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Background Context: Cervical osteochondroma is a rare cause of myelopathy. Traditional treatment is open laminectomy with or without fusion. There is limited literature on unilateral bi-portal endoscopic en-bloc resection of cervical osteochondroma. Study Design: We describe a case of a 39-year-old male diagnosed with cervical compressive myelopathy. The pathologic site is located on the ventral surface of C4 lamina. Herein we describe a step-by-step method of unilateral biportal endoscopy (UBE) en-bloc resection of extra-dural sublaminar osteochondroma for patient who had cervical myeloradiculopathy. Spinous process sparing osteotomy was performed to conserve the spinous process and supraspinous ligament.. Outcome Measures: The patient was successfully treated via UBE and the operative time was 50 minutes with no intra-operative complications. Patient symptoms improved in the immediate postoperative period and by 3 months he regained fine motor functions of hand. Conclusions: Unilateral biportal endoscopic en bloc cervical laminectomy can effectively decompress cervical spine and remove posterior benign cervical tumor. UBE preserves musculature and posterior ligamentous complex and thus reduces postoperative neck pain and postlaminectomy kyphosis.
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Background: Traditionally, open wide laminectomy and discectomy have been advocated for the treatment of cauda equina syndrome caused by lumbar disc herniation. We aimed to evaluate the technical feasibility of uniportal interlaminar endoscopy in treating cauda equina syndrome. Methods: Nine patients with cauda equina syndrome underwent uniportal endoscopic decompression and discectomy from December 2020 to December 2022. Data were collected retrospectively. Patients diagnosed with cauda equina syndrome were operated on within 6 hours of presentation to the hospital. The visual analogue score (VAS), Oswestry disability index (ODI), and bladder/bowel score were used to measure the outcome. Results: Analysis showed that VAS scores for leg pain and back pain significantly decreased from preoperative scores of 8.22±0.79 and 4.67±1.76 to postoperative day 1 scores of 0.67±0.67 and 2.56±1.42 (p<.05). The ODI scores improved from preoperative 52.33±11.93 to postoperative (day 1) 14±6.80. Eight patients had early recovery (1 week) of bladder and bowel functions, and one had delayed recovery at 8 months. None of the patients had a residual bowel/bladder deficit. Macnab's criteria outcomes were excellent in all patients at the final follow-up. Conclusions: Uniportal endoscopic lumbar endoscopic unilateral laminotomy with bilateral decompression and subsequent interlaminar endoscopic lumbar discectomy is a safe and effective minimally invasive course of treatment for cauda equina syndrome as an alternative to open laminectomy in our cohort of patients.
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BACKGROUND CONTEXT: Conventional open lumbar decompression is a widely accepted procedure for degenerative lumbar disease. However, it is associated with morbidity due to damage to the paraspinal muscles and posterior ligamentous complex. Endoscopic spine surgery (ESS) is considered the least invasive type of spine surgery in modern times and was developed to minimize the iatrogenic injury to the paraspinal muscles. PURPOSE: Many studies are reported to estimate the paraspinal muscle damage after an open or minimal invasive spine surgery by radiological methods (magnetic resonance imaging [MRI] and computed tomography], biochemistry (creatinine phosphokinase level), or electrophysiology (electoneuromyography). The objectives of this study were to assess paraspinal muscles changes after lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD) based on preoperative and 6-month postoperative MRIs. PATIENT SAMPLE: We studied 159 consecutive patients with lumbar degenerative disease who underwent LE-ULBD at a spine specialty hospital from 2018 to 2019. STUDY DESIGN: The current study was a single-center, single-surgeon, retrospective case study. OUTCOME MEASURES: Changes of paraspinal muscles after LE-ULBD measured on lumbar MRI. METHODS: Postoperative paraspinal muscles changes are evaluated on a picture archiving and communication system by measuring the cross-sectional area (CSA) of multifidus and erector spinae muscles along with the fatty infiltration of muscle on Kjaer's scale at the level of surgery on the ipsilateral and contralateral sides