Medicina

Research

9 pages, 1561 KiB

Open AccessArticle

Predictive Factors for Poor Outcome following Chemonucleolysis with Condoliase in Lumbar Disc Herniation

by Shu Takeuchi, Junya Hanakita, Toshiyuki Takahashi, Tomoo Inoue, Manabu Minami, Izumi Suda, Sho Nakamura and Ryo Kanematsu

Medicina 2022, 58(12), 1868; https://doi.org/10.3390/medicina58121868 - 18 Dec 2022

Cited by 6 | Viewed by 2120 | Correction

Abstract

Background and Objectives: Condoliase, a chondroitin sulfate ABC endolyase, is a novel and minimally invasive chemonucleolytic drug for lumbar disc herniation. Despite the growing number of treatments for lumbar disc herniation, the predicting factors for poor outcomes following treatment remain unclear. The aim [...] Read more.

Background and Objectives: Condoliase, a chondroitin sulfate ABC endolyase, is a novel and minimally invasive chemonucleolytic drug for lumbar disc herniation. Despite the growing number of treatments for lumbar disc herniation, the predicting factors for poor outcomes following treatment remain unclear. The aim of this study was to determine the predictive factors for unsuccessful clinical outcome following condoliase therapy. Material and Methods: We performed a retrospective single-center analysis of 101 patients who underwent chemonucleolysis with condoliase from January 2019 to December 2021. Patients were divided into good outcome (i.e., favorable outcome) and poor outcome (i.e., requiring additional surgical treatment) groups. Patient demographics and imaging findings were collected. Clinical outcomes were evaluated using the numerical rating scale and Japanese Orthopaedic Association scores at baseline and at 1- and 3-month follow-up. Pretreatment indicators for additional surgery were compared between the 2 groups. Results: There was a significant difference in baseline leg numbness between the good outcome and poor outcome groups (6.27 ± 1.90 vs. 4.42 ± 2.90, respectively; p = 0.033). Of the 101 included patients, 32 received a preoperative computed tomography scan. In those patients, the presence of calcification or ossification in disc hernia occurred more often in the poor outcome group (61.5% vs. 5.3%, respectively; p < 0.001; odds ratio = 22.242; p = 0.014). Receiver-operating characteristics curve analysis for accompanying calcification or ossification showed an area under the curve of 0.858 (95% confidence interval, 0.715–1.000; p = 0.001). Conclusions: Calcified or ossified disc herniation may be useful predictors of unsuccessful treatment in patients with condoliase administration. Full article

(This article belongs to the Special Issue New Advance in Minimally Invasive Spine Surgery)

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9 pages, 2697 KiB

Open AccessArticle

Minimally Invasive Resection of Benign Osseous Tumors of the Spinal Column: 10 Years’ Experience and Long-Term Outcomes of a Specialized Center

by Khalil Salame, Zvi Lidar, Morsi Khashan, Dror Ofir and Gilad J. Regev

Medicina 2022, 58(12), 1840; https://doi.org/10.3390/medicina58121840 - 15 Dec 2022

Cited by 3 | Viewed by 1511

Abstract

Background and Objectives: Benign osseous tumors of the spinal column comprise about 10% of all spinal tumors and are rare cause for surgery. However, these tumors pose various management challenges and conventional surgery may be associated with significant morbidity. Previous reports on [...] Read more.

Background and Objectives: Benign osseous tumors of the spinal column comprise about 10% of all spinal tumors and are rare cause for surgery. However, these tumors pose various management challenges and conventional surgery may be associated with significant morbidity. Previous reports on minimally invasive resection of these lesions are rare. We report a series of patients managed by total resection of benign osseous spine tumors using MIS techniques. Surgical decisions and technical considerations are discussed. Materials and Methods: A retrospective evaluation of prospectively collected data of patients who underwent minimally invasive surgery for removal of benign osseous vertebral tumors. Demographic, clinical and radiographic features, operative details and final pathological reports were summarized. Primary outcomes were completeness of tumor resection and pain relief assessed by VAS for back and leg pain. Secondary outcome measures were recurrence of tumor on repeat post-operative MRI and postoperative unstable deformity on standing scoliosis X-rays. Results: This series included 32 cases of primary osseous spine tumors resected by minimally invasive techniques. There were 17 males and 15 females aged 5–68 years (mean 23.3). The follow-up period was 8–90 months (mean 32 months) and the preoperative symptoms duration was 9–96 months. Axial spinal pain was the presenting symptom in all the patients. Five patients also complained about radicular pain and four patients had antalgic scoliosis. The tumor involved the thoracic spine in 12 cases, the lumbar segment in 11, the cervical in 5 and the sacral area in 4 cases. Complete tumor removal was performed in all patients. No procedure-related complications were encountered. Histopathology showed osteoid osteoma in 24 patients, osteoblastoma in 5 patients, and fibrous dysplasia, fibroadenoma and eosinophilic granuloma in one case each. All patients experienced significant pain relief after surgery, and had stopped pain medications by 12 months postoperatively. No patient suffered from tumor recurrence or spinal deformity. Conclusions: Minimally invasive surgery is feasible for total removal of selected benign vertebral tumors and may have some advantages over conventional surgical techniques. Full article

