Minimally Invasive Spine Surgery Research Articles

Robotics and navigation in spine surgery: A narrative review

IntroductionIn recent decades, there has been a rising trend of spinal surgical interventional techniques, especially Minimally Invasive Spine Surgery (MIS), to improve the quality of life in an effective and safe manner. However, MIS techniques tend to be difficult to adapt and are associated with an increased risk of radiation exposure. This led to the development of ‘computer-assisted surgery’ in 1983, which integrated CT images into spinal procedures evolving into the present day robotic-assisted spine surgery. The authors aim to review the development of spine surgeries and provide an overview of the benefits offered. It includes all the comparative studies available to date. MethodsThe manuscript has been prepared as per “SANRA-a scale for the quality assessment of narrative review articles”. The authors searched Pubmed, Embase, and Scopus using the terms “(((((Robotics) OR (Navigation)) OR (computer assisted)) OR (3D navigation)) OR (Freehand)) OR (O-Arm)) AND (spine surgery)” and 68 articles were included for analysis excluding review articles, meta-analyses, or systematic literature. ResultsThe authors noted that 49 out of 68 studies showed increased precision of pedicle screw insertion, 10 out of 19 studies show decreased radiation exposure, 13 studies noted decreased operative time, 4 out of 8 studies showed reduced hospital stay and significant reduction in rates of infections, neurological deficits, the need for revision surgeries, and rates of radiological ASD, with computer-assisted techniques. ConclusionComputer-assisted surgeries have better accuracy of pedicle screw insertion, decreased blood loss and operative time, reduced radiation exposure, improved functional outcomes, and lesser complications.

TECHNIQUES OF MINIMALLY INVASIVE SURGERY IN ADULT DEGENERATIVE SPINAL DEFORMITY : A SYSTEMATIC REVIEW

Adult spinal deformities are a leading cause of pain and disability in the modern world. Advances in modern healthcare has allowed the population’s life expectancy to increase substantially. Despite this, there has been a marked increase in the number of ill and disabled individuals, leading to impairment in their quality of life. In order to continue performing successfully as an adult beyond retirement age, it is imperative to avoid pain and limitations in physical activity. When an adult develops a spinal deformity, surgery can help alleviate pain and reduce disability. Adult scoliosis is defined as a spine curvature greater than 10 degrees in a patient older than 18 years; nevertheless, in more severe cases, treatment is sometimes advised. Degeneration may be accelerated by asymmetric disk/facet degeneration or osteoporotic insufficiency fractures. Recently, minimally invasive spine surgery (MIS) has been at the forefront of innovation in spine surgery. MIS spine surgery not only refers to surgery through a smaller incision, but also to a technique that strives to reduce the approach-related morbidity associated with conventional open spine surgery. According to the findings of this study, Surgeons have to be prepared to offer both open or MIS for patients. Various MIS technique and its combination including hybrid surgery are used in cases of adult spinal deformity, the appropriate technique chosen for the surgery should include factors such as the spinopelvic harmony, age and outcome prediction of each patients into consideration as each technique has its own advantages and disadvantages.

Complications in endoscopic spine surgery: a systematic review.

