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Du Q, Wang ZJ, Zheng HD, Wang SF, Cao GR, Xin ZJ, Zhang MB, Kong WJ, Liao WB. Anterior percutaneous full-endoscopic transcorporeal decompression for cervical disc herniation: a finite element analysis and long-term follow-up study. BMC Musculoskelet Disord 2024; 25:639. [PMID: 39134982 PMCID: PMC11321056 DOI: 10.1186/s12891-024-07754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 08/01/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the long-term consequences on the cervical spine after Anterior transcorporeal percutaneous endoscopy cervical discectomy (ATc-PECD) from the biomechanical standpoint. METHODS A three-dimensional model of the normal cervical spine C2-T1 was established using finite element method. Subsequently, a disc degeneration model and degeneration with surgery model were constructed on the basis of the normal model. The same loading conditions were applied to simulate flexion, extension, lateral bending and axial rotation of the cervical spine. We calculated the cervical range of motion (ROM), intradiscal pressure, and intravertebral body pressure under different motions for observing changes in cervical spine biomechanics after surgery. At the same time, we combined the results of a long-term follow-up of the ATc-PECD, and used imaging methods to measure vertebral and disc height and cervical mobility, the Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to assess pain relief and neurological functional recovery. RESULTS The long-term follow-up results revealed that preoperative JOA score, neck VAS score, hand VAS score, IDH, VBH, and ROM for patients were 9.49 ± 2.16, 6.34 ± 1.68, 5.14 ± 1.48, 5.95 ± 0.22 mm, 15.41 ± 1.68 mm, and 52.46 ± 9.36° respectively. It changed to 15.71 ± 1.13 (P < 0.05), 1.02 ± 0.82 (P < 0.05), 0.77 ± 0.76 (P < 0.05), 4.73 ± 0.26 mm (P < 0.05), 13.67 ± 1.48 mm (P < 0.05), and 59.26 ± 6.72° (P < 0.05), respectively, at 6 years postoperatively. Finite element analysis showed that after establishing the cervical spondylosis model, the overall motion range for flexion, extension, lateral bending, and rotation decreased by 3.298°, 0.753°, 3.852°, and 1.131° respectively. Conversely, after establishing the bone tunnel model, the motion range for these actions increased by 0.843°, 0.65°, 0.278°, and 0.488° respectively, consistent with the follow-up results. Moreover, analysis of segmental motion changes revealed that the increased cervical spine mobility was primarily contributed by the surgical model segments. Additionally, the finite element model demonstrated that bone tunneling could lead to increased stress within the vertebral bodies and intervertebral discs of the surgical segments. CONCLUSIONS Long-term follow-up studies have shown that ATc-PECD has good clinical efficacy and that ATc-PECD can be used as a complementary method for CDH treatment. The FEM demonstrated that ATc-PECD can lead to increased internal stresses in the vertebral body and intervertebral discs of the operated segments, which is directly related to cervical spine degeneration after ATc-PECD.
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Affiliation(s)
- Qian Du
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, China
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, ZunYi, 563000, China
| | - Zheng-Ji Wang
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, China
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, ZunYi, 563000, China
| | - Hai-Dong Zheng
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, China
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, ZunYi, 563000, China
| | - Shu-Fa Wang
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, China
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, ZunYi, 563000, China
| | - Guang-Ru Cao
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, China
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, ZunYi, 563000, China
| | - Zhi-Jun Xin
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, China
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, ZunYi, 563000, China
| | - Min-Bo Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, China
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, ZunYi, 563000, China
| | - Wei-Jun Kong
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, China.
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, ZunYi, 563000, China.
| | - Wen-Bo Liao
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, ZunYi, 563000, China.
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, ZunYi, 563000, China.
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Nishikawa M, Naito K, Yoshimura M, Yamagata T, Iseda K, Hara M, Ikuno H, Ohata K, Goto T. Application and Advantages of the Trans-Unco-Discal (TUD) Approach for Cervical Spondylotic Myelopathy and Radiculopathy: Classification and Modification of Surgical Technique Based on the Location of Spinal Cord and/or Nerve Root Compression. J Clin Med 2024; 13:2666. [PMID: 38731195 PMCID: PMC11084969 DOI: 10.3390/jcm13092666] [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: 03/03/2024] [Revised: 04/15/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Purpose: We assess the application and advantages of modifying the trans-unco-discal (TUD) approach which we underwent for cervical myelo-radiculopathy. We present the surgical techniques of the modified TUD approach. Materials and Methods: The material was 180 cases where anterior cervical decompression (ACD) was performed by the modified TUD approach. We classified the material into four groups based on the location of the nerve root and/or spinal cord compression: I, compression of the root at intervertebral foramen (IVF); II, compression of the posterior margin of the vertebral body; III, compression of the IVF and posterior margin of the vertebral body; IV, compression of the bilateral IVF and posterior margin of the vertebral body. We applied the modified TUD approach to these four types. We present the surgical procedures and techniques for the modified TUD approach. The Japanese orthopedic association (JOA) score and neuroradiological alignment were examined. Results: The improvement rate of the JOA score was 78.4% at 6 months post-surgery and 77.5% in the most recent examinations. By the modified TUD approach, compressive lesions of the spinal cord and/or nerve roots were removed, and good alignment was acquired and sustained. Conclusions: ACD by the modified TUD approach safely achieved appropriate decompression for the spinal cord and/or nerve roots, and the patients had a high improvement rate and good alignment. Complications were less common than with other surgical procedures. If the TUD approach and endoscopic approaches can be combined, their application to new area is anticipated.
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Affiliation(s)
- Misao Nishikawa
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, 6-17-33 Satanakamachi, Moriguchi City 570-0002, Osaka, Japan; (T.Y.); (K.I.)
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8595, Osaka, Japan; (K.N.); (T.G.)
| | - Kentaro Naito
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8595, Osaka, Japan; (K.N.); (T.G.)
| | - Masaki Yoshimura
- Department of Neuropathology, Yao Tokusyukai General Hospital, 1-17, Wakakusacho, Yao City 581-0011, Osaka, Japan;
| | - Toru Yamagata
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, 6-17-33 Satanakamachi, Moriguchi City 570-0002, Osaka, Japan; (T.Y.); (K.I.)
| | - Keiichi Iseda
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, 6-17-33 Satanakamachi, Moriguchi City 570-0002, Osaka, Japan; (T.Y.); (K.I.)
| | - Mitsuhiro Hara
- Department of Neurology, Moriguchi-Ikuno Memorial Hospital, 6-17-33 Satanakamachi, Moriguchi City 570-0002, Osaka, Japan;
| | - Hiromichi Ikuno
- Department of Neuroradiology, Moriguchi-Ikuno Memorial Hospital, 6-17-33 Satanakamachi, Moriguchi City 570-0002, Osaka, Japan;
| | - Kenji Ohata
- Department of Neurosurgery, Naniwa-Ikuno Hospital, 1-10-3 Daikoku Naniwa-ku, Osaka 556-0014, Osaka, Japan;
| | - Takeo Goto
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8595, Osaka, Japan; (K.N.); (T.G.)
