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BACKGROUND: Degenerative lumbar spine disease is the leading cause of disability and work absenteeism worldwide. Lumbar microdiscectomy became the standard treatment for herniated discs and stenotic disease. With the evolution of different techniques, endoscopic spinal surgery emerged to minimize the surgical footprint while providing at least non-inferior results. Currently, two different types of endoscopic spine procedures are dominating the surgical scenario: "Full-Endoscopic" (FE) and Unilateral Biportal Endoscopic" (UBE) Spine Surgery. The aim of this study is to describe and analyze their indications, their technical characteristicswithitsadvantagesanddisadvantagesofbothtechniquesandtheirfuture trends. METHODS: We performed a narrative review of the most relevant articles published up to August 2023 through a Pub Med search. The search terms " FE Spine Surgery" and " UBE Spine Surgery" were used. The articles selected, were independently reviewed by 3 authors and 55 full text articles were reviewed. RESULTS: The FE and UBE Spine Surgery techniques were described. The FE technique is performed with a monoportal access under constant saline irrigation. The FE comprises the transforaminal and the interlaminar approaches, and the indication depends from the pathology to treat, and still remains controversial. UBE can approach also the spine from a posterior, postero lateral,and para spinal route. It uses two different ports addressed to a target with continuous irrigation. The process of establishing these two portals is called triangulation. CONCLUSIONS: FE and UBE spine surgery have demonstrated outcomes comparable to open surgery, minimizing complications and surgical footprint.
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Degeneração do Disco Intervertebral , Vértebras Lombares , Humanos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Endoscopia/métodos , Neuroendoscopia/métodos , Discotomia/métodosRESUMO
The treatment for lumbar spinal stenosis has advanced through the use of minimally invasive surgery techniques. Endoscopic methods go even further, with studies showing that both uniportal and biportal endoscopic techniques have outcomes comparable to traditional approaches. However, there is limited knowledge of the step-by-step decompression process when using the unilateral biportal endoscopic (UBE). To address this, the authors introduce the five steps in the "Z" sequence, which aims to reduce surgical time and complications. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23182.
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OBJECTIVE: We aim to report the outcomes and feasibility of endoscopic spine surgery used to treat symptomatic spinal metastases patients. This is the most extensive series of spinal metastases patients who underwent endoscopic spine surgery. METHODS: A worldwide collaborative network group of endoscopic spine surgeons, named 'ESSSORG,' was established. Patients diagnosed with spinal metastases who underwent endoscopic spine surgery from 2012 to 2022 were retrospectively reviewed. All related patient data and clinical outcomes were gathered and analyzed before the surgery and the followtime period of 2 weeks, 1 month, 3 months, and 6 months. RESULTS: A total of 29 patients from South Korea, Thailand, Taiwan, Mexico, Brazil, Argentina, Chile, and India, were included. The mean age was 59.59 years, and 11 of them were female. The total number of decompressed levels was 40. The technique was relatively equal (15 uniportal; 14 biportal). The average length of admission was 4.41 days. Of all patients with an American Spinal Injury Association Impairment Scale of D or lower before surgery, 62.06% reported having at least one recovery grade after the surgery. Almost all clinical outcomes parameters statistically significantly improved and maintained from 2 weeks to 6 months after the surgery. Few surgical-related complications (4 cases) were reported. CONCLUSION: Endoscopic spine surgery is a valid option for treating spinal metastases patients as it could yield comparable results to other minimally invasive spine surgery techniques. As the aim is to improve the quality of life, this procedure is valuable and holds value in palliative oncologic spine surgery.
