Neurospine最新文献

{"title":"Uniportal Full Endoscopic 270° Decompression for Thoracic 1-2 Hard Disc Herniation With Ossification of the Ligamentum Flavum.","authors":"Hyun-Jin Ma, Sang Ho Lee, Chan Hong Park","doi":"10.14245/ns.2449044.522","DOIUrl":"https://doi.org/10.14245/ns.2449044.522","url":null,"abstract":"<p><p>This article aims to demonstrate the uniportal full endoscopic surgery for treating complex anterior and posterior spinal pathology at the T1-2 level, offering a invasive, accessible, stable, and versatile approach to challenging anatomical situations. Uniportal full endoscopic surgery is one of the most minimally invasive spinal surgeries, utilizing slim, elongated, and compact instruments that provide access to lesions from any angle and distance. This characteristic makes the technique especially suitable for hard, such as the T1-2 level, where traditional approaches may be limited or difficult. We present the case of a 39-year-old male patient (height, 187 cm; weight, 130 kg) who developed myelopathy due to a hard disc herniation and ossification of the ligamentum flavum at the T1-2 leading to paraparesis, which was more severe on the left side. An anterior approach was challenging due to the anatomical constraints at the T1-2 level, as well as the patient's body size. A posterior access via the interlaminar approach facilitated the removal of the ossified ligamentum flavum. However, to the anterior lesion remained problematic without spinal cord retraction. Using the uniportal full endoscope, we were able to approach both anterior and posterior lesions through an incision 8 cm lateral to the midline, allowing for the treatment of the entire 270° arc of the pathology. The slim and elongated nature of the full endoscope enabled effective decompression without exerting pressure on the spinal cord, providing access from any angle and distance. This technique can be applied to a variety of cases involving difficult-to-access spinal.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"21 4","pages":"1108-1115"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative Nerve Root Protection in Full-Endoscopic Facet-Resecting Lumbar Interbody Fusion: Controlled Cage Glider Rotation Using the GUARD (Glider Used As a Rotary Device) Technique.","authors":"Yu-Chia Hsu, Hao-Chun Chuang, Wei-Lun Chang, Yuan-Fu Liu, Chao-Jui Chang, Yu-Meng Hsiao, Yi-Hung Huang, Keng-Chang Liu, Chien-Min Chen, Hyeun-Sung Kim, Cheng-Li Lin","doi":"10.14245/ns.2449126.563","DOIUrl":"https://doi.org/10.14245/ns.2449126.563","url":null,"abstract":"<p><p>This video presents a case of L4-5 unstable spondylolisthesis treated with full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF), emphasizing the GUARD (Glider Used as a Rotary Device) technique for nerve root protection. This innovative approach involves controlled rotation of the cage glider before cage insertion to minimize the risk of nerve root injury, a significant complication in Endo-TLIF procedures. The GUARD technique, validated in previous cadaveric studies, provides enhanced safety during cage insertion by protecting the nerve root. A 48-year-old woman with a 3-year history of progressive low back pain and bilateral lower extremity radiculopathy (right-sided predominance) was diagnosed with L4-5 unstable spondylolisthesis and spinal stenosis. After failure of conservative management, she underwent uniportal full-endoscopic facet-resecting transforaminal lumbar interbody fusion using the GUARD technique. Postoperatively, the patient experienced significant symptomatic improvement and resolution of radiculopathy, without any intraoperative nerve root injury or postoperative neurological deficits. This case demonstrates the effectiveness of the GUARD technique in reducing neurological complications and improving patient outcomes.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"21 4","pages":"1141-1148"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety Profile of Biportal Endoscopic Spine Surgery Compared to Conventional Microscopic Approach: A Pooled Analysis of 2 Randomized Controlled Trials.","authors":"Sang-Min Park, Kwang-Sup Song, Dae-Woong Ham, Ho-Joong Kim, Min-Seok Kang, Ki-Han You, Choon Keun Park, Dong-Keun Lee, Jin-Sung Kim, Hong-Jae Lee, Hyun-Jin Park","doi":"10.14245/ns.2448718.359","DOIUrl":"10.14245/ns.2448718.359","url":null,"abstract":"<p><strong>Objective: </strong>To compare the safety profiles of biportal endoscopic spinal surgery (BESS) and microscopic spinal surgery (MSS) for lumbar disc herniation and spinal stenosis by analyzing the associated adverse events.