Posterior Discectomy Research Articles

A Novel Free-hand Technique of Pedicle Screw Placement in the Lumbar Spine: Accuracy Evaluation and Preliminary Clinical Results.

Pedicle screw implantation is the most common technique to achieve stability during spinal surgeries. Current methods for locating the entry point do not have a quantified criteria and highly rely on the surgeons' experience. Therefore, we aim to propose a quantified pedicle screw placement technique in the lumbar spine and to investigate its accuracy and safety in clinical practice. We conducted a retrospective study involving 110 patients who received spinal surgery in our hospital from August 2018 to August 2021. All patients included had herniation of a single lumbar disc and were consistently treated with posterior discectomy, inter-body fusion, and transpedicular internal fixation. For 54 patients in the observation group, the pedicle screws were placed with our technique, which is located at 4 mm below the superior edge of the transverse process in line with the lateral margin of the superior articular process. For 56 patients in the control group, pedicle screws were placed according to the traditional crista lambdoidalis method. Comparisons were made in terms of the operation time, blood loss, time for exposure, the accuracy of placement, and postoperative complications. Furthermore, we applied our method to 64 patients with indistinguishable crista lambdoidalis and evaluated the accuracy of screw placement and clinical outcomes according to the visual analogue scale (VAS) and the Japanese Orthopaedic Association (JOA) score. There was no significant difference in intraoperative bleeding, accuracy of placement, and postoperative complications between our technique and the traditional crista lambdoidalis method (P > 0.05). However, the exposure time before screw placement (12.8 ± 0.3 vs. 17.4 ± 0.3, P = 0.001) and the total surgery time (97.2 ± 1.9 vs 102.3 ± 0.9, P = 0.020) were significantly shortened with our method. Additionally, in cases with indistinguishable crista lambdoidalis, our technique showed satisfying accuracy, with 97.6% screws placed in appropriate trajectory on the first attempt and all screws eventually positioned in the safe zone according to the Gertzbein-Robbins grading. All patients experienced steady improvement after surgery. Placing pedicle screws at 4 mm below the superior edge of the transverse process in line with the lateral margin of the superior articular process is a viable pedicle screw placement method. With this method, we observed a higher success rate and shorter operation time. In addition, this method can be applied in cases with indistinguishable crista lambdoidalis, and have satisfied success rate and clinical outcome.

The first experience with fully endoscopic posterior cervical foraminotomy and discectomy for radiculopathy performed in Viet Duc University Hospital

The aim of the article is to present the first experience of applying a full-endoscopic posterior cervical foraminotomy and discectomy performed at Viet Duc University Hospital in Hanoi and describe the outcomes of such surgical intervention. This surgical series includes 20 patients underwent surgery through full-endoscopic posterior cervical foraminotomy and discectomy. The definitive diagnosis of the patients and the evidence for surgical treatment was radiculopathy due to lateral or intraforaminal disk herniation, foraminal stenosis, and lateral recess stenosis. Patients with discogenic cervical radiculopathy but with a contraindication to endoscopic posterior cervical foraminotomy and discectomy were not subject to surgical intervention. All patients underwent a CT and MRT examination of the cervical spine before and after surgery as complementary diagnostic methods. Besides radiological diagnostic methods, electroneuromyography and spondylography were performed with functional samples, i.e., with head tilts in the front and back, to eliminate segmental instability. The timing and degree of the root pain syndrome regression were assessed using a VAS scale (visual and analog scale) with a subsequent comparison of preoperative and postoperative performance. Immediately after the operation, all patients noted a complete or nearly complete regression of the pain syndrome.

