Navigation-Assisted Full-Endoscopic Radiofrequency Rhizotomy Versus Fluoroscopy-Guided Cooled Radiofrequency Ablation for Sacroiliac Joint Pain Treatment: Comparative Study.

OBJECTIVE: Sacroiliac joint (SIJ) pain is a common cause of chronic low back pain. Full-endoscopic rhizotomy of lateral branches of dorsal rami innervating SIJ is a potential option for patients' refractory to medical treatment. The full-endoscopic rhizotomy is sometimes challenging under fluoroscopic guidance. This study is to evaluate the effectiveness of the navigation-assisted full-endoscopic rhizotomy for SIJ pain. METHODS: The study was a retrospective match-paired study that enrolled consecutive patients undergoing navigation-assisted full-endoscopic rhizotomy for SIJ pain. The patient demographics, clinical outcomes, and operative parameters of endoscopic rhizotomy were compared with conventional cooled radiofrequency ablation (RFA) treatment. RESULTS: The study enrolled 72 patients, including 36 patients in the endoscopic group. Thirty-six patients in the cooled RFA group were matched by age as the control. The follow-up time was at least 1 year. Patient characteristics were similar between the groups. The navigation-assisted endoscopic rhizotomy operation time was significantly longer than the cooled RFA. The visual analogue scale (VAS) for pain and Oswestry Disability Index (ODI) significantly decreased after each treatment. However, the between-group comparison revealed that the VAS and ODI of the patients after endoscopic rhizotomy were significantly lower than those after the cooled RFA group. There were no postoperative complications in the study. CONCLUSION: Navigation-assisted full-endoscopic rhizotomy is an alternative to SIJ pain treatment. Integrating intraoperative navigation can ensure accurate full-endoscopic rhizotomy to provide better durability of pain relief than the cooled RFA.

A Pilot Study of Radiculopathy Following Osteoporotic Vertebral Fracture in Elderly Patients: An Algorithmic Approach to Surgical Management.

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.

How I do it? Fully endoscopic rhizotomy assisted with three-dimensional robotic C-arm navigation for sacroiliac joint pain.

BACKGROUND: In some cases, the conventional C-arm fluoroscopy can barely identify anatomical landmarks such as the dorsal sacral foramen. A fully endoscopic rhizotomy under three-dimensional (3D) provides satisfactory results in the treatment of sacroiliac (SI) joint pain. METHODS: The workflow of a fully endoscopic rhizotomy under 3D robotic C-arm navigation system is introduced. CONCLUSION: The presented technique is novel, effective, and safe for the treatment of SI joint pain. The 3D navigation system guides the operator to easily locate the target points for finding the medial branches of L5 and sacral lateral branches from S1, S2, and S3 dorsal foramina under endoscopic visualization.

Technical Considerations of Interlaminar Approach for Lumbar Disc Herniation.

With the evolution of endoscopic instruments and techniques, full-endoscopic spine surgery has attracted more attention worldwide in recent years. At the initial stage, surgeons conducted endoscopic lumbar discectomy using the transforaminal approach. Next, interlaminar endoscopic lumbar discectomy was developed to treat a herniation disc at the L5-S1 level. The progression in interlaminar endoscopic techniques has further broadened the indications for full-endoscopic spine surgery. However, the steep learning curve of endoscopic procedures has remained challenging. The use of interlaminar endoscopic lumbar discectomy entails many essential skills to manage the different anatomical structures of the spine. From the perspective of successful and safe interlaminar endoscopic lumbar discectomy, we have discussed the technical considerations for endoscopic procedures.

Suprapedicular Retrocorporeal Technique of Transforaminal Full-Endoscopic Lumbar Discectomy for Highly Downward-Migrated Disc Herniation.

