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Chen H, Zhang Z, Bian Z, Hou C, Li M, Zhu L, Wang X. Transforaminal Endoscopic Discectomy for Thoracolumbar Disc Herniation: A Retrospective Study and Technical Note. World Neurosurg 2023; 178:70-77. [PMID: 37454905 DOI: 10.1016/j.wneu.2023.07.013] [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: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Thoracolumbar disc herniation (TLDH) is a rare disorder with unique characteristics that can result in undesirable surgical outcomes after traditional discectomy. In view of the widespread use of transforaminal endoscopic discectomy for lower lumbar disc herniation, we investigated treatment of TLDH by this procedure. The purpose of this study was to evaluate the clinical efficacy of transforaminal endoscopic discectomy for treating TLDH and share our technical experience. METHODS We retrospectively evaluated the clinical data of 19 patients who had undergone transforaminal endoscopic discectomy for TLDH in our institution between April 2018 and July 2021. Operation time, follow-up time, blood loss, postoperative hospital stay, visual analog scale scores for low-back and leg pain, and Japanese Orthopedic Association (JOA) scores were evaluated. RESULTS The differences between preoperative and postoperative JOA and visual analog scale scores were significant (P < 0.05). According to the JOA scores, 14 of the 19 patients had excellent improvement, 3 had good improvement, and 2 had fair improvement; thus, the rate of satisfactory improvement was 89.5%. CONCLUSIONS Operation time, blood loss, postoperative hospital stay, and surgical outcomes were favorable. Transforaminal endoscopic discectomy is an ideal surgical procedure for treating TLDH.
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Affiliation(s)
- Hao Chen
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhen Zhang
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenyu Bian
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Changju Hou
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Maoqiang Li
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liulong Zhu
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuepeng Wang
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Identification of the Magna Radicular Artery Entry Foramen and Adamkiewicz System: Patient Selection for Open versus Full-Endoscopic Thoracic Spinal Decompression Surgery. J Pers Med 2023; 13:jpm13020356. [PMID: 36836589 PMCID: PMC9964931 DOI: 10.3390/jpm13020356] [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: 01/26/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Casually cauterizing the radicular magna during routine thoracic discectomy may have dire consequences. METHODS We performed a retrospective observational cohort study on patients scheduled for decompression of symptomatic thoracic herniated discs and spinal stenosis who underwent a preoperative computed tomography angiography (CTA) to assess the surgical risks by anatomically defining the foraminal entry level of the magna radicularis artery into the thoracic spinal cord and its relationship to the surgical level. RESULTS Fifteen patients aged 58.53 ± 19.57, ranging from 31 to 89 years, with an average follow-up of 30.13 ± 13.42 months, were enrolled in this observational cohort study. The mean preoperative VAS for axial back pain was VAS of 8.53 ± 2.06 and reduced to a postoperative VAS of 1.60 ± 0.92 (p < 0.0001) at the final follow-up. The Adamkiewicz was most frequently found at T10/11 (15.4%), T11/12 (23.1%), and T9/10 (30.8%). There were eight patients where the painful pathology was found far from the AKA foraminal entry-level (type 1), three patients with near location (type 2), and another four patients needing decompression at the foraminal (type 3) entry-level. In five of the fifteen patients, the magna radicularis entered the spinal canal on the ventral surface of the exiting nerve root through the neuroforamen at the surgical level requiring a change of surgical strategy to prevent injury to this important contributor to the spinal cord's blood supply. CONCLUSIONS The authors recommend stratifying patients according to the proximity of the magna radicularis artery to the compressive pathology with CTA to assess the surgical risk with targeted thoracic discectomy methods.
