Minimally Invasive Spine Surgery Research Articles

Bibliometric Patent Review of Minimally Invasive Spine Surgery.

This study analyzes patents associated with minimally invasive spine surgery (MISS) found on the Lens open online platform. The goal of this research was to provide an overview of the most referenced patents in the field of MISS and to uncover patterns in the evolution and categorization of these patents. MISS has rapidly progressed, with a core focus on minimizing surgical damage, preserving the natural anatomy, and enabling swift recovery, all while achieving outcomes that rival traditional open surgery. While prior studies have primarily concentrated on MISS outcomes, the analysis of MISS patents has been limited. To conduct this study, we used the Lens platform to search for patents that included the terms "minimally invasive" and "spine" in their titles, abstracts, or claims. We then categorized these patents and identified the top 100 with the most forward citations. We further classified these patents into 4 categories: Spinal Stabilization Systems, Joint Implants or Procedures, Screw Delivery System or Method, and Access and Surgical Pathway Formation. Five hundred two MISS patents were identified initially, and 276 were retained following a screening process. Among the top 100 patents, the majority had active legal status. The largest category within the top 100 patents was Access and Surgical Pathway Formation, closely followed by Spinal Stabilization Systems and Joint Implants or Procedures. The smallest category was Screw Delivery System or Method. Notably, the majority of the top 100 patents had priority years falling between 2000 and 2009, indicating a moderate positive correlation between patent rank and priority year. Thus far, patents related to Access and Surgical Pathway Formation have laid the foundation for subsequent innovations in Spinal Stabilization Systems and Screw Technology. This study serves as a valuable resource for guiding future innovations in this rapidly evolving field.

Comparison of Intradural Bupivacaine With Epidural Levobupivacaine in Lumbar Endoscopic Spinal Surgery

Objective: In lumbar endoscopic spinal surgery, the choice of a regional anesthetic is important for reducing complications and can affect patient recovery and comfort.Methods: A retrospective analysis was conducted of 66 lumbar microdiscectomies (LMDs) under epidural anesthesia (EA) (n=45) or intradural anesthesia (IA) (n=21) performed by the same surgeon and anesthesiologist. The choice of regional anesthesia in LMD (epidural or intradural) differs between anesthesiologists, and the most frequently anesthetic method used in LMD is general or IA.Results: EA may be more reliable than IA, as it enables the surgeon to perform a neurological exploration by requesting the patient to make leg or foot movements during surgery, but few studies have compared these 2 anesthetic methods in LMD. We found that there was a statistically significant difference (p<0.05) between the 2 groups in the postoperative recovery times and in the use of vasopressors during surgery.Conclusion: We suggest that EA reduces the length of time to ambulate, length of stay in the postanesthesia care unit, and the time until initiation of postoperative rehabilitation. Compared to IA, it offers greater hemodynamic stability and allows neurological exploration during surgery.

Current Status and Future of Endoscopic Spinal Surgery in Latin America and Spain

Current Status and Future of Endoscopic Spinal Surgery in Latin America and Spain

PL-TOSP, the Novel Entry Point in Transforaminal Endoscopic Spine Surgery: Radiological Analysis with Prospective Surgical Evaluation and Review of Literature of Various Skin Entry Points

