ji-Ho Jung, Jong-Hoon Jeong, Jong-Hwan Hong, Moon-Soo Han, Jung-Kil Lee
    Journal of Minimally Invasive Spine Surgery and Technique.2026; 11(1): 163.     CrossRef
  • Meta-Analysis of Learning Curve in Endoscopic Spinal Surgery: Impact on Surgical Outcomes
    Juan Álvarez de Mon-Montoliú, Juan Castro-Toral, César Bonome-González, Manuel González-Murillo
    Global Spine Journal.2025; 15(4): 2500.     CrossRef
  • Classification of endoscopic spine procedures
    Mazda Farshad, Christoph J. Laux, Florian Wanivenhaus, José M. Spirig, Jonas Widmer, Michael Kelly, Javier Quillo-Olvera, Jin-Sung Kim, Facundo van Isseldyk, Sohrab Gollogly, James Yue, Xuexiao Ma, Vincent Hagel, Frédéric Cornaz
    North American Spine Society Journal (NASSJ).2025; 22: 100603.     CrossRef
  • Large-Channel Interlaminar Endoscopic Discectomy for Highly Migrated Lumbar Disc Herniation: Effectiveness and Safety
    Shicheng Zheng, Qinghua Zhao, Zongshan Hu, Haibo Li, Bin Wang, Zezhang Zhu, Yong Qiu, Xu Sun
    Journal of Pain Research.2025; Volume 18: 3821.     CrossRef
  • Rediscovering Posterior Cervical Foraminotomy/Diskectomy With the Endoscope: A Favorable Cost Comparison with the Traditional Treatment of a Cervical Radiculopathy
    Campbell Liles, Hani Chanbour, Alexander T. Lyons, Emma Ye, Omar Zakieh, Robert J. Dambrino, Iyan Younus, Soren Jonzzon, Richard A. Berkman, Julian G. Lugo-Pico, Amir M. Abtahi, Byron F. Stephens, Scott L. Zuckerman, Raymond J. Gardocki
    Operative Neurosurgery.2025;[Epub]     CrossRef
  • Three-dimensional virtual surgical planning enhances precision and safety in percutaneous transforaminal endoscopic discectomy: a retrospective comparative study
    Yang Fuguo, Chen Kang, Luo Yuanchao, He Renjian
    Journal of Orthopaedic Surgery and Research.2025;[Epub]     CrossRef
  • Outcome of Percutaneous Endoscopic Lumbar Discectomy in Relation to the Surgeon’s Experience: Propensity Score Matching
    Seong Son, Michael Y. Oh, Han Byeol Park, Alexander M. Lopez
    Bioengineering.2024; 11(4): 312.     CrossRef
  • Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years
    Xinyu Yang, Shijun Zhang, Junxiao Su, Sai Guo, Yakubu Ibrahim, Kai Zhang, Yonghao Tian, Lianlei Wang, Suomao Yuan, Xinyu Liu
    Neurospine.2024; 21(1): 303.     CrossRef
  • Percutaneous endoscopic transforaminal discectomy and unilateral biportal endoscopic discectomy for lumbar disc herniation: a comparative analysis of learning curves
    Zhangfu Li, Honghao Yang, Yaoshen Zhang, Chaofan Han, Yuzeng Liu, Li Guan, Jincai Yang, Yong Hai, Aixing Pan
    European Spine Journal.2024; 33(6): 2154.     CrossRef
  • Learning curve analyses in spine surgery: a systematic simulation-based critique of methodologies
    Conor McNamee, Salman Keraidi, Jake McDonnell, Andrew Kelly, Julia Wall, Stacey Darwish, Joseph S. Butler
    The Spine Journal.2024; 24(10): 1789.     CrossRef
  • Is Close Supervision by a Senior Surgeon Necessary During the Initial Days of Performing Endoscopic Lumbar Discectomy? A Retrospective Comparative Study between Two Fellowship Trained Surgeons to Assess the Learning Curve
    Syed Ifthekar, Shih-Min Lee, Sang-Ho Lee, Sang-Ha Shin, Junseok Bae
    Journal of West African College of Surgeons.2024;[Epub]     CrossRef
  • The evolution and integration of technology in spinal neurosurgery: A scoping review
    Moksada Regmi, Weihai Liu, Shikun Liu, Yuwei Dai, Ying Xiong, Jun Yang, Chenlong Yang
    Journal of Clinical Neuroscience.2024; 129: 110853.     CrossRef
  • Is minimally invasive surgery a game changer in spinal surgery?
    Sang-Min Park, Ho-Joong Kim, Jin S. Yeom
    Asian Spine Journal.2024; 18(5): 743.     CrossRef
  • Evolving Paradigms in Spinal Surgery: A Systematic Review of the Learning Curves in Minimally Invasive Spine Techniques
    Kun Wu, Zhihe Yun, Siravich Suvithayasiri, Yihao Liang, Dimas Rahman Setiawan, Vit Kotheeranurak, Khanathip Jitpakdee, Enrico Giordan, Qinyi Liu, Jin-Sung Kim
    Neurospine.2024; 21(4): 1251.     CrossRef
  • Reply to letter to the editor regarding, “Biportal endoscopic versus microscopic discectomy for lumbar herniated disc: a randomized controlled trial”
    Sang-Min Park, Ho-Joong Kim
    The Spine Journal.2023; 23(3): 469.     CrossRef
  • Letter to the editor regarding, “Biportal endoscopic versus microscopic discectomy for lumbar herniated disc: A randomized controlled trial” by Park et al. Concepts, analyses and interpretation of noninferiority randomized controlled trials
    Pravesh S. Gadjradj, Fabian Sommer, Rodrigo Navarro-Ramirez, Judith D. de Rooij
    The Spine Journal.2023; 23(3): 467.     CrossRef
  • Initial learning curve after switching to uniportal endoscopic discectomy for lumbar disc herniations
    Catherine Olinger, Alex Coffman, Chad Campion, Kirk Thompson, Raymond Gardocki
    European Spine Journal.2023; 32(8): 2694.     CrossRef
  • Training to be a spinal endoscopic surgeon: What matters?
    Yizhou Xie, Qun Zhou, Yongtao Wang, Chengzhi Feng, Xiaohong Fan, Yang Yu
    Frontiers in Surgery.2023;[Epub]     CrossRef
  • Why Endoscopic Spine Surgery?
    Woo-Keun Kwon, Se-Hoon Kim
    Neurospine.2023; 20(1): 7.     CrossRef
  • Commentary on “Complications and Management of Endoscopic Spinal Surgery”
    Hyeun-Sung Kim, Pang Hung Wu, Il-Tae Jang
    Neurospine.2023; 20(1): 78.     CrossRef
  • Full endoscopic spine surgery
    Pramod V. Lokhande
    Journal of Orthopaedics.2023; 40: 74.     CrossRef
  • The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries
    Siravich Suvithayasiri, Young-Jin Kim, Yanting Liu, Warayos Trathitephun, Akarawit Asawasaksaku, Javier Quillo-Olvera, Vit Kotheeranurak, Haroldo Chagas, Cristian Correa Valencia, Marcus Vinicius Serra, Facundo Van Isseldyk, Lung-Hsing Lee, Chien-Min Chen
    Neurospine.2023; 20(2): 608.     CrossRef
  • 8,602 View
  • 250 Download
  • 24 Web of Science
  • 26 Crossref

