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Jowdy PK, Soliman MAR, Quiceno E, Azmy S, Popoola DO, Aguirre AO, Khan A, Slosar PJ, Pollina J, Mullin JP. Clinical and Radiographic Outcomes of Anterior Lumbar Interbody Fusions Using a Titanium Cage with a Biomimetic Surface. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38395054 DOI: 10.1055/a-2275-0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
Abstract
BACKGROUND We analyzed clinical and radiographic outcomes in patients undergoing anterior lumbar interbody fusions (ALIFs) using a new biomimetic titanium fusion cage (Titan nanoLOCK interbody, Medtronic, Minneapolis, Minnesota, United States). This specialized cage employs precise nanotechnology to stimulate inherent biochemical and cellular osteogenic reactions to the implant, aiming to amplify the rate of fusion. To our knowledge, this is the only study to assess early clinical and radiographic results in ALIFs. METHODS We conducted a retrospective review of data for patients who underwent single or multilevel ALIF using this implant between October 2016 and April 2021. Indications for treatment were spondylolisthesis, postlaminectomy syndrome, or spinal deformity. Clinical and radiographic outcome data for these patients were collected and assessed. RESULTS A total of 84 patients were included. The mean clinical follow-up was 36.6 ± 14 months. At 6 months, solid fusion was seen in 97.6% of patients. At 12 months, solid fusion was seen in 98.8% of patients. Significant improvements were seen in patient-reported outcome measures (PROMs; visual analog scale and Oswestry Disability Index) at 6 and 12 months compared with the preoperative scores (p < 0.001). One patient required reoperation for broken pedicle screws 2 days after the ALIF. None of the patients required readmission within 90 days of surgery. No patients experienced an infection. CONCLUSIONS ALIF using a new titanium interbody fusion implant with a biomimetic surface technology demonstrated high fusion rates (97.6%) as early as 6 months. There was significant improvement in PROMs at 6 and 12 months.
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Affiliation(s)
- Patrick K Jowdy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Mohamed A R Soliman
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Esteban Quiceno
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Shady Azmy
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
| | - Daniel O Popoola
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
| | - Alexander O Aguirre
- Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
| | - Asham Khan
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Paul J Slosar
- Peninsula Orthopedic Associates, Daly City, California, United States
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
| | - Jeffrey P Mullin
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, United States
- Department of Neurosurgery, Buffalo General Medical Center, Kaleida Health, Buffalo, New York, United States
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Louie PK, Alostaz M, Bansal A, Drolet CE, Gyawali P, Khan N, Vivelo N, Farrokhi F. A Tubular-Mounted Digital Camera Versus Optical Surgical Microscope for Minimally Invasive Lumbar Decompression Surgery: The Impact on Operative Times, Ergonomics, and Workflow. World Neurosurg 2024; 184:e65-e71. [PMID: 38218447 DOI: 10.1016/j.wneu.2024.01.036] [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: 12/24/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE Understanding ergonomic impact is foundational to critically evaluating value and safety of enabling technologies in minimally invasive spine surgeries. This study assessed the impact of a tubular-mounted digital camera (TMDC) versus an optical surgical microscope (OSM) in single-level minimally invasive spine surgeries on operative times, durotomy rate, surgeon ergonomics, safety, and operating room workflow. METHODS This retrospective study compared consecutive single-level minimally invasive lumbar decompression surgeries in a TMDC cohort (September 2021-June 2022) with an historical OSM cohort (January 2020-July 2021). Data included patient demographics, operative times, durotomy incidence, surgeon ergonomics (Rapid Entire Body Assessment scores), and equipment impact via staff surveys. Operative times were assessed by t test, while Pearson χ2 test compared sex. Age, body mass index, and Charlson Comorbidity Index comparisons were made by Wilcoxon rank sum tests, and survey results were analyzed with Wilcoxon signed rank tests. RESULTS TMDC and OSM groups included 74 and 82 patients, respectively. Age, sex, and Charlson Comorbidity Index did not significantly differ between groups. The TMDC group had a higher body mass index (29.6 ± 5.1) than the OSM group (29.0 ± 7.5) (P = 0.04). The TMDC group had significantly shorter operative times (57.3 ± 16.6 minutes) than the OSM group) (66.7 ± 22.5 minutes) (P = 0.004), with no difference in durotomy rates (P = 0.42). TMDC use yielded lower Rapid Entire Body Assessment scores compared with OSM (4.1 ± 0.77) (P < 0.001). Surveys indicated improved safety, setup time, and workflow with TMDC (P < 0.001). CONCLUSIONS TMDC in single-level minimally invasive lumbar decompression surgery improved surgeon ergonomics, reduced operative times, and maintained durotomy rates, enhancing operating room efficiency. Evaluating ergonomic impact of technology is vital for safety and value assessment.
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Affiliation(s)
- Philip K Louie
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, Washington, USA.
| | - Murad Alostaz
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Aiyush Bansal
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Caroline E Drolet
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Purnima Gyawali
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Nadia Khan
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Nicole Vivelo
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Farrokh Farrokhi
- Center for Neurosciences and Spine, Department of Neurosurgery, Virginia Mason Franciscan Health, Seattle, Washington, USA
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Brown NJ, Pennington Z, Kuo CC, Lopez AM, Picton B, Solomon S, Nguyen OT, Yang C, Tantry EK, Shahin H, Gendreau J, Albano S, Pham MH, Oh MY. Endoscopic Anterior Lumbar Interbody Fusion: Systematic Review and Meta-Analysis. Asian Spine J 2023; 17:1139-1154. [PMID: 38105638 PMCID: PMC10764124 DOI: 10.31616/asj.2023.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 12/19/2023] Open
Abstract
Laparoscopic anterior lumbar interbody fusion (L-ALIF), which employs laparoscopic cameras to facilitate a less invasive approach, originally gained traction during the 1990s but has subsequently fallen out of favor. As the envelope for endoscopic approaches continues to be pushed, a recurrence of interest in laparoscopic and/or endoscopic anterior approaches seems possible. Therefore, evaluating the current evidence base in regard to this approach is of much clinical relevance. To this end, a systematic literature search was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the following keywords: "(laparoscopic OR endoscopic) AND (anterior AND lumbar)." Out of the 441 articles retrieved, 22 were selected for quantitative analysis. The primary outcome of interest was the radiographic fusion rate. The secondary outcome was the incidence of perioperative complications. Meta-analysis was performed using RStudio's "metafor" package. Of the 1,079 included patients (mean age, 41.8±2.9 years), 481 were males (44.6%). The most common indication for L-ALIF surgery was degenerative disk disease (reported by 18 studies, 81.8%). The mean follow-up duration was 18.8±11.2 months (range, 6-43 months). The pooled fusion rate was 78.9% (95% confidence interval [CI], 68.9-90.4). Complications occurred in 19.2% (95% CI, 13.4-27.4) of L-ALIF cases. Additionally, 7.2% (95% CI, 4.6-11.4) of patients required conversion from L-ALIF to open surgery. Although L-ALIF does not appear to be supported by studies available in the literature, it is important to consider the context from which these results have been obtained. Even if these results are taken at face value, the failure of endoscopy to have a role in the ALIF approach does not mean that it should not be incorporated in posterior approaches.
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Affiliation(s)
- Nolan J. Brown
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN,
USA
| | - Cathleen C. Kuo
- Department of Neurosurgery, University at Buffalo, Buffalo, NY,
USA
| | - Alexander M. Lopez
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Bryce Picton
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Sean Solomon
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Oanh T. Nguyen
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Chenyi Yang
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | | | - Hania Shahin
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Julian Gendreau
- Johns Hopkins Whiting School of Engineering, Baltimore, MD,
USA
| | - Stephen Albano
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
| | - Martin H. Pham
- Department of Neurosurgery, University of California, San Diego, La Jolla, CA,
USA
| | - Michael Y. Oh
- Department of Neurosurgery, University of California, Irvine, Orange, CA,
USA
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Kassicieh AJ, Rumalla K, Segura AC, Kazim SF, Vellek J, Schmidt MH, Shin PC, Bowers CA. Endoscopic and Nonendoscopic Approaches to Single-Level Lumbar Spine Decompression: Propensity Score-Matched Comparative Analysis and Frailty-Driven Predictive Model. Neurospine 2023; 20:119-128. [PMID: 37016860 PMCID: PMC10080425 DOI: 10.14245/ns.2346110.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/24/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: The endoscopic spine surgery (ESS) approach is associated with high levels of patient satisfaction, shorter recovery time, and reduced complications. The present study reports multicenter, international data, comparing ESS and non-ESS approaches for singlelevel lumbar decompression, and proposes a frailty-driven predictive model for nonhome discharge (NHD) disposition.Methods: Cases of ESS and non-ESS lumbar spine decompression were queried from the American College of Surgeons National Surgical Quality Improvement Program database (2017–2020). Propensity score matching was performed on baseline characteristics frailty score (measured by risk analysis index [RAI] and modified frailty index-5 [mFI-5]). The primary outcome of interest was NHD disposition. A predictive model was built using logistic regression with RAI as the primary driver.Results: Single-level nonfusion spine lumbar decompression surgery was performed in 38,686 patients. Frailty, as measured by RAI, was a reliable predictor of NHD with excellent discriminatory accuracy in receiver operating characteristic (ROC) curve analysis: C-statistic: 0.80 (95% confidence interval [CI], 0.65–0.94) in ESS cohort, C-statistic: 0.75 (95% CI, 0.73–0.76) overall cohort. After propensity score matching, there was a reduction in total operative time (89 minutes vs. 103 minutes, p = 0.049) and hospital length of stay (LOS) (0.82 days vs. 1.37 days, p < 0.001) in patients treated endoscopically. In ROC curve analysis, the frailty-driven predictive model performed with excellent diagnostic accuracy for the primary outcome of NHD (C-statistic: 0.87; 95% CI, 0.85–0.88).Conclusion: After frailty-based propensity matching, ESS is associated with reduced operative time, shorter hospital LOS, and decreased NHD. The RAI frailty-driven model predicts NHD with excellent diagnostic accuracy and may be applied to preoperative decisionmaking with a user-friendly calculator: nsgyfrailtyoutcomeslab.shinyapps.io/lumbar_decompression_dischargedispo.
