Therapeutic Strategy of Percutaneous Transforaminal Endoscopic Decompression for Stenosis Associated With Adult Degenerative Scoliosis

Percutaneous transforaminal endoscopic decompression versus posterior short-segment fusion for treating degenerative lumbar scoliosis with lumbar spinal stenosis: a cohort study with a minimum five year followup

PURPOSE

This retrospective cohort study aimed to compare the clinical outcomes of percutaneous transforaminal endoscopic decompression (PTED) with those of posterior lumbar interbody fusion (PLIF) for the treatment of degenerative lumbar scoliosis (DLS) with lumbar spinal stenosis (LSS).

METHODS

In this study, 143 DLS patients who met the inclusion criteria from January 2016 to March 2019 were retrospectively analyzed and divided into the PTED and PLIF groups. The propensity score matching (PSM) method was used to adjust for imbalanced confounding variables between the groups. The visual analog scale (VAS) and Oswestry Disability Index (ODI) scores were then used to compare the clinical outcomes between the two groups. Furthermore, changes in radiological characteristics and surgical complications were assessed.

RESULTS

After PSM, 86 patients were included in the study with a followup duration of at least five years. Postoperative VAS and ODI scores were significantly improved in both groups at all time points compared with preoperative values (p < 0.001). However, the PTED group had higher VAS scores for back pain and ODI scores than the PLIF group at five years postoperatively (p < 0.05). For radiological parameters, the Cobb angle decreased in the PLIF group but increased in the PTED group at the final followup (p < 0.05). A decrease in the adjacent disc height was observed in the PLIF group at the final followup (p < 0.001).

CONCLUSION

Both PTED and PLIF achieved relatively satisfactory outcomes in treating DLS with LSS after a minimum five year followup. However, further studies are required to better determine the characteristics of spinal deformities amenable to each procedure.

Transforaminal Endoscopic Decompression Alone Versus Limited Decompression/Fusion in the Treatment of Adult Degenerative Scoliosis: A Retrospective Study

Study DesignA retrospective study.ObjectivesTo investigate and compare the clinical and radiographical outcomes of endoscopic decompression alone and limited decompression/fusion surgery in the treatment of adult degenerative scoliosis (ADS).MethodsFollow-up data of 53 patients with lower limb radiculopathy associated with ADS who underwent focal surgical treatment were collected (endoscope group: 31 patients treated by transforaminal endoscopic decompression alone; fusion group: 22 patients who underwent limited decompression/fusion). The following data were retrospectively analyzed and compared between the two group: the demographics, Lenke-Silva level, radiographic parameters, surgical data, visual analogue scale (VAS) for back/leg pain, the Oswestry disability index (ODI), and the modified MacNab criteria.ResultsThe mean follow-up period was 15.68 ± 3.26 months. The most frequent Lenke-Silva level was I in the endoscope group, and III in the fusion group. Preoperative Cobb angle in the endoscope group was significantly lower than that in the fusion group (23.92 ± 9.06 vs 39.58 ± 13.12, P < 0.05). All patients exhibited improved VAS and ODI scores postoperatively (P < 0.05). At the last follow-up, the Cobb angle had progressed by 1.51° in the endoscope group, whereas radiographic parameters were significantly improved in the fusion group. The reoperation and complication rate in the endoscope group were lower than those in the fusion group. The satisfaction rate post-surgery was comparable between the two groups.ConclusionsFor patients with focal ADS, both limited decompression/fusion and transforaminal endoscopic decompression are viable treatment options. Advanced transforaminal endoscopic techniques enable effective decompression of the symptomatic foramen with minimal complication risk and negligible deformity progression, even in cases of significant scoliosis. While limited fusion surgery can achieve comparable clinical outcomes, it offers inferior deformity correction.

Clinical and radiological outcomes of lumbar endoscopic decompression for treating lumbar spinal stenosis and degenerative lumbar scoliosis: a retrospective study at mean 4.4 years follow-up

Purpose

To assess the clinical and radiological outcomes of lumbar endoscopic decompression for the treatment of lumbar spinal stenosis (LSS) with concurrent degenerative lumbar scoliosis (DLS).

Methods

This study retrospectively reviewed 97 patients with LSS and DLS who underwent lumbar endoscopic decompression between 2016 and 2021. The average follow-up duration was 52.9 months. Another 97 LSS patients without DLS were selected as the control group. The pre- and postoperative visual analog score (VAS) and the Oswestry disability index (ODI) were recorded and analyzed to compare clinical outcomes. Radiological findings, such as coronal balance and intervertebral disc height, have also been reported.

