Laminectomy with Rib Shears: A Technical Note.

Introduction: Laminectomy/laminoplasty either free or vascularized pedicle flap is currently performed with a variety of expensive instruments. Use of Tudor Edwards rib shears to perform above procedure is described. Materials and Methods: Tudor Edwards rib shear was used to cut lamina in 18 cases for a variety of spinal lesions. Depending upon the size of lesion, laminectomy/laminoplasty was required for 2 to 8 levels. Vascularized pedicle laminoplasty or free flap laminoplasty was done with Tudor Edwards rib shears. Ligamentum flavum and interspinous and supraspinous ligaments were preserved in cases of vascularized pedicled laminoplasty, which was carried out in 12 cases. Free flap laminoplasty was carried out in 6 cases. Results: In all our cases, laminectomy was successfully achieved with rib shears without any injury to the dura or its underlying structures. It was possible to perform vascularized pedicle laminoplasty or free flap laminoplasty in all cases. Laminectomy was easier to perform in the cervical region and dorsal region, while it was difficult in the lumbar region due to the wider, thick lamina and its angulation, especially in adults. Conclusion: Laminectomy/laminoplasty with Tudor Edwards rib shears is quick, safe, and easy. Beveled cut edges with minimal bony loss prevents sinking of laminoplasty, thereby facilitates lamina fixation. This is an alternative method of performing laminectomy/laminoplasty, especially for those not having accessibility to expensive equipment.

The Role of Vancomycin Powder During Spinal Cord Stimulator Implantation: A Case Series and Review of the Literature.

OBJECTIVE: We examined the role of intrawound vancomycin powder as prophylaxis against postoperative surgical site infection (SSI) after spinal cord stimulator (SCS) implantation. METHODS: We performed a retrospective analysis of 153 consecutive patients who had undergone permanent SCS implantation surgery via open laminectomy between 2014 and 2020. We queried the patients' medical records for patient age, sex, relevant medical history, and whether intrawound vancomycin had been administered. We compared the rates of SSI (primary outcome) and seroma (secondary outcome) within 3 months after surgery between the vancomycin and no-vancomycin groups. Finally, we conducted multivariable logistic regression analyses to identify independent predictors of postoperative SSI or seroma. RESULTS: Of the 153 patients, 59% were women, and the average age was 65.4 years. Overall, 3 patients (2%) had developed an SSI: 2 (methicillin-resistant Staphylococcus aureus, Klebsiella) in the vancomycin group and 1 (methicillin-sensitive Staphylococcus aureus) in the no-vancomycin group. This difference in SSI rate between the 2 groups was insignificant (P = 0.73). Three seromas, all in the no-vancomycin group, accounted for a statistically significant difference in seroma formation between the 2 groups (P = 0.04). Multivariate logistic regression failed to identify any perioperative characteristics as independent predictors of postoperative SSI or seroma. CONCLUSIONS: Our experience suggests open laminectomy for SCS implantation surgery can be performed with a low postoperative SSI rate, with or without the use of powdered vancomycin. We found no evidence suggesting that the use of powdered vancomycin is unsafe or related to postoperative seroma formation. We failed to draw any definitive conclusions regarding its efficacy, despite referencing the largest single case series of SCS implantation to date.

Placement of Surgical Spinal Cord Stimulation Leads Using Spinal Process Splitting Laminotomy: Technical Note.

OBJECTIVE: Spinal cord stimulation has become an established method within the therapy of chronic pain allowing for significant pain relief. Surgical leads usually must be implanted via a surgical procedure involving unilateral or bilateral muscle detachment and partial laminectomy. METHODS: We present the application of a novel minimal invasive microsurgical approach for lead placement, which combines the beneficial advantages of anatomic midline lead placement while preserving the midline structures, avoiding muscle detachments, and thus ensuring spinal stability: spinal process splitting laminotomy. CONCLUSIONS: The spinal process splitting laminotomy technique can be successfully applied to introduce the surgical leads for spinal cord stimulation.