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Su H, Wang ZJ, He W, Xin ZJ, Du Q, Kong WJ, Liao WB. Anterior Percutaneous Full-Endoscopic Transcorporeal with Single-Incision Treatment for Noncontiguous 2-Level Cervical Disc Herniation: Technical Report and Early Follow-Up. World Neurosurg 2024; 185:115-125. [PMID: 38237801 DOI: 10.1016/j.wneu.2023.11.083] [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: 11/04/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 03/11/2024]
Abstract
BACKGROUND Noncontiguous 2-level cervical disc herniation (NCT-CDH) is a common condition that often requires surgical intervention. In this study, we developed a surgical approach for the treatment of NCT-CDH using anterior percutaneous full-endoscopic single incision through the vertebral body. We provide a brief overview of its safety, efficacy, and feasibility, along with a description of our relevant surgical experience. METHODS A retrospective study was conducted, involving 30 patients who were followed up for at least 12 months. Preoperative and postoperative visual analog scale, Japanese Orthopedic Association scores, Nurick scores, intervertebral disc height, and modified Macnab criteria were recorded. Patients underwent regular radiological evaluations throughout the follow-up period. RESULTS Postoperative computed tomography, magnetic resonance imaging, and X-ray examinations revealed bone tunnel healing, intact drilled vertebral bodies without collapse, adequate decompression of the spinal canal, and normal cervical mobility. There was a significant improvement in postoperative visual analog scale, Japanese Orthopedic Association scores, Nurick scores, and modified Macnab criteria compared to the preoperative values (P < 0.05). CONCLUSIONS Our study revealed that the anterior percutaneous full-endoscopic transcorporeal with single-incision treatment for NCT-CDH is a safe and feasible surgical method. Therefore, it can be considered as a viable treatment option for patients with NCT-CDH.
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Affiliation(s)
- Heng Su
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zheng-Ji Wang
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen He
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhi-Jun Xin
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qian Du
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wei-Jun Kong
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen-Bo Liao
- Department of Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, Guizhou, China.
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Andreão FF, Maia M, Sousa MP, Mancilha MDS, de Barros Oliveira L, Quadros DG, Serra MV. Letter to the Editor Regarding "Anterior Percutaneous Full-Endoscopic Transcorporeal with Single-Incision Treatment for Noncontiguous 2-Level Cervical Disc Herniation: Technical Report and Early Follow-Up". World Neurosurg 2024; 185:459-460. [PMID: 38741302 DOI: 10.1016/j.wneu.2024.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Filipi Fim Andreão
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Matheus Maia
- State University of Pará, Santarém, Para, Brazil
| | - Marcelo Porto Sousa
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Chen G, Xin Z, Kong W, Wu F, Li X, Qiao Y, Yan X, Liao W. Anterior Full-endoscopic Single-port Double Transcorporeal Spinal Cord Decompression for Noncontinuous Two-segment Cervical Spondylotic Myelopathy: A Technical Note. Orthop Surg 2024; 16:754-765. [PMID: 38287224 PMCID: PMC10925512 DOI: 10.1111/os.13988] [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: 06/03/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE In clinical practice, noncontinuous two-segment spinal cord cervical spondylosis is a particular form of cervical degenerative disease. Traditional anterior open surgery frequently comes with severe trauma, risks, and debatable treatment options. This study aimed to describe for the first time a novel minimally invasive technique, namely, anterior full-endoscopic single-port double transcorporeal spinal cord decompression for the treatment of patients with noncontinuous two-segment cervical spondylotic myelopathy. METHOD From February 2020 to May 2021, five patients with noncontinuous two-segment cervical spondylotic myelopathy were treated with anterior full-endoscopic single-port double transcorporeal spinal cord decompression. Two bone channels were established by the trephine through the vertebral body oblique upward and downward to the herniated disc osteophyte complex, and the full-endoscopic system could decompress the spinal cord through the channels. All cases were followed up for over 2 years. The modified Japanese Orthopaedic Association (mJOA) score and visual analogue scale (VAS) score before and after operation and during follow-up were used to evaluate the clinical effectiveness. Radiological examinations, including CT and MRI, were utilized to evaluate the efficacy of spinal cord decompression and bone channel repair. RESULTS All operations were successfully completed and the average operation time was 185 min, with no operation-related complications. Compared with the preoperative evaluation, the mJOA score and VAS score were improved at each time point after operation and follow-up. Postoperative CT and MRI scans showed that the intervertebral disc-osteophyte complex was removed through the vertebral bone passage, and the spinal cord was fully decompressed. After 24 months of follow-up, CT and MRI scans showed that the bone channel was almost repaired and healed. CONCLUSION Anterior full-endoscopic single-port double transcorporeal spinal cord decompression is an effective minimally invasive technique for noncontinuous two-segment cervical spondylosis. It provides precise and satisfactory spinal cord decompression under endoscopic visualization with minimum trauma.
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Affiliation(s)
- Gang Chen
- Department of OrthopedicsThe Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Zhijun Xin
- Department of Orthopedic SurgeryThe Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Weijun Kong
- Department of OrthopedicsThe Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Fujun Wu
- Department of Orthopedic SurgeryThe Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Xuyan Li
- Department of Orthopedic SurgeryThe Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Yanyu Qiao
- Department of OrthopedicsThe Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Xiang Yan
- Department of OrthopedicsThe Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Wenbo Liao
- Department of OrthopedicsThe Second Affiliated Hospital of Zunyi Medical UniversityZunyiChina
- Department of Orthopedic SurgeryThe Affiliated Hospital of Zunyi Medical UniversityZunyiChina
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Ye S, Li DL, Kong WJ, Xin ZJ, Ao J, Liao WB, Du Q. Surgical Essentials and 2-Year Follow-Up Results of Channel Repair in Endoscopic Transcorporeal Discectomy for Cervical Disc Herniation. World Neurosurg 2024; 182:e755-e763. [PMID: 38097167 DOI: 10.1016/j.wneu.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To evaluate long-term outcomes and surgical essentials of channel repair in endoscopic transcorporeal discectomy for cervical disc herniation. METHODS From October 2019 to March 2020, 24 patients with cervical disc herniation underwent channel repair after percutaneous full-endoscopic anterior transcorporeal cervical discectomy. Five interventions were performed at C3-C4, 11 were performed at C4-C5, and 8 were performed at C5-C6. Clinical outcomes were evaluated by Neck Disability Index, Japanese Orthopaedic Association, and visual analog scale scores. Radiologic changes were evaluated with intervertebral disc height and drilled vertebral height. RESULTS All procedures were completed with a mean operating time of 86.40 ± 8.19 minutes. Swollen neck was observed in 5 patients, which resolved within 2 hours. At the final follow-up, Neck Disability Index, Japanese Orthopaedic Association, and visual analog scale scores were improved significantly compared with preoperative assessments (P < 0.05); intervertebral disc height was decreased significantly (P < 0.05); and loss of drilled vertebral height was not significant (P > 0.05). All 24 bony channels disappeared by 3 months postoperatively. No other complications were observed. CONCLUSIONS Percutaneous full-endoscopic anterior transcorporeal cervical discectomy with channel repair offers a minimally invasive and effective treatment option for patients with cervical disc herniation. This technique demonstrates favorable clinical outcomes, including preservation of cervical spine mobility and minimal complications. Although there was a significant loss of intervertebral disc height, no vertebral collapse occurred. Strict adherence to surgical indications and precautions is crucial for successful outcomes. Further research and long-term studies are required to validate the efficacy and safety of this approach in a larger patient population.
