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He BL, Zhu ZC, Lin LQ, Sun JF, Huang YH, Meng C, Sun Y, Zhang GC. Comparison of biportal endoscopic technique and uniportal endoscopic technique in Unilateral Laminectomy for Bilateral Decomprssion (ULBD) for lumbar spinal stenosis. Asian J Surg 2024; 47:112-117. [PMID: 37331857 DOI: 10.1016/j.asjsur.2023.05.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/29/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE Unilateral laminotomy for bilateral decompression (ULBD) has been adopted widely to treat lumbar spinal stenosis (LSS). The objective of the study is to investigate clinical and radiological outcomes of the biportal endoscopic ULBD (BE-ULBD) and uniportal endoscopic ULBD (UE-ULBD). METHODS We collected retrospectively 65 patients' data who met the inclusion criteria (July 2019-June 2021). 33 patients underwent BE-ULBD surgery, and 32 patients underwent the UE-ULBD surgery, and were followed up for at least 1 year. The following preoperative and postoperative outcomes were compared between groups: the visual analog scale (VAS) for pain, the Oswestry disability index (ODI) for nerve function, and modified Macnab criteria for satisfaction, the cross-sectional area of the dural sac (DSCSA), the mean angle of facetectomy. RESULTS Age, BMI, gender, levels of involvement and duration of symptoms were not significantly different at baseline in this study. Clinical data showed that postoperative ODI, VAS scores and Modified Macnab Criteria were not statistically different between the two groups. The BE-ULBD group had a shorter operation time than the UE-ULBD group (P < 0.001). Patients in the BE-ULBD group had a larger postoperative expansion of DSCSA expansion postoperatively (85.58 ± 3.16 mm2 VS 71.43 ± 3.35 mm2, P < 0.001) and a larger contralateral facetectomy angle (63.95 ± 3.34° vs 57.80 ± 3.43°, P < 0.001) compared with patients in the UE-ULBD group. There were no statistical differences in the incidence of postoperative complications between the two groups. CONCLUSION Both the BE-ULBD and the UE-ULBD yielded clinical improvement in terms of pain and stenosis symptoms. The BE-ULBD technique has the advantages of the shorter operation time, larger DSCSA expansion and larger contralateral facetectomy angle.
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Affiliation(s)
- Bang-Lin He
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Zhi-Cheng Zhu
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Li-Qun Lin
- Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Ji-Fu Sun
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China.
| | - Yong-Hui Huang
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Chen Meng
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Yan Sun
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
| | - Guang-Cheng Zhang
- Department of Spine Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, 212001, China
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Tan H, Yu L, Xie X, Liu N, Zhang G, Li X, Yang Y, Zhu B. Consecutive Case Series of Uniportal Full-endoscopic Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis: Relationship between Decompression Range and Functional Outcomes. Orthop Surg 2023; 15:3153-3161. [PMID: 37853983 PMCID: PMC10693994 DOI: 10.1111/os.13928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023] Open
Abstract
OBJECTIVE Uniportal full-endoscopic unilateral laminotomy for bilateral decompression (UFE-ULBD) has been used to treat lumbar spinal stenosis (LSS) with satisfactory outcomes. However, a limited number of studies have investigated the relationship between decompression range and clinical outcomes. This study aimed to investigate the efficacy of UFE-ULBD for single-segment LSS and to explore the relationship between the decompression range and functional outcomes. METHODS Single-segment LSS patients who had undergone UFE-ULBD using an interlaminar approach between November 2021 and February 2023 were retrospectively analyzed. Patient demographics, visual analogue scale (VAS) scores for leg and back pain, Oswestry disability index (ODI) scores, modified MacNab grades, and radiological outcomes, including the decompression ratio of the disc-flava ligament space and osseous lateral recess, the enlargement ratio of superior articular process interval, lamina interval dural sac cross-sectional area (DSCA), were collected. The independent sample t-tests, paired sample t-tests, chi-square tests, Fisher's exact tests, and Pearson's and Spearman's correlation analyses were used. RESULTS Forty patients (23 males, and 17 females) were retrospectively enrolled in this study. The mean follow-up period was 12 months. At the last follow-up, VAS scores for leg pain and back pain decreased from 6.0 ± 0.8 to 1.0 ± 1.9 (p < 0.001), and from 6.0 ± 0.8 to 1.2 ± 1.8 (p < 0.001) respectively; ODI score decreased from 71.7 ± 6.2 to 24.3 ± 21.3 (p < 0.001). According to the modified MacNab criteria, the results were excellent in 28 (70%), good in 5 (12.5%), fair in 6 (15%), and poor in 1 (2.5%), with an excellent-good rate of 82.5%. The postoperative DSCA enlarged from 57.69 ± 21.86 to 150.75 ± 39.33 mm2 (p < 0.001), with an enlargement ratio of 189.43 ± 107.83%. No difference in clinical or radiological parameters was detected between patients with excellent, good, fair, or poor outcomes based on the modified MacNab criteria. CONCLUSION UFE-ULBD can provide satisfactory clinical and radiological outcomes in single-segment LSS patients. With sufficient exposure to the dural sac boundary, the functional outcome was not related to the radiological decompression range in LSS patients who had undergone UFE-ULBD.
