Transforaminal Endoscopic Discectomy Combined With an Interspinous Process Distraction System for Spinal Stenosis.

BACKGROUND: The combination of the percutaneous transforaminal endoscopic decompression (PTED) with an interspinous process distraction system (IPS) may offer additional benefit in the treatment of spinal stenosis in patients who have failed nonsurgical treatment. METHODS: We retrospectively reviewed the medical records of 33 patients diagnosed with lumbar stenosis and radiculopathy and treated them with transforaminal endoscopic lumbar decompression between 2013 and 2017. Primary outcome measures were modified Macnab as well as preoperative and postoperative visual analog scale (VAS) criteria and the Oswestry Disability Index (ODI). Only patients with a minimum follow-up of 2 years were included. RESULTS: A total of 28 patients were treated with a combination of PTED and percutaneous IPS (group A), and 5 patients were treated with PTED and mini-open IPS (group B). In group A patients, there was a 4.48 reduction in the VAS score. The ODI changed from 50.25 preoperatively to 18.2 postoperatively, and excellent and good Macnab outcomes were obtained in 78% of patients. In group B patients, the mean VAS reduction was 5.2 points. The ODI changed from 44.34 preoperatively to 14.62 postoperatively, and 80% of group B patients achieved excellent and good Macnab outcomes. No complications related to PTED or IPS were observed throughout the 2-year follow-up. CONCLUSIONS: The addition of IPS to the PTED procedure in select patients may offer additional benefits to patients being treated for lumbar lateral stenosis and foraminal stenosis with low-grade spondylolisthesis. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: Feasibility study.

Surgical treatment of cervical radiculopathy using an anterior cervical endoscopic decompression.

BACKGROUND: Anterior endoscopic cervical decompression with discectomy and foraminotomy is an alternative to open surgical treatment of unrelenting cervical radiculopathy (CR) in patients who have failed non-operative treatment. The purpose of the study is to present the clinical outcomes of patient with CR treated with an anterior endoscopic approach. METHODS: We reviewed the medical records of 293 patients diagnosed with CR and treated with an anterior endoscopic cervical decompression between 1997 and 2018. Primary outcome measures were modified Macnab as well as pre- and postoperative visual analog scale (VAS) criteria. RESULTS: The average surgical time was 65 minutes. At 12 months follow-up, Excellent and Good Macnab outcomes were achieved in 90.1% of patients. The average VAS score reduction was 5.6. Complications occurred in 8 patients and were treated with a second procedure in 10 patients. CONCLUSIONS: The anterior endoscopic cervical decompression is an attractive alternative to open anterior cervical discectomy and fusion (ACDF) with a low complication and reoperations rate.

Surgeon training and clinical implementation of spinal endoscopy in routine practice: results of a global survey.

BACKGROUND: Training of spine surgeons may impact the availability of contemporary minimally invasive spinal surgery (MIS) to patients and drive spine surgeons' clinical decision-making when applying minimally invasive spinal surgery techniques (MISST) to the treatment of common degenerative conditions of the lumbar spine. Training requirements and implementation of privileges vary in different parts of the world. The purpose of this study was to analyze the training in relation to practice patterns of surgeons who perform lumbar endoscopic spinal surgery the world over. METHODS: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Surgeons were asked the following questions: (I) please indicate your training? (II) What type of MISST spinal surgery do you perform? (III) How would you rate your experience in MIS lumbar spinal surgery and what percentage of your practice is MISST? And (IV) which avenue did you use to train for the MISST you currently employ in your clinical practice today? Descriptive statistics were applied to count responses and cross-tabulated them to the surgeon's training. Pearson Chi-square measures, kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances using statistical package SPSS version 25.0. RESULTS: A total of 430 surgeons accessed the survey. The completion rate was 67.4%. Analyzing the responses of 292 surveys submitted by 97 neurosurgeons (33.2%), 161 orthopaedic surgeons (55.1%), and 34 surgeons of other postgraduate training (11.6%) showed that only 14% (41/292) of surgeons had completed a fellowship. Surgeons rated their skill level 33.5% of the time as master and experienced surgeon, and 35.6% of the time as novice or surgeon with some experience. There were more master (64.6% versus 29.2%) and experienced (52% versus 40%) surgeons amongst orthopaedic surgeons than amongst neurosurgeons at a statistically significant level (P=0.11). There were near twice as many orthopaedic surgeons (54.3%) using endoscopic procedures in the lumbar spine as their favorite MISST than neurosurgeons (35.4%; P=0.096). Endoscopic spine surgeons' main sources of knowledge acquisition were (I) learning in small meetings (57.3%), (II) attending workshops (63.1%), and (III) national and international conferences (59.8%). CONCLUSIONS: The majority of spine surgeons reported more than half of their cases employing MISST at a high skill level. Very few MISST surgeons are fellowship trained but attend workshops and various meetings suggesting that many of them are self-thought. Orthopaedic surgeons were more likely to implement endoscopic spinal surgery into the routine clinical practice. As endoscopic spine surgery gains more traction and patient demand, minimal adequate training will be part of the ongoing debate.

