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Wang W, Cui Y, Sun X, Zhang H, Yin W, Cui X, Jiao W. Transforaminal posterior lumbar interbody fusion microscopic safe operating area: a three-dimensional model study based on computed tomography imaging. J Orthop Surg Res 2024; 19:342. [PMID: 38849945 PMCID: PMC11161984 DOI: 10.1186/s13018-024-04830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Endoscopic spine lumbar interbody fusion (Endo-LIF) is well-regarded within the academic community. However, it presents challenges such as intraoperative disorientation, high rates of nerve damage, a steep learning curve, and prolonged surgical times, often occurring during the creation of the operative channel. Furthermore, the undefined safe operational zones under endoscopy continue to pose risks to surgical safety. We aimed to analyse the anatomical data of Kambin's triangle via CT imaging to define the parameters of the safe operating area for transforaminal posterior lumbar interbody fusion (TPLIF), providing crucial insights for clinical practice. METHODS We selected the L4-L5 intervertebral space. Using three-dimensional (3D), we identified Kambin's triangle and the endocircle within it, and recorded the position of point 'J' on the adjacent facet joint as the centre 'O' of the circle shifts by angle 'β.' The diameter of the inscribed circle 'd,' the abduction angle 'β,' and the distances 'L1' and 'L2' were measured from the trephine's edge to the exiting and traversing nerve roots, respectively. RESULTS Using a trephine with a diameter of 8 mm in TPLIF has a significant safety distance. The safe operating area under the TPLIF microscope was also clarified. CONCLUSIONS Through CT imaging research, combined with 3D simulation, we identified the anatomical data of the L4-L5 segment Kambin's triangle, to clarify the safe operation area under TPLIF. We propose a simple and easy positioning method and provide a novel surgical technique to establish working channels faster and reduce nerve damage rates. At the same time, according to this method, the Kambin's triangle anatomical data of the patient's lumbar spine diseased segments can be measured through CT 3D reconstruction of the lumbar spine, and individualised preoperative design can be conducted to select the appropriate specifications of visible trephine and supporting tools. This may effectively reduce the learning curve, shorten the time operation time, and improve surgical safety.
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Affiliation(s)
- Wei Wang
- Department of Orthopaedic, Fuyang Hospital Affiliated with Bengbu Medical University (Fuyang People's Hospital), Fuyang, China
| | - Yukai Cui
- Department of Orthopaedic, Fuyang Hospital Affiliated with Anhui Medical University (Fuyang People's Hospital), Fuyang, China
| | - Xiaohao Sun
- Department of Orthopaedic, Fuyang Hospital Affiliated with Anhui Medical University (Fuyang People's Hospital), Fuyang, China
| | - Haoran Zhang
- Department of Orthopaedic, Fuyang Hospital Affiliated with Anhui Medical University (Fuyang People's Hospital), Fuyang, China
| | - Wen Yin
- Department of Orthopaedic, Fuyang Hospital Affiliated with Anhui Medical University (Fuyang People's Hospital), Fuyang, China
- Department of Orthopaedic, Anhui Provincial Clinical Medical Research Center for Spinal Deformities, Fuyang, China
| | - Xilong Cui
- School of Mechatronics Engineering and Automation, Shanghai University, 333 Nanchen Road, Shanghai, 200072, China.
- Department of Orthopaedic, Anhui Provincial Clinical Medical Research Center for Spinal Deformities, Fuyang, China.
| | - Wei Jiao
- Department of Orthopaedic, Fuyang Hospital Affiliated with Bengbu Medical University (Fuyang People's Hospital), Fuyang, China.
- Department of Orthopaedic, Fuyang Hospital Affiliated with Anhui Medical University (Fuyang People's Hospital), Fuyang, China.
- Department of Orthopaedic, Anhui Provincial Clinical Medical Research Center for Spinal Deformities, Fuyang, China.
