1
|
Stone BK, Paradkar R, Anderson GM, Daniels A, Iyer S, Derman PB, Telfeian AE, Basques B. Development of an Endoscopic Spine Surgery Program: Overview and Basic Considerations for Implementation. JB JS Open Access 2023; 8:e22.00152. [PMID: 37731772 PMCID: PMC10508372 DOI: 10.2106/jbjs.oa.22.00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Endoscopic spine surgery (ESS) is an innovative technique allowing for minimally invasive, direct visualization of spinal abnormalities. The growth of ESS in the United States has been stunted by high start-up costs, low reimbursement rates, and the steep learning curve associated with mastering endoscopic techniques. Hergrae, we describe the current state and future direction of ESS and provide key action items for ESS program implementation.
Collapse
Affiliation(s)
- Benjamin K. Stone
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - George M. Anderson
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Alan Daniels
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | | | - Albert E. Telfeian
- Department of Neurosurgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Bryce Basques
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| |
Collapse
|
2
|
Spallone A, Visocchi M, Greco F, Signorelli F, Gladi M, Fasinella R, Belogurov A, Iacoangeli M. Costotransversectomy in the Surgical Treatment of Mediolateral Thoracic Disk Herniations: Long-Term Results and Recent Minimally Invasive Technical Adjuncts. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:375-383. [PMID: 38153496 DOI: 10.1007/978-3-031-36084-8_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Thoracic herniated disks are relatively rare. They account for approximately 2% of all intervertebral herniated disks in large series. Traditional surgery via laminectomy has frequently yielded disappointing results, although the recent literature reports that anterior calcified thoracic herniation was successfully treated with this approach. This issue has encouraged a search for alternatives, such as anterolateral, lateral, and posterolateral approaches to the thoracic spine. From January 2009 to December 2019, we selected 66 patients harboring a symptomatic median-paramedian herniated disk at the level of the thoracic spine, treated at the authors' institutions. The present experience would give further support to the use of costotrasversectomy, along with its "mini-invasive" modifications, as a suitable and safe approach for thoracic disk disease. Although we must admit that endoscopy is likely to become the gold standard of surgical method in the future and that the anterior approach with mini-toracotomy without rib removal will become popular, the future scenario could certainly reserve an important place for the approach we have used in the surgical management of this challenging spinal pathology, mainly because of the approach's versatility and short learning curve.
Collapse
Affiliation(s)
- Aldo Spallone
- Institute of Bioorganic Chemistry, Neuroscience, Russian Academy of Sciences, Moscow, Russia
- NCL-Neurological Center of Latium, Rome, Italy
| | | | - Fabio Greco
- Skull Base Surgery Unit, Campus Bio-Medico University, Rome, Italy
| | - Francesco Signorelli
- Institute of Neurosurgery, Le Marche Polytechnic University and Polyclinic, Ancona, Italy
| | - Maurizio Gladi
- Institute of Bioorganic Chemistry, Neuroscience, Russian Academy of Sciences, Moscow, Russia
- NCL-Neurological Center of Latium, Rome, Italy
| | - Rossella Fasinella
- Institute of Bioorganic Chemistry, Neuroscience, Russian Academy of Sciences, Moscow, Russia
- NCL-Neurological Center of Latium, Rome, Italy
| | - Alexey Belogurov
- Institute of Bioorganic Chemistry, Neuroscience, Russian Academy of Sciences, Moscow, Russia
- NCL-Neurological Center of Latium, Rome, Italy
| | - Maurizio Iacoangeli
- Institute of Bioorganic Chemistry, Neuroscience, Russian Academy of Sciences, Moscow, Russia.
- NCL-Neurological Center of Latium, Rome, Italy.
| |
Collapse
|
3
|
Tan Y, Li X, Zhang Q, Zhou X, Zhang J. Surgical strategy and outcomes for thoracolumbar disc herniation with Autologous Bone-Fusion or Cage-Fusion surgery: case series and literature review. Biotechnol Genet Eng Rev 2022:1-13. [PMID: 36544424 DOI: 10.1080/02648725.2022.2159634] [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: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
To analyze the clinical characteristics and surgical outcomes of TLDH with Autologous Bone-Fusion for T10-L1 TLDH or Cage-Fusion for T12-L3 TLDH. This is a retrospective multi-center clinical study, involving a total of 43 patients with TLDH who underwent surgery in our institutions from December 2013 to January 2021. In all, 15 of 43 patients (34.9%) with T10-11(2)/T11-12(5)/T12-L1 (8) TLDH underwent Autologous Bone-Fusion surgery and 28 of 43 patients (65.1%) with T12-L1(3)/L1-L2(12)/L2-L3(13) TLDH underwent Cage-Fusion surgery. Demographic data, clinical characteristics and perioperative outcomes were recorded. During the follow-up, pre- to post-operative ODI, VAS back and leg pain scores significantly decreased (P1.2 = 0.001) and the score changes had no significant difference between two groups (P3 = 0.81, 0.59, 0.68). The intraoperative blood loss and operation time showed no significant difference between two groups (P = 0.056, 0.072). The patients showed prominent improvement of hypokinesia and satisfactory rate in two groups (5/7, 71.4% VS 9/12, 75.0%, P = 0.633; 11, 73.3% VS 25, 89.3%, P = 0.281). Notably, no recurrence and severe complications were reported. The choice of surgery approach should be individualized by clinical characteristics and radiology. Selectively Autologous Bone-Fusion for T10-L1 TLDH or Cage-Fusion for T12-L3 TLDH provided adequate nerve decompression and immediate stability. The overall fusion surgical outcomes were satisfactory without major complications during follow-up.
