Degenerative Spinal Disease

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neurodegenerative Diseases".

Deadline for manuscript submissions: closed (1 September 2021) | Viewed by 49561

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Guest Editor
President, Harrison Spinartus Hospital, Seoul, Republic of Korea
Interests: minimally invasive spine surgery; endoscopic spine surgery; spine surgery
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Special Issue Information

Dear Colleagues,

An increasingly aging population has led to the rapid increase in degenerative spinal diseases. In order to maintain a high quality of life, there is a need for a minimally invasive spinal surgical tool option. Endoscopic spinal surgery is the field of spinal surgery that best meets contemporary needs. It has developed steadily over the past 20 years, and its scope of application has been expanding.

This Special Issue examines the present and future of endoscopic surgery.

Dr. Hyeun Sung Kim
Guest Editor

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Keywords

  • Minimally invasive spine surgery
  • Endoscopic spine surgery
  • Uniportal
  • Biportal
  • Degenerative spinal disease
  • Transforaminal
  • Interlaminar
  • Discectomy
  • Decompression
  • Lumbar interbody fusion

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Published Papers (12 papers)

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11 pages, 733 KiB  
Article
Efficacy of DiscoGel in Treatment of Degenerative Disc Disease: A Prospective 1-Year Observation of 67 Patients
by Kajetan Latka, Klaudia Kozlowska, Marek Waligora, Waldemar Kolodziej, Tomasz Olbrycht, Jacek Chowaniec, Stanislaw Hendryk, Miroslaw Latka and Dariusz Latka
Brain Sci. 2021, 11(11), 1434; https://doi.org/10.3390/brainsci11111434 - 28 Oct 2021
Cited by 11 | Viewed by 5071
Abstract
Patients with degenerative disc disease may suffer from chronic lumbar discogenic (DP) or radicular leg (RLP) pain. Minimally invasive DiscoGel therapy involves the percutaneous injection of an ethanol gel into the degenerated disk’s nucleus pulposus. This paper compares the 1-year outcome of such [...] Read more.
Patients with degenerative disc disease may suffer from chronic lumbar discogenic (DP) or radicular leg (RLP) pain. Minimally invasive DiscoGel therapy involves the percutaneous injection of an ethanol gel into the degenerated disk’s nucleus pulposus. This paper compares the 1-year outcome of such treatment in DP and RLP patients. We operated on 67 patients (49 men and 18 women) aged 20–68 years (mean age 46 ± 11 years) with DP (n = 45) and RLP (n = 22), of at least 6–8 weeks duration, with no adverse effects. We evaluated the treatment outcome with Core Outcome Measures Index (COMI) and Visual Analog Scale (VAS). A year after the ethanol gel injection, in the DP cohort, COMI and VAS dropped by 66% (6.40 vs. 2.20) and 53% (6.33 vs. 2.97), respectively. For the RLP patients, the corresponding values dropped 48% (7.05 vs. 3.68) and 54% (6.77 vs. 3.13). There were no differences between the cohorts in COMI and VAS at the follow-up end. Six months into the study, 74% of DP and 81% of RLP patients did not use any analgesics. Ethanol gel therapy can be effective for many patients. Moreover, its potential failure does not exclude surgical treatment options. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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16 pages, 2375 KiB  
Article
Evaluation of Two Methods (Inside-Out/Outside-In) Inferior Articular Process Resection for Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion: Technical Note
by Hyeun-Sung Kim, Pang-Hung Wu, Jin-Woo An, Yeon-Jin Lee, Jun-Hyung Lee, Myeong-Hun Kim, Inkyung Lee, Jong-Sung Park, Jun-Hyung Lee, Jun-Hwan Park and Il-Tae Jang
Brain Sci. 2021, 11(9), 1169; https://doi.org/10.3390/brainsci11091169 - 3 Sep 2021
Cited by 13 | Viewed by 5824
Abstract
Objective: There is limited literature comparing the uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion outside-in approach (ETLIF (O)) with the inside-out approach (ETLIF (I)). Methods: Radiological evaluation was performed on disc height restoration and coronal wedging angle, and operation time (inferior articular [...] Read more.
