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Journal of Minimally Invasive Spine Surgery and Technique
Number of Followers: 1  

  This is an Open Access Journal Open Access journal
ISSN (Online) 2508-2043
Published by Korean Minimally Invasive Spine Surgery Society Homepage  [1 journal]
  • Minimally Invasive Transforaminal Lumbar Interbody Fusion with Enhanced
           Recovery after Surgery ...

    • Abstract: Objective: The objective of this study was to examine a spine na've community hospital
      PubDate: Thu, 27 Oct 2022 00:00:01 +010
  • Target-oriented Percutaneous Lumbar Annuloplasty in Ambulatory Spine
           Center: Proctorship ...

    • Abstract: Objective: To describe an alternative technique of annuloplasty for treatment of chronic discogenic back pain in an ambulatory setting.Method: A retrospective review of all patients presenting with chronic discogenic low back pain and managed by target-oriented thermal annuloplasty at our institute from May 2015 to June 2019 was performed. The procedure is carried out under local anaesthesia in prone position. The principle of the technique relies on dividing the posterior annulus into nine equal segments on AP-view of the C-arm. The trajectory is through the Kambin
      PubDate: Fri, 21 Oct 2022 00:00:01 +010
  • A Prospective Study of the Accidental Durotomies in Microendoscopic Lumbar
           Spine Decompression ...

    • Abstract: Objective: To study the incidence, risk factors, surgical outcomes of accidental durotomies (ADT) in patients of microendoscopic lumbar decompression surgeries (MLDS) and the postoperative patient mobilization protocol.Methods: A total of 550 patients who underwent MLDS from January 2012 to march 2020 under single surgeon and single institute were included in the study and incidence of ADT risk factors like age, BMI, smoking status, diabetes mellitus, surgeon
      PubDate: Thu, 22 Sep 2022 00:00:01 +010
  • Comparative Study of Percutaneous Endoscopic Lumbar Discectomy and Open
           Lumbar Microdiscectomy ...

    • Abstract: Objective: The purpose of this study is to evaluate the clinical outcome of cauda equina syndrome (CES) using percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM).Methods: Fifteen patients with CES either underwent PELD or OLM from January 2017 to December 2019. The patients were divided into 2 groups according to the surgical methods: the PELD group (with 7 patients, 5 males and 2 females) and the OLM group (with 8 patients, 6 males and 2 females). The clinical outcomes were evaluated by the Visual Analogue Scale score (VAS), motor grade of lower extremities, perineal sensation, anal tone, and bladder dysfunction. Results: Both groups reported a significant postoperative reduction of VAS score for back and leg pain. When comparing the two groups, there was no significant difference in the improvement of leg pain. However, the improvement in back pain was significantly higher in the PELD group than in the OLM group (p=0.05). In the PELD and OLM groups, all 15 patients showed an improvement in preoperative CES symptoms including impaired lower limb motor power, perineal sensations, anal sphincter tone and bladder function at the one-year follow-up. The operation time (p=0.01) and length of hospital stay (p=0.01) were shorter in the PELD group compared with the OLM group. In the PELD group, the intraoperative bleeding was negligible whereas in the OLM group.Conclusion: The advantages of PELD, indicate it is a good alterative or option for the treatment of CES patients considering the appropriate indication.
      PubDate: Thu, 22 Sep 2022 00:00:01 +010
  • A Clinical Pilot Study Showing the Safety and Efficacy of Intramuscular
           Injection of ...

    • Abstract: Objective: The objective of this study was to assess the safety and efficacy of intramuscular injection of atelocollagen for the prevention of paraspinal muscle atrophy after spine surgery. Atelcollagen has been widely used as an intradermal filler to restore soft tissue defect. Many studies demonstrated that atelocollagen provides good therapeutic results by promoting cell proliferation and enhances the healing effect on injured connective tissues such as tendons and fasciae, while causing few complications. Methods: A total of 118 patients who underwent single level of posterior lumbar interbody fusion (PILF) between December 2017 and April 2019 were retrospectively reviewed. In the study group of 60 patients, 3 mL of gel-type 3% atelocollagen solution was prepared and injected into the multifidus muscle during wound closure. Clinical efficacy was evaluated by the improvement of back pain, elevation of a muscle enzyme, and inflammatory markers. Radiologic efficacy was evaluated with a comparison of density and cross-sectional area (CSA) of multifidus and erector spinae muscle in CT images. Results: Visual analogue scale (VAS) scores for back pain was not significantly lower in the study group postoperatively compared with the control group. The reduction of postoperative paraspinal muscle density and CSA was significantly lower in the study group. The serum level of muscle enzyme and inflammatory markers were significantly lower in the study group. No major procedure-related complications were observed during the follow-up period.Conclusion: Intramuscular injection of atelocollagen is safe and feasible for the prevention of paraspinal muscle atrophy after spine surgery. This novel method seems advantageous for accelerating wound healing without causing inflammation.
      PubDate: Thu, 22 Sep 2022 00:00:01 +010
  • Comparative Study of the Differences in Radiologic Results for
           Percutaneous Endoscopic Lumbar ...

