Global and Current Research Trends of Unilateral Biportal Endoscopy/Biportal Endoscopic Spinal Surgery in the Treatment of Lumbar Degenerative Diseases: A Bibliometric and Visualization Study

Cerebral complications after unilateral biportal endoscopic surgery: A case report

BACKGROUND

Unilateral biportal endoscopic (UBE) surgery has developed rapidly during the past decade. Continuous epidural space irrigation is generally considered the principal reason for cerebral complications following UBE surgery. We present a case of mental symptoms during the general anesthesia awakening period due to pneumocephalus.

CASE SUMMARY

A 70-year-old woman with lumbar disc herniation underwent UBE surgery stably under general anesthesia. Uncontrollable hypertension occurred immediately after transfer to the postoperative care unit, accompanied by increased heart rate and tachypnea. During the recovery process, the patient responded to external stimuli but was confused and unable to complete command actions. Neck stiffness and significantly increased muscle strength on the left side indicated the presence of de-cerebrate rigidity. An urgent brain computed tomography scan showed pneumocephalus compressing the brainstem. After receiving analgesia and sedation treatment, the patient was conscious three hours later and recovered rapidly. She was discharged on the fifth postoperative day and followed up for 3 months with no surgical or brain complications.

CONCLUSION

Cerebral complications emerging during the general anesthesia awakening period following UBE surgery are not entirely due to increased intracranial pressure. Pneumocephalus induced by dural injury may also be a potential cause.

Unilateral biportal endoscopic decompression combined with percutaneous pedicle screw fixation offers new treatment option for thoracolumbar burst fractures with secondary spinal stenosis

The purpose of this study was to present the surgical technique of Unilateral Biportal Endoscopic (UBE) decompression combined with percutaneous pedicle screws for the treatment of thoracolumbar burst fractures with secondary spinal stenosis. Thoracolumbar burst fracture is a common traumatic disease in spinal surgery. In the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification of thoracolumbar fractures, Type A fractures have the highest incidence, accounting for about 70%, with A1 and A3 types being the most common1. In Type A3 fractures, there is often a displacement of fracture fragments into the spinal canal, leading to secondary spinal stenosis. The traditional approach is posterior open surgery pedicle screws combined with direct visualization for decompression, which requires extensive stripping of paravertebral muscles and resection of more bone, and is more traumatic2, which is not in line with the current development concept of minimally invasive spine. The UBE technique in spinal endoscopy is currently a hot spot in the development of minimally invasive spine3, and we attempted to utilize UBE decompression combined with percutaneous pedicle screws to treat thoracolumbar burst fracture with spinal stenosis, which provides a new option for the surgical treatment of thoracolumbar burst fracture with secondary spinal stenosis. We included five patients with thoracolumbar burst fractures with secondary spinal stenosis admitted to our hospital between January 2023 and January 2024, who were treated with UBE decompression combined with percutaneous pedicle screw internal fixation by our team. The degree of correction of spinal deformity was assessed using the sagittal Cobb angle and the percentage of height of the anterior margin of the vertebral body, the rate of canal encroachment was used to assess the decompression of the spinal canal, and the recovery of the patients' ability to live was assessed using the Visual Analogue Scale (VAS) and Japanese Orthopaedic Association (JOA) Score. The results showed that the average operative length of the patients was 154.2 min, and the average intraoperative bleeding was 90 ml; the sagittal Cobb angle averaged 22.23° preoperatively, and 6.10° at 3 days postoperatively; the anterior vertebral body height ratio averaged 36.77% preoperatively, and 91.16% at 3 days postoperatively; and the residual spinal canal volume averaged 52.01% preoperatively, and 91.58% at 3 days postoperatively; VAS score averaged 7 preoperatively and 2 at 3 days postoperatively; JOA score averaged 8.4 preoperatively and 22.4 at 3 days postoperatively. UBE decompression combined with percutaneous pedicle screws is effective in the treatment of thoracolumbar burst fractures with secondary spinal stenosis and is a safe, minimally invasive surgical option for this patient population.

Delta large-channel endoscopy versus unilateral biportal endoscopy decompressive laminectomy for lumbar spinal stenosis: a prospective randomized controlled trial

BACKGROUND

Delta large-channel endoscopy and unilateral biportal endoscopy (UBE) are prominent minimally invasive techniques for treating lumbar spinal stenosis, known for minimal tissue damage, clear visualization, and quick recovery. However, rigorous controlled research comparing these procedures is scarce, necessitating further investigation into their respective complications and long-term effectiveness. This randomized controlled trial aims to compare their perioperative outcomes, focusing on postoperative recovery and complications over time.

METHODS

In total, 101 participants were randomly assigned to Delta large-channel endoscopy group (n = 50) or UBE group (n = 51). Primary measures were Oswestry Disability Index (ODI) scores and operation time. Secondary measures included VAS, EQ-5D, JOA scores, intraoperative blood loss, hospital stay duration, and costs. Perioperative complications such as dural tears, incision infections, hematomas, thrombosis, and reoperation rates were recorded.

RESULTS

The Delta group consistently showed lower mean ODI scores throughout the follow-up than UBE group, with significant differences at 2 weeks postoperative (P = 0.048), though they were not significant by 1 month (P = 0.124), 2 months (P = 0.821) and 3 months (P = 0.350). Operation times were shorter in the Delta group (P < 0.001). Hospitalization costs and intraoperative blood loss were slightly higher in the UBE group (P < 0.001). No significant differences were noted in the other secondary outcomes at various post-surgery intervals, such as VAS, EQ-5D, JOA scores, hospital stay duration and complications.

CONCLUSION

Both techniques are safe and effective when performed by experienced surgeons. Compared to UBE, Delta large-channel endoscopy can shorten surgery time and reduce blood loss, and more importantly, it promotes faster recovery of lumbar function in the early postoperative period.

RESEARCH REGISTRATION UNIQUE IDENTIFYING NUMBER (UIN)

Name of the registry: Chinese Clinical Trial Registry chictr.org.cn. ( http://www.chictr.org.cn/index.aspx ). Unique Identifying number or registration ID: ChiCTR2300076237. Hyperlink to your specific registration (must be publicly accessible and will be checked): https://www.chictr.org.cn/showproj.html?proj=207 ,844.

A comparative analysis of unilateral biportal endoscopic and open laminectomy in multilevel lumbar stenosis

Background

Approximately 103 million people across the globe suffer from symptomatic lumbar spinal stenosis, impacting their health and quality of life. The unilateral biportal endoscopic technique is effective for treating single-segment degenerative lumbar spinal stenosis and is seen as a viable alternative to traditional open lumbar laminectomy. However, research on the application of this technique for multilevel lumbar spinal stenosis remains lacking.

Objective

To compare the clinical effects of unilateral biportal endoscopy (UBE) and open lumbar decompression (OLD) in the treatment of multilevel lumbar spinal stenosis (MLSS).

Methods

This retrospective study was conducted from February 2019 to December 2023 and compared the outcomes of Multilevel UBE surgery to OLD. The included patients were divided into two groups, namely the UBE group (n = 42, 86 surgical segments) and the OLD group (n = 40, 82 surgical segments). At the 1-year follow-up, the imaging findings, visual analogue scale (VAS), Oswestry disability index (ODI), and Zurich Claudication Questionnaire (ZCQ) were assessed. MRI measurements of the dural sac (CSA) and paravertebral cross-sectional area (PMA) were taken before surgery and at the final follow-up.

Results

The surgical segments of the two groups primarily consisted of adjacent segments (UBE 78.6% vs. OLD 78.8%), with a higher proportion of bilateral decompression in the OLD group (UBE 24.4% vs. OLD 28.0%). Preoperative imaging evaluation indicated a higher prevalence of grade C (severe stenosis) compared to grade D (severe stenosis) in both groups (UBE 74.4% vs. OLD 72%). The OLD group exhibited significantly greater blood loss compared to the UBE group (147.63 ± 26.55 vs. 46.19 ± 25.25 mL, p < 0.001). In addition, the duration of hospitalization in the OLD group was notably longer compared to the UBE group (7.58 ± 1.39 vs. 4.38 ± 1.56 days, p < 0.05). Paravertebral muscle atrophy (PMA) in the UBE group was significantly lower than in the OLD group (3.49 ± 3.03 vs. 5.58 ± 3.00, p < 0.05). Significantly elevated serum creatine kinase (CK) levels were observed in both groups, peaking at 1-day post-surgery, with the UBE group showing significantly lower levels than the OLD group (108.1 ± 12.2 vs. 364.13 ± 20.24 U/L, p < 0.05). On postoperative day 7, a significant decrease in liver enzyme levels was found in UBE group compared to the preoperative levels (61.81 ± 7.14 vs. 66.10 ± 8.26 U/L, p < 0.05). The Oswestry Disability Index (ODI) and Zurich Claudication Questionnaire (ZCQ) scores at 1 week, 6 months, and 1 year post-operation showed significant improvement compared to the preoperative scores in both groups (p < 0.05). The study found statistically significant differences in both the Visual Analog Scale (VAS) score (2.28 ± 0.59 vs. 2.85 ± 0.74, p < 0.05) and the Oswestry Disability Index (ODI) score (36.28 ± 2.03 vs. 37.57 ± 1.98, p < 0.05) at 1 week post-surgery between the two groups. However, no significant variations in scores were noted between preoperative and postoperative time points at other follow-up intervals.

Conclusion

The unilateral biportal endoscopic technique was applied to treat multilevel lumbar spinal stenosis, demonstrating decreased intraoperative bleeding and lower postoperative muscle-related complications compared to open lumbar decompression. Furthermore, UBE was found to promote early mobilization.

Learning Curve of Uniportal Compared With Biportal Endoscopic Techniques for the Treatment of Lumbar Disc Herniation

OBJECTIVES

Currently, unilateral biportal endoscopic (UBE) and uniportal full-endoscopic (UFE) techniques for the treatment of lumbar disc herniation (LDH) are gaining popularity. However, studies investigating the number of surgeries needed for surgeons to achieve proficiency in these procedures are lacking. This study aims to compare the early learning curve for UBE and UFE when treating LDH.

METHODS

The learning curve for two fellowship-trained surgeons at our institution was retrospectively assessed for 160 consecutive patients (UFE: n = 100, UBE: n = 60) who underwent procedures between September 2020 and May 2023. Surgeon 1 first learned UBE, followed by UFE (S1BF), while Surgeon 2 first learned UFE and then UBE (S2FB). Operation time was evaluated as the primary outcome for determining the learning curve using cumulative sum (CUSUM) analysis. Secondary outcomes assessing endoscopic prowess include surgical outcomes, such as fluoroscopy usage times, postoperative hospital stays, the incidence of complications, and clinical outcomes, including visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI) score and modified MacNab criteria.

