Transnasal endoscopy-guided percutaneous access to the sphenopalatine ganglion for neurostimulation in the treatment of primary headache: operative technique and feasibility

Abstract Objectives: Cluster headache is considered a trigeminal autonomic cephalalgia and may present with characteristic symptoms of sympathetic/parasympathetic activation on the affected side of the face, such as nasal discharge, tearing, and conjunctival injection. Invasive therapies targeting the sphenopalatine ganglion have been performed in these headache syndromes and can have a medication-sparing effect, especially in refractory, difficult-to-manage cases. The gate control theory of pain suggests that electric pulses delivered to nerve tissues can modulate neuronal activity, thus aiding in management of nociceptive or neuropathic pain, and studies have demonstrated the efficacy and safety of sphenopalatine ganglion neurostimulation. Within this context, we sought to assess the feasibility of a new surgical technique for neurostimulation of the sphenopalatine ganglion in a cadaver dissection model. Methods: The technique was developed through dissection of two cadaver heads. We divided the procedure into two stages: an endonasal endoscopic approach to expose the sphenopalatine ganglion and confirm electrode placement, and a cervicofacial approach to introduce the electrode array and position the internal pulse-generator unit. Computed tomography was performed to confirm implant placement at the end of the procedure. Results: The pulse-generator unit was successfully placed through a retroauricular incision, as is already standard for cochlear implant placement. This should reduce the incidence of perioperative sequelae, especially pain and swelling in the oral region, which are a common complication of previous approaches used for this purpose. Control imaging confirmed proper electrode placement. The device used in this study allows the patient to modulate the intensity of the stimulus, reducing or even obviating the need for drug therapy. Conclusion: The novel technique described herein, based on percutaneous access guided by transmaxillary endoscopy, can provide great precision in electrode array positioning and decreased perioperative morbidity, combining the advantages of endoscopic approaches with those of the retroauricular route. Level of evidence: 3.

Observation of early clinical efficacy of unilateral biportal endoscopy technique in the treatment of lumbar postoperative adjacent segmental diseases / 中国骨伤

OBJECTIVE@#To investigate early clinical efficacy of unilateral biportal endoscopy technique for the treatment of lumbar postoperative adjacent segmental diseases.@*METHODS@#Fourteen patients with lumbar postoperative adjacent segmental diseases were treated with unilateral biportal endoscopy technique from June 2019 to June 2020. Among them, there were 9 males and 5 females, aged from 52 to 73 years old, and the interval between primary and revision operations ranged from 19 to 64 months. Adjacent segmental degeneration occurred after lumbar fusion in 10 patients and after lumbar nonfusion fixation in 4 patients. All the patients received unilateral biportal endoscopy assisted posterior unilateral lamina decompression or unilateral approach to the contralateral decompression. The operation time, postoperative hospital stay and complications were observed. The visual analogue scale (VAS) of low back pain and leg pain, Oswestry Disability Index (ODI), modified Japanese Orthopaedic Association (mJOA) score were recorded before operation and at 3 days, 3 months, and 6 months after operation.@*RESULTS@#All procedures were successfully completed. Surgical duration ranged from 32 to 151 min. Postoperative CT showed adequate decompression and preservation of most joints. Out of bed walking 1 to 3 days after surgery, postoperative hospital stay was 1 to 8 days, and postoperative follow-up was 6 to 11 months. All 14 patients returned to normal life within 3 weeks after surgery, and VAS, ODI, and mJOA scores improved significantly at 3 days and 3, 6 months after surgery. One patient occurred cerebrospinal fluid leak after operation, received local compression suture, and the wound healed after conservative treatment. One patient occurred postoperative cauda equina neurologic deficit, which was gradually recovered about 1 month after rehabilitation therapy. One patients advented transient pain of lower limbs after surgery, and the symptoms were relieved after 7 days of treatment with hormones, dehydration drugs and symptomatic management.@*CONCLUSION@#Unilateral biportal endoscopy technique has a good early clinical efficacy in the treatment of lumbar postoperative adjacent segmental diseases, which may provide a new minimally invasive, non-fixation option for the treatment of adjacent segment disease.