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PURPOSE: To describe the surgical technique and methodology to successfully plan and execute an endoscopic foraminotomy in patients with isthmic or degenerative spondylolisthesis, according to each patient's unique characteristics. METHODS: Thirty patients with degenerative or isthmic spondylolisthesis (SL) with radicular symptoms were included from March 2019 to September 2022. Treating physician registered patients' baseline and imaging characteristics, as well as preoperative back pain VAS, leg pain VAS and ODI. Subsequently, authors treated the included patients with an endoscopic foraminotomy according to a "patient-specific" tailored approach. RESULTS: Nineteen patients (63.33%) had isthmic SL and 11 patients (36.67%) had degenerative SL. 75.86% of the cases had a Meyerding Grade 1 listhesis. One of the transforaminal foraminotomies with lateral recess decompression in degenerative SL had to be aborted because of intense osseous bleeding. Of the remaining 29 patients, one patient experienced recurrence of the sciatica pain that required subsequent reintervention and fusion. No other intraoperative or post-operative complications were observed. None of the patients developed post-operative dysesthesia. In 86.67% of the patients, the foraminotomy was implemented using a transforaminal approach. In the remaining 13.33% of the cases, an interlaminar contralateral approach was used. Lateral recess decompression was performed in half of the cases. Mean follow-up time was 12.69 months, reaching a maximum of 40 months in some patients. Outcome variables such as VAS for leg and back pain, as well as ODI, showed statistically significant reduction since the 3-month follow-up visit. CONCLUSION: In the presented case series, endoscopic foraminotomy achieved satisfactory outcomes without sacrificing segmental stability. The proposed patient-specific "tailored" approach allowed to successfully design and execute the surgical strategy to perform an endoscopic foraminotomy through transforaminal or interlaminar contralateral approaches.
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Foraminotomia , Ciática , Fusão Vertebral , Espondilolistese , Humanos , Foraminotomia/métodos , Espondilolistese/diagnóstico por imagem , Espondilolistese/cirurgia , Espondilolistese/complicações , Endoscopia/métodos , Dor nas Costas/etiologia , Ciática/etiologia , Resultado do Tratamento , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Fusão Vertebral/métodosRESUMO
OBJECTIVE: The ever-growing number of articles related to full-endoscopic spine surgery published in the last few decades presents a challenge which is perplexing and time-consuming in identifying the current research status. The study aims to identify and analyze the most cited works related to full-endoscopic decompression spine surgery, compare the articles published by different publishers and area, and show the current publication status of full-endoscopic research. METHODS: Using Bibliometrix, CiteSpace, and VOSviewer, we analyzed the bibliometric data selected from the Web of Science database between 1992 and 2022. Spine has the highest H-index with the most-cited journal in the field of full-endoscopic decompression spine surgery. China ranked as the most productive country, whereas the most cited with high H-index papers came from South Korea. For the author analysis, Yeung AT, Ruetten S, Hoogland T, Ahn Y, Choi G, and Mayer HM were the most impactful authors in the global and local citations. The most productive organization is Wooridul Spine Hospital. CONCLUSION: The bibliometric study showed a growing trend of research on full-endoscopic decompression spine surgery over the past 30 years. It has demonstrated that there is a significant increase in the number of authors, institutions, and internationally collaborated countries. However, the quality of studies is still low, and the lack of high-quality clinical evidence and the trend of general journal submissions has somewhat affected the quality of endoscopy journals in recent years.
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PURPOSE: The primary purpose of this study was to determine radiation exposure of the surgeon during transforaminal endoscopic lumbar foraminotomy (TELF). Secondary purpose of this study was to compare clinical and radiologic outcomes between TELF under C-arm fluoroscopic guidance (C-TELF) and O-arm navigation-guided TELF (O-TELF). METHODS: The author reviewed patients' medical records who underwent TELF at our institute from June 2015 to November 2022. A total of 40 patients were included (18 patients with C-TELF and 22 with O-TELF). Basic demographic data were collected. Preoperative/postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) were recorded at the outpatient clinic. Radiologic features were compared on X-rays at each follow-up. The degree of foraminal expansion was measured/compared through MRI. In the C-TELF group, the amount of exposure was calculated with a dosimeter. RESULTS: Average surgeon's effective dose in the C-TELF group was 0.036 mSv. In the case of the O-TELF group, there was no radiation exposure during operation. However, the operation time in the O-TELF group was about 37 min longer than that in the C-TELF group. There were significant improvements in VAS/ODI after operation in both groups. Complications were identified in three patients. CONCLUSION: O-TELF showed similarly favorable clinical and radiologic outcomes to C-TELF in lumbar foraminal stenosis, including complication rate. Compared to C-TELF, O-TELF has an advantage of not wearing a lead apron since the operator is not exposed to radiation. However, the operation time was longer with O-TELF due to O-arm setting time. Because there are pros and cons, the choice of surgical method depends on the surgeon's preference.