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Affiliation(s)
- Alexander J. Kassicieh
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Aaron C. Segura
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
| | - John Vellek
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- School of Medicine, New York Medical College (NYMC), Valhalla, NY, USA
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Peter C. Shin
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, USA
- Corresponding Author Christian A. Bowers Department of Neurosurgery, University of New Mexico Health Sciences Center, 1 University New Mexico, MSC10 5615, Albuquerque, NM 81731, USA
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Zhang G, Jia B, Wang P, Xu C, Liu J, Tang C, Jiang H, Tan X, Wu N. Pure endoscopic minimally invasive surgery with a non‑expandable tubular retractor for intradural extramedullary spinal tumors. Exp Ther Med 2023; 25:137. [PMID: 36845956 PMCID: PMC9947587 DOI: 10.3892/etm.2023.11836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/20/2023] [Indexed: 02/16/2023] Open
Abstract
Minimally invasive spinal surgery (MISS) for intradural extramedullary (IDEM) spinal tumors is a safe and effective surgical strategy. Currently, various tubular retractors are widely used in the MISS of IDEM spinal tumors, primarily relying on microscopic visualization. To the best of the authors' knowledge, there is no report of pure endoscopic surgery with parallel non-expandable tubular retractors for IDEM spinal lesions. The present study reports a case series of IDEM spinal tumors that were treated via pure endoscopic MISS with a parallel non-expandable tubular retractor. The extent of tumor resection was evaluated by comparing preoperative and postoperative magnetic resonance imaging (MRI). The initial and follow-up clinical conditions were assessed according to the visual analog scale for pain and the modified McCormick scale for neurological status. Postoperative MRI demonstrated that all cases had achieved a gross total resection. After the operation, the clinical symptoms of all patients were significantly improved and there were no serious postoperative complications. At the initial follow-up, the pain experienced by the patients was significantly reduced or had even disappeared, and the neurological deficit was improved by at least one grade on the modified McCormick scale. The present report indicates that pure endoscopic MISS with a parallel non-expandable tubular retractor may be an effective and safe surgical strategy for IDEM spinal tumor resection.
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Affiliation(s)
- Gang Zhang
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Bin Jia
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China
| | - Pan Wang
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Chaoling Xu
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China
| | - Jie Liu
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Chao Tang
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Haotian Jiang
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Xiaorong Tan
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Graduate Institute, Chongqing Medical University, Chongqing 400016, P.R. China
| | - Nan Wu
- Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing 401147, P.R. China,Correspondence to: Professor Nan Wu, Department of Neurosurgery, Chongqing General Hospital, University of Chinese Academy of Sciences, 118 Xingguang Avenue, Liangjiang New Area, Chongqing 401147, P.R. China
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Di Perna G, Marengo N, Matsukawa K, Mahieu G, Baldassarre BM, Petrone S, De Marco R, Zeppa P, Ajello M, Fiumefreddo A, Zenga F, Garbossa D, Cofano F. Three-Dimensional Patient-Matched Template Guides Are Able to Increase Mean Diameter and Length and to Improve Accuracy of Cortical Bone Trajectory Screws: A 5-Year International Experience. World Neurosurg 2023; 170:e542-e549. [PMID: 36402304 DOI: 10.1016/j.wneu.2022.11.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze whether significant differences exist between free-hand three-dimensional (3D) planning-guided cortical bone trajectory (CBT) screw placement and 3D-printed template-guided CBT screw positioning in terms of accuracy, size of screws, and potential complications. METHODS In this retrospective study, data of adult patients in whom CBT screws were placed for lumbar degenerative pathologies were extracted from a prospectively collected database and analyzed. Patients in whom screws were placed using free-hand 3D planning-guided technique were compared with patients in whom screws were positioned using customized 3D-printed templates. Size of the screws, accuracy, clinical outcomes, and complications were analyzed. RESULTS The study evaluated 251 patients (1004 screws). The free-hand 3D planning-guided group included 158 patients (632 screws), and the 3D-printed template-guided group included 93 patients (372 screws). The 3D-printed template-guided group involved screws of larger size from L3 to S1. Differences between the 2 groups in terms of accuracy parameters reached statistical significance (P ≤ 0.05). CONCLUSIONS With the use of 3D patient-matched template guides, mean diameter and length of CBT screws could be safely increased due to improved accuracy of screw placement. Based on previous evidence regarding CBT biomechanical properties, these advantages could allow increased fixation strength over traditional convergent pedicle screw trajectories. Further biomechanics studies are needed.
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Affiliation(s)
- Giuseppe Di Perna
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Spine Surgery Unit, "Casa di Cura Clinica Città di Bra", Bra, Italy
| | - Nicola Marengo
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Keitaro Matsukawa
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Musashimurayama, Tokyo, Japan
| | - Geert Mahieu
- Orthopaedic Surgery Department, ORTHOCA - AZ Monica Hospital, Antwerp, Belgium
| | | | | | - Raffaele De Marco
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.
| | - Pietro Zeppa
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Marco Ajello
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Alessandro Fiumefreddo
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Francesco Zenga
- Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Diego Garbossa
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Neurosurgery Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Fabio Cofano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy; Spine Surgery Unit, Humanitas Gradenigo Hospital, Turin, Italy
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Neuman BJ, Wang KY, Harris AB, Raad M, Hostin RA, Protopsaltis TS, Ames CP, Passias PG, Gupta MC, Klineberg EO, Hart R, Bess S, Kebaish KM. Return to work after adult spinal deformity surgery. Spine Deform 2023; 11:197-204. [PMID: 36219391 DOI: 10.1007/s43390-022-00552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine the proportions of patients returning to work at various points after adult spinal deformity (ASD) surgery and the associations between surgical invasiveness and time to return to work. METHODS Using a multicenter database of patients treated surgically for ASD from 2008 to 2015, we identified 188 patients (mean age 51 ± 15 years) who self-reported as employed preoperatively and had 2-year follow-up. Per the ASD-Surgical and Radiographical Invasiveness Index (ASD-SR), 118 patients (63%) underwent high-invasiveness (HI) surgery (ASD-SR ≥ 100) and 70 (37%) had low-invasiveness (LI) surgery (ASD-SR < 100). Patients who self-reported ≥ 75% normal level of work/school activity were considered to be working full time. Chi-squared and Fisher exact tests were used to compare categorical variables (α = .05). RESULTS Preoperatively, 69% of employed patients worked full time. Postoperatively, 15% of employed patients were full time at 6 weeks, 70% at 6 months, 83% at 1 year, and 84% at 2 years. Percentage of employed patients working full time at 2 years was greater than preoperatively (p < .001); percentage of patients returning to full time at 6 weeks was lower in the HI (5%) than in the LI group (19%) (p = .03), a difference not significant at later points. CONCLUSIONS Most adults returned to full-time work after ASD surgery. A smaller percentage of patients in the HI group than in the LI group returned to full-time work at 6 weeks. Patients employed full time preoperatively will likely return to full-time employment after ASD surgery. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Brian J Neuman
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA
| | - Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA
| | - Andrew B Harris
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA
| | - Richard A Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, TX, USA
| | | | - Christopher P Ames
- Department of Neurologic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Robert Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline Street, JHOC 5223, Baltimore, MD, 21287, USA.
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de Castro JPS, Brock RS, Teixeira MJ, Figueiredo EG. Ultrasound-Guided In-Plane Interlaminar Lumbar Endoscopic Approach with Smartphone and Portable Light Source: Description of a New Surgical Technique. ARQUIVOS BRASILEIROS DE NEUROCIRURGIA: BRAZILIAN NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1756459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction Endoscopic spine surgery enables the minimally invasive treatment of pathologies affecting the spinal cord and roots. Herein we describe an unprecedented technique Ultrasound-Guided in-plane interlaminar lumbar endoscopic approach with a smartphone and portable light source.
Methods The interlaminar approach was performed in a cadaveric specimen at L4 to 5 and L5 to S1 bilaterally. A curvilinear 2 to 5 MHz ultrasound probe was employed, the puncture was performed with the needle, a guide wire was inserted until the flavum ligament, followed by the dilator and working cannula. A 30° spinal endoscope, with an optical adapter of the endoscope camera for smartphone and portable endoscope lighting was inserted, the flavum ligament was visualized, and an opening in this site was performed with the scissors. Open dissection of the specimen was subsequently performed by identifying the puncture site in the interlaminar window.
Results The four interlaminar punctures were successfully guided by ultrasound; the opening of the ligamentum flavum was performed in the most lateral part of the interlaminar space, near the junction of the superior and inferior articular processes of the corresponding vertebrae in all the punctures.
Discussion The ultrasound makes possible to identify facets, foramina, transverse processes, and the interlaminar space. It is possible to minimize the use of radioscopy and its associated risks, both for patients and health professionals.
Conclusions The ultrasound-guided, in-plane, interlaminar, lumbar endoscopic approach with smartphone-adapted endoscope and portable light source is feasible and practical, minimizing radiation risks and making it possible to perform endoscopic spinal surgery.