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Affiliation(s)
- Sheng Ye
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - De-Li Li
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wei-Jun Kong
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; Department of Orthopaedic Surgery, Zunyi Hospital of Traditional Chinese Medicine, Zunyi, Guizhou, China
| | - Zhi-Jun Xin
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jun Ao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen-Bo Liao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qian Du
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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Li J, Ao J, Hu X, Du Q, Qin J, Ji WJ, Xin Z, Liao W. Percutaneous Fully-endoscopic Anterior Transcorporeal Procedure for the Treatment of Isolated Ossification of the Posterior Longitudinal Ligament in the Cervical Spine: A Case Report. Orthop Surg 2024; 16:514-520. [PMID: 38111022 PMCID: PMC10834199 DOI: 10.1111/os.13966] [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: 02/17/2023] [Revised: 11/04/2023] [Accepted: 11/16/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND With the development of spinal endoscopic techniques, on the basis of our previous experience in treating various types of cervical disc herniation with this endoscopic technique, we took the lead in applying the percutaneous fully endoscopic anterior transcorporeal procedure to be utilized in the treatment of the isolated cervical ossification of the posterior longitudinal ligament (OPLL). CASE PRESENTATION A 66-year-old male patient who weighed 57 kg, with a height of 169 cm was admitted to the hospital on September 16, 2021 because of recurrent pain and numbness in the neck, shoulder, and right arm for 2 years, which as aggravated for the last 2 weeks. Two years ago, the patient developed neck and shoulder pain accompanied by right arm pain without obvious predisposing factors, and numbness in the first web space of the right hand. In the last 2 weeks, he had difficulty moving the right arm, but no pain or numbness in the contralateral arm. MRI and CT scans demonstrated that the ossified posterior longitudinal ligament of the cervical 5/6 vertebrae with spinal canal stenosis and seriously compressed the spinal cord patient was treated with a percutaneous fully endoscopic anterior transcorporeal procedure. CONCLUSION Our percutaneous fully endoscopic anterior transcorporeal procedure is a feasible, minimally invasive surgery for treating isolated ossification of the posterior longitudinal ligament in the cervical spine.
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Affiliation(s)
- Jin Li
- Department of OrthopaedicsAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Jun Ao
- Department of OrthopaedicsAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Xiaolin Hu
- Department of OrthopaedicsAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Qian Du
- Department of OrthopaedicsAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Jianpu Qin
- Department of OrthopaedicsAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Wen Jun Ji
- Department of OrthopaedicsAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Zhijun Xin
- Department of OrthopaedicsAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Wenbo Liao
- Department of OrthopaedicsAffiliated Hospital of Zunyi Medical UniversityZunyiChina
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Wang ZJ, Du Q, Wang SF, Su H, He W, Liao WB, Xin ZJ, Kong WJ. Anterior transcorporeal approach combined with posterior translaminar approach in percutaneous endoscopic cervical discectomy for two-segment cervical disc herniation treatment: a technical report and early follow-up. J Orthop Surg Res 2024; 19:3. [PMID: 38167157 PMCID: PMC10763675 DOI: 10.1186/s13018-023-04471-4] [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: 08/26/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Full endoscopic techniques are being gradually introduced from single-segment cervical disc herniation surgery to two-segment cervical disc herniation surgery. However, there is no suitable full endoscopic treatment for mixed-type two-segment cervical disc herniation (MTCDH) in which one segment herniates in front of the spinal cord and the other segment herniates behind the spinal cord. Therefore, we introduce a new full endoscopic technique by combining an anterior transcorporeal approach and a posterior translaminar approach. In addition, we provide a brief description of its safety, efficacy, feasibility, and surgical points. METHODS Thirty patients with MTCDH were given full endoscopic surgical treatment by a combined transcorporeal and transforaminal approach and were followed up for at least 12 months. RESULTS Clinical assessment scales showed that the patient's symptoms and pain were significantly reduced postoperatively. Imaging results showed bony repair of the surgically induced bone defect and the cervical Cobb angle was increased. No serious complications occurred. CONCLUSION This technique enables minimally invasive surgery to relieve the compression of the spinal cord by MTCDH. It avoids the fusion of the vertebral body for internal fixation, preserves the vertebral motion segments, avoids medical destruction of the cervical disc to the greatest extent possible, and expands the scope of adaptation of full endoscopic technology in cervical surgery.
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Affiliation(s)
- Zheng-Ji Wang
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qian Du
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Shu-Fa Wang
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Heng Su
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen He
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen-Bo Liao
- Orthopedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
| | - Zhi-Jun Xin
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wei-Jun Kong
- The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, Guizhou, China
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He W, Du Q, Wang ZJ, Xin ZJ, Wu FJ, Kong WJ, Su H, Liao WB. Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord via one vertebra with two bony channels for adjacent two-segment cervical spondylotic myelopathy: a technical note. BMC Musculoskelet Disord 2023; 24:844. [PMID: 37884962 PMCID: PMC10601313 DOI: 10.1186/s12891-023-06978-7] [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: 07/30/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The current treatments for adjacent two-segment cervical spondylotic myelopathy (CSM) include two-segment anterior cervical discectomy and fusion (ACDF) and single-segment anterior cervical corpectomy and fusion (ACCF). Long-term follow-up has demonstrated that both procedures have complications such as reduced cervical mobility, accelerated degeneration of adjacent segments and loosening of internal fixation screws. The purpose of this study is to demonstrate the feasibility, safety, and efficacy of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) via one vertebra with two bony channels for the treatment of adjacent two-segment CSM and to present our surgical experience. METHODS Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) via one vertebra with two bony channels was performed for 12 patients with adjacent two-segment CSM with follow-up care for at least 12 months. The Visual analog scale (VAS) and the Japanese Orthopedic Association Score (JOA) were recorded, and modified Macnab criteria were used to evaluate the treatment excellence rate. Radiological examinations, including X-ray, computed tomography (CT) and magnetic resonance imaging (MRI), were used to evaluate spinal cord decompression, intervertebral stability and healing of the bony channel. RESULTS All 12 patients completed the operation successfully. No postoperative complications, such as dysphagia, Horner's syndrome, or laryngeal recurrent nerve palsy, were found. The postoperative VAS and JOA scores were significantly improved compared with those before surgery(P < 0.001). According to the modified Macnab criteria, the clinical outcome was excellent in 8 cases, good in 3 cases and fine in 1 case at the final follow-up and the excellent and good rate was 91.7%. Postoperative and follow-up imaging showed significant spinal cord decompression, well-healed bony channels and no cervical instability. CONCLUSIONS This study is the first report of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord via one vertebra with two bony channels. This procedure has the advantages of less trauma, faster recovery, fewer complications and no need to implant internal fixators. This is a minimally invasive, feasible and safe surgical procedure for patients with adjacent two-segment CSM.
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Affiliation(s)
- Wen He
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Qian Du
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zheng-Ji Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zhi-Jun Xin
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Fu-Jun Wu
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wei-Jun Kong
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Heng Su
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen-Bo Liao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
- Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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Ma Y, Xin Z, Kong W, Zhang L, Du Q, Liao W. Transcorporeal decompression using a fully-endoscopic anterior cervical approach to treat cervical spondylotic myelopathy: surgical design and clinical application. BMC Musculoskelet Disord 2022; 23:1031. [PMID: 36451136 PMCID: PMC9710048 DOI: 10.1186/s12891-022-06001-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is a common procedure for treating cervical spondylotic myelopathy (CSM), however, ACDF may cause pseudoarthrosis, accelerated degeneration of adjacent segments, loss of activity of fused segments and other complications. The full-endoscopic technique can treat CSM, without the aforementioned complications above. Therefore, it is of great clinical value to investigate the surgical scheme of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC). METHODS A total of 28 cases with single-segment Cervical spondylotic myelopathy (CSM) from April 2017 to July 2019 were involved in this study. The size of the disc-osteophyte complex was measured using imaging data prior to the operation. The diameter and direction of the bony passage was determined according to the size and central position of the complex, respectively. Twenty-eight patients underwent the above scheme for CSM. The clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores. The imaging assessment included MRI, CT and X-rays. RESULTS The diameter of the designed bony passage was about 6.9 mm, and directed toward the lower edge of the diseased lower vertebral body oblique to the center of the disc-osteophyte complex. All patients successfully completed the operation. The postoperative neck pain VAS and JOA were significantly improved compared to preoperative values (p < 0.01). Postoperative MRI indicated complete decompression of the spinal cord. CT scanning 1 year after the operation revealed an almost healed bony passage and X-ray imaging showed satisfactory physiological curvature of the cervical spine, without cervical instability. CONCLUSION Based on the diameter and direction of the bony passage, as determined by the size and position of the disc-osteophyte complex, indicated by MRI and CT scanning, anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord offers good decompression of the spinal cord and ensures excellent therapeutic outcome.