This systematic review aims to investigate the complication rate of endoscopic spine surgeries, stratifying them by technique, district and kind of procedure performed. This study was conducted according to the PRISMA statement. The literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Register, OTseeker and ScienceDirect database. Types of studies included were observational studies (cohort studies, case-control studies and case series) and randomised or quasi-randomised clinical with human subjects. No restrictions on publication year were applied. Repeated articles, reviews, expert's comments, congress abstracts, technical notes and articles not in English were excluded. Several data were extracted from the articles. In particular, data of perioperative (≤ 3 months) and late (> 3 months) complications were collected and grouped according to: (1) surgical technique [uniportal full-endoscopic spine surgery (UESS) or unilateral biportal endoscopic spine surgery (UBESS)]; (2) spinal district treated [cervical, thoracic or lumbar] and (3) type of procedure [discectomy/decompression or fusion]. Complication analysis was performed in subgroups with at least 100 patients to have clinically meaningful statistical validity. A total of 117 full-text articles were assessed for eligibility. Of the 117 records included, 95 focused their research on UESS (14 LOE V, 33 LOE IV, 43 LOE III and five LOE II) and 23 on UBESS (three LOE V, eight LOE IV, 10 LOE III and two LOE II). A total of 20,020 patients were extracted to investigate the incidence of different perioperative and late complications, 10,405 for UESS and 9615 for UBESS. The present study summarises the complications reported in the literature for spinal endoscopic procedures. On the one hand, the most relevant described were perioperative complications (transient neurological deficit, dural tear and dysesthesia) that are especially meaningful for endoscopic discectomy and decompression. On the other hand, late complications, such as mechanical implant failure, are more common in endoscopic interbody fusion. I.

Full Endoscopic Spine Surgery with Image-Guided Navigation System as “Hybrid Endoscopic Spine Surgery”: A Narrative Review

Endoscopic surgery is adopted as a minimally invasive technique in several surgical fields. Endoscopic spine surgery (ESS) was performed initially for lumbar discectomy but is currently widely utilized for various pathologies. Similar to other endoscopic techniques, ESS has a steep learning curve that has recently been a topic of discussion. Image-guided navigation systems have been developed for spine surgery. Intraoperative computed tomography enables the use of an image-guided navigation system in ESS, which is a suitable approach for managing complex lesions. Full-ESS is currently being adopted for certain cervical pathologies, and the incorporation of an image-guided navigation system will soon enable surgery for other cervical pathologies.

Is Minimally Invasive Spinal Surgery Superior to Endoscopic Spine Surgery in Postoperative Radiologic Outcomes of Lumbar Spine Degenerative Disease? A Systematic Review.

Minimally invasive spinal surgery (ESS) are both well-established surgical techniques for lumbar spinal stenosis; however, there is limited literature comparing the efficacy of the two techniques with respect to radiologic decompression data. In this review, PubMed, Google Scholar, and Scopus databases were systematically searched from inception until July 2022 for studies that reported the radiologic outcomes of endoscopic and minimally invasive approaches for decompressive spinal surgery, namely, the spinal canal area, neural foraminal area, and neural foraminal heights. Of the 378 articles initially retrieved using MeSH and keyword search, 9 studies reporting preoperative and postoperative spinal areas and foraminal areas and heights were finally included in our review. Of the total 581 patients, 391 (67.30%) underwent MISS and 190 (32.70%) underwent ESS. The weighted mean difference between the spinal canal diameter in pre- and postoperative conditions was 56.64 ± 7.11 and 79.52 ± 21.31 mm2 in the MISS and ESS groups, respectively. ESS was also associated with a higher mean difference in the foraminal area postoperatively (72 ± 1 vs. 35.81 ± 11.3 mm2 in the MISS and ESS groups, respectively), but it was comparable to MISS in terms of the foraminal height (0.32 ± 0.037 vs. 0.29 ± 0.03 cm in the MISS and endoscopic groups, respectively). Compared with MISS, ESS was associated with improved radiologic parameters, including spinal canal area and neural foraminal area in the lumbar spinal segments. Both techniques led to the same endpoint of neural decompression when starting with a more severe compression. However, the present data do not allow the correlation of the radiographic results with the related clinical outcomes.

The application of the concept of minimal invasive spine surgery in the development and innovation of cervical expansive laminoplasty

Posterior cervical decompression is an important method for the treatment of cervical myelopathy resulting from cervical stenosis due to various pathology.Over the past 40 years,scholars from all over the world have made unremitting efforts in exploring the posterior decompression of the cervical spine and the protection and reconstruction of the cervical spine function,and have achieved remarkable results.The new concept of minimally invasive spinal surgery has stimulated the development of the new technology of cervical expansive laminoplasty via trans-muscular space approach and brought about new progress in the surgical treatment of cervical spondylosis.Cervical expansive laminoplasty via trans-muscular space approach provided a better solution for the posterior decompression while protecting and reconstructing the structure and function of the cervical spine.These achievements are not only the concrete embodiment and practice of the concept of minimally invasive spine surgery in posterior cervical spine surgery,but also show the persistent and endless pursuit of spinal surgeons to realize the concept of original ecological surgery in the cervical spine.

