Pain improvement and reoperation rate after full-endoscopic decompression for lateral recess stenosis: a 10-year follow-up.

PURPOSE: To share long-term clinical outcomes and our experience with full-endoscopic interlaminar decompression (FEI) for lateral recess stenosis (LRS). METHODS: We included all patients who underwent FEI for LRS from 2009 to 2013. VAS for leg pain, ODI, neurological findings, radiographic findings, and complications were analyzed at one week, one month, three months, and one year postoperation. The telephone interview for local patients with simple questions was done approximately ten years after the operation. International patients receive an email with the same questionnaire as local patients during the same follow-up period. RESULTS: One hundred and twenty-nine patients underwent FEI for LRS with complete data during 2009-2013. Most of the patients (70.54%) had LRS radiculopathy for less than one year, mainly L4-5 (89.92%), followed by L5-S1 (17.83%). Early outcomes three months after surgery showed that most patients (93.02%) reported significant pain relief, and 70.54% reported no pain at their ODI scores were significantly reduced from 34.35 to 20.32% (p = 0.0052). In contrast, the mean VAS for leg pain decreased substantially by 3.77 points (p < 0.0001). There were no severe complications. At ten years of follow-up, 62 patients responded to the phone call or email. 69.35% of the patients reported having little or no back or leg pain, did not receive any further lumbar surgery, and were still satisfied with the result of the surgery. There were six patients (8.06%) who underwent reoperation. CONCLUSION: FEI for LRS was satisfactory at 93.02%, with a low complication rate during the early follow-up period. Its effect seems to decline slightly in the long term at a 10-year follow-up. 8.06% of the patients subsequently underwent reoperation.

Bilateral Lumbar Facet Synovial Cysts as a Cause of Radiculopathy.

Remarkable advancements in endoscopic spinal surgery have led to successful outcomes comparable to those of conventional open surgery with the benefits of less traumatization and postoperative spinal instability. Bilateral lumbar facet cysts are rarely found in the spinal canal. We report a rare case of L4-L5 bilateral lumbar facet cysts compressing the nerve root in a patient who presented with L5 radiculopathy. Endoscopic decompression and removal of the cysts without fusion were performed. Histopathology revealed synovial cysts. Postoperatively, the patient showed a total resolution of symptoms with sustained benefits at the final evaluation. No recurrence of pain and no further segmental instability were observed at the 1-year follow-up.

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.

Posterior epidural sequestrated disc presenting with contralateral radiculopathy: a very rare case.

INTRODUCTION: Posterior epidural sequestrated disc is a fairly uncommon condition. We report a case of an unusual presentation of posterior epidural migration with contralateral symptoms. We emphasize a high index of suspicion for early recognition and treatment to promote a good neurological recovery. CASE PRESENTATION: A 58-year-old man with a history of severe back pain for 1 week developed sudden right leg weakness while walking. Neurological examination revealed motor and sensory impairments of the right lower extremities (positive right straight leg raising test, right tibialis anterior grade 2/5, right extensor hallucis longus grade 1/5, decreased pinprick sensation of L4-5 dermatome right side) according to the Standards for Neurological Classification of Spinal Cord Injury as Asia Impairment Scale D. Magnetic resonance images showed an acute disc herniation at L4-5 on the left side, cranially migrated and sequestrated to the posterior epidural area, causing severe compression to the cauda equina in the thecal sac. The patient was successfully treated with surgery (transforaminal lumbar interbody fusion) on an urgent basis. We saw significant neurological recovery on the first day after surgery. Motor power recovery was achieved with a minor deficit at 4 weeks. At the follow-up examination at 3 months, the patient had no residual neurological deficits as Asia Impairment Scale E. DISCUSSION: Posterior epidural sequestrated disc with contralateral radiculopathy is very rare. This case brings a new presentation of posterior epidural sequestrated disc. To our knowledge, this is the first report of a case with an unusual presentation of contralateral radiculopathy.

Full-Endoscopic Interlaminar Lumbar Discectomy: Retrospective Review of Clinical Results and Complications in 545 International Patients.