Treatment of stable degenerative lumbar spondylolisthesis with percutaneous endoscopic surgery through two different approaches / 中国骨伤

OBJECTIVE@#To assess the clinical effects of percutaneous endoscopic surgery through two different approaches for stable degenerative lumbar spondylolisthesis.@*METHODS@#Sixty-four patients with stable degenerative lumbar spondylolisthesis who underwent percutaneous endoscopic procedures between January 2016 and December 2019 were divided into transforaminal approach group and interlaminar approach group according to surgical approaches, 32 patients in each group. There were 16 males and 16 females in transforaminal approach group, aged from 52 to 84 years old with an average of (66.03±9.60) years, L2 slippage in 4 cases, L3 slippage in 5, and L4 slippage in 23. There were 17 males and 15 females in interlaminar approach group, aged from 46 to 81 years old with an average of (61.38±9.88) years, L3 slippage in 3 cases, L4 slippage in 15, and L5 slippage in 14. Operative time, intraoperative fluoroscopy times, and postoperative bedtime were compared between two groups. Anteroposterior displacement values, interbody opening angles, and the percentage of slippage were measured on preoperative and postoperative 12-month dynamic radiographs. Visual analogue scale (VAS) of low back pain and lower extremity pain, and the Japanese Orthopaedic Association (JOA) score before and after surgery were observed, and clinical effects were evaluated according to the modified MACNAB criteria.@*RESULTS@#All operations were successfully completed, and patients in both groups were followed up for more than 1 year, and without complications during follow-up period. ①There was no significant difference in operation time between two groups(P>0.05). Intraoperative fluoroscopy times were longer in transforaminal approach group than that in intervertebral approach group(P<0.05). Postoperative bedtime was shorter in transforaminal approach group than that in intervertebral approach group (P<0.05).② No lumbar instability was found on dynamic radiography at 12 months postoperatively in both groups. There were no significant differences in anteroposterior displacement values, interbody opening angles, and the percentage of slippage between two groups postoperative 12 months and preoperative 1 day(P>0.05). ③There was no significant difference between two groups in VAS of low back pain at 3 days and 1, 12 months after the operation compared with the preoperative(P>0.05), but the VAS of the lower extremity pain was significantly improved compared with the preoperative(P<0.05). Both of groups showed significant improvement in JOA score at 12 months compared with preoperatively(P<0.05). There was no significant difference in VAS of low back pain, lower extremity pain and JOA scores between two groups during the same period after surgery(P>0.05). According to modified Macnab criteria, excellent, good, fair and poor outcomes were 21, 7, 3 and 1 in transforaminal approach group respectively, and which in intervertebral approach group were 20, 7, 5 and 0, there was no significant difference in clinical effect between the groups(P>0.05).@*CONCLUSION@#Intervertebral approach may reduce intraoperative fluoroscopy times and transforaminal approach can shorten postoperative bedtime, both approaches achieve satisfactory results in the treatment of stable degenerative lumbar spondylolisthesis with no progression of short-term slippage.

Percutaneous foraminal endoscopy for the treatment of lumbar lateral recess stenosis in elderly / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy and safety of percutaneous foraminal endoscopy in the treatment of lumbar lateral recess stenosis in elderly.@*METHODS@#The clinical data of 31 elderly patients with lumbar lateral recess stenosis treated by percutaneous foraminal endoscopic decompression from March 2018 to August 2019 were retrospectively analyzed. Including 16 males and 15 females, aged from 65 to 81 years with an average of (71.13±5.20) years, the course of disease ranged from 3 months to 7 years with an average of (14.36±6.52) months. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess clinical symptom and functional status before operation and 1, 6, 12 months after operation. At the final follow-up, the modified Macnab standard was used to evaluate clinical efficacy.@*RESULTS@#All patients were completed the operation successfully. The operation time was from 75 to 120 min with an average of (97.84±11.22 ) min. All 31 patients were followed up from 12 to 28 months with an average of (17.29±5.56) months. Postoperative lumbago-leg pain VAS and ODI were significantly improved at 1, 6, and 12 months(P<0.01). At the final follow-up, according to the modified Macnab standard to evaluate the effect, 23 got excellent results, 5 good, 3 fair. One patient had severe adhesions between peripheral tissues and nerve root, and postoperative sensory abnormalities in the lower extremities were treated conservatively with traditional Chinese medicine and neurotrophic drugs, which recovered at 2 weeks after surgery. No complications such as nerve root injury and infection occurred.@*CONCLUSION@#The intervertebral foraminal endoscopy technique, which is performed under local anesthesia for a short period of operation, ensures adequate decompression while minimizing complications, and is a safe and effective surgical procedure for elderly patients with lumbar lateral recess stenosis.

