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Ding Y, Zhang H, Jiang Q, Li T, Liu J, Lu Z, Yang G, Cui H, Lou F, Dong Z, Shuai M, Ding Y. Finite element analysis of endoscopic cross-overtop decompression for single-segment lumbar spinal stenosis based on real clinical cases. Front Bioeng Biotechnol 2024; 12:1393005. [PMID: 38903190 PMCID: PMC11186988 DOI: 10.3389/fbioe.2024.1393005] [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: 02/28/2024] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction: For severe degenerative lumbar spinal stenosis (DLSS), the conventional percutaneous endoscopic translaminar decompression (PEID) has some limitations. The modified PEID, Cross-Overtop decompression, ensures sufficient decompression without excessive damage to the facet joints and posterior complex integrity. Objectives: To evaluate the biomechanical properties of Cross-Overtop and provide practical case validation for final decision-making in severe DLSS treatment. Methods: A finite element (FE) model of L4-L5 (M0) was established, and the validity was verified against prior studies. Endo-ULBD (M1), Endo-LOVE (M2), and Cross-Overtop (M3) models were derived from M0 using the experimental protocol. L4-L5 segments in each model were evaluated for the range of motion (ROM) and disc Von Mises stress extremum. The real clinical Cross-Overtop model was constructed based on clinical CT images, disregarding paraspinal muscle influence. Subsequent validation using actual FE analysis results enhances the credibility of the preceding virtual FE analysis. Results: Compared with M0, ROM in surgical models were less than 10°, and the growth rate of ROM ranged from 0.10% to 11.56%, while those of disc stress ranged from 0% to 15.75%. Compared with preoperative, the growth rate of ROM and disc stress were 2.66%-11.38% and 1.38%-9.51%, respectively. The ROM values in both virtual and actual models were less than 10°, verifying the affected segment stability after Cross-Overtop decompression. Conclusion: Cross-Overtop, designed for fully expanding the central canal and contralateral recess, maximizing the integrity of the facet joints and posterior complex, does no significant effect on the affected segmental biomechanics and can be recommended as an effective endoscopic treatment for severe DLSS.
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Affiliation(s)
- Yiwei Ding
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Hanshuo Zhang
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Navy Clinical College, Anhui Medical University, Hefei, Anhui, China
| | - Qiang Jiang
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Tusheng Li
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiang Liu
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Navy Clinical College, Anhui Medical University, Hefei, Anhui, China
| | - Zhengcao Lu
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Guangnan Yang
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
- Department of Orthopedics, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Hongpeng Cui
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Fengtong Lou
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Zhifeng Dong
- Mechanical and Electronic Engineering Department, China University of Mining and Technology, Beijing, China
| | - Mei Shuai
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yu Ding
- Orthopedics, TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, China
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Choi SJ, Kang DWD, Ham CH, Kim JH, Kwon WK. Full endoscopic surgery for calcium pyrophosphate deposition disease (CPPD) in the cervical ligamentum flavum: report of two cervical myelopathy cases. Acta Neurochir (Wien) 2024; 166:185. [PMID: 38639798 DOI: 10.1007/s00701-024-06080-4] [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: 03/26/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
Calcium pyrophosphate deposition disease (CPPD), known as pseudogout, is characterized by the accumulation of calcium pyrophosphate crystals in musculoskeletal structures, primarily joints. While CPPD commonly affects various joints, involvement in the cervical spine leading to myelopathy is rare. Surgical intervention becomes necessary when conservative measures fail, but reports on full endoscopic surgeries are extremely rare. We present two successful cases where full endoscopic systems were used for CPPD removal in the cervical spine. The surgical technique involved a full endoscopic approach, adapting the previously reported technique for unilateral laminotomy bilateral decompression. Full-endoscopic removal of cervical CPPD inducing myelopathy were successfully removed with good clinical and radiologic outcomes. The scarcity of endoscopic cases for cervical ligamentum flavum CPPD is attributed to the condition's rarity. However, our successful cases advocate for endoscopic surgery as a potential primary treatment option for CPPD-induced cervical myelopathy, especially in elderly patients or those with previous cervical operation histories. This experience encourages the consideration of endoscopic surgery for managing cervical ligamentum flavum CPPD as a viable alternative.
