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Ke W, Zhi J, Hua W, Wang B, Lu S, Fan L, Li L, Yang C. Percutaneous posterior full-endoscopic cervical foraminotomy and discectomy: a finite element analysis and radiological assessment. Comput Methods Biomech Biomed Engin 2020; 23:805-814. [PMID: 32406769 DOI: 10.1080/10255842.2020.1765162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Percutaneous posterior full-endoscopic cervical foraminotomy and discectomy (PECFD) is recognized as a safe, effective, and minimally invasive treatment for cervical spondylotic radiculopathy (CSR). However, the potential mechanisms of the degenerative changes and postoperative recurrence after PECFD are unclear. In this study, a finite element (FE) analysis and radiological assessment were performed to evaluate the biomechanical effects after PECFD. The FE model indicated that the ROM and IDP of C5-C6 increased significantly after PECFD in the extension loading. The radiological evaluation revealed that the extension ROM of C2-C7 and the operative level increased significantly at the one-year follow-up compared with that obtained preoperatively. Combining the FE results and radiological changes, we conclude that the increase in the ROM and IDP at the operative level in the extension loading is the potential cause of the degenerative changes and recurrences after PECFD surgery.
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Affiliation(s)
- Wencan Ke
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Jinggang Zhi
- State Key Laboratory of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, PR China
| | - Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Bingjin Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Saideng Lu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | - Lina Fan
- State Key Laboratory of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, PR China
| | - Li Li
- State Key Laboratory of Digital Manufacturing Equipment and Technology, School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, PR China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
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Yang J, Chu L, Deng Z, Kai-Xuan L, Deng R, Chen H, Liu P, Liu T, Rong X, Hao D. [Clinical study of single-level cervical disc herniation treated by full-endoscopic decompression via anterior transcorporeal approach]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:543-549. [PMID: 32410418 DOI: 10.7507/1002-1892.201905118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach. Methods According to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C 3, 4 in 2 cases, C 4, 5 in 8 cases, C 5, 6 in 9 cases, and C 6, 7 in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated. Results Full-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation ( P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one ( t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation ( t=0.881, P=0.421). Conclusion Full-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results.
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Affiliation(s)
- Junsong Yang
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | | | - Zhongliang Deng
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China
| | | | - Rui Deng
- Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Hao Chen
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Peng Liu
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Tuanjiang Liu
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
| | - Xueqin Rong
- Pain Spine Minimally Invasive Center of Hainan Third People Hospital, Sanya Hainan, 572000, P.R.China
| | - Dingjun Hao
- Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi'an Jiaotong University, Xi'an Shaanxi, 710054, P.R.China
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Yao S, Ouyang B, Lu T, Chen Q, Luo C. Treatment of cervical spondylotic radiculopathy with posterior percutaneous endoscopic cervical discectomy: Short-term outcomes of 24 cases. Medicine (Baltimore) 2020; 99:e20216. [PMID: 32443351 PMCID: PMC7254843 DOI: 10.1097/md.0000000000020216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
To determine the short-term clinical outcomes of single-segment cervical spondylotic radiculopathy treated with posterior percutaneous endoscopic cervical discectomy (PPECD).Data of a total of 24 patients who underwent PPECD and local anesthesia for single-level segmental cervical spondylotic radiculopathy between March 2016 and December 2017 were reviewed. The Japanese Orthopaedic Association, visual analog scale (VAS), and neck disability index scores at preoperative 1 day, postoperative 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year were recorded. The modified MacNab criteria at the last follow-up were re-recorded for the evaluation of clinical effectiveness.All operations were successfully completed under endoscopic guidance. No patient showed spinal cord, nerve root, vascular injuries, dural tears or other complications. The postoperative VAS scores of the arm and neck were significantly reduced compared with the preoperative VAS scores (P < .05), while postoperative the Japanese Orthopaedic Association scores were significantly increased (P < .05). The postoperative neck disability index scores were significantly reduced compared with preoperative scores (P < .05). The modified MacNab criteria at the last follow-up showed 16 excellent cases, 8 good cases, 0 fine cases, and 0 poor cases. Postoperative magnetic resonance imaging and cervical 3-dimensional computed tomography reconstruction showed that the intervertebral disc was adequately resected and the nerve root was not under compression.PPECD is safe and effective for the treatment of single-segment cervical spondylotic radiculopathy.
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Hofstetter CP, Ahn Y, Choi G, Gibson JNA, Ruetten S, Zhou Y, Li ZZ, Siepe CJ, Wagner R, Lee JH, Sairyo K, Choi KC, Chen CM, Telfeian AE, Zhang X, Banhot A, Lokhande PV, Prada N, Shen J, Cortinas FC, Brooks NP, Van Daele P, Kotheeranurak V, Hasan S, Keorochana G, Assous M, Härtl R, Kim JS. AOSpine Consensus Paper on Nomenclature for Working-Channel Endoscopic Spinal Procedures. Global Spine J 2020; 10:111S-121S. [PMID: 32528794 PMCID: PMC7263337 DOI: 10.1177/2192568219887364] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
STUDY DESIGN International consensus paper on a unified nomenclature for full-endoscopic spine surgery. OBJECTIVES Minimally invasive endoscopic spinal procedures have undergone rapid development during the past decade. Evolution of working-channel endoscopes and surgical instruments as well as innovation in surgical techniques have expanded the types of spinal pathology that can be addressed. However, there is in the literature a heterogeneous nomenclature defining approach corridors and procedures, and this lack of common language has hampered communication between endoscopic spine surgeons, patients, hospitals, and insurance providers. METHODS The current report summarizes the nomenclature reported for working-channel endoscopic procedures that address cervical, thoracic, and lumbar spinal pathology. RESULTS We propose a uniform system that defines the working-channel endoscope (full-endoscopic), approach corridor (anterior, posterior, interlaminar, transforaminal), spinal segment (cervical, thoracic, lumbar), and procedure performed (eg, discectomy, foraminotomy). We suggest the following nomenclature for the most common full-endoscopic procedures: posterior endoscopic cervical foraminotomy (PECF), transforaminal endoscopic thoracic discectomy (TETD), transforaminal endoscopic lumbar discectomy (TELD), transforaminal lumbar foraminotomy (TELF), interlaminar endoscopic lumbar discectomy (IELD), interlaminar endoscopic lateral recess decompression (IE-LRD), and lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD). CONCLUSIONS We believe that it is critical to delineate a consensus nomenclature to facilitate uniformity of working-channel endoscopic procedures within academic scholarship. This will hopefully facilitate development, standardization of procedures, teaching, and widespread acceptance of full-endoscopic spinal procedures.
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Affiliation(s)
| | - Yong Ahn
- Gachon University, Incheon, South Korea
| | - Gun Choi
- Wooridul Spine Hospital, Pohang, South Korea
| | | | - S. Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
| | - Yue Zhou
- Xinquiao Hospital, Third Military Medical University, Chongquing, China
| | - Zhen Zhou Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | | | - Ralf Wagner
- Ligamenta Spine Center, Frankfurt am Main, Germany
| | - Jun-Ho Lee
- Kyung Hee University Medical Centre, Seoul, South Korea
| | | | | | - Chien-Min Chen
- Changhua Christian Hospital, Changhua, and Dayeh University, Changhua
| | - A. E. Telfeian
- Rhode Island Hospital, The Warren Alpert Medical School of Brown, Providence, RI, USA
| | - Xifeng Zhang
- The General Hospital of Chinese People’s Liberation Army, Beijing, China
| | - Arun Banhot
- Columbia Asia Hospital, Gurugram, Haryana, India
| | | | - N. Prada
- Foscal International Clinic, Floridablanca, Colombia
| | - Jian Shen
- Mohawk Valley Orthopedics, Amsterdam, NY, USA
| | - F. C. Cortinas
- Hospital Angeles Pedregal Camino Santa Teresa, Mexico City, Mexico
| | | | | | - Vit Kotheeranurak
- Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | - Saqib Hasan
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Gun Keorochana
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mohammed Assous
- Razi Spine Clinic-Minimally Invasive Spine Surgery, Amman, Jordan
| | - Roger Härtl
- Weill Cornell Medical College, New York, NY, USA
| | - Jin-Sung Kim
- St. Mary’s Hospital, The Catholic University of Korea, Seoul, South Korea
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Apostolakis S. Transcorporeal Tunnel Approach for Cervical Radiculopathy and Myelopathy: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 138:318-327. [PMID: 32217171 DOI: 10.1016/j.wneu.2020.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The transcorporeal tunnel approach is a relatively new alternative of anterior cervical decompression and fusion for the treatment of cervical radiculopathy and myelopathy, with its main presumed advantage being the preservation of the intervertebral space. The aim of the present article is to present the outcomes of the systematic review and meta-analysis regarding the short-term outcomes of this surgical technique. METHODS A systematic review and a meta-analysis using the random-effects method of the available studies were performed to assess the safety and efficiency of the transcorporeal tunnel approach for cervical radiculopathy and myelopathy. RESULTS In total, 15 eligible studies were identified, with a cumulative number of 254 patients. Pooled data yielded a complication rate of 0.053 and a failure rate of the technique of 0.081; a patient-reported favorable outcome of 0.94 was documented. The available data did not allow for a definite conclusion on the effects of the technique on the intervertebral space height. CONCLUSIONS Although technically challenging, like all minimally invasive methods, the transcorporeal tunnel approach seems to be a safe and efficient option for the treatment of cervical radiculopathy and myelopathy, presenting comparable outcome profiles to alternative open or less invasive techniques.
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Zhang Z, Gao J, Liao W. [Research progress in minimally invasive treatment of cervical nerve root canal stenosis under total endoscope]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:256-259. [PMID: 32030960 DOI: 10.7507/1002-1892.201906026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress of total endoscopic minimally invasive technique in treating cervical nerve root canal stenosis (CNRCS). Methods The related literature at home and abroad was extensively reviewed. The research history, current situation, research progress, advantages and disadvantages of minimally invasive treatment of CNRCS under total endoscope were summarized. Results In recent years, with the continuous development of minimally invasive technique of total endoscope in spine surgery, the surgical treatment methods are also constantly innovated. Compared with the traditional open surgery, minimally invasive treatment of CNRCS under total endoscope can obtain better effectiveness, keep the stability of the cervical segment to the maximum extent, reduce the impact on the activity of the cervical spine and the occurrence of related surgical complications, which is an effective minimally invasive technology. Conclusion The minimally invasive treatment of CNRCS under total endoscope has achieved some results, which is expected to be one of the indispensable means to treat CNRCS, but it still needs to be improved.