Comparison of clinical efficacy between percutaneous endoscopic transforaminal discectomy and coblation nucleoplasty in the treatment of inclusive lumbar disc herniation / 中国骨伤

OBJECTIVE@#To observe clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and target radioffrequency thermal coblation nucleoplasty(CN) on inclusive lumbar disc herniation(LDH) in different age groups, and provide a basis for clinical formulation of precise and individualized treatments.@*METHODS@#A retrospective analysis of 219 patients with lumbar disc herniation treated with PETD and CN between January 2018 and June 2021 was performed, in which 107 patients were treated with PETD and 112 with CN. Patients were stratified by age into young group(≤45 years old), middle-aged group(>45 years old and <60 years old) and older group(≥60 years old). Before treatment, 3 days, 1 month and 6 months after treatment, visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, infrared thermal imaging temperature difference (△T) and lumbar range of motion (ROM) were evaluated and clinical efficacy were compared in the different age groups between two treatment methods.@*RESULTS@#①VAS and JOA score outcomes, in the same age group and the same treatment method, the VAS and JOA scores at different time points postoperatively were obviously improved (P<0.05). For the same age group and the different treatment methods, the older group had lower VAS and higher JOA scores after PETD than after CN (P<0.05), and there was no significant difference between the young group and middle-aged group (P>0.05). There was no significant difference in VAS and JOA scores at the same time between age groups by PETD treatment (P>0.05). The VAS was higher and the JOA score was lower in older group than in young group and middle-aged group at 1, 6 months after CN treatment(P<0.05). ②△T and ROM outcomes, in the same age group and same treatment method, postoperative △T and ROM at different time points were obviously improved(P<0.05). There was no significant difference in △T between two methods of PETD and CN at the same age(P>0.05), there was no significant difference in ROM between young group and middle-aged group(P>0.05), ROM was higher after PETD treatment than after CN treatment(P<0.05). There was no significant difference in △T and ROM at the same time between age groups by PETD treatment(P>0.05). There was no significant difference in △T between age groups by CN treatment, but the ROM was smaller in older group than in young group and middle-aged group after CN treatment(P<0.05).@*CONCLUSION@#Both PETD and CN for inclusive LDH have good efficacy, the curative benefit for older patients receiving PETD within 6 months after surgery more than CN, and CN is more appropriate for young and middle-aged patients.

Visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy for lumbar disc herniation / 中国骨伤

OBJECTIVE@#To compare the clinical efficacy between visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy (VPTED) and traditional percutaneous transforaminal endoscopic discectomy(PTED) in the treatment of lumbar disc herniation.@*METHODS@#The clinical data of 60 patients with lumbar disc herniation admitted from June 2019 to December, 2020 was retrospectively analyzed. There were 38 males and 22 females, aged from 26 to 58 years old with an average of (43.63±8.48) years, 47 cases were on L4,5 segment and 13 cases were on L5S1 segment. Among them, 32 were treated with VPTED (group A) and 28 were treated with traditional PTED (group B). The general conditions of all the patients were recorded, including intraoperative fluoroscopy times, operation time, hospital stay and surgical complications during follow-up. The arthroplasty area ratio was observed by sagittal CT at the middle level of the intervertebral foramen. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score of low back pain, Oswestry disability index (ODI) were used to evaluate the clinical efficacy between two groups.@*RESULTS@#All patients were followed up from 9 to 15 months with an average of (12.10±1.16) months. There was no statistical difference of preoperative general data between two groups. The operation time, fluoroscopy times and hospital stay were (70.47±5.87) min, (13.66±1.34) times and (6.31±0.69) d in group A, and (90.71±7.66) min, (22.82±2.48) times and (6.54±0.92) d in group B. The operation time and intraoperative fluoroscopy times in group A were lower than those in group B(P<0.05). There was no significant difference in hospital stay between two groups (P>0.05). No obvious surgical complications were found during the follow-up in both groups. The arthroplasty area ratio in group A was (29.72±2.84)% and (29.57±2.20)% in group B, respectively, with no significant difference (P>0.05). There was no significant difference in VAS, ODI and JOA score between two groups before operation and at the final follow-up(P>0.05), but the final follow-up was significantly improved(P<0.05).@*CONCLUSION@#The two surgical methods have definite clinical efficacy in the treatment of lumbar disc herniation. Visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy has the advantages of high efficiency and rapidity when establishing the channel, and can significantly reduce the operation time and intraoperative fluoroscopy times.