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Affiliation(s)
- Haining Tan
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Lingjia Yu
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Xuehu Xie
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Ning Liu
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Guoqiang Zhang
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Xiang Li
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Yong Yang
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Bin Zhu
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
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Adelhoefer SJ, Berger J, Mykolajtchuk C, Gujral J, Boadi BI, Fiani B, Härtl R. Ten-step minimally invasive slalom unilateral laminotomy for bilateral decompression (sULBD) with navigation. BMC Musculoskelet Disord 2023; 24:860. [PMID: 37919696 PMCID: PMC10621193 DOI: 10.1186/s12891-023-06940-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 10/06/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Unilateral laminotomy for bilateral decompression (ULBD) is a MIS surgical technique that offers safe and effective decompression of lumbar spinal stenosis (LSS) with a long-term resolution of symptoms. Advantages over conventional open laminectomy include reduced expected blood loss, muscle damage, mechanical instability, and less postoperative pain. The slalom technique combined with navigation is used in multi-segmental LSS to improve the workflow and effectiveness of the procedure. METHODS We outline ten technical steps to achieve a slalom unilateral laminotomy for bilateral decompression (sULBD) with navigation. In a retrospective case series, we included patients with multi-segmental LSS operated in our institution using the sULBD between 2020 and 2022. The primary outcome was a reduction in pain measured by Visual Analogue Scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI). RESULTS In our case series (N = 7), all patients reported resolution of initial symptoms on an average follow-up of 20.71 ± 9 months. The average operative time and length of hospital stay were 196.14 min and 1.67 days, respectively. On average, VAS (back pain) was 4.71 pre-operatively and 1.50 on long-term follow-up of an average of 19.05 months. VAS (leg pain) decreased from 4.33 to 1.21. ODI was reported as 33% pre-operatively and 12% on long-term follow-up. CONCLUSION The sULBD with navigation is a safe and effective MIS surgical procedure and achieves the resolution of symptoms in patients presenting with multi-segmental LSS. Herein, we demonstrate the ten key steps required to perform the sULBD technique. Compared to the standard sULBD technique, the incorporation of navigation provides anatomic localization without exposure to radiation to staff for a higher safety profile along with a fast and efficient workflow.
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Affiliation(s)
- Siegfried J Adelhoefer
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Jessica Berger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Catherine Mykolajtchuk
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Jaskeerat Gujral
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Blake I Boadi
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Brian Fiani
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, Weill Cornell Medicine and New York Presbyterian Hospital - Och Spine, 525 E 68th St, Box 99, New York, NY, 10065, USA.