Collapse
Affiliation(s)
- YiXuan Tan
- Department of Orthopedics, Shanghai Changzhen Hospital, Shanghai, China
| | - Xiaoming Li
- Department of Orthopaedics, 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang, China
| | - Qian Zhang
- Qindao Special servicemen Recuperation Center of PLA Navy, Qingdao, China
| | - Xuhui Zhou
- Department of Orthopedics, Shanghai Changzhen Hospital, Shanghai, China
| | - Jiefeng Zhang
- Department of Orthopaedics, 72nd Group Army Hospital, Huzhou University, Huzhou, Zhejiang, China
| |
Collapse
|
4
|
Kilmister EJ, Guy N, Wickremesekera A, Koeck H. Image-guided transthoracic transpedicular microdiscectomy for a giant thoracic disc herniation: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE2297. [PMID: 36593678 PMCID: PMC9514284 DOI: 10.3171/case2297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/08/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND This case series reports on five consecutive patients who underwent image-guided transpedicular transthoracic microdiscectomy. The authors retrospectively reviewed five patients who had undergone Stealth image-guided transpedicular transthoracic microdiscectomy between 2015 and 2021. OBSERVATIONS Image guidance with O-arm verified critical anatomical landmarks in the setting of large central calcified and/or soft tissue disc prolapse. This allowed limited rib head resection, pedicle removal, and corpectomy to give adequate access and not require interbody fusion. The authors performed a partial posterior corpectomy anterior to the affected disc prolapse and microsurgical delivery of the affected disc anteriorly into the corpectomy cave away from the thecal sac. Electronic and radiographic records were analyzed at their initial presentation and at follow-up. The median patient age was 51 years (range, 44-56 years), with 80% of the patients being males. Four of five patients had significant improvement of their presenting clinical symptoms. One patient had a complicated postoperative recovery with a pneumothorax and subsequent bilateral pneumonia requiring intensive care. Another patient developed delayed postoperative worsening of paraparesis. LESSONS The use of Stealth image guidance with O-arm for transthoracic microdiscectomy for complex calcified thoracic disc herniation is an effective operative technical adjunct to verify anatomical landmarks and limit the microsurgical procedure.
Collapse
|
5
|
Full Endoscopic Surgery for Thoracic Pathology: Next Step after Mastering Lumbar and Cervical Endoscopic Spine Surgery? BIOMED RESEARCH INTERNATIONAL 2022; 2022:8345736. [PMID: 35615011 PMCID: PMC9126676 DOI: 10.1155/2022/8345736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/03/2022] [Indexed: 11/18/2022]
Abstract
Thoracic disc herniation and stenosis are relatively rare, and various symptoms make them difficult to diagnose. Due to the complexity of neural and vascular structure, surgical treatment of thoracic pathology is challenging. Endoscopic spine surgery is an emerging minimally invasive surgical option. Based on wide experience on the cervical and lumbar spine, an endoscopic approach for the thoracic pathology can be performed beyond the learning curve. Transforaminal approach for thoracic disc herniation, endoscopic unilateral approach, and bilateral decompression for thoracic stenosis have been reported as favorable and safe surgical options. In the present study, the authors described the detailed surgical procedure as well as tips and tricks.