Cement-Augmented and Dual-Headed Posterior Screw Reconstruction After Corpectomy for Metastatic Tumor Resection.

BACKGROUND: Metastatic spinal tumors have a well-documented deleterious effect on the overall strength of the bony spine. Surgical interventions must address not only removal of the tumor itself, but the integrity of reconstructive hardware constructs as well. METHODS: We present a series of 8 patients with metastatic spine tumors who were successfully treated with tumor resection and reconstruction of residual 3-column defect with cement-augmented fenestrated pedicle screws and dual-rod posterior stabilization. RESULTS: All patients demonstrated resolution of their presenting neurologic symptoms. CONCLUSIONS: This series supports the use of the aforementioned constructs in conjunction to provide added stability and reduce hardware failure when treating a diversity of spinal tumors.

Polypropylene mesh inhibits post-laminectomy compressive scar formation in rabbits: Histopathological and computational morphometric evaluation.

We evaluated the effect of polypropylene mesh placement on post-laminectomy compressive scar formation in rabbits. Twenty-two white male New Zealand rabbits were distributed into two groups (n = 11). In the control group, the animals underwent lumbosacral laminectomy, whereas in the mesh group, the rabbits were submitted to lumbosacral laminectomy followed by the attachment of a polypropylene mesh to the vertebrae by the application of N-butyl cyanoacrylate. After eight weeks, the rabbits were euthanized, and the laminectomy area was collected for macro- and microscopic analyses. Macroscopically, we evaluated the (1) vertebral canal height; (2) laminectomy width and (3) length; and (4) fibrosis width, (5) height, and (6) length. Microscopically, we evaluated (7) fibroblasts; (8) the thickness of the dura-mater; and (9) the distance between the dura-mater and the laminectomy area. Macroscopically, there were no differences between the groups regarding vertebral canal height; width and length of the laminectomy; and fibrosis width. However, the height, and length of fibrosis were smaller in the mesh group. Microscopically, there were no differences in dura mater thickness and the distance between the dura mater and laminectomy area, but fewer fibroblasts were observed in the mesh group. This indicated that the polypropylene mesh improved tissue repair, with greater tissue organization. The results demonstrate that the use of a polypropylene mesh in the treatment of post-laminectomy wounds in rabbits reduces the severity of compressive fibrous scar formation. Polypropylene mesh is presented as a good alternative to reduce complications associated with laminectomy surgeries.

Patient Outcomes After Single-level Coflex Interspinous Implants Versus Single-level Laminectomy.

STUDY DESIGN: Retrospective cohort analysis. OBJECTIVE: The aim of this study was to compare postoperative outcomes of Coflex interspinous device versus laminectomy. SUMMARY OF BACKGROUND DATA: Coflex Interlaminar Stabilization device (CID) is indicated for one- or two-level lumbar stenosis with grade 1 stable spondylolisthesis in adult patients, as an alternative to laminectomy, or laminectomy and fusion. CID provides stability against progressive spondylolisthesis, retains motion, and prevents further disc space collapse. METHODS: Patients ≥18 years' old with lumbar stenosis and grade 1 stable spondylolisthesis who underwent either primary single-level decompression and implantation of CID, or single-level laminectomy alone were included with a minimum 90-day follow-up at a single academic institution. Clinical characteristics, perioperative outcomes, and postoperative complications were reviewed until the latest follow-up. χ2 and independent samples t tests were used for analysis. RESULTS: Eighty-three patients (2007-2019) were included: 37 cases of single-level laminectomy (48.6% female) were compared to 46 single-level CID (50% female). CID cohort was older (CID 69.0 ±â€Š9.4 vs. laminectomy 64.2 ±â€Š11.0, P = 0.042) and had higher American Society of Anesthesiologists (ASA) grade (CID 2.59 ±â€Š0.73 vs. laminectomy 2.17 ±â€Š0.48, P = 0.020). CID patients had higher estimated blood loss (EBL) (97.50 ±â€Š77.76 vs. 52.84 ±â€Š50.63 mL, P = 0.004), longer operative time (141.91 ±â€Š47.88 vs. 106.81 ±â€Š41.30 minutes, P = 0.001), and longer length of stay (2.0 ±â€Š1.5 vs. 1.1 ±â€Š1.0 days, P = 0.001). Total perioperative complications (21.7% vs. 5.4%, P = 0.035) and instrumentation-related complication was higher in CID (10.9% vs. 0% laminectomy group, P = 0.039). There were no other significant differences between the groups in demographics or outcomes. CONCLUSION: Single-level CID devices had higher perioperative 90-day complications, longer operative time, length of stay, higher EBL compared to laminectomies alone. Similar overall revision and neurologic complication rates were noted compared to laminectomy at last follow-up.Level of Evidence: 3.

