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Complex and Minimally Invasive Spine Surgery

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A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Surgery".

Deadline for manuscript submissions: closed (31 January 2021) | Viewed by 30913

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Special Issue Editor

Prof. Dr. Hisashi Koga

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Guest Editor

Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan
Interests: minimally invasive spine surgery; endoscopic spine surgery

Special Issue Information

Dear colleague,

In recent years, minimally invasive spine surgery (MISS) has received a great deal of attention from both spine surgeons and patients suffering from spinal diseases.

The development of MISS mainly depends on the improvement of the operative instruments and procedures. Among those improvements, various technological and technical improvements to the spinal endoscope have evolved. We have also discovered novel anatomical and pathophysiological findings from the operative field under spinal endoscopy. The obtained novel knowledge on spinal diseases is promising to open up new therapeutic approaches in the field of MISS.

The purpose of this Special Issue entitled “Complex and Minimally Invasive Spine Surgery” is to update knowledge on MISS. Since there are still some technologies and techniques that have not been fully established, we must make efforts to improve them. We hope this Issue will provide a good opportunity to validate such new strategies. We are pleased to invite you and your colleagues to submit all kinds of articles, including original research, meta-analyses, and review articles, providing current trends in MISS.

Prof. Dr. Hisashi Koga
Guest Editor

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Keywords

minimally invasive
spine surgery
endoscope
operative instrument
operative procedure

Published Papers (12 papers)

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Research

11 pages, 10359 KiB

Open AccessArticle

Stand-Alone Posterior Expandable Cage Technique for Adjacent Segment Degeneration with Lumbar Spinal Canal Stenosis: A Retrospective Case Series

by Woo-Jin Choi, Seung-Kook Kim, Manhal Alaraj, Hyeun-Sung Kim and Su-Chan Lee

Medicina 2021, 57(3), 237; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57030237 - 04 Mar 2021

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Abstract

Background and Objectives: Symptomatic adjacent segment degeneration (ASD) with lumbar spinal canal stenosis (LSCS) is a common complication after spinal intervention, particularly interbody fusion. Stand-alone posterior expandable cages enable interbody fusion with preservation of the previous operation site, and screw-related complications are avoided. Thus, the aim of this study was to investigate the clinicoradiologic outcomes of stand-alone posterior expandable cages for ASD with LSCS. Materials and Methods: Patients with persistent neurologic symptoms and radiologically confirmed ASD with LSCS were evaluated between January 2011 and December 2016. The five-year follow-up data were used to evaluate the long-term outcomes. The radiologic parameters for sagittal balance, pain control (visual analogue scale), disability (Oswestry Disability Index), and early (peri-operative) and late (implant) complications were evaluated. Results: The data of 19 patients with stand-alone posterior expandable cages were evaluated. Local factors, such as intervertebral and foraminal heights, were significantly corrected (p < 0.01 and p < 0.01, respectively), and revision was not reported. The pain level (p < 0.01) and disability rate (p < 0.01) significantly improved, and the early complication rate was low (n = 2, 10.52%). However, lumbar lordosis (p = 0.62) and sagittal balance (p = 0.80) did not significantly improve. Furthermore, the rates of subsidence (n = 4, 21.05%) and retropulsion (n = 3, 15.79%) were high. Conclusions: A stand-alone expandable cage technique should only be considered for older adults and patients with previous extensive fusion. Although this technique is less invasive, improves the local radiologic factors, and yields favorable clinical outcomes with low revision rates, it does not improve the sagittal balance. For more widespread application, the strength of the cage material and high subsidence rates should be improved. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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8 pages, 4427 KiB

Open AccessArticle

Microendoscope-Assisted Versus Open Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Multicenter Retrospective Cohort Study

by Masayoshi Fukushima, Nozomu Ohtomo, Michita Noma, Yudai Kumanomido, Hiroyuki Nakarai, Keiichiro Tozawa, Yuichi Yoshida, Ryuji Sakamoto, Junya Miyahara, Masato Anno, Naohiro Kawamura, Akiro Higashikawa, Yujiro Takeshita, Hirohiko Inanami, Sakae Tanaka and Yasushi Oshima

Medicina 2021, 57(2), 150; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57020150 - 08 Feb 2021

