1
|
Li W, Han J, Xin Q, Liu Q, Feng C, Liu Y, Zhang D. Finite element mechanical analysis of ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery. J Orthop Surg Res 2023; 18:979. [PMID: 38124107 PMCID: PMC10734093 DOI: 10.1186/s13018-023-04476-z] [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: 09/19/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Unilateral bilateral endoscopic spine surgery (UBE) is often performed to treat lumbar spinal stenosis and disc herniation. It has become a prominent method in endoscopic spine surgery because of its very low learning curve and broader operative field of vision. Currently, the ipsilateral approach and contralateral approach have been established for disc herniation in the foraminal area, intervertebral foramen region, or pedicle region. The contralateral method offers many benefits over the ipsilateral approach, including less bone labour during microsurgical decompression and the preservation of facet joints. However, because it uses the interlaminar window approach, it inevitably involves osteotomy of the patient's superior and inferior articular processes, which may result in corresponding deterioration in the spine's biomechanical stability and subsequent adjacent facet joint diseases caused by facet joint degeneration postoperatively. OBJECTIVE As a result, the purpose of this work is to use a finite element model to evaluate how the ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery affect spinal stability while treating identical intervertebral disc herniation. STUDY DESIGN In this study, a three-dimensional lumbar-sacral spine model was built and verified. Osteotomies were conducted for armpit-type lumbar disc herniation (LDH), periradicular-type LDH, and shoulder-type LDH. Postoperative lumbar spine models of the ipsilateral approach and contralateral approach in unilateral bilateral endoscopic spine surgery were developed. The von Mises stress on the endplate, shear force on the annulus fibrosus, pressure inside the intervertebral disc, and range of motion (ROM) of the L3 segment were all determined. The results of our well-validated model showed that osteotomy done in the ipsilateral approach deteriorated most biomechanical metrics. RESULTS In the majority of loading conditions, the contralateral approach caused the intervertebral disc's biomechanical properties to increase, and the ipsilateral approach caused the intervertebral disc's biomechanical properties to increase sharply more than the contralateral approach. CONCLUSION The contralateral approach, which is now extensively employed in unilateral bilateral endoscopic spine surgery, may be regarded as an ideal surgical alternative for treating lumbar disc herniation without producing iatrogenic instability. This approach has a low facet joint reduction rate, minimum soft tissue injury, and precisely identifies the midline of the central spinal canal during the retraction of the thecal sac and nerve roots.
Collapse
Affiliation(s)
- Wenzheng Li
- Department of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, 030012, Shanxi, China
| | - Junjian Han
- Department of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, 030012, Shanxi, China
| | - Qingyun Xin
- Department of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, 030012, Shanxi, China
| | - Qitao Liu
- Department of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, 030012, Shanxi, China
| | - Chao Feng
- Department of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, 030012, Shanxi, China
| | - Yichan Liu
- Shanxi University of Chinese Medicine, Taiyuan, 030024, Shanxi, China
| | - Dengjun Zhang
- Department of Orthopaedics, The Fifth Clinical Medical College of Shanxi Medical University, Taiyuan, 030012, Shanxi, China.
| |
Collapse
|
2
|
Lee DH, Lee DG, Park CK, Jang JW, Hwang JS, Kim JY, Cho YE, Lee SW, Lee DC, Han BS, Han SY. Saving Stabilizing Structure Treatment With Bilateral-Contralateral Decompression for Spinal Stenosis in Degenerative Spondylolisthesis Using Unilateral Biportal Endoscopy. Neurospine 2023; 20:931-939. [PMID: 37798987 PMCID: PMC10562235 DOI: 10.14245/ns.2346504.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the treatment of spinal stenosis with spondylolisthesis using bilateral-contralateral unilateral biportal endoscopic (UBE) decompression to minimize facet joint damage. METHODS We retrospectively evaluated 42 patients with grade 1 spondylolisthesis who underwent bilateral-contralateral UBE decompression between July 2018 and September 2019. To identify segmental instability, static and dynamic images from preoperative and postoperative procedures and final follow-up radiographs were reviewed. Lateral radiograph slippage ratio, sagittal motion, and facet joint preservation were evaluated. Clinical assessments were conducted using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. RESULTS The average final follow-up period was 26.5 ± 1.3 months. The average preoperative slip percentage was 15.70% ± 5.25%, which worsened to 18.80% ± 5.41% at the final follow-up (p < 0.005). The facet joint preservation rate was 95.6% ± 4.1% on the contralateral side. Improvements in the VAS scores (leg pain: from 7.9 ± 2.2 to 3.1 ± 0.7; p < 0.005; back pain: from 7.2 ± 3.0 to 2.8 ± 1.0; p < 0.005) were observed at the final follow-up. The mean preoperative ODI was 26.19 ± 3.42, which improved to 9.6 ± 1.0 (p < 0.005). Thirteen patients exhibited delayed focal segmental instability following decompression. Despite the absence of symptoms or improvement with conservative treatment in the majority of patients with delayed instability, two patients required fusion surgery to address the instability. Additionally, 2 patients developed facet synovial cysts, while 2 experienced spinous process fractures. CONCLUSION Bilateral decompression with a contralateral UBE approach could be an effective and alternative treatment method to reduce instability in spinal stenosis with grade 1 spondylolisthesis.
Collapse
Affiliation(s)
- Dong Hyun Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Dong-Geun Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Choon Keun Park
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Jae-Won Jang
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Jin Sub Hwang
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Jun Yong Kim
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Yong-Eun Cho
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Sang Won Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Dong Chan Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Bang Sang Han
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Sang Yeop Han
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| |
Collapse
|
3
|
Kotheeranurak V, Liawrungrueang W, Quillo-Olvera J, Siepe CJ, Li ZZ, Lokhande PV, Choi G, Ahn Y, Chen CM, Choi KC, Van Isseldyk F, Hagel V, Koichi S, Hofstetter CP, Del Curto D, Zhou Y, Bolai C, Bae JS, Assous M, Lin GX, Jitpakdee K, Liu Y, Kim JS. Full-Endoscopic Lumbar Discectomy Approach Selection: A Systematic Review and Proposed Algorithm. Spine (Phila Pa 1976) 2023; 48:534-544. [PMID: 36745468 DOI: 10.1097/brs.0000000000004589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/28/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A systematic review of the literature to develop an algorithm formulated by key opinion leaders. OBJECTIVE This study aimed to analyze currently available data and propose a decision-making algorithm for full-endoscopic lumbar discectomy for treating lumbar disc herniation (LDH) to help surgeons choose the most appropriate approach [transforaminal endoscopic lumbar discectomy (TELD) or interlaminar endoscopic lumbar discectomy (IELD)] for patients. SUMMARY OF BACKGROUND DATA Full-endoscopic discectomy has gained popularity in recent decades. To our knowledge, an algorithm for choosing the proper surgical approach has never been proposed. MATERIALS AND METHODS A systematic review of the literature using PubMed and MeSH terms was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient samples included patients with LDH treated with full-endoscopic discectomy. The inclusion criteria were interventional research (randomized and nonrandomized trials) and observation research (cohort, case-control, case series). Exclusion criteria were case series and technical reports. The criteria used for selecting patients were grouped and analyzed. Then, an algorithm was generated based on these findings with support and reconfirmation from key expert opinions. Data on overall complications were collected. Outcome measures included zone of herniation, level of herniation, and approach (TELD or IELD). RESULTS In total, 474 articles met the initial screening criteria. The detailed analysis identified the 80 best-matching articles; after applying the inclusion and exclusion criteria, 53 articles remained for this review. CONCLUSIONS The proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.