Biportal endoscopic surgery for lumbar spine herniated discs: a narrative review of its clinical application and outcomes.

Lumbar disk herniation (LDH) is a common condition affecting millions worldwide. The management of LDH has evolved over the years, with the development of newer surgical techniques that aim to provide better outcomes with minimal invasiveness. One promising emerging technique is biportal endoscopic spinal surgery (BESS), which utilizes specialized endoscopic equipment to treat LDH through two small incisions. This review aims to assess the effectiveness of BESS as a management option for LDH by analyzing the available literature on surgical outcomes and potential complications associated with the technique. Our review shows that BESS is associated with favorable postoperative results as judged by clinical scoring systems, such as visual analog scale, Oswestry disability index, and MacNab criteria. BESS has several advantages over traditional open surgery, including minimized blood loss, a shorter duration of hospitalization, and an expedited healing process. However, the technique has limitations, such as a steep learning curve and practical challenges for surgeons. Our review offers recommendations for the optimal use of BESS in clinical practice, and provides a foundation for future research and development in this field, aiming to improve patient outcomes and quality of life.

Essential Surgical Techniques During Fully Endoscopic Spine Surgery: A Historical Review and Future Perspectives

Full-endoscopic spine surgery (FESS) offers minimally invasive techniques for treating spinal lesions with smaller incisions, leading to reduced tissue damage and consequently more rapid patient recovery. The essential techniques in FESS —namely, the transforaminal and interlaminar approaches—have evolved with technological advances in endoscopic systems and surgeon expertise. The transforaminal approach consists of “inside-out” and “outside-in” techniques that have distinct applications depending on the patient’s condition. The interlaminar approach, similar to traditional spinal surgery techniques, is gaining wider acceptance due to its efficacy in addressing unique anatomical challenges. Advanced procedures, such as endoscopic laminectomy and interbody fusion surgery, coupled with navigation systems, have broadened the scope of endoscopic spine surgery, making it an increasingly vital tool in modern spinal surgery.

Overview and Prevention of Complications During Biportal Endoscopic Cervical Spine Surgery

Purpose: Biportal endoscopic spine surgery is becoming popular for various spinal pathologies, including cervical and thoracic spine diseases. However, the safety of biportal endoscopic cervical spine surgery (BECSS) has not been fully investigated, and inexperienced surgeons can cause serious complications. The study aimed to evaluate the complications of BECSS and identify tips for preventing them through a literature review and retrospective analysis of case series. Methods: Articles on BECSS were electronically retrieved from multiple databases, with inclusion criteria including controlled and case series designs, detailed reporting of complications and/or reoperations, and the use of BECSS. The study excluded simple review articles and case reports. The clinical data of 45 patients who underwent BECSS at our institution were collected, and information was extracted on demographic features, surgery type, surgical level, surgery-related complications, and reoperations and their reasons.Results: The study retrieved a total of 67 studies from 5 databases, of which 6 were included after screening. In total, 227 cases of BECSS were identified, and the overall complication rate was 0%–14.3%. Complications included dura tearing, symptom recurrence, incomplete decompression, postoperative epidural hematoma, and transient paralysis. Reoperation was performed in 3 cases.Conclusion: BECSS has similar complication rates to those of other surgical techniques. It is important to provide extensive education, share knowledge and experience, and conduct further research to minimize complications and improve outcomes for patients, as is the case with other spinal surgical procedures.