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Foraminotomia , Cirurgia Assistida por Computador , Humanos , Foraminotomia/métodos , Imageamento Tridimensional , Cirurgia Assistida por Computador/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: The study aims to assess the current development status of transforaminal full-endoscopic spine surgery (TFES) by exploring and analyzing the published literature to obtain an overview of this field and discover the evolution and emerging topics that are underrepresented. METHODS: Using Bibliometrix, CiteSpace, and VOSviewer, we analyzed the bibliometric data selected from the Web of Science Core Collection between January 2002 and November 2022. The descriptive and evaluative analyses of authors, institutes, countries, journals, keywords, and references are compiled. The quantity of research productivity was measured by the number of publications that were published. A quality indicator was thought to be the number of citations. In the bibliometric analysis of authors, areas, institutes, and references, we calculated and ranked the research impact by various metrics, such as the h-index and m-index. RESULTS: A total of 628 articles were identified in the field of TFES by the 18.73% annual growth rate of research on the subject from 2002 to 2022, constituting the documents are by 1961 authors affiliated with 661 institutions in 42 countries or regions and published in 117 journals. The USA (n = 0.20) has the highest international collaboration rate, South Korea has the highest H-index value (h = 33), and China is ranked as the most productive country (n = 348). Brown univ., Tongji univ., and Wooridul Spine represented the most productive institutes ranked by the number of publications. Wooridul Spine Hospital demonstrated the highest quality of paper publication. The Pain Physician had the highest h-index (n = 18), and the most cited journal with the earliest publication year in the area of FEDS is Spine (t = 1855). CONCLUSION: The bibliometric study showed a growing trend of research on transforaminal full-endoscopic spine surgery over the past 20 years. It has shown a significant increase in the number of authors, institutions, and international collaborating countries. South Korea, the United States, and China dominate the related areas. A growing body of evidence has revealed that TFES has leapfrogged from its infancy stage and gradually entered a mature development stage.
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Bibliometria , Endoscopia , Humanos , China , República da Coreia , Coluna Vertebral/cirurgiaRESUMO
ABSTRACT Introduction: The interest in spinal endoscopy is rising, particularly among younger spine surgeons. Formalized postgraduate training programs for endoscopic spinal surgery techniques are lacking behind. Methods: The authors performed a retrospective survey study amongst participants of the 2022 AMCICO endoscopic surgery symposium. Descriptive and correlative statistics were done on the surgeon's responses recorded in multiple-choice questions. In addition, surgeons were asked about their clinical experience and preferences with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, and future training requirements. SPSS (version 27) statistical software package was used for data analysis. Descriptive statistic measures were used to count responses and calculate the mean, range, standard deviation, and percentages. In addition, chi-square statistics were used to determine the strength of the association between factors. Results: The online survey was accessed by 321 surgeons, of which 92 completed it (53.4%). Demographic data showed the majority of responding surgeons being orthopedic surgeons (73.6%) and under the age of 50 (69.2%), with over half (51.1%) having less than three months of formalized training in endoscopic spinal surgery techniques. Most surgeons practiced uni-portal (58.9%) versus bi-portal (3.4%) spinal endoscopy. The transforaminal approach (65.5%) was preferred over the interlaminar method (34.4%). The bi-portal technique was indicated almost exclusively for the lumbar spine (94.8%). For endoscopically assisted spinal fusions, a uni-portal approach was preferred by 72% of surgeons over a bi-portal procedure (24.5%). 84.1% of respondents were interested in navigation, of which 30.7% preferred optical over electromagnetic technology (18.2%). Robotics was of interest to 51.1% of survey participants. Respondents' bias was estimated with course attendance assessments, with 37% of surgeons having attended all three days, 27.2% two days, and 16.3% one day. One-fifth of responding spine surgeons did not participate in any curriculum activities but completed the survey. The academic impact of the AMCICO endoscopy symposium was high, with 68.1% of respondents indicating interest in continued training and 61.1% of trainees ready to apply their newly acquired knowledge base to clinical practice. Conclusion: The interest in spinal endoscopy surgery techniques and protocols is high among AMCICO members. Many surgeons are interested in learning advanced endoscopic surgical techniques to integrate the technology into their surgical procedure portfolio to address common painful conditions of the degenerative spine beyond herniated discs and foraminal stenosis. The authors concluded that its academic impact was high based on the responses given by the participating surgeons. Level of evidence III; Retrospective study.
