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Coker C, Park J, Jacobson RD. Neurologic Approach to Radiculopathy, Back Pain, and Neck Pain. Prim Care 2024; 51:345-358. [PMID: 38692779 DOI: 10.1016/j.pop.2024.02.003] [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] [Indexed: 05/03/2024]
Abstract
Back pain and neck pain are common in clinical practice, but significant challenges and pitfalls exist in their diagnosis, treatment, and management. From the neurologic standpoint, cervical radiculopathy and lumbosacral radiculopathy are characterized by neck pain or back pain accompanied by sensory and motor symptoms in an arm or leg. The basic neurologic examination is vital, but testing like electromyography and MRI is often needed especially in cases that fail conservative management. Oral medications, injection-based therapies, physical therapy, and surgical evaluation all have a place in the comprehensive neurologic management of back and neck pain and associated radiculopathy.
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Affiliation(s)
- Canaan Coker
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 1118, Chicago, IL 60612, USA
| | - Jade Park
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 1118, Chicago, IL 60612, USA
| | - Ryan D Jacobson
- Department of Neurological Sciences, Rush University Medical Center, 1725 W. Harrison Street, Suite 1118, Chicago, IL 60612, USA.
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Zhou Y, Zhou C, Li Q, Cai L, Kou B, Fang W, Yao Z, Wei M, Zhang S, Liu W. Efficacy of PE-PLIF with a novel ULBD approach for lumbar degeneration diseases: a large-channel endoscopic retrospective study. J Orthop Surg Res 2024; 19:269. [PMID: 38685055 PMCID: PMC11057128 DOI: 10.1186/s13018-024-04755-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE This study aims to assess the effectiveness of Percutaneous Endoscopic Posterior Lumbar Interbody Fusion (PE-PLIF) combined with a novel Unilateral Laminotomy for Bilateral Decompression (ULBD) approach using a large-channel endoscope in treating Lumbar Degenerative Diseases (LDD). METHODS This retrospective analysis evaluates 41 LDD patients treated with PE-PLIF and ULBD from January 2021 to June 2023. A novel ULBD approach, called 'Non-touch Over-Top' technique, was utilized in this study. We compared preoperative and postoperative metrics such as demographic data, Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) score, surgical details, and radiographic changes. RESULTS The average follow-up duration was 14.41 ± 2.86 months. Notable improvements were observed postoperatively in VAS scores for back and leg pain (from 5.56 ± 0.20 and 6.95 ± 0.24 to 0.20 ± 0.06 and 0.12 ± 0.05), ODI (from 58.68 ± 0.80% to 8.10 ± 0.49%), and JOA scores (from 9.37 ± 0.37 to 25.07 ± 0.38). Radiographic measurements showed significant improvements in lumbar and segmental lordosis angles, disc height, and spinal canal area. A high fusion rate (97.56% at 6 months, 100% at 12 months) and a low cage subsidence rate (2.44%) were noted. CONCLUSIONS PE-PLIF combined with the novel ULBD technique via a large-channel endoscope offers significant short-term benefits for LDD management. The procedure effectively expands spinal canal volume, decompresses nerve structures, improves lumbar alignment, and stabilizes the spine. Notably, it improves patients' quality of life and minimizes complications, highlighting its potential as a promising LDD treatment option.
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Affiliation(s)
| | | | | | - Lei Cai
- Wuhan Fourth Hospital, Wuhan, China
| | | | | | - Zhi Yao
- Wuhan Fourth Hospital, Wuhan, China
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Haghshenas V, Huang M. Endoscopic Diskectomy of Rostrally and Caudally Migrated Lumbar Disk Herniations: A Technique Video. World Neurosurg 2024; 181:20. [PMID: 37625632 DOI: 10.1016/j.wneu.2023.08.074] [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: 04/05/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
Surgical treatment of extremely migrated caudal and rostral lumbar disk herniations is technically challenging. Traditional open technique often requires more bone resection, which can lead to rare but significant complications such as pars fracture or instability requiring fusion surgery. Endoscopic diskectomy is a safe alternative to traditional open surgery with acceptable complication rates.1-4 Endoscopic diskectomy provides the advantage of excellent visualization and maneuverability while minimizing soft tissue trauma and bony resection, which can result in less postoperative pain, less opioid consumption, and quicker recovery.5 We present a surgical technique guide (Video 1) for endoscopic diskectomy of 2 patients with very high rostral (grade 1) and caudal (grade 6) lumbar disk herniations as graded by Ahn's modification of the Lee-Kim grading classification.6,7 Risks, benefits, and alternatives to surgery were discussed with the patients, and they consented to the procedure. This video is not a replacement for hands-on training.
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Affiliation(s)
- Varan Haghshenas
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, Texas, USA.
| | - Meng Huang
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA
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Garcia D, Akinduro O, Nottmeier E, Pirris S. Hybrid Minimally Invasive Endoscopic Approach for Gaseous Protrusion Causing L5 Radiculopathy. World Neurosurg 2023; 180:2. [PMID: 37625630 DOI: 10.1016/j.wneu.2023.08.076] [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: 07/28/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
We present an illustrative case of a hybrid approach between minimally invasive and endoscopic spine surgery techniques. We utilized this hybrid approach for the first 3 cases to help diminish the learning curve as we started a spinal endoscopy program. The patient is an 85-year-old woman with a prior history of arthrodesis at L3-5. She presented with severe leg pain and imaging evidence of degenerative disk disease with disk protrusion in the extraforaminal zone at L5-S1. Computed tomography imaging shows the disk protrusion to be gaseous in nature. Given failure of conservative management and patient refusal for extension of her prior fusion, she was offered a combined minimally invasive navigated technique and endoscopic approach for far lateral diskectomy. After obtaining the correct trajectory, with confirmation by intraoperative fluoroscopy, microscopic visualization was used to identify the protruded disk and the exiting nerve root (Video 1). Given the difficult visualization, a 30-degree endoscopic probe was used, which enabled real-time visualization of the gaseous protrusion being released in the liquid medium. After decompression, microscopic visualization was used for confirmation, with the patient obtaining a good surgical outcome and complete relief of her presenting pain. This case illustrates the synergism between endoscopic and minimally invasive spine surgery techniques and the unique advantages of enabling visualization of spinal anatomy through a liquid medium with the use of an endoscope.1-3.
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Affiliation(s)
- Diogo Garcia
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Oluwaseun Akinduro
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Eric Nottmeier
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Stephen Pirris
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida, USA.