Collapse
Affiliation(s)
- Vit Kotheeranurak
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | | | - Javier Quillo-Olvera
- Department of Neurosurgery, The Brain and Spine Care, Minimally Invasive Spine Surgery Group, Spine Center, Hospital H+, Queretaro City, Mexico
| | - Christoph J Siepe
- Schön Clinic Munich Harlaching, Munich, Germany
- Paracelsus Medical University (PMU), Salzburg, Austria
| | - Zhen Zhou Li
- The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | - Gun Choi
- Wooridul Spine Hospital, Pohang, South Korea
| | - Yong Ahn
- Gachon University, Incheon, South Korea
| | | | | | | | - Vincent Hagel
- University Spine Center Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Sairyo Koichi
- Tokushima University Graduate School, Kuramoto, Tokushima, Japan
| | | | - David Del Curto
- School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Yue Zhou
- Xinquiao Hospital, Third Military Medical University, Chongquing, China
| | - Chen Bolai
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Jun Seok Bae
- Wooridul Spine Hospital, Gangnam-Gu Seoul, Korea
| | - Muhammed Assous
- Razi Spine Clinic-Minimally Invasive Spine Surgery, Amman, Jordan
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Khanathip Jitpakdee
- Orthopedic Department, Queen Savang Vadhana Memorial Hospital. Sriracha, Chonburi, Thailand
| | - Yanting Liu
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
4
|
Ju CI, Lee SM. Complications and Management of Endoscopic Spinal Surgery. Neurospine 2023; 20:56-77. [PMID: 37016854 PMCID: PMC10080410 DOI: 10.14245/ns.2346226.113] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
In the past, the use of endoscopic spine surgery was limited to intervertebral discectomy; however, it has recently become possible to treat various spinal degenerative diseases, such as spinal stenosis and foraminal stenosis, and the treatment range has also expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spine surgery develops and its indications widen, more diverse and advanced surgical techniques are being introduced, and the complications of endoscopic spine surgery are also increasing accordingly. We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and key words were set as “endoscopic spinal surgery,” “endoscopic cervical foramoinotomy,” “PECD,” “percutaneous transforaminal discectomy,” “percutaneous endoscopic interlaminar discectomy,” “PELD,” “PETD,” “PEID,” “YESS” and “TESSYS.” We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic lumbar surgery was divided into full endoscopic interlaminar and transforaminal approaches and a unilateral biportal approach. We performed a comprehensive review of available literature on complications of endoscopic spinal surgery. This study particularly focused on the prevention of complications. Regardless of the surgical methods, the most common complications related to endoscopic spinal surgery include dural tears and perioperative hematoma. transient dysesthesia, nerve root injury and recurrence. However, Endoscopic spinal surgery, including full endoscopic transforaminal and interlaminar and unilateral biportal approaches, is a safe and effective a treatment for lumbar as well as cervical and thoracic spinal diseases such as disc herniation, lumbar spinal stenosis, foraminal stenosis and recurrent disc herniation.
Collapse
Affiliation(s)
- Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
- Corresponding Author Chang Il Ju Department of Neurosurgery, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea
| | - Seung Myung Lee
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| |
Collapse
|
5
|
Kim HS, Wu PH, Jie Chin BZ, Jang IT. Systematic Review of Current Literature on Clinical Outcomes of Uniportal Interlaminar Contralateral Endoscopic Lumbar Foraminotomy for Foraminal Stenosis. World Neurosurg 2022; 168:392-397. [DOI: 10.1016/j.wneu.2022.04.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/14/2022]
|
6
|
Chiang PL, Chen YY, Chen KT, Hsu JC, Wu C, Lee CY, Huang TJ, Huang YH, Chen CM, Wu MH. Comparison Between Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression and Other Decompression Approaches for Lumbar Spinal Stenosis: A Systematic Review. World Neurosurg 2022; 168:369-380. [DOI: 10.1016/j.wneu.2022.08.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
|
7
|
Contraindications and Complications of Full Endoscopic Lumbar Decompression for Lumbar Spinal Stenosis: A Systematic Review. World Neurosurg 2022; 168:398-410. [DOI: 10.1016/j.wneu.2022.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
|
8
|
Tian D, Zhu B, Liu J, Chen L, Sun Y, Zhong H, Jing J. Contralateral inclinatory approach for decompression of the lateral recess and same-level foraminal lesions using unilateral biportal endoscopy: A technical report. Front Surg 2022; 9:959390. [DOI: 10.3389/fsurg.2022.959390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/25/2022] [Indexed: 11/06/2022] Open
Abstract
ObjectiveUnilateral biportal endoscopic (UBE)surgery is being increasingly adopted as a minimally invasive technique. The purpose of the current study was to introduce a novel surgical technique for lateral recess and same-level foraminal decompression by the contralateral inclinatory approach with unilateral biportal endoscopy(CIA-UBE) at the lumbar level.MethodsBetween January 2020 and February 2022, 10 patients suffering from lateral recess and same-level foraminal stenosis at the lumbar level underwent UBE surgery by contralateral inclinatory approach (CIA-UBE). Magnetic resonance imaging (MRI) scans were examined after surgery to measure the cross-sectional area (CSA) of the spinal canal (CSA-SC), the CSA of the intervertebral foramen (CSA-IVF), and the CSA of the facet joint (CSA-FJ). Postoperative radiologic images using computed tomography (CT) were obtained to investigate the existence of facet joint violation. Clinical outcomes were assessed using Oswestry Disability Index (ODI) scores and visual analogue scale (VAS) scores for buttock and radicular pain.ResultsTen levels were decompressed, and the mean age of the patients was 56.92 ± 13.26 years. The mean follow-up period was 7.60 ± 4.47 months. The average operative time was 85.14 ± 25.65 min. Postoperative CT and MRI revealed ideal neural decompression of the treated segments in all patients. CSA-IVF and CSA-FJ improved significantly, indicating good foraminal and lateral recess decompression with less damage to facet joints. Preoperative VAS and ODI scores improved significantly after surgery.ConclusionCIA-UBE may be an effective surgical treatment of the lateral recess and same-level foraminal stenosis at the lumbar level, which provides successful surgical decompression for traversing and exiting nerve roots with a better operative view and easier surgical manipulation. This approach may also help to maximize the preservation of the facet joint.