(This article belongs to the Special Issue New Advance in Minimally Invasive Spine Surgery)

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11 pages, 3468 KiB

Open AccessArticle

First Clinical Experience with a Novel 3D C-Arm-Based System for Navigated Percutaneous Thoracolumbar Pedicle Screw Placement

by Eric Mandelka, Jula Gierse, Paul A. Gruetzner, Jochen Franke and Sven Y. Vetter

Medicina 2022, 58(8), 1111; https://doi.org/10.3390/medicina58081111 - 17 Aug 2022

Cited by 3 | Viewed by 2198

Abstract

Background and Objectives: Navigated pedicle screw placement is becoming increasingly popular, as it has been shown to reduce the rate of screw misplacement. We present our intraoperative workflow and initial experience in terms of safety, efficiency, and clinical feasibility with a novel [...] Read more.

Background and Objectives: Navigated pedicle screw placement is becoming increasingly popular, as it has been shown to reduce the rate of screw misplacement. We present our intraoperative workflow and initial experience in terms of safety, efficiency, and clinical feasibility with a novel system for a 3D C-arm cone beam computed-tomography-based navigation of thoracolumbar pedicle screws. Materials and Methods: The first 20 consecutive cases of C-arm cone beam computed-tomography-based percutaneous pedicle screw placement using a novel navigation system were included in this study. Procedural data including screw placement time and patient radiation dose were prospectively collected. Final pedicle screw accuracy was assessed using the Gertzbein–Robbins grading system. Results: In total, 156 screws were placed. The screw accuracy was 94.9%. All the pedicle breaches occurred on the lateral pedicle wall, and none caused clinical complications. On average, a time of 2:42 min was required to place a screw. The mean intraoperative patient radiation exposure was 7.46 mSv. Conclusions: In summary, the investigated combination of C-arm CBCT-based navigation proved to be easy to implement and highly reliable. It facilitates the accurate and efficient percutaneous placement of pedicle screws in the thoracolumbar spine. The careful use of intraoperative imaging maintains the intraoperative radiation exposure to the patient at a moderate level. Full article

(This article belongs to the Special Issue New Advance in Minimally Invasive Spine Surgery)

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15 pages, 1528 KiB

Open AccessArticle

One-Year Clinical Outcomes of Minimal-Invasive Dorsal Percutaneous Fixation of Thoracolumbar Spine Fractures

by Babak Saravi, Sara Ülkümen, Sebastien Couillard-Despres, Gernot Lang and Frank Hassel

Medicina 2022, 58(5), 606; https://doi.org/10.3390/medicina58050606 - 27 Apr 2022

Cited by 4 | Viewed by 2431

Abstract

Introduction: Minimal-invasive instrumentation techniques have become a workhorse in spine surgery and require constant clinical evaluations. We sought to analyze patient-reported outcome measures (PROMs) and clinicopathological characteristics of thoracolumbar fracture stabilizations utilizing a minimal-invasive percutaneous dorsal screw-rod system. Methods: We included all patients [...] Read more.