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Affiliation(s)
- Zihan Zhang
- Department of Spinal Pelvic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - Jian'an Gao
- Department of Spinal Pelvic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
| | - Wenbo Liao
- Department of Spinal Pelvic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563000, P.R.China
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Lubelski D, Ramhmdani S, Pennington Z, Theodore N, Bydon A. Utility of Posterior Longitudinal Ligament Resection During Anterior Cervical Decompression for Radiculopathy. World Neurosurg 2020; 137:e425-e429. [PMID: 32035200 DOI: 10.1016/j.wneu.2020.01.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Anterior cervical diskectomy and fusion (ACDF) is the main surgical treatment of cervical radiculopathy. Controversy exists about the need to resect the posterior longitudinal ligament (PLL) to directly decompress the nerve roots, or if it is sufficient to indirectly decompress with diskectomy and graft placement. The objective of this study was to determine the effect of PLL resection after ACDF. METHODS A retrospective review was performed of all patients that underwent first-time ACDF for cervical radiculopathy at a single tertiary care institution between 1999 and 2013. Comparative analyses and multivariable logistic regression were performed. RESULTS Two hundred patients were included with a mean follow-up of 39 months. Average age was 54 years, 62% were women, and diabetes and current smoking status were noted in 11% and 15%, respectively. PLL resection was performed in 127 patients (64%), and no significant differences in baseline characteristics were observed between the 2 cohorts. One durotomy occurred in the resected PLL cohort, and none were seen in the unresected PLL group. No differences were seen in perioperative complications. At the time of last follow-up, improvement in radiculopathy was observed in 94% of the resected PLL group compared with 81% of the unresected PLL group (P = 0.008). After controlling for confounders, PLL resection had 3.8 times greater odds of leading to postoperative improvement in radiculopathy. CONCLUSIONS ACDF leads to a high rate of success in improvement of preoperative radiculopathy. Excision of PLL during surgery leads to 3.8 times greater odds of improvement in this symptom, with no significant difference in the complication rate.
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Affiliation(s)
- Daniel Lubelski
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Seba Ramhmdani
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Zach Pennington
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
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Chung AS, Kimball J, Min E, Wang JC. Endoscopic spine surgery-increasing usage and prominence in mainstream spine surgery and spine societies. JOURNAL OF SPINE SURGERY 2020; 6:S14-S18. [PMID: 32195409 DOI: 10.21037/jss.2019.09.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Andrew S Chung
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jon Kimball
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Elliot Min
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey C Wang
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Kong W, Xin Z, Du Q, Cao G, Liao W. Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord for single-segment cervical spondylotic myelopathy: The technical interpretation and 2 years of clinical follow-up. J Orthop Surg Res 2019; 14:461. [PMID: 31870395 PMCID: PMC6929378 DOI: 10.1186/s13018-019-1474-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/14/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND ACDF is the standard procedure for treatment of cervical spondylotic myelopathy (CSM), but a long-term follow-up has been revealed some associated complications of swallowing discomfort, displacement of the fusion device, and accelerated degeneration of the adjacent segment. OBJECTIVE To evaluate the clinical outcomes of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) for single-segment CSM and to analyze the clinical efficacy, surgical characteristics, and complication prevention. METHODS A total of 32 patients who underwent APFETDSC for single-segment CSM from Aug. 2015 to Apr. 2017 were reviewed. Operating time, time of walking out of bed postoperation, length of hospitalization, complications, neck pain visual analog scale (VAS), and Japanese Orthopaedic Association Score (JOA) were evaluated. Measurement of intervertebral height (HI) of surgical segments on cervical neutral X-ray, Harrison's method was used to measure cervical spine angle (CSA). RESULTS The operation time was 103.3 ± 12.95 min, time of walking out of bed after surgery was 19.81 ± 4.603 h, the length of postoperative hospital stay was 57.48 ± 19.48 h. The postoperative neck pain VAS and JOA were significantly improved compared with preoperation(p < 0.001). The postoperative HI was statistical significance decreased compared with preoperation(p < 0.001), but the HI reduction was less than 0.5 mm, without adverse clinical symptoms. The postoperative CSA was significantly improved compared with preoperative(p < 0.001). The excellent and good rate was 87.5%, and the JOA improvement rate was 75.52 ± 11.11%. There was no cervical instability, vertebral fracture, wound infection, and other complications. CONCLUSIONS APFETDSC is a safe and effective minimally invasive technique with small auxiliary injuries for single-segment CSM while avoiding the sequelae of ACDF. Its short-term clinical efficacy was good and no significant effect on cervical stability.
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Affiliation(s)
- Weijun Kong
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
| | - Zhijun Xin
- Department of Spine Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, 563000 Guizhou China
| | - Qian Du
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
| | - Guangru Cao
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
| | - Wenbo Liao
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
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Full-endoscopic (bi-portal or uni-portal) versus microscopic lumbar decompression laminectomy in patients with spinal stenosis: systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:595-611. [PMID: 31863273 DOI: 10.1007/s00590-019-02604-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/13/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lumbar stenosis causes pain in the lower lumbar spine and lower extremities and reduces the patient's quality of life and walking ability. Thus, these conditions are common surgical indications for spinal stenosis. Previous reports have shown satisfactory clinical outcomes of the full-endoscopic (FE) and MI technique decompressive laminectomy for lumbar stenosis. However, they still remain controversial. OBJECTIVE We conducted a systematic review and meta-analysis to compare the postoperative outcomes between FE (bi-portal or uni-portal) and MI technique decompressive laminectomy for lumbar stenosis. METHOD We searched all comparative studies that compared postoperative outcomes (operative time, VAS for back and leg pain, ODI in 3 months and last follow-up) of full-endoscopic (bi-portal or uni-portal) and microscopic technique decompressive laminectomy for lumbar stenosis from the PubMed and Scopus databases up to October 16, 2019. RESULTS Nine of 1107 studies (five comparative studies and four RCT) (N = 994 patients) were eligible; all studies were included in pooling of FE and MI decompression. Five and three studies were included in pooling of bi-portal endoscopic, uni-portal endoscopic and MI decompression. All three techniques were compared in one study. Eight, nine, seven, eight, five, seven, eight and nine studies were included in pooling of VAS for back, leg, ODI in 3 months and last follow-up and operative time, respectively. The UMD of VAS for back, leg, ODI in 3 months and last follow-up of FE group was - 0.63 (95% CI - 1.15, - 0.12), - 0.15 (- 0.42, 0.11), - 2.06 (- 3.76, - 0.39), - 0.07 (- 0.22, 0.08), - 0.16 (- 0.29, - 0.03), - 0.20 (- 1.20, 0.81) scores and - 3.00 (- 12.25, 6.25) minutes when compared to MI in lumbar stenosis. In terms of complication, FE was lower risk of 0.62 (0.40, 0.96) times when compared to MI. After subgroup analysis, BESS had significant lower back and leg pain within 3 months when compared to MI group, while uni-portal FE had significant lower leg pain in the last follow-up and complication when compared to MI group. There had no difference in ODI and operative time between two groups. CONCLUSION FE had statistically significant lower back pain, lower leg pain and lower risk of having complications when compared to MI decompression in lumbar stenosis, while there is no difference in ODI and operative time between both groups. Comparing to MI, BESS had better early postoperative back pain while uni-portal FE had better leg pain and risk of having complications. Larger, prospective randomized controlled studies are needed to confirm these findings as the current literature is still insufficient. LEVEL OF EVIDENCE III.
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Minimally Invasive Posterior Cervical Foraminotomy as an Alternative to Anterior Cervical Discectomy and Fusion for Unilateral Cervical Radiculopathy: A Systematic Review and Meta-analysis. Spine (Phila Pa 1976) 2019; 44:1731-1739. [PMID: 31343619 DOI: 10.1097/brs.0000000000003156] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE The aim of this study was to evaluate clinical outcomes, complications, and reoperations of minimally invasive posterior cervical foraminotomy (MI-PCF) for unilateral cervical radiculopathy without myelopathy, in comparison to anterior cervical decompression and fusion (ACDF). SUMMARY OF BACKGROUND DATA ACDF is a standard treatment for cervical radiculopathy secondary to lateral disc herniation or foraminal stenosis. Recent studies have suggested MI-PCF to be an effective alternative to ACDF. However, concern for reoperation and whether similar improvements in clinical outcomes can be achieved has led to a debate in the literature. METHODS We comprehensively searched PubMed, CINAHL Plus, and SCOPUS utilizing terms related to MI-PCF. Two independent reviewers assessed potential studies and extracted data on clinical outcome scores (neck disability index [NDI], visual analog scale [VAS]-neck, and VAS-arm), reoperation proportion, and complications. Studies included were on noncentral cervical pathology, published in the last 10 years, had a sample size of >10 patients, and reported data on minimally invasive techniques for posterior cervical foraminotomy. Heterogeneity and publication bias analyses were performed. The pooled proportions of each outcome were compared to those of ACDF obtained from two previously published studies. RESULTS Fourteen studies were included with data of 1216 patients. The study population was 61.8% male, with a mean age of 51.57 years, and a mean follow-up of 30 months. MI-PCF resulted in a significantly greater improvement in VAS-arm scores compared to ACDF, and similar improvements in VAS-neck and NDI scores. Proportions of complications and reoperations were similar between the two cohorts. The most common complications were transient neuropraxia, wound-related, and durotomy. CONCLUSION Our findings suggest that MI-PCF may be utilized as a safe and effective alternative to ACDF in patients with unilateral cervical radiculopathy without myelopathy, without concern for increased reoperations or complications. LEVEL OF EVIDENCE 3.
