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Kumar V, Bansal P, Ksheerasagar VP, Dhatt SS. Comparison of endoscopic decompression to open laminectomy in patients with thoracic ossified ligamentum flavum - a systematic review and meta-analysis. Neurosurg Rev 2024; 47:345. [PMID: 39037535 DOI: 10.1007/s10143-024-02591-x] [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: 05/14/2024] [Revised: 07/02/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
In recent years, there has been growing interest in an alternative approach for treating TOLF, such as endoscopic decompression, which minimizes the disruption of surrounding tissues. It is important to understand the advantages, disadvantages, and potential differences in outcomes associated with each approach. This comparative study aims to evaluate and contrast the effectiveness, safety, and outcomes of these two surgical techniques, open laminectomy and endoscopic decompression, in the management of thoracic OLF. The literature review was conducted on Embase, PubMed, Scopus and Google Scholar databases. After a thorough screening of all search results, 14 studies were shortlisted, from which data was extracted, and statistical analysis was done. Pooled analysis was done to ascertain the intra-operative and post-operative outcomes after surgery for TOLF. Overall, 351 patients were included in the study for evaluation. 174 patients were operated on by open laminectomy, and 177 patients were seen in the endoscopy group. Decreased operative time was seen in the endoscopic subgroup. The mean length of hospital stay of 6.6 days. Both groups showed improvement in mJOA and VAS score. The recovery rate for the reported study cohort was 66.8%, with the Endoscopic surgical approach showing a positive correlation with the mean recovery rate. The dural tear was the most common complication, with a rate of 6.6%. The mean estimated infection rate was 2.7% and postoperative CSF leak was 3.7%, with a trend of significantly higher rates in the open subgroup. Both of the groups showed improvement in functional scores, VAS scores, and cross-sectional area. However, the Endoscopic decompression group experienced reduced hospital stays, operating times, and intraoperative blood loss. The most frequent side effects were CSF leak and dural tear. A few cases showed revision and infection. None of the problems differed between the groups.
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Affiliation(s)
- Vishal Kumar
- Department Of Orthopaedics, PGIMER, Chandigarh, India
| | - Parth Bansal
- Department Of Orthopaedics, PGIMER, Chandigarh, India
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Antonacci CL, Zeng FR, Ford B, Wellington I, Kia C, Zhou H. A narrative review of endoscopic spine surgery: history, indications, uses, and future directions. JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:295-304. [PMID: 38974485 PMCID: PMC11224785 DOI: 10.21037/jss-23-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/12/2024] [Indexed: 07/09/2024]
Abstract
Background and Objective The concept of endoscopic surgery began in the 1930s and has since undergone numerous advancements in both technology and surgical indications. Its main benefit is providing the opportunity to perform surgery while minimizing disruption to surrounding structures. The purpose of this review is to summarize the history, uses, and future directions for spine endoscopic surgery. Methods A review of national databases was performing using key terms "endoscopic", "spine" and "surgery" for literature from 1900 to 2023. Studies that aimed to describe the utilities of endoscopic surgeries, associated outcomes, limitations, and future directions were included. Studies that were not in English were excluded. Key Content and Findings This review includes a brief overview of the history of endoscopic surgery and its current two main approaches, transforaminal and interlaminar approaches. It then summarizes the main indications and utilization of endoscopic surgery in the lumbar, cervical and thoracic spine, as well as expansion in managing spine tumors, infections, and outpatient surgical cases. Conclusions There are many rising indications and uses for endoscopic spine surgery in nearly every aspect of the spine. Compared to conventional spine surgery, there is early evidence showing endoscopic surgery is associated with less post-operative pain, shorter hospital stays, and possibly quicker recovery times. As current trends in spine surgery move towards minimally invasive techniques, it is anticipated that the use of endoscopic surgery will continue to expand.