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Affiliation(s)
- Yanyan Ma
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China ,Rehabilitation Department, Guizhou Provincial Orthopedics Hospital, Sixian street, Guiyang, 550007 China
| | - Zhijun Xin
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China
| | - Weijun Kong
- grid.413390.c0000 0004 1757 6938Orthopaedics, The Second Affiliated Hospital of Zunyi Medical University, Intersection between Xinpu Avenue and Xinlong Avenue, Zunyi, 563006 China
| | - Longsheng Zhang
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China
| | - Qian Du
- grid.413390.c0000 0004 1757 6938Orthopaedics, The Second Affiliated Hospital of Zunyi Medical University, Intersection between Xinpu Avenue and Xinlong Avenue, Zunyi, 563006 China
| | - Wenbo Liao
- grid.413390.c0000 0004 1757 6938Department of Spinal Surgery, The Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563099 Guizhou China
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Alomar SA, Maghrabi Y, Baeesa SS, Alves ÓL. Outcome of Anterior and Posterior Endoscopic Procedures for Cervical Radiculopathy Due to Degenerative Disk Disease: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1546-1560. [PMID: 34402323 PMCID: PMC9393995 DOI: 10.1177/21925682211037270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES Cervical spine endoscopic discectomy and decompression have gained popularity in the last decade. This review aimed to shed light on the current outcomes of cervical spine endoscopic procedures for degenerative disc disease (DDD) and to calculate a pooled estimate of various outcome measures. METHODS We retrieved articles published in English related to endoscopic cervical spine procedures from 3 central databases from inception until September 2020. A subgroup analysis based on the anterior versus the posterior approach was performed. RESULTS Thirty-one articles fulfilled the eligibility criteria and included 1,410 patients. A successful outcome was observed in 91.3% (88.6-93.4%, P = 0.000). This percentage was lower for the anterior approach (89.6% [85.8-92.5%], P = 0.000) than for the posterior approach (94.2% [90.4-96.5%], P = 0.000). A higher percentage of poor outcomes was reported for the anterior approach (5.7% [3.2-10.1%], P = 0.000 vs. 2.3% [1-5.5%], P = 0.000 for the posterior approach). The overall complication rate was 7.2% (5.2-9.8%, P = 0.000). There was a slightly higher complication rate for the anterior approach (7.9% [4.5-13.3%], P = 0.000) than for the posterior approach (6.7% [4.4-10%], P = 0.000). The revision rate was 4.2% (2.6-6.8%, P = 0.000); and 4.2% (1.8-9.7%, P = 0.000) for the anterior approach and 4.00% (2.2-7.4%, P = 0.000) for the posterior approach. CONCLUSIONS There is a higher success rate and lower complication rate with the posterior approach than with the anterior approach. However, high-quality randomized controlled trials are vital to evaluate the efficacy of these procedures.
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Affiliation(s)
- Soha A. Alomar
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yazid Maghrabi
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saleh S. Baeesa
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,Saleh S. Baeesa, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Óscar L. Alves
- Centro Hospitalar De Gaia, Hospital Lusíadas Porto, Porto, Portugal
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A Novel Technique of Endoscopic Anterior Transcorporeal Approach with Channel Repair for Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion. World Neurosurg 2021; 154:109-116. [PMID: 34280535 DOI: 10.1016/j.wneu.2021.07.038] [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: 04/21/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To first report the application of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) with channel repair for a patient with adjacent segment disease (ASD) after anterior cervical discectomy and fusion. METHODS PEATCD with channel repair was performed for a patient with ASD at the cranial level adjacent to previous fusion at the C5-C6 level. The pre- and postoperative clinical symptoms were evaluated with Japanese Orthopedic Association and visual analog scale (VAS). The radiological examinations included magnetic resonance imaging, computed tomography, and plain radiographs, which were used to evaluate the cervical alignment, stability, intraoperative decompression, and bony channel. RESULTS The procedure was successfully completed within 70 minutes. The drainage tube was unnecessary. No surgery-related complications were recorded. The postoperative neck pain immediately improved to VAS 3 from preoperative VAS 6. The Japanese Orthopedic Association scores also took a turn for the better gradually from preoperative 10 to final 16 (improvement rate 85.7%). The muscle power recovered completely, and the Hoffman sign turned to negative during follow-up periods. Magnetic resonance imaging 1 week postoperatively showed a total removal of the herniation. The bony channel was almost disappeared on computed tomography images 3 months postoperatively. During postoperative periods, no relapse, channel collapse, bone plug migration, or instability was observed. CONCLUSION As a novel and supplemental procedure for ASD after anterior cervical discectomy and fusion, PEATCD combines the advantages of transcorporeal approach and endoscopy together, which decreases iatrogenic damage to disc, preserves the cervical motion segment, and reduces surgical trauma. As the limitations of 1 case show, the effectiveness and reliability of PEATCD for patients with ASD should be verified in further studies.
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Yu Y, Jiang Y, Xu F, Mao Y, Yuan L, Li C. Percutaneous Full-Endoscopic C2 Ganglionectomy for the Treatment of Intractable Occipital Neuralgia: Technical Note. Oper Neurosurg (Hagerstown) 2021; 21:E472-E478. [PMID: 34195836 DOI: 10.1093/ons/opab228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/03/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The C-2 dorsal root ganglionectomy procedure can provide effective treatment for intractable occipital neuralgia (ON). However, the traditional microsurgery of C2 ganglionectomy needs a wide incision and significant paraspinous muscle dissection for adequate visualization. The indications of endoscopic spine surgery are ever expanding, with the development of endoscopic armamentaria and technological innovations. OBJECTIVE To validate the feasibility of the approach and describe several operative nuances based on the authors' experience. In this paper, the authors describe a patient with intractable ON who was successfully treated with a percutaneous full-endoscopic C2 ganglionectomy. METHODS We describe the case of an 83-yr-old female with a 2-yr history of left ON who did not respond to a series of treatments, including physical therapy, drug therapy, injection therapy, and radiofrequency therapy. After careful examination, we performed a percutaneous, full-endoscopic left C2 ganglionectomy. RESULTS The patient was successfully treated with a percutaneous full-endoscopic ganglionectomy. Afterwards, her intractable and constant pain was relieved. There was no cerebrospinal fluid leakage, incision infection, neck deformity, or other complications. CONCLUSION C2 ganglionectomy can be accomplished successfully using a full-endoscopic uniportal surgical technique under continuous irrigation, which has the advantages of excellent illumination and visualization, reduced surgery-related trauma, and reduced bleeding.
