The 4ｔｈ ISMISS
sson

The 14ｔｈ MISS Summit Forum
March 25 fri. – April 24 sun.
Aichi Spine Hospitalhonorary president

Hansjoerg Leu.
Gun Choi
Dezawa Akira
ｐresident

Koichi Sairyochairman

Fujio Ito
Zenya Itoboard member
Abdullah Merter, Alfonso García Chávez, Arvind Bhave, Arvind Kulkarni,
Ayhan Cömert, Byapak Paudel, Byeong cheol Rim, ChristianMorgenstern, Cigdem Mumcu, Daisuke Sakai, Elmer Jose Arevalo
Meceda, Hidetomi Terai, Hiroki Yoshimatsu, Hyeun Sung Kim, Javier
Quillo Olvera, Jin Hwa Eum, Jun Ho Lee, Jwo-Luen Pao, Kai-Uwe
Lewandrowski, Ken Ishii, Keng-Chang Liu, Kuniyoshi Tsuchiya, Malcolm
Pestonji, Masataka Sakane, Masatsune Yamagata, Michael Schubert,
Nobuyuki Shimokawa, Nurbyek Baban, Rafael Cruz Bundoc, Seiji
Yamaya, Shoichi Kokubun, Son Sang kyu, Tarik Yazar, Tatsushi Inoue,
Tolgay Satana, Verapan Kuansongtham, Wiwat Wajanavisit, Yi Hung
Huang, Yoshinori Kyoh, Chien-Min Chen, Shigeki Urayama, Kazunari
FushimiINDEX
Honorary president
S-1

Gun Choi

President's lecture
A-1

Koichi Sairyo

Chairman's lecture
B-1

Fujio Ito

B-2

Zenya Ito

Special lecture
C-1

Abdullah Merter

C-2

Alfonso García Chávez

C-3

Arvind Bhave

C-4

Arvind G Kulkarni

C-5

Ayhan Cömert

C-6

Byapak Paudel

C-7

Byeong cheol Rim

C-8

Christian Morgenstern

C-9

Cigdem Mumcu

C-10

Daisuke Sakai

C-11

Elmer Jose Arevalo Meceda

C-12

Hidetomi Terai

C-13

Hiroki Yoshimatsu

C-14

Hyeun Sung Kim

C-15

Javier Quillo olvera

C-16

Jin Hwa Eum

C-17

Jun Ho Lee

C-18

Jwo-Luen Pao

C-19

Kai-Uwe Lewandrowski

C-20

Ken Ishii

C-21

Keng-Chang Liu

C-22

Kuniyoshi Tsuchiya

C-23

Malcolm Pestonji

C-24

Masataka Sakane

C-25

Masatsune Yamagata

C-26

Michael Schubert

C-27

Nobuyuki Shimokawa

C-28

Nurbyek Baban

C-29

Rafael Cruz Bundoc

C-30

Seiji Yamaya

C-31

Shoichi Kokubun

C-32

Son, Sang Kyu

C-33

Tarik Yazar

C-34

Tatsushi Inoue

C-35

Tolgay Satana

C-36

Verapan Kuansongtham

C-37

Wiwat Wajanavisit

C-38

Yi-Hung Huang

C-39

Yoshinori Kyoh

C-40

Chien-Min Chen

C-41

Shigeki Urayama

C-42

Kazunari Fushimi

LecturesD-1

Abdul Kadir Hadar

D-2

Akarawit Asawasaksakul

D-3

Ali Hammed

D-4

Bhupesh Patel

D-5

Chaiyaporn Siramanakul

D-6

Chang, Chien-Chun

D-7

Ching-Hsiao Yu

D-8

Chul-Woo Lee

D-9

Gun Keorochana

D-10

Kwan-Su (David) Song

D-11

Marcio Robertti Ramalho Da Cunha

D-12

Matee Phakawech

D-13

Meng-Huang Wu

D-14

Nantawat Uttamo

D-15

Pradyumna Pai Raiturkar

D-16

Saran Pairuchvej

D-17

Seok-Bong Jun

D-18

Songwut

D-19

Urawit Piyapromdee

D-20

Zhang Wei

D-21

Shisheng He

D-22

En Song

SirivitmaitreeProgram
Honorary president

honorary president

Title

Gun Choi
Pohang Wooridul Hospital

Education and Professional Workcv

S-1

ProgramPresident’s lecturepresident

A-1

Full-Endoscopic Surgery for Professional Athletes: Discectomy,
Foraminotomy, Thermal Annuloplasty and Disc Cleaning.
Koichi Sairyo
Department of Orthopedics, Tokushima University
In this educational lecture, I will explain the pathology of the low back pain in professional athletes, such as
herniated disc, foraminal stenosis, discogenic pain and type 1 Modic change (MC). I prefer to dotransforaminal (TF) approach, since I am the student of great Professor Tony Yeung.
Using TF approach, the full-endoscopic spine surgery can be done under the local anesthesia with just 8mm skinincision. That should the minimally invasive spine surgery in the world. Currently.
Any type of the herniated disc can be removed with TF-FESS. Using the high speed drill, foraminal stenosis isalso solved with FESS-foraminotomy. As the pain generator for the discogenic pain, high signal intensity zone
(HIZ) at the posterior annulus fibrosus on T2-MRI has been proposed. Recently, Professor Yeung proposed the
toxic annular tear (TAT) in discography and on CT-discography. To treat the pathology, radio-pulse thermal
annuloplasty is useful. With the bipolar, cauterization of the HIZ and TAT can be done. Type 1 MC is anotherpathology causing low back pain in professional athletes. The surgical gold standard for type 1 MC is fusion;
however, very recently, I established the FESS-disc cleaning surgery for this pathology. It is very useful to treat
the endplate inflammation.
Most of the professional athletes are having the FESS surgery during season-off; then, they can return in thenext season successfully. Even though, when they undergo FESS in season, they can return about 3 months
after surgery.
In conclusion, there are several pathology of low back pain in professional athletes, and mostly they can betreated by FESS without losing additional season.

Education and Professional Work
Professor and Chairman, Department of Orthopedics, Tokushima University, Tokushima, Japan.
1988:
MD degree, Tokushima University School of Medicine
1994:
PhD degree, Tokushima University Graduate School of Medical Sciences
1995-1997: Post Dr. follow, University of Iowa, Iowa, USA
1998:
Assistant Professor, Tokushima University Hospital
1999:
Associate Professor, Tokushima University School of Medicine
2003-2005: Post Dr. follow, University of Toledo, Ohio, USA
2010:
Associate Professor, Teikyo University Mizonokuchi Hospital
2013- present:
Professor and Chairman, Tokushima University
International SocietyInternational Society for Study of the Lumbar Spine: ISSLS (active member)International Society for the advancement of the spine surgery: ISASS (member)International Society of Endoscopic Spine Surgery: ISESS (Board member candidate)
International Intradiscal Therapy Society: IITS (Congress President 2021)
International Society for Minimal Intervention in Spinal Surgery: ISMISS (Asia representative)
Asian Congress Minimally Invasive Spine Surgery: ACMISST (Board member, Japan representative)
Pacific Asian Society for Minimally Invasive Spine Surgery: PASMISS (Board member)World Congress Minimally Invasive Spine Surgery: WCMISST (Congress President 2021)
Japanese Society
Japanese Orthopaedic Association JOA (Board member)
Japanese Society for Spine Surgery and Related Research: JSSR (Board member, education committee)
Japanese Orthopaedic Society for Sports Medicine: JOSSM(Society vice president since 2019, CONGRESS PRESIDENT 2018)
Japanese Society of the Minimally Invasive Spine Surgery: JASMISS(Society President since 2020, CONGRESS PRESIDENT 2019)Japanese Society of the full-endoscopic trans-Kambin lumbar Interbody Fusion: JEKLIF(Society President since 2020, CONGRESS PRESIDENT 2020&2022)

Program
Chairman’s lecturechairman

B-1

Percutaneous Full-Endoscopic Lumbar Interbody Fusion(PELIF) of any lumbar level from L2/3 to L5/S1
Fujio Ito
President of Aichi Spine Hospital
Background: Various methods of lumbar intebody fusion surgery have been performed for lumbar interbody
instability. PLIF and TLIF have risks such as dura damage and neuropathy due to invasive spinal canal, anddamage to the back muscles and resection of articular joints were also relatively invasive. XLIF, OLIF and ALIF
have sometimes a risk of serious damage to the intestines, ureters, great vessels, segmental arteries, upper andlower splanchnic nerves (retrograde ejaculation), peritoneum, and bladder.
Objective: To avoid those complications, we have developed a percutaneous full endoscopic trans-Kambin’s
safety triangle lumbar interbody fusion (PELIF) with an 8 mm outer sheath. Intervertebral disc and softcartilage endplate can be resected thorough Kambin’s safety triangle. Lumbar intervertebral instability cases
were fused using an intervertebral cage (sometimes expandable cage) and percutaneous pedicle screws (PPSs).
We would like to examine its invasiveness, results, problems, etc.
Methods: Rotate the outer-sheath cutter with a sharp edge and remove the intervertebral disc and endplate fromone side with wide foramen or radiculopathy. The bilateral decompression is performed at L5/S1 level. Severe
instability segment is fused with two cages. After enlarging foramen, one or two expandable cages are
sandwiched between the two L-shaped retract sliders with protecting the exiting roots by the round outersurface. The cancellous bone collected from the pelvis with 5 mm trephine is filled through the outer-cylinder.
Results: Cases were 29 (15 males and 14 females), 58.3 ± 14.2 years old. In each case, only one segment was
targeted, and L2/3: 1case, L3 / 4: 5 cases, L4 / 5: 16 cases, and L5 / S: 7 cases. The breakdown of the diseasenames was as follows：15 cases of degenerative spondylolisthesis, 2-lumbar instability, 3-spondylolyticspondylolisthesis, 3-spondylolysis, 3-bilateral foraminal stenosis and 3-degenerative vacuumed disc change. One
year later, the Macnab’s evaluation showed that 26 of 29 cases were excellent or good. Interbody fusion wascompleted in 28 cases on CT. In one case, the irritating symptoms of the exiting root persisted for three to six
months. The patient with spinal canal stenosis showed a magnified image on MRI. No cases of infection, duramater / nerve damage, hematoma were observed.
Conclusions: PELIF is indirect decompression method by stretching redundant thickened ligament andexpanding the spinal canal. The dura, intestine, and large blood vessels don’t appear in the surgical field. If thereis radiculopathy due to disc herniation or lateral recess stenosis, it is also possible to decompress them directly.

Education and Professional Work
Visiting professor of spine surgery, department of neurosurgery, Fujita Health University
Chairman of 1st ISMISS combined with 10th MISS Summit Forum in 2017
Chairman of 2nd ISESS (International Society of Endoscopic Spine Surgery)and 2nd ISMISS (International Society of Minimal Intervention in Spine Surgery)combined with 11th MISS Summit Forum in 2018
Chairman of 4th ISMISS combined with 14th MISS Summit Forum in 2021
Secretary-general of the Japan Spine Dock Society
President of MISS Summit Forum at Aichi Spine Hospital (Annual meeting)
MEMBERSHIPSThe Japanese Orthopaedic Association
Japanese Society for the Study of Endoscopic & Minimally Invasive Spine Surgery
Japanese Society of Lumbar Spine Disorders
Honorary board member of PASMISSBoard member of ACMISSTCEO of MISS Summit Forumchairman

B-2

UBE vs another OP
Zenya Ito
Aichi Spine Hospital
Background:
Many minimum invasive surgery against lumber canal stenosis was performed. UBEL is also very small invasive
surgery. However the utility of UBEL against another MIS technique is not reported. The purpose of this study
is to compare clinical results of another surgery with those of UBEL in patients with single-level lumbar spinal
canal stenosis.
Methods
The subjects consisted of 262 patients that underwent MEL:139 cases, 81 PEL cases and UBEL:42 cases who
were followed up for at least 6 months. All patients had lumber canal stenosis for one level. Outcomes of thepatients were assessed with the duration of surgery, the bone resection area in 3DCT, the facet preservation
rates in CT axial imagery, visual analogue scale (VAS) for low back pain, the Oswestry Disability Index (ODI),
and the EuroQol 5 Dimension (EQ-5D). Statistical analyses were carried out using a student-t test and an χ2
test. A p-value of <0.05 were considered significant. For statistical analysis, we used the software program SPSS.
Results
The bone resection area in 3DCT was 1.5 for MEL vs 1.0 cm 2 for UBEL (p<0.05). The facet preservation rates
on the advancing side and the opposite side were 78% vs 86% (advancing side: MEL vs UBEL) and 85% vs 94%(opposite side). (p<0.05)
The VAS(low back pain) score, VAS(leg pain), ODI and EQ-5D significantly dropped in both groupat final period (p<0.05), however exhibiting no between the two groups at each period. MEL resulted in greaternumbers of complications - being 5 cases of hematoma paralysis, 8 cases of dura injury, 2 cases of reoperation,
as opposed to zero cases of hematoma paralysis and only 2 cases of dura injury resulting from UBEL.
And then UBEL was shorter operation time than PEL. (p<0.05)
Conclusions
The UBEL method is a more useful technique than the MEL method as it requires a smaller bone resection areaand produces fewer complications and good result as PEL.

Education and Professional WorkEDUCATION:
April 1992 to March 1998, student of Nagoya University School of Medicine, obtained the M.D. degree
April 2004 to March 2008, Ph.D. student in the Postgraduate Course of Nagoya University School of Medicine
Nagoya University
LICENSURE & CERTIFICATION:
・National Board of Medicine, Registration No. 392818
・Board-certified Spine Surgeon approved by the Board of the Japanese Society for Spine Surgery and Related
research
FELLOWSHIP OR STUDY ABROAD:
・2008/June APOA spine travelling fellowship selected as the only member from Japan・2009/Aug-2010/Sep Emory spine center clinical and research fellowship
ACADEMIC APPOINTMENTS:
Assistant Professor of orthopedic section in Nagoya University
HOSPITAL APPOINTMENTS:
1998/Apr-2003/Mar Nagoya 1st red cross Hospital
2003/Apr -2004/Sep National center for Geriatrics and Gerontology
2004/Sep -2005/Mar Atsumi Hospital
2005/Apr -2008/Mar Student in the Postgraduate Course of Nagoya University School of Medicine
2008/Apr -2009/Jul Medical staff in Nagoya University Hospital
2009/Aug-2010/Sep International clinical fellowship of Emory Spine Center
2010/Oct-2011/Mar Toyohashi municipal Hospital
2011/Apr-2016/Mar Assistant professor in Nagoya University Hospital
2016/Apr-2017/Mar Aichi Spine Institute vise president
2017/Apr -Present Aichi Spine Hospital Chair

ProgramSpecial lectureboard member

C-1

Unilateral biportal endoscopic dural repair withbovine pericardium collogen patch
Abdullah Merter*, Mustafa Onur KARACA***Associate Professor, Ankara University School of Medicine**Orthopaedic Surgeon, Ankara University School of Medicine
Background
Unilateral biportal endoscopic surgery (UBES) is one of the popular minimally invasive spine surgery
techniques used to treat lomber degenerative spinal diseases More effective and safer surgery can be performed
compared to uniportal techniques, thanks to its ability to be performed without compromising visual capacity
and hand movements. However, dural injury is the most common complication of endoscopic spine surgery withan incidence rate of 1.7% to 4.3%. Conversion to open surgery for direct repair could become necessary duringendoscopic spinal surgery.To date, there is a lack of consensus in the literature regarding the management ofincidental durotomy in endoscopic spine surgery. . Vycril mesh, fibrin sealant patch and direct endoscopic repair(with suture or clips) have recently been described in the literature for the endoscopic treatment of incidental
dural tears. In this study, we used bovine pericardium collogen patch(tutopatch) to treat incidental dural tears
endoscopically and we aimed to share the clinical and radiological results of the cases.
Objectives:
We aimed to present the clinical and radiological results of incidental dural ruptures treated endoscopically with
Tutopatch.
Methods:
We retrospectively reviewed the medical and radiographic records of surgically treated patients who underwent
UBES at a single institute between January 2018 and December 2019. In the present series, during the original
surgery to treat the dural rupture, repair was performed according to the so-called extradural technique: a thinlayer of fibrin glue (Tisseel; Baxter AG, Vienna, Austria) was injected to seal the arachnoid, then a dural
substitute, bovine dehydrated pericardium (Tutopatch; Tutogen Medical GmbH, Neunkirchen am Brand,
Germany)was positioned in the extradural space covering the dural opening, dragging the dural substitute inoverlay position.
Clinical outcomes were evaluated using modified Macnab criteria, Oswestry disability index (ODI), and visual
analogue scale (VAS) of the leg and back. Cerebrospinal fluid(CSF) leakage or related problems, incidence
rate and radiological results at postoperative 1st month MRI were investigated.
Results:
1003 patients, representing 1562 levels, underwent UBES. Fifteen dural injuries occurred, and the incidence
rate was 1.4%. 14 of patients with dural rupture was on the cental cauda equine and one of them occurred on
the travering root. No cases progressed to surgical site infection , infectious spondylitis, cerebro spinal fluid
leakage, pseudomeningocele, meningitis or head pain. Overall for mean and standard deviation preoperative, 1week postoperative, 3 months, and final follow-up for visual analog scale were 7.8 ± 1.4, 3.6 ± 1.2, 2.5 ± 1.1,
and 2.0 ± 1.2, and for Oswestry Disability Index are 72.5 ± 8.0, 34.3 ± 8.8, 26.6 ± 6.9, and 23.4 ± 7.0. 13of the patients recovered “good” and 2 with “excellent” results according to the Macnab criteria.
Conclusion:
Dural injury during UBES can occur because of the various anatomical features of the meningo-vertebral
ligaments, adhesion or dural folding. A dural rupture can be safely controlled with a simple patchy
reinforcement (Tutopatch) under unilateral biportal endoscopic vision.
Education and Professional WorkABDULLAH MERTER M.D.
Current Address
Associate Professor
Ankara Medicine Faculty, Ibn-i Sina Hospital
Orthopaedics and Traumatology Department/Ankara/Turkey
e-mail:dr.merter@gmail.com
Date of Birth06.06.1985
EDUCATION
2018-2019 Spine fellowship researcher (Minimally Invasive Endoscopic Spine Surgery), Aichi Spine Hospital,
Inuyama-shi, Aichi prefecture, JAPAN2018
Clinical fellowship, Minimally Invasive Endoscopic Spine Surgery, ParkWeonWook Spine Hospital,
Busan, SOUTH KOREA
2009-2015
Research assistant, Orthopaedics and Traumatology Department, Ankara University
Medicine Faculty, Ankara,TURKEY
2003-2009
Undergraduate education, Selcuk University Meram Medicine Faculty,Konya,TURKEY

board member

C-2

Transforaminal Endoscopic Foraminotomy Instead of
Fusion Surgery in Foraminal Stenosis Cases
Alfonso García Chávez
Hospital Angeles Tijuana
In recent years there has been a special interest towards Endoscopic Spine Procedures. I will share someconcepts on “Transforaminal Endoscopic Foraminoplasty as an option to fusion surgery in foraminal stenosis
cases”.
Endoscopic foraminotomy was possible thanks to a number of events. The major milestone was the descriptionof the “transforaminal safe working corridor” known as the Kambin’s Triangle. This step made it possible forother surgeons to continue exploring the foraminal region by further devolping highly specialized instruments tobetter adapt the visual aid of the endoscope and provide extra room for the exiting nerve root, giving start to a
new era in the endoscopic surgery approaches, by broadening its indications to include other pathologies that
couldn’t be safely performed before.
The setup for Transforaminal Endoscopy is credited to Dr. Anthony Yeung. And later by Dr. Thomas Hoogland.
Yeung developed a working channel scope with integrated irrigation system and Hoogland introduced acanulated blunt tip hand-controlled drill bit to perform percutaneous foraminotomy. Next came strong
competitors that continued to improve the design of their basic instrument set, both for differentiation andincrease safety when decompressing the aging spine. We are now experiencing the Golden Age, where the rapid
interest and usability of these systems has produced high quality evidence to support the integration of thistoolset to the already immense offerings of spine surgical innovations.
As we move forward and experience this Golden Age, we can now communicate that: -Endoscopic Surgery has
broader indications than 10 yrs ago. -That it offers an improved surgical view -It is a muscle preserving
technique -With less bleeding, less postop pain, reduced infection rate and a fast recovery.

Education and Professional Work
Dr. Alfonso García Chávez Minimally Invasive and Endoscopic Spine Surgery+52 (664) 635 1852
+52 1 (664) 204 3196
facebook.com/espaldasaludable
linkedin.com/espaldasaludable@saludablespalda espaldasaludable.mx
Certified by “International UBE Spine Surgery Society”
2017 Active Member “North American Spine Society” 2017 NASS Member ID 420499
2017 JOIMAX® Faculty2019 AOSpine plus member ID 100024980
2020 Elsiever Editorial Reviewer.
2021 AMCICO (Mexican Spine Surgeons Association) Member
2021 Faculty, ESPINEA Universidad de Karlsruhe, Royal College of Surgeons of Edinburgh (Título en trámite)board member

C-3

Transforaminal Endoscopic surgery in challenging
conditions
Arvind Bhave
Deenanath Mangeshkar Hospital
Transforaminal endoscopic discectomy is frequently performed minimally invasive surgery now a days. Main
indication being prolapsed lumbar intervertebral disc, causing unilateral leg pains which is not relieves byconservative treatment.
In this presentation, endoscopic discectomy in challenging multiple situations is presented.
Endoscpoic discectomy can be successfully used in superior or inferiorly migrated disc prolapse. Extraforaminal
herniations, redu surgery in failed back syndrome.
Result: Percutaneous Endoscopic discectomy can be successfully done in multiple disc herniation pathologies
with satisfying results.