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Affiliation(s)
| | - Francine R. Zeng
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Brian Ford
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Ian Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Cameron Kia
- Orthopedic Associates of Hartford, Bone and Joint Institute, Hartford, CT, USA
| | - Hanbing Zhou
- Orthopedic Associates of Hartford, Bone and Joint Institute, Hartford, CT, USA
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Kim JY, Heo DH. Biportal endoscopic cervical open-door laminoplasty to treat cervical spondylotic myelopathy. Acta Neurochir (Wien) 2024; 166:182. [PMID: 38632148 DOI: 10.1007/s00701-024-06076-0] [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: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Although cervical laminoplasty is a frequently utilized surgical intervention for cervical spondylotic myelopathy, it is primarily performed using conventional open surgical techniques. We attempted the minimally invasive cervical laminoplasty using biportal endoscopic approach. METHODS Contralateral lamina access is facilitated by creating space through spinous process drilling, followed by lamina hinge formation. Subsequently, the incised lamina is elevated from ipsilateral aspect, and secure metal plate fixation is performed. CONCLUSION We successfully performed the cervical open door laminoplasty using biportal endoscopic approach. Biportal endoscopic cervical open-door laminoplasty may be a minimally invasive technique that can prevent complications related with open surgery.
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Affiliation(s)
- Ji Yeon Kim
- Department of Neurosurgery, Spine Center, Seran General Hospital, Seoul, South Korea
| | - Dong Hwa Heo
- Department of Neurosurgery, Endoscopic Spine Surgery Center, Harrison Spinartus Hospital Chungdam, 646 Samseong-ro, Gangnam-gu, Seoul, 06084, South Korea.
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Kim JY, Choi SY, Kim KM. Biportal endoscopic transforaminal thoracic interbody fusion for the treatment of thoracic myelopathy. Acta Neurochir (Wien) 2024; 166:134. [PMID: 38472541 DOI: 10.1007/s00701-024-06030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Biportal endoscopic spine surgery independently controls two hands, similar to microscopic surgery, and utilizes a broader working space that is not disturbed by retractors under clear-magnified endoscopic vision. These advantages facilitate successful neural decompression and safe transforaminal interbody fusion, even in patients with thoracic spondylotic myelopathy. METHODS A wide laminectomy and precise total facetectomy, in conjunction with partial pediculotomy, establish a secure transforaminal space for cage insertion. Endplate preparation and cage insertion were performed without retracting the spinal cord under direct endoscopic vision. CONCLUSION Biportal endoscopic transforaminal thoracic interbody fusion can be a feasible technique for treating thoracic spondylotic myelopathy at the thoracolumbar junction levels.
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Affiliation(s)
- Ji Yeon Kim
- Department of Neurosurgery, Spine Center, Seran General Hospital, 256, Tongil-ro, Jongno-gu, Seoul, 03030, South Korea
| | - Su Yong Choi
- Department of Neurosurgery, Spine Center, Seran General Hospital, 256, Tongil-ro, Jongno-gu, Seoul, 03030, South Korea.
| | - Kyoung Mo Kim
- Department of Neurosurgery, Spine Center, Seran General Hospital, 256, Tongil-ro, Jongno-gu, Seoul, 03030, South Korea
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Sha Q, Huang Z, Liu J, Ge P, Zhang Y, Song E, Sun Z, Zhu T, Shen C, Qian J. Safety and efficacy of one-hole split endoscope technique for surgical treatment of thoracic ossification of the ligamentum flavum. Sci Rep 2024; 14:4342. [PMID: 38383583 PMCID: PMC10881547 DOI: 10.1038/s41598-024-55055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/20/2024] [Indexed: 02/23/2024] Open
Abstract
Surgical intervention is typically recommended for thoracic ossification of the ligamentum flavum (TOLF). This study aimed to evaluate the efficacy and safety of a novel non-coaxial one-hole split endoscope (OSE) technique for treating TOLF. We performed OSE procedure on 13 patients with TOLF from June 2022 to July 2023. The mean operative time was 117.5 ± 15.4 min. VAS scores for lower limbs decreased from 6.5 ± 0.8 preoperative to 1.6 ± 0.4 at the last follow-up (P < 0.001). ODI scores improved from 62.4 ± 5.7 preoperative to 18.6 ± 2.2 at the last follow-up (P < 0.001), and mJOA scores increased from 5.1 ± 1.6 preoperative to 8.4 ± 1.5 at the latest follow-up (P < 0.001). All patients achieved ASIA scale grade D or E at the final follow-up, except for two patients remained residual limb numbness. None of the thirteen patients suffered from severe perioperative complications. The OSE technique proves to be a safe and effective procedure for treating TOLF or even with dura mater ossification, characterized by minimal surgical trauma, relatively smooth learning curve and flexible operation.
