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Pao JL. Preliminary Clinical and Radiological Outcomes of the "No-Punch" Decompression Techniques for Unilateral Biportal Endoscopic Spine Surgery. Neurospine 2024; 21:732-741. [PMID: 38955542 PMCID: PMC11224751 DOI: 10.14245/ns.2448376.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To avoid the most offending surgical instrument for dural tears, we develop a "no-punch" decompression technique for unilateral biportal endoscopic (UBE) spine surgery. METHODS This retrospective study enrolled 68 consecutive patients with degenerative lumbar spinal stenosis segments. The treatment results were evaluated using the visual analogue scale (VAS) for low back and leg pain, the Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI). Radiological outcomes were evaluated using the preoperative and postoperative magnetic resonance imaging. RESULTS This study included 36 male and 32 female patients who received 109 segments of decompression, with an average age of 68.7 (37-90 years). The average operation time was 52.2 minutes. The average hospital stay was 3.1 days. There were no dural tears but 3 minor surgical complications, all treated conservatively. The VAS for low back and leg pain improved from 4.6 and 7.0 to 0.8 and 1.2. The JOA score improved from 16.2 to 26.8, with an improvement rate of 82.0%. The ODI improved from 50.1 to 18.7. All these improvements were statistically significant. The cross-sectional dural area improved from 61.1 to 151.3 mm2, with an average increase of 90.2 mm2 and 205.3%. 87.1% of the ipsilateral facet joints and 84.7% of the contralateral facet joints were preserved. In 61% of the decompressed segments, the ipsilateral facet joints were preserved better than the contralateral facet joints. CONCLUSION The UBE "no-punch" decompression technique effectively avoids the dural tears. It provides effective neural decompression, excellent facet joint preservation, and good treatment outcomes.
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Affiliation(s)
- Jwo-Luen Pao
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
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Burkett D, Brooks N. Advances and Challenges of Endoscopic Spine Surgery. J Clin Med 2024; 13:1439. [PMID: 38592293 PMCID: PMC10932008 DOI: 10.3390/jcm13051439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
The purpose of this paper is to review the data supporting current endoscopic surgical techniques for the spine and the potential challenges and future of the field. The origins of endoscopic spine surgery can be traced back many decades, with many important innovations throughout its development. It can be applied to all levels of the spine, with many robust trials supporting its clinical outcomes. Continued clinical research is needed to explore its expanding indications. Although the limitations of starting an endoscopic program can be justified by its cost effectiveness and positive societal impact, challenges facing its widespread adoption are still present. As more residency and fellowship programs include endoscopy as part of their spine training, it will become more prevalent in hospitals in the United States. Technological advancements in spine surgery will further propel and enhance endoscopic techniques as they become an integral part of a spine surgeon's repertoire.
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Affiliation(s)
| | - Nathaniel Brooks
- Neurosurgery Department, University of Wisconsin Hospitals and Clinics, Madison, WI 53792, USA;
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Sun S, Luo H, Wang Y, Xi Y, Fang K, Wu T. Artificial spinal dura mater made of gelatin microfibers and bioadhesive for preventing cerebrospinal fluid leakage. Chem Commun (Camb) 2024; 60:2353-2356. [PMID: 38323482 DOI: 10.1039/d3cc06278c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Artificial spinal dura mater was designed by combining solution blow-spun gelatin microfibers and dopamine-capped polyurethane bioadhesive. Notably, the gelatin microfibers had a special pore structure, good water adsorption capability, and excellent burst pressure resistance. The bioadhesive layer contributed to the excellent sealing performance in the wet state. This material provides a promising alternative as an artificial spinal dura mater to prevent cerebrospinal fluid leakage.
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Affiliation(s)
- Shengdong Sun
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textiles and Clothing, Qingdao University, Qingdao, 266071, China.
- Collaborative Innovation Center for Eco-Textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao, 266071, China
| | - Hao Luo
- Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao, 266071, China.
| | - Yuanfei Wang
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textiles and Clothing, Qingdao University, Qingdao, 266071, China.
