Objectives: The aim of this study was to determine the clinical safety and efficacies of a new transforaminal approach endoscopic irrigation and annular repairment system for the treatment of lumbar disc herniation.Methods: From October 2017 to June 2019, we enrolled 16 patients, with imaging confirmation of single-level disk herniation with disk height≥5 mm, and who failed≥6 weeks of nonsurgical treatment. MRI,CT and X-rays were performed. All patients underwent transforaminal approach endoscopic discectomy use the novel endoscopic system, after discectomy we used the novel irrigator inserted into the tears of annulus fibrosus for intradiscal irrigation, then we used a novel full endoscopic annular repairment device close the annular defects which was an automatic stitching and tying device. The VAS and ODI scores were observed before operation and at 1 day, 1 month, 6 months and last follow-up after the operation. Results:The procedure was successfully performed in all cases. Average operation time was 95 minutes, Average blood loss was 15.3±3.8ml. At last follow-up (9.6±1.7 months), all patients experienced a clinically important improvement of their VAS for ipsilateral leg pain, which improved from 7.3±0.2 preoperatively to 1.8±0.3 postoperatively (P=0.001). The ODI improved from 52±3.8 preoperatively to 20.1±4.4 at last follow-up (P=0.001). There was no recurrence of disc herniation. Conclusions:Early results showed the use of the new transforaminal approach endoscopic irrigation and annular repairment system for the treatment of lumbar disc herniation are beneficial for short term outcomes demonstrating reduction in symptomatic disc reherniation with low post-operative complication rates.

Objective: Comparison of results of overall success rates of four Elder patient suffered radiculopathy with stenosis whom merely performing surgery (FBSS) with Spinal Stenosis patient without laminectomy or decomperssion
Material and Methods:
Percutaneous endoscopic foraminoplasty (debridement or osseos enlargement with trphine/shaver and the last using all endoscopic tecniques. The comparison criteria included the recurrence and open procedure rates as well as patient satisfaction rates, Oswestry scales and VAS Exclusion Criteria Multiple level (>1 level), Instability, <60 years old or nondegenerative spine, Infection, Tumors
Patients 2011-2020 240 patients were included prospective study 163 females 77males Main age 67 Follow up 18m ( range 3-48 months)
Results
Both groups showed statistically significant improvement in the VAS, SLR test, ODI.. In regarding to qualty of life, there was a statistically no significant increament 2 group (p<0.006). Pure stenosis patient group treated by ELF has no additional treatment requirement after all
Discussion , To make sure of Radicular pain, treatment is the main should have been carried out prior to all MISS procedures. Thus, the surgeon should perceive the available endoscopic devices (Shaver s,Trimers, trephines and RF) those would be necessary during the operation.
Conclusion
We concluded that the patient which are previously detected as single level stenosis by MRI and further be performed endoscopic Lumbar Foraminoplasty outcomes is statsiticaly no significant difference with FBSS group whom already been enlarged laminar level by open surgical methods. Foraminal enlargement could be the most efficient treatment without laminectomy in selected single level stenosis.

Most surgeons have thought that posterior decompression is crutial to treat isthmic spondylolisthesis with radicular pain. However, surgical procedure not only requires wide muscle dissection but can also lead to spinal instability. When mastered, oblique interbody fusion (OLIF) is a minimally invasive technique for the treatment of spondylolisthesis with no need for direct decompression. The authors present a clinical case of a 45-year-old man, referred to orthopaedic department for chronic low back pain (VAS 5) with left L4 radicular pain (VAS 5) and paresthesia of left thigh. ODI was 16%. He had no motor or sensitive impairment and osteotendinous reflexes were normal. Lateral X-ray of lumbar spine showed a L4-L5 bilateral lytic spondylolysis with grade 1 Meyerding spondylolisthesis. MRI revealed L4-L5 disc degeneration and protrusion with left L4 root compromise. The patient was proposed L4-L5 minimally invasive OLIF adding minimally invasive posterior stabilization. Blood loss was less than 150ml, the patient was encouraged to ambulate on day 1 postoperative and was discharged from hospital at day 3. No complications were registered. At 1 year follow up the patient has an improvement at back pain (VAS 2) and no leg pain or paresthesia was registered. Postoperative ODI was 6%. CT scan at six months postoperative confirmed successful fusion. OLIF can indirectly decompress the spinal canal in lumbar degenerative spondylolisthesis. Posterior decompression was not necessary to relieve leg symptoms. This procedure offers many advantages, such as preservation of posterior arch, no nerve retraction, less blood loss, high fusion rate and early discharge.