OBJECTIVE: Anatomical barriers (e.g., pedicles, narrow foramina) can hinder direct access to, and removal of, disc fragments that have migrated far downward. Using transforaminal full-endoscopic lumbar discectomy (FELD), we devised a modified technique, the suprapedicular retrocorporeal approach, for herniations in which the disc has migrated to the axilla of the traversing nerve roots. In the present report, we have described our preliminary results. METHODS: Soft, highly downward-migrated disc herniation was treated with transforaminal FELD through the suprapedicular retrocorporeal approach in 22 patients from June 2017 to May 2019. The clinical outcomes were evaluated, including the preoperative and postoperative visual analog scale scores for the back and leg, Oswestry disability index, and MacNab criteria for surgical success. RESULTS: The affected discs were at L4-L5 in 14 patients, L3-L4 in 6 patients, and L5-S1 in 2 patients. In each case, the affected disc was successfully removed using the suprapedicular retrocorporeal approach. The mean follow-up was 18.1 ± 5.7 months. The mean visual analog scale scores for back and leg pain improved significantly (P < 0.05 for both). The mean Oswestry disability index had decreased from 62.5 ± 14.2 preoperatively to 10.5 ± 5.9 postoperatively (P < 0.05). Using the MacNab criteria, 13 patients reported excellent outcomes and 9, good outcomes. No complications or recurrence developed during follow-up. CONCLUSIONS: The suprapedicular retrocorporeal technique is a feasible and effective surgical option in transforaminal FELD for the treatment of herniation in which the disc has migrated to the axilla of the traversing nerve roots.

Full Endoscopic Removal of Cervical Spinal Epidural Abscess: Case Report and Technical Note.

Spinal epidural abscess is a rare disease that is less likely to occur in the cervical region. When it occurs here, cervical spondylodiscitis can develop. Surgical treatment is recommended because of possible life-threatening septic and neurological complications. We present a case of an 81-year-old man who suffered from right side paralysis and was subsequently diagnosed with a C4 to C7 epidural abscess. We utilized full endoscopic surgery for patient management. The traditional surgical methods for treating cervical epidural abscesses may cause spinal instability. There has only been one previous case report on the endoscopic-assisted method. Minimal invasive surgery by a full endoscopic method can be done with a small incision and is associated with minimal blood loss and muscle damage. This is the first report on cervical epidural abscess drainage utilization a full endoscopic method. We recommend this alternative minimally invasive method to manage cervical epidural abscess.

Symptomatic Lumbar Juxtafacet Cyst Treated by Full Endoscopic Surgery.

BACKGROUND: Juxtafacet cysts (JFCs) include both synovial and ganglion cysts adjacent to a spinal facet joint or arising from the ligamentum flavum of the spinal facet joints. Various treatments have been proposed; however, a surgical approach appears to be most effective. The aim of this study was to review patients with lumbar JFCs treated using a full endoscopic approach and elaborate the details of the surgical routes and techniques and their merits and pitfalls. METHODS: All patients with lumbar JFCs underwent complete endoscopic cyst removal. Muscle power, visual analog scale score, modified MacNab criteria score, and magnetic resonance imaging were assessed during follow-up. RESULTS: The study enrolled 8 patients. Five patients received an interlaminar approach, 2 patients received a transforaminal approach, and 1 patient received a transfacet approach. Visual analog scale scores decreased from a mean of 7.75 (range, 5-10) before surgery to 0.625 (range, 0-2) after surgery, and modified MacNab criteria score ranged from good to excellent after surgery. No neurologic injuries were observed. CONCLUSIONS: JFCs could be effectively treated by full endoscopic surgery. The type of approach should be based on the anatomic site of the lesion and the condition of the patient. The interlaminar approach is appropriate for cysts located in the lower segment with larger interlaminar space. The transforaminal or transfacet approach is preferred for patients for whom general anesthesia is a high risk.

Full Endoscopic Discectomy, Debridement, and Drainage for High-Risk Patients with Spondylodiscitis.

