Modified MacNab Criteria Research Articles

Destandau Tekni̇ğiyle Lomber Diskektomi̇ Kısa Vadede Daha İyi Sonuçlar Veri̇yor

Background: The long-term results of patients who underwent lumbar discectomy using the Desdandau technique (EDDT) and standard open technique (SOD) were compared. Materials and Methods: A retrospective screening was made of patients, aged 18-70 years, who underwent single-level lumbar discectomy between 2007 and 2011. A total of 52 patients met the study criteria and were separated into 2 groups according to the surgical technique used, the EDDT group (n: 27) and the SOD group (n:25). All patients were compared using Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria. Results. The mean follow-up period was calculated as 158.2±9.2 months in the EDDT group and 161.2±11.1 months in the SOD group. The preoperative VAS and ODI values were observed to be similar in both groups (p=0.829); p=0.120 respectively). At the early postoperative visit, VAS and ODI values were lower in the EDDT group (VAS: EDDT: 2.2±0.6; SOD: 4.1±0.8, p<0.001; ODI: EDDT: 15.4±1.6, SOD: 29.1±1.9, p<0.001, respectively), however, there was no significant difference in VAS and ODI scores between the two groups at the last control (VAS: EDDT: 2.1±0.4, SOD: 2.4±0.5, p=0.078; ODI: EDDT: 14.6±2.1, SOD: 15.1±1.2, p=0.033, respectively). According to the modified MacNab criteria, good and excellent results were obtained in 88% of the SOD group and 92% of the EDDT group. Conclusion: The study found that the long-term results of both techniques were similar. However, the Destandau technique had better early results. The endoscopic method seems to be better in terms of early return to daily activities.

Comparison of percutaneous endoscopic interlaminar discectomy and conventional open lumbar discectomy for L4/5 and L5/S1 double-segmental lumbar disk herniation

ObjectiveAlthough spinal endoscopic techniques have shown great advantages in the treatment of single-segment lumbar disk herniation (LDH), the therapeutic advantages for double-segment LDH are controversial. To compare the outcomes of percutaneous endoscopic interlaminar discectomy (PEID) versus conventional open lumbar discectomy (COLD) for the treatment of L4/5 and L5/S1 double-segmental LDH.MethodsFrom January 2016 to September 2021, we included 50 patients with double-segmental LDH who underwent PEID (n = 25) or COLD (n = 25). The clinical outcomes between the two groups were evaluated using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified MacNab criteria. Moreover, the incision length, operation time, intraoperative fluoroscopy time, postoperative bedtime, hospital stays, and complications were also recorded and compared after surgery.ResultsIn both groups, the VAS and ODI scores at different timepoints postoperatively were significantly improved compared with those preoperatively (P < 0.05) According to the modified MacNab criteria, the excellent or good outcome rate was 92% in the PEID group and 88% in the COLD group. The PEID group had shorter incision length, postoperative bedtime, and hospital stays than the COLD group. However, the operation time was shorter and intraoperative fluoroscopy time was fewer in the COLD group. In addition, there was no significant difference between the two groups in terms of surgical complications during the postoperative follow-up period.ConclusionsBoth PEID and COLD have good efficacy and high safety for management of L4/5 and L5/S1 double-segmental LDH. Compared with the COLD group, the PEID group had more operative time as well as more intraoperative fluoroscopy, but it had a more minimally invasive surgical incision as well as faster postoperative recovery.

Percutaneous uniportal full-endoscopic surgery for treating symptomatic lumbar facet joint cysts under local anesthesia combined with monitored anesthesia care: a preliminary report of eight cases with at least 1 year follow-up.

Lumbar facet joint cysts (FJCs) are a relatively rare clinical pathology that can result in radiculopathy or neurogenic claudication. Various treatments such as percutaneous aspiration and surgery have been reported to have good clinical outcomes. However, few clinical studies have aimed to treat symptomatic lumbar FJCs by using uniportal full-endoscopic (UFE) surgery. This study aimed to investigate the preliminary clinical outcomes of UFE surgery for the treatment of lumbar FJCs under local anesthesia combined with monitored anesthesia care (MAC). Eight patients (five males and three females) with symptomatic lumbar FJCs who underwent UFE surgery under local and MAC anesthesia were enrolled in this study between January 2018 and April 2022. The clinical characteristics, radiological features, operative information, visual analog scale (VAS) score, Oswestry disability index (ODI), and overall outcome rating based on the modified MacNab criteria were retrospectively analyzed. Of the eight patients, four underwent a transforaminal approach and four underwent an interlaminar approach. Postoperatively, the mean VAS score for leg pain decreased from 6.1 before surgery to 0.6 after surgery, and the ODI decreased from 74.5% to 14.7%. All patients were followed up for more than 1 year, and the good-to-excellent rate based on the modified MacNab criteria remained 100% at the last follow-up. No complications occurred during the follow-up period. Lumbar FJCs can cause severe radiating leg pain and/or neurogenic claudication due to the dural sac compression and nerve roots. As an alternative treatment, UFE decompression under local and MAC anesthesia may provide effective clinical outcomes for symptomatic lumbar FJCs.