Resumo: Introdução: O interesse em cirurgia endoscópica da coluna tem aumentado especialmente entre os jovens cirurgiões, contudo, são poucos os centros que atualmente oferecem programas de treinamento nesta disciplina. Métodos: Foi realizada uma pesquisa retrospectiva entre os participantes do simpósio de "Cirurgia Minimamente Invasiva e Endoscópica da Coluna Vertebral" realizado durante o Congresso AMCICO 2022. Estatísticas descritivas e testes de correlação foram aplicados às respostas das perguntas de múltipla escolha. Os cirurgiões foram questionados sobre experiência clínica e preferências pela endoscopia espinhal, histórico de treinamento, tipos de descompressão lombar endoscópica que realizaram e requisitos futuros para um treinamento adicional. O software estatístico SPSS (versão 27) foi utilizado para a análise de dados. As medidas estatísticas descritivas foram utilizadas para quantificar as respostas e calcular a mediana, a média, o desvio padrão e as porcentagens. O qui-quadrado foi empregado para determinar a associação entre os fatores estudados. Resultados: A pesquisa on-line foi visualizada por 321 cirurgiões, dos quais 92 a completaram (53,4%). As informações demográficas mostraram que a maioria dos participantes são cirurgiões ortopédicos (73,6%) e menores de 50 anos (69,2%), com mais da metade deles (51,1%) possuindo menos de 3 meses de treinamento formal em técnicas endoscópicas. A maioria dos cirurgiões pratica abordagens uniportais (58,9%, contra 3,4% bi-portais). A abordagem transforaminal (65,5%) foi preferida em relação à abordagem interlaminar (34,4%). A abordagem biportal foi selecionada como a abordagem indicada para a região lombar (94,8%). Para a fusão endoscopia-assistida, a abordagem unilateral foi preferida por 72% dos participantes contra a abordagem biportal (24,5%). Os sistemas de navegação foram de interesse para 84,1% dos participantes, dos quais 30,7% responderam que preferiam a óptica em vez da eletromagnética (18,2%). O uso da robótica foi de interesse para 51,1% dos participantes. O viés dos participantes foi calculado com base no percentual de participação, onde 37% participaram de todos os 3 dias de conferências, 27,2% participaram de 2 dias e 16,3% participaram de apenas um dia. Um quinto dos cirurgiões não participaram das atividades do simpósio e ainda assim responderam à pesquisa. O impacto acadêmico do simpósio de "Cirurgia Minimamente Invasiva e Endoscópica da Coluna Vertebral" foi alto, com 68,1% dos participantes respondendo que têm interesse em treinamento adicional nestas técnicas e 61,1% respondendo que estão prontos para aplicar novos conhecimentos em sua prática médica. Conclusão: O interesse em técnicas cirúrgicas endoscópicas da coluna vertebral é alto entre os membros da AMCICO. Um grande número de cirurgiões está interessado em aprender técnicas cirúrgicas endoscópicas avançadas da coluna vertebral e integrar esta tecnologia como parte de suas ferramentas cirúrgicas para resolver problemas comuns que afetam a coluna com doença degenerativa, além de hérnias de disco e estenoses foraminais. Baseados nas respostas fornecidas pelos cirurgiões participantes, os autores concluem que o impacto acadêmico foi elevado. Nível de evidência III; Estudo retrospectivo.