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Affiliation(s)
| | - Roger Schmidt Brock
- Departament of Neurology, Hospital das Clínicas da Universidade de São Paulo, São Paulo – SP, Brazil
| | - Manoel Jacobsen Teixeira
- Departament of Neurology, Hospital das Clínicas da Universidade de São Paulo, São Paulo – SP, Brazil
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Gong J, Huang X, Luo L, Liu H, Wu H, Tan Y, Li C, Tang Y, Zhou Y. Radiation Dose Reduction and Surgical Efficiency Improvement in Endoscopic Transforaminal Lumbar Interbody Fusion Assisted by Intraoperative O-arm Navigation: A Retrospective Observational Study. Neurospine 2022; 19:376-384. [PMID: 35793934 PMCID: PMC9260536 DOI: 10.14245/ns.2143324.662] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 05/10/2022] [Indexed: 01/25/2023] Open
Abstract
Objective: Endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) has gained increasing popularity among spine surgeons. However, with the use of fluoroscopy, intraoperative radiation exposure remains a major concern. Here, we aim to introduce Endo-TLIF assisted by O-arm-based navigation and compare the results between O-arm navigation and fluoroscopy groups.Methods: Sixty-four patients were retrospectively analyzed from May 2019 to September 2020; the nonnavigation group comprised 34 patients, and the navigation group comprised 30 patients. Data on radiation dose, blood loss, postoperative drains, surgery time, complications, and length of hospital stay (LOS) were collected. Clinical outcomes were evaluated from postoperative data such as fusion rate, Oswestry Disability Index (ODI), and visual analogue scale (VAS). Radiation dose and surgery time were selected as primary outcomes; the others were second outcomes.Results: All patients were followed up for at least 12 months. No significant differences were detected in intraoperative hemorrhage, postoperative drains, hospital LOS, or complications between the 2 groups. The radiation dose was significantly lower in the navigation group compared with the nonnavigation group. The time of cannula placement and pedicle screw fixation was significantly reduced in the navigation group. No significant differences were detected between the clinical outcomes in the 2 groups (VAS and ODI scores).Conclusion: The present study demonstrates that O-arm-assisted Endo-TLIF is efficient and safe. Compared with fluoroscopy, O-arm navigation could reduce the radiation exposure and surgical time in Endo-TLIF surgery, with similar clinical outcomes. However, the higher doses exposed to patients remains a negative effect of this technology.
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Affiliation(s)
- Junfeng Gong
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Xinle Huang
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Liwen Luo
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Huan Liu
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Hao Wu
- Department of Clinical Laboratory, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Ying Tan
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
| | - Yu Tang
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
- Corresponding Author Yue Zhou Department of Orthopedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopaedics, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing, China
- Corresponding Author Yue Zhou Department of Orthopedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
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10
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Lin Y, Rao S, Liu B, Sun Y, Zhao S, Su G, Chen S, Li Y, Chen B. Percutaneous full endoscopic C1 laminectomy for developmental atlantal stenosis with myelopathy: a case report of three cases and review of the literature. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:720. [PMID: 35845524 PMCID: PMC9279768 DOI: 10.21037/atm-22-2282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Abstract
Background Developmental atlantal stenosis with myelopathy (DASM) in adults is a rare disease that only sporadic cases have been reported over the years. C1 laminectomy (C1L) is one of the most common operations for its treatment. However, as an open surgery, it has shortcomings such as large trauma and slow postoperative rehabilitation, and minimally invasive spine surgery (MISS) offers alternative treatment options with advantages. MISS instruments expand the technical capabilities of surgeons, which allows safer and more effective therapeutics for difficult and complicated diseases. This case report presents a new minimally invasive approach; percutaneous full endoscopic C1 laminectomy (PFEC1L), for the treatment of DASM, and to consolidate the current literature on the condition to summarize its etiologies, clinical manifestations, diagnostic criteria, surgical management, and prognoses. Case Description The patient in Case 1 presented with neck pain and numbness and weakness in the limbs. The patient in Case 2 presented with numbness in the extremities and the patient in Case 3 presented with bilateral hand numbness and left lower limb weakness. They were all diagnosed with DASM and underwent PFEC1L treatment to maintain the enlargement and decompression of the atlantal canal, which achieved favorable outcomes without complications during the postoperative follow-up visit. Conclusions DASM is rare but potentially dangerous. Its diagnosis is made based on clinical manifestations combined with radiological imaging examinations, especially computed tomography (CT) scan and magnetic resonance imaging (MRI). While C1L is the most common surgical method, PFEC1L is a new feasible and safe therapeutic option with comparable good outcomes and the advantage of being minimally-invasive. To our knowledge this is the first report that PFEC1L was applied for DASM treatment.
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Affiliation(s)
- Yongpeng Lin
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyuan Rao
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bingxin Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yueli Sun
- Spine Disease Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuai Zhao
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Guoyi Su
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shudong Chen
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongjin Li
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bolai Chen
- Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangzhou, China.,Guangzhou University of Chinese Medicine, Guangzhou, China
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11
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Mo K, Gupta A, Laljani R, Librizzi C, Raad M, Musharbash F, Al Farii H, Lee SH. Laminectomy Versus Laminectomy with Fusion for Intradural Extramedullary Tumors: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 164:203-215. [PMID: 35487493 DOI: 10.1016/j.wneu.2022.04.046] [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: 02/17/2022] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The primary objective of our systematic review and meta-analysis was to systematically compare the reported outcomes between laminectomy and laminectomy with fixation/fusion (LF) for the treatment of intradural extramedullary tumors (IDEMTs). Our secondary objective was to compare the outcomes between different laminectomy exposure techniques. METHODS PubMed and Embase were queried for literature on laminectomy and LF for IDEMTs. Reports of transforaminal approaches, interlaminar approaches, corpectomy, pediatrics patients, intramedullary tumors, technical studies, animal or cadaver studies, and literature reviews were excluded. The outcome measures recorded were pain, neurologic function, functional independence, cerebrospinal fluid leak, and wound infection. Where possible, the laminectomy technique (partial laminectomy [PL] vs. total laminectomy [TL]) was specified. Stata, version 17, was used for the fixed effects inverse variance meta-analysis. RESULTS Of 1849 reports assessed, 17 were included. The meta-analysis revealed that laminectomy (PL or TL) resulted in higher rates of postoperative sagittal instability compared with LF (odds ratio, 1.81; P < 0.001). No differences in any other postoperative outcome were observed between laminectomy and LF (P = 0.44). The systematic review also revealed no differences in postoperative pain, neurologic function, or functional independence or disability between PL and TL. Some evidence suggested that TL might result in greater rates of sagittal instability compared with PL. CONCLUSIONS No differences between LF, PL, or TL in pain, neurologic deficit, functional independence, cerebrospinal fluid leak, or wound infection were reported. Laminectomy had greater odds of sagittal instability compared with LF. Patients with preoperative sagittal instability requiring extensive removal of the posterior spinal column to achieve adequate resection of large tumors might benefit from LF.
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Affiliation(s)
- Kevin Mo
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Arjun Gupta
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Orthopaedic Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rohan Laljani
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christa Librizzi
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Farah Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Humaid Al Farii
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sang Hun Lee
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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12
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Bizdikian AJ, El Rachkidi R. Posterior Ligamentous Complex Injuries of the Thoracolumbar Spine: Importance and Surgical Implications. Cureus 2021; 13:e18774. [PMID: 34796064 PMCID: PMC8590454 DOI: 10.7759/cureus.18774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/05/2022] Open
Abstract
The soft tissues surrounding the spine play a primordial role in its stability, the most important of which are located posteriorly and are deemed the posterior ligamentous complex (PLC). Injuries to the PLC in the setting of thoracolumbar trauma are often dreaded and little attention has been given to them in the management protocols of thoracolumbar trauma. This review aims to summarize and contextualize current concepts in PLC injuries of the thoracolumbar spine with the aim to provide a clear guide for clinical management. Injuries to the PLC may be suspected on the clinical exam but are often missed, leading to serious complications, including instability and neurological compromise. The diagnosis is often made indirectly by spinal radiographs and CT-scanning or by direct visualization of soft tissues via magnetic resonance imaging. The latter remains the standard imaging modality and is mandatory for patients with a high suspicion of PLC injury. PLC injuries are associated with vertebral fractures and follow a progressive pattern of severity, depending on the mechanism of injury and extent of trauma. Surgical management is warranted, as PLC damage renders the spine unstable. Although fusion was once the standard of care and remains applicable for certain patients, recent endeavors of temporary spinal fixation without fusion are increasingly gaining traction in patients with PLC injuries. In conclusion, PLC injuries are challenging as they are often missed, poorly understood, and are not easily managed. Proper diagnosis and management are crucial to avoid long-standing complications such as spinal instability. Considering the paucity of available data on such an important topic in thoracolumbar trauma, this review article aims to contextualize current concepts in PLC injuries in order to demystify this sparsely covered subject.