Functional Outcomes After Discectomy for Recurrent Lumbar Herniation Using the Destandau Endospine System: A Retrospective Study of 44 Patients.

Background Recurrent disc herniation is a major cause of morbidity and surgical failure after disc surgery. This study aimed to investigate the feasibility, safety, and effectiveness of the Destandau endospine system (DES) for treating recurrent lumbar disc herniation (LDH). Methodology A total of 44 patients who underwent minimally invasive Destandau endoscopic lumbar discectomy (DELD) for recurrent LDH were included in this study. All data were collected retrospectively. The preoperative and postoperative visual analog scale (VAS) score was used for the evaluation and gradation of pain. The clinical outcome was analyzed according to modified MacNab criteria. The minimum follow-up was two years. Preoperative and postoperative VAS scores were compared using the paired Student's t-test. Statistical significance was set at a p-value <0.05. Results The mean surgical time was 30 ± 20 minutes. The VAS score for leg pain was improved in all cases from 5.9 ± 2.1 to 1.7 ± 1.3 (p< 0.001). In 98% of cases, a successful outcome was noted (excellent or good outcome according to MacNab criteria). In three (7%) patients, incidental durotomy occurred, but there was no neurological worsening, cerebrospinal fluid fistula, or negative influence on the clinical outcome. No recurrence or instability occurred in our series. Conclusions The clinical outcomes of minimally invasive DES for LDH were found to be comparable with the reported success rates of other minimally invasive techniques reported in the existing literature. The dural tear rate was independent of postoperative morbidity and functional outcome. The technique is a safe and effective treatment option for recurrent LDH.

Clinical Effects of the End-Love Technique in the Treatment of Recurrent Lumbar Disc Herniation 1 Year After Surgery.

The number of patients with lumbar disc herniation in China is increasing year by year. Percutaneous endoscopic lumbar discectomy (PELD) is currently the main surgical method for treating lumbar disc herniation (LDH). However, with the increase in the number of surgical cases, the number of patients with recurrent lumbar disc herniation (RLDH) is also increasing. Currently, the common method in China is lumbar fusion surgery, but this surgery would cause the loss of fusion segment mobility and considerable postoperative complications. In order to solve the problem above the following technique will be studied: the technique of posterior lumbar laminectomy and nucleus pulposus removal under fully visualized spinal endoscopy (ENDO-LOVE) to treat RLDH. Its clinical effects will be observed in this paper, too. This series includes RLDH patients treated with ENDO-LOVE technology between January 2017 and January 2021. All patients will undergo at least three follow-up visits one year after surgery. The modified MacNab standard, VAS, JOA, and ODI scores will be used to evaluate clinical efficacy, observe for cerebrospinal fluid leak, nerve root injury, and surgical site infection, and evaluate clinical safety. All 29 patients completed the surgery successfully. Three patients had postoperative pain and numbness in the area of nerve root innervation, and all patients had no serious complications. The VAS, JOA scores and ODI indices of back pain and leg pain 1-day, 3-months, and 1-year postoperatively differed statistically significantly from the preoperative scores (p < 0.05). Efficacy evaluated at 1-year postoperatively using the modified MacNab criteria showed an excellent rate of 89.7%. ENDO-LOVE technology has demonstrated good clinical efficacy and safety in the treatment of patients with RLDH. It should be considered for all patients with this condition.

