ABSTRACT
Objective:To compair the clinical effect of endoscopic spine surgery with and without assistance of an electromagnetic navigation surgical robot(ENSR) system in the treatment of lumbar disc herniations(LDH).Methods:From March 2021 to December 2021, 73 patients with LDH underwent endoscopic minimally invasive treatment in the Department of Spine Surgery, Limin Hospital of Weihai High District. Thirty-eight patients were treated with endoscopic spine surgery assisted by domestic ENSR system(ENSR group), and 35 patients were treated with endoscopic spine surgery alone(endoscopic group). The patients received follow up regularly by telephone or Wechat. The intraoperative fluoroscopy times, puncture times, upper facet arthroplasty times, operation time, preoperative and postoperative Visual Analogue Scale(VAS), Japanese Orthopaedic Association Scores(JOA), and the MOS item short from health survey(SF-36)were compared between the 2 groups. The early postoperative efficacy was evaluated by modified MacNab criteria at 1 week after surgery. SPSS 26.0 was used to analyse the data. P<0.05 was considered that the difference was statistically significant. Results:The age, gender, body mass index(BMI) and other general data of the 2 groups were basically the same, and there was no statistically significant difference( P>0.05). There was no significant difference in the excellent and good rate of postoperative treatment between ENSR group(97.37%) and endoscopic group(94.29%)( Z=0.90, P>0.05). In terms of operation time, intraoperative fluoroscopy times, puncture times, and plasty times, ENSR group[(67.00±17.00) min, (4±2) times, 1 time, 1 time, respectively] was compared with the endoscopic group[(82.00±16.00] min, (17±6) times, (9±5) times, (5±2) times], and the difference was statistically significant( t=3.87,12.62, 9.87, respectively, P<0.05). There were significant differences in VAS, JOA and SF-36 scores between the 2 groups between before and after surgery( F=106.42, 112.14, 26.88, respectively, P<0.05). There was no significant difference in VAS, JOA and SF-36 scores before and after surgery between the 2 groups( F=0.95, 3.54, 0.97, respectively, P>0.05). Conclusion:The endoscopic spine surgery assisted by the ENSR can achieve satisfactory clinical results and is a safe and effective surgical assistance system. For the endoscopic surgery, assisted by the ENSR has obvious advantages in reducing the times of fluoroscopy, puncture, and facet arthroplasty, and shortening the operation time.
ABSTRACT
In recent years, with the development and maturity of endoscopic technique, endoscopic spinal surgery represented by water media and optical rigid endoscope has been widely used in the treatment of many disorders in the cervical, thoracic and lumbar spine. Endoscopic spinal surgery shows similar clinical effects as traditional open surgery or other minimally invasive procedures, and is favored by spinal surgeons due to its advantages of less trauma and rapid recovery after surgery. However, the large-scale application of endoscopic technique brings problems such as non-standard nomenclature and unreasonable indications. Therefore, this article will summarize the surgical nomenclature and indications of endoscopic spinal surgery, in order to provide a reference for spinal surgeons to understand and apply endoscopic technology reasonably.
ABSTRACT
Lateral approach percutaneous spinal endoscopy， one of the most representative spinal endoscopic procedures， has ranked among the mainstream spinal operations that are facilitated to be understood and mastered by surgeons. The surgeries possess advantages of precise curative effect and wide scope of application after a series of conceptual innovations and reforms including YESS technology， TESSYS technology， eccentric trepan technology， visualized plasty technology， full-endoscopic visualization technology， and spinal endoscopy technology from the perspective of open surgery. Moreover， lateral approach percutaneous spinal endoscopy has formed a technology cluster that is inclusive with broad development prospects based on the introduction of high-tech technologies such as artificial intelligence and various navigation technologies.
