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Gunjotikar S, Pestonji M, Tanaka M, Komatsubara T, Ekade SJ, Heydar AM, Hieu HK. Evolution, Current Trends, and Latest Advances of Endoscopic Spine Surgery. J Clin Med 2024; 13:3208. [PMID: 38892919 PMCID: PMC11172902 DOI: 10.3390/jcm13113208] [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: 04/15/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The aging of the population in developing and developed countries has led to a significant increase in the health burden of spinal diseases. These elderly patients often have a number of medical comorbidities due to aging. The need for minimally invasive techniques to address spinal disorders in this elderly population group cannot be stressed enough. Minimally invasive spine surgery (MISS) has several proven benefits, such as minimal muscle trauma, minimal bony resection, lesser postoperative pain, decreased infection rate, and shorter hospital stay. Methods: A comprehensive search of the literature was performed using PubMed. Results: Over the past 40 years, constant efforts have been made to develop newer techniques of spine surgery. Endoscopic spine surgery is one such subset of MISS, which has all the benefits of modern MISS. Endoscopic spine surgery was initially limited only to the treatment of lumbar disc herniation. With improvements in optics, endoscopes, endoscopic drills and shavers, and irrigation pumps, there has been a paradigm shift. Endoscopic spine surgery can now be performed with high magnification, thus allowing its application not only to lumbar spinal stenosis but also to spinal fusion surgeries and cervical and thoracic pathology as well. There has been increasing evidence in support of these newer techniques of spine surgery. Conclusions: For this report, we studied the currently available literature and outlined the historical evolution of endoscopic spine surgery, the various endoscopic systems and techniques available, and the current applications of endoscopic techniques as an alternative to traditional spinal surgery.
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Affiliation(s)
- Sharvari Gunjotikar
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward, Okayama 702-8055, Japan; (S.G.); (T.K.); (S.J.E.); (A.M.H.); (H.K.H.)
| | - Malcolm Pestonji
- Department of Orthopedic Surgery, Golden Park Hospital and Endoscopic Spine Foundation India, Vasai West, Thane 401202, Maharashtra, India;
| | - Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward, Okayama 702-8055, Japan; (S.G.); (T.K.); (S.J.E.); (A.M.H.); (H.K.H.)
| | - Tadashi Komatsubara
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward, Okayama 702-8055, Japan; (S.G.); (T.K.); (S.J.E.); (A.M.H.); (H.K.H.)
| | - Shashank J. Ekade
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward, Okayama 702-8055, Japan; (S.G.); (T.K.); (S.J.E.); (A.M.H.); (H.K.H.)
| | - Ahmed Majid Heydar
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward, Okayama 702-8055, Japan; (S.G.); (T.K.); (S.J.E.); (A.M.H.); (H.K.H.)
| | - Huynh Kim Hieu
- Department of Orthopedic Surgery, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Minami Ward, Okayama 702-8055, Japan; (S.G.); (T.K.); (S.J.E.); (A.M.H.); (H.K.H.)
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Zileli M, Karakoç HC, Bölük MS. Pros and Cons of Minimally Invasive Spine Surgery. Adv Tech Stand Neurosurg 2024; 50:277-293. [PMID: 38592534 DOI: 10.1007/978-3-031-53578-9_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
This paper reviews current knowledge on minimally invasive spine surgery (MISS). Although it has significant advantages, such as less postoperative pain, short hospital stay, quick return to work, better cosmetics, and less infection rate, there are also disadvantages. The long learning curve, the need for special instruments and types of equipment, high costs, lack of tactile sensation and biplanar imaging, some complications that are hard to treat, and more radiation to the surgeon and surgical team are the disadvantages.Most studies remark that the outcomes of MISS are similar to traditional surgery. Although patients demand it more than surgeons, we predict the broad applications of MISS will replace most of our classical surgical approaches.
