Microendoscopic Surgery Research Articles

Full endoscopic treatment of dural tears in lumbar spine surgery.

An incidental durotomy is a common complication of spinal surgery. Its treatment remains challenging, especially in endoscopic procedures. The objective of this study is to describe a technique for endoscopic dural closure which is safe and effective. From a prospective database all endoscopic spinal procedures with incidental durotomy were identified. Retrospectively, video recordings were analysed with a special reference to the applied technique of dural closure. Additionally 1, 6 and 12week follow-up examinations were evaluated for clinical outcome and associated complications. Out of 212 consecutive patients, an intraoperative dural tear was observed in nine patients (4.2%). A dural tear occurred in 1.1% of cases of lumbar disc herniation, in 7.9% of cases with lumbar spinal stenosis, in 37.5% of cases with a synovial cyst. An autologous muscle sample was harvested within the operative field and grafted at the dural defect in several layers. Fixation of the transplantation and watertight closure were achieved by the application of fibrin sealant with gelfoam. The mean time for dural closure was 209s (range 47-420s). Postoperatively no CSF fistula, no new deficits nor worsening of a pre-existing neurological deficit occurred. None of the patients had problems with wound healing, or discomfort which could be related to the CSF leak. Dural closure with an autologous muscle graft in combination with fibrin sealant patch is a fast, safe and alternative technique for the management of dural tear in microendoscopic surgery.

Comparison of Three Different Paraspinous Unilateral Approaches to the Spinal Canal for Lumbar Decompression-Minimally 2-Year Postoperative Evaluation

Background: The purpose of this study is to investigate the differences of the clinical results and imaging findings among three different bilateral decompression via unilateral approach with a minimum 2-year follow-up period. Methods: Thirty consecutive patients with lumbar spinal canal stenosis who had undergone bilateral decompression via 3 different unilateral paraspinous approaches with a minimum 2-year follow-up period were chosen retrospectively for groups A (conventional open surgery), B (mini open surgery), and C (micro-endoscopic surgery). The clinical results and imaging findings of these three groups were then investigated. Results: A significant difference in length of incision and intraoperative blood loss per level decompressed was seen with group A>B>C. Operative time per level decompressed was longer in group C than in groups A or B. Japanese Orthopaedic Association (JOA) score recovery rate was lower in group B than in group C. The change ratios of cross-sectional area (CSA) of the ipsilateral and contralateral multifidus were smaller in group A than in groups B or C. Ipsilateral facet joint preservation was less in group A than group C, and contralateral facet joint preservation was less in group A than in groups B or C. The difference in change in slippage was greater in group A than in group C. Conclusion: This study revealed that bilateral decompression via a unilateral approach using mini open or microendoscopic procedures could be better surgical interventions compared to a conventional unilateral open approach for paravertebral muscle and facet joint preservation for at least 2 years.

Assessment of Postoperative Epidural Hematoma after Lumbar Microendoscopic Surgery

Introduction Symptomatic postoperative spinal epidural hematoma (SEH) is observed occasionally but rarely gets into serious complication after lumbar spinal surgery. It is also known that SEH occurs even in the endoscopic surgery. The purpose of this study is to assess characteristics and outcome of those cases which had SEH treated surgically after the initial microendoscopic surgery in the lumbar spine. Method From 2003 to 2015, total of 1249 patients with lumbar disc herniation or canal stenosis underwent microendoscopic discectomy or laminectomy in our institution. Traditional open spinal surgeries were compared with those microendoscopic surgeries. Six patients after microendoscopic surgery in the series required evacuation of SEH after the initial surgery were included in this study. Preoperative characteristics of the patients, clinical outcome and postoperative course were assessed. Result The incidence of SEH after microendoscopic surgeries required additional treatment was 0.48% (6 of 1249). The incidence of SHE after open spinal surgeries were 0.77% (11 of 1421). The initial procedure was microendscopic discectomy in three cases and microendoscopic laminotomy in three cases. One patient had hypertension, two patients had prediabetes and one patient had thrombocytopenia (12.110*3/μl) by hepatitis. Three cases were treated in the acute stage (within 24 hours after the surgery) and three cases were treated in the subacute stage (between 3 and 7 days after the surgery). In all cases, severe leg pain was appeared in short time. Two patients got muscle weakness. After the surgical evacuation of hematoma, all cases recovered from neurological symptoms and leg pain immediately. But one patient had repetitive leg pain after the evacuation with local anesthesia or general anesthesia. Finally Blood transfusion and factor VIII were required to stop SEH. Factor VIII activity of the patient was 58% at two days after the initial surgery. The patient fully recovered at six months after the initial surgery. Conclusion The incidence of SEH was not significant in comparison with a conventional method. It was considered that narrow epidural space by microendoscopic surgery affected dural compression by even a little bleeding. Basically, in preventing SEH, preoperative bleeding tendency, intraoperative bleeding, postoperative blood pressure and drainage should be confirmed. Even though, it was very difficult to detect the crucial factor of the symptomatic SHE, patient factor like bleeding and cerebrospinal pressure or iatrogenic factor like redundant invasion may lead to symptomatic SHE. Prompt treatment for symptomatic SEH was necessary.

