Full-Endoscopic Decompression for Thoracic Ossification of the Ligamentum Flavum Combined with Dural Ossification.

Ossification of the ligamentum flavum (OLF) can result in spinal stenosis. Thoracic spinal cord compression due to spinal stenosis is a common cause of progressive thoracic myelopathy in Asian countries. The incidence of complications is high in open decompression surgeries for thoracic OLF. With dural ossification (DO), the risk of complications is even higher in thoracic OLF. We introduce a full-endoscopic decompression surgery for thoracic OLF combined with DO under local anesthesia. Hemilaminectomy is performed using a high-speed burr under the endoscopy first, and then decompression of the contralateral spinal canal is completed using an "over the top" technique. DO resection uses the eggshell technique; after the base of the DO is cut from the lamina, forceps or lamina rongeurs are typically used for removal. The dural defect left after resection does not need repair. Neurological function was improved, and no complications such as hematoma or neck pain occurred. On imaging, no pseudodural cyst, cerebrospinal fluid leakage, or wound complications were observed after the operation. Endoscopic surgery causes less damage to the posterior ligament complex, so no cases of persistent back pain complaints or secondary internal fixation requirements were found in this study. Full-endoscopic decompression can achieve good imaging and clinical effects in the treatment of thoracic OLF with DO.

Epidemiological Investigation of 387 Individuals Over 65 Years Old With Osteoporotic Fractures.

Context: With the rapidly aging population globally, osteoporosis (OP) has become a major public health problem, and fracture is a common complication of OP. Older adults, especially postmenopausal women, have a higher incidence of OP. Objective: The study intended to analyze the clinical information, epidemiological characteristics, treatments, and follow-up results of patients with osteoporotic fractures (OPFs) in adults over 65 years old, to provide data support for the prevention, treatment, and use of OPF focus groups in clinical practice. Design: The research team performed a retrospective analysis using electronic medical records and related imaging data of patients. Setting: The study took place at Hebei General Hospital in Hebei, China. Participants: Participants were 387 patients over 65 years old with osteoporotic fractures who had been admitted to the hospital between July 2012 and July 2018. Outcome Measures: The research team recorded participants' ages, genders, fracture causes, and fracture sites. The team performed a follow-up analysis on refractures, treatment with anti-osteoporotic drugs, exercise, and survival status within the 3 years after surgery. Results: The study's male-to-female ratio was 1:3.1, and the rate of osteoporotic fracture for females was significantly higher than that of males. The mean age of participants with fractures was 75.6 ± 8.5 years, and most fractures occurred in participants 78 to 85 years old. Of the 387 participants, 169 participants had hip fractures (43.67%); 98 had vertebral compression fractures (25.32%); 51 had distal radius and ulna fractures (13.18%); 42 had proximal humerus fractures (10.85%); and 27 had other fractures (6.98%). The number of women with fractures at each site was greater than the number of men, but the differences weren't statistically significant (P > .05). The main causes of injury were falls (71.58%), and the main place of the occurrence of injury was at home (65.6%). Of the 387 participants, 346 had surgical treatment (89.41%), and the effective rate of surgical treatment was 99.42%. Three years after surgery, the research team followed up with 235 participants, for a follow-up rate of 60.72%. Within the 3 years of the follow-up period, 61 participants had refractures (25.63%), 29 received treatment with regular anti-osteoporotic drugs (12.34%), 36 exercised twice or more a week (15.32%), and 32 had died for various reasons (13.62%). Conclusions: The study preliminarily described the epidemiological characteristics of 387 osteoporotic fractures in adults over 65 years old. More women had fractures than men; the hip was the most common fracture site, and falls were the main cause of injury. Most of the fractures occurred in the place of residence, and the refracture rate was 25.96% at three years after surgery.

Comparison of unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation: A systematic review and meta-analysis.