Grinding trajectory generator in robot-assisted laminectomy surgery.

PURPOSE: Grinding trajectory planning for robot-assisted laminectomy is a complicated and cumbersome task. The purpose of this research is to automatically obtain the surgical target area from the CT image, and based on this, formulate a reasonable robotic grinding trajectory. METHODS: We propose a deep neural network for laminae positioning, a trajectory generation strategy, and a grinding speed adjusting strategy. These algorithms can obtain surgical information from CT images and automatically complete grinding trajectory planning. RESULTS: The proposed laminae positioning network can reach a recognition accuracy of 95.7%, and the positioning error is only 1.12 mm in the desired direction. The simulated surgical planning on the public dataset has achieved the expected results. In a set of comparative robotic grinding experiments, those using the speed adjustment algorithm obtained a smoother grinding force. CONCLUSION: Our work can automatically extract laminar centers from the CT image precisely to formulate a reasonable surgical trajectory plan. It simplifies the surgical planning process and reduces the time needed for surgeons to perform such a cumbersome operation manually.

Guidelines for cortical screw versus pedicle screw selection from a fatigued decompressive lumbar laminectomy model show similar stability and less bone mineral density dependency.

BACKGROUND: Traditional pedicle screws are the gold standard for lumbar spine fixation; however, cortical screws along the midline cortical bone trajectory may be advantageous when lumbar decompression is required. While biomechanic investigation of both techniques exists, cortical screw performance in a multi-level lumbar laminectomy and fusion model is unknown. Furthermore, longer-term viability of cortical screws following cyclic fatigue has not been investigated. METHODS: Fourteen human specimens (L1-S1) were divided into cortical and pedicle screw treatment groups. Motion was captured for the following conditions: intact, bilateral posterior fixation (L3-L5), fixation with laminectomy at L3-L5, fixation with laminectomy and transforaminal lumbar interbody fusion at L3-L5 both prior to, and following, simulated in vivo fatigue. Following fatigue, screw pullout force was collected and "effective shear stress" [pullout force/screw surface area] (N/mm2) was calculated; comparisons and correlations were performed. FINDINGS: In flexion-extension and lateral bending, all operative constructs significantly reduced motion compared to intact (P < 0.05), regardless of pedicle or cortical screws; only posterior fixation with and without laminectomy significantly reduced motion in axial rotation (P < 0.05). Pedicle screws significantly increased average pullout strength (944.2 N vs. 690.2 N, P < 0.05), but not the "effective shear stress" (1.01 N/mm2 vs. 1.1 N/mm2, P > 0.05). INTERPRETATION: In a posterior laminectomy and fusion model, cortical screws provided equivalent stability to pedicle screw fixation, yet had significantly lower screw pullout force. No differences in "effective shear stress" warrant further investigation of the effect of screw length/diameter in the aforementioned screw trajectories.

Ultrasonic bone scalpel for thoracic spinal decompression: case series and technical note.

