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Krishnan A, Murugan C, Panthackel M, Anil A, Degulmadi D, Mayi S, Rai RR, Dave MB, Narvekar M, Killekar R, Krishnan PA, Dave BR. Transforaminal Endoscopic Ventral Stenosis Decompression in Calcified Lumbar Disc Herniation: A Long Term Outcome in 79 Patients. World Neurosurg 2024; 186:e191-e205. [PMID: 38531475 DOI: 10.1016/j.wneu.2024.03.104] [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: 12/30/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Calcified lumbar disc herniations (CLDH) causing calcified ventral stenosis pose a therapeutic challenge to the treating surgeon due to their neural adhesions, location, and hardness. METHODS This retrospective study analyzed all the cases of CLDH/calcified ventral stenosis managed by transforaminal endoscopic lumbar discectomy with a minimum follow-up of 24 months. The preoperative images were analyzed for the level, migration; and grade (Lee's migration zones), and location (Michigan State University classification). Detailed surgical technique and intraoperative parameters including the duration of surgery and complications have been recorded. The clinical parameters including visual analog scale (VAS), Oswestry disability index (ODI), length of stay in hospital, days of return to basic work, and patient satisfaction index were analyzed. Postoperatively the images were analyzed for the adequacy of decompression. RESULTS The mean VAS for back pain and leg pain was 4.7 ± 2.6 (0-9), and 7.45 ± 2.2 (1-10), respectively. The mean preoperative ODI was 78.2 ± 13.2 (63.2-95.6). Nineteen patients (24%) had neurological deficits preoperatively. The mean duration of surgery was 90.5 ± 15.8 (58-131) minutes. Postoperative magnetic resonance imaging revealed adequate decompression in 97.5% (n = 77). The mean duration of hospital stay was 1.05 ± 0.22 (1-2) days, and the postoperative back and leg pain VAS was 1.14 ± 1.2 (0-3) (P < 0.05) and 1.7 ± 0.5 (0-6) (P < 0.05), respectively. The ODI at final follow-up was 6.5 ± 3.7 (2.2-18) (P < 0.05). Neurological recovery occurred in 17 (89.5%) patients and they returned to basic work/jobs in 19.5 ± 3.3 (14-26) days. The mean patient satisfaction index was 1.18 ± 0.47 (1-2) at a mean follow-up of 5.52 ± 2.91 (2-12.75) years. CONCLUSIONS Transforaminal endoscopic lumbar discectomy is a complete, safe, and efficacious procedure in patients with CLDH with earlier recovery considering the surgery is performed with the patient being awake.
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Affiliation(s)
- Ajay Krishnan
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India; Department of Spine Surgery, Bhavnagar Institute of Medical Science, Bhavnagar, Gujarat, India.
| | - Chandhan Murugan
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Mikeson Panthackel
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Abhijith Anil
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Devanand Degulmadi
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Shivanand Mayi
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Ravi Ranjan Rai
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Mirant B Dave
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Mrugank Narvekar
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Rohan Killekar
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Preety Ajay Krishnan
- Department of Radiodiagnosis, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Bharat R Dave
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India; Gujarat University, Ahmedabad, Gujarat, India
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Eghbal K, Zafarshamspour S, Sookhaklari M, Saffarian A, Taheri R. Clinical Outcome of Pedicle-Sparing Transfacet Diskectomy and Fusion with Segmental Instrumentation for Thoracic Disc Herniation. J Neurol Surg A Cent Eur Neurosurg 2024; 85:240-245. [PMID: 36584877 DOI: 10.1055/a-2005-0620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Thoracic disk herniations (TDHs) are relatively rare compared with their cervical and lumbar counterparts. Posterior approaches allow for a simpler and less invasive surgery than anterior and lateral approaches. A pedicle-sparing transfacet approach was initially described in 1995, and modified in 2010. A few clinical series have reported the outcome of this procedure in patients with TDH. This study aimed to evaluate the outcomes and complications of pedicle-sparing transfacet