Cited by 2 | Viewed by 1654

Abstract

Background and objectives: Minimally invasive surgery has become popular for posterior lumbar interbody fusion (PLIF). Microendoscope-assisted PLIF (ME-PLIF) utilizes a microendoscope within a tubular retractor for PLIF procedures; however, there are no published reports that compare Microendoscope-assisted to open PLIF. Here we compare the surgical and clinical outcomes of ME-PLIF with those of open PLIF. Materials and Methods: A total of 155 consecutive patients who underwent single-level PLIF were registered prospectively. Of the 149 patients with a complete set of preoperative data, 72 patients underwent ME-PLIF (ME-group), and 77 underwent open PLIF (open-group). Clinical and radiographic findings collected one year after surgery were compared. Results: Of the 149 patients, 57 patients in ME-group and 58 patients in the open-group were available. The ME-PLIF procedure required a significantly shorter operating time and involved less intraoperative blood loss. Three patients in both groups reported dural tears as intraoperative complications. Three patients in ME-group experienced postoperative complications, compared to two patients in the open-group. The fusion rate in ME-group at one year was lower than that in the open group (p = 0.06). The proportion of patients who were satisfied was significantly higher in the ME-group (p = 0.02). Conclusions: ME-PLIF was associated with equivalent post-surgical outcomes and significantly higher rates of patient satisfaction than the traditional open PLIF procedure. However, the fusion rate after ME-PLIF tended to be lower than that after the traditional open method. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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8 pages, 1980 KiB

Open AccessArticle

Clinical Evaluation of Microendoscopy-Assisted Oblique Lateral Interbody Fusion

by Tomohide Segawa, Hisashi Koga, Masahito Oshina, Katsuhiko Ishibashi, Yuichi Takano, Hiroki Iwai and Hirohiko Inanami

Medicina 2021, 57(2), 135; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57020135 - 03 Feb 2021

Cited by 4 | Viewed by 1716

Abstract

Background and objectives: Oblique Lateral Interbody Fusion (OLIF) is a widely performed, minimally invasive technique to achieve lumbar lateral interbody fusion. However, some complications can arise due to constraints posed by the limited surgical space and visual field. The purpose of this study was to assess the short-term postoperative clinical outcomes of microendoscopy-assisted OLIF (ME-OLIF) compared to conventional OLIF. Materials and Methods: We retrospectively investigated 75 consecutive patients who underwent OLIF or ME-OLIF. The age, sex, diagnosis, and number of fused levels were obtained from medical records. Operation time, estimated blood loss (EBL), and intraoperative complications were also collected. Operation time and EBL were only measured per level required for the lateral procedure, excluding the posterior fixation surgery. The primary outcome measure was assessed using the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). The secondary outcome measure was assessed using the Oswestry Disability Index (ODI) and the European Quality of Life–5 Dimensions (EQ-5D), measured preoperatively and 1-year postoperatively. Results: This case series consisted of 14 patients in the OLIF group and 61 patients in the ME-OLIF group. There was no significant difference between the two groups in terms of the mean operative time and EBL (p = 0.90 and p = 0.50, respectively). The perioperative complication rate was 21.4% in the OLIF group and 21.3% in the ME-OLIF group (p = 0.99). In both groups, the postoperative JOABPEQ, EQ-5D, and ODI scores improved significantly (p < 0.001). Conclusions: Although there was no significant difference in clinical results between the two surgical methods, the results suggest that both are safe surgical methods and that microendoscopy-assisted OLIF could serve as a potential alternative to the conventional OLIF procedure. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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9 pages, 2113 KiB

Open AccessArticle

Partial Resection of Spinous Process for the Elderly Patients with Thoraco-Lumbar Kyphosis: Technical Report

by Hirohiko Inanami, Hiroki Iwai, So Kato, Yuichi Takano, Yohei Yuzawa, Kazuyoshi Yanagisawa, Takeshi Kaneko, Tomohide Segawa, Ko Matsudaira, Hiroyuki Oka, Masahito Oshina, Masayoshi Fukusima, Fumiko Saiki and Yasushi Oshima

Medicina 2021, 57(2), 87; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57020087 - 21 Jan 2021