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Wang Y, Liu H, Lin A, Zhang H, Ma X. Surgical Strategy and Outcomes of Full Endoscopic Lumbar Discectomy for Recurrent Lumbar Disk Herniation Following a Previous Full Endoscopic Lumbar Discectomy. Orthop Surg 2023; 15:2602-2611. [PMID: 37537498 PMCID: PMC10549842 DOI: 10.1111/os.13844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/25/2023] [Accepted: 07/06/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE Recurrent lumbar disc herniation (RLDH) cannot be prevented after full endoscopic lumbar discectomy (FELD), and the optimal surgical treatment for RLDH after FELD remains controversial. The aim of the study was to suggest a surgical strategy for FELD to treat RLDH following a previous FELD and to present surgical outcomes. METHODS Between February 2015 and March 2022, 68 patients with RLDH were surgically treated with FELD retrospectively. An original approach was suggested for the treatment of early recurrence (24 h-2 weeks). The full endoscopic transforaminal technique (FETD) was considered for patients requiring local anesthesia, and in RLDH with FETD indications or FEID technological difficulties. The full endoscopic interlaminar technique (FEID) was chosen in RLDH with FEID indications. Both FEID and FETD were suitable if no FEID or FETD technological difficulties existed. Clinical efficacy was evaluated using the visual analog scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria. Postoperative follow-up data at 24 h, 3 months, and final-follow-up were recorded. Operation time and clinical outcomes were assessed with t test. p-value < 0.05 was considered statistically significant. RESULTS All 68 patients had an average follow-up time of 23.8 months (range, 6-76 months). In the 13 cases of early recurrence, the operation time (32.30 ± 9.67 vs. 58.00 ± 6.16 min) in the original surgical approach group was shorter than that in the changing surgical approach group (p < 0.05). In the 28 cases of L4/5 FETD recurrence (>2 weeks), the operation time (66.17 ± 12.18 vs. 53.60 ± 5.45 min) in the FETD group was more than that in the FEID group (p < 0.05). In the 22 cases of L5S1 recurrence (>2 weeks), the operation time (55.75 ± 8.79 vs. 79.33 ± 6.65 min) in the FEID group was shorter than in the FETD group (p < 0.05). The postoperative VAS and ODI scores at 24 h, 3 months, and final-follow up were all significantly improved, compared with their preoperative counterparts (p < 0.05). Based on the modified MacNab criteria, 88.23% of patients showed excellent or good results. Re-recurrence occurred in three patients at 3 months. No surgical complications were observed in any of the 68 cases. CONCLUSION FELD is a safe and effective treatment option for RLDH with previous FELD. For early recurrence, the original approach was suggested. Both FEID and FETD were effective and safe for recurrence (>2 weeks), but FEID seemed more efficient for L4/5 RLDH after previous FETD and for L5S1 RLDH.
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Affiliation(s)
- Yan Wang
- Department of OrthopedicsThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Houchen Liu
- Department of OrthopedicsThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Antao Lin
- Department of OrthopedicsThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Hao Zhang
- Department of OrthopedicsThe Affiliated Hospital of Qingdao UniversityQingdaoChina
| | - Xuexiao Ma
- Department of OrthopedicsThe Affiliated Hospital of Qingdao UniversityQingdaoChina
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Bansal P, Vatkar AJ, Baburaj V, Kumar V, Dhatt SS. Effect of obesity on results of endoscopic versus open lumbar discectomy: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2023; 143:5589-5601. [PMID: 37041263 DOI: 10.1007/s00402-023-04870-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 04/02/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Lumbar disc herniation in obese individuals poses unique surgical challenges which can influence outcomes in such patients. Limited studies are available evaluating the results of discectomy in obese persons. The aim of this review was to compare outcomes in obese and non-obese individuals; and to analyse whether approach to surgery had a bearing on these outcomes. METHODS The literature search was conducted on four databases (PubMed, Medline, EMBASE, and CINAHL) and PRISMA guidelines were followed. After screening by the authors, eight studies were shortlisted from which data were extracted and analysed. Comparative analysis was done for lumbar discectomy (microdiscectomy or minimally invasive vs. endoscopic technique) between obese and non-obese groups from the six comparative studies in our review. Pooled estimates and subgroup analysis was done to ascertain the effect of surgical approach on outcomes. RESULTS Eight studies published between 2007 and 2021 were included. Mean age of study cohort was 39.05 years. Mean operative time was significantly shorter in the non-obese group mean difference of 15.1 min (95% CI - 0.24 to 30.5). On subgroup analysis, obese individuals operated via endoscopic approach had significantly decreased operative time as compared to open approach. Blood loss and complication rates were also lower in the non-obese groups, but not statistically significant. CONCLUSION Significantly less mean operative time was seen in non-obese individuals and when obese patients were operated via endoscopic approach. This difference between obese and non-obese groups was significantly more in the open subgroup as compared to the endoscopic subgroup. No significant differences in blood loss, mean improvement in VAS score, recurrence rate, complication rate and length of hospital stay was found between obese and non-obese patients as well as between endoscopic versus open lumbar discectomy within the obese subgroup. The learning curve associated with endoscopy makes it a challenging procedure.
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Affiliation(s)
- Parth Bansal
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | | | | | - Vishal Kumar
- Department of Orthopaedics, PGIMER, Chandigarh, India.
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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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Gong S, Cui L, Liu H, Ye Y. Clinical efficacy of posterior endoscopic cervical modified trench technique in the treatment of cervical spondylotic myelopathy: A retrospective study. Medicine (Baltimore) 2023; 102:e33772. [PMID: 37233430 PMCID: PMC10219704 DOI: 10.1097/md.0000000000033772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
To investigate the clinical efficacy of the posterior endoscopic cervical modified trench technique in the treatment of cervical spondylotic myelopathy (CSM). This retrospective study included 9 patients with single-segment CSM, who were treated with posterior endoscopic cervical modified trench technique. Related clinical data, the visual analog scale, Japanese Orthopedic Association (JOA) ratings, JOA improvement rate, the minimum sagittal diameter of the spinal canal, and surgical complications were recorded. There were 5 men and 4 females, with an average age of 60.44 ± 16.49 years. Without any significant side effects like paralysis, vascular damage, or cerebrospinal fluid leaking, all surgeries were successfully completed. One year's worth of follow-up with patients lasted for 8.56 ± 3.68 months. When compared to before surgery, the postoperative visual analog scale ratings, JOA scores, and minimum sagittal diameter of the spinal canal value all showed a substantial improvement (P < .01). At the most recent follow-up, 2 patients had a JOA improvement rate of >75%, 6 patients had a JOA improvement rate of 74 to 50%, 1 patient had a JOA improvement rate of 49 to 25%, and none had a JOA improvement rate of <25%. The JOA improvement rate was above 90% for overall excellent and good ratings. In our study, the ventral epidural space may be maneuvered more easily and instrument-induced nerve discomfort is decreased when using the posterior endoscopic cervical modified trench approach with posterior endoscopy. The short-term clinical effect of the posterior endoscopic cervical modified trench technique for CSM is satisfactory.
