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Kim JH, Kim YJ, Ryu KS, Kim JS. Comparison of the Clinical and Radiological Outcomes of Full-Endoscopic Laminotomy and Conventional Subtotal Laminectomy for Lumbar Spinal Stenosis: A Randomized Controlled Trial. Global Spine J 2024; 14:1760-1770. [PMID: 36757395 DOI: 10.1177/21925682231155846] [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] [Indexed: 02/10/2023] Open
Abstract
STUDY DESIGN Randomized controlled trial. OBJECTIVE The primary objective of this study was to compare the short-term clinical and radiological outcomes of full-endoscopic lumbar laminotomy (FEL) with those of subtotal lumbar laminectomy (STL) for lumbar spinal stenosis (LSS). METHODS In this prospective randomized trial a total of 52 patients were enrolled from May 2016 to September 2021 after providing written informed consent. The authors investigated 45 patients who were followed up for more than 6 months. RESULTS There were significant improvements in visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores after the operation in both groups. The FEL group tended to have significantly shorter hospital stay. Interestingly, a statistically significant increase in postoperative lumbar lordosis and segmental angle was observed in the FEL group and both groups, respectively. Spondylolisthesis was exacerbated or newly developed in five of the 21 patients (24%) in the STL group. In contrast, improvement in spondylolisthesis was observed in two of the 24 patients (8%) in the FEL group. There were no complications that resulted in fatal sequelae and no significant difference in the complication rate. CONCLUSIONS The clinical results of FEL were similar to those of STL. In addition, the results of FEL were superior to those of STL in terms of a decrease in the postoperative length of stay and radiologic instability, such as iatrogenic spondylolisthesis. The results of this study indicate that FEL is a comparable surgical method to STL for LSS.
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Affiliation(s)
- Jung-Hoon Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Jin Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyeong-Sik Ryu
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Zhou Y, Zhou C, Li Q, Cai L, Kou B, Fang W, Yao Z, Wei M, Zhang S, Liu W. Efficacy of PE-PLIF with a novel ULBD approach for lumbar degeneration diseases: a large-channel endoscopic retrospective study. J Orthop Surg Res 2024; 19:269. [PMID: 38685055 PMCID: PMC11057128 DOI: 10.1186/s13018-024-04755-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE This study aims to assess the effectiveness of Percutaneous Endoscopic Posterior Lumbar Interbody Fusion (PE-PLIF) combined with a novel Unilateral Laminotomy for Bilateral Decompression (ULBD) approach using a large-channel endoscope in treating Lumbar Degenerative Diseases (LDD). METHODS This retrospective analysis evaluates 41 LDD patients treated with PE-PLIF and ULBD from January 2021 to June 2023. A novel ULBD approach, called 'Non-touch Over-Top' technique, was utilized in this study. We compared preoperative and postoperative metrics such as demographic data, Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) score, surgical details, and radiographic changes. RESULTS The average follow-up duration was 14.41 ± 2.86 months. Notable improvements were observed postoperatively in VAS scores for back and leg pain (from 5.56 ± 0.20 and 6.95 ± 0.24 to 0.20 ± 0.06 and 0.12 ± 0.05), ODI (from 58.68 ± 0.80% to 8.10 ± 0.49%), and JOA scores (from 9.37 ± 0.37 to 25.07 ± 0.38). Radiographic measurements showed significant improvements in lumbar and segmental lordosis angles, disc height, and spinal canal area. A high fusion rate (97.56% at 6 months, 100% at 12 months) and a low cage subsidence rate (2.44%) were noted. CONCLUSIONS PE-PLIF combined with the novel ULBD technique via a large-channel endoscope offers significant short-term benefits for LDD management. The procedure effectively expands spinal canal volume, decompresses nerve structures, improves lumbar alignment, and stabilizes the spine. Notably, it improves patients' quality of life and minimizes complications, highlighting its potential as a promising LDD treatment option.