RESULTS

The learning curve analysis identified the cutoff point in UBE at 14 cases and 11 cases for S1BF and S2FB, respectively, and in UFE at 31 cases and 27 cases, respectively. Without UFE or UBE experience, at the last follow-up, both the VAS back and leg pain in UFE were significantly higher than that in UBE (p < 0.05). Furthermore, the incidence of complications of UFE was also higher than that of UBE (29.0% vs. 7.1%). When surgeons have previous UFE or UBE experience, there was no significant difference in the clinical outcomes between UFE and UBE, and the complication rates were also similar (p > 0.05). After gaining UBE experience, the UFE performed by S1BF showed significantly better outcomes in fluoroscopy usage times (p = 0.024), surgical complications (p = 0.036), last follow-up VAS back pain (p = 0.003), and leg pain (p < 0.001) compared to S2FB. However, after gaining UFE experience, the S2FB only showed significant improvement in operation time (p = 0.041) during the process of learning UBE compared to S1BF.

CONCLUSIONS

Regardless of whether UBE or UFE is learned first, both techniques can significantly shorten the learning curve for the other technique. We recommend prioritizing the learning of UBE. Compared with UBE, the learning curve for UFE was significantly steeper and longer with higher incidence of complications in the early stage.

The Top 100 Cited Articles on Cervical Disc Arthroplasty: A Bibliometric Analysis

STUDY DESIGN

Bibliometric analysis.

OBJECTIVE

Cervical disc arthroplasty (CDA) has emerged as an effective surgical intervention for degenerative cervical disc disease with potential advantages over traditional cervical fusion. This bibliometric analysis aimed to assess the current state of research on CDA by analyzing the relevant literature using bibliometric indicators.

SUMMARY OF BACKGROUND DATA

Web of Science Core Collection.

METHODS

A comprehensive search was conducted using the Web of Science database, for articles related to CDA published in the last 19 years. The top 100 articles were reviewed using bibliometric analysis. Publication trends, citation patterns, authorship, and collaboration networks were analyzed using VOSviewer and the Bibliometrix package in RStudio.

RESULTS

The results revealed a significant increase in the number of publications related to CDA over the past 2 decades, with most of the articles being published in orthopedic and spine surgery journals. The most frequently cited articles were related to clinical outcomes, complications, and biomechanical studies of CDA. Co-authorship analysis identified influential authors and collaborative networks, highlighting the multidisciplinary nature of CDA research involving neurosurgeons, orthopedic surgeons, and engineers. Overall, this bibliometric analysis provides a comprehensive overview of the current state of research on CDA, highlighting the key research themes, influential authors, and collaborative networks in the field.

CONCLUSION

These findings can serve as a guide for researchers, clinicians, and policymakers to identify knowledge gaps, research trends, and future directions in the field of CDA.

The Development of Spinal Endoscopic Ultrasonic Imaging System With an Automated Tissue Recognition Algorithm

STUDY DESIGN

Preclinical experimental study.

OBJECTIVE

To develop an intraoperative ultrasound-assisted imaging device, which could be placed at the surgical site through an endoscopic working channel and which could help surgeons recognition of different tissue types during endoscopic spinal surgery (ESS).

SUMMARY OF BACKGROUND DATA

ESS remains a challenging task for spinal surgeons. Great proficiency and experience are needed to perform procedures such as intervertebral discectomy and neural decompression within a narrow channel. The limited surgical view poses a risk of damaging important structures, such as nerve roots.

METHODS

We constructed a spinal endoscopic ultrasound system, using a 4-mm custom ultrasound probe, which can be easily inserted through the ESS working channel, allowing up to 10 mm depth detection. This system was applied to ovine lumbar spine samples to obtain ultrasound images. Subsequently, we proposed a 2-stage classification algorithm, based on a pretrained DenseNet architecture for automated tissue recognition. The recognition algorithm was evaluated for accuracy and consistency.

RESULTS

The probe can be easily used in the ESS working channel and produces clear and characteristic ultrasound images. We collected 367 images for training and testing of the recognition algorithm, including images of the spinal cord, nucleus pulposus, adipose tissue, bone, annulus fibrosis, and nerve roots. The algorithm achieved over 90% accuracy in recognizing all types of tissues with a Kappa value of 0.875. The recognition times were under 0.1 s using the current configuration.

CONCLUSION

Our system was able to be used in existing ESS working channels and identify at-risk spinal structures in vitro. The trained algorithms could identify 6 intraspinal tissue types accurately and quickly. The concept and innovative application of intraoperative ultrasound in ESS may shorten the learning curve of ESS and improve surgical efficiency and safety.

[Effectiveness of unilateral biportal endoscopy technique combined with percutaneous pedicle screw fixation in treatment of lumbar burst fractures]

Objective

To compare the effectiveness of unilateral biportal endoscopy (UBE) technique assisted spinal canal decompression combined with percutaneous pedicle screw internal fixation versus traditional open decompression and internal fixation for treatment of lumbar burst fractures.

Methods

A retrospective study was conducted on the clinical data of 61 patients with single-segment lumbar burst fractures who met the selection criteria and were admitted between October 2022 and December 2023. Of them, 25 patients received UBE technique assisted decompression combined with percutaneous pedicle screw fixation (UBE group), while 36 patients were treated with traditional posterior unilateral hemilaminectomy decompression and internal fixation (open group). There was no significant difference in baseline data between the two groups ( P>0.05), including gender, age, body mass index, fracture segment, cause of injury, AO classification of lumbar fractures, and preoperative height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion, the classification of American Spinal Injury Association (ASIA) grading, visual analogue scale (VAS) score, and Oswestry disability index (ODI). The operation time, intraoperative blood loss, and postoperative complications were recorded and compared between the two groups. VAS score, ODI, and ASIA grading were used to evaluate the effectiveness before operation, at 1 week after operation, and at last follow-up. Lumbar anteroposterior and lateral X-ray films and CT were performed to measure the segmental kyphosis angle, height ratio of the anterior margin of injured vertebra, and the rate of spinal canal invasion.

Results

Surgery was successfully completed in both groups. No complication such as dural sac, nerve root, or vascular injury was found during operation, and all incisions healed by first intention. There was no significant difference in operation time between the two groups ( P>0.05), the UBE group revealed significant less intraoperative blood loss when compared with open group ( P<0.05). Patients in both groups were followed up 6-20 months, with an average of 13 months. There was no loosening, breakage, or failure of internal fixation in all patients. The ASIA grading, VAS score, ODI of the two groups significantly improved at 1 week after operation and further improved at last follow-up ( P<0.05). There was no significant difference in ASIA grading at 1 week after operation and last follow-up between the two groups ( P>0.05), but the VAS score and ODI in the UBE group were significantly superior to the open group ( P<0.05). At 1 week after operation, the height ratio of the anterior margin of injured vertebra, segmental kyphosis angle, rate of spinal canal invasion significantly improved when compared to preoperative ones ( P<0.05), the height ratio of the anterior margin of injured vertebra and segmental kyphosis angle significantly decreased at last follow-up when compared to the values at 1 week after operation ( P<0.05), but the rate of spinal canal invasion was further significantly improved, and there was no significant difference between the two groups at different time point postoperatively.

Conclusion

UBE technique assisted spinal canal decompression combined with percutaneous pedicle screw fixation is a safe and effective treatment for lumbar burst fractures, which with little trauma and faster recovery when compared with traditional open decompression and internal fixation.

Comparison of results among UBE-TLIF, MIS-TLIF and open TLIF for Meyerding grade I lumbar spondylolisthesis: a retrospective study

BACKGROUND

The unilateral biportal endoscopic (UBE) technique has garnered significant attention for its little paraspinal iatrogenic damage, expedited recovery, and low complication rates. This method is also applicable to open transforaminal lumbar interbody fusion (TLIF). Therefore, this study aimed to conduct a comparative analysis of the outcomes associated with unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF), minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and TLIF for Meyerding grade I lumbar spondylolisthesis.

METHODS

The study examined the outcomes of 79 patients with Meyerding grade I lumbar spondylolisthesis who underwent single-level intervertebral fusion. Clinical assessments included the measurement of pain levels using the Visual Analogue Scale (VAS) for low back and leg pain, the Oswestry Disability Index (ODI), surgical data, and demographic information. Imaging techniques were utilized to evaluate the fusion rate.

RESULTS

The VAS-Back demonstrated a statistically significant improvement in Group UBE-TLIF compared to the other groups at the one-week postoperative evaluation (p < .05). Additionally, the UBE-TLIF group exhibited a significantly longer total operative time compared to the other groups (p < .05). However, it was noted that the Postop Hemovac drain were significantly greater in the MIS-TLIF and TLIF groups compared to the UBE-TLIF group (p < .05).

CONCLUSIONS

The present research demonstrated the effectiveness of UBE-TLIF, MIS-TLIF, and TLIF as surgical approaches for treating Meyerding grade I lumbar spondylolisthesis. Among these methods, UBE-TLIF demonstrated a reduction in Postop Hemovac drain, and an increase in operative duration.

The evolution and integration of technology in spinal neurosurgery: A scoping review

Spinal disorders pose a significant global health challenge, affecting nearly 5% of the population and incurring substantial socioeconomic costs. Over time, spinal neurosurgery has evolved from basic 19th-century techniques to today's minimally invasive procedures. The recent integration of technologies such as robotic assistance and advanced imaging has not only improved precision but also reshaped treatment paradigms. This review explores key innovations in imaging, biomaterials, and emerging fields such as AI, examining how they address long-standing challenges in spinal care, including enhancing surgical accuracy and promoting tissue regeneration. Are we at the threshold of a new era in healthcare technology, or are these innovations merely enhancements that may not fundamentally advance clinical care? We aim to answer this question by offering a concise introduction to each technology and discussing in depth its status and challenges, providing readers with a clearer understanding of its actual potential to revolutionize surgical practices.

The biportal endoscopic posterior open-door laminoplasty with the use of mini-plate for cervical spondylotic myelopathy: Case report and literature review

INTRODUCTION

Biportal endoscopy, a newly developed technique rapidly applied in lumbar spine surgery, has recently been utilized for treating cervical spine diseases. We present a case of cervical spondylotic myelopathy managed with open-door laminoplasty fixed by mini-plate and performed with biportal endoscopy assistance.

