The Spot Sign and Intraventricular Hemorrhage are Associated with Baseline Coagulopathy and Outcome in Intracerebral Hemorrhage.

BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is the second most prevalent subtype of stroke and has high mortality and morbidity. The utility of radiographic features to predict secondary brain injury related to hematoma expansion (HE) or increased intracranial pressure has been highlighted in patients with ICH, including the computed tomographic angiography (CTA) spot sign and intraventricular hemorrhage (IVH). Understanding the pathophysiology of spot sign and IVH may help identify optimal therapeutic strategies. We examined factors related to the spot sign and IVH, including coagulation status, hematoma size, and location, and evaluated their prognostic value in patients with ICH. METHODS: Prospectively collected data from a single center between 2012 and 2015 were analyzed. Patients who underwent thromboelastography within 24 h of symptom onset and completed follow-up brain imaging and CTA within 48 h after onset were included for analysis. Multivariate logistic regression analyses were performed to identify determinants of the spot sign and IVH and their predictive value for HE, early neurological deterioration (END), in-hospital mortality, and functional outcome at discharge. RESULTS: Of 161 patients, 50 (31.1%) had a spot sign and 93 (57.8%) had IVH. In multivariable analysis, the spot sign was associated with greater hematoma volume (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03), decreased white blood cell count (OR 0.88; 95% CI 0.79-0.98), and prolonged activated partial thromboplastin time (OR 1.14; 95% CI 1.06-1.23). IVH was associated with greater hematoma volume (OR 1.02; 95% CI 1.01-1.04) and nonlobar location of hematoma (OR 0.23; 95% CI 0.09-0.61). The spot sign was associated with greater risk of all adverse outcomes. IVH was associated with an increased risk of END and reduced HE, without significant impact on mortality or functional outcome. CONCLUSIONS: The spot sign and IVH are associated with specific hematoma characteristics, such as size and location, but are related differently to coagulation status and clinical course. A combined analysis of the spot sign and IVH can improve the understanding of pathophysiology and risk stratification after ICH.

The insect peptide CopA3 blocks programmed cell death by directly binding caspases and inhibiting their proteolytic activation.

Caspases play essential roles in apoptotic processes, which is necessary for cellular homeostasis. However, over-activation of caspases and subsequent excessive apoptosis is considered a main cause of Parkinson's disease and liver diseases. Here, we found that the insect-derived peptide, CopA3, which has shown antiapoptotic effects in many apoptosis models, directly binds to caspases. The resulting complexes do not dissociate during denaturing polyacrylamide gel electrophoresis, as evidenced by a distinct shift in the migration of caspase reflecting an increase in their molecular weight. Surface plasmon resonance and experiment using cysteine-substituted mutants of CopA3 collectively revealed that binding of CopA3 to caspases is dependent on an internal cysteine residue. Notably, CopA3 binding significantly inhibited proteolytic activation of downstream caspases by upstream caspases. In summary, the demonstration that CopA3 directly binds to caspases and inhibits their activating cleavage suggests a possible therapeutic approach for treating human diseases resulting from uncontrolled apoptosis.

Quality improvement of general anteroposterior radiographic image of vertebral body according to optimum angle of incidence.

OBJECTIVE: In this study, we present an appropriate angle of incidence to reduce the distortions in images of L4 and L5 during a general anteroposterior radiograph examination. METHOD: We selected 170 patients who had normal radiological findings among those who underwent anteroposterior and lateral examination for lumbar vertebrae. An optimum angle of incidence wa suggested through the statistical analysis by measuring the lumbar lordosis angle and the intervertebral disc angle in these 170 patients. RESULT: We suggested the incident angle (10.28°) of L4 and the incident angle (23.49°) of L5. We compared the distorted area ratios when the incident angle was 0°, 10°, and 23.5° using the ATOM® phantom. The ratio for the L4 decreased from 14.90% to 12.11% and that of the L5 decreased from 15.25% to 13.72% after applying the angle of incidence. We determined the incident angle (9.34°) of L4 and (21.26°) of L5 below 30° of LLA. Thus, we determined the incident angle (11.21°) of L4 and (25.73°) of L5 above 30° of LLA. CONCLUSION: When you apply the optimum angle of incidence, the distortion of image was minimized and an image between the joints adjacent to the anteroposterior vertebral image with an accurate structure was obtained. As a result, we were able to improve the quality of the image and enhance diagnostic information.

