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Chen M, Yu Q, Cheng S, Hu T, Wang X, Lei B, Qin C, Long Q, Deng Z, Yan Z. Posterior Lateral Endoscopic Cervical Discectomy Through a Lateral Mass Approach in the Treatment of Cervical Spondylotic Radiculopathy. World Neurosurg 2024; 185:e1064-e1073. [PMID: 38490445 DOI: 10.1016/j.wneu.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVE The present study outlines the feasibility, safety, and short-term clinical outcomes of posterior lateral endoscopic cervical discectomy (PLECD) through a lateral mass approach for treating cervical spondylotic radiculopathy (CSR). METHODS This single-center retrospective observational study involved 30 patients with single-level CSR who had failed conservative treatment and presented with clinical symptoms consistent with imaging findings undergoing PLECD via a lateral mass approach. Primary outcomes included the visual analog scale (VAS) for neck and arm pain, the Japanese Orthopedic Association (JOA) score, and the modified MacNab criteria. Radiographic follow-up consisted of static and dynamic cervical radiographs and computed tomographic scans. RESULTS Thirty patients (13 men and 17 women; mean age 48.8 ± 11.9 years) underwent this procedure, and the mean operative time was 74.90 ± 13.52 minutes. Mean follow-up was 7.37 ± 2.17 months. The VAS scores for the neck and arm decreased significantly at the last follow-up (neck, 26.80 ± 4.75 to 9.87 ± 1.78; arm, 71.30 ± 8.48 to 14.73 ± 4.00) (P < 0.05). The JOA score also decreased from 13.47 ± 1.36 to 15.90 ± 0.92 at the last follow-up (P < 0.05). Twenty-nine patients demonstrated satisfactory outcomes based on the modified MacNab criteria at the last follow-up. All patients exhibited a positive clinical response, experiencing relief from symptoms. Postoperative computed tomography (CT) scans confirmed the complete removal of lesions. CONCLUSIONS PLECD through a lateral mass approach, as an alternative to conventional "keyhole" approaches, proves to be a novel and viable therapeutic option for CSR, demonstrating both high efficacy and safety.
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Affiliation(s)
- Mingxin Chen
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingshuai Yu
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Si Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Hu
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Wang
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Lei
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chaofan Qin
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingyan Long
- Department of Clinical Skills Training Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhongliang Deng
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengjian Yan
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Kim HS, Wu PH, Tze-Chun Lau E, Jang IT. Narrative Review of Uniportal Posterior Endoscopic Cervical Foraminotomy. World Neurosurg 2024; 181:148-153. [PMID: 37821026 DOI: 10.1016/j.wneu.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
Cervical radiculopathy is a common and disabling cervical condition characterized by symptoms including axial neck pain, radicular pain, weakness, and numbness in one or both arms. Common causes include herniated discs and foraminal stenosis, often accompanied by varying degrees of degenerative disc disease and uncovertebral joint hypertrophy. In the treatment of cervical radiculopathy, there is an increasing preference for posterior foraminotomy over anterior cervical discectomy and fusion due to the avoidance of fusion-related complications. As endoscopic spine surgery techniques continue to evolve, there is a rising interest in posterior endoscopic cervical foraminotomy and posterior endoscopic cervical discectomy as effective treatments for cervical radiculopathy. Because these procedures can performed through a single subcentimeter incision with minimal soft tissue damage, they can often be carried out as ambulatory procedures. In this narrative review, we examined current literature addressing the indications, surgical techniques, outcomes, and potential complications associated with posterior cervical endoscopic approaches.
