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Taçyıldız AE, İnceoğlu F. Classification of Osteophytes Occurring in the Lumbar Intervertebral Foramen. Tomography 2024; 10:618-631. [PMID: 38668404 PMCID: PMC11053472 DOI: 10.3390/tomography10040047] [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: 03/24/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Surgeons have limited knowledge of the lumbar intervertebral foramina. This study aimed to classify osteophytes in the lumbar intervertebral foramen and to determine their pathoanatomical characteristics, discuss their potential biomechanical effects, and contribute to developing surgical methods. METHODS We conducted a retrospective, non-randomized, single-center study involving 1224 patients. The gender, age, and anatomical location of the osteophytes in the lumbar intervertebral foramina of the patients were recorded. RESULTS Two hundred and forty-nine (20.34%) patients had one or more osteophytes in their lumbar 4 and 5 foramina. Of the 4896 foramina, 337 (6.88%) contained different types of osteophytes. Moreover, four anatomical types of osteophytes were found: mixed osteophytes in 181 (3.69%) foramina, osteophytes from the lower endplate of the superior vertebrae in 91 (1.85%) foramina, osteophytes from the junction of the pedicle and lamina of the upper vertebrae in 39 foramina (0.79%), and osteophytes from the upper endplate of the lower vertebrae in 26 (0.53%) foramina. The L4 foramen contained a significantly higher number of osteophytes than the L5 foramen. Osteophyte development increased significantly with age, with no difference between males and females. CONCLUSIONS The findings show that osteophytic extrusions, which alter the natural anatomical structure of the lumbar intervertebral foramina, are common and can narrow the foramen.
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Affiliation(s)
- Abdullah Emre Taçyıldız
- Department of Neurosurgery, Faculty of Medicine, Turgut Özal University, Malatya 44090, Turkey
- Department of Neurosurgery, Faculty of Medicine, Karabuk University, Karabuk 78200, Turkey
| | - Feyza İnceoğlu
- Department of Biostatistics, Faculty of Medicine, Turgut Özal University, Malatya 44090, Turkey;
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Chang P, Rogowski BC, Aziz KA, Bharthi R, Valls L, Esplin N, Williamson RW. Foraminal stenosis and radiculopathy secondary to tophaceous gout: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23298. [PMID: 38145559 PMCID: PMC10751219 DOI: 10.3171/case23298] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/19/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Tophaceous gout is a severe form of gout that results in the formation of large nodules, or tophi, in the affected joints and surrounding tissues. Gouty tophi in the spine have a constellation of presentations that often mimic other pathologies and may not be easily discernable from more common pathologic processes. OBSERVATIONS A 47-year-old female with a history of chronic renal disease, obesity, gout, inflammatory polyarthritis, and multiple sclerosis presented with 6 months of low-back pain and lumbar radiculopathy affecting the right lower extremity. A lumbar magnetic resonance imaging study revealed right foraminal stenosis and spondylolisthesis at levels L4-5. An intraspinal extradural mass was noted adjacent to the traversing right L5 and exiting right L4 nerve roots. A bilateral decompressive laminectomy, facetectomy, and foraminotomy of L4-5 was performed. A calcific, chalky-white mass was discovered in the foramen, and pathology determined the specimen to be a gout tophus. Postoperatively, the patient endorsed the resolution of her preoperative symptoms, which have not returned on follow-up. LESSONS Reports of gouty depositions compressing the spinal cord in the current literature are relatively rare. Although the diagnosis of gouty tophi can only be confirmed histologically, patient history may serve as a helpful diagnostic tool.
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Affiliation(s)
- Patrick Chang
- College of Medicine, Drexel University, Philadelphia, Pennsylvania
| | | | - Khaled Abdel Aziz
- College of Medicine, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania; and
| | - Rosh Bharthi
- College of Medicine, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania; and
| | - Lance Valls
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Nathan Esplin
- Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania
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Hutchins J, Hebelka H, Svensson PA, Myklebust TÅ, Lagerstrand K, Brisby H. Cervical Foraminal Changes in Patients with Intermittent Arm Radiculopathy Studied with a New MRI-Compatible Compression Device. J Clin Med 2023; 12:6493. [PMID: 37892631 PMCID: PMC10607115 DOI: 10.3390/jcm12206493] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Diagnosing cervical foraminal stenosis with intermittent arm radiculopathy is challenging due to discrepancies between MRI findings and symptoms. This can be attributed to the fact that MRI images are often obtained in a relaxed supine position. This study aims to evaluate the feasibility of the Dynamic MRI Compression System (DMRICS) and to assess possible changes in cervical foramina, with both quantitative measurements and qualitative grading systems, with MRI during a simulated Spurling test. Ten patients (five women and five men, ages 29-45) with previously confirmed cervical foraminal stenosis underwent MRI scans using DMRICS. MRI images were acquired in both relaxed and provoked states. A radiologist assessed 30 foramina (C4-C7) on the symptomatic side in both patient positions. Quantitative and qualitative measures were performed, including the numeric rating scale (NRS) and the Park and Kim grading systems. The provoked state induced concordant neck and arm pain in 9 of 10 patients. Significant shifts in Park and Kim foraminal gradings were noted: 13 of 27 Park gradings and 9 of 27 Kim gradings escalated post provocation. No quantitative changes were observed. This pilot study indicates that the DMRICS device has the potential to improve diagnostic accuracy for cervical radiculopathy, demonstrating induced cervical foraminal changes during a simulated Spurling test while performing MRI.
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Affiliation(s)
- John Hutchins
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
| | - Hanna Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
| | - Pär-Arne Svensson
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
| | - Tor Åge Myklebust
- Department of Registration, Cancer Registry Norway, 0379 Oslo, Norway
| | - Kerstin Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, SE413 45 Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, SE413 45 Gothenburg, Sweden
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4
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Kose HC, Akkaya OT. Predictive Factors Associated with Successful Response to Percutaneous Adhesiolysis in Chronic Lumbar Radicular Pain. J Clin Med 2023; 12:6337. [PMID: 37834981 PMCID: PMC10573688 DOI: 10.3390/jcm12196337] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/17/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Percutaneous adhesiolysis (PEA) is of interest in the treatment of lumbar radicular pain. This study aimed to assess the effectiveness of PEA in patients with chronic lumbar radicular pain refractory to epidural steroid injections and to determine predictive factors, including demographic, clinical, and procedural data, to provide superior treatment efficacy. One hundred and ninety-three patients were reviewed. Successful treatment outcome was described as a 50% reduction in the visual analog scale score. Among the 193 patients, 109 (56.2%) exhibited a positive treatment response at 12 months. In multivariate logistic regression analysis, no depression (OR, 3.105; 95% CI, 1.127-8.547; p = 0.028), no spondylolisthesis (OR, 2.976; 95% CI, 1.246-7.092; p = 0.014), no previous lumbar surgery (OR, 2.242; 95% CI, 1.067-4.716; p = 0.033), mild foraminal stenosis (OR, 3.460; 95% CI, 1.436-8.333; p = 0.006), no opioid use (OR, 1.782; 95% CI, 0.854-3.717; p = 0.123), and baseline pain scores (OR, 0.787; 95% CI, 0.583-1.064; p = 0.120) were the predictive factors significantly associated with unsuccessful treatment outcome. PEA is a useful treatment option for patients with chronic lumbar radicular pain refractory to epidural steroid injections. A history of lumbar surgery, spondylolisthesis, depression, and severe foraminal stenosis could be associated with a poor prognosis.
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Affiliation(s)
- Halil Cihan Kose
- Department of Pain Medicine, Kocaeli City Hospital, 41060 Kocaeli, Turkey
| | - Omer Taylan Akkaya
- Department of Pain Medicine, Health Science University Etlik City Hospital, 06120 Ankara, Turkey;
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Cao Z, Li Z, Zhao H, Wang J, Hou S. Revisional Endoscopic Foraminal Decompression via Modified Interlaminar Approach at L5-S1 after Failed Posterior Instrumented Lumbar Fusion in Elderly Patients. Bioengineering (Basel) 2023; 10:1097. [PMID: 37760199 PMCID: PMC10525451 DOI: 10.3390/bioengineering10091097] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/27/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Elderly people usually have poorer surgical tolerance and a higher incidence of complications when undergoing revision surgery after posterior instrumented lumbar fusion (PILF). Full-endoscopic transforaminal surgery is a safe and effective option, but sometimes, it is difficult to revise L5-S1 foraminal stenosis (FS) after PILF. Therefore, we developed full-endoscopic lumbar decompression (FELD) at the arthrodesis level via a modified interlaminar approach under local anesthesia. This study aimed to describe the technical note and clinical efficacy of the technique. Eleven patients with unilateral lower limb radiculopathy after PILF underwent selective nerve root block and then underwent FELD. Magnetic resonance imaging (MRI) and computer tomography (CT) were performed on the second postoperative day. Their clinical outcomes were evaluated with a Visual analog scale (VAS) of low back pain and sciatica pain, Oswestry disability index (ODI), and the MacNab score. Complete decompression was achieved in every case with FELD without serious complications. Postoperative VAS of sciatica pain and ODI at each time point and VAS of low back pain and ODI after three months postoperatively were significantly improved compared with those preoperative (p < 0.05). According to the MacNab criteria, seven patients (63.6%) had excellent results at the two-year follow-up, and four patients (36.4%) had good results. No patients required further revision surgery. FELD, via a modified interlaminar approach, is effective for treating unilateral L5-S1 FS after PILF in elderly people.
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Affiliation(s)
| | - Zhenzhou Li
- Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing 100048, China; (Z.C.); (H.Z.); (J.W.); (S.H.)
