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Choi SJ, Kang DWD, Ham CH, Kim JH, Kwon WK. Full endoscopic surgery for calcium pyrophosphate deposition disease (CPPD) in the cervical ligamentum flavum: report of two cervical myelopathy cases. Acta Neurochir (Wien) 2024; 166:185. [PMID: 38639798 DOI: 10.1007/s00701-024-06080-4] [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: 03/26/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
Calcium pyrophosphate deposition disease (CPPD), known as pseudogout, is characterized by the accumulation of calcium pyrophosphate crystals in musculoskeletal structures, primarily joints. While CPPD commonly affects various joints, involvement in the cervical spine leading to myelopathy is rare. Surgical intervention becomes necessary when conservative measures fail, but reports on full endoscopic surgeries are extremely rare. We present two successful cases where full endoscopic systems were used for CPPD removal in the cervical spine. The surgical technique involved a full endoscopic approach, adapting the previously reported technique for unilateral laminotomy bilateral decompression. Full-endoscopic removal of cervical CPPD inducing myelopathy were successfully removed with good clinical and radiologic outcomes. The scarcity of endoscopic cases for cervical ligamentum flavum CPPD is attributed to the condition's rarity. However, our successful cases advocate for endoscopic surgery as a potential primary treatment option for CPPD-induced cervical myelopathy, especially in elderly patients or those with previous cervical operation histories. This experience encourages the consideration of endoscopic surgery for managing cervical ligamentum flavum CPPD as a viable alternative.
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Affiliation(s)
- Seung Jin Choi
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | | | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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Chien KT, Chen YC, Chang TK, Liu YC, Chen LP, Huang YC, Lian YS, Li JY. Novel Cervical Endoscopic Unilateral Laminoforaminotomy for Bilateral Decompression in Cervical Spondylosis Myeloradiculopathy: A Technical Note and Clinical Results. J Clin Med 2024; 13:1910. [PMID: 38610675 PMCID: PMC11012691 DOI: 10.3390/jcm13071910] [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: 01/24/2024] [Revised: 03/05/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open
Abstract
Background: This study investigates the efficacy of the Cervical Endoscopic Unilateral Laminoforaminotomy for Bilateral Decompression (CE-ULFBD) technique in treating cervical myeloradiculopathy, primarily caused by degenerative spondylosis. Traditionally managed through multisegmental anterior cervical discectomy and fusion (ACDF) or laminoplasty combined with foraminotomy, this condition has recently experienced a promising shift towards minimally invasive approaches, particularly endoscopic spinal decompression. While empirical evidence is still emerging, these techniques show potential for effective treatment. Method: The objective was to evaluate the outcomes of CE-ULFBD in achieving single or multilevel bilateral foraminal and central decompression, emphasizing the reduction of injury to posterior cervical muscles and the associated postoperative neck soreness common in conventional procedures. This paper delineates the surgical procedures involved in CE-ULFBD and presents the clinical outcomes of nine patients diagnosed with myeloradiculopathy due to severe cervical stenosis. Result: Assessments were conducted using the Visual Analogue Scale (VAS) for neck and arm pain and the Modified Japanese Orthopaedic Association scale (mJOA) for the activity measurement of daily living. Results indicated a considerable decrease in pain levels according to the VAS, coupled with significant improvements in functional capacities as measured by the mJOA scale. Additionally, no major postoperative complications were noted during the follow-up period. Conclusion: The study concludes that CE-ULFBD is a safe and effective approach for the treatment of cervical myeloradiculopathy resulting from severe cervical stenosis, offering a viable and less invasive alternative to traditional decompressive surgeries.
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Affiliation(s)
- Kai-Ting Chien
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
- Institute of Applied Arts, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Yu-Cheng Chen
- Department of Medical Education, MacKay Memorial Hospital, Taipei 104217, Taiwan
| | - Ting-Kuo Chang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
- Department of Medicine, Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Yueh-Ching Liu
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
| | - Lei-Po Chen
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
- Department of Medicine, Mackay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City 252, Taiwan
| | - Yu-Ching Huang
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
| | - Yan-Shiang Lian
- Department of Orthopaedic Surgery, MacKay Memorial Hospital, Taipei 104217, Taiwan; (K.-T.C.)
