Transforaminal Endoscopic Solution to a Kyphoplasty Complication: Technical Note

Percutaneous endoscopic translaminar approach in a patient with pedicle screw malposition and cement leakage

We present a 79-year-old female patient who had L2-5 dynamic stabilization with cement (Polymethylmethacrylate) injection 6 weeks prior. Due to post-operative right radicular pain, a lumbar CT was scheduled in which a malposition of the right L4 screw and cement leakage was observed. Via a percutaneous translaminar endoscopic approach the leaked cement was removed and the portion of the screw in contact with the nerve root was drilled. With this minimal-invasive procedure, the patient was relieved of her radicular pain.

Novel Polyethylene Terephthalate Screw Sleeve Implant: Salvage Treatment in a Case of Spine Instability after Vertebroplasty Failure

INTRODUCTION

The management of osteoporotic fractures is sometimes rather challenging for spinal surgeons, and considering the longer life expectancy induced by improved living conditions, their prevalence is expected to increase. At present, the approaches to osteoporotic fractures differ depending on their severity, location, and the patient's age. State-of-the-art treatments range from vertebroplasty/kyphoplasty to hardware-based spinal stabilization in which screw augmentation with cement is the gold standard.

CASE PRESENTATION

We describe the case of a 74-year-old man with an L5 osteoporotic fracture. The patient underwent a vertebroplasty (VP) procedure, which was complicated by a symptomatic cement leakage in the right L4-L5 neuroforamen. We urgently decompressed the affected pedicle via hemilaminectomy. At that point, the column required stability. The extravasation of cement had ruled out the use of cement-augmented pedicle screws but leaving the pedicular screws alone was not considered sufficient to achieve stability. We decided to cover the screws with a polyethylene terephthalate sleeve (OGmend^®) to avoid additional cement leakage and to reinforce the screw strength required by the poor bone quality.

CONCLUSION

In the evolving technologies used for spinal surgery, screws sleeve implants such as OGmend^® are a useful addition to the surgeon's armamentarium when an increased pull-out strength is required and other options are not available.

A modified trajectory of kyphoplasty via superior pedicle notch for osteoporotic vertebral compression fractures: Technique note and clinical result

Background

Percutaneous extra-pedicular kyphoplasty can achieve better clinical results than transpedicular kyphoplasty. However, lumbar segment artery injury as a disaster complication limits its clinical application.

Objective

To describe and evaluate a modified trajectory of kyphoplasty for the treatment of osteoporotic vertebral compression fractures (OVCF).

Methods

Eighty-one patients who underwent percutaneous kyphoplasty (PKP) for lumbar OVCF at our hospital between May 2017 and May 2021 were enrolled. The patients were divided into an observation group (via the superior pedicle approach) and a control group (via the transpedicular approach) according to the surgical trajectory. The surgical procedure was described in detail, and the imaging parameters were recorded. Preoperative and postoperative clinical data were collected for statistical analysis.

Results

PKP via the superior pedicle notch approach could offer large abduction and cranial inclination angles without serious complications. The rate of paravertebral leakage was significantly lower in the observation group than in the control group. Surgery with a superior pedicle notch approach had a shorter operative time and fewer fluoroscopies.

Conclusions

PKP via the superior pedicle notch approach is a modified extra-pedicular approach for lumbar osteoporotic vertebral compression fractures. This trajectory is an easy-to-use target position because it enters the vertebral body directly. A shorter operative time and lower radiation exposure can enhance recovery after surgery.

Case Report: Full-Endoscopic Surgery for Bullet Wounds of the Spine: A Report of Three Cases

Objectives

To determine the feasibility and evaluate effectiveness of full-endoscopic surgery in gunshot wound of the spine.

Methods

Three clinical cases of lumbar and thoracic spine bullet wounds made by firearms and traumatic weapons are described. Percutaneous endoscopic surgery was performed to extract bullet from the spinal canal. The results are compared to the data from literature.

Results

Percutaneous endoscopic approach to spinal canal with a possibility to extract a bullet, decompression of nerve roots, defect closure of the dura mater is demonstrated.

Conclusion

Good clinical outcomes allows to recommend percutaneous endoscopic surgery to manage similar lumbar and thoracic spine bullet wounds at the tertiary care level.

Delayed neurological deficits caused by cement extravasation following vertebroplasty: a case report

Delayed neurological deficits secondary to percutaneous vertebroplasty caused by cement leakage is a rare condition. Although cement extravasation during percutaneous vertebroplasty is not uncommon, most cases are clinically asymptomatic, and symptomatic cement extravasation that requires surgical excision is rarely reported. Herein, a case of L4 radiculopathy secondary to cement leakage is reported that involved the delayed onset of neurological symptoms. The patient was treated using a minimally invasive transforaminal endoscopic approach. The clinical and imaging findings and treatment methods are discussed.

Full-endoscopic spine surgery for radiculopathy after osteoporotic vertebral compression fractures: a case report

Full-endoscopic spine surgery (FESS) is a suitable treatment for lumbar disc herniation (LDH) and foraminal stenosis. Here, we describe the usefulness of FESS for treating radiculopathy after osteoporotic vertebral compression fractures (OVCFs). Between October 2018 and April 2019, three female patients (mean age, 81.7 years) with radiculopathy after OVCFs underwent FESS. Decompression of the corresponding nerve root was achieved using several FESS techniques, including foraminoplasty, discectomy, and removal of osteophyte or cement leakage. The mean operative time was 60.7 min. Preoperative and postoperative statuses were evaluated using numerical rating scale (NRS) scores. The mean pre- and postoperative NRS scores were 9 and 2.3, respectively. We observed no postoperative complications. Our results demonstrate that FESS is a safe and effective minimally invasive treatment for radiculopathy after OVCFs, with the potential to be an alternative to vertebroplasty, balloon kyphoplasty (BKP), or lumbar interbody fusion.

