Full-endoscopic Spine Surgery for the Treatment of Lumbar Ligamentous Flavum Hematoma.

Lumbar ligamentous flavum hematoma (LFH) is a relatively rare pathology, and it is difficult to differentiate it from other cystic lesions. Full-endoscopic spine surgery (FESS), an excellent approach for clear and magnified operative visual field since it allows saline irrigation and minimizes destruction of surrounding tissues, has been applied to the treatment. This study aims to present a case series of patients with lumbar LFH treated by FESS.This case series consists of 17 lumbar LFH cases treated by FESS between May 2018 and November 2021 at a single institution. Patient background and operative data were collected from their medical records. The numerical rating scale (NRS), Oswestry Disability Index (ODI), and European Quality of Life-5 Dimensions (EQ-5D) were recorded preoperatively and postoperatively.Elderly men tend to suffer from lumbar LFH at the L4/5 vertebral level. Discontinuity with facet joint was confirmed under endoscopic visualization in all 17 cases. Blood clots were also observed in all cases under endoscope. The mean operative time was 68.6 min without complication. The patients were discharged at average 1.4 days after FESS with significant improvement of NRS score (P < 0.001). ODI and EQ-5D scores 2-year postoperatively statistically improved (P < 0.001), and there was no recurrence during followup period.The operative outcomes of lumbar LFH treated by FESS were satisfactory. FESS excels not only in the diagnosis but also in the treatment of lumbar LFH.

Full-endoscopic discectomy utilizing an interlaminar approach for gas-containing herniation at L5-S1.

Background: Intradiscal gas is frequently observed in older patients with disc degeneration and can occasionally result in nerve root compression. Case Description: A 79-year-old male patient presented with increasing left lower extremity sciatica. Lumbar computed tomography (CT) and magnetic resonance (MR) images revealed a left paramedian L5-S1 gas-containing disc herniation. Utilizing an interlaminar approach, a full-endoscopic discectomy (FED) was performed at L5-S1. During disc removal, we countered intradiscal gas bubbles. Postoperatively, the patient's symptoms/signs fully resolved, and follow-up MR and CT images revealed total resection of the disc herniation, and no further gas. Conclusion: Through an interlaminar FED, we effectively removed an L5-S1 MR/CT-documented gas-containing disc herniation.

Endoscopic Treatment of Lumbar Degenerative Disc Disease: A Narrative Review of Full-Endoscopic and Unilateral Biportal Endoscopic Spine Surgery.

BACKGROUND: Degenerative lumbar spine disease is the leading cause of disability and work absenteeism worldwide. Lumbar microdiscectomy became the standard treatment for herniated discs and stenotic disease. With the evolution of different techniques, endoscopic spinal surgery emerged to minimize the surgical footprint while providing at least non-inferior results. Currently, two different types of endoscopic spine procedures are dominating the surgical scenario: "Full-Endoscopic" (FE) and Unilateral Biportal Endoscopic" (UBE) Spine Surgery. The aim of this study is to describe and analyze their indications, their technical characteristicswithitsadvantagesanddisadvantagesofbothtechniquesandtheirfuture trends. METHODS: We performed a narrative review of the most relevant articles published up to August 2023 through a Pub Med search. The search terms " FE Spine Surgery" and " UBE Spine Surgery" were used. The articles selected, were independently reviewed by 3 authors and 55 full text articles were reviewed. RESULTS: The FE and UBE Spine Surgery techniques were described. The FE technique is performed with a monoportal access under constant saline irrigation. The FE comprises the transforaminal and the interlaminar approaches, and the indication depends from the pathology to treat, and still remains controversial. UBE can approach also the spine from a posterior, postero lateral,and para spinal route. It uses two different ports addressed to a target with continuous irrigation. The process of establishing these two portals is called triangulation. CONCLUSIONS: FE and UBE spine surgery have demonstrated outcomes comparable to open surgery, minimizing complications and surgical footprint.

Full-endoscopic spine surgery in oldest old patients aged over 90 years:A case report.