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Affiliation(s)
- Aren Joe Bizdikian
- Department of Orthopaedics and Traumatology, Hotel-Dieu de France Hospital, Beirut, LBN
| | - Rami El Rachkidi
- Department of Orthopaedics and Traumatology, Hotel-Dieu de France Hospital, Beirut, LBN
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13
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Louie PK, Vaishnav AS, Gang CH, Urakawa H, Sato K, Chaudhary C, Lee R, Mok JK, Sheha E, Lafage V, Qureshi SA. Development and Initial Internal Validation of a Novel Classification System for Perioperative Expectations Following Minimally Invasive Degenerative Lumbar Spine Surgery. Clin Spine Surg 2021; 34:E537-E544. [PMID: 34459472 DOI: 10.1097/bsd.0000000000001246] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 06/23/2021] [Indexed: 12/17/2022]
Abstract
STUDY DESIGN This was a prospective consecutive clinical cohort study. OBJECTIVE The purpose of our study was to develop and provide an initial internal validation of a novel classification system that can help surgeons and patients better understand their postoperative course following the particular minimally invasive surgery (MIS) and approach that is utilized. SUMMARY OF BACKGROUND DATA Surgeons and patients are often attracted to the option of minimally invasive spine surgery because of the perceived improvement in recovery time and postsurgical pain. A classification system based on the impact of the surgery and surgical approach(es) on postoperative recovery can be particularly helpful. METHODS Six hundred thirty-one patients who underwent MIS lumbar/thoracolumbar surgery for degenerative conditions of the spine were included. Perioperative outcomes-operative time, estimated blood loss, postsurgical length of stay (LOS), 90-day complications, postoperative day zero narcotic requirement [in Morphine Milligram Equivalent (MME)], and need for intravenous patient-controlled analgesia (IV PCA). RESULTS Postoperative LOS and postoperative narcotic use were deemed most clinically relevant, thus selected as primary outcomes. Type of surgery was significantly associated with all outcomes (P<0.0001), except intraoperative complications. Number of levels for fusion was significantly associated with operative time, in-hospital complications, 24 hours oral MME, and the need for IV PCA and LOS (P<0.0001). Number of surgical approaches for lumbar fusion was significantly associated with operative time, 24 hours oral MME, need for IV PCA and LOS (P<0.001). Based on these parameters, the following classification system ("Qureshi-Louie classification" for MIS degenerative lumbar surgery) was devised: (1) Decompression-only; (2) Fusion-1 and 2 levels, 1 approach; (3) Fusion-1 level, 2 approaches; (4) Fusion-2 levels, 2 approaches; (5) Fusion-3+ levels, 2 approaches. CONCLUSIONS We present a novel classification system and initial internal validation to describe the perioperative expectations following various MIS surgeries in the degenerative lumbar spine. This initial description serves as the basis for ongoing external validation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Evan Sheha
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
| | | | - Sheeraz A Qureshi
- Hospital for Special Surgery
- Weill Cornell Medical College, New York, NY
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14
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Chen KT, Choi KC, Song MS, Jabri H, Lokanath YK, Kim JS. Hybrid Interlaminar Endoscopic Lumbar Decompression in Disc Herniation Combined With Spinal Stenosis. Oper Neurosurg (Hagerstown) 2021; 20:E168-E174. [PMID: 33294926 DOI: 10.1093/ons/opaa360] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 08/29/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endoscopic spine surgery is an alternative to the traditional treatment of lumbar disc herniation. However, the traditional technique of interlaminar endoscopic approach is challenging and risky in patients with concomitant spinal stenosis. OBJECTIVE To report a modified technique called hybrid interlaminar endoscopic lumbar decompression as an effective treatment. METHODS Patients with combined lumbar disc herniation and lateral recess stenosis undergoing full-endoscopic interlaminar lumbar discectomy were retrospectively studied. The hybrid interlaminar endoscopic discectomy technique, as well as the use of 2 endoscopes with different diameters, is described in detail. The large endoscope is used for the laminotomy procedure, while the small endoscope is used for the discectomy procedure. The demographics and clinical outcomes of the patients are presented. RESULTS A total of 19 patients were included in this study. The mean age was 46.7 yr. The visual analog scale for back and leg pain improved from 5.6 ± 3.4 and 7.5 ± 2.3 to 1.8 ± 1.3 and 1.8 ± 1.6, respectively (P < .001). The mean Oswestry Disability Index improved from 59.9 ± 21.2 preoperatively to 18.2 ± 8.5 postoperatively (P < .001). The follow-up was 8.2 mo on average. No major complications occurred, but 2 patients reported mild postoperative paresthesia. One patient had an early recurrence and underwent repeat endoscopic discectomy. CONCLUSION Full-endoscopic lumbar discectomy provides excellent access to the intracanalicular herniation site of an intervertebral disc. By using the endoscopic technique presented here, surgeons can safely and efficiently achieve adequate decompression in patients with lumbar disc herniation combined with spinal stenosis.
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Affiliation(s)
- Kuo-Tai Chen
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.,Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan
| | - Kyung-Chul Choi
- Department of Neurosurgery, the Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Myung-Soo Song
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hussam Jabri
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yadhu K Lokanath
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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15
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Microendoscope-Assisted Versus Open Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Multicenter Retrospective Cohort Study. ACTA ACUST UNITED AC 2021; 57:medicina57020150. [PMID: 33567496 PMCID: PMC7916072 DOI: 10.3390/medicina57020150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/28/2021] [Accepted: 02/03/2021] [Indexed: 11/17/2022]
Abstract
Background and objectives: Minimally invasive surgery has become popular for posterior lumbar interbody fusion (PLIF). Microendoscope-assisted PLIF (ME-PLIF) utilizes a microendoscope within a tubular retractor for PLIF procedures; however, there are no published reports that compare Microendoscope-assisted to open PLIF. Here we compare the surgical and clinical outcomes of ME-PLIF with those of open PLIF. Materials and Methods: A total of 155 consecutive patients who underwent single-level PLIF were registered prospectively. Of the 149 patients with a complete set of preoperative data, 72 patients underwent ME-PLIF (ME-group), and 77 underwent open PLIF (open-group). Clinical and radiographic findings collected one year after surgery were compared. Results: Of the 149 patients, 57 patients in ME-group and 58 patients in the open-group were available. The ME-PLIF procedure required a significantly shorter operating time and involved less intraoperative blood loss. Three patients in both groups reported dural tears as intraoperative complications. Three patients in ME-group experienced postoperative complications, compared to two patients in the open-group. The fusion rate in ME-group at one year was lower than that in the open group (p = 0.06). The proportion of patients who were satisfied was significantly higher in the ME-group (p = 0.02). Conclusions: ME-PLIF was associated with equivalent post-surgical outcomes and significantly higher rates of patient satisfaction than the traditional open PLIF procedure. However, the fusion rate after ME-PLIF tended to be lower than that after the traditional open method.
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16
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Hijji FY, Jenkins NW, Parrish JM, Narain AS, Hrynewycz NM, Brundage TS, Singh K. Does day of surgery affect length of stay and hospital charges following lumbar decompression? JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2020. [DOI: 10.1177/2210491720941211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design: This is a retrospective cohort study. Introduction: Spine procedures are the most expensive surgical interventions on a per-case basis. Previously, orthopedic procedures occurring later in the week have been associated with an increased length of stay (LOS) and consequent increase in costs. However, no such analysis has been performed on common spinal procedures such as minimally invasive lumbar decompression (MIS LD). The purpose of this study is to determine if there is an association between day of surgery and LOS or direct hospital costs after MIS LD. Materials and Methods: A prospectively maintained surgical database of patients who underwent primary, single, or multilevel MIS LD for degenerative spinal pathology between 2008 and 2017 was reviewed. Patients undergoing MIS LD were grouped as early in the week (Monday/Tuesday) or late in the week (Thursday/Friday). Differences in patient demographics and preoperative characteristics were compared using χ 2 analysis or Student’s t-test. Associations between date of surgery, LOS, and costs were assessed using multivariate linear regression. Results: A total of 717 patients were included. Of these, 420 (58.6%) were in the early surgery cohort and 297 (41.4%) were in the late surgery cohort. There were no differences in demographic characteristics, operative levels, operative time, blood loss, or hospital LOS between cohorts ( p > 0.05). Furthermore, there was no difference in total direct costs or specific cost categories between cohorts ( p > 0.05). Discussion: The timing of surgery within the week is not associated with differences in inpatient LOS or hospital costs following MIS LD. As such, hospitals should not alter surgical scheduling patterns to restrict these procedures to certain days within the week.
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Affiliation(s)
- Fady Y Hijji
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ankur S Narain
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nadia M Hrynewycz
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Thomas S Brundage
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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17
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Sun MS, Yuchi CX, Cai XY, Du CF, Mo ZJ. Parametric study of anterior percutaneous endoscopic cervical discectomy (APECD). Comput Methods Biomech Biomed Engin 2020; 24:687-699. [PMID: 33258380 DOI: 10.1080/10255842.2020.1846186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Anterior percutaneous endoscopic cervical discectomy (APECD) is a common treatment for cervical spondylotic radiculopathy (CSR). In this study, the effects of various channel diameters and approach angles on cervical vertebrae on postoperative outcomes in APECD surgery were explored. A finite element model of intact cervical C3-C7 was constructed and then modified to obtain six surgical models. Range of motion (ROM) and intradiscal pressure (IDP) were calculated under different conditions of flexion (Fle), extension (Ext), lateral bending, and axial rotation. During Fle and bending to the left (LB), the ROM was closer to the intact model when the angle of approach was 90°. During bending to the left (LB) and rotation to the left (LR), the ROM changed considerably (43.2%, 33.7%, respectively) where the angle of approach was 45°. As the surgical channel diameter increased, the extent of the change in ROM compared with the intact model also increased. IDP decreased by 48% and 49%, respectively, compared with the intact model at the C5-C6 segment where the angle of approach was 45° and 60° during Fle, while it changed little at 90°, by less than 10%. The IDP was increased noticeably by 117.6%, 82.1%, and 105.8%, for channel diameters of 2, 3 and 4 mm, respectively. And declined noticeably during LB and LR (LB: 27.1%, 27.1%, 38.5%; LR: 37.4%, 35.5%, 48.7%). The results demonstrated that the shorter the surgical path, the smaller surgical diameter, the less the biomechanical influence on the cervical vertebra.
