Impact of Superiors' Ethical Leadership on Subordinates' Unethical Pro-Organizational Behavior: Mediating Effects of Followership.

This study examined the impact of superiors' ethical leadership on subordinates' unethical pro-organizational behavior (UPB) and the mediating effects of followership. The research subjects were officials from the ten central departments of the South Korean government, and a cross-sectional survey was conducted among them. Overall, 404 questionnaires were used in the empirical analysis. Multiple regression analysis and Hayes Process Macro were used to validate the research hypotheses, which examined the relationship among ethical leadership, followership, and UPB. The results are as follows: First, the relationship between ethical leadership and followership was statistically significant. Second, the study showed that followership had a statistically significant effect on UPB but not ethical leadership. Third, testing the hypotheses regarding the mediating effect of followership on the relationship between ethical leadership and UPB revealed statistically significant results. This study confirms that followership significantly influences UPB and suggests that ethical leadership is an important precedent factor of followership. The study concludes with the theoretical and practical implications of these findings, along with the study's limitations.

Ambient air pollution and the risk of neurological diseases in residential areas near multi-purposed industrial complexes of korea: A population-based cohort study.

Emerging evidence suggest that long-term exposure to air pollution may induce adverse effects on the central nervous system. However, no study explored the associations in large industrial complex (IC) areas which are one of the major contributors to air pollution. Therefore, we aimed to investigate the pollution status and the association between residential proximity and incidence of neurological diseases near two major ICs characterized as multi-purposed ICs in Korea. A retrospective cohort of residents near the ICs was constructed using Korea's health insurance data and monitored from 2008 to 2019. Emission amounts of the ICs and the air pollution status in the nearby (exposed) and remote (control) area were evaluated using data from national regulatory networks, and hazard ratios (HRs) and 95% confidence intervals (CIs) for neurological diseases of the exposed group compared to the control group were calculated using Cox proportional regression models. Overall, the complexes emitted large amounts of VOCs, CO, NOx, and PM10, and annual levels of ambient PM (2.5, 10), gaseous substances (NO2, SO2), VOCs and PAHs were higher in the exposed area compared to the control and/or the national average. The risk of inflammatory disease of the CNS (G00-09) and extrapyramidal and movement disorders (G20-26) were higher in the exposed area with a HR (95% CI) of 1.36 (1.10-1.68) and 1.33 (1.27-1.39) respectively. Among the subclasses, other extrapyramidal and movement disorders (G25) and epilepsy (G40) were associated with higher risks in the exposed area (HR (95%CI): 1.11 (1.04-1.18), 1.08 (1.00-1.16)) after adjusting for potential confounders. These results suggest that people living near ICs are more likely to be exposed to higher air pollution levels and have higher risks of developing several neurological disorders. However, further epidemiological studies in these industrial areas supplemented with other indicators of environmental exposure and control of other diverse factors are warranted.

Low-Level Environmental Mercury Exposure and Thyroid Cancer Risk Among Residents Living Near National Industrial Complexes in South Korea: A Population-Based Cohort Study.

Background: Previous studies suggested that mercury may be linked to thyroid cancer due to its bioaccumulation in the thyroid gland, but no studies have evaluated the association between mercury exposure and thyroid cancer risk. We examined the relationship between mercury exposure and thyroid cancer risk, with the potential modification of hematological parameters. Methods: We performed a secondary analysis of a prospective cohort study among residents living near industrial complexes in South Korea (recruited from 2003 to 2011). Incident thyroid cancer cases (C73, ICD-10 code) were identified from the National Cancer Registry and Statistics Korea. Urinary mercury concentrations were measured using thermal decomposition amalgamation atomic absorption spectrometry (TDA-AAS). Cox proportional hazards regression models (adjusted for age, sex, educational level, smoking status, and employment) were used to estimate the hazard ratio (HR) and confidence interval [CI] between mercury exposure and the incidence of thyroid cancer. Results: We documented 69 cases of thyroid cancer in a total of 5213 participants during follow-up (median 8.7 years). The geometric mean of urinary mercury concentration was 1.8 µg/L for thyroid cancer cases and 1.2 µg/L for noncases (p for difference = 0.001). After adjusting for potential confounders, those in the highest tertile of urinary mercury levels had a twofold higher risk of thyroid cancer (HR = 1.97 [CI 1.03 - 3.80] in the highest tertile vs. the lowest tertile, p for trend = 0.043). This association was stronger for those with lower mean corpuscular volume and mean corpuscular hemoglobin status. Conclusions: Urinary mercury concentration was positively associated with the risk of thyroid cancer among residents living near national industrial complexes, and this association was influenced by red blood cell indices status. These results provide some evidence suggesting the adverse effects of environmental metal pollution in the development of thyroid cancer.

