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author:("Min, Sang-yuk")
1.  Usefulness of Contralateral Indirect Decompression through Minimally Invasive Unilateral Transforaminal Lumbar Interbody Fusion 
Asian Spine Journal  2014;8(4):453-461.
Study Design
Retrospective study.
Purpose
This study aims to investigate the clinical and radiological results of contralateral indirect decompression through minimally invasive unilateral transforaminal lumbar interbody fusion (MI-TLIF).
Overview of Literature
Several studies have proposed that blood loss and operation time could be reduced through a unilateral approach, although many surgeons have forecast that satisfactory foraminal decompression is difficult to achieve through a unilateral approach.
Methods
The study included 30 subjects who had undergone single-level MI-TLIF. Visual analogue scale (VAS) and Oswestry disability index (ODI) were analyzed for clinical assessment. Disc height, segmental lordosis, and lumbar lordosis angle were examined for radiological assessment. The degree of contralateral indirect decompression was evaluated through a comparative analysis, with a magnetic resonance imaging (MRI) performed preoperatively and at one year postoperatively.
Results
Intraoperative blood loss volume was 308.75 mL in the unilateral approach group (UAP), and 575.00 mL in the bilateral approach group (BAP), showing a statistically significant difference. Operation time was 139.50 minutes in the UAP group, and 189.00 minutes in the BAP group, exhibiting a statistically significant difference (p<0.05). On the other hand, no significant difference was found in VAS, ODI, disc height, lordosis angles and the degree of nerve decompression in the vertebral foramen, using MRI, between the two groups (p>0.05).
Conclusions
Satisfactory results were acquired with MI-TLIF conducted through the unilateral approach of contralateral indirect decompression, in alignment with the bilateral approach. Therefore, contralateral indirect decompression is thought to be a useful procedure in reducing the operation time and volume of blood loss.
doi:10.4184/asj.2014.8.4.453
PMCID: PMC4149988  PMID: 25187862
Spinal fusion; Surgical procedures, Minimally invasive; Unilateral approach
2.  Risk Factors of New Compression Fractures in Adjacent Vertebrae after Percutaneous Vertebroplasty 
Asian Spine Journal  2011;5(3):180-187.
Study Design
Retrospective study.
Purpose
To evaluate risk factors related to the development of new fractures in adjacent vertebrae after percutaneous vertebroplasty.
Overview of Literature
Recent reports indicate that undue numbers of new fractures in adjacent vertebral bodies occur after percutaneous vertebroplasty.
Methods
One hundred four of 369 patients who underwent percutaneous vertebroplasty were followed for over 1 year. Fifty-four patients (51.9%) subsequently suffered from adjacent vertebral fractures. Age, lumbar lordotic angle, sacral slope, pelvic tilt, pelvic incidence, bone mineral density, amounts of cement injected, the restoration of vertebral height, kyphotic angle differences preexisting fracture, and intradiscal cement leakage were noted.
Results
Average bone mineral density was -3.52 in the fracture group and -2.91 in the fracture-free group; the risk of adjacent vertebral fracture increased as bone mineral density decreased (p < 0.05). Intradiscal cement leakage occurred in 18 patients (33.3%) in the fracture group, indicating that the risk of adjacent vertebral fracture increased with intradiscal cement leakage. In addition, 36 patients (66.7%) in the fracture group had a pre-existing fracture; thus, the presence of a preexisting fracture was found to be significantly associated with an increased risk of an adjacent vertebral fracture (p < 0.05). Higher restoration rates are associated with a greater likelihood of developing adjacent vertebral fractures (p < 0.05).
Conclusions
The factors found to contribute significantly to new fractures in adjacent vertebral bodies after percutaneous vertebroplasty were a lower bone mineral density, a greater restoration rate of vertebral height, a pre-existing fracture, and intradiscal cement leakage.
doi:10.4184/asj.2011.5.3.180
PMCID: PMC3159067  PMID: 21892391
Adjacent vertebral fractures; Percutaneous vertebroplasty; Risk factors
3.  The Quantitative Analysis of Back Muscle Degeneration after Posterior Lumbar Fusion: Comparison of Minimally Invasive and Conventional Open Surgery 
Asian Spine Journal  2009;3(2):89-95.
Study Design
Prospective controlled study.
Purpose
The results of conventional open surgery was compared with those from minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for lumbar fusion to determine which approach resulted in less postoperative paraspinal muscle degeneration.
Overview of Literature
MI TLIF is new surgical technique that appears to minimize iatrogenic injury. However, there aren't any reports yet that have quantitatively analyzed and proved whether there's difference in back muscle injury and degeneration between the minimally invasive surgery and conventional open surgery in more than 1 year follow-up after surgery.
Methods
This study examined a consecutive series of 48 patients who underwent lumbar fusion in our hospital during the period, March 2006 to March 2008, with a 1-year follow-up evaluation using MRI. There were 17 cases of conventional open surgery and 31 cases of MI-TLIF (31 cases of single segment fusion and 17 cases of multi-segment fusion). The digital images of the paravertebral back muscles were analyzed and compared using the T2-weighted axial images. The point of interest was the paraspinal muscle of the intervertebral disc level from L1 to L5. Picture archiving and communication system viewing software was used for quantitative analysis of the change in fat infiltration percentage and the change in cross-sectional area of the paraspinal muscle, before and after surgery.