Clinical and Radiological Outcomes of Spinous Process-Splitting Laminectomy for Lumbar Spinal Stenosis at 1 Year: A Preliminary Report of a Single-Institution Experience

Objective: This study investigated the clinical and radiological outcomes of lumbar spinous process-splitting laminectomy (LSPSL) performed to treat lumbar spinal stenosis at a single institution in Korea. Methods: A retrospective review was conducted of patients who underwent LSPSL for lumbar spinal stenosis between June 2020 and February 2022, with a minimum 1-year follow-up. Clinical outcomes were assessed using the visual analogue scale (VAS), Oswestry Disability Index (ODI), European quality of life - 5 dimensions - 5 levels (EQ-5D-5L), European quality of life VAS (EQ-VAS), and modified MacNab criteria. One year after surgery, radiological outcomes were evaluated through computed tomography scan to assess the spinolaminar bone union rate and patterns.Results: Out of 38 patients, data from 30 patients (male:female = 17:13) and 36 surgical levels were analyzed. The mean age was 67 years (range, 46–88 years). The preoperative mean leg VAS score and ODI significantly decreased at the 1-year postoperative follow-up (leg VAS, 6.6–3.8; p = 0.001; ODI, 19.3–10.9, p = 0.006). The EQ-5D-5L index and EQ-VAS also significantly improved (0.52–0.77, p &lt; 0.001; 50.8–67.1, p = 0.018; respectively). Using the modified MacNab criteria, the study reported excellent and good outcomes in 80% of patients at the 1-year follow-up, with no serious complications observed. The overall spinolaminar union rate was 77.8% (complete union, 58.3%; partial union 19.4%).Conclusion: LSPSL was found to provide favorable clinical outcomes and a satisfactory rate of posterior bony structure restoration for lumbar spinal stenosis, making it a feasible treatment option.

Evaluation of Safety and Efficacy of Preoperative Coronal MRI-Guided Minimally Invasive Surgery for Cervical Spondylotic Radiculopathy.

BACKGROUND Key-hole surgery is a minimally invasive technique that has shown promise in various surgical procedures. This study aimed to assess the clinical effectiveness of preoperative coronal MRI-assisted key-hole surgery for the treatment of patients with cervical spondylotic radiculopathy (CSR). MATERIAL AND METHODS A total of 30 patients diagnosed with CSR and undergoing key-hole surgery with CMRI assistance were included in the study. Various parameters, including surgical segments, incision length, disease duration, operative time, intraoperative fluoroscopy times, intraoperative blood loss, complications, and length of hospitalization, were recorded. Precise measurements of Cobb angles and intervertebral space height were taken before and after the surgical procedure. Surgical outcomes were evaluated using modified Macnab criteria, visual analogue scale (VAS), Japanese Orthopaedic Association Scores (JOA), and neck disability index (NDI). RESULTS The average duration of disease was 6.47±3.29 months, with an average incision length of 1.94±0.15 cm and operative time of 57.83±4.34 minutes. The average intraoperative blood loss was 33.70±9.28 ml, with an average of 3.50±0.73 intraoperative fluoroscopies. The average duration of hospitalization was 4.10±1.27 days. Preoperative and postoperative measurements showed no statistically significant difference in C2-C7 Cobb angles and intervertebral space height. However, there were significant improvements in postoperative VAS, NDI, and JOA scores compared to preoperative scores. The surgical effectiveness rate was 100%, with a high rate of good and excellent outcomes. CONCLUSIONS The findings of this study suggest that preoperative CMRI-assisted key-hole surgery for single-segment CSR is a safe and effective treatment option with low complication rates. The clinical benefits include high security and good outcomes. Further research and larger studies are warranted to validate these findings.

The Clinical Outcome of Transforaminal Lumbar Interbody Fusion and Laminectomy for Single-Level Lumbar Canal Stenosis with Grade 1 and 2 Spondylolisthesis

Background: Lower back pain is a common cause of disability that affects mobility and quality of life (QOL) in both adult and elderly patients. Initial management of lower back pain includes anti-inflammatory drugs, analgesics, physiotherapy, and epidural steroid infiltration. Despite multiple attempts of conservative management, if a patient develops refractory radicular pain with or without neurologic deficit and claudication, surgery is indicated. The two main approaches to surgical intervention include decompression (laminectomy only) and decompression with fusion [transforaminal lumbar interbody fusion (TLIF)].&#x0D; Methods: The study was done between May 2019 and November 2022. In this randomized study, we compared the clinical outcome of TLIF and laminectomy for single-level lumbar canal stenosis with grade 1 and 2 spondylolisthesis. Forty patients with single-level lumbar canal stenosis with grade 1 and 2 spondylolisthesis were randomly divided into two equal groups. Patients in both groups were followed up for 2 years.&#x0D; Results: In this study, we also noted estimated amount of blood loss, procedure time, time taken for ambulation, length of hospitalization, and demography. The Oswestry Disability Index (ODI) scores improved significantly postoperatively. The modified MacNab criteria suggest the outcomes rated as excellent/good rate of 90% in TLIF and 85% in laminectomy.&#x0D; Conclusion: We evaluated that TLIF procedures were associated with slightly more significant improvement in clinical outcomes in all of the scoring systems that were applied; TLIF provides early ambulation but a higher cost of treatment and longer hospital stay compared to laminectomy. Laminectomy procedures are associated with lesser economic burden, hospital stay, and blood loss, as well as shorter surgical duration compared to TLIF.

Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord via one vertebra with two bony channels for adjacent two-segment cervical spondylotic myelopathy: a technical note

BackgroundThe current treatments for adjacent two-segment cervical spondylotic myelopathy (CSM) include two-segment anterior cervical discectomy and fusion (ACDF) and single-segment anterior cervical corpectomy and fusion (ACCF). Long-term follow-up has demonstrated that both procedures have complications such as reduced cervical mobility, accelerated degeneration of adjacent segments and loosening of internal fixation screws. The purpose of this study is to demonstrate the feasibility, safety, and efficacy of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) via one vertebra with two bony channels for the treatment of adjacent two-segment CSM and to present our surgical experience.MethodsAnterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) via one vertebra with two bony channels was performed for 12 patients with adjacent two-segment CSM with follow-up care for at least 12 months. The Visual analog scale (VAS) and the Japanese Orthopedic Association Score (JOA) were recorded, and modified Macnab criteria were used to evaluate the treatment excellence rate. Radiological examinations, including X-ray, computed tomography (CT) and magnetic resonance imaging (MRI), were used to evaluate spinal cord decompression, intervertebral stability and healing of the bony channel.ResultsAll 12 patients completed the operation successfully. No postoperative complications, such as dysphagia, Horner’s syndrome, or laryngeal recurrent nerve palsy, were found. The postoperative VAS and JOA scores were significantly improved compared with those before surgery(P < 0.001). According to the modified Macnab criteria, the clinical outcome was excellent in 8 cases, good in 3 cases and fine in 1 case at the final follow-up and the excellent and good rate was 91.7%. Postoperative and follow-up imaging showed significant spinal cord decompression, well-healed bony channels and no cervical instability.ConclusionsThis study is the first report of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord via one vertebra with two bony channels. This procedure has the advantages of less trauma, faster recovery, fewer complications and no need to implant internal fixators. This is a minimally invasive, feasible and safe surgical procedure for patients with adjacent two-segment CSM.

Transforaminal Endoscopic Lumbar Diskectomy versus Open Microdiskectomy for Symptomatic Lumbar Disk Herniation: A Comparative Cohort Study on Costs and Long-Term Outcomes.

Transforaminal endoscopic lumbar diskectomy (TELD) is considered an effective treatment for lumbar disk herniation (LDH). There is a paucity of studies comparing in detail the costs and long-term clinical outcomes of TELD and open microdiskectomy (MD), especially in developing countries. Thus, we sought to provide a multidimensional insight into this matter by comparing the direct costs and long-term outcomes of TELD with those of MD. The electronic health records of 434 patients with LDH who underwent either TELD or MD were collected from February 2011 to October 2014. Within a 7-year follow-up period, 412 patients, comprising 203 patients treated with TELD and 209 patients treated with MD, were fully evaluated. Patient characteristics, operative time, intraoperative blood loss (IBL), postoperative hospital stay, time to return to work (RTW), perioperative complications, and direct costs were collected. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. The postoperative ODI and VAS scores improved significantly in both groups (p < 0.001). In accordance with the modified MacNab criteria, the rate of excellent and good outcomes was 88.67 and 88.03% in the TELD and MD groups, respectively. There were no significant differences between the groups in the clinical outcomes and perioperative complications. However, IBL, hospital stay, and RTW were significantly reduced in the TELD group (p < 0.05). Twenty-one cases in the TELD group and nine in the MD group underwent reoperation due to recurrence (p < 0.05). Total inpatient cost per patient was $1,596 in the TELD group and $1,990 in the MD group (p < 0.05). TELD for the treatment of symptomatic LDH could be an affordable strategy, providing certain advantages of minimally invasive procedures such as shorter hospital stay and earlier recovery along with comparable clinical outcomes to the conventional surgical method.

Consecutive Case Series of Uniportal Full-endoscopic Unilateral Laminotomy for Bilateral Decompression in Lumbar Spinal Stenosis: Relationship between Decompression Range and Functional Outcomes.