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de Castro JPS, Brock RS, Teixeira MJ, Figueiredo EG. Ultrasound-Guided In-Plane Interlaminar Lumbar Endoscopic Approach with Smartphone and Portable Light Source: Description of a New Surgical Technique. ARQUIVOS BRASILEIROS DE NEUROCIRURGIA: BRAZILIAN NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1756459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Introduction Endoscopic spine surgery enables the minimally invasive treatment of pathologies affecting the spinal cord and roots. Herein we describe an unprecedented technique Ultrasound-Guided in-plane interlaminar lumbar endoscopic approach with a smartphone and portable light source.
Methods The interlaminar approach was performed in a cadaveric specimen at L4 to 5 and L5 to S1 bilaterally. A curvilinear 2 to 5 MHz ultrasound probe was employed, the puncture was performed with the needle, a guide wire was inserted until the flavum ligament, followed by the dilator and working cannula. A 30° spinal endoscope, with an optical adapter of the endoscope camera for smartphone and portable endoscope lighting was inserted, the flavum ligament was visualized, and an opening in this site was performed with the scissors. Open dissection of the specimen was subsequently performed by identifying the puncture site in the interlaminar window.
Results The four interlaminar punctures were successfully guided by ultrasound; the opening of the ligamentum flavum was performed in the most lateral part of the interlaminar space, near the junction of the superior and inferior articular processes of the corresponding vertebrae in all the punctures.
Discussion The ultrasound makes possible to identify facets, foramina, transverse processes, and the interlaminar space. It is possible to minimize the use of radioscopy and its associated risks, both for patients and health professionals.
Conclusions The ultrasound-guided, in-plane, interlaminar, lumbar endoscopic approach with smartphone-adapted endoscope and portable light source is feasible and practical, minimizing radiation risks and making it possible to perform endoscopic spinal surgery.
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Affiliation(s)
| | - Roger Schmidt Brock
- Departament of Neurology, Hospital das Clínicas da Universidade de São Paulo, São Paulo – SP, Brazil
| | - Manoel Jacobsen Teixeira
- Departament of Neurology, Hospital das Clínicas da Universidade de São Paulo, São Paulo – SP, Brazil
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Zhao T, Shen J, Zheng B, Huang Y, Jin M, Morizane K, Shao H, Chen X, Zhang J. The 100 Most-Cited Publications in Endoscopic Spine Surgery Research. Global Spine J 2021; 11:587-596. [PMID: 32677522 PMCID: PMC8119913 DOI: 10.1177/2192568220934740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN A bibliometric review of the literature. OBJECTIVE Our objective was to identify and analyze the 100 most-cited publications in the field of endoscopic spine surgery (ESS). METHODS In order to determine the top cited 100 articles, a 3-step approach was employed. First, the 100 most-cited ESS studies were identified using the key phrase "endoscopic spine surgery." Then, 8 keywords were identified from the 100 studies of step 1 were used to conduct a second round searching in all databases of the Web of Science. Finally, when the results of the first and second steps were overlapped, duplicated studies were removed. The 100 top-cited articles were used for further analysis. RESULTS The citation number of the top 100 most-cited articles ranged from 44 to 236 with a mean value of 84.4. The most productive periods were from 2001 to 2010. The majority of publications came from Spine and Neurosurgery, where Spine holds the largest number of 35 articles, followed by Neurosurgery with 13 articles. Overall, 10 countries contributed to the 100 articles, with the most productive country being the United States, followed by Germany and Korea. CONCLUSION This bibliometric study is meant to produce a list of intellectual milestones in the field of ESS. This article's identification of the most influential articles in the field of ESS gives us a unique and comprehensive insight into the development of ESS in the past several decades.