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Affiliation(s)
| | | | | | - Lei Cai
- Wuhan Fourth Hospital, Wuhan, China
| | | | | | - Zhi Yao
- Wuhan Fourth Hospital, Wuhan, China
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Ju CI, Lee SM. Complications and Management of Endoscopic Spinal Surgery. Neurospine 2023; 20:56-77. [PMID: 37016854 PMCID: PMC10080410 DOI: 10.14245/ns.2346226.113] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
In the past, the use of endoscopic spine surgery was limited to intervertebral discectomy; however, it has recently become possible to treat various spinal degenerative diseases, such as spinal stenosis and foraminal stenosis, and the treatment range has also expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spine surgery develops and its indications widen, more diverse and advanced surgical techniques are being introduced, and the complications of endoscopic spine surgery are also increasing accordingly. We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and key words were set as “endoscopic spinal surgery,” “endoscopic cervical foramoinotomy,” “PECD,” “percutaneous transforaminal discectomy,” “percutaneous endoscopic interlaminar discectomy,” “PELD,” “PETD,” “PEID,” “YESS” and “TESSYS.” We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic lumbar surgery was divided into full endoscopic interlaminar and transforaminal approaches and a unilateral biportal approach. We performed a comprehensive review of available literature on complications of endoscopic spinal surgery. This study particularly focused on the prevention of complications. Regardless of the surgical methods, the most common complications related to endoscopic spinal surgery include dural tears and perioperative hematoma. transient dysesthesia, nerve root injury and recurrence. However, Endoscopic spinal surgery, including full endoscopic transforaminal and interlaminar and unilateral biportal approaches, is a safe and effective a treatment for lumbar as well as cervical and thoracic spinal diseases such as disc herniation, lumbar spinal stenosis, foraminal stenosis and recurrent disc herniation.
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Affiliation(s)
- Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
- Corresponding Author Chang Il Ju Department of Neurosurgery, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea
| | - Seung Myung Lee
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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Eun DC, Lee YH, Park JO, Suk KS, Kim HS, Moon SH, Park SY, Lee BH, Park SJ, Kwon JW, Park SR. A Comparative Analysis of Bi-Portal Endoscopic Spine Surgery and Unilateral Laminotomy for Bilateral Decompression in Multilevel Lumbar Stenosis Patients. J Clin Med 2023; 12:jcm12031033. [PMID: 36769686 PMCID: PMC9918291 DOI: 10.3390/jcm12031033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
The clinical and radiological results before and after surgery were compared and analyzed for patients with multilevel lumbar stenosis who underwent bi-portal endoscopic spine surgery (BESS) and microscopic unilateral laminotomy for bilateral decompression (ULBD). We retrospectively identified 47 and 49 patients who underwent BESS and microscopic ULBD, respectively, who were diagnosed with multi-level lumbar stenosis. Clinical outcomes were evaluated using the visual analog scale score for both back and leg pain, and medication (pregabalin) use and Oswestry Disability Index (ODI) scores for overall treatment outcomes were used pre-operatively and at the final follow-up. Radiological outcomes were evaluated as the percentage of dura expansion volume, and percentage preservation of both facets and both lateral recess angles. The follow-up period of patients was about 17.04 months in the BESS group and about 16.90 months in the microscopic ULBD group. The back and leg visual analog scale (VAS) scores and average pregabalin use decreased more significantly in the BESS group than in the microscopic ULBD group (each p-value 0.0443, <0.001, 0.0378). All radiological outcomes were significantly higher in the BESS group than in the ULBD group. The change in ODI in two-level spinal stenosis showed a significantly higher value in the BESS group compared to the microscopic ULBD group (p-value 0.0335). Multilevel decompression with the BESS technique in multiple spinal stenosis is an adequate technique as it shows better clinical and radiological results than microscopic ULBD during a short-term follow-up period.