Aspergilloma clinically mimicking Achilles tendon xanthoma in a non-immunocompromised patient: A case report.

A 48-year-old woman visited our outpatient clinic complaining of discomfort while wearing shoes due to a large mass around her Achilles tendon. The mass was firm, non-tender, non-reducible, and moved with the Achilles tendon, similar to Achilles tendon xanthoma. However, magnetic resonance imaging revealed multiple heterogeneous, nodular lesions with low T1 and T2 signal intensity, and histological examination of the biopsy specimen revealed the mass to contain hyphae of Aspergillus, indicating aspergilloma. The purpose of this case report is to emphasize that a tumor around the Achilles tendon can be something other than xanthoma even when the clinical features are typical of xanthoma. LEVEL OF CLINICAL EVIDENCE: 4.

Homology differences between complete Sacbrood virus genomes from infected Apis mellifera and Apis cerana honeybees in Korea.

Sacbrood virus (SBV) represents a serious threat to the health of managed honeybees. We determined four complete SBV genomic sequences (AmSBV-Kor1, AmSBV-Kor2, AcSBV-Kor3, and AcSBV-Kor4) isolated from Apis mellifera and Apis cerana in various regions of South Korea. A phylogenetic tree was constructed from the complete genomic sequences of these Korean SBVs (KSBVs) and 21 previously reported SBV sequences from other countries. Three KSBVs (not AmSBV-Kor1) clustered with previously reported Korean genomes, but separately from SBV genomes from other countries. The KSBVs shared 90-98 % identity, and 89-97 % identity with the genomes from other countries. AmSBV-Kor1 was least similar (~90 % identity) to the other KSBVs, and was most similar to previously reported strains AmSBV-Kor21 (97 %) and AmSBV-UK (93 %). Phylogenetic analysis of the partial VP1 region sequences indicated that SBVs clustered by host species and country of origin. The KSBVs were aligned with nine previously reported complete SBV genomes and compared. The KSBVs were most different from the other genomes at the end of the 5' untranslated region and in the entire open reading frame. A SimPlot graph of the VP1 region confirmed its high variability, especially between the SBVs infecting A. mellifera and A. cerana. In this genomic region, SBVs from A. mellifera species contain an extra continuous 51-nucleotide sequence relative to the SBVs from A. cerana. This genomic diversity may reflect the adaptation of SBV to specific hosts, viral cross-infections, and the spatial distances separating the KSBVs from other SBVs.

Targeted antitumor efficacy and imaging via multifunctional nano-carrier conjugated with anti-HER2 trastuzumab.

In this study, we prepared iron oxide nanoparticle and doxorubicin-loaded multifunctional nano-carrier (IONP/DOX-MFNC), capable of simultaneous cancer targeting via a herceptin monoclonal antibody, controlled anticancer drug delivery, as well as imaging modalities of magnetic resonance imaging (MRI) and near-infrared fluorescence (NIRF) imaging. IONP and DOX were efficiently loaded into the nano-carrier, and a desirable pH-responsive release of DOX was achieved by MFNC. The nano-carrier showed much higher cellular uptake and stronger cytotoxicity to HER2 overexpressed SK-BR-3 (human breast cancer cells) than MCF-7, a negative control cell, suggesting specific cancer targeting via HER2 receptor. In an in vivo tumor xenograft model, IONP/DOX-MFNC showed higher tumor uptake and significantly enhanced tumor regression than the nano-carrier without the antibody. Thus, DOX-loaded, multi-functional nano-carrier with HER2 antibody was effective for both imaging and therapy, showing the potential for early stage cancer diagnosis and simultaneous therapy. FROM THE CLINICAL EDITOR: In this study, efficacy -both for imaging and treatment - was demonstrated on a doxorubicin and iron oxide nanoparticle loaded multifunctional nano-carrier with HER2 antibody to show the potential for early stage cancer diagnosis and simultaneous therapy.

Identifying preoperative factors associated with the postoperative nasal synechia in patients undergoing closed reduction of the nasal bone fracture.