    • Abstract: Objective: Lumbar foraminal stenosis is a common pathology that causes back pain and radiculopathy. Percutaneous endoscopic lumbar foraminotomy (PELF) is a minimally invasive surgical procedure reported to be effective in the treatment of foraminal stenosis; however, no studies have been conducted that compare the on radiographic results of PELF and conventional techniques for the treatment of foraminal stenosis, such as microscopic foraminotomy and micro-endoscopic foraminotomy. This study aimed to report postoperative changes in the lumbar foraminal parameters on computed tomography (CT) after PELF and to compare the radiological efficacy of the PELF technique with that of the conventional techniques.Methods: Radiographic evaluation of the neuroforamen was based on CT scans taken preoperatively and 3 months postoperatively in the PELF and conventional groups. The Japanese Orthopaedic Association (JOA) score for back pain, visual analog scale (VAS), and JOA back pain evaluation questionnaire (JOABPEQ) were evaluated preoperatively and at 3 months postoperatively in the PELF group.Results: The PELF and conventional groups comprised 21 and 17 patients, respectively. In the PELF group, the JOA score, VAS of back pain, and JOABPEQ of low back pain showed significant improvement; however, VAS of leg pain and leg numbness and the other components of JOABPEQ showed no significant differences. There were significant increases in the foraminal area, superior foraminal width (SFW), and middle foraminal width (MFW). Additional radiological evaluation for patients who underwent microscopic or micro-endoscopic lumbar foraminotomy was almost equivalent.Conclusion: Percutaneous endoscopic lumbar foraminotomy is a minimally invasive technique that is as effective as conventional techniques for the treatment of foraminal stenosis.
      PubDate: Mon, 19 Sep 2022 00:00:01 +010
  • Comparative Study of the Outcomes of Unilateral Biportal Endoscopic
           Discectomy and Tubular ...

    • Abstract: Objective: Unilateral biportal endoscopic (UBE) discectomy and tubular microdiscectomy (TMD) are widely practiced methods for treatment of lumbar disc herniation. Good clinical outcomes of these methods are reported in many papers, but there are a few comparative studies. This study reports the clinical outcomes of UBE and TMD as minimally invasive surgery methods for lumbar disc herniations and discusses the effectiveness of UBE.Methods: Sixty-seven patients who had undergone single-level discectomy using one of two methods, UBE or TMD, underwent a prospective follow-up examination. Thirty-four of these patients underwent discectomy using UBE, and the remaining 33 patients underwent TMD. In addition to the traditional measures of outcome, the improvement of generic health-related quality of life and disease-specific measurements like Visual Analogue Scale (VAS) score, Short-form 36 (SF-36), and Oswestry Disability Index (ODI) were evaluated and compared.Results: Sixty-seven patients with more than 6 months of post-operative follow-up evaluations were included. The mean improvements in the VAS scores for back pain and leg pain and ODI were 2.0, 3.7, and 26.5 for the UBE group and 1.6, 3.0, and 19.4 for the TMD group. The SF-36 physical health component subscale score improved from 35.4 pre-operatively to 54.8 at the last follow-up in the UBE group, and the mental health score improved from 43.5 to 55.1 (TMD group: from 34.9 to 54.3 and 44.2 to 57.1, respectively). Conclusion: The clinical outcomes of the UBE group are comparable to those of the TMD group. The results indicate that UBE for lumbar disc herniation can be performed safely and effectively as a treatment modality.
      PubDate: Mon, 19 Sep 2022 00:00:01 +010
  • Far-Lateral Cervical Approach as a Minimally Invasive Technique for
           Excision of Upper Cervical ...