Objective: There is limited literature comparing the uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion outside-in approach (ETLIF (O)) with the inside-out approach (ETLIF (I)). Methods: Radiological evaluation was performed on disc height restoration and coronal wedging angle, and operation time (inferior articular process resection time/total operation time) and clinical evaluation were made. Result: 48 cases of inside-out and 38 cases of outside-in cases were included. Compared to inside-out, the outside-in approach had significantly less operative time required to resect inferior articular process: 36.55 ± 10.37, and total operative time: 87.45 ± 20.14 min compared to 49.83 ± 23.97 and 102.56 ± 36.53 min, respectively, for the inside-out approach, p < 0.05. Compared to the preoperative state, both cohorts achieved significant improvement of VAS and ODI at post-operative 1 week, 3 months and at final follow up. Both cohorts achieved statistically significant increased disc height with 5.00 ± 2.87 mm, 5.49 ± 2.33 mm and statistically significant improvement in coronal wedge angle with 1.76 ± 1.63°, 3.24 ± 2.92° in the inside-out and outside-in approaches respectively. Conclusions: Complete removal of inferior articular process is the key part of endoscopic fusion with two methods that can be applied: an inside-out approach or an outside-in approach. Comparing both techniques, the outside-in approach has a shorter operative time required for inferior articular process resection and total length of operation with similar good clinical and radiological outcomes. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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11 pages, 1952 KiB  
Article
Clinical Outcomes of Biportal Endoscopic Interlaminar Decompression with Oblique Lumbar Interbody Fusion (OLIF): Comparative Analysis with TLIF
by Ho-Jin Lee, Eugene J. Park, Jae-Sung Ahn, Sang Bum Kim, Youk-Sang Kwon and Young-Cheol Park
Brain Sci. 2021, 11(5), 630; https://doi.org/10.3390/brainsci11050630 - 13 May 2021
Cited by 14 | Viewed by 2742
Abstract
Oblique lumbar interbody fusion (OLIF) improves the spinal canal, with favorable clinical outcomes. However, it may not be useful for treating concurrent, severe central canal stenosis (SCCS). Therefore, we added biportal endoscopic spinal surgery (BESS) after OLIF, evaluated the combined procedure for one-segment [...] Read more.
Oblique lumbar interbody fusion (OLIF) improves the spinal canal, with favorable clinical outcomes. However, it may not be useful for treating concurrent, severe central canal stenosis (SCCS). Therefore, we added biportal endoscopic spinal surgery (BESS) after OLIF, evaluated the combined procedure for one-segment fusion with clinical outcomes, and compared it to open conventional TLIF. Patients were divided into two groups: Group A underwent BESS with OLIF, and Group B were treated via TLIF. The length of hospital stay (LOS), follow-up period, operative time, estimated blood loss (EBL), fusion segment, complications, and clinical outcomes were evaluated. Clinical outcomes were measured using Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and the modified Macnab criteria. All the clinical parameters improved significantly after the operation in Group A. The only significant between-group difference was that the EBL was significantly lower in Group A. At the final follow-up, no clinical parameter differed significantly between the groups. No complications developed in either group. We suggest that our combination technique is a useful, alternative, minimally invasive procedure for the treatment of one-segment lumbar SCCS associated with foraminal stenosis or segmental instability. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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8 pages, 706 KiB  
Article
Clinical Outcomes of Interlaminar Percutaneous Endoscopic Decompression for Degenerative Lumbar Spondylolisthesis with Spinal Stenosis
by Pornpavit Sriphirom, Chaiyaporn Siramanakul, Preewut Chaipanha and Chalit Saepoo
Brain Sci. 2021, 11(1), 83; https://doi.org/10.3390/brainsci11010083 - 10 Jan 2021
Cited by 14 | Viewed by 2496
Abstract
The use of traditional open decompression alone in degenerative spondylolisthesis can lead to the development of postoperative spinal instability, whereas percutaneous endoscopic decompression can preserve the attachment of intervertebral muscles, facet joint capsules, and ligaments that stabilize the spine. The study’s aim was [...] Read more.