BACKGROUND: Transforaminal full-endoscopic spine surgery (FESS) is the least invasive spinal surgery and can be performed under local anesthesia. In Japan, the population is rapidly aging and the number of spinal surgeries performed in the elderly is also increasing. OBJECT: In this report, we describe 3 patients aged 90 years or older in whom we performed FESS under local anesthesia. CASE: The first case was a 90-year-old man who presented with severe leg pain. He had multiple medical comorbidities and was unsuitable for general anesthesia. We performed FESS. After surgery, the leg pain resolved with full recovery of muscle strength. He was discharged with no perioperative complications. The second case was a 90-year-old man who presented with severe leg pain. MRI showed a herniated nucleus pulposus and foraminal stenosis at L4/5. We performed FESS. The leg pain improved immediately after surgery. The third case was a 91-year-old woman in whom we diagnosed left L5 radiculopathy due to foraminal stenosis at L5/S1. After surgery, her leg pain was relieved. CONCLUSION: FESS is a good surgical procedure for elderly patients who are in a poor general condition because it is minimally invasive and can be performed under local anesthesia with early mobilization. J. Med. Invest. 71 : 169-173, February, 2024.

Full-Endoscopic Foraminal Decompression for Foraminal Stenosis Following Osteoporotic Vertebral Fracture in an Elderly Woman Under Local Anesthesia:A Case Report.

Osteoporotic vertebral fracture (OVF) is common in the elderly population. In this report, we describe a case with radiculopathy due to foraminal stenosis caused by OVF in a very elderly patient that was treated successfully by full-endoscopic foraminotomy under local anesthesia. The patient was an 89-year-old woman who presented with a chief complaint of left leg pain for 5 years. She visited a couple of hospitals and finally consulted us to determine the exact cause of the pain. Computed tomography scans were obtained and selective nerve root block at L3 was performed. The diagnosis was radiculopathy at L3 due to foraminal stenosis following OVF. The patient had severe heart disease, so we decided to avoid surgery under general anesthesia and planned full-endoscopic spine surgery under local anesthesia. We performed transforaminal full-endoscopic lumbar foraminotomy at L3-L4 to decompress the L3 nerve root. The leg pain disappeared completely immediately after surgery. Postoperative computed tomography confirmed appropriate bone resection. The leg pain did not recur during a year of postoperative follow-up. OVF may cause lumbar radiculopathy as a result of foraminal stenosis, and transforaminal full-endoscopic lumbar foraminotomy under local anesthesia would be the best option in an elderly patient with poor general condition. J. Med. Invest. 71 : 179-183, February, 2024.

Full endoscopic resection of large bilateral synovial cysts in lumbar spine.

Synovial spinal cysts cause radiculopathy and back pain, with rare reports of cauda equina syndrome. Hypermobility and instability are cornerstones for synovial cyst formation. The incidence is around 5%, and data for bilateral cysts are lacking. Surgery is indicated after conservative measures fail. Recurrence is common and is potentially due to joint violation and destabilization from open surgery. This could be prevented via ultra-minimally invasive approaches. The authors present full endoscopic removal of bilateral synovial cysts in a patient with grade 1 stable spondylolisthesis and include a 360° view for confirmation of complete decompression. Postoperatively, the patient reported immediate pain relief. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23208.

Comparative outcomes of obese and non-obese patients with lumbar disc herniation receiving full endoscopic transforaminal discectomy: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to assess the impact of full endoscopic transforaminal discectomy (FETD) on clinical outcomes and complications in both obese and non-obese patients presenting with lumbar disc herniation (LDH). METHODS: A systematic search of relevant literature was conducted across various primary databases until November 18, 2023. Operative time and hospitalization were evaluated. Clinical outcomes included preoperative and postoperative assessments of the Oswestry Disability Index (ODI) and visual analogue scale (VAS) scores, conducted to delineate improvements at 3 months postoperatively and during the final follow-up, respectively. Complications were also documented. RESULTS: Four retrospective studies meeting inclusion criteria provided a collective cohort of 258 patients. Obese patients undergoing FETD experienced significantly longer operative times compared to non-obese counterparts (P = 0.0003). Conversely, no statistically significant differences (P > 0.05) were observed in hospitalization duration, improvement of VAS for back and leg pain scores at 3 months postoperatively and final follow-up, improvement of ODI at 3 months postoperatively and final follow-up. Furthermore, the overall rate of postoperative complications was higher in the obese group (P = 0.02). The obese group demonstrated a total incidence of complications of 17.17%, notably higher than the lower rate of 9.43% observed in the non-obese group. CONCLUSION: The utilization of FETD for managing LDH in individuals with obesity is associated with prolonged operative times and a higher total complication rate compared to their non-obese counterparts. Nevertheless, it remains a safe and effective surgical intervention for treating herniated lumbar discs in the context of obesity.