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Ahn Y, Park HB. Transforaminal Endoscopic Lumbar Foraminotomy for Juxta-Fusional Foraminal Stenosis. J Clin Med 2023; 12:5745. [PMID: 37685812 PMCID: PMC10488747 DOI: 10.3390/jcm12175745] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/10/2023] Open
Abstract
Adjacent segment foraminal stenosis is a significant adverse event of lumbar fusion. Conventional revision surgery with an extended fusion segment may result in considerable surgical morbidity owing to extensive tissue injury. Transforaminal endoscopic lumbar foraminotomy (TELF) is a minimally invasive surgical approach for symptomatic foraminal stenosis. This study aimed to demonstrate the surgical technique and clinical outcomes of TELF for the treatment of juxta-fusional foraminal stenosis. Full-scale foraminal decompression was performed via a transforaminal endoscopic approach under local anesthesia. A total of 22 consecutive patients who had undergone TELF were evaluated. The included patients had unilateral foraminal stenosis at the juxta-fusional level of the previous fusion surgery, intractable lumbar radicular pain despite at least six months of non-operative treatment, and verified pain focus by imaging and selective nerve root block. The visual analog scale and Oswestry Disability Index scores significantly improved after the two-year follow-up period. The modified MacNab criteria were excellent in six patients (27.27%), good in 12 (55.55%), fair in two (9.09%), and poor in two (9.09%), with a 90.91% symptomatic improvement rate. No significant surgical complications were observed. The minimally invasive TELF is effective for juxta-fusional foraminal stenosis.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea;
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Oshina M, Kawamura N, Hara N, Higashikawa A, Ono T, Takeshita Y, Azuma S, Fukushima M, Iwai H, Kaneko T, Inanami H, Oshima Y. A Propensity Score-matched Analysis of Clinical Outcomes Between Single-level and Multilevel Intervertebral Decompression for Cervical Radiculopathy. Spine (Phila Pa 1976) 2023; 48:247-252. [PMID: 36255352 PMCID: PMC9855740 DOI: 10.1097/brs.0000000000004508] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN Retrospective multicenter study with propensity score matching. OBJECTIVE To compare the clinical outcomes of single-level and multilevel intervertebral decompression for cervical degenerative radiculopathy. SUMMARY OF BACKGROUND DATA In patients with cervical radiculopathy, physical examination findings are sometimes inconsistent with imaging data. Multilevel decompression may be necessary for multiple foraminal stenosis. Additional decompression is more invasive yet expected to comprehensively decompress all suspected nerve root compression areas. However, the surgical outcomes of this approach compared with that of single-level decompression remain unknown. MATERIALS AND METHODS The data of patients with spinal surgery for pure cervical radiculopathy were collected. Patients were categorized into the single-level (SLDG) or multilevel (MLDG) intervertebral decompression group at C3/C4/C5/C6/C7/T1. Demographic data and patient-reported outcome scores, including the Neck Disability Index (NDI) and Numerical Rating Scale (NRS) scores for pain and numbness in the neck, upper back, and arms, were collected. The NDI improvement rates and changes in NRS scores were analyzed one year postoperatively at patient-reported outcome evaluation. Propensity score matching was performed to compare both groups after adjusting for baseline characteristics, including the preoperative NDI and NRS scores. RESULTS Among the 357 patients in this study, SLDG and MLDG comprised 231 and 126 patients, respectively. Two groups (n=112, each) were created by propensity score matching. Compared with the MLDG, the SLDG had a higher postoperative NDI improvement rate ( P =0.029) and lower postoperative arm numbness NRS score ( P =0.037). Other outcomes tended to be more favorable in the SLDG than in the MLDG, yet no statistical significance was detected. CONCLUSIONS In patients with cervical radiculopathy, the surgical outcomes of the SLDG showed better improvement in clinical outcomes than those of the MLDG. Numbness remained on the distal (arms) rather than the central (neck and upper back) areas in patients receiving multilevel decompression.
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Affiliation(s)
- Masahito Oshina
- Department of Orthopedic Surgery, NTT Medical Center Tokyo, Tokyo, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Nobuhiro Hara
- Department of Orthopedic Surgery, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Akiro Higashikawa
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Kanto Rosai Hospital, Kanagawa, Japan
| | - Takashi Ono
- Department of Spinal Surgery, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo, Japan
| | - Yujiro Takeshita
- Department of Orthopedic Surgery, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, Kanagawa, Japan
| | - Seiichi Azuma
- Department of Orthopedic Surgery, Saitama Red Cross Hospital, Saitama, Japan
| | | | - Hiroki Iwai
- Iwai Orthopedic Medical Hospital, Tokyo, Japan
| | | | | | - Yasushi Oshima
- Department of Orthopaedic Surgery, the University of Tokyo, Tokyo, Japan
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8
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Maugeri R, Brunasso L, Sciortino A, Scerrati A, Buscemi F, Basile L, Giammalva GR, Costanzo R, Bencivinni F, Bruno E, Matranga D, Maniscalco L, Gioia F, Tumbiolo S, Iacopino DG. The Impact of Single-Level ACDF on Neural Foramen and Disc Height of Surgical and Adjacent Cervical Segments: A Case-Series Radiological Analysis. Brain Sci 2023; 13. [PMID: 36672082 DOI: 10.3390/brainsci13010101] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Background: ACDF has become one of the established procedures for the surgical treatment of symptomatic cervical spondylosis, showing excellent clinical results and effective improvements in neural functions and neck pain relief. The main purpose of ACDF is neural decompression, and it is considered by some authors as an indirect result of the intervertebral distraction and cage insertion and the consequent restoration of the disc space and foramen height. Methods: Radiological data from 28 patients who underwent single-level ACDF were retrospectively collected and evaluated. For neural foramen evaluation, antero-posterior (A-P) and cranio-caudal (C-C) diameters were manually calculated; for intervertebral disc height the anterior, centrum and posterior measurement were calculated. All measurements were performed at surgical and adjacent (above and below) segments. NRS, NDI and also the mJOA and Nurick scale were collected for clinical examination and complete evaluation of patients’ postoperative outcome. Results: The intervertebral disc height in all its measurements, in addition to the height (C-C diameter) of the foramen (both right and left) increase at the surgical segment when comparing pre and postop results (p < 0.001, and p = 0.033 and p = 0.001). NRS and NDI radiculopathy scores showed improved results from pre- to post-op evaluation (p < 0.001), and a negative statistical correlation with the improved disc height at the surgical level. Conclusions: The restoration of posterior disc height through cage insertion appears to be effective in increasing foraminal height in patients with symptomatic preoperative cervical foraminal stenosis.
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Ahn Y, Park HB, Yoo BR, Jeong TS. Endoscopic lumbar foraminotomy for foraminal stenosis in stable spondylolisthesis. Front Surg 2022; 9:1042184. [PMID: 36439521 PMCID: PMC9687795 DOI: 10.3389/fsurg.2022.1042184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Open decompression with fusion is the gold-standard surgical technique for spondylolisthesis. However, it may be too extensive for patients with foraminal stenosis with stable spondylolisthesis. The endoscopic lumbar foraminotomy (ELF) technique was developed as a minimally invasive surgical option for foraminal stenosis. Some authors have reported the outcomes of ELF for various spondylolistheses. However, few studies have demonstrated foraminal stenosis in advanced stable spondylolisthesis. This study aimed to describe the surgical technique and results of ELF for radiculopathy due to foraminal stenosis in patients with stable spondylolisthesis. METHODS Consecutive 22 patients who suffered from radiculopathy with spondylolisthesis underwent ELF. The inclusion criterion was unilateral radicular leg pain due to foraminal stenosis in stable spondylolisthesis. After the percutaneous transforaminal approach, foraminal decompression was performed using various surgical devices under endoscopic visualization. Surgical outcomes were measured using the visual analog pain score, Oswestry disability index, and modified MacNab criteria. RESULTS Pain scores and functional outcomes improved significantly during the 12-month follow-up periods. The rate of clinical improvement was 95.5% (21 of 22 patients). One patient experienced a dural tear and subsequent open surgery. CONCLUSION ELF can be effective in foraminal stenosis in stable spondylolisthesis. Technical points specializing in foraminal decompression in spondylolisthesis are required for clinical success.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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Yin M, Ding X, Zhu Y, Lin R, Sun Y, Xiao Y, Wang T, Yan Y, Ma J, Mo W. Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Uncinate Process Resection: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1956-1967. [PMID: 35349779 PMCID: PMC9609504 DOI: 10.1177/21925682221084969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
STUDY DESIGN This is a meta-analysis and systematic review of the available literature. OBJECTIVE In the case of severe foraminal stenosis, conducting uncinate process resection (UPR) during ACDF could achieve complete nerve root decompression and significant relief of neurological symptoms for CR. However, there is some controversy regarding its necessity and safety. This study aims to compare the safety and efficacy of ACDF with UPR and ACDF. METHODS The following electronic databases were searched: Medline, PubMed, Embase, the Cochrane Central Register of Controlled Trials, Evidence Based Medicine Reviews, VIP, and CNKI. And the following data items were considered: baseline demographics, efficacy evaluation indicators, radiographic outcome, and surgical details. RESULTS 10 studies were finally identified, including 746 patients who underwent ACDF with UPR compared to 729 patients who underwent ACDF. The group of ACDF with UPR had statistically longer intraoperative time (95% CI: 4.83, 19.77, P = .001) and more intraoperative blood loss (95% CI: 12.23, 17.76, P < .001). ACDF with UPR obtained a significantly better improvement of Arm VAS at postoperative first follow-up (95% CI: -1.85, -.14 P = .02). There was no significant difference found in improvement of Neck VAS at postoperative latest follow-up (95% CI: -.88, .27, P = .30), improvement of Arm VAS at postoperative latest follow-up (95% CI: -.59, -.01, P = .05), improvement of NDI (95% CI: -2.34, .33, P = .14), JOA (95% CI: -.24, .43, P = .56), change of C2-C7 lordosis (95% CI: -.87, 1.33, P = .68), C2-C7 SVA (95% CI: -.73, 5.08, P = .14), T1 slope (95% CI: -2.25, 1.51, P = .70), and fusion rate (95% CI: .83, 1.90 P = .29). CONCLUSION ACDF with UPR is an effective and necessary surgical method for CR patients with severe foraminal stenosis.