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, 266001, China
| | - Yongming Xi
- Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao, 266071, China.
| | - Kuanjun Fang
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textiles and Clothing, Qingdao University, Qingdao, 266071, China.
- Collaborative Innovation Center for Eco-Textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao, 266071, China
- Laboratory for Manufacturing Low Carbon and Functionalized Textiles in the Universities of Shandong Province, Qingdao, 266071, China
- State Key Laboratory for Biofibers and Eco-textiles, 308 Ningxia Road, Qingdao 266071, China
| | - Tong Wu
- Shandong Key Laboratory of Medical and Health Textile Materials, College of Textiles and Clothing, Qingdao University, Qingdao, 266071, China.
- Collaborative Innovation Center for Eco-Textiles of Shandong Province and the Ministry of Education, Qingdao University, Qingdao, 266071, China
- Affiliated Hospital of Qingdao University, Qingdao Medical College, Qingdao University, Qingdao, 266071, China.
- Institute of Neuroregeneration & Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao University, Qingdao, 266071, China
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Greil ME, Bergquist J, Kashlan ON, Kwon WK, Durfy S, Hofstetter CP. Incidence and management of dural tears in full-endoscopic unilateral laminotomies for bilateral lumbar decompression. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2889-2895. [PMID: 37264093 DOI: 10.1007/s00586-023-07749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To report incidence of dural lacerations in lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) and to describe patient outcomes following a novel full-endoscopic bimanual durotomy repair. METHODS Retrospective review of prospectively collected database including 5.5 years of single surgeon experience with LE-ULBD. Patients with no durotomy were compared with patients who experienced intraoperative durotomy, including demographics, ASA score, prior surgery, number of levels treated, procedure time, hospital length of stay (LOS), visual analogue scale, perioperative complications, revision surgeries, use of analgesics, and Oswestry Disability Index (ODI). RESULTS In total, 13/174 patients (7.5%) undergoing LE-ULBD experienced intraoperative durotomy. No significant differences in demographic, clinical or operative variables were identified between the 2 groups. Sustaining a durotomy increased LOS (p = 0.0019); no differences in perioperative complications or rate of revision surgery were identified. There was no difference in minimally clinically important difference for ODI between groups (65.6% for no durotomy versus 55.6% for durotomy, p = 0.54). CONCLUSION In this cohort, sustaining a durotomy increased LOS but, with accompanying intraoperative repair, did not significantly affect rate of complications, revision surgery or functional outcomes. Our method of bimanual endoscopic dural repair provides an effective approach for repair of dural lacerations in interlaminar ULBD cases.
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Affiliation(s)
- Madeline E Greil
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA
| | - Julia Bergquist
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Woo-Keun Kwon
- Department of Neurosurgery, College of Medicine, Korea University Guro Hospital, Korea University, Seoul, Republic of Korea
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA.
