Nerve Root Decompression Research Articles

Early effectiveness of unilateral biportal endoscopic discectomy combined with annulus fibrosus suture in the treatment of lumbar disc herniation

To analyze the early effectiveness of unilateral biportal endoscopic discectomy (UBED) combined with annulus fibrosus suture in the treatment of lumbar disc herniation (LDH). The clinical data of 19 patients with LDH treated with UBED and annulus fibrosus suture between October 2020 and October 2021 were retrospectively analyzed. There were 12 males and 7 females with an average age of 39.1 years (range, 26-59 years). The operative segment was L 4, 5 in 13 cases, and L 5, S 1 in 6 cases. The mean disease duration was 6.7 months (range, 3-15 months). Preoperative neurological examination showed that muscle strength, sensation, and tendon reflex weakened or disappeared in varying degrees. Single annulus fibrosus suture (14 cases) or anchor assisted annulus fibrosus suture (5 cases) was selected according to the location of annulus fibrosus tears. Visual analogue scale (VAS) score was used to assess the low back and leg pain before operation and at 3 days, 3 months, and 6 months after operation. Oswestry disability index (ODI) was used to evaluate the function recovery of lumbar spine before operation and at 3 days, 3 months, and 6 months after operation. At 3 days and 3 months after operation, MRI was used to examine the removal of nucleus pulposus and decompression of nerve root. MacNab criteria was used to evaluate the effectiveness at 6 months after operation and the recovery of nerve root function was recorded. All operations were successfully completed with a mean operation time of 52.7 minutes (range, 40-75 minutes). There was no complication such as nerve injury, spinal cord hypertension syndrome, or dural sac tear during operation, and no complication such as infection, aggravation of nerve damage, or cerebrospinal fluid leakage after operation. All the patients were followed up 6-10 months (mean, 8.2 months). Postoperative MRI showed that the herniated disc was completely removed and nerve roots were fully decompressed. During the follow-up, there was no recurrence of disc herniation. The VAS scores of low back pain and leg pain and ODI at each time point after operation significantly improved when compared with those before operation, and those at 6 months after operation further improved than those at 3 days and 3 months after operation, all showing significant differences ( P<0.05). At 6 months after operation, MacNab standard was used to evaluate the effectiveness, and the results were excellent in 14 cases, good in 4 cases, and fair in 1 case, with an excellent and good rate of 94.7%. Neurological examination showed that the sensation and muscle strength of the affected nerve root innervated area recovered significantly when compared with those before operation ( P<0.05); the recovery of tendon reflex was not obvious, showing no significant difference when compared with that before operation ( P>0.05). UBED combined with annulus fibrosus suture is a safe and effective technique for LDH and early effectiveness is satisfactory.

MRI changes of adjacent segments after transforaminal lumbar interbody fusion (TLIF) and foraminal endoscopy: A case-control study.

Background:Intervertebral foramen endoscopy has developed rapidly, but compared with transforaminal lumbar interbody fusion (TLIF), the progress of degeneration is unknown. We aim to compare the changes of intervertebral disc and intervertebral foramen in adjacent segments after TLIF and endoscopic discectomy for patients with lumbar disc herniation (LDH).Methods:From 2014 to 2017, 87 patients who were diagnosed with single-level LDH and received surgery of TLIF (group T, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up (FU). The neurological function was originally evaluated by the Japanese Orthopaedic Association (JOA) scores. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration Pfirrmann scores.Results:There was no significant difference in baseline characteristics, JOA improvement rate, reoperation rate and complications between the two groups. The age, average blood loss, average hospital stays and average operation time in group F were lower than those in group T. During the last FU, HIS, CA and FA decreased in both groups, and the changes in group T were more significant than those in group F (P < .05). There was no significant difference in FH changes between the two groups (P > .05).Conclusion:Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar disc height loss and intervertebral foramina reduction in the adjacent segment after endoscopic surgery is lower.

Commentary: Traumatic Spinopelvic Dissociation With Sacral Cauda Equina Syndrome-Demonstrating Fracture Reduction, Stabilization, and Transsacral Circumferential Nerve Root Decompression: 2-Dimensional Operative Video.