BACKGROUND: The purpose of this study was to analyze unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar disc herniation. METHODS: PubMed, EMBASE, Web of Science, Cochrane Database, CNKI, and Wanfang databases were searched online. All statistical analyses were performed using STATA 16.0. RESULTS: The selection criteria were met by 6 studies with a total of 281 patients (142 cases in the UBE group and 139 cases in the PELD group) and good methodological quality. PELD has the potential to improve outcomes such as operation time and intraoperative hemorrhage (MD = 36.808, 95% CI (23.766, 49.850), P = .000; MD = 59.269, 95% CI (21.527, 97.010), P = .000) compared with UBE. No differences were found in the back pain VAS score at preoperative (MD = -0.024, 95% CI [-0.572, 0.092], P = .998), at 1 day after operation (MD = -0.300, 95% CI [-0.845, 0.246], P = .878), the VAS score of leg pain at preoperative (MD = -0.099, 95% CI [-0.417, 0.220], P = .762), at 1 day after operation (MD = 0.843, 95% CI [0.193, 1.492], P = .420), at 1 month after operation (MD = -0.027, 95% CI [-0.433, 0.380], P = .386), at 6 months after operation (MD = 0.122, 95% CI [-0.035, 0.278], P = .946), hospital stay (MD = 3.708, 95% CI [3.202, 4.214], P = .000) and other clinical effects between UBE and PELD group. CONCLUSIONS: There are no significant differences in clinical efficacy between UBE and PELD, according to the research. However, PELD has the potential to improve outcomes such as operation time and intraoperative hemorrhage. As just a result, PELD is better suited in the treatment of lumbar disc herniation.

The classification of coronal deformity based on preoperative global coronal malalignment for adult spinal deformity is questionable.

STUDY DESIGN: Retrospective case-control radiographic study. OBJECTIVE: To identify main effects of preoperative pattern and global coronal malalignment (GCM) on postoperative coronal imbalance in degenerative lumbar scoliosis (DLS) patients and evaluate the rationality of the classification of coronal deformity based on preoperative GCM. A classification of coronal deformity based on preoperative GCM (20 mm set as the threshold of coronal imbalance) has been proposed recently, but whether it is practical is unclear. METHODS: One hundred twelve DLS patients treated with posterior instrumented fusion were reviewed. Coronal measurements included GCM and major Cobb angle. Based on relationship between C7 PL and major curve, preoperative patterns were classified into: Pattern 1(concave pattern), C7 PL shifted to the concave side of major curve; Pattern 2(convex pattern), C7 PL shifted to the convex side of major curve. Patients were separated into 4 groups (3 types): Type 0-1: GCM < 20 mm plus Pattern 1; Type 0-2: GCM < 20 mm plus Pattern 2; Type 1: GCM > 20 mm plus Pattern 1; Type 2: GCM > 20 mm plus Pattern 2. After comparison within patterns or among 4 groups, further factorial analysis was performed. RESULTS: Significant differences regarding postoperative GCM or coronal imbalance/balance ratio existed among 4 groups (F = 6.219, p = 0.001; x2 = 22.506, p < 0.001, respectively), despite no significant difference in intra-pattern 1(concave pattern) or intra-pattern 2(convex pattern) groups. Two-way analysis of variance showed preoperative pattern exhibited significant effect on postoperative GCM or imbalance/balance ratio (F(1,108) = 14.286, p < 0.001; F(1,108) = 30.514, p < 0.001, respectively) while neither preoperative GCM alone nor interaction of preoperative GCM with pattern did. CONCLUSION: In DLS patients, it's the preoperative pattern other than GCM that had main effects on postoperative coronal imbalance. Classification of coronal deformity based on preoperative GCM is questionable.

The treatment effect of posterior lumbar fusion surgery on patients suffering from lumbar disc herniation concurrent with peroneal nerve paralysis.