The use of traditional open decompression alone in degenerative spondylolisthesis can lead to the development of postoperative spinal instability, whereas percutaneous endoscopic decompression can preserve the attachment of intervertebral muscles, facet joint capsules, and ligaments that stabilize the spine. The study’s aim was to determine clinical as well as radiologic outcomes associated with interlaminar percutaneous endoscopic decompression in patients with stable degenerative spondylolisthesis. For this study, 28 patients with stable degenerative spondylolisthesis who underwent percutaneous endoscopic decompression were enrolled. The clinical outcomes in terms of the visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated. Radiologic outcomes were determined by measuring the ratio of disc height and the vertebral slippage percentage using lateral standing radiographs. The average follow-up period was 25.24 months. VAS and ODI were significantly improved at the final follow-up. In terms of ratio of disc height and vertebral slippage percentage found no significant difference between the preoperative and postoperative periods. One patient underwent further caudal epidural steroid injection. One patient underwent fusion because their radicular pain did not improve. Interlaminar percutaneous endoscopic decompression is an effective procedure with favorable outcomes in selected patients with stable degenerative spondylolisthesis. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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9 pages, 2686 KiB  
Article
Cranio-Vertebral Junction Triangular Area: Quantification of Brain Stem Compression by Magnetic Resonance Images
by Chih-Chang Chang, Ching-Lan Wu, Tsung-Hsi Tu, Jau-Ching Wu, Hsuan-Kan Chang, Peng-Yuan Chang, Li-Yu Fay, Wen-Cheng Huang and Henrich Cheng
Brain Sci. 2021, 11(1), 64; https://doi.org/10.3390/brainsci11010064 - 6 Jan 2021
Cited by 5 | Viewed by 3085
Abstract
(1) Background: Most of the currently used radiological criteria for craniovertebral junction (CVJ) were developed prior to the popularity of magnetic resonance images (MRIs). This study aimed to evaluate the efficacy of a novel triangular area (TA) calculated on MRIs for pathologies at [...] Read more.
(1) Background: Most of the currently used radiological criteria for craniovertebral junction (CVJ) were developed prior to the popularity of magnetic resonance images (MRIs). This study aimed to evaluate the efficacy of a novel triangular area (TA) calculated on MRIs for pathologies at the CVJ. (2) Methods: A total of 702 consecutive patients were enrolled, grouped into three: (a) Those with pathologies at the CVJ (n = 129); (b) those with underlying rheumatoid arthritis (RA) but no CVJ abnormalities (n = 279); and (3) normal (control; n = 294). TA was defined on T2-weighted MRIs by three points: The lowest point of the clivus, the posterior-inferior point of C2, and the most dorsal indentation point at the ventral brain stem. Receiver operating characteristic (ROC) analysis was used to correlate the prognostic value of the TA with myelopathy. Pre- and post-operative TA values were compared for validation. (c) Results: The CVJ-pathology group had the largest mean TA (1.58 ± 0.47 cm2), compared to the RA and control groups (0.96 ± 0.31 and 1.05 ± 0.26, respectively). The ROC analysis calculated the cutoff-point for myelopathy as 1.36 cm2 with the area under the curve at 0.93. Of the 81 surgical patients, the TA was reduced (1.21 ± 0.37 cm2) at two-years post-operation compared to that at pre-operation (1.67 ± 0.51 cm2). Moreover, intra-operative complete reduction of the abnormalities could further decrease the TA to 1.03 ± 0.39 cm2. (4) Conclusions: The TA, a valid measurement to quantify compression at the CVJ and evaluate the efficacy of surgery, averaged 1.05 cm2 in normal patients, and 1.36 cm2 could be a cutoff-point for myelopathy and of clinical significance. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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7 pages, 504 KiB  
Communication
Development of a Machine-Learning Model of Short-Term Prognostic Prediction for Spinal Stenosis Surgery in Korean Patients
by Kyeong-Rae Kim, Hyeun Sung Kim, Jae-Eun Park, Seung-Yeon Kang, So-Young Lim and Il-Tae Jang
Brain Sci. 2020, 10(11), 764; https://doi.org/10.3390/brainsci10110764 - 22 Oct 2020
Cited by 2 | Viewed by 1894
Abstract
Background: In this study, based on machine-learning technology, we aim to develop a predictive model of the short-term prognosis of Korean patients who received spinal stenosis surgery. Methods: Using the data obtained from 112 patients with spinal stenosis admitted at N hospital from [...] Read more.
