Unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the Interlaminar Endoscopic Surgical System(iLESSYS) Delta for the treatment of lumbar spinal stenosis (LSS) in the elderly.@*METHODS@#Total of 29 patients with LSS treated with the iLESSYS Delta from December 2018 to January 2021 were retrospectively analyzed, including 12 males and 17 females with an average age of (71.52±10.82) years old ranging from 63 to 83 years old. All patients had definite intermittent claudication, mainly neurogenic symptoms of both lower limbs. All patients had single-level spinal stenosis, including L3,4 5 cases, L4,5 21 cases, and L5S1 3 cases. Visual analogue scale (VAS), Oswestry Disability Index (ODI) and modified Macnab assessment criteria were used to evaluate pain, low back pain dysfunction index and clinical efficacy, respectively.@*RESULTS@#All 29 cases were successfully completed. The operation time was (73.45±5.89) min, the intraoperative blood loss was (9.93±0.83) ml, the hospital stay was (4.03±0.41) days, and the follow-up was more than 12 months. The VAS scores of low back pain before surgery and 1 day, 1 month, 3 months, 1 year after surgery were 2.31±0.88, 1.45±0.62, 1.21±0.61, 1.10±0.55, 1.03±0.49;VAS of leg pain were 6.48±0.49 0.56, 1.97±0.61, 1.31±0.59, 1.17±0.59, 1.10±0.55;ODI scores were 38.41±2.74, 18.14±1.17, 5.17±0.53, 5.07±0.45, 4.90±0.48;low back and leg pain VAS score and ODI score have statistically significant differences between preoperative and postoperative follow-up time points (P<0.05). The MacNab efficacy evaluation at 1-year follow-up:excellent in 22 cases, good in 5 cases and fair in 2 cases.@*CONCLUSION@#The clinical effect of unilateral interlaminar approach 270° circular spinal canal decompression under the iLESSYS Delta for the treatment of lumbar spinal stenosis in the elderly is satisfactory, with the advantages of less trauma and less bleeding, large microscopic operation space, sufficient decompression, and ideal post-operative recovery, and at the same time, it can minimize the damage to the stable structure of the lumbar spine, which is an ideal surgical method for the treatment of elderly lumbar spinal stenosis.

Posterior-only spinal fusion without rib head resection for treating type I neurofibromatosis with intra-canal rib head dislocation

OBJECTIVES: Patients with Type I neurofibromatosis scoliosis with intra-canal rib head protrusion are extremely rare. Current knowledge regarding the diagnosis and treatment for this situation are insufficient. The purpose of this study is to share our experience in the diagnosis and surgical treatments for such unique deformities. METHODS: Six patients with Type I neurofibromatosis scoliosis with rib head dislocation into the spinal canal were diagnosed at our institution. Posterior instrumentation and spinal fusion without intra-canal rib head resection via a posterior-only approach was performed for deformity correction and rib head extraction. The efficacy and outcomes of the surgery were evaluated by measurements before, immediately and 24 months after the surgery using the following parameters: coronal spinal Cobb angle, apex rotation and kyphosis of the spine and the intra-canal rib head position. Post-operative complications, surgery time and blood loss were also evaluated. RESULTS: Patients were followed up for at least 24 months post-operatively. The three dimensional spinal deformity was significantly improved and the intra-canal rib head was significantly extracted from the canal immediately after the surgery. At follow-up 24 months after surgery, solid fusions were achieved along the fusion segments, and the deformity corrections and rib head positions were well maintained. There were no surgery-related complications any time after the surgery. CONCLUSIONS: Systematic examinations are needed to identify patients with Type I neurofibromatosis scoliosis with rib head dislocation into the canal who can be treated by posterior-only spinal fusion without rib head resection. .

Experiencia en tratamiento quirúrgico de cinco casos de siringomielia / Experience in surgical treatment of five cases of syringomyelia

Siringomielia, cavidades quísticas dentro del cordón espinal. Con incidencia baja de 8.4 por 100000 por año, Presentamos nuestra experiencia en tratamiento quirúrgico de 5 casos de siringomielia. Se presenta serie clínica, sin distinción de edad ni sexo, con diagnostico de siringomielia y que cumplan con los criterios quirúrgicos establecidos por el grupo. Estudiamos 5 pacientes, la totalidad de los casos presentaron síndrome disociativo medular por siringomielia, 4 casos sexo femenino, promedio de edad de 40,8 años, rango de seguimiento de 6 años a 6 meses, 5 casos procedentes del estado Mérida, 100% diagnostico por resonancia, 3 caso localización cervical, 1 caso la etiología es hemangioma capilar, a los 5 se les realizo derivación siringosubaracnoidea con mejoría clínica y en el postoperatorio tardío un 20% presento recidiva, manejada conservadoramente.