Education and Professional Work
NAME: DR. ARVIND BHAVE.
ADDRESS: C/O: BHAVE HOSPITAL,48, PARVATI INDUSTRIALESTATE, PUNE-SATARA RD. PUNE, MAHARASHTRA
INDIA.411009. PHONE/FAX NO +91-20-24225323.
E-MAIL:arvindbhave05@gmail.com ,RESIDENCE:D-202, PateSanskruti, 1231 Sahakarnagar,PUNE
Maharashtra, INDIA,411009.
PHONE NO: +91-20-24200200.
BIRTH DATE: 05-05-1964. (FIFTH MAY NINETEENSIXTYFOUR.)
AWARDS RECEIVED:*ONE OF THE TEN OUTSTANDING YOUNG PERSONALITIES OF PUNE. [TOYP].
*INTERNATIONAL FELLOWSHIP-GOVT.OF ISRAEL-FOR INTERNATIONAL POSTGRADUATE
TRAINING COURSE IN
ORTHOPAEDIC[SPINE] SURGERY at TEL-AVIV UNIVERSITYISRAEL.1998.
*BOMBAY ORTHOPAEDIC_WOCHARDT FELLOWSHIP FOR
1998-99- [BOS SPINE FELLOW].
*BEST PAPER AWARD -at the Research Society Annual Conference of the B.J. MEDICAL COLLEGE,
PUNE1999.
*SELECTED FOR WORLD ORTHOPAEDIC CONCERN FELLOWSHIP FOR 2000.
*SELECTED FROM ASIAN SPINE SURGEONS FOR JAPANESE SPINAL FELLOWSHIP -2001.
*BEST PAPER AWARD at RESEARCH SOCIETY –BHARATI VIDYAPEETH DEEMED UNIVERSITY. -2000& 2002 [TWO TIMES].

board member

C-4

Is it not imperative to have a precise estimate of the burden of spinal osteoporosis
for an individual and the community at large? Recommendations to designatequantitative-CT (Q-CT) to be the gold standard for detecting spinal osteoporosis
Arvind G Kulkarni
Mumbai Spine Scoliosis & Disc Replacement Centre
BACKGROUND: Globally, osteoporosis is the commonest denominator for most spinal disorders. Vertebralcompression-fractures (VCFs), implant-loosening, pseudarthrosis, proximal-junctional-failures, sagittal
imbalance and revision surgeries challenged by osteoporosis are omnipresent. Preponderant component (80%)
of spinal load is borne by the anterior column which happens to be the site of VCFs, pedicle-screw-purchase andinterbody-fusions and is anatomically laden with trabecular bone. Trabecular bone strength is best evaluatedusing quantitative-CT(Q-CT). However, DXA (Dual X-ray absorptiometry) scan continues to be theinvestigation of choice to assess spinal bone density, despite realizing its well-known drawbacks. In view of the
global liability of osteoporosis in terms of morbidity, mortality, financial and social implications, is it notimperative to have a precise estimate of the burden of spinal osteoporosis for an individual and the community
at large?
OBJECTIVE: Refinement of guidelines for screening osteoporosis
METHODS: Bone mineral density (BMD) of post-menopausal women was evaluated using either Q-CT or
DXA between January2018-December2020.Comparison studies of the distribution of age and T-scores of bonedensities obtained from the two study groups: age-matched, sex-matched and common skeletal site of interest(L1-L4 vertebrae) were performed. Mann-Whitney test, correlation and regression analyses were performed,
and bell curves were plotted.
RESULTS:Out of 718 post-menopausal women that were evaluated, 447 underwent Q-CT (age 50-89) and 271 underwent
DXA(age 49-89). The two groups were comparable with respect to age (p value > 0.5). The mean and mode Tscores obtained with Q-CT and DXA were found to be - 2.71, -3.8 and -1.63, -1.7 respectively. A significant
difference in T- scores was observed in Q-CT and DXA groups (p-value <0.0001). Among patients who werescreened using Q-CT, 58.16% were osteoporotic, 37.58% were osteopenic and 4.25% exhibited normal BMD,
while the respective percentages in the DXA group were 30.63%, 49.82% and 19.55%.
CONCLUSION: Apparent spinal osteoporosis is just the tip of the iceberg. Vertebral trabecular bone takes the
spotlight in the context of spinal osteoporosis and hence its precise evaluation is extremely critical for
appropriate management. DXA underestimates spinal-BMD and is hence questionable. Q-CT on the other
hand provides a more precise estimation of trabecular bone mineral density. The authors strongly recommend
Q-CT to replace DXA as the gold standard for evaluation of spinal osteoporosis. This step will have a large
global impact in minimizing the morbidity and mortality related to osteoporosis related spinal manifestations
and surgical complications, thus ensuring safety and quality.

Education and Professional WorkDr Arvind G Kulkarni is one of the pioneers of Minimally Invasive Spinal surgery and Artificial Disc replacementin India.
He is the Associate Editor of Journal of Minimally Invasive Spine Surgery and Techniques (JMISST, Korea). He ison the Editorial board of Asian Spine Journal (ASJ, Korea), International Journal of Spine Surgery (IJSS, USA),
Indian Spine Journal (ISJ) and Journal of Clinical Orthopaedics (Official publication of Bombay Orthopaedic
Society).
He is one of the few selected members on the review board of the prestigious international journal ‘Spine’.
He is in the executive council of ASSI (Association of Spine Surgeons of India) in the educational and research task
force and Secretary of MISSAB (Minimally Invasive Spine Surgeons of Bharat). He is one of the founder membersof MISSAB. He served as Fellowship Officer for AO Spine-Indian Sub-continent. His team was recently awarded
one of the Best Papers of 2021 in the International Safety in Spine Surgery for their project on ‘Spine surgery
Check-list’ under Best New Methodologies and Techniques to Enhance Safety in Spine Surgery.

board member

C-5

From anatomy of the spine to clinical applications:
recent advances and translational research
Ayhan Cömert
Department of Anatomy, Ankara University
Chronic low back and neck pain is associated with intervertebral disc degeneration. Differentiation of
notochord-like cells into chondrocyte-like cells is correlated with disc degeneration and aging. Disc's capacity
for regenerating itself is exhausted over time. New idea is to direct and refine differentiation of adult andhuman-induced pluripotent stem cells into notochord-like and nucleus pulposus-like cells for use in novel cellbased therapies. Human-induced pluripotent stem cells (hiPSCs) have attracted much attention for theirpotential use in cell-based therapies. Additionally, treatment of degenerative disc disease with allogeneic
mesenchymal stem cells, their long-term follow-up results were discussed. New studies are under discussion tovalid alternatives for treatment of degenerative disc disease because was published that they can provide
effective and durable pain relief together with objective improvements to disc degeneration. There are major
limitations as difficulties to generalize the results to large populations, as well as the lack of detailed
determination of the optimal dosage of cells. Anatomical protection neurovascular structures is importantduring transforaminal approaches. Here major vessels include the abdominal aorta, the inferior vena cava, andthe common iliac arteries and veins, situated directly anterior to the lumbar spine. Injury to the great vessels andsympathetic and superior hypogastric plexus anterior to the intervertebral disc should be always kept in mind
during disc surgery and instruments should not be inserted much into the disc space. However, serious
complications may occur due to the proximity of the intervertebral disc to adjacent neurovascular structures.
Anatomical investigations support that for instance cooled blood may enter the internal vertebral venous plexus
from subcutaneous veins and that could very well serve both warming and cooling of the spinal cord.
Additionally, injury to nerve roots and perforation into the anterior annulus fibrosis and anterior longitudinal
ligament with major vascular injury is rare during surgical approaches. However, anatomical protection of
epidural venous system during transforaminal approaches is an important advantage. The internal vertebral
venous plexus was connected to segmental veins outside the vertebral column via intervertebral veins that run
through the intervertebral foramen. It is known that, the veins from the erector spinae drained into
intervertebral veins. Additionally, there are many clinical cases describing the symptomatic epidural venous
engorgements and anatomic variations in the literature.

Education and Professional WorkPERSONAL DETAILS:
Address: Department of Anatomy Ankara University, School of Medicine
06100 Sihhiye, Ankara, TURKEY
Profession : Professor of Anatomy
Nationalit: Turkish
Mail: comertayhan@yahoo.com ; comert@medicine.ankara.edu.tr
Cellular Phone: +90 535 8467218
Awards•ISMISS Turkey 2011 Innovative research award, ISMISS Turkey Congress, Antalya, Turkey (“Morphometry andAnatomy of the Lumbosacral Dorsal Root Entry Zones”)•Ankara University, School of Medicine, “Prof. Dr. Hikmet Yavuz” Best research award, 2008
•The American Society of Colon and Rectal Surgeons: The ASCRS Barton Hoexter, MD, Best Video Award:“Perineal anatomy for colorectal surgeons”, 2016
PROJECTSThe Scientific and Technological Research Council of Turkey TÜBİTAK 104S402 SBAG SBAG-AYD-479
Yumuşak ve sert doku malzeme deney sistemine elektronik veri toplama biriminin eklenmesi 2005 /2006
Turkish Neurosurgical Society Türk Nöroşirürji Derneği Araştırma Projesi. Deneysel akut omurilik yaralanmasında(spine injury) granülosit koloni stimülan faktörün (GCSF) antiinflamatuar etkisi 2007
Celal Bayar University Research Projects, Celal Bayar Üniversitesi Bilimsel Araştırma Projesi Tıp 2005- 47 Sıçan
beyninde fokal iskeminin matriks metaloproteinaz ve ekstraselüler matriks proteinlerinin dağılımlarına etkisinin
immunohistokimyasal yöntemle değerlendirilmesi 2005/2007
The Scientific and Technological Research Council of Turkey TÜBİTAK 108S075 İnsan dişsiz çene kemiklerinin
mikromekaniksel özelliklerinin incelenmesi 2008/2011

board member

C-6Disc, Pain generators, Percutaneous Full Endoscopic
Management
Byapak PaudelGrande Int. Hospital, Kathmandu, Nepal
Introduction:
Disc is an important structure of spine and when pathological it can be associated with low back pain with orwithout radiating or referred pain.
Disc degeneration/injury leads to Discogenic back pain, pain due to prolapsed intervertebral disc (PIVD) andstenosis related pain.
Treatment:Discogenic back pain:Now it can be managed by percutaneous full endoscopic technique.A landmark paper on percutaneous full endoscopic technique for management of discogenic back pain has been
published. The most recent promising percutaneous full endoscopic technique uses laser for ablation ofsinuvertebral nerve extradiscally with 96.1% good to excellent result. Prior treatment methods for discogenic
back pain has less favorable outcome and has problems.
PIVD related pain:Now it can also be managed by percutaneous full endoscopic technique either byInterlaminar (PEILD) or Transforaminal (PETLD) approach. PETLD can be done through 3 routes. Results
are eqivalent to microsurgical discectomy with added benefits of Minimally Invasive spine Surgery. It can bedone for all kinds of disc herniations with more than 96% success (98.1% as per endoscopic successgrading/scoring). It can also be done successfully for high grade inferiorly migrated disc herniations by
Suprapedicular Circumferential Opening Technique (SCOT technique).
Stenosis related pain:Now it can also be managed by percutaneous full endoscopic technique. The first landmark
paper uses contralateral unilateral approach for decompression of bilateral spinal stenosis with 96 % good to
excellent outcome. PESLD (Percutaneous Endoscopic Stenotic Lumbar Decompression) neither violates facet
joint nor violates soft tissue. In previous microsurgical techniques there is problem of facet violation and soft
tissue violation.
Endoscopic fusion: Literatures are coming up with equivalent or better outcome after endoscopic fusion to treat
spinal pain.
Conclusion:•
Disc degeneration/injury leads to Discogenic back pain, pain due to prolapsed intervertebral disc
(PIVD) and stenosis related pain.
•
Percutaneous full endoscopic techniques are least invasive of minimally invasive spine surgery (MISS)
having advantages of minimally invasive surgery (MIS) than open or microsurgical techniques.
•
Discogenic back pain, PIVD and stenosis can be managed successfully by percutaneous full endoscopic
techniques.
•
Treatment of discogenic back pain, discectomy and stenosis decompression, fusion will all be
percutaneous full endoscopic in near future.
•
In due course of time all spinal problem can be solved by percutaneous endoscopic techniques.

Education and Professional Work
Dr. Byapak Paudel
DOB: 4th July 1973 AD (Nepal)
Qualification, Post
MD, MS (Ortho), Fellowship Minimally Invasive Endoscopic Spine Surgery
Consultant Orthopedic and Spine Surgeon
Assistant Director Spine Services, Grande International Hospital
Consultant Nepal Health Research Council (NHRC) for Spinal Trauma Registry- Nepal project
Faculty of National Board of Medical Specialties - Orthopaedics: Medical Education Commission Nepal
General Secretary Association of Spine Surgeons of Nepal (ASSN) –Present
Founder Joint Secretary Association of Spine Surgeons of Nepal (ASSN) Estd. 2012
Member Institutional Review Committee (IRC) Grande Int. Hospital- Approved by Nepal Health Research Council(NHRC)

board member

C-7

A Incidental conversion of full endoscopic posterior cervical foraminotomy tounilateral biportal endoscopic posterior cervical decompressive laminectomy
under lateral decubitus position with local anesthesia and sedation
Byeong cheol Rim
Department of Neurosurgery, RIMS neurosclinic, Cheongju-si,
Chungbuk-do, South Korea
This 46 years old man, his symptom was severe radiation arm pain, intractab arm pain was even not responsed to
epidural steroid injection neurolysis. It was planned to get the operation by full endoscopic posterior cervicalforaminotomy for decompression at the level of C5/6, Right side.
Just after a puncture of skin and placing the working sleeve into the lesion site, incidental and mechanical failureof endoscope and instruments for a full endoscopic posterior cervical foraminotomy (PCF) under lateral decubitus
position with local anesthesia.
At that time, we can not to do continue the planned operation, and so we convert it to biportal endoscopic posteriorcervical foraminotomy under lateral decubitus position with local anesthesia.
This talk is something for this inicidental conversion of endoscopic assisted posterior cervical foraminotomy orlaminectomy under lateral decubitus position with local anesthesia. At first, we made a table tilted a litte about
20~30 degrees from full lateral decubitus position of patient. We need a more skin puncture and making trjectoryfor endoscope by using serial dillation and a little 10mm more extended skin incision for placing transparent UBE
plastic work sleeve for easy work of instruments in concern of cord damage because of heavy posterior cervicalmuscles and unfamiliar position of UBE in cervical operation. During the operation, also, epidural catheter used
for injection of local anesthetics epidurally. we did not perform the discectomy, only decompressive laminectomy
done. The result was very good, his pain was gone since 10 months ago. It was feasibe that unilateral biportal
endoscopic posterior cervical laminectomy with local anesthesia and can be a good alternative option for in case of
unable full endoscopic posterior cervical foraminotomy. The other side we have to study more about the limitationand future applicable indication for endoscopic posterior cervical foraminotomy.

Education and Professional Work
Address
Office : Department of Neurosurgery
RIMS Neuroclinic
1360 Garosu-ro, HeungDeok-gu, Cheongju-si, Chungcheongbuk-do
South Korea
Post code) 28597
Tel: 043) 232- 6788
(82) 10 -6438-3379
E-mail : bcrim7533@gmail.com
Licensure and Certification
Licensed to Practice Medicine in Korea, 1994
Korean Board of Neurosurgery, 1999
Master of medicine (ChungBuk National University, College of Medicine), 1997
PhD. ChungBuk National University, College of Medicine, 2007

board member

C-8

Advances in cervical endoscopic spine surgery - anterior andposterior approach and cervical fusion with the PSLD scope
Christian Morgenstern*, Rudolf Morgenstern*Morgenstern Institute of Spine, Centro Médico Teknon,Barcelona Spain
Endoscopic cervical spine surgery has gained adoption in recent time due to the increasing popularity of endoscopic
posterior cervical foraminotomy for foraminal herniations in the cervical spine. At the same time, endoscopic anteriorcervical discectomy (ACD) has not seen a comparable widespread adoption. Reasons for this may relate to the anterior
endoscopic approach being considered difficult and hazardous, as well as the popularity of the gold-standard open
anterior cervical approach. Moreover, popularity of endoscopic cervical surgery has also been limited by the costs ofinvesting in a separate cervical endoscope endoscope and instrumentation.
We want to introduce a case series and present clinical examples showing the applications of endoscopic ACD andendoscopic posterior foraminotomy using only one endoscope (Maxmore PSLD scope) that was originally designed
for the lumbar spine. The advantages of using a lumbar endoscope for cervical spine surgery include increased
versatility and robustness of the instruments, lower costs and excellent visualization. At the same time, we havedeveloped custom instrumentations to facilitate the anterior approach with the PSLD scope.
We also present a case series of endoscopic ACD and fusion (ACDF) which allows us to place a cervical interbody
cage through a 25mm skin incision. We believe that endoscopic ACDF has the advantages of excellent visualizationand disk preparation with the endoscope, as well as less soft tissue disruption as the approach does not requiredissection nor continuous soft tissue traction with a spreader

Education and Professional Work
Teaching instructor (international faculty) in international workshops for endoscopic spine surgery (AO Spine,
Maxmore Spine, etc.)
Board certified orthopedic surgeon (German Board, Berlin)
Residency training at Charité Universitätsmedizin Berlin, Germany
Fellowship trained MIS and endoscopic spine surgeon
Publications / Societies
More than 100 abstracts and papers in international peer-reviewed journals and international conferences (NASS,
Eurospine, AO Spine GSC, ISMISS, etc.)
Reviewer for more than 10 international journals
Member of NASS, Eurospine, AO Spine, ISASS, IEEE

board member

C-9

Some Useful Tips for Biportal Endoscopy
Cigdem Mumcu
Republic of Turkey Ministry of Health Sultanbeyli State
Hospital
Abstract:
UBE is a new endoscopic technique for treatment of all degenerative spine diseases. In this method two portals
are used, and these two portals move in all directions independently. That is a big progress, its property offers awide range of spectrum for indication. Moreover, the endoscopic trajectory has same steps as convantional
microsurgery with excellent panoramic view. UBE has many advantages such as protection of themusculoligamenteous complex, a smaller incision, less postoperative back pain and short hospitalization.
Another advantage is that UBE does less postoperative morbidity by reducing incidence of epidural fibrosis.
Furthermore all kinds of degenerative spine diseases such as herniated disc, spinal stenosis, revision surgery,fusion surgery, far out syndrome, facet cyst, many complicated cases and also spine deformities can be treatedwith UBE.
Such benefits of UBE surgery including simple discrimination of anatomic structures, tender manipulation ofpathology with magnified endoscopic view, and detailed operative information might contribute to get
successful result in all the spine pathologies.

Education and Professional Work
Dr. Mumcu has special training in Unilateral Biportal Endoscopy (UBE) by Dr. Sang Kyu Son, Busan Park Weon
Wook Hospital in Korea. UBE is the last endoscopic spine procedure that higly effective on all degenerative spinediseases. Along with many other minimal invasive spinal procedures, Dr Mumcu is trained in Sacral Epiduroscopic
Laser Disc Decompression (SELD) by Dr Kang Taek Lim at Seoul Good Doctor TeunTeun Hospital in Korea,
Endoscopic Spine Surgery by Dr Gun Choi at Pohang Wooridul Hospital in Korea, and Regenerative Medicine(platelet-rich-plasma and stem cell) and Endoscopic Spine Precedures by Dr Atif Malik at American Spine Center
in USA.
She is a member of Turkish Society of Unilateral Biportal Endoscopy, Turkish Neurosurgery Society, Turkish
Spinal and Peripheral Nerve Surgery Society, Turkish Spine Society (TOD), AOSpine, International High-TechSpine Society (IHTSS). Dr. Mumcu is married and has two daughters. She enjoys spending time with her family,
travelling, and yoga. She currently works at Sultanbeyli State Hospital in Istanbul.

board member

C-10

Clinical development of Tie2 positive nucleus pulposus
progenitor cell product for low back pain
Daisuke Sakai
Tokai University School of Medicine
Low back pain affects various individuals, from the working population to the locomotive syndrome of theelderly, and its social and economic impact is unignorable. In particular, the intervertebral disc, which is closely
related to low back pain, is a tissue that changes significantly with aging and degeneration, and degeneration of
the intervertebral disc leads to the development of herniated disc and various spinal degenerative diseases.
Stem/progenitor cells have been isolated from various musculoskeletal tissues. Recently, cells with MSC-like
properties have been isolated from degenerate human intervertebral discs, providing support for the presence of
mesenchymal progenitors.
We have isolated progenitor cells from human and mouse nucleus pulposus(NP) of the intervertebral discs thatare different to adhesive MSCs, able to form spheres similar to neural progenitors. These cells have self-renewal
and multipotential characteristics consistent with progenitor cells. These progenitors express Tie2 as a marker
that progress toward Tie2+/GD2+ cells, with the subsequent expression of CD24 and CD44 as markers fornucleus pulposus (NP) cells in culture and self-renewal property is then lost. Therefore, cells that express Tie2
may be a novel source of donor NP cells in cell therapy for degenerative disc disease.
In order to develop a cell therapeutic agent derived from Tie2 positive NP cells, we isolated NP cells from young
donors who had undergone herniotomy for lumbar disc herniation. Minced NP tissue was macroscopicallyisolated and tissue was brought into whole tissue organ culture for 2 weeks. Thereafter, tissue was thenenzymatically digested and cells were expanded in 2D culture for 2 weeks. Tie2 positivity was checked after
harvest and counted. Tie2 positivity, proteoglycan and type II collagen positivity after expansion culture wasmeasured by flow-cytometry.
Tie2 positive NP cells may provide superior outcomes in cell therapy for degenerative disc disease and loe backpain compared to other cell products.

Education and Professional Work
Name: Daisuke Sakai Nationality: Japanese
Born: April, 9th, 1973
Address: 1-8-24 Nishikamakura, Kamakura-shi, Kanagawa, Japan, 248-0035
Society Appointments
Japanese Orthopaedic Association
2011-2014, 2017- International Affairs Committee member,2015-2016 Advisor 2018~ Chairman
2016-2019 Low Back Pain Guideline Committee member
2018- present Lumbar Disc Hernia Guideline Committee member
Japanese Society for Spine Surgery and Related Research
2016-present, International Affairs Committee member Japanese Scoliosis Research Society
2017-present, International Affairs Committee Society
Journal Editorial Appointments
Journal of Orthopaedic Research – Spine 2017- present, Co-Editor-in-Chief
Journal of Orthopaedic Surgery, Official Journal of APOA 2011- present, Basic Science Section Editor
Journal of Orthopaedic Research 2011- present, Editorial Board
Journal of Orthopaedic Science 2010- present, Editorial Board
Scientific Reports
2019- present Editorial Board
Awards
2003 Research Encouragement AwardInternational Society for the Study of Lumbar Spine (Japan Branch)2003 Young Researcher Award The Naito Foundation
2004 Research Encouragement Award The Kanagawa Foundation for Intractable Disease2006 North American Spine Society Best Research Paper Award
2013 Research Recognition Award, The Japanese Orthopaedic Association

board member

C-11

Step by Step Technique of Full Endoscopic Trans-oral, C2
Transcorporeal, C2-3 Disc Hernia Fragmentectomy andSpinal Cord Decompression using Spinal Endoscope
Elmer Jose Arevalo Meceda
Chairman, Bicol Brain and Spine Care Center
Disc Hernia in the C2-3 level is very rare at incidence rate of 0.2-0.45%. It presents with high cervical spinal
cord compression and myelopathy -radiculopathy which is highly debilitating. To manage patients sufferingfrom this condition, decompression of the spinal cord is required. Due to its rarity, there is no standard oftreatment and literature only has case reports and case series where anterior techniques and posterior transdural
techniques are elucidated.
I will present a step by step technique of a successful full endoscopic trans-oral, C2 transcorporeal approach inspinal cord decompression using spinal endoscope under continuous saline irrigation and its outcome in apatient where anterior approaches are comtraindicated.