Exposure to several polychlorinated biphenyls (PCBs) is associated with chronic kidney disease among general adults: Korean National Environmental Health Survey (KoNEHS) 2015-2017.

We investigated the association between major persistent organic pollutants (POPs) exposure and chronic kidney disease (CKD) among general adult population of Korea. For this purpose, a subset of the adult population (n = 1276) participated in Korean National Environmental Health Survey (KoNEHS) Cycle 3 (2015-2017) were analyzed for twenty-four POPs in serum, including organochlorine pesticides (OCPs), polychlorinated biphenyls (PCBs), and polybrominated diphenyl ethers (PBDEs), and were derived for estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR). Multivariable linear regression was conducted to assess the association between POPs exposure and CKD-related parameters including eGFR and uACR. As sensitivity analyses, principal component analysis was conducted. Moreover, the U.S. National Health and Nutrition Examination Survey (NHANES) 1999-2004 data were chosen to compare with the observations of the Korean adults. Approximately 7.7% of the Korean adult population possessed CKD based on either eGFR (<60 ml/min/1.73 m2) or uACR (≥30 mg/g) criteria. Among the POPs that were detected in ≥70% of the subjects, PCB153 (ß = -1.61, 95% CI: -2.55, -0.67, P = 0.001) and PCB180 (ß = -1.47, 95% CI: -2.53, -0.40, P = 0.007) exhibited significant associations with decreased eGFR, especially in females. In male participants, hexachlorobenzene (HCB) was associated with eGFR (ß = -0.79, 95% CI: -1.53, -0.04, P = 0.040). Sex-dependent associations with eGFR were also shown in the PCA model. Moreover, the sex-dependent associations of PCBs were similarly observed in the adult populations of the US NHANES. However, POPs exposure was not associated with uACR, regardless of association model or population. The observed associations of PCBs are supported by several experimental studies reported elsewhere. To our knowledge, it is the first report that suggests significant associations of PCBs and HCB with eGFR among general population, and further validations in other populations are warranted.

Controlling of lattice strains for crack-free and strong ferroelectric barium titanate films by post-thermal treatment.

In this study, we experimentally demonstrate fabrication of ultra-smooth and crystalline barium titanate (BTO) films on magnesium oxide (MgO) substrates by engineering lattice strain and crystal structure via thermal treatment. We observe that oxygen-depleted deposition allows growth of highly strained BTO films on MgO substrates with crack-free surface. In addition, post-thermal treatment relaxes strain, resulting in an enhancement of ferroelectricity. Surface roughening of the BTO films caused by recrystallization during post-thermal treatment is controlled by chemical-mechanical polishing (CMP) to retain their initial ultra-smooth surfaces. From Raman spectroscopy, reciprocal space map (RSM), and capacitance-voltage (C-V) curve measurements, we confirm that the ferroelectricity of BTO films strongly depend on the relaxation of lattice strain and the phase transition from a-axis to c-axis oriented crystal structure.

Profile of Environmental Chemicals in the Korean Population-Results of the Korean National Environmental Health Survey (KoNEHS) Cycle 3, 2015-2017.

The Korean National Environmental Health Survey (KoNEHS) program provides useful information on chemical exposure, serves as the basis for environmental health policies, and suggests appropriate measures to protect public health. Initiated on a three-year cycle in 2009, it reports the concentrations of major environmental chemicals among the representative Korean population. KoNEHS Cycle 3 introduced children and adolescents into the analysis, where the blood and urine samples of 6167 participants were measured for major metals, phthalates, phenolics, and other organic compounds. Lead, mercury, cadmium, metabolites of DEHP and DnBP, and 3-phenoxybenzoic acid levels of the Korean adult population tended to decrease compared to previous survey cycles but remained higher than those observed in the US or Canada. Both bisphenol A (BPA) and trans,trans-muconic acid concentrations have increased over time. Heavy metal concentrations (blood lead, and cadmium) in children and adolescents were approximately half that of adults, while some organic substances (e.g., phthalates and BPA) were high. BPA showed higher levels than in the US or Canada, whereas BPF and BPS showed lower detection rates in this cycle; however, as these are increasingly used as a substitute for BPA, further research is necessary. As environmental chemicals may affect childhood health and development, additional analyses should assess exposure sources and routes through continuous observations.