BACKGROUND: Thoracic spinal stenosis (TSS) is a rare but intractable disease that fails to respond to conservative treatment. Thoracic spinal decompression, which is traditionally performed using high-speed drills and Kerrison rongeurs, is a time-consuming and technically challenging task. Unfavorable outcomes and high incidence of complications are the major concerns. The development and adaptation of ultrasonic bone scalpel (UBS) have promoted its application in various spinal operations, but its application and standard operating procedure in thoracic decompression have not been fully clarified. Therefore, the purpose of this study is to describe our experience and technique note of using UBS and come up with a standard surgical procedure for thoracic spinal decompression. METHODS: A consecutive of 28 patients with TSS who underwent posterior thoracic spinal decompression surgery with UBS between December 2014 and May 2015 was enrolled in this study. The demographic data, perioperative complications, operation time, estimated blood loss, and pre- and postoperative neurological statuses were recorded and analyzed. Neurological status was evaluated with a modified Japanese Orthopaedic Association (JOA) scale, and the neurological recovery rate was calculated using the Hirabayashi's Method. RESULTS: Thoracic spinal decompression surgery was successfully carried out in all cases via a single posterior approach. The average age at surgery was 49.7 ± 8.5 years. The mean operative time of single-segment laminectomy was 3.0 ± 1.4 min, and the blood loss was 108.3 ± 47.3 ml. In circumferential decompression, the average blood loss was 513.8 ± 217.0 ml. Two cases of instrument-related nerve root injury occurred during operation and were cured by conservative treatment. Six patients experienced cerebrospinal fluid (CSF) leakage postoperatively, but no related complications were observed. The mean follow-up period was 39.7 ± 8.9 months, the average JOA score increased from 4.7 before surgery to 10.1 postoperatively, and the average recovery rate was 85.8%. CONCLUSIONS: The UBS is an optimal instrument for thoracic spinal decompression, and its application enables surgeons to decompress the thoracic spinal cord safely and effectively. This standard operating procedure is expected to help achieve favorable outcomes and can be used to treat various pathologies leading to TSS.

Dimensional Characterization of the Human Cervical Interlaminar Space as a Guide for Safe Application of Minimally Invasive Dilators.

BACKGROUND: The risk of interlaminar passage of a dilator into the cervical spinal canal in minimally invasive approaches is currently unknown. Among the various anthropometric data reported in the literature, there is no report of the interlaminar dimensions in the cervical spine. OBJECTIVE: To report the cervical interlaminar dimensions in neutral, flexion, and extension. METHODS: A total of 8 spines were sectioned into cervical (C2-T1) segments. Digitized coordinate data defining the locations and movements of chosen anatomic points on the laminar edges at a given spinal level were used to compute the dimensions during a static neutral posture, flexion, and extension positions to mimic the positions during surgery. Interlaminar dimensions were averaged and categorized for each vertebral level and spinal posture. RESULTS: Based on the reported measurements, the smallest diameter dilator in commonly used dilator sets has the potential to traverse the interlaminar space at all levels in flexion. In a neutral posture, the average interlaminar distance at C2-3, C6-7, and C7-T1 was still greater than 2.0 mm, the smallest diameter of the initial dilator. The largest interlaminar distance was at C6-7 in flexion (7.68 ± 1.60 mm). CONCLUSION: Because dilators pass directly onto the cervical lamina without visualization of the midline structures, the interlaminar distances have increased relevance in the minimally invasive cervical approaches of foraminotomy and laminectomy. The data in this report demonstrate the theoretical risk of interlaminar passage with small diameter dilators in posterior minimally invasive approaches to the cervical spine.

Influence of Lumbar Stenosis Surgery on Sacroiliac Joint Pain-Long-Term Results.

