Postoperative evaluation of the cross-sectional area of paraspinal muscle and clinical findings in patients who had interlaminar route uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion (EPTLIF) after 2 years. Overview of Literature: There are limited short-term follow-up studies on efficacy, safety, and physiological changes with a 2-year follow-up. There is no study on paraspinal muscle cross-sectional area change in patients who had undergone uniportal EPTLIF. Methods: We evaluated patients who underwent EPTLIF with a minimum 24-month follow-up. Clinical parameters of the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were measured at the preoperative, 1-week postoperative mark, postoperative 3-month mark, and final follow-up. Preoperative and 1-year postoperative magnetic resonance imaging measurement of preoperative and postoperative Kjaer grade, right and left psoas muscle mass area, and right and left paraspinal muscle mass area was performed. Results: EPTLIF with a minimum 24-month follow-up of 35 levels was included. The complication rate was 6%, and the mean Bridwell's fusion grade was 1.37 (1-2). There was statistically significant improvement at 1 week, 3 months, and 2 years in VAS (4.11±1.23, 4.94±1.30, and 5.46±1.29) and in ODI (40.34±10.06, 46.69±9.14, and 49.63±8.68), respectively (p<0.05). Successful operation rate with excellent and good MacNab's criteria at 2 years was 97%. There was an increment of statistically significant bilateral psoas muscle cross-sectional area, right side (70.03±149.1 mm²) and left side (67.59±113.2 mm²) (p<0.05). Conclusions: Uniportal EPTLIF achieved good fusion and improved clinical outcomes with favorable paraspinal musculature bulk at the 2-year follow-up.

To evaluate the clinical and radiological effects of epidural fluid hematoma in the medium term after lumbar endoscopic decompression. Overview of Literature: There is limited literature comparing the effect of postoperative epidural fluid hematoma after uniportal endoscopic decompression. Methods: Magnetic resonance imaging (MRI) and clinical evaluation were performed for patients with single-level uniportal endoscopic lumbar decompression with a minimum follow-up of 2 years. Results: A total of 126 patients were recruited with a minimum follow-up of 26 months. The incidence of epidural fluid hematoma was 27%. Postoperative MRI revealed a significant improvement in the postoperative dura sac area at postoperative day 1 and at the upper endplate at 6 months in the hematoma cohort (39.69±15.72 and 26.89±16.58 mm 2 ) as compared with the nonhematoma cohort (48.92±21.36 and 35.1±20.44 mm 2 ), respectively (p<0.05); and at the lower endplate on postoperative 1 day in the hematoma cohort (51.18±24.69 mm 2 ) compared to the nonhematoma cohort (63.91±27.92 mm 2 ) (p<0.05). No significant difference was observed in the dura sac area at postoperative 1 year in both cohorts. The hematoma cohort had statistically significant higher postoperative 1-week Visual Analog Scale (VAS; 3.32±0.68) pain and Oswestry Disability Index (ODI; 32.65±5.56) scores than the nonhematoma cohort (2.99±0.50 and 30.02±4.84, respectively; p<0.05). No significant difference was found at the final follow-up VAS, ODI, and MRI dura sac area.

Although the conventional anterior approach is the gold-standard procedure for multilevel cervical spondylotic radiculopathy, the fully-endoscopic posterior approach has recently become more popular. We present the case of a 73-year-old female patient with neck pain radiating to right shoulder and arm. The patient had adjacent-level cervical foraminal stenosis at C5–6 and C6–7 on right side and was managed with modified fully-endoscopic posterior foraminotomy at C5–6 and C6–7 with total pediculectomy of C6. The patient exhibited excellent clinical results, without any instability during long-term follow-up. Fully-endoscopic posterior cervical 2-level foraminotomy using total pediculectomy can be applied in patients for whom the anterior cervical approach is contraindicated, with the added advantages of the minimally invasive posterior approach. The technique has an extensive learning curve and needs to be selected according to the pathology.