Results

Both groups' mean VAS scores for back pain, leg pain, and ODI were significantly improved two weeks after surgery and at the final follow-up (p < 0.001). There was no significant difference in the prevalence of surgical complications or patient satisfaction rates. However, patients in the DLS group reported more severe back pain at the final follow-up than those in the LSS group (p = 0.039). Radiological follow-up revealed no significant deterioration in coronal imbalance or loss of disc height in either group.

Conclusion

Lumbar endoscopic decompression can be a safe and effective surgical technique for treating LSS with DLS, particularly in elderly patients with poor general conditions.

Clinical outcomes of percutaneous transforaminal endoscopic decompression for the treatment of degenerative lumbar scoliosis associated with spinal stenosis in elderly individuals: a matched comparison study

PURPOSE

This retrospective cohort study evaluated the efficacy and safety of percutaneous transforaminal endoscopic decompression (PTED) in elderly patients with degenerative lumbar scoliosis (DLS) associated with lumbar spinal stenosis (LSS).

STUDY DESIGN

A matched comparison study.

METHODS

In total, 97 patients with DLS associated with LSS who underwent PTED under local anesthesia between 2016 and 2021 were retrospectively analyzed. Using the inclusion and exclusion criteria, 24 patients aged ≥ 80 years were screened and included in the study group. Then, 24 patients aged 50-80 years were matched according to gender, date of surgery, and surgical levels were included in the control group. Clinical outcomes such as the visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, modified MacNab criteria, radiological parameters, and complications were assessed. The independent sample t-test, Pearson's chi-square test and Fisher's exact test were used to compare the parameters between the study and control groups.

RESULTS

The study group had significantly higher mean American Society of Anesthesiologists classification and age-adjusted Charlson Comorbidity Index scores than the control group (2.42 ± 0.72) vs. 5.25 ± 1.03 and 1.67 ± 0.76 vs. 3.17 ± 2.10, respectively). The VAS scores for pain in two legs and back and ODI scores significantly improved at two weeks after surgery and at the final followup (p < 0.05). The study group had higher back pain VAS and ODI scores than the control group at the final followup (p < 0.05). In addition, the complication and patient satisfaction rates were similar between the two groups (p > 0.05). The overall radiological parameters were comparable between the two groups, and there was no significant deterioration in coronal imbalance or loss of disc height between the two groups.

CONCLUSION

Elderly patients (aged ≥ 80 years) with DLS associated with LSS are less fit and have a greater number of comorbidities. However, they can achieve satisfactory outcomes with PTED, which are comparable to those of patients < 80 years. PTED under local anesthesia can also be an efficient alternative to conventional open lumbar decompression surgery for treating elderly patients with comorbidities.

Percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: an efficacy analysis

OBJECTIVE

This retrospective study evaluated the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar disc herniation (LDH).

METHODS

Data of 107 LDH patients admitted to the People's Hospital of Pingyang between July 2019 and May 2023 were analyzed retrospectively, including 51 cases treated with conventional open discectomy (control group) and 56 cases undergoing PTED (research group). We compared curative effects, operation time, intraoperative blood loss (IBL), incision length, time until ambulation, hospital stay, pre- and post-treatment pain intensity, lumbar function, and complications. Pain intensity was measured using the the Visual Analogue Scale (VAS), and the lumbar function was assessed by the Oswestry Disability Index (ODI). In addition, the factors influencing the efficacy in LDH patients were analyzed.

RESULTS

The research group showed a statistically higher overall efficacy (P=0.034, χ2=4.479), longer operation time (P=0.002, t=3.114), less IBL (P<0.001, t=29.725), earlier ambulation (P<0.001, t=8.628), shorter hospital stay (P<0.001, t=8.628), and smaller incision length (P<0.001, t=15.948) than the control group. In addition, the postoperative VAS score (P<0.001, t=5.621) and ODI score (P<0.001, t=4.909) were reduced significantly after treatment and were lower in the research group than in the control group. The research group was also associated with a significantly lower overall complication rate (7.14% vs. 21.57%; P=0.032, χ2=4.608), including reduced incidence of lumbar spinal mobility limitation, incontinence, postoperative infection, and cauda equina syndrome. Furthermore, age, course of disease, and treatment method were strongly associated with the treatment efficacy in LDH patients.

CONCLUSIONS

PTED is more effective than conventional open discectomy for LDH treatment. It reduces IBL, shortens incision length, facilitates patient recovery, alleviates postoperative pain, improves lumbar function, and minimizes the risk of postoperative complications.

Extreme cases in percutaneous transforaminal endoscopic surgery: case series and brief review of the literature

PURPOSE

Percutaneous transforaminal endoscopic decompression (PTED) is a minimally invasive method of surgical treatment of miscellaneous spinal conditions. We describe our experience with PTED in extreme cases of foraminal stenosis (FS) in adult degenerative scoliosis (ADS), recurrent foraminal stenosis (RFS) after previous open decompression surgery and adjacent segment disease (ASD) after previous lumbar fusion.