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Affiliation(s)
- Seung Jin Choi
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | | | - Chang Hwa Ham
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Joo Han Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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Feng Z, Wu Y, Wu H, Jon TG, Yuan Y, Chen Z, Wang Y. A Modified Laminotomy for Interlaminar Endoscopic Lumbar Discectomy: Technical Report and Preliminary Results. Neurospine 2023; 20:1513-1523. [PMID: 38171317 PMCID: PMC10762391 DOI: 10.14245/ns.2346572.286] [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: 05/15/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To introduce a technique of laminotomy using a common trephine to enlarge the interlaminar space at L4/5 segment for interlaminar endoscopic lumbar discectomy (IELD) and report the anatomical basis of this procedure, technical details, as well as primary clinical outcomes of a consecutive patient cohort with L4/5 lumbar disc herniation (LDH). METHODS On anteroposterior fluoroscopy, the intersection of the medial edge of the inferior articular process and the inferior endplate of L4 vertebra was taken as the target. Using a common trephine, laminotomy was performed to remove a big portion of the posterior wall of the canal under the guidance of endoscopy. From June 2018 to December 2021, the consecutive patients who underwent L4/5 IELD were prospectively studied. Clinical outcomes were assessed at the day before surgery, 1 day, 1 month, 3 months, 12 months after surgery, and the last follow-up. Numerical Rating Scale, Roland-Morris Disability Questionnaire (RMDQ), and MacNab criteria were used to evaluate back and leg pain, the quality of life, and clinical efficacy, respectively. RESULTS There were 64 men and 44 women, with an age of 50.3 ± 14.9 years. The operating time was 74.54 ± 17.42 minutes. The mean follow-up time was 32.7 ± 18.6 months (range, 12-64 months). The complications of IELD included numbness, neck pain, and recurrence. Both leg pain (6.2 ± 1.9 vs. 1.8 ± 0.8, p < 0.001) and back pain (3.1 ± 2.3 vs. 1.7 ± 0.9, p < 0.001) quickly improved after this procedure and maintained (1.1 ± 1.5, 1.1 ± 1.3) at final follow-up. Physical disability due to back pain, as assessed using RMDQ, was improved remarkably after surgery (15.0 ± 5.8 vs. 2.9 ± 4.1, p < 0.001). In addition, MacNab outcome grade was evaluated as good-to-excellent in 96 cases (88.9%). CONCLUSION A convenient technique of laminotomy using a common trephine was proposed for the L4/5 IELD. It can efficiently enlarge the interlaminar entry to perform endoscopic discectomy. This procedure is particularly suitable for treating LDH with concomitant lumbar spinal stenosis and migrated herniated disc.
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Affiliation(s)
- Zhiyun Feng
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxu Wu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Honghao Wu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tae Gyong Jon
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Yuan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhong Chen
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Lee DH, Lee DG, Park CK, Jang JW, Hwang JS, Kim JY, Cho YE, Lee SW, Lee DC, Han BS, Han SY. Saving Stabilizing Structure Treatment With Bilateral-Contralateral Decompression for Spinal Stenosis in Degenerative Spondylolisthesis Using Unilateral Biportal Endoscopy. Neurospine 2023; 20:931-939. [PMID: 37798987 PMCID: PMC10562235 DOI: 10.14245/ns.2346504.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate the treatment of spinal stenosis with spondylolisthesis using bilateral-contralateral unilateral biportal endoscopic (UBE) decompression to minimize facet joint damage. METHODS We retrospectively evaluated 42 patients with grade 1 spondylolisthesis who underwent bilateral-contralateral UBE decompression between July 2018 and September 2019. To identify segmental instability, static and dynamic images from preoperative and postoperative procedures and final follow-up radiographs were reviewed. Lateral radiograph slippage ratio, sagittal motion, and facet joint preservation were evaluated. Clinical assessments were conducted using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. RESULTS The average final follow-up period was 26.5 ± 1.3 months. The average preoperative slip percentage was 15.70% ± 5.25%, which worsened to 18.80% ± 5.41% at the final follow-up (p < 0.005). The facet joint preservation rate was 95.6% ± 4.1% on the contralateral side. Improvements in the VAS scores (leg pain: from 7.9 ± 2.2 to 3.1 ± 0.7; p < 0.005; back pain: from 7.2 ± 3.0 to 2.8 ± 1.0; p < 0.005) were observed at the final follow-up. The mean preoperative ODI was 26.19 ± 3.42, which improved to 9.6 ± 1.0 (p < 0.005). Thirteen patients exhibited delayed focal segmental instability following decompression. Despite the absence of symptoms or improvement with conservative treatment in the majority of patients with delayed instability, two patients required fusion surgery to address the instability. Additionally, 2 patients developed facet synovial cysts, while 2 experienced spinous process fractures. CONCLUSION Bilateral decompression with a contralateral UBE approach could be an effective and alternative treatment method to reduce instability in spinal stenosis with grade 1 spondylolisthesis.