PRESENTATION OF CASE

The patient, a 62-year-old woman, presented with gradually developing weakness in the lower extremities. CT and MR images showed cervical stenosis at C4-5 and C5-6. We performed a posterior open-door laminoplasty using biportal endoscopy assisted by a mini-plate. After completing the gutters on both sides of the hinge and open-door, we detached the spinous process from the lamina through endoscopic-guided burr grinding. The skin incisions of the portals on the open-door side were connected for direct fixation of the elevated lamina with a mini-plate. There was improvement in ambulatory capacity for the patient along with radiological evidence of decompressed cervical canal.

DISCUSSION

Endoscopic technology is increasingly employed in spinal surgery, with several studies documenting the utilization of biportal endoscopic techniques to facilitate open-door laminoplasty procedures for managing myelopathic cervical spondylosis. The procedures we report allow for safer and more efficient placement of the mini-plate that prevents door re-closing.

CONCLUSIONS

The potential applications of biportal endoscopic technology in open-door cervical spine surgery are worth considering, given the soft tissue damage caused by traditional posterior cervical spine surgery. However, the safety and effectiveness of this method still require more studies with a larger number of cases and longer follow-up to be substantiated.

Unilateral biportal endoscopic versus microscopic transforaminal lumbar interbody fusion for degenerative lumbar spinal stenosis in China: study protocol for a prospective, randomised, controlled, non-inferiority trial

INTRODUCTION

Degenerative lumbar spinal stenosis is a common cause of low back or leg pain and disability in the elderly population. Patients with spinal stenosis who fail to respond to conservative treatment often require surgical interventions. Minimally invasive transforaminal lumbar interbody fusion (TLIF) with microscopic tubular technique (MT-TLIF) is a well-established procedure for lumbar spinal stenosis. Recently, a novel MIS technique, unilateral biportal endoscopic TLIF (UBE-TLIF), has been frequently performed to treat spinal stenosis. However, the efficacy and safety of using UBE-TLIF in this population have not been well examined.

METHODS AND ANALYSIS

A total of 96 patients with lumbar spinal stenosis will be randomly assigned to the UBE-TLIF group or the MT-TLIF group at a 1:1 ratio to receive UBE-TLIF or MT-TLIF treatment respectively. The primary outcome is the Oswestry Disability Index (ODI) score at 1 year after receiving the surgery. Secondary outcomes include the ODI scores at additional time points, Visual Analogue Scale score, 36-Item Short Form Survey questionnaire, EuroQol 5 Dimensions questionnaire, radiological measurements (disc height, lumbar lordosis angles and vertebral fusion rate) and general condition during hospitalisation.

ETHICS AND DISSEMINATION

This protocol is approved by the Medical Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University. All participants of the study will be well informed and written informed consent will be requested. Findings from this trial will be published in peer-reviewed publications, specifically in orthopedic and spinal journals. The completion of this study will not only examine the use of UBE-TLIF in lumbar spinal stenosis but also provide helpful clinical references.

TRIAL REGISTRATION NUMBER

ChiCTR2300069333.

A quantitative analysis of artificial intelligence research in cervical cancer: a bibliometric approach utilizing CiteSpace and VOSviewer

Background

Cervical cancer, a severe threat to women's health, is experiencing a global increase in incidence, notably among younger demographics. With artificial intelligence (AI) making strides, its integration into medical research is expanding, particularly in cervical cancer studies. This bibliometric study aims to evaluate AI's role, highlighting research trends and potential future directions in the field.

Methods

This study systematically retrieved literature from the Web of Science Core Collection (WoSCC), employing VOSviewer and CiteSpace for analysis. This included examining collaborations and keyword co-occurrences, with a focus on the relationship between citing and cited journals and authors. A burst ranking analysis identified research hotspots based on citation frequency.

Results

The study analyzed 927 articles from 2008 to 2024 by 5,299 authors across 81 regions. China, the U.S., and India were the top contributors, with key institutions like the Chinese Academy of Sciences and the NIH leading in publications. Schiffman, Mark, featured among the top authors, while Jemal, A, was the most cited. 'Diagnostics' and 'IEEE Access' stood out for publication volume and citation impact, respectively. Keywords such as 'cervical cancer,' 'deep learning,' 'classification,' and 'machine learning' were dominant. The most cited article was by Berner, ES; et al., published in 2008.

Conclusions

AI's application in cervical cancer research is expanding, with a growing scholarly community. The study suggests that AI, especially deep learning and machine learning, will remain a key research area, focusing on improving diagnostics and treatment. There is a need for increased international collaboration to maximize AI's potential in advancing cervical cancer research and patient care.

Effect of Cage Material and Size on Fusion Rate and Subsidence Following Biportal Endoscopic Transforaminal Lumbar Interbody Fusion

OBJECTIVE

Biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF) is an emerging, minimally invasive technique performed under biportal endoscopic guidance. However, concerns regarding cage subsidence and sufficient fusion during BE-TLIF necessitate careful selection of an appropriate interbody cage to improve surgical outcomes. This study compared the fusion rate, subsidence, and other radiographic parameters according to the material and size of the cages used in BE-TLIF.

METHODS

In this retrospective cohort study, patients who underwent single-segment BE-TLIF between April 2019 and February 2023 were divided into 3 groups: group A, regular-sized three-dimensionally (3D)-printed titanium cages; group B, regular-sized polyetheretherketone cages; and group C, large-sized 3D-printed titanium cages. Radiographic parameters, including lumbar lordosis, segmental lordosis, anterior and posterior disc heights, disc angle, and foraminal height, were measured before and after surgery. The fusion rate and severity of cage subsidence were compared between the groups.

RESULTS

No significant differences were noted in the demographic data or radiographic parameters between the groups. The fusion rate on 1-year postoperative computed tomography was comparable between the groups. The cage subsidence rate was significantly lower in group C than in group A (41.9% vs. 16.7%, p=0.044). The severity of cage subsidence was significantly lower in group C (0.93±0.83) than in groups A (2.20±1.84, p=0.004) and B (1.79±1.47, p=0.048).

CONCLUSION

Cage materials did not affect the 1-year postoperative outcomes of BE-TLIF; however, subsidence was markedly reduced in large cages. Larger cages may provide more stable postoperative segments.

Identifying authorial roles in research: A Kano model-based bibliometric analysis for the Journal of Medicine (Baltimore) 2023

The landscape of research roles within academic journals often remains uncharted territory, with authorial contributions frequently reduced to linear hierarchies (e.g., professor and assistant professor). The Kano model, traditionally used in customer satisfaction research, offers a nuanced framework for identifying the multifaceted roles of authors in scholarly publications. This study utilizes the Kano model to dissect and categorize the roles of authors in the medicine field. To conform to the hypothesis, China is the research leader while the US is the research collaborator, as reflected in the publications of the journal of Medicine (Baltimore) in the year 2023. We conducted a comprehensive bibliometric analysis of all research articles published in the journal of Medicine (Baltimore) in 2023. The Kano model was applied to classify authors into 5 categories reflective of their research roles: followers, leaders, partners, contributors, and collaborators. Data on author publications and co-authorship networks with multi-author rates (MARs) were analyzed to assign Kano categories based on the authorship positions of first and corresponding authors. Descriptive statistics and network analysis tools were used to interpret the data, including radar plots, geographical maps, and Kano diagrams. The analysis covered 1976 articles, uncovering a complex network of author roles that extends beyond the conventional binary distinction of lead and supporting authors (i.e., leading, and following researchers). A research leader in China and a collaborator in the US were conformed to support the hypothesis, based on their publications (1148 vs 51) and MARs (12.20% vs 19.61%). The Kano classification was visually adapted to classify authors (or entities) into 5 categories. The combined choropleth and geographical network maps were illustrated to identify author roles in research briefly. The Kano model serves as an effective tool for uncovering the diverse contributions of authors in medical research. By moving beyond the lead and follower dichotomy, this study highlights the intricate ecosystem of authorial roles, emphasizing the importance of each in advancing knowledge within the field of medicine. Future application of the Kano model could foster a more collaborative and inclusive recognition of contributions across various disciplines.

Global Trends in Research of Programmed Cell Death in Osteoporosis: A Bibliometric and Visualized Analysis (2000-2023)

Osteoporosis (OP) is a systemic metabolic bone disease that is characterized by decreased bone mineral density and microstructural damage to bone tissue. Recent studies have demonstrated significant advances in the research of programmed cell death (PCD) in OP. However, there is no bibliometric analysis in this research field. This study searched the Web of Science Core Collection (WoSCC) database for literature related to OP and PCD from 2000 to 2023. This study used VOSviewers 1.6.20, the "bibliometrix" R package, and CiteSpace (6.2.R3) for bibliometric and visualization analysis. A total of 2905 articles from 80 countries were included, with China and the United States leading the way. The number of publications related to PCD in OP is increasing year by year. The main research institutions are Shanghai Jiao Tong University, Chinese Medical University, Southern Medical University, Zhejiang University, and Soochow University. Bone is the most popular journal in the field of PCD in OP, and the Journal of Bone and Mineral Research is the most co-cited journal. These publications come from 14,801 authors, with Liu Zong-Ping, Yang Lei, Manolagas Stavros C, Zhang Wei, and Zhao Hong-Yan having published the most papers. Ronald S. Weinstein was co-cited most often. Oxidative stress and autophagy are the current research hot spots for PCD in OP. This bibliometric study provides the first comprehensive summary of trends and developments in PCD research in OP. This information identifies the most recent research frontiers and hot directions, which will provide a definitive reference for scholars studying PCD in OP.

Global trends and hotspots related to whiplash injury: A visualization study

Whiplash injury, commonly occurring as a result of car accidents, represents a significant public health concern. However, to date, no comprehensive study has utilized bibliometric approaches to analyze all published research on whiplash injury. Therefore, our study aims to provide an overview of current trends and the global research landscape using bibliometrics and visualization software. We performed a bibliometric analysis of the data retrieved and extracted from the Web of Science Core Collection database in whiplash injury research up to December 31, 2022. Research articles were assessed for specific characteristics, such as year of publication, country/region, institution, author, journal, field of study, references, and keywords. We identified 1751 research articles in the analysis and observed a gradual growth in the number of publications and references. The United States (379 articles, 21.64%), Canada (309 articles, 17.65%), and Australia (280 articles, 16.00%) emerged as the top-contributing countries/regions. Among institutions, the University of Queensland (169 articles, 9.65%) and the University of Alberta (106 articles, 6.05%) demonstrated the highest productivity. "Whiplash," "Neck Pain," "Cervical Spine Disease," and "Whiplash-associated Disorders" are high-frequency keywords. Furthermore, emerging areas of research interest included traumatic brain injury and mental health issues following whiplash injury. The number of papers and citations has increased significantly over the past 2 decades. Whiplash injury research is characteristically multidisciplinary in approach, involving the fields of rehabilitation, neuroscience, and spinal disciplines. By identifying current research trends, our study offers valuable insights to guide future research endeavors in this field.