Environmental health survey for children residing near mining areas in South Gobi, Mongolia.

BACKGROUND: We evaluated the level and factors of heavy metal exposure to children residing in the Togttsetsii, Khanbogd, and Bayandalai soums of South Gobi province, Mongolia. METHODS: A total of 118 children aged 9-12 years were surveyed, and the level of heavy metal exposure in their bodies was investigated. Exposure was investigated by measuring concentrations of heavy metals such as cadmium, lead, and mercury in the blood; mercury concentration in the hair; and total arsenic in the urine. RESULTS: Blood cadmium concentration had geometric averages of 0.16 µg/L in the children from Bayandalai, 0.15 µg/L Tsogttsetsii, and 0.16 µg/L Khanbogd. Blood lead concentration showed a relatively higher geometric average of 7.42 µg/dL in the children from Bayandalai compared to 4.78 µg/dL and 5.15 µg/dL in those from Tsogttsetsii and Khanbogd, respectively. While blood mercury concentration was the highest in the children from Bayandalai, with a value of 0.38 µg/L, those from Tsogttsetsii and Khanbogd had similar concentrations of 0.29 µg/L and 0.29 µg/L, respectively. Hair mercury concentration was the highest in the children from Bayandalai, with a value of 78 µg/g, a particularly significant difference, with a concentration of 0.50 µg/g in those from Khanbogd. Urine arsenic concentration was the highest in the children from Khanbogd, with a value of 36.93 µg/L; it was 26.11 µg/L in those from Bayandalai and 23.89 µg/L in those from Tsogttsetsii. CONCLUSIONS: The high blood lead concentration of children in Bayandalai was judged to be due to other factors in addition to mine exposure; the reason why blood and hair mercury concentration was higher in children from Bayandalai may have been due to exposure to many small-scale gold mines in the area. In the case of Khanbogd, it was estimated that the high arsenic level in urine was caused by the effect of mines.

Urinary parabens and their potential sources of exposure among Korean children and adolescents: Korean National Environmental Health Survey 2015-2017.

Parabens are used as a preservative in several consumer products including cosmetics, personal care products, and medicinal products. These chemicals have been suspected for estrogenicity and potential adverse endocrine outcomes in humans. For the first time, exposure profiles and potential sources of major parabens are investigated for a nationally representative population of children and adolescents of Korea. In addition, major determinants of urinary paraben levels were identified. For this purpose, the children, and adolescents (n = 2355, 3-18 years of age) who participated in the Korean National Environmental Health Survey cycle 3 (2015-2017) were studied. Adjusted multiple linear regression models were employed to investigate the relationships of several potential demographic and behavioral determinants of exposure, with the urinary levels of three parabens; methyl, ethyl, and propyl paraben. Methyl and propyl paraben levels of the Korean children and adolescents were comparable to those of the US, but the high exposure group (95th percentile) showed much higher levels of exposure. Moreover, urinary ethyl paraben levels are always higher than those of other countries. The uses of personal care products including liquid soaps, fragrance products, nail polish, or antiseptic products were significantly associated with urinary paraben levels. In addition, dietary sources such as fast food and canned food consumption were identified as major contributors to ethyl paraben levels. For methyl and propyl parabens, the use of fever medications and ointments were identified as major determinants of the exposure, especially among the younger children of 3-5 years of age. These observations are related to the Korean regulations that permit the use of the parabens as preservatives in foods and medications. The findings demonstrate that the exposure profile of parabens among Korean children are unique, and mitigation efforts for some parabens are required in Korea. Further studies are warranted to confirm the exposure sources of parabens and to develop mitigation measures among Korean children and adolescents.

First nationwide exposure profile of major persistent organic pollutants among Korean adults and their determinants: Korean National Environmental Health Survey Cycle 3 (2015-2017).