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Affiliation(s)
- Shuangquan Gong
- The Minimally Invasive Spinal Department of Mianyang Orthopedic Hospital, Mianyang City, Sichuan Province, China
| | - Liqiang Cui
- The Minimally Invasive Spinal Department of Mianyang Orthopedic Hospital, Mianyang City, Sichuan Province, China
| | - Hongjun Liu
- The Minimally Invasive Spinal Department of Mianyang Orthopedic Hospital, Mianyang City, Sichuan Province, China
| | - Yu Ye
- The Minimally Invasive Spinal Department of Mianyang Orthopedic Hospital, Mianyang City, Sichuan Province, China
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Postoperative Pain Management after Full Endoscopic Lumbar Discectomy: An Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121817. [PMID: 36557019 PMCID: PMC9786695 DOI: 10.3390/medicina58121817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/26/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022]
Abstract
Background: Surgical incision pain, rebound pain, and recurrence can manifest themselves in different forms of postoperative pain after full endoscopic lumbar discectomy (FELD). This study aims to evaluate various postoperative pains after FELD and summarize their characteristics. Methods: Data about the demographic characteristics of patients, pain intensity, and functional assessment results were collected from January 2016 to September 2019. Clinical outcomes including Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, were obtained. Results: A total of 206 patients were enrolled. ODI and VAS of the patients significantly decreased after FELD at 12-month follow-up. A total of 193 (93.7%) patients had mild surgical incision pain after FELD and generally a VAS < 4, and it mostly resolved on its own within 3 days. A total of 12 (5.8%) patients experienced rebound pain, which was typically characterized by pain (mainly leg pain with or without back pain), generally occurring within 2 weeks after FELD and lasting < 3 weeks. The pain levels of rebound pain were equal to or less than those of preoperative pain, and generally scored a VAS of < 6. The recurrence rate was 4.4%. Recurrence often occurs within three months after surgery, with the pain level of the recurrence being greater than or equal to the preoperative pain. Conclusions: Different types of postoperative pain have their own unique characteristics and durations, and treatment options are also distinct. Conservative treatment and analgesia may be indicated for rebound pain and surgical incision pain, but recurrence usually requires surgical treatment.
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Xie YZ, Shi Y, Zhou Q, Feng CQ, Zhou Y, Li T, Yu Y, Fan XH. Comparison of the safety and efficacy of unilateral biportal endoscopic lumbar interbody fusion and uniportal endoscopic lumbar interbody fusion: a 1-year follow-up. J Orthop Surg Res 2022; 17:360. [PMID: 35870934 PMCID: PMC9308319 DOI: 10.1186/s13018-022-03249-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives To compare the short-term outcomes of unilateral biportal endoscopic lumbar interbody fusion (BLIF) and uniportal endoscopic lumbar interbody fusion (ULIF). Methods Sixty patients diagnosed with L4/5 spinal stenosis who underwent BLIF and ULIF were included (30 in each group). Clinical evaluation was performed preoperatively and postoperatively in the 1st week, 1st month, and 1st year. Factors such as the visual analogue score (VAS), Oswestry Disability Index (ODI), operative time, surgical complications, and radiological outcomes (fusion rate, screw loosening, and cage subsidence) were compared between the two groups. Results All patients showed improved mean VAS and ODI at all three postoperative follow-ups, and no statistically significant differences were detected between the BLIF and ULIF groups. The mean operative time in the BLIF group was shorter than that in the ULIF group. Nerve root injury occurred in two patients in the BLIF group, while leakage of cerebrospinal fluid occurred in one patient in the ULIF group. All adverse events were treated adequately prior to discharge. The fusion rates with definite and probable grades were significantly higher in the BLIF group than that in the ULIF group. One case of cage subsidence with no screw loosening occurred in each group. Conclusion Both BLIF and ULIF are safe and effective surgical techniques. Compared with ULIF, BLIF has the advantages of shorter operative time and a higher fusion rate. Other merits of BLIF include a wider surgical field, greater maneuverability of instruments, visibility during cage implantation, and transverse orientation of the cage.
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Zhao Q, Xiao L, Wu Z, Liu C, Zhang Y. Comparison of the efficacy of fully endoscopic spine surgery using transforaminal and interlaminar approaches in the treatment of prolapsed lumbar 4/5 disc herniation. J Orthop Surg Res 2022; 17:391. [PMID: 35964096 PMCID: PMC9375331 DOI: 10.1186/s13018-022-03282-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background There is still much controversy about whether transforaminal or interlaminar fully endoscopic spine surgery can better treat lumbar 4/5 disc herniation. Therefore, this study intends to compare the clinical efficacy of fully endoscopic spine surgery through transforaminal and interlaminar approaches in the treatment of lumbar 4/5 disc herniation. Methods Seventy-six patients with lumbar 4/5 disc herniation admitted from March 2019 to June 2020 were divided into the transforaminal approach group (endoscopic transforaminal lumbar discectomy, ETLD; 54 cases) and the interlaminar approach group (endoscopic interlaminar lumbar discectomy, EILD; 22 cases) according to different surgical methods. The general clinical data and clinical evaluation scale of the patients were compared. Results The post-operative ODI and VAS scores were significantly better in the EILD group (P < 0.05). The VAS and ODI scores of patients with upper-shoulder and sub-axillary types in the EILD group were superior to those in the ETLD group (P < 0.05), while the VAS and ODI scores of patients with the pre-radicular type were better when they underwent ETLD rather than EILD (P < 0.05). Patients with Lee zone III type in the EILD group had better post-operative ODI scores than those in the ETLD group (P < 0.05), but there was no significant difference in VAS scores (P > 0.05). Patients with Lee zone IV type who underwent EILD had better VAS and ODI scores than those who underwent ETLD (P < 0.05). Conclusions For patients with a prolapsed intervertebral disc that belongs to the upper-shoulder type, sub-axillary type, or Lee III or IV type, EILD can achieve better outcomes.
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Affiliation(s)
- Quanlai Zhao
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Liang Xiao
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Zhongxuan Wu
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Chen Liu
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Yu Zhang
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China.