Research progress of airway inflammation in asthma: A bibliometric analysis

BACKGROUND

In recent years, the prevalence of asthma has gradually increased and the number of asthmatics worldwide has reached 358 million, which has caused huge economic loss. Airway inflammation is an important feature of asthma, and international research in this field has a high degree of heat. Therefore, this paper uses the bibliometric method to systematically review and visualize the literature in this field, aiming to provide some reference value for follow-up related research.

METHODS

To retrieve the research literature on airway inflammation in asthma from 2003 to 2022 in the Web of Science Core Collection database. The bibliometric method was used to systematically analyze the included literature data by using visualization analysis software such as CiteSpace (6.2. R4) and VOSviewer (1.6.19).

RESULTS

A total of 1892 articles published in 423 journals were included in this study, from 1912 institutions in 62 countries/regions. The number of articles published between 2003 and 2022 showed a trend of fluctuating growth. The country with the largest number of articles published was China (558,29.49 %), followed by the United States (371,19.61 %) and Korea (212,11.21 %). Gibson, Peter G is the author with the highest number of publications, and Journal of Allergy and Clinical Immunology is the most published journal.

CONCLUSION SUBSECTIONS

This study systematically reveals the state of the literature in the field of airway inflammation in asthma over the past 20 years. The exploration of inflammatory cell components, pathway molecules and biological agents are research hotspots in this field and should be further studied.

Comparing the Efficacy and Safety of Unilateral Biportal Endoscopic Decompression with Percutaneous Endoscopic Lumbar Decompression for Lumbar Degenerative Diseases: A Meta-Analysis

OBJECTIVE

Unilateral biportal endoscopic decompression (UBED) offers the advantages of minimal tissue damage, operational flexibility, and clear visualization, positioning it as an innovative and minimally invasive endoscopic technique. Nevertheless, the clinical evidence supporting the use of UBED in the treatment of degenerative lumbar diseases is limited and conflicting.

METHODS

As of October 1, 2023, a comprehensive search was conducted across databases including Web of Science, PubMed, Embase, and the Cochrane Library to identify all published studies on minimally invasive UBED for the treatment of degenerative lumbar diseases. Data pertaining to patient demographics, fluoroscopy time, operative duration, intraoperative hemorrhage, hospitalization length, visual analog scale (VAS) score for back and leg pain, MacNab criteria, Oswestry Disability Index (ODI), and complication rates were extracted. The Newcastle-Ottawa scale was utilized to assess the quality.

RESULTS

Twelve articles were included, involving 816 patients. The back VAS score (95% confidence interval [CI]: -0.09-0.07, P = 0.75), MacNab criteria (95% CI: 0.52-2.3, P = 0.82), fluoroscopy time (95% CI: -7.03 to -0.4, P = 0.08), and the incidence of complications (95% CI: 0.5-1.73, P = 0.82) were not significantly different, while the leg VAS score (95% CI: 0.01-0.18, P = 0.03), ODI score (95% CI: -1.03 to -0.09, P = 0.02), operation time (95% CI: 5.76-20.62, P = 0.0005), hospitalization length (95% CI: 0.41-2.76, P = 0.008), and intraoperative hemorrhage (95% CI: 21.92-72.44, P = 0.0003) were significantly different.

CONCLUSIONS

UBED offers superiority in ODI, flexibility, and visual field clarity. Conversely, percutaneous endoscopic lumbar decompression presents advantages in terms of operation duration, blood loss, hospitalization length, and leg VAS score. These factors should be thoroughly considered when selecting a surgical approach.

Progress and research trends in neurogenic bladder after spinal cord injury bibliometric analysis based on web of science database: An observational study

Neurogenic bladder (NB) is a significant complication that often occurs after spinal cord injury. It results from urinary dysfunction caused by the injury, disrupting the normal neural control of the bladder and urethra. Symptoms of NB can include urinary frequency, urgency, incontinence, and retention, all of which can greatly impact the quality of life of affected individuals. While there are articles and reviews on NB, fewer specifically address NB following spinal cord injury. This study examined 1095 publications from January 1, 2000, to March 27, 2024, in the Web of Science core database using bibliometric software like VOSviewer, CiteSpace, and Bibliometrics. The analysis revealed an increasing trend in the number of publications, with the United States and China leading in research output. Professor Jeremy B. Myers from the University of Utah had the highest number of publications, while the University of Michigan and the University of Pittsburgh were the institutions with the most publications. The journal Neurourology and Urodynamics had the highest number of articles, and common keywords included management, quality of life, and dysfunction, highlighting key areas of focus for scholars.

Unilateral biportal endoscopic discectomy versus microdiscectomy for lumbar disc herniation: a systematic review and meta-analysis

PURPOSE

This study aimed to compare unilateral biportal endoscopic discectomy (UBED) with microdiscectomy (MD) for treating lumbar disk herniation (LDH).

METHODS

A comprehensive literature search was conducted in the Embase, PubMed, Cochrane Library, CNKI, and Web of Science databases from database inception to April 2023 to identify studies comparing UBED and MD for treating LDH. This study evaluated the visual analog scale (VAS) score, Oswestry disability index (ODI), Macnab scores, operation time, estimated blood loss, hospital stay, and complications, estimated blood loss, visual analog scale (VAS) score, Oswestry disability index (ODI), and Macnab scores at various pre- and post-surgery stages. The meta-analysis was performed using RevMan 5.4 software.

RESULTS

The meta-analysis included 9 distinct studies with a total of 1001 patients. The VAS scores for low back pain showed no significant differences between the groups at postoperative 1-3 months (P = 0.09) and final follow-up (P = 0.13); however, the UBED group had lower VAS scores at postoperative 1-3 days (P = 0.02). There were no significant differences in leg pain VAS scores at baseline (P = 0.05), postoperative 1-3 days (P = 0.24), postoperative 1-3 months (P = 0.78), or at the final follow-up (P = 0.43). ODI comparisons revealed no significant differences preoperatively (P = 0.83), at postoperative 1 week (P = 0.47), or postoperative 1-3 months (P = 0.13), and the UBED group demonstrated better ODI at the final follow-up (P = 0.03). The UBED group also exhibited a shorter mean operative time (P = 0.03), significantly shorter hospital stay (P < 0.00001), and less estimated blood loss (P = 0.0002). Complications and modified MacNab scores showed no significant differences between the groups (P = 0.56 and P = 0.05, respectively).

CONCLUSION

The evidence revealed no significant differences in efficacy between UBED and MD for LDH treatment. However, UBED may offer potential benefits such as shorter hospital stays, lower estimated blood loss, and comparable complication rates.

Deep brain stimulation in Parkinson's disease: A scientometric and bibliometric analysis, trends, and research hotspots

Parkinson disease (PD), a prevalent neurodegenerative ailment in the elderly, relies mainly on pharmacotherapy, yet deep brain stimulation (DBS) emerges as a vital remedy for refractory cases. This study performs a bibliometric analysis on DBS in PD, delving into research trends and study impact to offer comprehensive insights for researchers, clinicians, and policymakers, illuminating the current state and evolutionary trajectory of research in this domain. A systematic search on March 13, 2023, in the Scopus database utilized keywords like "Parkinson disease," "PD," "Parkinsonism," "Deep brain stimulation," and "DBS." The top 1000 highly cited publications on DBS in PD underwent scientometric analysis via VOS Viewer and R Studio's Bibliometrix package, covering publication characteristics, co-authorship, keyword co-occurrence, thematic clustering, and trend topics. The bibliometric analysis spanned 1984 to 2021, involving 1000 cited articles from 202 sources. The average number of citations per document were 140.9, with 31,854 references. "Movement Disorders" led in publications (n = 98), followed by "Brain" (n = 78) and "Neurology" (n = 65). The University of Oxford featured prominently. Thematic keyword clustering identified 9 core research areas, such as neuropsychological function and motor circuit electrophysiology. The shift from historical neurosurgical procedures to contemporary focuses like "beta oscillations" and "neuroethics" was evident. The bibliometric analysis emphasizes UK and US dominance, outlining 9 key research areas pivotal for reshaping Parkinson treatment. A discernible shift from invasive neurosurgery to DBS is observed. The call for personalized DBS, integration with NIBS, and exploration of innovative avenues marks the trajectory for future research.

Trends and focal points in pelvic floor reconstruction for pelvic organ prolapse: A bibliometric analysis

OBJECTIVE

This study aims to investigate the current research trends and focal points in the field of pelvic floor reconstruction for the management of pelvic organ prolapse (POP).

METHODS

To achieve this objective, a bibliometric analysis was conducted on relevant literature using the Citespace database. The analysis led to the creation of a knowledge map, offering a comprehensive overview of scientific advancements in this research area.

RESULTS

The study included a total of 607 publications, revealing a consistent increase in articles addressing pelvic floor reconstruction for POP treatment. Most articles originated from the United States (317 articles), followed by Chinese scholars (40 articles). However, it is important to note that the overall number of articles remains relatively low. The organization with the highest publication frequency was the Cleveland Clinic in Ohio, where Matthew D. Barber leads the academic group. Barber himself has the highest number of published articles (18 articles), followed by Zhu Lan, a Chinese scholar (10 articles). Key topics with high frequency and mediated centrality include stress urinary incontinence, quality of life, impact, and age. The journal with the largest number of papers from both domestic and international researchers is INT UROGYNECOL J. The study's hotspots mainly focus on the impact of pelvic floor reconstruction on the treatment and quality of life of POP patients. The United States leads in this field, but there is a lack of cooperation between countries, institutions, and authors. Moving forward, cross-institutional, cross-national, and cross-disciplinary exchanges and cooperation should be strengthened to further advance the field of pelvic floor reconstructive surgery for POP research.