Education and Professional Work
neurospineejam@gmail.com; eameceda@uerm.edu.ph,ejameceda@stlukes.com.ph; mobile: +639178111133
Short Description: Dr. Meceda is a Neurosurgeon, a Minimally Invasive Spine Surgeon,
A Pioneer Endoscopic Spine Surgeon in the Philippines,
Assistant Professor of Neurosciences, UERMMMC, College of Medicine
Chairman of the Bicol Brain and Spine Care Center and a
Visiting Neurosurgery Consultant of the
St. Luke’s Medical Center- Global City, Institute of Neurosciences,and Capitol Medical Center, Department ofSurgery
Present Positions:
Chairman, Bicol Brain and Spine Care Center (April 2021 to present )Head, Section of Neurosurgery, Bicol Medical Center (Assistant Professor, UERMMMC, College of Medicine, Department of Clinical Neurosciences
Consultant Neurosurgeon, MIS-Spine
Endoscopic Spine Surgery Specialist
Academy of Filipino Neurosurgeons Inc, Treasurer, January 2021- January 2022
Academy of Filipino Neurosurgeons Inc., Board Member, January 2020 to present
Philippine Spine Society, Member, MISS Research Group 2017 to present
Board Member, Asian Congress of Minimally Invasive Spine Surgery, 2019 to present
Philippine Representative to Asian Congress of MISS, 2018
Board Member, ASEAN Minimally Invasive Spine Surgery and Techniques Congress, 2016 to present
Philippine Representative to ASEANMISST, 2016
Scientific Committee Chairman, 5th ASEAN Minimally Invasive Spine Surgery and Techniques 2019
Board Member, 12th – 14th MISS Summit Forum 2019 to present, Aichi, Japan
Executive Presidium, International Society of Endoscopic Spine Surgery (ISESS), 2017 to present
International Faculty and Investigator, trans-Sacral/ trans-Foraminal Epiduroscopic Surgery
tSELD Study Group, Good Doctor Teun Teun Hospital/AICHI Spine Hospital (December 2015 to present)board member

C-12

Minimum Invasive Posterior Lumbar Interbody Fusion (PLIF) using
TASS (Trans-articular surface screw) for Isthmic Spondylolisthesis
Hidetomi Terai
Dept. of Orthopaedic Surgery,
Osaka City University Graduate School of Medicine
Since 2014, we have performed minimum invasive posterior interbody fusion (PLIF) for isthmic
spondylolisthesis using originally developed screw insertion technique “Trans-articular surface screw (TASS)
for S1” combined with cortical bone trajectory CBT) screwing for L5.
The procedure enables a proficient surgeon to perform L5/S PLIF with 5cm diameter single skin incision.
Bilateral PLIF is performed using 3-dimensional porous titanium cage (Vusion Ti 3D, Japan Medical Dynamic
Marketing) after Gill’s procedure. After PLIF, CBT screw of L5 is inserted from L5 pedicle stump’s surface,which becomes visible after PLIF. The direction of CBT screw is from medial to lateral and from caudal tocranial. Screw tip should locate within the vertebral body. The average screw width and length are 5.5 mm and
35 mm, respectively. After L5 screw insertion, TASS is performed. The entry point of TASS is one third fromthe lateral border and one third cranial from the caudal border of the facet in the superior articular process of
S1. The screw tip should toward promontorium in the sagittal plane. The screw length should be enough long toreach the anterior vertebral wall but not be longer to penetrate it (35-40 mm in most cases). The screw width
should be as wide as possible unless otherwise breaching medial wall of S1 pedicle (6.5-7.5 mm). The screw
purchase pathway and screw length should be directly examined with feeler under fluoroscope after drilling andtapping.
Practical technique of this minimum invasive PLIF with the above-mentioned technique for patients with L5
isthmic spondylolisthesis will be introduced in this VIDEO presentation.

Education and Professional WorkPERSONAL INFORMAION
Date of Birth: October 24, 1970
Place of Birth: Osaka, Japan
Citizenship: JapaneseProfessional Address: Department of Orthopaedic Surgery
Osaka city University Graduate School of medicine
HONORS AND AWARDS
1999 Research award from Nakatomi Health and Wellness Organization2007 Research award from Chiyoda Health and Wellness Organization2009 Research award from Japan Foundation for aging and health2019 Best presentation award in 26th meeting of JPSTSS (Japan Society for the Surgical Technique for Spine andSpinal Nerves)
EDITORIAL ACTIVITIESAd Hoc reviewer: Journal of Orthopaedic Science Acta Biomaterial Biomaterials Bone
Journal of Biomedical and material research
Journal of Orthopaedic Surgery and Research
etc…
MAJOR CLINICAL AND RESEARCH INTERESTS
Spine surgery (Scoliosis, Pediatric, Degenerative, Minimum invasive),
Regenerative medicine, Bone graft substituteboard member

C-13

Has it become easier to learn how to perform full-endoscopic spine surgery?:Effectiveness of the Endoscopic Surgical Skill Qualification system in fullyendoscopic lumbar discectomy.
Hiroki Yoshimatsu, Yasushi Miura, Shu Nakamura, Motohide Shibayama, Zenya Ito, Minoru
Yamada, Naoto Hoshi, Keita Kuraishi, Kenzo Shimizu, Guanghua Li, Fujio Ito
Department of Spine Surgery, Aichi Spine Hospital, Japan【Background】 In 2004, the Endoscopic Surgical Skill Qualification (ESSQ) system for the spine of theJapanese Orthopaedic Association (JOA) was established ahead of other countries in order to facilitate thesound spread and progress of endoscopic spine surgery in Japan. In 2013, the ESSQ system of fully-endoscopic
lumbar discectomy (FELD) was started.
【Purpose】 This study aimed to compare the process for acquisition of FELD between surgeons who started
the FELD procedure before 2013 and surgeons who started it after 2013. We examined the efficacy of the ESSQ
system in FELD and the present problems.
【Materials and Methods】 We performed a questionnaire survey on the process of the acquisition of FELD.
Nine endoscopic spine surgeons (6 certified endoscopic spine surgeons and 3 non-certified endoscopic spine
surgeons) were targeted. The study population was divided into two groups, the first period and the second
period, according to the time that the procedure was introduced in fully-endoscopic spine surgery (FESS), andthe two groups were compared.
【Results】 There was a high incidence of complications in the early stage (from the first operation to 30 cases)of the introduction of FELD. There were 7 Drs that required revision surgery due to a lack of decompression, 6
Drs in dura tear and 5 Drs that required a change in the planned operation method based on the intraoperative
findings. The types of complications in the early stage were different between two groups. In the first group,
there was breakage of operation instruments, convulsive seizure and intraoperative neck pain. In the second
group, there exiting nerve root injury and dura tear were frequent. There was an important difference in thecontents of the education that the operators received. In the second group, the operators participated in various
training sessions and received coaching on endoscopic spine surgery from a supervisor. All members pointed out
the effectiveness of the ESSQ system in FELD.
【Discussion】 To minimize the occurrence of complications, a committee of the ESSQ system in the JOA
emphasizes the importance of the continuation of instructional activity and the establishment of an education
system. In this study, following the introduction of the ESSQ system, the enhancement and diversification of thecontents of education were seen and the establishment of the instruction system advanced. As a result, it is now
easier to learn FESS. However, the complications observed in the early stage of its introduction have not beensolved. In fact, some of the complications that accompanied the expansion of the indications have increased.
These results show that further enhancement of education in patient selection, operation technique and otherareas, is required to achieve safe FESS.

Education and Professional Work
Education and Professional Work
1996 M.D., Kurume University School of Medicine
2001 Ph.D.(Doctorate of Medical Science), Kurume University, Department of Orthopaedic Surgery
2001 Medical Staff of Orthopaedic Surgery in Kurume University
2006 Manager of Spine of Orthopaedic Surgery in St. Mary’s Hospital
2011 Vice-Head of Medical Office of Orthopaedic Surgery in Kurume University
2013 Head of Medical Office of Orthopaedic Surgery in Kurume University
2015 Chief physician of Spine and Spinal Cord Center in Omigawa General Hospital2017 Spine fellow in Pohang Wooridul hospital, Korea
2017 Chief of Spine Surgery Division in Aichi Spine hospitalboard member

C-14

Effect of Dorsal Root Ganglion Retraction in Endoscopic Lumbar Decompressive
Surgery for Foraminal Pathology: A Retrospective Cohort Study of Interlaminar
Contralateral Endoscopic Lumbar Foraminotomy and Discectomy versus
Transforaminal Endoscopic Lumbar Foraminotomy and Discectomy
Hyeun Sung Kim, Ji Yeon Kim, Pang Hung Wu, Il-Tae Jang
Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Republic of Korea
OBJECTIVE: Postoperative dysesthesia (POD) is a common complication in surgery involving foraminal diseases,
including lumbar foraminal or extraforaminal herniated nucleus pulposus (HNP). Minimal dorsal root ganglion(DRG) retraction is key to preventing POD. We compared the clinical results, safety, and efficacy between theparaspinal transforaminal approach requiring DRG retraction and the interlaminar contralateral approach without
DRG retraction for foraminal and extraforaminal diseases.
METHODS: A retrospective cohort study was performed of 50 patients who underwent uniportal transforaminal
endoscopic lumbar foraminotomy and discectomy (TELD) and 50 patients who underwent anuniportal interlaminar
contralateral endoscopic lumbar foraminotomy and discectomy (ICELF) because of lumbar foraminal HNP. The
operated levels, combined degenerative diseases, postoperative complications, and POD were analyzed. The visual
analog scale (VAS) pain scores modified Oswestry Disability Index, and MacNab criteria for evaluating pain
disability and response were analyzed.
RESULTS: In the ICELF group (total, n [ 7, 14%), there were 5 (10%) and 2 (4%) patients with POD grade 1 and
2, respectively. In the TELD group (total, n [ 13, 26%), there were 7 (14%), 5 (10%), and 1 (2%) patients with
POD grade 1, 2, and 3, respectively. The overall occurrence rate of grade 2 and greater POD was higher in the
TELD group (n [ 6, 12%) than in the ICELF group (n [ 2, 4%). In the ICELF group, 3 of 9 patients (33%) withcombined canal structure deforming diseases had POD, of whom none had POD of grade 2 and greater. In the
TELD group, 4 of 7 patients (57%) with combined canal structure deforming diseases had POD, of whom all had
POD of grade 2 and greater. Two surgical groups showed favorable clinical outcomes with the visual analog scale,Oswestry Disability Index, and MacNab criteria.
CONCLUSIONS: Both TELD and ICELF were found to treat foraminal or extraforaminal HNP with good clinicaloutcomes. ICELF might have a lower POD rate in complicated cases such as adjacent segment disease, degenerative
spondylolisthesis, and isthmic spondylolisthesis. This surgical procedure could be an alternative in complicated cases
or in patients with an anatomically limited L5-S1 level. However, the procedure is technically challenging to perform.

Education and Professional WorkHYEUN SUNG KIM, MD, PhD (Dr. Harrison Kim)
(Neurosurgery Specialist / Director of the Nanoori Hospital Gangnam)
A Section Editor of World Neurosurgery / Neurospine / IJSS / Associate Editor of BMC Musculoskeletal
Disorders / Academic Editor of Medicine / Guest Editor of Brain Sciences
Medical College of Chosun University, Gwangju, South Korea (1994~1999)
neurospinekim@gmail.com, neuros@hanmail.net, https://www.facebook.com/hyeunsung.kim
Major Career2018 Parviz Kambin Award (Best Award of the Endoscopic Spine Surgery)2019 NASS annual meeting: Endoscopic Spine Surgery Workshop and Symposium Director
2021 KOSESS (Korean Research Society of Endoscopic Spine Surgery) President
Editor: World Neurosurgery / Neurospine / IJSS / BMC Musculoskeletal Disorders / Medicine / JMISST

board member

C-15

The role of unilateral biportal endoscopy (UBE, BESS, dualPortal)
for cervical degenerative pathologies
Javier Quillo olvera
Hospital H+, Querétaro
Abstract
Minimally invasive spine surgery (MISS) in all its variants has been shown to offer clinical and radiological outcomessimilar to those obtained with conventional techniques with the added value of a lower collateral effect associatedwith the procedure. This is helpful since the patient has favorable short-term clinical results, which leads to a shorterrecovery time, especially for a quick mobilization out of bed after spinal surgery.
Among the minimally invasive spine techniques are water-based endoscopy, uniportal endoscopy or full-endoscopy,
and biportal endoscopy. Both are techniques that depend on continuous saline irrigation to appreciate the anatomy.
In addition, both procedures are target-addressed, which means a high specificity of execution. This results in minor
trauma to paraspinal tissues, less injury to stabilizing structures, and decreased procedure-related risks. However,uniportal endoscopic techniques require equipment that can be expensive for some regions, a steeper learning curvefor some surgeons, and some limitation in the surgical field regarding the use of surgical tools.
Biportal endoscopic surgery aims to overcome the uniportal issues by offering more comfort with a more range of
freedom of the surgical instruments since they have an independent channel from the endoscope. Similar
visualization and a minor trauma for paraspinal tissues can be obtained during its execution with slight differencescompared to uniportal procedures.
Biportal endoscopic surgery has evolved, and diverse KOLs worldwide have reported advanced techniques to treat
cervical degenerative pathologies, such as herniated discs, foraminal stenosis, and central stenosis in patients withspondylotic myelopathy. Precision and specificity are required in these pathologies, and biportal endoscopic
technique is an acceptable treatment option for covering these goals.
This represents a constant evolution and adaptation of lumbar techniques to other spine regions. Finally, this talkgives an overview of biportal endoscopic techniques for degenerative pathologies of the cervical spine.

Education and Professional Work
Javier Quillo-Olvera M.D.
Spinal Neurosurgeon and Neurology Professor.
Anahuac University, School of Medicine, Hospital H+, Querétaro City, México.
Head of The Brain and Spine Care, Minimally Invasive Spine Surgery Group, Hospital H+ Queretaro.
Endoscopy Faculty for AOSpine.
Member of the Academic Committee of Inter-American Minimally Invasive Spine Surgery Society (SICMI).
Member of Mexican Association of Spine Surgeons (AMCICO).

board member

C-16

Preliminary Technical Report; Endoscopic Extreme TLIF(eXTLIF) for Large CageJin Hwa Eum , Dong Hwa Hoe
Burjeel Royal Hospital, UAE, Seoul Bumin Hospital, Korea
Introduction:
Mini-TLIF has allowed for a minimally invasive method to treat degenerative lumbar spinal pathologies. Endoscopic
interbody fusion techniques are used frequently right now. One of the disadvantages of the mini-TLIF andendoscopic fusion surgeries is using a relatively small cage with a small fusion bed compared to other large XLIF or
OLIF cages. We used a OLIF cage instead of a small TLIF cage for a larger size fusion bed and spacer under theendoscopic extreme TLIF procedure.
Materials and Methods:
8 patients who underwent endoscopic extreme TLIF from December 2019 to January 2020 were included in thisstudy. Clinical outcomes were assessed using a visual analogue scale (VAS). Whole and segmental lordotic angle werecompared postoperatively.
Images and clinical findings that include surgical techniques and related complications were analyzed.
Results:
The mean age of the patients (4 men, 3 women) was 65.5 years old. The mean VAS score was improved. The Cobb’s
angle of whole and segmental lumbar lordotic angle were improved except one patient. One patient resulted withtransient nerve root irritation, but there were no significant neurologic deteriorations or major complications werenoted.
Conclusion:
The endoscopic extreme TLIF (eXTLIF) procedure provides us a larger interbody fusion bed and spacer comparedto those of TLIF surgery. Further long-term study is required.

Education and Professional Work
JinHwaEum,M.D.
South Korea, +82 10 7687 2357

jinspsp@hanmail.net

Leadership, Membership, Presentations
Presenter, “Translaminal Endoscopic Discectomy”
The 4th Biennial Korea-Japan Conference on Spinal Surgery, 2003.
1st presentation about UBE surgery.
Exchange Visitor, Albert Einstein College of Medicine of Yeshiva University,New York, 1994 – 1995.
Member, International Chapter, NASS (North American Spine Society)
Volunteer & Community Work
Mentor for new medical doctors entering spinal residency
Active in hospital volunteer programs
References Available Upon Request

board member

C-17

Anterior Endoscopic Cervical Unco-Foraminotomy
Jun Ho Lee
Dept of Neurosurgery Kyung Hee University Medical Centre
Seoul 02447 Rep of Korea
ABSTRACT
Endoscopic anterior cervical unco-foraminotomy is a general encompassing term for surgeries performed in ourpractice for two major purposes: the first specific purpose is merely to enlarge a narrowed neural foramen, and thesecond purpose is its use as a conduit to remove surgically treated pathological entities such as herniated soft discfragments, bone spurs. This MISS cervical procedure has often been entitled as “anterior cervical foraminoplasty”
because the narrowed neural foramen, which most often is narrowed due to bone spurs along the medial foraminal
wall, is remodeled to restore normal caliber. The endoscopic ventral uncinated process resective decompression(unco-foraminotomy) can help to ameliorate arm pain more promptly in cervical radiculopathy patients with stenotic
neural foramens. However, this non-fusing MISS cervical decompressive technique has been fraught withbiomechanical issues especially in terms of cervical stability maintenance.
An investigation regarding the effect of uncinated process resection (UPR) during the standard ACDF has revealed
that if the sum of UPR is ≥38%, the possibility of subsidence increases significantly. Moreover, following unilateral
unco-foraminotomy, a significant alteration in mobility of the segment is found, especially during lateral bending andaxial rotation. Also, according to the analysis of the biomechanical Influences of trans corporeal tunnels on C4 vertebra
under physical compressive load under flexion movement using a finite element analysis, trans corporeal tunnel in C4
vertebrae without endplate excision should be limited with diameter of 6 mm, and a tunnel diameter >10 mm, excisionof the endplate >8 mm, and excision of the center side of the endplate has been recommended to be avoided.
Further investigations of the natural course of disc degeneration and the impact on mobility after uncoforaminotomy are needed.

Education and Professional WorkPERSONAL INFORMATION
Professor
Department of Neurosurgery, Spine Section Kyung Hee University Medical Centre
23 Kyung Hee Dae Ro, Dong Dae Mun-Gu Seoul, South KOREA
Post Code 02447
Tel: +82-2-958-8405 Fax: +82-2-958-8385 E-mail: moo9924@khu.ac.kr
MEMBERSHIPInternational member, Tier I, Member’s Feedback Committee, North American Spine Society
Member & International Faculty, AOSpine Davos course, Asia-Pacific & North America
Member & Executer, Walter E Dandy Neurosurgical Society
Member, Korean Neurosurgical Society
Member, Korean Spine Neurosurgical Society

board member

C-18

Push To The Limit, Revision Spine Surgeries Using
The UBE Technique
Jwo-Luen
Jwo-Luen PaoPao, MD
Far-Eastern Memorial Hospital, New Taipei,
Taiwan【Abstract】
As spine surgeries were widely performed, an increasing number of patients required revision surgeries due toneglected pathologies, newly developed pathologies, or complications in previous surgeries.
From Sept 2018 to Dec 2020, 76 patients received revision surgeries in the lumbar spines using biportal
endoscopic techniques. They were 36 males and 40 females with an average age of 68.0 (ranged 36 ~ 87). The
indications for revision included adjacent segment disease (ASD) following spine fusions in 31 patients,
recurrent disc herniation in 11 patients, neglected foramen stenosis and far-out syndrome in 8 patients, restenosis in 8 patients, newly developed stenosis in 5 patients, post-decompression instability in 5 patients,
inadequate decompression 3 patients, and implants related complication (interbody fusion cages, interspinous
devices, and transpedicle screws) in 3 patients. Revisions were performed on previously operated levels in 44
patients and new levels in 32 patients. Three major biportal endoscopic approaches were used: interlaminarlaminotomy in 30 patients, paraspinal foraminal decompression in 26 patients, and revision biportal endoscopictransforaminal lumbar interbody fusion in 20 patients.
The treatment results were very encouraging with significant relief of neurological symptoms, sciatica, and low
back pain in most of the patients. With minimal blood loss and post-operative wound pain, the average hospital
stay was only 3.2 days for decompression alone and 4.8 days revision fusion. Most of the patients start toambulate on the 1st or 2nd post-operative day. Follow-up MRI showed adequate decompression in most of thepatients with minimal new soft tissue injury. Complications including 5 tiny dural tears were treatedconservatively. Secondary surgeries were required in 3 patients due to inadequate decompression and postdecompression segmental instability. According the MacNab criteria, 66 patients (86.8%) had good andexcellent results, 8 patients (10.5%) had fair results, and 2 patients (2.6%) had poor results.
Using biportal endoscopic techniques in revision spine surgeries is a revolutionary advancement. In selectedcases, the revision surgeries could be done successfully with small surgical wounds, minimal soft tissue injury
and blood loss. Removal or revision of the old implants was only indicated in patients who required extension of
the fusion segments.