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Affiliation(s)
- Hyeun Sung Kim
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, South Korea.
| | - Pang Hung Wu
- Achieve Spine and Orthopaedic Centre, Mount Elizabeth Hospital, Singapore, Singapore
| | - Eugene Tze-Chun Lau
- JurongHealth Campus, Orthopaedic Surgery, National University Health System, Singapore, Singapore; Kent Ridge Campus, Orthopaedic Surgery, National University Health System, Singapore, Singapore
| | - Il-Tae Jang
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, South Korea
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Ju CI, Kim P, Seo JH, Kim SW, Lee SM. Complications of Cervical Endoscopic Spinal Surgery: A Systematic Review and Narrative Analysis. World Neurosurg 2023; 178:330-339. [PMID: 37479028 DOI: 10.1016/j.wneu.2023.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND There are no systematic evidence-based medical data on the complications of endoscopic cervical spinal surgery. This narrative analysis compiled data from various studies that examined endoscopic complications, such as cervical disc herniation and foraminal stenosis. This study aimed to investigate the efficacy and safety of endoscopic surgery in cervical radiculopathy. METHODS We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and keywords were set as "endoscopic cervical spinal surgery", "endoscopic cervical discectomy", "endoscopic cervical foraminotomy", and "percutaneous endoscopic cervical discectomy". We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic cervical surgery was divided into three categories: full endoscopic anterior, endoscopic posterior, and unilateral biportal approaches. We excluded duplicate publications, studies without full text, studies without complications or incomplete information, and studies that did not provide the necessary data for extraction, animal experiments, or reviews. RESULTS Difficulties in swallowing, hematoma, and hoarseness are common complications associated with the anterior cervical approach. In contrast, complications of the posterior approach include nerve root injury, hematoma, and dysesthesia. However, endoscopic cervical spinal surgery, including the full endoscopic anterior, posterior, and unilateral biportal approaches, is a safe and effective treatment for cervical radiculopathy. CONCLUSIONS Complications of full endoscopic cervical spinal surgery differ significantly depending on the anterior and posterior approaches. In the anterior approach, swallowing difficulty, recurrent disc, hematoma, and dysphonia are the common complications. In contrast, transient dysesthesia, dural tears, upper limb motor deficits, and persistent arm pain are commonly reported with the posterior approach.
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Affiliation(s)
- Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea.
| | - Pius Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Jong Hun Seo
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seok Won Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
| | - Seung Myung Lee
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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Ju CI, Lee SM. Complications and Management of Endoscopic Spinal Surgery. Neurospine 2023; 20:56-77. [PMID: 37016854 PMCID: PMC10080410 DOI: 10.14245/ns.2346226.113] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
In the past, the use of endoscopic spine surgery was limited to intervertebral discectomy; however, it has recently become possible to treat various spinal degenerative diseases, such as spinal stenosis and foraminal stenosis, and the treatment range has also expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spine surgery develops and its indications widen, more diverse and advanced surgical techniques are being introduced, and the complications of endoscopic spine surgery are also increasing accordingly. We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and key words were set as “endoscopic spinal surgery,” “endoscopic cervical foramoinotomy,” “PECD,” “percutaneous transforaminal discectomy,” “percutaneous endoscopic interlaminar discectomy,” “PELD,” “PETD,” “PEID,” “YESS” and “TESSYS.” We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic lumbar surgery was divided into full endoscopic interlaminar and transforaminal approaches and a unilateral biportal approach. We performed a comprehensive review of available literature on complications of endoscopic spinal surgery. This study particularly focused on the prevention of complications. Regardless of the surgical methods, the most common complications related to endoscopic spinal surgery include dural tears and perioperative hematoma. transient dysesthesia, nerve root injury and recurrence. However, Endoscopic spinal surgery, including full endoscopic transforaminal and interlaminar and unilateral biportal approaches, is a safe and effective a treatment for lumbar as well as cervical and thoracic spinal diseases such as disc herniation, lumbar spinal stenosis, foraminal stenosis and recurrent disc herniation.