| | - Jian-You Li
- Institute of Applied Arts, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
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Kwon H, Park JY. The Role and Future of Endoscopic Spine Surgery: A Narrative Review. Neurospine 2023; 20:43-55. [PMID: 37016853 PMCID: PMC10080412 DOI: 10.14245/ns.2346236.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
Many types of surgeries are changing from conventional to minimally invasive techniques. Techniques in spine surgery have also changed, with endoscopic spine surgery (ESS) becoming a major surgical technique. Although ESS has advantages such as less soft tissue dissection and normal structure damage, reduced blood loss, less epidural scarring, reduced hospital stay, and earlier functional recovery, it is not possible to replace all spine surgery techniques with ESS. ESS was first used for discectomy in the lumbar spine, but the range of ESS has expanded to cover the entire spine, including the cervical and thoracic spine. With improvements in ESS instruments (optics, endoscope, endoscopic drill and shaver, irrigation pump, and multiportal endoscopic), limitations of ESS have gradually decreased, and it is possible to apply ESS to more spine pathologies. ESS currently incorporates new technologies, such as navigation, augmented and virtual reality, robotics, and 3-dimentional and ultraresolution visualization, to innovate and improve outcomes. In this article, we review the history and current status of ESS, and discuss future goals and possibilities for ESS through comparisons with conventional surgical techniques.
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Affiliation(s)
- Hyungjoo Kwon
- Department of Neurosurgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Clinical Consequences of Incidental Durotomy during Full-Endoscopic Lumbar Decompression Surgery in Relation to Intraoperative Epidural Pressure Measurements. J Pers Med 2023; 13:jpm13030381. [PMID: 36983563 PMCID: PMC10052087 DOI: 10.3390/jpm13030381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
Background: Seizures, neurological deficits, bradycardia, and, in the worst cases, cardiac arrest may occur following incidental durotomy during routine lumbar endoscopy. Therefore, we set out to measure the intraoperative epidural pressure during lumbar endoscopic decompression surgery. Methods: We conducted a retrospective observational cohort study to obtain intraoperative epidural measurements with an epidural catheter-pressure transducer assembly through the spinal endoscope on 15 patients who underwent lumbar endoscopic decompression of symptomatic lumbar herniated discs and spinal stenosis. The endoscopic interlaminar technique was employed. Results: There were six (40.0%) female and nine (60.0%) male patients aged 49.0667 ± 11.31034, ranging from 36 to 72 years, with an average follow-up of 35.15 ± 12.48 months. Three of the fifteen patients had seizures with durotomy and one of these three had intracranial air on their postoperative brain CT. Another patient developed spinal headaches and diplopia on postoperative day one when her deteriorating neurological function was investigated with a brain computed tomography (CT) scan, showing an intraventricular hemorrhage consistent with a Fisher Grade IV subarachnoid hemorrhage. A CT angiogram did not show any abnormalities. Pressure recordings in the epidural space in nine patients ranged from 20 to 29 mm Hg with a mean of 24.33 mm Hg. Conclusion: Most incidental durotomies encountered during lumbar interlaminar endoscopy can be managed without formal repair and supportive care measures. The intradural spread of irrigation fluid and intraoperatively used drugs and air entrapment through an unrecognized durotomy should be suspected if patients deteriorate in the recovery room. Ascending paralysis may cause nausea, vomiting, upper and lower motor neuron symptoms, cranial nerve palsies, hypotension, bradycardia, and respiratory and cardiac arrest. The recovery team should be prepared to manage these complications.
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Posterior Endoscopic Cervical Decompression in Metastatic Cervical Spine Tumors: An Alternative to Palliative Surgery. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202211000-00002. [PMID: 36322577 PMCID: PMC9633083 DOI: 10.5435/jaaosglobal-d-22-00201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/14/2022] [Indexed: 01/24/2023]
Abstract
Metastatic spinal cord compression of the cervical spine is a well-known consequence of cancer that generally manifests as an oncological emergency. This study presents and describes an alternative to the minimally invasive posterior full-endoscopic approach for direct decompression and tumor debulking from the metastasis of hepatocellular carcinoma (HCC) in the cervical spine. A 54-year-old man presented with progressive cervical radiculopathy that had persisted for 3 months. The underlying disease was HCC. Radiographic examination revealed evidence of metastatic spinal cord compression with an epidural mass at the C4-C5 levels, which compressed the C4-C5 spinal cord without bony destruction. The modified Tomita score was 6 to 8 points based on palliative surgery. A posterior full-endoscopic approach to remove the tumor from the metastasis of HCC in the cervical spine was done. A postoperative radiographic study revealed adequate tumor mass resection and spinal decompression. The patient was extremely satisfied with this alternative treatment and achieved complete neurologic recovery at 1 month and no recurrent symptoms at the 6-month follow-up. The technique of posterior full-endoscopic decompression of cervical metastasis causing unilateral radiculopathy, presented in this study, is feasible. This surgical intervention seems to be optional minimally invasive and acts as an alternative to palliative surgery.