OBJECTIVE: To investigate whether sacroiliac join (SIJ) pain can be secondary to walking with a flexed posture resulting from stenosis with neurogenic claudication, and resolves spontaneously after lumbar decompression. METHODS: A review of charts from January 1, 2014, through March 3, 2019, was performed to identify consecutive cases of adults 35 years of age or older with surgical spinal stenosis with neurogenic claudication as well as concomitant severe SIJ pain. Posture was considered flexed during walking if self-reported, confirmed by a close companion, or observed directly. SIJ pain was diagnosed clinically ± confirmatory injection. A 10-point visual analog scale was used to assess SIJ pain. The primary endpoint was SIJ pain improvement at a minimum of 24 months' follow-up. SIJ pain improvement at 3 months was used to assess the rate of improvement as a secondary endpoint. RESULTS: Ten patients (3 female) met entry criteria: 4 were treated with decompression alone; 6 with decompression and spinal fusion. Mean SIJ visual analog scale pain score improved by 6.9 ± 2.4 (8.7 ± 1.6-1.8 ± 2.2; P < 0.0005). Results were similar for 20 patients at the secondary endpoint of 3 months. CONCLUSIONS: Sacroiliac joint pain shows robust, rapid, reliable, and durable improvement following lumbar decompressive surgery. The addition of a spinal fusion also leads to a similar improvement in SIJ pain. This study demonstrates the importance of evaluating the specific source of low back pain in patients with stenosis, claudication, and SIJ pain so as to more effectively plan appropriate surgery.

How I do it: en-bloc subaxial cervical laminectomy using a high-speed drill with a footplate attachment.

BACKGROUND: Cervical laminectomy is a common strategy to decompress the spinal canal. METHODS: The anatomy of the cervical spine and surrounding critical structures as viewed from the posterior approach is described. The use of a high-speed drill with a footplate attachment to make laminar troughs with an en-bloc subaxial cervical laminectomy is described with a discussion on surgical technique and complication avoidance. CONCLUSION: This technique allows for a safe, comfortable, and rapid decompression of the cervical spine with minimal risk. For routine cases, this may potentially be more safe and cost-effective than using a cutting bur or bone scalpel attachment.

Comparison of microendoscopic selective laminectomy versus conventional laminoplasty in patients with degenerative cervcical myelopathy: a minimum 2-year follow-up study.

BACKGROUND: Although microendoscopic partial laminectomy for patients with degenerative cervical myelopathy (DCM) has been reported and demonstrated good results, a detailed comparison of its mid-term surgical results with those of laminoplasty (LP) has not been reported. The aim of this study was to compare the surgical outcomes, complications, and imaging parameters of cervical microendoscopic interlaminar decompression (CMID) via a midline approach versus conventional laminoplasty, with a minimum follow-up period of 2 years. METHODS: Two hundred and fifty-four patients who underwent either LP or CMID for DCM between May 2008 and April 2015 were enrolled. All patients routinely underwent LP (C3-6 or C3-7) before December 2011, whereas CMID was performed at the one or two affected level(s) only in patients with single- or two-level spinal cord compression after 2012. Surgical procedure (CMID): For single-level patients (e.g., C5-6), partial laminectomy of C5 and C6 was performed under a microendoscope. For two-level patients (e.g., C5-6-7), decompression was completed by performing a C6 laminectomy. We compared surgical outcomes and radiographic parameters between the CMID and LP groups. RESULTS: Of the 232 patients followed up for > 2 years, 87 patients with single- or two-level spinal cord compression, 46 that underwent CMID, and 41 that underwent LP were identified. There were no differences in the baseline demographic data of the patients between the groups. CMID showed better outcomes in terms of postoperative axial pain and quality of life, although both procedures showed good neurological improvement. Two and one patient complained of C5 palsy and hematoma, respectively, only in the LP group. The postoperative range of motion was worse and the degree of postoperative posterior spinal cord shift was larger in the LP group. CONCLUSION: Selective decompression by CMID demonstrated surgical outcomes equivalent to those of conventional LP, which raises a question regarding the requirement of extensive posterior spinal cord shift in such patients. Although the indications of CMID are limited and comparison with anterior surgery is mandatory, it can be a minimally invasive procedure for DCM. .