Advancements and Challenges in Robot-Assisted Bone Processing in Neurosurgical Procedures.

OBJECTIVE: Practical applications of nerve decompression using neurosurgical robots remain unexplored. Our ongoing research and development initiatives, utilizing industrial robots, aim to establish a secure and efficient neurosurgical robotic system. The principal objective of this study was to automate bone grinding, which is a pivotal component of neurosurgical procedures. METHODS: To achieve this goal, we integrated an endoscope system into a manipulator and conducted precision bone machining using a neurosurgical drill, recording the grinding resistance values across 3 axes. Our study encompassed 2 core tasks: linear grinding, such as laminectomy, and cylindrical grinding, such as foraminotomy, with each task yielding unique measurement data. RESULTS: In linear grinding, we observed a proportional increase in grinding resistance values in the machining direction with acceleration. This observation suggests that 3-axis resistance measurements are a valuable tool for gauging and predicting deep cortical penetration. However, problems occurred in cylindrical grinding, and a significant error of 10% was detected. The analysis revealed that multiple factors, including the tool tip efficiency, machining speed, teaching methods, and deflection in the robot arm and jig joints, contributed to this error. CONCLUSION: We successfully measured the resistance exerted on the tool tip during bone machining with a robotic arm across 3 axes. The resistance ranged from 3 to 8 Nm, with the measurement conducted at a processing speed approximately twice that of manual surgery performed by a surgeon. During the simulation of foraminotomy under endoscopic grinding conditions, we encountered a -10% error margin.

Full endoscopic resection of ventral thoracic osteophyte and repair of spontaneous CSF leak.

Spontaneous CSF leaks frequently cause headaches, meningismus, and nausea due to intracranial hypotension. When conservative treatment fails, surgical repair is indicated. Especially ventral leaks necessitate invasive approaches with substantial blood loss and tissue trauma. Full endoscopic spine surgery (FESS) enables circumferential access via the transforaminal approach. Here, the authors show the successful repair of a ventral CSF leak in the thoracic spine after removal of bony osteophytes utilizing FESS with placement of a dural substitute and sealant. Lasting symptom relief was reported. These results suggest that FESS is safe and efficient for the repair of spontaneous and incidental CSF leaks. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23209.

Return-to-play outcomes after full-endoscopic spine surgery under local anesthesia in professional baseball players: Comparison by timing of surgery.

BACKGROUND: Full-endoscopic spine surgery via a transforaminal approach (TF-FESS) is minimally invasive and could help athletes quickly return to play. When treating professional athletes, we have to consider their season schedule. In this study, we investigated the characteristics of Japanese professional baseball players who underwent TF-FESS and examine how the timing of surgery influenced their postoperative course. METHODS: Ten players who underwent TF-FESS (discectomy, foraminoplasty, or thermal annuloplasty according to their diagnosis) under local anesthesia were analyzed. Multilevel surgeries were performed at the same time in patients with lesions at multiple levels. The patients were divided into three groups according to timing of surgery (pre/during/post-season). Time to complete return to play and duration of official game loss were compared between the three groups. RESULTS: All players (100 %) could return to their original level of professional play after FESS surgery. Seven of the 10 patients underwent two-level surgery. The mean time until complete return to play was 4.6 months (range, 2-8 months) and the mean duration of game loss was 1.5 months (range, 0-4 months). The mean duration of game loss was shorter in the post-season group than in the other groups (0.9 vs 2,4 months), and 4 of 6 patients in the post-season group did not miss any games. CONCLUSIONS: TF-FESS is a good technique for achieving a quick return to play in professional baseball players. In particular, surgery performed during the post-season could allow players to return to play after adequate rehabilitation with no game loss.

