Scientific View on Endoscopic Spine Surgery: Can Spinal Endoscopy Become a Mainstream Surgical Tool?

Comparison of one-hole split endoscopic discectomy and microendoscopic discectomy in the treatment of lumbar disk herniation: a one-year retrospective cohort study

BACKGROUND

We aim to compare and assess the surgical parameters and follow-up information of one-hole split endoscopic discectomy (OSE) and microendoscopic discectomy (MED) in the treatment of LDH.

METHODS

This study included 154 patients with degenerative lumbar disk disease. Sixty-eight patients underwent OSE and 86 patients MED. The VAS score for lower back and lower limb radiation pain, ODI score, modified MacNab score, estimated blood loss (EBL), length of the incision, amount of C-reactive protein, and recurrence and complication rates were examined as indicators for clinical outcomes and adverse events.

RESULTS

After surgery, the VAS and ODI scores in the two groups significantly decreased. On the third day after surgery, the VAS and ODI scores of the OSE group were significantly better than those of the MED group. The VAS and ODI scores preoperatively and at 1 month, 3 months, 6 months, and 12 months following the procedure did not substantially vary between the two groups. There was less EBL and a shorter incision with OSE than with MED. There was no significant difference in the rate of complications between the two groups.

CONCLUSION

Compared with MED, OSE is a new alternative option for LDH that can achieve similar and satisfactory clinical outcomes. Furthermore, OSE has many advantages, including less EBL and a smaller incision. Further clinical studies are needed to confirm the effectiveness of OSE.

Applications of navigation in full-endoscopic spine surgery

PURPOSE

Advancement in all surgery continues to progress towards more minimally invasive surgical (MIS) approaches. One of the platform technologies which has helped drive this trend within spine surgery is the development of endoscopy; however, the limited anatomic view experienced when performing endoscopic spine surgery requires a significant learning curve. The use of intraoperative navigation has been adapted for endoscopic spine surgery, as this provides computer-reconstructed visual data presented in three dimensions, which can increase feasibility of this technique to more surgeons.

METHODS

This paper will describe the principles, technical considerations, and applications of stereotactic navigation-guided endoscopic spine surgery.

RESULTS

Full-endoscopic spine surgery has advanced in recent years such that it can be utilized in both decompressive and fusion surgeries. One of the major pitfalls to any minimally invasive surgery (including endoscopic) is that the limited surgical view can often complicate the surgery or confuse the surgeon, leading to longer operative times, higher risks, among others. This is the real utility to using navigation in conjunction with the endoscope-when registered correctly and utilized appropriately, navigated endoscopic spine surgery can take some of the guesswork out of the minimally invasive approach.

CONCLUSIONS

Using navigation with endoscopy in spine surgery can potentially expand this technique to surgeons who have yet to master endoscopy as the assistance provided by the navigation can alleviate some of the complexities with anatomic understanding and surgical planning.

Clinical Efficacy of Interlaminar and Transforaminal Spinal Endoscopy in the Treatment of Lumbar Spinal Stenosis

Purpose

To compare the application effect of interlaminar technique (ILT) and transforaminal technique (TFT) spinal endoscopies in lumbar spinal stenosis (LSS) treatment.

Material and Methods

The data of 46 patients aged 65 years or older diagnosed with LSS between January 2019 and March 2021 were retrospectively reviewed in this study. They underwent ILT (21 patients) or TFT (25 patients) spinal endoscopy surgery, and outcomes were analyzed utilizing the visual analog scale (VAS), Oswestry disability index (ODI), and Japanese orthopedic association (JOA) scale. Lumbar stability was also evaluated using the change in dynamic position X-ray of the spine. We also built three-dimensional (3D) finite element of ILT and TFT spine models and compared them with the stability of the intact spine.

Results

The ILT group had a longer operation time than the TFT group, and patients in ILT and TFT groups had comparable VAS scores for back pain. However, the TFT group had higher VAS scores for leg pain than the ILT group 3, 6 and 12 months postoperatively. The JOA and ODI scores of the 2 groups improved after surgery, and there were statistical differences between the 2 groups at 6 and 12 months follow-up, which proved that functional recovery was better in ILT group. The pre- and postoperative change in dynamic position X-ray of the spine proved that ILT and TFT would not destroy the spine's stability. 3D finite element lumbar spine model analysis also demonstrated this point.

Conclusion

Both ILT and TFT can provide good clinical outcomes; compared with TFT, the ILT approach provided more thorough decompression and was more suitable for treating LSS.

Recent Updates on Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications

A number of minimally invasive spine surgeries (MISSs) have been developed to address the drawbacks of open spine surgery. Their advantages include small skin incisions, reduction in tissue damage, quick recovery, and short hospital stay. However, the clinical outcomes are comparable to open surgery. There was a cap on the number of indications that could be set for all spinal illnesses. The indications for MISSs have been expanding owing to mechanical and technological advances in medical equipment. Thus, this review presents the various MISSs developed to date, surgical indications, surgical techniques, and their advantages and disadvantages.