Uniportal full-endoscopic unilateral laminotomy for bilateral decompression (UFE-ULBD) has been used to treat lumbar spinal stenosis (LSS) with satisfactory outcomes. However, a limited number of studies have investigated the relationship between decompression range and clinical outcomes. This study aimed to investigate the efficacy of UFE-ULBD for single-segment LSS and to explore the relationship between the decompression range and functional outcomes. Single-segment LSS patients who had undergone UFE-ULBD using an interlaminar approach between November 2021 and February 2023 were retrospectively analyzed. Patient demographics, visual analogue scale (VAS) scores for leg and back pain, Oswestry disability index (ODI) scores, modified MacNab grades, and radiological outcomes, including the decompression ratio of the disc-flava ligament space and osseous lateral recess, the enlargement ratio of superior articular process interval, lamina interval dural sac cross-sectional area (DSCA), were collected. The independent sample t-tests, paired sample t-tests, chi-square tests, Fisher's exact tests, and Pearson's and Spearman's correlation analyses were used. Forty patients (23 males, and 17 females) were retrospectively enrolled in this study. The mean follow-up period was 12 months. At the last follow-up, VAS scores for leg pain and back pain decreased from 6.0 ± 0.8 to 1.0 ± 1.9 (p < 0.001), and from 6.0 ± 0.8 to 1.2 ± 1.8 (p < 0.001) respectively; ODI score decreased from 71.7 ± 6.2 to 24.3 ± 21.3 (p < 0.001). According to the modified MacNab criteria, the results were excellent in 28 (70%), good in 5 (12.5%), fair in 6 (15%), and poor in 1 (2.5%), with an excellent-good rate of 82.5%. The postoperative DSCA enlarged from 57.69 ± 21.86 to 150.75 ± 39.33 mm2 (p < 0.001), with an enlargement ratio of 189.43 ± 107.83%. No difference in clinical or radiological parameters was detected between patients with excellent, good, fair, or poor outcomes based on the modified MacNab criteria. UFE-ULBD can provide satisfactory clinical and radiological outcomes in single-segment LSS patients. With sufficient exposure to the dural sac boundary, the functional outcome was not related to the radiological decompression range in LSS patients who had undergone UFE-ULBD.

A comparative study between functional and radiological outcome of short and long segment transpedicular fixation for unstable thoracolumbar vertebral fractures

: Management of unstable thoracolumbar fracture remains controversial between short segment and long segment pedicle screw fixation. Surgical stabilization is indicated to adequately decompress the spinal canal, maximizing neurological recovery and creating spinal stability. : A comparative study in unstable thoracolumbar fractures fixed with short and long segment transpedicular screw fixation was done and followed up for 6 months. For functional assessment Modified MACNAB criteria, Oswestry disability index and Visual analogue scale scoring system used. Neurological status, radiological kyphotic angle correction were analyzed.: A total of 30 cases were included in the study of which 23 were male and 7 females. The mean age was 36.77 years. Younger individuals were more susceptible to road traffic accident. L1 was the most common vertebral level involved. Cases with a higher ASIA grade had a better improvement post operatively compared to one with a lesser ASIA grade preoperatively (P Value 0.003). Cases with lesser number of transfers had a better outcome at final followup. (P value 0.018). At all months of followup both short and long segment fixation groups have statistically significant kyphotic deformity correction, but long segment have better correction with 19.86 degrees pre-operative to 8.8 degrees at the end of 6 month of followup. : Short segment transpedicular fixation gives better functional outcome than long segment transpedicular fixation, but long segment transpedicular stabilization gives better radiological results in the form of kyphotic deformity correction.

Channel-assisted cervical key hole technology combined with ultrasonic bone osteotome versus posterior percutaneous endoscopic cervical foraminotomy: a clinical retrospective study

PurposeThe search for more effective and safe treatment methods for cervical spondylotic radiculopathy (CSR) has led to the rapid development and increasing popularity of minimally invasive posterior cervical foraminotomy (MI-PCF). This study aims to compare two important approaches for MI-PCF surgery: the channel-assisted cervical key hole technology combined with ultrasonic bone osteotome (CKH-UBO) and posterior percutaneous endoscopic cervical foraminotomy (PPECF).MethodsData from patients treated with single-level CKH-UBO (n = 35) or PPECF (n = 40) were analyzed. Clinical outcomes, including visual analogue scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and modified Macnab criteria, were assessed preoperatively, as well as at three days, three months, and one year postoperatively.ResultsThe percentages of patients with excellent and good outcomes were 97.14% and 92.5%, respectively. The average surgical time in the CKH-UBO group was significantly shorter than in the PPECF group (p < 0.001), while the average incision length in the PPECF group was significantly smaller than in the CKH-UBO group. There were no significant differences between the two groups in terms of blood loss, hospital stay, and clinical outcomes at three days, three months, and 12 months postoperatively.ConclusionCKH-UBO can achieve the same surgical outcomes as PPECF for the treatment of CSR. However, CKH-UBO saves more time but requires patients to undergo larger incisions.