Education and Professional Work
Jwo-Luen Pao, MD
Chief of Spine Surgery & Clinical Assistant Professor
Chief of Department of Orthopedic Surgery
Far Eastern Memorial Hospital, New Taipei, Taiwan
21, 2nd Sec., Nanya South Road, Banqiao District, New Taipei, 22060 Taiwan
Tel: +886-2-8966-7000 ext 2888; Fax: +886-2-77282894
Website: http://www.iSpineCare.com
E-mail: jwoluenpao@gmail.com; drpao@ispinecare.com
Positions in Medical Society
Board member of the Pan Asian Society for Minimally Invasive Spine Surgery (PASMISS)
Board member of the Taiwan Society for Minimally Invasive Spine Surgery (TSMISS)
President of the Taiwan Society for Endoscopic Spine Surgery 2022 (TSESS)
National and Regional Faculty of the AOSpine Foundation
Member of the Taiwan Spine Society
Member of the Taiwan Orthopedic Association
Member of North American Spine Society (NASS)

board member

C-19

FEASIBILITY OF DEEP LEARNING ALGORITHMS FORREPORTING IN ROUTINE SPINE MAGNETICRESONANCE IMAGING
1Kai-Uwe Lewandrowski
2Naru Muraleedharan,3Steven Allen Eddy,
4Vikram Sobti, and 5Brian D. Reece
Staff Orthopaedic Spine Surgeon Center for Advanced Spine Care of Southern Arizona andSurgical Institute of Tucson
Department of Orthopaedics, Fundacion Universitaria Sanitas
ABSTRACT
Background: Artificial intelligence is gaining traction in automated medical imaging analysis. Development of
more accurate MRI predictors of successful clinical outcomes is necessary to define indications for surgery better,
improve clinical outcomes with targeted minimally invasive and endoscopic procedures, realize cost savings unneeded
spine care.
Objective: To demonstrate the ability for deep learning neural network models to identify features in Magnetic
Resonance Imaging (MRI) DICOM data sets that represent varying intensities or severities of common spinal
pathologies and injuries and to demonstrate the feasibility of generating automated verbal MRI reports comparable
to those produced by reading radiologists.
Methods: Three-dimensional anatomical model of the lumbar spine was fitted to each of the patient’s MRIs
by a team of technicians. MRI T1, T2, sagittal, axial, and transverse reconstruction image series were used to train
segmentation models by the intersection of the 3D model through these image sequences. Class definitions wereextracted from the radiologist report for the central canal – (0) no disc bulge/protrusion/canal stenosis, (1) disc bulge
without canal stenosis, (2) disc bulge resulting in canal stenosis, and (3) disc herniation/protrusion/extrusion resulting
in canal stenosis. For both neural foramina were assessed with either – (0) neural foraminal stenosis absent, or (1)neural foramina are stenosis present. Reporting criteria for the pathologies at each disc level and, when available, thegrading of severity were extracted, and Natural Language Processing (NLP) model was used to generate a verbal andwritten report.
Results: The initial prediction validation of the implemented deep learning algorithm was done on 20% of
the data-set, which was not used for AI training. Out of the 17,800 total disc locations for which MRI images andradiology reports were available, 14,720 were used to train the model, and 3,560 were used to validate against. The
convergence of validation accuracy achieved with the deep learning algorithm for the foraminal stenosis detector was
81% (sensitivity 72.4.4%, specificity 83.1%) after 25 complete iterations through the entire training data-set (epoch).
The accuracy for the central stenosis detector was 86.2 % (sensitivity 91.1%, specificity 82.5%), and 85.2% (sensitivity
81.8%, specificity 87.4%) for the disc herniation detector.
Conclusions: Deep learning algorithms may be used for routine reporting in spine magnetic resonance imaging.
There was a minimal disparity between accuracy, sensitivity, and specificity, indicating that the data was not overfitted
to the training set. The authors concluded that variability in the training data tends to reduce over-fitting andover-training as the deep neural network models learn to focus on the common pathologies. In future studies should
demonstrate its accuracy and predictive value of favorable clinical outcomes with intervention and surgery.

Education and Professional Work" He currently is in private practice at the Center For Advanced Spinal Care of Southern Arizona in Tucson and
the Surgical Institute of Tucson.
" He is a Clinical Assistant Professor at the University of Arizona in Tucson, and visiting Professor at the
Universidade de Estado do Rio de Janeiro, Gaffree Gingle.
" He has authored over 68 papers, over 40 book chapters, 10 posters presentations and edited 13 text books. He
holds 6 patents. He has had numerous national and international speaking engagements.
" In his practice in Tucson, he focuses on minimally invasive spinal surgery to improve clinical outcomes while
minimizing the impact of spinal surgery. He is an expert on outpatient endoscopic spinal surgery procedures andhas published a best-selling text book on it which has been translated in other languages as well.
" In his spare time, Dr. Lewandrowski loves to travel, he speaks 7 languages, and has multiple hobbies including
piano, cooking, sailing, and bee keeping.

board member

C-20

Clinical Update on Minimally Invasive Spinal Treatment(MIST)
Ken Ishii
Department of Orthopaedic Surgery, School of Medicine,International University of Health and Welfare (IUHW)
Various minimally invasive surgery (MIS) techniques are gaining popularity due to an aging population and theneeds of patients with spinal disorders. MIS is a widely developing field that has the potential to decrease surgicalrisks and improve recovery, compared with traditional open spinal surgery. MIS was initially applied for indicationsof spinal decompression surgeries. The percutaneous nucleotomy technique, which was reported by Hijikata in
1975, developed to full-endoscopic surgery (FES). The micro endoscopic discectomy (MED) procedure wasestablished in 1997. To date, these endoscopic surgeries have been spread and applied for various surgicalprocedures including laminectomy, laminoplasty, and foraminotomy, etc.
During the last decade, MIS techniques have also been used for spinal fusion or stabilization techniques, which areclassified as minimally invasive spine stabilization (MISt) procedures including percutaneous pedicle screws (PPS)
fixation, lateral lumbar interbody fusion (XLIF, OLIF, ACR), balloon kyphoplasty (BKP), percutaneousvertebroplasty, interspinous process motion-sparing implant, cortical bone trajectory, cervical total discreplacement, etc. In particular, procedures that PPS are practiced widely, such as MIS-transforaminal lumbarinterbody fusion (TLIF) and MIS long fixation. The indications of MIS-fusion with PPS insertion technique include
various lumbar degenerative diseases, isthmic spondylolisthesis, burst fractures, spinal metastasis, spinal deformity,
as well as spinal infection. These MIS techniques typically provide preservation of paraspinal musculature, less blood
loss, shorter operative time, less postoperative pain, lower infection rate, more cost-effective, compared to
traditional open techniques.
In this lecture, I will introduce the efficacies and benefits of PPS fixation and new aspects related to LIF combinedwith PPS procedure. The spinal surgery has recently experienced much technological innovation. I will also mention
that the computer-assisted navigation and augmented reality demonstrate significant advantages in complicated andintractable MIS cases.

Education and Professional Work
Professor and Chairman,
852 Hatakeda, Narita City, Chiba, 286-8520, Japan
1-4-3, Mita, Minato-ku, Tokyo 108-8329 Japan
Birthplace Tokyo, Japan
TEL +81-3-3451-8121, FAX +81+3-3454-0067, Email kenishii88@gmail.com,
HONORS/AWARDS
2004
Grant of The Uehara Memorial Foundation
2006-2008 Grant of The General Insurance Association of Japan
2009
Grant of Japan Orthopaedics and Traumatology Foundation
2009
Asia Traveling fellowship (Japanese Society for Spine Surgery and Related Research) 20092010
Cervical Spine Research Society Asia Pacific Section (CSRS-AP) Poster Award 20102011
1st Keio Intellectual Property Award 2011
2012
The American Academy of Orthopaedic Surgeons (AAOS) Guest Nation Poster Award 2012
2012
The Japanese Orthopaedic Association Encouragement Award 20122015
Cervical Spine Research Society (CSRS) travelling fellowship 2015
2015
Keio Sanshikai Kitajima Award 20152015
The 30th Annual Research Meeting of the Japanese Orthopaedic Association Poster Award, etc

board member

C-21

Posterior Full Endoscopic Cervical Decompression (P-FECD)
for Unilateral Radiculopathy after Anterior Cervical
Discectomy and Fusion (ACDF)
Keng-Chang Liu
Buddhist Dalin Tzu Chi General Hospital【Introduction】
Neurologic symptoms may occur after ACDF because of inadequate decompression, scar adhesion or naturaldegeneration. The pathologic lesions usually locate on the posterolateral edge of vertebral body. When revisional
surgery is indicated, repeated anterior approach would be disturbed by the adhesive scar and previous interbody
fusion, and associated with high morbidity. Posterior approach should be convenient for decompression, buttraumatization to posterior structure is the main concern. The purpose of this study is to present the potential of
the P-FECD as a good option for revisional surgery after ACDF.
【Materials and Methods】
From Jan. 2020 to Dec. 2021, 4 patients (2 male and 2 female) with a mean age of 49 (range, 42 to 62) years
underwent P-FECD for unilateral radicular symptoms after ACDF. Residual neurologic symptoms occurred in 1
patient, recurrent in 2, and contralateral side symptoms in 1. P-FECD was performed in all 4 patients.
【Results】
After P-FECD, all 4 patients had significant improvement in neurologic symptoms, and obtained excellent
results. There were no intraoperative or postoperative complications. The average hospital stay was 2 days.
【Discussion】
The main lesion for the failed ACDF usually is the posterolateral osteophytosis. P-FECD as a revisional
procedure after ACDF has several advantages: (1) approach is not interfered with scar or previous fusion, (2)adequate posterior decompression can be achieved with posterior structure minimally traumatized, (3)segmental stability is preserved and unnecessary instrumentation can be prevented, and (4) complications
related to repeated anterior approach can be avoided.
【Conclusions】
This study shows P-FECD is a good option of revisional surgery for unilateral radiculopathy after ACDF.

Education and Professional Work
Nationality: Taiwan
Current Postition：
Director, Division of Spine Surgery, Department of Orthopedics, Dalin Tzu Chi General Hospital, Buddhist Tzu
Chi Medical Foundation, Taiwan
Educational Background：Department of Medicine, National Cheng Kung University, Tainan, Taiwan
Department of Orthopedic Surgery, National Cheng Kung University, Taiwan
Current Title:
1. Director, Division of Spine Surgery, Department of Orthopedics, Buddhist Dalin Tzu Chi General Hospital,
Taiwan2. Assistant Professor, School of Medicine, Tzu chi University, Taiwan
Work Performance：
1. Member of Taiwan orthopedic association
2. Member of Taiwan Spine Society
3. Member of Taiwan Society of Minimally Invasive Spine Surgery
4. Board member of Pacific Asian Society of Minimally Invasive Spine Surgery (Representative of Taiwan)
5. Board member of International Society of Endoscopic Spine Surgery (Representative of Taiwan)
6. Board member of Taiwan society of endoscopic spine surgery
E Mail:kengchangliu@gmail.com
kcliu@tzuchi.com.twboard member

C-22

Versatility of Full Endoscopic surgery for lumbar
foraminal and extraforaminal lesions
Kuniyoshi Tsuchiya
Department of Orthopaedics, JCHO Kyushu Hospital
Lumbar extraforaminal lesions are generally considered difficult to treat for two reasons: their diagnosis and theirsurgical difficulties.
In the diagnosis of lumbar extraforaminal lesion, MRI findings is of great importance. In this point, some typicalfindings are reported. Those are horizontal directional change of the pathway and tapering or rupture of nerve root
signals. Far lateral syndrome should be also addressed especially on L5/S1 level.
Double crush lesions, in which single nerve root is compressed at two different areas along its pathway can’t betreated by single approach even with FESS.
Different from double crush, multiple roots involvement is sometimes seen in lumbar pathological condition.
When treating multiple roots involvement at the same level, fusion surgery had been the gold standard for a longtime.
Full endoscopic spine surgery (FESS) can be one of the alternatives for fusion surgery.
Single-side lateral recess stenosis can be treated from outside of the foramen and thus decompression of multiple
roots become possible with single approach using FESS. Foraminal area is also able to be reached from outside of
the foramen and it is an exclusive advantage of FESS.
There is another advantage. Surgical field for extraforaminal lesions tends to be bloody because of the abundanceof small vessels. Perfusion used in FESS serves to keep visual field clear with hydrostatic pressure.
On the other hand, bleeding will put serious effect on vision and massive bleeding makes it impossible to continue
the procedures. Thus, tight control of bleeding, especially of small arteries around the foramen is especially
important in FESS surgery.
All the compressive lesions around single foramen, including far lateral lesion can be treated successfully fromsingle approach with FESS.
In this talk, general management and tips for single portal surgery of lumbar extraforaminal lesions will be
discussed.

Education and Professional Work
Name: Kuniyoshi Tsuchiya M.D., Ph.D.
Director, Department of Orthopaedic Surgery and Chief Spine Surgeon
JCHO Kyushu Hospital
1980-1986: Kyushu University, school of medicine (M.D.)
Graduate school of medicine, Kyushu University (Ph.D.)
LICENSES/CERTIFICATION
2010- : Board certified surgeon of Microendoscopic Spine Surgery
2016- : Board certified surgeon of Full Endoscopic Spine Surgery
Activities:
2012-: Delegate: Japanese Spinal Instrumentation Society
2018-: Delegate: AO spine Japan
2019-: Editorial Committee: guideline for lumbar canal stenosis

board member

C-23

ENDOSCOPIC FUSION KLIF UBE-ENDO TLIF
Malcolm Pestonji
Professor Mgm University Kamothe Navi Mumbai
Abstract
Endoscopic spine fusion is now a reality
Trans facetal lumbar interbody fusion thru the kambin’s triangle has been developed as an indirect decompression
technique being a viable alternative technique to Olif and Alif surgeries
avoiding all the morbidity and complications associated with the above procedures also with the advantage of being
able to do L5 S1 fusions all under local anaesthesia with patient awake and aware doing his own Neuromonitoring
as a distinct advantage
Alternatively the development of unilateral bi portal Endoscopy as an effective tool for endoscopic fusion especiallyin cases of redo spine surgeries and also under awake sensory epidural anaesthesia has augmented thearmamentarium of endoscopic spine surgeons to evolve in dealing with all degenerative spine pathologies
combining all posterior pathologies with anterior visualised end plate preparation giving both the benefits of direct
and indirect decompression
The era of spine endoscopy has truely awakened

Education and Professional WorkDr Malcolm D Pestonji MS Ortho, D Ortho Mob: +91 9326471376 Orthopaedic Spine Surgeon ,Regd no 64209
Off : 0250-2334780 Golden Park Hospital Res: 0250-2334992 Vasai (West)
Current Attachments
Orthopedic Endoscopic Spine Surgeon Golden Park Hospital Vasai. Honorary Professor of Endoscopic Spine
Surgery MGM University of Health Science, Navi Mumbai, Kamothe. Honorary Professor of Endoscopic Spine
Surgery at Bareilly International University & Rohilkand Medical College Hospital, Honorary Endoscopic Spine
Surgeon Holy Spirit Hospital Mahakali Andheri (East) Mumbai.
Publications:Operative Manual-Transforaminal Stitchless Surgery Under Local Anaesthesia for Lumbar Spine, January 2019
Bentham’s Contemporary Endoscopic Spine Surgery Cervical Spine
MY VISION
Endoscopic spine surgery has evolved into a safe result oriented surgery the world over. Today due to changing
patient demographics there is a higher incidence of canal stenosis in the spondylotic spine along with many otherproblems. Endoscopic spine surgery is the answer to all those problems. I will be honored to be a faculty at Fortis
Hospital Mulund for Endoscopic Spine Surgery

board member

C-24

Pain management for top athletes with spinal facet
joint disorders and ossification disorders
Masataka Sakane
Department of Orthopedic Surgery & Rehabilitation Tsukuba Gakuen Hospital
It is easy to imagine that repetitive movements due to the competitive characteristics of top athletes exert amechanical load on the spinal facet joints. However, the diagnosis tends to be delayed and the treatment forchronic pain is not enough for early recovery. We will present some examples of top athletes in various sports
who have returned to the competition after performing diagnosis for spinal facet joint pain and ossification
disorder, nerve ablation using radio waves, nerve block, and minimally invasive surgery.
Patients: Two baseball pitchers (1 professional, 1 university), 1 professional baseball fielder, 1 sepak takraw
player, 1 rugby forward, and 1 hammer thrower. After clinical diagnosis, level diagnosis is performed using
selective nerve / facet joint block, and radio wave device (Neurothermo NT500, Abott Medical) was used.
Under local anesthesia and C-arm, we used in an appropriate combination of nerve destruction mode (80degrees, continuous wave 60 for seconds) and nerve block mode (42 degrees, pulse wave for 120 seconds).
Results: Facet joint disorders and ossification disorders occurred on the opposite side of the pitcher and on thesame side of the fielder. Hammer throw (counterclockwise rotation) resulted in a right disc herniated disk andleft ossification at the thoracolumbar junction.
After rhizotomy of symptom-reproducible facet joints, upper and lower facet joints, and transverse processes,
athletic rehabilitation started about 1 week later, and it was possible to return to competition in 2 months, andthe effect lasted for 6-12 months. Athletes with hernia and ossification of the ligamentum flavum underwent
surgery under a microscope and returned in 6 months.
Conclusion: Top athletes' facet joint disorders and ligament ossification are affected by competitive
characteristics, and high-frequency nerve block treatment is effective for chronic pain for a certain period oftime.

Education and Professional Work
Name ： Masataka Sakane, MD, PhD
Date of Birth： 16/09.1963
Education：MD 1989 School of Medicine, University of Tsukuba
PhD 1998 University of Tsukuba
Work Experience：
1989 Orthopedic resident, Tsukuba University Hospital
1995 Research fellow, Pittsburgh University
1999 Assistant professor, Ibaraki Prefectural University
2002 Assistant professor, University of Tsukuba
2008 Associate professor, University of Tsukuba
2016 Director, Orthopedic surgery & Rehabilitation, Tsukuba Gakuen Hospitalboard member

C-25

Let's master the power tool for screw insertion
Masatsune Yamagata
Spine and Low Back Pain Center,
Dept of Orthopaedic Surgery, Chiba Rosai Hospital, Ichihara, Chiba JAPANThe work of inserting screws and fixing them is widely performed in the world. A screwdriver is used for
fixing, but recently power tools are often used. However, only few spine surgeons are experiencing. The fieldof spine lags behind other fields probably because of the major safety issues. However, with the progress ofengineering technology, power tools that can be safely used in the spine field have been developed. I will
introduce this power tool. The torque can be maintained at low speed, and it is possible to insert the screw byfeeling the manual owl insertion.
Technique: A 3 mm burr is used to create a hole in the posterior elements as the entry point, then a 2.4 mm
flexible drill is inserted through the opening burr hole. A power drill can be used safely and slowly. The
flexibility of the specially designed 2.4 mm drill bit allows the drill to deflect off hard cortical channels of thepedicle and redirects to preferentially advance down the pedicle channel. Next, a 3 mm blunt-tipped reamer isinserted into the pedicle channel to complete the pedicle cannulation. It may reduce radiation exposure during
surgeries.
There are some reports about the accuracy of pedicle screw placement. The powered instruments inserted
pedicle screws as accurately as did conventional manual instruments. In addition, the use of power instruments
significantly reduced the time needed for inserting pedicle screws.
Conclusions: Power pedicle preparation and screw insertion offers a safe and efficient alternative to manualtechniques with the following potential advantages: 1. Less screw toggle, which is associated with stronger
screw purchase, 2. Less force applied to the patient’s spine, which is desirable from safety, 3. Less muscle
exertion for the surgeon, which could reduce overuse injuries of surgeons. 4. Less exposure of radiation during
surgery.

Education and Professional Work
Affiliation:
Spine and Low Back Pain Center
Department of Orthopaedic Surgery Chiba Rosai Hospital, Japan Organization of Occupational Health and Safety
2-16, Tatsumidai-Higashi, Ichihara, Chiba, Japan 290-0003
Phone: 81-436-74-1111
1976 Japanese Orthopaedic Association,(Director 2015-2019, Honorary Member)1986 Japan Spine Research Society
1990 International Society for the Study of the Lumbar Spine, (Senior Member)1991 The Japanese Society for Spine Surgery and Related Research
1998 Japan Society for Endoscopic Surgery (Councilor, Special Member)1999 Japanese Society for the Study of Endoscopic & Minimally Invasive Spine Surgery(Honorary Member, President 2001)
2001 Pacific and Asian Society of Minimally Invasive Spine Surgery(Board Member President 2021)
2009 The Japanese Society of Lumbar Spine Disorders(Director President 2015)2016 ISESS, International Society of Endoscopic Spine Surgery(executive committee 2018 Vice President of the 2nd meeting of ISESS)

board member

C-26

Endoscopic spine surgery is not equal endoscopic spine surgery- What are the differences and examples of 20 years personal experience Michael Schubert
Apex-spine
Background:
Microscopic dorsal lumbar discectomy is still the gold standard treatment for lumbar symptomatic disc herniation.
To reduce the complication rate and to eliminate the risks of general anaesthesia, more minimal invasive procedures
gain significant interest in patients and spine surgeons. In the last 60 years several other less invasive percutaneoustechniques have been developed.
Patient Sample:
Various treatment options from 20 years of endoscopic spinal surgery are shown as examples
Purpose:Demonstration of the differences of endoscopic spine surgery like interlaminar or transforaminal and as outside-in
or insideout technique and personal experiences (ETD).
Methods:
All patients were treated under local anaesthesia and could be discharged the day after surgery. From a lateralapproach under X-ray control first the foramen intervertebrale was enlarged and a working cannula and an endoscope
was inserted in the ventral part of the spinal canal (TED). The prolapsed or extruded part was removed underendosopic vision with special forcepses. Different case reports of spine surgery complications or spine problems
where endoscopy is the best solution to avoid major surgery
Results:
Endoscopy spine surgery of the thoracal and lumbar spine is possible also for almost all problems in the spinal canal.
Like removal of disc herniations, cyst decompression, bone cement dislocation after kyphoplasy, bone fragment
removal independent of location in lumbar or thoracic spine.
Conclusion:
The endoscopic transforaminal discectomy (TED) in the out-side-in technique appears to be a safe, effective
procedure without significant complications and it seems a good alternative to other endoscopic spine proceduresor open microdiscectomy independent of size or location of the herniated disc or presence foraminal stenosis as well

Education and Professional Work
Sciences
Since 1989 More than 14.000 spine surgery’s
Since 1989 Around 10.000 endoscopic spine procedures
Since 1989 More than 300 oral presentations in the field of spine
Since 1989 Multiple publications and book chapters
Since 2003 International instructor and visiting professor
Since 2003 More than 400 trained spine surgeons
Since 1990 Member of multiple Spine organizations (NASS, ISASS, ISMISS; IITS; DWG, etc.)

board member

C-27

MIS fixation for acute cervical spine injury
Nobuyuki Shimokawa, Hidetoshi Sato, Takafumi Inoue
Department of neurosurgery, Tsukazaki hospital, Hyogo,
Japan
Introduction: The application of MIS for cervical spine injury is getting available with the development ofsurgical peripherals such as intraoperative navigation systems. It is important to carry out MIS fixation safely
and reliably.
Aim:To present utility and safety of MIS fixation such as osteosynthesis using O-Arm for cervical spine injuries
Materials and Methods:Since 2017, internal fixation was performed using O-arm for 7 consecutive cases ofcervical spine injury. The age ranged from 25 to 72 years, with an average age of 58.7 years. There were 4 males
and 3 females. The breakdown of the cervical spine injury was Hangman fracture in 3 cases, hemi-lateral lateralmass fracture in 1 case, Anderson type 3 axial dens fracture in 1 case, C2 vertebral body fracture in 1 case, andhemi-lateral pedicle fracture in 1 case. For reducible fractures, so-called osteosynthesis with screw crossing thefracture line, applying manual compression force to the fracture line was performed. For C2 dens fractures, C1
lateral mass screws and C2 pedicle screws were inserted for minimal invasive fashion.
Results: Bony fusion of the fracture line was obtained in the postoperative image evaluation in all cases. Implant
was removed from 4 months to 1 year after obtaining bony fusion of the fracture.
Conclusion: Internal fixation with MIS such as osteosynthesis for acute cervical spinal injury is considered to be
one optional technique of the safe and useful surgical techniques.