There Is No Spine Surgery Without the Risk of Complications: A Deep Dive Into the Realm of Minimally Invasive and Endoscopic Spine Surgery

There Is No Spine Surgery Without the Risk of Complications: A Deep Dive Into the Realm of Minimally Invasive and Endoscopic Spine Surgery

Endoscopic Approach for Cervical Disease: Successful Points

The advent of endoscopic technology has facilitated the evolution of endoscopic techniques and broadened the indications of fully endoscopic spine surgery. Endoscopic cervical spinal surgery is currently effective for treating herniated intervertebral discs, foraminal stenosis, and central canal stenosis. Although growing evidence has revealed the safety and advantages of endoscopic approaches, fully endoscopic spine surgical procedures remain challenging and have a steep learning curve, especially in the cervical spine. The anatomical features and pathologic patterns of the cervical spine also affect the application of endoscopic approaches. In this review, the authors introduce the successful points of fully endoscopic cervical spine surgery.

Unipedicular-Screw Index Vertebra Manipulation Technique for Minimally Invasive Short-Segment Thoracolumbar Fracture Fixation.

Minimally invasive spine surgery (MIS) has revolutionized fixation of thoracolumbar fractures with burst elements. Recent studies have proven that percutaneous pedicle screw instrumentation is as effective as open instrumentation but with reduced intraoperative blood loss and operative duration. Techniques such as short-segment pedicle screw fixation including the fractured vertebra have shown satisfactory radiological correction and functional outcomes, avoiding the need for extensile posterior constructs. In the present study, the authors our technique utilizing unipedicular index vertebra fixation and manipulation in MIS for thoracolumbar fractures with burst elements. To our knowledge, this technique is not well described in literature as open approaches are often adopted for the above. The authors sought to highlight the 2-year radiological and functional outcomes of 20 consecutive patients who underwent this technique. A retrospective review of prospectively collected data was conducted on 20 patients with thoracolumbar fractures with burst elements who underwent fixation using our technique. Patient data collected included demographic characteristics, mechanism of injury, associated injuries, neurological deficit at the time of admission, pre- and postoperative neurological evaluation, and length of hospital stay. Radiological investigations included plain radiographs, computed tomography of the spine with reconstruction, and magnetic resonance imaging of the spine, which provided data for radiological fracture classifications such as AO Spine and derivation of Thoracolumbar Injury Classification and Severity Score, as well as preoperative planning. Radiological investigations in the postoperative period were carried out by standing radiographs or EOS whole spine at each postoperative follow-up for up to 2 years. Radiological parameters-vertebral wedge angle, regional kyphosis angle, coronal Cobb angle, and anterior and posterior vertebral body heights-were recorded at preoperative, intraoperative, postoperative, and up to 2-year follow-up. Clinical outcome scores (visual analog score [VAS] and Oswestry Disability Index [ODI]) were also recorded at similar timepoints. Radiological outcomes reflect significant lordotic corrections of the vertebral wedge angles up to 2-year follow-up when compared with preoperative values (intraoperative: P = 0.06; postoperative: P = 0.001; 3 months: P = 0.002; 6 months: P = 0.004; 1 year: P = 0.011; 2 years: P = 0.016). Additionally, significant lordotic corrections of regional kyphosis angles (intraoperative: P = 0.00; postoperative: P = 0.00; 3 months: P = 0.031; 6 months: P = 0.039) and increases in anterior vertebral body heights (postoperative: P = 0.001; 3 months: P = 0.010; 6 months: P = 0.020) at up to 6-month follow-up were found. Preoperatively, median VAS of 85 (range 30-100) and ODI of 90 (range 40-98) were recorded. Statistically significant improvements in VAS and ODI were found across all timepoints when compared with preoperative values, with a mean VAS of 11.5 (SD 4.8) and ODI of 9.9 (SD 4.5) at 2-year follow-up. Surgical management of thoracolumbar fractures with or without neurological deficit has a role in reducing nursing requirements and postoperative morbidity in patients with polytrauma and other associated injuries. Our approach in treating thoracolumbar fractures with burst elements using MIS short-segment fixation and unipedicular screw manipulation technique shows satisfactory radiological correction and high rates of fracture union while reducing approach-related morbidity and improving functional outcomes.