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Humanos , Coluna VertebralRESUMO
OBJECTIVE: The objective of the study was to conduct a single-arm meta-analysis and comprehensive systematic review to identify the efficacy and safety of transforaminal endoscopic surgery for the treatment of lumbar foraminal stenosis (LFS). METHODS: The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The PubMed, Web of Science, and Embase databases were searched from inception to February 20, 2022. Primary research results were visual analog scale scores, Oswestry Disability Index scores, MacNab criterion scores, and reported adverse events. Subgroup analyses were performed on the primary outcome to evaluate the potential effects of several clinical factors that affected the results. RESULTS: Of the 2020 studies identified, 9 met the inclusion criteria, and 316 participants were eligible for meta-analysis. The meta-analysis results found that transforaminal endoscopic surgery for the treatment of LFS was associated with a significant improvement in postoperative 12-month clinical indicators: 8 studies reported improvements in visual analog scale scores: -5.38, Oswestry Disability Index scores: -40.44, and MacNab criterion scores: odds ratio = 0.86; 8 studies reported 11.53% adverse events occurred in a total of 295 patients, and the most commonly reported event was transient postoperative dysesthesia, which occurred in 26 patients in a total of 6 studies with 240 patients (10.83%). CONCLUSIONS: Transforaminal endoscopic surgery positively affects postoperative LFS patients' clinical indicators; however, high-level literature with randomized controlled trials is needed to confirm this technique's applicability in LFS.
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Estenose Espinal , Humanos , Constrição Patológica/cirurgia , Descompressão Cirúrgica/métodos , Endoscopia/métodos , Vértebras Lombares/cirurgia , Estudos Retrospectivos , Estenose Espinal/cirurgia , Resultado do TratamentoRESUMO
Anterior cage migration is the most infrequent and dangerous complication seen in posterior lumbar interbody fusion (PLIF) procedures. We report the case of a 74-year-old woman who underwent PLIF at the L5-S1 level. During the surgery, one of the PLIF-cages dislodged anteriorly into the abdominal cavity without vascular injury. An anterior retroperitoneal approach to remove the cage and complete the fusion was made. The patient was discharged 2 weeks later with encouraging clinical results. In a patient hemodynamically stable, removing the cage by a vascular surgeon, and complete the Anterior Lumbar Interbody Fusion could be a feasible option at L5-S1.
La migración anterior del implante para fusión lumbar es la complicación más infrecuente y peligrosa asociada a la fusión intersomática posterior (PLIF). Reportamos el caso de un paciente femenino de 74 años, operada de PLIF en L5-S1. Durante la cirugía, una de las cajas usadas migró a la cavidad abdominal, sin ocasionar lesión vascular. Para remover el implante y completar la fusión lumbar un abordaje retroperitoneal anterior fue realizado. La paciente fue egresada 2 semanas después con éxito. En un paciente hemodinamicamente estable, este abordaje puede ser una opción para revertir la complicación y completar la fusión lumbar vía anterior.
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Vértebras Lombares , Fusão Vertebral , Idoso , Feminino , Humanos , Vértebras Lombares/cirurgia , Região Lombossacral , Espaço Retroperitoneal/cirurgia , Fusão Vertebral/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Lumbar burst fractures (complete or incomplete) of L5 have a low incidence, accounting for 1.2% of all spinal burst fractures. Treatment for these fractures remains controversial. Decompression of neural elements and stabilization of the spine to preserve lordosis and avoid kyphotic deformity are recommended when a patient has a neurological deficit and an unstable fracture. Otherwise, the fracture could be managed conservatively. METHODS: We report a detailed step-by-step unilateral biportal endoscopy technique used in a patient with an L5 incomplete burst fracture and neurological deficit. RESULTS: The patient had an acceptable immediate postoperative course; lower back pain and radicular symptoms improved significantly after surgery. CONCLUSIONS: Our unilateral biportal endoscopy technique for L5 incomplete burst fractures offers the capability to perform enough decompression of neural elements and assist other procedure-related maneuvers under direct endoscopic visualization. This technique could be considered another minimally invasive spine surgery option for treating selected patients with L5 incomplete burst fractures.