    • Abstract: Objective: To demonstrate the surgical details of the far-lateral approach (FLA) as a minimally invasive technique for the excision of the upper cervical anterolateral and anterior meningiomas and dumbbell schwannomas, and to assess the clinical and radiological outcomes in patients who underwent surgery.Methods: In this technical report and case series we demonstrated the FLA technique and reported patients who underwent the FLA for C1-C4 anterolateral and anterior meningiomas and dumbbell schwannomas between June 2007 and June 2020. All patients
      PubDate: Wed, 07 Sep 2022 00:00:01 +010
  • Full Endoscopic Interlaminar Contralateral Lumbar Foraminotomy for
           Recurrent L5-S1 ...

    • Abstract: After endoscopic lumbar foraminotomy, decreased disc height commonly causes foraminal restenosis and accompanying lateral recess stenosis. Interlaminar contralateral endoscopic lumbar foraminotomy can be used to treat multiple recurrent lesions instead of fusion surgery. Dorsal foraminal-extraforaminal decompression is challenging because of severe perineural adhesions. Therefore, neural decompression should be focused on the ventral foraminal expansion along the virgin dissection plane between the exiting nerve root and ventral foraminal pathologies. The prominent bony spur and herniated disc were removed using an endoscopic drill and forceps. As the foramen was enlarged, the endoscope was introduced deeper through the caudal-ventral foramen space to explore the extraforaminal and far-out lesions. Postoperatively, neurological deficits of L5 radiculopathy and radiating leg pain improved. The expanded foraminal-extraforaminal space was well maintained without progression of lateral wedging on the one-year follow-up images. We successfully treated recurrent foraminal-extraforaminal stenosis and combined lateral recess stenosis using the full endoscopic interlaminar contralateral approach at the L5-S1 level. This technique may be an alternative surgical method to treat the recurrent foraminal-extraforaminal stenosis in the collapse of the L5-S1 neuroforamen. However, this technique should be considered in highly selected patients unsuitable for fusion operations.
      PubDate: Thu, 25 Aug 2022 00:00:01 +010
  • A Multi-surgeon Robotic-guided Thoracolumbar Fusion Experience: Accuracy,
           Radiation, ...

    • Abstract: Objective: Robotic guidance provides indirect visualization of key anatomic landmarks to facilitate minimally invasive surgery (MIS) and is emerging as a reliable and accurate technique for posterior spine instrumentation. We sought to describe eight years of experience with robotic guidance at a high-volume, multi-surgeon center. We hypothesize that robotic guidance will lead to (1) low rates of complication, readmissions, and revision surgery, (2) reduced fluoroscopic radiation exposure, (3) and accurate thoracolumbar instrumentation.Methods: A retrospective review of complications, revision surgery, and readmission rates in patients undergoing thoracolumbar fusion surgery utilizing three robotic generations. Secondary analysis was conducted comparing the three robotic generations for complications, revision surgery, accuracy, and readmission rates along with intraoperative fluoroscopic duration. Results: A total of 628 patients (3,874 robotic-guided screws) ages 12'81 years-old (43.9% male) were included in the study. At one year, the cumulative complication incidence was 15.5% with a 10.3% incidence of surgical complications (3.7% wound, 1.2% robot-related, and 5.4% non-robot-related complications). At one year, the revision surgery incidence was 9.4%. There was no statistical difference between complications, readmission, or revision surgery after initial admission among the three robotic generations. The average intraoperative fluoroscopic duration was 53.8 seconds (11.9 seconds per screw and 17.6 seconds per instrumented level).Conclusion: Robotic guidance in thoracolumbar instrumented fusions was associated with low complication, revision surgery, and readmission rates. Our results suggest robotic guidance can provide accurate guidance with minimal adverse events in thoracolumbar instrumentation.
      PubDate: Thu, 18 Aug 2022 00:00:01 +010
  • Use of Minimally Invasive Spine Surgery in the Management of High-grade
           Thoracolumbar Spine Injuries