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

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

The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries.

We aim to report the outcomes and feasibility of endoscopic spine surgery used to treat symptomatic spinal metastases patients. This is the most extensive series of spinal metastases patients who underwent endoscopic spine surgery. A worldwide collaborative network group of endoscopic spine surgeons, named 'ESSSORG,' was established. Patients diagnosed with spinal metastases who underwent endoscopic spine surgery from 2012 to 2022 were retrospectively reviewed. All related patient data and clinical outcomes were gathered and analyzed before the surgery and the followtime period of 2 weeks, 1 month, 3 months, and 6 months. A total of 29 patients from South Korea, Thailand, Taiwan, Mexico, Brazil, Argentina, Chile, and India, were included. The mean age was 59.59 years, and 11 of them were female. The total number of decompressed levels was 40. The technique was relatively equal (15 uniportal; 14 biportal). The average length of admission was 4.41 days. Of all patients with an American Spinal Injury Association Impairment Scale of D or lower before surgery, 62.06% reported having at least one recovery grade after the surgery. Almost all clinical outcomes parameters statistically significantly improved and maintained from 2 weeks to 6 months after the surgery. Few surgical-related complications (4 cases) were reported. Endoscopic spine surgery is a valid option for treating spinal metastases patients as it could yield comparable results to other minimally invasive spine surgery techniques. As the aim is to improve the quality of life, this procedure is valuable and holds value in palliative oncologic spine surgery.

Commentary on "The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries".

Commentary on "The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries".

MINIMALLY INVASIVE SPINE SURGERY FOR POST-TRAUMATIC KYPHOSIS: A SYSTEMIC LITERATURE REVIEW AND RETROSPECTIVE CASE ANALYSIS

Study Design: Retrospective case analysis and systematic literature review. Objective: To comprehensively review minimally invasive surgery (MIS) for post-traumatic kyphosis. Methods: A systematic PubMed search was conducted for MIS and kyphotic deformities were published between 2012 and 2022. Sixteen patients between 2017 and 2021 met the criteria. Demographic data, surgical characteristics, and full-length radiographic parameters were collected pre- and post-operatively, and at final follow-up. Results: Twenty-three articles were included. The mean age was 67 years, and the mean follow-up was 17 months. The mean operative time was 331 min and blood loss was 252 ml. Pre-operative radiographic outcomes were as follows: Lumbar lordosis (LL), 16.84± 26.40[Formula: see text]; pelvic incidence (PI), 48.95± 14.34[Formula: see text]; PI-LL mismatch, 32.11± 31.92[Formula: see text]; pelvic tilt (PT), 32.74± 10.41[Formula: see text]; and sagittal vertical axis (SVA), 95.33± 59.62 mm. At the final follow-up, LL was 19.98± 16.16[Formula: see text] ([Formula: see text] = 0.51229), PI was 50.82± 10.19[Formula: see text] ([Formula: see text] = 0.61438), PI-LL mismatch was 30.84± 17.18[Formula: see text] ([Formula: see text] = 0.74696), PT was 27.14± 10.28[Formula: see text] ([Formula: see text] = 0.00386), and SVA was 49.73± 25.51 mm ( [Formula: see text] = 0.00465). The mean ODI and VAS scores for back pain at baseline and at 96 months follow-up were 33.2–19.7 and 8.4–2.5, respectively. Conclusion: Age-adjusted MIS provides correction of sagittal alignment for posttraumatic kyphosis that satisfies patient demand.