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Li C, Tang X, Chen S, Meng Y, Zhang W. Clinical application of large channel endoscopic decompression in posterior cervical spine disorders. BMC Musculoskelet Disord 2019; 20:548. [PMID: 31739780 PMCID: PMC6862807 DOI: 10.1186/s12891-019-2920-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background We investigated the clinical value of posterior percutaneous endoscopic decompression (PED) for single-segment cervical spondylotic myelopathy (CSM) and cervical spondylotic radiculopathy (CSR). Methods: Clinical data from February 2016 to March 2018 were collected for 32 patients with single-segment CSM or CSR who underwent posterior cervical percutaneous large channel endoscopic decompression and completed a regular follow-up exam at 12 months after surgery. Patient data included: age (range 30–81 years and mean of 49.5 years) and surgical information (operation time, bleeding volume, hospital stay, complications, etc.). The Japan Orthopedic Association (JOA) score and pain visual analog scale (VAS) were used to evaluate the surgical outcome for each patient. Cervical spine radiographs were used to evaluate cervical curvature (Cervical spondylotic angle (CSA), C2–7 Cobb angle) and CT and MRI were used to assess the extent of laminectomy and nerve root decompression. The JOA score, VAS score, cervical curvature were analyzed statistically, and the clinical outcome was evaluated using modified Macnab criteria at the last patient follow-up exam. Results The JOA and VAS scores were compared before and after surgery (1 day Pre-op; 3 days, 3 months and 12 months Post-op). The differences were statistically significant (P < 0.05). There were significant differences in cervical curvature (C2–7 Cobb angle) between the time points (1 day Pre-op; 3 days, 3 months and 12 months Post-op), but the differences were no statistically significant in CSA angle (P < 0.05) The operation time range was 45–110 min (mean 68.6 ± 23.8 min); the intraoperative blood loss range was 20–85 ml (mean28 ± 14.8 ml), and the hospital stay was 3–8 days (mean4.5 days). At the last follow-up, the clinical efficacy was evaluated using modified Macnab criteria. The results were excellent in 18 cases, good in 11 cases, and fair in 3 cases. The combined excellent and good rate was 93.75%. Postoperative CT and MRI showed that the compression of the spinal cord or nerve roots was completely relieved. Conclusion Endoscopic decompression of posterior cervical vertebral disorders is a safe, effective, and minimally invasive surgical procedure with rapid recovery times. This procedure warrants additional research and clinical application.
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Affiliation(s)
- Chengli Li
- Department of Spine surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.,Department of orthopaedics, Yantai Affiliated Hospital of Binzhou Medical College, Yantai, 264100, Shandong Province, China
| | - Xiaojie Tang
- Department of orthopaedics, Yantai Affiliated Hospital of Binzhou Medical College, Yantai, 264100, Shandong Province, China
| | - Song Chen
- Department of Spine surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yongchun Meng
- Department of orthopaedics, Yantai Affiliated Hospital of Binzhou Medical College, Yantai, 264100, Shandong Province, China
| | - Wei Zhang
- Department of Spine surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
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MacDowall A, Heary RF, Holy M, Lindhagen L, Olerud C. Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register. J Neurosurg Spine 2019; 32:344-352. [PMID: 31731263 DOI: 10.3171/2019.9.spine19787] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/10/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The long-term efficacy of posterior foraminotomy compared with anterior cervical decompression and fusion (ACDF) for the treatment of degenerative disc disease with radiculopathy has not been previously investigated in a population-based cohort. METHODS All patients in the national Swedish Spine Register (Swespine) from January 1, 2006, until November 15, 2017, with cervical degenerative disc disease and radiculopathy were assessed. Using propensity score matching, patients treated with posterior foraminotomy were compared with those undergoing ACDF. The primary outcome measure was the Neck Disability Index (NDI), a patient-reported outcome score ranging from 0% to 100%, with higher scores indicating greater disability. A minimal clinically important difference was defined as > 15%. Secondary outcomes were assessed with additional patient-reported outcome measures (PROMs). RESULTS A total of 4368 patients (2136/2232 women/men) met the inclusion criteria. Posterior foraminotomy was performed in 647 patients, and 3721 patients underwent ACDF. After meticulous propensity score matching, 570 patients with a mean age of 54 years remained in each group. Both groups had substantial decreases in their NDI scores; however, after 5 years, the difference was not significant (2.3%, 95% CI -4.1% to 8.4%; p = 0.48) between the groups. There were no significant differences between the groups in EQ-5D or visual analog scale (VAS) for neck and arm scores. The secondary surgeries on the index level due to restenosis were more frequent in the foraminotomy group (6/100 patients vs 1/100), but on the adjacent segments there was no difference between groups (2/100). CONCLUSIONS In patients with cervical degenerative disc disease and radiculopathy, both groups demonstrated clinical improvements at the 5-year follow-up that were comparable and did not achieve a clinically important difference from one another, even though the reoperation rate favored the ACDF group. This study design obtains population-based results, which are generalizable.
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Affiliation(s)
- Anna MacDowall
- 1Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Robert F Heary
- 2Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Marek Holy
- 3Department of Orthopedics, Örebro University Hospital, Örebro; and
| | - Lars Lindhagen
- 4Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Claes Olerud
- 1Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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A Novel Hybrid Endoscopic Approach for Anterior Cervical Discectomy and Fusion and a Meta-Analysis of the Literature. World Neurosurg 2019; 131:e237-e246. [DOI: 10.1016/j.wneu.2019.07.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/29/2022]
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Posterior percutaneous endoscopic cervical foraminotomy and discectomy for degenerative cervical radiculopathy using intraoperative O-arm imaging. Wideochir Inne Tech Maloinwazyjne 2019; 14:551-559. [PMID: 31908702 PMCID: PMC6939211 DOI: 10.5114/wiitm.2019.88660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Posterior percutaneous endoscopic cervical foraminotomy and discectomy (P-PECD) is a minimally invasive technique for the treatment of degenerative cervical radiculopathy. The O-arm, an intraoperative mobile computed tomography (CT) scanner, may improve spine surgery outcomes. Aim To evaluate clinical outcomes of O-arm assisted P-PECD in patients with degenerative cervical radiculopathy. Material and methods Between January 2013 and January 2018, 32 patients with degenerative cervical radiculopathy who underwent P-PECD were followed up for 12 months. Their demographic, clinical and surgical data were reviewed retrospectively. All patients received intraoperative O-arm scanning to assess working cannula placement and decompression. The visual analogue scale (VAS), the neck disability index (NDI), and Odom’s criteria were used to evaluate clinical outcomes. Results Compared with preoperative values, mean NDI, neck-VAS, and arm-VAS scores were dramatically improved 1 week postoperatively, and the improvement was maintained for at least a year after surgery (from 27.6 ±10.5, 5.8 ±1.7, and 7.2 ±2.3 to 1.4 ±0.8, 1.1 ±0.8 and 0.9 ±0.6, respectively). According to Odom’s criteria, 27/32 patients (84.4%) reported excellent or good results. There were no permanent complications. One patient suffered from transient thumb weakness due to a cervical nerve root injury caused by the spinal needle. Conclusions P-PECD aided by intraoperative O-arm imaging is a safe, effective, and minimally invasive procedure for treating degenerative cervical radiculopathy that can provide accurate cannula placement and thorough decompression.
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Liu W, Yao L, Li X, Tian Z, Ning C, Yan M, Wang Y. Percutaneous endoscopic thoracic discectomy via posterolateral approach: A case report of migrated thoracic disc herniation. Medicine (Baltimore) 2019; 98:e17579. [PMID: 31593145 PMCID: PMC6799733 DOI: 10.1097/md.0000000000017579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Minimally invasive surgeries for thoracic disc herniation (TDH) evolved rapidly in recent years, and multiple approaches have been put forward. Thoracic discectomy via percutaneous spine endoscopy (PSE) is inadequately documented because of the low prevalence of TDH and the high difficulty of thoracic spine endoscopy techniques. Herein, we present a TDH case who underwent percutaneous endoscopic thoracic discectomy. PATIENT CONCERNS A 28-year-old male suffered backpain and partial paralysis in lower extremities. DIAGNOSES Magnet resonance imaging demonstrated T11-12 TDH, with cranially migrated disc fragment. INTERVENTIONS The patient underwent percutaneous endoscopic thoracic discectomy via posterolateral approach with the assistance of endoscopic reamer in the procedure of foramino-laminaplasty. OUTCOMES The patient's muscle force improved immediately, and the backpain relieved after 5 days post-surgery. In the 6-month follow-up, he had normal muscle force without paresthesia in lower limbs. LESSONS The innovative design of endoscopic reamer provides effective plasty and access establishment with lower risk and difficulty, which ensures the vision and the operating space of the procedure of decompression. With this technique, the indications of thoracic PSE were broadened to both ventral and dorsal thoracic stenosis.
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Affiliation(s)
- Wei Liu
- Department of Spine Surgery, the First Hospital of Jilin University
| | - Liyu Yao
- Department of Pediatric Surgery, the First Hospital of Jilin University, Changchun
| | - Xingchen Li
- Intervertebral Disc Center, the Third Hospital of Henan Province, Zhengzhou
| | - Zhisen Tian
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun, P.R. China
| | - Cong Ning
- Department of Spine Surgery, the First Hospital of Jilin University
| | - Ming Yan
- Department of Spine Surgery, the First Hospital of Jilin University
| | - Yuanyi Wang
- Department of Spine Surgery, the First Hospital of Jilin University
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Ruetten S, Hahn P, Oezdemir S, Baraliakos X, Godolias G, Komp M. Surgical treatment of cervical subaxial intraspinal extradural cysts using a full-endoscopic uniportal posterior approach. J Orthop Surg (Hong Kong) 2019; 26:2309499018777665. [PMID: 29793373 DOI: 10.1177/2309499018777665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Symptomatic intraspinal extradural cysts of the cervical subaxial spine are rare, but usually require surgery. Conventional posterior decompression is the gold standard. However, there is increasing experience with endoscopic surgical techniques. The purpose of the study is to evaluate the technical implementation and outcomes of a full-endoscopic uniportal technique via the posterior approach in patients with symptomatic intraspinal extradural cysts of the cervical subaxial spine. METHODS Seven consecutive patients with a subaxial location of symptomatic intraspinal extradural cysts were decompressed in a full-endoscopic uniportal technique via the posterior approach between 2009 and 2015. Imaging and clinical data were collected in follow-up examinations for 18 months. RESULTS In all cases, the cyst was completely removed and adequate decompression was achieved using the full-endoscopic uniportal technique. One patient developed a dural leak that was sutured and covered intraoperatively. No other complications requiring treatment were observed. All patients had a good clinical outcome with stable regression of the radicular and central nerve pain or neurological deficits. The imaging follow-up showed sufficient decompression in all cases. No evidence was found of increasing instability during the follow-up period. CONCLUSION The full-endoscopic uniportal operation with a posterior approach allows the resection of the cyst and can minimize trauma and destabilization and has technical benefits and a low complication rate. It is an alternative surgical method that can offer advantages and is considered by the authors to be the surgical technique of choice for cervical subaxial intraspinal extradural cysts.