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Affiliation(s)
- Yong Yu
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ye Jiang
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Fulin Xu
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Yuhang Mao
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Lutao Yuan
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Chen Li
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, China
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于 庆, 邓 瑞, 石 磊, 楚 磊, 程 昀, 晏 铮, 柯 珍, 邓 忠. [Posterior percutaneous endoscopy via vertical anchor technique combined with trench technique for single-segmental central cervical disc herniation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:579-585. [PMID: 33998211 PMCID: PMC8175194 DOI: 10.7507/1002-1892.202101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the clinical feasibility, safety, and effectiveness of posterior percutaneous endoscopy via vertical anchor technique combined with trench technique for single-segmental central cervical disc herniation. METHODS Between July 2017 and August 2019, 13 patients with the single-segmental central cervical disc herniation suffering from various neurologic deficits were treated with posterior percutaneous endoscopy via vertical anchor technique combined with trench technique. There were 6 males and 7 females with an average age of 50.5 years (range, 43-64 years). Disease duration ranged from 3 to 17 months (mean, 9.2 months). The clinical symptoms of 5 cases were mainly neck pain, radiculopathy, and numbness in upper limbs, and the visual analogue scale (VAS) score was 6.60±0.55. The clinical symptoms of 8 cases were myelopathy including upper extremities numbness, weakness, and trouble walking, and the modified Japanese Orthopedic Association (mJOA) score was 12.75±0.71. The surgery-related complications, operation time, and intraoperative blood loss were recorded, and the results of clinical symptoms were measured by VAS scores and mJOA scores. RESULTS All procedures were completed successfully, no severe complications such as dural tears or cerebrospinal fluid leakage occurred. The operation time ranged from 83 to 164 minutes (mean, 101.2 minutes). The intraoperative blood loss was 25-50 mL (mean, 33.1 mL). After operation, 12 of 13 cases were followed up 10-24 months (mean, 17.6 months). The VAS scores of patients with preoperative pain symptoms were 2.40±0.55 on the first day after operation and 1.80±0.45 at last follow-up, which were significantly lower than those before operation ( P<0.05). The mJOA scores of patients with the symptoms of spinal cord injury were 12.63±0.52 on the first day after operation and 14.29±0.95 at last follow-up, and the score at last follow-up was significantly higher than that before operation ( P<0.05). Acute extremities weakness occurred for the postoperative hematoma formation in 1 case (disc herniation at C 4, 5) presented with myelopathy preoperatively, and muscle strength was recovered after the clearance of hematoma and spinal cord decompression under percutaneous endoscopy. CONCLUSION Posterior percutaneous endoscopy via vertical anchor technique and trench technique for single-segmental central cervical disc herniation was clinical feasible, safe, and effective, and could be an alternative approach to the treatment of central cervical disc herniation.
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Affiliation(s)
- 庆帅 于
- 重庆医科大学附属第二医院骨科-脊柱外科中心(重庆 400010)Department of Orthopedics-Spine Surgery Center, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - 瑞 邓
- 重庆医科大学附属第二医院骨科-脊柱外科中心(重庆 400010)Department of Orthopedics-Spine Surgery Center, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - 磊 石
- 重庆医科大学附属第二医院骨科-脊柱外科中心(重庆 400010)Department of Orthopedics-Spine Surgery Center, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - 磊 楚
- 重庆医科大学附属第二医院骨科-脊柱外科中心(重庆 400010)Department of Orthopedics-Spine Surgery Center, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - 昀 程
- 重庆医科大学附属第二医院骨科-脊柱外科中心(重庆 400010)Department of Orthopedics-Spine Surgery Center, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - 铮剑 晏
- 重庆医科大学附属第二医院骨科-脊柱外科中心(重庆 400010)Department of Orthopedics-Spine Surgery Center, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - 珍勇 柯
- 重庆医科大学附属第二医院骨科-脊柱外科中心(重庆 400010)Department of Orthopedics-Spine Surgery Center, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
| | - 忠良 邓
- 重庆医科大学附属第二医院骨科-脊柱外科中心(重庆 400010)Department of Orthopedics-Spine Surgery Center, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China
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Yu T, Wu JP, Zhang J, Yu HC, Liu QY. Comparative evaluation of posterior percutaneous endoscopy cervical discectomy using a 3.7 mm endoscope and a 6.9 mm endoscope for cervical disc herniation: a retrospective comparative cohort study. BMC Musculoskelet Disord 2021; 22:131. [PMID: 33530967 PMCID: PMC7856779 DOI: 10.1186/s12891-021-03980-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/14/2021] [Indexed: 11/12/2022] Open
Abstract
Background Posterior percutaneous endoscopy cervical discectomy (p-PECD) is an effective strategy for the treatment of cervical diseases, with a working cannula ranging from 3.7 mm to 6.9 mm in diameter. However, to date, no studies have been performed to compare the clinical outcomes of the use of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of patients with unilateral CDH treated with p-PECD using a 3.7 mm endoscope and a 6.9 mm endoscope. Methods From January 2016 to June 2018, a total of 28 consecutive patients with single-level CDH who received p-PECD using either the 3.7 mm or the 6.9 mm endoscope were enrolled. The clinical results, including the surgical duration, hospitalization, visual analog scale (VAS) score and modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were also performed during follow-up. Results Tthere was a significant difference in regard to the average identification time of the “V” point (18.608 ± 3.7607 min vs. 11.256 ± 2.7161 min, p < 0.001) and the mean removal time of the overlying tissue (16.650 ± 4.1730 min vs. 12.712 ± 3.3079 min, p < 0.05) for the use of the 3.7 mm endoscope and the 6.9 mm endoscope, respectively. The postoperative VAS and MacNab scores of the two endoscopes were significantly improved compared with those the preoperative scores (p < 0.05). Conclusion The application of both the 3.7 mm endoscope and 6.9 mm endoscope represent an effective method for the treatment of CDH in selected patients, and no significant difference can be observed in the clinical outcomes of the endoscopes. The 6.9 mm endoscope shows superiority to the 3.7 mm endoscope in terms of the efficiency of “V” point identification, the removal of overlying soft tissue and the prevention of spinal cord injury. However, the 6.9 mm endoscope may be inferior to the 3.7 mm endoscope in regards to anterior foraminal decompression due to its large diameter; this result needs to be further evaluated with the support of a large number of randomized controlled trials.
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Affiliation(s)
- Tong Yu
- Department of orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jiu-Ping Wu
- Department of orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jun Zhang
- Department of orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Hai-Chi Yu
- Department of orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Qin-Yi Liu
- Department of orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
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Bilateral translaminar osseous-channel assisted percutaneous full-endoscopic ligamentectomy decompression for thoracic myelopathy due to ossification of the ligamentum flavum: a technical note. Wideochir Inne Tech Maloinwazyjne 2020; 16:429-441. [PMID: 34136042 PMCID: PMC8193760 DOI: 10.5114/wiitm.2020.100719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction A variety of surgical procedures have been introduced to treat patients with thoracic myelopathy (TM) caused by ossification of the ligamentum flavum (OLF). However, they are accompanied by significant trauma and risk, and their surgical outcomes are not always satisfactory. Aim To describe a bilateral translaminar osseous-channel assisted posterior percutaneous full-endoscopic ligamentectomy decompression (p-PELD) technique as a novel minimally invasive procedure for treating patients with TM due to OLF. Material and methods A 51-year-old female patient with persistent thoracolumbar back pain and progressive numbness in the bilateral lower extremities for 2 years underwent percutaneous vertebroplasty (PVP) for T11 osteoporotic compression fractures (OCF) in a regional hospital one week prior to hospitalization. TM caused by canal stenosis and dorsal spinal cord compression at T10/11 secondary to OLF and an OCF at T11 were diagnosed based on clinical presentations and radiologic examinations. After bilateral p-PELD for TM was performed at T10/11, the result was confirmed based on postoperative radiographic and clinical results. Results The bilateral OLF was completely removed by the p-PELD technique. No complications were encountered, and her symptoms were sufficiently improved after surgery. The VAS score was 6 points preoperatively and decreased to 0 points at the last follow-up (24 months). The modified Japanese Orthopaedic Association (mJOA) score improved from 2 points preoperatively to 10 points at the final follow-up. Conclusions As a minimally invasive technique, the bilateral translaminar osseous-channel assisted p-PELD procedure provided precise and sufficient decompression for the treatment of OLF-related TM.