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Affiliation(s)
- Tingxiao Zhao
- Zhejiang Provincial People’s
Hospital, Hangzhou, Zhejiang, China,Hangzhou Medical College People’s Hospital, Hangzhou, Zhejiang,
China,Bengbu Medical College, Bengbu, Anhui, China,These authors contribute equally to this study
| | - Jianjian Shen
- Cixi People’s Hospital, Ningbo, Zhejiang, China,These authors contribute equally to this study
| | - Biao Zheng
- Hangzhou Yuhang Orthopedics Hospital, Hangzhou, Zhejiang,
China,These authors contribute equally to this study
| | - Yazeng Huang
- Zhejiang Provincial People’s
Hospital, Hangzhou, Zhejiang, China,Hangzhou Medical College People’s Hospital, Hangzhou, Zhejiang,
China,Bengbu Medical College, Bengbu, Anhui, China
| | - Mengran Jin
- Zhejiang Provincial People’s
Hospital, Hangzhou, Zhejiang, China,Hangzhou Medical College People’s Hospital, Hangzhou, Zhejiang,
China
| | | | - Haiyu Shao
- Zhejiang Provincial People’s
Hospital, Hangzhou, Zhejiang, China,Hangzhou Medical College People’s Hospital, Hangzhou, Zhejiang,
China
| | - Xinji Chen
- Zhejiang Provincial People’s
Hospital, Hangzhou, Zhejiang, China,Hangzhou Medical College People’s Hospital, Hangzhou, Zhejiang,
China
| | - Jun Zhang
- Zhejiang Provincial People’s
Hospital, Hangzhou, Zhejiang, China,Hangzhou Medical College People’s Hospital, Hangzhou, Zhejiang,
China,Jun Zhang, Department of Orthopedics,
Zhejiang Provincial People’s Hospital, Shangtang Road 158#, Hangzhou, Zhejiang,
310014, China.
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Park J, Ham DW, Kwon BT, Park SM, Kim HJ, Yeom JS. Minimally Invasive Spine Surgery: Techniques, Technologies, and Indications. Asian Spine J 2020; 14:694-701. [PMID: 33108835 PMCID: PMC7595822 DOI: 10.31616/asj.2020.0384] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022] Open
Abstract
Over the past few decades, interest in minimally invasive spine surgery (MISS) has increased tremendously due to its core principle of minimizing approach-related injury while providing outcomes similar to traditional open spine procedures. With technical and technological advancements, MISS has expanded its utility not only to simple spinal stenosis, but also to complex spinal pathologies such as metastasis, trauma, or adult spinal deformity. In this article, we review the techniques and technology in MISS and discuss the indications, benefits, and limitations of MISS.
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Affiliation(s)
- Jiwon Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dae-Woong Ham
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Byung-Taek Kwon
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Kang T, Park SY, Park GW, Lee SH, Park JH, Suh SW. Biportal endoscopic discectomy for high-grade migrated lumbar disc herniation. J Neurosurg Spine 2020; 33:360-365. [PMID: 32413861 DOI: 10.3171/2020.2.spine191452] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although endoscopic procedures for lumbar disc herniation have improved greatly and offer many advantages, the indications are limited mostly to nonmigrated or low-grade migrated disc herniation. Endoscopic application in migrated disc herniation cases is still challenging and technically demanding. The goal in this study was to determine the feasibility of biportal endoscopic discectomy for removal of high-grade migrated disc herniation. METHODS A retrospective review was performed in 262 patients who had undergone biportal endoscopic discectomy after the diagnosis of lumbar herniated disc. According to preoperative MRI findings, disc herniation was classified into 5 zones based on the direction and distance from the disc space. Patients were divided into 2 groups-a high-grade migration group and a low-grade migration group. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified Macnab criteria, and those outcomes and operation time were compared between the 2 groups. RESULTS There were 10 patients with "high-grade up," 8 with "low-grade up," 98 with disc-level, 102 with "low-grade down," and 44 with "high-grade down" herniation, thereby yielding 54 patients in the high-grade group and 208 in the low-grade group. Demographic data for the 2 groups showed no significant difference. There was no significant difference between the 2 groups in ODI, VAS, and modified Macnab criteria. Operation time between the 2 groups was not significantly different (60.74 vs 65.63 minutes, p > 0.05). CONCLUSIONS Biportal endoscopic discectomy can be effective for high-grade migrated lumbar disc herniation with no prolonged operation time and satisfactory clinical outcomes.
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Grasso G. New Challenges for the Betterment of Spine Health. World Neurosurg 2020; 140:509-511. [PMID: 32797982 DOI: 10.1016/j.wneu.2020.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Giovanni Grasso
- Section of Neurosurgery, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy.