Biomechanical affect of percutaneous transforaminal endoscopic discectomy on adjacent segments with different degrees of degeneration:a finite element analysis / 中国骨伤

OBJECTIVE@#To investigate the biomechanical affect of percutaneous transforaminal endoscopic discectomy(PTED) on adjacent segments with different degrees of degeneration and related risk of adjacent segment diseases (ASD) caused by this operation.@*METHODS@#A healthy male adult volunteer was selected, and the lumbosacral vertebra image data was obtained by CT scan, and the external contour of the bone structure was reconstructed. On this basis, the external contour of the bone structure was fitted by using the smooth curve in 3D-CAD software, and the complete three-dimensional finite element modelof the non degenerate L@*RESULTS@#In the finite element model without adjacent segmental disc degeneration, the annulus fibrosus von Mises stress and intradiscal pressure of the PTED model showed only a slight increase under most stress conditions, and a slight decrease in a few conditions, and there was no significant change trend before and after surgery. In the original degenerated adjacent segment disc model, the biomechanical indicators related to disc degeneration in the pre- and post-PTED model showed significant deterioration, leading to an increased risk of potential adjacent spondylopathy.@*CONCLUSION@#PTED surgery will not lead to the significant deterioration of postoperative biomechanical environment of non-degeneration adjacent intervertebral discs, and the original degeneration of adjacent intervertebral discs is a important risk factor for ASD.

A case-control study of cervical spine Key-hole technique and anterior cervical Zero-P system in the treatment of cervical spondylotic radiculopathy / 中国骨伤

OBJECTIVE@#To explore the short-term clinical efficacy of single-stage cervical spondylotic radiculopathy (CSR) between the minimally invasive Key-hole technique and anterior cervical Zero profile intervertebral fusion system (Zero-P).@*METHODS@#A retrospective analysis was performed on 45 patients who underwent surgical treatment for CSR from January 2017 to January 2020, including 21 in Key hole group (12 males and 9 females), followed up for 10-22(13.2±2.3) months;24 cases in Zero-P group (14 males and 10 females), and the follow up period was 10 to 23(12.7±1.9) months. Perioperative conditions (incision length, intraoperative blood loss, operation time, length of hospital stay, and complications) were compared between two groups, and X-rays of cervical spine before and after surgery and at the final follow-up were taken to analyzed curvature of the cervical spine, visual analogue scale(VAS) of pain before and after surgery, Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) score of cervical spine were recorded to evaluate clinical efficacy.@*RESULTS@#In Key-hole group and Zero-P group, the surgical incision length, intraoperative blood loss, operation time, final follow-up Cobb angle and immediate postoperative VAS score respectively were (1.2±0.2) cm, (5.3±0.3) cm;(35.3±9.7) ml, (120.2±13.5) ml;(56.4±11.3) min, (90.6±12.6) min;(3.2±3.9)°, (7.3±3.8)°;(2.8±1.2)points, (3.8±1.1) points;the Zero-P group was larger than the Key hole group, with statistical significance(@*CONCLUSION@#The cervical spine Key-hole technology is similar to the anterior cervical Zero-P system in the treatment of CSR. The Key-hole technique has certain advantages in incision length, intraoperative blood loss, and operation time. It is a safe, effective and can be widely used cervical spine surgery method.