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Jiang Z, Wang A, Wang C, Kong W. Analysis of compliance and efficacy of integrated management of whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation. J Orthop Surg Res 2020; 15:381. [PMID: 32887632 PMCID: PMC7650293 DOI: 10.1186/s13018-020-01920-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 08/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Percutaneous spinal endoscopy is a new type of surgery for the treatment of cervical disc herniation. It can avoid the complications of the classic anterior cervical discectomy and fusion (ACDF) approach and the risk of adjacent spondylosis. How can we effectively improve patients’ awareness of spinal endoscopy and their election of endoscopic techniques? Objective To analyze the compliance and clinical effect of the integrated management of the whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation. Methods Retrospective analysis of 72 patients with cervical disc herniation undergoing surgery in our hospital from August 2015–August 2017 was performed. The whole-process integrated management model was used for all the patients. The 36 patients in the experimental group were treated by percutaneous full-endoscopic cervical discectomy, and the 36 patients in the control group were treated by ACDF. The postoperative feeding time, time to get out of bed, length of hospital stay, compliance, clinical efficacy, and recurrence rate of neck pain were observed. Changes between the preoperative and postoperative pain visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed. Results The postoperative feeding time in the experimental group was 8.319 ± 1.374 h, the postoperative time to get out of bed was 16.64 ± 3.728 h, and the hospitalization time was 6.403 ± 0.735 days. The excellent and good clinical efficacy rate was 91.67%, the compliance rate was 88.89%, and the neck pain recurrence rate was 5.56%. The postoperative feeding time in the control group was 26.56 ± 9.512 h, the postoperative time to get out of bed was 45.06 ± 9.027 h, and the length of hospital stay was 8.208 ± 0.865 days. The excellent and good clinical efficacy rate was 88.89%, the compliance rate was 69.4%, and the neck pain recurrence rate was 8.33%. There was no significant difference between the two groups in the excellent efficacy rate and the neck pain recurrence rate, p > 0.05. The compliance rate in the experimental group was better than that in the control group, and the difference was statistically significant, p < 0.05. The hospitalization time of the experimental group was significantly lower than that of the control group, and the difference was statistically significant, p < 0.05. The postoperative VAS scores and JOA scores of the two groups were significantly better than the preoperative scores, and the difference was statistically significant, p < 0.05; there was no significant difference between the two groups, p > 0.05. Conclusion The integrated management of the whole course can effectively improve the compliance of patients with cervical disc herniation receiving endoscopic treatment, yield the same treatment effect as the classic operation, shorten the hospitalization time, speed up the turnover of hospital beds, and improve satisfaction with medical quality and is worthy of clinical application.
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Affiliation(s)
- Zhongyan Jiang
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China
| | - Ansu Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China
| | - Chong Wang
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China
| | - Weijun Kong
- Department of Orthopedics Surgery, Affiliated Hospital of Zunyi Medical University, No.149 Dalian Road, Zunyi, 563000, Guizhou, China. .,Department of Orthopedics Surgery, The Second Affiliated Hospital of Zunyi Medical University, No.1 Xinpu Road, Zunyi, 563000, Guizhou, China.
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杨 俊, 楚 磊, 邓 忠, Kai-Xuan L, 邓 锐, 陈 浩, 刘 鹏, 刘 团, 荣 雪, 郝 定. [Clinical study of single-level cervical disc herniation treated by full-endoscopic decompression via anterior transcorporeal approach]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:543-549. [PMID: 32410418 PMCID: PMC8171849 DOI: 10.7507/1002-1892.201905118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 02/27/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach. METHODS According to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C 3, 4 in 2 cases, C 4, 5 in 8 cases, C 5, 6 in 9 cases, and C 6, 7 in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated. RESULTS Full-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation ( P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one ( t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation ( t=0.881, P=0.421). CONCLUSION Full-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results.
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Affiliation(s)
- 俊松 杨
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 磊 楚
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 忠良 邓
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - Liu Kai-Xuan
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 锐 邓
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 浩 陈
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 鹏 刘
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 团江 刘
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 雪芹 荣
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 定均 郝
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
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Apostolakis S. Transcorporeal Tunnel Approach for Cervical Radiculopathy and Myelopathy: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 138:318-327. [PMID: 32217171 DOI: 10.1016/j.wneu.2020.03.082] [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: 01/06/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The transcorporeal tunnel approach is a relatively new alternative of anterior cervical decompression and fusion for the treatment of cervical radiculopathy and myelopathy, with its main presumed advantage being the preservation of the intervertebral space. The aim of the present article is to present the outcomes of the systematic review and meta-analysis regarding the short-term outcomes of this surgical technique. METHODS A systematic review and a meta-analysis using the random-effects method of the available studies were performed to assess the safety and efficiency of the transcorporeal tunnel approach for cervical radiculopathy and myelopathy. RESULTS In total, 15 eligible studies were identified, with a cumulative number of 254 patients. Pooled data yielded a complication rate of 0.053 and a failure rate of the technique of 0.081; a patient-reported favorable outcome of 0.94 was documented. The available data did not allow for a definite conclusion on the effects of the technique on the intervertebral space height. CONCLUSIONS Although technically challenging, like all minimally invasive methods, the transcorporeal tunnel approach seems to be a safe and efficient option for the treatment of cervical radiculopathy and myelopathy, presenting comparable outcome profiles to alternative open or less invasive techniques.
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20
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Degenerative cervical myelopathy: Recent updates and future directions. J Clin Orthop Trauma 2020; 11:822-829. [PMID: 32879568 PMCID: PMC7452218 DOI: 10.1016/j.jcot.2020.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
Advances in patient selection, surgical techniques, and postoperative care have facilitated spine surgeons to manage complex spine cases with shorter operative times, reduced hospital stay and improved outcomes. We focus this article on a few areas which have shown maximum developments in management of degenerative cervical myelopathy and also throw a glimpse into the future ahead. Imaging modalities, surgical decision making, robotics and neuro-navigation, minimally invasive spinal surgery, motion preservation, use of biologics are few of them. Through this review article, we hope to provide the readers with an insight into the present state of art in cervical myelopathy and what the future has in store for us.