Cited by 1 | Viewed by 2106

Abstract

Background and objectives: Global sagittal imbalance with lumbar hypo-lordosis can cause low back pain (LBP) during standing and/or walking. This condition has recently been well-known as one of the major causes of reduced health-related quality of life (HRQOL) in elderly populations. Decrease in disc space of anterior elements and an increase in the spinous process height of posterior elements may both contribute to the decrease in lordosis of the lumbar spine. To correct the sagittal imbalance, the mainstream option is still a highly invasive surgery, such as long-segment fusion with posterior wedge osteotomy. Therefore, we developed a treatment that is partial resection of several spinous processes of thoraco-lumbar spine (PRSP) and lumbar extension exercise to improve the flexibility of the spine as postoperative rehabilitation. Materials and Methods: Consecutively, seven patients with over 60 mm of sagittal vertical axis (SVA) underwent PRSP. The operation was performed with several small midline skin incisions under general anesthesia. After splitting the supraspinous ligaments, the cranial or caudal tip of the spinous process of several thoraco-lumbar spines was removed, and postoperative rehabilitation was followed to improve extension flexibility. Results: The average follow-up period was 13.0 months. The average blood loss and operation time were 11.4 mL and 47.4 min, respectively. The mean SVA improved from 119 to 93 mm but deteriorated in one case. The mean numerical rating scale of low back pain improved from 6.6 to 3.7 without any exacerbations. The mean Oswestry Disability Index score was improved from 32.4% to 19.1% in six cases, with one worsened case. Conclusions: We performed PRSP and lumbar extension exercise for the patients with LBP due to lumbar kyphosis. This minimally invasive treatment was considered to be effective in improving the symptoms of low back pain and HRQOL, especially of elderly patients with lumbar kyphosis. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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9 pages, 2273 KiB

Open AccessArticle

Fluid Lubrication and Cooling Effects in Diamond Grinding of Human Iliac Bone

by Yoshihiro Kitahama, Hiroo Shizuka, Ritsu Kimura, Tomo Suzuki, Yukoh Ohara, Hideaki Miyake and Katsuhiko Sakai

Medicina 2021, 57(1), 71; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57010071 - 14 Jan 2021

Cited by 2 | Viewed by 1764

Abstract

Background and Objectives: Although there have been research on bone cutting, there have been few research on bone grinding. This study reports the measurement results of the experimental system that simulated partial laminectomy in microscopic spine surgery. The purpose of this study was to examine the fluid lubrication and cooling in bone grinding, histological characteristics of workpieces, and differences in grinding between manual and milling machines. Materials and Methods: Thiel-fixed human iliac bones were used as workpieces. A neurosurgical microdrill was used as a drill system. The workpieces were fixed to a 4-component piezo-electric dynamometer and fixtures, which was used to measure the triaxial power during bone grinding. Grinding tasks were performed by manual activity and a small milling machine with or without water. Results: In bone grinding with 4-mm diameter diamond burs and water, reduction in the number of sudden increases in grinding resistance and cooling effect of over 100 °C were confirmed. Conclusion: Manual grinding may enable the control of the grinding speed and cutting depth while giving top priority to uniform torque on the work piece applied by tools. Observing the drill tip using a triaxial dynamometer in the quantification of surgery may provide useful data for the development of safety mechanisms to prevent a sudden deviation of the drill tip. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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11 pages, 1980 KiB

Open AccessArticle

Three-Dimensional Volumetric Changes and Clinical Outcomes after Decompression with DIAM™ Implantation in Patients with Degenerative Lumbar Spine Diseases

by Cheng-Yu Li, Mao-Yu Chen, Chen-Nen Chang and Jiun-Lin Yan

Medicina 2020, 56(12), 723; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120723 - 21 Dec 2020

Cited by 4 | Viewed by 3130

Abstract

Background and objectives: The prevalence of degenerative lumbar spine diseases has increased. In addition to standard lumbar decompression and/or fusion techniques, implantation of interspinous process devices (IPDs) can provide clinical benefits in highly selected patients. However, changes in spinal structures after IPD implantation using magnetic resonance imaging (MRI) have rarely been discussed. This volumetric study aimed to evaluate the effect of IPD implantation on the intervertebral disc and foramen using three-dimensional assessment. Materials and Methods: We retrospectively reviewed patients with lumbar degenerative disc diseases treated with IPD implantation and foraminotomy and/or discectomy between January 2016 and December 2019. The mean follow-up period was 13.6 months. The perioperative lumbar MRI data were processed for 3D-volumetric analysis. Clinical outcomes, including the Prolo scale and visual analog scale (VAS) scores, and radiographic outcomes, such as the disc height, foraminal area, and translation, were analyzed. Results: Fifty patients were included in our study. At the one-year follow-up, the VAS and Prolo scale scores significantly improved (both p < 0.001). The disc height and foraminal area on radiographs also increased significantly, but with limited effects up to three months postoperatively. MRI revealed an increased postoperative disc height with a mean difference of 0.5 ± 0.1 mm (p < 0.001). Although the mean disc volume difference did not significantly increase, the mean foraminal volume difference was 0.4 ± 0.16 mm³ (p < 0.05). Conclusions: In select patients with degenerative disc diseases or lumbar spinal stenosis, the intervertebral foramen was enlarged, and disc loading was reduced after IPD implantation with decompression surgery. The 3D findings were compatible with the clinical benefits. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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9 pages, 674 KiB

