Clinical Outcomes of Interlaminar Percutaneous Endoscopic Uniportal Pars Decompression for Lumbar Spondylolysis.

BACKGROUND: To evaluate the clinical and radiological outcomes of a novel full endoscopic procedure performed via an interlaminar approach to decompress entrapped nerve roots in patients with lumbar spondylolysis. METHODS: Patients who underwent interlaminar percutaneous endoscopic pars decompression were included in this retrospective cohort study. Patients with back pain and dynamic lumbar instability were excluded from the study. Clinical parameters related to outcomes, including the Oswestry Disability Index (ODI) and visual analog scale (VAS) for leg pain, were assessed before and after surgery. The radiological outcomes, vertebral slippage percentage, and motion radiographs were evaluated preoperatively and postoperatively. RESULTS: Of the 11 patients included in the study, 5 had spondylolysis alone, 1 of whom had spondylolysis at L3-L4 and L4-L5, and 4 of whom had it at L5-S1; and 6 patients had spondylolysis in combination with spondylolisthesis, of whom 4 had involvement at L5-S1, 1 had involvement at L4-L5, and 1 had involvement at L3-L4. At a mean follow-up period of 22.64 months, 63.3% of patients achieved more than 50% improvement in ODI score and 90.91% of patients achieved more than 50% improvement in VAS score. Spondylolysis with vertebral slippage had inferior ODI improvement outcomes as compared with spondylolysis alone, but the VAS was not significantly different. No significant difference was observed on the slippage percentage observed between the pre- and postoperative periods. However, 1 patient experienced vertebral slippage after surgery, but fusion surgery was not required. CONCLUSIONS: Interlaminar percutaneous endoscopic pars decompression is a safe and successful treatment for patients with stable lumbar spondylolysis and nerve root compression. Even in situations in which vertebral slippage occurs, spinal fusion may not be the best option for all patients with lumbar spondylolysis. CLINICAL RELEVANCE: The interlaminar percutaneous endoscopic pars decompression is a safe and successful procedure for treatment of patients with stable lumbar spondylolysis and nerve root compression.

Surgeons' Perspective, Learning Curve, Motivation, and Obstacles of Full-Endoscopic Spine Surgery in Thailand: Results From A Nationwide Survey.

Objective: To report a nationwide survey of the endoscopic spine surgeons across Thailand. Furthermore, the survey will be focused on the perspective of experience, learning curve, motivations, and obstacles at the beginning of their practices. Materials and Methods: The online survey consisting of 16 items was distributed to spine surgeons who are performing endoscopic spine surgery in Thailand via the Google forms web-based questionnaire to investigate participants' demographics, backgrounds, experience in endoscopic spine surgery, motivations, obstacles, and future perspectives. The data was recorded from January 7, 2020 to January 21, 2022. Descriptive statistics were used for analysis. Results: A total of 42 surveys were submitted by 6 neurosurgeons (14.3%) and 36 orthopedic surgeons (85.7%). From the surgeons' perspective, the average number of cases that should be performed until one feels confident, consistently good outcomes, and has minimal complications was 27.44 ± 32.46 cases. For surgeons who starting the endoscopic spine practice, at least 3 workshop participation is needed. Personal interest (39 selected responses) and trending marketing or business purpose (25 selected responses) were the primary motivators for endoscopic spine surgery implementation. Lack of support (18 selected responses) and afraid of complications (16 selected responses) were pertinent obstacles to endoscopic spine surgery implementation. Conclusions: The trend of endoscopic spine surgery has continued to grow in Thailand, shown by the rate of implementation of endoscopic spine surgery reported by Thai spine surgeons. The number of appropriate cases until one feels confident was around 28 cases. The primary motivator and obstacles were personal interest and lack of support.

Clinical Outcomes of Interlaminar Percutaneous Endoscopic Decompression for Degenerative Lumbar Spondylolisthesis with Spinal Stenosis.