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Affiliation(s)
- Meng-Si Sun
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Chen-Xi Yuchi
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Xin-Yi Cai
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Cheng-Fei Du
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, China.,National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, Tianjin University of Technology, Tianjin, China
| | - Zhong-Jun Mo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Rehabilitation Technical Aids Technology and System of the Ministry of Civil Affairs, National Research Centre for Rehabilitation Technical Aids, Beijing, China
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18
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Keil H, Luxenhofer M, Vetter SY, Beisemann N, Grützner PA, Franke J. Evaluation of image quality and assessability of a new flat‐panel 3D C‐arm compared to mobile and fixed computed tomography in posterior spinal fixation. Int J Med Robot 2020; 17:e2181. [DOI: 10.1002/rcs.2181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/25/2020] [Accepted: 10/07/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Holger Keil
- Department of Trauma and Orthopaedic Surgery Krankenhausstr Universitätsklinikum Erlangen Erlangen Germany
| | - Miriam Luxenhofer
- BG Trauma Center Ludwigshafen Department of Trauma and Orthopaedic Surgery Ludwigshafen Germany
| | - Sven Y. Vetter
- BG Trauma Center Ludwigshafen Department of Trauma and Orthopaedic Surgery Ludwigshafen Germany
| | - Nils Beisemann
- BG Trauma Center Ludwigshafen Department of Trauma and Orthopaedic Surgery Ludwigshafen Germany
| | - Paul A. Grützner
- BG Trauma Center Ludwigshafen Department of Trauma and Orthopaedic Surgery Ludwigshafen Germany
| | - Jochen Franke
- BG Trauma Center Ludwigshafen Department of Trauma and Orthopaedic Surgery Ludwigshafen Germany
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19
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Czigléczki G, Nagy Z, Padányi C, Banczerowski P. Biportal endoscopic technique in the treatment of spinal stenosis: early clinical experiences and results. Neurol Res 2020; 42:1085-1088. [PMID: 32892719 DOI: 10.1080/01616412.2020.1803603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Minimally invasive procedures in spine surgery have undergone significant development in recent times. A demand emerged from both surgeons and patients to develop and perform these types of surgeries in order to prevent biomechanical and surgical complications. Our study aimed to present early clinical results of a biportal endoscopy technique in the treatment of degenerative spinal stenosis. METHOD We created a retrospective database of patients who underwent biportal spinal endoscopic decompression at the National Institute of Clinical Neuroscience, Department of Neurosurgery, Semmelweis University, Budapest, Hungary, in 2019. The surgical steps of technique is discussed in details. RESULTS Retrospectively, we identified and collected 21 patients in our retrospective analysis. The early results after endoscopic decompression were excellent, 17 patients (81%) mentioned good general comfort which coincided with small incisions and the preservation of posterior spinal muscles. Three patients (14%) mentioned good condition and minor postoperative pain which could be controlled with analgesics. One patients (5%) mentioned postoperative discomfort. The patients were controlled at 3, 6 and 9 months. The mean follow-up time was 7 months. DISCUSSION Biportal endoscopic technique was developed to fulfil the requirements of minimally invasive techniques. Our results indicate this method may be highly effective for the treatment of lumbar spinal stenosis and an alternative to conventional microsurgical decompression; however, our study limited by its retrospective manner and small population size.
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Affiliation(s)
- Gábor Czigléczki
- Department of Spinal Surgery, National Institute of Clinical Neurosciences , Budapest, Hungary.,Department of Neurosurgery, Semmelweis University , Budapest, Hungary
| | - Zoltan Nagy
- Department of Spinal Surgery, National Institute of Clinical Neurosciences , Budapest, Hungary.,Department of Neurosurgery, Semmelweis University , Budapest, Hungary
| | - Csaba Padányi
- Department of Spinal Surgery, National Institute of Clinical Neurosciences , Budapest, Hungary
| | - Péter Banczerowski
- Department of Spinal Surgery, National Institute of Clinical Neurosciences , Budapest, Hungary.,Department of Neurosurgery, Semmelweis University , Budapest, Hungary
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20
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Chan AY, Lien BV, Choi EH, Chan AK, Hanna G, Lopez AM, Brown NJ, Gattas S, Kirillova L, Horton D, Fote G, Hanst B, Perry R, Lee YP, Golshani K, Hsu FPK, Oh MY. Back pain outcomes after minimally invasive anterior lumbar interbody fusion: a systematic review. Neurosurg Focus 2020; 49:E3. [DOI: 10.3171/2020.6.focus20385] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEMinimally invasive anterior lumbar interbody fusion surgery (MIS ALIF) is a technique that restores disc height and lumbar lordosis through a smaller exposure and less soft-tissue trauma compared to open approaches. The mini-open and laparoscopic assistance techniques are two main forms of MIS ALIF. The authors conducted a systematic review that sought to critically summarize the literature on back pain following MIS ALIF.METHODSIn March 2020, the authors searched the PubMed, Web of Science, and Cochrane Library databases for studies describing back pain visual analog scale (VAS) outcomes after MIS ALIF. The following exclusion criteria were applied to studies evaluated in full text: 1) the study included fewer than 20 patients, 2) the mean follow-up duration was shorter than 12 months, 3) the study did not report back pain VAS score as an outcome measure, and 4) MIS ALIF was not studied specifically. The methodology for the included studies were evaluated for potential biases and assigned a level of evidence.RESULTSThere were a total of 552 patients included from 13 studies. The most common biases were selection and interviewer bias. The majority of studies were retrospective. The mean sample size was 42.3 patients. The mean follow-up duration was approximately 41.8 months. The mean postoperative VAS reduction was 5.1 points. The mean VAS reduction for standalone grafts was 5.9 points, and 5.0 points for those augmented with posterior fixation. The most common complications included bladder or urinary dysfunction, infection, and hardware-related complications.CONCLUSIONSThis was a systematic review of back pain outcomes following MIS ALIF. Back pain VAS score was reduced postoperatively across all studies. The complication rates were low overall. MIS ALIF is safe and effective at reducing back pain in appropriate patient populations.
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Affiliation(s)
| | | | | | - Andrew K. Chan
- 2Department of Neurological Surgery, University of California, San Francisco, California
| | | | | | | | | | | | | | | | | | - Ryan Perry
- 3Orthopedic Surgery, University of California, Irvine; and
| | - Yu-Po Lee
- 3Orthopedic Surgery, University of California, Irvine; and
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21
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Grasso G. New Challenges for the Betterment of Spine Health. World Neurosurg 2020; 140:509-511. [PMID: 32797982 DOI: 10.1016/j.wneu.2020.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Giovanni Grasso
- Section of Neurosurgery, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
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22
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Suo S, Chen Y, Mao X, Chen S, Fu Z. Percutaneous Endoscopic Surgery for Lumbar Discal Cyst: Two Case Reports. J Med Cases 2020; 11:178-181. [PMID: 34434392 PMCID: PMC8383649 DOI: 10.14740/jmc3474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/18/2020] [Indexed: 11/20/2022] Open
Abstract
Discal cyst is a rare disease, the pathogenesis is not yet clear and its symptoms are very similar to lumbar disc herniation. Although some cases may regress spontaneously, most cases of lumbar discal cysts are treated surgically. At present, there is no consensus on the treatment of this disease. The authors report the clinical usefulness of the percutaneous endoscopic transforaminal surgery technique in two patients with the lumbar 4-5 discal cyst. The clinical symptoms of both patients were unilateral lower extremity pain and lower back pain. Magnetic resonance imaging of the lumbar spine revealed lumbar discal cysts, causing compression to the spinal dura and roots. Both patients received conservative treatment for more than 6 months, but the clinical symptoms persisted so surgical treatment by percutaneous endoscopic transforaminal surgery without additional discectomy was performed under local anesthesia. The symptoms were relieved immediately after removal of the discal cysts. Postoperative magnetic resonance imaging showed that both patients had complete excision of discal cysts and complete decompression of the treated segmental. There were no recurrent lesions and complications during the follow-up period. We believe that percutaneous transforaminal endoscopic surgery could be a safe, mini-invasive and appropriate method for the treatment of discal cysts.
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Affiliation(s)
- Shiqi Suo
- Department of Orthopedics, Affiliated Hospital of Hebei University of Engineering, Handan 056002, China
| | - Yanan Chen
- Department of Orthopedics, Affiliated Hospital of Hebei University of Engineering, Handan 056002, China
| | - Xirui Mao
- Department of Orthopedics, Affiliated Hospital of Hebei University of Engineering, Handan 056002, China
| | - Song Chen
- Department of Orthopedics, Affiliated Hospital of Hebei University of Engineering, Handan 056002, China
| | - Zhian Fu
- Department of Orthopedics, Affiliated Hospital of Hebei University of Engineering, Handan 056002, China
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23
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Chen C, Yuchi CX, Gao Z, Ma X, Zhao D, Li JW, Xu B, Zhang CQ, Wang Z, Du CF, Yang Q. Comparative analysis of the biomechanics of the adjacent segments after minimally invasive cervical surgeries versus anterior cervical discectomy and fusion: A finite element study. J Orthop Translat 2020; 23:107-112. [PMID: 32642425 PMCID: PMC7322474 DOI: 10.1016/j.jot.2020.03.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 01/24/2023] Open
Abstract
Purpose Percutaneous full-endoscopic anterior cervical discectomy (PEACD) and posterior cervical foraminotomy (PCF) as alternatives to anterior cervical discectomy and fusion (ACDF) are extensively used in the treatment of patients with cervical spondylotic radiculopathy. The possibility of avoiding the risk of accelerated degeneration of the adjacent segments caused by fusion is claimed to be the theoretical advantage of these approaches; however, there is a paucity of supportive evidence from biomechanical data. Therefore, this study investigated and compared the effects of PCF, PEACD, and ACDF on the adjacent segments and operative segments of the cervical spine from a biomechanical standpoint. Method A normal and intact three-dimensional finite element digital model of C4-C7 was constructed and validated, and the finite element models of PEACD, PCF, and ACDF were obtained by modifying the C4-C7 model. All models were exposed to identical conditions of load during flexion, extension, axial rotation, and lateral bending. We calculated the range of motion (ROM), intervertebral disc pressure (IDP), and facet joint contact force (FJCF) of the operative segment and the adjacent segment in different motion conditions. Result The conventional ACDF had a remarkable influence on the ROM and IDP of the operative segment and the adjacent segments. In the PEACD model, the change of ROM was not noticeable; the IDP of the operative segment was significantly smaller, whereas the change of IDP of the adjacent segment was insignificant. In the PCF model, the ROM and IDP of all segments remained unaffected.During extension, the facet joint contact force changed significantly after ACDF, and it changed slightly after PECAD and PCF. Conclusion By comparatively analyzing the biomechanical changes of the cervical spine after PCF, PEACD, and ACDF using the finite element method, we suggested that PCF and PEACD were more suitable for surgical intervention of cervical spondylotic radiculopathy than ACDF from a biomechanical point of view and PCF may outperform PEACD.