Background: In this study, based on machine-learning technology, we aim to develop a predictive model of the short-term prognosis of Korean patients who received spinal stenosis surgery. Methods: Using the data obtained from 112 patients with spinal stenosis admitted at N hospital from February to November, 2019, a predictive analysis was conducted for the pain index, reoperation, and surgery time. Results: Results show that the predicted area under the curve was 0.803, 0.887, and 0.896 for the pain index, reoperation, and surgery time, respectively, thereby indicating the accuracy of the model. Conclusion: This study verified that the individual characteristics of the patient and treatment characteristics during surgery enable a prediction of the patient prognosis and validate the accuracy of the approach. Further studies should be conducted to extend the scope of this research by incorporating a larger and more accurate dataset. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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14 pages, 4529 KiB  
Article
Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine
by Paulo Sérgio Teixeira de Carvalho, Max Rogério Freitas Ramos, Alcy Caio da Silva Meireles, Alexandre Peixoto, Paulo de Carvalho, Jr., Jorge Felipe Ramírez León, Anthony Yeung and Kai-Uwe Lewandrowski
Brain Sci. 2020, 10(8), 522; https://doi.org/10.3390/brainsci10080522 - 5 Aug 2020
Cited by 5 | Viewed by 2778
Abstract
(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root [...] Read more.
(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root and its dorsal root ganglion (DRG) by manipulating the working cannula or endoscopic instruments may play a role. (2) Objective: To assess whether intraoperative neurophysiological monitoring can help prevent nerve root injury by identifying neurophysiological events during the initial placement of the endoscopic working cannula and the directly visualized video endoscopic procedure. (3) Methods: The authors performed a retrospective chart review of 65 (35 female and 30 male) patients who underwent transforaminal endoscopic decompression for failed non-operative treatment of lumbar disc herniation from 2012 to 2020. The patients’ age ranged from 22 to 86 years, with an average of 51.75 years. Patients in the experimental group (32 patients) had intraoperative neurophysiological monitoring recordings using sensory evoked (SSEP), and transcranial motor evoked potentials (TCEP), those in the control group (32 patients) did not. The SSEP and TCMEP data were analyzed and correlated to the postoperative course, including dysesthesia and clinical outcomes using modified Macnab criteria, Oswestry disability index (ODI), visual analog scale (VAS) for leg and back pain. (4) Results: The surgical levels were L4/L5 in 44.6%, L5/S1 in 23.1%, and L3/L4 in 9.2%. Of the 65 patients, 56.9% (37/65) had surgery on the left, 36.9% (24/65) on the right, and the remaining 6.2% (4/65) underwent bilateral decompression. Postoperative dysesthesia occurred in 2 patients in the experimental and six patients in the control group. In the experimental neuromonitoring group, there was electrodiagnostic evidence of compression of the exiting nerve root’s DRG in 24 (72.7%) of the 32 patients after initial transforaminal placement of the working cannula. A 5% or more decrease and a 50% or more decrease in amplitude of SSEPs and TCEPs recordings of the exiting nerve root were resolved by repositioning the working cannula or by pausing the root manipulation until recovery to baseline, which typically occurred within an average of 1.15 min. In 15 