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Chen CM, Chen PC, Chen YC, Wang GC. Use artificial neural network to recommend the lumbar spinal endoscopic surgical corridor. Tzu Chi Med J 2022; 34:434-440. [PMID: 36578635 PMCID: PMC9791850 DOI: 10.4103/tcmj.tcmj_281_21] [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: 10/11/2021] [Revised: 12/31/2021] [Accepted: 03/21/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives The transforaminal and interlaminar approaches are the two main surgical corridors of full endoscopic lumbar surgery. However, there are no quantifying methods for assessing the best surgical approach for each patient. This study aimed to establish an artificial intelligence (AI) model using an artificial neural network (ANN). Materials and Methods Patients who underwent full endoscopic lumbar spinal surgery were enrolled in this research. Fourteen pre-operative factors were fed into the ANN. A three-layer deep neural network was constructed. Patient data were divided into the training, validation, and testing datasets. Results There were 899 patients enrolled. The accuracy of the training, validation, and test datasets were 87.3%, 85.5%, and 85.0%, respectively. The positive predictive values for the transforaminal and interlaminar approaches were 85.1% and 89.1%, respectively. The area under the curve of the receiver operating characteristic was 0.91. The SHapley Additive exPlanations algorithm was utilized to explain the relative importance of each factor. The surgical lumbar level was the most important factor, followed by herniated disc localization and migrating disc zone level. Conclusion ANN can effectively learn from the choice of an experienced spinal endoscopic surgeon and can accurately predict the appropriate surgical approach.
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Affiliation(s)
- Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan,College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan
| | - Pei-Chen Chen
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Ying-Chieh Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Guan-Chyuan Wang
- Division of Neurosurgery, Department of Surgery, Mennonite Christian Hospital, Hualien, Taiwan,Address for correspondence: Dr. Guan-Chyuan Wang, Division of Neurosurgery, Department of Surgery, Mennonite Christian Hospital, 44, Min-Chuan Road, Hualien, Taiwan. E-mail:
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Xu DR, Luan LR, Ma XX, Cong ZC, Zhou CL. Comparison of electromagnetic and optical navigation assisted Endo-TLIF in the treatment of lumbar spondylolisthesis. BMC Musculoskelet Disord 2022; 23:522. [PMID: 35650587 PMCID: PMC9158260 DOI: 10.1186/s12891-022-05443-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
Uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion (Endo-TLIF) with percutaneous pedicle screw fixation is a promising, minimally invasive method for the treatment of lumbar spondylolisthesis. However, repeated radiation exposure from X-rays and the steep learning curve remain to be improved.
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Affiliation(s)
- De-Rong Xu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Liang-Rui Luan
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Xue-Xiao Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Zhi-Chao Cong
- Hi-Tech Zone Li Min Hospital of Weihai Central Hospital Medical Group, Weihai, Shandong Province, People's Republic of China, 264209.
| | - Chuan-Li Zhou
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China.
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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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Tan R, Lv X, Wu P, Li Y, Dai Y, Jiang B, Ren B, Lv G, Wang B. Learning Curve and Initial Outcomes of Full-Endoscopic Posterior Lumbar Interbody Fusion. Front Surg 2022; 9:890689. [PMID: 35574552 PMCID: PMC9096087 DOI: 10.3389/fsurg.2022.890689] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Study DesignThis was a retrospective cohort study.ObjectiveWe evaluated the feasibility, safety, and accuracy of full-endoscopic posterior lumbar interbody fusion (FE-PLIF) by assessing the learning curve and initial clinical outcomes.Summary of Background DataLow back pain is one of the crucial medical conditions worldwide. FE-PLIF has been reported to be a minimally invasive method to treat mechanical low back pain, but there lacks a thorough evaluation on this new technique.MethodsThe patients were divided into three groups in the order of operating date, implying that Group A consisted of the initial 12 cases, Group B the subsequent 12 cases, and Group C the last 12 cases. The data of patients were reviewed for gender, age, preoperative symptoms, satisfaction, as well as clinical outcomes demonstrated by visual analog scale (VAS). The operative time and intraoperative fluoroscopy were recorded to demonstrate the learning curve and the extent of radiographic exposure. Statistical significance was set at a p < 0.05 (two-sided).ResultsThe patients enrolled in this study were followed up at an average of 1.41 ± 0.24 years. Overall, patients were satisfied with the surgery. The average number of intraoperative fluoroscopy was 6.97 ± 0.74. A significant improvement was observed in the VAS of both lumbar pain and leg pain. The overall fusion rate was 77.7%. Complications were reported in two patients in Group A, one in Group B, and none in Group C. The average operative time showed a trend of gradual decline. The learning curve was characterized using a cubic regression analysis as y = –27.07x + 1.42x2–0.24x3 + 521.84 (R2 = 0.617, p = 0.000).ConclusionsFE-PLIF is an effective and safe method for treating low back pain caused by short-segmental degenerative diseases. The learning curve of this technique is steep at the initial stage but acceptable and shows great potential for improvement.
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Cai H, Liu C, Lin H, Wu Z, Chen X, Zhang H. Full-endoscopic foraminoplasty for highly down-migrated lumbar disc herniation. BMC Musculoskelet Disord 2022; 23:303. [PMID: 35351069 PMCID: PMC8966215 DOI: 10.1186/s12891-022-05254-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Multiple surgical approaches have been studied and accepted for the removal of highly downward migrated lumbar disc herniation (LDH). Here, we investigated the efficacy and safety of full-endoscopic foraminoplasty for highly downward migrated LDH. PATIENTS AND METHODS Thirty-seven patients with highly down-migrated LDH treated by the full-endoscopic foraminoplasty between January 2018 and January 2020 were retrospectively investigated. Clinical parameters were evaluated preoperatively and 1, 6, and 12 months postoperatively, using pre- and post-operative Oswestry Disability Index (ODI) scores for functional improvement, visual analog scale (VAS) for leg and back pain, and modified MacNab criteria for patients satisfactory. RESULTS Thirty-seven patients with highly downward migrated LDH were successfully removed via the transforaminal full-endoscopic discectomy. The average VAS back and leg pain scores were significantly reduced from 7.41 ± 1.17 and 8.68 ± 1.06 before operation to 3.14 ± 0.89 and 2.70 ± 0.46 at postoperative 1 month, and 1.76 ± 0.59 and 0.92 ± 0.28 at postoperative 12 months, respectively (P < 0.05). The average ODI scores were reduced from 92.86 ± 6.41 to 15.30 ± 4.43 at postoperative 1 month, and 9.81 ± 3.24 at postoperative 12 months (P < 0.05). Based on the modifed MacNab criteria, 36 out of 37 patients (97.30%) were rated as excellent or good outcomes. CONCLUSION The full-endoscopic foraminoplasty can be used successfully for surgical removal of high grade down-migrated LDH, and it could serve as an efficient alternative technique for patients with highly downward migrated LDH.