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Affiliation(s)
- Mehmet Zileli
- Neurosurgery Department, Sanko University, Gaziantep, Turkey
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Amato MCM, Carneiro VM, Fernandes DS, de Oliveira RS. Intracranial Pressure Evaluation in Swine During Full-Endoscopic Lumbar Spine Surgery. World Neurosurg 2023; 179:e557-e567. [PMID: 37690580 DOI: 10.1016/j.wneu.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Neurological complications during full-endoscopic spine surgery (FESS) might be attributed to intracranial pressure (ICP) increase due to continuous saline infusion (CSI). Understanding CSI and ICP correlation might modify irrigation pump usage. This study aimed to evaluate invasive ICP during interlaminar FESS; correlate ICP with irrigation pump parameters (IPPs); evaluate ICP during saline outflow occlusion, commonly used to control bleeding and improve the surgeon's view; and, after durotomy, simulate accidental dural tear. METHODS Five swine were monitored, submitted to total intravenous anesthesia, and positioned ventrally. A parenchymal catheter was installed through a skull burr for ICP monitoring. Lumbar interlaminar FESS was performed until exposure of neural structures. CSI was used within progressively higher IPPs (A [60 mm Hg, 350 mL/minute] to D [150 mm Hg, 700 mL/minute]), and ICP was documented. During each IPP, different situations were grouped: intact dura with open channels (A1-D1) or occlusion test (A2-D2); dural tear with open channels (Ax1-Dx1) or occlusion test (Ax2-Dx2). ICP <20 mm Hg was defined as safe. RESULTS Basal average ICP was 8.1 mm Hg. Adjustment in total intravenous anesthesia or suspension of tests was necessary due to critical ICP or animal discomfort. It was safe to operate with all IPPs with opened drainage channels (A1-D1) even with dural tear (Ax1-Dx1). Several occlusion tests (A2-D2, Ax2-Dx2) caused ICP increase (e.g., 86.1 mm Hg) influenced by anesthetic state and hemodynamics. CONCLUSIONS During FESS, CSI might critically raise ICP. Keeping drainage channels open, with ideal anesthetic state, ICP remains safe even with high IPPs, despite dural tear. Drainage occlusions can quickly raise ICP, being even more severe with higher IPPs. Total intravenous anesthesia may protect from ICP increase and may allow longer drainage occlusion or higher IPPs.
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Affiliation(s)
- Marcelo Campos Moraes Amato
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
| | - Vinicius Marques Carneiro
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Denylson Sanches Fernandes
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ricardo Santos de Oliveira
- Division of Neurosurgery, Department of Surgery and Anatomy, University Hospital, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Park MK, Park JY, Son SK. Complications of Endoscopic Thoracic Spine Surgery: Overview and Complication Avoidance. World Neurosurg 2023; 179:127-132. [PMID: 37619844 DOI: 10.1016/j.wneu.2023.08.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
In endoscopic thoracic spine surgery, adaptations of thoracic surgical techniques such as full endoscopic uniportal and biportal surgical techniques have been developed. Full endoscopic uniportal surgery for thoracic disc herniation or thoracic ossified ligamentum flavum (OLF) has been performed via transforaminal and interlaminar approaches. In the case of thoracic OLF or thoracic spinal stenosis, the uniportal interlaminar approach is appropriate. The uniportal interlaminar approach has been used to treat thoracic OLF and has shown good surgical results. Thoracic OLF removal via a biportal endoscopic technique has been developed recently and is described in a few studies. Although endoscopic thoracic spine surgery has significant advantages, complications often occur with this approach. We reviewed the literature to date on the complications associated with endoscopic spine surgery in thoracic pathology. This review emphasizes how to avoid and manage complications. Based on the results of several previous studies, endoscopic thoracic spine surgery could be associated with fewer potential complications than conventional surgery. Endoscopic spine surgery has remarkable advantages; however, endoscopic thoracic surgery is technically challenging and is potentially associated with serious complications. To minimize the risk of avoidable complications, surgeons should be familiar with prevention methods and pitfalls.