Since 2009, Korea has measured the exposure levels of major environmental chemicals and heavy metals among representative adult populations through the Korean National Environmental Health Survey (KoNEHS). However, exposure to persistent organic pollutants (POPs) has never been assessed. This study reports the serum concentrations of twenty-four POPs and their influencing factors for Korean adults (n = 1295) who participated in the KoNEHS Cycle 3 (2015-2017). The POPs included seven organochlorine pesticides (OCPs), eleven polychlorinated biphenyls (PCBs), and six polybrominated diphenyl ethers (PBDEs). Among them, three OCPs (i.e., hexachlorobenzene (HCB), p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT), and p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE)) and five PCBs (i.e., PCB52, PCB118, PCB138, PCB153, and PCB180) were detected in over 60% of the samples. PBDEs were not detected at a detection frequency of 60% or above. The most frequently detected POPs were p,p'-DDE (99.8%, geometric mean of 128.47 ng/g lipid), followed by PCB180 (98.8%, 8.49 ng/g lipid), PCB153 (98.8%, 13.14 ng/g lipid), HCB (96.2%, 67.08 ng/g lipid), PCB138 (95.2%, 8.84 ng/g lipid), PCB118 (89.6%, 2.66 ng/g lipid), p,p'-DDT (80.5%, 6.68 ng/g lipid), and PCB52 (71.2%, 1.57 ng/g lipid). The concentrations of most POPs were lower than or similar to concentrations reported in national-scale biomonitoring surveys. The only exception was HCB, whose concentration was up to seven-fold higher than the concentration reported by the Canadian Health Measures Survey. Excluding HCB and PCB52, most POPs showed increasing serum levels among older adults, adults with higher body mass index, adults living in coastal areas, and more frequent fish consumption. Relatively higher POP concentrations were observed in menopausal women. This study provides the first data on POP exposure levels among the representative adult population in Korea, and the results highlight the need to integrate POPs in the national biomonitoring program.

Chronic Exposure to Lead and Cadmium in Residents Living Near a Zinc Smelter.

This study aimed to measure lead (Pb) and cadmium (Cd) exposure levels in residents living near a zinc (Zn) smelter in Seokpo-myeon, Bonghwa-gun, South Korea, and identify factors affecting exposure. Residents aged ≥20 years living within 3 km and ≥30 km away from the smelter were classified as the exposure group (n = 549), and the control group (n = 265), respectively. Data were obtained through a questionnaire survey. Blood Pb levels in the exposure group (4.19 µg/dL) were higher than in the control group (2.70 µg/dL). The exposure group (1.32 µg/L) also had higher urinary Cd concentrations than the control group (0.80 µg/L). Male sex, older age, previous work at the smelter, smoking, and proximity to the smelter were associated with higher blood Pb levels on multivariate analysis; urinary Cd concentration was significantly higher in women, those who were older, those with experience of working in a Zn smelter or mine, those with proximity to the Zn smelter, and those who consumed locally grown vegetables. In conclusion, Zn smelters are major source of Pb and Cd pollution and require ongoing public health management to prevent potential adverse health effects.

Toluene concentrations in the blood and risk of thyroid cancer among residents living near national industrial complexes in South Korea: A population-based cohort study.

BACKGROUND: Toluene is classified as a possible carcinogen, but its role on thyroid cancer is not well established. Vehicle emissions are one of the largest contributed sources of toluene, but no studies evaluating the influence of living near a road on the association between toluene and the incidence of thyroid cancer have been reported. Therefore, we examined potential associations between blood toluene concentrations and incidence risk of thyroid cancer, and an effect modification of living near a road. METHODS: We conducted a prospective cohort study using data from South Korean "Monitoring Project for Exposure to Environmental Pollutants and Health Effects among Residents Living near Industrial Complexes" survey. Study participants living near national industrial complexes were recruited from January 2003 to 2011. Incidence and mortality cases of thyroid cancer (C73, ICD-10 code) were identified using the National Cancer Registry and Statistics Korea, respectively. Blood toluene concentrations were measured using gas chromatography mass spectrometry. We used Cox proportional hazards regression models to estimate the hazard ratios (HR) and the 95% confidence interval (CI) between blood toluene concentrations and thyroid cancer risk. RESULTS: During the follow-up (median 8.6 years), 33 cases of thyroid cancer were diagnosed. The geometric mean of the toluene concentration in the blood was 0.56 µg/L for cases and 0.29 µg/L for non-cases. After adjusting for potential confounders, a positive association between blood toluene concentrations and thyroid cancer was found (HR = 2.77, 95% CI = 1.00-7.65 in the highest tertile vs. the lowest tertile, p for trend = 0.044). This positive association was stronger in people living near a road (≤50 m). CONCLUSIONS: Blood toluene concentrations may be positively associated with the incidence risk of thyroid cancer. Moreover, this association may be stronger among people living near a road.

