Combined unilateral biportal endoscopy and video-assisted thoracoscopic surgery for complete excision of a T3-T4 right ganglioneuroma.

Ganglioneuroma (GN) is a rare solid neoplasm developing from neural crest cells of sympathetic ganglia or adrenal medulla. It usually presents as an asymptomatic mass in the retroperitoneal space and mediastinum. Resection through open surgery or minimal access is recommended. The video illustrates the case of a 23-year-old female with an incidental finding of thoracic GN. The authors performed a combined, staged approach to ensure complete resection, which involved unilateral T3-4 biportal endoscopy (UBE) for rhizotomy and nerve root decompression, followed by video-assisted thoracoscopic surgery (VATS) for complete excision. The procedure was uneventful, with full recovery and no postoperative complications. The video can be found here: https://stream.cadmore.media/r10.3171/2024.2.FOCVID23210.

Navigation-guided endoscopic lumbar decompression on foramen and lateral recess in advanced scoliosis.

An 84-year-old woman presented with left leg radiating pain for 18 months and a numeric rating scale score of 8. From examination, motoric on left knee extension was grade 4, with dysesthesia and numbness along the left anterolateral thigh. Imaging showed left L3-4 foraminal and lateral recess stenosis with severe-degree scoliosis. The patient underwent navigation-guided endoscopic transforaminal foraminotomy and lateral recess decompression on the left L3-4 level with a good outcome. Three-years' follow-up showed a well-maintained clinical outcome and coronal sagittal balance. This video explores navigation-guided endoscopic lumbar decompression for neural compression in advanced scoliosis. Further research is encouraged to establish long-term efficacy. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23195.

Efficacy of Allograft Versus Bioactive Glass-Ceramic Cage in Anterior Cervical Discectomy and Fusion: A Randomized Controlled Study.

STUDY DESIGN: A randomized controlled trial. OBJECTIVE: The aim of this study is to compare the efficacy of allografts and bioactive glass-ceramic (BG) cages for anterior cervical discectomy and fusion (ACDF) in treating cervical degenerative disc disease. METHODS: We conducted a single-center, randomized controlled trial between August 2017 and August 2022. Participants were randomized into two groups, and consecutive patients requiring ACDF were randomly assigned to receive either the allograft cage or the BG cage. The surgical outcomes measured included pain levels, neck disability, surgical details, and radiological assessments. RESULTS: Of the 45 assessed, 40 participants were included, with 18 in the allograft cage group and 22 in the BG cage group. By the 12-month follow-up, both groups exhibited significant improvements in pain levels and disability scores, with no notable intergroup differences. Over 85% of patients in both groups were satisfied with their outcomes. Radiological assessments revealed stability in the cervical spine with both cage types post intervention. Although both materials showed a trend toward increased subsidence over time, the difference between them was not statistically significant. Fusion rates were comparable between the groups at 12 months, with BG cage showing a slightly higher early fusion rate at 6 months. No significant differences were observed between the two groups in terms of complications. CONCLUSIONS: Both allograft and BG cages are effective in ACDF surgeries for cervical degenerative disc disease, with both contributing to substantial postoperative improvements. Differences in disc height, interspinous motion, and subsidence were not significant in the last follow-up, indicating both materials' suitability for clinical use. Future research with a larger cohort and longer follow-up is needed to confirm these preliminary findings.

The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective.

Lumbar interbody fusion stands as a preferred surgical solution for degenerative lumbar spine diseases. The procedure primarily aims to establish lumbar segment stability, directly addressing patient symptoms associated with spinal complications. Traditional open surgery, though effective, is linked with notable morbidities and extended recovery time. To mitigate these concerns, minimally invasive surgery (MIS) has garnered significant popularity, presenting an appealing alternative with numerous benefits such as reduced soft tissue trauma, decreased blood loss, and expedited recovery. Among MIS procedures, full endoscopic spinal surgery, characterized by its minimal invasiveness, holds the potential to further minimize morbidities while enhancing surgical outcomes. Endoscopic lumbar interbody fusion, a novel procedure within this paradigm, has gained attention for offering advantages comparable to those of minimally invasive transforaminal lumbar interbody fusion. However, the safety, efficacy, and associated surgical techniques and instrument design of this method continue to be subjects of ongoing debate. This paper critically reviews current evidence on the safety, efficacy, and advantages of endoscopic lumbar spinal interbody fusion, examining whether it could indeed supersede existing mainstream techniques.

