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Li T, Huang J, Zhang H, Lu Z, Liu J, Ding Y. Full endoscopic laminotomy decompression versus anterior cervical discectomy and fusion for the treatment of single-segment cervical spinal stenosis: a retrospective, propensity score-matched study. J Orthop Surg Res 2024; 19:227. [PMID: 38581052 PMCID: PMC10998346 DOI: 10.1186/s13018-024-04710-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/01/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE Anterior cervical discectomy and fusion (ACDF) is the standard procedure for the treatment of cervical spinal stenosis (CSS), but complications such as adjacent segment degeneration can seriously affect the long-term efficacy. Currently, posterior endoscopic surgery has been increasingly used in the clinical treatment of CSS. The aim of this study was to compare the clinical outcomes of single-segment CSS patients who underwent full endoscopic laminotomy decompression or ACDF. METHODS 138 CSS patients who met the inclusion criteria from June 2018 to August 2020 were retrospectively analyzed and divided into endoscopic and ACDF groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the groups. Then, perioperative data were recorded and clinical outcomes were compared, including functional scores and imaging data. Functional scores included Visual Analog Scale of Arms (A-VAS) and Neck pain (N-VAS), Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), and imaging data included Disc Height Index (DHI), Cervical range of motion (ROM), and Ratio of grey scale (RVG). RESULTS After PSM, 84 patients were included in the study and followed for 24-30 months. The endoscopic group was significantly superior to the ACDF group in terms of operative time, intraoperative blood loss, incision length, and hospital stay (P < 0.001). Postoperative N-VAS, A-VAS, JOA, and NDI were significantly improved in both groups compared with the preoperative period (P < 0.001), and the endoscopic group showed better improvement at 7 days postoperatively (P < 0.05). The ROM changes of adjacent segments were significantly larger in the ACDF group at 12 months postoperatively and at the last follow-up (P < 0.05). The RVG of adjacent segments showed a decreasing trend, and the decrease was more marked in the ACDF group at last follow-up (P < 0.05). According to the modified MacNab criteria, the excellent and good rates in the endoscopic group and ACDF group were 90.48% and 88.10%, respectively, with no statistically significant difference (P > 0.05). CONCLUSION Full endoscopic laminotomy decompression is demonstrated to be an efficacious alternative technique to traditional ACDF for the treatment of single-segment CSS, with the advantages of less trauma, faster recovery, and less impact on cervical spine kinematics and adjacent segmental degeneration.
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Affiliation(s)
- Tusheng Li
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Jie Huang
- Department of Orthopaedics, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Hanshuo Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Zhengcao Lu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Jiang Liu
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, People's Republic of China
| | - Yu Ding
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
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Mehrotra A, Singh K, Kanjilal S, Dikshit P, Kumar A, Verma PK, Das KK, Jaiswal AK, Kumar R. Expanding the Horizons of Minimally Invasive Spine Surgery: Experience of the Destandau Technique for the Treatment of Multiple Spinal Diseases. World Neurosurg 2024; 181:e970-e977. [PMID: 37951463 DOI: 10.1016/j.wneu.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE Minimally invasive spine surgery is rapidly gaining popularity because of its versatile nature. Traditionally, prolapsed disc has been the most common disease targeted using this technique. However, its usefulness for various other diseases has also been shown in studies. We present our experience of using this technique for various spinal diseases apart from prolapsed discs. METHODS This is a retrospective study in which patients operated on by a single surgeon from January 2019 to April 2023 were included. Cases that required conversion to open technique were excluded. Intraoperative findings and postoperative courses were obtained from patient records. RESULTS A total of 47 patients were included in the study, of whom 29 were male and 18 were female. The various diseases treated comprised intradural extramedullary (IDEM) tumors (n = 23), hypertrophied/ossified ligamentum flavum (n = 9), arachnoid cysts (n = 6), dermoid/epidermoid cysts (n = 4), detethering of cord (n = 3), and posterior cervical decompression for an ossified posterior longitudinal ligament (n = 2). The average duration of surgery was 2.1 ± 1.2 hours and the mean intraoperative blood loss was 138.4 ± 59.1 mL. The mean length of hospital stay was 2.3 ± 0.9 days. Two patients had superficial wound infection and none of the operated patients had cerebrospinal fluid leakage. Re-exploration was not required in any of the operated patients. CONCLUSIONS Minimally invasive techniques for dealing with multiple diseases involving the spine are as good as traditional open techniques, with some additional advantages of lesser tissue trauma, early return to work, and so on. However, one must overcome the steep learning curve before adopting them in day-to-day practice.