(010) A Novel Collaborative Protocol for Successful Management of PGAD/GPD Mediated by Tarlov Cyst-induced Radiculopathy of Sacral Spinal Nerve Roots in the Cauda Equina

Abstract Introduction In 2012, Komisaruk et al introduced the concept that neurologic-based women’s sexual health issues, genito-pelvic dysesthesia (GPD), could be caused by radiculopathy of sacral spinal nerve roots within the cauda equina. Over the last 4 years, to more effectively manage patients with suspected cauda equina pathology, a robust collaboration among sexual medicine, spine surgery and neurophysiology disciplines has been established. Objectives The aim of this study is to review the collaborative experience in managing patients with genito-pelvic dysesthesia. Methods We defined GPD in the broadest sense to include both unwanted, unrelenting, distressing arousal, pain and/or itching symptoms &amp;gt;6 mo (hyperfunction), and also persistent degrees of genital anesthesia leading to orgasmic dysfunction &amp;gt;6 mo (hypofunction). Charts from 2015 to 2019 of GPD patients presenting to our sexual medicine facility where neurogenital testing results were consistent with radiculopathy of sacral spinal nerve roots within the cauda equina were reviewed retrospectively. Lumbar and sacral MRIs were obtained and reviewed simultaneously in collaborative bi-monthly meetings and identified as having or not having treatable spinal abnormalities, subdivided into subtle or obvious. When appropriate, a transforaminal epidural spinal injection (TFESI) or caudal block with anesthetic agent and/or steroid was administered and the outcome measured by Patient Global Impression of Improvement (PGI-I). Those with clinically significant symptom reduction were considered for minimally invasive spine surgery (MISS). Results 734 patients (586 women; 80%; mean age 47 +/− 24) met criteria for this retrospective chart review. 637 lumbar and/or sacral MRIs were reviewed. A total of 112 TFESI were performed, 90 of which showed positive responses with more than 60% improvement on PGI-I of 1,2. 57 surgeries were performed. 17 patients (71% women) with PGAD underwent MISS for herniated nucleus pulposus and or annular tear. 76% declared post-op clinical improvement with PGI-I 1,2,3 with mean follow-up of 12 months (4 - 30 months). Conclusions Cauda equina pathology can cause unwanted, unrelenting, distressing neurologic-based GPD from radiculopathy of sacral spinal nerve roots. In selected cases these GPDs may be reversed by MISS. There are management benefits from collaboration among sexual medicine, spine surgery and neurophysiology specialists. Disclosure No.

Minimally Invasive Decompression With Noninstrumented Facet Fusion Versus Minimally Invasive Transforaminal Lumbar Interbody Fusion for Stenosis Associated With Grade 1 Lumbar Degenerative Spondylolisthesis.

Retrospective matched cohort study. With a growing interest in minimally invasive spine surgery (MIS), the question of which technique is the most advantageous for patients with low-grade degenerative lumbar spondylolisthesis (DLS) still remains unclear. To compare patient-reported outcomes, perioperative morbidity, and rates of reoperation between MIS decompression with either unilateral noninstrumented facet fusion (MIS-F) or with transforaminal interbody fusion (MIS-T) for grade 1 DLS. Twenty patients who underwent MIS-T and 20 patients with MIS-F were matched based on age, sex, and preoperative ODI, VAS back, and VAS leg. All patients had DLS with at least 4 millimeters of translation on standing radiographs. Exclusion criteria included prior level surgery, multilevel instability, disk impinging on the exiting nerve root, spondylolisthesis from significant facet arthropathy, or foraminal compromise from disk collapse. ODI, VAS back, VAS leg, and patient satisfaction measured by the North American Spine Society questionnaire were tracked at 3, 6, 12, and 24 months postoperatively. Minimum clinically important differences and substantial clinical benefits were calculated. MIS-F and MIS-T resulted in decreased ODI at 3, 6, and 12 months following the index procedure. Sixty percent of MIS-F and 83% of MIS-T patients reached minimum clinically important difference at 1 year postoperatively; however, using the threshold of 30% ODI reduction from baseline, 67% of MIS-F and 83% MIS-T ( P = 0.25) achieved this goal. Forty-three percent of MIS-F and 59% of MIS-T patients met substantial clinical benefits. Satisfaction at 1 year, measured by a score of 1 or 2 on the North American Spine Society questionnaire, was 64% for MIS-F and 83% for MIS-T. MIS-F and MIS-T are effective treatment options for spinal stenosis associated with low-grade DLS. Both techniques result in comparable patient-reported outcomes and satisfaction up to 2 years and have similar long-term reoperation rates. More evidence is required to delineate optimal selection characteristics for MIS-F versus MIS-T.