Minimally Invasive Spinal Surgery SMISS-Neurospine Special Issue

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Assessing the Learning Process of Transforaminal Endoscopic Discectomy for Sciatica
Neurospine. 2022;19(3):563-570.   Published online September 30, 2022
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Assessing the Learning Process of Transforaminal Endoscopic Discectomy for Sciatica
Neurospine. 2022;19(3):563-570.   Published online September 30, 2022
Close
Objective
Percutaneous transforaminal endoscopic discectomy (PTED) is gaining popularity by both surgeons and patients as a less invasive treatment option for sciatica. Concerns, however, exist for its learning curve. No previous study has assessed the learning process of PTED. Hereby we present the learning process of 3 surgeons learning PTED.
Methods
This analysis was conducted alongside a multicenter randomized controlled trial. After attending a cadaveric workshop, 3 spine-dedicated surgeons started performing PTED, initially under the supervision of a senior surgeon. After each 5 cases, and up to case 20, the learning process was evaluated using the validated questionnaires (objective structured assessment of technical skills [OSATS], global operative assessment of laparoscopic skills [GOALS]) and a 10-step checklist specifically developed for PTED.
Results
In total, 3 learning curve surgeons performed a total of 161 cases. Based on self-assessment, surgeons improved mostly in the domains “time and motion,” “respect for tissue,” and “knowledge and handling of instruments.” Learning curve surgeons were more able to detect differences in performances on the OSATS than the senior surgeon. Based on the GOALS, the biggest improvements could be seen in “depth-perception” and “autonomy.” Based on the 10-item specific checklist, all surgeons performed all 10 steps by case 10, while only 1 surgeon performed all steps adequately by case 15.
Conclusion
Based on these study results, PTED appears to be successfully adopted stepwise by 3 spine-dedicated surgeons. From 15 cases on, most steps are performed adequately. However, more cases might be necessary to achieve good clinical results. Validated tools are needed to determine the cutoff when a surgeon should be able to perform PTED independently.