    • Abstract: Objective: Spinal fractures often have devastating sequelae. Thoracolumbar fractures are classified using the Thoracolumbar Injury Classification and Severity score (TLICS) to determine the severity of injury and to guide treatment. Recently advancements in minimally invasive spine surgery (MISS) have led to new approaches to high-severity fractures. Studies have suggested that MISS may yield similar outcomes to conventional, more invasive procedures while producing several benefits.Methods: This retrospective study involves 46 patients treated from 2005 through 2020 for high grade thoracolumbar trauma from T2 to L5 with a minimum follow-up of 6-months treated with MISS techniques using percutaneous instrumentation. Results: Average TLICS was 7.5. Patient derived outcome measures with average length of follow-up of 602 days included Oswestry Disability Index 28.9, Patient Satisfaction Index 4.2, Short Form-12 Mental Component Score 51.9, and Short Form-12 Physical Component Score 37.7. Average estimated blood loss was 119.2 mL.Conclusion: The TLICS is a validated tool used to guide surgical intervention in high grade trauma. The utilization of MISS techniques for the treatment and stabilization of thoracolumbar trauma is efficacious and a viable alternative to traditional open approaches.
      PubDate: Thu, 18 Aug 2022 00:00:01 +010
  • Robotic-assisted Superior Gluteal Nerve Tumour Resection

    • Abstract: Sciatic notch tumours of the intra-pelvic variety are rare lesions and commonly arise from the sciatic nerve. These are usually benign neurogenic tumours and the most common of them is schwannoma. Conventional laparotomy techniques have associated surgical morbidity and significant blood loss. The advent of robotic systems and refinement in robotic-assisted surgical techniques to access deep lying pre-sacral lesions has offered a novel way to surgically handle such lesions thereby reducing morbidity, hospital stay and blood loss. Here we are presenting a case of non-discogenic sciatica which was attributed to superior gluteal nerve tumour and was surgically resected using robotic-assisted technique.
      PubDate: Thu, 18 Aug 2022 00:00:01 +010
  • End-points of Decompression of in Lumbar Transforaminal Endoscopic Spine
           Surgery: A Narrative ...

    • Abstract: Objective: Executions of indications/extended indications are associated with higher than normal rates of symptomatic recurrences and treatment failures, especially for novice surgeons incorporating Percutaneous Transforaminal endoscopic lumbar discectomy/decompression (PTELD) techniques. Causes of failures can be manifold and can occur because of a residual or a complete fragment causing persistent compression or associated unaddressed stenosis. To prevent this problem, proper training, multiple instrument inventory, variable techniques are needed with progressive learning.
      Authors aim to suggest objective and subjective criteria to define end-points/adequacy of decompression (EPD).Methods: PubMed database search was limited to locate only adequacy of decompression of PTELD and thus included specific keywords:
      PubDate: Fri, 29 Apr 2022 00:00:01 +010
  • Full-endoscopic Intradiscal Surgery: State of the Art

    • Abstract: Two types of full-endoscopic intradiscal surgery have been described in the literature. The first is full-endoscopic thermal annuloplasty, which was introduced in 2004 for discogenic pain. The proposed pain generator is a high signal intensity zone or a toxic annular tear, which can be treated by full-endoscopic thermal annuloplasty using a bipolar radio-pulse device. The second is full-endoscopic disc cleaning surgery, which is more recent and has been used to treat intractable chronic low back pain due to type 1 Modic change. In this review, we describe the current status of full-endoscopic intradiscal surgery.
      PubDate: Fri, 29 Apr 2022 00:00:01 +010
  • Oblique Lateral Lumbar Interbody Fusion at L2-L5: Proposal of a New
           CT-based Preoperative ...

    • Abstract: Objective: Oblique anterior to psoas (ATP) lumbar fusion is associated with advantages such as sufficient indirect decompression and restoration of lordosis. However, the ATP approach risks damaging the vascular elements anterior to the spine, and it requires a complicated left oblique surgical corridor that puts the contralateral neural elements at risk. Therefore, a thorough preoperative assessment of the location of entry into the disc space, a feasible trajectory to complete the intervertebral space procedure, and the possible retraction of the psoas muscle under these conditions are considered in this article.Methods: From January 2019 to January 2020, 160 lumbar CT scans were evaluated. Only 124 images from the L2-L3, L3-L4, and L4-L5 levels met the inclusion criteria. The length of the anterior vertebral line (AVL) and the middle-third of the disc in the anteroposterior axis were measured to localize the entry point (EP). The distance between the anterior arterial vessel (AV) and the EP was also measured. The trajectory commonly used to set the surgical instruments into the disc space was called
      PubDate: Fri, 29 Apr 2022 00:00:01 +010
  • Lateral Lumbar Interbody Fusion in the Outpatient Setting with Multimodal
           Analgesic Protocol: ...

