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Kishima K, Yagi K, Yamashita K, Tezuka F, Morimoto M, Takata Y, Sakai T, Maeda T, Sairyo K. Full-endoscopic spine surgery in oldest old patients aged over 90 years:A case report. THE JOURNAL OF MEDICAL INVESTIGATION 2024; 71:169-173. [PMID: 38735715 DOI: 10.2152/jmi.71.169] [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: 05/14/2024]
Abstract
BACKGROUND Transforaminal full-endoscopic spine surgery (FESS) is the least invasive spinal surgery and can be performed under local anesthesia. In Japan, the population is rapidly aging and the number of spinal surgeries performed in the elderly is also increasing. OBJECT In this report, we describe 3 patients aged 90 years or older in whom we performed FESS under local anesthesia. CASE The first case was a 90-year-old man who presented with severe leg pain. He had multiple medical comorbidities and was unsuitable for general anesthesia. We performed FESS. After surgery, the leg pain resolved with full recovery of muscle strength. He was discharged with no perioperative complications. The second case was a 90-year-old man who presented with severe leg pain. MRI showed a herniated nucleus pulposus and foraminal stenosis at L4/5. We performed FESS. The leg pain improved immediately after surgery. The third case was a 91-year-old woman in whom we diagnosed left L5 radiculopathy due to foraminal stenosis at L5/S1. After surgery, her leg pain was relieved. CONCLUSION FESS is a good surgical procedure for elderly patients who are in a poor general condition because it is minimally invasive and can be performed under local anesthesia with early mobilization. J. Med. Invest. 71 : 169-173, February, 2024.
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Affiliation(s)
- Kazuya Kishima
- Department of Orthopedic Surgery, Hyogo College of Medicine, Hyogo, Japan
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Kiyoshi Yagi
- Department of Orthopedics, Tokushima University, Tokushima, Japan
- Department of Orthopedic Surgery, Nagoya City University, Aichi, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | | | - Yoichiro Takata
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
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Otake Y, Tezuka F, Yamashita K, Morimoto M, Sugiura K, Takeuchi M, Tamaki S, Fujitani J, Kageyama H, Sairyo K. Full-Endoscopic Foraminal Decompression for Foraminal Stenosis Following Osteoporotic Vertebral Fracture in an Elderly Woman Under Local Anesthesia:A Case Report. THE JOURNAL OF MEDICAL INVESTIGATION 2024; 71:179-183. [PMID: 38735718 DOI: 10.2152/jmi.71.179] [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: 05/14/2024]
Abstract
Osteoporotic vertebral fracture (OVF) is common in the elderly population. In this report, we describe a case with radiculopathy due to foraminal stenosis caused by OVF in a very elderly patient that was treated successfully by full-endoscopic foraminotomy under local anesthesia. The patient was an 89-year-old woman who presented with a chief complaint of left leg pain for 5 years. She visited a couple of hospitals and finally consulted us to determine the exact cause of the pain. Computed tomography scans were obtained and selective nerve root block at L3 was performed. The diagnosis was radiculopathy at L3 due to foraminal stenosis following OVF. The patient had severe heart disease, so we decided to avoid surgery under general anesthesia and planned full-endoscopic spine surgery under local anesthesia. We performed transforaminal full-endoscopic lumbar foraminotomy at L3-L4 to decompress the L3 nerve root. The leg pain disappeared completely immediately after surgery. Postoperative computed tomography confirmed appropriate bone resection. The leg pain did not recur during a year of postoperative follow-up. OVF may cause lumbar radiculopathy as a result of foraminal stenosis, and transforaminal full-endoscopic lumbar foraminotomy under local anesthesia would be the best option in an elderly patient with poor general condition. J. Med. Invest. 71 : 179-183, February, 2024.
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Affiliation(s)
- Yu Otake
- Department of Orthopedics, Tokushima University, Tokushima, Japan
- Department of Orthopedic Surgery, St. Lukas Hospital, Tokyo, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | | | - Kosuke Sugiura
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Makoto Takeuchi
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Shunsuke Tamaki
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Junzo Fujitani
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Hiroshi Kageyama
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
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Morimoto M, Tamaki S, Ogawa T, Fujimoto S, Sugiura K, Takeuchi M, Manabe H, Tezuka F, Yamashita K, Fujitani J, Sairyo K. Advantages of Full-endoscopic Trans-Kambin's Triangle Lumbar Interbody Fusion for Degenerative Spondylolisthesis: Illustrative Cases. NMC Case Rep J 2023; 10:87-92. [PMID: 37131495 PMCID: PMC10149142 DOI: 10.2176/jns-nmc.2022-0287] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/28/2022] [Indexed: 05/04/2023] Open
Abstract
Various approaches to lumbar interbody fusion have been described. The usefulness of full-endoscopic trans-Kambin's triangle lumbar interbody fusion has recently been reported. This technique has several advantages in patients with degenerative spondylolisthesis, including the ability to improve symptoms without decompression surgery. Moreover, given that the entire procedure is performed percutaneously, it can be performed without increasing the operation time or surgical invasiveness, even in obese patients. In this article, we discuss these advantages and illustrate them with representative cases.
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Affiliation(s)
- Masatoshi Morimoto
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Shunsuke Tamaki
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Takayuki Ogawa
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Shutaro Fujimoto
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Makoto Takeuchi
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Hiroaki Manabe
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Junzo Fujitani
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
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Inokuchi T, Tezuka F, Yamashita K, Morimoto M, Sugiura K, Fujitani J, Sairyo K. Transforaminal Full-endoscopic Discectomy for Gas-containing Herniated Nucleus Pulposus at L5-S1 Under Local Anesthesia : A Case Report. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:328-331. [DOI: 10.2152/jmi.69.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Takashi Inokuchi
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Masatoshi Morimoto
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Junzo Fujitani
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
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