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Affiliation(s)
- Chao Chen
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin 300211, China
| | - Chen-Xi Yuchi
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin 300384, China
| | - Ziwei Gao
- Tianjin Medical University, Tianjin 300070, China.,Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin 300211, China
| | - Xinlong Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin 300211, China
| | - Dong Zhao
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin 300211, China
| | - Jun-Wei Li
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin 300384, China
| | - Baoshan Xu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin 300211, China
| | - Chun-Qiu Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin 300384, China
| | - Zheng Wang
- Department of Orthopedics, No.1 Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Cheng-Fei Du
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin 300384, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin 300211, China
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24
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Vadalà G, De Salvatore S, Ambrosio L, Russo F, Papalia R, Denaro V. Robotic Spine Surgery and Augmented Reality Systems: A State of the Art. Neurospine 2020; 17:88-100. [PMID: 32252158 PMCID: PMC7136092 DOI: 10.14245/ns.2040060.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022] Open
Abstract
Instrumented spine procedures have been performed for decades to treat a wide variety of spinal disorders. New technologies have been employed to obtain a high degree of precision, to minimize risks of damage to neurovascular structures and to diminish harmful exposure of patients and the operative team to ionizing radiations. Robotic spine surgery comprehends 3 major categories: telesurgical robotic systems, robotic-assisted navigation (RAN) and virtual augmented reality (AR) systems, including AR and virtual reality. Telesurgical systems encompass devices that can be operated from a remote command station, allowing to perform surgery via instruments being manipulated by the robot. On the other hand, RAN technologies are characterized by the robotic guidance of surgeon-operated instruments based on real-time imaging. Virtual AR systems are able to show images directly on special visors and screens allowing the surgeon to visualize information about the patient and the procedure (i.e., anatomical landmarks, screw direction and inclination, distance from neurological and vascular structures etc.). The aim of this review is to focus on the current state of the art of robotics and AR in spine surgery and perspectives of these emerging technologies that hold promises for future applications.
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Affiliation(s)
- Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sergio De Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Luca Ambrosio
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University of Rome, Rome, Italy
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25
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Chen S, Suo S, Li C, Wang Y, Li J, Zhang F, Zhang W. Clinical Application of Percutaneous Transforaminal Endoscopic Surgery in Lumbar Discal Cyst. World Neurosurg 2020; 138:e665-e673. [PMID: 32194264 DOI: 10.1016/j.wneu.2020.03.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Discal cyst is very rare and can cause intractable low back pain and radiating leg pain. Symptoms are hard to distinguish from lumbar disc herniation. The best treatment for discal cyst is controversial. Most lumbar discal cysts are treated surgically, while most studies of percutaneous transforaminal endoscopic surgery are case reports. This study investigated the clinical value of percutaneous transforaminal endoscopic surgery for lumbar discal cyst. METHODS A retrospective study was conducted in 9 patients with a discal cyst from June 2016 to November 2018. All patients had been treated by percutaneous transforaminal endoscopic surgery via a superior vertebral pedicle notch approach. Surgical outcomes were evaluated preoperatively and postoperatively using a visual analog scale for leg pain and the Oswestry Disability Index. At the final follow-up, patients were evaluated for clinical efficacy using modified Macnab criteria. RESULTS All 9 patients had remission of symptoms after removal of discal cysts. Postoperative magnetic resonance imaging showed that all patients had complete excision of discal cysts and complete decompression of the treated segment. There were no recurrent lesions during follow-up. Mean operative time was 68.67 ± 14.02 minutes. Mean hospitalization time was 4.22 ± 1.64 days. Preoperative visual analog scale and Oswestry Disability Index score improved significantly after surgery. Visual analog scale leg score improved from 7.88 ± 1.05 preoperatively to 1.78 ± 0.66 at final follow-up (P < 0.05), and ODI score improved from 53.65 ± 12.46 to 16.25 ± 8.76 (P < 0.05). According to the modified Macnab criteria, 5 patients (55.6%) were rated excellent, 3 patients (33.3%) were rated good, and 1 patient (11.1%) was rated fair at final follow-up, with an overall excellent and good rate of 88.9%. There were no serious complications during follow-up. CONCLUSIONS Percutaneous transforaminal endoscopic surgery could be a safe, minimally invasive surgical treatment for discal cyst, particularly suitable for patients who cannot undergo general anesthesia.
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Affiliation(s)
- Song Chen
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China; Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, China
| | - Shiqi Suo
- Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, China
| | - Chengli Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunxia Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiaqi Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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26
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Mezei T, Horváth A, Pollner P, Czigléczki G, Banczerowski P. Research on the predicting power of the revised Tokuhashi system: how much time can surgery give to patients with short life expectancy? Int J Clin Oncol 2020; 25:755-764. [PMID: 31993865 PMCID: PMC7118051 DOI: 10.1007/s10147-019-01612-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/10/2019] [Indexed: 12/01/2022]
Abstract
Object The primary treatment option for symptomatic metastatic spinal tumors is surgery. Prognostic systems are designed to assist in the establishment of the indication and the choice of surgical methodology. The best-known prognostic system is the revised Tokuhashi system, which has a predictive ability of about 60%. In our study, we are attempting to find the reason for its poor predictive ability, despite its proper separation ability. Methods We have designed a one-center-based retrospective clinical trial, by which we would like to test the feasibility and the inaccuracy of the revised Tokuhashi system. In our database, there are 329 patients who underwent surgery. Statistical analysis was performed. Results A significant increase in survival time was observed in the ‘conservative’ category. Earlier studies reported OS 0.15 at the 180-day control time, in contrast with our 0.38 OS value. The literature suggested supportive care for this category, but in our population, every patient underwent surgery. Our population passes the 0.15 OS value on day 475. We propose an adjustment of the Tokuhashi category scores. We observed significant success in resolving pain. Motor functions were improved or stabilized compared to changes in vegetative dysfunction. Conclusion According to our results, the Tokuhashi scoring system makes very conservative predictions and prefers non-surgical palliative or supportive care. Surgical treatment increases the life expectancy of patients in poor condition. We propose modifying the therapeutic options of the revised Tokuhashi system, taking into consideration modern spine surgery techniques.
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Affiliation(s)
- Tamás Mezei
- Department of Neurosurgery, Semmelweis University, 57 Amerikai Rd, Budapest, 1145, Hungary. .,National Institute of Clinical Neurosciences, 57 Amerikai Rd, Budapest, 1145, Hungary.
| | - Anna Horváth
- 3rd Department of Internal Medicine, Semmelweis University, 4 Kútvölgyi Rd, Budapest, 1125, Hungary
| | - Péter Pollner
- MTA-ELTE Statistical and Biological Physics Research Group, 1/a. Pázmány Péter S., Budapest, 1117, Hungary.,Health Services Management Training Center, Semmelweis University, 2 Kútvölgyi Rd, Budapest, 1125, Hungary
| | - Gábor Czigléczki
- Department of Neurosurgery, Semmelweis University, 57 Amerikai Rd, Budapest, 1145, Hungary.,National Institute of Clinical Neurosciences, 57 Amerikai Rd, Budapest, 1145, Hungary
| | - Péter Banczerowski
- Department of Neurosurgery, Semmelweis University, 57 Amerikai Rd, Budapest, 1145, Hungary.,National Institute of Clinical Neurosciences, 57 Amerikai Rd, Budapest, 1145, Hungary
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27
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Ahn Y. Devices for minimally-invasive microdiscectomy: current status and future prospects. Expert Rev Med Devices 2019; 17:131-138. [PMID: 31865755 DOI: 10.1080/17434440.2020.1708189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The current gold standard technique for lumbar disc herniation (LDH) is open lumbar microdiscectomy. The use of a tubular retractor system in the microdiscectomy technique can minimize tissue trauma by muscle-splitting sequential dilation during the surgical approach. This review aimed to describe the devices and surgical procedure of this minimally invasive microdiscectomy (MI-MD) and to discuss the pros and cons of the use of tubular retractors.Areas covered: Published medical literatures were extensively reviewed to summarize the practical devices and techniques related to the MI-MD for LDH. The placement of the tubular retractor by gradual muscle-splitting dilation technique may reduce muscle damage and postoperative wound pain. The use of flexible arm may easily change the tube direction and create a wide surgical field.Expert opinion: With reference to published literature, the MI-MD provides comparable clinical outcomes with less tissue trauma and early recovery. Development of devices for MI-MD is still ongoing. Extensive studies, including high-quality randomized trials, are required to establish a more practical and relevant MI-MD technique.
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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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28
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Complications with Minimally Invasive Transforaminal Lumbar Interbody Fusion for Degenerative Spondylolisthesis in the Obese Population. Spine (Phila Pa 1976) 2019; 44:E1401-E1408. [PMID: 31725689 DOI: 10.1097/brs.0000000000003160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A level-3 retrospective cohort analysis. OBJECTIVE The aim of this study was to describe obesity's effect on complications and outcomes in degenerative spondylolisthesis patients treated by minimally invasive transforaminal lumbar interbody fusion (MI TLIF). SUMMARY OF BACKGROUND DATA Obesity is associated with a greater complication rate among lumbar spine surgery patients. Poor clinical outcomes might likewise be supposed, but the association is not well established. Minimally invasive techniques have been developed to reduce complications and improve clinical outcomes in comparison to traditional open techniques. METHODS We reviewed 134 consecutive patients with degenerative spondylolisthesis undergoing MI TLIF. Subjects were grouped into nonobese (N = 65) and obese (N = 69) cohorts. The obese group was further subdivided by BMI. Patient demographics, perioperative complications, and outcome scores were collected over a minimum of 24 months. Four periods (intraoperative, postoperative hospitalization, 6-month, and 24-month postoperative) were assessed. RESULTS Cohort demographics were not significantly different, but it was noted that obese patients had more major comorbidities than nonobese patients. There was no difference in intraoperative complications between the two groups. The in-hospital complication rate was significantly greater in the obese group. The 6-month postoperative complication rate was not different between cohorts. Wound drainage was most common and noted only in the obese cohort. Complications at 24 months were not different but did trend toward significance in the obese for recurrence of symptoms and total complications. Functional outcome was better among nonobese subjects compared with obese subjects at every interval (significant at 6 and 12 months). Back pain scores were significantly better among nonobese subjects than obese subjects at 24 months, but Leg Pain scores were not different. CONCLUSIONS MI TLIF can be safely performed in the obese population despite a higher in-hospital complication rate. Knowledge of common complications will help the treatment team appropriately manage obese patients with degenerative spondylolisthesis. LEVEL OF EVIDENCE 3.