Smartphone applications for remote patient monitoring reduces clinic utilization after full-endoscopic spine surgery.

INTRODUCTION: The rising number of outpatient spine surgeries creates challenges in postoperative management and care. Telemedicine offers a unique opportunity to reduce in-person clinic visits and improve resource allocation. We aimed to investigate the impact of a validated smartphone application on clinic utilization following full-endoscopic spine surgery (FESS). METHODS: We evaluated patients undergoing FESS from 2020 to 2022 and a pre-COVID control group (CG) from 2018 to 2019. Subsequently, we divided the patients into three groups: one using the application (intervention group, IG), and two CGs (2020-2022, CG and 2018-2019, historical control group (HG)). We analyzed the post-surgical hospitalization rate, all follow-ups, and virtually transmitted patient-reported outcomes. RESULTS: A total of 115 patients were included in the IG. The CG consisted of 137 and the HG of 202 patients (CG and HG in the following). Group homogeneity was satisfactory regarding patient age (p = 0.9), sex (p = 0.88), and body mass index (p = 0.99). IG patients were treated as outpatients significantly more often [14.78% vs. 29.2% vs. 37.62% (p < 0.001)]. Additionally, IG patients showed significantly higher follow-up compliance [74.78% vs. 40.14% vs. 37.13% (p < 0.001)] 3-month post-surgery and fewer in-patient follow-up visits [(0.5 ± 0.85 vs. 1.32 ± 0.8 vs. 1.33 ± 0.7 (p < 0.001)]. CONCLUSION: Our results underline the feasibility, efficacy, and safety of remote patient monitoring following FESS. Furthermore, they highlight the opportunity to implement a virtual wound checkup, and to substantially improve postoperative follow-up compliance via telemedicine.

Assessing the impact of obesity on full endoscopic spine surgery: surgical site infections, surgery durations, early complications, and short-term functional outcomes.

OBJECTIVE: An increasing number of obese patients undergoing elective spine surgery has been reported. Obesity has been associated with a substantially higher number of surgical site infections and a longer surgery duration. However, there is a lack of research investigating the intersection of obesity and full endoscopic spine surgery (FESS) in terms of functional outcomes and complications. The aim of this study was to evaluate wound site infections and functional outcomes following FESS in obese patients. METHODS: Patients undergoing lumbar FESS at the participating institutions from March 2020 to March 2023 for degenerative pathologies were included in the analysis. Patients were divided into obese (BMI > 30 kg/m2) and nonobese (BMI 18-30 kg/m2) groups. Data were collected prospectively using an approved smartphone application for 3 months postsurgery. Parameters included demographics, surgical details, a virtual wound checkup, the visual analog scale for back and leg pain, and the Oswestry Disability Index (ODI) as a functional outcome measure. RESULTS: A total of 118 patients were included in the analysis, with 53 patients in the obese group and 65 in the nonobese group. Group homogeneity was satisfactory regarding patient age (obese vs nonobese: 55.5 ± 14.7 years vs 59.1 ± 17.1 years, p = 0.25) and sex (p = 0.85). No surgical site infection requiring operative revision was reported for either group. No significant differences for blood loss per level (obese vs nonobese: 9.7 ± 16.8 ml vs 8.0 ± 13.3 ml, p = 0.49) or duration of surgery per level (obese vs nonobese: 91.2 ± 57.7 minutes vs 76.8 ± 39.2 minutes, p = 0.44) were reported between groups. Obese patients showed significantly faster improvement regarding ODI (-3.0 ± 9.8 vs 0.7 ± 11.3, p = 0.01) and leg pain (-4.4 ± 3.2 vs -2.9 ± 3.7, p = 0.03) 7 days postsurgery. This effect was no longer significant 90 days postsurgery for either ODI (obese vs nonobese: -11.4 ± 11.4 vs -9.1 ± 9.6, p = 0.24) or leg pain (obese vs nonobese: -4.3 ± 3.9 vs -3.5 ± 3.8, p = 0.28). CONCLUSIONS: The results highlight the effectiveness and safety of lumbar FESS in obese patients. Unlike with open spine surgery, obese patients did not experience significant increases in surgery time or postoperative complications. Interestingly, obese patients demonstrated faster early recovery, as indicated by significantly greater improvements in ODI and leg pain at 7 days after surgery. However, there was no difference in improvement between the groups at 90 days after surgery.