OBJECTIVE: To evaluate the efficacy and clinical results of full endoscopic debridement and drainage (FEDD) for high-risk patients with spondylodiscitis. METHODS: Fourteen patients who underwent FEDD at our institution between November 2015 and September 2017 were retrospectively reviewed. All patients had single-level infectious spondylodiscitis and were high-risk candidates for surgery. Their general condition was evaluated according to the American Society of Anesthesiologists grading system. The Charlson Comorbidity Index was used for comprehensive assessment of comorbidity status. Outcomes were evaluated by numeric rating scale (NRS) pain score, Oswestry Disability Index, modified Macnab criteria, and radiographic images at follow-up. RESULTS: All 14 patients experienced immediate relief of back pain after FEDD, with no procedure-related complications. The causative bacteria were identified in 10 of the 14 patients (71.5%). Half of the 14 patients had an American Society of Anesthesiologists score of ≥3. The average Charlson Comorbidity Index was 5.1 ± 1.6 points. Compared with the preoperative NRS score of 8.2 ± 0.9, the NRS scores at 1 week and 12 months after surgery were 3.4 ± 1.1 and 1.4 ± 1.2, respectively. A significant improvement in Oswestry Disability Index was observed after surgery (preoperative, 30.1 ± 3.9; 12 months postoperatively, 17.6 ± 6.2; P < 0.05). Satisfaction rate was 85.7% based on the Macnab criteria (excellent or good outcome). None of the patients developed any significant kyphotic deformity after FEDD. CONCLUSIONS: FEDD may be an effective alternative to extensive open surgery in patients with infectious spondylodiscitis, especially those who are high-risk candidates for surgery (elderly patients with multiple comorbidities and patients in poor general condition).

Utilizing real-time contrast medium to detect the fistula of giant spinal arachnoid cyst and treat with minimal invasive surgery.

BACKGROUND: Spinal arachnoid cysts are rare and have varied clinical manifestations depending on the affected spinal region and nerve roots. A complete cyst excision with fistula closure is the first choice of treatment. However, it might be difficult to localize the specific position of the fistula because previous images have no enhancements or the fistula is too tiny to be detected. CASE PRESENTATION: This case is a giant lumbar extradural arachnoid cyst. We administered a lumbar injection with contrast medium into subarachnoid space under digital subtraction angiography (DSA) and disclosed the fistula. Confirming the location of fistula enabled us to perform minimally invasive surgery to ligate the fistula. Surgical intervention for a spinal arachnoid cyst might encounter the problem of the formation of a postoperative cerebrospinal fluid (CSF) fistula. We propose the option of detecting the fistula preoperatively for minimal invasive surgery. Recurrence depends on the long-term follow-up, and more cases are needed to further evaluate our technique. CONCLUSIONS: The real-time contrast medium technique for spinal arachnoid cysts contributes to the complete ligation with minimally invasive surgery.

In situ self-spray coating system that can uniformly disperse a poorly water-soluble H2S donor on the colorectal surface to treat inflammatory bowel diseases.

Inflammatory bowel disease (IBD) is an intestinal inflammatory disorder. Exogenous hydrogen sulfide (H2S) donors such as diallyl trisulfide (DATS) have been used as anti-inflammatory mediators. However, an ideal method of administering DATS has yet to be established owing to its poor water solubility. Herein, a self-spray coating system that is derived from a DATS-loaded capsule with foaming capability (CAP-w-FC) is proposed for treating colitis. Following the rectal administration of CAP-w-FC into rats bearing colitis and its subsequent dissolution in the intestinal fluid, a spray coating system is self-assembled in situ. This system greatly promotes the dissolution of the poorly water-soluble DATS by producing nano-scaled micellar particles that are sprayed onto the large luminal surface of the colorectal tract. Following the internalization of the micellar particles by colon epithelial cells, their loaded DATS reacts with intracellular glutathione to yield H2S. This exogenous H2S then diffuses through plasma membranes to carry out its biological functions, including suppressing the overproduction of pro-inflammatory cytokines, inhibiting the adhesion of macrophages on the vascular endothelium, and repairing colonic inflamed tissues. Analytical results demonstrate that this self-spray coating system may be used as a unique drug delivery technique for covering the large colorectal surface to treat IBD.