Accuracy and evaluation of irradiation of novel localization devices with unique three-dimensional structures in microendoscopic spine surgery.

Although many reports are available on using a variety of instruments and techniques to prevent wrong-level spine surgery, the accurate localization of the correct spinal level remains problematic. At the same time, surgeons are also required to reduce radiation exposure to patients and operating room personnel. To solve these problems, we developed and used specially designed marking devices with a unique three-dimensional structure. To evaluate the accuracy of our novel devices for localization of the spinal level to prevent wrong-level surgery and reduce the amount and time of radiation exposure during surgery. This was a retrospective cohort study. In 8240 consecutive patients who underwent microendoscopic spine surgery between 1993 and 2012, the incidence of wrong-level surgery was studied. In addition, the amount of radiation exposure and total fluoroscopy time were measured in recent 100 consecutive patients using a digital dosimeter attached to the fluoroscope. Eight (0.097%) patients had undergone wrong-level surgery. The average radiation exposure was 0.26mGy (range 0.10-1.15mGy), and the average total fluoroscopy time was 3.1s (range 1-7s). Our novel localization devices and technique for their use in spine surgery are reliable and accurate for identifying the target level and contributed to reductions in preoperative localization error and radiation exposure to patients and operating room personnel.

Anterior transcorporeal approach of percutaneous endoscopic cervical discectomy for disc herniation at the C4–C5 levels: a technical note

Background ContextWith the continuous development of the spinal endoscopic technique in recent years, percutaneous endoscopic cervical discectomy (PECD) has emerged, which bridges the gap between conservative therapy and traditional surgery and has been mainly divided into the anterior transdiscal approach and the posterior interlaminar access. Because of the relatively greater violation to the anterior nucleus pulposus, there is a higher potential of postoperative intervertebral space decrease in the anterior transdiscal approach than in the posterior interlaminar access. In addition, when the herniated lesion is migrated upward or downward behind the vertebral body, both approaches, and even anterior cervical discectomy and fusion, are impractical, and corpectomy is commonly considered as the only efficacious treatment. Anterior transcorporeal approach under endoscopy could enable an individual and adjustable trajectory within the vertebral body under different conditions of disc herniation preserving the motion of adjacent segment, especially in a migrated or sequestered lesion. PurposeThis report aimed to first describe a novel anterior transcorporeal approach under endoscopy in which we addressed a migrated disc herniation at the C4–C5 levels. Study designA technical report was carried out. Patient sampleA 37-year-old woman presented with posterior neck pain and weakness of extremities for 9 months. On neurologic examination, tingling sensation and numbness were not obvious. However, the power of extremities was dramatically decreased at a level of 3. Hoffmann sign was positive in the bilateral hand. Magnetic resonance imaging (MRI) showed a huge herniation of the C4–C5 disc compressing the median area of the spinal cord. Besides the C4–C5 disc herniation, preoperative computer tomography (CT) also detected that the herniated disc had partial calcification. A novel anterior transcorporeal approach of PECD, through the vertebral body of C5, was performed to address a migrated disc herniation at the C4–C5 levels. Outcome measuresThe posterior neck pain was measured using the visual analog scale (VAS). MethodsA novel anterior transcorporeal approach under endoscopy was performed to address a migrated disc herniation at the C4–C5 levels. ResultsThis operation was accomplished in 75 minutes. Postoperatively, the drainage tube was retained into the drilling hole for 24 hours to avoid the possibility of hematoma. The patient was advised to wear a neck collar for 3 weeks. Immediately after the operation, the posterior neck pain improved from VAS 7/10 preoperatively to 3/10, and the myodynamia of extremities improved stepwise. At 12 hours postoperatively, the range of motion was also improved. In the further follow-up, the patient has completely recovered from the preoperative symptoms, whose myodynamia of extremities is normal. Besides the postoperative MRI, a total removal of the herniated disc and the transcorporeal drilling tunnel are observed in CT. At postoperative 3-month follow-up, neither disc space narrowing nor instability was observed on CT, in which the bone defect after drilling tunnelwas partially decreased, indicating bone healing. There were no surgery-related complications, such as dysphagia, Horner syndrome, recurrent laryngeal nerve palsy, vagus nerve injury, tracheoesophageal injury, or cervical hematocele. ConclusionsAs a supplement to the described surgical approach of PECD, the transcorporeal approach is a novel access for the treatment of cervical intervertebral disc herniation. Among the advantages of this approach are providing a clear visual field during microendoscopic surgery and decreasing the intraoperative iatrogenic injury to, as well as avoiding violation to the discal tissue. Theoretically, the potential of secondary decline of intervertebral height is low. However, as the limitation of one case shows, whether this transcorporeal approach is efficacious and reliable should be verified in a further comparative cohort study with a large volume of patients.

