A Pilot Study of Percutaneous Interlaminar Endoscopic Lumbar Sequestrectomy: A Modern Strategy to Tackle Medically-Refractory Radiculopathies and Restore Spinal Function

Effects of Xuefu Zhuyu Decoction on Inflammatory Factors and the NF-kappaB Signaling Pathway in Rats Model of Radicular Pain

Objective

To investigate the therapeutic effects and mechanisms of Xuefu Zhuyu Decoction (XFZYD) on radicular pain in rats with lumbar disc herniation (LDH).

Methods

Rat models of radicular pain were established and randomly divided into five groups: a control group, a model group, and three groups receiving low, medium, and high doses of XFZYD, with 12 rats per group. The rats in the treatment groups received different doses of XFZYD via oral administration, while the control and model groups received an equal volume of normal saline once daily for 7 days. Pain thresholds were measured, including the paw withdrawal threshold (PWT) and thermal paw withdrawal latency (PWL). The levels of inflammatory factors in the spinal dorsal horn tissue, including tumor necrosis factor α (TNF-α), transforming growth factor-β (TGF-β), interleukin-1β (IL-1β), and interleukin-6 (IL-6), were assessed using enzyme-linked immunosorbent assay (ELISA). Additionally, the expression of phosphorylated NF-κB in the spinal dorsal horn tissue was analyzed by Western blotting.

Results

Compared to the control group, the PWT and PWL in the model group were significantly decreased (p < 0.05), while the levels of TNF-α, TGF-β1, IL-1β, IL-6, and phosphorylated NF-κB in the spinal dorsal horn were significantly elevated (p < 0.05). The PWT and PWL in the low, medium, and high dose groups receiving XFZYD showed significant increases (p < 0.05) compared to the model group, and the levels of TNF-α, TGF-β1, IL-1β, IL-6, and phosphorylated NF-κB were significantly reduced (p < 0.05) across all dose groups.

Conclusion

Xuefu Zhuyu Decoction effectively reduces the release of inflammatory factors in the spinal dorsal horn of rats, enhances pain thresholds, and alleviates radicular neuropathic pain. The underlying mechanism may involve the inhibition of the NF-κB signaling pathway.

Pros and Cons of Minimally Invasive Spine Surgery

This paper reviews current knowledge on minimally invasive spine surgery (MISS). Although it has significant advantages, such as less postoperative pain, short hospital stay, quick return to work, better cosmetics, and less infection rate, there are also disadvantages. The long learning curve, the need for special instruments and types of equipment, high costs, lack of tactile sensation and biplanar imaging, some complications that are hard to treat, and more radiation to the surgeon and surgical team are the disadvantages.Most studies remark that the outcomes of MISS are similar to traditional surgery. Although patients demand it more than surgeons, we predict the broad applications of MISS will replace most of our classical surgical approaches.

Ultrasound-Guided In-Plane Interlaminar Lumbar Endoscopic Approach with Smartphone and Portable Light Source: Description of a New Surgical Technique

Introduction Endoscopic spine surgery enables the minimally invasive treatment of pathologies affecting the spinal cord and roots. Herein we describe an unprecedented technique Ultrasound-Guided in-plane interlaminar lumbar endoscopic approach with a smartphone and portable light source.

Methods The interlaminar approach was performed in a cadaveric specimen at L4 to 5 and L5 to S1 bilaterally. A curvilinear 2 to 5 MHz ultrasound probe was employed, the puncture was performed with the needle, a guide wire was inserted until the flavum ligament, followed by the dilator and working cannula. A 30° spinal endoscope, with an optical adapter of the endoscope camera for smartphone and portable endoscope lighting was inserted, the flavum ligament was visualized, and an opening in this site was performed with the scissors. Open dissection of the specimen was subsequently performed by identifying the puncture site in the interlaminar window.

Results The four interlaminar punctures were successfully guided by ultrasound; the opening of the ligamentum flavum was performed in the most lateral part of the interlaminar space, near the junction of the superior and inferior articular processes of the corresponding vertebrae in all the punctures.

Discussion The ultrasound makes possible to identify facets, foramina, transverse processes, and the interlaminar space. It is possible to minimize the use of radioscopy and its associated risks, both for patients and health professionals.

Conclusions The ultrasound-guided, in-plane, interlaminar, lumbar endoscopic approach with smartphone-adapted endoscope and portable light source is feasible and practical, minimizing radiation risks and making it possible to perform endoscopic spinal surgery.

Anterior-to-Posterior Epidural Migration of a Lumbar Disc Herniation at L1-L2: A Case Report

Protruded disc fragments that penetrate the posterior longitudinal ligament (PLL) migrate rostral or caudal in the vertical plane, some laterally in the horizontal plane, or into the foramina involving the anterior aspect of the spinal canal. Often, there is migration to the ventral epidural space. However, posterior epidural migration of a lumbar disc herniation (PEMLDH) is a rare phenomenon that makes the differential diagnosis challenging. We describe a rare case of anterior-to-posterior epidural migration of a lumbar disc herniation at the L1-L2 level. It was treated microsurgically after total laminectomy, and total resection of the lesion was carried out. PEMLDH is a unique condition causing neurological deficits at different levels. Due to different localization of disc herniations, optimal diagnosis becomes critical for determining the timing and type of treatment surgically.

A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery

In the first phase of development of lumbar endoscopic spine surgery, the focus was on removal of soft disc material through the working corridor of Kambin’s triangle using transforaminal endoscopic lumbar discectomy. With the introduction of the interlaminar approach and increased interest from both industry and surgeons, there has been an exponential development of endoscopic surgical equipment and a corresponding expansion of endoscopic techniques. Endoscopic treatment strategies are applied to conditions ranging from contained prolapsed intervertebral discs to noncontained migrated herniated discs, hard calcified discs, spinal stenosis in the central or lateral recess and the foraminal and extraforaminal region, and other combinations of degenerative conditions requiring decompression or fusion surgery. The further expansion of endoscopic surgical management involving complicated spinal cases and the final quartet of trauma, infections, tumors, and possibly deformities could be the future stage of endoscopic spine surgery development. This article covers the full range of current treatment strategies and presents possible future developments of endoscopic spine surgery for the management of lumbar spinal conditions.