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Affiliation(s)
- Mengchen Yin
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Xing Ding
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Yuefeng Zhu
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China
| | - Rui Lin
- Guangdong Provincial Hospital of
Chinese Medicine, Guangzhou, China
| | - Yueli Sun
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Xiao
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Tao Wang
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Yinjie Yan
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Junming Ma
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Mo
- Shanghai University of Traditional
Chinese Medicine, Shanghai, China,Long hua Hospital, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
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Krakowiak M, Rulewska N, Rudaś M, Broda M, Sabramowicz M, Jaremko A, Leki K, Sokal P. Interspinous Process Devices Do Not Reduce Intervertebral Foramina and Discs Heights on Adjacent Segments. J Pain Res 2022; 15:1971-1982. [PMID: 35860418 PMCID: PMC9292060 DOI: 10.2147/jpr.s356898] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Aim Interspinous process device (IPD) placement is an attractive treatment option for lumbar spinal and foraminal stenosis. The goal of the treatment is to release the stress on facets joints as well as decompress the nerve roots by enlarging the intervertebral foramina and narrowed canal recesses. Purpose To evaluate possible structural changes in the lumbar spine after implantation of an IPD on operated and adjacent segments. Patients and Methods Twenty-two patients were enrolled in the study. Preoperative MRI scans of the lumbar spine evaluated recess and foraminal stenosis prior to the application of an IPD. CT exams were performed and morphometric measurements were made to assess the size of intervertebral foramina after implantation on the operated and adjacent segments. Results Statistically significant enlargements in diameter and surface area of the intervertebral foramen were seen at the operating level. On the right and left sides, foraminal enlargement after the procedure was 1 mm in diameter. The average enlargement of the foramina surface area at the level of implantation was 10 mm2. The median interspinous distance was significantly enlarged by 3.5 mm. No significant changes in adjacent segments were observed. Clinical improvement was confirmed by the Oswestry Disability Index (ODI) and visual analog scale (VAS). Preoperative disability was reduced (mean ODI from 70.5 (12.25) to 49.5 (23.75)), as well as back pain (mean VAS from 8.0 (1.7) to 4.4 (2.6)) and pain in lower limbs (mean VAS from 7.4 (1.9) to 3.8 (2.9)). Conclusion Decompression surgery using an IPD is effective in the treatment of lumbar foraminal and canal stenosis. It provides relief of symptoms in short-term observation through enlargement of intervertebral foramina and decompression of neural roots. It reduces overload of facet joints of the operated segment and does not decrease the size of the intervertebral foramina and disc heights of adjacent segments.
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Affiliation(s)
- Mateusz Krakowiak
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Natalia Rulewska
- Students' Scientific Circle at the Department of Neurosurgery, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Marcin Rudaś
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Maciej Broda
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Michał Sabramowicz
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Andrzej Jaremko
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Krzysztof Leki
- Centre for Statistical Analysis, Nicolaus Copernicus University, Toruń, Poland
| | - Paweł Sokal
- Department of Neurosurgery and Neurology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
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12
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Özer AF, Akyoldaş G, Çevik OM, Aydın AL, Hekimoğlu M, Sasani M, Öktenoğlu T, Çerezci Ö, Süzer T. Lumbar Foraminal Stenosis Classification That Guides Surgical Treatment. Int J Spine Surg 2022; 16:8311. [PMID: 35710724 PMCID: PMC9421203 DOI: 10.14444/8311] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND There are numerous radiological and anatomical studies on lumbar foramina in the literature, but there are no distinctive studies about the relationship between treatment and the type of foraminal stenosis. This study was conducted to better evaluate foraminal stenosis and to plan treatment accordingly. METHODS Foraminal stenosis was divided into 2 groups: stable and unstable stenosis. Both groups were also divided into 4 subgroups in relation to the cause and type of compression and based on the structure of the intervertebral disc. The visual analog scale for leg pain (VAS-LP) and Oswestry Disability Index (ODI) scores were investigated before and after surgery. RESULTS A total of 115 patients (59 women and 56 men) underwent surgery for lumbar foraminal stenosis. The mean patient age was 56.1 years (range 17-80 years). The mean follow-up was 29 months (range 24-39 months). There were 36 patients (32%) with stable foraminal stenosis and 79 patients (68%) with unstable foraminal stenosis. The majority of the patients were identified as having unstable type 1 foraminal stenosis (45 of 115). The VAS-LP and ODI scores for each group decreased gradually during the follow-up periods and showed significant decrease during the last follow-up (P < 0.001). Interobserver and intraobserver agreement in the classification of foraminal stenosis was found to be nearly perfect. No patients experienced postoperative radiculopathy complication. Only 2 patients experienced superficial operation site infection and 1 showed deep wound infection. The patient who had a deep wound infection needed to repeat surgery for the infection. CONCLUSIONS We introduced a novel classification system for lumbar foraminal stenosis. We aimed to guide appropriate treatment modality depending on the determined classification. This classification helps to determine the optimal treatment. In the light of our findings, the patients who were operated according to our classification experienced satisfactory clinical outcomes and low complication rates. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Ali Fahir Özer
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Göktuğ Akyoldaş
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
| | - Orhun Mete Çevik
- Neurosurgery Department, Bakırköy Training and Research Hospital for Psychiatric and Nervous Diseases, Istanbul, Turkey
| | - Ahmet Levent Aydın
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
| | - Mehdi Hekimoğlu
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Tunç Öktenoğlu
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
- Neurosurgery Department, American Hospital, Istanbul, Turkey
| | - Önder Çerezci
- Physical Treatment and Rehabilitation Department, American Hospital, Istanbul, Turkey
| | - Tuncer Süzer
- Koç University School of Medicine, Neurosurgery Department, Istanbul, Turkey
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13
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Houra K, Saftic R, Klaric E, Knight M. Long-term Clinical Outcomes Following Endoscopic Foraminoplasty for Patients With Single-Level Foraminal Stenosis of the Lumbar Spine. Int J Spine Surg 2022; 16:139-150. [PMID: 35177520 DOI: 10.14444/8182] [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] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study is to evaluate the safety and long-term clinical outcomes of transforaminal endoscopic foraminoplasty using local anesthesia and total intravenous analgesia (TIVA) in patients with single-level lumbar foraminal stenosis and unilateral leg pain. METHODS Postoperative pain relief was self-evaluated by 46 consecutive patients using a visual analog scale (VAS) and Oswestry Disability Index (ODI). Patient scores were obtained before the procedure and at 6, 12, 24, and 60 months after surgery. RESULTS Pain reduction of at least 50% in the VAS score and a decrease of at least 50% or more in ODI score was achieved in 37 of 46 patients throughout the follow-up period. Median VAS score decreased from 7.5 preoperatively to 2.5 postoperatively. Median ODI score decreased from 62% preoperatively to 15% postoperatively. All patients reached 24-month follow-up and 37 patients reached 60-month follow-up. There were no surgery-related complications. CONCLUSION Transforaminal endoscopic foraminoplasty performed under local anesthesia and TIVA produces sustained reduction in pain and improves functionality in patients with single-level lumbar foraminal stenosis without complications even in patients with comorbidities. CLINICAL RELEVANCE Endoscopic foraminoplasty may be a useful adjunct to open micro decompressive surgery for patients with foraminal stenosis of the lumbar spine LEVEL OF EVIDENCE: 4.
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Affiliation(s)
- Karlo Houra
- Aksis Specialty Hospital for Spinal and Orthopedic Surgery, Zagreb, Croatia .,University North - University Center Varaždin, Varaždin, Croatia.,School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Robert Saftic
- Aksis Specialty Hospital for Spinal and Orthopedic Surgery, Zagreb, Croatia
| | - Emil Klaric
- School of Medicine, University of Rijeka, Rijeka, Croatia
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14
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Chang HS, Baba T, Matsumae M. Long-term Outcomes after Microsurgical Decompression of Lumbar Foraminal Stenosis and Adverse Effects of Preoperative Scoliosis: A Prospective Cohort Study. Neurol Med Chir (Tokyo) 2021; 61:598-606. [PMID: 34408108 PMCID: PMC8531878 DOI: 10.2176/nmc.oa.2021-0159] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Lumbar foraminal stenosis is a common disorder, with surgical treatment varying from simple decompression to interbody fusion. It is often associated with degenerative lumbar scoliosis, but the effects of scoliosis on outcomes are unclear. The objectives of this study were to clarify long-term outcomes after microsurgical decompression of lumbar foraminal stenosis through Wiltse’s approach and to determine the effects of scoliosis on these outcomes. A total of 86 consecutive patients with lumbar foraminal stenosis were prospectively followed after microsurgical decompression. They were categorized in multiple subcohorts with follow-up durations ranging from 6 months to 5 years. Outcomes were assessed using the Short Form 36 questionnaire (average physical scores and bodily pain scores). Local Cobb angle of the operative segment was measured preoperatively, and its effects on outcomes were analyzed. Average physical scores improved significantly from 33.8 (95% confidence interval [CI]: 29.1–38.5) preoperatively to 59.5 (95% CI: 54.6–64.3) at 6 months postoperatively and remained improved for 5 years. Bodily pain scores improved significantly from 23.7 (95% CI: 18.7–28.6) preoperatively to 56.3 (95% CI: 51.2–61.6) at 6 months postoperatively and remained improved for 5 years. Patients with preoperative scoliosis (local Cobb angle >10 degrees) had poorer outcomes: average physical scores were worse by 9.6 points (p = 0.07) and bodily pain scores were worse by 12.1 points (p = 0.02), compared with patients without scoliosis (local Cobb angle ≤10 degrees). Microsurgical foraminal decompression produced overall excellent outcomes in patients with lumbar foraminal stenosis. Preoperative scoliosis attenuated these beneficial effects.