Treatment of senile lumbar spinal stenosis by unilateral approach and bilateral decompression with large channel endoscopy / 中国骨伤

OBJECTIVE@#To evaluate clinical effect of unilateral approach and bilateral decompression via large channel endoscopic system for the treatment of lumbar spinal stenosis.@*METHODS@#The clinical data of 32 patients with lumbar spinal tenosis treated by unilateral approach and bilateral decompression via large channel endoscopy from February 2018 to February 2019 were retrospectively analyzed. There were 18 males and 14 females, aged 65 to 84 years old with an average of (70.6± 8.4) years. The course of disease was from 1 to 12 years. All 32 cases were accompanied by numbness or pain in the lower limbs, of which 28 cases were accompanied by intermittent claudication. Narrow segments were L@*RESULTS@#All the patients were followed up for 12-24 (17.68±2.43) months and all operations were successfully completed with the operation time of 70-160(85.64±11.94) min. Spinal dural tear occurred in 1 case during the operation, and sensory disturbance in the other side of lower limb in a short period of time occurred in 2 cases, all improved after corresponding treatment. Postoperative imaging showed that the spinal canal was significantly enlarged and the nerve root was fully released. Before operation and 3 days, 3 months, 1 year after operation, VAS scores of low back pain were 4.62 ±1.41, 2.73 ±1.35, 1.21 ±1.17, 1.11 ±0.34, respectively;VAS scores of leg pain were 6.83 ± 1.71, 3.10±1.50, 1.08±0.19, 0.89±0.24, respectively. VAS scores of low back pain and leg pain each time point after operation were obvious improved (@*CONCLUSION@#It is a safe and effective way to treat lumbar spinal stenosis with unilateral approach and bilateral decompression via large channel endoscopic system. It has the advantages of sufficient decompression, less trauma, fast recovery, high safety and low incidence of postoperative complications. It can minimize the damage to the stable structure of the lumbar spine and is an ideal minimally invasive operation for the treatment of lumbar spinal stenosis.

Treatment of tuberculosis of lumbar spine in elderly patients with percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation / 中国骨伤

OBJECTIVE@#To explore the clinical effects and advantages of percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation in the treatment of tuberculosis of lumbar spine in elderly.@*METHODS@#The clinical data of 32 patients with tuberculosis of lumbar spine received percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation from May 2013 to May 2016 were retrospectively analyzed. There were 13 males and 19 females, aged from 62 to 85 years old with an average of 75 years. Lesion segmental Cobb angle was 13° to 21° with an average of (16.52±3.20)°. Tuberculosis focal involved L₁-L₂ of 1 case, L₂-L₃ of 4 cases, L₃-L₄ of 15 cases, L₄-₅ of 10 case, L₅-S₁ of 2 cases. Cobb angle, VAS score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and ASIA grade were compared before and after operation. The stability of the spine and the recurrence of tuberculosis were evaluated.@*RESULTS@#All patients were followed up for 12-36 months with the mean of 24 months. Three patients complicated with giant paravertebral psoas abscess occurred sinus tract in canal orifice of drainage tube after irrigation, and healed in 3 months after operation. Other 29 patients obtained healing of phase I without sinus tract formation. The clinical symptoms of all patients obvious improved at 2 weeks to 3 months after operation and no complications such as severe heart and lung, liver and kidney dyfunction were found. VAS scores and Cobb angles were improved from preoperative(6.77±1.23) points and(16.52±3.20)° to(4.71±0.69) points and (4.24±1.22)° at 1 week after operation. No infection and tuberculosis recurrence were found at follow-up period. ESR and CRP were normal at final follow-up and ASIA grade had obvious improved.@*CONCLUSIONS@#Percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation is a simple, effective and safe method for tuberculosis of lumbar spine in elderly, and is worthy to recommend its clinical use.

Early postoperative serum levels of inflammatory mediators and biliary pressure level after laparocholedochoscopy plus holmium laser lithotripsy / 中华全科医师杂志

Retrospective analyses were performed for the clinical data of 67 patients with biliary calculi.Among them,laparocholedochoscopy plus holmium laser lithotripsy (n =31) and laparocholedochoscopy (n =36) were performed.As compared with laparocholedochoscopy,early postoperative serum inflammatory mediators of holmium laser lithotripsy were obviously lower,biliary pressure dropped faster and less volatile[(8.5±1.5)-(12.2±4.1) vs.(8.1 ±1.6)-(16.5±4.7) mmHg(1 mmHg=0.133 kPa)],operative duration [(93.5 ± 13.4) vs.(127.6 ± 34.5) min],conversion into laparotomy rate[3％ (1/31) vs.11％ (4/36)],postoperation SIRS rate[23％ (7/31) vs.42％ (15/36)],length of hospital stay [(8.5 ± 3.5) vs.(12.6 ± 3.9) days] and postoperative biliary residual stones rate [0％ (0/31) vs.8％ (3/36)]were also better than.