Objective: Compare revision rates and radiographic outcomes in patients receiving posterior cervical fusion of ≥3 levels that terminate at C7 vs T1, 2, or 3. Methods: A retrospective review of medical records identified posterior cervical fusion cases with at least one year of radiographic follow-up and fusion ≥ 3 segments. Identified cases divided into two groups based on location of lowest instrumented vertebra. Group 1 included fusions terminating at C7; group 2 included fusions terminating at T1, 2, or 3. At multiple intervals, Cervical Lordosis (CL), T1 Slope, Cervical Sagittal Vertical Axis (cSVA), Distal Segment Kyphosis, and T1 Slope-Cervical Lordosis Mismatch (T1S-CL) were measured. Need for revision surgery also documented. Results: 91 patients were included, 53 in Group 1 (mean age 58.9 yrs, 56.6% women) and 38 in Group 2 (mean age 64.4 yrs, 55% women). Revision rate did not reveal statistical difference between the two groups (Group 1: 9.4% vs. Group 2: 2.6% P=0.39).
There was no statistical difference in patients meeting criteria for DJK at final follow up (Group 1: 5.6% vs. Group 2: 5.2% P=0.9). A statistically significant increase in mean distal segment kyphosis at final follow-up was identified in Group 2 (Group 1: 0.82°, P=0.31 vs. Group 2: 2.5°, P=0.0001). Mean change in CL, T1 Slope, cSVA, and T1S-CL mismatch were not statistically different between the groups at final follow up. Conclusion: Revision rates, cervicothoracic radiographic parameters, DJK not significantly different when comparing multilevel posterior cervical fusions terminating at C7 versus the upper thoracic spine.

Children’s Orthopedics Education for Developing Nations (COEDN) is a unique full-time fellowship training model for orthopedic surgeons in developing nations.
Multiple volunteer surgeon-educators from developed countries travel to the host country to provide fellowship level training for 3-4 orthopedic surgeons who are interested in becoming their country's leaders and educators in pediatric orthopedic surgery. All COEDN volunteer surgeon-educators are part-time, recently retired or on sabbatical and can visit individually for 4-6 weeks, to provide a successive presence of trainers for a total of 12-24 months- as determined in conjunction with a national/ international accreditation body. Didactic, leadership and hands-on surgical training is provided per a formal curriculum.
Unlike classic fellowship train-abroad programs, training is done in-country, in their own operating rooms, with the fellows being the lead surgeons. Whole departmental staff benefit from these expert trainers. COEDN trainers do no independent service work.
Towards the goal of the establishment of a permanent, accredited regional training center, 3-4 of these fully trained and accredited Pediatric Orthopedic Surgeons will stay at their teaching institution and establish a nucleus for the training of future sub-specialists from their own and surrounding countries.
Sub-Saharan Africa is the current focus. There are only a handful of formal training centers for a rapidly rising population of over 1 billion, half of which is under the age 18. COEDN has run a successful program in Dar-Es-Salaam, Tanzania, and is currently training at CoRSU Hospital in Uganda. Future programs in many more countries requesting COEDN’s training assistance is planned.

Introduction: For the surgical treatment of single-level dynamic degenerative spondylolisthesis (DS), no consensus exists on the best approach for interbody fusion. The purpose of this paper is to compare two-year reoperation rates of anterior interbody fusion to posterior interbody fusion for the treatment of DS. Methods: The PearlDiver MARINER database was queried for patients with single-level degenerative spondylolisthesis who underwent either an anterior or posterior lumbar interbody fusion. Both populations were compared on multiple outcomes, including reoperation rate, complications, and readmission rates at 2 years. Results: There were 13,768 patients in the anterior group and 38,745 in the posterior group. At two years postoperatively, patients who underwent anterior interbody fusion were found to have higher rates of revision (14% vs. 12.7%, p<0.001), deep vein thrombosis (3.6% vs. 2.3%, p<0.001), and major medical complications (10.1% vs. 9.9%). Patients in the posterior group were more likely to have higher readmission rates (21.7% vs. 20.1%, p<0.05), blood transfusion (4.7% vs. 3.3%, p<0.001) and cauda equina (1.1% vs. 0.8%, p=0.005). Conclusion: At two years postoperatively, patients who underwent anterior interbody fusion for unstable DS were found to have higher rates of reoperation, DVT, ileus, and major medical complications. Patients who underwent posterior interbody fusion were found to have higher rates of readmission, transfusion and cauda equina at two-years postoperatively.

Introduction: To evaluate the efficacy and feasibility of selective treatment using PTES for responsibility segments in multi-level (≥2 levels) lumbar degenerative disease including lumbar disc herniation, lateral recess stenosis and intervertebral foraminal stenosis, which needed decompression and fusion for almost each involved level if open surgery was performed.

Materials and Methods: 211 patients of multi-level lumbar degenerative disease with unilateral or asymmetric bilateral leg pain underwent PTES. The involved nerve roots and the corresponding responsibility segments were determined according to the location of pain in the leg. PTES under local anesthesia was performed for the possible responsibility segment. If the patient had obvious relaxation of involved legs during the procedure, which confirmed that the treated segment was exactly responsible for the symptom, the operation could be finished. Or other possible responsibility segments should be treated using PTES till the involved legs were relaxed.

Results: In 211 cases, 203 patients underwent PTES for 1 segment, 7 cases for 2 segments through one small incision and 1 case for 3 segments. The VAS score of leg pain significantly dropped after operation. At 2-year follow-up, 97.2% (205/211) of the patients showed excellent or good outcomes according to MacNab classification. Two patients underwent reoperation of PTES for recurrence of disc herniation more than 6 months after surgery.

Conclusion: The responsibility segments in multi-level lumbar degenerative disease including lumbar disc herniation, lateral recess stenosis and intervertebral foraminal stenosis are selected for surgical treatment using PTES, which is effective, safe and minimally aggressive.