Environmental exposure to cadmium and risk of thyroid cancer from national industrial complex areas: A population-based cohort study.

BACKGROUND: Cadmium is known to act as a thyroid disruptor and carcinogen in humans. Recent evidence suggests that cadmium may play a role as a thyroid carcinogen due to its endocrine-disrupting activity, but this characterization remains unclear. OBJECTIVE: We investigated the association between urinary cadmium and primary thyroid cancer, and the modifying effect of diabetes on this association. METHODS: We included 5406 participants over 19 years old with measured urinary cadmium from samples collected at eight National Industrial Complex areas from 2003 to 2011. Among 5406 participants, 68 cases were diagnosed with thyroid cancer between enrollment and the end of follow-up (December 31, 2016). Incidence rate ratios for thyroid cancer were estimated using random-effects Cox proportional hazards models with follow-up time as the time scale. In addition, we conducted a stratified analysis by diabetes status. RESULTS: Compared with the lowest tertile, the middle and highest tertiles had higher risks of thyroid cancer, respectively (HRmiddle vs. lowest = 1.90, 95% CI = 0.93 to 3.91; HRhighest vs. lowest = 2.28, 95% CI = 1.09 to 4.78), with a significant dose-response relationship (P for trend = 0.03). There was no linear association between cadmium level and risk of thyroid cancer. Higher cadmium levels increased thyroid cancer risk in participants without diabetes (HRmiddle vs. lowest = 2.35, 95% CI = 1.05 to 5.24; HRhighest vs. lowest = 2.70, 95% CI = 1.18 to 6.19); although, an association between cadmium levels and thyroid cancer risk in participants with diabetes was not found. CONCLUSION: Low-level exposure to cadmium is associated with thyroid cancer risk. Our results provide the evidence to limit exposure to cadmium for cancer prevention in the general population. Further studies are needed to investigate the consequence of diabetes and antidiabetic drugs between cadmium and thyroid cancer.

Technical Considerations in Endoscopic Lumbar Decompression.

With technical development and evolution of endoscopic instruments, endoscopic spinal surgery has become one of the standard treatments for various lumbar spinal diseases ranging from a simple contained disc to complicated cases such as highly migrated disc herniation and other pathology combined with bony degeneration to produce foraminal and canal stenosis. Favorable clinical results of endoscopic decompression for lumbar stenotic disease were reported by several authors. However, studies have also reported limitations, such as steep learning curves and a relatively high complication rate compared with conventional techniques. The endoscopic lumbar decompression technique consists of many essential skills to manage different endoscopic anatomic structures of the spine. From the perspective of surgical completion and safety, this article discusses issues related to technical considerations in endoscopic lumbar decompression.

The Biportal Endoscopic Posterior Cervical Inclinatory Foraminotomy for Cervical Radiculopathy: Technical Report and Preliminary Results.

The purpose of the current study was to introduce a surgical technique for posterior cervical inclinatory foraminotomy (PCIF) using a percutaneous biportal endoscopic (BE) approach. Consecutive 7 patients underwent BE-PCIF for their cervical radiculopathy. Postoperative radiologic images (x-rays, computed tomography [CT], and magnetic resonance imaging [MRI]) were evaluated postoperatively for optimal neural decompression status and stability. A visual analogue scale (VAS) for the arm pain and the Neck Disability Index were used to evaluate clinical results in the preoperative and postoperative periods. Mean follow-up periods were 6.42 ± 2.99 months. The mean operative time was 101.42 ± 49.30 minutes. Postoperative MRI and CT revealed complete removal of herniated discs and ideal neural decompression of the treated segments in all patients. Disc height and stability were preserved on postoperative x-rays. Preoperative VAS and Oswestry Disability Index scores improved significantly after the surgery. BE-PCIF may be an effective surgical treatment of the cervical radiculopathic lesions, which provides successful surgical decompression as far as distal part of foramen with better operative view and more easy surgical manipulation. This approach may also minimize iatrogenic damages of the posterior cervical musculo-ligamentous structures and help to maximize the preservation of the facet joint.