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Asafu Adjaye Frimpong G, Aboagye E, Asafu-Adjaye Frimpong A, Coleman NE, Amankwah P, Quansah A. CT-Guided Percutaneous Laser Disc Decompression for Lumbar Discogenic Radiculopathy-Performance of a Novel Combi-Therapy. Lasers Surg Med 2019; 52:419-423. [PMID: 31475737 DOI: 10.1002/lsm.23149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES On the basis of reported immediate and short-term excruciating pain by patients in the post-procedural period of computed tomography (CT)-guided percutaneous laser disc decompression (PLDD) in our clinic, we present our initial clinical experience with a novel combi-therapy using a combination of CT-guided PLDD and CT-guided epidural nerve blocks, which proved effective in managing the pain. STUDY DESIGN/MATERIALS AND METHODS A total of 100 patients who met the criteria for PLDD, underwent treatment for lumbar discogenic radiculopathy between 2014 and 2017. Fifty-five percent of the patients were males and 45% were females with a mean age of 46.25 years. Ninety-five patients underwent one level PLDD and five patients two-level PLDD procedures. CT-guided epidural nerve block with a combination of Bupivacaine, Lignocaine, and Kenalog was used in a 3× procedure separated by a 1-week interval. The first nerve block was given the same day, immediately after the PLDD procedure. The visual analogue scale (VAS) for pain was used during the pre-procedure and post-procedure periods. RESULTS Among the patients who underwent one level PLDD, 88 had L4-L5 levels, 5 had L5-S1 levels and 2 had L3-L4 levels. L4-L5 and L5-S1 levels were the most common two-level PLDD locations in seven patients. Five patients in our study subsequently underwent open surgical treatment. All patients reported immediate pain relief, which was sustained after the procedure. The average pre-procedure VAS score was 7.6 (range from 5 to 8.2) and the VAS score immediately after the procedure was on average 0.5 (ranging from 0 to 2). CONCLUSIONS Findings from this initial experience using a combi-therapy of CT-guided PLDD and CT-guided epidural nerve block have shown the benefits of this novel approach, offering significant immediate pain relief in the post-procedural phase, favorable outcomes in the short to mid-term and a significantly reduced rate of re-surgery (7%) compared with the use of only CT-guided PLDD. Lasers Surg Med 00:1-5, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- George Asafu Adjaye Frimpong
- Radiology, Kwame Nkrumah University of Science and Technology, PMB University Post Office, KNUST, Kumasi, Ghana.,Radiology, Spectra Health Imaging and Interventional Radiology Centre, P.O. Box KS 5431, Kumasi, Ghana
| | - Evans Aboagye
- Radiology, Spectra Health Imaging and Interventional Radiology Centre, P.O. Box KS 5431, Kumasi, Ghana
| | | | - Nana Esi Coleman
- Radiology, Spectra Health Imaging and Interventional Radiology Centre, P.O. Box KS 5431, Kumasi, Ghana
| | - Pierre Amankwah
- Radiology, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana
| | - Ato Quansah
- Radiology, Komfo Anokye Teaching Hospital, P.O. Box 1934, Kumasi, Ghana
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30
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White SJW, Ranson WA, Cho B, Cheung ZB, Ye I, Carrillo O, Kim JS, Cho SK. The Effects of Preoperative Steroid Therapy on Perioperative Morbidity and Mortality After Adult Spinal Deformity Surgery. Spine Deform 2019; 7:779-787. [PMID: 31495479 DOI: 10.1016/j.jspd.2018.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 12/09/2018] [Accepted: 12/26/2018] [Indexed: 12/28/2022]
Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVES To identify the effects of preoperative steroid therapy on 30-day perioperative complications after adult spinal deformity (ASD) surgery. SUMMARY OF BACKGROUND DATA Chronic steroid therapy has demonstrated therapeutic effects in the treatment of various medical conditions but is also known to be associated with surgical complications. There remains a gap in the literature regarding the impact of chronic steroid therapy in predisposing patients to perioperative complications after elective surgery for ASD. METHODS We performed a retrospective analysis of data from the 2008-2015 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into two groups based on preoperative steroid therapy. Differences in baseline patient characteristics, comorbidities, and operative variables were assessed. Univariate analysis was performed to compare the incidence of perioperative complications. Multivariate stepwise logistic regression models were then used to adjust for baseline patient and operative variables in order to identify perioperative complications that were associated with preoperative steroid therapy. RESULTS We identified 7,936 patients who underwent surgery for ASD, of which 418 (5.3%) were on preoperative steroid therapy. Preoperative steroid therapy was an independent risk factor for four perioperative complications, including mortality (odds ratio [OR] 2.42, 95% confidence interval [CI] 1.30, 4.51; p = .005), wound dehiscence (OR 3.12, 95% CI 1.45, 6.70; p = .004), deep vein thrombosis (DVT) (OR 2.10, 95% CI 1.24, 3.55; p = .006), and blood transfusion (OR 1.34, 95% CI 1.08, 1.66; p < .007). CONCLUSIONS Patients on preoperative steroid therapy are at increased risk of 30-day mortality, wound dehiscence, DVT, and blood transfusion after surgery for ASD. An interdisciplinary approach to the perioperative management of steroid regimens is critical. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Samuel J W White
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - William A Ranson
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Brian Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Zoe B Cheung
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ivan Ye
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Oscar Carrillo
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jun S Kim
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Samuel K Cho
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Wewel JT, Godzik J, Uribe JS. The utilization of minimally invasive surgery techniques for the treatment of spinal deformity. JOURNAL OF SPINE SURGERY 2019; 5:S84-S90. [PMID: 31380496 DOI: 10.21037/jss.2019.04.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Minimally invasive spinal surgery (MISS) has evolved as a formidable alternative to traditional open techniques to address adult spinal deformity (ASD). As technology advances, an increasingly large body of techniques and implants are available for use in MISS deformity correction. MISS deformity correction includes anterior, lateral, and posterior techniques that can be tailored to each patient while capturing the strength of each respective technique. Previous limitations of obtaining sagittal correction have been overcome with anterior column realignment (ACR) and the mini-open pedicle subtraction osteotomy. This article will describe current techniques and their application for ASD correction.
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Affiliation(s)
- Joshua T Wewel
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jakub Godzik
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Juan S Uribe
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Guha D, Jakubovic R, Alotaibi NM, Klostranec JM, Saini S, Deorajh R, Gupta S, Fehlings MG, Mainprize TG, Yee A, Yang VX. Optical Topographic Imaging for Spinal Intraoperative Three-Dimensional Navigation in Mini-Open Approaches: A Prospective Cohort Study of Initial Preclinical and Clinical Feasibility. World Neurosurg 2019; 125:e863-e872. [DOI: 10.1016/j.wneu.2019.01.201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/20/2019] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
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Zhao Y, Bo X, Wang C, Hu S, Zhang T, Lin P, He S, Gu G. Guided Punctures with Ultrasound Volume Navigation in Percutaneous Transforaminal Endoscopic Discectomy: A Technical Note. World Neurosurg 2018; 119:77-84. [PMID: 30071330 DOI: 10.1016/j.wneu.2018.07.185] [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: 06/09/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Ultrasound volume navigation (UVN) has been widely used for accurate guidance and decreased radiation exposure. However, few studies have focused on the clinical significance of UVN in guiding percutaneous puncture in percutaneous transforaminal endoscopic discectomy (PTED). We evaluated UVN to guide percutaneous puncture in PTED. METHODS We retrospectively reviewed the medical records of 12 patients (8 men and 4 women), who had undergone PTED with the help of UVN or fluoroscopic guidance for lumbar disc herniation from November 2017 to December 2017. RESULTS The age of these 12 patients range was 26-71 years, and the body mass index range was 18.19-26.91 kg/m2. Of the 12 patients, 6 were in UVN group and 6 were in fluoroscopy group. The mean number of punctures was 1.00 in UVN group and 3.83 in fluoroscopy group. The mean exposure time was 3.60 and 13.80 seconds in UVN and fluoroscopy groups, respectively. The mean operation time was 48.17 minutes and 61.33 minutes in UVN and fluoroscopy groups, respectively. A positive relationship was found between operation time and exposure time (P < 0.05). All patients achieved excellent or good clinical outcomes. The Oswestry Disability Index and visual analog scales for leg pain and back pain all showed significant improvement after the procedure (P < 0.05). None of patients experienced a complication. CONCLUSIONS UVN decreased the number of puncture attempts, radiation exposure, and operation time compared with fluoroscopic guidance in PTED. Therefore, UVN is a feasible and efficient method for guiding percutaneous puncture in PTED.
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Affiliation(s)
- Yongzhao Zhao
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaowan Bo
- Department of Medical Ultrasound, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chuanfeng Wang
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuo Hu
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tianqi Zhang
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Peijie Lin
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shisheng He
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Guangfei Gu
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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Abstract
Due to a worldwide increase of cancer incidence and a longer life expectancy of patients with metastatic cancer, a rise in the incidence of symptomatic vertebral metastases has been observed. Metastatic spinal disease is one of the most dreaded complications of cancer as it is not only associated with severe pain, but also with paralysis, sensory loss, sexual dysfunction, urinary and fecal incontinency when the neurologic elements are compressed. Rapid diagnosis and treatment have been shown to improve both the quality and length of remaining life. This chapter on vertebral metastases with epidural disease and intramedullary spinal metastases will be discussed in terms of epidemiology, pathophysiology, demographics, clinical presentation, diagnosis, and management. With respect to treatment options, our review will summarize the evolution of conventional palliative radiation to modern stereotactic body radiotherapy for spinal metastases and the surgical evolution from traditional open procedures to minimally invasive spine surgery. Lastly, we will review the most common clinical prediction and decision rules, framework and algorithms, and guidelines that have been developed to guide treatment decision making.