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Affiliation(s)
- Hanhua Cai
- Department of Orthopaedic Surgery, Affiliated Hospital of Putian University, Putian, Fujian Province, China
| | - Chunhua Liu
- Department of Spinal Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medicine, Quanzhou, Fujian Province, China.
| | - Haibin Lin
- Department of Orthopaedic Surgery, Affiliated Hospital of Putian University, Putian, Fujian Province, China
| | - Zhiqiang Wu
- Department of Spinal Surgery, Quanzhou Orthopedic-Traumatological Hospital, Fujian University of Traditional Chinese Medicine, Quanzhou, Fujian Province, China
| | - Xuanhuang Chen
- Department of Orthopaedic Surgery, Affiliated Hospital of Putian University, Putian, Fujian Province, China
| | - Huaizhi Zhang
- Department of Orthopaedic Surgery, Affiliated Hospital of Putian University, Putian, Fujian Province, China
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Kim JS, Lee JH, Bae J, Lee DC, Shin SH, Keum HJ, Choi YS, Eun SS, Shin SH, Hong HJ, Kim JY, Kim TH, Lim W, Kim J, Park SM, Park HJ, Lee HJ. Comparative study of the efficacy and safety of minimally invasive interlaminar full-endoscopic discectomy versus conventional microscopic discectomy in single-level lumbar herniated intervertebral disc (ENDO-F Trial): a multicenter, prospective, randomized controlled trial protocol. J Orthop Surg Res 2022; 17:187. [PMID: 35346274 PMCID: PMC8962468 DOI: 10.1186/s13018-022-03052-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 03/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Advances in minimally invasive surgery have expanded the indications for interlaminar full-endoscopic discectomy. Although the clinical outcomes for this approach may be equivalent to those of conventional microscopic discectomy, the supporting evidence is still based on small, single-center, prospective, and retrospective studies. Therefore, a multicenter randomized controlled trial is warranted. Methods This will be a prospective, multicenter, randomized controlled trial comparing the efficacy and safety of interlaminar full-endoscopic discectomy to those of conventional microscopic discectomy. The trial will enroll 100 participants with a lumbar disc herniation, 50 in each group. The primary outcome will be the Oswestry Disability Index (ODI) score at 12 months post-surgery. Secondary outcomes will be back and leg pain (visual analog scale); the ODI; the EuroQol-5-dimension score; patient satisfaction; and walking distance/time and time to return to daily activities post-surgery. Surgical outcomes will include postoperative drainage, operative time, duration of hospital stay, postoperative creatine kinase level as an indicator of muscle injury, and postoperative scarring. Postoperative magnetic resonance imaging, computed tomography, and simple radiography will be performed to evaluate radiographic outcomes between the two surgical approaches. Surgery-related complications and adverse effects will be evaluated as safety outcomes. A single assessor at each participating hospital, blinded to group allocation, will assess the enrolled participants at baseline, at 2 weeks, and at 3, 6, and 12 months postoperatively. Discussion This trial is designed to determine whether interlaminar full-endoscopic discectomy is clinically comparable to microscopic discectomy to treat lumbar disc herniations. All efforts will be made to reduce bias, including adequate sample size, blinded analyses, and multicenter prospective registration. The outcomes will inform practice, providing the evidence needed for using interlaminar full-endoscopic over microscopic discectomy by confirming the potential of this technique to improve patient satisfaction and clinical outcomes. Trial registration: Clinical Research Information Service; cris.nih.go.kr. (KCT0006277); protocol version (v1, June 8, 2021).
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18
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Ultrasound Guidance for Full Endoscopic Spinal Surgery: A Technical Note. World Neurosurg 2022; 162:59-65. [PMID: 35338019 DOI: 10.1016/j.wneu.2022.03.066] [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: 02/12/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The use of intraoperative ultrasound (IOU) has proven to be useful in spinal surgery. In this study, we present the techniques of applying IOU in cervical, thoracic, and lumbar full-endoscopic spine surgery (FESS). METHODS For applying IOU in cervical FESS, first, we localize the surgical level by identifying the unique shape of C6 and C7 under ultrasound and then identify the cervical level subsequently. For the anterior approach, the endoscope passes through the cervical fascia between the carotid sheath and trachea/esophagus, which can be identified under ultrasound, and for the posterior approach, the endoscope docks on the facet joint under ultrasound. For applying IOU in thoracic FESS, we localize the surgical level by counting the ribs. The endoscope is advanced to the neural foramen under ultrasound without entering the pleural cavity. For applying IOU in lumbar FESS, we identify the surgical level by counting the interlaminar window from the sacrum. The endoscopic sheath is advanced to the neural foramen under ultrasound without entering the peritoneal cavity. RESULTS The use of IOU in FESS has the potential to reduce radiation exposure, reach a higher successful puncture rate, and decrease the operation time. Furthermore, IOU prevents radiolucent organs from damage during FESS. CONCLUSIONS We present the techniques of applying IOU in cervical, thoracic, and lumbar endoscopic spine surgery and hope that this will be helpful for physicians to master the IOU techniques.
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Franco D, Mouchtouris N, Gonzalez GA, Hines K, Mahtabfar A, Sivaganesan A, Jallo J. A Review of Endoscopic Spine Surgery: Decompression for Radiculopathy. Curr Pain Headache Rep 2022; 26:183-191. [PMID: 35122596 DOI: 10.1007/s11916-022-01017-x] [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] [Accepted: 01/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW With this manuscript the authors sought to write a succinct review of the origins, as well as the latest advancements in endoscopic spine surgery to serve as a reference frame for physicians looking to learn this approach. RECENT FINDINGS At its infancy, the indications for posterolateral and transforaminal endoscopic decompression remained narrow, which prevented the procedure from gaining rapid traction during those days. However, more recently the tides have turned and an increasing number of surgeons are starting to adopt this technique given all its advantages. With the advent of higher quality camera systems and instruments, indications to use a minimally invasive option have gotten significantly broader. The most basic indication for the use of this technology is a soft disc herniation causing compromise of a neural structure that has failed to be managed successfully with non-surgical therapies. The use of endoscopic techniques provides significant advantages to patient outcomes and patient recovery. Endoscopic procedures should not be used as a blanket approach to nerve root decompression, as they certainly have limitations. Most contraindications to this procedure are relative and serve mostly as points to consider when selecting the methods to address neural compression. As these techniques become more widely accepted, we expect its reach and indications to continue to broaden and diversify. The full integration of navigation technologies will likely leapfrog this procedure into the mainstream use.
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Affiliation(s)
- Daniel Franco
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA.
| | - Nikolaos Mouchtouris
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| | - Glenn A Gonzalez
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| | - Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| | - Aria Mahtabfar
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| | - Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| | - Jack Jallo
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
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Zhao QL, Hou KP, Wu ZX, Xiao L, Xu HG. Full-endoscopic spine surgery treatment of lumbar foraminal stenosis after osteoporotic vertebral compression fractures: A case report. World J Clin Cases 2022; 10:656-662. [PMID: 35097091 PMCID: PMC8771379 DOI: 10.12998/wjcc.v10.i2.656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/22/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery (FESS) combined with percutaneous vertebroplasty (PVP) in patients with vertebral compression fractures. We herein report such a case, including the patient’s treatment process and doctor’s surgical experience.
CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures. Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis (LFS). The patient’s symptoms were low back pain with pain in the lateral left leg. Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures, the use of FESS combined with PVP has rarely been reported. This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures. This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery. Thus, we suggest the continued accumulation of similar cases to discuss the wider application of FESS.
CONCLUSION For patients with osteoporotic vertebral compression fracture (OVCF) and LFS, PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen. Additionally, the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects. In general, FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.
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Affiliation(s)
- Quan-Lai Zhao
- Department of Spine Surgery, Wannan Medical College, Wuhu 241001, Anhui Province, China
| | - Kun-Peng Hou
- Department of Spine Surgery, Wannan Medical College, Wuhu 241001, Anhui Province, China
| | - Zhong-Xuan Wu
- Department of Spine Surgery, Wannan Medical College, Wuhu 241001, Anhui Province, China
| | - Liang Xiao
- Department of Spine Surgery, Wannan Medical College, Wuhu 241001, Anhui Province, China
| | - Hong-Guang Xu
- Department of Spine Surgery, Wannan Medical College, Wuhu 241001, Anhui Province, China
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Conceição Júnior RT, Santana Júnior RNDA. THE MICROSCOPIC AND ENDOSCOPIC TECHNIQUES IN LUMBAR DISCECTOMY: A SYSTEMATIC REVIEW. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222101246193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objectives: To compare microdiscectomy (MD) and endoscopic interlaminar discectomy (EID) as methods for the surgical treatment of lumbar disc herniation, describing their efficiency in reducing hospitalization time, pain, and neurological deficit, and comparing the findings and the quality of studies that used the microscopic and endoscopic techniques. Methods: A systematic literature review that used the PRISMA protocol as a methodology. The search was conducted in the PUBMED/MEDLINE and The Cochrane Library databases, using publications from the last 5 years in Portuguese and English. After applying the inclusion and exclusion criteria and validating the qualified studies via STROBE and CONSORT, there were a total of 16 studies for data compilation. Results: A sample of 1004 patients who underwent lumbar discectomy was obtained, 62% of whom were male, and 493 of whom underwent EID (49%) and 511 MD (51%). The mean patient age was 38.7 years and the predominant vertebral level operated was L5-S1 (64.8%). The EID had shorter surgical time (66.38 min) and hospitalization time (3.3 days), in addition to greater variation in the VAS LLLL score (5.38), while the MD presented greater variation in the VAS LUMBAR score (3.14). Conclusion: EID demonstrated efficacy like that of MD, given the similarity in the results obtained, in addition to non-inferiority in the reduction of pain and neurological deficit, and superiority in surgical and hospitalization times. Level of Evidence I; Systematic review .
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Castilho CAG, Guareschi Junior R, Meyer OD, Zylbersztejn S, Bello CD, Rodrigues NR, Loss F, Kisaki Y. PAIN INTENSITY AND FUNCTIONAL STATUS 30 DAYS AFTER SURGERY: DIFFERENCE BETWEEN TRANSFORAMINAL AND INTERLAMINAR PERCUTANEOUS ENDOSCOPICLUMBAR DISCECTOMIES. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222101259450] [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
ABSTRACT Objective: To compare the differences between transforaminal and interlaminar endoscopic approaches in terms of pain intensity and functionality 30 days after the surgical procedure. Methods: A retrospective cohort study, with patients treated by percutaneous interlaminar or transforaminal endoscopic discectomy at the Spine Service of the ISCMPA, in southern Brazil. Data were collected from the patients’ electronic medical records by two independent physicians. The clinical outcomes of pain intensity and lumbar functionality were evaluated, respectively, using the visual analogue scale and the Oswestry Disability Index. Results: Thirty-six patients were included in the study, with a mean age of 50.8 ± 15.3 years, 19 (52.8%) of whom were males. As for the clinical outcomes for both transforaminal and interlaminar percutaneous endoscopic approaches, we observed a statistically significant reduction in pain intensity (mean difference of 3.5 points, p < 0.001) and a statistically significant improvement in functionality (mean difference of 33.2 points, p < 0.001) when we compared the pre- and 30-day postoperative periods, with no significant differences in terms of approaches. The type of technical approach also differed in relation to the patients’ age, the location, type, and migration of the herniated disc, and the patient’s time in the operating room. Conclusion: There was a similar effect on pain reduction and restoration of lumbar functions, 30 days after percutaneous endoscopic discectomy, in both technical approaches, with no significant differences between them. Level of Evidence III; Retrospective comparative study.
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Affiliation(s)
| | | | | | | | | | | | - Felipe Loss
- Complexo Hospitalar Santa Casa de Porto Alegre, Brazil
| | - Yorito Kisaki
- Complexo Hospitalar Santa Casa de Porto Alegre, Brazil
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GUARESCHI JUNIOR ROSALINO, CASTILHO CLAUDIOAG, TERRA GUSTAVOGONÇALVES, ZYLBERSZTEJN SÉRGIO, CONRAD SAMUEL, BELLO CESARDALL, RODRIGUES NILSONRODINEI, LOSS FELIPE, KISAKI YORITO. PAIN INTENSITY AND FUNCTIONALITY AFTER PERCUTANEOUS ENDOSCOPIC DISCECTOMY: A RETROSPECTIVE COHORT STUDY. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212003247876] [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
ABSTRACT Objectives To evaluate pain intensity and functional status before and 30 days following percutaneous lumbar endoscopic discectomy. Methods A retrospective cohort study that included patients who underwent percutaneous endoscopic discectomy from January 2019 to October 2020 at the Irmandade Santa Casa de Misericórdia Hospital, in Porto Alegre. The data were collected from the electronic medical records of the patients by two independent physicians. Clinical outcomes were assessed using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Results Forty-six patients with a mean age of 52.6 ± 15.8 years, 27 of whom (58.7%) were male, were evaluated. Regarding clinical outcomes, a statistically significant improvement was observed in the comparison between the pre- and 30-day postoperative VAS and ODI scores, with no significant difference in relation to sex. No peri- or postoperative complications were observed. All patients successfully completed surgery and were discharged after recovery from anesthesia. Conclusion There was a significant improvement in pain and functional status 30 days after percutaneous endoscopic discectomy performed to correct lumbar disc herniation, with no difference in relation to sex. In addition, no peri- or postoperative complications were observed. Future studies, with longer follow-up times, comparing clinical outcomes from the various techniques of percutaneous endoscopic discectomy are necessary. Level of evidence III; Retrospective comparative study.