METHODS

Twenty-one (21) patients with FS encountered in the clinical framework of ADS (n = 6), previous open decompression surgery (n = 8) and ASD (n = 7) were prospectively reviewed. Patients were preoperatively assessed via clinical and radiologic evaluation. All patients underwent PTED in 2018-2019. Postoperative evaluation was conducted with clinical examination and evaluation of Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria in predetermined chronic intervals in a 1-2 years follow-up.

RESULTS

All patients were successfully managed with PTED. Operated levels were L3-L4 (19.0%), L4-L5 (52.4%) and L5-S1 (28.6%). No major perioperative complications were recorded. VAS and ODI scores were demonstrated to exhibit a clinically and statistically significant (p < 0.05) amelioration in all patients' categories directly postoperatively, which was preserved until the end of follow-up. Overall outcomes according to modified MacNab criteria were excellent in 12 patients (57.1%), good in 6 (28.6%) and fair in 3 (14.3%) patients.

CONCLUSIONS

PTED is safe and effective in extreme cases of FS encountered in patients with ADS, previous posterior open decompression surgery and ASD after previous spinal fusion.

Decompression Alone in the Setting of Adult Degenerative Lumbar Scoliosis and Stenosis: A Systematic Review and Meta-Analysis

STUDY DESIGN

Systematic review and meta-analysis.OBJECTIVESSurgical decompression alone for patients with neurogenic leg pain in the setting of degenerative lumbar scoliosis (DLS) and stenosis is commonly performed, however, there is no summary of evidence for outcomes.

METHODS

A systematic search of English language medical literature databases was performed for studies describing outcomes of decompression alone in DLS, defined as Cobb angle >10˚, and 2-year minimum follow-up. Three outcomes were examined: 1) Cobb angle progression, 2) reoperation rate, and 3) ODI and overall satisfaction. Data were pooled and weighted averages were calculated to summarize available evidence.

RESULTS

Across 15 studies included in the final analysis, 586 patients were examined. Average preoperative and postoperative Cobb angles were 17.6˚ (Range: 12.7 - 25˚) and 18.0 (range 14.1 - 25˚), respectively. Average change in Cobb angle was an increase of 1.8˚. Overall rate of reoperation ranged from 3 to 33% with an average of 9.7%. Average ODI before surgery, after surgery, and change in scores were 56.4%, 27.2%, and an improvement of 29% respectively. Average from 8 studies that reported patient satisfaction was 71.2%.

CONCLUSIONS

Current literature on decompression alone in the setting of DLS is sparse and is not high quality, limited to patients with small magnitude of lumbar coronal Cobb angle, and heterogenous in the type of procedure performed. Based on available evidence, select patients with DLS who undergo decompression alone had minimal progression of Cobb angle, relatively low reoperation rate, and favorable patient-reported outcomes.

Characteristics of the paravertebral muscle in adult degenerative scoliosis with PI-LL match or mismatch and risk factors for PI-LL mismatch

Objective

Pelvic incidence (PI) minus the lumbar lordosis (LL) angle (PI-LL) correlates with function and disability. It is associated with paravertebral muscle (PVM) degeneration and is a valuable tool for surgical planning of adult degenerative scoliosis (ADS). This study aims to explore the characteristics of PVM in ADS with PI-LL match or mismatch and to identify the risk factors for PI-LL mismatch.

Methods

A total of 67 patients with ADS were divided into PI-LL match and mismatch groups. The visual analog scale (VAS), symptom duration, and Oswestry disability index (ODI) were used to assess patients’ clinical symptoms and quality of life. The percentage of fat infiltration area (FIA%) of the multifidus muscle at the L1-S1 disc level was measured by using MRI with Image-J software. Sagittal vertical axis, LL, pelvic tilt (PT), PI, sacral slope, and the asymmetric and average degeneration degree of the multifidus were recorded. Logistic regression analysis was done to identify the risk factors for PI-LL mismatch.