The use of traditional open decompression alone in degenerative spondylolisthesis can lead to the development of postoperative spinal instability, whereas percutaneous endoscopic decompression can preserve the attachment of intervertebral muscles, facet joint capsules, and ligaments that stabilize the spine. The study's aim was to determine clinical as well as radiologic outcomes associated with interlaminar percutaneous endoscopic decompression in patients with stable degenerative spondylolisthesis. For this study, 28 patients with stable degenerative spondylolisthesis who underwent percutaneous endoscopic decompression were enrolled. The clinical outcomes in terms of the visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated. Radiologic outcomes were determined by measuring the ratio of disc height and the vertebral slippage percentage using lateral standing radiographs. The average follow-up period was 25.24 months. VAS and ODI were significantly improved at the final follow-up. In terms of ratio of disc height and vertebral slippage percentage found no significant difference between the preoperative and postoperative periods. One patient underwent further caudal epidural steroid injection. One patient underwent fusion because their radicular pain did not improve. Interlaminar percutaneous endoscopic decompression is an effective procedure with favorable outcomes in selected patients with stable degenerative spondylolisthesis.

Effects of posterior condylar osteophytes on gap balancing in computer-assisted total knee arthroplasty with posterior cruciate ligament sacrifice.

OBJECTIVE: Gap planning in navigated total knee arthroplasty (TKA) is a critical concern. Osteophytes are normally removed prior to gap planning, with the exception of posterior condylar osteophytes of the femur, which are removed after posterior condylar resection. This study investigated how posterior condylar osteophytes affect gap balancing during surgery. METHODS: This prospective study was conducted on 40 primary varus osteoarthritic knees with a posterior condylar osteophyte that underwent TKA navigation. For all knees, computed tomography (CT) was performed to evaluate osteophyte position. The extension gap and flexion gap were determined under navigation using a tension device with a distraction force of 44 lb. The extension gap and flexion gap were measured before and after osteophyte removal. RESULTS: This study revealed that the average osteophyte thickness after removal was 7.75 ± 5.34 mm. The average extension gap change was 0.64 ± 0.80 mm, and the average flexion gap change was 0.85 ± 1.12 mm. With respect to increases in the medial extension gap, lateral extension gap, medial flexion gap and lateral flexion gap, the average effects of posterior condylar osteophyte removal were 0.74 ± 0.81 mm, 0.53 ± 0.96 mm, 0.71 ± 0.97 mm and 1.00 ± 1.41 mm, respectively. Posterior condylar osteophyte thickness was also significantly associated with increases in the lateral extension gap (R2 = 0.107, p = 0.03), medial flexion gap (R2 = 0.101, p = 0.04) and lateral flexion gap (R2 = 0.107, p = 0.04). CONCLUSION: These results indicated that posterior condylar osteophytes of the femur affect gap balancing during TKA navigation.

Lateral Release Can Increase Range of Flexion during Computer Assisted Total Knee Arthroplasty with Patellar Maltracking.

Objective: The patellar tracking is an important factor that affect range of motion after total knee arthroplasty (TKA). Intraoperative patellar maltracking during TKA can be improved by performing lateral release. We hypothesized that TKA with patellar maltracking after undergoing lateral release can increase intraoperative range of flexion. Material and Method: A prospective study was conducted on 110 knees that underwent computer assisted TKA. The patellar tracking was assessed with no thumb test technique. Fifty-two knees were classified into negative no thumb test group, and 58 knees were classified into positive no thumb test group. The positive no thumb test group further received lateral release with outside to inside technique. The range of flexion was recorded before and after final implantation in both groups, and recorded after lateral release in positive no thumb test group. Results: After final implantation, the negative no thumb test group had significant greater flexion angle than the positive no thumb test group (128.20° and 123.90°). The range of flexion after performing the lateral release in positive no thumb test group increased the flexion up to 127.60°. Thus, there was no significant difference from the negative no thumb test group (128.20°). After the lateral release was performed, the flexion angle had significantly increased by 3.70°. Conclusion: The results indicated that intraoperative lateral release in patellar maltracking can improve range of flexion in computer assisted TKA.

Influence of a secondary downsizing of the femoral component on the extension gap: a cadaveric study.