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Affiliation(s)
- Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Kavindra Singh
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Soumen Kanjilal
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyadarshi Dikshit
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashutosh Kumar
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Pawan Kumar Verma
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Awadhesh Kumar Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Sanjay Gandhi Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Zhao XB, Ma YJ, Ma HJ, Zhang XY, Zhou HG. Clinical Efficacy of Posterior Percutaneous Endoscopic Unilateral Laminotomy with Bilateral Decompression for Symptomatic Cervical Spondylotic Myelopathy. Orthop Surg 2022; 14:876-884. [PMID: 35441460 PMCID: PMC9087468 DOI: 10.1111/os.13237] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To compare the clinical efficacy of posterior percutaneous endoscopic unilateral laminotomy (PPEUL) and anterior cervical decompression and fusion (ACDF) in the treatment of single‐segment spondylotic myelopathy (CSM). Methods This is a retrospective research, from January 2017 to December 2019, 30 cases were included in the PPEUL group and 32 cases were included in the ACDF group. The operative duration, blood loss, length of stay, complications, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, MacNab classification and imaging data were collected preoperatively, postoperative 1‐week, final follow‐up and statistically analyzed. Results The surgery was completed successfully on all patients, and there were no serious complications, such as nerve or spinal cord injury or infection. In the PPEUL and ACDF groups, the operative duration were 56.63 ± 1.40 and 65.21 ± 2.45 min, the intraoperative blood loss were 51.69 ± 3.23 and 50.51 ± 5.48 mL, and the hospitalization duration was 5.75 ± 1.43 and 6.38 ± 2.16 days. The follow‐up period in the PPEUL and ACDF groups was 24.96 ± 1.12 months and 25.65 ± 1.45 months, respectively. There was no significant difference in intraoperative blood loss between the two groups, but the hospitalization and operative durations in the PPEUL group were significantly shorter than those in the ACDF group (P < 0.05). The VAS scores at postoperative 1 week and final follow‐up were significantly improved compared with those before surgery. The JOA scores at postoperative 1 week and final follow‐up were significantly improved compared with those before surgery, but there was no significant difference between the two groups at the last follow‐up. The intervertebral disc height of the adjacent segment at the last follow‐up was significantly lower in the ACDF group than in the PPEUL group (P < 0.05), but there was no significant difference between the two groups in the intervertebral disc height of the surgical segment (P > 0.05). The rate of excellent and good results was 90.0% and 87.5%, respectively. Postoperative cervical CT and MRI showed that the spinal canal was fully decompressed and spinal cord compression was relieved. Conclusion PPEUL has the advantages of reduced trauma, rapid recovery and remarkable curative efficacy, so it is a new choice for the treatment of CSM.
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Affiliation(s)
- Xiao-Bing Zhao
- Department of Mini-Invasive Spinal Surgery, Third Hospital of Henan Province, Zhengzhou, China
| | - Ya-Jie Ma
- Department of Mini-Invasive Spinal Surgery, Third Hospital of Henan Province, Zhengzhou, China
| | - Hai-Jun Ma
- Department of Mini-Invasive Spinal Surgery, Third Hospital of Henan Province, Zhengzhou, China
| | - Xin-Yu Zhang
- Department of Mini-Invasive Spinal Surgery, Third Hospital of Henan Province, Zhengzhou, China
| | - Hong-Gang Zhou
- Department of Mini-Invasive Spinal Surgery, Third Hospital of Henan Province, Zhengzhou, China
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Hellinger S, Knight M, Telfeian AE, Lewandrowski KU. Patient selection criteria for percutaneous anterior cervical laser versus endoscopic discectomy. Lasers Surg Med 2022; 54:530-539. [PMID: 34989414 DOI: 10.1002/lsm.23514] [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: 10/05/2021] [Revised: 12/05/2021] [Accepted: 12/21/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Percutaneous anterior laser and anterior endoscopic cervical spine surgery are associated with less approach trauma than conventional open cervical spine surgery. The literature illustrating their appropriate use corroborated with objective outcome evidence is scarce. The authors were interested in comparing the clinical outcomes following percutaneous laser disc decompression (PLDD) versus percutaneous endoscopic disc decompression (PEDD). © 2021 Wiley Periodicals LLC. MATERIALS AND METHODS Thirty patients with soft contained symptomatic cervical disc herniations and an average age of 50.5 years (range 26 - 68 years; 16 males and 14 females) were prospectively enrolled in 2 groups of 15 patients to be either treated with PLDD or PEDD. All patients underwent PLDD or PEDD under local anesthesia and sedation. Clinical outcomes were assessed with the Macnab criteria VAS score for arm pain. Complications and reoperations were recorded. RESULTS There were significant reductions in the VAS score for arm pain from preoperative 8.4 ± 2.5 to 3.1 ± 1.2 in the PLDD group (P < 0.03), and from preoperative 8.6 ± 2.7 to 2.4 ± 1.1 (P < 0.01) in the PEDD group. In the PLDD group, Macnab outcomes were excellent in 21% of patients, good in 44%, fair in 21%, and poor in 14%. In the PEDD group, Macnab outcomes were excellent in 14% of patients, good in 32%, fair in 12%, and poor in the remaining 12%. There were no statistically significant differences in clinical outcomes between the PLDD and the PEDD group. There were no approach-related or surgical complications. CONCLUSIONS Tissue trauma is significantly reduced with laser and endoscopic surgery techniques. PLDD and PEDD are both suitable for the specific indication of soft, symptomatic contained cervical disc herniations. The authors' small prospective cohort study indicates that PLDD and PEDD are options for cervical decompression surgery when medical comorbidities or preferences by patients and surgeons dictate more minimally invasive strategies.