Purpose: The purpose of this study is to investigate the clinical effect of posterior lumbar fusion surgery on patients who suffer from lumbar disc herniation concurrent with peroneal nerve paralysis. Methods: The patients suffering from peroneal nerve paralysis and undergoing posterior lumbar fusion surgery between January 2012 and December 2019 were retrospectively reviewed. The data of the identified patients were then collected and processed. All patients were followed up post-operatively after discharge from the hospital. The data was analyzed in terms of Oswestry disability index (ODI), visual analogue scale (VAS) score, and relative lower-limb muscle strength. Results: A total of 87 patients (52 males and 35 females) aged 54 ± 11 years met the inclusion criteria for this study. These patients stayed in hospital for 16 ± 6 days and were followed up for 81 ± 24 months. Data analysis showed that muscle strength of the tibialis anterior and extensor digitorum significantly recovered at the last follow-up with a grade of 3 (median), compared to grade 0 at admission (p < 0.001). Furthermore, the median VAS score decreased to 1 at the last follow-up from 6 at admission (p < 0.001), and the ODI greatly improved with 10% (median) at the last follow-up, while it was 58% at admission (p < 0.001). The ODI improvement rate was 60% on average at the last follow-up. Multivariate regression analysis regarding the ODI and muscle strength improvement rates showed that advanced age was a risk factor for postoperative recovery. Conclusions: Most of the patients suffering from lumbar disc herniation concurrent with peroneal nerve paralysis can improve after undergoing posterior lumbar fusion surgery, but few can reach full recovery. Advanced age might be a risk factor that affects the prognosis of these patients after surgery.

Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis: A protocol for systematic review and meta-analysis.

OBJECTIVE: Systematic evaluation of the efficacy and safety of unilateral biportal endoscopic decompression in the treatment of lumbar spinal stenosis. METHODS: We conducted a systematic literature search and compared the randomized controlled trials (RCTs) and retrospective studies of unilateral biportal endoscopy (UBE) and microscopic decompression (MD) in the treatment of lumbar spinal stenosis from several databases. RESULTS: Seven studies were included. The results of meta-analysis showed that the operation time of UBE was shorter than that of MD. [SMD = -0.443, 95% CI (-0.717, -0.169), P  = .002]. Compared with MD, the patients' back pain was slighter on the 1st day, 1-2 months and 6 months after UBE. During the long-term follow-up, there was no significant difference in back pain between MD and UBE [SMD = -0.519, 95% CI (-0.934, -0.104), P  = .014]. There was no significant difference in lower limb visual analogue score (VAS) score between UBE decompression and MD [SMD = -0.105, 95% CI (-0.356, 0.146), P  = .412]. The results of meta-analysis showed that the C-reactive protein (CRP) level of UBE was lower than that of MD [weighted mean difference = -1.437, 95% CI (-2.347, -0.527), P  = .002]. There was no significant difference in other clinical effects between the 2 groups. CONCLUSION: The operation time of UBE was shorter than that of MD, and it was superior to micro decompression in early back VAS score, lower limb VAS score and early postoperative CRP level. There was no statistical difference between UBE and MD in other outcomes.

Accuracy of Robot-Assisted Percutaneous Pedicle Screw Placement under Regional Anesthesia: A Retrospective Cohort Study.