Abstract Purpose Aim of this study was to analyze variation in angulation of trajectories of various skin entry points in transforaminal endoscopic spine surgery with change in the physical parameters, namely, weight, abdominal girth, and body mass index and to validate our hypothesis that posterolateral (PL)-tip of spinous process (TOSP) entry has minimal variation in the angle of trajectory as compared with currently available skin entry points. The study included an analysis of the functional outcomes of these patients who underwent transforaminal endoscopy using the novel PL-TOSP technique, assessing improvements in pain and disability. Overview Entry point in transforaminal endoscopic lumbar discectomy (TELD) was taken as a rough distance of 10 to 12 cm from midline as proposed by Kambin whereas Yeung and Tsou advised entry point as distance between the center of the disc space and the posterior skin line measured on lateral. But entry points cannot be static as they tend to change according to changes in physical parameters. Materials and Methods This study comprises of radiological analysis and a prospective evaluation of these patients operated on using the PL-TOSP entry point. Radiological analytic study was performed on 50 symptomatic preoperative patients who underwent transforaminal endoscopy using the novel PL-TOSP entry point. A lumbar spine magnetic resonance imaging (MRI) field of vision (MRI-FOV) was performed for the patients including the abdominal perimeter. Weight, height, and abdominal girth of the patients were noted prior to MRI. Angulation of trajectory made by four standard entry points used in TELD, namely, 45–45, PL, TOSP), dorsum of facet joint, and our proposed entry point PL-TOSP (which is a midpoint between PL and TOSP entry), were calculated using MRI-FOV at L45 and L5S1 level. For the functional outcome analysis of these 50 patients, preoperative Visual Analogue Score (VAS) for lower limb pain and Oswestry Disability Index (ODI) were recorded. Postoperative VAS and ODI scores were reassessed at 2, 6, and 12 weeks. Statistical analysis was conducted to evaluate the significance of changes in VAS scores and ODI preoperative versus postoperative. A p-value of < 0.05 was considered statistically significant. Results Angle of trajectory with the horizontal for all five entry points varies with physical parameters. PL-TOSP entry point has the least variation with change in physical parameters as compared with other entry points. The range of angle for PL-TOSP entry was 21 to 29 degrees. In our study, there was improvement in postoperative VAS and ODI scoring systems which was statistically significant (p-value < 0.05). This suggests reliability of our proposed entry point with consistent postoperative improvement. Conclusion The novel PL-TOSP entry point for transforaminal endoscopy demonstrates superior stability in trajectory angle despite variations in physical parameters, and is associated with significant improvements in functional outcomes and pain reduction for patients with lower limb radiculopathy. Angulation of PL-TOSP trajectory with horizontal also corresponds to current generation of endoscopes (25 or 30 degrees).

Does Routine Post-Operative Use of Drainage in Minimally Invasive Lumbar Spine Surgery Offer Better Results?

Objective: The advantages of minimally invasive spine surgery (MISS) in lumbar degenerative diseases have been well described (less tissue damage, shorter hospital stay, better results in pain assessment). One aspect that has not yet been studied enough is the usage of a post-operative drain in MISS. The aim of this study was to determine whether drainage in MISS is necessary or not and what advantages or disadvantages its use offers. Materials - Methods: We conducted a systematic review of the published literature, searching articles published on Pubmed and Embasse until December 1st 2022, regarding MISS in the lumbar region and post-operative drain usage. Our inclusion criteria were original articles written in English and articles using minimally invasive techniques (usage of tubular retractors along with an endoscope or microscope, paramedian incision, percutaneous screw placement). 42 articles were assessed, and after careful examination and duplication exclusion, 26 research papers were included. Usage, type and duration of postoperative drainage, length of hospital stay, ambulation time and complications were extracted, and relevant results were pooled. Results: The majority of the included articles (80.7 %) reported using a negative-pressure post-operative drain tube. Drains were removed either 48 hours after surgery or when the drainage volume was less than 50ml/24h. Hospital stays and time to ambulation were shorter in cases where drainage was not used. There was no difference in complications between cases where drainage was used and those that it was not. Conclusion: The rationale behind post-operative drainage in MISS is to protect from surgical site infections and hematoma creation. Based on our study there is no evidence to support this hypothesis. On the contrary, our results suggest that the drawbacks of using a drain (pain, discomfort, anxiety, inconvenience of mobilisation, prolongation of hospitalisation) outweigh the advantages, thus making the routine use of postoperative drainage in MISS unnecessary.

The Development of Spinal Endoscopic Ultrasonic Imaging System with an Automated Tissue Recognition Algorithm.

Preclinical experimental study. To develop an intraoperative ultrasound-assisted imaging device, which could be placed at the surgical site through an endoscopic working channel and which could help surgeon recognition of different tissue types during endoscopic spinal surgery (ESS). ESS remains a challenging task for spinal surgeons. Great proficiency and experience are needed to perform procedures such as intervertebral discectomy and neural decompression within a narrow channel. The limited surgical view poses a risk of damaging important structures, such as nerve roots. We constructed a spinal endoscopic ultrasound system, using a 4-mm custom ultrasound probe, which can be easily inserted through the ESS working channel, allowing up to 10 mm depth detection. This system was applied to ovine lumbar spine samples to obtain ultrasound images. Subsequently, we proposed a two-stage classification algorithm, based on a pretrained DenseNet architecture for automated tissue recognition. The recognition algorithm was evaluated using accuracy and consistency. The probe can be easily used in the ESS working channel and produce clear and characteristic ultrasound images. We collected 367 images for training and testing of the recognition algorithm, including images of the spinal cord, nucleus pulposus, adipose tissue, bone, annulus fibrosus and nerve roots. The algorithm achieved over 90% accuracy in recognizing all types of tissues with a Kappa value of 0.875. The recognition times were under 0.1 s using the current configuration. Our system was able to be used in existing ESS working channels and clearly identified at-risk spinal structures in vitro. The pretrained algorithms could identify six intraspinal tissue types accurately and quickly. The concept and innovative application of intraoperative ultrasound in ESS may shorten the learning curve of ESS and improve surgical efficiency and safety.