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Li X, Liu J, Liu Z. Comparison of the results of open PLIF versus UBE PLIF in lumbar spinal stenosis: postoperative adjacent segment instability is lesser in UBE. J Orthop Surg Res 2023; 18:543. [PMID: 37516831 PMCID: PMC10386635 DOI: 10.1186/s13018-023-04038-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/22/2023] [Indexed: 07/31/2023] Open
Abstract
OBJECTIVE To compare the difference in efficacy between open PLIF and UBE for lumbar spinal stenosis and the effect on postoperative adjacent segment instability. METHOD The clinical data of 37 patients with PLIF and 32 patients with UBE for lumbar spinal stenosis were retrospectively analyzed to compare the differences in perioperative conditions and short- and medium-term outcomes. RESULTS All 69 patients completed the surgery successfully. The operating time, number of intraoperative fluoroscopies and hospital days were higher in the UBE group than in the open PLIF group. Intraoperative bleeding and postoperative drainage were lower than in the open PLIF group (P < 0.05). The visual analogue scale (VAS) of low back pain was lower in the UBE group than in the open PLIF group at 1 month and 3 months postoperatively (P < 0.05), and there were no statistically significant VAS scores for low back pain in the two groups at 1 day and 6 months postoperatively (P > 0.05). Leg pain VAS scores were lower in the UBE group than in the open PLIF group at 1 month, 3 months and 6 months postoperatively (P < 0.05), and leg pain VAS scores were not statistically significant in both groups at 1 day postoperatively (P > 0.05). The ODI index was lower in the UBE group than in the open PLIF group at 1 day and 1 month postoperatively (P < 0.05) and was not statistically significant in the two groups at 3 months and 6 months postoperatively (P > 0.05). There was no statistically significant difference between the two groups in postoperative interbody height, sagittal diameter of the spinal canal, efficacy of modified MacNab and interbody fusion (P > 0.05). The open PLIF group was more prone to postoperative adjacent vertebral instability than the UBE group, and the difference was statistically significant (P < 0.05). CONCLUSION With appropriate indications, the open PLIF group and the UBE group had similar short- and medium-term clinical outcomes for the treatment of lumbar spinal stenosis, but patients in the UBE group had better symptomatic improvement than the open PLIF group at 3 months postoperatively, and the effect on postoperative adjacent vertebral instability was smaller in the endoscopic group than in the open PLIF group.
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Affiliation(s)
- Xiaobin Li
- The Third Affiliated Hospital of Soochow University, Changzhou, China
- Yangzhou University, Yangzhou, China
| | - Jie Liu
- The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Zhiwei Liu
- The Third Affiliated Hospital of Soochow University, Changzhou, China.
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Wang YP, Qin SL, Yang S, Xu YF, Han PF. Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis: A systematic review and updated meta‑analysis. Exp Ther Med 2023; 26:309. [PMID: 37273751 PMCID: PMC10236128 DOI: 10.3892/etm.2023.12008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
The incidence of lumbar spinal stenosis is increasing annually, and with an ever-aging population and longer life expectancies, this trend will further continue. It is hoped that a more effective treatment can be found so that the patients can be relieved of their pain. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of unilateral biportal endoscopic surgery (UBE) and microscopic decompression surgery (MD) for the treatment of lumbar spinal stenosis. A literature search of related studies published until April 2022 was performed using PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.gov, Google Scholar, China National Knowledge Infrastructure (CNKI), and other databases. After filtering of references, 12 eligible studies were identified that compared UBE with MD as a treatment for lumbar spinal stenosis. Data were extracted and analysed using R. A total of 12 articles (four randomized controlled and eight cohort studies) were included, with a total of 1,067 patients: 250 men and 249 women in the UBE group and 290 men and 278 women in the MD group. The meta-analysis showed that the mean intraoperative blood loss in the UBE group [standardized mean difference (SMD)=-2.10, 95% confidence interval (CI) (-3.97, -0.23), P=0.03] was lower than that in the MD group. The postoperative Visual analogue scale (VAS) score for back pain [SMD=-0.52, 95% CI (-0.76, -0.27), P<0.01], leg pain [SMD=-0.30, 95% CI (-0.51, -0.08), P<0.01], postoperative Oswestry disability index [(ODI); SMD=-0.25, 95% CI (-0.48, -0.03), P=0.03], and postoperative C-reactive protein [(CRP); odds ratio (OR)=-0.92, 95% CI (-1.80, 0.03), P=0.04] were lower than those in the MD group. Complications (OR=0.60, 95% CI (0.37, 0.98), P=0.04) and hospital stay (SMD=-1.84, 95% CI (-2.85, 0.83), P <0.01] were also lesser in the UBE group than in the MD group. UBE was preferable to that in the MD group according to the modified MacNab score [OR=2.28, 95% CI (1.28, 4.06), P<0.01]. No significant differences were observed in the operation times between the groups. UBE surgery was found to be a better option for the treatment of lumbar spinal stenosis than MD surgery.