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Affiliation(s)
- Sebastian Ruetten
- 1 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St Elisabeth Group-Catholic Hospital Rhein-Ruhr, St Anna Hospital Herne/Marien Hospital Herne-University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
| | - Patrick Hahn
- 1 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St Elisabeth Group-Catholic Hospital Rhein-Ruhr, St Anna Hospital Herne/Marien Hospital Herne-University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
| | - Semih Oezdemir
- 1 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St Elisabeth Group-Catholic Hospital Rhein-Ruhr, St Anna Hospital Herne/Marien Hospital Herne-University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
| | - Xenophon Baraliakos
- 2 Center for Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr University of Bochum, Bochum, Germany
| | - Georgios Godolias
- 3 Center for Orthopedics and Traumatology of the St Elisabeth Group-Catholic Hospital Rhein-Ruhr, St Anna Hospital Herne/Marien Hospital Herne-University Hospital of the Ruhr University Bochum/Marien Hospital Witten, Herne, Germany
| | - Martin Komp
- 1 Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St Elisabeth Group-Catholic Hospital Rhein-Ruhr, St Anna Hospital Herne/Marien Hospital Herne-University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne, Germany
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120
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Bucknall V, Gibson JA. Cervical endoscopic spinal surgery: A review of the current literature. J Orthop Surg (Hong Kong) 2019; 26:2309499018758520. [PMID: 29455630 DOI: 10.1177/2309499018758520] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cervical endoscopic spinal surgery (CESS) is now regularly performed in some centres in the Far East, yet rarely in Europe and the United States. This review describes the application of CESS through anterior and posterior approaches with analysis of the available evidence supporting current techniques. An electronic literature search identified 52 papers and proceedings' abstracts of which 25 (16 anterior approach and 9 posterior approach) provided comparable clinical outcomes. The results revealed a good or excellent outcome from CESS in 91% (range 74-100%) with a complication rate of 5%. In a local cohort study, patients had 72% less neck pain (visual analogue scale rating) and 81% less arm pain at 6 months when CESS was used as an isolated procedure, and 74% less neck pain and 83% less arm pain when coupled with disc replacement or fusion at an adjacent level.
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Affiliation(s)
- Vittoria Bucknall
- The Royal Infirmary and University of Edinburgh, Little France, Edinburgh, UK
| | - Jn Alastair Gibson
- The Royal Infirmary and University of Edinburgh, Little France, Edinburgh, UK
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Percutaneous endoscopic lumbar discectomy and microsurgical laminotomy : A prospective, randomized controlled trial of patients with lumbar disc herniation and lateral recess stenosis. DER ORTHOPADE 2019; 48:157-164. [PMID: 30076437 DOI: 10.1007/s00132-018-3610-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sufficient decompression of the nerve root canal is still regarded as the method of choice when operating on patients with lumbar disc herniation (LDH) with lumbar lateral recess stenosis; however, tissue-sparing procedures are becoming more popular. Endoscopic techniques offer advantages and the benefits of rehabilitation, which have become the standard in many surgical operations when operating on the spine. A significant issue has been the upgrading of instruments to provide enough bone resection under continuous visual control. MATERIAL AND METHODS We examined patients who had LDH with lateral recess stenosis and compared the results of nerve root canal decompression using percutaneous endoscopic lumbar discectomy (PELD) with a microsurgical laminotomy (ML) technique. In this study 40 patients with full endoscopic decompression or microsurgery were followed up for 2 years. In addition to general and specific parameters, the following two parameters were also used for the investigation: the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). RESULTS Except for 1 patient in whom repair was done by fusion and 1 who was lost to follow-up, 38 patients remained in the study over the 2 years. The mean operating time in the PELD group was longer (p < 0.05), but intraoperative and postoperative blood loss was less than in the ML group (p < 0.05). The postoperative results were better than before surgery, and the VAS and ODI parameters indicated a clear improvement in leg pain and daily activities in both groups (p > 0.05). Of the patients three suffered increasing back pain (2 ML, 1 PELD). CONCLUSION The results indicated that the PELD can provide an effective supplement and serve as an alternative for LDH with lateral recess stenosis compared with the ML technique when the indication criteria are fulfilled. The PELD also has the advantage of being a minimally invasive intervention.
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122
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McClelland S, Goldstein JA. Minimally Invasive versus Open Spine Surgery: What Does the Best Evidence Tell Us? J Neurosci Rural Pract 2019; 8:194-198. [PMID: 28479791 PMCID: PMC5402483 DOI: 10.4103/jnrp.jnrp_472_16] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Spine surgery has been transformed significantly by the growth of minimally invasive surgery (MIS) procedures. Easily marketable to patients as less invasive with smaller incisions, MIS is often perceived as superior to traditional open spine surgery. The highest quality evidence comparing MIS with open spine surgery was examined. Methods: A systematic review of randomized controlled trials (RCTs) involving MIS versus open spine surgery was performed using the Entrez gateway of the PubMed database for articles published in English up to December 28, 2015. RCTs and systematic reviews of RCTs of MIS versus open spine surgery were evaluated for three particular entities: Cervical disc herniation, lumbar disc herniation, and posterior lumbar fusion. Results: A total of 17 RCTs were identified, along with six systematic reviews. For cervical disc herniation, MIS provided no difference in overall function, arm pain relief, or long-term neck pain. In lumbar disc herniation, MIS was inferior in providing leg/low back pain relief, rehospitalization rates, quality of life improvement, and exposed the surgeon to >10 times more radiation in return for shorter hospital stay and less surgical site infection. In posterior lumbar fusion, MIS transforaminal lumbar interbody fusion (TLIF) had significantly reduced 2-year societal cost, fewer medical complications, reduced time to return to work, and improved short-term Oswestry Disability Index scores at the cost of higher revision rates, higher readmission rates, and more than twice the amount of intraoperative fluoroscopy. Conclusion: The highest levels of evidence do not support MIS over open surgery for cervical or lumbar disc herniation. However, MIS TLIF demonstrates advantages along with higher revision/readmission rates. Regardless of patient indication, MIS exposes the surgeon to significantly more radiation; it is unclear how this impacts patients. These results should optimize informed decision-making regarding MIS versus open spine surgery, particularly in the current advertising climate greatly favoring MIS.
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Affiliation(s)
- Shearwood McClelland
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Division of Spine Surgery, Hospital for Joint Diseases, New York, NY, USA
| | - Jeffrey A Goldstein
- Department of Orthopaedic Surgery, NYU Langone Medical Center, Division of Spine Surgery, Hospital for Joint Diseases, New York, NY, USA
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123
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Ahn Y. Current techniques of endoscopic decompression in spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:S169. [PMID: 31624735 DOI: 10.21037/atm.2019.07.98] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Endoscopic spine surgery has become a practical, minimally invasive technique for decompression in patients with spinal disc herniation or stenosis. This review aimed to summarize the current techniques of endoscopic decompression technique in spine surgery and to discuss the benefits, limitations, and future perspectives of this minimally invasive technique. Endoscopic spine decompression surgery can be categorized according to the endoscopic property: percutaneous endoscopic (full-endoscopic), microendoscopic, and biportal endoscopic. It can also be classified based on the approach: transforaminal, interlaminar, anterior, posterior, and caudal approaches. Theoretically, each technique can be applied in the lumbar, cervical, and thoracic spine. The various endoscopic spine surgery techniques should be appropriately conducted according to the disease entities, level, and zone of pathologies. Although the current level of evidence is relatively low and the relevance of the technique is controversial, recent clinical results and the critical concept are promising. Development in optics, instruments, and approach will improve its safety and reduce technical complexity. In the meantime, high-quality clinical studies, including randomized trials and meta-analyses, are due for publication. Eventually, endoscopic spine surgery is expected to become the golden standard for spinal surgery.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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124
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Frucella G, Maldonado D. [Percutaneous Lumbar Endoscopic Discectomy: Presentation of 60 Cases Intervened in Argentina with Awake Patients]. Surg Neurol Int 2019; 10:S37-S45. [PMID: 31772818 PMCID: PMC6863058 DOI: 10.25259/sni_325_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique that has been used in different countries since the late eighties for the treatment of herniated discs. OBJECTIVE The objective of this study was to describe the results of PELD in a series of awake patients, treated with epidural anesthesia and mild sedation. MATERIALS AND METHODS In a group of 60 patients, who together had 77 discs operated on between April 2016 and March 2018, data were collected on patient age and gender, clinical presentation, and MRI abnormalities. The main outcome of interest was the difference between preoperative and postoperative Oswestry (Oswestry disability index [ODI]) scores 8 weeks after the procedure. Macnab criteria, operation duration, length of hospitalization, surgical complications, and the need for reoperation were other outcomes evaluated. All patients received epidural anesthesia and mild sedation. RESULTS The average reduction in ODI at 8 weeks was 48 points (standard deviation [SD] = 5), representing an average percentage reduction of 85% (SD = 8). By Macnab's criteria, 85% of patients experienced either an excellent or good result, while 10% and 5% had a fair and poor result, respectively. Average surgery time was 50 min and in-hospitalization stay 8.6 h. CONCLUSIONS In our series of surgical patients with lumbar disc herniations, PELD yielded very good results, manifest as significantly reduced pain, brief procedural durations, no complications, and short hospital stays. Patients accepted the option of being awake and immediately ambulatory, and the approach proved highly feasible to execute.
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Affiliation(s)
- Guillermo Frucella
- Servicio de Neurocirugía COT. Servicio de Neurocirugía Grupo Gamma, Rosario, Argentina
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125
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Hasan S, Härtl R, Hofstetter CP. The benefit zone of full-endoscopic spine surgery. JOURNAL OF SPINE SURGERY 2019; 5:S41-S56. [PMID: 31380492 DOI: 10.21037/jss.2019.04.19] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Minimally invasive spine procedures have undergone rapid development during the last decade. Efforts to decrease muscle crush injuries during prolonged retraction, avoid significant soft tissue stripping and minimize bony resection are surgical principles that are employed to prevent iatrogenic instability and provide patients with decreased post-operative pain and disability. Full-endoscopic spine surgery represents a tool for the spine surgeon to provide targeted access to spinal pathology utilizing these principles. Endoscopic techniques have seen over 30 years of evolution and innovation, however, early iterations of these techniques largely focused on transforaminal lumbar microdiscectomies. Currently, endoscopic techniques are utilized for approaching pathology in the cervical, thoracic and lumbar spine. There has been a growing body of literature that not only confirms the efficacy of these procedures but also underscores the advantages these procedures offer with respect to less morbidity and safer complication profiles. Endoscopic decompressions have been utilized in the settings of degenerative spinal stenosis, spondylolisthesis, scoliosis, previous fusion, tumor and infection. Furthermore, endoscopic interbody fusion has also been utilized in the lumbar spine as technology continues to advance. As technological innovation continues to facilitate reproducible surgical technique and expand the indications for use, we believe that endoscopic spine surgical techniques will provide surgeons with a more powerful and less morbid approach to spinal pathology that ultimately elevates the standard of care when treating our patients. We present a brief review of the history of endoscopic spine surgery, an overview of current techniques and review current outcomes of endoscopic spine surgical procedures in the context of an invasiveness/complexity index to elucidate the benefit zone of these newer techniques.
