1
|
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.
Collapse
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.
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Ahn Y. Anterior Endoscopic Cervical Discectomy: Surgical Technique and Literature Review. Neurospine 2023; 20:11-18. [PMID: 37016849 PMCID: PMC10080429 DOI: 10.14245/ns.2346118.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/28/2023] [Indexed: 04/03/2023] Open
Abstract
The conventional surgical technique for radiculopathy with cervical disc herniation (CDH) is anterior cervical discectomy and fusion, with a good clinical outcome and fusion rate. However, significant perioperative morbidity related to extensive surgical exposure has been reported. Therefore, anterior endoscopic cervical discectomy (AECD) using a working channel endoscope has been developed to reduce surgical complications and tissue damage. The objective of this study was to describe a cutting-edge technique for AECD of soft CDH. The primary indication is cervical radiculopathy with or without axial neck pain due to soft CDH. The surgical procedure consists of 2 parts: (1) a safe anterior percutaneous approach under fluoroscopic control and (2) selective endoscopic discectomy and foraminal decompression using specialized mechanical tools under endoscopic visualization. The clinical outcomes are comparable to those of conventional surgery and show the benefits of minimally invasive spine procedure. Perioperative data revealed typical minimalism, including reduced muscle damage, blood loss, operative time, and recovery time. With technical advancements in surgical instruments and optics, AECD will become more practical and safer. AECD is effective in selected CDH cases with cervical radiculopathy. However, high-quality clinical studies are needed to verify the effectiveness of this endoscopic cervical spinal procedure.
Collapse
Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
- Corresponding Author Yong Ahn Department of Neurosurgery, Gachon University Gil Medical Center, Gachon University College of Medicine, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea
| |
Collapse
|
4
|
Lin GX, Zhu MT, Kotheeranurak V, Lyu P, Chen CM, Hu BS. Current Status and research hotspots in the field of full endoscopic spine surgery: A bibliometric analysis. Front Surg 2022; 9:989513. [PMID: 36117817 PMCID: PMC9478389 DOI: 10.3389/fsurg.2022.989513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose We aimed to comprehensively analyze the current status, hotspots, and trends in full endoscopic spine surgery (FESS) research using bibliometric analysis and knowledge domain mapping. Methods The Web of Science database was used to screen FESS-related articles published between January 1, 1993 and June 10, 2022. The evaluation involved the following criteria: total number of articles; H-index; and contributions from countries/regions, institutions, journals, and authors. Results A total of 1,064 articles were included. Since 2016, there have been a significant number of publications in the field of FESS. The country/region contributing the largest number of articles was China (37.8%), followed by South Korea (24%), the United States (16.1%), Japan (5.7%), and Germany (5.1%). South Korea (35) had the highest H-index, followed by the United States (27), China (22), Japan (21), and Germany (20). World Neurosurgery (15.7%) published the largest number of FESS-related articles. However, among the top 10 most cited articles, six were published in Spine. The author who contributed the most was S.H. Lee (5.4%), and the largest number of contributions in this field originated from Wooridul Spine Hospital (South Korea; 6.1%). Notably, six of the 10 most published authors in this field were from South Korea. Of the top five productive institutions, three were from South Korea. The keywords with the strongest citation bursts in the field of FESS were “lumbar spine,” “discectomy,” “interlaminar,” “surgical technique,” “follow-up,” “excision,” “thoracic spine,” and “endoscopic surgery.” The 10 clusters generated in this study were: “endoscopic discectomy” (#0), “thoracic myelopathy” (#1), “recurrent lumbar disc herniation” (#2), “low back pain” (#3), “cervical vertebrae” (#4), “lumbar spinal stenosis” (#5), “transforaminal lumbar interbody fusion” (#6), “radiation exposure” (#7), “management” (#8), and “lumbar spine” (#9). Conclusion Global research on FESS is mostly concentrated in a few countries/regions and authors. South Korea has made the largest contribution to the field of FESS. Based on the most cited keyword bursts and clusters, the focus of FESS research was found to include its indications, management, and applications.
Collapse
Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
| | - Ming-Tao Zhu
- Department of Neurosurgery, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Pengfei Lyu
- Department of Breast Surgery, The First Affiliated Hospital of Hainan Medical University, Haikou, China
- Correspondence: Chien-Min Chen Pengfei Lyu Bao-Shan Hu
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Correspondence: Chien-Min Chen Pengfei Lyu Bao-Shan Hu
| | - Bao-Shan Hu
- Department of Orthopedics, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
- Correspondence: Chien-Min Chen Pengfei Lyu Bao-Shan Hu
| |
Collapse
|