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Song J, Samuel A, Shahi P, Fourman M, Shinn D, Dalal S, Araghi K, Melissaridou D, Vaishnav A, Sheha E, Dowdell J, Qureshi SA. The Impact of Preoperative Sagittal Imbalance on Long-term Postoperative Outcomes Following Minimally Invasive Laminectomy. HSS J 2024; 20:222-229. [PMID: 39281984 PMCID: PMC11393618 DOI: 10.1177/15563316231162851] [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: 12/05/2022] [Accepted: 01/04/2023] [Indexed: 09/18/2024]
Abstract
Background: Postoperative sagittal alignment has been shown to be associated with patient-reported outcome measures (PROMs) following open lumbar decompression procedures, although it is unknown whether preoperative sagittal imbalance affects clinical outcomes of minimally invasive surgical (MIS) decompression only surgery. Purpose: We sought to evaluate the impact of preoperative pelvic incidence-lumbar lordosis (PI-LL) imbalance on PROMs after MIS laminectomy for the treatment of neurogenic claudication symptoms. Methods: We conducted a retrospective cohort study of adult patients undergoing MIS laminectomy for degenerative lumbar spinal stenosis between April 2017 and April 2021 at a single institution. Of the 52 patients included (mean follow-up, 17 months) radiographs were taken prior to surgery and assessed for sagittal alignment parameters. Patients were grouped based on the preoperative PI-LL (balanced vs unbalanced). Changes in PROMs were compared between unbalanced PI-LL and balanced PI-LL groups. Minimal clinically important difference (MCID) for Oswestry Disability Index (ODI) was also assessed. Results: Of the 52 patients, 17 (32.7%) had unbalanced age-adjusted preoperative PI-LL. There was no significant difference found in PROMs between unbalanced and balanced PI-LL groups preoperatively or at final follow-up. Compared with those with unbalanced PI-LL, patients with balanced PI-LL were shown to have no added benefit in achieving MCID for ODI at long-term follow-up and no added benefit in the time to achieving MCID. Conclusion: These retrospective findings suggest that patients with unbalanced preoperative PI-LL may experience significant benefit in long-term clinical outcomes following MIS laminectomy, similarly to those with balanced PI-LL at baseline. The findings also suggest that the presence of sagittal imbalance preoperatively may not appreciably influence the long-term clinical outcomes following MIS laminectomy. Prospective study involving a larger population is warranted.
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Affiliation(s)
- Junho Song
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Andre Samuel
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Pratyush Shahi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Mitchell Fourman
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Daniel Shinn
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sidhant Dalal
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Kasra Araghi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Dimitra Melissaridou
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Avani Vaishnav
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Evan Sheha
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - James Dowdell
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Chang CJ, Liu YF, Hsiao YM, Chang WL, Hsu CC, Liu KC, Huang YH, Yeh ML, Lin CL. Full Endoscopic Spine Surgery for Cervical Spondylotic Myelopathy: A Systematic Review. World Neurosurg 2023; 175:142-150. [PMID: 37169077 DOI: 10.1016/j.wneu.2023.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) may seriously affect quality of life. In the literature, there is scarce evidence of the pros and cons of full endoscopic spine surgery in the treatment of CSM. The main purpose of this study was to conduct a systematic review to elucidate the efficacy of full endoscopic spine surgery in the management of patients with CSM. METHODS This systematic review was conducted in accordance with the PRISMA guidelines. A systematic search of Web of Science, PubMed MEDLINE, Embase, and Cochrane Library was conducted from the database inception to February 1, 2023. RESULTS The study included 183 patients and their age was 56.78 ± 7.87 years. The average surgical time calculated was 96.34 ± 33.58 minutes. Intraoperative blood loss ranged from a minimal amount to 51 mL. The average duration of hospital stay was 3.56 ± 1.6 days. The average span for follow-up was on an interval of 18.7 ± 6.76 months. Significant improvements were noted in all aspects of functional outcomes and image results after full endoscopic cervical spine surgery, with no major complications. CONCLUSIONS The current study found that both anterior transcorporeal and posterior surgical approaches could be used for the treatment of CSM with a full endoscopic technique. Indications of full endoscopic cervical spine surgery for CSM included cervical disc herniation, central canal stenosis, calcified ligamentum flavum, and ossification of the posterior longitudinal ligament. Improved postoperative outcomes with acceptable surgical complications were noted in this systematic review.
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Affiliation(s)
- Chao-Jui Chang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Yuan-Fu Liu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Yu-Meng Hsiao
- Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Che-Chia Hsu
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Keng-Chang Liu
- School of Medicine, Tzu Chi University, Hualien City, Taiwan; Department of Orthopaedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Yi-Hung Huang
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center (MDIC), National Cheng Kung University Hospital, Tainan, Taiwan
| | - Cheng-Li Lin
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center (MDIC), National Cheng Kung University Hospital, Tainan, Taiwan; Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan.
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Kim J, Heo DH, Lee DC, Chung HT. Biportal endoscopic unilateral laminotomy with bilateral decompression for the treatment of cervical spondylotic myelopathy. Acta Neurochir (Wien) 2021; 163:2537-2543. [PMID: 34213652 DOI: 10.1007/s00701-021-04921-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The advantages of biportal endoscopic approaches over conventional open surgery include the preservation of the normal structures, less intraoperative bleeding, fast postoperative recovery, and preservation of the motion segments. METHOD We attempted the posterior biportal endoscopic approach for cervical stenosis at the C5-C6-C7 levels. Biportal endoscopic right ipsilateral hemilaminectomy with bilateral decompression at the C5-C6-C7 levels and right foraminotomy at the C6-C7 level were performed under general anesthesia. CONCLUSIONS We successfully performed neural decompression at the C5-C6-C7 levels using biportal endoscopic surgery. The biportal endoscopic posterior cervical approach may be an alternative surgical method for treating cervical myelopathy.
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Affiliation(s)
- Jiyeon Kim
- Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, Anyang, South Korea
| | - Dong Hwa Heo
- Department of Neurosurgery, Spine Center, Seoul Bumin Hospital, Seoul, South Korea.
| | - Dong Chan Lee
- Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, Anyang, South Korea
| | - Hung Tae Chung
- Department of Neurosurgery, Spine Center, Seoul Bumin Hospital, Seoul, South Korea
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