A novel technique to develop thoracic spinal laminectomy and a methodology to assess the functionality and welfare of the contusion spinal cord injury (SCI) rat model.

This study reports the advantage of a novel technique employing a motorised dental burr to assist laminectomy over the conventional manual technique at T10-T11 vertebra level in a rat model of spinal cord injury. Twenty-four female rats were randomly assigned to four groups: (1) conventionally laminectomised, (2) dental burr assisted laminectomised, (3) conventionally laminectomised with spinal cord contusion and (4) dental burr assisted laminectomised with spinal cord contusion. Basso Beattie Bresnahan (BBB) score, postoperative body weights, rat grimace scale (RGS), open cage activity and rearing was studied at 1, 7, 14, 21 and 28 days postoperatively, and area of spinal tissue affected was evaluated histologically. Laminectomised and spinal cord injured rats from dental burr groups showed significantly more weight gain and less weight loss respectively in comparison with respective conventionally laminectomised groups at various time points. Significantly higher RGS score was noticed in conventionally laminectomised animals on Day 1 in comparison to burr assisted laminectomy and presence of pain was evident until Day 7 in the conventionally spinal cord injured group. BBB score did not differ between techniques, whereas laminectomy groups showed more resting time than spinal injury groups. High rearing score was significantly higher in groups which underwent dental burr assisted technique at various time points with respect to their conventional counterparts. This study suggests that the use of dental burr assisted technique to perform laminectomy will bring refinement by producing less pain, aiding in better recovery, removing procedural artefacts without affecting the outcome of the model.

Primary Ewing's sarcoma of the vertebral body: A case report.

RATIONAL: The occurrence of Ewing's sarcoma in the vertebral body of elderly women is extremely rare, and the case of Ewing's sarcoma in the spine with secondary surgical repair after wrong diagnosis and treatment has not been reported. We report a case involving primary Ewing's sarcoma of the vertebral body in an elderly female. Owing to its rarity and controversial issues, we report a case report to discuss its clinical features, treatments, radiological, and histological characteristics. PATIENT CONCERNS: The elderly female patient came to see us with the manifestation of total paralysis of both lower limbs. The patient with a vertebral compression fracture as the primary manifestation was misdiagnosed in another hospital. The patient underwent inappropriate surgical treatment and was transferred to our hospital for diagnosis and second-stage surgery. DIAGNOSES: The postoperative pathological examination and immunohistochemical examination in our hospital confirmed: Ewing's sarcoma; Surgical history at other hospitals suggests: after Bone cement injection. INTERVENTIONS: The patient underwent a T6 and T8 laminectomy and T5/6-T9 pedicle screw fixation. OUTCOMES: Reexamination 1 month after the surgery showed that the tumor had been partially resected, the spinal cord compression was relieved, the tumor did not grow further, and the patient's lower limb physical ability, tactile sense, algesia and temperature sense recovered slightly. LESSONS: For patients with ewing's tumor in the spinal canal with symptoms of spinal cord compression, even if the patients with poor results after a unadvisable operation, it is still necessary to be actively in spinal cord compression by surgery. The differential diagnosis of Ewing's sarcoma and compression fractures is very important. For patients with vertebral tumors, special attention should be taken during vertebroplasty for bone cement leakage caused by excessive bone cement injection and increased local pressure. And some experience with imaging and laboratory findings.

Preliminary experience with a digital robotic exoscope in cranial and spinal surgery: a review of the Synaptive Modus V system.