Efficacy of the erector spinae plane block with sedation for unilateral biportal endoscopic spine surgery and comparison with other anesthetic methods.

Erector spinae plane block (ESPB) is a new regional anesthesia. Unilateral biportal endoscopic (UBE) spine surgery, a minimal invasive technique, has been performed under not only general anesthesia (GA) but regional anesthesia including spinal anesthesia (SA). The aims of this study were to evaluate the efficacy of ESPB with sedation for UBE lumbar decompression and compare it with GA and SA. A retrospective age matched case-control study design was performed. Three groups (20 patients in each group) of patients who underwent UBE lumbar decompressions under each anesthetic method (GA, SA, or ESPB) were formed. The total anesthesia time excluding operation time, postoperative analgesia effects, hospital days, and complications related to anesthetic methods were evaluated. In the ESPB group, all the operations were performed without change of anesthetic methods and without anesthetic complications. But there were no anesthetic effects in the epidural space, which resulted in additional intravenous fentanyl usage. The mean of time from initiation of anesthesia to completion of surgical preparation was 23.3 ± 4.7min in the ESPB group, which was shorter than 32.3 ± 10.8min in the GA (p value = 0.001) or 33.3 ± 6.7min in the SA group (p < 0.001). The proportion of patients requiring first rescue analgesia within 30min was 30% in the ESPB group, which was lower than 85% in the GA (p < 0.001), but no significant different with 10% in the SA (p = 0.11). The mean of total hospital days in the ESPB was 3.0 ± 0.8, shorter than 3.7 ± 1.8 in the GA (p = 0.02) or 3.8 ± 1.1 in the SA group (p = 0.01). There was no case of postoperative nausea and vomiting in the ESBB even without prophylactic antiemesis. ESPB with sedation is a viable anesthetic option for UBE lumbar decompression.

Collagen Matrix Inlay Graft for Management of Incidental Durotomy During Full-Endoscopic Lumbar Spine Surgery: Technique and Case Series.

Endoscopic spine surgery (ESS) has a reduced rate of incidental durotomy (ID) compared with open spine surgery. However, there are unique challenges regarding the management of ID in ESS due to the single, deep, narrow working corridor and aqueous environment. Here, we present a collagen matrix inlay graft technique for the management of ID encountered during ESS. Three patients were identified via medical record review of full ESS where an intraoperative ID was encountered. These were all addressed endoscopically. All surgeries were performed by a single surgeon in the years 2019 to 2023. Patient, operative, and postoperative details, including patient-reported outcomes, were recorded. Briefly, the collagen matrix inlay graft technique included introducing a segment of collagen matrix into the surgical field and manipulating the collagen matrix so that it passed through the durotomy and resided within the dura, plugging the hole. Three IDs were identified out of a total of 295 eligible cases (1.02%). The IDs measured 2 to 2.5 mm in length. For these 3 patients, the duration of hospital stay ranged from 172 to 1,068 minutes. No patients exhibited signs or symptoms of cerebrospinal fluid leak at any postoperative timepoint. At the 6-week postoperative visit, all patients had achieved the minimum clinically important difference in Oswestry Disability Index, and all patients with available visual analog scale scores for leg and low back pain had achieved the cutoff for the minimum clinically important difference. We presented 3 cases of ID during uniportal full ESS who were repaired using a collagen matrix inlay technique. Prolonged bed rest was avoided, and all patients achieved excellent clinical outcomes without further complication. This technique may also be appropriate for other minimally invasive spine surgery techniques. ID is a common and undesirable complication of degenerative lumbar spine surgery. Endoscopic ID repair techniques provide an option to avoid conversion to open or tubular surgery for the management of ID.