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Falavigna A, Ramos MB, Wong CC, Barbagallo G, Brodke D, Al-Mutair A, Ghogawala Z, Riew KD. Commentary: Worldwide Knowledge and Attitude of Spine Surgeons Regarding Radiation Exposure. Neurosurgery 2018; 83:E153-E161. [DOI: 10.1093/neuros/nyy243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Asdrubal Falavigna
- Department of Neurosurgery, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
- Laboratory of Clinical Studies and Basic Models on Spinal Cord Pathologies, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Miguel Bertelli Ramos
- Laboratory of Clinical Studies and Basic Models on Spinal Cord Pathologies, University of Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil
| | - Chung Chek Wong
- Department of Orthopedic Surgery, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Kuching, Malaysia
| | - Giuseppe Barbagallo
- Department of Neurosurgery, Policlinico “G. Rodolico” University Hospital, Catania, Italy
| | - Darrel Brodke
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Abdulaziz Al-Mutair
- Alrazi Hospital, Ministry of Health/Kuwait Institute for Medical Specialization, Adailiya, Kuwait
| | - Zoher Ghogawala
- Alan and Jacqueline Stuart Spine Center, Department of Neurosurgery, Lahey Hospital and Medical Center, Burlington, Massachusetts
- Tufts University School of Medicine, Boston, Massachusetts
| | - K Daniel Riew
- The Och Spine Hospital, Department of Orthopedic Surgery, Columbia University, New York, New York
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Abstract
STUDY DESIGN This is a cross-sectional study. OBJECTIVE The purpose of this study is to evaluate the content of information available on the Internet regarding minimally invasive spine surgery (MISS). SUMMARY OF BACKGROUND DATA Patients look to the Internet for quick and accessible information on orthopedic procedures to help guide their personal decision making process regarding the care they receive. However, the quality of internet-based orthopedic education material varies significantly with respect to accuracy and readability. MATERIALS AND METHODS The top 50 results were generated from each of 3 search engines (Google, Yahoo!, and Bing) using the search term "minimally invasive spine surgery." Results were categorized by authorship type and evaluated for their description of key factors such as procedural benefits, risks, and techniques. Comparisons between search engines and between authorship types were done using the Freeman-Halton extension for the Fisher exact test. The content of websites certified by Health on the Net Foundation (HONcode) was compared with those not HONcode certified. RESULTS Of the 150 websites and videos, only 26% were authored by a hospital or university, whereas 50% were by a private physician or clinic. Most resources presented some benefits of MISS (84%, 126/150), but only 17% presented risks of the procedure (26/150). Almost half of all resources described the technique of MISS, but only 27% had thorough descriptions that included visual representations while 26% failed to describe the procedure. Only 12 results were HONcode certified, and 10 (83%) of these were authored by a medical industry company. CONCLUSIONS Internet-based resources on MISS provide inconsistent content and tend to emphasize benefits of MISS over risks.
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Lykissas MG, Giannoulis D. Minimally invasive spine surgery for degenerative spine disease and deformity correction: a literature review. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:99. [PMID: 29707548 DOI: 10.21037/atm.2018.03.18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
During the last two decades, minimally invasive techniques and instruments in spine surgery have undergone serious development in all fields. Specific advantages of these minimally invasive methods have put them forward in spine surgery in recent times. Preservation of important anatomical structures of the spine is a major factor for the evolution of these procedures. The lower prevalence of complications and faster rehabilitation of patients are some of the advantages of minimally invasive spine surgery (MISS). Due to the increasing use of minimally invasive methods in the clinical practice worldwide, there is a strong need for clarification of basic principles, tips and tricks, complications, and clinical outcomes. This review is an effort to provide a better understanding of some of these procedures.
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Affiliation(s)
- Marios G Lykissas
- Department of Orthopaedic Surgery, University of Crete School of Medicine, Heraklion, Greece
| | - Dionysios Giannoulis
- Department of Orthopaedic Surgery, University of Ioannina School of Medicine, Ioannina, Greece
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Good News: But Why Is the Incidence of Postoperative Ischemic Optic Neuropathy Falling? Anesthesiology 2017; 125:445-8. [PMID: 27362871 DOI: 10.1097/aln.0000000000001212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Maduri R, Bobinski L, Duff JM. Image Merge Tailored Access Resection (IMTAR) of Spinal Intradural Tumors. Technical Report of 13 Cases. World Neurosurg 2017; 98:594-602. [DOI: 10.1016/j.wneu.2016.05.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/27/2016] [Accepted: 05/28/2016] [Indexed: 12/18/2022]
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Grasso G, Landi A. Preliminary experience with lumbar facet distraction and fixation as treatment for lumbar spinal stenosis. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2017; 8:193-198. [PMID: 29021670 PMCID: PMC5634105 DOI: 10.4103/jcvjs.jcvjs_56_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: To assess the properties of facet fixation with the Facet Wedge system in patients affected by lumbar spinal stenosis (LSS). Summary of Background Data: Implant of intra-articular spacers is an emerging technique for lumbar degenerative disease. Methods: This study included forty patients (Group 1) with symptomatic LSS in whom intra-articular spacers have been implanted along with microdecompression (MD) of the neural structures. Group 1 has been compared with a homogeneous group of patients with LSS treated with MD without intra-articular spacers implant (Group 2). Clinical findings have been observed preoperatively and 3, 6, 12 months postoperatively using dedicated questionnaires (Zurich Claudication Questionnaire, visual analog scale, and Oswestry disability index). Results: One year following surgical treatment, 87% of the patients presented with good improvement of symptoms and 97% referred satisfaction for surgery. Overall, patients of Group 1 presented with significantly better clinical outcome when compared with the control group (P < 0.01). Conclusions: Intra-articular spacers showed significant and clinically meaningful improvements in pain and disability for up to 1 year. These findings need further studies and a longer follow-up.
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Affiliation(s)
- Giovanni Grasso
- Department of Experimental Biomedicine and Clinical Neurosciences, Neurosurgical Clinic, School of Medicine, University of Palermo, Palermo, Italy
| | - Alessandro Landi
- Department of Neurology and Psychiatry, Division of Neurosurgery A, Sapienza University of Rome, Rome, Italy
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Hwang HJ, Park HK, Lee GS, Heo JY, Chang JC. Predictors of Reoperation after Microdecompression in Lumbar Spinal Stenosis. KOREAN JOURNAL OF SPINE 2016; 13:183-189. [PMID: 28127375 PMCID: PMC5266098 DOI: 10.14245/kjs.2016.13.4.183] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/22/2016] [Accepted: 12/26/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The risk factors of reoperation after microdecompression (MD) for lumbar spinal stenosis (LSS) are unclear. In this study, we presented the outcomes of MD for degenerative LSS and investigated the risk factors associated with reoperation. METHODS A retrospective review was conducted using the clinical records and radiographs of patients with LSS who underwent MD. For clinical evaluation, we used the Japanese Orthopedic Association (JOA) scoring system for low back pain, body mass index, and Charlson comorbidity index. For radiological evaluation, disc height, facet angle, and sagittal rotation angle were measured in operated segments. Also the Modic change and Pfirrmann grade for degeneration in the endplate and disc were scored. RESULTS Forty-three patients aged 69±9 years at index surgery were followed for 48±25 months. The average preoperative JOA score was 6.9±1.6 points. The score improved to 9.1±2.1 points at the latest follow-up (p<0.001). Seven patients (16.3%) underwent reoperation. Clinical and radiological factors except operation level and Pfirrmann grade showed a p-value >0.1. Patients with Pfirrmann grade IV and lower lumbar segment had a 29.1% rate of reoperation (p=0.001), whereas patients without these factors had a 0% rate of reoperation. CONCLUSION Moderate disk degeneration (Pfirrmann IV) in lower lumbar segments is a risk factor of disk herniation or foraminal stenosis requiring reoperation after MD in LSS.
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Affiliation(s)
- Hee-Jong Hwang
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hyung-Ki Park
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Gwang-Soo Lee
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - June-Young Heo
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jae-Chil Chang
- Department of Neurosurgery, Soonchunhyang University College of Medicine, Seoul, Korea
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Soares GG. UNILATERAL LAMINOTOMY FOR BILATERAL MICRODECOMPRESSION OF STENOSIS OF THE LUMBAR CANAL. COLUNA/COLUMNA 2015. [DOI: 10.1590/s1808-185120151403147834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
With the aging of the world population, the treatment of stenosis of the lumbar canal has become an important issue in addressing degenerative diseases of the spine. The prevalence of this disease tends to increase as the number of surgeries and the impact on health care costs. This paper aims to describe in detail the technique of unilateral laminotomy for bilateral microdecompression (ULBM) of stenosis of the lumbar canal (LSC) and current clinical results, including their advantages, disadvantages and common complications, based on the available literature. Important studies have shown evidence that surgical treatment for LSC is more effective than the conservative, but without evaluating ULBM. Several studies on ULBM have been conducted since the 90s, showing the results of this technique, however, most of these are case series, retrospective studies or cohorts without proper control group or with weak statistical analysis to prove some evidence. A double-blind randomized clinical trial was found, but with short follow-up. We conclude that studies are needed with more solid evidence to prove the effectiveness of ULBM despite the clinical results being similar to those of classical surgery found in the literature.
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MIS lateral spine surgery: a systematic literature review of complications, outcomes, and economics. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24 Suppl 3:287-313. [DOI: 10.1007/s00586-015-3886-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 03/18/2015] [Accepted: 03/19/2015] [Indexed: 12/14/2022]
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