Innovations in Spinal Endoscopy

Innovations in spinal endoscopy technology and technique have broadened their applications during the past 10 years. Smaller outer-diameter working-channel endoscopes have permitted safe usage in the cervical spine for full endoscopic decompressions. Endoscopic fusions have now been widely reported, leveraging compatible instrumentation for disc preparation and expandable interbody grafts. This ultra-minimally invasive technique has also enabled the performance of fusion procedures in awake patients under monitored anesthesia care, affording speedier recovery and treatment options for those unable to undergo general anesthesia. Revision surgery after open or minimally invasive posterior discectomy or instrumentation can now be performed with endoscopic techniques, which often leverage the transforaminal approach to avoid scar tissue and adhesions. These procedures, among other endoscopic surgeries, are now being increasingly performed in ambulatory surgery centers, as safe outcomes, economic benefits to the healthcare system, and patients' desire to recover at home are becoming more apparent. Finally, the standardization of endoscopic terminology, which has long been a confounder to proper communication and education in this field, has recently been addressed by leading experts in a consensus document, which will serve as the foundation for future collaborative advancements.

Peer review of the book Bentham Science Publishers eBook* Contemporary Endoscopic Spine Surgery Volume 1: Cervical Spine edited by Kai-Uwe Lewandrowski, Jorge Felipe Ramírez León and Anthony Yeung

In the book ”Contemporary Endoscopic Spine Surgery”, edited by Kai-Uwe Lewandrowski, Jorge Felipe Ramírez León, and Anthony Yeung, information on the history of spinal endoscopy is provided. A number of aspects of spinal surgery are covered, in particular spinal pain, preoperative examination, indications for endoscopic surgery, anesthesia, outpatient surgery. New endoscopic technologies are described. Leading scientists presented the clinical results of spinal surgery. Information on endoscopic surgery of degenerative diseases of the spine (herniated cervical discs, stenosis, instability, spinal deformities) is provided. The monograph contains three volumes ("Cervical spine", "Lumbar spine" and "Modern technologies"). The volume "Cervical spine" covers the following topics: - endoscopy of the cervical spine: historical perspectives, present and future; - anesthesia for minimally invasive surgery of the cervical spine; - algorithms for choosing between anterior and posterior endoscopy of the cervical spine; - making clinical decisions full endoscopy of the cervical spine; - spine surgery: indications for and results of endoscopic posterior cervical rhizotomy; anterior endoscopic cervical discectomy; anterior transcorporeal approach to percutaneous endoscopy of the cervical spine; - discectomy: anterior endoscopic cervical discectomy and foraminoplasty for disc herniation and cervical spinal stenosis; posterior full endoscopic discectomy and foraminotomy; endoscopic decompression in cervical spondylogenic myelopathy. The publication can be useful for both neurosurgeons-interns and practicing neurosurgeons to expand their understanding of spinal endoscopic surgery.

Minimally Invasive Posterior Cervical Discectomy: 2-Dimensional Operative Video.

Minimally invasive posterior cervical microdiscectomy is an appropriate surgical approach for patients with foraminal stenosis from herniated disc with radicular symptoms that is not responsive to conservative management. While anterior cervical discectomy and fusion (ACDF) or arthroplasty is increasingly utilized to treat herniated disc, a posterior approach eliminates the risk of potential approach related injuries to the esophagus, carotid artery, or recurrent laryngeal nerve. Additional benefits of posterior decompression include avoidance of instrumentation, which represents an increased healthcare cost, as well as potential long-term risks of adjacent-level pathologies or device failures. A traditional open posterior cervical approach has the potential to cause significant postoperative pain due to dissection of the paraspinal musculature and the potential for disrupting the posterior tension band with inadvertent injury to the interspinous ligaments. Such disadvantages are reduced by utilizing the minimally invasive technique where a small tubular working channel is placed through a muscle splitting technique via a paramedian approach. This technique minimizes the need for muscle stripping, and thus decreases postoperative functional and structural disturbance. Discectomy in this case can also be safely performed with minimal retraction at the axilla of the nerve root. Additionally, this approach can be utilized in an ambulatory setting, which coupled with the lack of any additional instrumentation helps contribute to the overall healthcare cost savings of such a procedure. This video describes how the minimally invasive posterior cervical discectomy can be effectively and safely performed in this illustrative case. The patient consented to the procedure and publication.

