Clinical Features and Management of Seizure After Percutaneous Endoscopic Spine Surgery: A Retrospective Case Series Analysis

Tubular versus unilateral biportal endoscopy: MRI analysis after unilateral laminectomy for bilateral decompression in lumbar spinal stenosis

INTRODUCTION

Degenerative lumbar spinal stenosis frequently requires surgical intervention when conservative treatments fail. Minimally invasive techniques such as unilateral laminectomy for bilateral decompression have largely replaced traditional open laminectomy because of effective decompression and reduced tissue damage. This study compared the radiological and clinical outcomes of tubular decompression and unilateral biportal endoscopy (UBE) in patients with severe stenosis.

METHODS

This was a retrospective, monocentric, nonrandomized study including 103 patients with severe lumbar spinal stenosis (52 tubular decompression, 51 UBE) from July 2020 to April 2024. The primary radiological outcomes were changes in anteroposterior diameter and dural sac surface area, assessed by MRI. Clinical outcomes included operative time, complication rates, and patient-reported outcomes with the Oswestry Disability Index and visual analog scale for pain, evaluated preopertatively, 3 and 12 months postoperatively.

RESULTS

As compared with tubular decompression, UBE resulted in a more significant increase in anteroposterior diameter (+ 4.9 vs. + 3.75 mm, p < 0.001) and dural sac surface area (+ 95.8 vs. + 85.4 mm², p = 0.038). However, with both techniques, clinical improvements were similar at 3 and 12 months, with no significant difference in Oswestry Disability Index, visual analog scale score, or patient satisfaction. The complication rate, including reoperation, was low in both groups, but the incidence of symptomatic hematoma was higher with UBE than tubular decompression.

CONCLUSION

Both tubular decompression and UBE were effective for spinal stenosis treatment, with UBE providing superior radiological decompression, even in the early learning phase. However, the techniques were comparable in clinical outcomes at 3 months and 1 year. Further studies are needed to assess long-term results and refine patient selection criteria.

Rare Complications in Endoscopic Spinal Surgery: A Narrative Review of Unique Cases

STUDY DESIGN

Narrative Review.

OBJECTIVES

Endoscopic spine surgery is becoming an increasingly popular approach to treat spinal disease due to its minimally invasive nature. Although certain adverse events are well-reported within the literature, there is a scarcity of information for complications that are rare but still potentially serious. The purpose of this study is to describe these rare complications of endoscopic spine surgery and discuss management and prevention strategies.

METHODS

A search was conducted in PubMed and Embase to review the literature for all adverse events following endoscopic spine surgery, with no restrictions on publication year. Cohort and case report studies describing infrequently reported complications were collected for analysis.

RESULTS

A total of 38 studies were included which described rare complications in 93 patients following endoscopic spine surgery. These included neurological events (seizure, pseudomeningocele, pneumocephalus, upper limb palsy), vascular events (hemorrhage, hematoma, arteriovenous fistula), mechanical events (cage migration, guidewire breakage), and additional events (discal pseudocyst, pulmonary edema, arrhythmia, total spinal anesthesia).

CONCLUSIONS

Endoscopic spine surgery is rapidly evolving and emerging as a popular alternative to conventional approaches. Though regarded as a generally safe form of surgery, it is imperative that surgeons are aware of all complications which may occur, even those that may be infrequently reported in the literature.

Clinical Outcomes and Complications of Unilateral Biportal Endoscopic Posterior Cervical Foraminotomy: A Systematic Review and Meta-Analysis With a Comparison to Full-Endoscopic Posterior Cervical Foraminotomy

OBJECTIVE

The unilateral biportal endoscopic posterior cervical foraminotomy (UBE-PCF) has been recently adopted for unilateral radiating arm pain due to cervical herniated intervertebral disc or foraminal stenosis. We systematically meta-analyzed clinical outcomes and complications of the UBE-PCF and compared them with those of full-endoscopic PCF (FE-PCF).

METHODS

We systematically searched the PubMed, Embase, and Web of Science until February 29, 2024. Clinical outcomes and complications of the UBE-PCF and FE-PCF were collected and analyzed using the fixed-effect or random-effects model. Clinical outcomes of the UBE-PCF were compared with minimal clinically important difference (MCID) following PCF to evaluate the efficacy of UBE-PCF.

RESULTS

Ten studies were included in the meta-analysis. In the random-effects meta-analysis, the Neck Disability Index (NDI), visual analogue scale (VAS) neck, and VAS arm were significantly decreased after the UBE-PCF (p<0.001). The improvement of NDI, VAS neck, and VAS arm were significantly higher than MCID (p<0.05). The improvement of NDI, VAS neck, and VAS arm were not significantly different between the UBE-PCF and FE-PCF (p>0.05). Overall incidence of complications of the UBE-PCF was 6.2% (24 of 390). The most common complication was dura tear (2.1%, 8 of 390). The incidence in overall complications was not significantly different between the UBE-PCF and FE-PCF (p=0.813).

CONCLUSION

We found that the UBE-PCF significantly improved clinical outcomes. Regarding clinical outcomes and complications, the UBE-PCF and FE-PCF were not significantly different. Therefore, the UBE-PCF would be an advantageous surgical option comparable to FE-PCF for unilateral radiating arm pain.

Transforaminal Unilateral Biportal Endoscopic Spinal Surgery for Extraforaminal Lumbar Disc Herniation: A Retrospective Observational Study

OBJECTIVE

Biportal endoscopic spinal surgery (BESS) is recommended as a safer and less destructive option for lumbar disc herniations. However, limited data exist on clinical outcomes for extraforaminal lumbar disc herniation (ELDH) surgery. This retrospective study presents our preliminary experience with transforaminal unilateral BESS for ELDH.

METHODS

Patients with lumbar radiculopathy refractory to conservative treatment, diagnosed with ELDH by magnetic resonance imaging, and treated with transforaminal unilateral BESS in 2021-2023 in 2 institutions in Taiwan were eligible for inclusion. Those with lumbar spondylolisthesis grade 2 or more with segmental instability, history of drug abuse or psychiatric diseases, or with a follow-up duration <1 year were excluded. Primary outcomes included visual analog scale for pain, assessed at 1 week, 1 month, 6 months, and 1 year using generalized estimating equations analysis; success and satisfaction of BESS graded by the Macnab criteria; and perioperative complications. Secondary outcomes were operative time and hospital length of stay.

RESULTS

Seventeen patients were included in the analysis, with a mean age of 65.8 years; 11 (64.7%) were males and 15 (88.2%) had no prior lumbar spine surgery. mean operative time was 107.9 minutes, and length of stay was 3.5 days. Graded by Macnab criteria, 16 (94.1%) of patients had good to excellent outcomes. Only 1 patient experienced complications. No recurrence/reoperation was observed. Generalized estimating equations analysis showed that postoperative visual analog scale scores decreased significantly at 1 week (adjusted Beta [aBeta] = -5.47, standard error: 0.29, P < 0.001), 1 month (aBeta = -5.82), 6 months (aBeta = -5.88), and 1 year (aBeta = -6.29).

CONCLUSIONS

Transforaminal unilateral BESS is an alternative and feasible method for treating ELDH, producing good surgical outcomes with few complications and sustaining pain improvement. Future studies with larger patient numbers and comparisons between BESS and other minimally invasive techniques for ELDH are warranted.