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Affiliation(s)
- Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
- Corresponding Author Chang Il Ju Department of Neurosurgery, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea
| | - Seung Myung Lee
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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Gebreyohanes A, Erotocritou M, Choi D. Appraising The Evidence for Conservative versus Surgical Management of Motor Deficits in Degenerative Cervical Radiculopathy. Global Spine J 2023; 13:547-562. [PMID: 35708971 PMCID: PMC9972261 DOI: 10.1177/21925682221109562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Understanding the prevalence and outcome of motor deficits in degenerative cervical radiculopathy is important to guide management. We compared motor radiculopathy outcomes after conservative and surgical management, a particular focus being painful vs painless radiculopathy. METHODS MEDLINE and EMBASE databases were searched. We stratified each study cohort into 1 of 6 groups, I-VI, based on whether radiculopathy was painful, painless or unspecified, and whether interventions were surgical or non-surgical. RESULTS Of 10 514 initial studies, 44 matched the selection criteria. Whilst 42 (95.5%) provided baseline motor radiculopathy data, only 22 (50.0%) provided follow-up motor outcomes. Mean baseline prevalence of motor deficits was 39.1% (9.2%-73.3%) in conservative cohorts and 60.5% (18.5%-94.1%) in surgical cohorts. Group VI, 'surgically-managed motor radiculopathy with unclear pain status' had the largest number of cohorts. Conversely, no cohorts were found in Group III, 'conservatively-managed painless motor radiculopathy'. Large disparities in data quality made direct comparison of conservative vs operative management difficult. CONCLUSIONS Overall pre-intervention prevalence of motor deficits in degenerative cervical radiculopathy is 56.4%. Many studies fail to report motor outcomes after intervention, meaning statistical evidence to guide optimal management of motor radiculopathy is currently lacking. Our study highlights the need for more evidence, preferably from a prospective long-term study, to allow direct comparisons of motor outcomes after conservative and surgical management.
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Affiliation(s)
- Axumawi Gebreyohanes
- Victor Horsley Department of
Neurosurgery, The National Hospital for Neurology
and Neurosurgery, UK,University College London (UCL)
Medical School, UK,Axumawi Mike Hailu Gebreyohanes, BSc,
Complex Spine Team, Victor Horsley Department of Neurosurgery, The National
Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United
Kingdom.
| | | | - David Choi
- Victor Horsley Department of
Neurosurgery, The National Hospital for Neurology
and Neurosurgery, UK
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Zhong G, Feng F, Su X, Chen X, Zhao J, Shen H, Chen J, Lao L. Minimally Invasive
Full‐endoscopic
Posterior Cervical Foraminotomy and Discectomy: Introducing a Simple and Useful Localization Technique of the “V” Point. Orthop Surg 2022; 14:2625-2632. [PMID: 36102205 PMCID: PMC9531083 DOI: 10.1111/os.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Conventional localization technique of V point for full‐endoscopic posterior cervical foraminotomy and discectomy (FPCD) required repeated fluoroscopies, especially in patients with short and thick necks. To address this issue, the present study aimed to introduce a new localization technique of V point, and further evaluate its efficacy. Methods A K‐wire was inserted and fixed at the pedicle eye under A/P fluoroscopy, then a working channel was established quickly along with it. Thirty‐four patients who underwent minimally invasive FPCD assisted by the new technique were included in this study. The clinical and radiological data were collected and analyzed, including radiation dose, operative time, positioning time, visual analog scale (VAS) for neck and arm pain, neck disability index (NDI) scores, Cobb angle of operative level and range of motion of the cervical spine. Results All operations were performed successfully, and no iatrogenic nerve or vascular injury occurred. None of the patients needed to be transferred to open surgery or revision surgery. The mean radiation dose was found to be1.68 ± 0.36 mSv. The mean positioning time observed was 10.68 ± 5.42 min and the average operation time was 81.18 ± 10.87 min. The operation time significantly declined as the number of patients increased. A significant difference in operation time between the first (96.22 ± 10.36 min) and last quartile (75.00 ± 3.84 min) of cases was observed (t = 4.82, P < 0.001). The VAS scores for neck and arm pain, and NDI scores were significantly improved after surgery (PVAS−Neck<0.0001, PVAS−Arm<0.0001, PNDI<0.0001). Based on MacNab criteria, the excellent plus good rate was 91.17%. The Cobb angle of operative level and range of motion of the cervical spine were significantly improved postoperatively (t = 2.846, POA = 0.015; t = 2.232, PROM−CA = 0.026). Conclusion The new image‐assisted V point localization technique is simple and useful with little radiation exposure and short positioning time. FPCD assisted by the new technique could be a safe and effective alternative on properly selected patients.