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Affiliation(s)
- Man-Kyu Park
- Department of Neurosurgery, Good GangAn Hospital, Busan, South Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
| | - Sang-Kyu Son
- Department of Neurosurgery, Good Moonhwa Hospital, Busan, South Korea
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Bergamaschi JPM, de Brito MBS, de Araújo FF, Graciano RS, Utino ET, Lewandrowski KU, Wirth F. Surgical Technique of Central and Over-the-Top Full-Endoscopic Decompression of the Cervical Spine: A Technical Note. J Pers Med 2023; 13:1508. [PMID: 37888119 PMCID: PMC10608411 DOI: 10.3390/jpm13101508] [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: 08/30/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Endoscopic surgery of the cervical spine is constantly evolving and the spectrum of its indications has expanded in recent decades. Full-endoscopic techniques have standardized the procedures for posterior and anterior access. The full-endoscopic approach was developed to treat degenerative diseases with the least possible invasion and without causing instability of the cervical spine. The posterior full-endoscopic approach is indicated for the treatment of diseases of the lateral part of the vertebral segment, such as herniations and stenoses of the lateral recess and vertebral foramen. There has been little discussion of this approach to the treatment of central stenosis of the cervical spine. This technical note describes a step-by-step surgical technique for central and over-the-top full-endoscopic decompression in the cervical spine, using a 3.7 mm working channel endoscope. This technique has already been shown to be effective in a recent case series with a 4.7 mm working channel endoscope, and may represent a new treatment option for central or bilateral lateral recess stenosis. There is also the possibility of a bilateral full-endoscopic approach, but this may be associated with greater muscle damage and a longer operative time. Case series and comparative studies should be encouraged to confirm the safety and utility of this technique.
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Affiliation(s)
- João Paulo Machado Bergamaschi
- Atualli Spine Care Clinic, 745 Alameda Santos, Cj. 71, São Paulo 01419-001, Brazil; (F.F.d.A.); (R.S.G.)
- Atualli Academy, 2504 Brigadeiro Luís Antônio, Cj. 172, São Paulo 01402-000, Brazil; (E.T.U.); (F.W.)
| | | | - Fernando Flores de Araújo
- Atualli Spine Care Clinic, 745 Alameda Santos, Cj. 71, São Paulo 01419-001, Brazil; (F.F.d.A.); (R.S.G.)
| | - Ricardo Squiapati Graciano
- Atualli Spine Care Clinic, 745 Alameda Santos, Cj. 71, São Paulo 01419-001, Brazil; (F.F.d.A.); (R.S.G.)
| | - Edgar Takao Utino
- Atualli Academy, 2504 Brigadeiro Luís Antônio, Cj. 172, São Paulo 01402-000, Brazil; (E.T.U.); (F.W.)
| | | | - Fernanda Wirth
- Atualli Academy, 2504 Brigadeiro Luís Antônio, Cj. 172, São Paulo 01402-000, Brazil; (E.T.U.); (F.W.)
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Amato MCM, Aprile BC, de Oliveira RS. Full-endoscopic thoracic spine approaches. JOURNAL OF SPINE SURGERY (HONG KONG) 2023; 9:238-241. [PMID: 37841798 PMCID: PMC10570646 DOI: 10.21037/jss-23-73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/06/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Marcelo Campos Moraes Amato
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- Division of Neurosurgery, Amato-Day Hospital, São Paulo, SP, Brazil
| | | | - Ricardo Santos de Oliveira
- Division of Neurosurgery, Department of Surgery and Anatomy, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
- Division of Neurosurgery, Amato-Day Hospital, São Paulo, SP, Brazil
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Liu Y, Li X, Hou Y, Leng X, Yan M, Chen X, Huang H, Xu Y. Surgical outcomes of percutaneous endoscopic thoracic decompression in the treatment of multi-segment thoracic ossification of the ligamentum flavum. Acta Neurochir (Wien) 2023; 165:2131-2137. [PMID: 37166509 DOI: 10.1007/s00701-023-05603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/18/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Previous studies have demonstrated satisfactory outcomes of percutaneous endoscopic thoracic decompression (PETD) for single-segment thoracic ossification of the ligamentum flavum (TOLF). However, the clinical outcomes of PETD in patients with multi-segment TOLF (mTOLF) remain unclear. The aim of the present study was to evaluate the efficacy and safety of PETD for patients with multi-segment mTOLF. METHODS Eighteen consecutive patients (41 segments) with mTOLF were treated with PETD between January 2020 and December 2021. The clinical outcomes were evaluated using the modified Japanese Orthopaedic Association (mJOA) score and Visual Analog Scale (VAS), whereas radiographic parameters were measured by cross-section area of the spinal canal and anteroposterior diameter of the spinal cord. RESULTS The follow-up period ranged from 14 to 34 months. The mean operation time and blood loss were 154.06 ± 32.14 min and 61.72 ± 12.72 ml, respectively. Hospital stay after first-stage operation was 10.89 ± 2.42 days. The mJOA score and VAS score significantly improved at the final follow-up, with a mean mJOA recovery rate of 63.3 ± 21.90%. The incidence of complications was 12.2% per level. The radiographic outcomes showed adequate decompression of the spinal cord. CONCLUSIONS The present study demonstrates that PETD is effective and safe as a minimally invasive procedure to treat patients with mTOLF. All patients showed relief of their symptoms and improvement in neurological function.