Open AccessArticle

Comparative Study between Full-Endoscopic Discectomy and Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation

by Muneyoshi Fujita, Tomoaki Kitagawa, Masahiro Hirahata, Takahiro Inui, Hirotaka Kawano, Hiroki Iwai, Hirohiko Inanami and Hisashi Koga

Medicina 2020, 56(12), 710; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120710 - 18 Dec 2020

Cited by 5 | Viewed by 2208

Abstract

Background and objectives: Lumbar disc herniation (LDH) is a common disease in the meridian of life. Although surgical discectomy is commonly used to treat LDH, there are several different strategies. We compared the outcomes of uniportal full-endoscopic discectomy (FED) with those of microendoscopic discectomy (MED) in treating LDH. Materials and Methods: FED was performed using a 4.1-mm working channel endoscope, and MED was performed using a 16-mm diameter tubular retractor and endoscope. Data of patients with LDH treated with FED (n = 39) or MED (n = 27) by the single surgeon were retrospectively reviewed. Patient background information and operative data were collected. Pre- and postoperative low back and leg pain were evaluated using the numerical rating scale (NRS) score. Pre- and postoperative disc height index (DHI) values were calculated from plain radiographs, and the disc height loss was evaluated using the ratio (DHI ratio); Results: The median (interquartile range (IQR) Q25–75) operation times for FED and MED were 42 (33–61) and 43 (33–50) minutes, respectively. The median (IQR Q25–75) pre- and postoperative NRS scores for low back pain were 5 (2–7) and 1 (0–4), respectively, for FED and 6 (3–8) and 1 (0–2), respectively, for MED. The median (IQR Q25–75) pre- and postoperative NRS scores for leg pain were 7 (5–8) and 0 (0–2), respectively, for FED and 6 (5–8) and 0 (0–2), respectively, for MED. These data were not different between the FED and MED groups. The median (IQR Q25–75) DHI ratios of FED and MED were 0.94 (0.89–1.03) and 0.90 (0.79–0.95), respectively. The DHI ratio was significantly higher (p < 0.05) in the FED group than in the MED group, and there was less blood loss; Conclusions: The pain-relieving effect of FED in treating LDH was almost identical to that of MED. However, FED was superior to MED in preventing disc height loss, which is one of the indicators of postoperative disc degeneration. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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11 pages, 2139 KiB

Open AccessArticle

Microendoscopic Posterior Decompression for Treating Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum: Case Series

by Satoshi Baba, Ryutaro Shiboi, Jyunichi Yokosuka, Yasushi Oshima, Yuichi Takano, Hiroki Iwai, Hirohiko Inanami and Hisashi Koga

Medicina 2020, 56(12), 684; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120684 - 10 Dec 2020

Cited by 6 | Viewed by 2357

Abstract

Background and Objectives: Ossification of the ligamentum flavum (OLF) is a relatively common cause of thoracic myelopathy. Surgical treatment is recommended for patients with myelopathy. Generally, open posterior decompression, with or without fusion, is selected to treat OLF. We performed minimally invasive posterior decompression using a microendoscope and investigated the efficacy of this approach in treating limited type of thoracic OLF. Materials and Methods: Microendoscopic posterior decompression was performed for 19 patients (15 men and four women) with thoracic OLF with myelopathy aged between 35 to 81 years (mean age, 61.9 years). Neurological examination and preoperative magnetic resonance imaging (MRI) and computed tomography (CT) were used to identify the location and morphology of OLF. The surgery was performed using a midline approach or a unilateral paramedian approach depending on whether the surgeon used a combination of a tubular retractor and endoscope. The numerical rating scale (NRS) and modified Japanese Orthopedic Association (mJOA) scores were compared pre- and postoperatively. Perioperative complications and the presence of other spine surgeries before and after thoracic OLF surgery were also investigated. Results: Four midline and 15 unilateral paramedian approaches were performed. The average operative time per level was 99 min, with minor blood loss. Nine patients had a history of cervical or lumbar spine surgery before or after thoracic spine surgery. The mean pre- and postoperative NRS scores were 6.6 and 5.3, respectively. The mean recovery rate as per the mJOA score was 33.1% (mean follow-up period, 17.8 months), the recovery rates were significantly different between patients who underwent thoracic spine surgery alone (50.5%) and patients who underwent additional spine surgeries (13.7%). Regarding adverse events, one patient experienced dural tear, another experienced postoperative hematoma, and one other underwent reoperation for adjacent thoracic stenosis. Conclusion: Microendoscopic posterior decompression was applicable in limited type of thoracic OLF surgery including beak-shaped type and multi vertebral levels. However, whole spine evaluation is important to avoid missing other combined stenoses that may affect outcomes. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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15 pages, 6765 KiB