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Affiliation(s)
- Saqib Hasan
- Department of Neurological Surgery, The University of Washington - Seattle, Seattle, WA, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, The University of Washington - Seattle, Seattle, WA, USA
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Lin GX, Rui G, Sharma S, Kotheeranurak V, Suen TK, Kim JS. Does the Neck Pain, Function, or Range of Motion Differ After Anterior Cervical Fusion, Cervical Disc Replacement, and Posterior Cervical Foraminotomy? World Neurosurg 2019; 129:e485-e493. [PMID: 31150858 DOI: 10.1016/j.wneu.2019.05.188] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate clinical and radiologic results as well as biomechanical changes after anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), and posterior cervical foraminotomy (PCF) and/or discectomy in individuals with unilateral single-level cervical radiculopathy. METHODS A total of 97 patients received surgical treatment for unilateral intolerable radiculopathy between February 2012 and August 2017. Clinical outcomes included Neck Disability Index (NDI), visual analogue scale (VAS) for neck and arm pain, and modified Odom's criteria. Range of motion (ROM) of the whole cervical (C-ROM), operated segment (S-ROM), and upper and lower adjacent segment (U-ROM and L-ROM) were measured. RESULTS A total of 55 ACDFs, 21 CDRs, and 21 PCFs were performed. Clinical improvement in NDI and VAS scores were significant after surgery; however, there was no statistical significance among groups. Satisfaction rate (based on Odom's criteria) of PCF (76.2%) was inferior to that of ACDF (90.9%) and CDR (90.5%) without statistical difference. S-ROM, U-ROM, and L-ROM were slightly better in the CDR and PCF groups, without statistical significance. C-ROM significantly increased in CDR group (P = 0.04) and slightly increased in PCF group (P = 0.27). In the ACDF group, C-ROM decreased (P = 0.21) and on the contrary, the U-ROM and L-ROM increased (P > 0.05). CONCLUSIONS ACDF, CDR, and PCF resulted in pain relief and improvement in neck function for patients with unilateral radiculopathy. Comparatively, ACDF provides the lowest reoperation rate. CDR is effective in ameliorating cervical ROMs. PCF has a greater probability of reoperation; however, ROM after surgery is better than with ACDF.
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Affiliation(s)
- Guang-Xun Lin
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea; Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, PR China
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, PR China
| | - Sagar Sharma
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Vit Kotheeranurak
- Spine unit, Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Sriracha, Chonburi, Thailand
| | - Tsz-King Suen
- Department of Orthopaedics & Traumatology, Caritas Medical Centre, Kowloon West Cluster Hospital Authority, Hong Kong
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
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Moussa WM. Anterior cervical discectomy versus posterior keyhole foraminotomy in cervical radiculopathy. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2012.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Wael M. Moussa
- Department of Neurosurgery, Faculty of Medicine , Alexandria University , Egypt
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Abstract
RATIONALE Cervical ligamentum flavum gout (CLFG) is relatively rare, and its clinical manifestations are complicated; hence, it is often confused with ligamentum flavum ossification. Gout tophi may relate to certain risk factors, such as renal insufficiency and lack of long-term effective uric acid treatment. PATIENT CONCERNS A 73-year-old man had a half-year history of left upper extremity pain and numbness, which was aggravated 6 months ago. DIAGNOSES Computed tomography (CT) indicated spinal stenosis at the level of C5/6. Cervical stenosis was believed to be mostly related to the ossification of ligamentum flavum. The histological examination of the material removed during the surgery revealed fibrous tissues with pools of amorphous debris having a foreign body giant cell reaction, which is typical of urate gout. INTERVENTIONS We performed complete decompressions for this case with CLFG using posterior percutaneous endoscopic technique. OUTCOMES The patient experienced a progressive improvement in the left upper extremity pain after the surgery, and no signs of cerebrospinal fluid leakage, infection, or other complications were experienced. LESSONS The clinician should include spinal gout in the differential diagnosis when dealing with patients with hyperuricemia, renal insufficiency, and axial pain with or without neurologic deficits. We have applied the percutaneous endoscopic technique for the treatment of spinal gout. It performed direct decompression with minimizing trauma and instability, which could be used as an alternative choice.
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Affiliation(s)
- Lin Xie
- Department of Spine Surgery, Third Clinical Medical College of Nanjing University of Chinese Medicine
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu, China
| | - Xiang Zhang
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu, China
| | - Zhipeng Xi
- Department of Spine Surgery, Third Clinical Medical College of Nanjing University of Chinese Medicine
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu, China
| | - Jingchi Li
- Department of Spine Surgery, Third Clinical Medical College of Nanjing University of Chinese Medicine
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu, China
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129
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Ren J, Li R, Zhu K, Han X, Liu X, He Y, Sun Z. Biomechanical comparison of percutaneous posterior endoscopic cervical discectomy and anterior cervical decompression and fusion on the treatment of cervical spondylotic radiculopathy. J Orthop Surg Res 2019; 14:71. [PMID: 30832736 PMCID: PMC6399849 DOI: 10.1186/s13018-019-1113-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 02/25/2019] [Indexed: 12/03/2022] Open
Abstract
Background Cervical spondylotic radiculopathy is a common spinal disease. The traditional surgical treatment consists of anterior cervical decompression and fusion (ACDF), but it presents problems such as trauma and fusion complications. Percutaneous posterior endoscopic cervical discectomy (PPECD) is a new minimally invasive technology that has produced good clinical outcome, but further biomechanical comparisons are needed to guide the clinical work. The goal of this study was to compare the biomechanical characteristics of the two methods by finite element analysis. Method On the basis of the computed tomography scanning data of five cases of cervical spondylosis after PPECD surgery, five cases after ACDF surgery, and five non-surgical patients, software (Mimics 15.0, HyperMesh 12.0, and Abaqus 6.13) was adopted to establish a C1–C7 segment 3D finite element model. We also applied 50 N vertical load on the C1 surface and 1.5 Nm torque, simulated the anteflexion, rear protraction, and left and right lateral flexion and rotation, and observed the stability, stress distribution, and Cobb angular change of the surgical section of the cervical vertebra under different working conditions. Result The postoperative model under different working conditions demonstrated poorer stability than the non-surgical group, but the stability of the PPECD group was close to that of the non-surgical group. The stability of the ACDF group was the worst, especially when making lateral bending and posterior extension. The ACDF group also showed significant differences. The PPECD group showed uniform stress distribution, whereas the ACDF group was under large stress, which was primarily concentrated in the internal fixation system. In addition, the implant showed the potential for fracture. The Cobb angle of surgery section of the PPECD group was smaller than that of the ACDF group, and the stability of the section was good. Conclusion From the perspective of finite element analysis, the cervical vertebrae after PPECD treatment showed good biomechanical performance and stability.
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Affiliation(s)
- Jiabin Ren
- Department of Spinal Surgery, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Rui Li
- Department of Spinal Surgery, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Kai Zhu
- Department of Spinal Surgery, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Xuexin Han
- Department of Nursing, Binzhou Medical University Hospital, No.661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Xin Liu
- Department of Spinal Surgery, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China
| | - Yu He
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan Wangfujing, Beijing, 100010, China
| | - Zhaozhong Sun
- Department of Spinal Surgery, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, 256603, Shandong, China.
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130
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A Novel Posterior Trench Approach Involving Percutaneous Endoscopic Cervical Discectomy for Central Cervical Intervertebral Disc Herniation. Clin Spine Surg 2019; 32:10-17. [PMID: 29979215 DOI: 10.1097/bsd.0000000000000680] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This report describes a novel posterior trench approach involving percutaneous endoscopic cervical discectomy (PECD) for central cervical intervertebral disc herniation (CIVDH) and an evaluation of the feasibility, safety, and short-term clinical effect of this approach. BACKGROUND CONTEXT Central CIVDH is considered the contraindication for posterior PECD. MATERIALS AND METHODS A single-center retrospective observational study was performed with 30 patients managed with posterior PECD using the trench approach for symptomatic single-level central CIVDH. Primary outcomes included the measures of bodily pain and physical function based on the SF-36 and modified MacNab criteria. Radiographical follow-up included the static and dynamic cervical plain radiographs, computed tomographic scans, and magnetic resonance images. RESULTS A positive clinical response for symptom relief was achieved in all patients. The postoperative MRI showed total removal of the herniated disc. CONCLUSIONS As a supplement to the described surgical techniques of PECD, this trench approach provides novel access for the treatment of CIVDH, especially for the central type. The advantages of this technique include the provision of access to decompress the ventral region of the thecal sac and the ability to avoid damage to the facet joint. The steep learning curve might be a major disadvantage, and the sample volume is a limitation of the study; the effectiveness and reliability of the trench approach should be further verified in a comparative cohort study with a large volume of patients.
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131
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Incidence of C5 Palsy: Meta-Analysis and Potential Etiology. World Neurosurg 2019; 122:e828-e837. [DOI: 10.1016/j.wneu.2018.10.159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 11/15/2022]
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132
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Yu KX, Chu L, Yang JS, Deng R, Chen L, Shi L, Hao DJ, Deng ZL. Anterior Transcorporeal Approach to Percutaneous Endoscopic Cervical Diskectomy for Single-Level Cervical Intervertebral Disk Herniation: Case Series with 2-Year Follow-Up. World Neurosurg 2019; 122:e1345-e1353. [DOI: 10.1016/j.wneu.2018.11.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 11/04/2018] [Accepted: 11/07/2018] [Indexed: 12/26/2022]
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Full Endoscopic Key Hole Technique for Cervical Foraminal Stenosis: Is Mere Dorsal Decompression Enough? World Neurosurg 2019; 126:e16-e26. [PMID: 30685369 DOI: 10.1016/j.wneu.2019.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To study whether and when mere dorsal decompression is enough in the full endoscopic key hole technique for foraminal stenosis. METHODS We retrospectively reviewed a total of 22 patients with cervical foraminal stenosis who underwent full endoscopic key hole mere dorsal decompression in our institute from October 2016 to October 2017. RESULTS Preoperative neck disability index, neck visual analog scale score, and arm visual analog scale score were 25.8 ± 0.8, 4.9 ± 0.6, and 7.5 ± 0.5 in the group. Immediate postoperative scores were 6.9 ± 0.9, 1.3 ± 0.9, and 1.4 ± 0.5. Follow-up scores at 3 months (7.0 ± 0.9, 1.9 ± 0.6, and 2.7 ± 0.9), 6 months (7.3 ± 0.9, 2.1 ± 0.9, and 1.9 ± 0.5), and 12 months (7.6 ± 0.5, 2.5 ± 0.8, and 2.1 ± 0.7). The symptoms had improved significantly (P < 0.05). According to the Macnab criteria, 15 patients reported excellent results, 2 reported good results, and 2 reported fair results at the 12-month follow-up. CONCLUSIONS Stenosis is mainly caused by dorsal structures; mere dorsal decompression is enough. In both cases, the ventral and dorsal structures contributed to the stenosis. When there is no herniated soft fragment contributing to the stenosis, ventral decompression is not always necessary. If intraoperative exploration detects less tension formed by the ventral abnormal structures, mere dorsal decompression is enough to settle the symptoms.