Rectangular Tubular Retractor for Microendoscopic Lumbar Decompression.

Background A cylindrical working tube with a diameter of 16 mm has been used for endoscopic posterior lumbar spinal surgery. However, intraoperative muscle resection is significant when using the current conventional tubular retractor. Objective To describe a novel tubular retractor for microendoscopic surgery and to analyze the outcomes of lumbar decompressive laminotomy using this retractor. Materials and Methods We devised a novel tubular retractor by changing the medial and lateral sides of the conventional 16-mm cylindrical tubular retractor to planes with a mediolateral dimension of 10 mm (rectangular tubular retractor hereafter). The amount of muscle resection, osteotomy angle on the approach side, and operating time were compared between 25 intervertebral levels treated by bilateral decompression through a unilateral approach using the rectangular tubular retractor and 31 intervertebral levels treated with the same surgery using a 16-mm cylindrical tubular retractor. Results Due to the short mediolateral dimension, muscle resection decreased by 86%. The rectangular tubular retractor also decreased early postoperative wound pain. Because the craniocaudal dimension of the tubular retractor was maintained, surgical difficulty did not increase, resulting in only a slight increase in operating time. The facet joint on the approach side could be sufficiently preserved. Conclusions The rectangular tubular retractor reduced surgical invasiveness without increasing surgical difficulty.

A case report of microendoscopic surgery of lumbar canal stenosis with ossification of yellow ligament of achondroplasia

A case report of microendoscopic surgery of lumbar canal stenosis with ossification of yellow ligament of achondroplasia

Nursing of patients with thyroid cancer undergoing micro-endoscopic resection

Objective To explore the clinical effect of micro-endoscopic resection of thyroid cancer and supply corresponding nursing measures through comparison of micro-endoscopic resection and conventional thyroidectomy.Methods 60 cases of thyroid cancer patients during May 2011 to March 2012 were selected.The experimental group (30 cases) underwent micro-endoscopic resection,while the control group was given conventional thyroidectomy.Items such as the operation time,bleeding volume in operation,complication,incision length,postoperative pain evaluation,postoperative resumption time of activity of neck were compared between the two groups.Results The total operation time was (105.4±28.7)min in the experimental group,and (98.1±22.4) min in the control group respectively.The bleeding volume was (22.4±11.6) ml in the experimental group,and (47.3±18.2) ml in the control group respectively.The postoperative resumption time of activity of neck was (22.3±7.7) h in the experimental group,(39.0±10.8) h in the control group.The above items had significant statistical difference between two groups.The incidence of complication had significant statistical difference between two groups.The incision length of the experimental group was (2.95±0.13) cm,(7.72±0.93) cm in the control group,there was significant statistical difference between two groups.Conclusions Compared with conventional surgery,micro-endoscopic technique in thyroid surgery has good efficacy.And assisting with essential nursing strategy,the effcacy of microendoscopic technique can be improved. Key words: Thyroidectomy; Micro-endoscopic surgery; Conventional operation; Clinical comparison

Ordinary Disc Herniation Changing into Posterior Epidural Migration of Lumbar Disc Fragments Confirmed by Magnetic Resonance Imaging: A Case Report of a Successful Endoscopic Treatment

The posterior epidural migration of lumbar disc fragments is an extremely rare event with an unknown pathogenesis. To the best of our knowledge, there are no previously reported cases of a change of ordinary disc herniation into the posterior epidural migration of lumbar disc fragments as confirmed by magnetic resonance imaging (MRI). A 26-year-old male presented to our department complaining of left buttock and lateral leg pain. An ordinary herniation was shown in the first MRI. The patient's unilateral symptoms changed into bilateral symptoms while awaiting admission to the hospital. Posterior migrated lumbar disc fragments were shown in the second MRI taken at the time of admission. Microendoscopic surgery providing a detailed observation of the region was performed. Our case indicates that an ordinary lumbar disc herniation may lead to the posterior migration of lumbar disc fragments, and that microendoscopic surgery may provide a treatment.