Collapse
|
9
|
Zhang JJ, Zhou CL, Sun C, Xu DR, Bao M, Liu Y. Clinical Efficacy Study of the Quadrant Channel and Delta Large Channel Technique in the Treatment of Lumbar Degenerative Diseases. Int J Gen Med 2021; 14:2437-2447. [PMID: 34140799 PMCID: PMC8203276 DOI: 10.2147/ijgm.s309272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/11/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To compare the therapeutic effect of the quadrant channel and delta large channel techniques in lumbar degenerative diseases. Methods According to the inclusion criteria, 62 patients suffering from lumbar degenerative disease were selected for the present study, which was conducted from September 2018 to June 2020. Patients were divided into Group A (quadrant channel technology) and Group B (delta large channel technology), which comprised 28 and 34 patients, respectively. The factors compared between the two groups were operation time, length of incision, blood loss, ambulation time, length of hospitalization, visual analogue scale (VAS) preoperatively, 7 days postoperatively, and 30 days postoperatively, and Oswestry dysfunction score (ODI). Results The length of incision, blood loss, ambulation time, and length of hospitalization stay in Group A were significantly higher compared with Group B (P < 0.05). There was no significant difference between the two groups in operation time, preoperative ODI index, preoperative VAS scores, and thirty-day postoperative VAS scores (P > 0.05). The seven-day postoperative VAS score, seven-day postoperative ODI index, and thirty-day postoperative ODI index of Group A were significantly higher than those of Group B (P < 0.05). The preoperative VAS score and ODI index in both groups were significantly higher compared with after operation (P < 0.05). Conclusion Both surgical methods achieved a good clinical outcome in the treatment of lumbar degenerative diseases. The delta large channel technique may offer some advantages over quadrant channel technology, such as less trauma and bleeding and faster recovery time.
Collapse
Affiliation(s)
- Jia-Jun Zhang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, People's Republic of China
| | - Chuan-Li Zhou
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, People's Republic of China
| | - Chong Sun
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, People's Republic of China
| | - De-Rong Xu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, People's Republic of China
| | - Mei Bao
- Department of Pediatric Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, People's Republic of China
| | - Yong Liu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, People's Republic of China
| |
Collapse
|
10
|
Garg K, Kasliwal MK. Outcomes and complications following minimally invasive excision of synovial cysts of the lumbar spine: A systematic review and meta-analysis. Clin Neurol Neurosurg 2021; 206:106667. [PMID: 33984755 DOI: 10.1016/j.clineuro.2021.106667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/08/2021] [Accepted: 04/15/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Lumbar synovial cysts (LSC) are one of the manifestations of spinal degenerative cascade. Spinal stenosis or presence of instability in these patients can lead to various symptoms and surgery is indicated following failure of non-operative management for symptomatic synovial cysts. Surgery when performed consists of either decompression with resection of cyst with our without fusion. The efficacy and complications of minimally invasive techniques using tubular retractors (microscopic or endoscopic) in comparison to traditional open techniques remain to be studied. METHODS A comprehensive search of different databases was performed to retrieve studies describing the use of minimal invasive techniques using tubular retractors (both microscopic and endoscopic) in patients with LSC. Meta-analysis with subgroup analysis and metaregression was done. RESULTS Twenty articles were selected for the systematic review and meta-analysis with total of 388 patients. Eighty-six percent of patients (95% Confidence Interval (CI): 80-90%) had favorable outcome as per Macnab's criteria (excellent and good outcome) with the pooled standard mean difference between preoperative and postoperative Oswestry Disability Index (ODI) being -4.44 (95% CI -8.78 to -0.10, p-value=0.0474, I2 82%). The pooled percentage change in visual analogue scale (VAS) after surgery was 76.5% (95% CI 66.9-84%, I2 82%). The pooled proportion of incidental durotomies, cyst recurrence and patients requiring operation being 8% (95% CI 5-11%, I2 0%), 4% (95% CI 2-7%, I2 0%,) and 5% (95% CI 3-9%) respectively. Studies were homogeneous with an I2 value of 0%. Subgroup analysis revealed no significant difference in the outcome rates or complication rates between the microscopic and endoscopic subgroups. CONCLUSION Minimally invasive techniques for the resection of LSC is a safe and effective alternative to traditional surgical approaches with no difference between the microscopic and endoscopic approaches.
Collapse
Affiliation(s)
- Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manish K Kasliwal
- University Hospitals Cleveland Medical Centre, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| |
Collapse
|
11
|
Burkhardt BW, Oertel JM. Is Decompression and Partial Discectomy Advantageous Over Decompression Alone in Microendoscopic Decompression Of Monosegmental Unilateral Lumbar Recess Stenosis? Int J Spine Surg 2021; 15:94-104. [PMID: 33900962 PMCID: PMC7931747 DOI: 10.14444/8013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Endoscopic techniques are well accepted as surgical technique for decompression of lumbar lateral recess stenosis (LRS). It is uncertain if there is a difference in clinical outcome for decompression alone (DA) or decompression with partial discectomy (DPD) for the treatment of LRS. METHODS All files of patients who underwent an endoscopic procedure for lumbar LRS were identified from a prospectively collected database. Preoperative magnetic resonance imaging and endoscopic video were analyzed with special focus on the technique of nerve root decompression. Clinical outcome was assessed via a personal examination, a standardized questionnaire including the numeric rating scale (NRS) for leg and back pain, the Oswestry disability index (ODI), and the modified MacNab criteria to assess functional outcome and clinical success. RESULTS Sixty-six patients were identified of which 57 attended for evaluation (86.4%). DA was performed in 15 (26.3%) patients and DPD in 42 patients (73.7%). The mean follow-up was 45.0 months (range: 16-82 months). Fifty-two patients reported to be free of leg pain (91.1%), 42 patients had no noticeable back pain (73.7%), 49 patients had full muscle strength (85.9%), and 48 patients had no sensory disturbance (84.2%). The mean NRS for leg pain was 1, the mean NRS for back pain was 2, mean ODI was 16% (range: 0%-60%). Clinical success was noted in 49 patients (85.9%) and it was significantly higher for patients following DPD (P = .024). The overall repeat procedure rate was 12% with reoperation rate at the index segment in 10.5% of cases. There were no significant differences with respect to leg and back pain, ODI, and reoperation between both groups. CONCLUSION Microendoscopic DPD of LRS achieves a 92% clinical success rate which is significantly higher compared to 67% clinical success achieved by DA. There was no significant difference for the rate of reoperation, leg and back pain, and ODI. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| |