We conducted this study to identify preoperative factors that are associated with the postoperative nasal synechiae in patients with nasal bone fracture who underwent closed reduction.In the current single-center, retrospective study, we evaluated the fracture type, septal deviation angle (SDA), synechia scores (SSs) and visual analog scale (VAS) scores through a retrospective review of the medical records and computed tomography scans of 42 patients (n = 42) who had undergone closed reduction for nasal bone fracture at our medical institution during a period ranging from April to August 2013.The mean SS was significantly lower in the plane I group (n = 25) as compared with the plane II group (n = 17) (1.28 ± 1.77 vs 2.76 ± 1.89, P = 0.013). There was a significant positive correlation between the SDA and the SS with a formula of SS = 0.216SDA - 0.322 (r(2) = 0.532, P < 0.001) and between the SS and the VAS with a formula of VAS = 1.280SS + 0.612 (r(2) = 0.648, P < 0.001). Both the SS and VAS were significantly higher on the convex side as compared with the concave side of the nasal cavity.Our results indicate that patients with higher SDA or combined septal fractures might be at increased risks of developing the postoperative synechiae. Further large-scale, prospective studies are warranted to establish our results.

Proteomic screening of antigenic proteins from the hard tick, Haemaphysalis longicornis (Acari: Ixodidae).

Proteomic tools allow large-scale, high-throughput analyses for the detection, identification, and functional investigation of proteome. For detection of antigens from Haemaphysalis longicornis, 1-dimensional electrophoresis (1-DE) quantitative immunoblotting technique combined with 2-dimensional electrophoresis (2-DE) immunoblotting was used for whole body proteins from unfed and partially fed female ticks. Reactivity bands and 2-DE immunoblotting were performed following 2-DE electrophoresis to identify protein spots. The proteome of the partially fed female had a larger number of lower molecular weight proteins than that of the unfed female tick. The total number of detected spots was 818 for unfed and 670 for partially fed female ticks. The 2-DE immunoblotting identified 10 antigenic spots from unfed females and 8 antigenic spots from partially fed females. Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF) of relevant spots identified calreticulin, putative secreted WC salivary protein, and a conserved hypothetical protein from the National Center for Biotechnology Information and Swiss Prot protein sequence databases. These findings indicate that most of the whole body components of these ticks are non-immunogenic. The data reported here will provide guidance in the identification of antigenic proteins to prevent infestation and diseases transmitted by H. longicornis.

Molecular Prevalence of Acarapis Mite Infestations in Honey Bees in Korea.

Acarapis mites, including Acarapis woodi, Acarapis externus, and Acarapis dorsalis, are parasites of bees which can cause severe damage to the bee industry by destroying colonies and decreasing honey production. All 3 species are prevalent throughout many countries including UK, USA, Iran, Turkey, China, and Japan. Based on previous reports of Acarapis mites occurring in northeast Asia, including China and Japan, we investigated a survey of Acarapis mite infestations in honey bees in Korean apiaries. A total of 99 colonies of Apis mellifera were sampled from 5 provinces. The head and thorax of 20 bees from each colony were removed for DNA extraction. PCR assays were performed with 3 primer sets, including T, A, and K primers. Results indicated that 42.4% (42/99) of samples were Acarapis-positive by PCR assay which were sequenced to identify species. Each sequence showed 92.6-99.3% homology with reference sequences. Based on the homology, the number of colonies infected with A. dorsalis was 32 which showed the highest infection rate among the 3 species, while the number of colonies infected with A. externus and A. woodi was 9 and 1, respectively. However, none of the Acarapis mites were morphologically detected. This result could be explained that all apiaries in the survey used acaricides against bee mites such as Varroa destructor and Tropilaelaps clareae which also affect against Acarapis mites. Based on this study, it is highly probable that Acarapis mites as well as Varroa and Tropilaelaps could be prevalent in Korean apiaries.

Analysis of the RdRp, intergenic and structural polyprotein regions, and the complete genome sequence of Kashmir bee virus from infected honeybees (Apis mellifera) in Korea.

Kashmir bee virus (KBV) is one of the most common viral infections in honeybees. In this study, a phylogenetic analysis was performed using nine partial nucleotide sequences of RdRp and the structural polyprotein regions of South Korean KBV genotypes, as well as nine previously reported KBV genotypes from various countries and two closely related genotypes of Israeli acute paralysis virus (IAPV) and Acute bee paralysis virus (ABPV). The Korean KBV genotypes were highly conserved with 94-99 % shared identity, but they also shared 88-95 % identity with genotypes from various countries, and they formed a separate KBV cluster in the phylogenetic tree. The complete genome sequence of Korean KBV was also determined and aligned with previously reported complete reference genome sequences of KBV, IAPV, and ABPV to compare different genomic regions. The complete Korean KBV genome shared 93, 79, and 71 % similarity with the complete reference genomes of KBV, IAPV, and ABPV, respectively. The Korean KBV was highly conserved relative to the reference KBV genomes in the intergenic and 3' untranslated region (UTR), but it had a highly variable 5' UTR, whereas there was little divergence in the helicase and 3C-protease of the nonstructural protein, and the external domains of the structural polyprotein region. Thus, genetic recombination and geographical distance may explain the genomic variations between the Korean and reference KBV genotypes.