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Affiliation(s)
- Yunxuan Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xingchen Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
- Changchun University of Chinese Medicine, Changchun, 130117, China.
| | - Yingying Hou
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Xiangyang Leng
- Changchun University of Chinese Medicine, Changchun, 130117, China
| | - Ming Yan
- The Third Affiliated Clinical Hospital of Changchun University of Chinese Medicine, Changchun, 130118, China
| | - Xiaoxin Chen
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Honghan Huang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Yusheng Xu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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Telfeian AE, Wagner R. Transforaminal endoscopic thoracic discectomy: surgical technique. JOURNAL OF SPINE SURGERY (HONG KONG) 2023; 9:166-175. [PMID: 37435321 PMCID: PMC10331499 DOI: 10.21037/jss-22-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/04/2023] [Indexed: 07/13/2023]
Abstract
The major challenge inherent to the surgical treatment of thoracic disc herniations is that the disc herniation is often ventral to the spinal cord. Posterior approaches are difficult and dangerous due to the morbidity associated with retraction of the thoracic spinal cord. A ventral approach is not feasible due to the thoracic viscera. A lateral transcavitary approach is the standard for treating ventral thoracic disc pathology but is also quite morbid. Transforaminal endoscopic spine surgery has emerged as a minimally invasive technique for treating thoracic disc pathology and it can be performed in the outpatient setting even with the patient awake. Advances in endoscopic camera technologies as well as the availability of specialty instruments that can be used down a working channel endoscope has now made a myriad of spine pathologies accessible to the minimally invasive spine surgeon. The transforaminal approach and the angled endoscopic camera are an ideal combination for creating a technical advantage to accessing thoracic disc pathology in a minimally invasive fashion. The principal challenges to the approach are needle targeting and understanding the endoscopic visual anatomy. Many surgeons interested in pursuing this technique are often deterred by the burden of the cost and time it takes to become adept and performing the technique. Detailed here are the authors' step-by-step technique and illustrative video that demonstrate transforaminal endoscopic thoracic discectomy (TETD).
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Affiliation(s)
- Albert E. Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ralf Wagner
- Ligamenta Spine Centre, Frankfurt am Main, Germany
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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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Full-endoscopic discectomy for thoracic disc herniations: a single-arm meta-analysis of safety and efficacy outcomes. 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; 32:1254-1264. [PMID: 36867252 DOI: 10.1007/s00586-023-07595-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Surgical intervention is the treatment of choice in patients with thoracic disc herniation with refractory symptoms and progressive myelopathy. Due to high occurrence of complications from open surgery, minimally invasive approaches are desirable. Nowadays, endoscopic techniques have become increasingly popular and full-endoscopic surgery can be performed in the thoracic spine with low complication rates. METHODS Cochrane Central, PubMed, and Embase databases were systematically searched for studies that evaluated patients who underwent full-endoscopic spine thoracic surgery. The outcomes of interest were dural tear, myelopathy, epidural hematoma, recurrent disc herniation, and dysesthesia. In the absence of comparative studies, a single-arm meta-analysis was performed. RESULTS We included 13 studies with a total of 285 patients. Follow-up ranged from 6 to 89 months, age from 17 to 82 years, with 56.5% male. The procedure was performed under local anesthesia with sedation in 222 patients (77.9%). A transforaminal approach was used in 88.1% of the cases. There were no cases of infection or death reported. The data showed a pooled incidence of outcomes as follows, with their respective 95% confidence intervals (CI)-dural tear (1.3%; 95% CI 0-2.6%); dysesthesia (4.7%; 95% CI 2.0-7.3%); recurrent disc herniation (2.9%; 95% CI 0.6-5.2%); myelopathy (2.1%; 95% CI 0.4-3.8%); epidural hematoma (1.1%; 95% CI 0.2-2.5%); and reoperation (1.7%; 95% CI 0.1-3.4%). CONCLUSION Full-endoscopic discectomy has a low incidence of adverse outcomes in patients with thoracic disc herniations. Controlled studies, ideally randomized, are warranted to establish the comparative efficacy and safety of the endoscopic approach relative to open surgery.