ABSTRACT
【Objective】 To report the early clinical effects and surgical complications of endoscopic spinal fusion technology （Endo-LIF） in the treatment of degenerative lumbar disease. 【Methods】 The clinical data of 31 patients with degenerative lumbar spine disease treated with Endo-LIF from June 2019 to May 2021 were retrospectively analyzed. All the 31 patients underwent endoscopic spinal fusion therapy. We recorded the operation time， hospital stay duration， postoperative complications， visual analogue scale for pain （VAS）， oswestry dysfunction Index （ODI） and low back pain in the Chinese Orthopaedic Association Spine Group Surgery scoring standards before operation， immediately after operation， and the last follow-up to evaluate clinical efficacy. 【Results】 The operation time of the 31 patients was （134.80±34.98） min， the intraoperative blood loss was （100.13±18.49） mL， the hospital stay was （6.65±0.17） days， and the follow-up time was 6 to 18 （14±2.3） months. One patient had hematoma compression after surgery； he had incision made immediately to clear the hematoma and healed after bed rest. Two patients developed spinal hypertension and healed after bed rest. All the patients had no symptoms of nerve injury after operation， and the clinical symptoms were significantly relieved. We compared the perioperative VAS score and ODI index of all the patients， which were lower immediately after operation and at the last follow-up than those before the operation （P<0.05）， and the difference was statistically significant. 【Conclusion】 Endo-LIF technology has good short-term clinical effects and the advantages of milder trauma， less blood loss， and quick recovery after surgery. It is a safe and minimally invasive lumbar fusion surgery.
ABSTRACT
【Objective】 To investigate the effect or endoscopic discectomy via interlaminar approach in the treatment of lumbar disc herniation under local or general anesthesia. 【Methods】 We selected 78 patients with lumbar disc herniation （L5-S1） who underwent endoscopic discectomy via interlaminar approach from January 2018 to February 2020. According to the anesthesia method， they were divided into local anesthesia group （40 patients） and general anesthesia group （38 patients）. Baseline data， complications， operation time， length of hospital stay， hospitalization expenses， preoperative and postoperative VAS scores were compared between the two groups to evaluate the difference in clinical outcomes. 【Results】 There was no significant difference between the two groups in gender （23/17 vs. 20/18）， age （38.45±13.59 vs 37.39±13.35） years， preoperative VAS score （7.05±1.32 vs. 6.95±1.47）， or other baseline data （P>0.05）. The operation was completed successfully in both groups， and the operation time （83.57±13.24 vs. 86.28±15.43） minutes did not statistically differ （P>0.05）. No complications such as cerebrospinal fluid leakage， nerve injury， or wound infection occurred. In the local anesthesia group， the VAS pain score at 1d， 1 month and 6 months after surgery was 3.05±1.34， 1.90±0.98 and 1.80±1.09， respectively， which were significantly lower than those before surgery （P<0.001）. The VAS pain scores of the general anesthesia group at the above three time points were 3.24±2.01， 2.03±1.20 and 1.59±1.31， respectively， which were also significantly lower than those before surgery （P<0.001）， but the difference was not statistically significant compared with that of the local anesthesia group at the same time point （P>0.05）. However， compared with the general anesthesia group， the length of hospital stay （2.93±0.92） d and the cost of hospitalization （29 397.97±1 398.09） yuan in the local anesthesia group were decreased by 25.8% and 11.7%， respectively， with statistical significance （P<0.05）. 【Conclusion】 Endoscopic discectomy through interlaminar approach under local or general anesthesia can achieve good clinical outcomes in the treatment of lumbar disc herniation （L5-S1）. Compared with general anesthesia， local anesthesia brings a lower overall cost and a shorter hospital stay.