of the 24 patients with such latency and amplitude changes, a foraminoplasty was performed before advancing the endoscopic working cannula via the transforaminal approach into the neuroforamen to avoid an impeding nerve root injury and postoperative dysesthesia. (5) Conclusion: Neuromonitoring enabled the intraoperative diagnosis of DRG compression during the initial transforaminal placement of the endoscopic working cannula. Future studies with more statistical power will have to investigate whether employing neuromonitoring to avoid intraoperative compression of the exiting nerve root is predictive of lower postoperative dysesthesia rates in patients undergoing videoendoscopic transforaminal discectomy. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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12 pages, 1917 KiB  
Article
Novel Instruments for Percutaneous Biportal Endoscopic Spine Surgery for Full Decompression and Dural Management: A Comparative Analysis
by Young-Ho Hong, Seung-Kook Kim, Dong-Won Suh and Su-Chan Lee
Brain Sci. 2020, 10(8), 516; https://doi.org/10.3390/brainsci10080516 - 4 Aug 2020
Cited by 20 | Viewed by 3547
Abstract
Background: Post-laminectomy syndrome is a common cause of dissatisfaction after endoscopic interlaminar approach. Our aim was to evaluate the efficacy and safety of our two newly designed instruments for laminotomy, a dural protector attached to the scope and a knot pusher for water-tight [...] Read more.
Background: Post-laminectomy syndrome is a common cause of dissatisfaction after endoscopic interlaminar approach. Our aim was to evaluate the efficacy and safety of our two newly designed instruments for laminotomy, a dural protector attached to the scope and a knot pusher for water-tight suturing of the incidental dural tears. Material and Methods: This was a multicenter evaluation. Efficacy was quantified as the pre-to-postoperative improvement in pain (visual analog scale), disability (Oswestry Disability Index), patient satisfaction (modified MacNab score), and length of hospital stay. Safety was quantified by the incidence and location of dural tears, rate of revision, and radiological outcomes. Outcomes were evaluated between the control (before instrument development) and experimental (after instrument development) groups. Results: There was a significant improvement in leg pain in the experimental group (p = 0.03), with greater patient satisfaction in the control group (p < 0.01). There was no incidence of dural tears in the area of the traversing and exiting nerve roots in the experimental group. Water-tightness of sutures was confirmed radiologically. Conclusion: The novel dural protector and the knot pusher for water-tight sutures improved the efficacy and safety of decompression and discectomy; however, a prolonged operative time was a drawback. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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17 pages, 4530 KiB  
Article
Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note
by Pang Hung Wu, Hyeun Sung Kim, Yeon Jin Lee, Dae Hwan Kim, Jun Hyung Lee, Jun Bok Jeon, Harshavardhan Dilip Raorane and Il-Tae Jang
Brain Sci. 2020, 10(6), 373; https://doi.org/10.3390/brainsci10060373 - 15 Jun 2020
Cited by 44 | Viewed by 8494
Abstract
Background: Severe collapsed disc secondary to degenerative spinal conditions leads to significant foraminal stenosis. We hypothesized that uniportal posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling technique could be safely applied to the collapsed disc space to improve patients’ pain score, restore [...] Read more.