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Affiliation(s)
- Guibin Zhong
- Department of Orthopedics Baoshan Branch Ren Ji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Fan Feng
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Xinjin Su
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Xiuyuan Chen
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Junduo Zhao
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Hongxing Shen
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Jianwei Chen
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
| | - Lifeng Lao
- Department of Spine Surgery, Department of Orthopaedics Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China
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Platt A, Fessler RG, Traynelis VC, O’Toole JE. Minimally Invasive Posterior Cervical Foraminotomy Versus Anterior Cervical Fusion and Arthroplasty: Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1573-1582. [PMID: 34879736 PMCID: PMC9393980 DOI: 10.1177/21925682211055094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES Patients with lateral cervical disc and foraminal pathology can be treated with anterior and posterior approaches including anterior cervical discectomy and fusion(ACDF), cervical total disc arthroplasty(TDA), and minimally invasive posterior cervical foraminotomy(MIS-PCF). Although MIS-PCF may have some advantages over the anterior approaches, few comparative studies and meta-analyses have been done to assess superiority. METHODS This study includes a systematic review of the literature and meta-analysis of studies directly comparing minimally invasive posterior cervical foraminotomy to either anterior cervical discectomy and fusion or cervical total disc arthroplasty. RESULTS In comparing patients undergoing ACDF and MIS-PCF, operative time ranged from 68 to 97.8 minutes in the ACDF group compared to 28 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 33.84 to 112.8 hours in the ACDF group compared to 13.68 to 83.6 hours in the MIS-PCF group. The total complication rates were 3.72% in the ACDF group and 3.73% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the complication rate between the two procedures(OR .91; 95% CI 0.13, 6.43; P = .92, I2 = 59%). The total reoperation rate was 3.5% in the ACDF group and 5.4% in the MIS-PCF group. A random-effects model meta-analysis was carried out which failed to show a statistically significant difference in the reoperation rate between the two procedures(OR .66; 95% CI 0.33, 1.33; P = .25, I2 = 0). In comparing patients undergoing TDA and MIS-PCF, operative time ranged from 90.3 to 106.7 minutes in the TDA group compared to 77.4 to 93.9 minutes in the MIS-PCF group. Mean postoperative length of stay ranged from 103.2 to 165.6 hours in the TDA group and 93.6 to 98.4 hours in the MIS-PCF group. The complication rate ranged from 23.5 to 28.6% in the TDA group and 0 to 14.3% in the MIS-PCF group. The overall reoperation rates were 2.6% in the TDA group and 10.2% in the MIS-PCF group. CONCLUSIONS There is no clear superiority between MIS-PCF and ACDF/TDA in terms of operative time, postoperative length of stay, or rate of complications/reoperations. Further studies with increased follow-up intervals >48 months, and higher sample sizes are necessary to determine the true superiority of MIS-PCF and anterior neck approaches in treatment of lateral disc and foraminal pathology.
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Affiliation(s)
- Andrew Platt
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA,Andrew Platt, Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison St., Suite 855, Chicago, IL 60612 USA.