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Greil ME, Bergquist J, Kashlan ON, Kwon WK, Durfy S, Hofstetter CP. Incidence and management of dural tears in full-endoscopic unilateral laminotomies for bilateral lumbar decompression. Eur Spine J 2023; 32:2889-2895. [PMID: 37264093 DOI: 10.1007/s00586-023-07749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/20/2023] [Accepted: 04/25/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE To report incidence of dural lacerations in lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) and to describe patient outcomes following a novel full-endoscopic bimanual durotomy repair. METHODS Retrospective review of prospectively collected database including 5.5 years of single surgeon experience with LE-ULBD. Patients with no durotomy were compared with patients who experienced intraoperative durotomy, including demographics, ASA score, prior surgery, number of levels treated, procedure time, hospital length of stay (LOS), visual analogue scale, perioperative complications, revision surgeries, use of analgesics, and Oswestry Disability Index (ODI). RESULTS In total, 13/174 patients (7.5%) undergoing LE-ULBD experienced intraoperative durotomy. No significant differences in demographic, clinical or operative variables were identified between the 2 groups. Sustaining a durotomy increased LOS (p = 0.0019); no differences in perioperative complications or rate of revision surgery were identified. There was no difference in minimally clinically important difference for ODI between groups (65.6% for no durotomy versus 55.6% for durotomy, p = 0.54). CONCLUSION In this cohort, sustaining a durotomy increased LOS but, with accompanying intraoperative repair, did not significantly affect rate of complications, revision surgery or functional outcomes. Our method of bimanual endoscopic dural repair provides an effective approach for repair of dural lacerations in interlaminar ULBD cases.
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Affiliation(s)
- Madeline E Greil
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA
| | - Julia Bergquist
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Woo-Keun Kwon
- Department of Neurosurgery, College of Medicine, Korea University Guro Hospital, Korea University, Seoul, Republic of Korea
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA
| | - Christoph P Hofstetter
- Department of Neurological Surgery, University of Washington, 325 Ninth Ave, Box 359924, Seattle, WA, 98104, USA.
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Lokhande PV. Full endoscopic spine surgery. J Orthop 2023; 40:74-82. [PMID: 37197373 PMCID: PMC10183645 DOI: 10.1016/j.jor.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023] Open
Abstract
Background With a dramatic increase in elderly population worldwide, the prevalence of degenerative spine disease is steadily rising. Even though the entire spinal column is affected the problem is more commonly seen in the lumbar, cervical spine and to some extent the thoracic spine. The treatment of symptomatic lumbar disc or stenosis is primarily conservative with analgesics, epidural steroids and physiotherapy. Surgery is advised only if conservative treatment is ineffective. Conventional open microscopic procedures even though are still a gold standard, have the disadvantages of excessive muscle damage and bone resection, epidural scarring along with prolonged hospital stay and increased need of postoperative analgesics. Minimal access spine surgeries minimize surgical access related injury by minimizing soft tissue and muscle damage and also bony resection thus preventing iatrogenic instability and unnecessary fusions. This leads to good functional preservation of the spine and enhances early postoperative recovery and early return to work. Full endoscopic spine surgeries are one of the more sophisticated and advanced form of MIS surgeries. Purpose Full endoscopy has definitive benefits over conventional microsurgical techniques. These include better and clear vision of the pathology due to presence of irrigation fluid channel, minimal soft tissue and bone trauma, better and relatively easy approach to deep seated pathologies like thoracic disc herniations and a possibility to avoid fusion surgeries. The purpose of this article is to describe these benefits, give an overview of the two main approaches - transforaminal and interlaminar, their indications, contraindications and their limitations. The article also describes about the challenges in overcoming the learning curve and its future prospectives. Conclusion Full endoscopic spine surgery is one of the fastest growing technique in the field of modern spine surgery. Better intraoperative visualization of the pathology, lesser incidence of complications, faster recovery time, less postoperative pain, better relief of symptoms and early return to activity are the main reasons behind this rapid growth. With better patient outcomes and reduced medical costs, the procedure is going to be more accepted, relevant and popular procedure in future.