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Affiliation(s)
- Dong Hyun Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Dong-Geun Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Choon Keun Park
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Jae-Won Jang
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Jin Sub Hwang
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Jun Yong Kim
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Yong-Eun Cho
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Sang Won Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Dong Chan Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Bang Sang Han
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Sang Yeop Han
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
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Cho HS, Kim SH, Han JS, Kim BJ. Radiological Outcomes of Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis With and Without Discectomy. World Neurosurg 2023; 175:e1307-e1314. [PMID: 37164207 DOI: 10.1016/j.wneu.2023.04.124] [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: 03/18/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Unilateral laminotomy for bilateral decompression (ULBD) is a minimally invasive surgical technique widely used in patients with lumbar spinal stenosis and low-grade spondylolisthesis. However, few studies have investigated the long-term effects of the unilateral approach of ULBD on postoperative coronal imbalance, and the effect of additional discectomy on ULBD has not yet been evaluated in detail. METHODS Sixty-one patients with lumbar spinal stenosis who underwent ULBD with or without discectomy were identified. The ULBD with discectomy group included 27 patients, and the ULBD without discectomy group included 34 patients. We analyzed the changes in various radiographic parameters, such as global lordosis (GL), segmental lordosis (SL), global coronal angle (GCA), segmental coronal angle (SCA), disc height (DH), global range of motion (GROM), and segmental range of motion (SROM) following the surgery and compared these parameters between the two groups. RESULTS In patients who underwent ULBD with discectomy, segmental coronal angle (SCA) significantly decreased from 0.42 ± 4.41 (°±SD) preoperatively to -0.31 ± 4.87 postoperatively (P = 0.026), while disc height (DH) decreased from 8.80 ± 2.49 (mm ± SD) to 7.32 ± 2.60 (P < 0.001). These findings suggest a reduction in convexity as disc height decreased on the laminotomy side. However, the absolute SCA value tended to approach 0° postoperatively regardless of discectomy, indicating that the preoperative scoliosis has improved. In both groups, the lordotic angles and range of motion (ROM) parameters showed no changes before and after surgery. CONCLUSIONS ULBD preserved lumbar lordosis and motion with or without discectomy during the 2-year follow-up period. Improvement in coronal balance was observed after ULBD regardless of discectomy, without significant negative effects on sagittal and coronal spine stability.
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Affiliation(s)
- Hyun-Seo Cho
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Se-Hoon Kim
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Jeong Su Han
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Bum-Joon Kim
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
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Kwon WK, Kim SH. Why Endoscopic Spine Surgery? Neurospine 2023; 20:7-10. [PMID: 37016848 PMCID: PMC10080456 DOI: 10.14245/ns.2346014.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/30/2023] [Indexed: 04/03/2023] Open
Affiliation(s)
- Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Se-Hoon Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
- Corresponding Author Se-Hoon Kim Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, 123 Jeokgeum-ro, Danwon-gu, Ansan 15355, Korea
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Hara T, Ohara Y. Perioperative Management for Full-Endoscopic Lumbar Discectomy: Consideration From the Perspective of Preventing Complication. Neurospine 2023; 20:28-32. [PMID: 37016851 PMCID: PMC10080411 DOI: 10.14245/ns.2346056.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
In recent years, full-endoscopic discectomy (FED) has expanded its range of indications with the development of devices and various techniques. The advantage of FED over conventional surgery is that it is a minimally invasive procedure. However, intraoperative and postoperative precautions must be taken to prevent complications. It is necessary to avoid complications that could compromise the outcome of the procedure. Effective perioperative management is necessary to avoid complications; however, there is no set view for perioperative management in FED. In this study, we perform a literature review to examine the effectiveness of perioperative management methods for FED. The key to ensuring the efficacy and minimal invasiveness of FED is prevention of complications. Based on the result and literature review, we believe that the most manageable postoperative management after FED is prevention of recurrent disc herniation and hematoma formation. A drain should be placed to prevent postoperative hematoma formation. It is advisable to evaluate the patient’s symptoms and monitor C-reactive protein and erythrocyte sedimentation rate levels during the first week after surgery. Postoperative antibiotics were administered for 1 day.
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Affiliation(s)
- Takeshi Hara
- Spine and Spinal Cord Center, Juntendo University, Tokyo, Japan
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
- Corresponding Author Takeshi Hara Department of Neurosurgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Yukoh Ohara
- Spine and Spinal Cord Center, Juntendo University, Tokyo, Japan
- Department of Neurosurgery, Juntendo University, Tokyo, Japan
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