An endoscopic surgical technique for treating radiculopathy secondary to S1 nerve compression from a pedicle screw: technical note

Pedicle screw instrumentation is a widely used technique for fixating the spine in fusion surgery. One of the complications associated with pedicle screw placement is when a screw breaches the pedicle medially and causes the patient radicular pain or numbness or weakness. Revising a breached pedicle screw in a patient who has undergone a multilevel fusion surgery often requires that the patient undergo a very invasive revision surgical procedure. Here the authors present a technical note on decompressing an S1 nerve compressed by a breached pedicle screw by performing an endoscopic surgical approach through a 1-cm incision and drilling down the threads of the pedicle screw, directly decompressing the nerve without removing the screw.

Endoscopic Surgical Technique for Treating Sacral Radiculopathy Secondary to S1 Nerve Compression After Minimally Invasive Sacroiliac Joint Fusion: Technical Note

BACKGROUND

Sacroiliac (SI) joint fusion is considered for the treatment of degenerative sacroiliitis. The procedure has increased in popularity for patients who have exhausted less invasive treatment options since the development of percutaneous SI joint fusion systems. One possible complication of the procedure is a sacral radiculopathy that can result from compression of the S1 nerve by the SI joint fusion implant. Others have described revising the implant by removing it and replacing it with a shorter implant.

METHODS

Here we describe a minimally invasive endoscopic S1 nerve root decompression that does not require removing or revising the SI fusion implant.

RESULTS

The postoperative course was uneventful, and the patient's radicular pain improved immediately after surgery. Six months after his endoscopic procedure, the patient had no clinical symptoms related to the S1 nerve root compression and was symptomatically improved from her sacroiliac pain.

CONCLUSIONS

This technical note is for others to consider as a possible minimally invasive solution for the treatment of lumbar radiculopathy after a minimally invasive SI joint fusion procedure.

Guided Punctures with Ultrasound Volume Navigation in Percutaneous Transforaminal Endoscopic Discectomy: A Technical Note

OBJECTIVE

Ultrasound volume navigation (UVN) has been widely used for accurate guidance and decreased radiation exposure. However, few studies have focused on the clinical significance of UVN in guiding percutaneous puncture in percutaneous transforaminal endoscopic discectomy (PTED). We evaluated UVN to guide percutaneous puncture in PTED.

METHODS

We retrospectively reviewed the medical records of 12 patients (8 men and 4 women), who had undergone PTED with the help of UVN or fluoroscopic guidance for lumbar disc herniation from November 2017 to December 2017.

RESULTS

The age of these 12 patients range was 26-71 years, and the body mass index range was 18.19-26.91 kg/m². Of the 12 patients, 6 were in UVN group and 6 were in fluoroscopy group. The mean number of punctures was 1.00 in UVN group and 3.83 in fluoroscopy group. The mean exposure time was 3.60 and 13.80 seconds in UVN and fluoroscopy groups, respectively. The mean operation time was 48.17 minutes and 61.33 minutes in UVN and fluoroscopy groups, respectively. A positive relationship was found between operation time and exposure time (P < 0.05). All patients achieved excellent or good clinical outcomes. The Oswestry Disability Index and visual analog scales for leg pain and back pain all showed significant improvement after the procedure (P < 0.05). None of patients experienced a complication.

CONCLUSIONS

UVN decreased the number of puncture attempts, radiation exposure, and operation time compared with fluoroscopic guidance in PTED. Therefore, UVN is a feasible and efficient method for guiding percutaneous puncture in PTED.

An awake, minimally-invasive, fully-endoscopic surgical technique for treating lumbar radiculopathy secondary to heterotopic foraminal bone formation after a minimally invasive transforaminal lumbar interbody fusion with BMP: technical note

One complication associated with recombinant human bone morphogenetic protein (rhBMP-2) use in minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) is heterotopic bone growth at the neural foramen which results in the compression of neural structures. Here we present an awake, minimally invasive surgical approach for treating the radiculopathy that results from this excessive bone growth in the foramen. A 42-year-old male underwent a lumbar 4-sacral 1 MIS-TLIF by another surgeon. He did well in the initial postoperative period, but he began to note right leg pain and numbness in an L5 dermatomal pattern. The pain continued for 2 years despite interventional pain management, and he began to note left foot dorsiflexion weakness. An electromyography (EMG) showed a left L5 radiculopathy and a CT Lumbar spine demonstrated excessive bone growth in the right L4-5 neural foramen. The patient underwent an awake, endoscopic foraminotomy procedure utilizing a blunt tipped manual shaver drill system. The patient's radicular symptoms improved immediately, and he remained asymptomatic at the 1 year follow up. Heterotopic foraminal bone growth is one potential complication of rhBMP-2 use in the MIS-TLIF procedure. The endoscopic procedure described here is a minimally invasive surgical option that can be performed in an awake patient and is suggested a unique salvage or rescue procedure to be considered for the treatment of this potential rhBMP-2 complication.