Collapse
|
6
|
Lin W, Liu W, Ma WT, Xue Y. Per Pedicel-Ligament Flavum Tunnel Outside-In Foraminoplasty for T 10 -T 12 Discectomy under a Percutaneous Endoscope. Orthop Surg 2021; 13:253-259. [PMID: 33410235 PMCID: PMC7862147 DOI: 10.1111/os.12916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the effectiveness of T10 -T12 discectomy and per pedicel-ligament flavum tunnel outside-in foraminoplasty protocols under percutaneous endoscope. METHODS This retrospective study from September 2017 to June 2019 comprised 10 patients (mean age was 64.7 years, with 7 men and 3 women) with symptomatic thoracic disc herniation. Patients who had 12 months of follow-up and no cervical and lumbar spine surgery or trauma during the follow up period were included in the study. Patients underwent surgery at different levels: 3 patients for T10 -T11 and 7 patients for T11 -T12 . Percutaneous endoscopic thoracic discectomy was performed following under-vision foraminoplasty, which was based on lower pedicel-ligament flavum tunnel detection. Patients who presented with symptomatic soft disc herniation of the thoracic spine and did not respond to conservative treatments were included. Patients with calcified disc herniation or concomitant ossification of the posterior longitudinal ligament were excluded. The surgery involves four steps: (i) facet joint reaching procedures; (ii) sliding the working sleeve caudally to attach the pedicel, rotating the scope to detect the lower border of the superior articular process, the pedicel, and the lower pedicel-ligamentum flavum tunnel (PEFT) under vision, respectively; (iii) milling the superior articular process under vision; and (iv) finding and removing the disc protrusion after the posterior longitudinal ligament is resected. Patient outcomes were evaluated using vision analog scale scores, Oswestry disability index scores, and Japanese Orthopaedic Association scores. The VAS scores, Oswestry disability index scores, and Japanese Orthopaedic Association scores before and after the operation were compared by t-test for statistical analysis. MRI, CT, and plain X-rays were performed in of all the patients before and after surgery. RESULTS The patient was usually able to stand and walk approximately 2 h after the surgery. During the 12-month follow-up, all patients showed a significant improvement in pain. Postoperative thoracic MRI examination of all patients showed full decompression of the spinal cord and no residual pressure. Postoperative back pain and nerve root pain were significantly alleviated in all patients, and spinal cord function was significantly restored. The mean visual analog scale scores of patients postoperation were significantly better than those of patients preoperation (6.10 ± 1.37 vs 1.80 ± 0.79, P < 0.05). The mean ODI scores of patients postoperation were better than those of patients preoperation (13% ± 2.36% vs 55% ± 9.20%, P < 0.05). The mean JOA scores increased from 3.2 ± 0.75 to 9.3 ± 0.64. The JOA improvement rate was 79.6% ± 5.1%. There was 1 patient who had transient intercostal neuralgia. CONCLUSION Following pedicel-ligament flavum tunnel outside-in foraminoplasty protocols, T10 -T12 discectomy is relatively safe when conducted under percutaneous endoscope.
Collapse
Affiliation(s)
- Wei Lin
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Liu
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Wen-Ting Ma
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
7
|
Abstract
In the last five years, surgeons have applied endoscopic transforaminal surgical techniques mastered in the lumbar spine to the treatment of thoracic pathology. The aim of this systematic review was to collate the available literature to determine the place and efficacy of full endoscopic approaches used in the treatment of thoracic disc prolapse and stenosis. An electronic literature search of PubMed, Embase, the Cochrane database and Google Scholar was performed as suggested by the Preferred Reporting Items for Systematic Review and Meta-analysis statements. Included were any full-text articles referring to full endoscopic thoracic surgical procedures in any language. We identified 17 patient series, one cohort study and 13 case reports with single or of up to three patients. Although the majority included disc pathology, 11 papers related cord compression in a proportion of cases to ossification of the ligamentum flavum or posterior longitudinal ligament. Two studies described the treatment of discitis and one reported the use of endoscopy for tumour resection. Where reported, excellent or good outcomes were achieved for full endoscopic procedures in a mean of 81% of patients (range 46–100%) with a complication rate of 8% (range 0–15%), comparing favourably with rates reported after open discectomy (anterior, posterolateral and thoracoscopic) or by endoscopic tubular assisted approaches. Twenty-one of the 31 author groups reported use of local anaesthesia plus sedation rather than general anaesthesia, providing ‘self-neuromonitoring’ by allowing patients to respond to cord and/or nerve stimuli.
Cite this article: EFORT Open Rev 2021;6:50-60. DOI: 10.1302/2058-5241.6.200080
Collapse
Affiliation(s)
| | - Ralf Wagner
- Ligamenta Spine Centre, Frankfurt am Main, Germany
| | | |
Collapse
|
8
|
Khandge AV, Sharma SB, Kim JS. The Evolution of Transforaminal Endoscopic Spine Surgery. World Neurosurg 2020; 145:643-656. [PMID: 32822954 DOI: 10.1016/j.wneu.2020.08.096] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/22/2022]
Abstract
Transforaminal endoscopic spine surgery (T-ESS) has become a well-accepted technique. The first attempts at percutaneous discectomy by Kambin and Hijikata opened a new chapter of endoscopic spine surgery. By the last quarter of the twentieth century, spine surgeons had begun to adopt this novel technique. Many researchers helped advance endoscopic spine surgery, but the turning point was the description of a safe transforaminal triangle of safety by Parviz Kambin. Since then, the indications for T-ESS have increased as a result of the description of different surgical approaches such as inside-out, outside-in, and half-and-half. We present a review of crucial historical advancements in T-ESS and also discuss the evolution of endoscopes, the techniques used, development of endoscopic instruments and equipment, transforaminal thoracic endoscopy, transforaminal endoscopic interbody fusions, the growth of extended indications, and the future direction of T-ESS. This review provides a detailed description of key historical moments and a bird's-eye view of the vast scope of T-ESS.
Collapse
Affiliation(s)
| | - Sagar Bhupendra Sharma
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
| |
Collapse
|