Retrospective Case Control Study: Clinical and Computer Tomographic Fusion and Subsidence Evaluation for Single Level Uniportal Endoscopic Posterolateral Approach Transforaminal Lumbar Interbody Fusion Versus Microscopic Minimally Invasive Transforaminal Interbody Fusion.

STUDY DESIGN: Retrospective comparative study. OBJECTIVE: Assessment of difference in clinical and computer tomographic outcomes between the 2 cohorts. METHODS: Computer tomographic evaluation by Bridwell's grade, Kim's stage, Kim's subsidence grade and clinical evaluation by VAS, ODI and McNab's criteria on both cohorts. RESULTS: 33 levels of Endo-TLIF and 22 levels of TLIF were included, with a mean follow up of 14.3 (10-24) and 22.9 (13-30) months respectively. Both Endo-TLIF and TLIF achieved significant improvement of pain and ODI at post-operative 4 week, 3 months and at final follow up with VAS 4.39 ± 0.92, 5.27 ± 1.16 and 5.73 ± 1.21in Endo-TLIF and 4.55 ± 1.16, 5.05 ± 1.11 and 5.50 ± 1.20 in TLIF respectively and ODI at post-operative 1 week, 3 months and final follow up were 43.15 ± 6.57, 49.27 ± 8.24 and 51.73 ± 9.09 in Endo-TLIF and 41.73 ± 7.98, 46.18± 8.46 and 49.09 ± 8.98 in TLIF respectively, P < 0.05. Compared to TLIF, Endo-TLIF achieved better VAS with 0.727 ± 0.235 at 3 months and 0.727 ± 0.252 at final follow up and better ODI with 3.88 ± 1.50 at 3months and 3.42 ± 1.63 at final follow up, P < 0.05. At 6 months radiological evaluation comparison of the Endo-TLIF and TLIF showed significant with more favorable fusion rate in Endo-TLIF of -0.61 ± 0.12 at 6 months and -0.49 ± 0.12 at 1 year in Bridwell's grading and 0.70 ± 0.15 at 6 months and 0.56 ± 0.14 at 1 year in Kim's stage.There is less subsidence of 0.606 ± 0.18 at 6 months and -0.561 ± 0.20 at 1 year of Kim's subsidence grade, P < 0.05. CONCLUSION: Application of single level uniportal endoscopic posterolateral lumbar interbody fusion achieved better clinical outcomes and fusion rate with less subsidence than microscopic minimally invasive transforaminal lumbar interbody fusion in mid-term evaluation for our cohorts of patients.

Comparative Clinical and Radiographic Cohort Study: Uniportal Thoracic Endoscopic Laminotomy With Bilateral Decompression by Using the 1-Block Resection Technique and Thoracic Open Laminotomy With Bilateral Decompression for Thoracic Ossified Ligamentum Flavum.

BACKGROUND: Symptomatic thoracic myelopathy secondary to thoracic ossified ligamentum flavum (OLF) often requires decompression spinal surgery. OBJECTIVE: To compare clinical and radiological outcomes in uniportal endoscopic vs open thoracic decompression for thoracic OLF. METHODS: Retrospective evaluation of patients who underwent uniportal thoracic endoscopic unilateral laminotomy with bilateral decompression (TE-ULBD) by using the one-block resection technique compared with thoracic open laminotomy (TOL) with bilateral decompression. Radiological outcomes in MRI scan and clinical charts were evaluated. RESULTS: Thirty-five levels of TE-ULBD were compared with 24 levels of TOL. The overall complication rate of TOL was 15% while TE-ULBD was 6.5%. Both TOL and TE-ULBD cohort had significantly improved their visual analog scale (VAS), Oswestry Disability Index, and Japanese Orthopaedic Association (JOA) myelopathy score after operation. Comparative analysis of TE-ULBD performed statistically and significantly better than TOL in improvement of final VAS and JOA scores. The mean difference ± standard deviation of VAS and JOA improvement in final follow-up when compared with preoperative state of TE-ULBD and TOL was 0.717 ± 0.131 and 1.03 ± 0.2, respectively, P < .05. The mean Hirabayashi recovery rates were 94.5% (TE-ULBD) and 56.8% (TOL). There was no statistical difference in change in preoperative and final Oswestry Disability Index and MRI volume at upper endplate, middisk, and lower endplate canal cross-sectional area. CONCLUSION: Uniportal TE-ULBD achieved significantly improved pain and neurological recovery with sufficient spinal canal decompression, as compared with thoracic open laminectomy for patients with myelopathy secondary to OLF in our cohort.