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Chen KT, Choi KC, Shim HK, Lee DC, Kim JS. Full-endoscopic versus microscopic unilateral laminotomy for bilateral decompression of lumbar spinal stenosis at L4-L5: comparative study. Int Orthop 2022; 46:2887-2895. [PMID: 35984476 DOI: 10.1007/s00264-022-05549-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/09/2022] [Indexed: 01/22/2023]
Abstract
PURPOSE Full-endoscopic spine surgery for degenerative lumbar diseases is growing in popularity and has shown favourable outcomes. Lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has been used to treat lumbar spinal stenosis (LSS). However, studies comparing LE-ULBD to microscopic ULBD are lacking. This study compared the clinical efficacy and radiological outcomes between the LE-ULBD and microscopic ULBD. METHODS The study retrospectively enrolled patients undergoing either LE-ULBD or microscopic ULBD for spinal stenosis at the L4-L5 level. The demographic data, operative details, radiological images, clinical outcomes, and complications of patients from the two groups were compared through matched-pairs analysis. The minimum follow-up duration was 24 months. RESULTS There were 93 patients undergoing either LE-ULBD (n = 42) or microscopic ULBD (n = 51). The patient demographics were similar between the two groups. The LE-ULBD group had significantly less estimated blood loss, less analgesic use, and shorter hospitalization duration (P < .05). The endoscopic group had a significantly lower visual analog scale for back pain at all follow-up intervals compared with the microscopic group (P < .05). There were no significant differences in leg pain or Oswestry Disability Index. The cross-section area of the spinal canal was significantly wider after microscopic ULBD. There were no significant differences in post-operative degenerative changes in disc height, translational motion, or facet preservation rate. CONCLUSIONS LE-ULBD is comparable in clinical and radiological outcomes with enhanced recovery for single-level LSS. The endoscopic approach might further minimize tissue injury and enhance post-operative recovery.
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Affiliation(s)
- Kuo-Tai Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kyung-Chul Choi
- Department of Neurosurgery, Seoul Top Spine Hospital, Goyang, Korea
| | - Hyeong-Ki Shim
- Department of Neurosurgery, Seoul Top Spine Hospital, Goyang, Korea
| | - Dong-Chan Lee
- Department of Neurosurgery, the Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpo-daero, Seocho-gu, Seoul, 222, Korea.
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Han S, Zeng X, Zhu K, Wu X, Shen Y, Han J, Lin A, Meng S, Zhang H, Li G, Liu X, Tao H, Ma X, Zhou C. Clinical Application of Large Channel Endoscopic Systems with Full Endoscopic Visualization Technique in Lumbar Central Spinal Stenosis: A Retrospective Cohort Study. Pain Ther 2022. [PMID: 36057015 DOI: 10.1007/s40122-022-00428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Recently, large channel endoscopic systems and full endoscopic visualization technique have been used to perform unilateral laminotomy for bilateral decompression (ULBD) treatment for lumbar central spinal stenosis (LCSS). However, various endoscopic systems possess different design parameters, which may affect the technical points and treatment outcomes. The object of this retrospective study was to compare the efficiency, safety, and effectiveness of ULBD under the iLESSYS Delta system versus the Endo-Surgi Plus system. METHODS In the period from October 2020 to April 2021, ULBD was performed using the iLESSYS Delta system or Endo-Surgi Plus system to treat LCSS. Patients were classified into two groups based on the endoscopy system employed. Patient demographics, perioperative indexes, complications, and imaging characteristics were reviewed. Clinical outcomes were quantified using back and leg visual analog scale (VAS) scores and Oswestry Disability Index (ODI) at the time points of follow-up. RESULTS Thirty-two patients were assigned to the iLESSYS Delta system group and 37 to the Endo-Surgi Plus system group. In the comparison between the two groups, the Endo-Surgi Plus system possessed a shorter incision length and operation time (p < 0.005), and no statistical differences in other aspects were observed. The dural sacs of both groups were significantly expanded postoperatively compared to preoperatively (p < 0.001). Both groups experienced improvements in VAS and ODI scores at all time points (p < 0.001) and equally low frequency of complications. CONCLUSIONS Current research suggests that both the Endo-Surgi Plus system and iLESSYS Delta system achieved favorable high safety and clinical outcomes in ULBD for treatment of LCSS. The use of a fully visualized trephine may have increased the efficiency of the Endo-Surgi Plus system. Moreover, the Endo-Surgi Plus system may be associated with a wider decompression range and indications.