New Perspectives on Risk Assessment and Anticoagulation in Elective Spine Surgery Patients: The Impact of Ultra-Minimally Invasive Endoscopic Surgery Techniques on Patients with Cardiac Disease.

The advent of ultra-minimally invasive endoscopic spine surgery, characterized by significantly reduced surgery times, minimal blood loss, and minimal tissue trauma, has precipitated a paradigm shift in the preoperative management of patients with cardiac disease undergoing elective spine procedures. This perspective article explores how these advancements have influenced the requirements for preoperative cardiac workups and the protocols surrounding the cessation of anticoagulation and antiplatelet therapies. Traditionally, extensive cardiac evaluations and the need to stop anticoagulation and antiplatelet agents have posed challenges, increasing the risk of cardiac events and delaying surgical interventions. However, the reduced invasiveness of endoscopic spine surgery presents a safer profile for patients with cardiac comorbidities, potentially minimizing the necessity for rigorous cardiac clearance and allowing for more flexible anticoagulation management. This perspective article synthesizes current research and clinical practices to provide a comprehensive overview of these evolving protocols. It also discusses the implications of these changes for patient safety, surgical outcomes, and overall healthcare efficiency. Finally, the article suggests directions for future research, emphasizing the need for updated guidelines that reflect the reduced perioperative risk associated with these innovative surgical techniques. This discussion is pivotal for primary care physicians, surgeons, cardiologists, and the broader medical community in optimizing care for this high-risk patient population.

Pars interarticularis screws for posterior cervical fusion – investigating a new trajectory using a CT-based multiplanar reconstruction: Part I

BackgroundLateral mass screw fixation is the standard for posterior cervical fusion between C3 and C6. Traditional trajectories stabilize but carry risks, including nerve root and vertebral artery injuries. Minimally invasive spine surgery (MISS) is gaining popularity, but trajectories present anatomical challenges.Research Question.This study proposes a novel pars interarticularis screw trajectory to address these issues and enhance in-line instrumentation with cervical pedicle screws.Materials and MethodsA retrospective analysis of reformatted cervical CT scans included 10 patients. Measurements of the pars interarticularis morphology were performed on 80 segments (C3-C6). Two pars interarticularis screw trajectories were evaluated: Trajectory A (upper outer quadrant entry, horizontal trajectory) and Trajectory B (lower outer quadrant entry, cranially pointed trajectory). These were compared to standard lateral mass and cervical pedicle screw trajectories, assessing screw lengths, angles, and potential risks to the spinal canal and transverse foramen.ResultsTrajectory B showed significantly longer pars lengths (15.69 ± 0.65 mm) compared to Trajectory A (12.51 ± 0.24 mm; p < 0.01). Lateral mass screw lengths were comparable to pars interarticularis screw lengths using Trajectory B. Both trajectories provided safe angular ranges, minimizing the risk to delicate structures.Discussionand Conclusion.Pars interarticularis screws offer a viable alternative to lateral mass screws for posterior cervical fusion, especially in MISS contexts. Trajectory B, in particular, presents a feasible and safe alternative, reducing the risk of vertebral artery and spinal cord injury. Preoperative assessment and intraoperative technologies are essential for successful implementation. Biomechanical validation is needed before clinical application.

Full Endoscopic Transpedicular Discectomy for a Rostrally Migrated L5-S1 Disc Herniation in the Setting of Previous Lumbar Surgery: A Case Report With Intraoperative Video.