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Wang L, Wang T, Fan N, Yuan S, Du P, Si F, Wang A, Zang L. Efficacy of Repeat Percutaneous Endoscopic Lumbar Decompression for Reoperation of Lumbar Spinal Stenosis: A Retrospective Study. J Pain Res 2023; 16:177-186. [PMID: 36718399 PMCID: PMC9883990 DOI: 10.2147/jpr.s384916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Purpose To evaluate the efficacy of repeat percutaneous endoscopic lumbar decompression (PELD) in lumbar spinal stenosis (LSS) reoperation. Patients and Methods This study included patients with LSS who relapsed following treatment with PELD therapy between March 2017 and March 2020. Visual analog scale (VAS) scores and Oswestry Disability Index (ODI) were analyzed preoperatively, postoperatively at 3, 6, 12, and 24 months, and at final follow-up. The modified MacNab criteria were used to assess clinical effects. All complications were recorded. Results At a mean follow-up of 3 years, 24 patients with LSS who underwent repeat PELD were identified. The patients' mean operative time was 122.3±29.2 min, blood loss was 12.5±5.3 mL, and mean hospital stay was 7.0±1.9 days. VAS leg-pain score improved from 6.1±1.0 to 2.0±1.2 (P<0.001), VAS back-pain score improved from 6.2±0.8 to 2.1±1.1 (P<0.001), and ODI improved from 68.9±6.0 to 20.9±5.6 (P <0.001). According to the modified MacNab criteria, the good-to-excellent rate was 83.3%. Postoperative complications, including hematoma, nerve root injury, and dural injury, developed in four patients. Conclusion Repeat PELD for reoperation in patients with LSS has a good clinical effect, and is recommended in routine clinical practice. Careful intraoperative manipulation is recommended to prevent complications.
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Affiliation(s)
- Lei Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Lei Zang, Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, People’s Republic of China, Tel +86 13601252787, Email
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Hu Y, Fu H, Yang D, Xu W. Clinical efficacy and imaging outcomes of unilateral biportal endoscopy with unilateral laminotomy for bilateral decompression in the treatment of severe lumbar spinal stenosis. Front Surg 2023; 9:1061566. [PMID: 36684266 PMCID: PMC9852342 DOI: 10.3389/fsurg.2022.1061566] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/10/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To investigate the clinical efficacy and imaging outcomes of unilateral biportal endoscopy (UBE) with unilateral laminotomy for bilateral decompression (ULBD) in the treatment of severe lumbar spinal stenosis (SLSS). Methods We retrospectively analyzed 50 patients with SLSS treated with UBE-ULBD from October 2018 to March 2021. Visual analog scale (VAS) for back and legs pain, Oswestry disability index (ODI), modified Macnab criteria, complications, hospital stay, preoperative and postoperative dural sac cross-sectional area (DSCA) and Schizas grade, mean angle of facetectomy and osseous lateral recess decompression rate were examined. Results The mean follow-up period was 10.7 months. The mean hospital stay was 2.76 ± 1.02 days. At the final follow-up, VAS for back pain and legs pain decreased from 7.22 ± 0.95 to 1.26 ± 0.44 and from 7.88 ± 0.69 to 1.18 ± 0.39, respectively; ODI decreased from 69.88 ± 6.32% to 14.96 ± 2.75%. According to the modified Macnab criteria, the results were excellent in 24 (48%), good in 22 (44%), and fair in 4 (8%). Excellent or good results (a satisfactory outcome) were obtained in 92% of the patients. There were 2 cases of complications of dural sac tear. The postoperative DSCA was significantly enlarged compared with that before surgery, from 44.74 ± 9.85 to 126.86 ± 14.81 mm2. According to Schizas grade, the stenosis grade changes from preoperative grade C in 16 cases, grade D in 34 cases, to postoperative grade A in 40 cases, and grade B in 10 cases. The mean angle of facetectomy of the ipsilateral facet joint was 70.87 ± 5.68 ∘ , contralateral was 65.07 ± 4.98 ∘ . The decompression rate was 70.81 ± 4.43% (ipsilateral side) and 71.22 ± 3.68% (contralateral). Conclusions UBE-ULBD has a good clinical effect in the treatment of SLSS, and has achieved satisfactory results in spinal canal enlargement, undercutting of facet joints, and decompression effect. It is a safe and effective surgical for SLSS.