ABSTRACT
【Objective】 To analyze the effect of different range and location of foramen formation on the biomechanics of lumbar spine by three-dimensional finite element analysis （D-FEA）. 【Methods】 A complete model of the lumbar spine （L5）， M0， was developed using the finite element method， and the models M1， M2， M3， M4 and M5 were obtained by sequentially simulating the apical， medial 1/4， 2/4， 3/4 and 4/4 graded resections of the left superior articular process of L5 under a lateral posterior approach with full spinal endoscopy. The displacements were recorded in six conditions： forward flexion， back extension， left and right lateral bending， and left and right lateral rotation. The results were compared between the resected models and the unresected group M0. 【Results】 The three-dimensional finite model of the L4-L5 segment developed in this experiment was valid. Compared with the unresected group M0， the differences in ROM were statistically significant for M1 under forward flexion load （all P<0.05）， M2 under forward flexion and back extension load （all P<0.05）， M3 and M4 under forward flexion， back extension and left and right lateral bending load （all P<0.05）. The differences were statistically significant for M3 and M4 under anterior flexion， posterior extension， left and right lateral flexion， and right rotation loads （all P<0.05）； and for M5 under anterior flexion， posterior extension， left and right lateral flexion and right rotation loads （all P<0.05）. Compared with M0 in the unresected group， the differences were statistically significant for M1 under anterior flexion loads （all P<0.05）， M2 under anterior flexion and left and right rotation loads （all P<0.05）. The differences were statistically significant for M3， M4 and M5 in forward flexion and extension， left and right lateral flexion， and left and right rotational loading （all P<0.05）. 【Conclusion】 In the process of foramen formation， removal of the tip or the medial quarter of the unilateral single segment of the upper articular process of the lumbar spine will affect the stability of the lumbar spine， and increase the maximum value of the stress of the intervertebral disc during the activities of the lumbar spine. Removal of one half or more will significantly damage the biomechanics of the lumbar spine. In order to avoid damaging the normal biomechanics of the lumbar spine， the upper articular process should be protected as much as possible during the whole spinal endoscopic foraminal reconstruction.
ABSTRACT
【Objective】 To investigate the effect of decompression technique with bone-chisel under percutaneous spinal endoscopy through transforaminal approach in elderly patients with unilateral lateral recess stenosis （ULLRS）. 【Methods】 We enrolled 46 old patients with ULLRS who underwent percutaneous spinal endoscopy through transforaminal approach assisted with bone-chisel technique from March 2017 to July 2019. The visual analogue scale （VAS） score of low back pain and leg pain， the Oswestry dysfunction index （ODI）， and the modified MacNab score before and after operation were obtained. We also recorded preoperative and postoperative sagittal diameter measured by computer tomography （CT） to evaluate decompression of the lateral recess. All the patients were followed up for at least 1 year for complications. 【Results】 All the 46 patients were followed up for 17 to 42 months. Dural tear occurred in one case， transient nerve root irritation in two cases， and there were no other complications. The low back pain VAS score， lower limb pain VAS score， and ODI index of all the patients were significantly improved in the last follow-up （P<0.05）. The results of the modified MacNab efficacy evaluation at the last follow-up revealed that the excellent and good rate was 91.3% （excellent in 38， good in 4， and fair in 4）. The sagittal diameter （mm） of the bony lateral recess 1 year after surgery increased by an average of 55.8%， which was significantly better than that before surgery （t=6.354， 4.22±1.25 vs. 2.71±0.57， P<0.001）. 【Conclusion】 Percutaneous spinal endoscopy through transforaminal foramen approach combined with bone-chisel technique is effective in treating ULLRS in elderly patients.
ABSTRACT
Objective: To investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach. Methods: According to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C 3, 4 in 2 cases, C 4, 5 in 8 cases, C 5, 6 in 9 cases, and C 6, 7 in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated. Results: Full-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation ( P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one ( t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation ( t=0.881, P=0.421). Conclusion: Full-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results.
ABSTRACT
BACKGROUND: Neuroplasty by spinal endoscopy is a new technique in the field of treatment of herniated nucleus pulposus patients. This new technique allows the operator to visualize directly the epidural space and contiguous structures, thus allowing for detailed examination leading to a better understanding of the role of epidural adhesion in the development of sciatica. The aim of this prospective study is to determine effects of neuroplasty by spinal endoscopy in herniated nucleus pulposus patients. METHODS: Twelve patients with herniated disc were taken neuroplasty by spinal endoscopy. The patients were followed with verbal rating scale(VRS) for 2 weeks, 3 months and 6 months after neuroplasty. RESULTS: Four patients were posterocentral type and eight pateints were posterlateral type. The effects of neuroplasty by spinal endoscopy in posterolateral type were significantly higher than that of posterocentral type. But, age, duration of back pain and amount of irrigation saline were not related to effects of neuroplasty by spinal endoscopy. CONCLUSIONS: We conclude that it is important to determine posterocentral type or posterolateral type on MRI before neuroplasty by spinal endoscopy and the effects of treatment is well in posterolateral type.