Commentary: Traumatic Spinopelvic Dissociation With Sacral Cauda Equina Syndrome-Demonstrating Fracture Reduction, Stabilization, and Transsacral Circumferential Nerve Root Decompression: 2-Dimensional Operative Video.

Pros of the contralateral (over-the-top) approach to intra/extraforaminal lumbar disc herniations at the L5-S1 level.

Background: Minimally invasive approaches to intra/extraforaminal lumbar disc herniations offer the benefit of less bone removal and reduced nerve root manipulation at the L5-S1 level. Moreover, the potential to better preserve stability.Methods: Here, we summarized the efficacy of the contralateral approach to intraforaminal/extraforaminal lumbar disc herniations particularly focusing on the L5-S1 level. Variables studied included the level of these disc herniations, their locations within the foramina, and the anatomy of the facet joints.Results: A major “pro” for the contralateral interlaminar procedure at the L5-S1 level is that it does not require facet joint removal, or with a spondylotic facet, <30% joint excision, to directly visualize the intraforaminal/ extraforaminal nerve root. It, therefore, reduces the risk of creating iatrogenic instability, while offering a higher certitude of adequate nerve root visualization, decompression, and safer disc removal.Conclusion: The contralateral interlaminar approach is more suitable for all types of intra/extraforaminal disc herniations at the L5/S1 level. The most specific benefit of this approach is its avoidance of disruption/significant removal (i.e., <30%) of the facet joint to adequately expose the foraminal L5 nerve root, and more safely remove the intra/extraforaminal disc herniation.

Microvascular Decompression: A Bibliometric Analysis of the 100 Most Cited Articles

Bibliometric analyses assess the impact and influence of articles in the academic community. There is no previous work that has used bibliometric analysis of microvascular decompression (MVD). This study aims to identify and characterize the 100 most cited articles on MVD. Highly cited articles were identified assessing the Scopus library by using the keywords "microvascular decompression," "MVD," "nerve decompression," "nerve root decompression," and "microvascular surgery." Data were further processed by sampling techniques with defined inclusion and exclusion criteria. The number of citations, country of origin, institutions of origin, year of publication, type of cranial nerve disorder, type of article, and the publishing journal were analyzed. Further, article categories and the type of studies were investigated. The 100 most cited articles on MVD ranged from 951 to 76 total citations, and from 38.04 to 1.88 citations per year. Publication dates spanned a period from 1959 to 2015. The most frequently studied cranial nerve disorder was trigeminal neuralgia (n= 54). Articles were published in 29 journals, with Neurosurgery (n= 33) topping the list. The articles came from 14 different countries, with most contributions from the United States (n=55). Authors of the highly cited articles who received most citations were Peter J. Jannetta (n= 26), followed by Aage Møller (n= 13), and Marc Sindou (n= 11). This work provides a detailed evaluation of the 100 most cited articles on MVD, thus allowing recognition and selected reading of the most influential academic contributions related to this surgical technique in a variety of cranial nerve disorders.

Safety and Efficacy of Anterior Cervical Discectomy and Fusion with Uncinate Process Resection: A Systematic Review and Meta-Analysis.

Study designThis is a meta-analysis and systematic review of the available literature.ObjectiveIn the case of severe foraminal stenosis, conducting uncinate process resection (UPR) during ACDF could achieve complete nerve root decompression and significant relief of neurological symptoms for CR. However, there is some controversy regarding its necessity and safety. This study aims to compare the safety and efficacy of ACDF with UPR and ACDF.MethodsThe following electronic databases were searched: Medline, PubMed, Embase, the Cochrane Central Register of Controlled Trials, Evidence Based Medicine Reviews, VIP, and CNKI. And the following data items were considered: baseline demographics, efficacy evaluation indicators, radiographic outcome, and surgical details.Results10 studies were finally identified, including 746 patients who underwent ACDF with UPR compared to 729 patients who underwent ACDF. The group of ACDF with UPR had statistically longer intraoperative time (95% CI: 4.83, 19.77, P = .001) and more intraoperative blood loss (95% CI: 12.23, 17.76, P < .001). ACDF with UPR obtained a significantly better improvement of Arm VAS at postoperative first follow-up (95% CI: −1.85, −.14 P = .02). There was no significant difference found in improvement of Neck VAS at postoperative latest follow-up (95% CI: −.88, .27, P = .30), improvement of Arm VAS at postoperative latest follow-up (95% CI: −.59, −.01, P = .05), improvement of NDI (95% CI: −2.34, .33, P = .14), JOA (95% CI: −.24, .43, P = .56), change of C2-C7 lordosis (95% CI: −.87, 1.33, P = .68), C2-C7 SVA (95% CI: −.73, 5.08, P = .14), T1 slope (95% CI: −2.25, 1.51, P = .70), and fusion rate (95% CI: .83, 1.90 P = .29).ConclusionACDF with UPR is an effective and necessary surgical method for CR patients with severe foraminal stenosis.