Surgeon motivation, and obstacles to the implementation of minimally invasive spinal surgery techniques.

BACKGROUND: This study aimed to analyze the motivators and obstacles to the implementation of minimally invasive spinal surgery techniques (MISST) by spinal surgeons. Motivators and detractors may impact the availability of MISST to patients and drive spine surgeons' clinical decision-making in the treatment of common degenerative conditions of the lumbar spine. METHODS: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Descriptive statistics were employed to count the responses and compared to the surgeon's training. Kappa statistics and linear regression analysis of agreement were performed. RESULTS: A total of 430 surgeons accessed the survey. The completion rate was 67.4%. A total of 292 surveys were submitted by 99 neurosurgeons (33.9%), 170 orthopaedic surgeons (58.2%), and 23 surgeons of other postgraduate training (7.9%). Personal interest (82.5%) and patient demand (48.6%) were the primary motivators for MISST implementation. High equipment (48.3%) and disposables (29.1%) cost were relevant obstacles to MISST implementation. Local workshops (47.6%) and meetings in small groups (31.8%) were listed as the primary knowledge sources. Only 12% of surgeons were fellowship trained, but 46.3% of surgeons employed MISST in over 25% of their cases. CONCLUSIONS: The rate of implementation of MISST reported by spine surgeons was found to be high but impeded by the high cost of equipment and disposables. The primary motivators for spine surgeons' desire to implement were personal interest and patient demand.

Regional variations in acceptance, and utilization of minimally invasive spinal surgery techniques among spine surgeons: results of a global survey.

BACKGROUND: Regional differences in acceptance and utilization of MISST by spine surgeons may have an impact on clinical decision-making and the surgical treatment of common degenerative conditions of the lumbar spine. The purpose of this study was to analyze the acceptance and utilization of various minimally invasive spinal surgery techniques (MISST) by spinal surgeons the world over. METHODS: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Surgeons were asked the following questions: (I) Do you think minimally invasive spinal surgery is considered mainstream in your area and practice setting? (II) Do you perform minimally invasive spinal surgery? (III) What type of MIS spinal surgery do you perform? (IV) If you are performing endoscopic spinal decompression surgeries, which approach do you prefer? The responses were cross-tabulated by surgeons' demographic data, and their practice area using the following five global regions: Africa & Middle East, Asia, Europe, North America, and South America. Pearson Chi-Square measures, Kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances using statistical package SPSS Version 25.0. RESULTS: A total of 586 surgeons accessed the survey. Analyzing the responses of 292 submitted surveys regional differences in opinion amongst spine surgeons showed that the highest percentage of surgeons in Asia (72.8%) and South America (70.2%) thought that MISST was accepted into mainstream spinal surgery in their practice area (P=0.04) versus North America (62.8%), Europe (52.8%), and Africa & Middle East region (50%). The percentage of spine surgeons employing MISST was much higher per region than the rate of surgeons who thought it was mainstream: Asia (96.7%), Europe (88.9%), South America (88.9%), and Africa & Middle East (87.5%). Surgeons in North America reported the lowest rate of MISST implementation globally (P<0.000). Spinal endoscopy (59.9%) is currently the most commonly employed MISST globally followed by mini-open approaches (55.1%), and tubular retractor systems (41.8%). The most preferred endoscopic approach to the spine is the transforaminal technique (56.2%) followed by interlaminar (41.8%), full endoscopic (35.3%), and over the top MISST (13.7%). CONCLUSIONS: The rate of implementation of MISST into day-to-day clinical practice reported by spine surgeons was universally higher than the perceived acceptance rates of MISST into the mainstream by their peers in their practice area. The survey suggests that endoscopic spinal surgery is now the most commonly performed MISST.

Standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a threaded cylindrical peek cage: report of two cases.

We report two cases of a standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a stress-neutral non-expandable cylindrical threaded polyether ether ketone (PEEK) interbody fusion implant. Patients underwent full-endoscopic transforaminal decompression and fusion for symptomatic lateral recess stenosis due to disc herniation, and hypertrophy of the facet joint complex and ligamentum flavum and no more than grade I spondylolisthesis. Lumbar interbody fusion with cages traditionally calls for posterior supplemental fixation with pedicle screws for added stability. A more simplified version of lumbar decompression and fusion without pedicle screws would allow treating patients suffering from stenosis and instability induced sciatica-type low back and leg pain in an outpatient ambulatory surgery center setting (ASC). This would realize a significant reduction in cost as well as the burden to the patient with decreased postoperative pain and earlier return to function. A 62-year-old female patient had surgery at L4/5 for a 6-year history of worsening right sided sciatica-type leg- and low back pain. Another 79-year-old female had the same surgical management at L4/5 for a 5-year history of unrelenting left-sided spondylolisthesis-related symptoms. Both patients had an uneventful postoperative course until the last available follow-up of 24 weeks with greater than 60% VAS and Oswestry disability index (ODI) reductions. There was no evidence of implant expulsion, subsidence, or postoperative instability. We concluded that standalone outpatient lumbar transforaminal endoscopic interbody fusion with a non-expandable threaded cylindrical cage is feasible, and favorable clinical outcomes provide proof of concept to study long-term clinical outcomes in larger groups of patients.

Abordaje interlaminar complementamente endoscópico para hernias centrales extruidas y migradas en L5­S1. Serie de casos / Full-endoscopic interlaminar approach for L5- S1 extruded and migrated central hernias. Case series study

Introducción La cirugía endoscópica de columna ha demostrado ser una opción en el tratamiento de hernias discal y estenosis foraminal. El abordaje más empleado es la vía transforaminal, sin embargo, este abordaje es limitado en casos de hernias discales centrales extruidas y migradas. El abordaje interlaminar completamente endoscópico ha permitido el tratamiento sintomático de hernias discales centrales extruidas y migradas en el nivel L5 ­ S1, además es una novedosa alternativa para la resolución de las dificultades técnicas relacionadas con el abordaje posterolateral en éste nivel. El propósito del estudio es reportar los resultados obtenidos con el abordaje endoscópica interlaminar en el tratamiento de hernias discales centrales extruidas y migradas en dos años de seguimiento. Materiales y métodos Se realizó un estudio retrospectivo observacional descriptivo con las historias de pacientes que presentaron sintomatología radicular secundaria a hernia discal central en el nivel L5 ­ S1 y que fueron tratados con cirugía por abordaje interlaminar completamente endoscópico. Se evaluaron los índices de escala visual análoga (EVA) pre y posoperatorio, el criterio Oswestry ODI y el criterio MacNab. Resultados Entre los años 2008 y 2015 se realizaron un total de 99 procedimientos en el mismo número de pacientes. Todos fueron sometidos a una técnica quirúrgica estándar bajo anestesia local y sedación. La EVA tuvo una reducción de 5,81 puntos. El ODI bajó 45,63%. Y el 88% de los pacientes tuvo una completa satisfacción frente al tratamiento. Discusión Los resultados obtenidos en esta muestra permiten considerar la fragmentectomía interlaminar endoscópica bajo anestesia local y sedación como un procedimiento seguro, preciso y efectivo en la resolución del dolor secundario a hernias discales centrales extruidas y migradas en el nivel L5 ­ S1 que cursan con radiculopatía. El uso de anestesia local y sedación como única alternativa analgésica puede no ser la mejor opción en este tipo de técnicas Nivel de evidencia IV