BACKGROUND: Robot-assisted pedicle screw placement is usually performed under general anesthesia to keep the body still. The aim of this study was to compare the accuracy of the robot-assisted technique under regional anesthesia with that of conventional fluoroscopy-guided percutaneous pedicle screw placement under general anesthesia in minimally invasive lumbar fusion surgery. METHODS: This study recruited patients who underwent robot-assisted percutaneous endoscopic lumbar interbody fusion (PELIF) or fluoroscopy-guided minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) between December 2017 and February 2020 at a single center. Based on the method of percutaneous pedicle screw placement used, patients were divided into the robot-assisted under regional anesthesia (group RE-RO) and fluoroscopy-guided under general anesthesia (group GE-FLU) groups. The primary outcome measures were screw accuracy and the incidence of facet joint violation (FJV). Secondary outcome measures included X-ray and visual analogue scale (VAS) scores which were used to evaluate the degree of the postoperative pain at 4 hours and on postoperative days 1, 2, and 3. Intraoperative adverse events were also recorded. RESULTS: Eighteen patients were included in group RE-RO, and 23 patients were included in group GE-FLU. The percentages of clinically acceptable screws (Gertzbein and Robbins grades A and B) were 94.4% and 91.5%, respectively. There was no significant difference in the percentages of clinically acceptable screws (p=0.44) or overall Gertzbein and Robbins screw accuracy grades (p=0.35). Only the top screws were included in the analysis of FJVs. The percentages of FJV (Babu grades 1, 2, and 3) were 5.6% and 28.3%, respectively. This difference was statistically significant (p=0.01). Overall, the FJV grades in group RE-RO were significantly better than those in group GE-FLU (p=0.009). The mean fluoroscopy time for each screw in group RE-RO was significantly shorter than that in group GE-FLU (group RE-RO: 5.4 ± 1.9 seconds and group GE-FLU: 6.8 ± 2.0 seconds; p=0.03). The postoperative pain between the RE-RO and GE-FLU groups was not statistically significant. The intraoperative adverse events included 1 case of registration failure and 1 case of guide-wire dislodgment in group RE-RO, as well as 2 cases of screw misplacement in group GE-FLU. No complications related to anesthesia were observed. CONCLUSION: Robot-assisted pedicle screw placement under regional anesthesia can be performed effectively and safely. The accuracy is comparable to the conventional technique. Moreover, this technique has the advantage of fewer FJVs and a lower radiation time.

Full-Endoscopic Transforaminal Ventral Decompression for Symptomatic Thoracic Disc Herniation with or without Calcification: Technical Notes and Case Series.

BACKGROUND: Symptomatic thoracic disc herniation is a challenge in spinal surgery, especially for cases with calcification. Traditional open operation has a high complication rate. The authors introduced a modified full-endoscopic transforaminal ventral decompression technique in this study and evaluated its imaging and clinical outcomes. MATERIALS AND METHODS: Eleven patients with symptomatic thoracic disc herniation who underwent full-endoscopic transforaminal ventral decompression in a single medical center were enrolled. The surgical technique was performed as described in detail. Dilator sliding punching, endoscope-monitored foraminoplasty, and base cutting through the "safe triangle zone" are the key points of the technique. Clinical outcomes were assessed by the modified Japanese Orthopedic Association (mJOA) score for neurological improvement and the visual analogy score (VAS) for thoracic and leg pain. The operation time, hospital stay, and complications were also analyzed. RESULTS: Postoperative magnetic resonance imaging (MRI) revealed good decompression of the spinal cord. The mJOA improved from 7.4 (range: 5-10) to 10.2 (range: 9-11). Axial thoracic pain improved in 8 of 9 patients. Leg pain and thoracic radicular pain improved in all patients. No complications were observed. The average operation time was 136 minutes (range: 70-180 minutes). The average length of hospital stay was 5.3 days (range: 2-8 days). CONCLUSION: Minimally invasive full-endoscopic transforaminal ventral decompression for the treatment of symptomatic thoracic disc herniation with or without calcification is feasible and may be another option for this challenging spine disease.

Percutaneous Endoscopic Intercostal Neurectomy for Refractory Intercostal Neuralgia.

BACKGROUND: Refractory intercostal neuralgia is a troublesome disease with long treatment cycle and short-term therapeutic effects. No treatment modality has given effective pain relief. The authors present here a safe and effective endoscopic surgical option for refractory intercostal neuralgia. OBJECTIVES: To introduce the surgical techniques of percutaneous endoscopic intercostal neurectomy used for refractory intercostal neuralgia and to evaluate its safety and efficacy. STUDY DESIGN: A retrospective study. SETTING: The Department of Orthopedics at the Hebei General Hospital in China. METHODS: Thirteen patients with refractory intercostal neuralgia were treated with percutaneous endoscopic intercostal neurectomy. Patients were followed up to 12 months postoperatively. The pain was measured by the Visual Analog Scale (VAS) score. Complications, such as aspiration, dysfunction, infection, and local hematoma were analyzed. RESULTS: Pain was relieved in all 13 patients, with only 1 patient reporting burning sensation along the intercostal nerve distribution area after operation. No other complications were found. All patients had significant improvement, with significantly lower VAS scores recorded postoperatively. No recurrence was reported during the follow-up period. LIMITATIONS: The retrospective nature of this study is a limitation, as well as the small sample size and short observation time. CONCLUSIONS: Endoscopic intercostal neurotomy is an effective and safe minimally invasive surgical treatment for refractory intercostal neuralgia.