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Affiliation(s)
- Yue-Peng Wang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
- Department of Orthopaedics, Pinggu Hospital of Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 101200, P.R. China
| | - Shi-Lei Qin
- Department of Orthopaedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
| | - Su Yang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yun-Feng Xu
- Department of Orthopaedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
| | - Peng-Fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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Milton R, Kalanjiyam GP, S R, Shetty AP, Kanna RM. Dural injury following elective spine surgery - A prospective analysis of risk factors, management and complications. J Clin Orthop Trauma 2023; 41:102172. [PMID: 37483912 PMCID: PMC10362543 DOI: 10.1016/j.jcot.2023.102172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/28/2023] [Accepted: 05/28/2023] [Indexed: 07/25/2023] Open
Abstract
Incidental dural tears being a familiar complication in spine surgery could result in dreaded postoperative outcomes. Though the literature pertaining to their incidence and management is vast, it is limited by the retrospective study designs and smaller case series. Hence, we performed a prospective study in our institute to determine the incidence, surgical risk factors, complications and surgical outcomes in patients with unintended durotomy during spine surgery over a period of one year. The overall incidence in our study was 2.3% (44/1912). Revision spine surgeries in particular had a higher incidence of 16.6%. The average age of the study population was 51.6 years. The most common intraoperative surgical step associated with dural tear was removal of the lamina, and 50% of the injuries were during usage of kerrison rongeur. The most common location of the tear was paramedian location (20 patients) and the most common size of the tear was about 1 mm-5mm (31 patients). We observed that the dural repair techniques, placement of drain and prolonged post-operative bed rest didnot significantly affect the post-operative outcomes. One patient in our study developed persistent CSF leak, which was treated by subarachnoid lumbar drain placement. No patients developed pseudomeningocele or post-operative neurological worsening or re-exploration for dural repair. Wound complications were noted in 4 patients and treated by debridement and antibiotics. Based on our study, we have proposed a treatment algorithm for the management of dural tears in spine surgery.
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Affiliation(s)
- Raunak Milton
- Department of Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore, India
| | | | - Rajasekaran S
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
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Kim JY, Ha JS, Lee CK, Lee DC, Hong HJ, Choi SY, Park CK. Biportal Endoscopic Posterior Thoracic Laminectomy for Thoracic Spondylotic Myelopathy Caused by Ossification of the Ligamentum Flavum: Technical Developments and Outcomes. Neurospine 2023; 20:129-140. [PMID: 37016861 PMCID: PMC10080434 DOI: 10.14245/ns.2346060.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: Advanced biportal endoscopic surgery techniques can be used to treat thoracic myelopathy secondary to ossification of the ligamentum flavum (OLF). This case series elaborates on a feasible biportal endoscopic technique for thoracic OLF removal and evaluates clinical and radiological outcomes.Methods: A biportal endoscopic posterior thoracic laminectomy was performed to remove the thoracic OLF. Surgical techniques have evolved from inside-out piecemeal removal methods to outside-in <i>en bloc</i> removal methods. Preoperative computed tomography was performed to analyze dural ossification and OLF types. Intraoperative videos were reviewed to observe dural ossification and to determine the surgical method. Neurological outcomes were assessed using the Japanese Orthopaedic Association (JOA) score.Results: Clinical symptoms and neurological function improved markedly after surgery (JOA score, preoperative: 12.6 ± 1.0, final follow-up: 15.6 ± 1.2). The mean operation time per segment was not short (106.6 ± 38 minutes). At early experience stages, inside-out piecemeal decompression was used and it caused intraoperative spinal cord injury. However, outside-in <i>en bloc</i> decompression technique did not induce neural complications. Postoperative segmental instability and correlated mechanical back pain were not observed.Conclusion: The biportal endoscopic posterior thoracic approach is an attractive surgical option to treat thoracic spondylotic myelopathy secondary to OLF. Piecemeal inside-out decompression can induce irreversible spinal cord injury, especially in the early experience stages. Outside-in decompression is more efficient and safer than inside-out pattern procedures by minimizing dural manipulation. Nonetheless, this technique is technically demanding and should only be performed in selected patients after acquiring abundant experience with endoscopic spine surgeries.
