Background: The degenerative spondylosis can cause the difficulty in maintaining sagittal and coronal alignment of spine, and X-ray parameters are the gold standard to analyze the malalignment. This study aimed to develop a new 3D full body scanner to analyze the spinal balance and compare it to X-ray parameters. Methods: Ninety-seven adult participants who suffer degenerative spondylosis underwent 3D full body scanning, whole spine X-rays, clinical questionnaires and body composition analyses. The 5 inflection points (ear, shoulder, hip, knee, ankle) of the 3D scanner in the sagittal plane were automatically labeled by an AI algorithm. Three concepts are created including “the angle between two points with respect to the plumb line”, “the horizontal distances between two points in the sagittal plane” and “the angle between three points”. For the coronal plane, the shoulder gradient was analyzed. X-ray parameters of cervical, thoracolumbar and whole spine sagittal balance and coronal balances were compared. The body composition data and clinical questionnaire scores were compared to x-ray and 3D scanner parameters. Results: The correlation coefficient (C.C.) of dAB_hor (horizontal distance between ear and shoulder in the sagittal plane) and C2-C7 SVA was 0.478 (p-value < 0.001). The C.C. of aAC_sag (sagittal angle of ear-hip from the plumb line) and ODHA was 0.336 (p < 0.001). About coronal balance, the C.C. of shoulder gradient and clavicle angle from x-ray was 0.373 (p < 0.001). The C.C.s were merely affected by body composition data. But in multiple regression analysis, BMI affected 3D scanner data. Clinical symptoms showed correlations with aBCD(shoulder-hip-knee) and aCDE(hip-knee-ankle angle), which may reflect a compensatory pelvic retroversion and knee flexion for positive sagittal imbalance. Conclusions: This new 3D scanner has some strengths like radiation-free methods, correlation with x-ray parameters and clinical symptoms, independence to body composition data, and possibility of analyzing dynamic spine balance.

Kang TH, et al. J Korean Med Sci. 2025 Dec;41:e28. https://doi.org/10.3346/jkms.2026.41.e28

Background/Objectives: Transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are widely utilized techniques for degenerative lumbar diseases. This study compared radiological and clinical outcomes of LLIF and TLIF in patients undergoing lumbar fusion. Methods: This non-randomized prospective observational study enrolled 117 patients (LLIF: n = 17; TLIF: n = 100), with an inherent imbalance in group sizes, who underwent one- or two-level lumbar interbody fusion. Primary outcome was segmental lordotic angle (SLA) at the operated level. Secondary outcomes included disc height, lumbar lordotic angle, sagittal vertical axis, and patient-reported outcomes. Assessments were conducted at baseline, 3, 6, 12, and 24 months. Linear mixed models analyzed longitudinal data. Results: Mean SLA improvement was not significantly different between the groups (LLIF: 3.04° vs. TLIF: 3.18°, p = 0.782). No significant differences were observed for disc height (p = 0.518), lumbar lordotic angle (p = 0.718), or sagittal vertical axis (p = 0.866). Patient-reported outcomes improved significantly in both groups. Linear mixed model analysis revealed no significant between-group effects for Oswestry Disability Index (p = 0.335) or low back pain (p = 0.069). TLIF showed higher rates of dural tears and wound complications, while LLIF had more sympathetic chain injuries and transient psoas weakness. Overall complication rates were comparable (p > 0.05). Conclusions: TLIF and LLIF demonstrate comparable radiographic and clinical outcomes at 24-month follow-up. Surgical technique selection should be individualized based on patient-specific anatomical and clinical factors, considering distinct approach-specific complication patterns.