The surgical management of rostral disc herniations at L5-S1 poses challenges for conventional endoscopic approaches, particularly in patients who have had previous lumbar surgery. We present a full endoscopic transpedicular discectomy (FETD), whereby a pediculotomy is created to pass an endoscope through the pedicle for intracanal access. This addresses anatomic obstacles and potential complications associated with other endoscopic and minimally invasive or open techniques. To date, this is the only article to highlight this approach with a case report and intraoperative video. A 76-year-old man with a history of L3-S1 laminectomy presented with left leg pain and a near-complete left foot drop. An MRI revealed a left paracentral rostrally migrated disc herniation arising from L5-S1 with impingement of the exiting left L5 nerve root at the inferomedial aspect of the pedicle of L5. The patient consented to the FETD procedure. Using sequential reamers of increasing diameter and a high-speed burr, a superolateral to inferomedial pediculotomy was performed. This approach allowed us to target the pathology at the point of maximum compression without traversing the prior operative field. A transforaminal endoscopic approach was not possible with the iliac crest obstructing rostral angulation. The disc was successfully removed without any intraoperative complications, and after surgery, the patient's radiculopathy resolved without any radiographic evidence of instability. FETD is a unique approach that demonstrates the versatility of endoscopic spine surgery, offering advantages over conventional approaches particularly for rostral disc herniations at L5-S1 in the setting of prior lumbar surgery.

Endoscopic decompression of severe post-tuberculosis kyphosis related ossification of the ligamentum flavum: case report and literature review.

Spinal tuberculosis, if not promptly treated, can lead to kyphotic deformity, causing persistent neurological abnormalities and discomfort. Spinal cord compression can occur due to ossification of the ligamentum flavum (OLF) at the apex of kyphosis. Traditional surgical interventions, including osteotomy and fixation, pose challenges and risks. We present a case of thoracic myelopathy in a patient with post-tuberculosis kyphosis, successfully treated with biportal endoscopic spinal surgery (BESS). A 73-year-old female with a history of untreated kyphosis presented with walking difficulties and lower limb pain. Imaging revealed a kyphotic deformity of 120° and OLF-induced cord compression at T8-9. UBE was performed under spinal anesthesia. Using the BESS technique, OLF was successfully removed with minimal damage to the stabilizing structures. The patient exhibited neurological improvement after surgery, walking on the first day without gait instability. Follow-up at 1year showed no kyphosis progression or recurrence of symptoms. BESS successfully resolved the cord compression lesion with minimal blood loss and damage. In spinal tuberculosis-related OLF, conventional open surgery poses challenges. BESS emerges as an excellent alternative, providing effective decompression with reduced instrumentation needs, minimal blood loss, and preservation of surrounding structures. Careful patient selection and surgical planning are crucial for optimal outcomes in endoscopic procedures.

Full-Endoscopic Posterior Lumbar Interbody Fusion: A Review and Technical Note

Remarkable innovations in spinal endoscopic surgery have broadened its applications over the past 20 years. Full-endoscopic fusions have been widely reported, and several full-endoscopic approaches for interbody fusion have been published. In general, full-endoscopic lumbar interbody fusion (LIF) is called Endo-LIF, and facet-preserving endo-LIF through the transforaminal route is called trans-Kambin’s triangle LIF, which has a relatively longer history than facet-sacrificing endo-LIF via the posterolateral route. Both approaches can reduce intraoperative and postoperative bleeding. However, there is a higher risk of subsidence and exit nerve root injury. There is no direct decompression in either of the interbody fusions, and additional decompression is required if there is severe lumbar bony canal stenosis. However, the posterior interlaminar approach, which is a well-known standard in full-endoscopic spine surgery, has rarely been applied in the field of endoscopic lumbar fusion surgery. Full-endoscopic posterior LIF (FE-PLIF) via an interlaminar approach can accomplish direct decompression of bony canal stenosis and safe interbody fusion. FE-PLIF via an interlaminar approach demonstrated a longer operation time, less blood loss, and shorter hospitalization duration than minimally invasive transforaminal LIF. FE-PLIF, which can accomplish direct decompression for bony spinal canal stenosis, is superior to other Endo-LIFs. However, FE-PLIF requires technical dexterity to improve efficiency and reduce technical complexity.

Preliminary Clinical and Radiological Outcomes of the "No-Punch" Decompression Techniques for Unilateral Biportal Endoscopic Spine Surgery.