Education and Professional Work

Personal information
Name:Nobuyuki Shimokawa
Job Title: Head of Spine Center & Chairman of the Department of Neurosurgery
Department: Spine Center & Neurosurgery
Institution: Tsukazaki Hospital, Himeji city, Hyogo, JapanCountry: JapanE mail: nobu-shimo0215@snow.odn.ne.jp

Birth:1965/02/15

Academic Interests
2016-2021 Member of WFNS Spine committee
2016-at present
Member of The Section on Disorders of the Spine and Peripheral Nerves (DSPN)
2016-at present
Member of American Association of Neurological Surgeons (AANS)
2015-at present
Member of Cervical Spine Research Society Asia Pacific Section (CSRS-AP) & CSRS-Japan
2015- at present Delegate of AO spine Japan
2015-at present
Member of Board Trustee of the Neurospinal Society of Japan（NSJ)
2014 -at present Member of Congress of Neurosurgical Surgeons (CNS)
2013-2015 Inspector of Japanese Society of Spinal Surgery
2012-at present Review Board of Neurologia medico-chirurgica (official journal of the Japan Neurosurgical Society)2012 at present Editorial Board of the Japan Society of Neurotraumatology
2012-at present Editorial Board of the Japan Society of Neurosurgical Emergency
2012 –at present Editorial Board of the Japan Medical Society of Spinal Cord Lesion
2010-at present Member of Board Trustee of the Japan Society for the Study of Surgical Technique for Spine andSpinal Nerves2010 Board certification as Senior Member (Instructor) and Review Board SPINAL SURGERY (official journal ofJapanese Society of Spinal Surgery) by Japanese Society of Spinal Surgery
2008 Board certification as Technical Specialist by the Japanese Society of Neuroendoscopy
2006 Board certification as Spinal Surgeon by the Japanese Society of Spinal Surgery
2005 Stroke Specialist certified by the Japan Stroke Society
1997 Board certification as Neurosurgeon by Japan Neurosurgical Society

board member

C-28

Outcome of lumbar lateral recess stenosis with PSLD
Nurbyek Baban
Grand-Med hospital, Mongolia
Background:
Lateral recess stenosis is common pathology causing leg pain in the elderly population. Lateral recess stenosis is
usually caused by the herniation of the intervertebral disc, hypertrophy of the articular process, and hypertrophyof the ligamentum flavum. In the elderly population usually associated morbidity. Endoscopic decompression,
there are advantages in the operation technique, such as reduced traumatization.
For the development of endoscopic spine surgery in Mongolia, we started PSLD at January, 2018.
Percutaneous stenoscopic lumbar decompression (PSLD), optimized for lumbar stenosis is fitted for a surgeon
to perform laminectomy, flavectomy, foraminotomy and discectomy unilateral approach and bilateraldecompression as well as multi-level decompression.
Methods:
The study was retrospectively conducted with 100 consecutive cases, treated with PSLD under spinal epidural
anesthesia between 1th July 2019 to 1th June 2020.
Results:
Mean age of patients was 64.4 ± 5.4 years. Mean symptom duration was 24.1 ± 12.8 months. Postoperative
MRI revealed that PSLD increased the canal volume by mean 47.7% of preoperative one at the index segment(P< 0.001) and demonstrated that damage in the normal soft tissue including muscles and the extent ofremoved normal bony tissues appeared minimal. The mean improvements of VAS score and ODI were 4.0 (P<0.001) and 40% (P<0.001) respectively. Macnab outcome grade was 96% of patients. Mean duration ofoperating times was 32 minutes for unilateral decompression of 1 level and mean hospital stay 2.2 days.
Conclusion:
Decompression of spinal canal stenosis with PSLD not only improved the clinical outcomes but also increased
significantly canal volume at each index segments. The main advantage of this new technique in the current
study should be a potential of uniportal multi-level procedures under epidural anesthesia minimal damage of
normal anatomical structures surrounding the pathology, and short hospitalization.

Education and Professional Work
Personal data:
Family name: Baban First name: Nurbyek
E-mail: nurbeke@yahoo.com Telephone: 976-89117766
Current employer address: Grandmed hospital, Khan-Uul district Ulaanbaatar, Mongolia
Certificate
Mongolian National University of Medical Science, Postgraduate course of Surgery, Surgeon October 2009 – April 2011
Diploma
Mongolian National University of Medical Science, Medical Doctor, Bachelor of Science 2002-2008 Diploma
Bayan –Ulgii, secondary school №1
1992-2002
Professional Interest:
Endoscopic spine surgery

board member

C-29

Tubular Retractors as a Minimally Invasive
Technique for an Anterior Approach to C1-C2
Rafael Cruz Bundoc
University of the Philippines
Anterior approaches directed to decompress pathologies of C1 and C2 is technically challenging. The
conventional open technique involves a lot of possible collateral damage to the anatomy of the oral cavity andnasopharynx in retracting structures to gain our access to the atlanto-axial spine. This lecture describes analternative minimally invasive procedure to C1 and C2 utilizing tubular retractors over conventional open
mouth retractor systems. The lecture will demonstrate how one can use a tubular-endoscope set up to
decompress a tuberculous spondylitis at C1 and C2 as a classic example. It will show the simple instruments
needed to carry out the procedure in a systematic fashion. It is the aim of this lecture to provide a viable tool
when we plan future procedures involving an anterior approach to the atlanto-axial spine.

Education and Professional Work
Major Awards:
Philippine Talent Search for Young Scientist, Gold Award, given by the National Academy of Science andTechnology, 1995
TOYM (The Outstanding Young Men) Award in the Field of Medicine, 1997
Joseph Trueta Fellowship Awards, given by the Nuffield Orthopaedic Center,
Oxford University, United Kingdom, 1998
Honorary Fellow of the Girdlestone Society, given by the Nuffield Orthopaedic Center, 1999
TOYS (The Outstanding Young Scientist) Award given by National Academy of Science and Technology, 2000
Outstanding Philippine Doctors Award given by the Philippine Jaycees in cooperation with Department of Health,World Health Organization and Philippine Medical] Association, 2004
Metrobank Outstanding Teacher for 2005 given by the Metrobank Foundation
Eisenhower Fellow 2008 given by the Eisenhower Fellowship Foundation
Areas of Expertise: Cervical Spine Surgery
Scoliosis and Spine Deformity Surgery
Minimally Invasive Spine Surgery
Design/ Innovation of Instruments
Biomechanical Testing
Anatomical Studies
Prosthetic/Orthotic design
3D Printing surgical applications

board member

C-30

Full-endoscopic KLIF and Educational System in Japan
Seiji Yamaya
Department of Orthopaedic Surgery, Sendai Nishitaga Hospital
BackgroundFull-endoscopic trans-Kambin lumbar interbody fusion (KLIF) was reported in Japan in 2018. It consists ofsurgical procedures with posterior percutaneous pedicle screw fixation and full-endoscopic anterior interbody
fusion using a tran-Kambin approach. It developed for treating degenerative lumbar spondylolisthesis. KLIF canperform indirect decompression like XLIF or OLIF. XLIF or OLIF had some reports about serious complications
such as intestinal and major vascular injuries. Such complications are less likely to occur in KLIF due todifference approach. However, KLIF needs the peculiar attention to avoid exiting nerve root injury (ENRI)
because the surgical technique based on transforaminal full-endoscopic lumbar discectomy (TELD). ENRI hada reported frequency of 1.0%-8.9% and is known to reduce physical function and overall patient satisfaction
after TELD.
The educational system of TELD and KLIF is provided in Tokushima Univ in Japan. Surgeon can master thesurgical technique through seminar using the dry model and fresh cadaver. Before performing the KLIF, thesurgeon should be familiar with the surgical procedure of TELD under local anesthesia and foraminoplastic
outside-in technique to avoid ENRI. I started to perform KLIF after getting this educational system in 2018.
Objectives
There were few reports of KLIF. We studied the clinical outcomes, complications and intervertebral fusion rates
of initial 22 patients performed KLIF at one year postoperatively.
Methods
22 cases were performed KLIF by the same surgeon from November 2018 to 2020. The clinical outcomes (JOA
score, JOABPEQ, Visual analog scale of low back pain and lower extremity pain) and complications were
prospectively evaluated at 1 week, 1, 3, 6 and 12 months postoperatively. The degree of slippage (% slip) was
measured on an X-ray before and one year after surgery. The intervertebral fusion rate was evaluated using CT
one year after surgery.
Results
All of clinical outcomes improved significantly from as early as 1 month postoperatively compared topreoperatively. There were no serious complications. A transient symptom of exiting nerve root occurred in one
case, which improved after one month. The degree of slippage (% slip) improved significantly from 22% before
surgery to 8% after surgery, and the interbody bone fusion rate was 91% at one year postoperatively.
Conclusions
KLIF was an excellent minimally invasive procedure with good clinical results, reduction, and high interbody
fusion rate (91%). This procedure had no serious complications. In order to spread this surgical techniquesafely, it is important to develop the educational systems of TELD and KLIF for surgeons.

Education and Professional Work
Education: 2003, MD degree, Jichi Medical University.
2014, PhD degree, Department of Orthopaedic Surgery, Tohoku University.
Board certification in Japan: 2003 National Board of Medical Doctor. 2011 Approved Orthopaedic Surgeon by
Japanese Orthopaedic Association
2015 Board-certified spine surgeon (approved by the board of the Japanese Society for the Spine Surgery and
Related Research)2016 Board-certified endoscopic spine surgeon MED (approved by Japanese Orthopaedic Association)
2021 Board-certified endoscopic spine surgeon FED (approved by Japanese Orthopaedic Association)
Professional and academic employment history
2003 Iwate Prefectural Cyuou Hospital2010 Department of Orthopaedic Surgery, Tohoku University
2015 Clinical Spine Fellow (MED) of JSSR
Department of Orthopaedic Surgery, Wakayama Medical University
2017 Clinical Spine Fellow (FED) of JSSR
Department of Orthopaedic Surgery, Tokushima University
2017 an assistant professor, Tohoku University
2018 Director of the Center of Endoscopic Spine Surgery, Orthopaedic Surgery, Sendai Nishitaga Hospitalboard member

C-31

Myogelosis: Skin-to-Muscle Reflex and Effects
of Skin-Contact Substances
Shoichi Kokubun
Professor Emeritus, Tohoku University
NHO Sendai Nishitaga Hospital, Sendai, Japan
Myogelosis, hypertonicity of the muscle at rest, causes almost all nonspecific pain.
Pain and neurological hyperalgesia to pinprick are expressed in the skin area of the responsible muscle. The skinareas of muscles are completely different from those of nerve roots (dermatomes) and peripheral nerves.
The human body has a muscle tone regulation system comprising the muscle-to-muscle reflex by muscle
contraction, stretch or pressure and the skin-to-muscle reflex by stimulation to the skin. Recently, regarding
the latter, it was found that substances such as polyester, polyethylene and silicone generate excitatory inputs
and as a result, they heighten the muscle tone and cause pain. In contrast, inhibitory substances such as acrylic
fiber, acrylic resin and polyurethane lower the muscle tone and solve pain.
Wearing clothes including a mask and socks and ear pieces containing inhibitory substances instead of excitatory
substances is an essential treatment requirement. An effective self-treatment is affixation of adhesive tape withacrylic resin to the skin area of the responsible muscle. (163 words)

Education and Professional Work
Shoichi Kokubun, MD, PhD
Professor Emeritus Tohoku University
Research Center for Spine and Spinal Cord Disorders
NHO Sendai Nishitaga Hospital
2-11-11 Kagitori-Honcho, Taihaku-ku,
Sendai 982-8555, Japan
His major research and clinical activities are pediatric orthopaedics and spine and spinal cord surgery. He is theauthor of more than 150 original publications in English.
Internationally, the 2nd Triennial Congress of the International Federation of Paediatric Orthopaedic Societies(IFPOS) was a great success under his presidency in Sendai in 2001. He was National Delegate to SICOT (19992005), Chief National Delegate to the Asia-Pacific Orthopaedic Association (APOA) (2001-2006), and Chairmanof the Spine Section, APOA (2005-2008). He actively contributed to Bone and Joint Decade (2000-2010) as amember of its International Steering Committee from 2003 to 2010. He is now President of APOA (2021-2022).
At home, as Congress President, he held the Annual Congress of the Japanese Orthopaedic Association in 2004
and the Annual Meeting of the Japanese Spine Research Society in 2005. In addition, he was President in chargeof management of the Japanese Pediatric Orthopaedic Association from 2003 to 2009 and President of Japan
Orthopaedics and Traumatology Research Foundation, Inc., Tokyo, Japan from 2007 to 2017. He was given theAward for the Development of the Japanese Orthopaedic Association in 2018.

board member

C-32

UBE (Biportal Endoscopic Spine Surgery)
Son, Sang Kyu
Park Weon Wook Hospital
Looking for ways to treat spine better is still in process. Definitely, the UBE (Unilateral Biportal Endoscopy) is oneof those pursuits.
I would like to share some of the history related with the efforts made by forerunners in the journey of UBE. Dr. D J
De Antoni, an Argentine surgeon, published an article on lumbar discectomy using arthroscopy in 1996. Dr. Abdul
Gaffar from Bahrain presented poster on the same surgical technique on AAOS 2001. Dr. Eum, Jin Hwa introduced
Dr.Abdul Gaffar to Korean Spine Society in 2001. Dr. Eum, who modified lateral position to prone position andapplied the arthroacre® in spine surgery, performed the first case of lumbar discectomy in Korea. Since 2003, Dr.
Son, Sang Kyu established UBE basics (anatomy, concepts, instruments) and advanced to perform stenosis andfusion cases for the first time in the world. Dr. Son had held many professional training seminars to spread out thissurgical technique and became the 1st. president of UBE research society. Dr. Heo, Dong Hwa has spared no effort
to accumulate academic evidence while publishing papers. Prof. Lee, Sung who was the 2nd. President of UBE
research Society and Dr. Park, Chun Kun did lots of work to enlist the UBE as the Korean official surgery. The
pursuit for UBE development is still underway by the 3rd. president, Dr. Park, Chul Woong and many other young
surgeons such as Dr. Park, Man Kyu. So many professors and doctors in KOMISS and KOSESS are behind UBE
Until now, over 100UBE-related papers have been published globally. In about 27 number of countries, the UBE
surgery is being performed. Especially, the Turkey, China and India established local UBE Society and train theirlocal spine surgeons
to perform UBE surgery.
Following is the short summary on what is UBE. Every endoscopic procedure needs ‘working space’, but there is noclear pre-existing working space in the spinal posterior approach. The key point of UBE is how to make ‘working
space’. For the critical purpose, understanding the structure of the spinal anatomy. There is potential space between
multifidus muscle and lamina, and interfascicular space between small muscles of multifidus. UBE is the endoscopic
procedure being performed while utilizing the potential space to convert ‘atraumatic working space’.UBE is aminimally invasive surgery which focuses on saving muscle, not skin incision. UBE also follows the standard surgicalprinciple and techniques as in conventional surgery, with only critical difference of its being performed under fluidmedium.
The 8 basic concepts for UBE can be summarized such as below. Unilateral biportal endoscopy, fluid-medium
surgery, triangulation, semi-tubular system at working portal, one-hand surgery, lens inside, lens to be movable (notfixed) and pivot movement of instruments. UBE has nearly same indication as microsurgery and in some diseases
such as cervical foraminotomy, L5S1 extra foraminotomy, it shows better result than microsurgery. Still, thefollowing cases are contraindicated such as the high cervical disease, anterior cervical approach, severe OPLL, highgrade lumbar spondylolisthesis, severe scoliosis, severe trauma, severe infection, most all tumor etc.
Future agenda for UBE development includes accumulating more evidence, more microscopic surgeons perform the
UBE cases along with conversion trend of microscopic surgery to endoscopic surgery as witnessed in other surgicalarea. Last but not least, the development of UBE till now, technically and instrument-wise, can become thefoundation for robotic surgery and AI-based surgical solution.

Education and Professional Work
Son, Sang Kyu., M.D
General Director, Park Weon Wook Hospital in Busan, Korea
Mobile: +82-10-8575-9871
Email: bread0309@hanmail.net
Main Career & Activities
The First President of UBE Research Society (2017-2018)
The First President of Spine Endoscopy Research Society (2019-2020)(Present) Director for International Exchange, KOMISS(Present) Director for International Public Relations, KOSESS(Present) Honorary chairman of Turkish, Indian and Chinese UBE Society(Present) UBE Global Master, UBE development/training since 2003
(Present) General Director, International UBE Academy, Park Weon Wook Hospital(Present) Global Reference doctor for EndoSpineMax, UBE Solution Prodvider(Present) Chairperson, International Society of Unilateral Biportal Endoscopy (ISUBE)

board member

C-33

WHEN TRANSFORAMİNAL, WHEN UBE?
Tarik Yazar
Department of Orthopaedics University of Ankara
Almost all procedures in invasive surgery can be performed with UBE. We can do these attempts by creating
minimal trauma to the patient.
If it is necessary to reach the middle part of the neural canal, the UBE has the upper hand. Multilevel spinal
stenoses, diffuse stenoses are more easily resolved with UBE. Solution of possible complications is easier withUBE.
In UBE it is difficult to reach outside the middle part of the foramen. This requires personal talent and special
tools. The ipsilateral side is even more difficult. May require additional extra foraminal intervention.
If there is central stenosis, if it is moderate, if the recesses are good, if it is unilateral, it is better to enter fromthe lateral. No need to open ligamentum flavum. Better to approach paravertebral.
If deformity and degeneration are together, if there is stenosis on the concave side, if the scoliosis is more than
20 degrees, two-level decompression with paravertebral entry from the concave side is better.
If it is not necessary to go to the middle layer of the disc, it is correct to go transforaminal, if it issubligamentous, it is better to go transforaminal.
Both methods should be included in our surgical armamentarium. From time to time, one of the methods may
gain a priority indication. It may be necessary to apply both techniques in the same case, one after the other.
As a result, the spinal endoscopic surgeon must undergo a training that can use both techniques together.

Education and Professional Work
Place of birth
Artvin,Turkey
Date of birth
Nationality

26th of may 1951
Turkısh• In 1988, he graduated from Ankara University Faculty of Medicine, Department of Orthopedics andTraumatology. became an Associate Professor.
•In 1988, he received a patent number 28534 for the mechanical spinal system used in the treatment of spine,
trauma and deformity diseases, whose research was carried out at the Vienna International Patent Institute, andthis mechanical spinal system was produced in our country.
•He became a professor at Ankara University Faculty of Medicine in 2001.

board member

C-34

The advantage of DPEL over MED in the access to thespinal neural element
Tatsushi Inoue
Fujita Health University
Endoscopic laminotomy under irrigation is recently gaining increasing popularity. Professor Dezawa had
developed his original scope (DPEL) with 6mm working channel, which enables to use 4mm Kerrison rongeur
and 4mm-tip drill and to perform speedy bone removal. The DPEL is advantageous over MED in the access tothe spinal neural element about ten times, measured by Access Ratio (AR), which was defined as the maximal
ratio of the index root to the thecal sac in the operative field.
In this presentation, we also focus on safe detachment technique under water irrigation of the ligamentum
flavum from the theca.