Collapse
|
12
|
Li SJ, Wang F, Chen W, Su Y. Application of three dimensional (3D) curved multi-planar reconstruction images in 3D printing mold assisted eyebrow arch keyhole microsurgery. Brain Behav 2020; 10:e01785. [PMID: 32794658 PMCID: PMC7559599 DOI: 10.1002/brb3.1785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/08/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The application of multi-planar reconstruction of three dimensional (3D) curved surface in microsurgery of 3D printing mold assisted eyebrow arch keyhole approach was studied. METHODS Eighty patients with intracranial aneurysms who underwent treatment at our hospital were enrolled. The patients were divided into two groups: the traditional eyebrow keyhole approach microsurgery group (38 cases in the conventional treatment group) and the three-dimensional curved surface multi-plane reconstruction image combined with 3D printing technology assisted eyebrow keyhole approach microsurgery group (42 cases in the 3D printing assisted treatment group). The Hunt-Hess classification was used to make a preliminary estimation of the patient's condition. The 3D curved multi-planar reconstruction method was used to assist the surgical plan; CT scan was used to establish a 3D printing mold, and the patient's condition and surgical plan were accurately analyzed before surgery. The operative time and the size of the incision area were recorded; postoperative GOS score and postoperative complications were statistically investigated. RESULTS The 3D printing assisted treatment group (70.13 ± 15.56), (411.26 ± 10.38) mm2 , the operative time and incision area were significantly shorter than the conventional treatment group (120.35 ± 20.46), (663.55 ± 13.54) mm2 , p < .05); the GOS score showed that the 3D printing-assisted treatment group was significantly higher than the conventional treatment group (p < .05). The postoperative complication rate was significantly lower in the 3D print-assisted treatment group (9.52%) than in the conventional treatment group (47.36%, p < .05); the cure of intracranial aneurysms in the 3D printing assisted treatment group was more thorough than that in the conventional treatment group, and the difference was significant (p < .05). CONCLUSION Compared with the conventional eyebrow arch-hole approach microsurgery, the 3D surface multi-planar reconstruction image combined 3D printing assisted technology was safer and more effective, and the postoperative recovery was better and the incidence of complications was lower.
Collapse
Affiliation(s)
- Sheng-Jun Li
- Department of Neurosurgery, Linyi Central Hospital, Linyi, China
| | - Fang Wang
- Department of Emergency, Linyi Central Hospital, Linyi, China
| | - Wei Chen
- Department of Neurosurgery, Linyi Central Hospital, Linyi, China
| | - Ying Su
- Department of Neurosurgery, Linyi Central Hospital, Linyi, China
| |
Collapse
|
13
|
Park JH, Jang JW, Park WM, Park CW. Contralateral Keyhole Biportal Endoscopic Surgery for Ruptured Lumbar Herniated Disc: A Technical Feasibility and Early Clinical Outcomes. Neurospine 2020; 17:S110-S119. [PMID: 32746524 PMCID: PMC7410376 DOI: 10.14245/ns.2040224.112] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Spinal endoscopic surgery is increasingly adapted as a minimal invasive technique, however, significant facet joint violation may be developed after ipsilateral laminectomy. The aim of this study is to introduce surgical technique of contralateral keyhole biportal endoscopic surgery (CKES) for ruptured lumbar disc and report it is early surgical outcomes with facet joint violation. METHODS Between January to December 2019, 27 patients with ruptured lumbar disc were underwent CKES. Simple radiographs were obtained to investigate development of iatrogenic instability or spondylolisthesis. Magnetic resonance imaging scan was checked about 8 hours after surgery to evaluate successful removal of ruptured disc and existence of facet joint violation. Clinical outcomes were assessed by modified MacNab criteria, visual analogue scale (VAS) scores of back and radicular pain. RESULTS The mean age of the patients was 62.8 ± 12.48 years. The average operative time and mean follow-up period were 57.1 ± 21.36 minutes and 8.1 ± 3.78 months, respectively. Compared to preoperative scores, the VAS scores of back and radicular pain were significantly improved. Modified MacNab outcome grade was good to excellent in 96.3% (26 out of 27 patients) of patients. The reduction rate of facet joint plane was about 4.9% after contralateral approach. CONCLUSION CKES may be considered as an excellent surgical option to treat ruptured lumbar disc without the development of iatrogenic instability. Low rate of facet joint reduction, good visualization of lateral recess, and identification of accurate midline of central spinal canal are advantages of the procedure.
Collapse
Affiliation(s)
- Jung Hoon Park
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, Korea
| | - Jae Won Jang
- Department of Neurosurgery, Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Woo Min Park
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, Korea
| | - Cheul Woong Park
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, Korea
| |
Collapse
|
14
|
Kim HS, Wu PH, Jang IT. Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression Outside-In Approach: A Proctorship Guideline With 12 Steps of Effectiveness and Safety. Neurospine 2020; 17:S99-S109. [PMID: 32746523 PMCID: PMC7410378 DOI: 10.14245/ns.2040078.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/03/2020] [Indexed: 01/16/2023] Open
Abstract
Minimally invasive spinal surgery in particular lumbar endoscopic unilateral laminotomy with bilateral decompression becomes popular as it can be performed with regional anesthesia, soft tissue damages are minimized as endoscopic visualization and instruments can be brought close to operating area bypassing much of the intervening soft tissues for sufficient spinal decompression with ligamentum flavum resection despite less bony resection compared to open surgery. Overall, when well executed, it preserves spinal stability. Outside-in technique of decompression is also known as over the top decompression in minimally invasive literature. It involves maintaining deep layer of ligamentum flavum integrity till satisfactory bony decompression is achieved. Deep layer of ligamentum flavum is removed as final step of decompression. Preservation of the deep layer of ligamentum flavum protects the neural elements, allowing drills and sharp equipment to be used safely to perform bony decompression.In this study, we demonstrate the technical details of outside-in approach lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD). LE-ULBD Outside-in Technique is an effective and safe procedure in relieving lumbar spinal stenosis with favorable results with a follow-up for more than 1 year.