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Affiliation(s)
- Qi Sha
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Zhengdong Huang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jinhao Liu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Peng Ge
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yong Zhang
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - En Song
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, Yunnan, China
| | - Zhaozhong Sun
- Department of Spine, Binzhou Medical University Hospital, No. 661 Huanghe 2nd Road, Binzhou, Shandong, China
| | - Tenyue Zhu
- Department of Orthopaedics, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, China
| | - Cailiang Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China
| | - Jun Qian
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, 230032, Anhui, China.
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Yuh WT, Lee YS, Jeon JH, Choi I. Future of Endoscopic Spine Surgery: Insights from Cutting-Edge Technology in the Industrial Field. Bioengineering (Basel) 2023; 10:1363. [PMID: 38135953 PMCID: PMC10740435 DOI: 10.3390/bioengineering10121363] [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: 10/25/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023] Open
Abstract
In the evolving landscape of spinal surgery, technological advancements play a pivotal role in enhancing surgical outcomes and patient experiences. This paper delves into the cutting-edge technologies underpinning endoscopic spine surgery (ESS), specifically highlighting the innovations in scope cameras, RF equipment, and drills. The modern scope camera, with its capability for high-resolution imaging, offers surgeons unparalleled visualization, enabling precise interventions. Radiofrequency (RF) equipment has emerged as a crucial tool, providing efficient energy delivery for tissue modulation without significant collateral damage. Drills, with their enhanced torque and adaptability, allow for meticulous bone work, ensuring structural integrity. As minimally invasive spine surgery (MISS) becomes the standard, the integration and optimization of these technologies are paramount. This review captures the current state of these tools and anticipates their continued evolution, setting the stage for the next frontier in spinal surgery.
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Affiliation(s)
- Woon-Tak Yuh
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Republic of Korea;
- Department of Neurosurgery, Hallym University College of Medicine, 1 Hallym Daehak-gil, Chuncheon-si 24252, Gangwon-do, Republic of Korea
| | - You-Sang Lee
- R&D Team, Solendos Inc., 503 38-21 Digital-ro 31-gil Guro-gu, Seoul 08376, Republic of Korea;
| | - Jong-Hyeok Jeon
- Biounit Co., Ltd., 810~817, WB113, Misagangbyeonjungang-ro, Hanam-si 12939, Gyeonggi-do, Republic of Korea;
| | - Il Choi
- Department of Neurosurgery, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si 18450, Gyeonggi-do, Republic of Korea;
- Department of Neurosurgery, Hallym University College of Medicine, 1 Hallym Daehak-gil, Chuncheon-si 24252, Gangwon-do, Republic of Korea
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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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Wu PH, Chin BZJ, Kim HS, Sim SI, Jang IT. Uniportal Thoracic Endoscopic Unilateral Laminotomy with Bilateral Decompression of Thoracic Ossification of Ligamentum Flavum: A Systematic Review of Current Literature. World Neurosurg 2023; 178:340-350.e2. [PMID: 37480986 DOI: 10.1016/j.wneu.2023.07.066] [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: 05/29/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Thoracic ossification of ligamentum flavum (TOLF) is a rare disease that often results in worsening neurologic sequelae if left untreated. Although the gold standard treatment for TOLF is open posterior laminectomy, it is often accompanied by high rates of complications and perioperative morbidity. There have been studies looking into feasibility of endoscopic posterior decompression for TOLF, citing potential for lower perioperative morbidity and achieving similar functional outcomes to its open laminectomy counterparts. We provide an up-to-date systematic review of clinical outcomes after endoscopic posterior decompression for TOLF from the latest assemblage of evidence. METHODS A systematic review of the technique was conducted from May 2000 to May 2023. Articles were selected based on PRISMA guidelines. Eligibility of studies was independently by 2 reviewers, with disagreements resolved by a third author. RESULTS Nineteen primary references comprising 337 patients with TOLF who underwent endoscopic posterior decompression were included in the systematic review. Mean follow-up time across all studies ranged from 8.9 to 65.3 months. Mean age ranged from 51.2 to 63 years, with mean intraoperative blood loss ranging from 15 to 62 mL. There is significant improvement in visual analog scale (VAS) score, VAS back, VAS leg, modified Japanese Orthopaedic Association score, and Oswestry Disability Index compared with preoperative recorded values across all studies, with low rates of complications reported. CONCLUSIONS Endoscopic posterior spinal decompression is a safe and effective technique for treatment of TOLF, with a low rate of complications and improvement in pain and function.