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Affiliation(s)
| | | | | | | | - SAMUEL CONRAD
- Complexo Hospitalar Santa Casa de Porto Alegre, Brazil
| | | | | | - FELIPE LOSS
- Complexo Hospitalar Santa Casa de Porto Alegre, Brazil
| | - YORITO KISAKI
- Complexo Hospitalar Santa Casa de Porto Alegre, Brazil
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Clinical outcomes for patients with lateral lumbar radiculopathy treated by percutaneous endoscopic transforaminal discectomy versus tubular microdiscectomy: A retrospective review. Clin Neurol Neurosurg 2021; 208:106848. [PMID: 34339898 DOI: 10.1016/j.clineuro.2021.106848] [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] [Received: 05/22/2021] [Revised: 07/18/2021] [Accepted: 07/25/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgical management of lateral lumbar radiculopathy is evolving. TMD (Tubular microdiscectomy) and TELD (Transforaminal endoscopic lumbar discectomy) have emerged as viable MIS treatments. We aim to compare clinical outcomes of both techniques for the treatment of lateral lumbar radiculopathy in relation to pre-operative lumbar foraminal stenosis grade (LFS). METHODS Retrospective observational cohort study of patients with back and leg pain from single level foraminal nerve root compression that underwent TMD or TELD. Data analyzed included pre- and post-operative VAS leg and back pain, MacNab clinical outcome scores, hospital length of stay, complication rates, and operative time. Outcomes were correlated with a pre-operative MRI grading system for LFS. RESULTS 109 patients were enrolled (71 TELD and 38 TMD). Back and leg VAS pain scores improved in TELD and TMD (p < 0.0001). Patients with grade III stenosis showed significantly higher VAS scores (p < 0.01), and worse functional outcomes at latest follow-up compared with grade I/II LFS. Overall, there was no difference in outcome between procedure groups except that TMD VAS back pain scores were lower than TELD at last follow up (p < 0.05). Clinical outcome comparisons between procedures relating to LFS grade showed higher correlation of LFS to TELD (Spearman's rho (ρ)= 0.342 for TMD and 0.606 TELD). Regression analyses demonstrated correlation between higher-grade foraminal stenosis and poorer outcomes in TELD and TMD. CONCLUSIONS Both TELD and TMD are viable for treating lateral lumbar radiculopathy. Higher-grade foraminal stenosis can be indicative of poorer outcomes regardless of procedure type, however, the severity of pre-operative LFS correlates with clinical outcomes in TELD more significantly than TMD.
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Li J, Xu C, Zhang X, Xi Z, Liu M, Fang Z, Wang N, Xie L, Song Y. TELD with limited foraminoplasty has potential biomechanical advantages over TELD with large annuloplasty: an in-silico study. BMC Musculoskelet Disord 2021; 22:616. [PMID: 34246272 PMCID: PMC8272903 DOI: 10.1186/s12891-021-04504-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background Facetectomy, an important procedure in the in–out and out–in techniques of transforaminal endoscopic lumbar discectomy (TELD), is related to the deterioration of the postoperative biomechanical environment and poor prognosis. Facetectomy may be avoided in TELD with large annuloplasty, but iatrogenic injury of the annulus and a high grade of nucleotomy have been reported as risk factors influencing poor prognosis. These risk factors may be alleviated in TELD with limited foraminoplasty, and the grade of facetectomy in this surgery can be reduced by using an endoscopic dynamic drill. Methods An intact lumbo-sacral finite element (FE) model and the corresponding model with adjacent segment degeneration were constructed and validated to evaluate the risk of biomechanical deterioration and related postoperative complications of TELD with large annuloplasty and TELD with limited foraminoplasty. Changes in various biomechanical indicators were then computed to evaluate the risk of postoperative complications in the surgical segment. Results Compared with the intact FE models, the model of TELD with limited foraminoplasty demonstrated slight biomechanical deterioration, whereas the model of TELD with large annuloplasty revealed obvious biomechanical deterioration. Degenerative changes in adjacent segments magnified, rather than altered, the overall trends of biomechanical change. Conclusions TELD with limited foraminoplasty presents potential biomechanical advantages over TELD with large annuloplasty. Iatrogenic injury of the annulus and a high grade of nucleotomy are risk factors for postoperative biomechanical deterioration and complications of the surgical segment.
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Affiliation(s)
- Jingchi Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, 37# Wuhou Guoxue road, Chengdu, Sichuan Province, 610041, P.R. China
| | - Chen Xu
- Department of Spine Surgery, Changzheng Hospital Affiliated to the Naval Medical University, Shanghai, 200041, China
| | - Xiaoyu Zhang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Zhipeng Xi
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Mengnan Liu
- Macau University of Science and Technology, Macau, 999078, China
| | - Zhongxin Fang
- Fluid and Power Machinery Key Laboratory of Ministry of Education, Xihua University, Chengdu, 610039, China
| | - Nan Wang
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China
| | - Lin Xie
- Department of Spine Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine for Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, 210028, P.R. China.
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital/West China School of Medicine for Sichuan University, 37# Wuhou Guoxue road, Chengdu, Sichuan Province, 610041, P.R. China.
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Xu D, Han S, Wang C, Zhu K, Zhou C, Ma X. The technical feasibility and preliminary results of minimally invasive endoscopic-TLIF based on electromagnetic navigation: a case series. BMC Surg 2021; 21:149. [PMID: 33743668 PMCID: PMC7981827 DOI: 10.1186/s12893-021-01148-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/10/2021] [Indexed: 02/06/2023] Open
Abstract
Background Uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion (Endo-TLIF) with percutaneous pedicle screw fixation is a promising, minimally invasive method for the treatment of lumbar spondylolisthesis. However, repeated radiation exposure from X-rays and the steep learning curve remain to be improved. Methods This retrospective study explored the effects of electromagnetic navigation on improving Endo-TLIF with percutaneous pedicle screw fixation. Clinical information from 42 patients who had received Endo-TLIF with percutaneous pedicle screw fixation from May 2019 to November 2020 was analyzed retrospectively. The procedures were assisted under electromagnetic navigation. The rate of adjustment for guide wires, frequency of X-ray exposure, operative time, accuracy of pedicle screw location, and clinical outcomes were recorded. Results The mean follow-up for 42 patients was 11.9 ± 3.1 months. The mean age of the patients was 56.1 ± 9.26 years, with a female/male ratio of 25:17. According to postoperative CT scans and 3D reconstructions, the excellent and good rate of pedicle screws was 96.4%. The rate of adjustment for guide wires under the assistance of electromagnetic navigation was 1.78%, and the frequency of X-ray exposure was 8.27 ± 1.83. The operative time was 167.25 ± 28.16 min, including the duration of guide wire insertion (14.63 ± 5.45 min) and duration of decompression and cage placement (75.43 ± 13.97 min). The duration of hospitalization after operation was 2.59 ± 1.16 days. The preoperative VAS score was 7.51 ± 1.91, and the preoperative ODI was 82.42 ± 8.7%. At the last follow-up, the VAS score was 2.09 ± 0.59, and the ODI was 11.09 ± 3.2%. There were statistically significant improvements in the VAS score and ODI in all patients at the follow-up (p < 0.05). Conclusions Electromagnetic navigation can provide accurate positioning and guidance in real time, which improves the surgical efficiency of percutaneous pedicle screw placement and endoscopic decompression in Endo-TLIF with reduced radiation exposures. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01148-9.