P131. Liposomal Bupivacaine does not decrease postoperative opioid use or length of hospital stay in patients undergoing anterior and posterior lumbar discectomy and fusion

<h3>BACKGROUND CONTEXT</h3> Patients undergoing lumbar spinal surgery often report significant postoperative pain, necessitating increased postoperative analgesia and prolonging hospital stay. Liposomal bupivacaine (LB) is a novel local anesthetic encapsulated in a lipid bilayer, resulting in sustained-release analgesia, that is believed to decrease postoperative pain. While the efficacy of perioperative LB infiltration has been demonstrated in various orthopedic procedures, there has been little evidence for its use in patients undergoing lumbar spinal surgery. <h3>PURPOSE</h3> The aim of this paper was to evaluate the efficacy of liposomal bupivacaine for lowering postoperative opiate usage and length of hospital stay in the management of anterior and posterior lumbar decompression and fusion. <h3>STUDY DESIGN/SETTING</h3> A retrospective study consisting of 107 patients who underwent lumbar spinal surgery performed by a single surgeon (R.V.) from 2016 to 2019. <h3>PATIENT SAMPLE</h3> A total of 107 patients included in analysis were those who underwent anterior or posterior decompression and fusion for lumbar spondylolisthesis and stenosis. <h3>OUTCOME MEASURES</h3> Postoperative opiate use in morphine equivalents (mEq) and hospital length of stay (LOS). <h3>METHODS</h3> Demographic information, postoperative opiate use and length of hospital stay were obtained through in-depth review of electronic medical records (EMR). Data were analyzed using independent t-tests and multiple linear regression. <h3>RESULTS</h3> There were 51 (47.6%) patients who received LB, while 56 patients did not receive any perioperative local anesthetic. Patients who received LB did not have significantly lower postoperative opiate usage on postoperative day (POD) 0, POD1, POD2, or total per LOS (p=0.861, 0.602, 0.721, 0.974 respectively). Multivariate analysis showed age significantly predicted postoperative opiate usage on POD 0 (p=0.044) and total per LOS (p=0.035), while LB did not. Patients that received LB had a longer LOS with a mean of 5.45 days compared to 4.7 days for patients that did not receive LB, although significance was not reached (p=0.235). <h3>CONCLUSIONS</h3> Local anesthetics are often employed by surgeons to improve postoperative pain control. LB did not significantly decrease postoperative opiate use or shorten LOS. At this time LB was not shown to be clinically effective in patients undergoing anterior or posterior discectomy and fusion, though further evaluation is required. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Сравнительный анализ одноуровневого переднего и заднего спондилодеза при дегенеративных заболеваниях пояснично-крестцового отдела позвоночника

Transpedicular fixation (TPF) as a method of posterior fusion is currently the most common, reliable and economically justified option of spinal fusion in various diseases and injuries of the lumbar spine, having more than half a century of history. As a result of the search for less invasive and more effective methods of fixation of the spinal segments to improve the results of surgical treatment, shorten the hospitalization, and reduce the number of perioperative complications, an approach involving fusion with rigid implant from the anterior (ALIF) was developed. Objective. To analyze the immediate and long-term results of treatment of single-level herniated discs by total removal of the intervertebral disc using anterior access with a rigid spondylodesis (ALIF) and the method of posterior discectomy, spondylodesis and transpedicular fixation (TPF). Materials and methods. A prospective cohort study was conducted. The study included patients after total intervertebral disc removal by the ALIF method and patients after discectomy and TPF. The achieved result was evaluated using radiological tests, as well as using standardized questionnaires and surveys. Results. After the surgery, patients in both groups showed a significant reduction in pain on the NRS scale. Patients from the first group had 4 to 0 for back and 8 to 0 for leg, patients from the second group had 6 to 4 for back and 8 to 0 for leg. The quality-of-life assessment by ODI scale also showed a positive trend from 36 to 4 in the first group and from 22 to 12 in the second group. Clinically, the result of surgical treatment was rated as excellent 5 in the ALIF group and as good in the TPF group 4 on the modified subjective assessment scale Macnab. Conclusion. The ALIF method as a decompression-stabilizing surgical aid is less traumatic. The less invasive nature of the technique was confirmed by significantly shorter surgical intervention time, smaller volume of intraoperative blood loss, and a shorter period of hospitalization. In the long-term period, statistically significant differences were obtained indicating that the ALIF method is more effective than TPF.