The first case of Capillaria hepatica infection in a nutria (Myocastor coypus) in Korea.

This study reports the first case of Capillaria hepatica infection in a nutria in Korea. Ten nutrias, captured near the Nakdong River, were submitted to our laboratory for necropsy. White-yellowish nodules were found in the liver of 1 of the nutrias at necropsy. Histologically, the lesions were granulomatous, and infiltrations of lipid-laden macrophages, eosinophils, and several multinucleated giant cells were observed. The lesions consisted of numerous eggs and necrotic hepatocytes. The eggs were lemon-shaped and had polar plugs at the ends of both long sides. The eggs were morphologically identified as those of C. hepatica. Worldwide, C. hepatica infection in nutrias is very rare. Nutrias are a kind of livestock, as well as wildlife; therefore, an epidemiological study for parasitic infections needs to be conducted.

Chemically heparinized PEEK via a green method to immobilize bone morphogenetic protein-2 (BMP-2) for enhanced osteogenic activity.

Osseointegration remains one of the major challenges in the success of bone-related implants. Recently, polyetheretherketone (PEEK) has emerged as an alternative material in orthopedic and dental applications due to its bone-mimicking mechanical properties. However, its bioinertness resulting in poor osseointegration has limited its potential application. So, the surface modification of PEEK with bone morphogenetic protein-2 (BMP-2) can be a potential approach for improving osseointegration. In this study, we proposed the chemical modification of heparin onto PEEK through an environmentally benign method to exploit the BMP-2 binding affinity of heparin. The heparin was successfully functionalized on the PEEK surface via a combination of ozone and UV treatment without using organic solvents or chemicals. Furthermore, BMP-2 was efficiently immobilized on PEEK and exhibited a sustained release of BMP-2 compared to the pristine PEEK with enhancement of bioactivity in terms of proliferation as well as osteogenic differentiation of MG-63. The significant synergistic effect of BMP-2 and heparin grafting on osteogenic differentiation of MG-63 was observed. Overall, we demonstrated a relatively safe method where no harsh chemical reagent or organic solvent was involved in the process of heparin grafting onto PEEK. The BMP-2 loaded, heparin-grafted PEEK could serve as a potential platform for osseointegration improvement of PEEK-based bone implants.

A Comprehensive Analysis of Potential Complications after OLIF : A Review of Postoperative Magnetic Resonance Scans in Over 400 Cases.

Objective: This study focuses on identifying potential complications following oblique lumbar interbody fusion (OLIF) through routine magnetic resonance (MR) scans. Methods: From 650 patients who underwent OLIF from April 2018 to April 2022, this study included those with MR scans taken one-week post-operatively, and only for indirect decompression patients. The analysis evaluated postoperative MR images for hematoma, cage insertion angles, and indirect decompression efficiency. Patient demographics, post-operatively symptoms, and complications were also evaluated. Results: Out of 401 patients enrolled, most underwent 1- or 2-level OLIF. Common findings included approach site hematoma (65.3%) and contralateral psoas hematoma (19%). The caudal level OLIF was related with less orthogonality and deep insertion of cage. Incomplete indirect decompression occurred in 4.66% of cases but did not require additional surgery. Rare but symptomatic complications included remnant disc rupture (4 cases, 1%) and synovial cyst rupture (4 cases, 1%). Conclusion: This study has identified potential complications associated with OLIF, including approach site hematoma, contralateral psoas hematoma, cage malposition risk at caudal levels, and radiologically insufficient indirect decompression. Additionally, it highlights rare, yet symptomatic complications such as remnant disc rupture and synovial cyst rupture. These findings contribute insights into the relatively under-explored area of OLIF complications.

A Single-Center Experience of Robotic-Assisted Spine Surgery in Korea : Analysis of Screw Accuracy, Potential Risk Factor of Screw Malposition and Learning Curve.