Education and Professional WorkPRESENT APPOINTMENT:
Associate Professor
Department of Neurosurgery andDepartment of Spine and Spinal Cord Surgery
Fujita Health University
1-98 Dengakugakubo, Kutsukake-cho Toyoake, Aichi 470-1192, JAPANMEMBERS IN PROFESSIONAL SOCIETIES:Japan Neurosurgical Society
Japan Congress of Neurological Surgeons
The Japanese Society of Spine Surgery
The Japanese Society of Skull Base Surgery
Japanese Congress on Surgery for Cerebral Stroke
The Japanese Society for Pediatric Neurosurgery
Congress of Neurological Surgeons (US)American Association of Neurological Surgeons
American Association of Neurological Surgeons Spine Section
MAIN RESEARCH INTEREST:
Minimally Invasive Spinal Surgery
Skull Base Surgery

board member

C-35

Percutaneous Endoscopic Thoracic Discectomy
Tolgay Satana
Op. Dr. Tolgay Satana
ウェブサイトObjective:
The modern era of surgical endoscopy was initiated by the introduction of video-assisted endoscopic capabilities
in the late 1970s and 1980s.
経路案内
Arthroscopy for the
diagnosis and treatment of knee and shoulder pathologies grew and essentially replaced
open techniques. The revolutionary growth of laparoscopic general surgery began in the late 1980s.
保存
Indication:
Endoscopic strategies have been and are being employed predominantly for the treatment of the following
conditions: Lumbar, thoracic and cervical disc herniations with radicular symptoms foraminal stenosis withradicular symptoms degenerative facet joint cysts with radicular symptoms Diagnosis: Pretending Cardiologic,
Gastroenterologic symptoms Intestinal complaining, Fake Hearth attacks Medullapathy Spasticity Deepsensorial loose Sensorial disabilities Pain (lower extremity beside intestinal
Method:Posteriorlateral Thoracic Discectomy along the red arrow for avoidance of trauma to the nerve, spinal cord,
plural cavity, the lung and in the
costal artery via the “safety zone “Approach for Posterior lateral Thoracic Discectomy under fluoroscopic
guidance between the pedicle and rib
headline into the safety zone for discectomy Incrementally advanced at a 35? 45-degree angle from the sagittal
plain toward the center of the discThrough the “safety zone” between the inter-pedicular line and? the rib head Confirmatory provocative
discography to follow
Material:
2014-2021
24 patients were included prospective study
14 females 10 males
Main age 54
Follow up 18 m (range 3-48 months)
Results:
Patients responds are statistically significant improvement in the VAS, SLR test, ODI..
In regarding to quality of life, there was a statistically no significant increment (pEducation and Professional Work
Executive Member of IMLAS since 2000
Secretary of IMLAS Istanbul 2005
Guest Editor in Turkish Journal of Joint Surgery
Active member of Bone and Joint Turkey Osteoporosis and Osteoarthritis congress responsible of Spine section
for 9 years.
Member of Turkish Spine Society
Member of Turkish Ortopedic society
Board member of ISMISS and national representative of Turkey since 2005
Chairman of Turkish Chapter of ISLASSWALA board member
Founder and President of Turkish MISSFounder and Coordinator of ISMISS Turkey 2003-14
President of World Federation miss Congress in Istanbul and board member

board member

C-36

Thoracic Disc Herniation: An Extended Indication
for Full-Endoscopic Spine Surgery
Verapan Kuansongtham, Withawin Kesornsak
Bumrungrad International Hospital
Background
Symptomatic herniated thoracic disc (HTDs) account for only 0.15-1.8% of all intervertebral disc abnormalities
treated surgically. Surgical approaches include open thoracotomy and fusion, video-assisted thoracotomy anddiscectomy and posterior decompression with or without fusion. Full-endoscopic spine surgery has become more
popular in recent years. It offers less traumatization and improves early recovery while showing comparable
outcomes to the standard operations. In this presentation we present 2 clinical experience of thoracic discherniation treated successfully with endoscopic approach.
Main Idea
Unlike lower lumbar spine that the existing natural corridor is usually sufficient to pass the endoscope directly tothe pathology without bone resection, the opening either from the foraminal side or interlaminar side is relatively
narrow. Therefore, the surgeon must be very familiar with bone drilling to perform the endoscopic surgery in thisarea. Furthermore, it is imperative that there must be zero manipulation of the spinal cord to avoid injuring the
spinal any further. In this presentation we demonstrated the extraforaminal approach and interlaminar approach
respectively.
Conclusion
Full-endoscopic spinal surgery is another good alternative for soft thoracic disc herniation. It offers excellent
visualization of the surgical field. The patient can recover faster due to minimal tissue traumatization. However, it
is highly specialized procedure that needs specialized training.

Education and Professional Work168 • SUKHUMVIT 85 • BANGJAK • PRAKANONG • BANGKOK 10260 • THAI LAND TELEPHONE: +66 2
730 0333 • MOBILE: + 66 81 808 1188 FACSIMILE: +66 2 730 0777 • EMAIL: Verapan@Bumrungrad . com
SPECIAL CLINICAL TRAININGS
2007
International Training Course for Full Endoscopic Spine Surgery Herne/Cologne, Germany
2005
Radiosurgery and Radiotherapy BrainLAB Academy, Germany
2005
Gamma knife training
Karolinska University Hospital Gamma Knife Center, Stockholm, Sweden
SPECIAL CLINICAL INTERESTS
Full endoscopic lumbar and cervical surgery
o affiliated with St Anna Hospital Herne, Germanyo jointly organize annual training course for spine surgeons in Asiao co-instructor of training course in Germanyo supervises training at Ramathibodi Hospital
Percutaneous pedicular screw with minimally invasive inter-body fusion (supervises training
at Ramathibodi Hospital)
Minimally invasive neurosurgery

board member

C-37

MISS for Tuberculous spondylitis
Wiwat Wajanavisit
Ramathibodi Hospital, Mahidol University
Tuberculosis occurs in every part of the world. In 2020, the largest number of new TB cases occurred in Asia,with 60% of new cases. TB spine still often occurs and causes devastated results. The standard operation for TB
spine is anterior approach to undergo abscess drainage, debridement and fusion with bone graft. MISS is
another choice for the patient who is malnourished and could not tolerate to a major surgery. Percutaneous
Endoscopic Lumbar Debridement (PELD) under local anaesthesia is able to drain the surrounding abscess andalso the epidural abscess. Endoscopic debridement could successfully remove debris, caseous necrosis andsequestrated disc of TB spine.

Education and Professional WorkDATE OF BIRTH 20th June 1956
PLACE OF BIRTH Bangkok, Thailand
20/06/2016 –present Department of Orthopaedics Faculty of Medicine,Ramathibodi Hospital, Mahidol University
OFFICIAL APPOINTMENT 24th September 1990
TEL: +662-201-1589, FAX: +662-201-159 E-mail:wiwat.waj@mahidol.ac.th

HYPERLINK"mailto:wiwat.waj@mahidol.ac.th"board member

C-38

Percutaneous endoscopic transforaminal lumbar interbody
fusion: a novel technique- sentinel pinning with lateralretractor for protection of exiting root
Yi-Hung Huang1,21.Chia Yi Christian Hospital2.

National Cheng Kung University Hospital Taiwan

The endoscopic spine surgery (ESS) is rapidly developed and ESS combined with TLIF(endo-TLIF) is new
trend due to the least traumatization. The safe zone of foramen (Kambin triangle) is so limited, therefore
implanting a cage into disc space away from the exiting root or dura injury is a major challenge. We developed anovel technique “sentinel pinning with a retractor” to protect the exiting root as application of tunnel protector
and to implant a fixed size cage. The complete procedures were well described, and effectiveness was surveyed.
Methods and material
We inserted contralateral percutaneous pedicle screws firstly, inserted the guide-pin to the SAP, performed
foraminoplasty, discectomy and endplate preparing and inserted the sentinel pin docking at inferolateral borderof the cranial vertebral body under the monitor of endoscope and fluoroscope. We harvested synthetic bone
graft mixing with bone marrow aspirated from vertebral body and implanted a fixed size cage through the safe
quadrangular space created by sentinel pin and lateral retractor. We secured the screws and rods finally.
Demographics of patients, operation time and blood loss were recorded. Preoperative and postoperative Visual
Analogue Scale of back and legs and ODI scores were quantitatively assessed at 1, 3, 6, and 12 months after
surgery.
Results
To Dec.2019, a total of 35 patients and 45 levels (mean age 62.2 y/o) were evaluated. The overall mean VAS
score for back pain improved statically significantly, and mean ODI scores from 50.9 to 3.6 (P< 0.01)
postoperatively was significantly improved with a mean follow-up of 15 months There was no postoperative
permanent exiting root injury, iatrogenic durotomy and other neurogenic damage.
Conclusions
Postoperative scores for endo-TLIF by this novel technique significantly improved and no disabledcomplications. The procedure could be considered as a safe and effective TLIF.

Education and Professional Work
Department of Orthopaedic Surgery
Chia Yi Christian Hospital
Assistant professor
E-mail: cychaudiofan@gmail.com
Medical Association member:
1.Taiwan society of endoscopic spine surgery (TSESS): founding president
2.Pacific and Asian Society of Minimally invasive Spine Surgery (PASMISS): board member
3.Faulty member of Society for Minimally Invasive Spine Surgery(SMISS)
4.Taiwan Mini-invasive Spine Surgery Association: board member
5.Taiwan Spine Society
6.Taiwan Surgical Association
7.Formosa Association of the Surgery of Trauma
8.Taiwanese Osteoporosis Association

board member

C-39

Endoscopic Lateral Lumbar Interbody Fusion (ELLIF):
improved techniques and complication managements
Yoshinori Kyoh
Director of Kyoh Orthopaedics & Neurosurgery Clinic
Abstract
We started to perform Endoscopic Lateral Lumbar Interbody Fusion (ELLIF) five years ago at our clinic. In
these five years, the number of operated inter vertebrae segments amounted to about 200. In this series, twoserious complications occurred. Fortunately, in both cases, the patients were able to return to society. After thesecond case, we temporarily suspended the procedure of ELLIF and reviewed the indications and techniques,
and worked on the development of a dedicated flat muscle hook that allows the light source to reach into thedeep areas, as well as a transparent polyvinyl chloride sheath that can be attached to the endoscope, and we also
worked on the renovation of the shape of the sheath to be placed at the end. After the completion of thedevelopment, we resumed ELLIF. Currently, we have obtained very trustworthy surgical procedure and havestarted to perform ELLIF not only in a lateral position but also in a prone position. In this presentation, I willshow how to perform ELLIF without complications.

Education and Professional WorkCURRICULUM VITAE
Yoshinori Kyoh
Director of Kyoh Orthopaedics & Neurosurgery Clinic
PROFESSIONAL ADDRESS AND TELEPHONE:
Kyoh Orthopaedics & Neurosurgery Clinic
54-Misono-cho, Amagasaki-city, Hyogo, 660-0861 Japan
TEL+81-6-6411-0714 FAX+81-6-6411-5476
E-mail: yanghoonk@yahoo.co.jp (PC & iPhone)
BOARD CERTIFICATIONThe Japanese Orthopaedic Association
The Japanese Society for Spine Surgery and Related Research
AWARD
Best Oral Presentation Award -3rd PlaceThe 7th ACMISST & 18th KOMISS, 24-25 May, 2019, Seoul, Korea

board member

Full endoscopic thoracic decompression
Chien-Min Chen
Changhua- Christian Hospital

Education and Professional WorkC-40

board member

C-41

Full-endoscopic Translaminar Approach for Cranially Migrated
Lumbar Disc Herniation
Shigeki Urayama
Mizuno kinen HospitalObjective: The purpose of this study was to evaluate clinical outcomes of translaminar approach forpreforaminal disc herniation cranially migrated in the medial side of pedicle of the lumbar spine using fullendoscopic spine surgery system.
Methods: Thirty patients (23 men and 7 women) participated from January 2012. The affected level was L2/3 in
2, L3/4 in 10, L4/5 in 15, and L5/S1 in 3 patients. All patients but one complained of an exiting nerve root
syndrome with motor and sensory deficits. Mean follow-up periods were 30 months (3- 76 months).
Surgical technique: Indigocarmine is injected to stain herniated disc materials before the operation. Under
general anesthesia bone hole (10 millimeters in diameter) is accurately made in the lamina overlying the
extruded disc fragments. After inner cortical bone of lamina is exposed smoothly, epidural exploration starts at
the insertion of the yellow ligament or on the yellow ligament. Bone hole is enlarged with Kerrison forceps. In
the epidural fat tissue along the lateral border of thecal sac, dissection is performed to find blue-stained
extruded disc fragments. Drainage should be set. The patients are able to walk on the day of surgery.
Results: Mean operative time was 151 minutes (86- 270 minutes). Complication associated with surgery
occurred in 4 patients, dural tear, fracture of inferior process, and transient progression of palsy. J OA score was
3-23 points (mean, 11.6 points) before surgery, and improved by 25-29 points (mean, 27.8 points) at the latest
observation. VAS score of leg pain was preoperatively 50-100 mm (mean, 75mm), and also improved to 0 mm
in all patients but one (30 mm) at the final follow-up period.
Conclusion: This approach is the less-invasive and efficient technique to treat lumbar disc herniation
encroaching on the exiting nerve root in the preforaminal zone.

Education and Professional Work
NAME: SHIGEKI URAYAMA (Japan)
OFFICE: Mizuno Memorial Hospital
ADDRESS: 〒123-0841
6-32-10 Nishiarai Adachi Ward Tokyo, Japan
E-MAIL: u9r2a_ya4ma@yahoo.co.jp
1980: MD degree, Hamamatsu University School of Medicine
1986: PhD degree, Toyama Medical and Pharmaceutical University, Graduate School of Medical Sciences
MEMBERSHIP
Japanese Orthopaedic Association
Japanese Society for Spine Surgery and Related Research
Japanese Society of the Minimally Invasive Spine Surgery
Japan Society for the Study of Endoscopic Surgery
BEST PAPER AWARD
The 17th Annual Meeting of the Japan Society for the Study of Surgical Technique for Spine and Spinal Nerves(2010)
Percutaneous Vertebroplasty with Hydroxyapatite under Local Anesthesia for the Treatment of Osteoporotic
Vertebral Burst Fractures. J. Spine Res. 2:1230-1235, 2011

board member

C-42

Microendoscopic resection of the transverse process fortreatment of chronic low back pain with Bertolotti’s syndrome.
Kazunari Fushimi
Gifu Prefectural General Medical Center
Abstract:
Bertolotti's syndrome is a rare cause of low back pain among young patients. We present 15-year-old boy who
suffered from chronic low back pain. X-ray and CT showed pseudoarticulation between right transverse processof the L5 and sacral alar. Anesthetic injection at pseudoarticulation provided only temporary pain relief.
Posterior resection has been performed through microendoscopy. Partial resection of the transverse process was
successfully performed. However, after the surgery, he complained insufficient palsy of right L5 nerve root.
L5 nerve palsy gradually resolved without any additional surgical procedure, and fully recovered 6 months after
the surgery.

Education and Professional Work
Kazunari Fushimi, M.D., Ph.D.
Chief of Orthopaedic Surgery, Department of Orthopaedic Surgery, Spine Surgery Center,
Gifu Prefectural General Medical Center.
4-6-1 Noishiki, Gifu-City, Gifu 500-8717, Japan.
e-mail address: fushimi-kazu@gifu-hp.jp
Professional Background1995- 1997 Resident in Dept. of Orthopaedic Surgery, Gifu University Hospital.
1997- 2001 Orthopaedic Surgeon, Dept. of Orthopaedic Surgery, Hikone Municipal Hospital (Shiga, Japan).
2001-2005 Spine Surgeon, Gifu University Graduate School of Medicine.
2012-2015 Chief of Orthopaedic Surgery, Dept. of Orthpaedic Surgery, Kizawa Memorial Hospital.
2015-2021 Associate Professor, Dept. of Orthopaedic Surgery, Gifu University Graduate School of Medicine.
2021-2022 Chief of Orthopaedic Surgery, Dept. of Orthopaedic Surgery, Spine Surgery Center, Gifu Prefectural
General Medical Center.

Program
Lectures

D-1

Management of Tuberculous Spondylitis With Minimal
Invasive Surgery Debridement: A Case Series
Abdul Kadir Hadar
Department of Orthopaedic & Traumatology, Hasan Sadikin General Hospital – Padjadjaran
University
BackgroundIndonesia is the 2nd most country with high incidence of Tuberculosis with the rate of 391 per 100.000
population. Tuberculous spondylitis accounts for up to 5% of tuberculosis (TB) cases and represents about 50%
of all skeletal manifestation of TB. Open debridement is the common procedure for treating tuberculous
spondylitis, however it is related with more complications and increasing risk for more morbidities. Minimal
invasive surgery with percutaneous transforaminal endoscopy and percutaneous transpedicular surgery gaining
more popularity because of its advantages compared to traditional open surgery. In this study, we present 8
cases of tuberculous spondylitis treated with minimal invasive surgery debridement.
Method8 patients with tuberculous spondylitis were treated with percutaneous transforaminal endoscopic debridement(5) and percutaneous transpediculardebridement (3) surgery. Clinical outcomes were evaluated based on
postoperative complications, length of stay, and Visual analogue scale (VAS) during 1 st week, 2nd week and 4th
week post operatively.
ResultThere were no major complications were found in the period of 4 weeks, post-operative anemia (1), wounddehiscence (0) and there was no surgical site infection. Mean length of stay of 8 patients were 2.8 ± 0.7 days,
The mean VAS during 1st week was 2.2±0.1, 1.5±1.2 during the 2nd week, and 0.4±0.6 during the 4th week.
Conclusion
Minimal invasive surgery for tuberculous spondylitis with percutaneous transforaminal endoscopic debridement
and percutaneous transpedicular debridement showed a good clinical outcomes on short-term follow up andcould be an alternative management for tuberculous spondylitis.

Education and Professional Work
Phone +6222 2035477
Email orthounpad@gmail.com
Residence
Jalan Banyak Cipta Kidul Nomor 10,
Tatar Banyak Sumba, Kota Baru Parahyangan
Padalarang, Jawa Barat, Indonesia
Phone +6281221689217
Email dedeng_haddar@yahoo.com
Degree conferred : Orthopaedic Spine Consultant
Orthopaedic Residency September 2011 - August 2016
Department of Orthopaedics and Traumatology
Hasan Sadikin General Hospital
Faculty of Medicine Universitas Padjadjaran
Bandung, West Java, Indonesia
Degree conferred : Specialist in Orthopaedic Surgery
Compulsory Internship 2004 – 2006
Saiful Anwar General Hospital
Faculty of Medicine Universitas Brawijaya
Malang, East Java, Indonesia
Degree conferred : Dokter (Medical Doctor)
Medical School 2000 – 2004
Faculty of Medicine Universitas Brawijaya
Malang, East Java, Indonesia
Degree conferred : Sarjana Kedokteran(Bachelor degree in medicine)

D-2

Strategies for Expanding Your Endoscopic
Techniques
Akarawit Asawasaksakul
Back pain Clinic, Ramkhamhaeng Hospital, Bangkok,
ThailandRecently, Endoscopic spine procedures are gaining more popularity among spine surgeons around the world.
With smaller incision, effective decompression, lessen hospital stayed and the result that have no different fromconventional surgery, Endoscopy are now very close becoming a gold standard in treating many spine
pathologies. From these reasons, draw interest in many spine surgeons who want to adopt this modality andstart the journey on their own. What we all must face is a learning curve that is probably steeper compare towhat we familiar with and the results of the procedure itself is usually operator dependent. This means that toeffectively climb the curve, we need more strategic planning.
From my experiences assisting spine surgeons in Thailand doing their first few cases, I saw some of interesting
points that can be beneficial to surgeons who want to start doing endoscopy. In this presentation, I try to focus
on how to select your first few cases, that is crucial to maintain your motivation and confidence to do more
complexed cases in the future and I would like to use this opportunity to share my thought on this point
alongside the process of learning, observation & practicing.

Education and Professional Work
Name & degrees
Akarawit Asawasaksakul MD, Msc (Clinical Science)Contact Information- Mobile: +6681-9090254- Email: Asawasaksakul@hotmail.com
Honors and Awards- 2017: Scientific Chairman & Organizing Committee, ASEAN Minimally Invasive Spine Surgery & Techniques
2018 (ASEANMISST 2018), Bangkok Thailand- 2017: Reviewer of Medicine Journal- 2017: Invited Speaker for China-Thailand Forum of Spine Minimally Invasive, Beijing, China- 2018: Organizing Committee and Country Representative, ASEAN Minimally Invasive Spine Surgery &Techniques 2019 (ASEANMISST 2019), Manila, Philippines- 2019: Faculty & Organizing Committee, KOSESS & ASEANMISST Joint Winter Camp 2019, Bangkok, Thailand- 2020: Speaker, East meets West (Endoscopic Spine Surgery Webinar)- 500+ cases experience in Endoscopic Spine surgery

D-3

Complete resection of sticky ossified dorsal
meningioma without neurovascular complications.
Ali Hammed
TISHREEN UNIVERSITY HOSPITAL
Spinal meningioma is a common tumor. It represents 25% of all primary intra spinal tumors.Calcifications incases of spine meningioma are rare, and gross calcification was only observed in 1% to 5% of all cases of spinal
meningioma. Cases of completely ossified spinal meningioma are even rarer. The classification by the World
Health Organization (WHO) states that the histological classification of ossified meningioma has been
categorized as a phenotype of meningioma with mesenchymal component expression.
We report a case of A 75-year-old female presented with progressive heaviness in the lower limbs with gait
disturbance and paresthesia of the lower limbs for approximately 5 weeks. Neurological examination revealed
motor power grade of 4 for all muscle groups of the lower limbs and hypoesthesia with a sensory level below
T10.
Magnetic resonance imaging (MRI) revealed an intradural extramedullary plate- shaped mass compressing the
spinal cord at T7-T9. The mass showed hypointensity on both T1 and T2 images compared to the spinal cord.
Computed tomography without enhancement depicted a completely calcified intradural mass.
Although the lesion was very sticky to neurovascular components, Simpson grade I was achieved. Pathologic
evaluation revealed psammoma bodies, which suggested calcified meningioma. Neurologic symptoms subsided
dramatically and 2 weeks after the surgery, the patient was ambulatory without any disturbance in gait.
The surgical strategy for ossified meningiomas differs from that for other classical cases of meningiomas because
central tumor debulking can be challenging. Meticulous microsurgical dissection and using high drill and
Kerrison rongeur may help in softening the tumor and can facilitate total tumor removal.

