Transforaminal endoscopic lumbar discectomy: learning curve of a single surgeon.

Background: Transforaminal endoscopic lumbar discectomy (TELD) has well-recognized advantages and disadvantages in the literature. Some of the mentioned disadvantages are insufficient discectomy, higher recurrence rate and long learning curve (LC). The objective of this study is to describe the LC and analyze the survival rate of patients operated through TELD. Methods: Retrospective study of 41 cases operated through TELD by the same surgeon from June 2013 to January 2020, with a minimum follow-up of 6 months. Demographic data and information on operative time (OT), complications, hospital stay, hernia recurrence and reoperations were collected. LC of the TELD was analyzed using a cumulative sum (CUSUM) test for parameter stability for linear regression coefficients, using the CUSUM from recursive residuals. Results: Thirty-nine patients, 24 men (61.54%) and 15 women (38.46%), were included in the present cohort, and a total of 41 TELD were performed. The average OT was 96 minutes (SD =30) and the CUSUM of the recursive residuals shows learning of the TELD in the case 20. The mean OT in the first 20 cases was 114 minutes (SD =30) versus 80 minutes (SD =17) in the last 21 cases (P=0.0001). The rates of recurrent Dh were 17%, and 12% need reoperation. Conclusions: We consider that the LC of TELD requires operating 20 cases to perform the procedure with a significant reduction in OT, with minimal rates of reoperation and complications.

Spino-pelvic radiological parameters: Comparison of measurements obtained by radiologists using the traditional method versus spine surgeons using a semi-automated software (Surgimap).

Background: Spinopelvic balance measurement is a key point to get an appropriate diagnosis and treatment in a group of spine pathologies; thus, it seems necessary the evaluation of different methods for obtaining the most reliable values. For that reason, different automatic and semi-automatic computer-assisted tools have been developed, and one example of them is Surgimap. Purpose: To demonstrate that the sagittal balance measurements with Surgimap are equal and more time-efficient than with Agfa-Enterprise. Material and Methods: Retrospective-prospective study. Biased comparative analysis of radiographic measurements performed on two different occasions (96 h interval), between two spine surgeons using Surgimap and two radiologists using the traditional Cobb method (TCM) with the Agfa-Enterprise program in 36 full spine lateral X-ray, determining inter- and intra-observer reliability and the mean time required to obtain the measurements. Results: Measurements with both methods demonstrated an excellent intra-observer correlation (Surgimap: PCC 0.95 [0.85-0.99]; TCM: PCC 0.90 [0.81-0.99]). Inter-observer correlation also demonstrated an excellent relationship (PCC >0.95). Thoracic kyphosis (TK) demonstrated the lowest levels of inter-observer correlation (PCC: 0.75). The average time in seconds with TCM was 154.6, while with the Surgimap it was 41.8 s. Conclusion: Surgimap proved to be equally reliable and 3.5 times faster. Therefore, in consistency with the available literature, our results would allow us to promote the use of Surgimap as a clinical diagnostic tool considering precision and efficiency.

Sagittal balance: from theory to clinical practice.

Adequate sagittal balance (SB) is essential to maintain an upright, efficient, and painless posture. It has been shown that sagittal profile alterations affect quality of life of patients with a similar or even greater impact than chronic disease. Evaluation of the SB has gained much relevance in recent years, with recognition of its importance in the evaluation of spinal pathology. This review summarizes the basic principles of SB, aiming to obtain a practical, simple and understandable evaluation of the sagittal profile of a patient. SB is a dynamic process that involves a varying degree of energy expenditure. Distinguishing between a balanced, compensated imbalance or decompensated imbalanced patient, is relevant to diagnosis and therapeutic decision-making.