Effect of cryotherapy after spine surgery.

Study DesignHistorical controlled trial.PurposeTo clarify the usefulness of cryotherapy after spine surgery.Overview of LiteratureCryotherapy has generally been performed subsequent to surgery on joints and in this application its clinical effects are well understood. However, cryotherapy has yet to be used following spine surgery. Its clinical efficacy in this context is unknown.MethodsThirty six patients had undergone one level microendoscopic surgery. Sixteen were enrolled into the cooling group, with the remaining 20 making up the no postoperative cryotherapy control group. Cryotherapy was performed at 5℃ using an icing system. A silicone balloon catheter with a thermo sensor on the tip was placed in the surgical wound. The temperature in the wound was recorded every 30 minutes until the next morning. The relationship between the depth of the sensor and the temperature in the wound were investigated using simple linear regression analysis. Laboratory data, visual analogue scale (VAS) for wound pain and postoperative bleeding were investigated.ResultsThe mean temperature in the surgical wound was 37.0 in the control group and 35.0℃ in the cooling group (p<0.001). There was a positive correlation between the depth of the thermo sensor and the temperature in the wound in the cooling group (y=0.91x+30.2, r=0.67, p=0.004). There were no significant differences between the groups in terms of laboratory data, VAS or postoperative bleeding.ConclusionsThe temperature in the wound was decreased significantly by spinal surgery cryotherapy.

Microdiscectomy and Foraminotomy in Cervical Spondylotic Myelopathy and Radiculopathy: Anterior versus Posterior, Microendoscopic Surgery versus Mini-Open Microsurgery

Microdiscectomy and Foraminotomy in Cervical Spondylotic Myelopathy and Radiculopathy: Anterior versus Posterior, Microendoscopic Surgery versus Mini-Open Microsurgery

Microendoscopic Surgery for Lumbar Spinal Canal Stenosis with Compression Fracture

Microendoscopic Surgery for Lumbar Spinal Canal Stenosis with Compression Fracture

Microendoscopic surgery for spinal degenerative disease in Parkinson's disease

Microendoscopic surgery for spinal degenerative disease in Parkinson's disease

Minimally Invasive Surgery for Osteoid Osteoma of the Cervical Spine Using Microendoscopic Discectomy System

We report herein the case of an 18-year-old man who underwent endoscopic resection for an osteoid osteoma in the seventh cervical facet joint. The patient had experienced right neck pain for approximately one year, but no neurological abnormalities were noted. Cervical magnetic resonance imaging suggested an osteoid osteoma in the superior articular process of the seventh cervical vertebra. The tumor was resected microendoscopically. Operative time was 1 hour 29 minutes, and blood loss was 5 mL. During the two years since surgery, the patient has remained pain free with no cervical spine instability. We thus propose microendoscopic surgery for osteoid osteoma developing in a posterior element of the cervical spine is a potentially effective operative procedure.

Short-term Results of Spinal Micro-endoscopic Surgery for Lumbar Degenerative Spondylolisthesis

Short-term Results of Spinal Micro-endoscopic Surgery for Lumbar Degenerative Spondylolisthesis

Efficacy of Novel Minimally Invasive Surgery Using Spinal Microendoscope For Treating Extraforaminal Stenosis at the Lumbosacral Junction

