Current status and progress of percutaneous spinal endoscopy in the treatment of degenerative lumbar spinal stenosis / 中国骨伤

Percutaneous endoscopic spine decompression(PSED) in recent years in the treatment of degenerative lumbar spinal stenosis(DLSS) achieved excellent results.Compared with traditional open surgery, which is characterized by large trauma, much bleeding, longer bed stay and slow recovery, the rapid development of PSED technology has greatly reduced the surgical trauma, postoperative recovery time and complications of DLSS patients. PSED core as the target therapy, with minimal trauma at the same time to achieve satisfactory decompression effect for lumbar spinal stenosis. Depending on the level, location, and degree of lumbar spinal stenosis, it is important to determine the ideal treatment. However, in practice, PSED has insufficient understanding of the treatment of different pathological types of lumbar spinal stenosis, such as indication selection, surgical approach selection, advantages and limitations of various approaches, and endoscopic vertebral fusion.At present, with the deepening of PSED research and the improvement of endoscopic instruments, great progress has been made in the treatment of DLSS.In this paper, the research progress in the treatment of DLSS by PSED in recent years will be described from four aspects, namely, the grasp of indications, the selection of approaches, the advantages and disadvantages of endoscopic approaches, and endoscope-assisted vertebral fusion, in order to provide certain guidance for the clinical treatment of DLSS by PSED.

Liberación endoscópica del túnel cubital. Técnica y resultados clínico-funcionales / Endoscopic release of the ulnar tunnel. Technique and clinical-functional outcomes

Resumen: Introducción: El síndrome del túnel cubital es la segunda neuropatía por compresión de la extremidad superior, seguido del síndrome del túnel del carpo, por lo que es un motivo de consulta frecuente dentro de la cirugía de mano. Existen pocos estudios publicados acerca de la técnica endoscópica. Material y métodos: Se incluyeron 26 pacientes con el diagnóstico clínico y electromiográfico de síndrome de túnel cubital, en quienes se realizó liberación endoscópica del túnel cubital. Nueve (35%) fueron mujeres y 17 (65%) hombres. Se utilizó la clasificación de McGowan modificada y la clasificación de Wilson y Krout para analizar las características de las variables en su estado prequirúrgico y postquirúrgico. Resultados: Posterior a la intervención, obtuvimos 18 pacientes (69%) con resultado excelente, seis (24%) con un buen resultado y dos (7%) con resultados regulares o aceptables, obteniendo una p significativa con un valor < 0.05. Conclusión: La liberación endoscópica del túnel cubital se considera una técnica segura, con buenos resultados.

Abstract: Introduction: The ulnar tunnel syndrome is the second compressive neuropathy, followed by the carpal tunnel, making it a frequent reference in hand surgery. There are few published studies about endoscopic technique. Material and methods: We studied 26 patients with ulnar tunnel syndrome diagnosis, were operated by endoscopic release of the ulnar tunnel. Nine women (35%) and 17 (65%) male patients. We used the modified McGowan, and the Wilson and Krout classification to analyze preoperative and postoperative variables. Results: After endoscopic decompression we obtained 18 patients (69%) with excellent evolution, 6 (24%) with good evolution, and 2 (7%) with acceptable outcome. We obtained a significant p of < 0.05. Conclusion: Endoscopic decompression of the ulnar tunnel is a safe technique, less invasive and with good outcome.

Effectiveness of Endoscopic Sciatic Nerve Decompression for the Treatment of Deep Gluteal Syndrome / 대한고관절학회지

PURPOSE: The purpose of this retrospective study was to evaluate clinical outcomes of endoscopic nerve decompression in patients with deep gluteal syndromes (DGS). MATERIALS AND METHODS: Between October 2013 and March 2015, 24 patients who underwent surgical treatment of DGS were retrospectively included in this study. The mean age was 47 years (range, 35 to 76 years), and there were 11 males and 13 females. The mean duration of pain was 12 months (range, 5 to 35 months) and the mean follow-up period was 32 months (range, 26 to 45 months). Clinical evaluations included the visual analog scale (VAS) pain score, modified Harris hip score (mHHS), and the symptom-rating scale. RESULTS: Significant improvement in symptoms following endoscopic decompression were achieved as measured using the VAS score (decrease in the mean from 7.1±0.9 to 2.5±1.5; P < 0.001) and mHHS (increase from 59.4±6.5 to 85.0±8.3; P < 0.001). CONCLUSION: Endoscopic sciatic nerve decompression was satisfactory for treating recalcitrant DGS, making it an effective treatment option to improve symptoms of DGS.