A Review of Endoscopic Spine Surgery: Decompression for Radiculopathy.

With this manuscript the authors sought to write a succinct review of the origins, as well as the latest advancements in endoscopic spine surgery to serve as a reference frame for physicians looking to learn this approach. At its infancy, the indications for posterolateral and transforaminal endoscopic decompression remained narrow, which prevented the procedure from gaining rapid traction during those days. However, more recently the tides have turned and an increasing number of surgeons are starting to adopt this technique given all its advantages. With the advent of higher quality camera systems and instruments, indications to use a minimally invasive option have gotten significantly broader. The most basic indication for the use of this technology is a soft disc herniation causing compromise of a neural structure that has failed to be managed successfully with non-surgical therapies. The use of endoscopic techniques provides significant advantages to patient outcomes and patient recovery. Endoscopic procedures should not be used as a blanket approach to nerve root decompression, as they certainly have limitations. Most contraindications to this procedure are relative and serve mostly as points to consider when selecting the methods to address neural compression. As these techniques become more widely accepted, we expect its reach and indications to continue to broaden and diversify. The full integration of navigation technologies will likely leapfrog this procedure into the mainstream use.

Trephine-based foraminoplasty in PTED treatment of lumbar lateral recess stenosis.

During minimally invasive spine surgery, nerve root decompression is challenging due to the anatomical division and uncertainty in lumbar lateral recess (LLR). To evaluate the outcome and safety of foraminoplasty using percutaneous transforaminal endoscopic decompression (PTED) (performed with an aid of a trephine) in the treatment of lumbar lateral recess stenosis (LLRS). All operations were performed under local anesthesia and in prone position. The puncture point was 10-14 cm away from the midline of the spinous process. One hundred eight individuals with LLRS who underwent PTED from September 2016 to December 2020 in our hospital were enrolled in the study. Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were collected preoperatively after 1 day, 7 days, 1 month and at the final follow-up (June 2021). Low back pain and leg pain were measured using VAS score. Functional outcomes were assessed with ODI and modified Macnab criteria. After the surgery, the VAS score and ODI were statistically significant at all follow-up points compared with the pre-surgery (both p < 0.05). Based on the modified Macnab scores at the final follow-up, the satisfaction rate at postoperative 1 month was 96.3% and the satisfaction rate at postoperative 7 days was 70.38%. A significant difference was observed between the 2 groups (p < 0.05). Foraminoplasty using PTED performed with a trephine is one of the safe and effective, minimally invasive methods to treat LLRS.

Quantitative Assessment of Nerve Root Decompression During Lumbar Surgery: A Prospective Application of Contrast-Enhanced Ultrasound

Quantitative Assessment of Nerve Root Decompression During Lumbar Surgery: A Prospective Application of Contrast-Enhanced Ultrasound

A novel anatomo-physiologic high-grade spondylolisthesis model to evaluate L5 nerve stretch injury after spondylolisthesis reduction