Ahn YJ, et al. J Korean Soc Spine Surg. 2019 Dec;26(4):151-159. https://doi.org/10.4184/jkss.2019.26.4.151

Study Design: Retrospective case-control study. Objective: To evaluate the feasibility, safety, and perioperative outcomes of spinal anesthesia combined with erector spinae plane block and dexmedetomidine sedation (SES) compared with general anesthesia (GA) in patients undergoing biportal endoscopic lumbar decompression (BELD). Background: Regional anesthesia has shown advantages in spine surgery, including reduced complications and faster recovery. However, spinal anesthesia alone has limitations in duration and patient tolerance during prolonged prone positioning. The erector spinae plane block provides extended analgesia, and dexmedetomidine sedation offers patient comfort without respiratory depression. Evidence regarding the combined application of these techniques for lumbar decompression surgery, especially BELD, is limited. Materials and Methods: This retrospective study included 41 patients who underwent 1- or 2-level BELD between June 2023 and June 2024. Nineteen patients received SES, and 22 patients underwent GA. Outcomes included operative times, hemodynamic parameters, postoperative pain, ambulation timing, hospital stay, and complications. Results: All SES procedures were completed without conversion to GA. SES was associated with significantly shorter operation times and earlier emergence, improved intraoperative hemodynamic stability, reduced postoperative pain scores (Visual Analog Scale: 0.2 ± 0.7 vs. 2.7 ± 1.4, P < 0.001), earlier ambulation (0.5 ± 0.8 vs. 1.5 ± 0.8 d, P < 0.001), and shorter hospital stay (3.8 ± 1.5 vs. 6.6 ± 3.0 d, P < 0.001). No anesthesia-related complications occurred in the SES group, whereas the GA group experienced several complications, including postoperative nausea and vomiting. Conclusions: SES is a feasible and safe anesthetic technique for BELD, offering favorable perioperative outcomes compared with GA. These preliminary results support SES as a promising approach for enhanced recovery protocols in minimally invasive spine surgery. Larger randomized trials are needed to confirm its safety and effectiveness. Level of Evidence: Level III.

Background/Objectives: Biportal endoscopic (BE) surgery is increasingly used for transforaminal lumbar interbody fusion (TLIF), but its hemodynamic profile and early recovery in two-level fusion remain undefined relative to tubular minimally invasive surgery (MIS) and open approaches. We compared the hemodynamic burden and early functional recovery among BE-, MIS-, and open two-level TLIF. Methods: In this retrospective single-center study of three sequential, non-contemporaneous cohorts, 96 patients undergoing two-level (L2–S1) TLIF (BE, n = 22; MIS, n = 39; open, n = 35) were analyzed. The single primary endpoint was transfusion-corrected total blood loss (corrected TBL), derived from hematocrit changes. Secondary endpoints were intraoperative estimated blood loss (EBL), drainage, allogeneic transfusion, hidden blood loss (HBL), complications, and the Numeric Rating Scale(NRS), Oswestry Disability Index (ODI), and Functional Rating Index (FRI) at 3 months. Effect sizes with 95% confidence intervals (CIs) are reported alongside p-values. Results: Corrected TBL was highest in open TLIF (2.07 ± 0.86 L) versus BE-TLIF (1.36 ± 0.54 L; mean difference −0.71 L, 95% CI −1.09 to −0.34) and MIS-TLIF (1.53 ± 0.50 L; −0.55 L, −0.88 to −0.21), whereas BE- and MIS-TLIF were comparable (−0.17 L, −0.45 to 0.12). Transfusion was required in 13.6%, 20.5%, and 60.0%, respectively (p < 0.001), with no difference between the minimally invasive groups. Intraoperative EBL was lower in BE-TLIF than in MIS-TLIF (−226.8 mL, −395.3 to −58.2). HBL was lowest in open TLIF (p = 0.030), reflecting its far larger drainage volume. At 3 months, BE-TLIF showed greater FRI improvement than MIS-TLIF (−3.97, −7.04 to −0.90); for ODI, BE-TLIF exceeded open TLIF but not MIS-TLIF. Wound problems (11.4%) and delirium (22.9%) occurred only or most often after open TLIF. Conclusions: In two-level fusion, BE-TLIF was associated with a lower overall hemodynamic burden and transfusion requirement than open TLIF, while corrected TBL was comparable between BE- and MIS-TLIF. Given the non-contemporaneous cohorts, baseline imbalances, limited sample size, and potential residual confounding, these findings should be considered hypothesis-generating and require confirmation in prospective or contemporaneously controlled studies.