To avoid the most offending surgical instrument for dural tears, we develop a "no-punch" decompression technique for unilateral biportal endoscopic (UBE) spine surgery. This retrospective study enrolled 68 consecutive patients with degenerative lumbar spinal stenosis segments. The treatment results were evaluated using the visual analogue scale (VAS) for low back and leg pain, the Japanese Orthopaedic Association (JOA) scores, and the Oswestry Disability Index (ODI). Radiological outcomes were evaluated using the preoperative and postoperative magnetic resonance imaging. This study included 36 male and 32 female patients who received 109 segments of decompression, with an average age of 68.7 (37-90 years). The average operation time was 52.2 minutes. The average hospital stay was 3.1 days. There were no dural tears but 3 minor surgical complications, all treated conservatively. The VAS for low back and leg pain improved from 4.6 and 7.0 to 0.8 and 1.2. The JOA score improved from 16.2 to 26.8, with an improvement rate of 82.0%. The ODI improved from 50.1 to 18.7. All these improvements were statistically significant. The cross-sectional dural area improved from 61.1 to 151.3 mm2, with an average increase of 90.2 mm2 and 205.3%. 87.1% of the ipsilateral facet joints and 84.7% of the contralateral facet joints were preserved. In 61% of the decompressed segments, the ipsilateral facet joints were preserved better than the contralateral facet joints. The UBE "no-punch" decompression technique effectively avoids the dural tears. It provides effective neural decompression, excellent facet joint preservation, and good treatment outcomes.

Commercial suture passer improves efficiency and ease of use versus conventional needle in minimally invasive thoracolumbar fascia closure: a cadaveric analysis

BackgroundLow-profile suture passers have been introduced to facilitate thoracolumbar fascia closure in minimally invasive spine (MIS) surgery. The purpose of this study was to evaluate the closure time of a modern suture passer to a conventional curved need for MIS fascia closure in a cadaveric model. MethodsSix clinicians specializing in orthopedic spine surgery were recruited for the study and randomly assigned 1 cadaveric torso. Subcutaneous tissue was resected at L4-L5, replicating MIS surgery, followed by placement of a 60×18-mm or 100×18-mm tubular retractor for access. Clinicians were required to close the fascia with three unknotted, simple interrupted sutures using a swaged curved needle or suture passer (Spine Scorpion™, Arthrex, Inc., Naples, FL). The completion time was recorded, starting immediately before suturing and ending after the last pass. A time cutoff of 10 min was implemented in consideration of reasonable operating room time, and the number of achieved suture passes (of 6) were recorded. Clinicians were asked to qualitatively grade ease of use in relation to prior fascial closure experience per a 0-5 scale, where 0 is impossible and 5 is easiest. ResultsThe mean change in fascial closure completion time (Δ) was significantly reduced with the Spine Scorpion compared to the curved needle with the 60×18-mm retractor (Δ=5.80 min; 95% CI, 2.92-8.67 min; p=.004) and 100 × 18-mm retractor (Δ=5.28 min; 95% CI, 2.76-7.80 min; p=.003). Full closure was achieved within the time limit for all trials of the Spine Scorpion, while the standard needle achieved full closure in 67% (4 of 6) and 50% (3 of 6) of trials with the 60 × 18-mm and 100×18-mm retractors, respectively. Median ease-of-use scores with the 60×18-mm and 100×18-mm retractors, respectively, were 4.5 (range, 4-5) and 4.5 (range, 3-5) for the Spine Scorpion, and both 1.0 (range, 1-2) for the curved needle. ConclusionResults from this laboratory investigation using a suture passer for thoracolumbar fascia closure show a significant reduction in closure time and completion of the procedure compared to a conventional curved needle.

Endoscopic Versus Traditional Thoracic Discectomy: A Multicenter Retrospective Case Series and Meta-Analysis.