Background Endoscopic spine surgery has shown to be an option for disc hernias and foraminal stenosis. Although the most used approach is transforaminal, this approach is limited in cases of extruded and migrated central hernias. The full-endoscopic interlaminar approach has led to the treatment of the lumbar pain secondary to extruded and migrated central herniated discs at L5 - S1, and is an alternative for resolving technical difficulties related to the transforaminal approach at this level. The aim of this article is to report the results obtained with a full-endoscopic interlaminar approach for the treatment of central extruded and migrated herniated discs, with a two-year follow-up. Methods A descriptive observational retrospective study was conducted using the records of patients who had a radiculopathy secondary to a central herniated disc at level L5 - S1, and who were treated with a full-endoscopic interlaminar approach. An evaluation was made of the pre-operative and post-operative visual analogue scale (VAS) scores, Oswestry ODI criteria, and MacNab criteria. Results A total of 99 procedures were performed in the same number of patients between 2008 and 2015. All were treated with a standard surgical technique and under local anaesthesia and sedation. The visual analogue score showed a reduction of 5.81 points. The ODI was down 45.63%, and 88% of the patients were completely satisfied with the treatment. Discussion The results lead us to consider that full-endoscopic interlaminar fragmentectomy under local anaesthesia and sedation is a safe, accurate, and effective procedure for the treatment of radiculopathy related to L5 - S1 extruded and migrated central hernia. Use of local anaesthesia and sedation as the only analgesic alternative may not be the best option in this type of technique. Evidence Level IV

Guía de instrucción en habilidades para cirugía artroscópica / Instruction guide: basic skill training for arthroscopic surgery

La evolución de las técnicas quirúrgicas tradicionales y los modelos de formación de los cirujanos exigen cambios, por esta razón el centro de investigación y entrenamiento en cirugía de mínima invasión (CLEMI) ha desarrollado y aplicado modelos de enseñanza que permiten aprender técnicas quirúrgicas mínimamente invasivas como la artroscopia. CLEMI propone un modelo basado en simulación impartido en un ambiente controlado, estructurado y progresivo que vaya al ritmo individual de cada uno de los estudiantes. Inicialmente el estudiante encontrará conceptos teóricos de instrumental, equipos y ergonomía, posteriormente en la fase práctica usando un modelo de laparoscopia y finalmente usando un modelo de artroscopia con los que se realizan ejercicios para desarrollar destrezas técnicas. El entrenamiento en modelos bajo ambiente controlado disminuye el período de aprendizaje y eleva la competencia del estudiante. El objetivo principal del curso es alcanzar las habilidades mínimas necesarias para realizar con éxito una artroscopia en el paciente.

The evolution of traditional surgical techniques and training models for surgeons demand changes. For this reason, the Latin-American Centre for training in minimally invasive surgery (CLEMI) has developed and applied teaching models that allow surgeons to learn minimally invasive surgical techniques such as arthroscopy. CLEMI proposes a model based on simulation presented in a controlled, structured, and progressive environment that advances with the individual rhythm of each of the students. Initially, the student uses theoretical instrumental, equipment and ergonomics concepts. Later, in the practical phase, they then carry out exercises using a laparoscopy model and finally an arthroscopy model in order to develop their technical skills.