Intracranial Pressure Evaluation in Swine During Full-Endoscopic Lumbar Spine Surgery.

BACKGROUND: Neurological complications during full-endoscopic spine surgery (FESS) might be attributed to intracranial pressure (ICP) increase due to continuous saline infusion (CSI). Understanding CSI and ICP correlation might modify irrigation pump usage. This study aimed to evaluate invasive ICP during interlaminar FESS; correlate ICP with irrigation pump parameters (IPPs); evaluate ICP during saline outflow occlusion, commonly used to control bleeding and improve the surgeon's view; and, after durotomy, simulate accidental dural tear. METHODS: Five swine were monitored, submitted to total intravenous anesthesia, and positioned ventrally. A parenchymal catheter was installed through a skull burr for ICP monitoring. Lumbar interlaminar FESS was performed until exposure of neural structures. CSI was used within progressively higher IPPs (A [60 mm Hg, 350 mL/minute] to D [150 mm Hg, 700 mL/minute]), and ICP was documented. During each IPP, different situations were grouped: intact dura with open channels (A1-D1) or occlusion test (A2-D2); dural tear with open channels (Ax1-Dx1) or occlusion test (Ax2-Dx2). ICP <20 mm Hg was defined as safe. RESULTS: Basal average ICP was 8.1 mm Hg. Adjustment in total intravenous anesthesia or suspension of tests was necessary due to critical ICP or animal discomfort. It was safe to operate with all IPPs with opened drainage channels (A1-D1) even with dural tear (Ax1-Dx1). Several occlusion tests (A2-D2, Ax2-Dx2) caused ICP increase (e.g., 86.1 mm Hg) influenced by anesthetic state and hemodynamics. CONCLUSIONS: During FESS, CSI might critically raise ICP. Keeping drainage channels open, with ideal anesthetic state, ICP remains safe even with high IPPs, despite dural tear. Drainage occlusions can quickly raise ICP, being even more severe with higher IPPs. Total intravenous anesthesia may protect from ICP increase and may allow longer drainage occlusion or higher IPPs.

Propensity matched outcome analysis following microdiscectomy versus interlaminar endoscopic discectomy for L5-S1 disc herniation.

Purpose: The main purpose of the study is to perform a propensity-matched functional outcome analysis following microdiscectomy (MD) versus interlaminar endoscopic lumbar discectomy (IELD) for L5-S1 disc herniation. Although many studies have compared endoscopic lumbar discectomy and microdiscectomy, few have compared the outcomes of microdiscectomy (MD) and interlaminar endoscopic discectomy (IELD) at the L5-S1 level. Methods: This is a propensity-matched analysis of 100 patients (50 MD patients, 50 IELD patients) based on baseline covariates with a minimum of one-year follow-up. Patient-reported outcome measures were obtained from EMR during follow-up visits. Back pain and sciatic pain were assessed by the Visual Analogue Scale (VAS-B and VAS-L). Functional outcome was assessed using Oswestry Disability Index (ODI) Score and 12-item Short Form Survey (SF-12) score. Data were obtained at baseline (pre-op) and at 0, 1, 3, and 12 months post-operatively. Results: Mean operative time was significantly lower (p < 0.001) in the IELD group (44 min) compared to the MD group (59 min). Mean VAS-B at the immediate and 1-month postoperative period was significantly (p < 0.001) lower in the IELD group (0.36, 0.24) when compared with the MD group (1.74, 1.16). There was no significant difference between IELD and MD groups with regard to improvement in sciatic pain (VAS-L). ODI scores at 1 month and 3 months post-operative period were significantly (p < 0.001) lower in the IELD group (30.1, 23.2) when compared with the MD group (41, 27.5). However, there was no significant difference between the two groups with regards to VAS-B, ODI, and SF-12 at 1-year follow-up. Conclusion: Our findings indicate that the IELD group achieved better immediate and early postoperative outcomes despite no significant difference at one-year follow-up.