Collapse
Affiliation(s)
| | - Pang Hung Wu
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Korea.,National University Health Systems, Jurong Health Campus, Orthopaedic Surgery, Singapore
| | - Il-Tae Jang
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Korea
| |
Collapse
|
15
|
Wu PH, Kim HS, Lee YJ, Kim DH, Lee JH, Jeon JB, Raorane HD, Jang IT. Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note. Brain Sci 2020; 10:brainsci10060373. [PMID: 32549320 PMCID: PMC7348812 DOI: 10.3390/brainsci10060373] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023] Open
Abstract
Background: Severe collapsed disc secondary to degenerative spinal conditions leads to significant foraminal stenosis. We hypothesized that uniportal posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling technique could be safely applied to the collapsed disc space to improve patients’ pain score, restore disc height, and correct the segmental angular parameters. Methods: We included patients who met the indication criteria for lumbar fusion and underwent uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with pre-operative Computer Tomography mid disc height of less than or equal to 5 mm and MRI of Grade 3 Foraminal Stenosis. Visual analogue scale and computer tomography pre-operative and post-operative sagittal disc height in the anterior, middle and posterior part of the disc; sagittal focal segmental angle; mid coronal disc height and coronal wedge angles were evaluated. Results: 30 levels of Endo-TLIF were included, with a mean follow up of 12 months. The mean improvement in decreasing pain score was 2.5 ± 1.1, 3.2 ± 0.9 and 4.3 ± 1.0 at 1 week post operation, 3 months post operation and at final follow up, respectively, p < 0.05. There was significant increase in mid sagittal computer tomographic anterior, middle and posterior disc height of 6.99 ± 2.30, 6.28 ± 1.44, 5.12 ± 1.79 mm respectively, p < 0.05. CT mid coronal disc height showed an increase of 7.13 ± 1.90 mm, p < 0.05. There was a significant improvement in the CT coronal wedge angle of 2.35 ± 4.73 and the CT segmental focal sagittal angle of 1.98 ± 4.69, p < 0.05. Conclusion: Application of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion in patients with severe foraminal stenosis secondary to severe collapsed disc space significantly relieved patients’ pain and restored disc height without early subsidence or exiting nerve root dysesthesia in our cohort of patients.
Collapse
Affiliation(s)
- Pang Hung Wu
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
- National University Health System, JurongHealth Campus, Orthopaedic Surgery, Singapore 609606, Singapore
| | - Hyeun Sung Kim
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
- Correspondence:
| | - Yeon Jin Lee
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| | - Dae Hwan Kim
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| | - Jun Hyung Lee
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| | - Jun Bok Jeon
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| | - Harshavardhan Dilip Raorane
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| | - Il-Tae Jang
- Spine Surgery, Nanoori Gangnam Hospital, Seoul 06048, Korea; (P.H.W.); (Y.J.L.); (D.H.K.); (J.H.L.); (J.B.J.); (H.D.R.); (I.-T.J.)
| |
Collapse
|
16
|
Kim HS, Wu PH, Lee YJ, Kim DH, Jang IT. Technical Considerations of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion: A Review of Its Early Clinical Results in Application in Adult Degenerative Scoliosis. World Neurosurg 2020; 145:682-692. [PMID: 32531438 DOI: 10.1016/j.wneu.2020.05.239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Uniportal endoscopic posterolateral lumbar interbody fusion (Endo-TLIF) provides one of the least invasive forms of minimally invasive surgery, allowing large size cages which are commercially available for open and tubular microscopic transforaminal lumbar interbody fusion (TLIF) to be inserted through this approach. We studied the effect of such a technique on a series of patients with low-grade degenerative scoliosis. METHODS Endo-TLIF was applied to patients who had 10°-40° of degenerative adult scoliosis. Pre- and postoperative 1-week, 3-month, and final follow-up clinical status of visual analog scale, Oswestry Disability Index, perioperative complications, and Macnab criteria were collected. Roentgenogram to assess changes in Cobb angles was done. RESULTS There was statistically significant improvement of preoperative, 1-week postoperative, 3-month postoperative, and final follow-up mean of visual analog scale scores with 7.72 (5-10), 3.68 (3-6), 2.88 (2-4), and 1.96 (1-3), respectively, and with Oswestry Disability Index mean of 70.4 (52-86), 35.12 (26-56), 27.68 (24-38), and 24 (20-28), respectively (P < 0.05). In terms of Macnab criteria, 100% had good to excellent result. In terms of scoliosis measured by Cobb angle, there was statistically significant improvement. CONCLUSIONS Endo-TLIF is a safe and effective procedure in mild to moderate degenerative scoliosis with good early clinical results and improvement in coronal Cobb angle. It can be considered as an option if a short segment(s) fusion is planned for adult degenerative scoliosis.
Collapse
Affiliation(s)
- Hyeun Sung Kim
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea.
| | - Pang Hung Wu
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea; JurongHealth Campus, Orthopaedic Surgery, National University Health System, Singapore
| | - Yeon Jin Lee
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea
| | - Dae Hwan Kim
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea
| | - Il Tae Jang
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea
| |
Collapse
|
17
|
Akbary K, Kim JS, Park CW, Jun SG, Hwang IC. The Feasibility and Perioperative Results of Bi-Portal Endoscopic Resection of a Facet Cyst Along With Minimizing Facet Joint Resection in the Degenerative Lumbar Spine. Oper Neurosurg (Hagerstown) 2020; 18:621-628. [PMID: 31550357 DOI: 10.1093/ons/opz262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/07/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Presentation of degenerative facet cysts (FC) as radicular pain in patients is well established. The traditional treatment of FCs has been decompressive laminectomy with a medial facetectomy and cyst excision. A major disadvantage of open procedures with medial facetectomy is predisposition to further instability. OBJECTIVE To describe a contralateral bi-portal endoscopic excision of FC along with minimizing facet joint resection. METHODS Thirteen patients between March 2016 and December 2017 were evaluated retrospectively for clinical, radiological, and morphometric outcomes. Patients with complaints of unilateral radiculopathy with associated neurogenic claudication from degenerative lumbar FC were included. Clinical evaluation was by NRS leg pain and ODI scores, radiological evaluation was by MRI. For morphometric analysis, cross-sectional area of facet joint (CSA-FJ) was measured on MRI in square millimeters. RESULTS Thirteen FCs were decompressed (no adverse events) NRS leg pain and ODI improved from 6.85 ± 0.69 and 65.08 ± 7.95 preoperatively to 1 ± 0.91 and 13.46 ± 5.19 at 1-yr follow-up, respectively. CSA-FJ remained relatively well preserved from 212.83 ± 58.05 to 189.77 ± 62.93 post decompression (statistically insignificant, P = .3412). CONCLUSION Bi-portal endoscopic decompression of FC can be performed with good clinical and radiological outcomes. This surgical technique may be recommended for further evaluation as an addition in the armamentarium of a spine surgeon for treatment of degenerative lumbar FC.