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Meng S, Han J, Xu D, Wang Y, Han S, Zhu K, Lin A, Su K, Li Y, Han X, Ma X, Zhou C. Fully endoscopic transforaminal discectomy for thoracolumbar junction disc herniation with or without calcification under general anesthesia: Technical notes and preliminary outcomes. Front Surg 2023; 9:1067775. [PMID: 36684323 PMCID: PMC9852773 DOI: 10.3389/fsurg.2022.1067775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the feasibility, safety, and outcomes of percutaneous endoscopic transforaminal discectomy (PETD) for thoracolumbar junction disc herniation (TLDH) with or without calcification. Methods This study included 12 patients diagnosed with TLDH with or without calcification who met the inclusion criteria and underwent surgery for PETD from January 2019 to December 2021. The mean patient age, operation time, hospitalization time, time in bed, and complications were recorded. Patients were followed up for at least 9 months. Visual analog scale (VAS) scores for low-back and leg or thoracic radicular pain and modified Japanese Orthopedic Association score (m-JOA) scores were preoperatively evaluated, at 1 day and 3, 6, and 12 months postoperatively or at last follow-up. The modified MacNab criteria were used to evaluate clinical efficacy at 12 months postoperatively or at last follow-up. Results The mean patient age, operation time, hospitalization time, and time in bed were 53 ± 13.9 years, 101.3 ± 9.2 min, 4.5 ± 1.3 days, and 18.0 ± 7.0 h, respectively. The mean VAS scores of low-back and leg or thoracic radicular pain improved from 5.8 ± 1.5 and 6.5 ± 1.4 to 2.0 ± 0.9 and 1.3 ± 0.5, respectively (P < 0.05). The m-JOA score improved from 7.5 ± 1.2 to 10.0 ± 0.7 (P < 0.05). The overall excellent-good rate of the modified MacNab criteria was 83.3%. No severe complications occurred. Conclusion Fully endoscopic transforaminal discectomy and ventral decompression under general anesthesia is a safe, feasible, effective, and minimally invasive method for treating herniated discs with or without calcification at thoracolumbar junction zone.
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Affiliation(s)
- Shengwei Meng
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jialuo Han
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Derong Xu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Wang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuo Han
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kai Zhu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Antao Lin
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kunpeng Su
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yaxiong Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xing Han
- Operating Room, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuexiao Ma
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China,Correspondence: Chuanli Zhou Xuexiao Ma
| | - Chuanli Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China,Correspondence: Chuanli Zhou Xuexiao Ma
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Jing X, Gong Z, Qiu X, Zhong Z, Ping Z, Hu Q. "Cave-in" decompression under unilateral biportal endoscopy in a patient with upper thoracic ossification of posterior longitudinal ligament: Case report. Front Surg 2023; 9:1030999. [PMID: 36684180 PMCID: PMC9852340 DOI: 10.3389/fsurg.2022.1030999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/08/2022] [Indexed: 01/09/2023] Open
Abstract
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.
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Kilmister EJ, Guy N, Wickremesekera A, Koeck H. Image-guided transthoracic transpedicular microdiscectomy for a giant thoracic disc herniation: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE2297. [PMID: 36593678 PMCID: PMC9514284 DOI: 10.3171/case2297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 07/08/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND This case series reports on five consecutive patients who underwent image-guided transpedicular transthoracic microdiscectomy. The authors retrospectively reviewed five patients who had undergone Stealth image-guided transpedicular transthoracic microdiscectomy between 2015 and 2021. OBSERVATIONS Image guidance with O-arm verified critical anatomical landmarks in the setting of large central calcified and/or soft tissue disc prolapse. This allowed limited rib head resection, pedicle removal, and corpectomy to give adequate access and not require interbody fusion. The authors performed a partial posterior corpectomy anterior to the affected disc prolapse and microsurgical delivery of the affected disc anteriorly into the corpectomy cave away from the thecal sac. Electronic and radiographic records were analyzed at their initial presentation and at follow-up. The median patient age was 51 years (range, 44-56 years), with 80% of the patients being males. Four of five patients had significant improvement of their presenting clinical symptoms. One patient had a complicated postoperative recovery with a pneumothorax and subsequent bilateral pneumonia requiring intensive care. Another patient developed delayed postoperative worsening of paraparesis. LESSONS The use of Stealth image guidance with O-arm for transthoracic microdiscectomy for complex calcified thoracic disc herniation is an effective operative technical adjunct to verify anatomical landmarks and limit the microsurgical procedure.