Surgical Techniques Ensuring Success in Posterior Endoscopic Cervical Foraminotomy and Discectomy at C6-7 in Patients with Prominent Shoulders and Short Necks

Introduction: There is a steep learning curve for a successful posterior endoscopic cervical foraminotomy and discectomy (PECFD), an important surgery for cervical foraminal or lateral disc herniation, and cervical radiculopathy due to a small operation field. PECFD becomes even more challenging in patients who have prominent shoulders and/or short necks with C6–7-disc herniation, because of the difficulty to localize C6–7 vertebral structure under fluoroscopy. The study objective is to prove that the PECFD can be performed safely and successfully to C6–7-disc herniation on patients with prominent shoulders and/or short necks following our novel surgical techniques under fluoroscopic guidance. Materials and Methods: PECFD was performed on a patient who had an extruded foraminal disc herniation at C6–7 on the left with left arm pain and weakness. Due to his prominent shoulders and a short neck, the C6–7 anatomic site was not visible under traditional anterior-posterior (AP) and lateral fluoroscopic views. The authors inserted a reference needle to C4–5 facets between C4 and C5 pedicles under AP and lateral fluoroscopic views. Following the reference needle, the C6–7 facets were easily located with an oblique fluoroscopic view. A large endoscopic cannula was used initially for adequate resection of C6–7 facets, followed by a small cannula for nerve root handling with minimal pressure and discectomy. Results: The novel surgical techniques resulted in a complete resection of the C6–7-disc herniation and resolution of the patient’s radiculopathy with no postoperative complications. Conclusion: PECFD can be safely and successfully applied for C6–7-disc herniation in patients with prominent shoulders and/or short necks using our novel surgical techniques.

Comparative evaluation of posterior percutaneous endoscopy cervical discectomy using a 3.7\u2009mm endoscope and a 6.9\u2009mm endoscope for cervical disc herniation: a retrospective comparative cohort study

BackgroundPosterior percutaneous endoscopy cervical discectomy (p-PECD) is an effective strategy for the treatment of cervical diseases, with a working cannula ranging from 3.7 mm to 6.9 mm in diameter. However, to date, no studies have been performed to compare the clinical outcomes of the use of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of patients with unilateral CDH treated with p-PECD using a 3.7 mm endoscope and a 6.9 mm endoscope.MethodsFrom January 2016 to June 2018, a total of 28 consecutive patients with single-level CDH who received p-PECD using either the 3.7 mm or the 6.9 mm endoscope were enrolled. The clinical results, including the surgical duration, hospitalization, visual analog scale (VAS) score and modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were also performed during follow-up.ResultsTthere was a significant difference in regard to the average identification time of the “V” point (18.608 ± 3.7607 min vs. 11.256 ± 2.7161 min, p < 0.001) and the mean removal time of the overlying tissue (16.650 ± 4.1730 min vs. 12.712 ± 3.3079 min, p < 0.05) for the use of the 3.7 mm endoscope and the 6.9 mm endoscope, respectively. The postoperative VAS and MacNab scores of the two endoscopes were significantly improved compared with those the preoperative scores (p < 0.05).ConclusionThe application of both the 3.7 mm endoscope and 6.9 mm endoscope represent an effective method for the treatment of CDH in selected patients, and no significant difference can be observed in the clinical outcomes of the endoscopes. The 6.9 mm endoscope shows superiority to the 3.7 mm endoscope in terms of the efficiency of “V” point identification, the removal of overlying soft tissue and the prevention of spinal cord injury. However, the 6.9 mm endoscope may be inferior to the 3.7 mm endoscope in regards to anterior foraminal decompression due to its large diameter; this result needs to be further evaluated with the support of a large number of randomized controlled trials.