Collapse
Affiliation(s)
- Kutbuddin Akbary
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea.,Seoul St. Mary'
- 's Hospital, Spine Centre, Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Seoul St. Mary'
- 's Hospital, Spine Centre, Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Cheul Woong Park
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea
| | - Su Gi Jun
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea
| | - In Chang Hwang
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea
| |
Collapse
|
18
|
Iwai H, Inanami H, Koga H. Comparative study between full-endoscopic laminectomy and microendoscopic laminectomy for the treatment of lumbar spinal canal stenosis. JOURNAL OF SPINE SURGERY 2020; 6:E3-E11. [PMID: 32656392 DOI: 10.21037/jss-20-620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Lumbar spinal canal stenosis (LSCS) is a common disease in the elderly. Although surgical decompression using a posterior approach is commonly used to treat LSCS, there are several different strategies. We compared the outcomes of uniportal full-endoscopic laminectomy (FEL) and microendoscopic laminectomy (MEL) for treating LSCS. Methods FEL was performed using a 6.4-mm working channel endoscope and MEL was performed using a 16-mm diameter tubular retractor and endoscope. Patients with LSCS treated with FEL (n=60) and MEL (n=54) in our hospital during the same period were retrospectively reviewed. Patient background information and operative data were collected. The satisfaction score was also recorded at discharge and 3 months postoperatively. Results The mean operation time for FEL and MEL was 77.8 min and 54.6 min, respectively. The mean hospital stay after FEL and MEL surgery was 2.1 days and 4.7 days, respectively. These outcomes were significantly different between the two approaches. The satisfaction scores at both stages were not significantly different between the two groups. A dural tear occurred in one patient who underwent FEL and three patients who underwent MEL, but no symptoms resulted from the tear. Although postoperative hematoma occurred in seven who underwent FEL and two who underwent MEL, only one patient who underwent FEL required operative evacuation of the hematoma. Conclusions FEL using a 6.4-mm working channel endoscope can be used to treat patients with LSCS. Shortening of the operation time and prevention of postoperative hematoma are essential for this approach to be completely superior to MEL.
Collapse
Affiliation(s)
- Hiroki Iwai
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| |
Collapse
|
19
|
Chen KT, Jabri H, Lokanath YK, Song MS, Kim JS. The evolution of interlaminar endoscopic spine surgery. JOURNAL OF SPINE SURGERY 2020; 6:502-512. [PMID: 32656388 DOI: 10.21037/jss.2019.10.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Due to the aging population, patients required spinal surgery for degenerative spondylopathy is increasing. With the advent of surgical instruments and techniques, minimally invasive spine surgery is prevalent worldwide. Besides microscopic techniques, endoscopic spine surgery has gotten attention gradually in this surgical field for the past two decades. There are two essential approaches developed currently, including transforaminal and interlaminar approach. These innovative equipment and skills promote the progression of endoscopic surgery from discectomy to decompression of spinal stenosis. Meanwhile, they also opened up the application of endoscopic surgery in a complicated situation. From the perspective of emerging technologies and techniques, the authors will review the evolution and describe the prospects of the interlaminar endoscopic spine surgery (IESS).
Collapse
Affiliation(s)
- Kuo-Tai Chen
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.,Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi
| | - Hussam Jabri
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Yadhu K Lokanath
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Myung-Soo Song
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
20
|
Endoscopic Unilateral Laminotomy with Bilateral Discectomy Using Biportal Endoscopic Approach: Technical Report and Preliminary Clinical Results. World Neurosurg 2020; 137:31-37. [PMID: 32028006 DOI: 10.1016/j.wneu.2020.01.190] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bilateral or huge disc herniations cause bilateral radiculopathy and severe lower back pain. In such cases, a bilateral discectomy may be required to resolve the radicular pain in both legs. We attempted a surgical technique involving bilateral lumbar discectomy via a unilateral approach using a percutaneous biportal endoscopic technique. The purpose of the present study was to describe our surgical technique and investigate the clinical outcomes in symptomatic bilateral lumbar disc herniation. METHODS Eleven patients with bilateral disc herniation of the L4-L5 or L5-S1 segments were surgically treated using the percutaneous biportal endoscopic approach. Biportal endoscopic unilateral laminotomy with bilateral discectomy was performed in all patients. Postoperative magnetic resonance imaging was performed 1 day after surgery, and the clinical parameters were investigated preoperatively and postoperatively. RESULTS All enrolled patients were successfully treated by biportal endoscopic bilateral discectomy via a unilateral approach. Surgery was performed at the L4-L5 level in 1 patient and the L5-S1 level in 10 patients. The mean operative time was 67.5 ± 13.1 minutes. A visual analog scale of leg pain and the Oswestry disability index showed significant improvement after surgery (P < 0.05). CONCLUSION Endoscopic unilateral laminotomy with bilateral discectomy using the percutaneous biportal endoscopic approach could be an effective and alternative treatment of symptomatic bilateral herniated disc disease affecting L4-L5 or L5-S1 segments.
Collapse
|
21
|
Chen KT, Song MS, Kim JS. How I do it? Interlaminar contralateral endoscopic lumbar foraminotomy assisted with the O-arm navigation. Acta Neurochir (Wien) 2020; 162:121-125. [PMID: 31811466 DOI: 10.1007/s00701-019-04104-y] [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: 09/23/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The interlaminar contralateral endoscopic lumbar foraminotomy (ICELF) provides access to the foraminal pathology with less violation to facet than the ipsilateral approach. However, it is technically challenging even for an experienced surgeon. METHODS We introduce the step-by-step workflow of the interlaminar contralateral endoscopic lumbar foraminotomy assisted with O-arm navigation system. CONCLUSION The ICELF assisted with O-arm navigation is safe, accurate, and efficient for the treatment of lumbar foraminal stenosis. The CT-based navigation reshapes the learning curve of the advanced endoscopic technique, reducing the risk of facet joint violation, and minimizes radiation exposure to surgeons.
Collapse
|
22
|
Lee CW, Yoon KJ, Kim SW. Percutaneous Endoscopic Decompression in Lumbar Canal and Lateral Recess Stenosis - The Surgical Learning Curve. Neurospine 2019; 16:63-71. [PMID: 30943708 PMCID: PMC6449834 DOI: 10.14245/ns.1938048.024] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/18/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The purpose of this study is to characterize the learning curve of endoscopic lumbar decompression based on peri- and postoperative parameters and to suggest the potential of full endoscopic decompression as a primary treatment option for lumbar canal and lateral recess stenosis. METHODS The records of 223 consecutive patients who underwent percutaneous endoscopic decompression by a single surgeon for their lumbar canal and lateral recess stenosis were reviewed. Patients were stratified into group 1 (n=100) and group 2 (n=123), depending on their case number. After the 100th case, the procedural time reached a plateau and subsequent patients were assigned to the second group. Demographics and surgical outcomes, including operative times, change in dural sac dimensions, length of hospital stay, and intraoperative complication rates were compared between the 2 groups. Postoperative clinical outcomes, including the visual analogue scale (VAS), the Oswestry Disability Index (ODI) and reoperation rates were compared between the 2 groups (group 1, n=90; group 2, n=110) by follow-up evaluation. RESULTS Procedural times were greater in group 1 than group 2 (group 1, 105.26 minutes; group 2, 67.65 minutes; p<0.05) and they had higher complication rates (group 1, 16% [16 of 100]; group 2, 8.3% [8 of 123]; p<0.05). The length of hospitalization, postoperative improvement in VAS and ODI, and reoperation rates were not different between the groups. In both groups, stenotic spinal canals were effectively decompressed. CONCLUSION Continued surgical experience was associated with a reduction in operative times and less intraoperative complications. Although the learning curve was steep and additional surgical experience may be needed to overcome the learning curve, percutaneous full endoscopic lumbar decompression is a safe, clinically-feasible, and effective surgical technique and can be adopted as the primary treatment for lumbar canal and lateral recess stenosis.
