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Tae Seok Jeong, Seong Son, Sang Gu Lee, Yong Ahn, Jong Myung Jung, and Byung Rhae Yoo


The object of this study was to compare, after a long-term follow-up, the incidence and features of adjacent segment disease (ASDis) following lumbar fusion surgery performed via an open technique using conventional interbody fusion plus transpedicular screw fixation or a minimally invasive surgery (MIS) using a tubular retractor together with percutaneous pedicle screw fixation.


The authors conducted a retrospective chart review of patients with a follow-up period > 10 years who had undergone instrumented lumbar fusion at the L4–5 level between January 2004 and December 2010. The patients were divided into an open surgery group and MIS group based on the surgical method performed. Baseline characteristics and radiological findings, including factors related to ASDis, were compared between the two groups. Additionally, the incidence of ASDis and related details, including diagnosis, time to diagnosis, and treatment, were analyzed.


Among 119 patients who had undergone lumbar fusion at the L4–5 level in the study period, 32 were excluded according to the exclusion criteria. The remaining 87 patients were included as the final study cohort and were divided into an open group (n = 44) and MIS group (n = 43). The mean follow-up period was 10.50 (range 10.0–14.0) years in the open group and 10.16 (range 10.0–13.0) years in the MIS group. The overall facet joint violation rate was significantly higher in the open group than in the MIS group (54.5% vs 30.2%, p = 0.022). However, in terms of adjacent segment degeneration, there were no significant differences in corrected disc height, segmental angle, range of motion, or degree of listhesis of the adjacent segments between the two groups during follow-up. The overall incidence of ASDis was 33.3%, with incidences of 31.8% in the open group and 34.9% in the MIS group, showing no significant difference between the two groups (p = 0.822). Additionally, detailed diagnosis and treatment factors were not different between the two groups.


After a minimum 10-year follow-up, the incidence of ASDis did not differ significantly between patients who had undergone open fusion and those who had undergone MIS fusion at the L4–5 level.

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Dong Gyu Jang, Seok-Gu Kang, Sang Bok Lee, Do-Sung Yoo, Pil-Woo Huh, Kyoung-Souk Cho, Dal-Soo Kim, Chun Kun Park, and Joon Ki Kang

✓ Until now, calcified cephalhematoma has been treated by excision of the lesion and the use of an onlay autograft. The authors report their use of a less complicated alternative, simple excision and periosteal reattachment, in a 3-month-old male infant. They excised the calcified cap of cephalhematoma and reattached the periosteum to the exposed bone surface instead of using an onlay autograft technique. A follow-up CT scan demonstrated a smooth skull contour and good cosmetic appearance.

The authors note that this is the first report of the successful use of simple excision and periosteal reattachment for the treatment of a case of calcified cephalhematoma in which there was a depressed area after the calcified cap was removed. They conclude that in cases of calcified cephalhematoma it may be unnecessary to perform a complicated cranioplasty with bone harvested from the top of the calcification.