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Awaya T, Nishimura Y, Eguchi K, Nagashima Y, Ando R, Akahori S, Yoshikawa S, Haimoto S, Hara M, Takayasu M, Saito R. Radiological Analysis of Minimally Invasive Microscopic Laminectomy for Lumbar Canal Stenosis with a Focus on Multilevel Stenosis and Spondylolisthesis. World Neurosurg 2022; 164:e224-e234. [PMID: 35483569 DOI: 10.1016/j.wneu.2022.04.079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We retrospectively compared the radiological and clinical outcomes of two different surgical techniques (lumbar spinous process splitting laminectomy [LSPSL] and unilateral laminotomy for bilateral decompression [ULBD]) to treat lumbar spinal canal stenosis (LCS). METHODS We performed a retrospective comparative study of 141 consecutive patients with an average age of 70.8 ± 9.4 years who had undergone LSPSL or ULBD for LCS between April 2015 and April 2019. None of the patients had developed remote fractures of the spinous processes using either technique. These cases were divided into 2 groups: group L, 73 patients who had undergone LSPSL from April 2015 to April 2017; and group U, 68 patients who had undergone ULBD from May 2017 to April 2019. The clinical and radiological outcomes and surgical complications at the 1-year postoperative follow-up period were evaluated. RESULTS We found no significant differences in the operative time between the 2 groups. However, group U had had significantly less blood loss than group L. The facet joints were significantly well preserved in group U. We examined the multilevel and spondylolisthesis cases separately and found that both surgical procedures were equally effective and that the visual analog scale scores for back or leg pain and Japanese Orthopaedic Association scores had significantly improved postoperatively in each group. Group U showed better outcomes in terms of LCS recurrence, with 3 patients in the group L requiring repeat surgery. CONCLUSIONS We found both ULBD and LSPSL to be safe and effective techniques for LCS, even for patients with spondylolisthesis and multilevel disease. ULBD was superior in terms of recurrence prevention, preservation of the facet joints, and less blood loss.
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Affiliation(s)
- Takayuki Awaya
- Department of Neurosurgery, Nagoya University Hospital, Nagoya, Japan
| | - Yusuke Nishimura
- Department of Neurosurgery, Nagoya University Hospital, Nagoya, Japan.
| | - Kaoru Eguchi
- Department of Neurosurgery, Nagoya University Hospital, Nagoya, Japan
| | | | - Ryo Ando
- Department of Neurosurgery, Nagoya University Hospital, Nagoya, Japan
| | - Sho Akahori
- Department of Neurosurgery, Nagoya University Hospital, Nagoya, Japan
| | - Satoshi Yoshikawa
- Department of Neurosurgery, Nagoya University Hospital, Nagoya, Japan
| | - Shoichi Haimoto
- Department of Neurosurgery, Nagoya University Hospital, Nagoya, Japan
| | - Masahito Hara
- Department of Neurosurgery, Aichi Medical University Hospital, Nagakute, Japan
| | - Masakazu Takayasu
- Department of Neurosurgery, Inazawa Municipal Hospital, Inazawa, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University Hospital, Nagoya, Japan
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Hernandez RN, Wipplinger C, Navarro-Ramirez R, Soriano-Solis S, Kirnaz S, Hussain I, Schmidt FA, Soriano-Sánchez JA, Härtl R. Ten-Step Minimally Invasive Cervical Decompression via Unilateral Tubular Laminotomy: Technical Note and Early Clinical Experience. Oper Neurosurg (Hagerstown) 2021; 18:284-294. [PMID: 31245806 DOI: 10.1093/ons/opz156] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/18/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Minimally invasive techniques utilizing tubular retractors have become an increasingly popular approach to the spinal column. The concept of a unilateral laminotomy for bilateral decompression (ULBD), first applied in the lumbar spine, has recently been applied to the cervical spine for the treatment of cervical spondylotic myelopathy (CSM). A better understanding of the indications and surgical techniques is required to effectively educate surgeons on how to appropriately and safely perform tubular cervical laminotomy via ULBD. OBJECTIVE To describe a 10-step technique for minimally invasive cervical laminotomy and report our early clinical experience. METHODS A retrospective review identified 15 patients with CSM who were treated with this procedure. Visual analogue scale (VAS), neck disability index (NDI), and modified Japanese Orthopaedic Association (mJOA) scores were obtained pre- and postoperatively. RESULTS The mean age of the 15 patients was 73.1 ± 6.8 yr. The median number of levels treated was 1 (range 1-3). Mean operative time was 125.3 ± 30.8 or 81.7 ± 19.2 min per level. Mean estimated blood loss was 57.3 ± 24.6 cc. Median postoperative hospital length of stay was 36 h. No complications were encountered. Median follow-up was 18 mo. Mean pre- and postoperative VAS were 6.4 ± 2.4 and 1.0 ± 0.8, respectively (P < .001). Mean pre- and postoperative NDI were 46.4 ± 19.2 and 7.0 ± 6.9, respectively (P < .001). Mean pre- and postoperative Mjoa were 11.3 ± 2.5 and 14.5 ± 0.5, respectively (P < .001). CONCLUSION In our early clinical experience, minimally invasive cervical ULBD is safe and effective. Adherence to the presented 10-step technique will allow surgeons to safely address bilateral cervical pathology while avoiding complications.
