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Li Z, Yang H, Zhang Y, Han C, Liu Y, Guan L, Yang J, Hai Y, Pan A. Percutaneous endoscopic transforaminal discectomy and unilateral biportal endoscopic discectomy for lumbar disc herniation: a comparative analysis of learning curves. 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 2024; 33:2154-2165. [PMID: 38727735 DOI: 10.1007/s00586-024-08293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/14/2024] [Accepted: 04/29/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the learning curve of percutaneous endoscopic transforaminal discectomy (PETD) and interlaminar unilateral biportal endoscopic discectomy (UBED) in the treatment of lumbar disc herniation (LDH). METHODS Between 2018 and 2023, 120 consecutive patients with lumbar disc herniation (LDH) treated by endoscopic lumbar discectomy were retrospectively included. The PETD group comprised 87 cases, and the UBED group comprised 33 cases. Cumulative sum analysis was used to evaluate the learning curve, with the occurrence of complications or unresolved symptoms defined as surgical failure, and variables of different phases of the learning curve being compared. RESULTS The learning curve analysis identified the cutoff point at 40 cases in the PETD group and 15 cases in the UBED group. In the mastery phase, both PETD and UBED demonstrated a significant reduction in operation times (approximately 38 min for PTED and 49 min for UBED). In both PETD and UBED groups, the surgical failure rates during the learning and mastery phases showed no statistically significant differences. The visual analogue scale at the last follow-up was significantly lower than before surgery in both the PETD and UBED groups. CONCLUSION PETD and UBED surgery are effective in the treatment of LDH with a low incidence of complications. However, achieving mastery in PETD necessitates a learning curve of 40 cases, while UBED requires a minimum of 15 cases to reach proficiency.
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Affiliation(s)
- Zhangfu Li
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Honghao Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Yaoshen Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Chaofan Han
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Li Guan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Jincai Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China.
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China.
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China.
- Center for Spinal Deformity, Capital Medical University, Beijing, China.
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China.
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China.
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China.
- Center for Spinal Deformity, Capital Medical University, Beijing, China.
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Pojskić M, Bopp MHA, Nimsky C, Saß B. Surgical Treatment of Calcified Thoracic Herniated Disc Disease via the Transthoracic Approach with the Use of Intraoperative Computed Tomography (iCT) and Microscope-Based Augmented Reality (AR). MEDICINA (KAUNAS, LITHUANIA) 2024; 60:887. [PMID: 38929504 PMCID: PMC11206109 DOI: 10.3390/medicina60060887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: The aim of this study is to present our experience in the surgical treatment of calcified thoracic herniated disc disease via a transthoracic approach in the lateral position with the use of intraoperative computed tomography (iCT) and augmented reality (AR). Materials and Methods: All patients who underwent surgery for calcified thoracic herniated disc via a transthoracic transpleural approach at our Department using iCT and microscope-based AR were included in the study. Results: Six consecutive patients (five female, median age 53.2 ± 6.4 years) with calcified herniated thoracic discs (two patients Th 10-11 level, two patients Th 7-8, one patient Th 9-10, one patient Th 11-12) were included in this case series. Indication for surgery included evidence of a calcified thoracic disc on magnet resonance imaging (MRI) and CT with spinal canal stenosis of >50% of diameter, intractable pain, and neurological deficits, as well as MRI-signs of myelopathy. Five patients had paraparesis and ataxia, and one patient had no deficit. All surgeries were performed in the lateral position via a transthoracic transpleural approach (Five from left side). CT for automatic registration was performed following the placement of the reference array, with a high registration accuracy. Microscope-based AR was used, with segmented structures of interest such as vertebral bodies, disc space, herniated disc, and dural sac. Mean operative time was 277.5 ± 156 min. The use of AR improved orientation in the operative field for identification, and tailored the resection of the herniated disc and the identification of the course of dural sac. A control-iCT scan confirmed the complete resection in five patients and incomplete resection of the herniated disc in one patient. In one patient, complications occurred, such as postoperative hematoma, and wound healing deficit occurred. Mean follow-up was 22.9 ± 16.5 months. Five patients improved following surgery, and one patient who had no deficits remained unchanged. Conclusions: Optimal surgical therapy in patients with calcified thoracic disc disease with compression of dural sac and myelopathy was resectioned via a transthoracic transpleural approach. The use of iCT-based registration and microscope-based AR significantly improved orientation in the operative field and facilitated safe resection of these lesions.
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Affiliation(s)
- Mirza Pojskić
- Department of Neurosurgery, University of Marburg, 35039 Marburg, Germany; (M.H.A.B.); (B.S.)
| | - Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, 35039 Marburg, Germany; (M.H.A.B.); (B.S.)
- Marburg Center for Mind, Brain and Behavior (MCMBB), 35032 Marburg, Germany;
| | - Christopher Nimsky
- Marburg Center for Mind, Brain and Behavior (MCMBB), 35032 Marburg, Germany;
| | - Benjamin Saß
- Department of Neurosurgery, University of Marburg, 35039 Marburg, Germany; (M.H.A.B.); (B.S.)
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Cheng SH, Lin YT, Lu HT, Tsuei YC, Chu W, Chu WC. The Evolution of Spinal Endoscopy: Design and Image Analysis of a Single-Use Digital Endoscope Versus Traditional Optic Endoscope. Bioengineering (Basel) 2024; 11:99. [PMID: 38275579 PMCID: PMC10813680 DOI: 10.3390/bioengineering11010099] [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: 12/18/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
Spinal endoscopy has evolved significantly since its inception, offering minimally invasive solutions for various spinal pathologies. This study introduces a promising innovation in spinal endoscopy-a single-use digital endoscope designed to overcome the drawbacks of traditional optic endoscopes. Traditional endoscopes, despite their utility, present challenges such as fragility, complex disinfection processes, weight issues, and susceptibility to mechanical malfunctions. The digital endoscope, with its disposable nature, lighter weight, and improved image quality, aims to enhance surgical procedures and patient safety. The digital endoscope system comprises a 30-degree 1000 × 1000 pixel resolution camera sensor with a 4.3 mm working channel, and LED light sources replacing optical fibers. The all-in-one touch screen tablet serves as the host computer, providing portability and simplified operation. Image comparisons between the digital and optic endoscopes revealed advantages in the form of increased field of view, lesser distortion, greater close-range resolution, and enhanced luminance. The single-use digital endoscope demonstrates great potential for revolutionizing spine endoscopic surgeries, offering convenience, safety, and superior imaging capabilities compared to traditional optic endoscopes.
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Affiliation(s)
- Shih-Hao Cheng
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Yen-Tsung Lin
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
| | - Hsin-Tzu Lu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
| | - Yu-Chuan Tsuei
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - William Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11221, Taiwan
| | - Woei-Chyn Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan; (S.-H.C.); (Y.-T.L.); (Y.-C.T.)
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