Background: Severe collapsed disc secondary to degenerative spinal conditions leads to significant foraminal stenosis. We hypothesized that uniportal posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling technique could be safely applied to the collapsed disc space to improve patients’ pain score, restore disc height, and correct the segmental angular parameters. Methods: We included patients who met the indication criteria for lumbar fusion and underwent uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with pre-operative Computer Tomography mid disc height of less than or equal to 5 mm and MRI of Grade 3 Foraminal Stenosis. Visual analogue scale and computer tomography pre-operative and post-operative sagittal disc height in the anterior, middle and posterior part of the disc; sagittal focal segmental angle; mid coronal disc height and coronal wedge angles were evaluated. Results: 30 levels of Endo-TLIF were included, with a mean follow up of 12 months. The mean improvement in decreasing pain score was 2.5 ± 1.1, 3.2 ± 0.9 and 4.3 ± 1.0 at 1 week post operation, 3 months post operation and at final follow up, respectively, p < 0.05. There was significant increase in mid sagittal computer tomographic anterior, middle and posterior disc height of 6.99 ± 2.30, 6.28 ± 1.44, 5.12 ± 1.79 mm respectively, p < 0.05. CT mid coronal disc height showed an increase of 7.13 ± 1.90 mm, p < 0.05. There was a significant improvement in the CT coronal wedge angle of 2.35 ± 4.73 and the CT segmental focal sagittal angle of 1.98 ± 4.69, p < 0.05. Conclusion: Application of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion in patients with severe foraminal stenosis secondary to severe collapsed disc space significantly relieved patients’ pain and restored disc height without early subsidence or exiting nerve root dysesthesia in our cohort of patients. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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9 pages, 5776 KiB  
Article
Fully Endoscopic Transforaminal Lumbar Discectomy for Upward Migration of Upper Lumbar Disc Herniation: Clinical and Radiological Outcomes and Technical Considerations
by Dong Hwa Heo, Dong Keun Lee, Dong Chan Lee, Hyeun Sung Kim and Choon Keun Park
Brain Sci. 2020, 10(6), 363; https://doi.org/10.3390/brainsci10060363 - 10 Jun 2020
Cited by 11 | Viewed by 3451
Abstract
Microdiscectomy for the upward migration of upper lumbar herniated discs has a high risk of isthmus and facet injury. Fully endoscopic transforaminal discectomy can preserve normal bony structures during discectomy. The purpose of this study was to assess the clinical and radiological outcomes [...] Read more.
Microdiscectomy for the upward migration of upper lumbar herniated discs has a high risk of isthmus and facet injury. Fully endoscopic transforaminal discectomy can preserve normal bony structures during discectomy. The purpose of this study was to assess the clinical and radiological outcomes of fully endoscopic transforaminal discectomy for upward migrated upper lumbar herniated discs. All patients had upward migrated disc herniation from L1–L2 to L3–L4 levels and were treated using fully endoscopic transforaminal discectomy under local anesthesia. All enrolled patients were monitored for more than 12 months. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) of pain. Surgery-related complications were analyzed. In addition, radiological outcomes were investigated using postoperative magnetic resonance imaging (MRI) and lumbar dynamic X-ray. Twenty-eight patients were enrolled in this study. ODI and VAS significantly decreased after endoscopic transforaminal discectomy. Migrated ruptured disc particles were completely removed and confirmed on postoperative MRI in 26 of the 28 patients. Even though small remnant disc particles were detected in two patients, symptoms improved after endoscopic transforaminal discectomy. Early recurrence of herniated disc occurred at the operated segment in one patient. There were no significant complications associated with fully endoscopic transforaminal discectomy. Three patients experienced a postoperative transient tingling sensation and numbness of the leg. Fully endoscopic transforaminal lumbar discectomy may be an effective and alternative treatment option for upward migrated disc herniation in the upper lumbar area. In addition, fully endoscopic transforaminal lumbar discectomy may prevent complications associated with general endotracheal anesthesia and injuries of the isthmus and the facet joint. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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9 pages, 3136 KiB  
Technical Note
Minimally Invasive L5 Corpectomy with Navigated Expandable Vertebral Cage: A Technical Note
by Taro Yamauchi, Ashish Jaiswal, Masato Tanaka, Yoshihiro Fujiwara, Yoshiaki Oda, Shinya Arataki and Haruo Misawa
Brain Sci. 2021, 11(9), 1241; https://doi.org/10.3390/brainsci11091241 - 19 Sep 2021
Cited by 4 | Viewed by 3687
Abstract
Background: Conventional L5 corpectomy requires a large incision and an extended period of intraoperative fluoroscopy. We describe herein a new L5 corpectomy technique. Methods: A 79-year-old woman was referred to our hospital for leg pain and lower back pain due to an L5 [...] Read more.