Surgical treatment for symptomatic thoracic disc herniations (TDH) involves invasive open surgical approaches with relatively high complication rates and prolonged hospital stays. Although advantages of full endoscopic spine surgery (FESS) are well-established in lumbar disc herniations, data are limited for the endoscopic treatment of TDH despite potential benefits regarding surgical invasiveness. The aim of this study was to provide a comprehensive evaluation of potential benefits of FESS for the treatment of TDH. PubMed, MEDLINE, EMBASE, and Scopus were systematically searched for the term "thoracic disc herniation" up to March 2023 and study quality appraised with a subsequent meta-analysis. Primary outcomes were perioperative complications, need for instrumentation, and reoperations. Simultaneously, we performed a multicenter retrospective evaluation of outcomes in patients undergoing full endoscopic thoracic discectomy. We identified 3190 patients from 108 studies for the traditional thoracic discectomy meta-analysis. Pooled incidence rates of complications were 25% (95% CI 0.22-0.29) for perioperative complications and 7% (95% CI 0.05-0.09) for reoperation. In this cohort, 37% (95% CI 0.26-0.49) of patients underwent instrumentation. The pooled mean for estimated blood loss for traditional approaches was 570 mL (95% CI 477.3-664.1) and 7.0 days (95% CI 5.91-8.14) for length of stay. For FESS, 41 patients from multiple institutions were retrospectively reviewed, perioperative complications were reported in 4 patients (9.7%), 4 (9.7%) required revision surgery, and 6 (14.6%) required instrumentation. Median blood loss was 5 mL (IQR 5-10), and length of stay was 0.43 days (IQR 0-1.23). The results suggest that full endoscopic thoracic discectomy is a safe and effective treatment option for patients with symptomatic TDH. When compared with open surgical approaches, FESS dramatically diminishes invasiveness, the rate of complications, and need for prolonged hospitalizations. Full endoscopic spine surgery has the capacity to alter the standard of care for TDH treatment toward an elective outpatient surgery.

(082) DELAYED ORGASM CAN RESULT FROM LUMBOSACRAL DISC DISEASE DISRUPTING GENITAL SENSORY TRANSMISSION IN THE CAUDA EQUINA: A REVIEW

Abstract Introduction Delayed orgasm may be considered an unwanted, atypically long latency during most genital/sexual activity despite sexual stimulation, causing significant distress to the individual and/or partner, persisting for at least 6 months. Delayed orgasm is reported to affect 6.9% of women. It is associated with negative effects on sexual function, sexual satisfaction, and relationship satisfaction. Pharmacologic, endocrinologic, and neurobiological pathophysiological factors have been identified as possible etiologies of delayed orgasm, but an under-researched etiology is lumbosacral disc disease, specifically lumbosacral annular tear-induced sacral radiculopathy. The pelvic, pudendal, and sciatic nerves all merge at the S2-4 foramina where they coalesce to form the S2-4 nerve roots. These sacral spinal nerve roots (S2-4) ascend to the first synapse in the conus medullaris. During their ascent, they can be irritated mechanically by impingement/compression or chemically by exposure to the extruded nucleus pulposus from lumbosacral annular tears, and thereby disrupt genital sensory transmission with resultant delayed orgasm. The new evidence that delayed orgasm can be successfully treated by endoscopic spine surgery supports the association of delayed orgasm with sacral radiculopathy. There is still a paucity of research regarding delayed orgasm from lumbosacral disc disease. Objective To review the existing literature concerning the contribution of lumbosacral disc disease to delayed orgasm. Methods A literature search on delayed orgasm, its impacts and possible etiologies was performed. The following keywords were searched on Pubmed individually and in combination, related to the association between delayed orgasm and lumbosacral disc disease: delayed orgasm, delayed ejaculation, sexual dysfunction, anorgasmia, and persistent genital arousal disorder. Current definitions were compiled, and overall epidemiology, anatomy, and biopsychosocial factors of delayed orgasm were explored. Results There are a number of publications (n = 19) demonstrating the development of sexual dysfunction after damage to the sacral spinal nerve roots. Furthermore, several studies (n = 4) and case reports (n = 1) have demonstrated that treating lumbosacral disc disease reduces sexual dysfunction including improvement in delayed or reduced ejaculation. While delayed ejaculation encompasses the experience of delayed orgasm for some individuals, the literature fails to address delayed orgasm comprehensively in relation to lumbosacral disc disease, and thus fails to address treatment of lumbosacral disc disease and subsequent resolution of delayed orgasm. People with vulvas are particularly underrepresented in the literature studying the connection between lumbosacral disc disease and delayed orgasm. Conclusions While lumbosacral disc disease has many side effects that may impede daily function, sexual side effects can further detract from one’s personal life and relationship satisfaction. Thus, improving clinician awareness of sexual side effects, particularly delayed orgasm, can help improve treatment for individuals especially as they age. Further research is needed to strengthen the understanding of the effect of sacral radiculopathy on delayed orgasm as well as other sexual dysfunctions. Disclosure No.