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15
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Lin GX, Sun LW, Jhang SW, Ou SW, Chang KS, Tsai RY, Hu BS, Rui G, Chen CM. A Pilot Study of Radiculopathy Following Osteoporotic Vertebral Fracture in Elderly Patients: An Algorithmic Approach to Surgical Management. Geriatr Orthop Surg Rehabil 2021; 12:21514593211044912. [PMID: 34595048 PMCID: PMC8477680 DOI: 10.1177/21514593211044912] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Osteoporotic vertebral compression fractures (OVCF) due to severe and refractory back pain or neurological complications require surgical treatment. In this study, patients with radiculopathy due to foraminal stenosis following OVCF were surgically managed by performing transforaminal full-endoscopic lumbar foraminoplasty and/or discectomy (FELFD). Methods: From May 2015 to November 2019, fifteen patients underwent transforaminal FELFD. Patient data, Charlson comorbidity index (CCI), and American Society of Anesthesiologists (ASA) score were collected. Clinical outcomes, including pre- and postoperative Visual Analog Scale (VAS) scores for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria of response to surgical treatment, were evaluated. Results: Mean of age, bone mineral density (T-score), CCI, ASA, and follow-up duration were 69.5 ± 6.6 years, −2.6 ± 0.8, 5.2 ± 2.3, 2.4 ± 0.5, and 24.5 ± 8.8 months, respectively. Mean VAS for leg pain significantly decreased from 6.9 ± 0.8 preoperatively to 2.9 ± 1.1 (P < .05). Mean ODI decreased from 39.9 ± 3.2 preoperatively to 19.3 ± 4.6 postoperatively (P < .05). The satisfaction rate is 86.7% (based on Macnab criteria), showed six patients had excellent outcomes and seven had good outcomes. Conclusions: Transforaminal FELFD is an effective treatment option for patients with radiculopathy due to lumbar OVCF, including those with severe osteoporosis and elderly patients.
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Affiliation(s)
- Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Li-Wei Sun
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.,Institute of Biochemistry, Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan
| | - Shang-Wun Jhang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.,Department of Veterinary Medicine, National Chung Hsing University, Taiwan
| | - Su-Wei Ou
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Kai-Sheng Chang
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Ru-Yin Tsai
- Department of Anatomy, Faculty of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Bao-Shan Hu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.,College of Nursing and Health Sciences, Dayeh University, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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16
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Telfeian AE, Veeramani A, Zhang AS, Quinn MS, Daniels AH. Transforaminal 360° lumbar endoscopic foraminotomy in postfusion patients: technical note and case series. J Neurosurg Spine 2021; 36:16-22. [PMID: 34507292 DOI: 10.3171/2021.3.spine21206] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/29/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This report describes a minimally invasive lumbar foraminotomy technique that can be applied in patients who underwent complex spine decompression procedures or in patients with severe foraminal stenosis. METHODS Awake, endoscopic decompression surgery was performed in 538 patients over a 5-year period between 2014 and 2019. Transforaminal endoscopic foraminal decompression surgery using a high-speed endoscopic drill was performed in 34 patients who had previously undergone fusions at the treated level. RESULTS At 2-year follow-up, the mean (± SD) preoperative visual analog scale score for leg pain and the Oswestry Disability Index improved from 7.1 (± 1.5) and 40.1% (± 12.1%) to 2.1 (± 1.9) and 13.6% (± 11.1%). CONCLUSIONS A minimally invasive, awake procedure is presented for the treatment of severe lumbar foraminal stenosis in patients with lumbar radiculopathy after lumbar fusion.
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Affiliation(s)
- Albert E Telfeian
- 1Department of Neurosurgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital
| | | | - Andrew S Zhang
- 3Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Matthew S Quinn
- 3Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - Alan H Daniels
- 3Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island
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17
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Chen YL, Hu XD, Wang Y, Jiang WY, Ma WH. Contralateral radiculopathy after unilateral transforaminal lumbar interbody fusion: causes and prevention. J Int Med Res 2021; 49:3000605211037475. [PMID: 34461766 PMCID: PMC8414939 DOI: 10.1177/03000605211037475] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Unilateral transforminal lumbar interbody fusion (TLIF) with a single cage
can provide circumferential fusion and biomechanical stability. However, the
causes and prevention of contralateral radiculopathy following unilateral
TLIF remain unclear. Methods In total, 190 patients who underwent unilateral TLIF from January 2017 to
January 2019 were retrospectively reviewed. Radiological parameters
including lumbar lordosis, segmental angle, anterior disc height, posterior
disc height (PDH), foraminal height (FH), foraminal width, and foraminal
area (FA) were measured preoperatively and postoperatively. Preoperative and
postoperative visual analog scale scores were also recorded. Results The incidence of contralateral radiculopathy after unilateral TLIF was 5.3%
(10/190). The most common cause was contralateral foraminal stenosis.
Unilateral TLIF could increase the lumbar lordosis, segmental angle, and
anterior disc height but decrease the PDH, FA, and FH in patients with
symptomatic contralateral radiculopathy. The intervertebral cage should be
placed to cover the epiphyseal ring and cortical compact bone of the
midline, and the disc height can be increased to enlarge the contralateral
foramen. Conclusion The most common cause of contralateral radiculopathy is contralateral
foraminal stenosis. Careful preoperative planning is necessary to achieve
satisfactory outcomes. Improper unilateral TLIF will decrease the PDH, FA,
and FH, resulting in contralateral radiculopathy.
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Affiliation(s)
- Yun-Lin Chen
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Xu-Dong Hu
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Yang Wang
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Wei-Yu Jiang
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Wei-Hu Ma
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
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18
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Yang CC, Yeh KT, Liu KC, Wu WT. Ameliorated Full-Endoscopic Transforaminal Decompression for L5-S1 Foraminal and Extra foraminal Stenosis. Clin Spine Surg 2021; 34:197-205. [PMID: 34156037 PMCID: PMC8225233 DOI: 10.1097/bsd.0000000000001137] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 12/22/2020] [Indexed: 11/01/2022]
Abstract
STUDY DESIGN This is a retrospective review. OBJECTIVE To describe a modified surgical technique, full-endoscopic transforaminal decompression (FETD) in patients with L5-S1 foraminal stenosis or extraforaminal stenosis (EFS) and to detail the short-term results. SUMMARY OF BACKGROUND DATA Performing FETD surgery for L5-S1 FS and EFS is challenging because of high iliac crests in most cases and the difficulty in accurately differentiating between FS and EFS by images preoperatively. MATERIAL AND METHODS Patients who had solitary unilateral L5-S1 FS or EFS and had undergone FETD between October 2014 and December 2017 were included. In total, 22 patients underwent FETD for L5 root compressions at the L5-S1 levels. All patients were followed up for more than 1 year. RESULTS The mean visual analog scale score for back and leg pain, assessed preoperatively and at 12 months postoperatively, improved from 6.3±1.7 to 1.59±1.30 and from 7.29±0.78 to 1.41±1.20, respectively. The mean Oswestry Disability Index improved from 61.53% preoperatively to 15.8% at 12 months postoperatively. Neurovascular injury-related complications were absent in all these cases. CONCLUSION Successful short-term clinical outcome is achievable using the ameliorated FETD technique for treating L5-S1 FS and EFS.
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Affiliation(s)
- Chang-Chen Yang
- Institute of Medical Sciences, Tzu Chi University, Hualien
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Kuang-Ting Yeh
- School of Medicine, Tzu Chi University, Hualien
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC
| | - Keng-Chang Liu
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Wen-Tien Wu
- Institute of Medical Sciences, Tzu Chi University, Hualien
- School of Medicine, Tzu Chi University, Hualien
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC
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19
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Lee HJ, Park EJ, Ahn JS, Kim SB, Kwon YS, Park YC. Clinical Outcomes of Biportal Endoscopic Interlaminar Decompression with Oblique Lumbar Interbody Fusion (OLIF): Comparative Analysis with TLIF. Brain Sci 2021; 11:630. [PMID: 34068334 DOI: 10.3390/brainsci11050630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/03/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
Oblique lumbar interbody fusion (OLIF) improves the spinal canal, with favorable clinical outcomes. However, it may not be useful for treating concurrent, severe central canal stenosis (SCCS). Therefore, we added biportal endoscopic spinal surgery (BESS) after OLIF, evaluated the combined procedure for one-segment fusion with clinical outcomes, and compared it to open conventional TLIF. Patients were divided into two groups: Group A underwent BESS with OLIF, and Group B were treated via TLIF. The length of hospital stay (LOS), follow-up period, operative time, estimated blood loss (EBL), fusion segment, complications, and clinical outcomes were evaluated. Clinical outcomes were measured using Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and the modified Macnab criteria. All the clinical parameters improved significantly after the operation in Group A. The only significant between-group difference was that the EBL was significantly lower in Group A. At the final follow-up, no clinical parameter differed significantly between the groups. No complications developed in either group. We suggest that our combination technique is a useful, alternative, minimally invasive procedure for the treatment of one-segment lumbar SCCS associated with foraminal stenosis or segmental instability.
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20
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Chhugani S, Agarwal N, Sheikh F, Borca F, Spanoulis A, Galea I. Cervical spinal degenerative disease in multiple sclerosis. Eur J Neurol 2021; 28:2497-2502. [PMID: 33817913 DOI: 10.1111/ene.14855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/26/2021] [Accepted: 03/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Root and cord irritation from cervical spinal degenerative disease (SDD) may share clinical features with progressive multiple sclerosis (MS), so diagnostic overshadowing may occur. We hypothesized that cervical stenotic SDD is commoner in people with progressive MS, compared to controls. METHODS A retrospective case-control study of 111 cases (56 with progressive MS and 55 age- and sex-matched controls) was conducted. Five types of cervical SDD (disc degeneration, posterior disc protrusion, endplate changes, canal stenosis and foraminal stenosis) were assessed objectively on magnetic resonance imaging using published scales. Multivariable regression analysis was performed. RESULTS Moderate-to-severe cervical spinal degeneration occurred more frequently in progressive MS, compared to controls. In multivariable regression, foraminal stenosis was three times more likely in progressive MS (odds ratio 3.20, 95% confidence interval 1.27, 8.09; p = 0.014), and was more severe (p = 0.009). This finding was confirmed on retrospective evaluation of clinical radiology reports in the same population. Foraminal stenosis was twice as likely in progressive MS, compared to relapsing-remitting MS. CONCLUSIONS People with progressive MS are susceptible to foraminal stenosis. A higher index of suspicion for cervical SDD is required when appropriate neurological symptoms occur in the setting of progressive MS, to guide appropriate treatment or monitoring.