Internal Retractor for Percutaneous Full-Endoscopic Posterior Discectomy

Internal Retractor for Percutaneous Full-Endoscopic Posterior Discectomy

Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from

Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from

Percutaneous posterior full-endoscopic cervical foraminotomy and discectomy: a finite element analysis and radiological assessment

Percutaneous posterior full-endoscopic cervical foraminotomy and discectomy (PECFD) is recognized as a safe, effective, and minimally invasive treatment for cervical spondylotic radiculopathy (CSR). However, the potential mechanisms of the degenerative changes and postoperative recurrence after PECFD are unclear. In this study, a finite element (FE) analysis and radiological assessment were performed to evaluate the biomechanical effects after PECFD. The FE model indicated that the ROM and IDP of C5–C6 increased significantly after PECFD in the extension loading. The radiological evaluation revealed that the extension ROM of C2–C7 and the operative level increased significantly at the one-year follow-up compared with that obtained preoperatively. Combining the FE results and radiological changes, we conclude that the increase in the ROM and IDP at the operative level in the extension loading is the potential cause of the degenerative changes and recurrences after PECFD surgery.

Response to: Comment on “Effective Range of Percutaneous Posterior Full-Endoscopic Paramedian Cervical Disc Herniation Discectomy and Indications for Patient Selection”

Response to: Comment on “Effective Range of Percutaneous Posterior Full-Endoscopic Paramedian Cervical Disc Herniation Discectomy and Indications for Patient Selection”

Multiple level anterior cervical discectomy and fusion versus posterior laminectomy for the management of multilevel cervical spondylotic myelopathy: clinical and radiological outcome

BackgroundThough both anterior and posterior approach are used for the management of multilevel cervical spondylotic myelopathy (CSM), the choice between both approaches remains to be of considerable debate.Aim of the workThe aim of the study was to evaluate the clinical and radiographic outcomes of patients with multiple level CSM who underwent posterior laminectomy (PL) versus anterior cervical discectomy and fusion (ACDF).MethodsThis is a retrospective comparative study of 30 patients, with multiple level CSM managed by the authors, either by PL (n = 15) or ACDF (n = 15). Clinical outcome was assessed at 1, 3, 6, and 12 months postoperatively using the modified Japanese Orthopedic Association scale (mJOA) while the postoperative radiographic changes represented by the Cobb’s angle variation was recorded at 12 months postoperatively and compared with preoperative values. Also, the incidence of postoperative complications and neurological deterioration was recorded and studied between the two groups. Study duration was for 2 years from December 2014 to December 2016.ResultsBoth the ACDF and PL groups showed an improvement in the mJOA score mean value at 1 year after surgery in comparison with the preoperative evaluation data; however, on comparing between both groups at 1 year postoperatively, the median percent of increase in mJOA score was significantly higher in the ACDF group compared with the PL group (33.3% vs 22.2% respectively). On the other hand, the Cobb’s angle percent of change 1 year after surgery showed a median percent of increase of 18.7% in the ACDF group in contrast to a median decrease of − 11.1% in the PL group which was statistically significant. Minimal complications were reported in both groups.ConclusionBoth PL and ACDF are effective modalities for the surgical management of multilevel CSM showing good clinical outcome; however, when compared with the posterior approach, there was a statistical significant difference favoring ACDF regarding the median percent of increase in mJOA score and the postoperative Cobb’s angle improvement.

Comparing the postoperative results of single-level anterior cervical discectomy and fusion, cervical disc prosthesis and minimal invasive posterior cervical disc surgery