A retrospective case study of the spinal microendoscopic surgery for the treatment of extraforaminal stenosis at the lumbosacral junction. To evaluate the efficacy of a minimally invasive technique using spinal microendoscope and to examine the 2-year surgical outcome for this disease. The paraspinal approach has been the gold standard to expose the extraforaminal space. Although it seems to be ideal, the constricted surgical field of view may compromise the surgeon's ability and increase the risk of complications. This technique can be improved further. A total of 32 patients, who completed a minimum follow-up of 2 years after the surgery, were included in this study. The study group consisted of 16 men and 16 women with an average age at surgery of 64 years and a mean follow-up of 37.4 months. Clinical results were evaluated according to the Japanese Orthopaedic Association (JOA) scoring system, visual analog scale, and the North American Spine Society Low Back Outcome Instrument. Two of these patients required revision surgery to correct insufficient decompression in the foramen. In the 30 other patients, the mean JOA score was 15.1 points before surgery and 23.1 points at the final follow-up. The mean recovery rate was 60.1%. The JOA scores improved significantly after surgery and the satisfactory results were maintained until the final follow-up. The visual analog scale scores for low-back pain, leg pain, and numbness also significantly improved. Twenty-eight of 32 patients (87.6%) were satisfied with this procedure. The spinal microendoscopic surgery demonstrated efficacy for treating extraforaminal stenosis at the lumbosacral junction where the lesion is difficult to be exposed. Quick and easy access along with minimal damage to the back muscles and bony structures could be accomplished using the property of its oblique view and angled surgical equipments. This procedure has produced long-lasting favorable outcomes and high patient satisfaction. Novel minimally invasive surgery may replace conventional open methods.

Evaluation of Spinal Micro-endoscopic Surgery for Lumbar Canal Stenosis

Evaluation of Spinal Micro-endoscopic Surgery for Lumbar Canal Stenosis

内視鏡下後方除圧術におけるソノペットの使用経験とその有用性

内視鏡下後方除圧術は腰椎椎間板ヘルニア，腰部脊柱管狭窄症，頸椎症性神経根症などに対する手術療法として広く行われている．骨性除圧には彎曲したケリソン鉗子やハイスピードドリルなど，特殊に改良された器械が用いられる．黄色靭帯上での切除は安全な操作であるが，硬膜管あるいは神経根に接した骨性除圧にハイスピードドリルを用いる際には，神経を巻き込む危険性を伴う．今回我々は内視鏡下に超音波骨メス（ソノペット）を用いて安全な骨切除を行った症例を経験したので報告する．ソノペットの利点は，血管や神経など弾力性のある組織はその振動を吸収するため，破砕しないというところにある．ソノペット使用による重篤な副作用はこれまでのところ認められておらず，内視鏡下後方除圧術の骨性除圧におけるソノペット使用は有用であると思われた．

Technique skill and clinical choices of the YESS and TESSYS in percutaneous transforaminal endoscopic discectomy for lumbar disc herniations.

Objective To describe the techniques skill, indictions and clinical effects of the Yeung endoscopic spine system (YESS) and transforaminal endoscopic spine system (TESSYS) percutaneous transforaminal endoscopic techniques for lumbar disc herniations. Methods From September 2005 to May 2008, 201 patients with lumbar disc hemiations were treated with posterolateral endoscopic discectomy techniques. There were two techniques had been used in this group: 150 cases with YESS and 51 with TESSYS. There were 122 males and 79 females, with an average age of 33.5 years. Results The follow-up period was 12.5 months (range 3 to 36 months). 119 patients (follow-up rate was 79.3%) had been followed-up in YESS operative group, while 43 patients (follow-up rate was 84.3%) in TESSYS operative group. Pain was measured by means of the Visual Analogue Score (VAS), the patient satisfaction was evaluated by the Nakai outcome criteria. Mean VAS of YESS group was improved from 8.4±2.1 before the surgery to 2.4±0.8 one year after the surgery, while TESSYS group from 8.6±2.3 betore the surgery to 2.6±1.3 one year after the surgery. There scores all increased significantly compared with their preoperative ones. Overall, excellent or good outcomes were obtained in 87.5% of the YESS group and in 88.4% of the TESSYS group. No persistent nerve root injuries and dural tear were happened. Eight patients were unsatisfactory in YESS group and 3 in TESSYS group. Four patients (3.4%) were experienced persistent radiculopathy in YESS group, but only one (2.3%) happened radiculopathy in TESSYS group. Four recurrent cases (recurrent rate 3.4%) in YESS group and two recurrent patients (recurrent rate 4.7%) in TESSYS group had been underwent microendoscopic revision surgery. Conclusion Transforaminal percutaneous endoscopic discectomy is safe and effieacious in the treatment of lumbar disc herniations. However, proper selection for YESS and TESSYS techniques is important to ensure the successful and satisfactory outcome for the lumbar disc herniations. Key words: Intervertebral disk displacement; Endoseopes; Lumbar vertebrae

Microendoscopic surgery for lumbar disc herniation with nerve root anomaly. A case report

Microendoscopic surgery for lumbar disc herniation with nerve root anomaly. A case report