Citations

Citations to this article as recorded by  Crossref logo
  • Operative time, recurrence, and complications throughout the initial learning curve in transforaminal endoscopic lumbar discectomy
    Michelle D. Poelman, Annegien Boeykens, Biswadjiet S. Harhangi, Marc L. Schröder, Victor E. Staartjes
    Acta Neurochirurgica.2026;[Epub]     CrossRef
  • Integrated Optical and Magnetic Navigation for Simplified Percutaneous Transforaminal Endoscopic Lumbar Discectomy: A Novel Approach
    Xing-Chen Yao, Jun-Peng Liu, Xin-Ru Du, Li Guan, Yong Hai, Jincai Yang, Aixing Pan
    Neurospine.2025; 22(1): 297.     CrossRef
  • Is Close Supervision by a Senior Surgeon Necessary During the Initial Days of Performing Endoscopic Lumbar Discectomy? A Retrospective Comparative Study between Two Fellowship Trained Surgeons to Assess the Learning Curve
    Syed Ifthekar, Shih-Min Lee, Sang-Ho Lee, Sang-Ha Shin, Junseok Bae
    Journal of West African College of Surgeons.2024;[Epub]     CrossRef
  • Validity Evidence for Procedure-specific Competence Assessment Tools in Orthopaedic Surgery: A Scoping Review
    Yibo Li, Robert Chan, Matthew R.G. Menon, Joanna F. Ryan, Brett Mador, Sandra M. Campbell, Simon R. Turner
    JAAOS: Global Research and Reviews.2024;[Epub]     CrossRef
  • Outcome of Percutaneous Endoscopic Lumbar Discectomy in Relation to the Surgeon’s Experience: Propensity Score Matching
    Seong Son, Michael Y. Oh, Han Byeol Park, Alexander M. Lopez
    Bioengineering.2024; 11(4): 312.     CrossRef
  • Letter to the editor regarding, “Biportal endoscopic versus microscopic discectomy for lumbar herniated disc: A randomized controlled trial” by Park et al. Concepts, analyses and interpretation of noninferiority randomized controlled trials
    Pravesh S. Gadjradj, Fabian Sommer, Rodrigo Navarro-Ramirez, Judith D. de Rooij
    The Spine Journal.2023; 23(3): 467.     CrossRef
  • Reply to letter to the editor regarding, “Biportal endoscopic versus microscopic discectomy for lumbar herniated disc: a randomized controlled trial”
    Sang-Min Park, Ho-Joong Kim
    The Spine Journal.2023; 23(3): 469.     CrossRef
  • 7,156 View
  • 195 Download
  • 7 Web of Science
  • 7 Crossref

Case Reports

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Incarceration of Spinal Nerve Root through Incidental Durotomy as a Cause of Sciatica
Korean J Spine. 2017;14(3):103-105.   Published online September 30, 2017
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Incarceration of Spinal Nerve Root through Incidental Durotomy as a Cause of Sciatica
Korean J Spine. 2017;14(3):103-105.   Published online September 30, 2017
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Incidental durotomies are a frequent complication during spinal surgery. Cerebrospinal fluid (CSF) leakage from a dural tear may be visually apparent intraoperatively, but occasionally, a tear may not be recognized during the procedure. We report our experience in 2 cases of postoperative incarceration of nerve root as a cause of sciatica, without CSF leakage intraope- ratively. When durotomy attributable to surgical manipulation does occur, intraoperative identification is mandated. If a patient develops unexplainable postoperative pain and neurological deficits after lumbar discectomy, incarceration of nerve root should be considered in the differential diagnosis.