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Affiliation(s)
- Simran Chhugani
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nivedita Agarwal
- Section of Radiology, Santa Maria del Carmine Hospital, Rovereto, Italy
| | - Faraz Sheikh
- Department of Neuroradiology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Florina Borca
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Aginor Spanoulis
- Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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21
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Jo SH, Cho JH, Lee DG. Can Foraminal Stenosis Due to Lumbar Isthmic Spondylolisthesis Cause Axonopathy in the Lower Extremity? Healthcare (Basel) 2021; 9:511. [PMID: 33925226 DOI: 10.3390/healthcare9050511] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/03/2022] Open
Abstract
This study aimed to investigate, using electrodiagnosis, whether foraminal stenosis due to isthmic spondylolisthesis (IS) causes peripheral nerve axonopathy. We retrospectively reviewed the medical records of the Yeungnam University Hospital and included 46 patients (mean age = 60.8 ± 13.7 years; male:female = 24:22) with foraminal stenosis due to IS. We classified foraminal stenosis grading based on T2 and T1 sagittal spinal magnetic resonance imaging (MRI). Patients were divided into mild (n = 18) and severe foraminal stenosis (n = 28) groups. To evaluate axonopathy in the lower extremity, results of compound motor action potential (CMAP) of the extensor digitorum brevis muscle (EDB) and abductor hallucis brevis muscle (AHB), and sensory nerve action potential (SNAP) of the sural nerve were retrieved. No statistically significant difference was observed in the amplitude of CMAP of the EDB and AHB and SNAP of the sural nerve with the severity of foraminal stenosis. However, age showed a statistically significant relationship with the amplitude of NCS in the EDB, AHB, and sural nerves (p < 0.001). The severity of foraminal stenosis due to IS showed no relationship with axonopathy beyond age-related degeneration of the lower extremities. Therefore, if there is robust axonopathy in lower extremities, physicians should consider pathologies other than foraminal stenosis due to IS.
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22
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Kim JY, Lee YH, Yoo S, Kim JY, Joo M, Park HJ. Factors Predicting the Success of Adhesiolysis Using a Steerable Catheter in Lumbar Failed Back Surgery Syndrome: A Retrospective Study. J Clin Med 2021; 10:jcm10050913. [PMID: 33652702 PMCID: PMC7956797 DOI: 10.3390/jcm10050913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/09/2021] [Accepted: 02/22/2021] [Indexed: 01/02/2023] Open
Abstract
Failed back surgery syndrome (FBSS) is a commonly encountered disease after lumbar surgery. There are many cases where it is difficult to choose a treatment because no specific cause can be found. Nevertheless, according to recent reports, adhesiolysis has shown reasonable evidence. However, considering its poor cost-effectiveness, adhesiolysis cannot be used as the first line of treatment. FBSS patients often suffer from chronic pain; accordingly, they become frustrated when this treatment produces a poor response. Therefore, before the procedure, the target group must be selected carefully. We sought to identify the pre-procedure factors predicting the effect of adhesiolysis in FBSS. A total of 150 patients were evaluated and analyzed retrospectively. Of these 150 patients, 69 were classified as responders three months after the procedure (46%). The outer diameter of the catheter during the procedure and grade of foraminal stenosis were correlated with the procedure effect. In conclusion, of the 2.1 mm diameter of the catheter, 1.7 mm of it was used during the procedure, and the milder the foraminal stenosis, the greater the pain reduction effect was three months after the procedure.
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23
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Kamada M, Manabe H, Yamashita K, Sakai T, Maeda T, Sairyo K. Full-endoscopic Decompression of Foraminal Stenosis Caused by Facet Hypertrophy Contralateral to the Dominant Hand in a Baseball Pitcher: A Case Report. NMC Case Rep J 2020; 7:173-177. [PMID: 33062564 PMCID: PMC7538464 DOI: 10.2176/nmccrj.cr.2019-0075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 02/12/2020] [Indexed: 01/14/2023] Open
Abstract
Back pain and lower extremity pain have various causes and occasionally occur simultaneously, creating diagnostic difficulties. In addition, athletes require special consideration in terms of treatment. Here, we report a case of foraminal stenosis as a result of lumbar disc prolapse combined with facet hypertrophy contralateral to the dominant hand in a baseball pitcher that was successfully treated by minimally invasive full-endoscopic surgery. A 31-year-old left-handed male baseball pitcher presented with complaints of low back pain and right buttock pain while pitching. A diagnosis of foraminal stenosis caused by a disc bulge combined with facet hypertrophy contralateral to the dominant hand was made on the basis of physical and radiological findings. His symptoms improved immediately after transforaminal full-endoscopic lumbar discectomy and foraminoplasty under local anesthesia. He returned to play 3 months after surgery. Foraminal stenosis due to facet hypertrophy may occur in the side contralateral to the throwing arm in pitchers. Minimally invasive decompression using a full-endoscopic procedure is required for high-level athletes at this position.
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Affiliation(s)
- Mitsuhiro Kamada
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Hiroaki Manabe
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan
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24
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Jack AS, Osburn BR, Tymchak ZA, Ramey WL, Oskouian RJ, Hart RA, Chapman JR, Jacques LG, Tubbs RS. Foraminal Ligaments Tether Upper Cervical Nerve Roots: A Potential Cause of Postoperative C5 Palsy. J Brachial Plex Peripher Nerve Inj 2020; 15:e9-e15. [PMID: 32728377 PMCID: PMC7383057 DOI: 10.1055/s-0040-1712982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/23/2020] [Indexed: 01/23/2023] Open
Abstract
Background
Nerve root tethering upon dorsal spinal cord (SC) migration has been proposed as a potential mechanism for postoperative C5 palsy (C5P). To our knowledge, this is the first study to investigate this relationship by anatomically comparing C5–C6 nerve root translation before and after root untethering by cutting the cervical foraminal ligaments (FL).
Objective
The aim of this study is to determine if C5 root untethering through FL cutting results in increased root translation.
Methods
Six cadaveric dissections were performed. Nerve roots were exposed via C4–C6 corpectomies and supraclavicular brachial plexus exposure. Pins were inserted into the C5–C6 roots and adjacent foraminal tubercle. Translation was measured as the distance between pins after the SC was dorsally displaced 5 mm before and after FL cutting. Clinical feasibility of FL release was examined by comparing root translation between standard and extended (complete foraminal decompression) foraminotomies. Translation of root levels before and after FL cutting was compared by two-way repeated measures analysis of variance. Statistical significance was set at 0.05.
Results
Significantly more nerve root translation was observed if the FL was cut versus not-cut,
p
= 0.001; no difference was seen between levels,
p
= 0.33. Performing an extended cervical foraminotomy was technically feasible allowing complete FL release and root untethering, whereas a standard foraminotomy did not.
Conclusion
FL tether upper cervical nerve roots in their foramina; cutting these ligaments untethers the root and increases translation suggesting they could be harmful in the context of C5P. Further investigation is required examining the value of root untethering in the context of C5P.
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Affiliation(s)
- Andrew S Jack
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada.,Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States.,Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, Washington, United States
| | - Brooks R Osburn
- Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, Washington, United States.,Department of Neurosurgery, University of South Florida, Tampa, Florida, United States
| | - Zane A Tymchak
- Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, Washington, United States
| | - Wyatt L Ramey
- Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, Washington, United States
| | - Rod J Oskouian
- Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, Washington, United States
| | - Robert A Hart
- Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, Washington, United States
| | - Jens R Chapman
- Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, Washington, United States
| | - Line G Jacques
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, United States
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, United States
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25
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Nakajima D, Yamashita K, Tezuka F, Sugiura K, Ishihama Y, Manabe H, Takata Y, Sakai T, Maeda T, Sairyo K. Successful full-endoscopic decompression surgery under local anesthesia for L5 radiculopathy caused by L5-S foraminal stenosis and L4-5 lateral recess stenosis : A case report. J Med Invest 2020; 67:192-196. [PMID: 32378606 DOI: 10.2152/jmi.67.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In this report, we presented a 65 year-old male case having right leg pain due to L5 radiculopathy. Based on the radiological examination including CT, MRI and radiculography, double crash impingement of L5 nerve root due to L4-5 lateral recess and L5-S foraminal stenosis was diagnosed. Because of the strong pain, he could not work anymore. His job was a general manager of big hospital, he needed to return to job as soon as possible. We decided to conduct the full-endoscopic decompression surgery of ventral facetectomy (FEVF) for L4-5 lateral recess stenosis and foraminoplasty (FELF) for L5-S foraminal stenosis. The technique can be done under the local anesthesia with only 8 mm skin incision; thus, it must be the least invasive spine surgery. Soon after the surgery, he could return to the original job as a general manager. In conclusion, the full-endoscopic decompression surgery for the spinal canal stenosis such as FELF and FEVF would be minimally invasive procedure and it enable patients the quick return to the original activity. J. Med. Invest. 67 : 192-196, February, 2020.