OBJECTIVE: Recently, robotic-assisted spine surgery (RASS) has been considered a minimally invasive and relatively accurate method. In total, 495 robotic-assisted pedicle screw fixation (RAPSF) procedures were attempted on 100 patients during a 14-month period. The current study aimed to analyze the accuracy, potential risk factors, and learning curve of RAPSF. METHODS: This retrospective study evaluated the position of RAPSF using the Gertzbein and Robbins scale (GRS). The accuracy was analyzed using the ratio of the clinically acceptable group (GRS grades A and B), the dissatisfying group (GRS grades C, D, and E), and the Surgical Evaluation Assistant program. The RAPSF was divided into the no-breached group (GRS grade A) and breached group (GRS grades B, C, D, and E), and the potential risk factors of RAPSF were evaluated. The learning curve was analyzed by changes in robot-used time per screw and the occurrence tendency of breached and failed screws according to case accumulation. RESULTS: The clinically acceptable group in RAPSF was 98.12%. In the analysis using the Surgical Evaluation Assistant program, the tip offset was 2.37±1.89 mm, the tail offset was 3.09±1.90 mm, and the angular offset was 3.72°±2.72°. In the analysis of potential risk factors, the difference in screw fixation level (p=0.009) and segmental distance between the tracker and the instrumented level (p=0.001) between the no-breached and breached group were statistically significant, but not for the other factors. The mean difference between the no-breach and breach groups was statistically significant in terms of pedicle width (p<0.001) and tail offset (p=0.042). In the learning curve analysis, the occurrence of breached and failed screws and the robot-used time per screw screws showed a significant decreasing trend. CONCLUSION: In the current study, RAPSF was highly accurate and the specific potential risk factors were not identified. However, pedicle width was presumed to be related to breached screw. Meanwhile, the robot-used time per screw and the incidence of breached and failed screws decreased with the learning curve.

Robotic-Assisted Spine Surgery: Role in Training the Next Generation of Spine Surgeons.

OBJECTIVE: This study aimed to assess the degree of interest in robot-assisted spine surgery (RASS) among residents and to investigate the learning curve for beginners performing robotic surgery. METHODS: We conducted a survey to assess awareness and interest in RASS among young neurosurgery residents. Subsequently, we offered a hands-on training program using a dummy to educate one resident. After completing the program, the trained resident performed spinal fusion surgery with robotic assistance under the supervision of a mentor. The clinical outcomes and learning curve associated with robotic surgery were then analyzed. RESULTS: Neurosurgical residents had limited opportunities to participate in spinal surgery during their training. Despite this, there was a significant interest in the emerging field of robotic surgery. A trained resident performed RASS under the supervision of a senior surgeon. A total of 166 screw insertions were attempted in 28 patients, with 2 screws failing due to skiving. According to the Gertzbein-Robbins classification, 85.54% of the screws were rated as grade A, 11.58% as grade B, 0.6% as grade C, and 1.2% as grade D. The clinical acceptance rate was approximately 96.99%, which is comparable to the results reported by senior experts and time per screw statistically significantly decreased as experience was gained. CONCLUSION: RASS can be performed with high accuracy within a relatively short timeframe, if residents receive adequate training.

Newly developed glycogen synthase kinase-3 (GSK-3) inhibitors protect neuronal cells death in amyloid-beta induced cell model and in a transgenic mouse model of Alzheimer's disease.

Glycogen synthase kinase-3 (GSK-3) is emerging as a prominent therapeutic target of Alzheimer's disease (AD). A number of studies have been undertaken to develop GSK-3 inhibitors for clinical use. We report two novel GSK-3 inhibitors (C-7a and C-7b) showing good activity and pharmacokinetic (PK) profiles. IC50 of new GSK-3 inhibitors were in the range of 120-130 nM, and they effectively reduced the Aß-oligomers induced neuronal toxicity. Also, new GSK-3 inhibitors decreased the phosphorylated tau at pThr231, pSer396, pThr181, and pSer202, and inhibited the GSK-3 activity against Aß-oligomers induced neuronal cell toxicity. In B6;129-Psen1(tm1Mpm) Tg(APPSwe, tauP301L)1Lfa/Mmjax model of AD, oral administration of C-7a (20 mg/kg, 50 mg/kg) showed increased total arm entries and spontaneous alteration of Y-maze which was regarded as short-term memory. In particular, 50 mg/kg C-7a treated mice significantly decreased the level of phosphorylated tau (Ser396) in brain hippocampus. We suggest that new GSK-3 inhibitor (C-7a) is potential candidates for the treatment of AD.