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Bae J, Kim J, Lee SH, Kim JS. Comparative Analysis of Transforaminal Endoscopic Thoracic Discectomy and Microscopic Discectomy for Symptomatic Thoracic Disc Herniation. Neurospine 2022; 19:555-562. [PMID: 36203281 PMCID: PMC9537848 DOI: 10.14245/ns.2244294.147] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/03/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate the clinical outcomes of transforaminal endoscopic thoracic discectomy (TETD) and microscopic discectomy (MD) for the treatment of symptomatic thoracic disc herniation (TDH). METHODS Seventy-seven patients (mean, 55.9 years; follow-up, 11.2 months) with symptomatic TDH were retrospectively reviewed (39 TETD and 38 MD). Radiological factors and perioperative outcomes were reviewed. Visual analogue scale (VAS), Oswestry Disability Index (ODI), and American Spinal Injury Association impairment scale were used to evaluate clinical and functional outcomes. Patient satisfaction was evaluated using modified MacNab criteria. RESULTS The levels of surgery and the location of hernia were evenly distributed in the both groups. The operative time (70.6 minutes vs. 175.7 minutes), estimated blood loss (3.8 mL vs. 357.4 mL), and length of hospital stay (7.0 days vs. 13.0 days) were significantly different between the TETD and MD groups (p < 0.05). VAS scores for dorsal back pain and ODI scores were significantly improved in both groups (p < 0.05). Patients who underwent TETD tended to be more satisfied with the outcome in terms of the modified MacNab criteria (89.7% vs. 73.0%, p = 0.059). Two patients in the MD group underwent revision surgery, whereas one patient in the TETD group underwent MD because of incomplete decompression. CONCLUSION TETD for the symptomatic TDH is a feasible and safe procedure that could be used for a wider range of surgical levels with a shorter operative time and hospital stay and less blood loss. While achieving similar outcomes, TETD achieved better patient satisfaction because of the use of local anesthesia and its minimal invasiveness.
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Affiliation(s)
- Junseok Bae
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea,Corresponding Author Junseok Bae Department of Neurosurgery, Chungdam Wooridul Spine Hospital, 445 Hakdong-ro, Gangnam-gu, Seoul 06068, Korea
| | - Jisang Kim
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
| | - Sang-Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Full Endoscopic Surgery for Thoracic Pathology: Next Step after Mastering Lumbar and Cervical Endoscopic Spine Surgery? BIOMED RESEARCH INTERNATIONAL 2022; 2022:8345736. [PMID: 35615011 PMCID: PMC9126676 DOI: 10.1155/2022/8345736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/03/2022] [Indexed: 11/18/2022]
Abstract
Thoracic disc herniation and stenosis are relatively rare, and various symptoms make them difficult to diagnose. Due to the complexity of neural and vascular structure, surgical treatment of thoracic pathology is challenging. Endoscopic spine surgery is an emerging minimally invasive surgical option. Based on wide experience on the cervical and lumbar spine, an endoscopic approach for the thoracic pathology can be performed beyond the learning curve. Transforaminal approach for thoracic disc herniation, endoscopic unilateral approach, and bilateral decompression for thoracic stenosis have been reported as favorable and safe surgical options. In the present study, the authors described the detailed surgical procedure as well as tips and tricks.