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Affiliation(s)
- Daiki Nakajima
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | | | - Hiroaki Manabe
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Yoichiro Takata
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toshinori Sakai
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Toru Maeda
- Department of Orthopedics, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Tokushima University, Tokushima, Japan
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26
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Yeung A, Lewandrowski KU. Five-year clinical outcomes with endoscopic transforaminal foraminoplasty for symptomatic degenerative conditions of the lumbar spine: a comparative study of inside-out versus outside-in techniques. J Spine Surg 2020; 6:S66-S83. [PMID: 32195417 DOI: 10.21037/jss.2019.06.08] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Foraminal stenosis is a condition that is underappreciated by traditionally trained surgeons because the entire foraminal zone is not adequately visualized with the translaminar approach unless extensive removal of the facet is performed to expose the extraforaminal zone. Its direct endoscopic visualization is feasible with the inside-out and outside-in endoscopic transforaminal technique. The authors analyzed the differences in long-term 5-year clinical outcomes of endoscopic transforaminal foraminoplasty for symptoms from lumbar foraminal stenosis to better establish clinical indications for each technique. Methods Long-term 5-year MacNab outcomes, VAS scores, complications, and unintended aftercare were analyzed in a series of 176 patients consisting of 86 inside-out (group 1) and 90 outside-in (group 2) patients treated for sciatica-type back and leg pain due to lumbar foraminal stenosis. Results At minimum 5-year follow-up, excellent results according to the MacNab criteria were obtained in 93 (52.8%) patients, good in 63 (35.8%), fair in 17 (9.7%), and poor in 3 (1.7%), respectively. The mean preoperative VAS was 6.87±1.96. The mean postoperative VAS was 3.15±1.59 and 2.98±1.75 at last follow-up, respectively. Both postoperative VAS and final follow-up VAS were statistically reduced at a significance level of P<0001. There were no major approach-, surgical- or anesthesia-related complications in this series. The vast majority of patients (112/176; 63.6% of the study population) did not require any additional interventional or surgical treatment following the index transforaminal endoscopic decompression. Postoperative dysesthesia due to irritation of the dorsal root ganglion (DRG) as a consequence of operation next to the DRG occurred in 17 patients (9.7%) and was the most common benign postoperative sequelae. There was a higher reoperation rate in the outside-in group (35.6%) than in the inside-out group (8.1%). The secondary fusion rate was also higher with the outside-in (8.9%) than with the inside-out technique (2.3%). Ultimately, the long-term clinical outcomes with the endoscopic transforaminal decompression procedure were favorable regardless of whether the inside-out or outside-in technique was used. These numbers were generated by two experienced endoscopic surgeons with thousands of case experience. Conclusions Patients with symptomatic foraminal stenosis may be treated successfully with either the inside-out or the outside-in selective endoscopic discectomy (SED™) method while maintaining favorable long-term outcomes with a 3.2× decreased need for secondary fusion at 5-year follow-up when compared to recently reported reoperation rates for traditional decompression/fusion. Long-term clinical outcomes with the inside-out technique were presumably better because of the ability to visualize and decompress underneath the dural sac, the ventral facet and the axilla known as the hidden zone of MacNab.
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Affiliation(s)
- Anthony Yeung
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.,Desert Institute for Spine Care, Phoenix, AZ, USA
| | - Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, Tucson, AZ, USA.,Surgical Institute of Tucson, Tucson, AZ, USA.,Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia
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27
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Lewandrowski KU, Ransom NA. Five-year clinical outcomes with endoscopic transforaminal outside-in foraminoplasty techniques for symptomatic degenerative conditions of the lumbar spine. J Spine Surg 2020; 6:S54-S65. [PMID: 32195416 DOI: 10.21037/jss.2019.07.03] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Lumbar foraminal stenosis in the extraforaminal zone is best directly visualized with the outside-in transforaminal endoscopic technique. Stenosis in that area is often missed with traditional translaminar surgery. The authors analyzed the long-term 5-year clinical results, reoperation rates, and unintended after care with the outside-in endoscopic transforaminal foraminoplasty for symptoms from lumbar foraminal stenosis to better establish clinical indications and prognosticators of favorable outcomes. Methods Long-term 5-year Macnab outcomes, visual analog scale (VAS) scores, complications, and unintended aftercare were analyzed in a series of 90 patients treated with the transforaminal outside-in selective endoscopic discectomy (SED™) with foraminoplasty for foraminal and lateral recess stenosis. Results At minimum 5-year follow-up, excellent results according to the Macnab criteria were obtained in 61 (67.8%) patients, good in 23 (25.6%), fair in 6 (6.7%), respectively. The mean preoperative VAS 7.55. The mean postoperative VAS was 2.87 and at last follow-up 2.53. Both postoperative VAS and last follow-up VAS were statistically reduced at a significance level of P<0.0001. Postoperative dysesthesia occurred in 8 patients (8.9%). While most of the 32 follow-up surgeries following SED™ were additional endoscopic decompressions and rhizotomies (24/32; 75%) were non-fusion procedures, only 8 of the whole study series of 90 patients (8.9%) underwent fusion at the index SED™ level within the minimum 5-year follow-up period. One patient opted for an open laminectomy (1.1%). Conclusions Patients with symptomatic foraminal stenosis may be treated successfully in a staged manner with outside-in transforaminal endoscopic decompression while maintaining favorable long-term outcomes without the excessive need for fusion in the vast majority of patients. The reoperation fusion rate at 5-year follow-up was approximately 3 times lower when compared to recently reported reoperation rates following traditional translaminar decompression/fusion.
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona, Surgical Institute of Tucson, Tucson, AZ, USA.,Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia
| | - Nicholas A Ransom
- Department of Orthopaedics, Surgeon Surgical Institute of Tucson, Tucson, AZ, USA
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28
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Shim DW, Lee BH, Seo J, Hong H, Shin SC, Kim HS. Efficacy of computed tomography in prediction of operability of L5/S1 foraminal stenosis using region of interest: A STROBE-compliant retrospective study. Medicine (Baltimore) 2019; 98:e17422. [PMID: 31626098 PMCID: PMC6824739 DOI: 10.1097/md.0000000000017422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Symptoms of intervertebral foraminal stenosis are caused by compression of nerve root exiting the intervertebral foramen. Many attempts to measure the size of the neuromuscular exit have been made; however, only a few studies to compare the area differences between foramens by computed tomography (CT) were done. In this retrospective comparative study, we used the region of interest (ROI) in CT to measure and compare the area of intervertebral foramen between the healthy control group and the patient group.Eighty-one patients who underwent CT of the lumbar spine between May 2014 and December 2017 were enrolled. Using the medical imaging program, the foraminal area between L5 and S1 vertebrae was measured on the sagittal, coronal, and axial planes using ROI. Four groups were established for comparison: those diagnosed with foraminal stenosis by a radiologist and those who were not, those diagnosed with foraminal stenosis by orthopedic surgeons and those who were not. These groups were further divided into subcategories depending on whether the area was operated on for foraminal stenosis. Interobserver and intraobserver agreements were assessed.The mean age of patients was 56.5 years (range 17-84). The foraminal area of the surgical group on sagittal plane was significantly narrower than the control group (P = .005). However, the difference between the 2 groups on axial and coronal planes was not statistically significant (P > .1). Foraminal area <80 mm on sagittal images was a statistically significant risk factor for clinical symptom (P = .028) and that <65 mm was a statistically significant risk factor in predicting operability (P = .01). Interobserver and intraobserver agreements were fair to good on axial and coronal planes (about 0.7), whereas the agreements were excellent on sagittal plane (>0.9).In this study, we proved that measuring the intervertebral foraminal area using the ROI in CT in the lumbar spine is useful for diagnosing L5-S1 foraminal stenosis, especially on sagittal plane. Furthermore, not only does it provide aid in diagnosis, but it also helps predicting the operability of foraminal stenosis.
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Affiliation(s)
- Dong Woo Shim
- Department of Orthopaedic Surgery, Catholic Kwandong University College of Medicine, Seo-gu, Incheon
| | - Byung Ho Lee
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seodaemun-gu, Seoul
| | - Jiwoon Seo
- Department of Radiology, Catholic Kwandong University College of Medicine, Seo-gu, Incheon
| | - Hyunjoo Hong
- Department of Radiology, Didim Hospital, Bucheon, Gyeonggi-do
| | - Sung Chul Shin
- Department of Orthopaedic Surgery, Catholic Kwandong University College of Medicine, Seo-gu, Incheon
| | - Hak Sun Kim
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea
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29
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Segar AH, Riccio A, Smith M, Protopsaltis TS. Total uncinectomy of the cervical spine with an osteotome: technical note and intraoperative video. J Neurosurg Spine 2019; 31:1-4. [PMID: 31443083 DOI: 10.3171/2019.6.spine19332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 03/20/2019] [Accepted: 06/05/2019] [Indexed: 11/06/2022]
Abstract
Total uncinate process resection or uncinectomy is often required in the setting of severe foraminal stenosis or cervical kyphosis correction. The proximity of the uncus to the vertebral artery, nerve root, and spinal cord makes this a challenging undertaking. Use of a high-speed burr or ultrasonic bone dissector can be associated with direct injury to the vertebral artery and thermal injury to the surrounding structures. The use of an osteotome is a safe and efficient method of uncinectomy. Here the authors describe their technique, which is illustrated with an intraoperative video.