Citations

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  • 腰椎椎弓切除後に馬尾嵌頓を認めた1例
    祐加 西山, 晃章 塩川, 潤 田中, 達也 柴田, 京一 眞田, 秀祐 萩原, 颯太 佐々木, 卓明 山本
    Orthopedics & Traumatology.2024; 73(3): 406.     CrossRef
  • Nerve Root Herniation With Entrapment After Endoscopic Spine Decompression
    Sang Hun Park, Jung Hwan Lee, Chung Kee Chough
    Journal of Minimally Invasive Spine Surgery and Technique.2023; 8(2): 219.     CrossRef
  • Herniation of the cauda equina into the facet joint through a pseudomeningocele: A case report and literature review
    Jumpei Iida, Naohisa Miyakoshi, Michio Hongo, Hiroshi Sasaki, Hiroki Ito, Hitoshi Kubota, Takeshi Sato, Yoichi Shimada
    Surgical Neurology International.2021; 12: 30.     CrossRef
  • Incidental Durotomy in Lumbar Spine Surgery; Risk Factors, Complications, and Perioperative Management
    Hamid Hassanzadeh, Joshua Bell, Manminder Bhatia, Varun Puvanesarajah
    Journal of the American Academy of Orthopaedic Surgeons.2021; 29(6): e279.     CrossRef
  • Complications from the surgical treatment of lumbar stenosis
    Ananth S. Eleswarapu
    Seminars in Spine Surgery.2019; 31(3): 100711.     CrossRef
  • 10,865 View
  • 121 Download
  • 5 Crossref

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Lumbar Spinal Chondroma Presenting with Acute Sciatica
Korean J Spine. 2013;10(4):252-254.   Published online December 31, 2013
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Lumbar Spinal Chondroma Presenting with Acute Sciatica
Korean J Spine. 2013;10(4):252-254.   Published online December 31, 2013
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A 47-year-old woman visited with lumbago and severe left leg pain that had been presented for 1 week. The patient complained of severe radiating pain on left L3 sensory dermatome area and reported aggravation of leg pain at 20 degrees of hip flexion by straight leg raising test (SLRT). However, there was no motor weakness on neurological examination. Magnetic resonance imaging (MRI) demonstrated contrast enhancing spinal extradural mass at L2-3 level that was iso-signal intensity (SI) on T1-weighted images (WI), hypo-SI on T2WI. She was not able to walk and sleep due to incapacitating pain. Thus, surgical removal was performed via left partial laminectomy. Postoperatively, the radiating pain was relieved completely. Histopathologic examination revealed that the tumor consisted of chondroma, which had mature hyaline cartilage with nests of benign-appearing cells and calcium deposits in lacunae.

Citations

Citations to this article as recorded by  Crossref logo
  • Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS) with a far-lateral and extraforaminal approach for lumbar chondroma: a case report and literature review
    Pengyu Wang, Sheng Ding, Yu Li, Lebin Guo, Shiquan Zhang, En Song, Hua Zhong
    BMC Musculoskeletal Disorders.2026;[Epub]     CrossRef
  • A lumbar chondroma originating from the intervertebral disc
    Uma Gonchigar, Taryn Cazzolli, Samon Tavakoli-Sabour, Viktor Bartanusz
    Surgical Neurology International.2023; 14: 67.     CrossRef
  • Intraspinal periosteal chondroma in upper thoracic spine causing cord compression and myelopathy
    Rabi Khadka, Prarthana Pachhai, Ashim Gurung, Dipendra Kumar Shrestha, Sushil Krishna Shilpakar
    International Journal of Surgery Case Reports.2022; 93(C): 106964.     CrossRef
  • Chondromas of the Lumbar Spine: A Systematic Review
    Luis A. Robles, Greg M. Mundis
    Global Spine Journal.2021; 11(2): 232.     CrossRef
  • Enchondroma of the Thoracic Spine: Case Report and Review of Literature
    Jacob L. Goldberg, Joseph A. Carnevale, Thomas W. Link, Benjamin Liechty, A. John Tsiouris, Ali A. Baaj
    SN Comprehensive Clinical Medicine.2021; 3(2): 739.     CrossRef
  • Extradural Chondroma on the Lumbar Spine: A Case Report
    Yong Guk Kim, Tae Wan Kim, Eun Ju Kim, Kwan Ho Park
    The Nerve.2020; 6(2): 86.     CrossRef
  • Large enchondroma of the thoracic spine: a rare case report and review of the literature
    Jing Guo, Ju-zhou Gao, Lian-jin Guo, Zhi-xun Yin, Er-xing He
    BMC Musculoskeletal Disorders.2017;[Epub]     CrossRef
  • Periosteal chondroma with spinal cord compression in the thoracic spinal canal: a case report
    Dong Hyeok Kang, Byeong Seong Kang, Hong Bo Sim, Misung Kim, Woon Jung Kwon
    Skeletal Radiology.2016; 45(8): 1133.     CrossRef
  • Cervical Spine Chondroma Compressing Spinal Cord: A Case Report and Literature Review
    Yoon Hwan Byun, Seil Sohn, Sung-Hye Park, Chun Kee Chung
    Korean Journal of Spine.2015; 12(4): 275.     CrossRef
  • 8,042 View
  • 78 Download
  • 9 Crossref