Saving Stabilizing Structure Treatment With Bilateral-Contralateral Decompression for Spinal Stenosis in Degenerative Spondylolisthesis Using Unilateral Biportal Endoscopy.

This study aimed to evaluate the treatment of spinal stenosis with spondylolisthesis using bilateral-contralateral unilateral biportal endoscopic (UBE) decompression to minimize facet joint damage. We retrospectively evaluated 42 patients with grade 1 spondylolisthesis who underwent bilateral-contralateral UBE decompression between July 2018 and September 2019. To identify segmental instability, static and dynamic images from preoperative and postoperative procedures and final follow-up radiographs were reviewed. Lateral radiograph slippage ratio, sagittal motion, and facet joint preservation were evaluated. Clinical assessments were conducted using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. The average final follow-up period was 26.5 ± 1.3 months. The average preoperative slip percentage was 15.70% ± 5.25%, which worsened to 18.80% ± 5.41% at the final follow-up (p < 0.005). The facet joint preservation rate was 95.6% ± 4.1% on the contralateral side. Improvements in the VAS scores (leg pain: from 7.9 ± 2.2 to 3.1 ± 0.7; p < 0.005; back pain: from 7.2 ± 3.0 to 2.8 ± 1.0; p < 0.005) were observed at the final follow-up. The mean preoperative ODI was 26.19 ± 3.42, which improved to 9.6 ± 1.0 (p < 0.005). Thirteen patients exhibited delayed focal segmental instability following decompression. Despite the absence of symptoms or improvement with conservative treatment in the majority of patients with delayed instability, two patients required fusion surgery to address the instability. Additionally, 2 patients developed facet synovial cysts, while 2 experienced spinous process fractures. Bilateral decompression with a contralateral UBE approach could be an effective and alternative treatment method to reduce instability in spinal stenosis with grade 1 spondylolisthesis.

Transforaminal Endoscopic Lumbar Foraminotomy for Juxta-Fusional Foraminal Stenosis.

Adjacent segment foraminal stenosis is a significant adverse event of lumbar fusion. Conventional revision surgery with an extended fusion segment may result in considerable surgical morbidity owing to extensive tissue injury. Transforaminal endoscopic lumbar foraminotomy (TELF) is a minimally invasive surgical approach for symptomatic foraminal stenosis. This study aimed to demonstrate the surgical technique and clinical outcomes of TELF for the treatment of juxta-fusional foraminal stenosis. Full-scale foraminal decompression was performed via a transforaminal endoscopic approach under local anesthesia. A total of 22 consecutive patients who had undergone TELF were evaluated. The included patients had unilateral foraminal stenosis at the juxta-fusional level of the previous fusion surgery, intractable lumbar radicular pain despite at least six months of non-operative treatment, and verified pain focus by imaging and selective nerve root block. The visual analog scale and Oswestry Disability Index scores significantly improved after the two-year follow-up period. The modified MacNab criteria were excellent in six patients (27.27%), good in 12 (55.55%), fair in two (9.09%), and poor in two (9.09%), with a 90.91% symptomatic improvement rate. No significant surgical complications were observed. The minimally invasive TELF is effective for juxta-fusional foraminal stenosis.

Clinical outcome of percutaneous endoscopic lumbar decompression in treatment of elderly patients with lumbar spinal stenosis: a matched retrospective study.