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Affiliation(s)
- Yutong Hu
- Graduate School, Dalian Medical University, Dalian, China,Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Hao Fu
- Graduate School, Dalian Medical University, Dalian, China,Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Dongfang Yang
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China,Correspondence: Weibing Xu Dongfang Yang
| | - Weibing Xu
- Department of Spine Surgery, Dalian Municipal Central Hospital, Dalian, China,Correspondence: Weibing Xu Dongfang Yang
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Contraindications and Complications of Full Endoscopic Lumbar Decompression for Lumbar Spinal Stenosis: A Systematic Review. World Neurosurg 2022; 168:398-410. [DOI: 10.1016/j.wneu.2022.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
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He LM, Li JR, Wu HR, Chang Q, Guan XM, Ma Z, Feng HY. Percutaneous Endoscopic Posterior Lumbar Interbody Fusion with Unilateral Laminotomy for Bilateral Decompression Vs. Open Posterior Lumbar Interbody Fusion for the Treatment of Lumbar Spondylolisthesis. Front Surg 2022; 9:915522. [PMID: 35693306 PMCID: PMC9174668 DOI: 10.3389/fsurg.2022.915522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Endoscopic lumbar interbody fusion is a new technology that is mostly used for single-segment and unilateral lumbar spine surgery. The purpose of this study is to introduce percutaneous endoscopic posterior lumbar interbody fusion (PE-PLIF) with unilateral laminotomy for bilateral decompression (ULBD) for lumbar spondylolisthesis and evaluate the efficacy by comparing it with open posterior lumbar interbody fusion (PLIF). Methods Twenty-eight patients were enrolled in PE-PLIF with the ULBD group and the open PLIF group. The perioperative data of the two groups were compared to evaluate the safety of PE-PLIF with ULBD. The visual analog scale (VAS) back pain, VAS leg pain, and Oswestry Disability Index (ODI) scores of the two groups preoperatively and postoperatively were compared to evaluate clinical efficacy. Preoperative and postoperative imaging data were collected to evaluate the effectiveness of the operation. Results No differences in baseline data were found between the two groups (p > 0.05). The operation time in PE-PLIF with the ULBD group (221.2 ± 32.9 min) was significantly longer than that in the PLIF group (138.4 ± 25.7 min) (p < 0.05), and the estimated blood loss and postoperative hospitalization were lower than those of the PLIF group (p < 0.05). The postoperative VAS and ODI scores were significantly improved in both groups (p < 0.05), but the postoperative VAS back pain score in the PE-PLIF group was significantly lower than that in the PLIF group (p < 0.05). The excellent and good rates in both groups were 96.4% according to MacNab’s criteria. The disc height and cross-sectional area of the spinal canal were significantly improved in the two groups after surgery (p < 0.05), with no difference between the groups (p > 0.05). The fusion rates in PE-PLIF with the ULBD group and the PLIF group were 89.3% and 92.9% (p > 0.05), respectively, the cage subsidence rates were 14.3% and 17.9% (p > 0.05), respectively, and the lumbar spondylolisthesis reduction rates were 92.72 ± 6.39% and 93.54 ± 5.21%, respectively (p > 0.05). Conclusion The results from this study indicate that ULBD can be successfully performed during PE-PLIF, and the combined procedure is a safe and reliable treatment method for lumbar spondylolisthesis.
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Affiliation(s)
- Li-Ming He
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Department of Orthopaedic Surgery, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Orthopaedic Surgery, Tongji Shanxi Hospital, Taiyuan, China
| | - Jia-Rui Li
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Department of Orthopaedic Surgery, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Orthopaedic Surgery, Tongji Shanxi Hospital, Taiyuan, China
| | - Hao-Ran Wu
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Department of Orthopaedic Surgery, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Orthopaedic Surgery, Tongji Shanxi Hospital, Taiyuan, China
| | - Qiang Chang
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Department of Orthopaedic Surgery, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Orthopaedic Surgery, Tongji Shanxi Hospital, Taiyuan, China
| | - Xiao-Ming Guan
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Department of Orthopaedic Surgery, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Orthopaedic Surgery, Tongji Shanxi Hospital, Taiyuan, China
| | - Zhuo Ma
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Department of Orthopaedic Surgery, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Orthopaedic Surgery, Tongji Shanxi Hospital, Taiyuan, China
| | - Hao-Yu Feng
- Department of Orthopaedic Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Taiyuan, China
- Department of Orthopaedic Surgery, Third Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
- Department of Orthopaedic Surgery, Tongji Shanxi Hospital, Taiyuan, China
- Correspondence: Hao-Yu Feng
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