Full Endoscopy Combined with Allogeneic Bone Grafting for Benign Spinal Lesions: Technical Notes and Preliminary Clinical Results.

Benign lesions of the spine include benign tumors and tumor-like lesions of the spine, which usually occur in the thoracic and lumbar vertebrae. The incidence rate is low, accounting for about 1% of primary bone tumors. Few cases of endoscopic treatment of benign spinal lesions have been reported in the literature. Here, we introduce a new surgical technique using full endoscopy and allogeneic bone grafting to treat benign spinal lesions. All patients in this study successfully underwent the operation, and their pain was significantly relieved postoperatively. The patient VAS scores decreased from 3.07 ± 0.70 preoperatively to 0.33 ± 0.49 at the last follow-up visit (p < 0.05). The mean total blood loss (including drainage blood) was 16.67 ± 6.98 mL. The mean operative time was 63.33 ± 7.23 min. No patients developed numbness in the corresponding segmental distribution after surgery, none of the patients had serious postoperative complications, and none had focal recurrence during follow-up requiring reoperation. Patients reported symptom relief throughout the whole follow-up period. We believe that endoscopic surgery preserves the ligaments and soft tissues around the vertebral body, and that this technique is feasible with minimal trauma, rapid recovery, and good outcomes at short-term follow-up. This minimally invasive treatment modality offers a new option for the treatment of patients with benign spinal lesions.

Biomechanical Influences of Transcorporeal Tunnels on C4 Vertebra Under Physical Compressive Load Under Flexion Movement: A Finite Element Analysis.

BACKGROUND: Anterior percutaneous endoscopic transcorporeal cervical discectomy is an alternative operation for cervical disc herniation. However, few reports have evaluated the biomechanical influence of tunnels on vertebrae. We compared biomechanical distinctions between intact and tunneled models of vertebrae to analyze the safety of anterior percutaneous endoscopic transcorporeal cervical discectomy based on a C2-T1 finite element (FE) model. METHODS: Groups of C2-T1 FE models were simulated with C4 tunneled by 2 methods (group A: with partial superior endplate excision; group B: without partial superior endplate excision) and various tunnel diameters (6, 8, and 10 mm). All FE models were loaded under a 1-Nm flexion moment. RESULTS: The area and maximum of stress concentrations were correlated with tunnel diameter. The distribution of stress on C4 superior endplates showed no significant difference between B6 and the intact model (P > 0.05), but significant differences with other tunneled models (P < 0.001). Maximum stress on the lateral wall of tunnels was positively correlated with tunnel diameter and induced high risks of cancellous bone fracture for diameters reaching 10 mm in group B and 8 mm in group A. CONCLUSIONS: Transcorporeal tunnel in C4 vertebrae without endplate excision should be limited with diameter of 6 mm, and a tunnel diameter >10 mm, excision of the endplate >8 mm, and excision of the center side of the endplate should also be avoided.