</p><p><strong>Methods: </strong>We pooled data from 2 prospective randomized controlled trials involving 220 patients (110 in each group) who underwent single-level lumbar surgery. Participants aged 20-80 years with radiating pain due to lumbar disc herniation or spinal stenosis were included in this study. Adverse events were recorded and analyzed over a 12-month follow-up period.</p><p><strong>Results: </strong>The overall adverse event rates were 9.1% (10 of 110) in the BESS group and 17.3% (19 of 110) in the MSS group, which were not statistically significantly different (p=0.133). Notably, wound dehiscence occurred in 8.2% of MSS cases but in none of the BESS cases. Both groups showed similarly low rates of complications, such as dural tears, epidural hematoma, and nerve root injury. The most common adverse event in the BESS group was recurrent disc herniation (2.7%), whereas that in the MSS group was wound dehiscence (8.2%).</p><p><strong>Conclusion: </strong>BESS demonstrated a safety profile comparable to that of MSS for the treatment of lumbar disc herniation and spinal stenosis, with a trend towards fewer overall complications. BESS offers particular advantages in terms of reducing wound-related complications. These findings suggest that BESS is a safe alternative to conventional MSS and potentially offers the benefits of a minimally invasive approach without compromising patient safety.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"21 4","pages":"1190-1198"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744543/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of Transverse Process Hooks at Distal Thoracic Vertebrae in Uppermost Vertebral Instrumentation for Adult Spinal Deformity Surgery: Special Focus on Delayed-Onset Neurologic Deficits.","authors":"Sun-Joon Yoo, Hyun-Jun Jang, Bong Ju Moon, Jeong-Yoon Park, Sung Uk Kuh, Dong-Kyu Chin, Keun-Su Kim, Jun Jae Shin, Yoon Ha, Kyung-Hyun Kim","doi":"10.14245/ns.2448804.402","DOIUrl":"https://doi.org/10.14245/ns.2448804.402","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate the incidence of delayed-onset neurological deficits (DONDs), DOND-related reoperation rates following adult spinal deformity (ASD) surgery, and efficacy of transverse process hooks (TPHs) at the uppermost instrumented vertebra (UIV) compared to pedicle screws (PSs).</p><p><strong>Methods: </strong>We included 90 consecutive patients who underwent instrumented fusion from the sacrum to the distal thoracic spine for ASD, with a minimum follow-up of 24 months. Clinical and radiological outcomes were compared between 33 patients in the TPH group and 57 patients in the PS group, using the Scoliosis Research Society-22 Outcomes questionnaire (SRS-22), Medical Outcomes Study Questionnaire Short-Form 36 (SF-36), and various spinal sagittal parameters.</p><p><strong>Results: </strong>While absent in the TPH group, myelopathy occurred in 15.8% of the PS group, wherein 15 patients underwent reoperation. The change in the proximal junctional angle, from the pre- to postoperative assessment, was lower in the TPH group than in the PS group (0.2 vs. 6.6, p=0.002). Postoperative facet degeneration in the PS group progressed more significantly than in the TPH group (0.5 vs. 0.1, p=0.002). Surgical outcomes were comparable for both groups, except for the back visual analogue scale (3.5 vs. 4.1, p=0.010) and SRS-22 domains, including pain and satisfaction (3.3 vs. 2.9, p=0.033; 3.7 vs. 3.3, p=0.041). No intergroup difference was observed in SF-36.</p><p><strong>Conclusion: </strong>Using TPHs at the UIV level can prevent DOND, and thereby prevent postoperative myelopathy that necessitates reoperation; thus, TPHs is preferable over PSs in ASD surgery.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"21 4","pages":"1219-1229"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Outcomes of Biportal Endoscopic Decompression, Conventional Subtotal Laminectomy, and Minimally Invasive Transforaminal Lumbar Interbody Fusion for Lumbar Central Stenosis.","authors":"Mu Ha Lee, Hyun Jun Jang, Bong Ju Moon, Kyung Hyun Kim, Dong Kyu Chin, Keun Su Kim, Jeong-Yoon Park","doi":"10.14245/ns.2448830.415","DOIUrl":"10.14245/ns.2448830.415","url":null,"abstract":"<p><strong>Objective: </strong>Spinal stenosis is a prevalent condition; however, the optimal surgical treatment for central lumbar stenosis remains controversial. This study compared the clinical outcomes and radiological parameters of 3 surgical.</p><p><strong>Methods: </strong>unilateral laminectomy bilateral decompression with unilateral biportal endoscopy (ULBD-UBE), conventional subtotal laminectomy (STL), and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).