Objective: Comparison of preoperative and postoperative clinical characteristics of patients who underwent single-level anterior cervical discectomy and fusion, cervical discectomy and prosthesis or minimal invasive posterior cervical discectomy.Methods: The preoperative and the postoperative characteristics (0-, 3-, 12- and 24-month results) of patients who had undergone anterior cervical discectomy and fusion (24 patients, 40%), cervical discectomy and prosthesis (21 patients, 35%) or minimal invasive posterior cervical discectomy (15 patients, 25%), for single-level disc hernia of the C3 to C7 region at the İstanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital between February 2015 and December 2017 were evaluated postoperatively using visual pain scales, neck disability index (NDI) values and Odom’s criteria.Results: Postoperative visual analog scale and NDI scores were significantly decreased immediately after surgery in all groups (p < .001). Similarly, these two values at the second year were significantly decreased compared to post-op values (p < .001). When pre-op, post-op, third month, first year and second year scores were compared between the groups, a significant difference was found between the groups (p < .001). It was observed that the minimal invasive posterior cervical discectomy surgery was significantly better than the other two surgeries in all follow-up assessments (p < .001 for all follow-up).Conclusion: The early postoperative values of the visual pain scale and neck disability indicator were found to demonstrate immediate benefits of the surgeries, in addition to the further decrease at the 2-year follow-up in this study.

Posterolateral fusion combined with posterior decompression shows superiority in the treatment of severe lumbar spinal stenosis without lumbar disc protrusion or prolapse: a retrospective cohort study

BackgroundCurrently, discectomy and posterior decompression combined with lumbar circumferential fusion (CF) have been accepted as a major procedure for severe lumbar spinal stenosis (LSS). However, studies on severe LSS without protruded intervertebral disc to minimize study bias are lacking. We aimed to investigate the effectiveness of sole posterior decompression with lumbar posterolateral fusion (PLF) and the necessity of discectomy and CF in patients with severe LSS without lumbar disc protrusion or prolapse.MethodsThis retrospective cohort study included 153 severe LSS patients without lumbar disc protrusion or prolapse who were admitted in a tertiary spine center with at least a 2-year follow-up between January 2014 and August 2017. Patients were divided into the PLF (n = 77; those who underwent posterior decompression with PLF in 1–3 segments) or CF (n = 76; those who underwent posterior decompression and discectomy with CF in 1–3 segments) groups. Pedicle screw instrumentation was applied to avoid postoperative instability. Clinical outcomes were assessed by visual analog scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopedic Association Score (JOA, lumbar pain score). Duration of operation, blood loss, surgical cost, and postoperative complications were analyzed. Height of intervertebral space, lumbar lordosis, and bone union were confirmed by lumbar radiography or computed tomography.ResultsBoth groups achieved significant improvement in JOA, ODI, and VAS compared with preoperative values (P < 0.001), but without significant difference between the two groups. Both groups achieved high fusion rate without difference and correction of lumbar lordosis and intervertebral space height (P < 0.001), especially in the CF group (P < 0.05). Duration of operation, blood loss, and operation cost were significantly higher in the CF group than in the PLF group (P < 0.001). Eight complications were found in both groups (1, PLF group; 7, CF group; P < 0.05).ConclusionsAfter posterior decompression, PLF successfully achieves bony fusion and symptom relief with lower complication rate, lesser surgical blood loss, shorter operative time, and lesser cost than CF. Thus, sole posterior decompression with PLF is an effective treatment for severe LSS without lumbar disc protrusion or prolapse.

Case Report: Post Lumbar Discectomy Acute Iliac Arteriovenous Fistula; Endovascular Management and Literature Review

Posterior approach lumbar disc surgeries (LDS) can be associated with serious iatrogenic vascular complications which could be a serious life threatening condition. We report a rare case of right sided acute iliac vessels iatrogenic arteriovenous fistula (IAVF) which was diagnosed and managed in 24 hours duration in a 45 years old healthy female who underwent surgical posterior approach L4-5 discectomy. Intraoperative, she developed sudden hypotension, tachycardia, wide pulse pressure and acute drop of hemoglobin level without obvious operative site bleeding which raise the index of suspicion of vascular injury and urge the team for doing emergency CT angiography (CTA), vascular and endovascular team consultation for digital subtraction angiography (DSA) and endovascular management. Endovascular stenting is nowadays the modality of choice of intervention. We provide case report with literature review.