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Affiliation(s)
- Robert Nick Hernandez
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.,Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York.,Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rodrigo Navarro-Ramirez
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Sergio Soriano-Solis
- Soriano Institute for Minimally Invasive Spine Surgery, ABC Hospital, Mexico City, Mexico
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Ibrahim Hussain
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Franziska Anna Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | | | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
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Chang HS. Effect of Sagittal Spinal Balance on the Outcome of Decompression Surgery for Lumbar Canal Stenosis. World Neurosurg 2018; 119:e200-e208. [PMID: 30036716 DOI: 10.1016/j.wneu.2018.07.104] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Although sagittal spinal balance is known to affect the outcome of spinal deformity surgery, its effect on simple decompression surgery is not well understood. MATERIALS AND METHODS Patients who underwent unilateral laminotomy for bilateral decompression for lumbar canal stenosis were prospectively enrolled in the study. Before surgery and 6 months after surgery, the following sagittal-alignment parameters were measured: lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI-LL), and sagittal vertical axis (SVA). At the same time, short-form 36 (SF-36) and Visual Analogue Scale (VAS) were estimated. The patients were divided into the poor postoperative physical score group (P_poor), good postoperative physical score group (P_good), poor postoperative VAS group (V_poor), or good postoperative VAS group (V_good). The postoperative spinopelvic parameters were compared between the physical score and VAS groups, respectively. Finally, we examined the correlation between the spinopelvic parameters and the outcome scores using scatter plots and linear regression analysis. RESULTS Fifty-two patients were enrolled into the study. Although the spinopelvic parameters (LL, PT, PI-LL) significantly improved after surgery, the absolute values of improvement were relatively small. The postoperative spinopelvic parameters were significantly worse in the P_poor and the V_poor groups compared with the P_good and the V_good groups, respectively. The correlation analyses also showed that worse postoperative spinopelvic parameters correlated to worse outcome in SF-36 and VAS. CONCLUSIONS Sagittal spinal balance significantly affected the outcome of patients undergoing decompression surgery for lumbar canal stenosis, the knowledge of which may serve better patient management.
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Affiliation(s)
- Han Soo Chang
- Department of Neurosurgery, Tokai University, Kanagawa, Japan.
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Chang HS. Influence of Lumbar Lordosis on the Outcome of Decompression Surgery for Lumbar Canal Stenosis. World Neurosurg 2017; 109:e684-e690. [PMID: 29061449 DOI: 10.1016/j.wneu.2017.10.055] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/09/2017] [Accepted: 10/11/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Although sagittal spinal balance plays an important role in spinal deformity surgery, its role in decompression surgery for lumbar canal stenosis is not well understood. To investigate the hypothesis that sagittal spinal balance also plays a role in decompression surgery for lumbar canal stenosis, a prospective cohort study analyzing the correlation between preoperative lumbar lordosis and outcome was performed. METHODS A cohort of 85 consecutive patients who underwent decompression for lumbar canal stenosis during the period 2007-2011 was analyzed. Standing lumbar x-rays and 36-item short form health survey questionnaires were obtained before and up to 2 years after surgery. Correlations between lumbar lordosis and 2 parameters of the 36-item short form health survey (average physical score and bodily pain score) were statistically analyzed using linear mixed effects models. RESULTS There was a significant correlation between preoperative lumbar lordosis and the 2 outcome parameters at postoperative, 6-month, 1-year, and 2-year time points. A 10° increase of lumbar lordosis was associated with a 5-point improvement in average physical scores. This correlation was not present in preoperative scores. CONCLUSIONS This study showed that preoperative lumbar lordosis significantly influences the outcome of decompression surgery on lumbar canal stenosis.
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Affiliation(s)
- Han Soo Chang
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
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