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134
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Lin Y, Rao S, Li Y, Zhao S, Chen B. Posterior percutaneous full-endoscopic cervical laminectomy and decompression for cervical stenosis with myelopathy: a technical note. World Neurosurg 2019; 124:350-357. [PMID: 30648610 DOI: 10.1016/j.wneu.2018.12.180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Cervical stenosis with myelopathy caused by ossification of the ligamentum flavum is relatively rare, and surgical treatment is the preferred option. Previous surgical procedures usually require assisted internal fixation, while some problems may occur, such as large trauma, intraoperative bleeding, wound infection and internal fixation failure. The aim of this paper is to introduce a new minimally invasive surgical procedure for the treatment of upper cervical spinal stenosis complicated with myelopathy. METHODS AND RESULTS A 56-year-old male patient with cervical myelopathy (C2-3) caused by calcification of the ligamentum flavum underwent posterior percutaneous full-endoscopic cervical laminectomy and decompression (PECLD) and achieved a good clinical efficacy. A surgical incision just 1 cm in size was made, and there was little bleeding during the operation. The patient was hospitalized for 2 days and returned to work after 4 weeks. The patient's postoperative recovery of neurological function was significantly improved, the pain was obviously reduced, and the quality of life was remarkably improved. No intra- or postoperative surgical complications were encountered. CONCLUSIONS PECLD is an effective method for treating cervical stenosis associated with myelopathy due to ossification of the ligamentum flavum. It has the advantages of smaller trauma, less bleeding, shorter postoperative hospital stays and faster recovery. Taken together, this minimally technique can be considered as a good alternative to traditional open surgery.
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Affiliation(s)
- Yongpeng Lin
- Division of Spine Surgery Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, NO. 111 Dade Road, Guangzhou 510120, China
| | - Siyuan Rao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Yongjin Li
- Division of Spine Surgery Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, NO. 111 Dade Road, Guangzhou 510120, China
| | - Shuai Zhao
- Division of Spine Surgery Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, NO. 111 Dade Road, Guangzhou 510120, China
| | - Bolai Chen
- Division of Spine Surgery Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, NO. 111 Dade Road, Guangzhou 510120, China.
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135
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Endoscopic spine discectomy: indications and outcomes. INTERNATIONAL ORTHOPAEDICS 2019; 43:909-916. [DOI: 10.1007/s00264-018-04283-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023]
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136
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Abdalla A, Elaleem AAA. Anterior Discectomy and Fusion versus Posterior Foraminotomy in Treatment of Cervical Radiculopathy: A Comparative Prospective Study. OPEN JOURNAL OF MODERN NEUROSURGERY 2019; 09:441-451. [DOI: 10.4236/ojmn.2019.94042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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137
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Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4749560. [PMID: 30671454 PMCID: PMC6323537 DOI: 10.1155/2018/4749560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022]
Abstract
Purpose Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an eight-mm skin incision. For the patients with lumbar foraminal stenosis, the migrated disc is difficult to remove with a simple transforaminal approach. In such cases, the foraminoplasty techniques can be used. However, obtaining efficient foramen enlargement while minimizing radiation exposure and protecting the nerves can be challenging. Methods In this study, we propose a new technique called the Kiss-Hug maneuver. Under endoscopic viewing, we used the bevel tip of a working cannula as a bone reamer to enlarge the foramen. This allowed us to efficiently enlarge the lumbar foramen endoscopically without the redundancy and complications associated with reamers or trephines. Results Details of the four steps of the Kiss-Hug maneuver are reported along with adverse events. The advantages of this new technique include minimizing radiation exposure to both the surgeon and the patient and decreasing the overall operation time. Conclusion The endoscopic Kiss-Hug maneuver is a useful and reliable foraminoplasty technique that can enhance the efficiency of foraminoplasty while ensuring patient safety and reducing radiation exposure.
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138
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[The trend towards full-endoscopic decompression : Current possibilities and limitations in disc herniation and spinal stenosis]. DER ORTHOPADE 2018; 48:69-76. [PMID: 30535764 DOI: 10.1007/s00132-018-03669-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The most frequent causes of degenerative constrictions of the spinal canal are disk herniations and spinal stenoses. The lumbar and cervical spine is the most affected. SURGICAL PROCEDURES After conservative treatments have been exhausted, surgical intervention may be necessary. Today, microsurgical decompression is regarded as the standard procedure in the lumbar region, while in the cervical spine, microsurgical anterior decompression and fusion are standard. Full-endoscopic techniques for decompression are becoming increasingly widespread worldwide. The development of various surgically created approaches and appropriate instrument sets have made the full-endoscopic operation of disk herniations and spinal stenosis possible. This development has also permitted resection of soft disk herniations in the cervical spine. The use of the approaches depends on anatomical and pathological inclusion and exclusion criteria. RESULTS The clinical results of standard procedures have been achieved, which must be regarded as a minimum criterion for the introduction of new technologies. On the basis of EBM criteria, it can be established that using the full-endoscopic techniques developed, adequate decompression is achieved in the defined indications with reduced traumatization, improved visibility conditions, and positive cost benefits. Today, full-endoscopic operations may be regarded as an expansion and alternative within the overall concept of spinal surgery.
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139
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Sen RD, White-Dzuro G, Ruzevick J, Kim CW, Witt JP, Telfeian AE, Wang MY, Hofstetter CP. Intra- and Perioperative Complications Associated with Endoscopic Spine Surgery: A Multi-Institutional Study. World Neurosurg 2018; 120:e1054-e1060. [DOI: 10.1016/j.wneu.2018.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/31/2018] [Accepted: 09/02/2018] [Indexed: 12/31/2022]
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140
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Ruetten S, Hahn P, Oezdemir S, Baraliakos X, Merk H, Godolias G, Komp M. The full-endoscopic uniportal technique for decompression of the anterior craniocervical junction using the retropharyngeal approach: an anatomical feasibility study in human cadavers and review of the literature. J Neurosurg Spine 2018; 29:615-621. [PMID: 30192216 DOI: 10.3171/2018.4.spine171156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 04/18/2018] [Indexed: 11/06/2022]
Abstract
Objective Acute or progressive myelopathy may necessitate direct anterior decompression of the craniocervical junction and odontoidectomy. Different techniques with individual advantages and disadvantages can be used. In addition to the gold standard-the transoral approach-there is also increasing experience with the endoscopic transnasal technique. Other alternative methods are also being developed to reduce technical and perioperative problems. The aim of this anatomical study was to investigate the feasibility of the full-endoscopic uniportal technique with a retropharyngeal approach for decompression of the craniocervical junction, taking into consideration the specific advantages and disadvantages compared with conventional methods and the currently available data in the literature. Methods Five fresh adult cadavers were operated on. The endoscope used has a shaft cross-section of 6.9 × 5.9 mm and a 25° viewing angle. It contains an eccentric intraendoscopic working channel with a diameter of 4.1 mm. An anterior retropharyngeal approach was used. The anatomical structures of the anterior craniocervical junction were dissected and the bulbomedullary junction was decompressed. Results The planned steps of the operation were performed in all cadavers. The retropharyngeal approach allowed the target region to be accessed easily. The anatomical structures of the anterior craniocervical junction could be identified and dissected. The bulbomedullary junction could be adequately decompressed. No resections of the anterior arch of the atlas were necessary in the odontoidectomy. Conclusions Using the full-endoscopic uniportal technique with an anterior retropharyngeal approach, the craniocervical region can be adequately reached, dissected, and decompressed. This is a minimally invasive technique with the known advantages of an endoscopic procedure under continuous irrigation. The retropharyngeal approach allows direct, sterile access. The instruments are available for clinical use and have been established for years in other operations of the entire spine.
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Affiliation(s)
- Sebastian Ruetten
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne
| | - Patrick Hahn
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne
| | - Semih Oezdemir
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University of Bochum/Marien Hospital Witten, Herne
| | - Xenophon Baraliakos
- Center for Rheumatology, Rheumazentrum Ruhrgebiet, Ruhr University of Bochum, Herne
| | - Harry Merk
- Clinic for Orthopaedics and Orthopaedic Surgery, University Medicine Greifswald
| | - Georgios Godolias
- Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne University Hospital of the Ruhr University Bochum/Marien Hospital Witten, Herne; and
| | - Martin Komp
- Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group-Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne, University of Witten/Herdecke, Herne, Germany
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Wang P, Liao W. [Surgical design and clinical application of posterior percutaneous full-endoscopic cervical foraminotomy for cervical osseous foraminal stenosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:536-541. [PMID: 29806339 DOI: 10.7507/1002-1892.201801029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To design the method of posterior percutaneous full-endoscopic cervical foraminotomy (P-PECF) for treating cervical osseous foraminal stenosis and analyze its feasibility in clinical application. Methods The clinical data of 12 patients with cervical osseous foraminal stenosis who met the selection criteria between October 2015 and June 2017 were retrospectively analysed. There were 7 males and 5 females with an age of 52-63 years (mean, 57.6 years). The disease duration ranged from 15 days to 6 months (mean, 3.7 months). The segments included C 4, 5 in 2 cases, C 5, 6 in 6 cases, and C 6, 7 in 4 cases; all showing root pain or numbness caused by nerve root compression. All patients were treated with the P-PECF technique. At preoperation, immediately after operation, and at last follow-up, visual analogue scale (VAS) scores and neck disability index (NDI) were respectively recorded to assess the patient's quality of life and the pain of neck and arm. The clinical outcomes were evaluated by the modified Macnab criteria. Results All operations were successful. The operation time was 71-105 minutes (mean, 82 minutes); the intraoperative blood loss was about 5 mL. The CT of the cervical spine at 1 week postoperatively showed that the cervical root canal was enlarged and the nerve root compression was relieved. The symptoms of neck and arm pain and numbness were relieved; the hospitalization time was 2-5 days (mean, 3 days). All patients were followed up 6-18 months (mean, 12.3 months). Except for 1 patient's feeling transient hypoesthesia postoperatively, there was no complication such as hematoma, nerve root injury, or incision infection. The VAS scores and NDI at immediate postoperatively and at last follow-up were significantly improved when compared with preoperative scores ( P<0.05); and the scores also improved significantly at last follow-up when compared with the scores at immediate postoperatively ( P<0.05). According to modified Macnab criteria, the results were excellent in 9 cases, good in 2 cases, and fair in 1 case, with an excellent and good rate of 91.7%. Conclusion The P-PECF technique can enlarge the nerve root canal and relieve nerve root compression, and obtain better effectiveness by minimally invasive methods. It is a safe and feasible procedure.