The Novel Technique of Uniportal Endoscopic Interlaminar Contralateral Approach for Coexisting L5-S1 Lateral Recess, Foraminal, and Extraforaminal Stenosis and Its Clinical Outcomes.

BACKGROUND: Multifocal intra-and-extraspinal lumbar stenotic lesions could be decompressed with one endoscopic surgical approach, which has the advantages of functional structure preservation, technical efficacy, and safety. METHODS: A retrospective study was performed on 48 patients who underwent uniportal endoscopic contralateral approach due to coexisting lateral recess, foraminal, and extraforaminal stenosis at the L5-S1 level. Foraminal stenosis grade and postoperative dysesthesia (POD) were analyzed. Visual analog scale (VAS) pain scores, modified Oswestry Disability Index (ODI) scores, and MacNab criteria for evaluating pain disability and response were analyzed. RESULTS: The foraminal stenosis grade of the treated spinal levels was grade 1 (n = 16, 33%), grade 2 (n = 20, 42%), and grade 3 (n = 12, 25%). The rate of occurrence of POD grade 2 and above, which may be related to intraoperative dorsal root ganglion (DRG) retraction injury, was revealed to be 4.2% (two with grade 2, none with grade 3). The patients showed favorable clinical outcomes. CONCLUSIONS: Uniportal endoscopic interlaminar contralateral approach is an effective procedure to resolve combined stenosis (lateral recess, foraminal, and extraforaminal region) with one surgical approach at the L5-S1 level. It may be a minimal DRG retracting and facet joint preserving procedure in foraminal and extraforaminal decompression.

Anatomical Importance Between Neural Structure and Bony Landmark: Clinical Importance for Posterior Endoscopic Cervical Foraminotomy.

OBJECTIVE: Posterior endoscopic cervical foraminotomy (PECF) is a well-established, minimally invasive surgery for cervical radiculopathy, but have the more chances of neural structure damage due to the limited visibility and steeper learning curve. So, the anatomical understanding of the nerve associated with the bony structure will be an essential surgical guideline. METHODS: We measured the distance between the bilateral dura lateral edge and bilateral V-point on axial cuts of cervical magnetic resonance imaging and 3-dimensional spine computed tomography imaging, respectively, from 80 patients. We then calculate the distance and position between the dura lateral edge and the V-point as surgically critical width (SCW). Transverse interdural distance (TIDW), transverse inter-V-point distance, and anatomical facet joint width were measured. RESULTS: The mean TIDW decreased as the levels down in the 40s-60s but increased at the C4-5, C5-6, and C6-7 levels in the 70s. Statistically significant difference was shown at the C6-7 level between the 40s and the 70s. The mean anatomical inter-V-point distance markedly decreased at C5-6 and continued till the C7-Tl level at all age groups. Moreover, a statistically significant difference was shown at the C3-4 and C4-5 level between the 40s and the 70s. The mean negative values of SCW increased from the 40s to 70s at the C5-6 and C6-7 levels (C5-6: -0.60 ± 1.10 mm to -1.63 ± 1.56 mm; C6-7: -0.90 ± 0.74 mm to -2.18 ± 1.25 mm). There were statistically significant differences between the 2 aged groups at the C3-4, C4-5, C5-6, and C6-7 levels. CONCLUSION: A prediction of the correlated position between the lateral dura edge and the V-point is essential for the PECF not to injure the neural structure. In the case of a performing the PECF at the C5-6 and C6-7 level in the old-aged patient, it should be considered the laterally moved dura edge, and more extended bony remove is needed for less neural structure damage.

Reprint of: Safe Route for Cervical Approach: Partial Pediculotomy, Partial Vertebrotomy Approach for Posterior Endoscopic Cervical Foraminotomy and Discectomy.