Results

In the PI-LL match and mismatch groups, the average FIA% of the multifidus on the convex side was less than that on the concave side (P &lt; 0.05). There was no statistical difference of asymmetric degeneration degree of the multifidus between the two groups (P &gt; 0.05). In the PI-LL mismatch group, the average degeneration degree of the multifidus, VAS, symptom duration, and ODI were significantly higher than that in the PI-LL match group, respectively (32.22 ± 6.98 vs. 26.28 ± 6.23 (%), 4.33 ± 1.60 vs. 3.52 ± 1.46, 10.81 ± 4.83 vs. 6.58 ± 4.23 (month), 21.06 ± 12.58 vs. 12.97 ± 6.49, P &lt; 0.05). The average degeneration degree of the multifidus muscle was positively correlated with the VAS, symptom duration, and ODI, respectively (r = 0.515, 0.614, and 0.548, P &lt; 0.05). Sagittal plane balance, LL, PT, and the average degeneration degree of the multifidus were the risk factors for PI-LL mismatch (OR: 15.447, 95% CI: 1.274–187.269; OR: 0.001, 95% CI: 0.000–0.099; OR: 107.540, 95% CI: 5.195–2,225.975; OR: 52.531, 95% CI: 1.797–1,535.551, P &lt; 0.05).

Conclusion

The PVM on the concave side was larger than that on the convex side in ADS irrespective of whether PI-LL matched or not. PI-LL mismatch could aggravate this abnormal change, which is an important cause of pain and disability in ADS. Sagittal plane imbalance, decreased LL, higher PT, and larger average degeneration degree of the multifidus were independent risk factors for PI-LL mismatch.

Comparison of accuracy and safety between second-generation TiRobot-assisted and free-hand thoracolumbar pedicle screw placement

Background

Robot-assisted spine surgery aims to improve the accuracy of screw placement. We compared the accuracy and safety between a novel robot and free hand in thoracolumbar pedicle screw placement.

Methods

Eighty patients scheduled to undergo robot-assisted (40 patients) and free-hand (40 patients) pedicle screw placement were included. The patients’ demographic characteristics, radiographic accuracy, and perioperative outcomes were compared. The accuracy of screw placement was based on cortical violation and screw deviation. Safety outcomes mainly included operative time, blood loss, revision, and complications.

Results

A total of 178 and 172 screws were placed in the robot-assisted and free-hand groups, respectively. The rate of perfect screw position (grade A) was higher in the robot-assisted group than in the free-hand group (91.0% vs. 75.6%; P < 0.001). The rate of clinically acceptable screw position (grades A and B) was also higher in the robot-assisted group than in the free-hand group (99.4% vs. 90.1%; P < 0.001). The robot-assisted group had significantly lower screw deviation than the free-hand group [1.46 (0.94, 1.95) mm vs. 2.48 (1.09, 3.74) mm, P < 0.001]. There was no robot abandonment in the robot-assisted group. No revision was required in any of the groups.

Conclusions

Robot-assisted pedicle screw placement is more accurate than free-hand placement. The second-generation TiRobot–assisted thoracolumbar pedicle screw placement is an accurate and safe procedure.

Trial registration retrospectively registered

Comparison of percutaneous transforaminal endoscopic decompression and short-segment fusion in the treatment of elderly degenerative lumbar scoliosis with spinal stenosis

BACKGROUND

Degenerative lumbar scoliosis (DLS) combined with spinal stenosis is increasingly being diagnosed in the elderly. However, the appropriate surgical approach remains somewhat controversial. The aim of this study was to compare the results of percutaneous transforaminal endoscopic decompression (PTED) and short-segment fusion for the treatment of mild degenerative lumbar scoliosis combined with spinal stenosis in older adults over 60 years of age.

METHODS

Of the 54 consecutive patients included, 30 were treated with PTED and 24 were treated with short-segment open fusion. All patients were followed up for at least 12 months (12-24 months). Patient demographics, and perioperative and clinical outcomes were recorded. Visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, and modified Macnab criteria were used to assess clinical outcomes. At the same time, changes in disc height, segmental lordosis, coronal Cobb angle, and lumbar lordosis were compared.

RESULTS

The mean age was 68.7 ± 6.5 years in the PTED group and 66.6 ± 5.1 years in the short-segment fusion group. At 1 year postoperatively, both groups showed significant improvement in VAS and ODI scores compared with preoperative scores (p < 0.05), with no statistically significant difference between groups. However, VAS-Back and ODI were lower in the PTED group at 1 week postoperatively (p < 0.05). According to the modified Macnab criteria, the excellent rates were 90.0 and 91.6% in the PTED and short-segment fusion groups, respectively. However, the PTED group had a significantly shorter operative time, blood loss, postoperative hospital stay, postoperative bed rest, and complication rate. There was no significant difference in radiological parameters between the two groups preoperatively. At the last follow-up, there were significant differences in disc height, segmental lordosis at the L4-5 and L5-S1 levels, and Cobb angle between the two groups.

CONCLUSION

Both PTED and short-segment fusion for mild degenerative lumbar scoliosis combined with spinal stenosis have shown good clinical results. PTED under local anesthesia may be an effective supplement to conventional fusion surgery in elderly patients with DLS combined with spinal stenosis.