L5 nerve palsy is a well-known complication following reduction of high-grade spondylolisthesis. While several mechanisms for its occurrence have been proposed, the hypothesis of L5 nerve root strain or displacement secondary to mechanical reduction remains poorly studied. The aim of this cadaveric study is to determine changes in morphologic parameters of the L5 nerve root during simulated intraoperative reduction of high-grade spondylolisthesis. A standard posterior approach to the lumbosacral junction was performed in eight fresh-frozen cadavers with lumbosacral or lumbopelvic screw fixation. Wide decompressions of the spinal canal and L5 nerve roots with complete facetectomies were accomplished with full exposure of the L5 nerve roots. A 100% translational slip was provoked by release of the iliolumbar ligaments and cutting the disc with the attached anterior longitudinal ligament. To evaluate the path of the L5 nerves during reduction maneuvers, metal bars were inserted bilaterally at the inferomedial aspects of the L5 pedicle at a distance of 10 mm from the midpoint of the L5 pedicle screws. There was no measurable change in length of the L5 nerve roots after 50% and 100% reduction of spondylolisthesis. Mechanical strain or displacement during reduction is an unlikely cause of L5 nerve root injury. Further anatomical or physiological studies are necessary to explore alternative mechanisms of L5 nerve palsy in the setting of high-grade spondylolisthesis correction, and surgeons should favor extensive surgical decompression of the L5 nerve roots when feasible.

Long-Term Clinical Results with Radiological Correlations After Posterior Foraminotomy for Unilateral Cervical Discopathy

In lateral cervical disc herniations, posterior foraminotomy (PF) provides direct nerve root decompression and maintains segmental mobility. However, partial facetectomy can cause instability. This study evaluated long-term clinical outcomes related to cervical sagittal alignment after PF. The study included 48 consecutive patients with lateral cervical disc herniations who underwent PF. Pain and mobility were evaluated using the Numeric Rating Scale and Neck Disability Index (NDI), respectively. Sagittal alignment was evaluated using the modified Toyama method. Median Numeric Rating Scale arm, Numeric Rating Scale neck, and NDI scores improved by 7, 4.5, and 24 points, respectively. Corresponding mean minimal clinically important differences were achieved in 94%, 77%, and 98% of patients at a mean follow-up of 8.4 years. Of patients, 82% showed favorable radiological results (i.e., retained or developed lordosis or had straight spine), while 18% showed unfavorable radiological results (i.e., retained or changed toward kyphosis). The latter group had multilevel cervical degenerative disc disease (mcDDD) before PF. Nevertheless, the risk of developing kyphosis was only 2.6%, and the potential for improving sagittal balance was 43%. Follow-up median NDI scores, but not minimal clinically important differences, were significantly worse in patients with preoperative kyphosis (21 vs. 8; P= 0.03) or mcDDD (20 vs. 8; P= 0.024) compared with other patients. Patients with preoperative kyphosis or mcDDD had worse NDI outcomes but also benefited from PF. Sagittal alignment improved in >40% of patients, but coexisting mcDDD was a main risk factor for kyphosis persistence.

Effect of Arthroplasty vs Fusion for Patients With Cervical Radiculopathy

Surgical treatment for cervical radiculopathy is increasing. Treatment with motion preserving anterior cervical disc arthroplasty was introduced to prevent symptomatic adjacent segment disease, and there is need to evaluate results of this treatment compared with standard anterior cervical discectomy and fusion. To investigate clinical outcomes at 5 years for arthroplasty vs fusion in patients who underwent surgical treatment for cervical radiculopathy. This multicenter, single-blinded, randomized clinical trial included patients aged 25 to 60 years with C6 or C7 radiculopathy referred to study sites' outpatient clinics from 2008 to 2013. Data were analyzed from December 2019 to December 2020. Patients were randomly assigned to arthroplasty or fusion. Patients were blinded to which treatment they received. The surgical team was blinded until nerve root decompression was completed. The primary end point was change in Neck Disability Index (NDI) score. Secondary outcomes were arm and neck pain, measured with numeric rating scales (NRS); quality of life, measured with the EuroQol-5D (EQ-5D); reoperation rates; and adjacent segment disease. Among 147 eligible patients, 4 (2.7%) declined to participate and 7 (4.8%) were excluded. A total of 136 patients were randomized (mean [SD] age, 44.1 [7.0] years; 73 (53.7%) women), with 68 patients randomized to arthroplasty and 68 patients randomized to fusion. A total of 114 patients (83.8%) completed the 5-year follow-up. In the arthroplasty group, the mean NDI score was 45.9 (95% CI, 43.3 to 48.4) points at baseline and 22.2 (95% CI, 18.0 to 26.3) points at 5 years follow-up, and in the fusion group, mean NDI score was 51.3 (95% CI, 48.1 to 54.4) points at baseline, and 21.3 (95% CI, 17.0 to 25.6) points at 5 years follow-up. The changes in mean NDI scores between baseline and 5 years were statistically significant for arthroplasty (mean change, 24.8 [95% CI, 19.8 to 29.9] points; P < .001) and fusion (mean change, 29.9 [95% CI, 24.0 to 35.9] points; P < .001), but the change in mean NDI scores was not significantly different between groups (difference, 5.1 [95% CI, -2.6 to 12.7] points; P = .19). There were no significant differences in changes in arm pain (mean [SE] change, 3.5 [0.5] vs 3.1 [0.4]; P = .47), neck pain (mean [SE] change, 3.0 [0.5] vs 3.4 [0.5]; P = .50), EQ-5D (mean [SE] change, 0.39 [0.4] vs 0.45 [0.6]; P = .46), patients requiring reoperation (10 patients [14.7%] vs 8 patients [11.8%]; P = .61), and adjacent segment disease (0 patients vs 1 patient [1.5%]; P = .32) between the arthroplasty and fusion groups. In this randomized clinical trial, patients treated with arthroplasty and fusion reported similar and substantial clinical improvement at 5 years. ClinicalTrials.gov Identifier: NCT00735176.