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Liu X, Zhu Y. Endoscopic Bilateral Decompression for Cervical Stenosis Caused by Calcification of Ligamentum Flavum Through Unilateral Approach: Technical Note. Clin Spine Surg 2021; 34:183-188. [PMID: 32969868 DOI: 10.1097/bsd.0000000000001071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 08/19/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Technical report. OBJECTIVE The aim was to present a full endoscopic technique for bilateral decompression of cervical stenosis caused by calcification of ligamentum flavum through a unilateral approach. SUMMARY OF BACKGROUND DATA The minimally invasive surgical technique aims to preserve muscle and posterior structures to prevent iatrogenic instability and axial pain. Endoscopic resection of calcification of ligamentum flavum in the cervical spine has shown effectiveness. However, the removal of bilateral calcification lesions through a unilateral approach has been reported as an inadequate and technical demanding method. METHODS The illustrative case showed myelopathy caused by bilateral calcification of ligamentum flavum in the C5/C6 segment. A spinal multichannel endoscope with a rigid rod-lens was used to the operation under saline media. After a laminotomy was performed on the ipsilateral side, both the ipsilateral and the contralateral calcified lesions were resected through the same bone window. RESULTS The patient's hand function and walk ability were found significantly improved the next day after surgery. Complete removal of calcified lesions was confirmed by postoperative imaging studies. CONCLUSIONS Removal of bilateral calcification lesions in the cervical spine through a unilateral approach is possible with a spinal endoscope.
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Affiliation(s)
- Xinchun Liu
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of 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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Kim HS, Wu PH, Jang IT. Current and Future of Endoscopic Spine Surgery: What are the Common Procedures we Have Now and What Lies Ahead? World Neurosurg 2020; 140:642-653. [PMID: 32797991 DOI: 10.1016/j.wneu.2020.03.111] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 11/18/2022]
Abstract
The aging population around the world leads to increasing incidence of degenerative spinal conditions. There is a need for a minimally invasive technique in treatment for spinal conditions to meet the medical complexity and comorbidities that comes with aging. Principles of endoscopy are similar to minimally invasive surgery, which is to decrease pressure on soft tissue crushing from prolonged retraction, avoid soft tissue stripping and dissection, and bone and ligamentous preservation for optimal decompression without excessive destruction. Endoscopic spine surgery techniques started slowly in development in the 1970s to 2000s, with a rapid phase of development since the turn of the 21st century with endoscopic solutions developing in cervical, thoracic, and lumbar conditions with increasing complexity in nature of operation. Technological enhancement with progressively supportive literature is pushing boundaries of endoscopy from the early days of soft tissue procedure to current fusion procedures, endoscopic spine surgery techniques is covering more areas of spine than ever previously possible with good clinical results. We present a review on the current techniques available and postulated near future development for endoscopic spine surgery.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea.
| | - Pang Hung Wu
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea; Department of Orthopaedic Surgery, National University Health System, Jurong Health Campus, Singapore
| | - Il-Tae Jang
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea
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Wilson JR, Badhiwala JH, Moghaddamjou A, Martin AR, Fehlings MG. Degenerative Cervical Myelopathy; A Review of the Latest Advances and Future Directions in Management. Neurospine 2019; 16:494-505. [PMID: 31476852 PMCID: PMC6790745 DOI: 10.14245/ns.1938314.157] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 01/23/2023] Open
Abstract
The assessment, diagnosis, operative and nonoperative management of degenerative cervical myelopathy (DCM) have evolved rapidly over the last 20 years. A clearer understanding of the pathobiology of DCM has led to attempts to develop objective measurements of the severity of myelopathy, including technology such as multiparametric magnetic resonance imaging, biomarkers, and ancillary clinical testing. New pharmacological treatments have the potential to alter the course of surgical outcomes, and greater innovation in surgical techniques have made surgery safer, more effective and less invasive. Future developments for the treatment of DCM will seek to improve the diagnostic accuracy of imaging, improve the objectivity of clinical assessment, and increase the use of surgical technology to ensure the best outcome is achieved for each individual patient.
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Affiliation(s)
- Jamie R.F. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Jetan H. Badhiwala
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Ali Moghaddamjou
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Allan R. Martin
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Spinal Program, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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