Results
A comparison of the traditional posterior fusion method with MI-TLIF revealed single segment fusion to result in an average increase in fat infiltration in the paraspinal muscle of 4.30% and 1.37% and a decrease in cross-sectional area of 0.10 and 0.07 before and after surgery, respectively. Multi-segment fusion showed an average 7.90% and 2.79% increase in fat infiltration and a 0.16 and 0.10 decrease in cross-sectional area, respectively. Both single and multi segment fusion showed less change in the fat infiltration percentage and cross-sectional area, particularly in multi segment fusion. There was no significant difference between the two groups in terms of the radiologic results.
Conclusions
A comparison of conventional open surgery with MI-TLIF upon degeneration of the paraspinal muscle with a 1 year follow-up evaluation revealed that both single and multi segment fusion showed less change in fat infiltration percentage and cross-sectional area in the MI-TLIF but there was no significant difference between the two groups. This suggests that as time passes after surgery, there is no significant difference in the level of degeneration of the paraspinal muscle between surgical techniques.
doi:10.4184/asj.2009.3.2.89
PMCID: PMC2852079  PMID: 20404953
Paraspainal muscle; Fat degeneration; MRI; Posterior fusion
4.  Paraspinal muscle changes of unilateral multilevel minimally invasive transforaminal interbody fusion 
Purpose
We attempted to identify changes in back muscle atrophy occurring in multilevel minimally invasive transforaminal interbody fusion (MITLIF) and the impact of these changes on clinical outcomes.
Methods
This study was conducted on 92 patients who underwent unilateral MITLIF between 2006 and 2013, had been tracked with a follow-up for at least 1 year, and had been assessed by pre- and postoperative computed tomography (CT). For the clinical evaluation, a pre- and postoperative visualized analog scale (VAS) of the back and legs, and Oswestry Disability Index (ODI) were measured. CT was used for the evaluation of back muscle atrophy and a cross-sectional area (CSA) of the multifidus was measured at the level below a fused segment, excluding metal artifacts.
Results
There was no significant difference in the reduction of CSA between groups with one-, two-, or three-plus-segment fusion. In addition, no statistically significant differences were found in the pre- and postoperative VAS of the back, VAS of the legs, and ODI between the three groups. The reduction of CSA showed a statistically significant positive correlation with preoperative VAS of the back (p = 0.025, r = 0.562). On the other hand, no significant difference was found in VAS of the leg (p = 0.437, r = 0.082) and ODI (p = 0.106, r = 0.017).
Conclusion
When performing unilateral multilevel MITLIF, significant difference was not found in the atrophy of the multifidus according to the number of fused segments. The clinical outcomes also showed no significant difference. Therefore, unilateral MITLIF can be considered to be an effective surgical method to minimize lumbar muscle damage, even at multiple levels.
doi:10.1186/s13018-014-0130-3
PMCID: PMC4269953  PMID: 25499767
Spinal fusion; Minimally invasive surgery; Unilateral approach; Contralateral indirect decompression
5.  The clinical and radiological outcomes of multilevel minimally invasive transforaminal lumbar interbody fusion 
European Spine Journal  2012;22(5):1164-1172.
Purpose
To investigate the clinical and radiological outcomes of multilevel minimally invasive transforaminal lumbar interbody fusion (MITLIF) in multilevel degenerative lumbar diseases.
Methods
Of 172 patients who could be followed-up for at least 1 year after undergoing a MITLIF, a total of 127 patients in whom unilateral cages were used through a unilateral approach (consisting of 69 patients for single-level, 40 for two-level, and 18 for three- or higher-level) were retrospectively studied as subjects. In this study, clinical assessment parameters included Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI), while radiologic assessment parameters included disc height, segmental lordotic angle, and lumbar lordotic angle. At the last follow-up, the level of bone fusion was determined in accordance with the Brantigan and Steffee criteria for classification of fusion results.
Results
The VAS scores of back pain and radiating leg pain tended to improve postoperatively, and showed no significant difference among groups (p > 0.05). In terms of ODI, the results of functional assessments also indicated no significant difference among groups (p > 0.05). Similarly, there was no statistically significant difference in disc height, segmental lordotic angle, lumbar lordotic angle, and bone fusion depending on the number of fusion levels (p > 0.05).
Conclusions
Regardless of the number of fused levels, satisfactory clinical and radiological outcomes of MITLIF were seen in patients with spinal stenosis, which suggests that the said surgical procedure may be useful even for patients with multilevel spinal stenosis.
doi:10.1007/s00586-012-2619-y
PMCID: PMC3657044  PMID: 23250516
Multilevel interbody fusion; Minimally invasive surgery; Transforaminal; Lumbar interbody fusion

Results 1-5 (5)