An algorithm for selection of full endoscopic approach for symptomatic nerve root decompression.

Background Context: Both Transforaminal (TF) and Interlaminar (IL) endoscopic approaches are established techniques of decompression for lumbar compressive radiculopathy. In the absence of adequate literature, there is always some dilemma in selecting the approach for endoscopic decompression leading to long learning curves and high chances of inadequate decompression, iatrogenic instability, dural tear, or dysesthesia. Hence authors propose a new surgical nomenclature and algorithm for selection of endoscopic approach. Methods: This retrospective study included 396 of 626 consecutive patients who met the inclusion criteria, who underwent either TF (n=302) or IL (n=202) full endoscopic spine surgery. MRI findings of every patient were classified as per FAPDIS (Facet angle, Anterior pathology, Posterior pathology, Dorsal, Inferior, and Superior migration) algorithm. Inter-observer variations were calculated. The targeted nomenclature was used to define the selection of endoscopic TF or IL approach for symptomatic nerve root decompression. All patients were followed up for preop and postop 6 months VAS and Oswestry Disability Index score for validation of FAPDIS algorithm. Results: Median age: 46.8 years; Sides and levels operated 330 single-level ipsilateral, 54 multiple-level ipsilateral, 6 single-level bilateral, and 6 multiple-level bilateral. Interobserver agreement in the selection of TF approach was 0.873 and IL approach was 0.882. Interobserver variability was also calculated for each FAPDIS factor, selection of P3 and P4 pathology was the main reason for disagreement. All other FAPDIS factors show good to excellent correlation. The overall VAS score decreased from a preoperative value of 9 to 1 at 6 months follow-up (p-value < 0.001), and the overall Oswestry Disability Index score improved from 89 to 12 (p-value <.001). Conclusions: The author's new FAPDIS surgical nomenclature and algorithm is a reliable tool for describing the symptomatic nerve root compression for the selection of endoscopic surgical approach to achieve adequate decompression of offending neural structure with minimum challenges to minimize perioperative complication rate.

Validation of smartphone app-based digital patient reported outcomes in full-endoscopic spine surgery.

PURPOSE: Patient reported outcome measures (PROMs) are important tools to assess patient function, pain, disability, and quality of life. We aim to study the efficiency and validity of digital PROMs collection using a smartphone app compared to traditional paper PROMs. METHODS: Patients undergoing evaluation for full-endoscopic spine surgery were recruited from the outpatient clinic at Harborview Medical Center. Visual analogue scale (VAS), Oswestry disability index (ODI), and EQ5-5D PROMs were administered on paper and through a smartphone app called SpineHealthie. Compliance rates were collected, and PROM results were assessed for correlation between paper and digital methods. RESULTS: 123 patients were enrolled. 57.7% of patients completed paper PROMs, 82.9% completed digital PROMs, and 48.8% completed both. Of the patients that completed both, Spearman's correlation was greatest for VAS leg, ODI, and EQ5 index scores. Correlation was weaker for VAS back pain, neck pain, and upper extremity pain. Patients tended to report lower disability and higher quality of life on the digital PROM compared to the paper PROM. CONCLUSION: The SpineHealthie app effectively and accurately collects PROMs digitally, showing strong concordance with traditional paper PROMs. We conclude that digital PROMs constitute a promising strategy for monitoring patients after spine surgery over time.

Incidence and management of dural tears in full-endoscopic unilateral laminotomies for bilateral lumbar decompression.