Introduction: Minimal-invasive instrumentation techniques have become a workhorse in spine surgery and require constant clinical evaluations. We sought to analyze patient-reported outcome measures (PROMs) and clinicopathological characteristics of thoracolumbar fracture stabilizations utilizing a minimal-invasive percutaneous dorsal screw-rod system. Methods: We included all patients with thoracolumbar spine fractures who underwent minimal-invasive percutaneous spine stabilization in our clinics since inception and who have at least 1 year of follow-up data. Clinical characteristics (length of hospital stay (LOS), operation time (OT), and complications), PROMs (preoperative (pre-op), 3-weeks postoperative (post-op), 1-year postoperative: eq5D, COMI, ODI, NRS back pain), and laboratory markers (leucocytes, c-reactive protein (CRP)) were analyzed, finding significant associations between these study variables and PROMs. Results: A total of 68 patients (m: 45.6%; f: 54.4%; mean age: 76.9 ± 13.9) were included. The most common fracture types according to the AO classification were A3 (40.3%) and A4 (40.3%), followed by B2 (7.46%) and B1 (5.97%). The Median American Society of Anesthesiologists (ASA) score was 3 (range: 1–4). Stabilized levels ranged from TH4 to L5 (mean number of targeted levels: 4.25 ± 1.4), with TH10-L2 (12/68) and TH11-L3 (11/68) being the most frequent site of surgery. Mean OT and LOS were 92.2 ± 28.2 min and 14.3 ± 6.9 days, respectively. We observed 9/68 complications (13.2%), mostly involving screw misalignments and loosening. CRP increased from 24.9 ± 33.3 pre-op to 34.8 ± 29.9 post-op (p < 0.001), whereas leucocyte counts remained stable. All PROMs showed a marked significant improvement for both 3-week and 1-year evaluations compared to the preoperative situation. Interestingly, we did not find an impact of OT, LOS, lab markers, complications, and other clinical characteristics on PROMs. Notably, a higher number of stabilized levels did not affect PROMs. Conclusions: Minimal-invasive stabilization of thoracolumbar fractures utilizing a dorsal percutaneous approach resulted in significant PROM outcome improvements, although we observed a complication rate of 13.2% for up to 1 year of follow-up. PROMs were not significantly associated with clinicopathological characteristics, technique-related variables, or the number of targeted levels. Full article

(This article belongs to the Special Issue New Advance in Minimally Invasive Spine Surgery)

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Review

Jump to: Research, Other

8 pages, 884 KiB

Open AccessReview

The Prone Lateral Approach for Lumbar Fusion—A Review of the Literature and Case Series

by Gal Barkay, Ian Wellington, Scott Mallozzi, Hardeep Singh and Isaac L. Moss

Medicina 2023, 59(2), 251; https://doi.org/10.3390/medicina59020251 - 28 Jan 2023

Cited by 3 | Viewed by 1728

Abstract

Lateral lumbar interbody fusion is an evolving procedure in spine surgery allowing for the placement of large interbody devices to achieve indirect decompression of segmental stenosis, deformity correction and high fusion rates through a minimally invasive approach. Traditionally, this technique has been performed [...] Read more.

Lateral lumbar interbody fusion is an evolving procedure in spine surgery allowing for the placement of large interbody devices to achieve indirect decompression of segmental stenosis, deformity correction and high fusion rates through a minimally invasive approach. Traditionally, this technique has been performed in the lateral decubitus position. Many surgeons have adopted simultaneous posterior instrumentation in the lateral position to avoid patient repositioning; however, this technique presents several challenges and limitations. Recently, lateral interbody fusion in the prone position has been gaining in popularity due to the surgeon’s ability to perform simultaneous posterior instrumentation as well as decompression procedures and corrective osteotomies. Furthermore, the prone position allows improved correction of sagittal plane imbalance due to increased lumbar lordosis when prone on most operative tables used for spinal surgery. In this paper, we describe the evolution of the prone lateral approach for interbody fusion and present our experience with this technique. Case examples are included for illustration. Full article

(This article belongs to the Special Issue New Advance in Minimally Invasive Spine Surgery)

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Other

Jump to: Research, Review

1 pages, 214 KiB

Open AccessCorrection

Correction: Takeuchi et al. Predictive Factors for Poor Outcome following Chemonucleolysis with Condoliase in Lumbar Disc Herniation. Medicina 2022, 58, 1868

by Shu Takeuchi, Junya Hanakita, Toshiyuki Takahashi, Tomoo Inoue, Manabu Minami, Izumi Suda, Sho Nakamura and Ryo Kanematsu

Medicina 2023, 59(2), 268; https://doi.org/10.3390/medicina59020268 - 30 Jan 2023

Viewed by 859

Abstract

In the original publication [...] Full article

(This article belongs to the Special Issue New Advance in Minimally Invasive Spine Surgery)