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Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Neuroendoscopia/métodos , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Vertebroplastia/métodos , Adulto , Descompressão Cirúrgica/instrumentação , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Masculino , Neuroendoscopia/instrumentação , Traumatismos da Medula Espinal/diagnóstico por imagem , Traumatismos da Medula Espinal/etiologia , Fraturas da Coluna Vertebral/complicações , Fraturas da Coluna Vertebral/diagnóstico por imagem , Resultado do Tratamento , Vertebroplastia/instrumentaçãoRESUMO
BACKGROUND: The principal advantage of intraoperative spinal navigation is the ease of screw placement. However, visualization and the integration of navigation can be explored with the use of navigation-guided full-endoscopic techniques. OBJECTIVE: To describe the stepwise intraoperative navigation-assisted unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) technique and to present our preliminary results in a Mexican population. METHODS: A 10-step summary of the UBE-TLIF operative technique was described, and the clinical and radiological results are presented and analyzed. RESULTS: A total of 7 patients were treated. We observed the value of integrating navigation and endoscopic visualization when decompression had to be performed. CONCLUSION: Together, intraoperative navigation and direct visualization through the endoscope may be a useful surgical tool for surgeons with experience in endoscopic spinal surgery.
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Vértebras Lombares , Fusão Vertebral , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , México , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Degenerative lumbar spine disease (DLSD) is a heterogenous group of conditions that can significantly affect patients' quality of life. Lateral lumbar interbody fusion (LLIF) is one of the treatment modalities for DLSD that has been increasing in popularity over the past decade. The treatment of DLSD should be individualized based on patients' symptoms and characteristics to maximize outcomes. METHODS: Literature review, invited review. RESULTS: In this article, we will (1) review the use of the LLIF technique in the treatment of degenerative lumbar spine disease, (2) review the current concepts of LLIF, and (3) explore the evidence to date that will allow the reader to maximize the benefits of this technique. CONCLUSIONS: LLIF is an alternative for the treatment of degenerative pathologies of the lumbar spine via indirect decompression.
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Chiari malformation type 1 (CM-1) is an ectopia of the cerebellar tonsils below the foramen magnum that causes severe disability due to its neurologic symptoms. The treatment of choice for CM-1 is decompression of the craniovertebral junction (CVJ). In some patients only an extradural decompression by removing the atlanto-occipital ligament may be sufficient. In other patients, duraplasty is necessary. In this case, we report the operative technique used to treat a CM-1 in a 16-year-old male patient who presented with severe headache and gait instability. A micro-decompression of the suboccipital bone and posterior arch osteotomy of C1 through a 2-cm midline incision was performed under surgical microscope magnification. A duraplasty was performed through the same approach. The patient was discharged home after 2 days in the hospital and returned to regular activities at school 3 weeks after surgery. The minimally invasive technique presented here is a viable option for the posterior decompression of the CVJ in patients with CM-1 using a low-cost self-retaining retractor.
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Malformação de Arnold-Chiari/cirurgia , Vértebras Cervicais , Descompressão Cirúrgica/métodos , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Adolescente , Humanos , MasculinoRESUMO
PURPOSE OF STUDY: Standard treatment protocols for lumbar degenerative lesions in the setting of rheumatoid arthritis (RA) are lacking. The purpose of this study was to evaluate the clinical and radiologic outcomes of minimally invasive oblique lumbar interbody fusion (MI-OLIF) in RA patients having degenerative lumbar spine lesions. METHODS: This was a retrospective hospital-based case series (evidence level 4). Eight patients with degenerative lumbar disease with significant back pain and neurologic claudication underwent MI-OLIFwith polyetheretherketone cage insertion and posterior pedicle screw instrumentation. The clinical outcomes were measured by the numerical rating scale (NRS) for back and leg pain and the Oswestry Disability Index (ODI), and radiologic outcomes were studied on radiographs, computed tomography, and magnetic resonance imaging. Minimum follow-up duration was 1 year. RESULTS: Mean NRS results for back and leg pain preoperatively were 6.3 and 7.1 that improved to 2.6 and 2 for back and leg pain, respectively, at last follow-up. The mean ODI scores preoperatively were 58.02 that improved to 39.06 at last follow-up. All patients had good functional outcomes, good fusion rates, and were able to continue their activities of daily living without much disability at last follow-up. CONCLUSION: MI-OLIF in patients with symptomatic lumbar spine degenerative lesions with RA seems to provide good short-term clinical and radiologic outcomes.