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Affiliation(s)
- Ji Yeon Kim
- Department of Neurosurgery, Spine Center, Seran General Hospital, Seoul, Korea
| | - Ji Soo Ha
- Department of Neurosurgery, Spine Center, Yonsei Okay Hospital, Uijungbu, Korea
| | - Chang Kyu Lee
- Department of Neurosurgery, Spine Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Corresponding Author Chang Kyu Lee Department of Neurosurgery, Spine & Spinal Cord Institute, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
| | - Dong Chan Lee
- Department of Neurosurgery, Spine Center, Wiltse Memorial Hospital, Anyang, Korea
| | - Hyun Jin Hong
- Department of Neurosurgery, Spine Center, Wiltse Memorial Hospital, Anyang, Korea
| | - Su Yong Choi
- Department of Neurosurgery, Spine Center, Seran General Hospital, Seoul, Korea
| | - Choon Keun Park
- Department of Neurosurgery, Spine Center, Wiltse Memorial Hospital, Suwon, Korea
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Indications, Contraindications, and Complications of Biportal Endoscopic Decompressive Surgery for the Treatment of Lumbar Stenosis: A Systematic Review. World Neurosurg 2022; 168:411-420. [DOI: 10.1016/j.wneu.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022]
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Complications of Unilateral Biportal Endoscopic Lumbar Discectomy: A Systematic Review. World Neurosurg 2022; 168:359-368.e2. [DOI: 10.1016/j.wneu.2022.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 12/14/2022]
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Wang B, He P, Liu X, Wu Z, Xu B. Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Systematic Review of the Literature and Meta-analysis of Single-arm Studies. Orthop Surg 2022; 15:3-15. [PMID: 36394088 PMCID: PMC9837251 DOI: 10.1111/os.13437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 06/18/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This article aims to summarize the incidence of these complications through a meta-analysis, analyze the causes of complications and provide clinical promotion and recommendations. METHODS Databases and retrieval platform including PubMed, Web of science, Springer link, Cochrane clinical trials, ProQuest, ScienceDirect, Europe PMC, Wiley online, OVID, Clinical trials, CNKI and WanFang, and supplement the literature through Google Scholar, collect all the unilateral biportal endoscopy (UBE) controlled trials and non-controlled trials of UBE in the treatment of lumbar spinal stenosis (LSS). The search time limit is from January 1, 2000 to December 25, 2021. After two reviewers independently screened the literature, extracted data and evaluated the risk of bias in the included studies, meta-analysis was performed using Stata 15.1 software. RESULTS Finally, 24 studies were included, including 999 patients. The results of a single-arm rate meta-analysis showed that the overall complication rate of UBE treatment of LSS was 6.27% [95% CI (0.0412, 0.0876)], and the incidence of dural tear was 2.49% [95% CI (0.0133, 0.0390)], the incidence of transient paresthesia was 0.14% [95% CI (0.0000, 0.0072)], the incidence of postoperative spinal epidural hematoma was 0.27% [95% CI (0.0000, 0.0096)], the incidence of postop headache, inadequate decompression, root injury and infection was 0.00%. CONCLUSION Current evidence shows that the complication rate of UBE in the treatment of LSS is low, mainly due to dural tears. Limited by the number and quality of included studies, the above conclusions still need to be confirmed by more studies.