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Xie P, Feng F, Chen Z, He L, Yang B, Chen R, Wu W, Liu B, Dong J, Shu T, Zhang L, Chen CM, Rong L. Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis. BMC Musculoskelet Disord 2020; 21:546. [PMID: 32799839 PMCID: PMC7429717 DOI: 10.1186/s12891-020-03566-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background One advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS). Methods This is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed with LSS underwent the treatment of percutaneous transforaminal endoscopic decompression (PTED) and were followed up at 1 week, 3 months and 1 year postoperatively. Low back pain and leg pain were measured by Visual Analogue Scale scoring methods (VAS-back and VAS-leg), while functional outcomes were assessed by using the Oswestry Disability Index (ODI). All patients had one-level lumbar spinal stenosis. Results The most common type of stenosis was lateral recess stenosis (n = 22; 48.9%), followed by central stenosis (n = 13; 28.9%) and foraminal stenosis (n = 10: 22.2%). Regarding comparisons of VAS-back, VAS-leg, and ODI scores before and after operation, VAS and ODI scores significantly improved. The average leg VAS score improved from 7.01 ± 0.84 to 2.28 ± 1.43 (P < 0.001). The average ODI improved from 46.18 ± 10.11 to 14.40 ± 9.59 (P < 0.001). We also examined changes in ODI and VAS scores from baseline according to types of spinal stenosis, stenosis grade, spinal instability, and revision surgery in the same segment. The improvement percentage of leg VAS score was significantly less in patients with severe stenosis at both 3 months and 1 year postoperatively. The improvement percentages of ODI and leg VAS scores were significantly less in patients who had spinal instability and patients who had undergone revision surgery. Conclusion The PTED approach seems to give good results for the treatment of LSS. However, this approach may be less effective for LSS patients who have lumbar instability or require revision surgery in the same segment.
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Affiliation(s)
- Peigen Xie
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Feng Feng
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Zihao Chen
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Lei He
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Bu Yang
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Ruiqiang Chen
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Wenbin Wu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Bin Liu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Jianwen Dong
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Tao Shu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Liangming Zhang
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Chien-Min Chen
- Minimally Invasive Spine Center, Changhua Christian Hospital, No.135, Nansiao St., Changhua city, Changhua county, Taiwan.
| | - Limin Rong
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China.
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Konakondla S, Sofoluke N, Xia J, Grant R, Telfeian AE, Hofstetter CP, Slotkin JR. Transforaminal Endoscopic Approach for Large-Sample Tumor Biopsy using Beveled Working Channel for Core Technique: A Technical Note. World Neurosurg 2020; 141:346-351. [PMID: 32442734 DOI: 10.1016/j.wneu.2020.05.096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Identifying the histopathological diagnosis of a spinal tumor is the necessary step prior to pursuing subsequent treatment. Both minimally invasive and open spinal procedures have been described as useful methods of obtaining tumor tissue for diagnosis but differ by their limitations. Minimally invasive techniques, such as computed tomography-guided biopsies, can expose the patient to radiation, and the tissue obtained may be nondiagnostic. Tubular and open procedures require collateral soft-tissue damage and may require bony removal leading to iatrogenic injury. Endoscopic approaches to the spine can be employed to avoid treatment delay in diagnosis, decrease length of stay, and provide adequate tissue for diagnosis. METHODS We describe the surgical planning, tumor localization, and transforaminal endoscopic approach for tissue diagnosis of a lumbar spinal mass in a patient with a known history of Hodgkin lymphoma and non-Hodgkin lymphoma after a nondiagnostic computed tomography- guided biopsy. Final histopathological diagnosis of the lumbar spinal mass was consistent with large B-cell non-Hodgkin lymphoma. CONCLUSIONS We demonstrate the application of an endoscopic transforaminal approach in spine oncology. We also describe our technique on how we use a beveled working channel to obtain a large tissue core sample for definitive diagnosis.
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Affiliation(s)
- Sanjay Konakondla
- Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA.
| | - Nelson Sofoluke
- Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Jimmy Xia
- Weill Cornell Medical College, New York, New York, USA
| | - Ryan Grant
- Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, The University of Washington, Seattle, Washington, USA
| | - Jonathan R Slotkin
- Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
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Affiliation(s)
- Chun-Kun Park
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, 775 Gyeongsu-daero, Dongan-gu, Anyang 14041, Korea
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