The Emerging Roles of Nanocarrier Drug Delivery System in Treatment of Intervertebral Disc Degeneration-Current Knowledge, Hot Spots, Challenges and Future Perspectives

Low back pain (LBP) is a common condition that has substantial consequences on individuals and society, both socially and economically. The primary contributor to LBP is often identified as intervertebral disc degeneration (IVDD), which worsens and leads to significant spinal problems. The conventional treatment approach for IVDD involves physiotherapy, drug therapy for pain management, and, in severe cases, surgery. However, none of these treatments address the underlying cause of the condition, meaning that they cannot fundamentally reverse IVDD or restore the mechanical function of the spine. Nanotechnology and regenerative medicine have made significant advancements in the field of healthcare, particularly in the area of nanodrug delivery systems (NDDSs). These approaches have demonstrated significant potential in enhancing the efficacy of IVDD treatments by providing benefits such as high biocompatibility, biodegradability, precise drug delivery to targeted areas, prolonged drug release, and improved therapeutic results. The advancements in different NDDSs designed for delivering various genes, cells, proteins and therapeutic drugs have opened up new opportunities for effectively addressing IVDD. This comprehensive review provides a consolidated overview of the recent advancements in the use of NDDSs for the treatment of IVDD. It emphasizes the potential of these systems in overcoming the challenges associated with this condition. Meanwhile, the insights and ideas presented in this review aim to contribute to the advancement of precise IVDD treatment using NDDSs.

[Effectiveness of unilateral biportal endoscopy combined with percutaneous pedicle screw fixation in treatment of lumbar burst fractures with neurological symptoms]

Objective

To evaluate the effectiveness of spinal canal decompression assisted by unilateral biportal endoscopy (UBE) and percutaneous uniplanar pedicle screw internal fixation in the treatment of lumbar burst fractures with neurological symptoms.

Methods

Between June 2021 and December 2022, 10 patients with single level lumbar burst fracture with neurological symptoms were treated with spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw internal fixation. There were 7 males and 3 females with an average age of 43.1 years (range, 21-57 years). The injured vertebrae located at L 1 in 2 cases, L 2 in 4 cases, L 3 in 3 cases, and L 4 in 1 case. There were 7 cases of AO type A3 fractures and 3 cases of AO type A4 fractures. The total operation time, the time of operation under endoscopy, and complications were recorded. Pre- and post-operative visual analogue scale (VAS) score and American Spinal Injury Association (ASIA) scale (grading A-E corresponding to assigning 1-5 points for statistical analysis) were used to evaluate effectiveness. X-ray film and CT were performed to observe the fracture healing, and the ratio of anterior vertebral body height, Cobb angle, and rate of spinal canal invasion were measured to evaluate the reduction of fracture.

Results

All operations was successfully completed, and the spinal canal decompression and the bone fragment in spinal canal reduction completed under the endoscopy. Total operation time was 119 minutes on average (range, 95-150 minutes), and the time of operation under endoscopy was 46 minutes on average (range, 35-55 minutes). There was no complication such as dural sac, nerve root, or blood vessel injury during operation. All incisions healed by first intention. All patients were followed up 18.7 months on average (range, 10-28 months). The VAS score after operation significantly decreased when compared with that before operation ( P<0.05), and further improved at last follow-up ( P<0.05). The ASIA scale after operation significantly improved when compared with that before operation ( P<0.05), and there was no significant difference ( P>0.05) in the ASIA scale between at 1 week after operation and at last follow-up. The imaging examination showed that the screw position was good and the articular process joint was preserved. During follow-up, there was no loosening, fracture, or fixation failure of the internal fixation. The ratio of anterior vertebral body height and Cobb angle significantly improved, the rate of spinal canal invasion significantly decreased after operation ( P<0.05), and without significant loss of correction during the follow-up ( P>0.05).

Conclusion

Spinal canal decompression assisted by UBE and percutaneous uniplanar pedicle screw fixation is a feasible minimally invasive treatment for lumbar burst fractures with neurological symptoms, which can effectively restore the vertebral body sequence, as well as relieve the compression of spinal canal, and improve the neurological function.

Clinical effects of arthroscopic-assisted uni-portal spinal surgery and unilateral bi-portal endoscopy on unilateral laminotomy for bilateral decompression in patients with lumbar spinal stenosis: a retrospective cohort study

OBJECTIVE

To investigate the clinical effectiveness of Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS) in the treatment of lumbar spinal stenosis.

METHODS

A total of 475 patients with lumbar spinal stenosis from January 2019 to January 2023 were included in this study. Among them, 240 patients were treated with AUSS (AUSS group); the other 235 patients were treated with unilateral bi-portal endoscopy treatment (UBE group). The differences in surgery-related clinical indicators, pain degree before and after surgery, Oswestry Disability Index (ODI), CT imaging parameters of spinal stenosis, and clinical efficacy were compared between the two groups.

RESULTS

Patients in the AUSS group had a shorter operative time than those in the UBE group, and the length of incision and surgical bleeding were less than those in the UBE group, with statistically significant differences (P < 0.05). Before operation, there was no significant difference in the VAS score of low back pain and leg pain between the two groups (P > 0. 05). After operation, patients in both groups showed a significant reduction in low back and leg pain, and their VAS scores were significantly lower than before the operation (P < 0.05). Three months after surgery, the results of CT re-examination in both groups showed that the spinal stenosis of the patients was well improved, and the measurements of lumbar spinal interspace APDC, CAC, ICA, CAD and LAC were significantly higher than those before surgery (P < 0. 05). Besides, the lumbar function of patients improved significantly in both groups, and ODI measurements were significantly lower than those before surgery (P < 0.05).

CONCLUSION

Both AUSS and UBE with unilateral laminotomy for bilateral decompression can achieve good clinical results in the treatment of lumbar spinal stenosis, but the former has the advantages of simpler operation, shorter operation time, shorter incision length, and less surgical blood loss.

Current Global Research Trends of Tethered Cord Syndrome Surgery: A Scientometric and Visual Analysis

BACKGROUND

Since tethered cord syndrome (TCS) may lead to neurologic and motor dysfunction, surgeries often are applied to relieve the symptoms. The aim of the research was to explore the current global research trends of TCS surgery.

METHODS

In this article, articles on TCS surgery in the Web of Science Core Collection from 1980 to 2023 were searched. Research trends, countries, institutions, journals, authors, highly cited articles, and key words were analyzed using bibliometric methods. The literature co-citation network was mapped using VOSviewer, and research hotspots and trends were analyzed using CiteSpace.

RESULTS

A total of 432 publications were included. The number of publications and related research interest in the field of TCS surgery has increased globally year by year. The United States is the largest contributor (154 publications). The journal Childs Nervous System has the greatest number of publications (48 publications) and the most frequently cited journal is Neurosurgery (973 citations). In network visualization, the institution with the greatest contribution is University of California System (16 publications). Lee JY and Wang KC are the authors with the greatest number of publications (8 publications), and the most frequently cited author is Klekamp J (268 citations). Neurogenic bladder and spina bifida may be the next hot spot in this field.

CONCLUSIONS

This study will help researchers to identify the mainstream research directions and the latest hotspots in the field of TCS surgery and provide a reference for further research.

Unilateral Biportal Endoscopy for L5-S1 Extraforaminal Stenosis (Far Out Syndrome) - Technical Note with Literature Review

Introduction

Extraforaminal stenosis in L5-S1, or far-out syndrome (FOS), is defined as L5 nerve compression by the transverse process (TP) of the L5 and the ala of the sacrum and disc bulging with/without osteophytes and/or the thickened lumbosacral and extraforaminal ligament. This study aims to describe the unilateral biportal endoscopic decompression technique of the extraforaminal stenosis at L5-S1 or far out syndrome and evaluate its clinical results with a literature review.

Case Report

A 44-year-old male presented with severe right sharp shooting pain in the buttock, thigh, leg, foot, and/or toes with numbness in the foot and toes (Visual Analog Scale [VAS] 8/10) for six months with an Oswestry disability index (ODI) score of 70%. Her pain aggravated when bending forward and performing daily routine activities. He also complained of exaggeration of pain in daily regular activities. On physical examination, power in the right lower limbs was 5/5 as per the Medical Research Council (MRC) grading, and deep tendon reflexes were normal. Pre-operative X-ray and CT scan showed no instability or calcified disc osteophyte, and magnetic resonance imaging showed extraforaminal stenosis due to disc herniation at L5-S1 in Figure 1. We performed UBE-L5-S1extraforaminal discectomy surgery to resolve his symptoms. The operative time was 68 min; blood loss was 30 mL. After surgery, the patient was followed up at one week, six weeks, three months, six months, 12 months, and two years. The pain and tingling sensation in the legs improved at the 1-week follow-up, with a VAS score of 0/10 and an ODI score of 10% at the 2-year follow-up. Patient satisfaction was surveyed using Macnab's criteria at the final follow-up visit of 2 years and was found to be excellent. Post-operative imaging showed a good extraforaminal decompression at L5-S.

Conclusion

Unilateral biportal endoscopy technique has brought a paradigm shift in the treatment of spinal pathologies and has served as another treatment option for the past two decades. The UBE decompression technique for extraforaminal stenosis at L5-S1 has the advantages of minimally invasive spine surgery; it is a safe and effective treatment option for treating extraforaminal stenosis at L5-S1.

Comparison of Outcomes Between Endoscopic Transforaminal Lumbar Interbody Fusion and Minimally Invasive Transforaminal Lumbar Interbody Fusion in Patients With Single-Level Lumbar Degenerative Disease: A Retrospective Study

OBJECTIVE

The objective of this study was to compare the clinical and radiological outcomes of endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

METHODS

This retrospective study included 110 patients with single-level lumbar degenerative disease who underwent Endo-TLIF or MIS-TLIF between January 2019 and December 2021. Patients were divided into Endo-TLIF (n = 55) and MIS-TLIF groups (n = 55). Perioperative, clinical, and radiological outcomes were assessed.

RESULTS

The Endo-TLIF group had significantly lower blood loss and shorter hospital stay. However, the operation time was significantly longer and there was more x-ray exposure than in the MIS-TLIF group. There were no significant differences in complications between the groups. The Endo-TLIF group showed significantly lower creatine kinase levels than the MIS-TLIF group at 3 days postoperatively (P < 0.05), but not at 7 days postoperatively (P > 0.05). Oswestry Disability Index and visual analog scale scores were significantly reduced in both groups at different time points postoperation compared to preoperation. The visual analog scale score in the Endo-TLIF group was lower than that in the MIS-TLIF group at 3 days postoperatively. Moreover, no significant differences were found in fusion rates, lumbar lordosis, and lumbar segmental lordosis between the 2 groups (P > 0.05).

CONCLUSIONS

Endo-TLIF might be considered as an effective and reliable treatment option for single-level lumbar degeneration. It results in less trauma and faster postoperative recovery, but a longer operative time and more x-ray exposure than MIS-TLIF. Endo-TLIF has effects on clinical and radiological outcomes that are comparable to those of MIS-TLIF.