Comparison of accuracy and safety between robot-assisted and conventional fluoroscope assisted placement of pedicle screws in thoracolumbar spine: A meta-analysis.

OBJECTIVE: The purpose of this systematic review and meta-analysis is to explore the screw positioning accuracy, complications related to pedicle screw implantation, revision rate and radiation exposure between robot screw placement and traditional fluoroscopic screw placement. METHODS: We searched several databases, including CNKI, Wanfang database, cqvip datebase, PubMed, Cochrane library and EMBASE, to identify articles that might meet the criteria. Meta-analysis was performed using Revman 5.3 software. RESULTS: A total of 13 randomized controlled trial were included. The results showed that the pedicle screw accuracy of the robot assisted group was significantly better than that of the conventional freehand (FH) group (OR = 3.5, 95% confidence interval [CI] [2.75,4.45], P < .0001). There was no significant difference in the complications caused by pedicle screw implantation between the robot-assisted group and the conventional FH group [OR = 0.39, 95%CI (0.10,1.48), P = .17]. The rate of facet joint invasion in the robot-assisted group was significantly lower than that in the conventional FH group (OR = 0.06, 95%CI [0.01,0.29], P = .0006). The revision rate in the robot-assisted group was significantly lower than that in the conventional FH group (OR = 0.19, 95%CI [0.05,0.71], P = 0.0.01). There was no significant difference in the average radiation of pedicle screws implantation between the robot-assisted group and the conventional FH (mean difference = -7.94, 95%CI [-20.18,4.30], P = .20). CONCLUSION: The robot-assisted group was significantly better than the conventional FH in the accuracy of pedicle screw placement and facet joint invasion rate and revision rate. There was no significant difference in the complication and fluoroscopy time between the two groups.

Full-endoscopic decompression for thoracic ossification of ligamentum flavum: surgical techniques and clinical outcomes: A retrospective clinical study.

BACKGROUND: Many complications are associated with thoracic open decompression surgery, such as dural tears and neurological deficits. The clinical outcomes are also not satisfactory. Full-endoscopic decompression of the lumbar spinal canal has achieved satisfactory results for the treatment of lumbar spinal stenosis. This surgery may be used for the treatment of thoracic ossification of the ligamentum flavum (OLF) under local anesthesia. The aim of our study is to introduce the surgical techniques used for full-endoscopic decompression for thoracic OLF and to evaluate its safety and efficacy. METHODS: Fourteen patients with thoracic OLF (4 combined with dural ossification) underwent full-endoscopic decompression surgery. An interlaminar approach was performed. The anchoring method was used to establish the working passage. Spinal cord exposure began at a space between the ossification and the spinal cord, and dorsal and contralateral decompression were performed with the "Over the Top" technique. The modified Japanese Orthopedic Association score (11 points) was used to evaluate the efficacy during follow-up. At the same time, the visual analogue scale score for assessing back pain before and after the operation was evaluated. RESULTS: The average operation time was 159.73 ±â€Š62.09 minutes, and the hospitalization time was 7.43 ±â€Š1.79 days. The follow-up period ranged from 8 to 22 months. Neurological function was improved. There were no serious complications. Dural tears occurred in 5 patients, intraoperative neurological deterioration occurred in 1 patient, and intraoperative headache and neck pain occurred in 1 patient. CONCLUSION: Full-endoscopic decompression is an effective, safe surgical technique for thoracic OLF even the cases combined with dural ossification.