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Kong W, Xin Z, Du Q, Cao G, Liao W. Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord for single-segment cervical spondylotic myelopathy: The technical interpretation and 2 years of clinical follow-up. J Orthop Surg Res 2019; 14:461. [PMID: 31870395 PMCID: PMC6929378 DOI: 10.1186/s13018-019-1474-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/14/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND ACDF is the standard procedure for treatment of cervical spondylotic myelopathy (CSM), but a long-term follow-up has been revealed some associated complications of swallowing discomfort, displacement of the fusion device, and accelerated degeneration of the adjacent segment. OBJECTIVE To evaluate the clinical outcomes of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) for single-segment CSM and to analyze the clinical efficacy, surgical characteristics, and complication prevention. METHODS A total of 32 patients who underwent APFETDSC for single-segment CSM from Aug. 2015 to Apr. 2017 were reviewed. Operating time, time of walking out of bed postoperation, length of hospitalization, complications, neck pain visual analog scale (VAS), and Japanese Orthopaedic Association Score (JOA) were evaluated. Measurement of intervertebral height (HI) of surgical segments on cervical neutral X-ray, Harrison's method was used to measure cervical spine angle (CSA). RESULTS The operation time was 103.3 ± 12.95 min, time of walking out of bed after surgery was 19.81 ± 4.603 h, the length of postoperative hospital stay was 57.48 ± 19.48 h. The postoperative neck pain VAS and JOA were significantly improved compared with preoperation(p < 0.001). The postoperative HI was statistical significance decreased compared with preoperation(p < 0.001), but the HI reduction was less than 0.5 mm, without adverse clinical symptoms. The postoperative CSA was significantly improved compared with preoperative(p < 0.001). The excellent and good rate was 87.5%, and the JOA improvement rate was 75.52 ± 11.11%. There was no cervical instability, vertebral fracture, wound infection, and other complications. CONCLUSIONS APFETDSC is a safe and effective minimally invasive technique with small auxiliary injuries for single-segment CSM while avoiding the sequelae of ACDF. Its short-term clinical efficacy was good and no significant effect on cervical stability.
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Affiliation(s)
- Weijun Kong
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
| | - Zhijun Xin
- Department of Spine Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, 563000 Guizhou China
| | - Qian Du
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
| | - Guangru Cao
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
| | - Wenbo Liao
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
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Li C, Tang X, Chen S, Meng Y, Zhang W. Clinical application of large channel endoscopic decompression in posterior cervical spine disorders. BMC Musculoskelet Disord 2019; 20:548. [PMID: 31739780 PMCID: PMC6862807 DOI: 10.1186/s12891-019-2920-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/30/2019] [Indexed: 11/17/2022] Open
Abstract
Background We investigated the clinical value of posterior percutaneous endoscopic decompression (PED) for single-segment cervical spondylotic myelopathy (CSM) and cervical spondylotic radiculopathy (CSR). Methods: Clinical data from February 2016 to March 2018 were collected for 32 patients with single-segment CSM or CSR who underwent posterior cervical percutaneous large channel endoscopic decompression and completed a regular follow-up exam at 12 months after surgery. Patient data included: age (range 30–81 years and mean of 49.5 years) and surgical information (operation time, bleeding volume, hospital stay, complications, etc.). The Japan Orthopedic Association (JOA) score and pain visual analog scale (VAS) were used to evaluate the surgical outcome for each patient. Cervical spine radiographs were used to evaluate cervical curvature (Cervical spondylotic angle (CSA), C2–7 Cobb angle) and CT and MRI were used to assess the extent of laminectomy and nerve root decompression. The JOA score, VAS score, cervical curvature were analyzed statistically, and the clinical outcome was evaluated using modified Macnab criteria at the last patient follow-up exam. Results The JOA and VAS scores were compared before and after surgery (1 day Pre-op; 3 days, 3 months and 12 months Post-op). The differences were statistically significant (P < 0.05). There were significant differences in cervical curvature (C2–7 Cobb angle) between the time points (1 day Pre-op; 3 days, 3 months and 12 months Post-op), but the differences were no statistically significant in CSA angle (P < 0.05) The operation time range was 45–110 min (mean 68.6 ± 23.8 min); the intraoperative blood loss range was 20–85 ml (mean28 ± 14.8 ml), and the hospital stay was 3–8 days (mean4.5 days). At the last follow-up, the clinical efficacy was evaluated using modified Macnab criteria. The results were excellent in 18 cases, good in 11 cases, and fair in 3 cases. The combined excellent and good rate was 93.75%. Postoperative CT and MRI showed that the compression of the spinal cord or nerve roots was completely relieved. Conclusion Endoscopic decompression of posterior cervical vertebral disorders is a safe, effective, and minimally invasive surgical procedure with rapid recovery times. This procedure warrants additional research and clinical application.
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Affiliation(s)
- Chengli Li
- Department of Spine surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.,Department of orthopaedics, Yantai Affiliated Hospital of Binzhou Medical College, Yantai, 264100, Shandong Province, China
| | - Xiaojie Tang
- Department of orthopaedics, Yantai Affiliated Hospital of Binzhou Medical College, Yantai, 264100, Shandong Province, China
| | - Song Chen
- Department of Spine surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yongchun Meng
- Department of orthopaedics, Yantai Affiliated Hospital of Binzhou Medical College, Yantai, 264100, Shandong Province, China
| | - Wei Zhang
- Department of Spine surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
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Percutaneous Full-Endoscopic Anterior Transcorporeal Diskectomy for Massive Migrated Cervical Disk Herniation Treatment: Case Report and Review of the Literature. World Neurosurg 2019; 132:47-52. [PMID: 31442650 DOI: 10.1016/j.wneu.2019.08.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND With the continuous advancement of the spinal endoscopic technique in recent years, full-endoscopic operations provide a new approach for the treatment of migrated cervical disk herniation. CASE DESCRIPTION A 42-year-old man presented with nuchal pain and limb numbness for 2 months, with recently developed symptoms of unstable walking. Physical examination revealed a diminished skin sensitivity to pain and temperature, beginning at the C4 dermatome. The muscle strength of both upper limbs decreased to grade 4, and the muscle strength was grade 4 on both sides of the lower limbs. Hoffmann sign and ankle clonus were positive. Magnetic resonance imaging (MRI) and computed tomography (CT) scan demonstrated that a large piece of a segmental disk had migrated to the rear area of the C4 vertebral body and seriously compressed the spinal cord. A percutaneous full-endoscopic anterior transcorporeal cervical diskectomy was performed on the patient. CONCLUSIONS The postoperative Japanese Orthopaedic Association (JOA) score increased from 8 to 11 points. At 2-year follow-up, the JOA score was 16 points, the improvement rate was 88.9%, and cervical vertebrae MRI, cervical CT scan, and 3-dimensional reconstruction showed that the cervical vertebrae channel healed without vertebral fractures, bony channel collapse, adjacent segment degeneration, or intervertebral space height.
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Du Q, Lei LQ, Cao GR, Kong WJ, Ao J, Wang X, Wang AS, Liao WB. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy and channel repair: a technique note report. BMC Musculoskelet Disord 2019; 20:280. [PMID: 31182078 PMCID: PMC6558825 DOI: 10.1186/s12891-019-2659-0] [Citation(s) in RCA: 9] [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: 10/12/2018] [Accepted: 05/29/2019] [Indexed: 11/11/2022] Open
Abstract
Background Compared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). But surgical field and manipulation in traditional ATH was restricted by the narrow channel. Percutaneous full-endoscopic transdiscal cervical discectomy is a minimally invasive and functional spine surgery. However, significant loss of intervertebral disc height was inevitable. This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH). Methods Four patients with CDH were chosen to undergo PEATCD and CR with a follow-up care for at least 22 months. The visual analogue score (VAS), Japanese Orthopedic Association (JOA), and modified Macnab criteria were recorded during the postoperative periods. CT images were obtained to observe the healing of the channel at 1 week and 3 months after the operation. Results The average operating time was 83.75 min. Drainage tubes were unnecessary. No procedure-related complications occurred. The postoperative VAS and JOA scores were improved compared to those of the preoperative assessment. The clinical efficacy was excellent in 3 patients and good in 1 patient at final follow up stage according to the modified Macnab criteria. The hernia was removed completely in all patients according to postoperative MRI. Migration of the repair implementation and collapse of the drilled vertebrae were not observed during the postoperative periods. The bony channel was nearly absent on CT images obtained at 3 months postoperative. Conclusion This is the first time that the anterior transcorporeal cervical discectomy and CR have been performed simultaneously under endoscopy. Less damage to disc and the retained cervical motion segment were achieved through this method. This is a feasible, safe, and minimally invasive procedure. Trial registration Numbers: ChiCTR1800016383. Registered 29 may 2018. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry. Electronic supplementary material The online version of this article (10.1186/s12891-019-2659-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qian Du
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Lan-Qiong Lei
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Guan-Ru Cao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Wei-Jun Kong
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Jun Ao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Xin Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, 4059, Australia.,Translational Research Institute, School of Medicine, University of Queensland, Brisbane, Queensland, 4102, Australia
| | - An-Su Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China.,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China
| | - Wen-Bo Liao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, 563000, Guizhou, China. .,Joint Orthopaedic Research Center of Zunyi Medical University & University of Rochester Medical Center (JCMR-ZMU & URMC), Zunyi Medical University, Zunyi, 563000, Guizhou, China.
