Objective: To investigate risk factors associated with postoperative restenosis after full endoscopic lumbar foraminotomy (FELF) in patients with lumbar foraminal stenosis (LFS).Methods: A single-center, retrospective case-control study was conducted on patients diagnosed with foraminal stenosis who underwent FELF between August 2019 and April 2022. The study included 56 patients, comprising 18 cases and 38 controls. Clinical data, radiologic assessments, and surgical types were compared between the groups. The cutoff values of radiologic parameters that differentiate the 2 groups were investigated.Results: No significant difference in age, sex distribution, or presence of adjacent segment disease or grade I spondylolisthesis was observed between the groups. Cases had a higher degree of disc wedging angle (DWA) (3.0° ± 1.1° vs. 0.5° ± 1.4°, p < 0.001), larger coronal Cobb angle (CCA) (8.8° ± 5.1° vs. 4.7° ± 2.5°, p = 0.004), and smaller segmental lumbar lordosis (SLL) than controls (11.0 ± 7.4 vs. 18.0 ± 5.4, p = 0.001). Optimal cutoff values for DWA, CCA, and SLL were estimated as 1.8°, 7.9°, and 17.1°, respectively. A significant difference in surgical types was observed between cases and controls (p = 0.004), with the case group having a higher distribution of patients undergoing discectomy in addition to TELF.Conclusion: The study identified potential risk factors for restenosis after FELF in patients with LFS, including higher DWA, larger CCA, smaller SLL angle. We believe that discectomy should be perform with caution during FELF, as it can lead to subsequent restenosis.

Objective: Although several studies have reported successful fusion rates after oblique lumbar interbody fusion (OLIF) using allografts or dimerized bone matrix (DBM) instead of autografts, whether OLIF can achieve satisfactory solid fusion without the use of autografts remains unclear. This study investigated the real fusion rates after OLIF using allografts and DBM, which were evaluated using both dynamic radiographs and computed tomography scans.Methods: We enrolled 79 consecutive patients who underwent minimally invasive OLIF followed by percutaneous pedicle screw fixation. All patients were treated with OLIF between L2 and L5 and underwent radiographic and clinical follow-ups at 12, 18, and 24 months after surgery. Radiographic assessment of fusion was performed using the modified BrantigaSteffee-Fraser (mBSF) scale, which was categorized as follows: grades I (radiographic pseudoarthrosis), II (indeterminate fusion), and III (solid radiographic fusion). Other radiologic and clinical outcomes were evaluated using the following parameters: vertebral slippage distance, disc height, subsidence, Oswestry Disability Index (ODI), and visual analogue scale (VAS).Results: Clinical outcomes demonstrated significant improvements in the VAS scores for back pain, leg pain, and ODI after surgery. Subsidence was present in 34 cases (35.4%) at 12 months postoperatively, which increased to 47.9% and reached 50.0% at 1.5 years and 2 years after surgery, respectively. The solid fusion rate after OLIF was 32.3% at 1 year, increased to 58.3% at 1.5 years, and reached 72.9% at 2 years. Radiographic pseudoarthrosis was 24.0% at 1 year, which decreased to 6.3% at 1.5 years and 3.1% at 2 years.Conclusion: OLIF is a safe and effective surgical procedure for the treatment of degenerative lumbar diseases. The mBSF scale, which simultaneously evaluates both dynamic angles and bone bridge formation, offers great reliability for the radiological assessment of fusion. Moreover, OLIF using allografts and DBM, which is performed on one or 2 levels at L2–5, can achieve satisfactory fusion rates within 2 years after surgery.

This case report and video demonstrate the technique of full-endoscopic J-shaped transforaminal L5 exiting nerve decompression in Bertolotti syndrome. Bertolotti syndrome, characterized by a congenital lumbosacral transitional vertebra, often results in mechanical lower back pain and nerve root compression. A 69-year-old male presented with progressive radiating pain in the right leg and tingling in the L5 dermatome. Lumbar spine MRI revealed a right foraminal disc herniation at the L5–S1 level, with calcification and foraminal stenosis. The patient was also diagnosed with Castellvi type I Bertolotti syndrome, featuring a large L5 transverse process and a high iliac crest. These anatomical variations complicated the transforaminal approach, creating a narrow safety zone for conventional methods. The approach began with docking on the L5 transverse process. Endoscopic drilling was performed in a J-shaped configuration to partially resect the transverse process and alar wing, facilitating endoscope insertion into Kambin’s triangle. Foraminal decompression was achieved by removing the tip of the superior articular process (SAP), thereby decompressing the L5 exiting nerve root. Full-endoscopic spine surgery offers a safe and effective alternative to traditional open techniques for L5 nerve decompression in Bertolotti syndrome. This video presentation illustrates the intraoperative endoscopic approach, detailing the decompression techniques and highlighting the minimally invasive advantages of this method.