This retrospective cohort study aimed to evaluate the efficacy and safety of percutaneous endoscopic lumbar decompression (PELD) in elderly patients with lumbar spinal stenosis (LSS). A matched retrospective study. The research was conducted in Beijing Chaoyang Hospital, Capital Medical University, China. This study included patients treated with PELD for LSS from September 2016 to September 2020. Patients with LSS aged ≥ 80years were screened according to the inclusion and exclusion criteria as the study group, and then the same number of patients with LSS aged 50-80years were matched according to gender, stenosis type, and surgical segment as the control group. Preoperative patient status was assessed using the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) physical status classification score. Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI) scores, modified Macnab criteria, radiological parameters and complication rates. A total of 624 LSS patients met the screening criteria between September 2016 and September 2020, with 47 LSS patients ≥ 80years old serving as the study group. Forty-seven LSS patients aged 50-80years were matched to the study group according to gender, stenosis type, and stenosis segment. The CCI score (1.77 ± 1.67) and ASA classification (2.62 ± 0.74) of the study group were significantly higher than the CCI score (0.66 ± 0.96) and ASA classification (1.28 ± 0.54) of the control group, and the difference was statistically significant. Compared with preoperative data, postoperative ODI, leg pain VAS scores and back pain VAS scores were significantly improved in both groups (p < 0.05). However, no significant difference was found between two groups in preoperative and postoperative ODI, leg pain VAS scores and back pain VAS scores (p > 0.05). The operation time and postoperative hospital stay in control group were significantly lower than those in study (p < 0.05), but there was no significant difference in blood loss between the two groups (p > 0.05). Besides, overall radiological parameters were comparable in elder and younger patients (p > 0.05), and disc height (DH), lumbar lordosis and segmental lordosis decreased after twoyear follow-up in both groups (p < 0.05). In addition, complication rates were similar between the two groups (p > 0.05), and no serious complications and deaths were found. Single-centre retrospective design, non-randomized sample, small sample size. Although elderly LSS patients (≥ 80years old) are less fit and have more comorbidities, satisfactory outcomes can be achieved with PELD, comparable to those of LSS patients < 80years old, and without increased complications.

Effectiveness analysis of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope for L4, 5 degenerative lumbar spondylolisthesis

To compare the effectiveness of posterolateral approach lumbar interbody fusion assisted by one-hole split endoscope (OSE) and traditional posterior lumbar interbody fusion (PLIF) in the treatment of L4, 5 degenerative lumbar spondylolisthesis (DLS). The clinical data of 58 patients with DLS who met the selection criteria admitted between February 2020 and March 2022 were retrospectively analyzed, of which 26 were treated with OSE-assisted posterolateral approach lumbar interbody fusion (OSE group) and 32 were treated with PLIF (PLIF group). There was no significant difference between the two groups in terms of gender, age, body mass index, Meyerding grade, lower limb symptom side, decompression side, stenosis type, and preoperative low back pain visual analogue scale (VAS) score, leg pain VAS score, Oswestry disability index (ODI), and the height of the anterior and posterior margins of the intervertebral space (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were compared between the two groups. The low back pain and leg pain VAS scores and ODI before operation, at 1 month, 6 months after operation, and last follow-up, the height of anterior and posterior margins of the intervertebral space before operation, at 6 months after operation, and last follow-up, the modified MacNab criteria at last follow-up after operation were used to evaluate the effectiveness; and the Bridwell method at last follow-up was used to evaluate the interbody fusion. Both groups successfully completed the operation. Compared with the PLIF group, the OSE group showed a decrease in intraoperative blood loss and postoperative hospital stay, but an increase in operation time, with significant differences (P<0.05). In the OSE group, no complication such as nerve root injury and thecal sac tear occurred; in the PLIF group, there were 1 case of thecal sac tear and 1 case of epidural hematoma, which were cured after conservative management. Both groups of patients were followed up 13-20 months with an average of 15.5 months. There was no complication such as loosening, sinking, or displacement of the fusion cage. The low back pain and leg pain VAS scores, ODI, and the height of anterior and posterior margins of the intervertebral space at each time point after operation in both groups were significantly improved when compared with those before operation (P<0.05). Except for the VAS score of lower back pain in the OSE group being significantly better than that in the PLIF group at 1 month after operation (P<0.05), there was no significant difference in all indicators between the two groups at all other time points (P>0.05). At last follow-up, both groups achieved bone fusion, and there was no significant difference in Bridwell interbody fusion and modified MacNab standard evaluation between the two groups (P>0.05). OSE-assisted posterolateral approach lumbar interbody fusion for L4, 5 DLS, although the operation time is relatively long, but the postoperative hospitalization stay is short, the complications are few, the operation is safe and effective, and the early effectiveness is satisfactory.