The optimization scheme of posterior percutaneous endoscopic interlaminar decompression for degenerative lumbar spinal stenosis / 中国基层医药

Objective To observe the surgical results of modified percutaneous endoscopic interlaminar decompression(PEID) and traditional PEID in the treatment of degenerative lumbar spinal stenosis (DLSS),and to explore the optimizations scheme of PEID for DLSS.Methods 60 patients (36 males and 24 females) were brought into the research for DLSS.According to the different operation ways,the patients were randomly divided into the modified PEID group(observation group) and traditional PEID group (control group) according to the digital table method,30 cases in each group.The surgical outcome,indicators included the change in spinal canal,visual analogue scale (VAS) score and Oswestry disability index (ODI) at pre-operation,postoperative 3 d,postoperative 3 months and postoperative 6 months,operation time,headache and painful stiff nape incidence in the operation,postoperative complications were compared between the two groups.Results The VAS scores (postoperative 3 days,postoperative 3 months and postoperative 6 months) of the observation group were (4.37 ± 1.20) points,(2.59 ± 1.30) points,(1.29 ± 1.21)points respectively,which of the control group were (4.45 ± 1.22)points,(2.67 ± 1.36)points,(1.17 ± 1.10)points respectively,which were significantly better than (7.93 ± 1.56)points of the observation group and (8.22 ± 1.70) points of the control group before operation,the differences were statistically significant (F =1 254.387,512.762,all P ＜ 0.05).The ODI scores (postoperative 3 days,postoperative 3 months and postoperative 6 months) of the observation group were (48.64 ± 19.59) points,(27.66 ± 10.22) points,(10.69 ± 8.87) points respectively,which of the control group were (47.22 ± 20.96) points,(25.17 ± 11.93) points,(10.16 ± 7.89) points respectively,which were significantly better than (75.20 ± 23.20) points of the observation group and (70.35 ± 28.66) points of the control group before operation,the differences were statistically significant(F =1 254.387,512.762,all P ＜ 0.05).The VAS and ODI scores (pre-operation,postoperative 3 days,postoperative 3 months andpostoperative 6 months) of the observation group and control group had no statistically significant differences (VAS:t =2.088,2.124,3.021,3.173;ODI:t =2.366,1.079,1.694,1.573,all P ＞ 0.05).The incidence of neck pain and operation time of the observation group were 20.69％,(63 ± 7) min,which were significantly lower than 87.50％ and (157 ± 8)rin of the control group,the differences were statistically significant(t =3.601,2.167,all P ＜ 0.05).The central sagittal diameter of the spinal canal and the central transverse diameter of the spinal canal between the observation group and the control group had no statistically significant differences (x2 =4.260,t =3.694,all P ＞ 0.05).Conclusion Modified PEID has advantages in surgical efficiency,operation time and headache and painful stiff nape incidence compared with traditional PEID,so it can be chosen for DLSS.

Two Portal Percutaneous Endoscopic Decompression for Lumbar Spinal Stenosis: Preliminary Study

STUDY DESIGN: Retrospective. PURPOSE: To report the outcomes of patients with lumbar spinal stenosis treated with percutaneous endoscopic decompression, focusing on the results of clinical evaluations. OVERVIEW OF LITERATURE: There are no studies about two portal percutaneous endoscopic decompression in the treatment of lumbar spinal stenosis. METHODS: Medical and surgical complications were examined and clinical results were analyzed for 30 patients who consecutively underwent two portal percutaneous endoscopic decompression for lumbar spinal stenosis were reviewed. The operations were performed by unilateral laminotomy for bilateral decompression. RESULTS: All patients displayed clinical improvement when were evaluated with visual analog scale (VAS) score of pain, Oswestry disability index (ODI) and Macnab criteria. The improvement of VAS and ODI was 8.3±0.7 to 2.3±2.6 and 65.2±13.7 to 24.0±15.5, respectively (both p<0.05). Complications were the same as for open decompression. The most common complication was transient nerve root paresthesia. CONCLUSIONS: Surgical decompression with two portal percutaneous endoscopic decompression has initial benefits, but long-term studies should pay more attention to the risks of postoperative instability and restenosis as well as the need for re-operation. Further investigations with long-term results are thus required.

