Insomnia can coexist with chronic pain and is a major cause of rapidly increasing medical expenses. However, insomnia has not been fully evaluated in patients with chronic pain. This retrospective study aimed to identify the risk factors for insomnia in patients with chronic non-cancer pain. A total of 301 patients with chronic non-cancer pain were enrolled. Patients with the Athens insomnia scale scores ≥ 6 and < 6 were classified into insomnia (+) and insomnia (−) groups, respectively. All patients completed self-report questionnaires as part of their chronic pain treatment approach. Univariate and multivariate analyses were performed to predict insomnia. We found that 219 of 301 (72.8%) patients met the AIS criteria for insomnia. Significant differences were depicted between patients with and without insomnia in terms of body mass index, numeric rating scale, pain catastrophizing scale, hospital anxiety, and depression scale (HADS), pain disability assessment scale, EuroQol 5 dimension (EQ5D), and pain self-efficacy questionnaire. Multiple regression analysis identified the numeric rating scale, HADS, and EQ5D scores as factors related to insomnia in patients with chronic non-cancer pain. Anxiety, depression, and disability were associated with a greater tendency toward insomnia. HADS and EQ5D scores are useful screening tools for preventing insomnia in patients with chronic non-cancer pain.

Background/Objectives: Extraforaminal lumbar interbody fusion provides indirect decompression without entering the spinal canal, but its uptake has been limited by poor visualization and risk of exiting nerve root injury. We describe a minimally invasive exoscopic extraforaminal lumbar interbody fusion (exELIF) technique and evaluate its clinical and radiological outcomes. This study aims to describe the exELIF technique and report its early clinical and radiological outcomes. Methods: Twenty-six patients with lumbar degenerative diseases underwent exELIF using a 3D exoscope (ORBEYE). The procedure was performed through bilateral 30–40 mm posterior incisions. Clinical outcomes were assessed using the Japanese Orthopedic Association score preoperatively and at 1-year follow-up. Postoperative computed tomography evaluated interbody fusion. Operative time, blood loss, and complications were recorded. Results: Mean operative time was 131 ± 51 min, and mean estimated blood loss was 82 ± 99 mL. The mean JOA score improved from 15.2 ± 2.2 to 24.3 ± 2.6, with a mean recovery rate of 66% at 1 year. Interbody fusion was achieved in 96%. In an exploratory CUSUM analysis of 18 single-level fluoroscopy-guided cases, a transition in operative time was observed at approximately the 10th case; operative time and estimated blood loss decreased from 141.5 ± 39.2 min and 89.0 ± 77.8 mL in cases 1–10 to 80.1 ± 6.7 min and 21.2 ± 18.1 mL in cases 11–18 (p < 0.001 and p = 0.035, respectively), indicating a reduction of operative time with accumulated experience rather than a formally established learning curve. Three patients developed transient exiting nerve root symptoms that resolved spontaneously during follow-up. One patient at the L5/S level required revision surgery due to left L5 nerve root palsy caused by posterior migration of the bone graft; this complication led to a modification of the technique, with posterior bone grafting no longer performed at L5/S. Partial screw loosening was observed in 5 patients (19%), all of which were asymptomatic and required no additional intervention. Conclusions: ExELIF provides excellent visualization in deep surgical fields, allowing the use of conventional surgical instruments through minimally invasive incisions. This is an early feasibility report of a single-institution retrospective case series with a heterogeneous cohort and no control group; the present data therefore do not establish superiority over conventional or endoscopic ELIF. Within these limits, exELIF was associated with acceptable early clinical improvement and a high interbody fusion rate, and progressive reduction in operative time with experience suggests that it may be a technically feasible minimally invasive option for selected patients with lumbar degenerative disease and for revision surgery after lumbar decompression.

Background: Posterior decompression with instrumented fusion (PDF) is a conventional surgical procedure performed in patients with massive ossification of the posterior longitudinal ligament (OPLL); however, it is invasive to the posterior cervical tissues. In this report, we introduce a novel PDF technique, exoscopic minimally invasive open-door laminoplasty with pedicle screw fixation (exLAPPS), to treat cervical OPLL, while minimizing posterior tissue damage. Methods: ExLAPPS was indicated for patients with K-line (−) OPLL or a canal occupying a ratio of ≥50%, allowing decompression from C3 to C7. A small midline incision was used for the navigation reference placement and exoscopic minimally invasive open-door laminoplasty, whereas bilateral lateral incisions were utilized for posterior fixation, including pedicle screw insertion, based on the minimally invasive cervical pedicle screw technique. Results: A total of 7 patients with K-line (-) or a canal occupancy ≥50% underwent exLAPPS for cervical OPLL. The mean operative time was 248 min (range, 165–342 min) and the mean blood loss was 320 mL (range, 50–740 mL). Postoperative imaging demonstrated adequate spinal cord decompression in all patients. A total of 52 pedicle screws were inserted, with a pedicle screw deviation rate of 1.9%. Conclusions: ExLAPPS is a minimally invasive surgical technique designed for posterior decompression and fixation in patients with cervical OPLL. In this preliminary case series, the procedure was successfully performed with acceptable operative time, blood loss, and screw placement accuracy. Although the present study did not include a direct comparison with conventional procedures, these preliminary observations suggest that ExLAPPS is a feasible surgical option for selected patients with cervical OPLL.