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Artrite Reumatoide/cirurgia , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Atividades Cotidianas , Idoso , Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico por imagem , Feminino , Humanos , Degeneração do Disco Intervertebral/complicações , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Parafusos Pediculares , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: To present a case of spinal malignant fibrous histiocytoma in the fourth lumbar vertebra that received treatment by an L4 spondylectomy and placement of intervertebral expander and posterior fixation. CASE REPORT: A 47-year-old male patient with no relevant history presented with lumbar pain of 2 months' evolution. Treated conservatively, with slight improvement in pain, the patient persisted with low back pain irradiation to pelvic members, predominantly left-sided, accompanied by weakness and claudication. Clinically, he presented with paresthesias 3/5, hypoaesthesia L4, L5 and S1, predominantly left-sided. Lumbosacral computerized axial tomography evidence of an osteolytic lesion in the L4 body, predominantly left-sided, with invasion of the lumbar canal with poorly delimited margins; lumbosacral spine MRI showed hyperintense lesion in T2, heterogeneous, with irregular borders involving more than 60% of the vertebral body of L4 with invasion of the spinal canal causing compression to the roots. He was treated with an L4 spondylectomy and placement of intervertebral expander and posterior fixation. CONCLUSION: Spondylectomy is an effective option for the treatment of spinal malignant fibrous histiocytoma that involves combined approaches. However the challenge is greater since it requires a knowledge of the great abdominal vessels and multidisciplinary intervention.
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Descompressão Cirúrgica/métodos , Histiocitoma Fibroso Maligno/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Neoplasias da Coluna Vertebral/cirurgia , Histiocitoma Fibroso Maligno/complicações , Histiocitoma Fibroso Maligno/diagnóstico por imagem , Humanos , Fixadores Internos , Dor Lombar/etiologia , Vértebras Lombares/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Radiculopatia/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Use of a contralateral sublaminar endoscopic approach may minimize facet violation and better visualize the dura and cystic lesions during operation. The aim of this study was to introduce a surgical technique for contralateral sublaminar endoscopic removal of lumbar juxtafacet cysts using a percutaneous biportal endoscopic approach. METHODS: Ten cases of lumbar juxtafacet cyst were consecutively treated via a contralateral sublaminar endoscopic approach using percutaneous biportal endoscopic surgery. Postoperative magnetic resonance imaging scans were evaluated on postoperative day 1 for optimal removal of cysts and neural decompression status. Clinical findings were evaluated in preoperative and postoperative periods using a visual analog scale for leg pain and the Oswestry Disability Index. RESULTS: Ten lumbar juxtafacet cysts in 10 patients were treated using the contralateral sublaminar biportal endoscopic approach. Postoperative magnetic resonance imaging depicted complete removal of juxtafacet cysts and optimal neural decompression of treated segments in all patients. Preoperative visual analog scale and Oswestry Disability Index scores improved significantly after surgery: visual analog scale scores changed from 7.64 ± 0.71 preoperatively to 1.63 ± 1.28 at last follow-up visit (P < 0.05), and Oswestry Disability Index scores changed from 45.35 ± 16.15 to 15.82 ± 10.21 (P < 0.05). Mean operative time was 60.1 ± 23.4 minutes. CONCLUSIONS: A contralateral sublaminar approach using percutaneous biportal endoscopy may be an alternative treatment for symptomatic lumbar juxtafacet cysts. This approach may minimize iatrogenic facet violation and traumatization of posterior musculoligamentous structures.
Assuntos
Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Neuroendoscopia , Procedimentos Neurocirúrgicos , Estenose Espinal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos/cirurgia , Descompressão Cirúrgica/métodos , Dura-Máter/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/métodosRESUMO
BACKGROUND: Percutaneous endoscopic lumbar diskectomy (PELD) has evolved over the last decades and has become an effective treatment for soft disk herniations. However, while its use increases, newer complications have been discovered. CASE DESCRIPTION: We present the unique case of a woman who underwent PELD/foraminotomy to treat right-side foraminal disk herniations on L4-5 and L5-S1 in the same procedure. Ten days after surgery, the patient developed fever and severe low back pain radiated down her right leg. Magnetic resonance imaging showed a right pseudomeningocele arising from L4-5 and a nerve root herniated through the dural sac at the same lumbar segment. Blood cultures and fluid culture obtained from pseudomeningocele drainage depicted infection. Specific antibiotics were administrated, direct dura repair under the microscope was performed, and the patient improved symptomatically. CONCLUSIONS: PELD combined with foraminotomy is a relatively new and skill-demanding surgery which is indicated only in cases where foraminal disk herniation is combined with foraminal stenosis. This surgical strategy requires experience by the endoscopic surgeon to prevent procedure-related complications. Although rare, these complications can lead to increased morbidity.