A bibliometric and visualized analysis of nanoparticles in musculoskeletal diseases (from 2013 to 2023)

As the pace of research on nanomedicine for musculoskeletal (MSK) diseases accelerates, there remains a lack of comprehensive analysis regarding the development trajectory, primary authors, and research focal points in this domain. Additionally, there's a need of detailed elucidation of potential research hotspots. The study gathered articles and reviews focusing on the utilization of nanoparticles (NPs) for MSK diseases published between 2013 and 2023, extracted from the Web of Science database. Bibliometric and visualization analyses were conducted using various tools such as VOSviewer, CiteSpace, Pajek, Scimago Graphica, and the R package. China, the USA, and India emerged as the key drivers in this research domain. Among the numerous institutions involved, Shanghai Jiao Tong University, Chinese Academy of Sciences, and Sichuan University exhibited the highest productivity levels. Vallet-Regi Maria emerged as the most prolific author in this field. International Journal of Nanomedicine accounted for the largest number of publications in this area. The top five disorders of utmost significance in this field include osteosarcoma, cartilage diseases, bone fractures, bone neoplasms, and joint diseases. These findings are instrumental in providing researchers with a comprehensive understanding of this domain and offer valuable perspectives for future investigations.

Trends and hotspots in non-motor symptoms of Parkinson's disease: a 10-year bibliometric analysis

Non-motor symptoms are prevalent among individuals with Parkinson's disease (PD) and seriously affect patient quality of life, even more so than motor symptoms. In the past decade, an increasing number of studies have investigated non-motor symptoms in PD. The present study aimed to comprehensively analyze the global literature, trends, and hotspots of research investigating non-motor symptoms in PD through bibliometric methods. Studies addressing non-motor symptoms in the Web of Science Core Collection (WoSCC), published between January 2013 and December 2022, were retrieved. Bibliometric methods, including the R package "Bibliometrix," VOS viewer, and CiteSpace software, were used to investigate and visualize parameters, including yearly publications, country/region, institution, and authors, to collate and quantify information. Analysis of keywords and co-cited references explored trends and hotspots. There was a significant increase in the number of publications addressing the non-motor symptoms of PD, with a total of 3,521 articles retrieved. The United States was ranked first in terms of publications (n = 763) and citations (n = 11,269), maintaining its leadership position among all countries. King's College London (United Kingdom) was the most active institution among all publications (n = 133) and K Ray Chaudhuri was the author with the most publications (n = 131). Parkinsonism & Related Disorders published the most articles, while Movement Disorders was the most cited journal. Reference explosions have shown that early diagnosis, biomarkers, novel magnetic resonance imaging techniques, and deep brain stimulation have become research "hotspots" in recent years. Keyword clustering revealed that alpha-synuclein is the largest cluster for PD. The keyword heatmap revealed that non-motor symptoms appeared most frequently (n = 1,104), followed by quality of life (n = 502), dementia (n = 403), and depression (n = 397). Results of the present study provide an objective, comprehensive, and systematic analysis of these publications, and identifies trends and "hot" developments in this field of research. This work will inform investigators worldwide to help them conduct further research and develop new therapies.

Why does such a cyst appear after unilateral biportal endoscopy surgery: A case report and literature review

BACKGROUND

Unilateral biportal endoscopy (UBE) has been widely and skillfully used in the treatment of lumbar disc herniation and spinal canal stenosis. UBE surgery also brings some complications, such as dural tear, epidural hematoma, residual nucleus pulposus, etc. And we found a rare case of arachnoid cyst after UBE.

CASE PRESENTATION

A 48 years old female who had a history of cholecystectomy, nephrolithiasis, hyperthyroidism, chronic atrophic gastritis, and colonic polyps with several years of low back pain and numbness in both lower limbs was found have arachnoid cyst 3 years after UBE operation. We hope that we can give a new aspect of complication after the UBE treatment in the future.

CONCLUSION

We believe that the postoperative hypertension and the lack of postoperative back muscle strength training and some personal factors are the possible reasons for the arachnoid cyst in this case.

A bibliometric and visualization analysis of global research on postherpetic neuralgia from 2000 to 2022: A review

Postherpetic neuralgia (PHN) represents a notable clinical challenge as it is the most prevalent and severe complication of herpes zoster (HZ). The primary objective was to investigate the current research status and hotspots of PHN research during the period from 2000 to 2022. The literature pertaining to PHN was gathered through the utilization of the Web of Science Core Collection, spanning from January 2000 to December 2022. The software, CiteSpace version 6.2.R2, was employed to produce visual depictions of publications related to PHN across various dimensions such as year, country/region, institution, journal, author, keyword, and reference. This study involved a total of 3505 papers. The USA held a dominant position in the production of scholarly articles. Argentina exhibited the highest frequency of participation in international collaboration. Out of all the institutions, Pfizer exhibited the highest degree of productivity. Harvard University exhibited the highest frequency of participation in international collaboration. The Pain exhibited the most noteworthy productivity rate and citation count among all other journals. Ralf Baron was identified as the most productive author, whereas DWORKIN RH attained the highest citation count. Contemporary scholarly investigations are predominantly centered on identifying risk factors, devising preventative measures, and exploring novel and secure methods of pain management. The current investigation has revealed the focal areas and patterns of studies pertaining to PHN. Presently, the research in this field is focused on identifying the risk factors and preventive measures for PHN, alongside exploring novel and secure pain management strategies.

Bibliometric Insights in Advances of Chordoma: Global Trends and Research Development in the Last Decade

Chordoma is a rare tumor, but has a serious effect on the quality of life of patients. This study aims to assess the overall knowledge structure and trends in the development of chordoma research using a bibliometric analysis and visualization tool. Research datasets were acquired from the Web of Science. VOS viewer and CiteSpace visualization software were used to demonstrate collaborations and correlations. Annual trends in publications, distribution, H-index status, co-authorship status, and research hotspots were analyzed. A total of 1844 publications from 2012 to 2022 were included. The number of chordoma-related publications increased year by year. The United States contributed the most publications (717) and had the highest total citations (10130) and H-index (50), followed by China. The United States was also the country most frequently involved in international cooperation. The most productive organization involved in chordoma research was Massachusetts General Hospital. World Neurosurgery (114) published the most papers on chordoma. Hornicek FJ was the most productive author over the last decade (41). Initially, diagnosis and the location of onset captured the attention of the research society. Quality of life, risk factors, disability, minimally invasive surgical techniques, molecular targeted therapy, and radiotherapy technology are the research hotspots in recent years. Indeed, this study provides important insights into the overall landscape of chordoma research and also contributes to the further investigation of the international frontier of chordoma.

Global trends in the research and development of medical/pharmaceutical wastewater treatment over the half-century

The COVID-19 pandemic has severely impacted public health and the worldwide economy. The overstretched operation of health systems around the world is accompanied by potential and ongoing environmental threats. At present, comprehensive scientific assessments of research on temporal changes in medical/pharmaceutical wastewater (MPWW), as well as estimations of researcher networks and scientific productivity are lacking. Therefore, we conducted a thorough literature study, using bibliometrics to reproduce research on medical wastewater over nearly half a century. Our primary goal is systematically to map the evolution of keyword clusters over time, and to obtain the structure and credibility of clusters. Our secondary objective was to measure research network performance (country, institution, and author) using CiteSpace and VOSviewer. We extracted 2306 papers published between 1981 and 2022. The co-cited reference network identified 16 clusters with well-structured networks (Q = 0.7716, S = 0.896). The main trends were as follows: 1) Early MPWW research prioritized sources of wastewater, and this cluster was considered to be the mainstream research frontier and direction, representing an important source and priority research area. 2) Mid-term research focused on characteristic contaminants and detection technologies. Particularly during 2000-2010, a period of rapid developments in global medical systems, pharmaceutical compounds (PhCs) in MPWW were recognized as a major threat to human health and the environment. 3) Recent research has focused on novel degradation technologies for PhC-containing MPWW, with high scores for research on biological methods. Wastewater-based epidemiology has emerged as being consistent with or predictive of the number of confirmed COVID-19 cases. Therefore, the application of MPWW in COVID-19 tracing will be of great interest to environmentalists. These results could guide the future direction of funding agencies and research groups.

Preoperative Dyeing Technique for Decreasing Radiation Exposure in Unilateral Biportal Endoscopic Spine Surgery

BACKGROUND

Minimally invasive surgery has many advantages, including early recovery and cosmetic preservation. However, the higher radiation exposure to physicians and patients has drawbacks. Preoperative tissue dyeing techniques are feasible options for reducing radiation exposure and procedure time, but their efficacy has not yet been evaluated. Therefore, this study aimed to evaluate surgical outcomes and reduce radiation exposure during unilateral biportal endoscopy surgery.

METHODS

This was a prospective, case-controlled analysis in a tertiary hospital. Patients receiving experimental tissue dye and controls in the nondye group were compared from May 2020 to September 2021. The ipsilateral posterolateral approach (IPA) and the far lateral approach (FLA) were analyzed separately among all single-level spinal procedures without instrumentation. Operative details (operation time, improvement of back and leg pain, and length of hospital stay) and radiation exposure (dose and duration) were compared.

RESULTS

A total of 88 cases were included, consisting of 64 interlaminar approaches (experimental: 33, control: 31) and 24 FLAs (experimental: 13 and control: 11). In the IPA approach, the patient and physician radiation exposure doses and duration decreased significantly. Conversely, for the FLA, only the duration of the physician exposure decreased significantly.

CONCLUSIONS

Preoperative tissue dyeing techniques using IPA can reduce radiation exposure for physicians and patients. However, a decrease in the duration of radiation was observed only in physicians using the FLA. The dyeing technique is effective in IPA, but the efficacy of FLA is doubtful.

Transforaminal Interbody Fusion Using the Unilateral Biportal Endoscopic Technique Compared With Transforaminal Lumbar Interbody Fusion for the Treatment of Lumbar Spine Diseases: Analysis of Clinical and Radiological Outcomes

BACKGROUND

There has been a widespread application of minimally invasive spinal surgery techniques in the past few years. Unilateral biportal endoscopic has been successfully used in a variety of lumbar spine diseases, but there are few studies on lumbar fusion assisted by unilateral biportal endoscopy.

OBJECTIVE

To compare the clinical and radiological outcomes of transforaminal interbody fusion using the unilateral biportal endoscopic technique (UBEIF) and transforaminal lumbar interbody fusion (TLIF) in patients with lumbar disease.

METHODS

We studied 128 patients, 58 in the UBEIF group and 70 in the TLIF group. The Oswestry disability index, creatine kinase, visual analog score (VAS) for leg and back pain were used to assess clinical outcomes. Radiographic outcomes were assessed using the fusion rate, internal fixation loosening, and adjacent segment degeneration.