Comparative analysis of percutaneous endoscopic interlaminar discectomy for highly downward-migrated disc herniation

ObjectivesThis study aimed to evaluate the clinical efficacy and safety of percutaneous endoscopic interlaminar discectomy (PEID) for treating highly downward-migrated disc herniation.MethodsWe conducted a retrospective study on 39 patients with highly downward-migrated disc herniation who underwent PEID treatment between January 2015 and October 2020. The clinical outcomes, including the preoperative and postoperative visual analogue scale (VAS) for the back and leg, Oswestry Disability Index (ODI), and MacNab criteria for surgical success, were evaluated and compared to thirty-seven patients treated with posterior lumbar interbody fusion (PLIF).ResultsThe mean operation time of PEID was 93.00(77.00,110.00) min, while that of PLIF was 169.00(157.00,183.00) min. Continued improvement in both PEID and PLIF was observed in the VAS and ODI scores immediately after the surgery to the last follow‐up. The VAS and ODI scores of PEID one week after surgery were significantly different from those of PLIF. One patient with recurrent lumbar disc herniation in the same segment improved after undergoing repeat PEID, two patients had dura tears, and conservative treatment helped relieve the symptoms. The overall percentage of patients with good to excellent results of PELD according to the modified MacNab criteria was 97.43%, while that of PLIF was 94.60%.ConclusionsPEID has reliable efficacy and safety for treating highly downward-migrated disc herniation. And the long-term efficacy of PEID is comparable to PLIF. No severe complications occurred after surgery, and most patients’ symptoms were relieved.

Transiliac Endoscopic-Assisted L5S1 Intraforaminal Lumbar Interbody Fusion: Technical Considerations and Potential Complications

We sought to determine the clinical outcomes, complications, and fusion rates in transiliac endoscopic-assisted L5S1 intraforaminal lumbar interbody fusion (iLIF). Between September 2020 and September 2021, patients with L5S1 degenerative disk disease were enrolled in a prospective study on transiliac L5S1 iLIF and followed for a minimum of 12 months. Conflict of the preoperative planned approach with the ilium was mandatory. The primary outcome measures were the Oswestry Disability Index, the visual analog scale (VAS) score for low back pain (VAS back) and leg pain (VAS leg), and the modified MacNab criteria. The secondary outcomes were complications and fusion rates. Five consecutive patients were enrolled: 2 males and 3 females with a mean age of 50 ± 12.9. All had 12 months' follow-up. The mean improvement in the Oswestry Disability Index, VAS back, and VAS leg (44 ± 11.75, 6.6 ± 1.7, and 4.7 ± 4.2, respectively) was more than 3 times the minimum clinically important difference. The modified MacNab criteria were good or excellent in 80% of cases at all endpoints. Three patients had ipsilateral lower limb dysesthesia. One patient had revision surgery for foraminal bone fragment removal. All patients achieved fusion. The transiliac iLIF is a feasible but demanding surgical technique that allows overcoming cases in which the ilium prevents endoscopic transforaminal access to L5S1. Our preliminary results had good clinical outcomes and high fusion rates. The main complication was late-onset dysesthesia of the ipsilateral lower limb, 10 to 14 days after surgery. Special care must be taken to prevent L5 dorsal root ganglion injury.

Technical Feasibility and Early Clinical Outcome of Biportal Endoscopic Transforaminal Lumbar Interbody Fusion Using Larger Cage

Transforaminal lumbar interbody fusion with biportal endoscopic guidance (BE-TLIF) has been previously reported with promising clinical results. However, complications such as delayed union or subsidence occurred as with open surgery. We assumed using larger cages would result in less occurrence of such complications. We aimed to analyze the clinical outcome and technical feasibility of BE-TLIF using larger cages, initially designed for oblique lumbar interbody fusion. We enrolled cases that underwent single-level BE-TLIF between January 2021 and January 2022. Polyetheretherketone cages that were larger than the conventional size were used. Diagnoses were degenerative spondylolisthesis or isthmic spondylolisthesis. Visual analog scale scores of the back and leg and Oswestry Disability Index were collected perioperatively. Modified Macnab criteria were used to evaluate the patients at the final follow-up. Radiologic outcome of interbody fusion rate and perioperative complications were analyzed. A total of 35 cases were included in this study. The mean age was 67.5 ± 8.4 and consisted of 13 male patients, and the mean follow-up duration was 18.3 ± 3.7 months. The majority (32/35, 91.3%) of the index level was located within the lower lumbar region, L4-S1. Oswestry Disability Index scores improved from 65.4 ± 5.4 preoperatively to 15.4 ± 6.1 at the final follow-up (P < 0.001). Visual analog scale scores of the leg decreased from 7.9 ± 1.5 to 1.7 ± 1.5 at the final follow-up (P < 0.001). Per the modified Macnab criteria on the final follow-up, 94% of the patients reported good/excellent. Most (94.2%) of the patients showed fusion grade I and II at the 1-year follow-up. No patient showed subsidence or other postoperative complication. BE-TLIF using a larger cage was safely performed without risk of subsidence during the 1-year follow-up. A cage with a larger footprint may be advantageous in BE-TLIF in the aspect of interbody fusion and subsidence.