    • Abstract: Objective: Minimally invasive techniques and multimodal analgesia protocols have made spine surgery in the outpatient setting increasingly feasible. A number of spinal procedures have been documented in the outpatient setting, though the feasibility of lateral lumbar interbody fusion (LLIF) on an ambulatory basis has not been thoroughly assessed. To present a clinical case series of patients undergoing LLIF in the outpatient setting.Methods: A prospectively maintained surgical database was retrospectively reviewed to identify patients undergoing outpatient spine procedures with an enhanced multimodal analgesia protocol from October 2016 to February 2021. Patient demographics, medical and spinal diagnoses, procedural characteristics, operative duration, estimated blood loss (EBL), postoperative length of stay (LOS), postoperative pain scores, postoperative narcotic consumption, and incidence of any intra- or postoperative complications were collected. The state
      PubDate: Thu, 28 Apr 2022 00:00:01 +010
  • Do Patient Expectations Represent a More Important Clinical
           Difference' A Study of Surgical ...

    • Abstract: Objective: This study aims to compare the impact of achieving an MCID or meeting preoperative expectations on patient satisfaction following cervical spine procedures.Methods: A surgical database was retrospectively reviewed for cervical spine surgery patients from 2016 to 2020. Inclusion criteria were primary or revision, single- or multilevel cervical disc arthroplasty or anterior cervical discectomy and fusions (ACDF). Visual analogue scale (VAS) neck and arm pain was assessed preoperatively and postoperatively (6-week, 12-weeks, 6-months, 1-year). Preoperative patient expectation and postoperative satisfaction were recorded. MCID achievement was determined using previously established values. Expectations met and MCID achievement were compared as possible predictors of satisfaction.Results: One hundred and six cervical spine patients were included. Both meeting expectations and achieving MCID were significant predictors of satisfaction for arm pain at 6-weeks and 12-weeks (all p
      PubDate: Thu, 28 Apr 2022 00:00:01 +010
  • Multilevel Percutaneous Fenestrated Screw Fixation with Bone Cement
           Augmentation in Adult ...

    • Abstract: Objective: Fenestrated screw fixation with bone cement augmentation has been demonstrated to increase the pullout strength. Bone cement augmentation is performed to prevent screw failure. Although bone cement screw fixation and fenestrated screw fixation have been compared in many studies, there has been no study on the clinical effects and complication in long level percutaneous bone cement screw fixation. The study aimed to investigate the safety and efficacy of multilevel percutaneous fenestrated screw fixation with bone cement augmentation in the adult lumbar spinal deformity.Methods: We performed a retrospective study of 15 patients who underwent multilevel percutaneous fenestrated screw fixation (PFSF) with bone cement augmentation in a single spine surgeon between January 2018 and December 2020. The incidence of screw failure, body mass index (BMI), bone mineral density (BMD), past history, Visual analogue scale (VAS) score, Oswestry disability index (ODI), sagittal vertical axis (SVA), pelvic Tilt (PT), pelvic incidence (PI), sagittal slope (SS), lumbar lordosis (LL) and Cobbs angle were investigated in the patients.Results: All patients underwent percutaneous screw fixation using a bone cement additive. Mean BMD was '2.0
      PubDate: Thu, 28 Apr 2022 00:00:01 +010
  • Unilateral Biportal Endoscopic Translaminar Keyhole Approach to Treat
           High-grade Up-migrated ...

    • Abstract: The incidence of lumbar disc fragment migration is approximately 35%'72% of which 34% are high-grade up-migrated discs. Translaminar keyhole approach is a minimally invasive and true tissue sparing technique which has been applied to approach migrated disc herniation. The unilateral biportal endoscopic approach is an emerging technique among endoscopic spine surgery that combines the advantages of microscopic surgery with endoscopic surgery. In this technical report we demonstrate the surgical technique of performing the translaminar keyhole approach with unilateral biportal endoscopic spine surgery to treat high-grade up-migrated discs. As far as we know, this is the first technical report of unilateral biportal endoscopy with translaminar keyhole approach to treat high-grade up migrated lumbar disc herniation.
      PubDate: Thu, 28 Apr 2022 00:00:01 +010
  • Traumatic Bilateral Pars Fracture with Grade-I Spondylolisthesis Treated
           by Transforaminal ...