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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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Echt M, Holland R, Mowrey W, Cezayirli P, Ramos RDLG, Hamad M, Gelfand Y, Longo M, Kinon MD, Yanamadala V, Chaudhary S, Cho SK, Yassari R. Surgical Outcomes for Upper Lumbar Disc Herniations: A Systematic Review and Meta-analysis. Global Spine J 2021; 11:802-813. [PMID: 32744112 PMCID: PMC8165931 DOI: 10.1177/2192568220941815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To conduct a literature review on outcomes of discectomy for upper lumbar disc herniations (ULDH), estimate pooled rates of satisfactory outcomes, compare open laminectomy/microdiscectomy (OLM) versus minimally invasive surgical (MIS) techniques, and compare results of disc herniations at L1-3 versus L3-4. METHODS A systematic review of articles reporting outcomes of nonfusion surgical treatment of L1-2, L2-3, and/or L3-4 disc herniations was performed. The inclusion and exclusion of studies was performed according to the latest version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS A total of 20 articles were included in the quantitative meta-analysis. Pooled proportion of satisfactory outcome (95% CI) was 0.77 (0.70, 0.83) for MIS and 0.82 (0.78, 0.84) for OLM. There was no significant improvement with MIS techniques compared with standard OLM, odds ratio (OR) = 0.86, 95% CI (0.42, 1.74), P = .66. Separating results by levels revealed a trend of higher satisfaction with L3-4 versus L1-3 with OLM surgery, OR = 0.46, 95% CI (0.19, 1.12), P = .08. CONCLUSION Our analysis reveals that discectomy for ULDH has an overall success rate of approximately 80% and has not improved with MIS. Discectomy for herniations at L3-4 trends toward better outcomes compared with L1-2 and L2-3, but was not significant.
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Affiliation(s)
- Murray Echt
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
,Icahn School of Medicine at Mount Sinai, New York, NY, USA,Murray Echt, Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 439 Calhoun Avenue, Bronx, NY 10467, USA.
| | - Ryan Holland
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wenzhu Mowrey
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Phillip Cezayirli
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mousa Hamad
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Longo
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Merritt D. Kinon
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vijay Yanamadala
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Saad Chaudhary
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Yassari
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Fiani B, Siddiqi I, Reardon T, Sarhadi K, Newhouse A, Gilliland B, Davati C, Villait A. Thoracic Endoscopic Spine Surgery: A Comprehensive Review. Int J Spine Surg 2020; 14:762-771. [PMID: 33046537 DOI: 10.14444/7109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND From the 1990s, there has been growth in the literature demonstrating the feasibility of minimally invasive approaches for treating diverse spinal disorders. There is still much work to be done in circumnavigating the technical challenges and elucidating relative advantages of endoscopic techniques in spine surgery. In this comprehensive literature review, we discuss the history, advantages, disadvantages, approaches, and technology of, and critically examine peer-reviewed studies specifically addressing, endoscopic thoracic spinal surgery. METHODS Literature review was conducted with the key words "endoscopic," "minimally invasive," and "thoracic spinal surgery," using PubMed, Web of Science, and Google Scholar. RESULTS Review of 241 thorascopic procedures showed a success rate of 98% to 100%, low morbidity, and favorable complication profile. Review of 115 thoracic fixation procedures demonstrated high success rate, and 87% of screw positions were rated "good." Review of 55 full endoscopic uniportal decompressions showed sufficient decompression in most patients. Match pair analysis of 34 patients comparing video-assisted thoracoscopy surgery (VATS) or posterior spinal fusion reported the VATS group had increased operative duration but reduced blood loss. CONCLUSIONS Based on our literature review, there is a high rate of positive outcomes with endoscopic thoracic spine surgery, which reduces tissue dissection, intraoperative blood loss, and epidural fibrosis. However, the technical challenge highlights the importance of further training and innovation in this rapidly evolving field. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE There is growing evidence demonstrating the success of endoscopic thoracic spinal surgery. Populations that could be helped include the elderly and immunocompromised, who would benefit from decreased hospital stay and enhanced recovery time.
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Affiliation(s)
- Brian Fiani
- Desert Regional Medical Center, Palm Springs, California
| | - Imran Siddiqi
- Western University of Health Sciences College of Osteopathic Medicine, Pomona, California
| | - Taylor Reardon
- University of Pikeville, Kentucky College of Osteopathic Medicine, Pikeville, Kentucky
| | - Kasra Sarhadi
- Miller School of Medicine, University of Miami, Miami, Florida
| | | | | | - Cyrus Davati
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, New York
| | - Akash Villait
- Midwestern University, Arizona College of Osteopathic Medicine, Glendale, Arizona
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Butenschoen VM, Hoenikl L, Deschauer M, Meyer B, Gempt J. Bilateral thoracic disc herniation with abdominal wall paresis: a case report. Acta Neurochir (Wien) 2020; 162:2055-2059. [PMID: 32500255 PMCID: PMC8203549 DOI: 10.1007/s00701-020-04431-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/26/2020] [Indexed: 11/16/2022]
Abstract
We present a rare case of a patient initially presenting with unilateral abdominal wall bulging and radicular pain caused by a lateral disc herniation at Th11/12, later suffering from a hernia recurrence with bilateral disc prolapse and motor deficits. The patient underwent sequesterectomy via a right hemilaminectomy at Th11, and after 8 weeks, a bilateral sequesterectomy with semirigid fusion Th11/12 was performed. Unilateral motor deficits at the thoracic level have been discussed in case reports; a bilateral disc protrusion with abdominal wall bulging occurring as a recurrent disc herniation has never been described before.