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Affiliation(s)
- Peng Wang
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563000, P.R.China
| | - Wenbo Liao
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563000,
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Foster MT, Carleton-Bland NP, Lee MK, Jackson R, Clark SR, Wilby MJ. Comparison of clinical outcomes in anterior cervical discectomy versus foraminotomy for brachialgia. Br J Neurosurg 2018; 33:3-7. [PMID: 30450995 DOI: 10.1080/02688697.2018.1527013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIM The choice between anterior cervical discectomy & fusion (ACD) or posterior cervical foraminotomy (PCF) for the treatment of cervical brachialgia is controversial. This study aimes to compare clinical outcomes between these two operative inteventions for brachialgia. METHODS Retrospective review of prospectively collected data was performed. Patients receiving a primary ACD or PCF to treat brachialgia, in a single tertiary neurosurgical unit were included. Surgical details, and patient reported outcomes (COMI-Neck questionnaire) were extracted from a prospectively maintained spinal procedure database. Minimum clinically important difference (MCID) was defined as a change in COMI score of -2 at 12 months. The student t-test, Chi-square test, and linear regression were used to compare groups. RESULTS Between June 2011 ad February 2016 there were 634 ACD procedures (Median age 49; 321 Male), and 54 PCF procedures (Median age 50; 37 Male) perfomed for brachialgia. Age, ASA and pre-operative COMI were similar between the groups (p > .05). Complete outcome data was recorded at twelve months in 312 ACD and 36 PCF patients. Both ACD and PCF were associated with an improvement in COMI at 3 and 12 months (all p < .01). Mean change in COMI at 3 months was -2.38 for ACD, versus -2.31 for PCF (p = .88); at twelve months it was -2.94 for ACD, versus -2.67 for PCF (p = .55). MCID was seen in 59% of ACD cases, versus 58% of PCF cases at twelve months (p = .91). CONCLUSION There was no significant difference between outcomes in the ACD and PCF groups. This is supportive of published literature. The proposed multicenter RCTs may inform further.
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Affiliation(s)
- Mitchell T Foster
- a Department of Neurosurgery , The Walton Centre NHS Foundation Trust , Liverpool , UK
| | | | - Maggie K Lee
- a Department of Neurosurgery , The Walton Centre NHS Foundation Trust , Liverpool , UK
| | - Richard Jackson
- b Cancer Research UK Liverpool Cancer Trials Unit , University of Liverpool , Liverpool , UK
| | - Simon R Clark
- a Department of Neurosurgery , The Walton Centre NHS Foundation Trust , Liverpool , UK
| | - Martin J Wilby
- a Department of Neurosurgery , The Walton Centre NHS Foundation Trust , Liverpool , UK
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Dziedzic TA, Balasa A, Bielecki M, Przepiórka Ł, Kunert P, Marchel A. Morphometric Analysis for Surgical Treatment of Cervical Discopathy by Posterior Laminoforaminotomy: Radiologic Study and Technical Note. World Neurosurg 2018; 122:e455-e460. [PMID: 30347299 DOI: 10.1016/j.wneu.2018.10.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The main concern with the posterior approach is the risk of postoperative segmental instability. The most commonly cited rule is that removal of the medial half of the articular facet provides adequate surgical exposure and has no effect on stability. The aim of this study was to define the areas of the articular processes in the cervical spine that can be safely removed. METHODS Computed tomography scans of 50 cervical spines were analyzed. Measurements were analyzed for bone removal assuming the standard technique of posterior laminoforaminotomy. The width of the facet was measured at the level of the widest dimension. The height of the articular process was taken from the bottom (in the case of inferior process) or top (in the case of superior process) of the process. RESULTS The mean width of the articular process ranged from 11.8 ± 1.5 mm (range, 8.3-15.7 mm) at the C2-C3 level to 14.6 ± 1.7 mm at the C6-C7 level. At the cervicothoracic junction (C7-T1 level), the mean width decreased to 14.0 ± 1.7 mm. The mean value for both sides when the inferior articular process was measured at all levels was 5.0 ± 1.4 mm (range, 4.5-5.8 mm). The mean height of the superior articular process was 7.7 ± 1.5 mm (range, 6.8-8.3 mm). CONCLUSIONS Based on our findings, our "5-5-7 mm rule" corresponds to the amount of bone removal for each step of the laminoforaminotomy.
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Affiliation(s)
- Tomasz A Dziedzic
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland.
| | - Artur Balasa
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Mateusz Bielecki
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Przepiórka
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Kunert
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Marchel
- Department of Neurosurgery, Medical University of Warsaw, Warsaw, Poland
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Wan Q, Zhang D, Li S, Liu W, Wu X, Ji Z, Ru B, Cai W. Posterior percutaneous full-endoscopic cervical discectomy under local anesthesia for cervical radiculopathy due to soft-disc herniation: a preliminary clinical study. J Neurosurg Spine 2018; 29:351-357. [DOI: 10.3171/2018.1.spine17795] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVETo the authors’ knowledge, posterior percutaneous full-endoscopic cervical discectomy (PPFECD) has not been reported before as a procedure performed with patients under local anesthesia (LA). In this study, the authors report the outcomes of 25 patients treated by this technique, the surgical steps, and the procedure’s potential advantages.METHODSTwenty-five patients diagnosed with cervical radiculopathy due to soft-disc herniation (SDH) were treated by PPFECD. The intensities of arm and neck pain were measured using the visual analog scale (VAS) and the functional status was assessed using the Neck Disability Index (NDI) preoperatively and at 1, 3, 6, and 12 months postoperatively. Global outcome was also assessed using modified Macnab criteria, and outcomes were grouped as clinical success (excellent or good) and clinical failure (fair or poor). Complications were also recorded.RESULTSNo patient was lost to the follow-up. Significant and durable pain relief and cervical functional improvement were achieved postoperatively. Clinical success was achieved in 24 patients (96%), including 22 excellent and 2 good outcomes at the last follow-up. No serious complications occurred.CONCLUSIONSThe authors’ preliminary experience indicates that PPFECD under LA is a feasible and promising alternative for selected cases of cervical radiculopathy due to SDH, though the procedure’s effectiveness and safety still need confirmation from further studies.
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Affiliation(s)
- Quan Wan
- 1Department of Pain, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang
| | - Daying Zhang
- 2Department of Pain, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi; and
| | - Shun Li
- 1Department of Pain, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang
| | - Wenlong Liu
- 1Department of Pain, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang
| | - Xiang Wu
- 3Department of Anesthesiology, The Affiliated Hospital of School of Medicine of Ningbo University, Ningbo, Zhejiang, China
| | - Zhongwei Ji
- 1Department of Pain, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang
| | - Bin Ru
- 1Department of Pain, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang
| | - Wenjun Cai
- 1Department of Pain, Zhejiang Provincial People’s Hospital, Hangzhou, Zhejiang
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Ruetten S, Hahn P, Oezdemir S, Baraliakos X, Godolias G, Komp M. Full-endoscopic uniportal retropharyngeal odontoidectomy for anterior craniocervical infection. MINIM INVASIV THER 2018; 28:178-185. [PMID: 30179052 DOI: 10.1080/13645706.2018.1498357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Infections of the anterior craniocervical junction may require surgery. There are various techniques with individual advantages and disadvantages. This study evaluates the full-endoscopic uniportal technique via the anterior retropharyngeal approach for odontoidectomy, decompression, and debridement. MATERIAL AND METHODS Three patients with an infection of the anterior craniocervical junction with retrodental involvement were operated on between 2014 and 2016 using the full-endoscopic uniportal technique. Posterior stabilization was also performed with the same procedure for all patients. RESULTS The operation was technically satisfactory in all cases. No problems due to swelling of the pharyngeal soft tissue occurred. No other complications were observed. All patients had a satisfactory outcome with stable regression of the myelopathy symptoms and/or complete healing of the infection. The follow-up images showed sufficient decompression of bone and soft tissues in all cases. CONCLUSIONS The full-endoscopic uniportal technique with an anterior retropharyngeal approach can be an adequate and minimally invasive surgical technique for odontoidectomy, decompression, and debridement in infections of the craniocervical junction and can reduce access-related problems. The transoral, transnasal, and retropharyngeal approaches have different surgical fields due to the access trajectories, which must be taken into consideration depending on the anatomy and pathology when selecting a suitable technique.