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Moraes Amato MC, Aprile BC, Esteves LA, Carneiro VM, de Oliveira RS. Full Endoscopic Thoracic Discectomy: Is the Interlaminar Approach an Alternative to the Transforaminal Approach? A Technical Note. Int J Spine Surg 2022; 16:309-317. [PMID: 35444040 PMCID: PMC9930664 DOI: 10.14444/8209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Various approaches are used for decompressive surgeries in the thoracic spine depending on the location and consistency of the pathology, always avoiding manipulation of the thoracic spinal cord. Recently, there has been an effort to achieve adequate results and reduce morbidity with minimally invasive surgeries. Good outcomes and the advantages of full endoscopic spine surgery (FESS) have been proven for surgerical correction of herniated discs and stenoses in the lumbar and cervical spine. Similar evidence has recently been described for the thoracic spine, but it has not previously been reported in Brazil. Although the transforaminal approach is already established for the thoracic spine, the newly described interlaminar approach is equally efficient, and both techniques must be considered when treating thoracic spine diseases. The objective of the present article was to present the full endoscopic interlaminar and transforaminal techniques in patients with symptomatic disc herniation of the thoracic spine, discuss the rationality for implementing FESS in thoracic spine, and discuss the rationality in choosing between both approaches. METHODS Two patients were submitted to thoracic FESS. A transforaminal approach was chosen for a T10-T11 foraminal disc herniation; an interlaminar approach was selected for a paramedian T7-T8 disc extrusion. Data regarding operating time, intraoperative images, hospital stay, visual analog scales before and after FESS, course of recovery, and surgery satisfaction were evaluated. RESULTS The patients had eventless surgeries, improved from preoperative pain without morbidity. Both were satisfied and recovered well. Hospital stay was less than 6 hours after surgery. CONCLUSIONS Transforaminal and interlaminar FESS for thoracic disc herniation are safe, efficient, and minimally invasive alternatives. CLINICAL RELEVANCE Despite being an innovative technique with evident advantages, it should be carefully considered along with conventional technique for the treatment of thoracic spine diseases, since its clinical relevance is yet to be determined. LEVEL OF EVIDENCE: 4
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Lin YP, Lin R, Chen S, Rao SY, Zhao S, Wen T, Wang HS, Hu WX, Liu BX, Li XY, Li YJ, Chen BL. Thoracic full-endoscopic unilateral laminotomy with bilateral decompression for treating ossification of the ligamentum flavum with myelopathy. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:977. [PMID: 34277777 PMCID: PMC8267270 DOI: 10.21037/atm-21-2181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/15/2021] [Indexed: 11/06/2022]
Abstract
Background The aim of the present study was to evaluate the curative effect and safety of thoracic full-endoscopic unilateral laminotomy with bilateral decompression (TE-ULBD) for treating ossification of the ligamentum flavum (OLF) with myelopathy. Methods Between January 2015 and December 2018, 23 consecutive patients with symptomatic thoracic OLF were treated with TE-ULBD. Of these, 21 (13 women and 8 men, aged 49-75 years) were included in the study and followed up for a minimum of 1 year. The mean blood loss was 15.48 mL (10-30 mL), operative duration was 78.86 min (55-115 min), and hospitalization was 5.05 days (3-15 days). The Japanese Orthopaedic Association (JOA) was used to evaluate spinal cord function, and the curative effect was defined by the JOA improvement rate. The area of OLF (AOLF), the maximum spinal cord compression (MSCC), and the area of spinal cord (ASC) were used to evaluate OLF clearance and spinal cord decompression status. Results At the final follow up,the JOA score was 8.33 points (5-11 points), which was a significant improvement from the preoperative 5.33 points (3-9 points, P<0.01). The excellent and good rate was 76.19% (16/21). The average preoperative AOLF and AOLF ratio were 85.27±23.66 mm2 and 57.86%±11.86%, respectively, and the postoperative AOLF and AOLF ratio were 16.27±11.75 mm2 and 8.13%±5.38%, respectively. The MSCC increased from 27.99%±13.51% preoperatively to 48.02%±6.66% postoperatively. The ASC was 42.90±10.60 mm2 preoperatively and 64.54±21.36 mm2 postoperatively. There were statistically significant differences in all parameters preoperatively and postoperatively (P<0.01). One case had postoperative hematoma, and the symptoms gradually eased after 3 weeks of conservative treatment. There were no other complications. No recurrence of OLF was detected during the follow-up period. Conclusions TE-ULBD is safe and effective for thoracic OLF with the advantages of reduced trauma and bleeding, and faster recovery.
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Affiliation(s)
- Yong-Peng Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Rui Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Song Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Si-Yuan Rao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shuai Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Tao Wen
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Hong-Shen Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Wei-Xiong Hu
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Bing-Xin Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin-Yi Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yong-Jin Li
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Bo-Lai Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Division of Spine Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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