Guía de instrucción en artroscopia de rodilla nivel intermedio / Instruction guide in knee arthroscopy: Intermediate level

La evolución de las técnicas quirúrgicas tradicionales y los modelos de formación de los cirujanos exigen cambios, por esta razón el centro de investigación y entrenamiento en cirugía de mínima invasión (CLEMI) ha desarrollado y aplicado modelos de enseñanza que permiten entrenar técnicas quirúrgicas mínimamente invasivas como la artroscopia de rodilla. CLEMI propone un modelo basado en simulación impartido en un ambiente controlado, estructurado y progresivo que vaya al ritmo individual de cada uno de los estudiantes. Inicialmente el estudiante encontrará conceptos teóricos de instrumental, equipos y ergonomía, posteriormente en la fase práctica usando un modelo sintético anatómico de la rodilla y finalmente usando un modelo biológico con el que se realizan ejercicios para desarrollar destrezas exigidas por las técnicas quirúrgicas. El entrenamiento en modelos bajo ambiente controlado disminuye el período de aprendizaje y eleva la competencia del estudiante.

Changes are needed due to the evolution of traditional surgical techniques and surgeon training models. For this reason the minimally invasive surgery research and training centre (CLEMI) has developed and applied teaching models to help in the training of minimally invasive surgical techniques, such as knee arthroscopy. CLEMI proposes a model based on simulation taught in a controlled, structured, and progressive environment that is tailored to the individual rhythm of each of the students. Initially, the student will encounter theoretical concepts of instruments, equipment and, ergonomics. Later, in the practical phase, an anatomical synthetic model of the knee will be used in the practical phase, followed by a biological model in order to perform exercises to develop the skills required for the surgical techniques. Training in models under a controlled environment decreases the learning period and increases student skills.

Multispecialty and multilanguage training in spine surgery: A Latin-American experience / Entrenamiento en cirugía de columna en diferentes idiomas y especialidades. Experiencia latinoamericana

OBJECTIVE: To report the experience of minimally invasive spine surgery (MISS) training course in different languages and specialties for Latin American spine surgeons, and on their level of satisfaction with the curriculum. METHODS: A total of 29 hands-on training workshops were conducted over a period of 6 years, on using a MISS technique for degenerative disk disease. The participants completed two questionnaires aimed at evaluating the activities including the methodology, objectives, suitability of facilities, and instruments provided, as well as general satisfaction. Statistical analysis was performed using R 3.1.1 for Windows. Demographic and descriptive statistics were employed. RESULTS: A total of 366 specialists took part and included neurosurgeons, orthopaedists, and anaesthesiologists. The questionnaire was answered by 249 medical doctors from 12 Latin American countries, 98% of which professed to be satisfied with the training activity. CONCLUSIONS: The use of educational tools, such as surgical simulators contributes to the new learning process techniques and adds confidence to the surgeons. The implementation of workshops conducted using strict planning leads to a high level of satisfaction among the participants, thus minimizing the differences between specialties or languages

OBJETIVO: Presentar la experiencia lograda en el entrenamiento en técnicas mínimamente invasivas de columna para cirujanos de toda Latinoamérica con diferentes especialidades e idiomas, y reportar el grado de satisfacción con el currículo implementado. MÉTODOS: Se realizaron un total de 29 entrenamientos durante 6 años en una técnica mínimamente invasiva de columna para el tratamiento de discopatía degenerativa. Los participantes respondieron 2 encuestas con el fin de evaluar el contenido curricular general de la actividad de entrenamiento. Se analizaron las encuestas empleando el programa R 3.1.1 para Windows. RESULTADOS: Un total de 366 especialistas realizaron el entrenamiento. Las especialidades entre los participantes fueron: neurocirujanos, ortopedas y anestesiólogos. Las encuestas fueron contestadas por un total de 249 médicos de 12 países de América Latina. El 98% de los encuestados avaló el modelo educativo y el currículo en general. CONCLUSIONES: El uso de herramientas educativas, como la simulación quirúrgica, contribuye a los procesos de entrenamiento de nuevas técnicas quirúrgicas y permite a los cirujanos lograr confianza para el momento en que tengan que realizarlas. La implementación de talleres de entrenamiento conducidos bajo un plan curricular permite un alto grado de satisfacción en los participantes, y minimiza las diferencias entre especialidades e idiomas