    • Abstract: Traumatic spine injuries are common in young and adult population with worlds incidence estimated annual rate in 10.4'130.6 cases per million [1]. We are presenting a case of traumatic bilateral pars fracture with Grade-I spondylolisthesis treated by Endoscopic Transforaminal (Trans Kambian) spine fusion, under epidural analgesia and neuromonitoring. To the best of our knowledge this is a unique scenario reported for the first time in literature. Lumbar fusion although considered as the gold standard for the degenerative spine disease and Spondylolisthesis, Endoscopic Transforaminal (Trans Kambian) lumbar fusion popularly known as Endofusion/Endo-TLIF (Transforaminal lumbar interbody fusion) is a recent and effective minimally invasive option for certain cases. A 30-year male presented with severe low back pain and decreased sensations over dorsum of right foot after a fall of heavy metal pipe on his lower back. (VAS score 9/10). After thorough preop evaluation patient underwent Endoscopic Transforaminal (Trans Kambian) lumbar discectomy and fusion under epidural analgesia, with visualized endplate preparation. Specially designed Titanium Endo-bullet cage was inserted after percutaneous pedicle screw placement under neuromonitoring. Complete reduction of listhesis was achieved with near total relief in pain. Endoscopic TLIF ensures minimal tissue retraction and minimal alteration of the normal anatomy aiding in faster recovery and minimal blood loss. Patient was mobilized and discharged within 24 hours of surgery. We suggest Endo fusion is a safe and effective day care procedure for cases with traumatic bilateral pars fractures.
      PubDate: Thu, 28 Apr 2022 00:00:01 +010
  • Minimally Invasive versus Conventional Lumbar Interbody Fusion at
           L5'S1: A Retrospective ...

    • Abstract: Objective: This study aimed to evaluate the radiologic and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and conventional posterior lumbar interbody fusion (PLIF) at the L5'S1.Methods: We retrospectively reviewed patients who underwent posterior lumbar fusion (MIS-TLIF and PLIF) at only the L5'S1 and were followed up for more than 12 months. Age, sex, body mass index (BMI), bone mineral density (BMD), diagnosis, comorbid conditions, fusion rate, perioperative results, and pre- and postoperative radiographic parameters at the L5'S1 level, pelvic parameters and degree of spondylolisthesis, and clinical results were analyzed.Results: A total of 102 patients (46 male, 56 female) with a mean age of 57.1 years were evaluated. Fifty and fifty-two patients underwent MIS-TLIF and PLIF surgeries, respectively. Radiologic parameters increased from their preoperative measures at the last follow-up study; similarly, there were no intergroup differences. The fusion rates in the MIS-TLIF and PLIF groups were 86% and 82.7%, respectively. The subsidence rates in the MIS-TLIF and PLIF groups were 6% and 3.8%, respectively. There was no intergroup difference in terms of fusion rate and subsidence. Clinical outcomes also gradually improved after surgery in both groups without intergroup differences.Conclusion: In L5'S1 posterior spinal surgery, there was no significant difference between MIS-TLIF and conventional PLIF. Considering the operation time and estimated blood loss, MIS-TLIF is more effective than PLIF surgery in terms of postoperative health care and economics.
      PubDate: Thu, 28 Apr 2022 00:00:01 +010
  • Full-endoscopic Foraminotomy in Degenerative Spondylolisthesis: A

    • Abstract: Purpose Degenerative Lumbar Spondylolisthesis (DSL) is a common spinal pathology characterized by the anterior slippage of one vertebral body on another. DSL is caused mainly by degeneration of the intervertebral disc in the first place, with subsequent degeneration of the facet joints that end causing the slippage. As the disease evolves, stability is restored as a result of advanced degeneration and disc collapse. But while this natural evolution takes place, DSL may produce radicular symptoms by different mechanisms. To present a
      PubDate: Wed, 20 Apr 2022 00:00:01 +010
  • Only Surgical Decompression Is Sufficient for Multilevel Lumbar Spinal
           Stenosis with Calcified ...

    • Abstract: The purpose of this report was to share our successful cases of only surgical decompression for symptomatic multilevel lumbar spinal stenosis, by assessing treatment outcomes and perioperative complications. Two patients who had only surgical decompression for symptomatic multilevel lumbar spinal stenosis in March and May 2021 were investigated. They were preoperatively diagnosed with the calcified disc protrusion and vacuum disc in the intervertebral space by magnetic resonance imaging (MRI) and computed tomography (CT). The chief complaints were severe low back pain and bilateral sciatica 2 or 3 months ago. The patients reported also reported difficulty walking due to sciatica, for which they were admitted to Daegu Wooridul Spine Hospital. Under general anesthesia unilateral laminotomy for bilateral decompression (ULBD) was performed and discectomy was not done on the stenosis levels. Treatment outcomes were analyzed by preoperative and postoperative visual analog scale (VAS) for low back pain and sciatica (Back VAS and Leg VAS), improvement in walking, and postoperative MRI. Treatment outcomes were favorable: Low back pain and bilateral sciatica showed a VAS score improvement (Back VAS=3, Leg VAS=3), the patient
      PubDate: Fri, 15 Apr 2022 00:00:01 +010
  • Single Incision Tubular Decompression to Treat Multi-level Lumbar Spinal
           Stenosis: A ...