Innovative start-up strategies for single-stage deammonification with conventional activated sludge: Results of a pilot-scale demonstration.

This study investigated innovative start-up strategies of a pilot-scale sequencing batch reactor (SBR) for single-stage deammonification using activated sludge as the sole inoculum source. In 24 m3 aerobic oxidizing bacteria cultivation plant, nitrogen loss efficiency was suggested to be an indicator for determining duration of cultivation. In 12 m3 ANAMMOX (ANaerobic AMMonium OXidation) cultivation plant, combined strategy (sequential fed-batch and continuous modes) was adopted to promote ANAMMOX activity from activated sludge. Both the cultivated sludge were inoculated in 24 m3 pilot-plant for single-stage SBR with deammonification. The feed distribution strategy was used to cultivate ANAMMOX bacteria selectively resulting in nitrogen removal rate of 0.73 kg/m3/d and nitrogen removal efficiency of 86.5 ± 1.9% within 254 days. Candidatus Brocadia sp. 40 was enriched from undetectable to 22.7% relative abundance. These findings indicated that fast start-up of the deammonification process was possible without ANAMMOX seed sludge in pilot-scale reactor with various variables.

Comparison of Short-Term Associations between PM2.5 Components and Mortality across Six Major Cities in South Korea.

Association between short-term exposure to fine particulate matter (PM2.5) and mortality or morbidity varies geographically, and this variation could be due to different chemical composition affected by local sources. However, there have been only a few Asian studies possibly due to limited monitoring data. Using nationwide regulatory monitoring data of PM2.5 chemical components in South Korea, we aimed to compare the associations between daily exposure to PM2.5 components and mortality across six major cities. We obtained daily 24-h concentrations of PM2.5 and 11 PM2.5 components measured from 2013 to 2015 at single sites located in residential areas. We used death certificate data to compute the daily counts of nonaccidental, cardiovascular, and respiratory deaths. Using the generalized additive model, we estimated relative risks of daily mortality for an interquartile range increase in each pollutant concentration, while controlling for a longer-term time trend and meteorology. While elemental carbon was consistently associated with nonaccidental mortality across all cities, nickel and vanadium were strongly associated with respiratory or cardiovascular mortality in Busan and Ulsan, two large port cities. Our study shows that PM2.5 components responsible for PM2.5-associated mortality differed across cities depending on the dominant pollution sources, such as traffic and oil combustion.

Percutaneous Endoscopic Decompression in Lumbar Canal and Lateral Recess Stenosis - The Surgical Learning Curve.

OBJECTIVE: The purpose of this study is to characterize the learning curve of endoscopic lumbar decompression based on peri- and postoperative parameters and to suggest the potential of full endoscopic decompression as a primary treatment option for lumbar canal and lateral recess stenosis. METHODS: The records of 223 consecutive patients who underwent percutaneous endoscopic decompression by a single surgeon for their lumbar canal and lateral recess stenosis were reviewed. Patients were stratified into group 1 (n=100) and group 2 (n=123), depending on their case number. After the 100th case, the procedural time reached a plateau and subsequent patients were assigned to the second group. Demographics and surgical outcomes, including operative times, change in dural sac dimensions, length of hospital stay, and intraoperative complication rates were compared between the 2 groups. Postoperative clinical outcomes, including the visual analogue scale (VAS), the Oswestry Disability Index (ODI) and reoperation rates were compared between the 2 groups (group 1, n=90; group 2, n=110) by follow-up evaluation. RESULTS: Procedural times were greater in group 1 than group 2 (group 1, 105.26 minutes; group 2, 67.65 minutes; p<0.05) and they had higher complication rates (group 1, 16% [16 of 100]; group 2, 8.3% [8 of 123]; p<0.05). The length of hospitalization, postoperative improvement in VAS and ODI, and reoperation rates were not different between the groups. In both groups, stenotic spinal canals were effectively decompressed. CONCLUSION: Continued surgical experience was associated with a reduction in operative times and less intraoperative complications. Although the learning curve was steep and additional surgical experience may be needed to overcome the learning curve, percutaneous full endoscopic lumbar decompression is a safe, clinically-feasible, and effective surgical technique and can be adopted as the primary treatment for lumbar canal and lateral recess stenosis.

Biportal Endoscopic Spinal Surgery for Bilateral Lumbar Foraminal Decompression by Switching Surgeon's Position and Primary 2 Portals: A Report of 2 Cases With Technical Note.