Intradural disc herniation of L2/3: A case report and literature review.

Background: Intradural herniation (IDH) or transdural disc herniation is a rare presentation of lumbar disc disease. Preoperative imaging findings should be carefully and thoroughly interpreted. Although imaging modalities such as computed tomography (CT) or magnetic resonance imaging (MRI) are readily available, a definitive diagnosis cannot be made based solely on these modalities. Operative procedures must be planned to prevent unexpected complications. Case description: A 67-year-old man presented with right lower extremity weakness and numbness with bowel and bladder involvement for 2 weeks, after falling from a standing position. MRI revealed a large herniated disc at L2-L3, which was suspected to be IDH. Posterior discectomy and interbody fusion were also performed. Intraoperative findings revealed no disc material in the epidural space or dural sac tenting. Dorsal midline durotomy was performed, and a mass-like lesion was found and resected. Subsequently, pathological analysis revealed disc tissue with evidence of moderate chronic inflammation and a focal increase in fibrosis. The patient was discharged without complications. Results Outcome: Lower extremity strength improved to grades IV-V, accompanied by a return to normal bowel and bladder function within 1 month, without any wound complications. Lower extremity strength recovered fully to grade V, and the patient started walking independently within 6 months. Conclusions: A large disc herniation, suspected to be an IDH, should be thoroughly investigated by carefully reviewing MRI scans before proceeding with any surgical procedure to prevent unexpected situations. Nonetheless, preoperative imaging alone does not ensure a definitive diagnosis, and the differential diagnosis must include other mass-like lesions. Intraoperative findings and pathological reports are essential for definitive diagnosis of IDH.

Full-Endoscopic Anterior Odontoid Screw Fixation: A Novel Surgical Technique.

OBJECTIVE: First, to propose a novel minimally invasive technique of full-endoscopic anterior odontoid fixation (FEAOF) that aims to reduce the risk of retropharyngeal approach (both open and percutaneous techniques) to anterior odontoid screw fixation. Second, to describe steps of the procedure and, lastly, to report the initial outcomes in patients treated with this novel technique. METHODS: Four non-consecutive patients who were diagnosed with a displaced odontoid fracture (Anderson-D'Alonzo classification type II and Grauer subclassification type A or B) from 2019 to 2020 underwent surgical fixation by our novel technique for anterior odontoid screw fixation. A detailed technical approach of FEAOF for the surgical treatment of type II odontoid fractures was described, and the patients' outcomes based on postoperative radiographic results including computed tomography (CT), clinical outcome parameters including visual analogue scale (VAS) for neck pain both preoperatively and at postoperative follow-up, and range of neck motion at the final follow-up were reported. RESULTS: The mean age was 33.5 years (24-41), three patients were male. The mean operative time was 93.75 min, and the mean blood loss was 7.5 ml. An immediate post-operative thin-sliced CT showed that all patients achieved satisfactory reduction and proper screw position. No screw malposition or penetration was found. At a 6-month follow-up, a thin-sliced CT demonstrated solid bony union in every case. The mean VAS for neck pain was reduced from 6.5 to 0.6 at the 6-months follow-up. At the final follow-up, all patients showed improvement in ranges of motion without any complications; however, one patient was lost to follow-up. CONCLUSIONS: FEAOF is a feasible and effective option for treating type II odontoid fractures. The procedure is less invasive than other techniques and provides clear direct visualization of the involved structures.

Comparative Radiographic Analyses and Clinical Outcomes Between O-Arm Navigated and Fluoroscopic-Guided Minimally Invasive Transforaminal Lumbar Interbody Fusion.