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Affiliation(s)
- Vicki Marie Butenschoen
- School of Medicine, Klinikum rechts der Isar, Neurosurgical Department, Technical University of Munich, Munich, Germany
| | - Lisa Hoenikl
- School of Medicine, Klinikum rechts der Isar, Neurosurgical Department, Technical University of Munich, Munich, Germany
| | - Marcus Deschauer
- School of Medicine, Klinikum rechts der Isar, Neurological Department, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- School of Medicine, Klinikum rechts der Isar, Neurosurgical Department, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- School of Medicine, Klinikum rechts der Isar, Neurosurgical Department, Technical University of Munich, Munich, Germany
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Kim HS, Wu PH, Jang IT. Current and Future of Endoscopic Spine Surgery: What are the Common Procedures we Have Now and What Lies Ahead? World Neurosurg 2020; 140:642-653. [PMID: 32797991 DOI: 10.1016/j.wneu.2020.03.111] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 11/18/2022]
Abstract
The aging population around the world leads to increasing incidence of degenerative spinal conditions. There is a need for a minimally invasive technique in treatment for spinal conditions to meet the medical complexity and comorbidities that comes with aging. Principles of endoscopy are similar to minimally invasive surgery, which is to decrease pressure on soft tissue crushing from prolonged retraction, avoid soft tissue stripping and dissection, and bone and ligamentous preservation for optimal decompression without excessive destruction. Endoscopic spine surgery techniques started slowly in development in the 1970s to 2000s, with a rapid phase of development since the turn of the 21st century with endoscopic solutions developing in cervical, thoracic, and lumbar conditions with increasing complexity in nature of operation. Technological enhancement with progressively supportive literature is pushing boundaries of endoscopy from the early days of soft tissue procedure to current fusion procedures, endoscopic spine surgery techniques is covering more areas of spine than ever previously possible with good clinical results. We present a review on the current techniques available and postulated near future development for endoscopic spine surgery.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea.
| | - Pang Hung Wu
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea; Department of Orthopaedic Surgery, National University Health System, Jurong Health Campus, Singapore
| | - Il-Tae Jang
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea
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A Transforaminal Endoscopic Surgical Technique for Treating Lumbar Disc Herniation in the Setting of Spina Bifida. Case Rep Neurol Med 2020; 2020:1076847. [PMID: 32231822 PMCID: PMC7085356 DOI: 10.1155/2020/1076847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 01/15/2020] [Accepted: 02/08/2020] [Indexed: 11/26/2022] Open
Abstract
Recent literature suggests that adult patients with spina bifida receive surgery for degenerative disc disease at higher rates than the general population. However, sometimes the complex anatomic features of co-occurring spina bifida and lumbar disc herniation can significantly challenge standard surgical techniques. Here, the technical steps are presented for treating a foraminal lumbar 4-5-disc herniation in the setting of a patient with multifaceted degenerative and spina bifida occulta anatomy. Utilized is a minimally invasive approach that does not require general anesthesia or fusion and allows the patient to leave the same day. To the best of our knowledge, this is the first-reported case of endoscopic surgical decompression of a lumbar disc in a patient with spina bifida.
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Oyelese AA, Fridley J, Choi DB, Telfeian A, Gokaslan ZL. Minimally invasive direct lateral, retroperitoneal transforaminal approach for large L1-2 disc herniations with intraoperative CT navigational assistance: technical note and report of 3 cases. J Neurosurg Spine 2018; 29:46-53. [PMID: 29676674 DOI: 10.3171/2017.11.spine17509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Upper lumbar (L1-2, L2-3) disc herniations are distinct in their diffuse presenting clinical symptomatology and have poorer outcomes with surgical intervention than those following mid and lower lumbar disc herniations and disc surgery. The authors present the cases of 3 patients with L1-2 disc herniations and significant stenosis of the spinal canal. The surgical approach used here combined the principles of transforaminal percutaneous endoscopic discectomy and the extreme lateral lumbar interbody fusion procedures with intraoperative CT-guided navigational assistance. The approach provides a safe corridor of direct visualization to the ventral thecal sac with minimal bony resection and could, in principle, reduce neurological injury and biomechanical instability, which likely contribute to poor outcomes at this level.
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