Total facetectomy with/without fusion and facet-preserving microforaminotomy have been performed as conventional surgical treatments for lumbar foraminal stenosis (LFS). Recently, endoscopic spinal surgery has been introduced as a minimally invasive therapeutic modality of LFS by several authors. We report two cases of bilateral LFS at lumbosacral junction level successfully treated with a novel biportal endoscopic spine surgery (BES) technique using primary 2 portals. Two patients presented with chronic onset of back pain and neurogenic claudication symptom. They were diagnosed with bilateral LFS at L5-S1 level from magnetic resonance imaging and computed tomography preoperatively. BES for bilateral foraminal decompression was performed via contralateral approach bilaterally without additional skin incision or surgical trajectory by switching surgeon's position and primary 2 portals. After the surgery, preoperative patients' back and leg pain resolved and unilateral leg weakness of the 2 patients gradually improved in a few months. Postoperative radiologic images revealed significantly enlarged bilateral foramens at L5-S1 level.

Comparative Analysis between Three Different Lumbar Decompression Techniques (Microscopic, Tubular, and Endoscopic) in Lumbar Canal and Lateral Recess Stenosis: Preliminary Report.

PURPOSE: The purpose of our study is to compare the results of spinal decompression using the full-endoscopic interlaminar technique, tubular retractor, and a conventional microsurgical laminotomy technique and evaluate the advantages and clinical feasibility of minimally invasive spinal (MIS) lumbar decompression technique in the lumbar canal and lateral recess stenosis. METHODS: The authors retrospectively reviewed clinical and radiological data from 270 patients who received microsurgical (group E: 72 patients), tubular (group T: 34 patients), or full-endoscopic decompression surgery (group E: 164 patients) for their lumbar canal and lateral recess stenosis from June 2016 to August 2017. Clinical (VAS, ODI, and Mcnab criteria), radiologic (spinal canal diameter, segmental dynamic angle, and disc height), and surgical outcome parameters (CPK level, Operative time, blood loss, and hospital stay) were evaluated pre- and postoperatively and compared among the three groups by means of statistical analysis. Failed cases and complications were reviewed in all groups. RESULTS: The mean follow-up period was 6.38 months. The Overall clinical success rate was 89.4%. All groups showed favorable clinical outcome. The clinical and radiologic results were similar in all groups. Regarding surgical outcome, group E showed longer operation time than group M and T (group E: 84.17 minutes/level, group M: 52.22 minutes/level, and group T: 66.12 minutes/level) (p<0.05). However, groups E and T showed minimal surgical invasiveness compared with group M. Groups E and T showed less immediate postoperative back pain (VAS) (group E: 3.13, group M: 4.28, group T: 3.54) (p<0.05), less increase of serum CPK enzyme (group E: 66.38 IU/L, group M: 120 IU/L, and group T: 137.5 IU/L) (p<0.05), and shorter hospital stay (group E: 2.12 days, group M: 4.85 days, and group T: 2.83 days) (p<0.05). The rates of complications and revisions were not significantly different among the three groups. CONCLUSIONS: MIS decompression technique is clinically feasible and safe to treat the lumbar canal and lateral recess stenosis, and it has many surgical advantages such as less muscle trauma, minimal postoperative back pain, and fast recovery of the patient compared to traditional open microscopic technique.

The Usefulness of Percutaneous Endoscopic Technique in Multifocal Lumbar Pathology.

Introduction. The multifocal lumbar pathology including disc herniation and stenosis in the spinal canal or foramen has been considered the most difficult to approach surgically. It often requires mandatory dual approaches and/or fusion techniques. Traditional percutaneous endoscopic lumbar transforaminal and interlaminar approach has been focused on unifocal disc herniation. However, the development of endoscopic spinal instruments and surgical technique has broadened surgical indication and therapeutic boundary in endoscopic spine surgery. Cases Presentation. The authors present outcomes of four patients with multilumbar pathology including highly inferior migrated disc combined with lateral recess stenosis, multifocal disc herniation, bilateral disc herniations in spinal canal and foraminal disc herniation combined with central canal stenosis. They were successfully treated by percutaneous uniportal full endoscopic approach with single incision. Conclusion. Percutaneous endoscopic spine surgery is a safe and effective tool to figure out multilumbar pathology in a minimal invasive way.