Open AccessArticle

Application of an Expandable Cage for Reconstruction of the Cervical Spine in a Consecutive Series of Eighty-Six Patients

by Mirza Pojskic, Benjamin Saβ, Christopher Nimsky and Barbara Carl

Medicina 2020, 56(12), 642; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56120642 - 25 Nov 2020

Cited by 9 | Viewed by 4531

Abstract

Background and objectives: Expandable cages are frequently used to reconstruct the anterior spinal column after a corpectomy. In this retrospective study, we evaluated the perioperative advantages and disadvantages of corpectomy reconstruction with an expandable cage. Materials and Methods: Eighty-six patients (45 male and 41 female patients, medium age of 61.3 years) were treated with an expandable titanium cage for a variety of indications from January 2012 to December 2019 and analyzed retrospectively. The mean follow-up was 30.7 months. Outcome was measured by clinical examination and visual analogue scale (VAS); myelopathy was classified according to the EMS (European Myelopathy Scale) and gait disturbances with the Nurick score. Radiographic analysis comprised measurement of fusion, subsidence and the C2–C7 angle. Results: Indications included spinal canal stenosis with myelopathy (46 or 53.5%), metastasis (24 or 27.9%), spondylodiscitis (12 or 14%), and fracture (4 or 4.6%). In 39 patients (45.3%), additional dorsal stabilization (360° fusion) was performed. In 13 patients, hardware failure occurred, and in 8 patients, adjacent segment disease occurred. Improvement of pain symptoms, myelopathy, and gait following surgery were statistically significant (p < 0.05), with a medium preoperative VAS of 8, a postoperative score of 3.2, and medium EMS scores of 11.3 preoperatively vs. 14.3 postoperatively. Radiographic analysis showed successful fusion in 74 patients (86%). As shown in previous studies, correction of the C2–C7 angle did not correlate with improvement of neurological symptoms. Conclusion: Our results show that expandable titanium cages are a safe and useful tool in anterior cervical corpectomies for providing adequate anterior column support and stability. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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13 pages, 3459 KiB

Open AccessArticle

Chemonucleolysis with Chondroitin Sulfate ABC Endolyase for Treating Lumbar Disc Herniation: Exploration of Prognostic Factors for Good or Poor Clinical Outcomes

by Katsuhiko Ishibashi, Muneyoshi Fujita, Yuichi Takano, Hiroki Iwai, Hirohiko Inanami and Hisashi Koga

Medicina 2020, 56(11), 627; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56110627 - 19 Nov 2020

Cited by 12 | Viewed by 3104

Abstract

Background and Objectives: Chondroitin sulfate ABC endolyase (condoliase) was launched as a new drug for chemonucleolysis in 2018. Few studies assessed its clinical outcomes, and many important factors remain unclear. This study aimed to clarify the preoperative conditions in which condoliase could be highly effective. Materials and Methods: Of 47 patients who received condoliase, 34 were enrolled in this study. The mean age of the patients was 33 years. The average duration since the onset of disease was 8.6 months. We evaluated patients’ low back and leg pain using a numerical rating scale (NRS) score at two time points (before therapy and 3 months after therapy). We divided the patients into two groups (good group (G): NRS score improvement ≥ 50%, poor group (P): NRS score improvement < 50%). The parameters evaluated were age, disease duration, body mass index (BMI), and positive or negative straight leg raising test results. In addition, the loss of disc height and preoperative radiological findings were evaluated. Results: In terms of low back and leg pain, the G group included 9/34 (26.5%) and 21/34 (61.8%) patients, respectively. Patients’ age (low back pain G/P, 21/36.5 years) was significantly lower in the G group for low back pain (p = 0.001). High-intensity change in the protruded nucleus pulposus (NP) and spinal canal occupancy by the NP ≥ 40% were significantly high in those with leg pain in the G groups (14/21, p = 0.04; and 13/21, p = 0.03, respectively). Conclusions: The efficacy of improvement in leg pain was significantly correlated with high-intensity change and size of the protruded NP. Condoliase was not significantly effective for low back pain but could have an effect on younger patients. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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10 pages, 2404 KiB