</p><p><strong>Methods: </strong>This retrospective study included 86 patients, divided into ULBD-UBE (n=34), STL (n=24), and MIS-TLIF (n=28) groups. We evaluated demographics and perioperative factors and assessed clinical outcomes using the visual analogue scale (VAS), Oswestry Disability Index (ODI), and neurogenic intermittent claudication (NIC). Radiological parameters assessed included lumbar lordosis, L4S1 Cobb angle (L4S1), T12S1 Cobb angle (T12S1), increased cross-sectional dural area (CSA), dynamic angulation (DA), dynamic slip (DS), and development of postoperative instability.</p><p><strong>Results: </strong>The ULBD-UBE group showed a significantly shorter hospital stay duration and operation time and reduced blood loss than the other groups (p<0.001). ULBD-UBE group showed a trend towards greater VAS and ODI improvement at 1 month and postoperative NIC symptom relief. Radiologically, MIS-TLIF group exhibited lower postoperative DA and DS (p<0.001), indicating higher postoperative stability. Postoperative instability was lower in the ULBD-UBE group (2.9%) than in the STL group (16.7%) and similar to the MIS-TLIF group (0.0%) (p=0.028). The CSA was highest in the MIS-TLIF group (295.5%) compared to that in the other groups (ULBD-UBE, 216.3%; STL, 245.2%) (p<0.001).</p><p><strong>Conclusion: </strong>Compared to other procedures, ULBD-UBE is a safe, effective, and viable surgical procedure for treating lumbar central stenosis.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"21 4","pages":"1178-1189"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744548/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large-Scale Analysis of Trends and Complications in Lumbar Spondylolisthesis Surgery: A Commentary on \"National Trends in Lumbar Degenerative Spondylolisthesis With Stenosis Treated With Fusion Versus Decompression\".","authors":"Dong-Kyu Chin","doi":"10.14245/ns.2449356.678","DOIUrl":"https://doi.org/10.14245/ns.2449356.678","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"21 4","pages":"1078-1079"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Commentary on \"Predicting Neck Dysfunction After Open-Door Cervical Laminoplasty - A Prospective Cohort Patient-Reported Outcome Measurement Study\".","authors":"Nobuyuki Shimokawa","doi":"10.14245/ns.2449376.688","DOIUrl":"10.14245/ns.2449376.688","url":null,"abstract":"","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"21 4","pages":"1066-1067"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal Junctional Failure Development Despite Achieving Ideal Sagittal Correction According to Age-Adjusted Alignment Target in Patients With Adult Spinal Deformity: Risk Factor Analysis of 196 Cases Undergoing Low Thoracic to Pelvic Fusion.","authors":"Se-Jun Park, Jin-Sung Park, Dong-Ho Kang, Minwook Kang, Kyunghun Jung, Chong-Suh Lee","doi":"10.14245/ns.2448734.367","DOIUrl":"10.14245/ns.2448734.367","url":null,"abstract":"<p><strong>Objective: </strong>To identify the risk factors for proximal junctional failure (PJF) after adult spinal deformity (ASD) surgery despite ideal sagittal correction according to age-adjusted alignment target.</p><p><strong>Methods: </strong>The study included patients who underwent low thoracic to pelvic fusion for ASD and obtained ideal correction according to age-adjusted pelvic incidence minus lumbar lordosis. PJF was defined either radiographically as a proximal junctional angle (PJA) of >28° plus a difference in PJA of >22° or clinically as revision surgery for proximal junctional complications. Clinical and radiographic variables were assessed to identify the risk factors for PJF.</p><p><strong>Results: </strong>The final study cohort consisted of 196 patients, of whom 170 were women (86.7%), with an average age of 68.3 years. During mean follow-up duration of 45.9 months, PJF occurred in 43 patients (21.9%). Multivariate logistic regression analysis revealed that old age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.001-1.129; p=0.046), large preoperative sagittal vertical axis (OR, 1.007; 95% CI, 1.001-1.013; p=0.024), nonuse of a transverse process (TP) hook (OR, 5.556; 95% CI, 1.205-19.621; p=0.028), and high lumbar distribution index (LDI) (OR, 1.136; 95% CI, 1.109-1.164; p<0.001) were significant risk factors for PJF development.</p><p><strong>Conclusion: </strong>A sizeable proportion of patients (21.9%) developed PJF despite achieving ideal sagittal correction. Using TP hooks with avoiding excessive LDI can be helpful to further mitigate the risk of PJF development in this patient group.