BACKGROUND: The differences in clinical and radiographic outcomes between 3-dimensional computer navigation (NAV) and fluoroscopic-guided (FLUO) minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) are currently unclear, with different studies showing different advantages of each technique. This study aimed to compare the clinical and radiographic outcomes of NAV and FLUO MIS-TLIF. Furthermore, we determined the correlation between radiographic findings and predictable clinical outcomes. METHODS: Between January 2016 and October 2018, 97 consecutive patients who had undergone MIS-TLIF with the lumbosacral degenerative disease in our institute were retrospectively reviewed. Radiographic outcomes (angle of screw convergence, screw-to-pedicle diameter ratio, %screw depth, screw penetration, %fusion, and facet joint violation) were analyzed by 2 independent orthopedists using thin-slice computed tomography. Clinical outcomes were assessed with Oswestry Disability Index (ODI), visual analog scale (VAS), and satisfaction score. The association between radiographic and clinical outcomes was then analyzed to determine the predictable variable outcomes. RESULTS: Sixty-one patients (270 screws) in the FLUO group and 36 patients (172 screws) in the NAV group were compared. The NAV group showed a significantly higher %screw depth (89.04% ± 6.07% vs 85.18% ± 7.54%; P = 0.011), larger angle of screw convergence (27.7° ± 3.93° vs 18.44° ± 7.54°; P < 0.001), lower incidence of pedicle penetration (0% vs 3.7%; P = 0.016), and less facet joint violation (1.0% vs 8.1%; P = 0.003). The clinical results revealed a significantly better VAS and ODI in the NAV group at 6 and 12 months. The %screw depth correlated with the VAS back pain score at the 1-year follow-up. CONCLUSIONS: NAV MIS-TLIF showed superior screw placement accuracy, better screw convergence and depth, and lower cranial facet joint violation than FLUO MIS-TLIF. Furthermore, better clinical scores were revealed in the NAV group at the 6-month and 1-year follow-up.

Trajectory of Lumbar Translaminar Facet Screw Under Navigation: A Cadaveric Study.

STUDY DESIGN: Anatomic cadaver study. OBJECTIVE: Translaminar facet screw fixation supplements unilateral pedicle screw-rod fixation in minimally invasive transforaminal lumbar interbody fusion (TLIF). Various screw diameters, lengths, trajectories, and insertion points are used; however, they do not represent true screw trajectory. We aimed to evaluate lumbar laminar anatomy and suggest a safe and effective insertion point and trajectory during lumbar-translaminar facet screw fixation in an anatomic cadaver study. METHODS: O-arm navigation simulating the true translaminar facet screw trajectory was used to evaluate L1-S1 in cadaveric spines. The inner and outer diameters, length, and trajectory of the screw pathway were measured along the trajectory from the spinous process base through the contralateral lamina, crossing the facet joint to the transverse process base using 2 starting points: cephalad one-third (1/3SL) and one-half (1/2SL) of the spinolaminar junction. RESULTS: Using the 1/2SL starting point, the outer and inner lamina diameters did not differ significantly from L1-L5 (7.47 ± 1.38 to 6.7 ± 1.84 mm and 4.73 ± 1.04 to 3.86 ± 1.46 mm, respectively). Screw length (36.16 ± 4.02 to 49.29 ± 10.07 mm) and lateral angle increased (50.28° ± 8.78° to 60.77° ± 8.88°), but caudal angle decreased (16.19° ± 9.01° to 1.13° ± 11.31°). Lamina diameter and screw length did not differ with different starting points. L2-L3 caudal angles were lower in the 1/2SL starting point. CONCLUSION: A 36- to 50-mm translaminar facet screw-with 5.0-mm diameter for L1-L2 and 4.5-mm diameter for L3-L5-can be inserted at the middle of the spinolamina, especially during minimally invasive TLIF, with a 50° to 60° lateral angle relative to the spinous process, and a caudal angle of 16° to 1° relative to the spinolamina from L1-L5.

Full-endoscopic decompression for thoracic myelopathy caused by ossification of the ligamentum flavum: patient series.

BACKGROUND: This study aimed to describe the least invasive surgical technique of endoscopic decompression for thoracic myelopathy caused by ossification of the ligamentum flavum (OLF) and to review the literature available on the diagnosis and treatment of OLF. OBSERVATIONS: The mean age of the patients was 51.2 (range, 40-62) years, and the mean preoperative, 2-week postoperative, and last follow-up modified Japanese Orthopaedic Association scores were 6.6 (range, 4-10), 9.6 (range, 7-11), and 13 (range, 10-14), respectively. All patients were discharged within 48 hours after the surgery. The mean follow-up period was 13.2 (range, 7-18) months. No complication was found perioperatively, and none of the patients had postoperative instability during the follow-up period. LESSONS: Based on this clinical case series and literature review, the authors conclude that endoscopic decompression surgery is feasible and effective for managing thoracic myelopathy caused by OLF while minimizing surrounding tissue damage. Additionally, it enables shorter periods of hospital stay.