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Affiliation(s)
- Derong Xu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Shuo Han
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chao Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Kai Zhu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Chuanli Zhou
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
| | - Xuexiao Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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Fan N, Yuan S, Du P, Zhu W, Li L, Hai Y, Ding H, Wang G, Zang L. Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol. J Orthop Surg Res 2020; 15:479. [PMID: 33076965 PMCID: PMC7569762 DOI: 10.1186/s13018-020-02003-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background Transforaminal percutaneous endoscopic lumbar surgeries (PELS) for lumbar disc herniation and spinal stenosis are growing in popularity. However, there are some problems in the establishment of the working channel and foraminoplasty such as nerve and blood vessel injuries, more radiation exposure, and steeper learning curve. Rapid technological advancements have allowed robotic technology to assist surgeons in improving the accuracy and safety of surgeries. Therefore, the purpose of this study is to develop a robot-assisted system for transforaminal PELS, which can provide navigation and foraminoplasty. Methods The robot-assisted system consists of three systems: preoperative planning system, navigation system, and foraminoplasty system. In the preoperative planning system, 3D visualization of the surgical segment and surrounding tissues are realized using the multimodal image fusion technique of computed tomography and magnetic resonance imaging, and the working channel planning is carried out to reduce the risk for injury to vital blood vessels and nerves. In the navigation system, the robot can obtain visual perception ability from a visual receptor and automatically adjust the robotic platform and robot arm to the appropriate positions according to the patient’s position and preoperative plan. In addition, the robot can automatically register the surgical levels through intraoperative fluoroscopy. After that, the robot will provide navigation using the 6 degree-of-freedom (DOF) robot arm according to the preoperative planning system and guide the surgeon to complete the establishment of the working channel. In the foraminoplasty system, according to the foraminoplasty planning in the preoperative planning system, the robot performs foraminoplasty automatically using the high speed burr at the end of the robot arm. The system can provide real-time feedback on the working status of the bur through multi-mode sensors such as multidimensional force, position, and acceleration. Finally, a prototype of the system is constructed and performance tests are conducted. Discussion Our study will develop a robot-assisted system to perform transforaminal PELS, and this robot-assisted system can also be used for other percutaneous endoscopic spinal surgeries such as interlaminar PELS and percutaneous endoscopic cervical and thoracic surgeries through further research. The development of this robot-assisted system can be of great significance. First, the robot can improve the accuracy and efficiency of endoscopic spinal surgeries. In addition, it can avoid multiple intraoperative fluoroscopies, minimize exposure to both patients and the surgical staff, shorten the operative time, and improve the learning curve of beginners, which is beneficial to the popularization of percutaneous endoscopic spinal surgeries.
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Affiliation(s)
- Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Chaoyang-Tsinghua Digitization & Artificial Intelligence Orthopedic Laboratory, Beijing, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Chaoyang-Tsinghua Digitization & Artificial Intelligence Orthopedic Laboratory, Beijing, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Chaoyang-Tsinghua Digitization & Artificial Intelligence Orthopedic Laboratory, Beijing, China
| | - Wenyi Zhu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Chaoyang-Tsinghua Digitization & Artificial Intelligence Orthopedic Laboratory, Beijing, China
| | - Liang Li
- Chaoyang-Tsinghua Digitization & Artificial Intelligence Orthopedic Laboratory, Beijing, China.,Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.,Chaoyang-Tsinghua Digitization & Artificial Intelligence Orthopedic Laboratory, Beijing, China
| | - Hui Ding
- Chaoyang-Tsinghua Digitization & Artificial Intelligence Orthopedic Laboratory, Beijing, China.,Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Guangzhi Wang
- Chaoyang-Tsinghua Digitization & Artificial Intelligence Orthopedic Laboratory, Beijing, China. .,Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China.
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. .,Chaoyang-Tsinghua Digitization & Artificial Intelligence Orthopedic Laboratory, Beijing, China.
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Endoscopic Spine Surgery in Athletes: Case Series and Review of Literature. World Neurosurg 2020; 145:702-707. [PMID: 32891833 DOI: 10.1016/j.wneu.2020.08.211] [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: 07/01/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Degenerative spine disease is common in athletes and can progress to requiring surgical intervention. Traditional open surgical techniques necessitate prolonged recovery time and time away from play. Newly developed endoscopic surgical techniques may promote faster healing and recovery, and increased return to play. The goal of this paper is to summarize the current evidence in return to play after spine surgery and to present our series of 3 athletes who underwent endoscopic spine surgery. METHODS A complete search of all PubMed indexed articles pertaining to spine surgery in athletes was conducted. This was supplemented by a 3-patient case series of our own endoscopic spine experience in athletes. RESULTS There are no current widely accepted guidelines for return to play after spinal surgery. The best evidence available cites a return to play of 81% at 5.2-8.7 months after traditional open and minimally invasive surgery, and endoscopic surgery produces an average 88% return to play rate at 3 months. CONCLUSIONS Although return to play can vary widely, case-based evidence as well as biomechanical principles support endoscopic spine surgery as a viable surgical modality for the treatment of spinal pathologies in athletes.
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The protection of superior articular process in percutaneous transforaminal endoscopic discectomy should decreases the risk of adjacent segment diseases biomechanically. J Clin Neurosci 2020; 79:54-59. [PMID: 33070918 DOI: 10.1016/j.jocn.2020.07.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/09/2020] [Accepted: 07/11/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Facetectomy is a useful procedure in percutaneous transforaminal endoscopic discectomy (PTED) for the enlargement of surgical field and operative space and for the decompression of existing nerve roots for patients who suffer foraminal stenosis. Biomechanical deterioration can initially trigger the adjacent segment disease (ASD), and our previous literature proved that a large grade of facetectomy can increase the risk of biomechanical deterioration and resulting low back pain. However, no study has discussed whether different grades of facetectomy influence the risk of ASD. METHODS A validated osteoligamentous lumbosacral finite element model and corresponding PTED models with quarter and half facetectomy were constructed in our previous study. Biomechanical indicators were computed and recorded to evaluate the risk of ASD. RESULTS Obvious differences between the intact model and the quarter facetectomy model had no basis. Nevertheless, in most body positions, most of the above indicators deteriorated in the half facetectomy model. CONCLUSION On the basis of achieving the surgical purpose in PTED, the superior articular process should be protected to decrease the risk of ASD biomechanically.
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