| | - Richard G. Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | | | - John E. O’Toole
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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Alomar SA, Maghrabi Y, Baeesa SS, Alves ÓL. Outcome of Anterior and Posterior Endoscopic Procedures for Cervical Radiculopathy Due to Degenerative Disk Disease: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1546-1560. [PMID: 34402323 PMCID: PMC9393995 DOI: 10.1177/21925682211037270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES Cervical spine endoscopic discectomy and decompression have gained popularity in the last decade. This review aimed to shed light on the current outcomes of cervical spine endoscopic procedures for degenerative disc disease (DDD) and to calculate a pooled estimate of various outcome measures. METHODS We retrieved articles published in English related to endoscopic cervical spine procedures from 3 central databases from inception until September 2020. A subgroup analysis based on the anterior versus the posterior approach was performed. RESULTS Thirty-one articles fulfilled the eligibility criteria and included 1,410 patients. A successful outcome was observed in 91.3% (88.6-93.4%, P = 0.000). This percentage was lower for the anterior approach (89.6% [85.8-92.5%], P = 0.000) than for the posterior approach (94.2% [90.4-96.5%], P = 0.000). A higher percentage of poor outcomes was reported for the anterior approach (5.7% [3.2-10.1%], P = 0.000 vs. 2.3% [1-5.5%], P = 0.000 for the posterior approach). The overall complication rate was 7.2% (5.2-9.8%, P = 0.000). There was a slightly higher complication rate for the anterior approach (7.9% [4.5-13.3%], P = 0.000) than for the posterior approach (6.7% [4.4-10%], P = 0.000). The revision rate was 4.2% (2.6-6.8%, P = 0.000); and 4.2% (1.8-9.7%, P = 0.000) for the anterior approach and 4.00% (2.2-7.4%, P = 0.000) for the posterior approach. CONCLUSIONS There is a higher success rate and lower complication rate with the posterior approach than with the anterior approach. However, high-quality randomized controlled trials are vital to evaluate the efficacy of these procedures.
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Affiliation(s)
- Soha A. Alomar
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yazid Maghrabi
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saleh S. Baeesa
- Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia,Saleh S. Baeesa, Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, P.O. Box 80215, Jeddah 21589, Saudi Arabia.
| | - Óscar L. Alves
- Centro Hospitalar De Gaia, Hospital Lusíadas Porto, Porto, Portugal
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Ma W, Peng Y, Zhang S, Wang Y, Gan K, Zhao X, Xu D. Comparison of Percutaneous Endoscopic Cervical Keyhole Foraminotomy versus Microscopic Anterior Cervical Discectomy and Fusion for Single Level Unilateral Cervical Radiculopathy. Int J Gen Med 2022; 15:6897-6907. [PMID: 36061960 PMCID: PMC9439641 DOI: 10.2147/ijgm.s378837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the clinical and radiological outcomes between microscopic anterior cervical discectomy and fusion (ACDF) and percutaneous endoscopic cervical keyhole foraminotomy (PECF) for single level unilateral cervical radiculopathy. Methods A total of 127 patients (59 in PECF VS 68 in ACDF) were enrolled in this study from April 2016 to May 2018 with a minimum follow-up of 2 years. Clinical data including baseline data, Neck Disability Index (NDI), and Visual Analogue Scale for neck and arm (VAS-n, VAS-a) were collected and compared. Radiological evaluation such as disc height, ROM of cervical, Cobb’s angle of cervical and Cobb’s angle of operated segment was measured by two experienced radiologists in twice. Results There was no significant difference between the two groups in the baseline data, and hospital stay was significantly decreased in PECF group than ACDF group (P < 0.001). PECF group did not yield superior better outcomes in NDI, VAS-a and VAS-n than ACDF group except at 1-month follow-up. As for radiological outcomes, PECF group has significantly better cervical motion, cervical angle and segmental angle than ADCF group at 12- and 24-month follow-up visit (P < 0.05); however, ACDF had shown better disc height restoration and maintenance than PECF (P < 0.05). More complications including surface hematoma and swallowing difficulty were occurred in ADCF group. Conclusion Percutaneous endoscopic cervical keyhole foraminotomy could be the alternative method for anterior cervical discectomy and fusion in selective cases. However, the indication should be fulfilled, more studies need to be conducted to further testify the efficacy of PECF.