    • Abstract: Objective: To evaluate the technical feasibility and assess the clinical outcomes of tubular decompression (TD) in cases of multilevel lumbar canal stenosis operated through a single incision. TD has established itself in the surgical management of single level lumbar stenosis. Literature on performance of TD for multilevel stenosis through a single incision are non-existent.Methods: All patients undergoing TD for multilevel lumbar stenosis through a single incision from January 2007 to January 2018 were included. Patient demographics, operative and peri-operative details were documented. Patient based clinical outcomes, namely Visual Analogue Scale (VAS) scale for back and leg pain and Oswestry Disability Index (ODI) were assessed. Results: Favorable tube trajectory and adequate decompression could be achieved through a single incision to decompress multiple levels. The VAS improved from mean 3'1.5 (2'5) to 2'0.8 (1'4) and 7'1.4 (4'9) to 2'1 (1'5) for back and leg pain respectively; while the ODI improved from a mean 44.6'8.6 (32'68) to 20.2'5.3 (16'42) at 3 months post-op and was maintained at 1'0.8 (1'4), 1.6'0.67 (1'3) and 19'2.9 (16'26) respectively at 2 years follow-up.Conclusion: TD for multilevel stenosis done through a single incision is a feasible option with good to excellent results.
      PubDate: Fri, 15 Apr 2022 00:00:01 +010
  • A Two-year Outcome of Various Techniques of Discectomy On Complications: A
           Multicentric ...

    • Abstract: Objective: Various techniques of performing lumbar discectomy are prevalent, each having its rationale and claimed benefits. The authors ventured to assess the total complication rate of lumbar discectomy as well as the complication rates of individual complications, namely CSF leaks, superficial wound infections, deep wound infections, recurrence rates, re-operation rates, and wrong level surgery.Methods: This was a retrospective study of patients operated using open discectomy (OD), microdiscectomy (MD), microendoscopic discectomy (MED), interlaminar endoscopic lumbar discectomy (IELD), transforaminal endoscopic lumbar discectomy (TELD), and Destandau techniques (DT) with a minimum follow-up of 2 years. The inclusion criteria were age>15 years, failed conservative treatment for 4-6 weeks, and the involvement of a single lumbar level.Results: There is no statistically significant association between surgical technique and complications. The total complication rate was 12.89% in 946 operated cases. The most common complication was recurrence (5.81%), followed by re-operation (3.69%), CSF leak (1.90%), wrong level surgery (0.63%), superficial infection (0.52%) and deep infection (0.31%). There were minor differences in the incidence of complications between techniques.Conclusion: This is the first study to compare the complication rates of all the prevalent discectomy techniques across the globe in 946 patients. Although there were minor differences in incidences of complications between individual techniques, there was no statistical significance. The various rates of individual complications provide a reference value for future studies related to complications following discectomy.
      PubDate: Fri, 15 Apr 2022 00:00:01 +010
  • The Significance of Lumbar Probing Combined with Continuous Irrigation and
           Undercutting ...

    • Abstract: The purpose of this report was to present successful cases and technical notes of the patients with up migrated cervical disc herniation to the upper level who were successfully treated using anterior cervical discectomy and fusion (ACDF), describing the evaluation of treatment outcomes and perioperative complications. The cases of two patients who had ACDF in symptomatic up migrated cervical disc herniation to the upper level in February 2021 and November 2021 were reviewed. Two patients presented with a six-week history of posterior neck pain and radiating pain. Preoperative magnetic resonance imaging (MRI) confirmed a diagnosis of up migrated cervical disc extrusion. The patients were admitted to Daegu Wooridul Spine Hospital in Daegu, Korea. ACDF was performed under general anesthesia. Treatment outcomes were examined by comparing pre and postoperative Numeric Rating Scale (NRS), and MRI. Treatment outcomes were favorable: posterior neck pain and radiating pain showed a significant reduction in NRS. Postoperative MRI showed that the up migrated discs were successfully removed in both cases. Neither patient developed perioperative complications. Anterior cervical discectomy can be feasible in patients with symptomatic up migrated cervical disc herniation to the upper level.
      PubDate: Wed, 13 Apr 2022 00:00:01 +010
  • Using Swallowing Quality of Life to Compare Oropharyngeal Dysphagia
           Following Cervical Disc ...