Education and Professional Work(+963) 993724417 alihaamed9@gmail.com
https://www.facebook.com/ali.hammed.311 Althawra street, Lattakia, Syria
RESEARCHER AND RESEARCH REVIEWER IN INTERNATIONAL JOURNALS
1.BMC Musculoskeletal Disorders.
2.Interdisciplinary Neurosurgery: Advanced Techniques and Case .Management.
3.World neurosurgery.
4.Medicine.
5.Frontiers in Neurology, section Neurotraum.
6.Journal of oncology.
7.Clinical Case Reports.
HONOURS AND AWARDS
Global Neurosurgical Update and Educational Symposium - Best E-Poster – David and Lya
Neumann Foundation award

D-4

Pathology oriented approach in spine endoscopy
Bhupesh Patel
Asian Superspeciality Hospital
In era of rapidly evolving medical technology it is very pertinent to develop minimally invasive technique inspine surgery that can cause minimal damage to the host tissue and effectively gives same results what open
surgery could do
Endoscopic technique is the answer for that
We have different endoscopic approaches for degenerative and traumatic spine pathologies
There is no consensus for single approach for all kinds of pathology
In this presentation I am trying to chennelize particular endoscopic approach for particular pathology ofdegenerative spine disease

Education and Professional WorkDr Bhupesh Patel (D.Ortho, DNB Ortho (Mumbai), MNAMS) Fellowship Trained Spine Surgeon (Korea, Japan)
Consultant Minimally Invasive Spine Surgeon and Interventional Pain management specialist
Dr Bhupesh Patel is the pioneer in minimally invasive spine surgery especially spine endoscopy and small incisionspine surgery. He believes in philosophy of “A la carte approach” (do what is necessary) by minimising damage tothe body.
He always says “SMALL IS BEUTITIFUL AND LESS IS BETTER AS LIKE MINIMALLY INVASIVE SPINESURGERY”
Dr Bhupesh Patel is Orthopaedic surgeon by profession but devoted his carrier to the Spine surgery and axial pain
management.
Dr Bhupesh Patel’s dream goal is to provide spine care service by holistic and comprehensive approach. No one
should suffer from spine problems without diagnosis and their treatment by combining all the available modality ofspine care in the present era.

D-5

Clinical outcomes of interlaminar percutaneous endoscopic
uniportal pars decompression for lumbar spondylolysis
Chaiyaporn Siramanakul
Department of Orthopaedics, Paolo Phaholyothin HospitalObjective: To evaluate the clinical and radiological outcomes of a novel full endoscopic procedure performed via
an interlaminar approach to decompress entrapped nerve roots in patients with lumbar spondylolysis.
Methods: We reviewed 11 patients who underwent interlaminar percutaneous endoscopic pars decompression.
Patients with back pain and dynamic lumbar instability were excluded from the study. Clinical parameters
related to outcomes, including the Oswestry Disability Index (ODI) and visual analog scale (VAS) for leg pain,
were assessed before and after surgery. The radiological outcomes, vertebral slippage percentage, and motion
radiographs were evaluated preoperatively and postoperatively.
Results: Of the 11 patients involved in the study, 5 had spondylolysis alone, of which 1 had spondylolysis at L3-4
and L4-5, and 4 at L5-S1; and 6 patients had spondylolysis in combination with spondylolisthesis, of which 4
had involvement of L5-S1, 1 had involvement of L4-5, and 1 had involvement at L3-4. At a mean follow-up
period of 22.64 months, 63.3% of patients achieved more than 50% improvement in ODI scores, and 90.91% of
patients achieved more than 50% improvement in the VAS score. Spondylolysis with vertebral slippage had
inferior ODI improvement outcomes as compared to spondylolysis alone, but the VAS was not significantly
different. No significant difference was observed between the slippage percentage observed between the preand post-operative periods. However, 1 patient experienced vertebral slippage after surgery, although fusion
surgery was not required.
Conclusions: Interlaminar percutaneous endoscopic pars decompression is a safe and successful treatment forpatients with stable lumbar spondylolysis and nerve root compression. Even in situations in which vertebral
slippage occurs, spinal fusion may not be the best option for all patients with lumbar spondylolysis.

Education and Professional Work
Chaiyaporn Siramanakul, M.D.
Department of Orthopaedics, Paolo Phaholyothin Hospital, Thailand
Email Address: chaisira@hotmail.com
Academic Appointment:
2019-2020 Secretary General of Computer Assisted Orthopaedic Surgery Thailand Society
2014-2021 Computer Assisted Orthopaedic Surgery Thailand Society Committee
2016 13th Computer Assisted Orthopaedic Surgery Asia Pacific Organizing Committee, Pattaya, Thailand
2018 Scientific Program Chair of 14th Computer Assisted Orthopaedic Surgery Asia Pacific Meeting, Pattaya,
ThailandD-6

Application of endoscopic surgery in spine infection
Chang, Chien-Chun
China Medical University HospitalThe optimal indication and timing for surgical management for spine infection remains unclear, seemingly
because of a lack of research on the subject. Traditionally, surgery is indicated for a neurological deficit,
structural deformity, or nonsurgical treatment failure (Quinones et al., 2004; Rodts, 2004; Stoffel et al., 2011b;
Pola et al., 2012). The main goals of surgical treatment are the maximal preservation of neurological function,
the maintenance of structural alignment, and the elimination of the infection (Schinkel et al., 2003; Mann et al.,2004). However, surgical interventions are associated with considerable number of comorbidities (Deininger etal., 2009). Therefore, in recent years, minimally invasive surgery has been reported as an effective and efficient
treatment option, especially for elderly or immunocompromised patients or those with multiple comorbidities.
In this speech, we review all the infection spine cases in our hospital. We retrospective compare the clinicalresult of open surgery and endoscopic surgery between the patients. We try to make a consensus and guideline
for spine infection treatment with endoscopic surgery.

Education and Professional Work
Current Employments:
1.Attending doctor, Department of Orthopaedic Surgery, China Medical University Hospital, Taichung, Taiwan
2.Chief, minimally invasive spine surgery and endoscopic surgery, Spine center, China medical university hospital,
Taichung, Taiwan
Interests:
1.General Spine Surgery: deformity, degenerative disease, trauma, tumor
2.Minimally invasive spine surgery: Percutaneous Endoscopic surgery, Mis TLIF
3.Navigation spine surgery
4.Minimal incision joint replacement (Knee and hip arthroplasty)
Board Certification : Board of Orthopaedics, R.O.C.
Membership:
1. Director, 8th, 9th,10th Taiwan Society of Minimally Invasive Spine Surgery (TSMISS)
2. General Secretory, 7th Taiwan Society of Minimally Invasive Spine Surgery
3. Member, Formosa Medical Association, Taiwan
4. Member, Taiwan Orthopaedic association, Taiwan
5. Member, American Academy of Orthopaedic Surgeons
6. Member, Joint Reconstruction Society, Republic of china
7. Member, Taiwan Spine Society

D-7

Uni-portal Percutaneous lumbar stenotic decompression(PSLD) for Treating Degenerative Lumbar stenosis. A caseseries with minimal two years follow-up.
Ching-Hsiao Yu
Department of Orthopaedic Surgery, Taoyuan General Hospital【Background】
Full-endoscopic spine surgery (FESS) has gained popularity because it is the least minimally invasive techniquecompared to traditional open and tubular surgeries currently. Objective of this study is to evaluate the clinicaloutcome of uni-portal percutaneous stenotic lumbar decompression (PSLD) in the treatment of degenerative
lumbar stenosis with at least two-years follow-up.
【Methods】
From March. 2018 to Dec. 2020, we collected 152 consecutive patients including 130 degenerative lumbar
stenosis and 22 stable stenotic spondylolistheses. All patients sustained intermittent claudication and leg painwith or without mild back pain. One-portal percutaneous stenotic lumbar decompression (PSLD) withunilateral laminotomy bilateral decompression surgery (ULBD) was performed for all patients. The presenting
symptoms, operation method, operation time, length of hospital stays, and complications were reviewed.
Functional score as back and leg pain according to the visual analog scale and Oswestry Disability Index scores
were assessed. Minimum follow-up was 24 months.
【Results】 Sixty-six male and 84 female patients, with average aged 62.6 years (32-84 years ) were reviewed.
Preoperative intermittent claudication were presented in all 152 patients whereas 80 patients sustained
remarkable leg pain. Unilateral laminotomy bilateral decompression surgery (ULBD) was performed for all 152
patients and 190 segments. One level decompression was 114 patients while 38 patients has two-level
operations simultaneously. The mean operation time was 75 minutes (55- 160 minutes) for each level. The
average length of stay was 3.2 days. No patients used morphine for pain control. Six patients sustained
intraoperative durotomy. There was no postoperative infection. Ten patients sustained post-operative neuritis
and all of them recovered well later. At the latest follow-up, 8 patient received revision surgery. Five of themunderwent fusion surgery where 3 patients received revision endoscopic decompression surgery. The mean
ODI was significant improved from 52.2±2.1 to 17.2 ±2.6. Modified Macnab criteria were excellent in 60
patients (39.5%), good in 62 (40.7%), fair in 21 (13.8%), poor in 9 (5.9%).
【Conclusion】
In carefully-selected patients, percutaneous stenotic lumbar decompression (PSLD) is a safe and effective
minimally invasive surgery for patients with lumbar stenosis.

Education and Professional Work
Dr. Ching-Hsiao Yu. MD
AFFILIATION
Spine Chief, Department of Orthopaedic Surgery, Taoyuan General Hospital, Taiwan
MEMBERSHIP
Secretary General, Taiwan Society of Endoscopic Spine Surgery (TSESS)
Supervisor, Taiwan Society of Minimally Invasive Spine Surgery (TSMISS)
Taiwan Orthopaedic Association (TOA)
Taiwan Spine Society (TSS)
Taiwan Osteoporosis Association (TOA)
Asia Pacific Orthopaedic Association (APOA)
E-mail:smalloil1205@yahoo.com.tw

D-8

Surgical strategy in selection of ideal endoscopic
approach in various degenerative lumbar pathologies
Chul-Woo Lee
St. Peter’s Hospital
Endoscopic spinal surgery (ESS) emerged and was developed as an alternative to previous traditional methods
for degenerative lumbar disease. With such radical development of ESS, endoscopic surgeons have extended thesurgical indication of ESS from disc herniation to lumbar canal, lateral recess, and foraminal stenosis. Several
authors reported clinical success of endoscopic spinal surgery for various lumbar pathologies by using several
kinds of endoscopic approaches. Nonetheless, articles that mention and deal with about technical description indetail, limitations, and pitfalls of each endoscopic approach with comparison are scarce.
Four different endoscopic Approaches (transforaminal, midline, contralateral, paraspinal) have their own
unique surgical characteristics including advantages, disadvantages, and therapeutic boundary. Appropriate
approach selection and established surgical technique are prerequisite for the successful result of ESS in various
cases of lumbar degenerative diseases
The purpose of this presentation is to introduce the technical methods of the four different endoscopic
approaches for lumbar pathologies in detail and review their efficacy and clinical feasibility. The presenter also
will discuss the optimized application of endoscopic approach technique for the treatment of individualized
degenerative lumbar pathologies by comparing four different endoscopic approaches

Education and Professional Work
CHUL-WOO LEE, M.D., PhD.
St. Peter’s Hospital
Dogok-Dong 914-2, Kangnam-Gu, Seoul, Korea
Phone: +82-2-554-3472; Fax:+82-2-574-9414
Website : www.goodspine.or.kr
CURRENT POSITION
Staff surgeon, Neurosurgery Dept., St. Peter’s hospital
Clinical Professor, Soonchunhyang university medical school
A member of insurance committee of Korean Spinal Neurosurgery Society
A executive director of the Korean Minimally Invasive Spine Surgery Society (KOMISS)
A planning and coordination director of the Korean Research Society of the Endoscopic Spine Society (KOSESS)D-9

Extended indication and technique of Uniportal
endoscopic decompression in degenerative lumbar spine
Gun Keorochana
Ramathibodi Hospital, Mahidol University
The decompressive surgery for degenerative lumbar spine includes discectomy, laminectomy, laminotomy,
intradiscal therapy, facet cyst removal and facet joint denervation. Uniportal endoscopic surgery can be used inalmost all of these problems. Main approaches of uniportal endoscopic spine are posterolateral (includes
transforaminal and paraspinal) and interlaminar technique. The docking point, orientation, 3D anatomy, scope
view and surgical skill are difference between these 2 approaches. Different types and locations of the pathology,
also instrument availability and surgeon experience are the important factors of approach selection.
Transforaminal approach is conventionally used for long time through Kambin’s triangle and can address mostof the paracentral to foraminal lesion area. Paraspinal approach was established in cases of narrowing disc spaceor Kambin’s triangle and upper foraminal area lesions, and can address more at foraminal and extraforaminal
area. Interlaminar approach can reach to central, paracentral pathologies, also both unilateral and contralateralrecess area, and can be extended up and down to area medial to pedicles. Moreover, endoscope in interlaminar
approach can be tilted to contralateral foraminal lesion. This method can decompress ipsilateral andcontralateral traversing roots and contralateral exiting root of upper level (called three roots decompression)
Furthermore, uniportal endoscope can be applied in medial branch denervation for facet joint arthritis(rhizostomy) which can increase visualization and accuracy of this abrasive procedure.
With the innovated equipment, instrument and tool and the improvement of surgical technique and surgeons’skill, the indication for use of uniportal endoscopic spine surgery has been extended to all kinds ofdecompressive lumbar procedures including severe and multiple level stenosis, selected difficult cases e.g. severe
scoliosis, inadequate bone stock, or facet joint denervation. Endoscopic spine surgery should be more developedand evolved continuously in the future.

Education and Professional Work
NAME: Gun Keorochana M.D.
POSITION: Associate Professor
SEX: Male
PLACE OF BIRTH: Bangkok, Thailand
PRESENT ADDRESS: Spine Unit, Department of Orthopaedics,
Ramathibodi Hospital, Mahidol University
Rama VI Rd., Rajthevee, Bangkok,
Thailand 10400
TEL. +66 2 2011589 FAX. +66 2 2011599
e-mail: gun_keo@yahoo.com gun_keo@hotmail.com
AWARDS, HONORSAPOA Spine Traveling Fellowship 2005 to Hong Kong, Sendai and Taipei
AREA OF INTERESTS
Spinal interventions
Endoscopic spine surgery
Minimally invasive spine surgery
Vertebroplasty/Kyphoplasty
MIS TLIF
XLIF
MIDLF
Percutaneous pedicle screw

D-10

The Biportal endoscopic
Posterior cervical inclinatory foraminotomy
Kwan-Su (David) SongDepartment of Neurosurgery of Him-Plus Hospital
Posterior cervical foraminotomy (PCF) is a minimally invasive surgical technique whose superior surgical value
is once again being highlighted with the development of spinal endoscopes.
Nevertheless, sometimes when surgeons operate PCF surgery, they must decide between facet violations andincomplete decompression.
Even if more than 50% of the facet violation, it would be better to perform the surgery with more emphasis on
the decompression because of the regeneration effect. But the stress on the surgeon until the initial recovery
after surgery will be considerable.
Posterior cervical inclinatory foraminotomy (PCIF) has some advantages of facet preservation through facet
undercutting, trajectory along the root, and making it easier to perform instruments and tasks.
This presentation introduces surgical techniques and tips for each step.

Education and Professional Work
Name: Kwan-su Song, M.D.
Date of Birth: November 8, 1975
Place of Birth: Korea, Republic ofAddress:
Department of Neurosurgery, Him-plus hospital,
13, Sinwolkeun-gil, Suncheon-si, Jeollanam-do, Republic of Korea
Tel: +82-61-804-5000/ Mobile +82-10-7120-0955Fax: +82-61-804-5119
E-mail: sabiston002@hanmail.net, sabiston001@naver.com
Advantage•An award from the Minister of Health and Welfare. (2008)•Experience of about 2000 cases of operation of spinal surgery•The annular announcement of NAVI symposium of Endoscopic Spine Surgery (2018.07.15)•A best award case presentation from KOSESS (2018.09.30)•The annular announcement of The 7th ACMISST & 18th KOMISS international symposium (2019.03.24-25)•The annular announcement of The 19th KOMISS (2020.12.05)

D-11

Lumbar Nerve Root Fibrous Entrapment Treated
By Full Endoscopic Interlaminar Approach
Marcio Robertti Ramalho Da Cunha
NEUROSURGEON OF THE GENERAL HOSPITAL
NATAL-RN
INTRODUCTION
We have a lot of causes to entrap the lumbar nerve root s, bringing sciatica as a major symptoms, these
entrapments can be caused by many etiologies, such as : Intervertebral disc herniation,spinal stenosis, formationof osteophytes and adhesive fibrous entrapment . Even though the MRI did not demonstrate any signal ofradicular conflict, the patients below had a typical sciatica related to their level as a target point of pain.
METHODSA 58-year old woman came to our clinic in march 2017, she had no previous historical background of any
surgical spinal procedure, complaining of severe right sciatica aggravated by walking and coughing. She also had
numbness and tingling sensation in the lateral posterior part of her right foot,s . On physical examination thestraight leg raise test was positive at 45degreeb in association with abolished Achilles tendon reflex. The MRI
showed no signals of nerve conflict in the level L5/S1. So, after no response in the conservative treatment for six
months, we´ve decided to make a nerve blockage with a local anesthetic with positive relief for 12 hours. The
second one was a male 76 years-old with the same symptoms for more than 06 months with a positive relief after
the blockage in the level L5/S1, promoting relief of his symptoms for 08 hours.
RESULTSWe´ve made both surgical procedures under the basic steps of the Interlaminar full endoscopy . After opening
the yellow ligament we could see a total S1 entrapment by fibrous adhesive tissue around the nerve root. Aftersome surgical maneuvers with dissectors and punch scissors, we could liberate the nerve root and get back thefree pulsation of the root . The procedure was done under a skin incision of 08 mm and took around 34
minu.The patients had a hospital discharge in less than twelve hours .
CONCLUSIONSWe bring this new concept to treat lumbar nerve root entrapment by the basic steps of the Interlaminar
approach, decreasing the chances to entrap again the same level by the fibroses attached to the open
procedures .

Education and Professional Work
GENERAL INFORMATION:
NAME: MÁRCIO ROBERTTI RAMALHO DA CUNHA
E-MAIL: maramalho65@gmail.com
MOBILE: 5584994078437
PASSPORT NUMBER: FV-220467
ADDRESS: RUA JAGUARARI 5100 CASA 59 CANDELÁRIA NATAL-RN / BRAZILMEMBERSHIP AFFILIATION
1) TITULAR MEMBER OF BRAZILIAN NEUROSURGERY SOCIETY (1994)
2) TITULAR MEMBER OF BRAZILIAN SPINE SOCIETY (2009)3) Ao SPINE MEMBER
3) MEMBER OF LATINO AMERICAN STUDY GROUP OF NEUROENDOSCOPY / GLEN
4)CO FOUNDER MEMBER OF BRAZILIAN BRANCH OF I.S.E.S.S( INTERNATIONAL SOC. ENDOSCOPY
OF SPINAL SURGERY )PROFESSIONAL QUALIFICATIONS :PROFESSIONAL QUALIFICATIONS:
1) CHAIRMAN OF NEUROSURGERY OF THE GENERAL HOSPITAL NATAL-RN / H.W.G ( 2014)
2) SENIOR STAFF OF THE SPINAL SURGERY AREA OF CLINIC TRAUMA CENTER /NATAL-RN (2007)
3) U.F.R.N, ASSISTANT PROFESSOR OF THE NEUROSURGERY DEPARTMENT ( 1996-1999 )4) NEUROSURGEON OF THE GENERAL HOSPITAL NATAL-RN / H.WG ( 1994- 2018)

D-12

Percutaneous Stenoscopic Cervical
Decompression/Discectomy in my practiceMatee Phakawech
S-spine and nerve hospital
Introduction: Cervical spine surgical techniques had undergone significant advancement over time. Available
treatment options include decompression, open fusion surgery, and disc replacement. Nowadays thedevelopment of endoscopic spine surgical instrument gives us the possibility to perform cervical spine surgery ina less invasive manner.
Surgical technique: In my practice 95 percent of cervical spine problem can be fixed with endoscopic surgery.
However, traditional open surgery such as laminoplasty and disc replacement is still mandatory in cases withsevere nerve compression that have myelopathic symptoms. Nowadays I do endoscopic foraminotomy forpatient with nerve root compression, identifying the pain generator based on the dermatome of pain, correlatedwith x-ray and MRI. The aim of surgery to decompress the nerve root which is causing pain. This surgical
technique can be done even in multiple nerve root compression in the same surgical session. Moreover, in somecase with acute sequestered cervical disc herniation, the piece of sequestered disc material also can be removed
safely under posterior cervical endoscopic surgery. One more benefit of posterior cervical surgery is the surgery
can be done even in lower level of cervical spine such as C7-T1, which is difficult approach from anterior, in thesame way as upper level.
Conclusion: Endoscopic surgery in cervical spine can be the future of spine surgery. The benefit is less surgicaltrauma, shorter operative time, and shorter recovery time. However, the surgical technique still evolving andrequire a steep learning curve.

Education and Professional WorkHOME ADDRESS 150/7 Ladprao 81, Puttaraksa village, klongchaokhunsing, Whangthonglang, Bangkok, 10310
MOBILE PHONE+66 841957932
OFFICE ADDRESSS spine and nerve hospital
532/1 Praditmanutham Rd, Wangthonglang
Bangkok, 10310
OFFICE PHONE+66 20340808
OFFICE FAX+66 20340847
MEMBERSHIPS IN PROFESSIONAL SOCIETIES
Medical Council of Thailand
Royal College of Orthopaedic Surgeons of Thailand (RCOST)
Spine Surgery Thailand
Minimal Invasive Spine Surgery Thailand

D-13

Revision rates and surgical outcomes in full endoscopic
lumbar discectomy
Meng-Huang Wu
Spine Division, Department of Orthopedics, Taipei Medical University
Hospital【Introduction】
Lumbar disc herniation (LDH) is a common degenerative spinal disease. Although conventional open
discectomy (OD) is the standard surgical treatment, it is correlated with adverse outcomes, including recurrent
LDH (rLDH). Minimally invasive surgeries (MISs) for rLDH were developed, such as full endoscopic lumbar
discectomy (FELD). The effects of FELD and other such surgical procedures remain under debate.
【Materials and Methods】
A narrative review was conducted to identify studies analyzing causes of and risk factors for rLDH after FELD,
the current prevention and treatment strategies and compared the postoperative outcome and complication riskof FELD with those of microendoscopic discectomy (MED) and minimally invasive transforaminal interbody
fusion (MIS-TLIF) in rLDH treatment. A search was conducted on PubMed. Both retrospective andprospective comparative studies were included.
【Results】
FELD demonstrates shorter operation time, lower blood loss, and complication rates than OD and MIS-TLIF,
but without any significant differences in hospital stay duration and recurrence rate. Besides, FELD wereassociated with less pain than was MIS-TLIF. FELD has many advantages over the conventional MED including
no need for general anesthesia, less or no iatrogenic neurologic damage, low infection risk, direct approach to
the extruded disc fragment, minimal disturbance of the intracanal capsular structures, and no interference ofscar tissue to reach protruded or extruded rLDH.
【Discussion】
Postoperative magnetic resonance imaging is essential in this surgery. Complete understanding of the surgicalanatomy and the fundamental techniques of OD and MIS are the cornerstones for mastering FELD procedures.
Recognizing complications of FELD such as nerve root injury, retroperitoneal cavity injury, and great vessel
injury are also crucial. Appropriate postoperative monitoring and care massively influence patient prognosis as
well.
【Conclusions】
Revision rate for FELD is 5-8%. Revisional surgery via FELD is the most appropriate choice for rLDH because
it is associated with highest patient satisfaction in the early stages after surgery but also has higher recurrence
rate. MIS-TLIF should be considered for instability and high recurrence risk patients.