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Affiliation(s)
- Weihu Ma
- Orthopedic Department, Ningbo No.6 Hospital, Zhejiang, Ningbo, People’s Republic of China
| | - Yujie Peng
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Song Zhang
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Yulong Wang
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Kaifeng Gan
- Orthopedic Department, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xuchen Zhao
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
| | - Dingli Xu
- Clinical Medical Department, Medical School of Ningbo University Zhejiang, Ningbo, People’s Republic of China
- Correspondence: Dingli Xu, Email
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Zou P, Zhang X, Zhang R, Yang JS, Chu L, Wang XF, Wei JM, Chai X, Zhao YT, Liao B. The feasibility and safety of cocktail treatment of triple anti-inflammatory agents loaded with gelatin sponge promotes early recovery after posterior percutaneous endoscopic cervical discectomy. J Orthop Surg Res 2022; 17:290. [PMID: 35619183 PMCID: PMC9137142 DOI: 10.1186/s13018-022-03178-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate whether a cocktail therapy of dexamethasone, ropivacaine, dexmedetomidine, and vitamin B12 can achieve satisfactory pain relief and promote early functional recovery after PPECD. Methods Eighty single-level patients with CDH who received PPECD were retrospectively divided into two groups: the cocktail and control groups. Clinical data were recorded and evaluated by a dedicated physician who was not involved in the patient’s treatment. The primary clinical outcomes included visual analog scores (VASs) for upper limber pain and neck disability index (NDI) scores. The follow-up time points were preoperatively and postoperative 1 week, 1 month, 3 months, 6 months, and 12 months. The modified MacNab criteria was used to evaluate the surgical effect of the last follow-up. Results The follow-up data of 74 cases were complete, except 6 cases lost to follow-up. There was no significant difference between the two groups in demographics, duration of symptoms, operation stage (p > 0.05), and operation time (80.5 ± 5.5 vs. 81.5 ± 3.5 min). The VAS in the upper limbs pain was significantly higher postoperatively than preoperatively in both groups (p < 0.05). The cocktail group had a lower VAS than the control group 1 week postoperatively (p < 0.05); however, VAS not different between groups at the remaining time points. The NDI scores were significantly better postoperatively than preoperatively, and no significant differences were seen when comparing nodes at postoperative follow-up (p > 0.05). In the control group, two cases with foraminal stenosis were found to have unrelieved pain in the early postoperative period, but the pain was relieved at the final follow-up and did not convert to open decompression surgery. Conclusions Cocktail treatment, in which a drug sustained-release material made of gelatin sponge was impregnated with dexamethasone, ropivacaine, dexmedetomidine and vitamin B12, facilitates pain relief and early postoperative recovery after PPECD.
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Affiliation(s)
- Peng Zou
- Department of Orthopedics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Xiaoping Zhang
- Department of Orthopedics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Rui Zhang
- Department of Orthopedics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lei Chu
- Department of Minimally Invasive Spine Surgery, The Second Affiliated Hospital of Chongqing Medical University, No. 76 Linjiang Road, Chongqing, 400010, China
| | - Xiang-Fu Wang
- Department of Spinal Minimally Invasive Surgery, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Jian-Min Wei
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Shaanxi, China
| | - Xin Chai
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuan-Ting Zhao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| | - Bo Liao
- Department of Orthopedics, Tangdu Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
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11
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Kang MS, You KH, Han SY, Park SM, Choi JY, Park HJ. Percutaneous Full-Endoscopic versus Biportal Endoscopic Posterior Cervical Foraminotomy for Unilateral Cervical Foraminal Disc Disease. Clin Orthop Surg 2022; 14:539-547. [DOI: 10.4055/cios22050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Min-Seok Kang
- Department of Orthopedic Surgery, Spine Center, Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ki-Han You
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Song-Yup Han
- Department of Neurosurgery, Spine Center, Yonsei Knee Spine Hospital, Seoul, Korea
| | - Sang-Min Park
- Department of Orthopaedic Surgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun-Young Choi
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Hyun-Jin Park
- Department of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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12