Microendoscopic Decompression for Lumbar Disc Herniations: An Analysis of Short and Long Term Patient Reported Outcome Measures

INTRODUCTION

Endoscopic spine surgery is increasingly being used, and techniques, platforms, and applications are rapidly evolving. Despite substantial enthusiasm surrounding these techniques, there is a dearth of longer term patient-reported clinical outcomes. Within the United States in particular, there are yet to be reported large cohort studies with a notable follow-up. We sought to characterize the clinical outcomes of patients undergoing microendoscopic decompression (MED) for lumbar disk herniations.

METHODS

The records of patients with symptomatic lumbar disk herniations who underwent MED from May 2018 to February 2021 within a single practice were reviewed. Paired outcomes scores were evaluated using Patient-Reported Outcomes Measurement Information System parameters. Basic perioperative data including length of stay, estimated blood loss, mean opioid use, complication rate, and rate of revision were tabulated. Paired sample Student t-tests and paired Wilcoxon sign tests were used to compare normally distributed and nonparametric data, respectively.

RESULTS

Thirty-five patients with complete paired patient-reported outcome measures data and a minimum 6-month follow-up were included; 65.7% of the patients were male with a mean age of 47.1 years (SE 1.8). The mean follow-up was 590.6 days (SE 47.7). In total, 34 of the 35 patients (97.1%) were discharged on the day of their procedure. The estimated blood loss was <25 mL for each procedure. The mean opioid use after extubation and before discharge was 10.4 morphine milligram equivalents. At the 2-week follow-up, there were notable improvements in pain metrics and global health components. At the final follow-up, nearly all parameters showed notable improvement that exceeded minimally clinical important difference values. For most parameters, preoperative values outside of the "normal" range were within normal limits on postoperative testing.

DISCUSSION

MED resulted in sustained notable improvement in patient-reported outcome measures that exceeded minimally clinical important difference values at the average follow-up approximating 2 years. These findings substantiate the utility of this technique and additional investment in endoscopic spine technology.

DATA AVAILABILITY

Not publicly available; available upon request.

Percutaneous Transforaminal Full-Endoscopic Removal of Neurinoma of the Fifth Lumbar Nerve Root With Intraoperative Neuromonitoring: A Case Report

Background

Technical achievements and surgical techniques improvement contribute to the expansion of the endoscopic spine surgery possibilities. However, today there are few reports about the use of percutaneous endoscopy in spinal tumor surgery. A case of percutaneous transforaminal endoscopic removal of the lumbar spinal nerve tumor with intraoperative neuromonitoring is presented.

Case Description

A 59-year-old female was complaining of a left shin and foot pain, weakness, and paresthesia. Preoperative magnetic resonance imaging (MRI) revealed a tumor (neurinoma) at the left L5-S1 intervertebral foramen. Transforaminal endoscopic removal of an extramedullary tumor from an 8-mm skin incision with intraoperative neuromonitoring was performed. Postoperative MRI revealed the signs of total resection of the tumor.

Conclusion

The presented case confirms that percutaneous endoscopic removal of lumbar spine intraforaminal neurinomas can be safe and effective.

Patient Participation With a Mobile Phone Application for Objective Activity Assessment Before and After Spinal Fusion

Background 

Evolution within spine surgery is driven by a surgeon’s desire for expertise and significant improvement in their patients’ quality of life. As surgeons move away from using subjective patient-reported outcome (PRO) surveys, there must be an alternative objective metric in its place. Modern iPhone (Apple Inc., Cupertino, CA) technology can be used to capture daily activity in a simple, non-user biased manner. These health data can be used to analyze objective functional status in conjunction with PRO surveys to measure surgical outcomes.

Methods 

Patients who underwent an awake transforaminal lumbar interbody fusion (TLIF) between 2014 and 2018 at our institution were identified. Patients were consented and instructed to download the application “QS Access” (Quantified Self Labs, San Francisco, CA). Following data collection, we analyzed the demographic information of patients who were reached to gauge participation and feasibility of data exportation.

Results

A total of 177 patients who underwent an awake TLIF at our institution were contacted. Of those who answered, 41 (44.6%) agreed to participate and 51 (55.4%) declined to participate. When comparing those who either participated or declined, there were no significant differences in age (p=0.145), sex (p=0.589), or ethnicity (p=0.686).

Conclusion 

Our pilot study examined the patient participation in the novel usage of Apple "Health" data, queried from "QS Access" (Quantified Self Labs), to objectively measure relative patient functional status surrounding spinal fusion. We demonstrated that a smartphone-based application was mostly well received by our patient cohort and has the potential to be used as an objective operative metric moving forward.