Successful Endoscopic Decompression for Intramural Duodenal Hematoma with Gastric Outlet Obstruction Complicating Acute Pancreatitis

Non-traumatic intramural duodenal hematoma (IDH) with duodenal obstruction caused by acute pancreatitis is rare. Most patients with non-extensive hematoma show improvement with non-operative treatments. Percutaneous drainage or surgery may be necessary in cases with suspected malignancy, perforation, or intestinal tract obstruction. We present a case of IDH caused by acute pancreatitis that led to obstruction of the duodenum and an experience of successful endoscopic decompression of the hematoma.

2 Cases of Optic Nerve Decompression of Two Traumatic Optic Neuropathies Using Intranasal Endoscope / 대한이비인후과학회지

Traumatic optic neuropathy is a complication resulting from facial trauma, with an incidence of 2% to 5%. The most widely accepted treatments include observation, high dose steroid, surgical decompression and combination therapy of steroid and surgical treatment. However, there has been no established mode of treatment and there are still debates about what the best treatment should be for the patients with optic canal fracture. We experienced two cases of traumatic optic neuropathies due to intracanalicular fracture of the optic canal after trauma. Surgical decompression was performed using an endoscope int-ranasally one day after injury as required for minimal invasive surgery. We report the results and progression of these two cases.

The Results of the Endoscopic Decompression for the Treatment of Haglund's Disease / 대한족부족관절학회지

PURPOSE: Haglund's disease represents a painful heel caused by mechanically induced inflammation of the retrocalcaneal bursa and insertional Achilles tendinosis may coexist. Traditional open surgery can cause complications such as skin breakdown, painful scar and altered sensation around the heel. Endoscopic treatment offers the advantages that are related to minimally invasive procedure and we evaluate the clinical results and operative techniques of endoscopic decompression of retrocalcaneal space for Haglund's disease. MATERIALS AND METHODS: Our retrospective study included seven heels in six consecutive patients for which nonoperative treatment had failed and endoscopic decompression was performed. The mean age was forty-one years (range, 28 to 53 years). All of the patients had typical complaints of inflammation of the retrocalcaneal bursa and Fowler-Philip angle of more than 75degrees and positive parallel pitch lines were present on the lateral calcaneal radiograph. The endoscopic procedure consists of the resection of inflamed retrocalcaneal bursa and enough bone to prevent impingement of the bursa between the calcaneus and Achilles tendon. All patients were evaluated with radiologic angle, visual analogue scale (VAS) for pain and Ogilvie-Harris functional score. The mean follow-up was 18 months (range, 15 to 21 months). RESULTS: The mean operation time was 61 minutes (range, 50 to 85 minutes). VAS for pain and Fowler-Philip angle were decreased from preoperative 8.7 and 82degrees to postoperative 2.3 and 57degrees, respectively. One patient with ankylosing spondylitis had a fair result, 2 patients had good results and the remaining 3 patients had excellent results according to Ogilvie-Harris functional score. There were no surgical complications such as infection, Achilles tendon avulsion or abnormal heel sensation. CONCLUSION: The endoscopic decompression for Haglund's disease was demonstrated to have several advantages including low morbidity, allowance of functional rehabilitation, short recovery time and quick sports resumption. However a comparative study is needed to determine the value of endoscopic decompression and particular caution should be exerted for the enthesiopathy.

A Case of Transnasal Endoscopic Orbital Decompression in Grave's Ophthalmopathy / 대한이비인후과학회지

Grave's disease is an autoimmune disorder and affects thyroid gland and orbit. Ocular manifestations of this disease, referred to as Grave's ophthalmopathy are caused by deposition of antithyroglobulin immune complexes into extraocular muscles and orbital fats. Consequent increase in volume of orbital contents results in exopthalmos. Severe exopthalmos results in several significant visual consequences as follows: exposure keratitis, diplopia and optic neuropathy. Orbital decompression for Grave's ophthalmopathy has traditionally been performed through either an external or a transantral approach. The advent of intranasal endoscopes allowed for the development of a transnasal approach for medial and inferior orbital wall decompression. Recently, the authors experienced a case of Grave's ophthalmopathy complicated with exposure keratitis and performed endoscopic transnasal orbital decompression, so report this case with a review of literature.