Education and Professional Work
Academic Positions：
Associate editor, Clinical diagnostics and imaging, BMC Musculoskeletal Disorders (2018 IF: 2.002)
Academic editor, BioMed Research International (2018 IF: 2.197)
Visiting staff, TMU Research Center of Biomedical Devices Prototyping Production
AOPEER teacher, AO Clinical Investigation and Documentation (AOCID) and the AO Education Institute (AOEI)Employment Record：* Director, Spine Division, Department of Orthopedics, Taipei Medical University Hospital (Aug, 2020 - Present)* Chief Executive Officer, Taipei Medical University Biodesign Center (2021/10/1 - Present)* Director, Prospective Innovation Center, Taipei Medical University Hospital (Feb, 2022 - Present)* Vice Director, Prospective Innovation Center, Taipei Medical University Hospital (Jan, 2021 - Feb, 2022)* Attending Physician, Department of Orthopedic Surgery, Taipei Medical University Hospital, Taipei, Taiwan (July
1, 2015- Present)* Attending Physician, Department of Orthopedics Surgery, Spine Surgery Section, Chang-Gung Memorial Hospital,
Chiayi, Taiwan (Dec. 1, 2011 –June 30, 2015)* Attending Physician, Postal Hospital, Taipei, Taiwan (Jan. 1, 2016-Present)* Committee member, Joint Institutional Review Board, Taipei Medical University (2020/1/1~)

D-14
Extraforaminal disc herniation: a comparison of surgical techniquebetween full endoscopic discectomy and unilateral bi-portal endoscopic
discectomy (UBE)
Nantawat Uttamo
Veterans General Hospital
Extraforaminal lumbar disc herniations are quite rare. Their anatomical structures and the surgical approach are
more complexed than intracanalicular disc herniation due to an increased risk of postoperative complications.
Nowadays, endoscopic spinal surgery has more roles in the treatment of lumbar disc herniation. Both fullendoscopic discectomy and UBE discectomy have been progressively developed to better solve extraforaminal
problems and decrease complications. However, techniques and limitations between the 2 approaches aredifferent. Understanding both of them leads to better decision and patient outcome.

Education and Professional Work
Nantawat Uttamo, M.D.
PERSONEL INFORMATIONName Nantawat Uttamo
Work Address Department of Orthopaedic Surgery, Veterans General Hospital, Bangkok, Thailand
Telephone 087-188-9192
Home Address 291/28 BLOCS 77 Bldg., 6th Fl., Rd. Sukhumvit 77, Phrakanong Nuea, Wattana, Bangkok, Thailand
101100
Telephone 087-188-9192 E-mail Address Nantawat_U02@hotmail.com
PROFESSIONAL MEMBERSHIPS AND SOCIETIES2010 - present Thai Medical Council
2012 – present AO Trauma membership2015 - present Royal College of Orthopaedic Surgeons of Thailand (RCOST)2016 - present Spine Society of Thailand (SST)2016 – present Thai Society of Minimally Invasive Spinal Surgery and Techniques (ThaiSMISST)2017 – present ASEAN Minimally Invasive Spinal Surgery and Techniques (ASEANMISST)2017 – present North American Spine Society (NASS)
2020 - present AO Spine membership
NSTITUTIONAL/DEPARTMENTAL ADMINISTRATIVE RESPONSIBILITIES, COMMITTEEMEMBERSHIPS, AND OTHER ACTIVITIES• Interesting case: Spinal infection, Spine News, Issue 5 January 2015
• ThaiSMISST and ASEANMISST committee• General Secretary, Cadaveric Workshop Co-chairman and Speaker in 4th ASEANMISST in Collaboration with
NASS and Cadaveric Workshop 2018, Chiang Mai, Thailand• International medical coordinator for the Medical Sub-Committee of the Project “lumbar disc surgery for monks,
priests of various religions and underprivileged patients”, The 50th Anniversary Maha Vajiralongkorn HospitalFoundation• Reviewer of World Neurosurgery journal

D-15

Anatomic Considerations Transforaminal Approach:
Clinical implications
Pradyumna Pai Raiturkar
Consultant Spine Surgeon, Deenanath Mangeshkar Hospital, Pune India
Transforaminal access for treatment of Lumbar disc herniations and related pathologies has gained a lot of
attention in the 21st century and is regarded as one of the most successful minimally invasive interventions inselected cases. For the traditionally trained spine surgeon the transforaminal access is new and needs more
understanding. Transforaminal access is through the Kambin’s triangle described by Prof Parvez Kambin.
Anatomy and the variations of anatomy especially of the exiting nerve root in the neural foramen is the key tosuccessful planning and execution of transforaminal lumbar surgery without complications. I would describe thehistorical aspects and review articles describing Kambin triangle anatomy and would also describe way for MRI
analysis of the exiting nerve root relation to superior facet. This also helps us in understanding the cannula
dimension used for endoscopes and also the fact that time recquired for endoscopic procedure is also an
important consideration while undertaking the same to avoid complications and injury to exiting nerve root.

Education and Professional Work
About me.
I am a practicing orthopedic spine surgeon with an experience of 16 years trained in endoscopic spine surgery at
Wooridul Spine Hospital, South Korea with Prof Gun Choi, at Squaw Peak Centre Arizona with Prof Anthony Yeung
and also with Prof Ruetten in Germany and Prof Cheol Wong Park in South Korea. Interest in transforaminal,
interlaminar and Biportal endoscopic lumbar and cervical surgeries other than deformity, spinal infections Tumours
and microscopic interventions.

D-16

Full endoscopic rhizotomy in Sacroiliac joint pain :Evidence Based Guideline and Technical note
Saran Pairuchvej
Queen Savang Vadhana Memmorial Hospital
Sacroiliac joint (SI) pain is the condition That can be found among population wide range of age with incidenceof 30-60% . The cause of this condition could be from degenerative, inflammatory disease, trauma or Joint
disorder. According to the latest guideline,which focused on medication , physical therapy and painintervention. Radiofrequency ablation of SI joint was one of the treatment option with evidence supported ofmoderate to long-term outcome improvement. This presentation was about how to assess and manage patients
who had SI joint problems. The technical note and preliminary report of patient who undergone endoscopic
rhizotomy of SI joint were also demonstrated.

Education and Professional Work
Saran Pairuchvej , M.D.
Chief of Spine unit ,Spine Consultant of Orthopaedics Department
Queen Savang Vadhana Memmorial Hospital ,Sriracha Chonburi , Thailand
Tel: +6638-320-200 ext.1171 , +6681-345-6455
Born: November 12,1981
office address : Queen Savang Vadhana Memmorial Hospital , 290 Jermchompol Rd. ,Sriracha , Chonburi 20110
Email: runsan56@hotmail.com
Certifications
2010
Diplomat Thai board of Orthopaedics surgery
2010
Hand and Microsurgery workshop, Chiangmai, Thailand
2010
AO Advanced course on principles of operative fracture treatment Bangkok,Thailand
2011
Visiting fellowship for Spine training, Nishitaga hospital, Sendai, Japan
2011
Visiting fellowship for Spine training, Tohoku Chuo hospital, Yamagata, Japan2012
Fellowship of spine surgery, Ramathibodi hospital, Mahidol University,Thailand
2013
MIS and microendoscopic spine surgery, Wakayama, Japan
2013
Spinal injury center, Fukuoka, Japan
2015
Visiting doctors in Hospital de Gap, Gap, France

D-17

Posterior lumbar interbody fusion by biportal techniqueusing 30 degrees arthroscope in lumbar degenerative disease
Seok-Bong Jun
Orthopaedisc, Jinju Bon Hospital, Jinju-si, Gyeongsangnam-do
BackgroundThe endoscopic biportal surgical technique have a lot of advantages and Many spine surgeries are being done bythis methods
Objectives (or Aim)
The aim of study is to report the technique and advantages of posterior lumbar interbody fusion bybi(two)portal technique using 30 degrees arthroscope in lumbar spondylolisthesis
This study is preliminary clinical results
Methods
Of 70 patients who underwent bioportal endoscopic lumbar interbody fusion, 12 patients with multi-level fusion
were enrolled in this study. One portal was for irrigation and viewing, the other portal was for working andoutflow of water. We used 30 degrees arthroscope to get wider view.
The ipsilateral lamina and facet were removed using burr, punch and narrow osteotome,
Percutaneous pedicle screws with cage were used. The patients walked in the firist post-op day. Clinicaloutcome was analyzed by using numeric rating scale (NRS), Macnab criteria serially assessed before theprocedure, and at 3 months post procedure. Operation time and postop. Hb were assessed
Results
The NRS about low back pain fell from 7 to 2 scores at 3 months and about leg pain fell from 8 to 1 scores.
According to the Macnab criteria, ‘Excellent’ was obtained for eight patients, ‘Good’ results for three, and ‘Fair’
results for one patient.
For two segments, the average decrease in Hb was 2.1 in the first post-op day, For three segments was 2.8
There was no need for transfusion. Operation time took 2 hours 5 mins in two segments, and 2 hours 50 minsin three segments. There were no significant complications
Conclusions
The short term results show that posterior lumbar interbody fusion by bi(two)portal technique using 30 degrees
arthroscope can be an efficient and get early recovery.And This operation didn’t require transfusion. and wasless invasive But long term results should be researched

Education and Professional Work
Seok-Bong Jung
Orthopaedisc
Spine center, Jinju Bon Hospital, south Korea
AO spine delegate in Korea (2021- 2024)
PASMISS committee in 2020
Member of MISS association in Korea

D-18

Transala approach of unilateral biportal endoscopic discectomy for
extraforaminal herniated disc L5-S1: technical report and clinicaloutcomeSongwut

Sirivitmaitree

Department Of Orthopedics, Bandung Crown Prince Hospital
Propose: to describe the surgical technique of unilateral biportal endoscopic discectomy for extraforaminal
herniated disc at level of L5-S1and analyze clinical and radiogical outcome.
Methods: The retrospective study enrolled 9 patients with extraforaminal herniated disc at level of L5–S1 who
underwent transala approach by unilateral biportal endoscopic. We excluded patients with previous surgery anddynamic lumbar instability from this study. The surgical techniques were described step-by-step. The clinicaloutcomes were assessed as mean the visual analogue scale (VAS) for leg and bank pain, Oswestry Disability
Index (ODI) at pre-operative and 2 weeks post-operative. The radiographic outcome were assessed segmental
instability at pre-operative and 6-month post-operative
Results: a total of 9 cases with 3 males and 6 females were included in the study. The pre-operative mean VAS
scores for leg pain significantly decreased from 7.6 to 2.1 (p<0.05)
There was no significant difference in VAS scores for back pain (2.8 pre-operatively vs. 1.8 post-operatively)
The mean preoperative ODI score was 64.8. The postoperative ODI scores were 14.6 (p<0.05). There was no
iatrogenic segmental instability. Two patients had paraesthesia and symptoms were resolving for 6weeks.
Conclusions: transala approach is an effectively to achieve discectomy extraforaminal herniated disc at the L5–
S1 level especially minimize violence facet joint and more safely target point of camera and instrument. we
expected transala approach is an alternative approach to treat extraforaminal herniated disc at L5-s1 level.

Education and Professional WorkSongwut Sirivitmaitree, MD.
Department Of Orthopedics, Bandung Crown Prince Hospital, Thailand
Email Address: Dr-benz@hotmail.com
Education:
2005-2007
High School: Bodindecha (Sing Singhaseni) School2, Bangkok
2007-2012
M.D.: Faculty of medicine, Khon Kaen University, Khon Kaen, Thailand
Post-doctoral Training
2012-2014
Internship: Udon Hospital, Udon, Thailand
2014-2017
Residency Training In Orthopedics: Phramongkutklao Hospital and College of Medicine,
Bangkok, Thailand
2018-2019
Fellowship Training In Metabolic Bone disorder & Ortho Geriatric at
Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
Textbook
Textbook of endoscopic spinal surgery Thailand: Chapter Unilateral Biportal Endoscopic Paraspinal Approach forforaminal and extraforaminal Lesion
Honor, AwardFirst runner-up Poster award: Risk Factors for Cut out Failure of Proximal Femoral Fail Antirotation in Treatment ofUnstable Intertrochanteric Fractures: a Case Control Study. Proceeding of the joint Meeting Of Royal College ofOrthopedics of Thailand
Special clinical interest
Endoscopic spinal surgery, an experience over 200 patients

D-19

Endoscopic spine surgery in spondylodiscitis
Urawit Piyapromdee
Maharat Nakhon Ratchasima Hospital
Abstract:
In developing nations, spondylodiscitis is a frequent spine issue. Surgical drainage and radical debridement are
gold-standard treatments, but they require soft tissue dissection and bone resection during the surgery.
Endoscopic spine surgery is an alternative therapeutic option for spine disease that is minimally invasive tosurrounding soft tissue. Spondylodiscitis can also be treated by endoscopic spine surgery.
Endoscopic spine surgery is effective for patients with uncomplicated spondylodiscitis who do not havesegmental instability or considerable bone loss. However, it is an alternative for high-risk patients who areunable to withstand open surgery. Endoscopic surgery is performed with only local anesthetic and sedation.
The transforaminal technique through Kambin's triangle is the safest method for doing a tissue biopsy thatminimizes bone resection and soft tissue damage. The contaminated tissue was effectively removed with theassistance of an endoscope and a fluoroscope. Through the irrigation channel at the endoscope port, continuous
saline irrigation will diminish infective content.
An example of spondylodiscitis that did not respond to conservative therapy. The 77 years old female presentswith persistent low back pain that does not respond to intravenous antibiotics. A transforaminal endoscopic
technique was used to get a tissue sample and remove the infected tissue with saline irrigation. Examination of
the tissue revealed a non-tuberculous mycobacterial infection that responded to endoscopic excision andcontinuing antibiotic treatment.
The advancements in endoscopic spine surgery have altered the treatment approach for spondylodiscitis inrecent years. Patients can benefit from accurate tissue diagnosis along with tissue debridement and irrigation
while reducing soft tissue damage, resulting in a shorter recovery period for patients, especially those at higher
risk for complications.

Education and Professional WorkCURRICULUM VITAE
Name: Mr. Urawit Piyapromdee
Date of birth: 28th January 1982
Place of birth: Nakhon Ratchasima, Thailand
Religion: ChristianTel. 0816699446
E-mail : Urawit@gmail.com, Urawit.kr@cpird.in.th

D-20

Unilateral biportal endoscopic surgery for treating far lateral lumbar
disc herniation: technical report and preliminary clinical results
Zhang Wei
Spinal minimally invasive center, Hangzhou Traditional Chinese Medicine Hospital
Purpose To describe a surgical technique for far lateral lumbar disc herniation (FLLDH) using a percutaneous
unilateral biportal endoscopic discectomy (UBED) and to analyze early clinical results after endoscopic
decompression.
Method Consecutive 11 patients underwent UBED for their FLLDH. Postoperative radiologic images (x-rays,
computed tomography [CT], and magnetic resonance imaging [MRI]) were evaluated for neural status andstability. A visual analogue scale (VAS) for the leg pain and the Oswestry Disability Index (ODI) were used toevaluate clinical results in the preoperative and postoperative periods.
Results The mean follow-up periods were 4.1±2.3 months. The mean operative time was 64.7 ± 22.6 minutes.
Postoperative MRI and CT revealed complete removal of herniated discs and ideal neural decompression of thetreated segments in all patients. Disc height and stability were preserved on postoperative x-rays. Preoperative
VAS and ODI scores improved significantly after the surgery.
Conclusion UBED was an effective method for the FLLDH, which provides successful surgical decompression
without disturbance of spinal canal. This approach can also allow more easy surgical manipulation and minimize
iatrogenic damages of the posterior lumbar musculo-ligamentous structures.

Education and Professional Work
Mobile: 13696369519
Email: volcano8060@163.com
Education
1999-2004, Bachelor, North China Coal Medical College
2007-2010, Master's degree, Weifang medical college
2013-2017, Doctor's degree, Shandong University
Internship and residency
2002-2003, Kailuan Hospital (internship)
2005-2010, Shouguang People's Hospital (residency)
since2021, Hangzhou Traditional Chinese Medicine Hospital
License
Orthopedic Surgery
Membership
Shandong pain medicine society
Weifang orthopaedics society
Weifang sport medical society
Hobby
Medical illustration
Main Career
Since 2014, minimal invasive spine surgery (UBE/PELD/MED/PVP/PKP/MIS-TLIF under quadrant)

D-21

VBE-TLIF
Shisheng He
Shanghai Tenth People’s Hospital
Minimally invasive lumbar fusion technology is welcomed by doctors and patients because of its small amount of
trauma and rapid recovery. At present, the clinical application of endoscopic lumbar interbody fusion
technology can be divided into uniportal and unichannel coaxial endoscopy, unilateral bichannel endoscopy and
MED assisted lumbar interbody fusion.
Innovatively, V-shape Bichannel Endoscopy system, a new type of spinal endoscopy, enables uniportal bichannel
spinal endoscopy assisted lumbar interbody fusion with one incision. With two channels, the VBE systemenables surgeons to complete surgical procedures through the working channel under monitoring through theendoscopy channel.
In this part, we will introduce the VBE system and show its application in lumbar fusion under full-time andreal-time monitoring.

Education and Professional Work

D-22

Spinal endoscopic visualized technique for thetreatment of lumbar lateral recess stenosis
En Song
the First Affiliated Hospital of Kunming Medical University
Objective
Lumbar spinal stenosis is a common lumbar vertebrae disease in the elderly population, can lead to leg pain andlow back pain especially when walking. The aim of this retrospective study was to evaluate the efficacy andsafety of spinal endoscopic visualized technique for the treatment of lumbar lateral recess stenosis.
Methods
August 2019 to December 2020, 29 elderly patients (18 males and 11females) with symptomatic lateral recess
stenosis were underwent spinal endoscopic visualized technique therapy. Clinical outcomes were evaluated by
the visual analog scale (VAS) score of pain, Oswestry disability index (ODI) and the modified MacNab criteria
before operation and at 1 month, 6 months, and 1 year after the operation. Surgical outcomes including
operative time, the quantity of bleeding and complications were also investigated.
Results:
All surgical procedures were successfully performed by one experienced orthopedic surgeon with an average
operation time of 45.31± 12.58 minutes, the quantity of bleeding was 24.72±8.67ml. Patients were followed up
for a mean duration of 8.65±2.22 months. There were significant differences in VAS and ODI between
preoperative and postoperative score (P < 0.01). There was no significant difference in the visual analog scale
and Oswestry Disability Index scoring between postoperative 1 months, 3 months, and final follow-up(P >0.05). According to the modified MacNab criteria at the final follow-up, the excellent and good rate wereobtained in 93.10%, except 2 cases without obvious improvement.
Conclusions We considered that spinal endoscopic visualized technique for the treatment of two-level lumbar
lateral recess stenosis is an safe and effective treatment for patients with lumbar spinal stenosis.
Keywords: Lumbar spinal stenosis, Lateral recess stenosis, spinal endoscopic visualized technique

Education and Professional WorkWorking instruments（各種）(for Percutaneous full-Endoscope)migrated hernia rake®

内レトラクター®

PELIF®
(Percutaneous Lumbar
Interbody Fusion)※画像は現物大ではありません
フェジ鉗子：製造販売届出番号：21B2X10011000001.

経皮的全内視鏡内レトラクター：製造販売届出番号：21B2X10011000003
アウターシースカッター：製造販売届出番号：21B2X10011000004
レトラクトスライダー：製造販売届出番号：21B2X10011000005
トレフィンセット：製造販売届出番号：21B2X10011000006

全ての術野を明るく照らす。

○ 頚椎から腰椎まで、MISからOPEN surgeryまで対応のトータルシステム○ 自然な色の見え方と長寿命を両立するLED光源装置○ リユースタイプのライト用ケーブル

販売名：Phantomレトラクターシステム
医療機器製造販売届出番号：33B1X100011E0012〒709-0625 岡山市東区上道北方 688-1

TEL. 086-279-6278 FAX. 086-279-9510

外国製造業者
テダン サージカル イノベーションズ社（アメリカ合衆国）しあわせをかたちにする
人と技術の会社です。
確かな知識と技術
温かいハートで求められる製品をお届けしています。
ユニバぱんだ「もっと！」こころづかいハートウェアのお店u介 護 用 品 ・ 自 助 具 ・ リ ハ ビ リ 用 品 専 門 店

yo（社）日本義肢協会登録・中部107号

H

ea

fo

r

補装具のオーダーメイドを承ります®

lthy life

本 社：〒485‐8555 愛知県小牧市大字林 210 番地の 3
tel.（0568）47−1701
fax（0568）47−1702〒461‐0013
愛知県名古屋市東区飯田町 51 番地
tel.（052）939−3577
fax（052）939−3578

営業時間

営業時間 午前10時〜午後7時

午前8時30分〜午後5時

休業日：日・祝日

名古屋 営 業 所・ハートフルショップエイド・睡眠姿勢く〜すか
静 岡 営 業 所・靴工房
長 野 営業所

休業日：日・祝日

tel.（052）939-3577
tel.（054）288-1115
tel.（0263）48-2061

A4 Hal f

設備管理、警備、清掃、工事、オフィス商品販売までトータルに病院・介護施設の運営をサポート

星光ビル管理株式会社
東海営業第二部

名古屋市中村区那古野1-38-1
TEL: 052-583-0951

本社

大阪市中央区伏見町４丁目４－１
TEL: 06-6201-0021（代表）除菌濃度切替付（通常モード+無人モード）40 畳まで対応
オゾンで気軽に空間を除菌・消臭・清潔な空間を作ります

http://baba@babakikai.jp

株式会社馬場器械店 TEL.052-９０１-１５６７
希望小売価格：￥120,000（税別）→80,000(税込)
今ならＡ３ポスター付、待合に如何ですか