on T1W image. Correlations between imaging and visual analog scale (VAS) score for back, Oswestry Disability Index (ODI), and MacNab's criteria were examined in the preoperative and postoperative periods. RESULTS: Of the 159 patients included, 120 underwent a single level procedure and 39 a multilevel procedure. For single-level LE-ULBD group, mean (SD) preoperative, postoperative, and final follow-up VAS score (7.83 [1.37], 3.15 [0.67] and 2.19 [0.88]; P < 0.001) and ODI (74.09 [7.18], 27.88 [4.40], and 23.88 [4.56]; P < 0.001) improved significantly. Based on MacNab's criteria, the clinical result was excellent in 37 patients, good in 78 patients, and fair in 5 patients. For the multilevel LE-ULBD group, the mean (SD) preoperative, postoperative, and final follow-up VAS score (7.84 [1.38], 3.50 [0.60],and 2.44 [0.79]; P < 0.001) and ODI (74.1 [7.72], 31.30 [4.46], and 24.90 [4.75]; P < 0.001) also improved significantly . Based on MacNab's criteria, the clinical result was excellent in 6 patients, good in 31 patients, and fair in 2 patients.The functional CSA of paraspinal muscles for both groups showed no significant difference in the 6-month follow-up MRI. The fatty infiltration of paraspinal muscles significantly improved from 0.77 to 0.59 (P < 0.05) for the single level LE-ULBD group but not for the multilevel LE-ULBD group (P = 0.320). The mean dural sac CSA increased significantly for both groups (P < 0.001). CONCLUSION: Adequate neural decompression can be achieved with the preservation of paraspinal muscles after an ESS. Preservation of the paraspinal muscles along with the posterior ligamentous complex improves the stability of motion segment in the postoperative period, which ultimately results in better patient outcomes in related to postoperative pain and rehabilitation.Key.
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BACKGROUND CONTEXT: The Oswestry Disability Index (ODI) is the most commonly used outcome measure of functional outcome in spine surgery. The ability of the ODI to differentiate pain related functional limitation specifically related to degenerative lumbar spinal stenosis (LSS) is unclear. PURPOSE: The purpose of this study was to determine the ability of the functional subsections of the ODI to differentiate the specific patient limitation(s) from symptomatic LSS and the functional impact of surgery. STUDY DESIGN: Analysis of prospectively collected data from the Canadian Spine Outcomes and Research Network (CSORN). PATIENT SAMPLE: A total of 1,497 lumbar spinal stenosis patients with a dominant complaint of neurogenic claudication, radiculopathy or back pain were identified in the CSORN registry. OUTCOME MEASURES: The ODI questionnaire version 2.0 was assessed as an outcome measure. METHODS: The difference at baseline and the pre-to-post (1-year) surgical change of the ODI individual questions was assessed. Analysis of variance, two-tailed paired sample Student t test were used for statistical analysis. Cohen d was used as an index of effect size, defined as "large" when d ≥0.8. RESULTS: The mean age at surgery was 65 (±11) years and (50.8%) of the patients were female. Preoperatively, highest functional limitations were noted for standing, lifting, walking, pain intensity and social life (mean 3.2, 2.9, 2.5, 2.9, 2.5 respectively). At 1-year follow-up, overall there was a significant improvement in all individual questions and the overall ODI (all p<.001), with similar patterns seen for each dominant complaint. The greatest effect of surgery was noted in the walking, social life and standing domains (all d≥0.81), while personal care, sitting and lifting showed the least improvement (all d≤0.51). In subgroup analyses, the overall ODI baseline scores and subsection limitations were statistically significantly higher in females, those without degenerative spondylolisthesis and those undergoing fusion, although these differences were not considered clinically significant. Preoperative differentiation of LSS specific functional limitation and postoperative changes in all subgroups was similar to the overall LSS cohort. CONCLUSIONS: The results of this study support the ability of the ODI to differentiate the self-reported pain related functional effects of neurogenic claudication, radiculopathy or back pain from LSS and changes associated with surgical intervention. Disaggregated use of the ODI could be a simple tool to aid in preoperative education regarding specific areas of pain related dysfunction and potential for improvement with LSS surgery.