(037) VESTIBULODYNIA SECONDARY TO LUMBOSACRAL ANNULAR TEAR-INDUCED SACRAL RADICULOPATHY

Abstract Introduction Vestibulodynia is a prevalent problem in individuals with vulvas, with as many as 30% reporting complaints consistent with entry dyspareunia. Distinctive vestibulodynia pathophysiologies may include psychosocial factors, pelvic floor muscle dysfunction, dermatologic disorders, inflammatory disorders, hormonal deficiencies, neuroproliferative pathology, and pudendal neuropathy. Sacral radiculopathy is considered an inflammatory irritation of S2-S3 nerve roots in the cauda equina by various pathologies such as lumbosacral annular tear. S2-S3 nerve roots are formed by the convergence of the pelvic, pudendal, and sciatic nerves and genito-pelvic clinical symptoms may result from inflammatory involvement of the sensory fields of these nerves. Vestibulodynia may occur from sacral radiculopathy since the somatic and visceral afferent innervation of the vestibule occurs via the pudendal and pelvic nerves, respectively; however, to the best of our knowledge, there has not been a case series of such patients previously reported. Objective To perform a chart review of patients with vestibulodynia secondary to lumbosacral annular tear-induced sacral radiculopathy. Methods Vestibulodynia patients who presented to our sexual medicine clinic were evaluated by detailed history, vulvoscopy, vestibular anesthesia testing, neurogenital testing and lumbosacral MRI. When these tests warranted it, a transforaminal epidural spinal injection with 1 ml lidocaine 1% was performed to substantiate the diagnosis. If appropriate, spine surgery was performed. Improvement was assessed using the Patient Global Impression of Improvement (PGI-I). Results Four patients, 3 cis-gender women and 1 trans-man, mean age 33 years (range 25-42), were diagnosed with vestibulodynia secondary to lumbosacral annular tear-induced sacral radiculopathy. Concomitant sacral radiculopathy symptoms included: clitoral hypersensitivity (50%), bladder urgency/frequency (75%), umbilical hypersensitivity (75%), vaginal dysesthesia (25%), vulvar itching (50%), low back pain (100%), and sciatica (75%). Vulvoscopy was performed to exclude other forms of vestibulodynia. All patients had: a) positive cotton-tipped swab testing throughout the entire vestibule; b) negative vestibular anesthesia testing; c) abnormal neurogenital testing; d) lumbosacral MRI that revealed surgically treatable lumbosacral annular tear (L5-S1, L4-L5); e) transforaminal epidural spinal injection resulting in clinically significant symptom reduction. Lumbar endoscopic spine surgery resulted in improvement in 75% reporting PGI-I 1-3 (very much better - somewhat better). Conclusions We report the first series of patients with vestibulodynia resulting from lumbosacral annular tear-induced sacral radiculopathy. Clinicians should be aware that bothersome vestibulodynia in patients with vulvas can occur from cauda equina pathology (Region 3) outside the genitals (Region 1) and/or pelvis/perineum (Region 2). Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Elliquence.

Endoscopic Spine Surgery on Instagram: Analysis of Content and Engagement.

Introduction Social media platforms have changed the way society communicates and collaborates. Prior research in healthcare discusses how social media can empower patients, dispel health-related misinformation, and help maintain a patient-centered practice. The goal of this study was to evaluate the use of #endoscopicspinesurgery on Instagram and create a blueprint for creating engaging posts on the social media platform. Methodology Public Instagram posts (n= 171) that utilized #endoscopicspinesurgery were collected over three months in 2022. Each post was assessed for photo and caption content, likes, comments, number of followers, and hashtag information. Engagement rates were calculated for each post to assess the active interaction of post characteristics and content. Results The majority of posts were published by medical professionals (72/171, 42.1%) and industry-related user accounts (55/171, 32.2%). Content related to training, conferences, and the operating room garnered the highest average engagement. Post characteristics (number of hashtags and number of post photos) were significantly associated with engagement. Conclusions Results highlighted general trends in creating engaging social media posts, such as using hashtags intentionally to increase searchability and visibility, having higher numbers of photos in a post and using high-quality photos, and understanding the dynamic social media algorithms that may affect post viewership. When structuring social media posts, users should be aware of the audience they want to attract and construct their content accordingly.