BACKGROUND: Minimally invasive techniques have been developed to provide access to the disc with better visualization while causing less muscle trauma and its consequences. This study was aimed at evaluating the clinical outcomes and complications of the fully endoscopic lumbar discectomy interlaminar approach in a large number of patients. METHODS: Patients diagnosed with lumbar herniated nucleus pulposus who underwent fully endoscopic interlaminar lumbar discectomy between 2011 and 2016 were reviewed. Perioperative data, preoperative and postoperative Oswestry Disability Index (ODI) scores, visual analog scale (VAS) back pain scores, VAS leg pain scores, and complications were evaluated and recorded at 1 week and 3 and 6 months postoperatively and each year thereafter. RESULTS: The study cohort comprised 545 patients (average age, 46.43 years; 34.31% female). The affected levels were L2-3 in 1.47%, L3-4 in 6.96%, L4-5 in 49.45%, and L5-S1 in 44.69%. Mean preoperative ODI, VAS back pain score, and VAS leg pain score were 43.00%, 5.00, and 5.69, respectively. Postoperative ODI at 1 month was reduced to 15.59% and remained within a range of 14.83%18.32% throughout follow-up. Postoperative VAS back and leg pain score results at 1 week were decreased to 1.66 and 1.79, respectively, and remained at 1.89-3.14 and 1.59-2.66, respectively, throughout follow-up. Sixty-six recurrences (12.11%) were diagnosed. Intraoperative complications were nerve root-related (n = 3) and dural tear (n = 1). Postoperative complications included numbness (n = 18), weakness (n = 5), and residual disc (n = 1). No infections or hematomas were reported. CONCLUSIONS: Fully endoscopic interlaminar lumbar discectomy is a safe, effective option for treating lumbar disc herniation, with a long recurrence-free recovery.

Comparison between minimally invasive and open transforaminal lumbar interbody fusion.

OBJECTIVE: To compare the clinical and radiographic outcomes between minimally invasive and open transforaminal lumbar interbody fusion (TLIF) for treatment of lumbar spondylolisthesis MATERIAL AND METHOD: A retrospective clinical study of24 consecutive cases of lumbar spondylolisthesis treated by minimally invasive TLIF (n = 12) or open TLIF (n = 12) was done at Ramathibodi Hospital between June 2008 and December 2009. The following parameters were compared between the two groups, clinical and radiographic outcomes, blood loss, operative time, length of hospital stay, and complications. RESULTS: The average duration of follow-up was 28 months (range, 24 months to 38 months). There was significantly less intra-operative blood loss in minimally invasive TLIF group comparing to open TLIF group (317 cc vs. 645.83 cc: p-value = 0.04). No significant difference was observed in clinical outcomes (VAS or ODI at 2years), radiographic outcome (91.67% fusion rate in both groups), operative time (340 minutes vs. 324 minutes: p-value = 0.96) length of hospital stay (8.42 days vs. 8.33 days: p-value = 0.09) and major complication (8.33% in both groups) between the two groups. CONCLUSION: Minimally invasive TLIF has similar clinical outcomes and fusion rate compared to open TLIF with additional benefit of less intra-operative blood loss. However the operative field of this technique is limited so thorough knowledge of anatomy in this region is required

Factors predicting failure of conservative treatment in lumbar-disc herniation.

OBJECTIVE: To explore factors predicting failure of conservative treatment in lumbar-disc herniation. BACKGROUND: Sciatica due to lumbar-disc herniation is a common complaint of spine patients. Even though the natural course is favorable, surgery is necessary in at least 10% of cases. Current trends show surgery to be more cost-effective than prolonged conservative care. However; there is limited information about the usefulness of clinical and radiographic parameters to classify patients who are likely to fail conservative treatment. MATERIAL AND METHOD: Medical records of patients diagnosed with lumbar-disc herniation between January 1, 2007 and December 31, 2009 were studied. The records of patients in conservative and surgery groups were compared, for clinical features, MRI results and treatment modalities. RESULTS: Fifty cases (discectomy) and 50 controls (successful conservative treatment) were enrolled. Demographic data, presenting symptoms and physical examination did not differ apart from duration of symptoms. Logistic regression analysis did not find a significant association between percentage of canal compromised after controlling for disc-fragment size, duration of symptoms and types of disc herniation. However disc fragment size was strongly associated with surgical outcome (OR = 2.6). Duration of symptoms (OR = 1.2) and sequestered type of lesion (OR = 12.3) were associated with surgery in this model. The use of physiotherapy and epidural steroid injections was lower but the failure rate was higher. CONCLUSION: Long-duration, sequestered herniation and large fragment are predictive of failure in the conservative treatment of lumbar-disc herniation.