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Affiliation(s)
- Stefan Hellinger
- Department of Orthopedic Surgery, Arabellaklinik, Munich, Germany
| | - Martin Knight
- Consultant Endoscopic Spine Surgeon, Senior Lecturer Manchester University, The Medical Director, The Spinal Foundation, The Weymouth Hospital, 42 - 46 Weymouth Street London, 27 Harley Street, London, W1G 9QP
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kai-Uwe Lewandrowski
- Staff Orthopaedic Spine Surgeon Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson.,Associate Professor of Orthopaedic Surgery, Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia.,Department of Neurosurgery, UNIRIO, Rio de Janeiro, Brazil
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Yuan H, Zhang X, Zhang LM, Yan YQ, Liu YK, Lewandrowski KU. Comparative study of curative effect of spinal endoscopic surgery and anterior cervical decompression for cervical spondylotic myelopathy. JOURNAL OF SPINE SURGERY 2020; 6:S186-S196. [PMID: 32195427 DOI: 10.21037/jss.2019.11.15] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The aim of this study was to compare the clinical efficacy of endoscopic cervical spinal surgery with anterior cervical decompression and fusion (ACDF) in the treatment of cervical spondylotic myelopathy (CSM). Methods A total of forty-six CSM patients who were admitted to the Medical School of Chinese PLA and treated with endoscopic spine surgery or ACDF from January 2015 to June 2017 were collected. The patients were divided into the spinal endoscopy group and the ACDF group, according to the operation methods. The operation time, intraoperative blood loss and hospitalization stay of the two groups were recorded and compared. Japanese Orthopaedic Association (JOA) score before operation, three months, and one year after operation were recorded for intra-group and inter-group comparison. The improvement rates of JOA were compared between the two groups to evaluate the clinical efficacy. Results There were twenty-two cases in the spinal endoscopy group and twenty-four cases in the ACDF group. The mean operation lasting time, intraoperative blood loss and hospitalization stay in the spinal endoscopy group were significantly lower than those in the ACDF group (P<0.05). The postoperative JOA score of the two groups were significantly higher than those before the operation (P<0.05). There were no significant differences in the JOA score before operation, three months and one year after operation between the two groups (P>0.05). The improvement rates in the spinal endoscopy group were not significantly different compared to those in the ACDF group (P>0.05). There was no significant difference in the excellent rate (81.8% vs. 83.3%) between the spinal endoscopy group and the ACDF group (P>0.05). Conclusions The short-term efficacy of spinal endoscopic surgery and ACDF was equal in the treatment of CSM. The spinal endoscopic surgery was significantly superior to ACDF in reducing the operation time, the intraoperative blood loss and the hospitalization stay.
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Affiliation(s)
- Heng Yuan
- Department of Orthopaedics, No. 2 Affiliated Hospital, Shanxi Medical University, Taiyuan 030001, China
| | - Xifeng Zhang
- Department of Orthopedics, First Medical Center, PLA General Hospital, Beijing 100853, China
| | - Lei-Ming Zhang
- Department of Neurosurgery, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China
| | - Yu-Qiu Yan
- Minimally Invasive Spinal Surgery, Beijing Yuhe Integrated Traditional Chinese and Western Medicine Rehabilitation Hospital, Beijing 100039, China
| | - Yan-Kang Liu
- Department of Orthopaedics, No. 2 Affiliated Hospital, Shanxi Medical University, Taiyuan 030001, China
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, AZ, USA.,Department Neurosurgery, UNIRIO, Rio de Janeiro, Brazil.,Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia
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