Collapse
Affiliation(s)
- Chul-Woo Lee
- Department of Neurosurgery, St Peter's Hospital, Seoul, Korea
| | - Kang-Jun Yoon
- Department of Neurosurgery, St Peter's Hospital, Seoul, Korea
| | - Sung-Won Kim
- Department of Neurosurgery, St Peter's Hospital, Seoul, Korea
| |
Collapse
|
23
|
Lee CW, Yoon KJ, Ha SS. Comparative Analysis between Three Different Lumbar Decompression Techniques (Microscopic, Tubular, and Endoscopic) in Lumbar Canal and Lateral Recess Stenosis: Preliminary Report. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6078469. [PMID: 31019969 PMCID: PMC6451825 DOI: 10.1155/2019/6078469] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 03/07/2019] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of our study is to compare the results of spinal decompression using the full-endoscopic interlaminar technique, tubular retractor, and a conventional microsurgical laminotomy technique and evaluate the advantages and clinical feasibility of minimally invasive spinal (MIS) lumbar decompression technique in the lumbar canal and lateral recess stenosis. METHODS The authors retrospectively reviewed clinical and radiological data from 270 patients who received microsurgical (group E: 72 patients), tubular (group T: 34 patients), or full-endoscopic decompression surgery (group E: 164 patients) for their lumbar canal and lateral recess stenosis from June 2016 to August 2017. Clinical (VAS, ODI, and Mcnab criteria), radiologic (spinal canal diameter, segmental dynamic angle, and disc height), and surgical outcome parameters (CPK level, Operative time, blood loss, and hospital stay) were evaluated pre- and postoperatively and compared among the three groups by means of statistical analysis. Failed cases and complications were reviewed in all groups. RESULTS The mean follow-up period was 6.38 months. The Overall clinical success rate was 89.4%. All groups showed favorable clinical outcome. The clinical and radiologic results were similar in all groups. Regarding surgical outcome, group E showed longer operation time than group M and T (group E: 84.17 minutes/level, group M: 52.22 minutes/level, and group T: 66.12 minutes/level) (p<0.05). However, groups E and T showed minimal surgical invasiveness compared with group M. Groups E and T showed less immediate postoperative back pain (VAS) (group E: 3.13, group M: 4.28, group T: 3.54) (p<0.05), less increase of serum CPK enzyme (group E: 66.38 IU/L, group M: 120 IU/L, and group T: 137.5 IU/L) (p<0.05), and shorter hospital stay (group E: 2.12 days, group M: 4.85 days, and group T: 2.83 days) (p<0.05). The rates of complications and revisions were not significantly different among the three groups. CONCLUSIONS MIS decompression technique is clinically feasible and safe to treat the lumbar canal and lateral recess stenosis, and it has many surgical advantages such as less muscle trauma, minimal postoperative back pain, and fast recovery of the patient compared to traditional open microscopic technique.
Collapse
Affiliation(s)
- Chul-Woo Lee
- Department of Neurosurgery, St. Peter's Hospital, Seoul 135-809, Republic of Korea
| | - Kang-Jun Yoon
- Department of Neurosurgery, St. Peter's Hospital, Seoul 135-809, Republic of Korea
| | - Sang-Soo Ha
- Department of Neurosurgery, St. Peter's Hospital, Seoul 135-809, Republic of Korea
| |
Collapse
|
24
|
Contralateral Sublaminar Endoscopic Approach for Removal of Lumbar Juxtafacet Cysts Using Percutaneous Biportal Endoscopic Surgery: Technical Report and Preliminary Results. World Neurosurg 2019; 122:474-479. [DOI: 10.1016/j.wneu.2018.11.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/23/2022]
|
25
|
An JW, Lee CW. Surgical Treatment of Extra-Foraminal Gas Containing Pseudocyst Compressing L5 Nerve Root by Using Unilateral Biportal Endosopy: A Case Report. World Neurosurg 2019; 124:145-150. [PMID: 30659964 DOI: 10.1016/j.wneu.2018.12.186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022]
Abstract
BACKGOUND Most gaseous lumbar pseudocysts have been previously reported to be located in the spinal canal and successfully treated by several therapeutic methods. By comparison, a gas containing pseudocyst in lumbar extra-foraminal area is very rare. Here, the authors report a case of symptomatic gas containing cyst located in lumbar foramen. It was successfully treated with unilateral biportal endoscopic (UBE) surgery. CASE DESCRIPTION a 75-year-old man presented with severe left leg pain and tingling sensation refractory to conservative treatment that aggravated with weight bearing and position change. Computed tomography and magnetic resonance imaging showed a gas containing cyst compressing the left L5 nerve root ganglion in the foramina area at L5-S1 level. Gaseous extra-foraminal pseudocyst was successfully removed by UBE surgery via para-spinal approach. Vivid and clear endoscopic operative imaging of pseudocyst in detail was obtained during operation. The patient's symptom was significantly improved after the operation. CONCLUSIONS Gas containing pseudocyst in lumbar foraminal area is not common. Combined use of pre-operative MRI and CT can help diagnose gaseous pseudocyst and differentiate other pathologies. UBE technique which provides good operative visualization and delicate operative manipulation is a less invasive therapeutic method to treat foraminal gas containing pseudocyst.
Collapse
Affiliation(s)
- Jin-Woo An
- Department of Orthopedic Surgery, Bur-Team Hospital, Suwon, Korea
| | - Chul-Woo Lee
- Department of Neurosurgery, St. Peter's Hospital, Seoul, Korea.
| |
Collapse
|
26
|
The Usefulness of Percutaneous Endoscopic Technique in Multifocal Lumbar Pathology. BIOMED RESEARCH INTERNATIONAL 2019; 2019:9528102. [PMID: 30719454 PMCID: PMC6335722 DOI: 10.1155/2019/9528102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 12/18/2018] [Indexed: 12/30/2022]
Abstract
Introduction. The multifocal lumbar pathology including disc herniation and stenosis in the spinal canal or foramen has been considered the most difficult to approach surgically. It often requires mandatory dual approaches and/or fusion techniques. Traditional percutaneous endoscopic lumbar transforaminal and interlaminar approach has been focused on unifocal disc herniation. However, the development of endoscopic spinal instruments and surgical technique has broadened surgical indication and therapeutic boundary in endoscopic spine surgery. Cases Presentation. The authors present outcomes of four patients with multilumbar pathology including highly inferior migrated disc combined with lateral recess stenosis, multifocal disc herniation, bilateral disc herniations in spinal canal and foraminal disc herniation combined with central canal stenosis. They were successfully treated by percutaneous uniportal full endoscopic approach with single incision. Conclusion. Percutaneous endoscopic spine surgery is a safe and effective tool to figure out multilumbar pathology in a minimal invasive way.