Adjuvant surgical decision-making system for lumbar intervertebral disc herniation after percutaneous endoscopic lumber discectomy: a retrospective nonlinear multiple logistic regression prediction model based on a large sample

Lumbar disc herniation (LDH) is a common condition that can affects an individual' quality of life. In patients for whom conservative treatment is ineffective after 3 months, surgical treatment, such as percutaneous endoscopic lumbar discectomy (PELD), is recommended. Because PELD is minimally invasive and produces thorough nerve root decompression, both surgeons and patients often prefer it to other techniques. Surgeons find it challenging to prevent postoperative recurrent LDH (rLDH) when they use PELD. We created and verified a model for evaluating patients' recurrence risk factors before surgery so that surgeons can choose other surgical techniques when necessary. Retrospective study. One thousand eight hundred seven patients who underwent PELD at our hospital between 2012 and 2015 were enrolled. The main outcome measure was rLDH at any follow-up time point. Data were retrospectively analyzed for 1807 patients who underwent PELD at our hospital at some point between 2012 and 2015; all patients had been monitored for at least 5 years after surgery. They were divided into a recurrence group and a nonrecurrence group. Clinical and radiological risk factors were assessed over time to determine their correlations with recurrence and to exclude less important factors. A nonlinear multivariate logistic regression model was established to predict the recurrence rate before surgery. A total of 1706 patients were monitored after PELD; data were missing for 101 additional patients. The total recurrence rate was 10.38%, and the most common time from surgery to recurrence was 1 year. Ten risk factors were assessed and included in the analysis. Regarding clinical risk factors, patients with hypertension (p < .001; correlation coefficient R [R]=0.235; odds ratio [OR]=4.749), diabetes (p < .001; R=0.381; OR=16.797), a history of smoking (p < .001; R=0.347; OR=9.012), and a history of performing intense physical labor (p < .001; R=0.409; OR=19.592) had a higher recurrence rate. Regarding radiological risk factors, patients with disc degeneration (Pfirrmann grade III) (p < .001; R=0.228; OR=4.919), Modic changes (level 2) (p < .001; R=0.309; OR=7.934), herniation in the form of extrusion (p < .001; R=0.365; OR=12.228), a higher disc height index (DHI) (p < .001; R=0.336), and a larger segmental range of motion (p < .001; R=0.243) had a higher recurrence rate. When the lumbar motion angle was negative (p < .001; R=0.318; OR=13.680), the recurrence rate was high. The overall accuracy of the final model was 97.6% (1665 of 1706). The recognition rate for non-rLDH cases was 99.0% (1514 of 1529), and the rate for rLDH cases was 85.3% (151 of 177); the AUC was 0.9315. A simple model was used. For those patients with postoperative trauma (p < .001; R=0.382; OR=13.680), a comparison model was established, and the corresponding recurrence rate was 23.0% ± 25.0% (0-76%). A large cohort of patients underwent long-term monitoring, and 11 risk factors were verified for assessing each patient's risks before surgery to predict the postoperative recurrence of LDH following PELD. The risk of recurrence may be effectively reduced with the use of alternative surgical techniques in high risk cases.