Evaluation of clinical and radiological outcome of disk preserving functional cervical disk surgery

Introduction: Cervical radiculopathy is a neurological disfunction wherein a nerve root in the cervical spine becomes inflamed with disc herniation and uncovertebral osteophytes accounting for the majority of cases. The standard surgical treatment for this cervical radiculopathy till now is posterior lamino foraminotomy and anterior discectomy with or without fusion. This study describe the outcome of a minimally invasive anterior cervical disc preserving technique of upper vertebral transcorporeal anterior microforaminotomy to treat cervical radiculopathy Cervical. Objective: To Evaluate the clinical and radiological outcome of disk preserving functional cervical disk surgery. Material and Methods: This is a prospective non randomised hospital based study. The study population included 11 patients operated for cervical radiculopathy with the new technique at the department of Neurosurgery, Manipal Hospital, Bangalore during July 2007 to June 2010. The patients were followed up from 8 to 30 months with a mean follow up of 17 months for clinical and radiological outcome. Results: The mean age of the patient was 40.099.71 years. The majority of the patients (five) were in 31-40 age groups. Male patients (63.6%) were more as compared to females. All patients in this study had neck pain, radicular pain and weakness. Clinical symptoms were between 1 to 3months. The mean preoperative visual analogue scale score was 8.55 and postoperative score was 1.18. The VAS score reduced significantly postoperatively and it was statistically significant. There was no significant reduction in the disc height postoperatively. Conclusion: The Disk preserving functional cervical disk surgery is a minimal invasive procedure with the least complications and adequate motion at the operated site. Keywords: Cervical Disk Surgery, Cervical radiculopathy, Disk preserving, Disk Herniation

The Comparative Study of Full-Endoscopic Cervical Posterior Discectomy and Anterior Cervical Decompression and Fusion

The Comparative Study of Full-Endoscopic Cervical Posterior Discectomy and Anterior Cervical Decompression and Fusion

Treatment of L5 - S1 intervertebral disc herniation with posterior percutaneous full-endoscopic discectomy by grafting tubes at various positions via an interlaminar approach

BackgroundDepending on the location of the herniated disc at the shoulder, axilla, or ventral side of the compression nerve root, various puncture sites and channel entrances were selected so that the goal of targeted removal of the herniated disc could be achieved by a full-endoscopic technique. Achieving good clinical therapeutic efficacy through the natural gap of bones can maximally avoid related access complications, and the necessary techniques and relevant anatomical factors were analyzed.MethodsBetween August 2012 and August 2014, 98 patients with L5 - S1 intervertebral disc herniation were treated with posterior percutaneous full-endoscopic discectomy (PPFED) by grafting tubes at various positions via the interlaminar approach. The visual analog scale (VAS) and the Oswestry disability index (ODI) were used to assess the patients’ back and leg pain and the improvements in daily function, and the modified Macnab standard was used to evaluate the treatment efficacy.ResultsAll 98 patients successfully completed the surgery, 84 patients got out of bed and walked on the first postoperative day, and 14 patients got out of bed and walked on the second postoperative day. The preoperative ODI (56.032 ± 3.625) was significantly higher than the ODI score (8.147 ± 1.398) (F = 5343.054, P ≤ 0.001) 48 months after surgery. The preoperative VAS score (7.193 ± 0.875) was significantly higher than the postoperative VAS score (0.914 ± 0.500 points) (F = 1656.173, P ≤ 0.001). The differences in ODI and VAS scores before and after surgery were statistically significant (P < 0.05). Follow-up was conducted 1, 6, 12 and 48 months postoperatively, and the modified Macnab standard was used during the last follow-up to evaluate the efficacy: 67 cases were excellent, 20 cases were good, 7 cases were fair, and 0 cases were poor; the proportion of excellent and good cases was 92.6%.ConclusionsThe treatment of L5 - S1 intervertebral disc herniation with PPFED by grafting tubes at various positions via an interlaminar approach is a safe, effective, and minimally invasive surgical method. Reaching the location of a disc herniation directly through the natural gap in the bones can maximally avoid collateral injury from spine surgery.Trial registrationThe registration number of this clinical study is ChiCTR1800014588; it has been retrospectively registered with a registration date of 05/01/2018.