Synthesis and evaluation of 8-amino-[1,2,4]triazolo[4,3-a]pyridin-3(2H)-one derivatives as glycogen synthase kinase-3 (GSK-3) inhibitors.

New potent glycogen synthase kinase-3 (GSK-3) inhibitors, 8-amino-[1,2,4]triazolo[4,3-a]pyridin-3(2H)-one derivatives, were designed by modeling, synthesized and evaluated in vitro. Compound 17c showed good potency in enzyme and cell-based assays (IC50=111 nM, EC50=1.78 µM). Moreover, it has demonstrated desirable water solubility, PK profile, and moderate brain penetration.

A case of necrotizing sialometaplasia involving bilateral parotid glands.

Necrotizing sialometaplasia of the parotid gland is infrequent and can be mistaken as a malignant disease. Its etiology is thought to be an insufficient blood supply. Bilateral involvement of this disease in parotid glands has been rarely reported in the English literature. We report a case of necrotizing sialometaplasia diagnosed after superficial parotidectomy due to bilateral parotid masses in a 69-year old heavy smoking female.

Correlation between skin prick test and MAST-immunoblot results in patients with chronic rhinitis.

BACKGROUND AND OBJECTIVES: The most reliable method for confirming the causative allergens of allergic rhinitis is the skin prick test, followed by the multiple allergen simultaneous test (MAST), which reportedly has acceptable sensitivity and specificity. This study was designed to confirm whether a novel MAST-immunoblot assay can reliably diagnose allergic rhinitis. METHODS: A retrospective chart review was conducted of chronic rhinitis patients who visited Yeouido St. Mary's Hospital between January 2010 and June 2011. RESULTS: In total, 193 subjects (111 male, 82 female) were included, with a mean age of 30.08 years (range 6-77). The skin prick test detected 132 subjects as having one or more positive responses to allergens, and MAST detected 105 subjects as having one or more positive response. The sensitivity, specificity, and efficiency of the MAST assay were 63.16%, 65.57%, and 63.92%, respectively. Sensitivity, specificity and efficacy for common allergens were not high enough for MAST to replace skin prick test in detecting causative allergens. When correlation was defined as a difference between the classes of MAST and SPT of less than 2, the correlation rates for Dermatophagoides farina and Dermatophagoides pteronyssinus were 65.80% and 59.07%, respectively. CONCLUSION: The correlation between MAST and the skin prick test is not sufficiently strong to use MAST as a diagnostic test to confirm the causative allergen in allergic rhinitis. Further studies to confirm the reliability of MAST should be conducted.

Mini-Open Intercostal Retroperitoneal Approach for Upper Lumbar Spine Lateral Interbody Fusion.

OBJECTIVE: Conventional oblique lumbar interbody fusion (OLIF) approach is possible from the L2/3 to L4/5 levels. However, obstruction of the lower ribs (10th-12th) makes it difficult to maintain disc parallel maneuvers or orthogonal maneuvers. To overcome these limitations, we proposed an intercostal retroperitoneal (ICRP) approach to access the upper lumbar spine. This method does not expose the parietal pleura or require rib resection and employs a small incision. METHODS: We enrolled patients who underwent a lateral interbody procedure on the upper lumbar spine (L1/2/3). We compared the incidence of endplate injury between conventional OLIF and ICRP approaches. In addition, by measuring the rib line, the difference in endplate injury according to rib location and approach was analyzed. We also analyzed the previous period (2018-2021) and the year 2022, when the ICRP has been actively applied. RESULTS: A total of 121 patients underwent lateral interbody fusion to the upper lumbar spine (OLIF approach, 99 patients; ICRP approach, 22 patients). Endplate injuries occurred in 34 of 99 (34.3%) and 2 of 22 patients (9.1%) during the conventional and ICRP approaches, respectively (p = 0.037; odds ratio, 5.23). When the rib line was located at the L2/3 disc or L3 body, the endplate injury rate was 52.6% (20 of 38) for the OLIF approach but 15.4% (2 of 13) for the ICRP approach. Since 2022, the proportion of OLIF including L1/2/3 levels has increased 2.9-fold. CONCLUSION: The ICRP approach is effective in reducing the incidence of endplate injury in patients with a relatively lower rib line, without pleural exposure or rib resection.