Vascular decompression with videoendoscopy as a treatment for glossopharyngeal nerve neuralgia: clinical case and literature review

The objective is to demonstrate the effectiveness of the vascular decompression with videoendoscopy in the treatment of classical glossopharyngeal nerve neuralgia by a clinical case and to summarize the literature data on this subject. Clinical case. In February 2020, a 56-year-old patient with a clinical picture of glossopharyngeal nerve neuralgia was admitted to the Research Clinical Center of Specialized Medical Care and Medical Technologies. The pain syndrome bothered about 3 years, constantly took carbamazepine at a dose of 1200 mg per day, amitriptyline 75 mg per day, clonazepam 2 mg per day without effect. After further examination and differential diagnosis of causal neuralgia of the glossopharyngeal nerve, a neurovascular conflict appeared between the glossopharyngeal nerve, the posterior inferior cerebellar and vertebral arteries. A good postoperative clinical result was obtained. An analysis of the available scientific literature on this problem is carried out.Results. After performing vascular decompression of the root of the glossopharyngeal and vagus nerves, pain completely regressed (BNI - I, VAS - 0). 6 months after surgery, there is no pain, the patient does not receive drug therapy. In the course of the analysis of available literature, the effectiveness of vascular decompression in the treatment of patients with classical neuralgia reaches 98 %.Conclusion. Given the low incidence of glossopharyngeal neuralgia, the correct diagnosis and the choice of an appropriate treatment method determine the outcome of the disease. The performed operation in the volume of vascular decompression of the glossopharyngeal nerve root with the use of videoendoscopy allowed to completely stop the pain syndrome.

Effect of Microvascular Decompression of the Vagus Root Entry/Exit Zone on Blood Pressure in Patients with Hemifacial Spasm Associated with Essential Hypertension: A Retrospective Clinical Analysis.

Background This study aimed to evaluate blood pressure alterations after microvascular decompression (MVD) surgery in patients with hemifacial spasm (HFS) with coexisting hypertension (HTN). Methods A total of 56 patients with HFS with concurrent HTN who underwent MVD surgery in our center between 2015 and 2019 were retrospectively analyzed. Patients were divided into control and experimental groups: patients who received MVD treatment for only the facial nerve and those who received MVD for the affected facial nerve, ipsilateral vagus nerve, and adjacent ventrolateral medulla, respectively. Preoperative (3 days) and postoperative (7 days and 6 months) blood pressure measurements were analyzed. Results No statistically significant differences were observed in gender, age, HFS course, HTN course, HTN grade, and preoperative blood pressure between the two groups. No significant difference was observed between pre- and postoperative blood pressure in the control group. In the experimental group, systolic blood pressure significantly differed between 3 preoperative days and 7 postoperative days ( p < 0.05), as did diastolic blood pressure ( p < 0.05). Measurement at 6 postoperative months also showed significant differences for both systolic blood pressure and diastolic blood pressure compared with that at 3 preoperative days ( p < 0.05). HTN grade according to the World Health Organization classification criteria significantly differed between preoperative and postoperative measurements ( p < 0.05). Conclusion Vascular decompression of the ipsilateral vagus nerve roots may improve blood pressure management in patients with HFS with coexisting HTN who undergo MVD. Laterality of involvement (left vs. right) did not significantly differ.

Full-Endoscopic Oblique Lateral Lumbar Interbody Fusion: A Technical Note With 1-Year Follow-Up.