Assuntos
Infecções Bacterianas/etiologia , Discotomia Percutânea/efeitos adversos , Endoscopia/efeitos adversos , Pseudomonadaceae/patogenicidade , Infecções Bacterianas/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To compare the radiologic and clinical outcomes between oblique lumbar interbody fusion (OLIF) without laminectomy and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). METHODS: This was a retrospective study. Between April 2012 and January 2017, 25 patients in each of the MI-TLIF and OLIF groups were recruited as matched pairs. Clinical outcomes included visual analogue scale, Oswestry Disability Index, and satisfaction rates. Radiographic outcomes comprised disc height (DH) and fusion status. Intraoperative data and complications were collected. All patients completed the clinical and radiologic outcomes. Outcomes were compared preoperatively and postoperatively. RESULTS: Matched pairs were compared between 2 groups in terms of demographic data and preoperative measurements; less blood loss and shorter operative time were found in OLIF versus MI-TLIF (P < 0.001). The total complication rate was 36% in OLIF and 32% in MI-TLIF (P = 0.77). The outcomes of visual analogue scale and Oswestry Disability Index were significantly improved in both groups, and there was no significant difference between 2 groups. Satisfaction rates of the both groups were more than 90%. OLIF was superior to MI-TLIF with respect its capability to restore DH (P < 0.001). Earlier time of fusion was observed in OLIF (80%) compared with MI-TLIF (52%) at 6 months (P = 0.04). CONCLUSIONS: OLIF may achieve equivalent clinical and radiologic outcomes compared with MI-TLIF when the stenosis is minimal because the decompression performed is indirect. Furthermore, the OLIF shows less blood loss and shorter operative time, better restoration of DH, and earlier time to fusion than the MI-TLIF.
Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Espondilolistese/cirurgia , Dor nas Costas/etiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Degeneração do Disco Intervertebral/cirurgia , Tempo de Internação/estatística & dados numéricos , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Neuroendoscopia/métodos , Duração da Cirurgia , Medição da Dor , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Cuidados Pré-Operatórios , Estudos Retrospectivos , Espondilolistese/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: Recently, full-endoscopic lumbar decompression has shown encouraging clinical outcomes. However, there are no reports as to whether sufficient lumbar decompression through full-endoscopic procedures can be achieved. The purpose of this study is to investigate the radiologic outcomes of percutaneous biportal endoscopic decompression compared with those of conventional microscopic decompressive surgery. METHODS: A case-control prospective study was carried out. Patients were classified into 2 groups regarding the operation method (microscope group and endoscopic group). The cross-sectional area of the dura was measured both preoperatively and postoperatively at 5 axial cuts of T2-weighted magnetic resonance images in all subjects. In addition, clinical outcomes using visual analog scale for back and leg pain and Oswestry Disability Index were analyzed. Radiologic and clinical results were compared between groups. RESULTS: A total of 88 patients were enrolled in the study. Forty-two patients were assigned to the microscope group and 46 patients were assigned to the endoscopic group. Postoperatively, the dura was significantly expanded in each group (P < 0.05). Visual analog scale and Oswestry Disability Index scores improved after surgery in both groups (P < 0.05). In addition, there was no significant difference of dura expansion between the 2 groups (P > 0.05). Immediate postoperative pain score was significantly greater in the microscope group than in the endoscopic group (P < 0.05). CONCLUSIONS: Full-endoscopic lumbar decompression using percutaneous biportal endoscopic approach is a safe and effective treatment for lumbar spinal stenosis. Decompression can be achieved with the percutaneous endoscopic technique at a similar rate to that achieved by the microscopic approach.