RESULTS

Back and leg pain VAS scores in both groups were significantly lower 3, 6, and 12 months after surgery ( P < .05). A significant reduction in Oswestry disability index in both groups was observed 6 and 12 months after surgery ( P < .05). Compared with the TLIF group at 1 week after surgery, UBEIF patients' VAS score for back pain significantly improved ( P < .05). There was no difference in fusion rate between the 2 groups (98.27% vs 98.57%).

CONCLUSION

UBEIF and TLIF have similar clinical and radiographic outcomes in the treatment of single-segment lumbar disease with lumbar instability, including improved back and leg pain, improved disability, and high fusion rates. Furthermore, with UBEIF, less blood is lost, there is better relief of early back pain, and hospital stays are shorter.

Decompression via unilateral biportal endoscopy for severe degenerative lumbar spinal stenosis: A comparative study with decompression via open discectomy

Background

Previous studies have shown that the Unilateral Biportal Endoscopy is an effective and safety surgery for sufficient decompression of degenerative lumbar spinal stenosis. However, data are lacking in terms of its benefits when compared with conventional open lumbar discectomy (OLD), especially in patients with severe degenerative lumbar spinal stenosis (DLSS).

Aim

To compare the clini cal outcomes of two types decompressive surgery: unilateral biportal endoscopy-unilateral laminectomy bilateral decompression (UBE-ULBD) and conventional open lumbar discectomy (OLD) in severe degenerative lumbar spinal stenosis (DLSS).

Methods

We retrospectively analyzed patients who underwent UBE-ULBD (n = 50, operated at 50 levels; UBE-ULBD group) and conventional open lumbar discectomy (n = 59, operated at 47 levels; OLD group) between February 2019 and July 2021. All patients were diagnosed with severe stenosis based on the Schizas classification (Grade C or D) on MRI. We compared radiographic and clinical outcome scores [including the visual analog scale (VAS), Oswestry Disability Index (ODI), and Zurich Claudication Questionnaire (ZCQ)] between the 2 groups at 1 year of follow-up. The radiographic evaluation included the cross-sectional area (CSA) of the thecal sac and paraspinal muscles on MRI. Fasting blood was drawn before and 1 and 7 days after the operation to detect creatine kinase (CK). Surgical data perioperative complications were also investigated.

Results

The baseline demographic data of the 2 groups were comparable, including VAS, ODI and ZCQ scores, the cross-sectional area of the thecal sac and paraspinal muscles and creatine kinase levels. The dural sac CSA significantly increased post -operatively in both groups, which confirmed they benefited from comparable decompressive effects. The operative duration in the OLD group was less than the UBE-ULBD group (43.9 ± 5.6 min vs. 74.2 ± 9.3 min, p < 0.05). The OLD group was associated with more estimated blood loss than the UBE-ULBD group (111.2 ± 25.0 ml vs. 41.5 ± 22.2 ml, P < 0.05). The length of hospital stay (HS) was significantly longer in the OLD group than in the UBE-ULBD group (6.8 ± 1.6 vs. 4.0 ± 1.4 days, P < 0.05). The VAS, ODI, and ZCQ scores improved in both groups after the operation. Serum creatine kinase values in the UBE-ULBD group were significantly lower than in the OLD group at 1 day after surgery (108. 1 ± 11.9 vs. 347.0 ± 19.5 U/L, P < 0.05). The degree of paraspinal muscle atrophy in the UBE-ULBD group was significantly lower than in the OLD group at 1 year (4.50 ± 0.60 vs. 11.42 ± 0.87, P < 0.05).

Conclusions

UBE-ULBD and conventional OLD demonstrate comparable short-term clinical outcomes in treating severe DLSS. However, UBE-ULBD surgery was associated with a shorter hospital stay, less EBL and paravertebral muscle injury than OLD surgery.

[Application of unilateral biportal endoscopy technique in single-segment thoracic ossification of ligamentum flavum]

Objective

To investigate the safety and effectiveness of unilateral biportal endoscopy (UBE) technique in the treatment of single-segment thoracic ossification of ligamentum flavum (TOLF).

Methods

Between August 2020 and December 2021, 11 patients with single-segment TOLF were treated with UBE technique. There were 6 males and 5 females, with an average of 58.2 years (range, 49-72 years). The responsible segment was T _{6, 7} in 1 case, T _{7, 8} in 1 case, T _{8, 9} in 2 cases, T _{9, 10} in 2 cases, T _{10, 11} in 2 cases, and T _{11, 12} in 3 cases. Imaging examination showed that the ossification were located on the left side in 4 cases, on the right side in 3 cases, and on bilateral sides in 4 cases. The main clinical symptoms were chest and back pain or lower limb pain, all accompanied by lower limb numbness and fatigue. The disease duration ranged from 2 to 28 months (median, 17 months). The operation time, postoperative hospital stay, and complications were recorded. Visual analogue scale (VAS) score was used to evaluate the chest and back pain and low limb pain, and Oswestry disability index (ODI) and Japanese Orthopedic Association (JOA) score were used to evaluate functional recovery before operation and at 3 days, 1 month, 3 months after operation, and last follow-up. The anteroposterior diameter of the coronal spinal canal was measured by CT before and after operation to evaluate the effect of surgical decompression.

Results

All operations were successfully completed. The operation time was 50-105 minutes, with an average of 80.0 minutes. No postoperative complication such as dural sac tear, cerebrospinal fluid leakage, spinal nerve injury, or infection occurred. The postoperative hospital stay was 2-5 days, with an average of 3.1 days. All incisions healed by first intention. All patients were followed up 6-22 months, with an average of 14.8 months. CT measurement at 3 days after operation showed that the anteroposterior diameter of the spinal canal was (8.63±1.61) mm, which was significantly larger than that before operation [(3.67±1.37) mm] ( t=-12.181, P<0.001). The VAS score of chest and back pain and lower limb pain and ODI at each time point after operation were significantly lower than those before operation ( P<0.05). The above indexes were further improved after operation, except that there was no significant difference between at 3 months after operation and at last follow-up ( P>0.05), the differences between other time points were significant ( P<0.05). There was no recurrence during the follow-up period.

Conclusion

UBE technique is a safe and effective method to treat single-segment TOLF, but its long-term effectiveness needs to be further studied.

Knowledge domain and dynamic patterns in multimodal molecular imaging from 2012 to 2021: A visual bibliometric analysis

Multimodal molecular imaging technologies have been widely used to optimize medical research and clinical practice. Bibliometric analysis was performed to identify global research trends, hot spots, and scientific frontiers of multimodal molecular imaging technology from 2012 to 2021. The articles and reviews related to multimodal molecular imaging were retrieved from the Web of Science Core Collection. A bibliometric study was performed using CiteSpace and VOSviewer. A total of 4169 articles and reviews from 2012 to 2021 were analyzed. An increasing trend in the number of articles on multimodal molecular imaging technology was observed. These publications mainly come from 417 institutions in 92 countries, led by the USA and China. K. Bailey Freund published the most papers amongst the publications, while R.F. Spaide had the most co-citations. A dual map overlay of the literature shows that most publications were specialized in physics/materials/chemistry, and molecular/biology/immunology. Synergistic therapy in cancer, advanced nanotechnology, and multimodal imaging in ophthalmology are new trends and developing areas of interest. A global bibliometric and visualization analysis was used to comprehensively review the published research related to multimodal molecular imaging. This study may help in understanding the dynamic patterns of multimodal molecular imaging technology research and point out the developing areas of this field.

Postoperative Intracranial Hemorrhage after an Endoscopic L5-S1 Laminectomy and Discectomy: A Case Report and Literature Review

BACKGROUND

Postoperative intracranial hemorrhage (PIH) is a fairly rare but catastrophic perioperative complication following lumbar spine surgery. This is a case report of a 54-year-old male patient who experienced PIH 2 h after an endoscopic L5-S1 laminectomy and discectomy.

CASE PRESENTATION

A 54-year-old male patient presented with right L5-S1 radiculopathy that corresponded with the picture revealed in medical imaging and the signs seen upon physical examination. Subsequently, he underwent endoscopic L5-S1 laminectomy and discectomy. The patient presented with idiopathic unconsciousness and limb twitching 2 h after surgery. An emergency cranial CT scan was obtained which demonstrated intracranial hemorrhage. Following an emergency consultation with the Department of Neurology and Neurosurgery, the patient underwent an emergency interventional thrombectomy as per their orders. The surgery was performed successfully. However, the patient's situation did not improve and he died on the second postoperative day.

CONCLUSION

PIH after spinal endoscopic surgery is a rare but horrible complication. Several factors could lead to PIH. However, in this patient, the cause of PIH might be attributed to the long operation time combined with cerebrospinal fluid (CSF) leakage. Great attention should be attached to the issue of PIH development in spinal endoscopic procedures due to constant irrigation. This study aims to highlight the issue of PIH following endoscopic spinal surgery by presenting a case report of a patient who died despite successful surgery.

Bibliometric Analysis and Visualization of Research Progress in the Diabetic Nephropathy Field from 2001 to 2021

Methods

The PubMed database was searched to identify all studies related to DN that were published from 2001 to 2021, with these studies being separated into four time-based groups. The characteristics of these studies were analyzed and extracted using BICOMB. Biclustering analyses for each of these groups were then performed using gCLUTO, with these results then being analyzed and GraphPad Prism 5 being used to construct strategy diagrams. The social network analyses (SNAs) for each group of studies were conducted using NetDraw and UCINET.

Results

In total, 18,889 DN-associated studies published from 2001 to 2021 and included in the PubMed database were incorporated into the present bibliometric analysis. Biclustering analysis and strategy diagrams revealed that active areas of research interest in the DN field include studies of the drug-based treatment, diagnosis, etiology, pathology, physiopathology, and epidemiology of DN. The specific research topics associated with these individual areas, however, have evolved over time in a dynamic manner. Strategy diagrams and SNA results revealed podocyte metabolism as an emerging research hotspot in the DN research field from 2010 to 2015, while DN-related microRNAs, signal transduction, and mesangial cell metabolism have emerged as more recent research hotspots in the interval from 2016 to 2021.

Conclusion

Through analyses of PubMed-indexed studies pertaining to DN published since 2001, the results of this bibliometric analysis offer a knowledge framework and insight into active and historical research hotspots in the DN research space, enabling investigators to readily understand the dynamic evolution of this field over the past two decades. Importantly, these analyses also enable the prediction of future DN-related research hotspots, thereby potentially guiding more focused and impactful research efforts.

Clinical comparison of percutaneous transforaminal endoscopic discectomy and unilateral biportal endoscopic discectomy for single-level lumbar disc herniation

Purpose

To compare the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopic discectomy (UBE) for the treatment of single-level lumbar disc herniation (LDH).