Syringomyelia, cystic cavities within the spinal cord. With low incidence of 8.4 per 100000 per year, present our experience in surgical treatment of 5 cases of syringomyelia. We present clinical series, regardless of age, sex diagnosed with syringomyelia and meet surgical criteria established by the grupo. We studied 5 patients, all cases had spinal cord syndrome and syringomyelia dissociative 4 cases female, mean age of 40.8 years, range 6-year follow-up to 6 months, 5 cases from the state of Merida, 100% resonance diagnosis, 3 cases cervical lesion, 1 case of capillary hemangioma etiology, to 5 were conducted with clinical improvement siringosubaracnoidea bypass and postoperative period by 20% for 1 case of recurrent, conservatively managed.

Experiencia en cirugía lumbar endoscópia / Experience in lumbar endoscopic surgery

La cirugía endoscópica de columna, resultado de la inquietud de múltiples investigadores en encontrar técnicas menos invasivas para el tratamiento de problemas quirúrgicos. Serie clínica de 33 pacientes, sometidos a cirugía lumbar endoscópica y evolución clínica (2009–2011). 33 pacientes, el 91% mínimo 6 meses de evolución, 100% fueron manejados ambulatorio, 52% femenino, 48% masculinos, promedio de 49 años de edad, 60% diagnostico de Lumbalgia discogenica y 40% síndrome de receso lateral y radiculalgia, 30% empleados públicos, 50% Discectomía endoscopia un nivel, 30% dos niveles, 17% tres niveles y 3% cuatro niveles, 21% tenía signos radiculares preoperatorios, un paciente (3%) espondilodiscitis, 37% reagudización clínica e inestabilidad lumbar, 15% requirió otra cirugía y 9% se le plantea nueva cirugía. Se evaluaron con la escala visual análoga del dolor, test de incapacidad de Oswestry, criterios de Macnab. La cirugía endoscópica lumbar, técnica atractiva, al reducir la vía de abordaje, reduce las complicaciones de cicatrización y la temprana incorporación a sus actividades. En nuestra experiencia, obtuvimos un 76% entre buenos y aceptables resultados y 24% malos según Macnab, lo que obliga a ser acuciosos para seleccionar al paciente.

Endoscopic surgery of the spine, resulting from the concern of many researchers to find less invasive techniques for the treatment of surgical problems. A case series of 33 patients who underwent lumbar endoscopic surgery and clinical course (2009 - 2011). 33 patients, 91% at least 6 months duration, 100% were ambulatory, 52% female, 48% male, average age 49 years, 60% diagnosis of discogenic low back pain and 40% lateral recess syndrome and radiculalgia, 30% civil servants, 50% endoscopic discectomy level, 30% two levels, three levels 17% and 3% four levels, 21% had preoperative radicular findings, one patient (3%) spondylodiscitis, 37% and clinical worsening lumbar instability, 15% required another surgery and 9% is facednew surgery. Were evaluated with visual analog pain scale, Oswestry Disability test, Macnab criteria. The lumbar endoscopic surgery, technically attractive, reducing the surgical approach, reduces the complications of early healing and incorporation into its activities. In our experience, we obtained 76% between good and acceptable and 24% poor results according to Macnab, making it necessary to be diligent to select the patient.

Early results of multiple decompressive fenestrations in multisegmental degenerative lumbar canal stenosis

Removal of the posterior elements in decompressive laminectomy for lumbar canal stenosis carries the risk of instability that complicates surgery by inviting fusion. In this study, 16 cases with degenerative lumbar canal stenosis were operated upon using multiple fenestrations to decompress the canal at many levels with removal of lizamentum flavum and interspinous ligament only. This technique gave promising satisfactory results that exceeds results of classical laminectomy and needed no fusion. The good and excellent results reached 81.25% with an average follow up of 21 months. This minimal surgery was suitable for Egyptian patients at this age group as it suits their basic needs. This promising result still needs further studies in bigger groups of patients where classification into uniform groups regarding the pathology and clinical picture is advised for better assessment

Avaliaçäo de pacientes com estenose do canal cervical submetido a laminoplastia / Evaluation of patients with stenosis of the cervical canal submitted to laminoplasty

Os autores apresentam os resultados de revisäo clínica e por imagem de nove pacientes com estenose do canal cervical e mielopatia, submetidos a laminoplastia do tipo "porta aberta", com seguimento médio de três anos e sete meses e idade média de 61,8 anos. Concluem que, em funçäo dos resultados obtidos, a técnica descrita é uma opçäo a ser considerada nos casos de estenose do canal cervical que necessitam de descompressäo acima de três níveis.

Primary multiple intramedullary and intradural extramedullary hydatid cysts of lumbar spinal canal

A rare case is reported of a 42 year old male farmer who developed gradual paraparesis and incontinence following a radicular pain for which myelography at the L4- L5 interspace revealed complete block at L3. With a presumptive diagnosis of intradural spinal cord tumor he was operated and turned out to be a case of primary intramedullary and intradural extramedulary hydatid cyst of the terminal 2.5 cm of spinal cord and cauda equina. postoperatively he completely recovered and after seventeen years he is without neurological deficit or further manifestations of echinococcosis