Collapse
|
27
|
Lee CH, Choi M, Ryu DS, Choi I, Kim CH, Kim HS, Sohn MJ. Efficacy and Safety of Full-endoscopic Decompression via Interlaminar Approach for Central or Lateral Recess Spinal Stenosis of the Lumbar Spine: A Meta-analysis. Spine (Phila Pa 1976) 2018; 43:1756-1764. [PMID: 29794584 DOI: 10.1097/brs.0000000000002708] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A meta-analysis of five retrospective cohort studies. OBJECTIVE The aim of the study was to delineate the efficacy and safety of full-endoscopic decompression via the interlaminar approach for central or lateral recess spinal stenosis of the lumbar spine using a meta-analysis. SUMMARY OF BACKGROUND DATA The paradigm of spinal endoscopy is shifting from treatment of soft disc herniation to that of lumbar spinal stenosis. Technical advancements have enabled full-endoscopic decompression in spinal stenosis surgery. There is few strong evidence supporting this surgical technique, and clinicians usually rely on their own opinions and experiences. METHODS A systematic search of electronic databases, including PubMed, EMBASE, Cochrane Library, Web of science, and KoreaMed, up to August 2017 was performed to identify studies concerning full-endoscopic decompression via the interlaminar approach for lumbar spinal stenosis. Changes in clinical outcomes [Oswestry Disability Index (ODI) and Visual Analog Scales (VAS) for back and leg pain] were compared with the minimal clinically important difference (MCID) for each item. We then calculated the mean differences and 95% confidence intervals (95% CIs) using random-effects models. RESULTS We included data from five studies involving 156 patients at 6- and 12-month follow-ups. The majority of enrolled papers included patients with neurogenic claudication due to central stenosis refractory to conservative management and excluded patients with significant instability or previous surgery. The overall mean difference of patients with ODI and VAS scores for leg and back pain exceeded the criteria for MCID. ODI scores improved by 41.71 (95% CI, 39.80-43.62) after the surgery, which was twice the MCID. The VAS leg and back pain scores improved by 5.95 (95% CI, 5.70-6.21) and 4.22 (95% CI, 3.88-4.56), respectively, indicating statistically significant improvement over the MCID. CONCLUSION Successful clinical outcomes can be achieved with full-endoscopic decompression via the interlaminar approach for lumbar central spinal stenosis in patients for the defined indications. LEVEL OF EVIDENCE 2.
Collapse
Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul, the Republic of Korea
| | - Miyoung Choi
- National Evidence Based Healthcare Collaborating Agency (NECA), Seoul, the Republic of Korea
| | - Dal Sung Ryu
- Department of Neurosurgery, Inha University Hospital, College of Medicine, Inha University, Incheon, the Republic of Korea
| | - Il Choi
- Department of Neurological Surgery, Dongtan Sacred Heart Hospital, University of Hallym University, Hwaseong, the Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, the Republic of Korea.,Department of Neurosurgery, Seoul National University College of Medicine, Seoul, the Republic of Korea.,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, the Republic of Korea.,Clinical Research Institute, Seoul National University Hospital, Seoul, the Republic of Korea
| | - Hyeun Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, the Republic of Korea
| | - Moon-Jun Sohn
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine.,Neuroscience & Radiosurgery Hybrid Research Center, Inje University College of Medicine, Goyang, the Republic of Korea
| |
Collapse
|
28
|
Akbary K, Kim JS, Park CW, Jun SG, Hwang JH. Biportal Endoscopic Decompression of Exiting and Traversing Nerve Roots Through a Single Interlaminar Window Using a Contralateral Approach: Technical Feasibilities and Morphometric Changes of the Lumbar Canal and Foramen. World Neurosurg 2018; 117:153-161. [PMID: 29857220 DOI: 10.1016/j.wneu.2018.05.111] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/15/2018] [Accepted: 05/16/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Endoscopic surgery for lumbar stenosis is gaining acceptance because of the minimal muscle damage, short recovery times, reduced blood loss, and good clinical results. We report a novel technique of decompressing contralateral traversing and exiting nerve roots through a single interlaminar window, avoiding separate incision for foraminal decompression with minimal damage to facet joints and comparing morphometric changes after decompression. METHODS Between March and December 2017, 30 patients were evaluated retrospectively for clinical, radiologic, and morphometric outcomes. Patients with unilateral radiculopathy and magnetic resonance imaging (MRI) showing spinal stenosis at 2 levels (lateral recess and cranial level foraminal compression) were included. Clinical evaluation used a numerical rating scale (NRS) for leg pain and Oswestry Disability Index (ODI) scores, and radiologic evaluation used MRI. For morphometric analysis, the cross-sectional area of the intervertebral foramen (CSA-IVF), spinal canal (CSAC), and facet joint (CSA-FJ) was measured on MRI. RESULTS Thirty levels were decompressed (no adverse events). NRS leg pain and ODI scores improved from 7.5 ± 0.86 and 67.9 ± 9.7 preoperatively to 1.53 ± 0.86 and 15.7 ± 6.6 at last follow-up, respectively. CSAC improved from 99.34 ± 34.01 to 186.83 ± 41.41, indicating good canal decompression. CSA-IVF improved from 56.40 ± 19.28 to 97.60 ± 28.46, indicating good foraminal decompression. CSA-FJ improved from 231.37 ± 62.53 to 194.96 ± 50.56, indicating good foraminal decompression with less damage to facet joint. Morphometric changes were statistically significant (P < 0.05). CONCLUSIONS Biportal endoscopic decompression of the lateral recess and cranial foramen through a single interlaminar window can be performed using a contralateral approach. In view of the good clinical and radiologic outcomes of patients, with notable improvements in morphometric measurements at stenosed segments, this surgical technique is worthy of further evaluation and application.
Collapse
Affiliation(s)
- Kutbuddin Akbary
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea; Seoul St. Marýs Hospital, Spine Centre, Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Seoul St. Marýs Hospital, Spine Centre, Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Cheul Woong Park
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea.
| | - Su Gi Jun
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea
| | - Jae Ha Hwang
- Department of Neurosurgery, Daejeon Woori Hospital, Daejeon, South Korea
| |
Collapse
|