Oblique lateral lumbar interbody fusion (OLLIF) is a minimally invasive lumbar interbody fusion procedure using a bullet-shaped polyetheretherketone (PEEK) nonexpandable fusion cage modified to diminish risk to the exiting nerve root during posterolateral implantation through the Kambin safe zone under fluoroscopic guidance. The objective of this study was to present feasibility of this procedure and 1-year clinical outcome data. The authors present a prospective cohort study of 20 patients who underwent fluoroscopy-guided and full-endoscopic OLLIF in 22 segments allowing protection of the exiting nerve root from January 2018 to March 2019. The foraminoplasty, discectomy, endplate preparation, placement of bone graft and insertion of the fusion cage was done under continuous full-endoscopic visualization. The OLLIF fusion was backed up with bilateral percutaneous posterior supplemental pedicle screw fixation. Primary clinical outcome measures were the visual analog scale (VAS) of low back and leg pain, and Oswestry disability index (ODI) at 1 week, 3 months, 6 months, and 1 year after the operation. At final follow-up, the Macnab score was also evaluated. Secondary outcome measures were computed tomography (CT) assessment fusion using the Mannion classification of spinal fusion and adverse events related to the device as well as magnetic resonance imaging (MRI) assessment of nerve root decompression. All patients had significant relief of low back pain and leg pain, by VAS and ODI scores that improved significantly (P < .01). There were no complications. Postoperative lumbar MRI of all patients showed sufficient direct nerve decompression. At 1-year follow-up, excellent Macnab outcomes were obtained 13 patients, good in six, and fair in one. Impaired sensation and muscle strength of the involved nerve root significantly recovered in all but 2 patients (P < .05). According to the Mannion CT-based classification of spinal fusion, CT showed complete interbody fusion achieved in all 22 segments. Full-endoscopic OLLIF is a safe, effective, minimally invasive, economical, practical, and widely applicable minimally invasive interbody fusion technique in the lumbar spine. 3.

Characteristics of relief and residual low back pain after discectomy in patients with lumbar disc herniation: analysis using a detailed visual analog scale

BackgroundSeveral authors have reported favorable results in low back pain (LBP) for patients with lumbar disc herniation (LDH) treated with discectomy. However, detailed changes over time in the characteristics and location of LBP before and after discectomy for LDH remain unclear. To clarify these points, we conducted an observational study to determine the detailed characteristics and location of LBP before and after discectomy for LDH, using a detailed visual analog scale (VAS) bilaterally.MethodsWe included 65 patients with LDH treated by discectomy in this study. A detailed VAS for LBP was administered with the patient under 3 different conditions: in motion, standing, and sitting. Bilateral VAS was also administered (affected versus opposite side) for LBP, lower extremity pain (LEP), and lower extremity numbness (LEN). The Oswestry Disability Index (ODI) was used to quantify clinical status. Changes over time in these VAS and ODI were investigated. Pfirrmann grading and Modic change as seen by magnetic resonance imaging (MRI) were reviewed before and 1 year after discectomy to determine disc and endplate condition.ResultsBefore surgery, LBP on the affected side while the patients were in motion was significantly higher than LBP while they were sitting (p = 0.025). This increased LBP on the affected side in motion was improved significantly after discectomy (p < 0.001). By contrast, the residual LBP while sitting at 1 year after surgery was significantly higher than the LBP while they were in motion or standing (p = 0.015). At 1 year following discectomy, residual LBP while sitting was significantly greater in cases showing changes in Pfirrmann grade (p = 0.002) or Modic type (p = 0.025).ConclusionsImprovement of LBP on the affected side while the patient is in motion suggests that radicular LBP is improved following discectomy by nerve root decompression. Furthermore, residual LBP may reflect increased load and pressure on the disc and endplate in the sitting position.

Long-term clinical and radiological outcomes of anterior uncoforaminotomy for unilateral single-level cervical radiculopathy: retrospective cohort study

BACKGROUND CONTEXTAnterior cervical discectomy and fusion is a common procedure for degenerative cervical radiculopathy. In 1996, Dr. H.D. Jho reported an operative technique allowing nerve root decompression via anterior uncoforaminotomy whereas avoiding fusion. PURPOSETo assess long-term clinical and radiological outcomes of anterior uncoforaminotomy in patients with degenerative cervical spine pathology. STUDY DESIGNA single clinic, retrospective cohort study. PATIENT SAMPLEAdult patients who underwent anterior uncoforaminotomy from 2013 to 2018. OUTCOME MEASURESClinical outcomes were assessed using VAS, NDI, SF-36 criteria. Radiological parameters included sagittal balance, disc height and White anPanjabi criterion. MATERIALS AND METHODSAll patients underwent unilateral single-level anterior uncoforaminotomy, and long-term clinical and radiologic follow up was carried out. Clinical outcomes were assessed using VAS, NDI, SF-36 criteria. Radiological parameters evaluated included sagittal balance, disc height and White and Panjabi criteria (3.5 mm of translation, 11 degrees of kyphosis). The mean follow-up period was 33.3 ± 10.6 months (range 12–57 months). RESULTSAll measures of clinical outcome improved. VAS (neck) and VAS (arm) decreased 3 [2; 4] and 5 [3; 5.2] points (median [interquartile range]), respectively (p<0.001); NDI improved from 0.38 [0.36; 0.4], to 0.29 [0.22; 0.34] (p<0.001). Two patients (6%) required additional surgery one year after operation. There were no complications in the perioperative period. Disc height decreased 0.8 mm [0.1; 2.1] (p<0.001). All patients retained stability of the cervical spine based on White and Panjabi criteria. Sagittal balance parameters did not change significantly. CONCLUSIONUncoforaminotomy is an effective and safe method to decompress a unilateral single-level nerve root in degenerative cervical radiculopathy whereas preserving anatomy and motion of the cervical spine.