Desarrollo de un simulador de bajo costo para la adquisición de destrezas básicas en cirugía artroscópica / Development of a low-cost simulator to acquire basic arthroscopic skills

Introducción: El propósito del estudio fue desarrollar, bajo parámetros de expertos y evaluación de idoneidad por el usuario final, un simulador mecánico de bajo costo, que permita desarrollar destrezas básicas, pero fundamentales, en el aprendizaje de la artroscopia. Materiales y Métodos: El trabajo se dividió en tres fases; en la primera, se encuestaron expertos y se establecieron criterios para el desarrollo del simulador artroscópico. Luego, se desarrolló el prototipo del simulador usando, además de los criterios mencionados, las características del instrumental y los objetivos de cada ejercicio planteado. Por último, se llevaron a cabo pruebas, usando el simulador final, con ortopedistas que realizaron el entrenamiento. Resultados: Se obtuvieron algunos criterios de importancia para el desarrollo del simulador, que se emplearon en el desarrollo del modelo final, cuyo costo estuvo por debajo de los 300 dólares estadounidenses. En cuanto a la aplicación práctica, se obtuvo una satisfacción del 100% y una idoneidad del 97,4% por parte de los ortopedistas que realizaron el entrenamiento. Conclusiones: Desarrollar procesos de entrenamiento es una labor fundamental de los centros de aprendizaje quirúrgico. El simulador ArtroCLEMI II probó ser una herramienta útil en el desarrollo de destrezas básicas de artroscopia, con costos mínimos y alta versatilidad. Es necesario fortalecer los procesos curriculares aplicados a las curvas de aprendizaje quirúrgico.

Background: The purpose of the study was to develop, within the parameters of experts and specialists, the suitability of a low cost mechanical simulator, which allows developing basic arthroscopy skills. Methods: The methodology was divided into three phases; in the first one, experts were surveyed and criteria were established in the development of an arthroscopic simulator. After that, we developed the prototype of the simulator using, in addition to the above criteria, instrumental characteristics and objectives of each exercise. Finally, tests were performed with orthopedic surgeons using the final simulator. Results: We obtained some important criteria in the development of the simulator, which were used to develop the final model. The cost was less than US$300. In terms of practical application, the rate of satisfaction was 100% and that of suitability was 97.4% according to the orthopedists who conducted the training. Conclusions: To develop training processes is a fundamental task of surgical learning centers. The ArtroCLEMI II simulator proved to be a useful tool in the development of basic skills in arthroscopy with minimal costs and high versatility. It is necessary to strengthen curriculum processes applied to surgical learning curves.

Desarrollo de un simulador de bajo costo para la adquisición de destrezas básicas en cirugía artroscópica / Development of a low-cost simulator to acquire basic arthroscopic skills

Introducción: El propósito del estudio fue desarrollar, bajo parámetros de expertos y evaluación de idoneidad por el usuario final, un simulador mecánico de bajo costo, que permita desarrollar destrezas básicas, pero fundamentales, en el aprendizaje de la artroscopia. Materiales y Métodos: El trabajo se dividió en tres fases; en la primera, se encuestaron expertos y se establecieron criterios para el desarrollo del simulador artroscópico. Luego, se desarrolló el prototipo del simulador usando, además de los criterios mencionados, las características del instrumental y los objetivos de cada ejercicio planteado. Por último, se llevaron a cabo pruebas, usando el simulador final, con ortopedistas que realizaron el entrenamiento. Resultados: Se obtuvieron algunos criterios de importancia para el desarrollo del simulador, que se emplearon en el desarrollo del modelo final, cuyo costo estuvo por debajo de los 300 dólares estadounidenses. En cuanto a la aplicación práctica, se obtuvo una satisfacción del 100% y una idoneidad del 97,4% por parte de los ortopedistas que realizaron el entrenamiento. Conclusiones: Desarrollar procesos de entrenamiento es una labor fundamental de los centros de aprendizaje quirúrgico. El simulador ArtroCLEMI II probó ser una herramienta útil en el desarrollo de destrezas básicas de artroscopia, con costos mínimos y alta versatilidad. Es necesario fortalecer los procesos curriculares aplicados a las curvas de aprendizaje quirúrgico.(AU)