Background: Conventional L5 corpectomy requires a large incision and an extended period of intraoperative fluoroscopy. We describe herein a new L5 corpectomy technique. Methods: A 79-year-old woman was referred to our hospital for leg pain and lower back pain due to an L5 vertebral fracture. Her daily life had been affected by severe lower back pain and sciatica for more than 2 months. We initially performed simple decompression surgery, but this proved effective for only 10 months. Results: For revision surgery, the patient underwent minimally invasive L5 corpectomy with a navigated expandable cage without fluoroscopy. The second surgery took 215 min, and estimated blood loss was 750 mL. The revision surgery proved successful, and the patient could then walk using a cane. In terms of clinical outcomes, the Oswestry Disability Index improved from 66% to 24%, and the visual analog scale score for lower back pain improved from 84 to 31 mm at the 1-year follow-up. Conclusions: Minimally invasive L5 corpectomy with a navigated expandable vertebral cage is effective for reducing cage misplacement and surgical invasiveness. With this new technique, surgeons and operating room staff can avoid the risk of adverse events due to intraoperative radiation exposure. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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11 pages, 1119 KiB  
Case Report
Percutaneous Discectomy Followed by CESI Might Improve Neurological Disorder of Drop Foot Patients Due to Chronic LDH
by Trianggoro Budisulistyo and Firmansyah Atmaja
Brain Sci. 2020, 10(8), 539; https://doi.org/10.3390/brainsci10080539 - 11 Aug 2020
Cited by 1 | Viewed by 3217
Abstract
(1) Introduction: Epiconus and conus medullary syndromes that consisted of drop foot, pain, numbness, bladder or bowel dysfunction are serious problems might be caused by lumbar disc(s) herniation (LDH) compression. (2) Objective: To evaluate percutaneous discectomy effectivity for decompressing LDH lesions. (3) Case [...] Read more.
(1) Introduction: Epiconus and conus medullary syndromes that consisted of drop foot, pain, numbness, bladder or bowel dysfunction are serious problems might be caused by lumbar disc(s) herniation (LDH) compression. (2) Objective: To evaluate percutaneous discectomy effectivity for decompressing LDH lesions. (3) Case Report: Three patients suffered from drop feet, numbness, and bowel and bladder problems due to LDH compression. Patient #1 is a male (35 years old, basal metabolism index (BMI) = 23.9), point 1 on manual muscle test (MMT), with protrusion on L3 to S1 discs; Patient #2 is a female (62 years old, BMI = 22.4), point 3 on MMT, with protrusion on L2-4 and L5-S1 discs; Patient #3 is a female (43 years old, BMI = 26.6), point 4 on MMT, with extrusion on T12-L1 and L1-2 and L3-4 protruded discs. Six months follow-up showed of stand and walkability improvement with Patient #1 and #2. Patient #3 showed improvement in bowel and bladder problems within 10 weeks, without suffering of postoperative pain syndromes. (4) Discussion: Patient #1 and #2 showed better outcomes than Patient #3 who affected epiconus and cauda equina syndromes. Triamcinolone and lidocaine have analgesic and anti-inflammatory properties for improving intraepidural circulation adjacent to the lesion sites. (5) Conclusion: Drop foot caused by mechanical compression of LDH ought to be treated immediately. Lateral or posterolateral compression has better outcomes associated with anatomical structures. Discectomy through transforaminal approach that is followed by caudal epidural steroid injection (CESI) under fluoroscopic guidance is a safer and minimally invasive treatment with promising outcomes. Full article
(This article belongs to the Special Issue Degenerative Spinal Disease)
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