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Affiliation(s)
- Bin Wang
- Department of OrthopedicsJingling Hospital, Medicine College, Nanjing UniversityNanjingChina
| | - Peng He
- Department of OrthopedicsJingling Hospital, Medicine College, Nanjing UniversityNanjingChina
| | - Xiowei Liu
- Department of OrthopedicsJingling Hospital, Medicine College, Nanjing UniversityNanjingChina
| | - Zhengfang Wu
- Department of OrthopedicsJingling Hospital, Medicine College, Nanjing UniversityNanjingChina
| | - Bin Xu
- Department of OrthopedicsJingling Hospital, Medicine College, Nanjing UniversityNanjingChina
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Xu J, Wang D, Liu J, Zhu C, Bao J, Gao W, Zhang W, Pan H. Learning Curve and Complications of Unilateral Biportal Endoscopy: Cumulative Sum and Risk-Adjusted Cumulative Sum Analysis. Neurospine 2022; 19:792-804. [PMID: 35996762 PMCID: PMC9537833 DOI: 10.14245/ns.2143116.558] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/18/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the learning curve and complications of unilateral biportal endoscopy (UBE) in the treatment of lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS). METHODS This was a retrospective cohort analysis of 197 consecutive patients who received UBE unilateral laminotomy bilateral decompression (UBE-ULBD) or lumbar discectomy (UBE-LD) surgery, including 107 males and 90 females with an average age of 64.83 ± 14.29 years. Cumulative sum (CUSUM) and risk-adjusted cumulative sum analysis (RA-CUSUM) were used to evaluate the learning curve, with the occurrence of complications defined as surgical failure, and variables of different phase of the learning curve were compared. RESULTS The cutoff point of learning curve of UBE surgery was 54 cases according to CUSUM analysis. The learning curve of UBE-ULBD and UBE-LD were divided into 3 phases. The first cutoff points were 31 and 12 cases, and the second cutoff point were 67 and 32 cases respectively. With the progress of the learning curve, the operation time and postoperative hospital stays decreased. The visual analogue scale and Oswestry Disability Index at the last follow-up were significantly lower than that before surgery. The incidence of surgical failure was 6.11% and began to decrease after the 89th case based on RA-CUSUM analysis. The surgical failure rate decreased from 10.11% to 2.78 after the 89th case with significant different. CONCLUSION UBE surgery is effective in the treatment of LDH and LSS with low incidence of complications. But a learning curve of at least 54 cases still required for mastering UBE surgery.
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Affiliation(s)
- Jinchao Xu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Dong Wang
- Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jidan Liu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chengyue Zhu
- Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jianhang Bao
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenshuo Gao
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China,Corresponding Author Wei Zhang Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, No. 453 Tiyuchang Road, Xihu District, Hangzhou City, Zhejiang Province, China
| | - Hao Pan
- Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China,Co-Corresponding Author Hao Pan Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, No. 453 Tiyuchang Road, Xihu District, Hangzhou City, Zhejiang Province, China
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Kim J, Heo DH, Lee DC, Chung HT. Biportal endoscopic unilateral laminotomy with bilateral decompression for the treatment of cervical spondylotic myelopathy. Acta Neurochir (Wien) 2021; 163:2537-2543. [PMID: 34213652 DOI: 10.1007/s00701-021-04921-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The advantages of biportal endoscopic approaches over conventional open surgery include the preservation of the normal structures, less intraoperative bleeding, fast postoperative recovery, and preservation of the motion segments. METHOD We attempted the posterior biportal endoscopic approach for cervical stenosis at the C5-C6-C7 levels. Biportal endoscopic right ipsilateral hemilaminectomy with bilateral decompression at the C5-C6-C7 levels and right foraminotomy at the C6-C7 level were performed under general anesthesia. CONCLUSIONS We successfully performed neural decompression at the C5-C6-C7 levels using biportal endoscopic surgery. The biportal endoscopic posterior cervical approach may be an alternative surgical method for treating cervical myelopathy.
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Affiliation(s)
- Jiyeon Kim
- Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, Anyang, South Korea
| | - Dong Hwa Heo
- Department of Neurosurgery, Spine Center, Seoul Bumin Hospital, Seoul, South Korea.
| | - Dong Chan Lee
- Department of Neurosurgery, Spine Center, Leon Wiltse Memorial Hospital, Anyang, South Korea
| | - Hung Tae Chung
- Department of Neurosurgery, Spine Center, Seoul Bumin Hospital, Seoul, South Korea
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