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Affiliation(s)
- Anand H Segar
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health; and
| | - Alexander Riccio
- 1Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health; and
| | - Michael Smith
- 2Department of Neurosurgery, NYU Langone Medical Center, NYU Langone Health, New York, New York
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30
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Knio ZO, Hsu W, Marquez-Lara A, Luo TD, St Angelo JM, Medda S, O'Gara TJ. Far Lateral Tubular Decompression: A Case Series Studying One and Two Year Outcomes with Predictors of Failure. Cureus 2019; 11:e5133. [PMID: 31523563 PMCID: PMC6741369 DOI: 10.7759/cureus.5133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction The optimal surgical treatment of isolated lumbar foraminal stenosis has not been defined. Minimally invasive decompression of the foramen from a far lateral tubular decompression (FLTD) approach has been shown to not only have minimal morbidity but also highly variable success rates at short-term follow-up. It is important to quantify improvement and define the demographic and radiographic parameters that predict failure in this promising, minimally invasive surgical technique. This study investigates pain and disability score improvement following FLTD at 12 and 24 months and investigates associations with failure. Methods All patients who underwent lumbar FLTD by a single surgeon at a single institution from September 2015 to January 2018 were included in this prospective case series. Visual analog scale (VAS) for back pain and leg pain and Oswestry Disability Index (ODI) were collected preoperatively and at the 12- and 24- month follow-ups. Outcomes between visits were fitted to a linear mixed-effects model. The univariate analysis investigated demographic, radiographic, and operative associations with subsequent open revision. Results A total of 42 patients were included in this study. Back pain (VAS 5.84 to 3.32, p<0.001), leg pain (VAS 7.33 to 2.71, p<0.001), and ODI (48.97 to 28.50, p<0.001) demonstrated significant improvements at the 12-month follow-up. Back pain (VAS 3.71, p=0.004), leg pain (VAS 3.04, p<0.001), and ODI (30.63, p<0.001) improvements were maintained at 24-month follow-up. Four patients (9.5%) required subsequent open revision. Subsequent open revision was associated with prior spine surgery (RR=2.85 (2.07-3.63), p=0.045) and scoliosis ≥10° (RR=6.33 (4.87-7.80), p=0.013). Conclusion Back pain, leg pain, and ODI showed significant improvement postoperatively. Improvement is maintained at two years. Prior spine surgery and scoliosis ≥ 10° may be relative contraindications to FLTD.
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Affiliation(s)
- Ziyad O Knio
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, USA
| | - Wesley Hsu
- Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, USA
| | | | - Tianyi D Luo
- Department of Orthopaedic Surgery, Wake Forest Baptist Medical Center, Winston-Salem, USA
| | - John M St Angelo
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, USA
| | - Suman Medda
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, USA
| | - Tadhg J O'Gara
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, USA
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31
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Dunn C, Moore J, Sahai N, Issa K, Faloon M, Sinha K, Hwang KS, Emami A. Minimally invasive posterior cervical foraminotomy with tubes to prevent undesired fusion: a long-term follow-up study. J Neurosurg Spine 2018; 29:358-364. [PMID: 29957145 DOI: 10.3171/2018.2.spine171003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to compare anterior cervical discectomy and fusion (ACDF) and minimally invasive posterior cervical foraminotomy (MI-PCF) with tubes for the treatment of cervical radiculopathy in terms of the 1) overall revision proportion, 2) index and adjacent level revision rates, and 3) functional outcome scores. METHODS The authors retrospectively reviewed the records of consecutive patients who had undergone ACDF or MI-PCF at a single institution between 2009 and 2014. Patients treated for cervical radiculopathy without myelopathy and with a minimum 2-year follow-up were compared according to the procedure performed for their pathology. Primary outcome measures included the overall rate of revision with fusion and overall revision proportion as well as the rate of index and adjacent level revisions per year. Secondarily, self-reported outcome measures-Neck Disability Index (NDI) and visual analog scale (VAS) for arm (VASa) and neck (VASn) pain-at the preoperative and postoperative evaluations were analyzed. Standard binomial and categorical comparative analyses were performed. RESULTS Forty-nine consecutive patients were treated with MI-PCF, and 210 consecutive patients were treated with ACDF. The mean follow-up for the MI-PCF cohort was 42.9 ± 6.6 months (mean ± SD) and for the ACDF cohort was 44.9 ± 10.3 months. There was no difference in the overall revision proportion between the two cohorts (4 [8.2%] of 49 MI-PCF vs. 12 [5.7%] of 210 ACDF, p = 0.5137). There was no difference in the revision rate per level per year (3.1 vs. 1.7, respectively, p = 0.464). Moreover, there was no difference in the revision rate per level per year at the index level (1.8 vs. 0.7, respectively, p = 0.4657) or at an adjacent level (1.3 vs. 1.1, p = 0.9056). Neither was there a difference between the cohorts as regards the change from preoperative to final postoperative functional outcome scores (NDI, VASa, VASn). CONCLUSIONS Minimally invasive PCF for the treatment of cervical radiculopathy demonstrates rates of revision at the index and adjacent levels similar to those following ACDF. In order to confirm the positive efficacy and cost analysis findings in this study, future studies need to extend the follow-up and show that the rate of revision with fusion does not increase substantially over time.
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32
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Wu AM, Zhang K, Li XL, Cheng XF, Zhou TJ, Du L, Chen C, Tian HJ, Sun XJ, Zhao CQ, Li YM, Zhao J. The compression of L5 nerve root, single or double sites?-radiographic graded signs, intra-operative detect technique and clinical outcomes. Quant Imaging Med Surg 2018; 8:383-390. [PMID: 29928603 DOI: 10.21037/qims.2018.05.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background The L5 nerve root could be compressed at both L4-5 and L5-S1 regions. If L5 nerve root has confirmed compression at L4-5 level and questionable compression at L5-S1 foramina, performing both surgeries at L4-5 and L5-S1 levels may induce unnecessary extra surgery on L5-S1; however, ignoring foraminal stenosis of L5/S1 may require re-exploration. Methods Two hundred seventeen patients with L5 nerve root compressed at L4-5 lateral access were performed with L4-5 decompression and interbody fusion. Lee et al. grade classification was used to assess the foraminal stenosis of L5-S1 preoperatively. Nerve root probe was designed and used to detect if there were foraminal stenosis at L5-S1 level that compressing the exiting L5 nerve root. Visual analog scale (VAS) of low back pain, leg pain and Oswestry Disability Index (ODI) were used to assess clinical outcomes. Results For all of 217 patients who underwent L4-5 surgery, L5-S1 foramina were preoperatively assessed as: grade 0: 125 cases, grade 1: 58 cases, grade 2: 23 cases, and grade 3: 11 cases. After intra-operative L5 nerve root detection, 11/11 patients with grade 3 radiographic foraminal stenosis, 6/23 (26.1%) with grade 2 and 2/58 (3.4%) who had grade 1 underwent L4-5 and L5-S1 transforaminal lumbar interbody fusion (TLIF), the others received only L4-5 TLIF. Compared to pre-operative baseline data, both L4-5 TLIF and L4-5 and L5-S1 TLIF groups had significant decreased VAS of low back pain and leg pain, and ODI at 3 and 24 months after operation. Conclusions We suggested that our novel nerve root probe combined with pre-operative radiographic grade may be helpful to surgeons to identify the single or double compression of L5 nerve root and make a more precise surgical strategy to improve surgical outcome than the method depended on pre-operative radiographic grade alone.
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Affiliation(s)
- Ai-Min Wu
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China.,Department of Spine Surgery, Zhejiang Spine Surgery Centre, Orthopaedic Hospital, The Second Affiliated Hospital and Yuying Children's Hospital of the Wenzhou Medical University, The Second School of Medicine Wenzhou Medical University, The Key Orthopaedic Laboratory of Zhejiang Province, Wenzhou 325035, China
| | - Kai Zhang
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Xun-Lin Li
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Xiao-Fei Cheng
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Tang-Jun Zhou
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Lin Du
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Chen Chen
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Hai-Jun Tian
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Xiao-Jiang Sun
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Chang-Qing Zhao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
| | - Yan Michael Li
- Department of Neurosurgery, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jie Zhao
- Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Orthopaedic Implants, Shanghai 200011, China
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33
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Schell A, Rhee JM, Holbrook J, Lenehan E, Park KY. Assessing Foraminal Stenosis in the Cervical Spine: A Comparison of Three-Dimensional Computed Tomographic Surface Reconstruction to Two-Dimensional Modalities. Global Spine J 2017; 7:266-271. [PMID: 28660110 PMCID: PMC5476357 DOI: 10.1177/2192568217699190] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY DESIGN Retrospective radiographic study. OBJECTIVE The optimal radiographic modality for assessing cervical foraminal stenosis is unclear. Determination on conventional axial cuts is made difficult due in part to the complex, oblique orientation of the cervical neuroforamen. The utility of 3-dimensonal (3D) computed tomography (CT) reconstruction in improving neuroforaminal assessment is not well understood. The objective of this study is to determine inter-rater variability in grading cervical foraminal stenosis using 3 different CT imaging modalities: 3D CT surface reconstructions (3DSR), 2D sagittal oblique multiplanar reformations (2D-SOMPR), and conventional 2D axial CT imaging. METHODS Pretreatment CT scans of 25 patients undergoing surgery for cervical spondylotic radiculopathy were analyzed at 2 levels: C5-C6 and C6-C7. Simple interrater agreement and kappa-Fleiss coefficients were calculated for each imaging modality and stenosis grade. Image reviewers (attending spine surgeon, attending neuroradiologist, spine fellow) interpreted each CT scan in 3 different formats: axial, 2D-SOMPR, and 3DSR. Four cervical foramina at 2 spinal levels were graded as normal (no stenosis), mild (≤25% stenosis), moderate (25%-50% stenosis), or severe (>50% stenosis). RESULTS Across all imaging modalities, interrater reliability was fair when grading foraminal stenosis (κ < 0.4). Agreement was lowest for the axial images (κ = 0.119) and highest for the 3D CT reconstructions (κ = 0.334). 2D-SOMPR images also led to improved interrater reliability when compared with axial images (κ = 0.255). CONCLUSION Grading cervical foraminal stenosis using conventional axial CT imaging is difficult with low interrater reliability. CT modalities that provide a circumferential view of the cervical foramen, such as 2D-SOMPR and 3D CT reconstruction, had higher rates of interobserver reliability in grading foraminal stenosis than conventional axial cuts, with 3D having the highest. As these 3D reconstructions can be obtained at no additional cost or radiation exposure over a conventional CT scan, and because they can provide useful information in determining levels being considered for surgical decompression, we recommend they be utilized when evaluating cervical foramina.
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Affiliation(s)
- Adam Schell
- Case Western Reserve University, Cleveland, OH, USA
| | - John M. Rhee
- Emory University, Atlanta, GA, USA,John M. Rhee, Department of Orthopedic Surgery, Emory Spine Center, Emory University, 59 Executive Park South, Atlanta, GA 30327, USA.