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Affiliation(s)
- Pang Hung Wu
- Achieve Spine And Orthopaedic Centre, Mount Elizabeth Hospital, Singapore; National University Health System, Jurong Health Campus, Orthopaedic Surgery, Singapore
| | - Brian Zhao Jie Chin
- National University Health System, Jurong Health Campus, Orthopaedic Surgery, Singapore; National University Health System, Kent Ridge Campus, Orthopaedic Surgery, Singapore
| | - Hyeun Sung Kim
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea.
| | - Seth Ian Sim
- National University Health System, Kent Ridge Campus, Orthopaedic Surgery, Singapore
| | - Il-Tae Jang
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Republic of South Korea
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Dou NN, Wang HL, Hu SZ, Huang ZN, Zhong J, Li ST. Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression Surgery in Severe Lumbar Stenosis Under Electrophysiological Monitoring-Focused on Full-Visualized Trephine/Osteotome. Neurospine 2023; 20:1040-1046. [PMID: 37798996 PMCID: PMC10562220 DOI: 10.14245/ns.2346624.312] [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: 05/20/2023] [Revised: 07/03/2023] [Accepted: 07/15/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE Although endoscopic drill has the advantages in manipulation and hemostasis, whose low efficiency and blurred vision reduce the efficacy of lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD). The present study was designed to evaluate the safety and efficacy of full-visualized trephine/osteotome in the LE-ULBD surgery for severe lumbar stenosis. METHODS Fifty-seven severe lumbar stenosis patients who underwent LE-ULBD between January 2020 to January 2023 were enrolled, who were divided into drill and visualized trephine groups. The medical records including demographics, operative duration, intraoperative electrophysiological findings, postoperative hospital stay or hospital stay, postoperative outcomes and complications were retrospectively reviewed and analyzed. RESULTS A total of 57 patients included 15 in drill and 42 in trephine group were enrolled in the study. There was significant difference in the pre- and postoperative visual analogue scale and Oswestry Disability Index scores in both groups (p < 0.05). The mean operative duration in the trephine group (101.05 ± 12.18 minutes) was shorter than that in the drill group (134.67 ± 9.68 minutes) (p < 0.05). There was no statistical difference between the 2 groups in electrophysiological monitoring, posthospital stays, postoperative outcomes and complications. Abnormal free-electromyography (EMG) were recorded in 2 (13.3%) and 5 patients (11.9%) in the drill and trephine group. Intraoperative somatosensory evoked potential changes occurred in 3 (20%) and 3 patients (7.1%) in the drill and trephine group and all patients recovered immediately when surgery ended. No serious complications and recurrence occurred in all the patients. CONCLUSION Full-visualized trephine/osteotome has been approved to be convenient, safe and efficient in our study, which combined with translaminar inside-out technique and EMG monitoring especially free-EMG may offer a new choice in LE-ULBD surgery for lumbar stenosis patients.
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Affiliation(s)
- Ning-Ning Dou
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine, Xinhua Hospital, Shanghai, China
| | - Hao-lin Wang
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine, Xinhua Hospital, Shanghai, China
| | - Shao-Zhen Hu
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine, Xinhua Hospital, Shanghai, China
| | - Zheng-Nan Huang
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine, Xinhua Hospital, Shanghai, China
| | - Jun Zhong
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine, Xinhua Hospital, Shanghai, China
| | - Shi-Ting Li
- Department of Neurosurgery, Shanghai Jiao Tong University School of Medicine, Xinhua Hospital, Shanghai, China
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