A 30-Year Worldwide Research Productivity of Scientific Publication in Full-Endoscopic Decompression Spine Surgery: Quantitative and Qualitative Analysis.

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.

Unilateral Bi-portal Endoscopic Decompression via the Contralateral Approach in Asymmetric Spinal Stenosis: A Technical Note.

We discuss the technical details and operative advantages of approaching pathologies from the contralateral side in cases of asymmetric spinal stenosis. The contralateral approach offers better manipulative freedom and a more accessible target approach along the plane of the pathology, allowing safer decompression and facet preservation; further, this approach is ergonomic for surgeons. We recommend the adoption of this approach in decompressing asymmetric spinal stenosis.

Full Endoscopic Technique for High-Grade Up-Migrated Lumbar Disk Herniation via a Translaminar Keyhole Approach: Preliminary Series and Technical Note.

BACKGROUND AND STUDY AIMS: Technically and anatomically, accessing a high-grade migrated lumbar disk herniation (LDH) using traditional full endoscopic lumbar diskectomy (FELD) approaches (either transforaminal or interlaminar) is challenging. The objective of this study was to present an effective and safe surgical approach for high-grade up-migrated LDH by translaminar FELD. PATIENTS AND METHODS: Thirteen patients with soft high-grade up-migrated LDH treated with a translaminar FELD between May 2015 and July 2018 were reviewed in this study. Five of these patients had very high-grade up-migration. Clinical outcomes were assessed including preoperative and postoperative visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria. RESULTS: Overall, 7 of the 13 patients had disk-fragment migration at L4-L5: three at L5-S1, two at L3-L4, and the remaining one at L2-L3. In all cases, the highly up-migrated LDH was removed successfully through the translaminar approach, as confirmed by postoperative magnetic resonance imaging. The improvements of VAS for back and leg pain were 4.5 ± 0.9 to 1.3 ± 1.3 and 7.1 ± 1.0 to 1.6 ± 0.7, respectively (both p < 0.05). The ODI decreased from preoperative 41.9 ± 6.0 to postoperative 13.0 ± 4.1 (p < 0.05). According to the MacNab criteria, the satisfaction rate was 92.3% (excellent or good outcomes). None of the patients experienced any perioperative complications or recurrence during the follow-up period. CONCLUSION: Although full endoscopic technique via the translaminar keyhole route may not be used as a routine surgical approach, it could serve as a feasible alternative method for patients with highly up-migrated disk herniation.

Does the Neck Pain, Function, or Range of Motion Differ After Anterior Cervical Fusion, Cervical Disc Replacement, and Posterior Cervical Foraminotomy?

OBJECTIVE: To evaluate clinical and radiologic results as well as biomechanical changes after anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), and posterior cervical foraminotomy (PCF) and/or discectomy in individuals with unilateral single-level cervical radiculopathy. METHODS: A total of 97 patients received surgical treatment for unilateral intolerable radiculopathy between February 2012 and August 2017. Clinical outcomes included Neck Disability Index (NDI), visual analogue scale (VAS) for neck and arm pain, and modified Odom's criteria. Range of motion (ROM) of the whole cervical (C-ROM), operated segment (S-ROM), and upper and lower adjacent segment (U-ROM and L-ROM) were measured. RESULTS: A total of 55 ACDFs, 21 CDRs, and 21 PCFs were performed. Clinical improvement in NDI and VAS scores were significant after surgery; however, there was no statistical significance among groups. Satisfaction rate (based on Odom's criteria) of PCF (76.2%) was inferior to that of ACDF (90.9%) and CDR (90.5%) without statistical difference. S-ROM, U-ROM, and L-ROM were slightly better in the CDR and PCF groups, without statistical significance. C-ROM significantly increased in CDR group (P = 0.04) and slightly increased in PCF group (P = 0.27). In the ACDF group, C-ROM decreased (P = 0.21) and on the contrary, the U-ROM and L-ROM increased (P > 0.05). CONCLUSIONS: ACDF, CDR, and PCF resulted in pain relief and improvement in neck function for patients with unilateral radiculopathy. Comparatively, ACDF provides the lowest reoperation rate. CDR is effective in ameliorating cervical ROMs. PCF has a greater probability of reoperation; however, ROM after surgery is better than with ACDF.

Dimensions of the spinous process and interspinous space: a morphometric study.

PURPOSE: To measure the morphological dimensions of the spinous process (SP) and interspinous space, and provide a basis for the development of interspinous devices for the Korean or East Asian populations. METHODS: We retrospectively analyzed the anatomical parameters of 120 patients. The parameters included height, length, and width of SP, interspinous distance (supine, standing, and dynamic), cortical thickness of SP, and spino-laminar (S-L) angle. Correlations between measurements, age, and gender were investigated. RESULTS: The largest height, length, and cortical thickness and S-L angle were noted at L3. The largest width was observed at S1. The interspinous distance decreased significantly from L2-3 to L5-S1 and was significantly larger in the supine than in standing posture for L5-S1. Cortical thickness was gradually tapered from the anterior to the posterior position. The S-L angle at L2 and L3 was similar and significantly decreased from L3 to S1. An increased trend in width with aging and a decreased trend in distance (supine) were noted. A significant increase in height, length, and distance in males compared with females was also observed. CONCLUSIONS: The interspinous space is wider at the anterior, and the cortex is thicker anteriorly. Accordingly, it appears that the optimized implant position lies in the interspinous space anteriorly. The varying interspinous space with different postures and gradually narrowing with age suggest the need for caution when sizing the device. Gender differences also need to be considered when designing implantable devices.

Anterior transcorporeal tunnel approach for cervical myelopathy guided by CT-based intraoperative spinal navigation: Technical note.

Cervical spondylotic myelopathy (CSM) is the most common degenerative disease of the spine in elderly patients. Although there are several surgical options for the treatment of this disease, minimally invasive techniques for localized decompression of the true clinical generator of the patient's disease has revolutionized spinal surgery recently. This article presents an alternate application of the anterior transcorporeal tunnel approach in combination with computed tomography (CT)-based intraoperative navigation in the treatment of patients with cervical myelopathy secondary to spondylosis. Three clinical cases are used as examples to demonstrate how this procedure can be used to decompress a localized target in cervical spondylotic myelopathy. Clinical images of each case are shown. Cervical decompression was successfully achieved in all three patients, with the improvement of preoperative symptoms. The anterior transcorporeal tunnel approach combined with the use of CT-based intraoperative spinal navigation may be a feasible minimally invasive procedure for the treatment of cervical spondylotic myelopathy in selected cases.