BACKGROUND: Cervical radiculopathy is a common cervical spine condition. However, a paucity of data is available on the effect of partial pediculotomy and partial vertebrotomy (PPPV) for posterior endoscopic cervical foraminotomy (PECF) to treat cervical radiculopathy. We investigated the radiological and clinical outcomes of this approach. METHODS: We performed a retrospective evaluation of 30 patients with cervical radiculopathy who had undergone PPPV PECF. Pre- and postoperative radiographs were performed to evaluate for stability, and computed tomography (CT) was used to evaluate the foraminal dimensions and area in the sagittal view. Three-dimensional reconstruction of the area of decompression was also performed. The clinical outcomes were evaluated using the visual analog scale, Oswestry disability index, and the MacNab criteria. RESULTS: No complications or recurrence developed in our PPPV PECF cohort during the study period. At the preoperative, 1-week postoperative, 3-month postoperative, and final follow-up examinations, the mean visual analog scale scores and mean Oswestry disability index showed significant improvement (score, 7.6, 3.0, 2.1, and 1.7, respectively; P < 0.05; and score, 73.9, 28.1, 23.3, and 21.5, respectively; P < 0.05). All the patients scored good to excellent using the MacNab criteria. The radiological findings showed that PPPV PECF resulted in a significant increase in decompression in the foramen area for all CT-measured parameters compared with the mean preoperative values: 1) the sagittal area increased 60.1 ± 23.1 mm2; 2) the craniocaudal length increased 4.0 ± 1.54 mm; and 3) the ventrodorsal length increased 4.0 ± 1.97 mm; Also, the 3-dimensional CT scan reconstruction decompression area had increased 996 ± 266 mm2 (P < 0.05). CONCLUSION: PPPV PECF is a safe route for decompression of the cervical spine with good clinical and radiological outcomes.

Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note.

BACKGROUND: Severe collapsed disc secondary to degenerative spinal conditions leads to significant foraminal stenosis. We hypothesized that uniportal posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling technique could be safely applied to the collapsed disc space to improve patients' pain score, restore disc height, and correct the segmental angular parameters. METHODS: We included patients who met the indication criteria for lumbar fusion and underwent uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with pre-operative Computer Tomography mid disc height of less than or equal to 5 mm and MRI of Grade 3 Foraminal Stenosis. Visual analogue scale and computer tomography pre-operative and post-operative sagittal disc height in the anterior, middle and posterior part of the disc; sagittal focal segmental angle; mid coronal disc height and coronal wedge angles were evaluated. RESULTS: 30 levels of Endo-TLIF were included, with a mean follow up of 12 months. The mean improvement in decreasing pain score was 2.5 ± 1.1, 3.2 ± 0.9 and 4.3 ± 1.0 at 1 week post operation, 3 months post operation and at final follow up, respectively, p < 0.05. There was significant increase in mid sagittal computer tomographic anterior, middle and posterior disc height of 6.99 ± 2.30, 6.28 ± 1.44, 5.12 ± 1.79 mm respectively, p < 0.05. CT mid coronal disc height showed an increase of 7.13 ± 1.90 mm, p < 0.05. There was a significant improvement in the CT coronal wedge angle of 2.35 ± 4.73 and the CT segmental focal sagittal angle of 1.98 ± 4.69, p < 0.05. CONCLUSION: Application of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion in patients with severe foraminal stenosis secondary to severe collapsed disc space significantly relieved patients' pain and restored disc height without early subsidence or exiting nerve root dysesthesia in our cohort of patients.

Safe Route for Cervical Approach: Partial Pediculotomy, Partial Vertebrotomy Approach for Posterior Endoscopic Cervical Foraminotomy and Discectomy.

INTRODUCTION: Cervical radiculopathy is a common cervical spine condition. There is a paucity of literature discussing the effect of partial pediculotomy and partial vertebrotomy for posterior endoscopic cervical foraminotomy (PPPV PECF) on cervical radiculopathy. We investigated the radiologic and clinical outcomes of this approach. METHODS: This was a retrospective evaluation of 30 cases with cervical radiculopathy who underwent PPPV PECF. Preoperative, postoperative roentgenogram for evaluation of stability, computed tomography (CT) evaluation of foraminal dimensions, and area in sagittal view was performed. Three-dimensional reconstruction area of decompression evaluation was performed. Clinical outcomes of the visual analog scale, Oswestry Disability Index, and Macnab score were evaluated. RESULTS: There was no complication and recurrence in our PPPV PECF cohort during the study period. At preoperative, 1 week postoperative, and 3 months postoperative and final follow-up, the mean visual analog scale score had significant improvement, with scores of 7.6, 3.0, 2.1, and 1.7, respectively, P < 0.05, and also the mean Oswestry Disability Index, with scores of 73.9, 28.1, 23.3, and 21.5 respectively, P < 0.05. Macnab criteria showed all patients scoring good and excellent. Radiologic results showed PPPV PECF had a significant increase in decompression in the foramen area in all CT-measured parameters, as compared with the mean preoperative values; 1) sagittal area increased 60.1 ± 23.1 mm2, 2) CT craniocaudal length increased 4.0 ± 1.54 mm, 3) CT ventrodorsal length increased 4.0 ± 1.97 mm, and 4) 3-dimensional CT scan reconstruction decompression area increased 996 ± 266 mm2, P < 0.05. CONCLUSIONS: PPPV PECF is a safe route of decompression of cervical spine with good clinical and radiologic outcome.