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Yu T, Wu JP, Zhang J, Yu HC, Liu QY. Comparative evaluation of posterior percutaneous endoscopy cervical discectomy using a 3.7 mm endoscope and a 6.9 mm endoscope for cervical disc herniation: a retrospective comparative cohort study. BMC Musculoskelet Disord 2021; 22:131. [PMID: 33530967 PMCID: PMC7856779 DOI: 10.1186/s12891-021-03980-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 01/14/2021] [Indexed: 11/12/2022] Open
Abstract
Background Posterior percutaneous endoscopy cervical discectomy (p-PECD) is an effective strategy for the treatment of cervical diseases, with a working cannula ranging from 3.7 mm to 6.9 mm in diameter. However, to date, no studies have been performed to compare the clinical outcomes of the use of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of patients with unilateral CDH treated with p-PECD using a 3.7 mm endoscope and a 6.9 mm endoscope. Methods From January 2016 to June 2018, a total of 28 consecutive patients with single-level CDH who received p-PECD using either the 3.7 mm or the 6.9 mm endoscope were enrolled. The clinical results, including the surgical duration, hospitalization, visual analog scale (VAS) score and modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were also performed during follow-up. Results Tthere was a significant difference in regard to the average identification time of the “V” point (18.608 ± 3.7607 min vs. 11.256 ± 2.7161 min, p < 0.001) and the mean removal time of the overlying tissue (16.650 ± 4.1730 min vs. 12.712 ± 3.3079 min, p < 0.05) for the use of the 3.7 mm endoscope and the 6.9 mm endoscope, respectively. The postoperative VAS and MacNab scores of the two endoscopes were significantly improved compared with those the preoperative scores (p < 0.05). Conclusion The application of both the 3.7 mm endoscope and 6.9 mm endoscope represent an effective method for the treatment of CDH in selected patients, and no significant difference can be observed in the clinical outcomes of the endoscopes. The 6.9 mm endoscope shows superiority to the 3.7 mm endoscope in terms of the efficiency of “V” point identification, the removal of overlying soft tissue and the prevention of spinal cord injury. However, the 6.9 mm endoscope may be inferior to the 3.7 mm endoscope in regards to anterior foraminal decompression due to its large diameter; this result needs to be further evaluated with the support of a large number of randomized controlled trials.
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Affiliation(s)
- Tong Yu
- Department of orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jiu-Ping Wu
- Department of orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jun Zhang
- Department of orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Hai-Chi Yu
- Department of orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China
| | - Qin-Yi Liu
- Department of orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
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13
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Zhang Y, Ouyang Z, Wang W. Percutaneous endoscopic cervical foraminotomy as a new treatment for cervical radiculopathy: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e22744. [PMID: 33157922 PMCID: PMC7647593 DOI: 10.1097/md.0000000000022744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is the gold standard treatment for this cervical radiculopathy. Posterior endoscopic cervical foraminotomy (PECF), an effective alternative to ACDF, is becoming widely used by an increasing number of surgeons. However, comparisons of the clinical outcomes of ACDF and PECF remain poorly explored. The purpose of this study was to evaluate and compare visual analog scale (VAS)-arm scores, VAS-neck scores, neck disability index (NDI) scores, reoperation, and complications in PECF and ACDF. MATERIALS AND METHODS We comprehensively searched electronic databases or platforms, including PubMed, Web of Science, EMBASE, and the Cochrane Controlled Trial Center, using the PRISMA guidelines. The required information, including VAS-arm scores, VAS-neck scores, NDI scores, reoperation, and complications, was extracted from qualified studies and independently tested and compared by 2 researchers. The methodological index for nonrandomized studies was used to evaluate study quality. RESULTS Nine studies consisting of 230 males and 256 females were included. The mean age of the included patients was 49.6 years, and the mean follow-up time was 20.6 months. The VAS-arm scores were significantly higher, and VAS-neck scores and NDI scores of PECF showed greater improvement trends for PECF than ACDF. The complication proportion of patients with PECF was lower, while the proportion of reoperation was similar between PECF and ACDF. ACDF was the most common revision surgery. The most common complication of PECF was transient paresthesia. CONCLUSION Compared with ACDF, PECF is safe and effective in patients with unilateral cervical radiculopathy without myelopathy, and PECF does not increase the probability of reoperation and complications.
