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Wu X, Liu W, Xiao X, Fan Y, Gu G, Yu S, Yan H, Wang X, Li X, Zhao Y, Ni H, He S. Comparison of the clinical outcomes of VBE-TLIF versus MIS-TLIF for single-level degenerative lumbar diseases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1120-1128. [PMID: 38347273 DOI: 10.1007/s00586-023-08096-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 11/06/2023] [Accepted: 12/08/2023] [Indexed: 03/19/2024]
Abstract
OBJECTIVE This research aims to compare the clinical outcomes of VBE-TLIF and MIS-TLIF for the treatment of patients with single-level degenerative lumbar diseases. METHODS Ninety patients were enrolled in this study. The estimated blood loss, operation time, postoperative hospitalization days, time to functional exercise, amount of surgical drain and inflammatory index were recorded. The visual analog scale, Oswestry dysfunction index and modified MacNab criteria were used to assessed the patient's back and leg pain, functional status and clinical satisfaction rates. RESULTS The average operation time of the VBE-TLIF group was longer than that of the MIS-TLIF group. The time for functional exercise, length of hospital stay, estimated blood loss and amount of surgical drain in the VBE-TLIF group were relative shorter than those in the MIS-TLIF group. Additionally, the levels of CRP, neutrophil, IL-6 and CPK in the VBE-TLIF group were significantly lower than those in the MIS-TLIF group at postoperative days 1 and 3, respectively (P < 0.001). Patients undergoing VBE-TLIF had significantly lower back VAS scores than those in the MIS-TLIF group on postoperative days 1 and 3 (P < 0.001). No significant differences were found in the clinical satisfaction rates (95.83 vs. 95.24%, P = 0.458) or interbody fusion rate (97.92 vs. 95.24%, P = 0.730) between these two surgical procedures. CONCLUSIONS Both VBE-TLIF and MIS-TLIF are safe and effective surgical procedures for patients with lumbar diseases, but VBE-TLIF technique is a preferred surgical procedure with merits of reduced surgical trauma and quicker recovery.
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Affiliation(s)
- Xinbo Wu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Wei Liu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Xiao Xiao
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Yunshan Fan
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Guangfei Gu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Shunzhi Yu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Huang Yan
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Xiang Wang
- Department of Nursing, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Xifan Li
- Department of Radiological, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Yingchuan Zhao
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Haijian Ni
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China
| | - Shisheng He
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Yanchang Road 301, Shanghai, 200072, People's Republic of China.
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Xiao Q, Wu J, Chu F, Li Y. How I do it: dual operation channels percutaneous endoscopic far-lateral transforaminal lumbar interbody fusion. Acta Neurochir (Wien) 2024; 166:57. [PMID: 38302618 PMCID: PMC10834613 DOI: 10.1007/s00701-024-05946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 12/07/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND The current surgical procedure of interbody fusion in the lumbar spine has several limitations including low efficiency, potential endplate damage, overdose radiation exposure, and failure of fusion. METHODS Through the endoscopic operating channel, we efficiently removed the superior and inferior articular processes and decompressed the ligamentum flavum. Another operating channel was established under endoscopic monitoring to excise the annulus fibrosus, remove the cartilaginous endplate using open instruments, perform interbody bone grafting, and place a non-expandable polyetheretherketone open surgical fusion cage. CONCLUSION Lumbar interbody fusion was performed successfully using a far-lateral transforaminal approach combined with dual operation channels of percutaneous endoscopic-assisted technique.
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Affiliation(s)
- Qingqing Xiao
- Neck-Shoulder and Lumbocrural Pain Division 1, Sichuan Province Orthopedic Hospital, Chengdu, 610041, China
| | - Ji Wu
- Neck-Shoulder and Lumbocrural Pain Division 1, Sichuan Province Orthopedic Hospital, Chengdu, 610041, China
| | - Fuming Chu
- Neck-Shoulder and Lumbocrural Pain Division 1, Sichuan Province Orthopedic Hospital, Chengdu, 610041, China
| | - Yue Li
- Neck-Shoulder and Lumbocrural Pain Division 1, Sichuan Province Orthopedic Hospital, Chengdu, 610041, China.