Objective : To evaluate clinical and radiological outcomes of biportal endoscopic posterior cervical inclinatory foraminotomy (BE-PCIF) to treat cervical spondylotic radiculopathy (CSR).Methods : This retrospective study included patients with CSR who underwent BE-PCIF between April 2020 and April 2023. Patient demographic data were collected and clinical outcomes were assessed using the Visual analog scale (VAS) and MacNab criteria. Various radiological parameters, including inclinatory angles, were collected and correlations with demographic or radiological factors were evaluated.Results : We included 101 patients (46 men and 55 women) with a mean age of 56.99 years, encompassing 162 surgical levels primarily affecting the C5-6 and C6-7 vertebrae. The postoperative VAS scores decreased to less than 1, with 90.1% of patients reporting excellence according to the MacNab criteria. None of the patients experienced any major postoperative complications, including instability. The isthmic distance (ID) expansion ratio, representing the degree of distal decompression, was 2.4, with a minor facet resection rate of 0.4. Right-sided surgeries or surgeries at lower cervical levels correlated with higher inclinatory angles, with a p-value of 0.003 each. Significant correlations were noted between the inclinatory angle and both the facet resection rate and ID expansion ratio, with coefficients of 0.45 and 0.3, respectively, both having a p-value of <0.001, indicating strong statistical significance.Conclusion : BE-PCIF effectively relieves pain and enhances clinical outcomes in CSR patients. The use of the inclinatory angle approach facilitates cervical foraminal expansion and sufficient neural decompression, with higher angles required for adequate decompression at lower cervical levels.

This article provides a comprehensive examination of Bertolotti syndrome (BS), a disorder characterized by back pain due to a lumbosacral transitional vertebra, to facilitate surgical decision-making by exploring various surgical options, including the innovative approach of endoscopic spine surgery. A review of existing literature and studies on BS published until December 2023 was undertaken, utilizing databases such as PubMed and Google Scholar to identify relevant information. The review offers an integrated overview of the essential knowledge of BS and a comprehensive range of surgical treatments. Symptomatic BS can manifest as pain originating from pseudoarticulation and the facet joints, discs, adjacent segments, and the L5 root, indicating a diverse distribution of pain sources. Furthermore, various surgical strategies are tailored to the specific origin of pain, including pseudoarticulation resection, transverse processectomy, decompression, nerve root decompression, fusion, and endoscopic spine surgery. For individuals with BS contemplating surgical solutions, performing a detailed assessment of symptoms and physical evaluations is imperative to accurately identify the origin of the pain. The choice of a surgical strategy must be meticulously customized according to the identified source of pain, guaranteeing a tailored and efficacious treatment for each patient.

The preventive measures against the spread of COVID-19 have negatively impacted the mental health of people with chronic diseases. This cross-sectional study investigated the association between mental health and hand hygiene practices in patients with hypertension (HTN) and diabetes mellitus (DM) (n = 74,296) during the COVID-19 pandemic. Their anxiety about contracting COVID-19 and death, depression, and hand hygiene practices were compared to that of controls. Multiple logistic regression analysis showed that the patients had higher anxiety and depression and poorer hand hygiene practices than controls. Anxiety about contracting COVID-19 was associated with increased handwashing before eating (aOR = 1.59), after using the restroom (aOR = 1.61), after returning from outdoors (aOR = 1.69), for at least 30 s (aOR = 1.45), and with soap or hand sanitizer (aOR = 1.43). However, depression was associated with decreased handwashing before eating (aOR = 0.50), after using the restroom (aOR = 0.51), after returning from outdoors (aOR = 0.51), for at least 30 s (aOR = 0.73), and with soap or hand sanitizer (aOR = 0.63). Anxiety about death showed similar results. Psychological support for people with chronic diseases in crisis situations may promote self-care activities such as hand hygiene for infection control.