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14
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Shen J, Telfeian AE, Shaaya E, Oyelese A, Fridley J, Gokaslan ZL. Full endoscopic cervical spine surgery. JOURNAL OF SPINE SURGERY 2020; 6:383-390. [PMID: 32656375 DOI: 10.21037/jss.2019.10.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The authors present 4 techniques for fully-endoscopic cervical spine surgery with accompanying case series: (I) posterior cervical unilateral laminectomy and bilateral decompression, (II) posterior cervical foraminotomy (PCF), (III) anterior cervical discectomy, and (IV) anterior transcorporeal discectomy. Methods We retrospectively reviewed fully endoscopic cervical spine surgery cases at one high-volume endoscopic center in the United States and present clinical data extracted from endoscopic spine surgery performed over a 6-year period with a minimum clinical follow up of 1 year. Results A series of 114 patients who underwent fully endoscopic cervical spine surgery between 2012 and 2018 is presented. Clinical results and technical data are presented. Conclusions Fully endoscopic cervical spine surgery is an emerging surgical technique for addressing cervical radiculopathy and myelopathy through a minimally invasive approach.
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Affiliation(s)
- Jian Shen
- Mohawk Valley Orthopedics, Amsterdam, NY, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Elias Shaaya
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Adetokunbo Oyelese
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Jared Fridley
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Ziya L Gokaslan
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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15
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Vaishnav AS, Othman YA, Virk SS, Gang CH, Qureshi SA. Current state of minimally invasive spine surgery. JOURNAL OF SPINE SURGERY 2019; 5:S2-S10. [PMID: 31380487 DOI: 10.21037/jss.2019.05.02] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Over the past two decades, minimally invasive surgical approaches have become increasingly feasible, efficient and popular for the management of a wide range of spinal disorders, with a growing body of research demonstrating numerous advantages of these techniques over the traditional open approach. In this article, we review the technologies and innovations that are expanding the horizon of minimally invasive spine surgery (MISS), and highlight high-quality peer-reviewed literature in the past year that expands our knowledge and understanding of indications, advantages and limitations of MISS.
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Affiliation(s)
| | - Yahya A Othman
- Hospital for Special Surgery, New York, NY, USA.,Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
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16
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Lin Y, Rao S, Li Y, Zhao S, Chen B. Posterior percutaneous full-endoscopic cervical laminectomy and decompression for cervical stenosis with myelopathy: a technical note. World Neurosurg 2019; 124:350-357. [PMID: 30648610 DOI: 10.1016/j.wneu.2018.12.180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE Cervical stenosis with myelopathy caused by ossification of the ligamentum flavum is relatively rare, and surgical treatment is the preferred option. Previous surgical procedures usually require assisted internal fixation, while some problems may occur, such as large trauma, intraoperative bleeding, wound infection and internal fixation failure. The aim of this paper is to introduce a new minimally invasive surgical procedure for the treatment of upper cervical spinal stenosis complicated with myelopathy. METHODS AND RESULTS A 56-year-old male patient with cervical myelopathy (C2-3) caused by calcification of the ligamentum flavum underwent posterior percutaneous full-endoscopic cervical laminectomy and decompression (PECLD) and achieved a good clinical efficacy. A surgical incision just 1 cm in size was made, and there was little bleeding during the operation. The patient was hospitalized for 2 days and returned to work after 4 weeks. The patient's postoperative recovery of neurological function was significantly improved, the pain was obviously reduced, and the quality of life was remarkably improved. No intra- or postoperative surgical complications were encountered. CONCLUSIONS PECLD is an effective method for treating cervical stenosis associated with myelopathy due to ossification of the ligamentum flavum. It has the advantages of smaller trauma, less bleeding, shorter postoperative hospital stays and faster recovery. Taken together, this minimally technique can be considered as a good alternative to traditional open surgery.
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Affiliation(s)
- Yongpeng Lin
- Division of Spine Surgery Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, NO. 111 Dade Road, Guangzhou 510120, China
| | - Siyuan Rao
- The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China
| | - Yongjin Li
- Division of Spine Surgery Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, NO. 111 Dade Road, Guangzhou 510120, China
| | - Shuai Zhao
- Division of Spine Surgery Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, NO. 111 Dade Road, Guangzhou 510120, China
| | - Bolai Chen
- Division of Spine Surgery Center, Guangdong Provincial Hospital of Traditional Chinese Medicine, NO. 111 Dade Road, Guangzhou 510120, China.
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