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Morimoto M, Wada K, Tamaki S, Soeda S, Sugiura K, Manabe H, Tezuka F, Yamashita K, Sairyo K. Clinical Outcome of Full Endoscopic Trans Kambin's Triangle Lumbar Interbody Fusion: A Systematic Review. World Neurosurg 2023; 178:317-329. [PMID: 37453727 DOI: 10.1016/j.wneu.2023.07.026] [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: 05/22/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Full-endoscopic (FE) lumbar interbody fusion (LIF) is now a widely used type of minimally invasive surgery (MIS). Although FE-LIF includes LIF with foraminoplasty via a Kambin's triangle approach (FE-KLIF) and LIF with foraminotomy via an interlaminar approach, these techniques are rarely discussed separately. This review evaluates the outcomes and complications of FE-KLIF reported in the literature. The PubMed, Medline, Embase, Web of Science, and Cochrane Library databases were searched for studies reporting the outcomes of FE-KLIF. Of 464 publications assessed, 11 met our inclusion criteria. Although the most frequently treated level was L4/5, L5/S1 was also treated. FE-KLIF was performed under local anesthesia and sedation or under epidural anesthesia without general anesthesia. Visual analog scale and Oswestry Disability Index scores were improved postoperatively in all uncontrolled studies; however, there was no significant difference in these scores in studies that compared FE-KLIF with posterior LIF (PLIF) or MIS-transforaminal LIF (TLIF). There was also no significant difference in the fusion rate between FE-KLIF and PLIF or MIS-TLIF. In terms of complications, although there were no reports of hematoma, dural tear and surgical site infection were reported in 1 paper each, with transient nerve disorders reported in 5 studies (frequency, 1.8%-23.5%). This review indicates that FE-KLIF is a feasible and viable surgical option for lumbar degenerative disease. However, the amount and level of evidence is low for the studies included in this review, and the data on long-term outcomes remain limited.
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Affiliation(s)
| | - Keizo Wada
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Shunsuke Tamaki
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Saori Soeda
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Hiroaki Manabe
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
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Jitpakdee K, Liu Y, Heo DH, Kotheeranurak V, Suvithayasiri S, Kim JS. Minimally invasive endoscopy in spine surgery: where are we now? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2755-2768. [PMID: 36856868 DOI: 10.1007/s00586-023-07622-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Endoscopic spine surgery (ESS) is a minimally invasive surgical technique that offers comparable efficacy and safety with less collateral damage compared to conventional surgery. To achieve clinical success, it is imperative to stay abreast of technological advancements, modern surgical instruments and technique, and updated evidence. PURPOSES To provide a comprehensive review and updates of ESS including the nomenclature, technical evolution, bibliometric analysis of evidence, recent changes in the spine communities, the prevailing of biportal endoscopy, and the future of endoscopic spine surgery. METHODS We conducted a comprehensive review of the literature on ESS for the mentioned topics from January 1989 to November 2022. Three major electronic databases were searched, including MEDLINE, Scopus, and Embase. Covidence Systematic Review was used to organize the eligible records. Two independent reviewers screened the articles for relevance. RESULTS In total, 312 articles were finally included for review. We found various use of nomenclatures in the field of ESS publication. To address this issue, we proposed the use of distinct terms to describe the biportal and uniportal techniques, as well as their specific approaches. In the realm of technical advancement, ESS has rapidly evolved from addressing disc herniation and spinal stenosis to encompassing endoscopic fusion, along with technological innovations such as navigation, robotics, and augmented reality. According to bibliometric analysis, China, South Korea, and the USA have accounted for almost three-quarters of total publications. The studies of the biportal endoscopy are becoming increasingly popular in South Korea where the top ten most-cited articles have been published. The biportal endoscopy technique is relatively simple to adopt, as it relies on a more familiar approach, requires less expensive instruments, has a shorter learning curve, and is also well-suited for interbody fusion. The uniportal approach provided the smallest area of soft tissue dissection. While robotics and augmented reality in ESS are not widely embraced, the use of navigation in ESS is expected to become more streamlined, particularly with the emergence of recent electromagnetic-based navigation technologies. CONCLUSIONS In this paper, we provide a comprehensive overview of the evolution of ESS, as well as an updated summary of current trends in the field, including the biportal and uniportal approaches. Additionally, we summarize the nomenclature used in ESS, present a bibliometric analysis of the field, and discuss future directions for the advancement of the field.
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Affiliation(s)
- Khanathip Jitpakdee
- Spine Unit, Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Chonburi, Thailand
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yanting Liu
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong Hwa Heo
- Endoscopic Spine Surgery Center, Neurosurgery, Champodonamu Spine Hospital, Seoul, South Korea
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Siravich Suvithayasiri
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Orthopaedic and Musculoskeletal Centre, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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