diskectomy with interbody fusion and segmental instrumentation in patients with TDH. METHODS Twenty-one consecutive patients with symptomatic TDH referred to our tertiary care center were included in this retrospective study. All patients underwent a pedicle-sparing transfacet diskectomy with polyetheretherketone (PEEK) cage interbody fusion and short segmental instrumentation. Distribution of TDH, operative duration, blood loss, Visual Analog Scale (VAS) pain scores, Nurick grades, modified Japanese Orthopaedic Association (mJOA) scores, and fusion rate were assessed. RESULTS All patients had single-level herniations. The most common location was T12-L1 (38.1%), followed by T11-T12 (33.3%). All patients were successfully operated on with no cerebrospinal fluid (CSF) leaks or wrong-level surgery. The VAS scores significantly diminished from 4.9 (preoperatively) to 2 (18 months after surgery). The average mJOA score increased from 4.6 to 8.5, and the average Nurick grade decreased from 3.1 to 1.6. All patients reported significant improvement in quality of life relative to their preoperative status. CONCLUSION A modified pedicle-sparing transfacet diskectomy combined with PEEK cage interbody fusion and segmental instrumentation offers a safe and less invasive approach for the treatment of TDHs.
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Affiliation(s)
- Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saber Zafarshamspour
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Surgery, Rafsanjan University of Medical Sciences, Kerman, Iran
| | | | - Arash Saffarian
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Taheri
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Puhakka J, Jeszenszky D, Mannion AF, Loibl M, Kleinstück F, Fekete TF, Haschtmann D. Patient-reported outcomes 1 and 2 years after transforaminal thoracic interbody fusion (TTIF). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1089-1097. [PMID: 37987852 DOI: 10.1007/s00586-023-08042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 10/06/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023]
Abstract
STUDY DESIGN Retrospective Cohort Study with prospectively collected data. PURPOSE Transforaminal interbody fusion was initially designed for the lumbar spine. A similar approach was later introduced for the thoracic spine (TTIF). Here we report the surgical technique and the Core Outcome Measures Index (COMI) at 1-year and 2-year follow-ups, as well as the sagittal radiographic kyphosis correction of TTIF, achieved at 1 year and the latest follow-up. METHODS All TTIF procedures from 2012 to 2020 were included. COMI scores were collected preoperatively and at 1- and 2-year follow-ups. The sagittal angle between the upper and lower endplates at the segment where TTIF was performed was measured on preoperative, 1-year postoperative, and last available radiographs. RESULTS Seventy-nine TTIF procedures were performed for 64 patients (36% males; mean age 67.5 (SD 15.3) years). COMI score reduced from a mean value of 8.1 (SD 1.4) preoperatively to 4.7 (SD 2.7) at 1-year follow-up and 4.7 (SD 2.7) at 2-year follow-up. The mean correction of segmental kyphosis was 10.8 (SD 7.3, p < 0.0001) degrees at 1-year follow-up and 9.3 (SD 7.0, p < 0.0001) degrees at the final follow-up 3.4 (SD 1.4) years after the operation. Kaplan-Meier analysis for reoperations showed a 5-year survival of 91% (95% CI 0.795-1) for primary TTIF operations and survival of 77% (95% CI 0.651-0.899) for TTIFs performed after earlier fusion operations. CONCLUSIONS TTIF is a feasible procedure in the thoracic spine. Kyphosis correction of approximately 10° was maintained at 1-year and final follow-up. Over 69% at 1-year and 61% at 2-year follow-up achieved MCID for COMI.
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Affiliation(s)
- Jani Puhakka
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Orthopaedics and Traumatology, University of Helsinki, Helsinki, Finland.
| | - Dezsö Jeszenszky
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Anne F Mannion
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Markus Loibl
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Frank Kleinstück
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Tamás F Fekete
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
| | - Daniel Haschtmann
- Spine Center, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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