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"21 4","pages":"1080-1090"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Full-Endoscopic Anterior Cervical Decompression and Fusion for Cervical Myelopathy.","authors":"Christian Morgenstern","doi":"10.14245/ns.2448796.398","DOIUrl":"https://doi.org/10.14245/ns.2448796.398","url":null,"abstract":"<p><p>This article aims to introduce a novel full-endoscopic anterior cervical discectomy and fusion (ACDF) procedure to treat cervical myelopathy. Adoption of endoscopic anterior cervical procedures has been lagging due to safety concerns and the necessity of placing an interbody cage. We have developed novel instrumentation and a modified percutaneous anterior cervical approach that allows a safe and reproducible full-endoscopic ACDF. Specially designed retractor blades facilitate percutaneous placement of a zero-profile cervical interbody cage. A 64-year-old male patient presents with chronic neck pain and bilateral paresthesia in his upper extremities, mild ataxia, and positive Hoffmann sign. He has a history of deep vein thrombosis 5 years prior. Preoperative magnetic resonance imaging and computed tomography scans show a degenerated disk, severe central canal stenosis with cord compression and a hyperintense cord signal at C5-6, compatible with cervical myelopathy. An electromyography of upper extrimities shows suspicion of myelopathy at C5-6. Full-endoscopic ACDF was performed at C5-6 to decompress the canal and restore disk height with a zero-profile interbody cage. Postoperatively the patient showed improvement of his symptoms with reduced pain and disability scores and was discharged from the hospital within 24 hours of the surgery. Outcome is satisfactory at 2-year postoperative follow-up. Full-endoscopic ACDF enables excellent visualization of the posterior endplates and cervical canal with constant irrigation, facilitating treatment of cervical myelopathy. No retraction is required during discectomy and decompression, decreasing the risk of postoperative dysphagia, hoarseness and bleeding. A zero-profile interbody cage can be percutaneously placed with special retractor blades.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"21 4","pages":"1119-1125"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143008996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Full-Endoscopic Resection of a Lumbar Intradural Tumor (Schwannoma): Video Case Report and Description of the Surgical Technique.","authors":"Vincent Hagel, Facundo Van Isseldyk","doi":"10.14245/ns.2449080.540","DOIUrl":"https://doi.org/10.14245/ns.2449080.540","url":null,"abstract":"<p><p>Endoscopic spinal surgery has gained increasing popularity over the past 10 years. Its muscle-preserving nature, reduction in postoperative pain, and lower complication rates have contributed to the growing number of surgeons adopting this technique year after year. This same progression has led to the application of the technique in oncological pathology, primarily for separation surgeries and biopsies of extradural lesions. However, reports in the literature on the use of this technique to treat intradural spinal tumors remain scarce. To present a case report of a patient with an intradural lesion, compatible with schwannoma, successfully removed using a fully endoscopic technique. A 46-year-old female patient presented with a long-standing history of low back pain and bilateral leg pain. The pain worsened over the past few months before her initial presentation. She also reported experiencing weakness in her feet and intermittent hypesthesia in her legs. Magnetic resonance imaging (MRI) showed a small intradural extramedullary tumor at the L1 level. Given the patient's young age, the tumor location at the thoracolumbar junction, and the rather small tumor size, a full-endoscopic approach was selected and performed. A step-by-step video of the surgical technique is provided with the manuscript. The current follow-up period is 2.5 years, with the patient remaining asymptomatic. The most recent follow-up MRI, conducted 16 months after the surgery, indicated no signs of recurrence. To our knowledge, this is the first video report providing a step-by-step description of this procedure. More high-quality evidence is needed to properly evaluate the safety and outcomes of this technique.</p>","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":"21 4","pages":"1096-1099"},"PeriodicalIF":3.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11744534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}