Combined transgastric and transcolonic endoscopic cholecystectomy in porcine models / 中华消化杂志

Objective To assess the feasibility and safety of combined transgastric and transcolonic endoscopic cholecystectomy in porcine model.Methods Five female miniature swines were subjected to cholecystectomy by the combined transgastric and transcolonic approach using two flexible endoscopes.The gastric wall of the swine was punctured with a needle knife,followed by dilatation with a balloon-dilator via the transgastric access.then a double channel endoscope was advanced into the peritoneal cavity.Another double-channel endoscope was advanced via a transcolonic access.Gallbladder excision was performed using transcolonic endoscope assisted by transgastric endoscope.After eholecystectomy the gastric and the colonic incisions were closed with clips.The animal was examined 14 days after operation.Results Cholecystectomy was failed in 4 swines because of incomplete exposing the gallbladder(3 swines)and hemarrhage during separating the gallbladder from the liver bed(1 swine).Only one swine was successfully performed cholecystectomy.But 3 perforations were found in the diaphragm which might be done by transcolonic endoscope.The swine lost 4 kg 14 days after the operation.The necropsy revealed a complete transmural healing of the gastric incision with minimal adhesions and a complete healing of the colonic incision with heavy adhesions.An abscess with severe adhesions was found in the right lower quadrant.One perforation of the diaphragm healed,and the other two perfolrations merged and formed a diverticulum embedded with the liver.Conclusion Combined transgastric and transcolonic approach appears difficult for cholecystectomy and the safety remains tO be further studied.

Clinical study of internal rigid fixation for mandibular condylar fractures / 中华创伤杂志

Objective To investigate the clinical effect of internal rigid fixation with miniature titanium plate for mandibular condylar fracture under endoscope. Methods Twenty-two cases with mandibular condylar fractures were treated with transcutaneous puncturing and internal rigid fixation with miniature titanium plate under endoscope. Results All cases obtained a good recovery both of facial contour and bone healing. Mandibular movement was normal in 21 cases and biting function good in 20.Conclusions Under endoscope, the internal rigid fixation for mandibular condylar fracture is a good method with little trauma, accurate reduction and stable fixation but without complication and can be used for treatment of fractures of mandibular condylar neck or subcondylar condyle.

Percutaneous endoscopic laser-assisted discectomy on L_5S_1 herniated nucleus pulposus through trans-interlaminar approach / 中华骨科杂志

Objective To investigate the efficacy of percutaneous endoscopic laser-assisted discectomy (PELD) on L5S1 herniated nucleus pulposus by posterior paramedian trans-interlaminar approach (PEILD). Methods 168 consecutive patients underwent PEILD between May 2002 and December 2003, and were analyzed retrospectively. All cases were operated in outpatient department under local anesthesia in Wooridul Spine Hospital of Korea. Of the 168 cases, 92 were males, and 76 females with a mean age of 42.8 years (range,18 to 73 years ). The classification of herniated disc position related to spinal canal and pedicle, was central in 22, para-central in 120, foraminal in 23, and extraforaminal in 3. The average of iliosacral distance was 38.6 mm. "C" arm fluoroscopy was needed during operation. All of the patients were given conservative management for 6 to 8 weeks without relief of radiculalgia. The AP film was used to make sure to have enough working interlaminar space of posterior percutaneous approach for L5S1 herniated nucleus pulposus. Results The operative time was 30 to 90 mins with an average of 45 mins, and the mean hospitalization was 1.3 days. The average follow-up duration was 8.3 months (range, 5 to 19 months), and the patients were evaluated at 2 day, 2 week, and 1, 2, 6 and 12 month respectively. The clinical results were assessed by MacNab criteria, there were excellent in 43.5%, good in 47.0%, fair in 4.8%, and poor in 4.8%, and successful rate was 90.5%. 8 cases showed incomplete removal of the pathological disc on postoperative MRI without changes of symptoms and signs, then open laminectomy and microdiscectomy (OLM) were performed, including 4 of foraminal type, 3 of extraforaminal type and 1 of central type. 1 case displayed discitis, which was improved one month later by intravenous antibiotics, immobilization and bedrest. 26 cases showed transient postoperative paresthesia, improved by conservative treatment. Conclusion L5S1 disc herniation can be effectively treated with percutaneous endoscopic laser discectomy through posterior paramedian trans-interlaminar approach, which is easier for the patients with higher iliac spines.