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Yolas C, Ozdemir NG, Okay HO, Kanat A, Senol M, Atci IB, Yilmaz H, Coban MK, Yuksel MO, Kahraman U. Cervical disc hernia operations through posterior laminoforaminotomy. J Craniovertebr Junction Spine 2016; 7:91-5. [PMID: 27217655 PMCID: PMC4872569 DOI: 10.4103/0974-8237.181854] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy. MATERIALS AND METHODS We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015. RESULTS The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years). Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). On control examinations, there was no finding of instability or cervical kyphosis. CONCLUSION Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis.
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Affiliation(s)
- Coskun Yolas
- Department of Neurosurgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Nuriye Guzin Ozdemir
- Department of Neurosurgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Hilmi Onder Okay
- Department of Neurosurgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ayhan Kanat
- Department of Neurosurgery, Recep Tayyip Erdogan University, Rize, Turkey
| | - Mehmet Senol
- Department of Neurosurgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Ibrahim Burak Atci
- Department of Neurosurgery, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Hakan Yilmaz
- Department of Neurosurgery, Duzce Ataturk State Hospital, Duzce, Turkey
| | - Mustafa Kemal Coban
- Department of Neurosurgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Mehmet Onur Yuksel
- Department of Neurosurgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Umit Kahraman
- Department of Neurosurgery, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
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Yilmaz H, Ertürk AR, Karataş A, Atci İB, Yurt A. Posterior laminoforaminotomy in the treatment of lateralcervical herniated disc and foraminal stenosis. Turk J Med Sci 2016; 46:424-9. [PMID: 27511506 DOI: 10.3906/sag-1412-61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/12/2014] [Accepted: 06/24/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Posterior cervical laminoforaminotomy is an effective surgical treatment in selected cases of cervical radiculopathy caused by posterolateral herniated discs or foraminal stenosis. The aim of the present study was to evaluate the surgical techniques, rates of complications, long-term outcomes, advantages, and disadvantages of keyhole foraminotomy retrospectively. MATERIALS AND METHODS Keyhole foraminotomy was performed in 83 patients. In 51 patients (61.5%) soft disc herniation was removed, and in 32 of them (38.5%) osteophytes were evident. The clinical data were evaluated according to Odom's criteria, and the mean follow-up time was 6 months. RESULTS Postoperative results were classed as excellent in 66 patients (79.5%), good in 13 patients (15.7%), fair in 3 patients (3.6%), and poor in only 1 patient (1.2%). Radiculopathy symptoms regressed in 79 patients (95%). Among the 83 patients, surgical complications (dural injury and level error) were noted in 2 patients (2.4%). CONCLUSION Posterior laminoforaminotomy is applied to selected patients with a low complication rate. The advantages of this surgery are suitable visualization of the nerve root, preserved motion of the operated segment, avoidance of cervical instability, and a decrease in the length of hospital stay.
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Affiliation(s)
- Hakan Yilmaz
- Department of Neurosurgery, Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Ali Rıza Ertürk
- Department of Neurosurgery, Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Ayşe Karataş
- Department of Neurosurgery, İzmir Katip Çelebi University, Atatürk Education and Research Hospital, İzmir, Turkey
| | - İbrahim Burak Atci
- Department of Neurosurgery, Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Alaettin Yurt
- Department of Neurosurgery, Bozyaka Education and Research Hospital, İzmir, Turkey
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Schmökel H, Rapp M. Lameness caused by an extradural lumbosacral foraminal synovial cyst in three German Shepherd Dogs. Vet Comp Orthop Traumatol 2016; 29:83-8. [PMID: 26511526 DOI: 10.3415/VCOT-15-04-0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/04/2015] [Indexed: 11/17/2022]
Abstract
Three German Shepherd Dogs that were presented for investigation of chronic unilateral hindlimb lameness and pain in the lumbosacral region were diagnosed with an intraspinal, extradural synovial cyst and reactive fibrosis protruding into the foramen of the lumbosacral articulation using magnetic resonance imaging and histology. This extradural mass compressed the nerve root in the foramen and the cauda equina. During a dorsal laminectomy and unilateral partial foraminotomy, the cyst and the fibrotic tissue were removed with the aid of a 2.4 mm 30° arthroscope for visualization of the foramen. The fibrotic tissue surrounding the cysts was in all cases confluent with the annulus of the intervertebral disc. The histological examination confirmed the diagnosis of a synovial cyst in all three cases by finding inflamed synovial membrane in the samples from the wall of the cyst as well as reactive fibrosis and cartilaginous metaplasia in the surrounding tissue. The three patients improved after the surgery and were pain free during the follow-up evaluations.
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Hojo Y, Ito M, Abumi K, Kotani Y, Sudo H, Takahata M, Minami A. A late neurological complication following posterior correction surgery of severe cervical kyphosis. Eur Spine J 2011; 20:890-8. [PMID: 20936306 PMCID: PMC3099150 DOI: 10.1007/s00586-010-1590-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 12/28/2009] [Revised: 07/21/2010] [Accepted: 09/25/2010] [Indexed: 10/19/2022]
Abstract
Though a possible cause of late neurological deficits after posterior cervical reconstruction surgery was reported to be an iatrogenic foraminal stenosis caused not by implant malposition but probably by posterior shift of the lateral mass induced by tightening screws and plates, its clinical features and pathomechanisms remain unclear. The aim of this retrospective clinical review was to investigate the clinical features of these neurological complications and to analyze the pathomechanisms by reviewing pre- and post-operative imaging studies. Among 227 patients who underwent cervical stabilization using cervical pedicle screws (CPSs), six patients who underwent correction of cervical kyphosis showed postoperative late neurological complications without any malposition of CPS (ND group). The clinical courses of the patients with deficits were reviewed from the medical records. Radiographic assessment of the sagittal alignment was conducted using lateral radiographs. The diameter of the neural foramen was measured on preoperative CT images. These results were compared with the other 14 patients who underwent correction of cervical kyphosis without late postoperative neurological complications (non-ND group). The six patients in the ND group showed no deficits in the immediate postoperative periods, but unilateral muscle weakness of the deltoid and biceps brachii occurred at 2.8 days postoperatively on average. Preoperative sagittal alignment of fusion area showed significant kyphosis in the ND group. The average of kyphosis correction in the ND was 17.6° per fused segment (range 9.7°-35.0°), and 4.5° (range 1.3°-10.0°) in the non-ND group. A statistically significant difference was observed in the degree of preoperative kyphosis and the correction angles at C4-5 between the two groups. The diameter of the C4-5 foramen on the side of deficits was significantly smaller than that of the opposite side in the ND group. Late postoperative neurological complications after correction of cervical kyphosis were highly associated with a large amount of kyphosis correction, which may lead foraminal stenosis and enhance posterior drift of the spinal cord. These factors may lead to both compression and traction of the nerves, which eventually cause late neurological deficits. To avoid such complications, excessive kyphosis correction should not be performed during posterior surgery to avoid significant posterior shift of the spinal cord and prophylactic foraminotomies are recommended if narrow neuroforamina were evident on preoperative CT images. Regardless of revision decompression or observation, the majority of this late neurological complication showed complete recovery over time.
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Affiliation(s)
- Yoshihiro Hojo
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638 Japan
| | - Manabu Ito
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638 Japan
| | - Kuniyoshi Abumi
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638 Japan
| | - Yoshihisa Kotani
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638 Japan
| | - Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638 Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638 Japan
| | - Akio Minami
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638 Japan
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Abstract
STUDY DESIGN Case-series study. OBJECTIVE To describe the clinical presentation, characteristic findings of imaging studies, and treatment of lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis. BACKGROUND. Lumbar lesions in rheumatoid arthritis are relatively rare, with a limited number of systemic reports. METHODS Six patients with lumbar radiculopathy caused by foraminal stenosis in rheumatoid arthritis were treated. The patients were all women with a mean age of 69 years and mean rheumatoid arthritis duration of 15 years. The medical records and imaging studies of all patients were reviewed. RESULTS The affected nerve roots were L4 in four patients and L3 in two patients. Foraminal stenosis was not demonstrated in magnetic resonance images in four of the six patients. Selective radiculography with nerve root block reproduced pain, manifested blocking effect, and demonstrated compression of the nerve root by the superior articular process of the lower vertebra in all patients. Conservative treatment was performed on one patient, and surgery was conducted for the rest of the five patients; radiculopathy was improved in all patients. CONCLUSIONS Lumbar foraminal stenosis is a characteristic pathology of rheumatoid arthritis, and should be kept in mind in the diagnosis of lumbar radiculopathy. Selective radiculography is useful in the diagnosis of affected nerve roots.
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Affiliation(s)
- Tomoaki Koakutsu
- Department of Orthopaedic Surgery, Nishitaga National Hospital, Sendai, Japan.
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Abstract
Lumbar spinal stenosis (LSS) is most commonly due to degenerative changes in older individuals. LSS is being more commonly diagnosed and may relate to better access to advanced imaging and to an ageing population. This review focusses on radicular symptoms related to degenerative central and lateral stenosis and updates knowledge of LSS pathophysiology, diagnosis and management. Since patients with anatomic LSS can range from asymptomatic to severely disabled, the clinical diagnosis focusses on symptoms and examination findings associated with LSS. Imaging findings are helpful for patients with persistent, bothersome symptoms in whom invasive treatments are being considered. There is limited information from high-quality studies about the relative merits and demerits of commonly used treatments. Interpreting and comparing results of available research are limited by a lack of consensus about the definition of LSS. Nevertheless, evidence supports decompressive laminectomy for patients with persistent and bothersome symptoms. Recommendations favour a shared decision-making approach due to important trade-offs between alternative therapies and differences among patients in their preferences and values.
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Affiliation(s)
- Stephane Genevay
- Division of Rheumatology, University Hospitals of Geneva, Switzerland, Tel: 0041 22 382 36 73, Fax: 0041 22 382 35 35
| | - Steven J Atlas
- General Medicine Division, Massachusetts General Hospital, Boston MA, USA, Tel: 617-724-4736, Fax: 617-724-3544
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