12 pages, 3754 KiB

Open AccessCase Report

Single Level Spondylolisthesis Associated Sagittal Plane Imbalance Corrected by Pre-Psoas Interbody Fusion Using Anterior Column Release with 30° Expandable Hyperlordotic Cage

by Mansour Mathkour, Stephen Z. Shapiro, Tyler Scullen, Cassidy Werner, Mitchell D. Kilgore, Velina S. Chavarro and Daniel R. Denis

Medicina 2022, 58(9), 1172; https://doi.org/10.3390/medicina58091172 - 29 Aug 2022

Viewed by 3456

Abstract

Background: Loss of lumbar lordosis caused by single level degenerative spondylolisthesis can trigger significant sagittal plane imbalance and failure to correct lumbopelvic parameters during lumbar fusion can lead to poor outcome or worsening deformity. Anterior column release (ACR) through a pre-psoas approach allows [...] Read more.

Background: Loss of lumbar lordosis caused by single level degenerative spondylolisthesis can trigger significant sagittal plane imbalance and failure to correct lumbopelvic parameters during lumbar fusion can lead to poor outcome or worsening deformity. Anterior column release (ACR) through a pre-psoas approach allows the placement of a hyperlordotic cage (HLC) to improve lumbar lordosis, but it is unclear if the amount of cage lordosis affects radiological outcomes in real-life patient conditions. Methods: Three patients were treated with ACR and 30° expandable HLC for positive sagittal imbalance secondary to single-level spondylolisthesis. Patients reported baseline and post-operative Oswestry Disability Index (ODI) and Numeric Pain Score (NRS). Radiographic parameters of sagittal balance included lumbar lordosis (LL), sagittal vertical axis (SVA) and pelvic incidence-lumbar lordosis mismatch (PI-LL). Results: Surgical indications were sagittal plane imbalance caused by L4–L5 degenerative spondylolisthesis (n = 2) and L3–L4 spondylolisthesis secondary to adjacent segmental degeneration (n = 1). Average post-operative length of stay was 3 days (range 2–4) and estimated blood loss was 266 mL (range 200–300). NRS and ODI improved in all patients. All experienced improvements in LL (

\bar{x}

preop = 33°,

\bar{x}

postop = 56°), SVA (

\bar{x}

preop = 180 mm,

\bar{x}

postop = 61 mm) and PI-LL (

\bar{x}

preop = 26°,

\bar{x}

postop = 5°). Conclusion: ACR with expandable HLC can restore sagittal plane balance associated with single-level spondylolisthesis. Failure to perform ACR with HLC placement during pre-psoas interbody fusion may result in under correction of lordosis and poorer outcome for these patients. Full article

(This article belongs to the Special Issue New Advance in Minimally Invasive Spine Surgery)

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7 pages, 1119 KiB

Open AccessTechnical Note

A Modified Approach for Minimally Invasive Tubular Microdiscectomy for Far Lateral Disc Herniations: Docking at the Caudal Level Transverse Process

by Murray Echt, Adewale Bakare and Richard G. Fessler

Medicina 2022, 58(5), 640; https://doi.org/10.3390/medicina58050640 - 5 May 2022

Cited by 1 | Viewed by 2119

Abstract

Background and Objectives: The use of minimally invasive retractor systems has significantly decreased the amount of tissue dissection and blood loss, and the duration of post-operative recovery after far-lateral disc herniations (FLDH). In this technical note, the technique of docking the tubular [...] Read more.

Background and Objectives: The use of minimally invasive retractor systems has significantly decreased the amount of tissue dissection and blood loss, and the duration of post-operative recovery after far-lateral disc herniations (FLDH). In this technical note, the technique of docking the tubular retractor on the caudal transverse process is described for an efficient approach with a decreased need for manipulation of the exiting nerve root. Materials and Methods: The case reported is that of a woman affected by a right-sided FLDH at the L4–5 level causing an L4 radiculopathy with weakness and numbness. A review of the literature for FLDH regarding the key anatomy used during a far lateral approach was also performed. Results: The patient showed a significant improvement of her dorsiflexion weakness and radiating leg pain at her 2-week and 5-week post-operative visits, and at a 6-month follow-up she had near-complete relief of her symptoms, including resolution of foot numbness. Prior techniques for tubular microdiscectomy for FLDH report docking on the facet joint, pars interarticularis, and the cranial transverse process. Conclusions: This technical note details that the utility of docking a tubular retractor at the caudal transverse process improves upon already established techniques for minimally invasive tubular discectomy for FLDH. Full article

(This article belongs to the Special Issue New Advance in Minimally Invasive Spine Surgery)

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