Background: The purpose of the study was to develop, within the parameters of experts and specialists, the suitability of a low cost mechanical simulator, which allows developing basic arthroscopy skills. Methods: The methodology was divided into three phases; in the first one, experts were surveyed and criteria were established in the development of an arthroscopic simulator. After that, we developed the prototype of the simulator using, in addition to the above criteria, instrumental characteristics and objectives of each exercise. Finally, tests were performed with orthopedic surgeons using the final simulator. Results: We obtained some important criteria in the development of the simulator, which were used to develop the final model. The cost was less than US$300. In terms of practical application, the rate of satisfaction was 100% and that of suitability was 97.4% according to the orthopedists who conducted the training. Conclusions: To develop training processes is a fundamental task of surgical learning centers. The ArtroCLEMI II simulator proved to be a useful tool in the development of basic skills in arthroscopy with minimal costs and high versatility. It is necessary to strengthen curriculum processes applied to surgical learning curves.(AU)

Discectomía percutánea dorsolateral para el tratamiento de la hernia discal hansen tipo II en los segmentos T11 a L6 en perros: Estudio en cadáveres / Dorsolateral percutaneous discectomy for the treatment of the hansen type II herniated disc of the T11-L6 segments in dogs: A study on cadavers

El propósito de este estudio fue describir un abordaje quirúrgico para una discectomía percutánea en los discos intervertebrales de los niveles T11-L6 en cadáveres de perros. El abordaje se realizó por vía percutánea dorsolateral, guiado por fluoroscopio, en los niveles T11 a L6 en seis cadáveres frescos de caninos adultos sanos de diferentes razas. Se les practicó una discectomía mecánica con pinzas sacabocados de 2 mm y discectomía térmica con radiofrecuencia por abordaje mínimamente invasivo. El abordaje percutáneo y la discectomía fueron posibles en el 96% de las muestras. La distancia promedio de ingreso de la aguja con respecto a la línea media fue de 4,3 (± 1,276 cm). El promedio de angulación fue de 50,1 ± 14,785 grados, con respecto al plano horizontal. La cantidad de material discal retirada fue de aproximadamente 10 mm y la implementación de todo el procedimiento dejó una herida de 4 mm. Se demostró que el abordaje percutáneo dorsolateral en perros hace posible acceder directamente al disco intervertebral a través de un procedimiento mínimamente invasivo. La discectomía percutánea podría ser una alternativa de descompresión en pacientes con patología degenerativa discal y hernias protruidas en el segmento toracolumbar. Se hace necesario realizar un estudio clínico para evaluar la eficacia de este procedimiento.

The purpose of this study was to describe surgical approach for a percutaneous discectomy of the T11-L6 intervertebral discs in canine cadavers. A percutaneous dorsolateral approach, guided by fluoroscopy, at the level of the T11 to L6 intervertebral discs in six healthy adult fresh canine cadavers of different breeds was performed. A minimally invasive mechanical percutaneous discectomy with a 2-mm forceps and a thermal discectomy with radiofrequency, were carried out. Both the percutaneous approach and the discectomy were possible in 96% of the samples. The average distance of needle penetration with respect to the midline was 4.3 ± 1276 cm. With respect to the horizontal plane, the mean angle was 50.1 ± 14785 degrees. The amount of disc material removed was approximately 10 mm, and the implementation of the entire procedure left a 4 mm wound. It was demostrated that the dorsolateral percutaneous approach in dogs enables a direct access to the intervertebral disk through a minimally invasive procedure. Percutaneous discectomy could be an alternative for decompression in patients with degenerative disc pathologies and protruded hernias in the thoracolumbar segment. It is deemed clinical studies to evaluate the efficacy of this procedure.