PURPOSE: To report incidence of dural lacerations in lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) and to describe patient outcomes following a novel full-endoscopic bimanual durotomy repair. METHODS: Retrospective review of prospectively collected database including 5.5 years of single surgeon experience with LE-ULBD. Patients with no durotomy were compared with patients who experienced intraoperative durotomy, including demographics, ASA score, prior surgery, number of levels treated, procedure time, hospital length of stay (LOS), visual analogue scale, perioperative complications, revision surgeries, use of analgesics, and Oswestry Disability Index (ODI). RESULTS: In total, 13/174 patients (7.5%) undergoing LE-ULBD experienced intraoperative durotomy. No significant differences in demographic, clinical or operative variables were identified between the 2 groups. Sustaining a durotomy increased LOS (p = 0.0019); no differences in perioperative complications or rate of revision surgery were identified. There was no difference in minimally clinically important difference for ODI between groups (65.6% for no durotomy versus 55.6% for durotomy, p = 0.54). CONCLUSION: In this cohort, sustaining a durotomy increased LOS but, with accompanying intraoperative repair, did not significantly affect rate of complications, revision surgery or functional outcomes. Our method of bimanual endoscopic dural repair provides an effective approach for repair of dural lacerations in interlaminar ULBD cases.

Full-endoscopic technique mitigates obesity-related perioperative morbidity of minimally invasive lumbar decompression.

PURPOSE: Obesity is associated with increased surgical complexity and postoperative complications in spine surgery. Minimally invasive procedures have been shown to lessen some of the increased risk in obese patients. This study investigated whether utilization of a working channel endoscope can further mitigate obesity-associated challenges in spinal surgery. METHODS: A retrospective review of a single-surgeon database was conducted for all adult patients undergoing full-endoscopic unilateral laminotomies for bilateral decompression between November 2015 and March 2021. Data collected included body mass index, in operating room preparation time, procedure time, length of hospital stay, use of analgesics, complications, and quality of life measured by Oswestry Disability Index. RESULTS: Our cohort included 174 patients. Of these, 74 (42.5%) were obese. The average age was 63.6 years. In-operating room preparation time was 70.0 ± 1.7 min for obese patients and 64.4 ± 1.5 min for non-obese patients (p = 0.02). There was no difference in operative time, durotomy rates or other perioperative complications between obese and non-obese patients. Hospital length of stay trended toward longer in the obese group, but did not reach significance. A greater percentage of obese patients were still using both narcotic and non-narcotic pain medications 2 weeks after surgery. There was no significant difference in functional outcomes between groups. CONCLUSION: Full-endoscopic unilateral laminotomies for bilateral decompression are safe and effective in both non-obese and obese patients. The use of an endoscope can partially mitigate obesity-related morbidity in lumbar decompression. However, obesity is significantly related to increased postoperative analgesic use.

Full endoscopic spine surgery.

Background: With a dramatic increase in elderly population worldwide, the prevalence of degenerative spine disease is steadily rising. Even though the entire spinal column is affected the problem is more commonly seen in the lumbar, cervical spine and to some extent the thoracic spine. The treatment of symptomatic lumbar disc or stenosis is primarily conservative with analgesics, epidural steroids and physiotherapy. Surgery is advised only if conservative treatment is ineffective. Conventional open microscopic procedures even though are still a gold standard, have the disadvantages of excessive muscle damage and bone resection, epidural scarring along with prolonged hospital stay and increased need of postoperative analgesics. Minimal access spine surgeries minimize surgical access related injury by minimizing soft tissue and muscle damage and also bony resection thus preventing iatrogenic instability and unnecessary fusions. This leads to good functional preservation of the spine and enhances early postoperative recovery and early return to work. Full endoscopic spine surgeries are one of the more sophisticated and advanced form of MIS surgeries. Purpose: Full endoscopy has definitive benefits over conventional microsurgical techniques. These include better and clear vision of the pathology due to presence of irrigation fluid channel, minimal soft tissue and bone trauma, better and relatively easy approach to deep seated pathologies like thoracic disc herniations and a possibility to avoid fusion surgeries. The purpose of this article is to describe these benefits, give an overview of the two main approaches - transforaminal and interlaminar, their indications, contraindications and their limitations. The article also describes about the challenges in overcoming the learning curve and its future prospectives. Conclusion: Full endoscopic spine surgery is one of the fastest growing technique in the field of modern spine surgery. Better intraoperative visualization of the pathology, lesser incidence of complications, faster recovery time, less postoperative pain, better relief of symptoms and early return to activity are the main reasons behind this rapid growth. With better patient outcomes and reduced medical costs, the procedure is going to be more accepted, relevant and popular procedure in future.