Open AccessArticle

A Comparative Study on the Minimal Invasiveness of Full-Endoscopic and Microendoscopic Cervical Foraminotomy Using Intraoperative Motor Evoked Potential Monitoring

by Masahiro Hirahata, Tomoaki Kitagawa, Muneyoshi Fujita, Ryutaro Shiboi, Hirotaka Kawano, Hiroki Iwai, Hirohiko Inanami and Hisashi Koga

Medicina 2020, 56(11), 605; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56110605 - 11 Nov 2020

Cited by 3 | Viewed by 1964

Abstract

Background and Objectives: Full-endoscopic cervical foraminotomy (FECF) and microendoscopic cervical foraminotomy (MECF) are effective surgeries for cervical radiculopathy and are considered minimally invasive in terms of damage to paraspinal soft tissue. However, no studies have quantitatively compared FECF and MECF in terms of neurological invasiveness. The aim of this study was to compare the neurological invasiveness of FECF and MECF using intraoperative motor evoked potential (MEP) monitoring. Materials and Methods: A chart review was conducted of 224 patients with cervical radiculopathy who underwent FECF or MECF between April 2014 and March 2020. Patients were 37 women and 187 men, with a mean age of 51 (range, 21–86) years. FECF was performed in 143 cases and MECF was performed in 81 cases. Results: Average MEP amplitude significantly increased from 292 mV before to 677 mV after nerve root decompression in patients who underwent the FECF. The average improvement rate was 273%. In patients who underwent the MECF, average MEP amplitude significantly increased from 306 mV before to 432 mV after nerve root decompression. The average improvement rate was 130%. The improvement rate was significantly higher for FECF compared with MECF. Conclusions: MEP amplitude increased after nerve root decompression in both FECF and MECF, but the improvement rate was higher in FECF. These results suggest that FECF might be more minimally invasive than MECF in terms of neurological aspects. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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10 pages, 2696 KiB

Open AccessArticle

Full-Endoscopic Lumbar Interbody Fusion for Treating Lumbar Disc Degeneration Involving Disc Height Loss: Technical Report

by Tsuyoshi Harakuni, Hiroki Iwai, Yasushi Oshima, Hirokazu Inoue, Tomoaki Kitagawa, Hirohiko Inanami and Hisashi Koga

Medicina 2020, 56(9), 478; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina56090478 - 17 Sep 2020

Cited by 5 | Viewed by 2722

Abstract

Background and Objectives: Lumbar disc degeneration (LDD) is the main cause of lower back pain and leads to corresponding disc height loss. Although lumbar interbody fusion (LIF) is commonly used for treating LDD, several different treatment strategies are available. We performed a minimally invasive full-endoscopic LIF (FELIF) using a uniportal full-endoscopic system. Materials and Methods: FELIF was performed for 12 patients with LDD with disc-height loss using a 4.1 mm working channel endoscope and a newly developed slider for cage insertion. The mean age of the patients was 68.3 years; the patients presented with single vertebral level involvement. The Brandner’s disc index was used for evaluating the postoperative increase in the disc height. Preoperative and postoperative leg pain was evaluated using the numerical rating scale (NRS) score. Results: The mean operation time for FELIF was 109.4 min. The mean duration of hospital stay after FELIF was 7.7 days. There were no operative and postoperative complications, even without drainage during the mean follow-up period of 6.2 months (range, 2–10 months). The Brandner’s disc index improved statistically significant (p > 0.01). The mean preoperative and postoperative NRS scores were 6.5 and 1.2, respectively. Conclusions: FELIF using a 4.1 mm working channel endoscope can be used for treating LDD with disc height loss. Radiculopathy caused by foraminal stenosis was the most suitable operative indication for FELIF. Full article

(This article belongs to the Special Issue Complex and Minimally Invasive Spine Surgery)

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