Materials and methods

From January 2020 to November 2021, 62 patients with single-level LDH were retrospectively reviewed. All patients underwent spinal surgeries at the Affiliated Hospital of Chengde Medical University and Beijing Tongren Hospital, Capital Medical University. Among them, 30 patients were treated with UBE, and 32 were treated with PTED. The patients were followed up for at least one year. Patient demographics and perioperative outcomes were reviewed before and after surgery. The Oswestry Disability Index (ODI), visual analog scale (VAS) for back pain and leg pain, and modified MacNab criteria were used to evaluate the clinical outcomes. x-ray examinations were performed one year after surgery to assess the stability of the lumbar spine.

Results

The mean ages in the UBE and PTED groups were 46.7 years and 48.0 years, respectively. Compared to the UBE group, the PTED group had better VAS scores for back pain at 1 and 7 days after surgery (3.06 ± 0.80 vs. 4.03 ± 0.81, P < 0.05; 2.81 ± 0.60 vs. 3.70 ± 0.79, P < 0.05). The UBE and PTED groups demonstrated significant improvements in the VAS score for leg pain and ODI score, and no significant differences were found between the groups at any time after the first month (P > 0.05). Although the good-to-excellent rate of the modified MacNab criteria in the UBE group was similar to that in the PTED group (86.7% vs. 87.5%, P > 0.05), PTED was advantageous in terms of the operation time, estimated blood loss, incision length, and length of postoperative hospital stay.

Conclusions

Both UBE and PTED have favorable outcomes in patients with single-level LDH. However, PTED is superior to UBE in terms of short-term postoperative back pain relief and perioperative quality of life.

"Cave-in" decompression under unilateral biportal endoscopy in a patient with upper thoracic ossification of posterior longitudinal ligament: Case report

Background

Thoracic ossification of the posterior longitudinal ligament (TOPLL) requires surgery for spinal cord decompression. Traditional open surgery is extremely invasive and has various complications. Unilateral biportal endoscopy (UBE) is a newly developed technique for spine surgery, especially in the lumbar region, but rare in the thoracic spine. In this study, we first used a different percutaneous UBE "cave-in" decompression technique for the treatment of beak-type TOPLL.

Methods

A 31-year-old female with distinct zonesthesia and numbness below the T3 dermatome caused by beak-type TOPLL (T2-T3) underwent a two-step UBE decompression procedure. In the first step, the ipsilateral lamina, left facet joint, partial transverse process, and pedicles of T2 and T3 were removed. In the second step, a cave was created by removing the posterior third of the vertebral body (T2-T3). The eggshell-like TOPLL was excised by forceps, and the dural sac was decompressed. All procedures are performed under endoscopic guidance. A drainage tube was inserted, and the incisions were closed after compliance with the decompression scope via a C-arm. The patient's preoperative and postoperative radiological and clinical results were evaluated.

Results

Postoperative CT and MR films conformed complete decompression of the spinal cord. The patient's lower extremity muscle strength was greatly improved, and no complications occurred. The mJOA score improved from 5 to 7, with a recovery rate of 33.3%.

Conclusion

UBE spinal decompression for TOPLL showed favorable clinical and radiological results and offers the advantages of minimal soft tissue dissection, shorter hospital stays, and a faster return to daily life activities.

Bibliometric analysis of traditional Chinese medicine research on heart failure in the 21st century based on the WOS database

Introduction

Heart Failure (HF) is a key area of research in human medicine, and traditional Chinese medicine (TCM) is an important branch of this field. This study aimed to use bibliometric methods to sort out the trajectory of TCM research on HF in this century (2000-2022) from a high dimension and to analyze its characteristics, hotspots and frontiers.

Methods

In this study, the search formula "TS=(("traditional Chinese medicine") OR ("Chinese medicine")) AND TS=("heart failure")" was used to find relevant studies included in the Web of Science Core Collection from 2000 to 2022. Targeted literature records were analyzed and mapped using CiteSpace and VOSviewer.

Results

The authors and collaborators of this study were still in the formation process, but several well-known scholars were included: YONG WANG, WEI WANG, etc. The main research institutions in this research area were Beijing Univ Chinese Med, China Acad Chinese Med Sc, etc. The main country of study was China. Current research hotspots and frontiers were Qili Qiangxin capsules, extracts (Tanshinone ⅡA, Panax ginseng, etc.), cardiac hypertrophy, ventricular remodeling, oxidative stress, signaling pathways, network pharmacology, etc. Influential journals that publish papers in this field were the Journal of Ethnopharmacology, Scientific Reports, Biomedicine & Pharmacotherapy, etc. The top 3 co-cited journals were Circulation, J ethnopharmacol, and J am coll cardiol.

Conclusions

We analyzed valuable details in TCM research on HF in the 21st century, which may help researchers identify potential collaborators and partner institutions, hotspots, and frontiers in the field.

Complete removal of intraspinal extradural mass with unilateral biportal endoscopy

Introduction

Unilateral biportal endoscopic (UBE) technique can easily decompress the bony spinal canal and accommodate all open surgical instruments under endoscopic guidance. However, indications and reports of this technique have been limited to degenerative and infectious diseases.

Methods

We used the UBE technique for the decompression and removal of extradural mass lesions in five patients. Under endoscopic guidance, a unilateral approach was used, and decompression and flavectomy were performed. After decompression, removal of the tumor was performed using various forceps. We evaluated the technical process of the procedure, the patient's pre- and postoperative symptoms, and operative radiology and pathologic results.

Results

Postoperative pain and disability improved clinically for all patients. Four patients were confirmed as having an epidural cyst and one patient was diagnosed with hemangioma. During follow-up, no recurrence was observed.

Conclusions

We successfully removed five extradural mass lesions using a biportal endoscopic posterior approach without complications. The biportal endoscopic approach may have advantages, such as minimizing trauma to the normal structures, magnified endoscopic view, and early recovery after the surgery. Biportal endoscopy may be used as an alternative surgical treatment for symptomatic intraspinal extradural benign lesions.

A bibliometrics and visualization analysis of cannabidiol research from 2004 to 2021

Cannabidiol, a non-psychoactive component extracted from the plant cannabis sativa, has gained growing focus in recent years since its extensive pharmacology effects have been founded. The purpose of this study intends to reveal the hot spots and frontiers of cannabidiol research using bibliometrics and data visualization methods. A total of 3,555 publications with 106,793 citations from 2004 to 2021 related to cannabidiol were retrieved in the Web of Science database, and the co-authorships, research categories, keyword burst, and reference citations in the cannabidiol field were analyzed and visualized by VOSviewer and Citespace software. Great importance has been attached to the pharmacology or pharmacy values of cannabidiol, especially in the treatment of neuropsychiatric disorders, such as epilepsy, anxiety, and schizophrenia. The mechanisms or targets of the cannabidiol have attracted the extreme interest of the researchers, a variety of receptors including cannabinoids type 1, cannabinoids type 2, 5-hydroxytriptamine1A, and G protein-coupled receptor 55 were involved in the pharmacology effects of cannabidiol. Moreover, the latest developed topic has focused on the positive effects of cannabidiol on substance use disorders. In conclusion, this study reveals the development and transformation of knowledge structures and research hotspots in the cannabidiol field from a bibliometrics perspective, exploring the possible directions of future research.

[Brief history, global trends, and Chinese mission of unilateral biportal endoscopy technique]

The current unilateral biportal endoscopy (UBE) technique was originated from Argentina and developed in South Korea, which was rapidly growing and popularizing in China. The adoption of spinal endoscopy, using small cameras placed inside body with continuous water irrigation, providing better surgical field with less tissue dissection and quicker recovery for patients. As with other disciplines, the use of spinal endoscopy in spinal surgery will become increasingly widespread. UBE technique will promote the popularization of spinal endoscopy in China with monoportal endoscopy technique. At the same time, biportal endoscopy has better expansibility, the application of accessory incision may provide solution for more complicated spinal disease. Chinese spine surgeon should better understand the trends in spinal endoscopy, seize the opportunity of the rapidly evolving in spinal healthcare, and to promote the popularization of UBE across the globe.

Safety and efficacy of unilateral and bilateral pedicle screw fixation for lumbar degenerative diseases by transforaminal lumbar interbody fusion: An updated systematic review and meta-analysis

Background

The purpose of this study was to compare the safety and efficacy of unilateral vs. bilateral pedicle screw fixation (BPSF) for lumbar degenerative diseases.

Methods

Electronic databases including PubMed, Web of science, the Cochrane Library, Scopus, MEDLINE, EMBASE, EBSCO were searched by computer. The deadline was set for June 1, 2022. This study included all high-quality randomized controlled trials (RCTs), prospective clinical controlled studies (PRO), and retrospective studies (Retro) that compared unilateral and bilateral pedicle screw fixation in the treatment of lumbar degenerative diseases. Revman5.3 software was used for meta-analysis after two researchers independently screened the literature, extracted data, and assessed the risk of bias in the study.

Results

Fourteen studies with a total of 1,086 patients were included. Compared with BPSF, unilateral pedicle screw fixation (UPSF) has shorter operation time and hospital time, and less blood loss and operation cost, operation time [SMD = −1.75, 95% CI (−2.46 to −1.03), P < 0.00001], hospital time [SMD = −1.10, 95% CI (−1.97 to −0.22), P = 0.01], Blood loss [SMD = −1.62, 95% CI (−2.42 to −0.82), P < 0.0001], operation cost [SMD = −14.03, 95% CI (−20.08 to −7.98), P < 0.00001], the ODI after bilateral pedicle screw fixation was lower, and the degree of lumbar dysfunction was lighter, [SMD = 0.19, 95% CI (0.05–0.33), P = 0.007], better fusion effect, fusion rate [RR=0.95, 95% CI (0.91–1.00), P = 0.04]. VAS-Low back pain [SMD = 0.07, 95% CI (−0.07–0.20), P = 0.35], VAS-Leg pain [SMD = 0.18, 95% CI (−0.00–0.36), P = 0.05], SF-36 [SMD = 0.00, 95% CI (−0.30–0.30), P = 1.00], complications rate [RR = 0.94, 95% CI (0.9154–1.63), P = 0.82], the overall difference was not statistically significant.

Conclusions

Currently limited evidence suggests that UPSF significantly reduces blood loss, significantly shortens the operative time and hospital stay, and reduces blood loss and costs. After BPSF, the ODI was lower, the degree of lumbar spine dysfunction was lower, and the fusion rate was significantly higher. The VAS, SF-36, and complications scores of the two groups were comparable, and there was no significant clinical difference.