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Affiliation(s)
- Sebastian Ruetten
- a Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group , Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne, University Hospital of the Ruhr University of Bochum/Marien Hospital Witten , Herne , Germany
| | - Patrick Hahn
- a Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group , Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne, University Hospital of the Ruhr University of Bochum/Marien Hospital Witten , Herne , Germany
| | - Semih Oezdemir
- a Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group , Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne, University Hospital of the Ruhr University of Bochum/Marien Hospital Witten , Herne , Germany
| | - Xenophon Baraliakos
- b Center for Rheumatology, Rheumazentrum Ruhrgebiet , Ruhr University of Bochum , Herne , Germany
| | - Georgios Godolias
- c Center for Orthopedics and Traumatology of the St. Elisabeth Group , Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne, University Hospital of the Ruhr University Bochum/Marien Hospital Witten , Herne , Germany
| | - Martin Komp
- a Center for Spine Surgery and Pain Therapy, Center for Orthopedics and Traumatology of the St. Elisabeth Group , Catholic Hospital Rhein-Ruhr, St. Anna Hospital Herne/Marien Hospital Herne, University Hospital of the Ruhr University of Bochum/Marien Hospital Witten , Herne , Germany
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146
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Zheng C, Huang X, Yu J, Ye X. Posterior Percutaneous Endoscopic Cervical Diskectomy: A Single-Center Experience of 252 Cases. World Neurosurg 2018; 120:e63-e67. [PMID: 30077024 DOI: 10.1016/j.wneu.2018.07.141] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/14/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Posterior percutaneous endoscopic cervical foraminotomy and diskectomy has remarkably evolved with successful results. Although percutaneous endoscopic cervical diskectomy (PECD) has gained popularity, the risk of surgical failure may be a major obstacle to performing PECD. We analyzed unsuccessful cases requiring reoperation. The objective of this article was to find common causes of surgical failure and elucidate the limitations of the conventional PECD technique. METHODS Surgery-related complications were reviewed from the initial 252 cases of a single surgeon. The patients had cervical disk herniation or radiculopathy and underwent percutaneous endoscopic surgical management. We investigated clinical outcomes and complications. A retrospective review was performed on all patients who had undergone PECD between April 2013 and April 2016. Unsuccessful PECD was defined as a case requiring reoperation within 6 weeks after primary surgery. Chart review was done, and pre-, intra-, and postoperative radiographic reviews were performed. All unsuccessful PECD cases were classified according to the type of herniated disc, location of herniation, extruded disk migration, working channel position, and intra- and postoperative findings. RESULTS The mean operative time was 89.4 minutes (range, 60-180 minutes). The mean intraoperative blood loss was 20.3 mL (range, 10-800 mL). Cerebrospinal fluid leakage occurred in 1 patient and healed well. The follow-up period ranged from 24 to 60 months. The mean score on the visual analog scale improved from 8.67 ± 1.30 preoperatively to 7.83 ± 1.40 at 1 month postoperatively to 1.67 ± 1.30 at the final follow-up (P < 0.05), with a recovery rate of 67.9% ± 21.2%. CONCLUSIONS Surgeons should be aware of the specific complications for the PECD approach.
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Affiliation(s)
- Changkun Zheng
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military, Medical University, Shanghai, China
| | - Xiaodong Huang
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military, Medical University, Shanghai, China
| | - Jiangming Yu
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military, Medical University, Shanghai, China
| | - Xiaojian Ye
- Department of Orthopaedics, Changzheng Hospital Affiliated to the Second Military, Medical University, Shanghai, China.
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Full-endoscopic Uniportal Odontoidectomy and Decompression of the Anterior Cervicomedullary Junction Using the Retropharyngeal Approach. Spine (Phila Pa 1976) 2018; 43:E911-E918. [PMID: 29438218 DOI: 10.1097/brs.0000000000002561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A study of a series of consecutive full-endoscopic uniportal decompressions of the anterior craniocervical junction with retropharyngeal approach. OBJECTIVE The aim of this study was to evaluate the direct anterior decompression of the craniocervical junction in patients with bulbomedullary compression using a full-endoscopic uniportal technique via an anterolateral retropharyngeal approach. SUMMARY OF BACKGROUND DATA Acute or progressive myelopathy may necessitate direct anterior decompression of the craniocervical junction and odontoidectomy. Different techniques with individual advantages and disadvantages can be used. In addition to the gold standard - the transoral approach - there is increasing experience with the endoscopic transnasal technique. Other alternative procedures are also being developed. METHODS Between 2013 and 2016, eight patients with basilar impression, retrodental pannus, or retrodental infection were operated in the full-endoscopic uniportal technique with a retropharyngeal approach. Anterior decompression of the bulbomedullary junction with odontoidectomy was performed. All patients additionally underwent posterior stabilization. Imaging and clinical data were collected in follow-up examinations for 1 year. RESULTS The bulbomedullary junction was adequately decompressed. No problems due to swelling of pharyngeal soft tissue occurred. One patient required revision due to secondary bleeding. No other complications were observed. All patients had a good clinical outcome with stable regression of the myelopathy symptoms and/or healing of the infection. The imaging follow-up showed sufficient decompression of bone and soft tissue in all cases. No evidence was found of increasing instability or failure of posterior fusion. CONCLUSION In the operated patients, the full-endoscopic uniportal surgical technique with anterior retropharyngeal approach was found to be a sufficient and minimally invasive method with the known advantages of an endoscopic procedure under continuous irrigation. It should not be viewed only as competition for other surgical techniques - due to its individual technical parameters, it can also be considered to be an alternative or complementary procedure. LEVEL OF EVIDENCE 4.
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Chu L, Yang JS, Yu KX, Chen CM, Hao DJ, Deng ZL. Usage of Bone Wax to Facilitate Percutaneous Endoscopic Cervical Discectomy Via Anterior Transcorporeal Approach for Cervical Intervertebral Disc Herniation. World Neurosurg 2018; 118:102-108. [PMID: 30026139 DOI: 10.1016/j.wneu.2018.07.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Currently, anterior transdiscal access and posterior interlaminar approach are the main approaches for percutaneous endoscopic cervical discectomy (PECD). To overcome access shortcomings, we previously described a novel anterior endoscopic transcorporeal approach on a migrated cervical disc. We innovatively introduced bone wax into endoscopic surgery to aid hemostasis and facilitate the process of drilling an intracorporeal tunnel. METHODS Five patients with cervical intervertebral disc herniation (CIDH) were treated by PECD via the anterior transcorporeal approach. During the operation, we marked the punctured tunnel with bone wax containing indigo carmine as a guide and smeared bone wax on the endoscopic burr to aid hemostasis. RESULTS A satisfactory clinical outcome was observed in all 5 patients postoperatively; pain and neurologic condition were dramatically improved. Surgery-related complications, such as esophageal injury, vascular rupture, hematoma, intervertebral disc infection, or postoperative headache, were not encountered. A computed tomography scan was used to observe the process of bone healing. At 3-month postoperative follow-up, the bone defect within the drilling tunnel had partially shrank and was completely healed at 6 months postoperatively. CONCLUSIONS The anterior endoscopic transcorporeal approach for PECD is a novel, valuable alternative for the treatment of CIDH. Bone wax could indeed facilitate the operation by guiding the drilling process and instantly controlling the bleeding without obvious interference with bone healing. Long-term follow-up is warranted in further clinical studies.
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Affiliation(s)
- Lei Chu
- Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, District Yuzhong, Chongqing, China
| | - Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ke-Xiao Yu
- Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, District Yuzhong, Chongqing, China
| | - Chien-Min Chen
- Department of Neurosurgery, Changhua Christian Hospital, Changhua City, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Zhong-Liang Deng
- Department of Orthopaedics, The Second Affiliated Hospital, Chongqing Medical University, District Yuzhong, Chongqing, China.
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The Learning Process of Endoscopic Spinal Surgery for Degenerative Cervical and Lumbar Disorders Using the EasyGO! System. World Neurosurg 2018; 119:479-487. [PMID: 30282595 DOI: 10.1016/j.wneu.2018.06.206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Among spinal surgeons, the safety of endoscopic spinal techniques has been criticized as the result of a prolonged learning curve and divergent surgical technique from traditional microsurgery. In this manuscript, the authors assessed the learning curve of 4 experienced microsurgical neurosurgeons in endoscopic spinal surgery. METHODS Retrospectively, the surgical reports, the endoscopic video recording, and the files of all patients who underwent an endoscopic procedure for the treatment of cervical and lumbar disc herniation from January 2011 to December 2017 were reviewed. The learning process was assessed via several parameters: surgical time, intraoperative complications, dural tear, nerve root injury, conversion to microsurgery, new postoperative neurologic deficits, repeated procedure, and early recurrent disc herniation. RESULTS The learning process of for 4 surgeons was assessed on the basis of 308 procedures. The mean surgical time for the initial procedure ranges from 58 to 97 minutes and improved to 51-85 minutes for the last procedures. A shorter surgical time had no influence on the rate of intraoperative complication and repeated procedure. Increased working space had a significant influence on the surgical time. The number of procedure to reach the asymptote varied from 10 to 20 depending on the endoscopic system and the surgeon. CONCLUSIONS The learning process in endoscopic tubular-assisted spinal surgery is variable, and the asymptote might be reached after 10-20 procedures. The amount of working space and instrument angulation affects the surgical time. The decrease of surgical time had no significant influence on the rate of intraoperative complication and repeated procedures.
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Dunn C, Moore J, Sahai N, Issa K, Faloon M, Sinha K, Hwang KS, Emami A. Minimally invasive posterior cervical foraminotomy with tubes to prevent undesired fusion: a long-term follow-up study. J Neurosurg Spine 2018; 29:358-364. [PMID: 29957145 DOI: 10.3171/2018.2.spine171003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to compare anterior cervical discectomy and fusion (ACDF) and minimally invasive posterior cervical foraminotomy (MI-PCF) with tubes for the treatment of cervical radiculopathy in terms of the 1) overall revision proportion, 2) index and adjacent level revision rates, and 3) functional outcome scores. METHODS The authors retrospectively reviewed the records of consecutive patients who had undergone ACDF or MI-PCF at a single institution between 2009 and 2014. Patients treated for cervical radiculopathy without myelopathy and with a minimum 2-year follow-up were compared according to the procedure performed for their pathology. Primary outcome measures included the overall rate of revision with fusion and overall revision proportion as well as the rate of index and adjacent level revisions per year. Secondarily, self-reported outcome measures-Neck Disability Index (NDI) and visual analog scale (VAS) for arm (VASa) and neck (VASn) pain-at the preoperative and postoperative evaluations were analyzed. Standard binomial and categorical comparative analyses were performed. RESULTS Forty-nine consecutive patients were treated with MI-PCF, and 210 consecutive patients were treated with ACDF. The mean follow-up for the MI-PCF cohort was 42.9 ± 6.6 months (mean ± SD) and for the ACDF cohort was 44.9 ± 10.3 months. There was no difference in the overall revision proportion between the two cohorts (4 [8.2%] of 49 MI-PCF vs. 12 [5.7%] of 210 ACDF, p = 0.5137). There was no difference in the revision rate per level per year (3.1 vs. 1.7, respectively, p = 0.464). Moreover, there was no difference in the revision rate per level per year at the index level (1.8 vs. 0.7, respectively, p = 0.4657) or at an adjacent level (1.3 vs. 1.1, p = 0.9056). Neither was there a difference between the cohorts as regards the change from preoperative to final postoperative functional outcome scores (NDI, VASa, VASn). CONCLUSIONS Minimally invasive PCF for the treatment of cervical radiculopathy demonstrates rates of revision at the index and adjacent levels similar to those following ACDF. In order to confirm the positive efficacy and cost analysis findings in this study, future studies need to extend the follow-up and show that the rate of revision with fusion does not increase substantially over time.
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