BACKGROUND: The microscope is the standard tool for microneurosurgery worldwide. However, the reduced illumination of the surgical field with the use of a conventional microscope during surgeries of deeply located pathologies remains unaddressed. Accordingly, different exoscope systems have recently been introduced in clinical practice. Here, we report our initial experience with the digital 2-dimensional Synaptive Modus V exoscope system in spinal and cranial surgery. METHODS: During a 2-week period between 27 September to 11 October 2018, we used the Synaptive Modus V exoscope system and performed eight neurosurgical procedures including spine (n = 4) and cranial procedures (n = 4). Visual quality, depth perception, complications, switching to microscope comfort level of the surgeon, and learning curve during surgery were evaluated. RESULTS: A total of eight procedures were performed, namely, vestibular schwannoma (n = 1), skull base meningioma (n = 1), olfactory groove meningioma (n = 1), tentorial meningioma (n = 1), anterior cervical discectomy (n = 1), cervical laminectomy (n = 1), and lumbar disc herniation (n = 2). The overall results were comparable to the operative microscope with better visual quality and greater comfort for the surgeon. CONCLUSION: The Synaptive Modus V system is a safe tool to perform common spinal surgeries and intracranial tumor resection. Image quality is better than a microscope but with slightly less depth perception. Vigorous training in the laboratory may be helpful before clinical use.

Application of an interspinous process device after minimally invasive lumbar decompression could lead to stress redistribution at the pars interarticularis: a finite element analysis.

BACKGROUND: An interspinous process device, the Device for Intervertebral Assisted Motion (DIAM™) designed to treat lumbar neurogenic disease secondary to the lumbar spinal stenosis, it provides dynamic stabilization after minimally invasive (MI) lumbar decompression. The current study was conducted using an experimentally validated L1-L5 spinal finite element model (FEM) to evaluate the limited decompression on range of motion (ROM) and stress distribution on a neural arch implanted with the DIAM. METHODS: The study simulated bilateral laminotomies with partial discectomy at L3-L4, as well as unilateral and bilateral laminotomies with partial discectomy combined with implementation of the DIAM at L3-L4. The ROM and maximum von Mises stresses in flexion, extension, lateral bending, and axial torsion were analyzed in response to the hybrid protocol in comparison with the intact model. RESULTS: The investigation revealed that decreased ROM, intradiscal stress, and facet joint force at the implant level, but considerably increased stress at the pars interarticularis were found during flexion and torsion at the L4, as well as during extension, lateral bending, and torsion at the L3, when the DIAM was implanted compared with the defect model. CONCLUSION: The results demonstrate that the DIAM may be beneficial in reducing the symptoms of stress-induced low back pain. Nevertheless, the results also suggest that a surgeon should be cognizant of the stress redistribution at the pars interarticularis results from MI decompression plus the application of the interspinous process device.

Is biportal technique/endoscopic spinal surgery satisfactory for lumbar spinal stenosis patients?: A prospective randomized comparative study.

BACKGROUND: Lumbar decompressive surgery is a standard surgical technique for lumbar spinal stenosis. Many new surgical techniques have been introduced, ranging from open surgery to minimally invasive procedures. Minimally invasive surgical techniques are preferred because patients experience less postoperative pain and shorter hospital stays. However, the success rate of minimally invasive techniques have been controversial. The object of this study was to assess the feasibility of spinal decompression using biportal technique/endoscopic surgery compared with microscopic surgery. METHODS: Seventy lumbar spinal stenosis patients undergoing laminectomy were included in this study. A number table was used to randomize the patients into two groups: a biportal technique/endoscopic surgery group (BG-36) and a microscopic surgery group (OG-34). One surgeon performed either biportal technique/endoscopic decompression or microscopic decompression using a tubular retractor, depending on the group to which the patient was randomized. Perioperative data and clinical outcomes at postoperative 6 months were collected and analyzed. RESULTS: The demographic data and level of surgery were comparable between the two groups. A shorter operation time (36 ±â€Š11 vs 54 ±â€Š9 min), less hemovac drain output (25.5 ±â€Š15.8 vs 53.2 ±â€Š32.1 ml), less opioid usage (2.3 ±â€Š0.6 vs 6.5 ±â€Š2.5 T) and shorter hospital stay (1.2 ±â€Š0.3 vs 3.5 ±â€Š0.8 days) were shown in BG. The BG experienced no significant differences in clinical outcomes compared with OG. Favorable clinical outcomes were shown at 6 months after surgery in both groups. CONCLUSION: Lumbar decompressive surgery using biportal technique/endoscopy showed favorable clinical outcomes, less pain and a shorter hospital stay compared to microscopic surgery in patients with lumbar spinal stenosis.