Prevalencia de dolor osteomuscular en cirujanos artroscopistas y su relación con el entrenamiento en ergonomía y las posturas adecuadas / Ergonomy related pain in arthroscopist surgeons

Introducción: la cirugía artroscópica presenta algunos inconvenientes derivados en gran medida de la manipulación de una variedad de instrumentos mediante maniobras más o menos complicadas con visualización de la imagen a través de un monitor. Los equipos biomédicos en general están diseñados desde la perspectiva de seguridad y comodidad para el paciente y pocas veces contemplan aspectos relacionados con la ergonomía de los cirujanos. Por tal motivo, se diseñó un estudio encaminado a establecer la prevalencia de dolor osteomuscular en cirujanos ortopedistas que realizan artroscopia. Materiales y métodos: se realizó una encuesta a 180 cirujanos artroscopistas nacionales e internacionales durante el Congreso Internacional de Artroscopia de la Sociedad Colombiana de Cirugía Ortopédica y Traumatología (SCCOT) en el año 2008. Se analizaron con estadística descriptiva únicamente las encuestas completamente diligenciadas (174 encuestas). Resultados: el 65 % de los ortopedistas reportaron dolor osteomuscular de predominio en columna cervical y dorsolumbar presente antes de iniciar una jornada quirúrgica y el 74,7 % al terminar la jornada quirúrgica. El 33 % de los encuestados presentan algún síndrome crónico de origen osteomuscular secundario a su actividad laboral. Discusión: el entrenamiento en ergonomía podría reducir la prevalencia de la sintomatología perioperatoria del cirujano hasta en un 12%, lo cual puede ser clínicamente importante y justificaría plenamente el entrenamiento. Los cirujanos artroscopistas aquejan dolor pre y posoperatorio principalmente en columna y hombro.

Anatomía quirúrgica del abordaje cervical anterior en la oveja / Surgical anatomy of sheep cervical anterior approach

Introducción: a pesar de que la columna vertebral de la oveja ha sido ampliamente utilizada como modelo experimental en el desarrollo de técnicas quirúrgicas aplicables en medicina humana, aún no se ha descrito la anatomía específica de la región anterior del cuello de la oveja, importante para el abordaje cervical anterior utilizado en la cirugía de mínima invasión en columna. El propósito de este trabajo es describir la anatomía de la región anterior del cuello de la oveja identificando la posición y las relaciones de las estructuras de importancia para el cirujano en el abordaje cervical anterior. Materiales y métodos: se realizó un estudio descriptivo exploratorio en 5 cadáveres de ovejas. Se disecó la región anterior de los cuellos y se midieron los diámetros y posición de las arterias carótidas, el esófago, la tráquea y las venas yugulares con respecto a la línea media del cuerpo vertebral y se estudió la disposición de los músculos anteriores al cuerpo vertebral en cada uno de los niveles cervicales. Resultados: la posición promedio para todos los segmentos en conjunto con respecto a la línea media de la arteria carótida fue de 23,0 mm (SD 6,477) y de la yugular, de 34,6 mm (SD 11,066). El diámetro promedio de la carótida fue de 5,5 mm (SD 1,192) mientras que el de la yugular fue de 9,4 mm (SD 4,394). No se encontraron diferencias significativas entre segmentos para ninguna de las dos estructuras. La altura del espacio intervertebral en el borde ventral fue en promedio de 5,6 mm (SD 2,01). Discusión: el cuello de la oveja ha sido parcialmente estudiado y aún persisten interrogantes frente a la posibilidad de utilizarlo como modelo para ciertas técnicas quirúrgicas. El presente estudio logró determinar la viabilidad del modelo experimental específicamente en sus segmentos C3-C4, C4-C5 y C5-C6 para técnicas cervicales anteriores de columna.