A narrative review of endoscopic spine surgery: history, indications, uses, and future directions.

The concept of endoscopic surgery began in the 1930s and has since undergone numerous advancements in both technology and surgical indications. Its main benefit is providing the opportunity to perform surgery while minimizing disruption to surrounding structures. The purpose of this review is to summarize the history, uses, and future directions for spine endoscopic surgery. A review of national databases was performing using key terms "endoscopic", "spine" and "surgery" for literature from 1900 to 2023. Studies that aimed to describe the utilities of endoscopic surgeries, associated outcomes, limitations, and future directions were included. Studies that were not in English were excluded. This review includes a brief overview of the history of endoscopic surgery and its current two main approaches, transforaminal and interlaminar approaches. It then summarizes the main indications and utilization of endoscopic surgery in the lumbar, cervical and thoracic spine, as well as expansion in managing spine tumors, infections, and outpatient surgical cases. There are many rising indications and uses for endoscopic spine surgery in nearly every aspect of the spine. Compared to conventional spine surgery, there is early evidence showing endoscopic surgery is associated with less post-operative pain, shorter hospital stays, and possibly quicker recovery times. As current trends in spine surgery move towards minimally invasive techniques, it is anticipated that the use of endoscopic surgery will continue to expand.

Evolution, Current Trends, and Latest Advances of Endoscopic Spine Surgery.

Background: The aging of the population in developing and developed countries has led to a significant increase in the health burden of spinal diseases. These elderly patients often have a number of medical comorbidities due to aging. The need for minimally invasive techniques to address spinal disorders in this elderly population group cannot be stressed enough. Minimally invasive spine surgery (MISS) has several proven benefits, such as minimal muscle trauma, minimal bony resection, lesser postoperative pain, decreased infection rate, and shorter hospital stay. Methods: A comprehensive search of the literature was performed using PubMed. Results: Over the past 40 years, constant efforts have been made to develop newer techniques of spine surgery. Endoscopic spine surgery is one such subset of MISS, which has all the benefits of modern MISS. Endoscopic spine surgery was initially limited only to the treatment of lumbar disc herniation. With improvements in optics, endoscopes, endoscopic drills and shavers, and irrigation pumps, there has been a paradigm shift. Endoscopic spine surgery can now be performed with high magnification, thus allowing its application not only to lumbar spinal stenosis but also to spinal fusion surgeries and cervical and thoracic pathology as well. There has been increasing evidence in support of these newer techniques of spine surgery. Conclusions: For this report, we studied the currently available literature and outlined the historical evolution of endoscopic spine surgery, the various endoscopic systems and techniques available, and the current applications of endoscopic techniques as an alternative to traditional spinal surgery.

Effect of saline irrigation temperature difference on postoperative acute pain and hypothermia during biportal endoscopic spine surgery.

Recently, enhanced recovery after surgery (ERAS) protocols have attracted attention; they emphasize on avoiding intraoperative hypothermia while performing lumbar fusion surgery. However, none of the studies have reported the protocol for determining the temperature of saline irrigation during biportal endoscopic spine surgery (BESS) procedure. This study evaluated the effectiveness of warm saline irrigation during BESS in acute postoperative pain and inflammatory reactions. Fifty-five patients who underwent BESS procedure were retrospectively analyzed for the incidence of perioperative hypothermia (< 36oC), postoperative inflammatory factors (white blood cells (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL-6), serum amyloid A (SAA)), and clinical outcomes (back visual analog scale (VAS) score, postoperative shivering). The patients were divided into the warm and cold saline irrigation groups. Hemoglobin, WBC, ESR, creatine kinase, and creatine kinase-muscle brain levels did not significantly differ between the warm and cold saline groups. The mean CRP, IL-6, and SAA levels were significantly higher in the cold saline group than in the warm saline group (p = 0.0058, 0.0028, and 0.0246, respectively); back VAS scores were also higher with a statistically significant difference until two days postoperatively (p < 0.001). During the entire procedure, the body temperature was significantly lower in the cold saline irrigation group, but the hypothermia incidence rate significantly differed 30min after the operation was started. Using warm saline irrigation during BESS is beneficial for early recovery after surgery, as it is associated with reduced postoperative pain and complication rates.