Lessons Learned Using a High-Definition 3-Dimensional Exoscope for Spinal Surgery.

BACKGROUND: The operative microscope has significantly advanced modern neurosurgical spine surgery but continues to be limited by high costs, suboptimal optics, poor ergonomics, and difficulties with maneuverability. We believe the novel 4K high-definition (4K-HD) 3-dimensional (3D) exoscope (EX), may improve the surgical corridor through advancements in illumination, ergonomics, magnification, and depth of field and has the potential to be utilized in neurosurgical education and training. OBJECTIVE: To evaluate the surgical potential of a novel 3D EX system in spinal surgery. METHODS: Retrospective analysis over 6 mo of all patients who have undergone spinal surgery at Northwell Health using the 3D EX. Nuances of surgical theater positioning, advantages/disadvantages of the EX and clinical sequelae of the patients were analyzed. RESULTS: All 10 patients who underwent spinal surgery utilizing the EX experienced excellent surgical and clinical outcomes without complications. The low-profile EX allowed for excellent operative corridors and instrument maneuverability. The large monitor also resulted in an immersive surgical experience, and gave team members the same 3D vision as the operator. CONCLUSION: This study demonstrates the feasibility of utilizing the 3D 4K-HD EX system and highlights potential technical assets of this novel technology in regard to optics, ergonomics, and maneuverability. Further clinical research is needed to examine the clinical effectiveness of the EX system for different surgical approaches through quantitative methodology.

Determination of surgical exposure obtained with integrated endoscopic thoracolumbar hemilaminectomy in large-breed cadaveric dogs.

OBJECTIVE: To define boundaries of minimally invasive integrated endoscopic hemilaminectomy at 4 sites in the canine thoracolumbar spine. STUDY DESIGN: Experimental, randomized cadaveric study. ANIMALS: Six cadaver dogs that had been humanely euthanized for reasons unrelated to this study. METHODS: Hemilaminectomy was performed with an integrated endoscopic system at T11-12, T12-13, L1-2, and L2-3, 1 at each site, on the left or right side of each dog. Each site was randomly assigned either a 19-mm or a 23-mm cannula. The entire procedure, including soft tissue dissection, was performed through the cannula. Afterward, spines were imaged by computed tomography (CT) to measure the cranial and caudal extent of the hemilaminectomy from the center of the disc space. RESULTS: The mean ± SD cranial extent of the hemilaminectomy was 4.5 ± 1.4 mm for the 19-mm cannula and 5.6 ± 1.4 mm for the 23-mm cannulas (P = .0757). The caudal extent of the hemilaminectomy was 9.5 ± 2.2 mm for the 19-mm cannula and 10.3 ± 1.6 mm for the 23-mm cannula (P = .206). The mean length of the hemilaminectomy was 13.0 ± 1.5 mm for the 19-mm cannula and 15.0 ± 2.1 mm for the 23-mm cannula (P = .022). CONCLUSION: Integrated endoscopic systems were reliably used to access the spinal canal within the range of the above measurements relative to the disc space as identified by CT or magnetic resonance imaging. CLINICAL SIGNIFICANCE: Integrated endoscopy can be considered as an option in dogs with thoracolumbar disc extrusions or other pathology measuring within the parameters defined by this study. Access may be possible beyond the dimensions defined in this study with probing and repositioning.