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1.  Mini-Open Approach for Direct Lateral Lumbar Interbody Fusion 
Asian Spine Journal  2014;8(4):491-497.
Study Design
Retrospective analysis.
To introduce the mini-open lateral approach for the anterior lumbar interbody fusion (ALIF), and to investigate the advantages, technical pitfalls and complications by providing basic knowledge on extreme lateral interbody fusion (XLIF) or direct lumbar interbody fusion (DLIF).
Overview of Literature
Recently, minimally invasive lateral approach for the lumbar spine is revived and receiving popularity under the name of XLIF or DLIF by modification of mini-open method when using the sequential tubular dilator and special expandable retractor system.
Seventy-four patients who underwent surgery by the mini-open lateral approach from September 2000 to April 2008 with various disease entities were included. Blood losses, operation times, incision sizes, postoperative time to mobilization, length of hospital stays, technical problems and complications were all analyzed.
The blood losses and operation times of patients who underwent simple ALIF were 61.2 mL and 86 minutes for one level, 107 mL and 106 minutes for two levels, 250 mL and 142.8 minutes for three levels, and 400 mL and 190 minutes for four levels of fusion. The incision sizes were on average 4.5 cm for one level, 6.3 cm for two levels, 8.5 cm for three levels and 10.0 cm for four levels of fusion. The complications were retroperitoneal hematoma (2 cases), pneumonia (1 case) and transient lumbosacral plexus palsy (3 cases).
Trials of mini-open lateral approach would be helpful before the trial of XLIF or DLIF. However, special attention is required for complications such as transient lumbosacral plexus palsy.
PMCID: PMC4149993  PMID: 25187867
Lumbar spine; Mini-open lateral approach; Interbody fusion
2.  Correlation of Pelvic Parameters with Isthmic Spondylolisthesis 
Asian Spine Journal  2009;3(1):21-26.
Study Design
A retrospective radiological evaluation.
To verify that PI is related with progression of IS as well as development of IS and to assess the differences of pelvic parameters between the L4 & L5 IS, as well as between single & two level IS.
Overview of Literature
High pelvic incidence (PI) has been known to be related with development of IS. However, the previous studies were limited to just L5 spondylolisthesis or there was no differentiation between L4 & L5 spondylolisthesis
Sixty five IS patients and 30 persons as a control group participated the study. Among the 65 patients, 30 had L4 IS, 30 had L5 IS and 5 had bi-level IS. We used the whole spine lateral radiographs to measure the slip percentage, the pelvic tilt (PT) and the pelvic incidence (PI), and we compared them between the normal control group and the IS patients, as well as between single-level and bi-level spondylolisthesis, and we investigated the correlation between the degree of slip of spondylolisthesis and the pelvic parameters.
The averages of the PT, PI and lumbar lordosis (LL) in the control group and the IS group were 11.0° vs 21.4° (p<0.001), 49.1° vs 61.8° (p<0.001) and 48.5° vs 57.6° (p<0.001), respectively. On comparison between the L4 and L5 IS groups, there was no difference in all the pelvic parameters (p>0.05). On comparison between the single-level IS group and the bilevel IS group, there was a significant difference of the PT and PI (p<0.05), and the slip percentage had a correlation with only the PI among all the pelvic parameters (Spearman's r=0.293, p=0.023). There was a significant correlation of the degree of slip with the PI for the L5 single level IS, but not with the L4 single level IS (r=0.362, p=0.05).
The high pelvic incidence can be a factor of L4 & L5 spondylolysis and it may have an influence on the slip progression in patients with L5 isthmic spondylolisthesis, but not on the slip progression in patients with L4 IS. Yet other factors seem to have an influence on the slip progression in patients with L4 isthmic spondylolisthesis.
PMCID: PMC2852036  PMID: 20404942
Isthmic spondylolisthesis; Pelvic parameter; Sacral slope; Pelvic tilt; Pelvic incidence
3.  A Broken Drill-bit Fragment Causing Severe Radiating Pain after Cervical Total Disc Replacement: A Case Report 
Asian Spine Journal  2011;5(2):125-129.
This is a case report of a 38-year-old man with severe radiating pain on upper extremity after cervical total disc replacement (TDR). We faced an unusual complication that has not been reported yet. He underwent cervical TDR for left central disc protrusion on C5-6. After the surgery, preoperative symptom disappeared. However, at postoperative 1 year, he complained severe right-sided radiating pain that had a sudden onset. On postoperative X-ray, a metal fragment which seemed like a broken drill bit was shown within the spinal canal. To remove that, right-sided anterior microforaminotomy on C5-6 was performed and the metal fragment was removed successfully. After that, anterior fusion was done because the motion of the artificial disc was minimal and the removed structure seemed to attenuate stability during cervical motion. The operation resulted in prompt symptomatic relief. During cervical TDR, particular attention should be paid to the procedures that require using drill-bits.
PMCID: PMC3095802  PMID: 21629488
Drill-bit fragment; Complication; Cervical total disc replacement

Results 1-3 (3)