Is Decompression and Partial Discectomy Advantageous Over Decompression Alone in Microendoscopic Decompression Of Monosegmental Unilateral Lumbar Recess Stenosis?

Endoscopic techniques are well accepted as surgical technique for decompression of lumbar lateral recess stenosis (LRS). It is uncertain if there is a difference in clinical outcome for decompression alone (DA) or decompression with partial discectomy (DPD) for the treatment of LRS. All files of patients who underwent an endoscopic procedure for lumbar LRS were identified from a prospectively collected database. Preoperative magnetic resonance imaging and endoscopic video were analyzed with special focus on the technique of nerve root decompression. Clinical outcome was assessed via a personal examination, a standardized questionnaire including the numeric rating scale (NRS) for leg and back pain, the Oswestry disability index (ODI), and the modified MacNab criteria to assess functional outcome and clinical success. Sixty-six patients were identified of which 57 attended for evaluation (86.4%). DA was performed in 15 (26.3%) patients and DPD in 42 patients (73.7%). The mean follow-up was 45.0 months (range: 16-82 months). Fifty-two patients reported to be free of leg pain (91.1%), 42 patients had no noticeable back pain (73.7%), 49 patients had full muscle strength (85.9%), and 48 patients had no sensory disturbance (84.2%). The mean NRS for leg pain was 1, the mean NRS for back pain was 2, mean ODI was 16% (range: 0%-60%). Clinical success was noted in 49 patients (85.9%) and it was significantly higher for patients following DPD (P = .024). The overall repeat procedure rate was 12% with reoperation rate at the index segment in 10.5% of cases. There were no significant differences with respect to leg and back pain, ODI, and reoperation between both groups. Microendoscopic DPD of LRS achieves a 92% clinical success rate which is significantly higher compared to 67% clinical success achieved by DA. There was no significant difference for the rate of reoperation, leg and back pain, and ODI. 4.

Use of Intraoperative Computed Tomography Improves Outcome of Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Single-Center Retrospective Cohort Study

To provide data about surgical workflow, accuracy, complications, radiation exposure, and learning curve effect in patients who underwent minimally invasive (MIS) transforaminal lumbar interbody fusion with navigation coupled with mobile intraoperative computed tomography. A retrospective analysis was performed of data from consecutive patients who underwent single- or double-level MIS transforaminal lumbar interbody fusion at a single institution; mobile intraoperative computed tomography combined with a navigation system was used as the sole intraoperative imaging method to place pedicular screws; decompression and interbody fusion were performed through a 22-mm tubular retractor. Clinical data, perioperative complications, accuracy of pedicular screw placement, and radiation exposure were analyzed. A learning curve effect on surgical time and accuracy was assessed. A total of 408 screws in 100 patients were analyzed. In all cases, spinal navigation allowed for identification of pedicular trajectories and greatly facilitated nerve root decompression through the MIS approach. Overall accuracy according to Heary classification was 95.3%. Nineteen screws (4.7%) presented a minor lateral breach (<2 mm), not clinically significant. Surgical time, blood loss, and patient radiation exposure compared favorably with reported values from other series using three-dimensional navigation. A learning curve effect on surgical time, but not on screw accuracy, was identified. MIS transforaminal lumbar interbody fusion can now be performed without any radiation exposure to the surgeon and operating room staff, with almost absolute accuracy during screw positioning and tubular decompression. A learning curve effect on surgical time, but not on overall screw accuracy, may be expected.