Laparoscopic and transurethral resection of bladder tumor / 中华泌尿外科杂志

Objective To investigate a minimal invasive surgical therapy for tumors in the an terior wall close to bladder neck. Methods A 5～10 mm incision was made in abdominal wall below the umbilicus and laparoscopic devices were introduced into the bladder.Tumors were excised and coa gulated under the monitoring of cystoscopy. Results Tumors at the anterior wall of bladder were easily exposed and removed.The recovery time was nearly the same as that of TURBT.No tumor recurrence was observed in 3～10 months period. Conclusions Tumors at the anterior wall of bladder could be easily removed by the combined use of cystoscopy and laparoscopy and open surgery might be avoided.

Operative treatment of lumbar disc herniation with microendoscopic discectomy / 中华骨科杂志

Objective To study the technical details, clinical results and complication of microendoscopic discectomy (MED) for the treatment of lumbar disc herniation. Methods Ninety cases of lumbar disc herniation were operated upon with MED, and followed up for 24-32 months. Under direct endoscopic manipulation, semi circular excision of the inferior part of lamina, removal of the lateral part of the ligamentum flavum and the medial part of the facet were performed. The annulus fibrosus was circularly excised and the nucleus pulposus was removed. Results After operation, the patients could walk in 1.9 days, resumed their daily activities in (2.4?1.9) weeks and went back to work in (4.3?3.8) weeks. The rate of improvement was 83.1%. Several technical problems could happen in the beginning of using MED, including wrong identification of the vertebral level, difficulty to enter into the spinal canal and to control the bleeding, as well as injury of nerve root, dura mater and facet joint. Conclusion The advantages of MED are removal of the annulus fibrosus, the calcified ligamentum flavum and osteophyte under direct vision. However, sometimes it is difficult to fix the tip of microendoscopic tube on the surface of the lamina. Improvement is needed for the instrument design in order to increase the safety and easier manipulation.

Feasibility of endoscopic transoral-transpharyngeal approach to atlantoaxis / 中华骨科杂志

Objective To evaluate the feasibility of endoscopic transoral-transpharyngeal approach to the upper cervical. Methods Anatomic characteristics were observed and measured in the anterior column of 50 dry atlas and axis specimens. Conventional and endoscopic methods to decompress the spinal cord and excise the cartilage surface of the atlantoaxial joint by transoral-transpharyngeal approach were taken respectively in two groups of cadaveric heads and necks. All the cadaveric specimens were then open dissected to evaluate endoscopic operation methods, decompression size and the "safe zone". Results The anterior arch of atlas was of a length of (19.8?2.3) mm, the height of odontoid was (15.9?1.9) mm, the width (10.5?0.6) mm, and the thickness (11.5?1.9) mm; the maximal transverse diameter of superior facet of axis was (15.1?1.6) mm, and the anteroposterior one was (17.7?1.3) mm. The anterior tubercle of the atlas could be acted as landmark leading to the endoscopic atlantoaxis surgery. The arch could be drilled either from the tubercle to the lateral side or broken from the junction to the lateral mass. Endoscopic odontoid dissection should begin at the apex of the odontoid, and proceed inferiorly. It was necessary to move or slope the working tube to explore atlantoaxial lateral joint and dissect its cartilage, but the width and depth of cartilage dissection should be limited to 12 mm and 10 mm in order to avoid damage to vertebral artery and spinal cord. Measurements after postoperative open dissection showed that endoscopic decompression size were not significantly different from that of conventional method. There was a "safe zone" in the front of atlantoaxis of transoral-transpharyngeal approach, with (45.9?3.6) mm wide and (29.4?2.5) mm high. Conclusion Endoscopic transoral-transpharyngeal approach to the upper cervical is technically feasible, which had a good exploration and could get the same decompressing size with conventional transoral-transpharyngeal approach.