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Hasan S, Härtl R, Hofstetter CP. The benefit zone of full-endoscopic spine surgery. JOURNAL OF SPINE SURGERY 2019; 5:S41-S56. [PMID: 31380492 DOI: 10.21037/jss.2019.04.19] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Minimally invasive spine procedures have undergone rapid development during the last decade. Efforts to decrease muscle crush injuries during prolonged retraction, avoid significant soft tissue stripping and minimize bony resection are surgical principles that are employed to prevent iatrogenic instability and provide patients with decreased post-operative pain and disability. Full-endoscopic spine surgery represents a tool for the spine surgeon to provide targeted access to spinal pathology utilizing these principles. Endoscopic techniques have seen over 30 years of evolution and innovation, however, early iterations of these techniques largely focused on transforaminal lumbar microdiscectomies. Currently, endoscopic techniques are utilized for approaching pathology in the cervical, thoracic and lumbar spine. There has been a growing body of literature that not only confirms the efficacy of these procedures but also underscores the advantages these procedures offer with respect to less morbidity and safer complication profiles. Endoscopic decompressions have been utilized in the settings of degenerative spinal stenosis, spondylolisthesis, scoliosis, previous fusion, tumor and infection. Furthermore, endoscopic interbody fusion has also been utilized in the lumbar spine as technology continues to advance. As technological innovation continues to facilitate reproducible surgical technique and expand the indications for use, we believe that endoscopic spine surgical techniques will provide surgeons with a more powerful and less morbid approach to spinal pathology that ultimately elevates the standard of care when treating our patients. We present a brief review of the history of endoscopic spine surgery, an overview of current techniques and review current outcomes of endoscopic spine surgical procedures in the context of an invasiveness/complexity index to elucidate the benefit zone of these newer techniques.
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Affiliation(s)
- Saqib Hasan
- Department of Neurological Surgery, The University of Washington - Seattle, Seattle, WA, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital, New York, NY, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, The University of Washington - Seattle, Seattle, WA, USA
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Okazaki T, Nakagawa H, Mure H, Yagi K, Hayase H, Takagi Y, Saito K. Microdiscectomy and Foraminotomy in Cervical Spondylotic Myelopathy and Radiculopathy. Neurol Med Chir (Tokyo) 2018; 58:468-476. [PMID: 30298831 PMCID: PMC6236210 DOI: 10.2176/nmc.oa.2018-0077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study was to assess the efficacy of microdiscectomy, cage fixation, and right tranuncal foramintomy for the patients suffering from right radiulo-myelopathy. Anterior cervical foraminotomy was reported to be an effective option for the treatment of cervical degenerative radiculopathy but with the problem of recurrence. Since Hakuba reported the method of trans-unco-discal approach in 1976, it was designed as keyhole foraminotomy which was called transuncal approach, transpedicular approach or transvertebral approach. In the anterior approach, we usually use the right-sided approach because most of us are right-handed surgeons. We retrospectively investigated our patients who had the right foraminal stenosis causing radiculopathy and were treated with microdiscectomy, cage fixation, and right keyhole transuncal foraminotomy. Since 2011, 23 patients were treated with the manner. All of the 23 patients who had central canal stenosis and among the 23 patients, 8 patients showed only right radiculopathy and 15 patients showed radiculo-myelopathy. In all patients, the radiculopathy disappeared or significantly improved without any complications postoperatively. The average of VAS scores was 7.6 ± 2.2 in preoperative state, 2.8 ± 2.2 at discharge, and 1.1 ± 1.6 in 1 month after surgery. The average of follow-up time was 38.3 months and they had no recurrence of radiculopathy. We showed that this manner is effective and one option for the combined disease of right foraminal and canal stenosis and we believe that this manner is not complex and safe if we can understand the anatomy.
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Affiliation(s)
- Toshiyuki Okazaki
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital.,Department of Neurosurgery, Tokushima University
| | | | - Hideo Mure
- Department of Neurosurgery, Tokushima University
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School
| | - Hitoshi Hayase
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | | | - Koji Saito
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
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Du Q, Wang X, Qin JP, Kong WJ, Cai YQ, Ao J, Friis T, Xu H, Liao WB. In Reply to the Letter to the Editor Regarding "Percutaneous Full-Endoscopic Anterior Transcorporeal Procedure for Cervical Disc Herniation: A Novel Procedure and Early Follow-Up Study". World Neurosurg 2018; 118:386. [PMID: 30248814 DOI: 10.1016/j.wneu.2018.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Qian Du
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xin Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Translational Research Institute, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jian-Pu Qin
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wei-Jun Kong
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yu-Qiang Cai
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jun Ao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Thor Friis
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hao Xu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wen-Bo Liao
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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Parihar VS, Yadav N, Ratre S, Dubey A, Yadav YR. Endoscopic Anterior Approach for Cervical Disc Disease (Disc Preserving Surgery). World Neurosurg 2018; 115:e599-e609. [PMID: 29702310 DOI: 10.1016/j.wneu.2018.04.107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To report our experience of endoscopic disc removal by anterior approach for management of cervical myelopathy in 210 patients. METHODS A retrospective study of 187 cases of single- and 23 cases of double-level disc disease was performed. Cases of myelopathy with or without unilateral or bilateral radiculopathy and unilateral radiculopathy with either soft or hard disc prolapse were included. Patients with ≥3 disc levels, unstable spine, infections, trauma, significant posterior compression, congenital canal stenosis, disc extending more than half the vertebral body height, and prior surgery at the same level were excluded. RESULTS C5-6 (n = 119 patients), C6-7 (n = 58 patients), C4-5 (n = 49 patients), C3-4 (n = 6 patients), and C2-3 (n = 1 patient) levels were represented. Visual analog scale and Nurick grading system were used to assess severity of neck and arm pain and functional outcomes, respectively. Preoperative mean visual analog scale scores for arm and neck pain were 6.7 and 3.2, respectively, which improved to 1.7 and 1.1 at 3 months after surgery. The average preoperative Nurick grade improved from 2.64 to 0.81 at 6 months postoperatively. Follow-up was 6-54 months. CONCLUSIONS Endoscopic anterior discectomy (disc preserving surgery) is an effective and safe alternative in cervical disc disease. Although there was reduction in disc height, clinical outcome was good at an average 29 months of follow-up. Long-term follow-up is required to assess any progressive disc degeneration and clinical results.
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Affiliation(s)
- Vijay Singh Parihar
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Nishtha Yadav
- Department of Radiology and Imaging, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Shailendra Ratre
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Amitesh Dubey
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Yad Ram Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India.
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