Fijación posterior monosegmentaria en fracturas de la columna toracolumbar / Fixação posterior monossegmentar nas fraturas da coluna toracolombar / Posterior monosegmental fixation in thoracolumbar spine fractures

OBJETIVO: Evaluar los resultados de la fijación pedicular posterior monosegmentaria en el manejo de las fracturas toracolumbares, buscando las variables que influyen en la falla de esta técnica. MÉTODOS: Serie de casos operados en un período de 10 años. Se identificaron 33 pacientes. 5 fueron eliminados por insuficiencia de datos. 28 pacientes fueron evaluados, la edad promedio fue 36 años con una mediana de seguimiento de 30 meses. Se definió fracaso radiológico del tratamiento como falla del implante y/o un aumento de la cifosis local > o = a 10º en el último control radiográfico respecto al posoperatorio inmediato. Se definió mal resultado clínico como: el desarrollo de complicaciones, el reposo laboral mayor al p90 de la muestra y/o la incapacidad para retornar al trabajo. RESULTADOS: Cuatro pacientes (14 por ciento) presentaron falla radiológica del tratamiento. Tuvimos tres complicaciones precoces y 2 tardías, con un 92,8 por ciento de retorno al mismo trabajo tras un promedio de 3,4 meses de reposo laboral. No observamos correlaciones estadísticas al analizar las variables estudiadas con respecto a la falla de la cirugía. Conclusión: La fijación monosegmentaria tiene buenos resultados en el tratamiento de las fracturas toracolumbares. En nuestra serie, tuvimos buenos resultados clínicos en un 93 por ciento y radiológicos en el 86 por ciento de los pacientes. No observamos correlaciones estadísticas con respecto a la falla de la cirugía, sin embargo, los pacientes que fallaron radiológicamente tenían mayor cifosis preoperatoria y/o mayor corrección posoperatoria.

OBJETIVO: Avaliar os resultados da fixação pedicular posterior monossegmentar no manejo das fraturas toracolombares, buscando as variáveis que influenciam a falha da técnica. MÉTODOS: Série de casos operados em um período de 10 anos. Foram identificados 33 pacientes. Cinco foram eliminados devido à insuficiência de dados. Dos 28 pacientes avaliados, a idade média foi de 36 anos com média de seguimento de 30 meses. O fracasso radiológico do tratamento foi definido como uma falha do implante e/ou aumento > ou = 10º de cifose segmentar no último controle radiográfico respeitando as medidas obtidas no controle pós-operatório. Definiu-se como mal resultado clínico: desenvolvimento de complicações, a necessidade de afastamento laboral maior do que o p90 do resto da amostra e/ou impossibilidade de retorno ao trabalho. RESULTADOS: Quatro pacientes (14 por cento) apresentaram insuficiência radiológica no tratamento. Tivemos três complicações precoces e duas tardias. 92,8 por cento dos pacientes retornaram ao mesmo trabalho após um tempo médio de 3,4 meses de repouso laboral. Não foram observadas correlações estatísticas ao analisar as variáveis em relação ao fracasso da cirurgia. CONCLUSÃO: A fixação monossegmentar obteve bons resultados no tratamento das fraturas toracolombares. Em nossa série tivemos bons resultados clínicos em 93 por cento e radiológicos em 86 por cento dos pacientes. Não foram observadas correlações estatísticas em relação ao fracasso da cirurgia, no entanto, nos pacientes que tiveram falha radiográfica observamos maior cifose pré-operatória e/ou maior correção pós-operatória.

OBJECTIVE: To evaluate the results of monosegmental fixation for the treatment of thoracolumbar fractures, to identify possible variables that influence treatment failure. METHODS: Case series of patients operated in a 10-year period. 33 patients were identified. Of these, 5 were eliminated due to insufficient data. 28 patients were evaluated, with a mean age 36 years and median follow up of 30 months. We defined radiological treatment failure as > or = 10 degrees of increased local Kyphosis in the radiographs in the last follow-up, compared with the measurements from the initial radiographs performed postoperatively or failure of the implant. We defined poor clinical results as complications, time out of work > to P 90 of the study group and/or inability to return to work. RESULTS: 4 patients (14 percent) presented radiological treatment failure. 3 suffered acute complications, and had 2 delayed complications. 92.8 percent of the patients returned to their jobs, with a mean postoperative time out of work of 3.4 months. no statistically significant differences were detected among the different evaluated variables evaluated and the levels of treatment failure. CONCLUSION: Posterior monosegmental fixation has good results in the treatment of thoracolumbar fractures. In our series we had good clinical results in 93 percent and radiological results in 86 percent of the patients. We did not find any variable that could be correlated with treatment failure, although the cases considered failures according to the radiological exams had a major preoperative kyphosis and a greater postoperative kyphosis correction than those who did not.