The purpose of this study was to evaluate the effect of a secondary reduction of the femoral component size on flexion and extension gaps intraoperatively in posterior-stabilized total knee arthroplasty (PS-TKA) monitored by computer-assisted surgery. The authors hypothesized that cutting additional bone on the posterior femoral condyle may increase the extension gap due to the posterior capsule and soft tissue loosening. Reduction of the femoral component size was performed by additional 4-in-1 cuts after the PS-TKA on 15 cadaveric knees using a ligamentous tension device with the aid of computer-assisted surgery. Measurements of the medial and lateral flexion gaps, as well as the medial and lateral extension gaps, were recorded before and after reducing the femoral component size. Trial components were used from a mobile-bearing total knee system.After reducing the femoral component size, the medial and lateral flexion and extension gaps measured larger than their initial size. The mean increases of the medial extension and flexion gaps and the lateral extension and flexion gaps were 1.3 ± 0.9, 1.0 ± 1.2, 1.1 ± 1.2, and 1.3 ± 1.3 mm, respectively; all 4 differences were significant (P ≤ .05). Surgeons should be aware of the effect of downsizing components intraoperatively because it might lead to an extension laxity. Thus, a downsizing of the femoral component may compromise the postoperative stability of TKA.

Radiographic assessment in bilateral primary total knee arthroplasty: computer-assisted surgery vs. conventional surgery.

OBJECTIVE: The purpose of this retrospective study is to compare the efficiency of computer-assisted surgery (CAS) and conventional method (CONV) in TKA using mechanical axis (MA) and component alignment measured on the post-operative radiograph in the same patient by different technique for TKA on both sides of the knee. MATERIAL AND METHOD: Fifty-two TKA in twenty-six patients with primary osteoarthritis of both knees that underwent stage bilateral TKA by computer-assisted surgery one side and conventional method on the other side were inclusion criteria. Digital long-leg weight-bearing radiographs were taken. The mechanical axis (MA), femoral component in coronal plane (FFC), tibial component in coronal plane (FTC), femoral component in sagittal plane (SFC) and tibial component in sagittal plane (STC) were measured and compared. RESULTS: The MA indicated that computer-assisted surgery (CAS) is significantly improved accuracy compared with conventional method (178.12 degrees +/- 1.56 degrees and 176.15 degrees +/- 1.85 degrees respectively p = 0.00). For FFC alignment, the results showed that CAS group is significantly more accurate than CONV group (88.58 degrees +/- 1.30 degrees and 87.38 degrees +/- 2.02 degrees respectively, p = 0.07). CAS group showed less distribution and fewer outliers of data than CONV group. For FTC, SFC and STC alignment, the means of both groups were no difference (p > 0.05). Otherwise, the numbers of outlier CONV group trend toward greater than CAS group (FTC 3.8% and 0%, SFC 30.8% and 0%, respectively). There was no report of change in the navigator group procedure to conventional method during surgery and no perioperative or postoperative complications were noted. CONCLUSION: Computer-assisted surgery (CAS) is a safe and useful intraoperative tool for total knee arthroplasty to improve accuracy of mechanical axis, good implant position and reduce number of postoperative implant outlier. Clinical studies will be required for clinical outcome assessment.

Comparison of clinical and radiographic outcomes between minimally invasive lateral approach and mini-midvastus approach in total knee arthroplasty.

OBJECTIVE: To compare clinical and radiographic outcome between minimally invasive lateral approach and mini-midvastus approach in total knee arthroplasty. MATERIAL AND METHOD: Patients with 28 knees were underwent total knee arthroplasty. They were divided into two groups. 14 knees were underwent total knee arthroplasty with lateral approach and the other 14 knees were operated with mini-midvastus approach. Clinical evaluation was done with visual analog scale from the second day to the fifth day after surgery. WOMAC score and range of motion was recorded at the third month. Including operative time and incision length was evaluated. Prosthetic component angles was measured with radiographic evaluation at the third month. RESULTS: The results revealed no significant difference between lateral approach and mini-midvastus approach in terms of visual analog scale, incision length, operative time, range of motion, WOMAC score and prosthetic alignment. CONCLUSION: Lateral approach in total knee arthroplasty had no difference clinical and radiographic outcomes compare with mini-midvastus approach.