Pancreaticobiliary duct drainage for the treatment of acute necrotizing pancreatitis / 中国普通外科杂志

Objective To observe the therapeutic efficacy of endoscopic pancreaticobiliary duct drainage for acute necrotizing pancreatitis. Methods 41 cases of acute necrotizi ng pancreatitis were randomly divided into pancreaticobiliary duct drainage (21 causes) group and control group (20 cases).Results The procedure was successful in all 21 cases. The difference bet ween the two groups was statistically significant including hospital stay 〔(2 8?12) days vs. (37?19) days,P

Preliminary report of anterior cervical discectomy and interbody fusion by endoscope / 中华骨科杂志

Objective To explore the technical feasibility and effects of ant erior cervical discectomy and interbody fusion using endoscopic technique. Metho ds A retrospective study was undertaken in 23 patients with single segmental cer vical fracture and dislocation or cervical spondylotic myelopathy. There were 14 males and 9 females with an average age of 41.5 years (range, 23 to 64). The fr acture and dislocation patients consisted of 2 cases with complete tetraplegia e ither of C3,4 or C4,5, 3 with incomplete tetraplegia of C5,6 and 2 of C4,5 free from nervous symptoms. The operative procedures included anterior cervical disce ctomy and interbody fusion with insertion of cage or/and plate fixation through an endoscopic working canal. Results All 23 cases were followed-up from 6 to 18 months. The operative incisions healed smoothly. All patients achieved interbody fusion, and no loosening or displacement of the cage and plate occurred. For th e cervical fracture and dislocation patients, by Frankel's classification, 2 cas es with complete tetraplegia showed no any improvement, 2 cases with incomplete tetraplegia improved from grade C preoperatively to grade D postoperatively, 1 c ase with incomplete tetraplegia upgrade from C to E, 2 cases without nervous sym ptoms maintained preoperative status. For cervical spondylotic myelopathy patien ts, according to Odom's scoring system, 10 cases were assessed as excellent (dis appearance of all symptoms), 5 good (alleviation of main symptoms), 1 fair (alle viation of partial symptoms). 94% patients gained excellent and good results. No complications occurred in this series. Conclusion With the improvement of the t echnique and instrument, the endoscopic procedures can be used for anterior cerv ical discectomy, interbody fusion and internal fixation. It presents microsurgic al advantages such as minimal incision, less traumatic reaction, clear intraoper ative visualization, and less postoperative discomfort comparing to traditional approach.

Anterior cervical discectomy and intervertebral fusion using endoscopic procedure / 中华骨科杂志

Objective To report the results using endoscopic techniques in ce rvical discectomy and intervertebral fusion. Methods From October 2002 to August 2003, 26 patients underwent cervical discectomy and intervertebral fusion using endoscopic techniques. 16 patients had been followed-up more than 3 months, inc luding 4 females and 12 males. The average age was 53.2 years (range, 23 to 65 y ears). The disorders lasted from 3 to 14 months before surgery. There were 3 cas es of cervical injury associated cervical disc herniation (CDH), 8 of cervical s pondylotic myelopathy (CSM), 2 of solitary ossification of the posterior longitu dinal ligament (OPLL), and 3 of radiculopathy. The mean preoperative ADL of Japa nese Orthopedic Association (JOA) score was 7.2. The working channel was inserte d through a 2 cm long incision, the protruded discs or ossified posterior longit udinal ligaments were excised for complete decompression, then an appropriate in tervertebral PEEK fusion cage was implanted. Results All patients obtained endos copic cervical discectomy and interbody fusion successfully. None of cases was c onverted to open procedures. The surgery lasted an average of 120 min (range, 50 to 150 min), mean blood loss was 110 ml (range, from 40 to 140 ml). There was n o complication during operation and no any stimulating symptoms on laryngopharyn x after surgery. However, postoperative hemorrhage of the incision occurred in 1 case, then an injury of a thyroid vessel was found during immediate exploration . The follow-up period extended from 3 to 8 months (mean, 6.5 months), the aver age preoperative ADL of JOA score was 13.1 while the improvement rate was 60.2%. Conclusion The cervical discectomy and intervertebral fusion through endoscopi c approach is able to reduce the soft tissue injury and the incidence of stimula ting symptoms on laryngopharynx, which makes the surgery more safe. The indicati ons for this procedure include cervical disc herniation, cervical myelopathy, ra diculopathy, and traumatic cervical disc injury on C3,4 to C5,6 segments.