    • Abstract: Objective: To evaluate dysphagia outcomes using the swallowing quality of life (SWAL-QOL) questionnaire between patients undergoing cervical disk arthroplasty (CDA) or anterior cervical discectomy and fusion (ACDF).Methods: A retrospective review of a prospective surgical database was performed to identify individuals who underwent cervical procedures between 2014 and 2020. Patient-reported outcome measures (PROMs) were collected using SWAL-QOL, VAS, NDI, and SF-12 PCS. All measures were recorded at the preoperative to 6-month postoperative timepoint. Patients were grouped according to cervical procedure and instrumentation used. Differences in PROMs and SWAL-QOL domains were evaluated by t-test and one-way ANOVA with post-hoc testing, respectively. Simple linear regression was employed to evaluate the relationship between number of levels operated on and postoperative outcomes. Results: A total of 161 patients were included. ACDF and CDA patients demonstrated no significant differences in VAS neck and arm, or NDI at any timepoint. However, CDA patients had significantly worse SWAL-QOL scores at 6-months. Preoperative VAS neck was significantly worse for patients who underwent either an ACDF procedure with a stand alone cage or CDA as compared to patients who underwent an ACDF with anterior plating. At 6-months postoperatively, CDA patients reported a significantly worse
      PubDate: Thu, 17 Mar 2022 00:00:01 +010
  • Minimally Invasive Iliac Screw Insertion: Clinical Case Series and
           Technical Note

    • Abstract: Objective: Iliac screw fixation has numerous indication and techniques. To describe the technique of minimally invasive screw insertion of the iliac screw by freehand and navigated iliac screw placement using intraoperative image guidance.Methods: Bilateral iliac screws were inserted in a total of seven patients. Five patients underwent navigation guided iliac screw placement and the freehand technique was used in 2 patients. Results: A total of 7 patients underwent minimally invasive iliac screw fixation in our series. The pathology in 4 of the cases was spondylodiscitis, among them 2 cases each at L5-S1 and L4-L5, one with the destruction of L5 vertebral body and the other with the destruction of both L4 and L5 vertebral bodies. Of the remaining cases, two cases had sacral insufficiency fracture and the last case was implant failure after L2-L5 oblique lumbar fusion. None of the cases required conversion to open procedure and none had wound or hardware related complications till the last follow-up. All patients had an uneventful post-operative period with improvement in pain scores and were mobilized on the 1st postoperative day. One 50-year-old female patient suffering from L5-S1 tubercular spondylodiscitis died due to underlying chronic kidney disease three months post-surgery. Conclusion: Minimal invasive iliac screw placement with or without navigation offers the same biomechanical stability as the open approach but without the need for extensive soft tissue exposure needed for a conventional/open procedure; thereby reducing exposure-related complications and enhancing post-operative recovery and early mobilization. Incorporating intra-operative 3D navigation provides real-time multi-planar images which help in easy planning and safe screw placement whilst reducing radiation exposure.
      PubDate: Thu, 17 Mar 2022 00:00:01 +010
  • A Novel Technique of the Full Endoscopic Interlaminar Contralateral
           Approach for Symptomatic ...

    • Abstract: Objective: Extraforaminal juxtafacet cyst is rare and present a surgical challenge due to its anatomical location. This study aimed to introduce the surgical technique of interlaminar contralateral endoscopic lumbar foraminotomy (ICELF) for extraforaminal juxtafacet cyst removal and reveal its approach-related benefits.Method: The endoscope was docked on the ipsilateral spinolaminar junction and access the contralateral foraminal area through the contralateral sublaminar space created by the fine drilling. As the foraminal was enlarged by foraminal ligament removal and the superior articular process drilling, the endoscope was introduced deeper to the extraforaminal area without violation of the foraminal disc. Combined foraminal stenosis was also resolved while exploring the foraminal space. Subsequently, the extraforaminal cyst was safely and entirely removed while exposing the cyst-nerve root adhesion site with an endoscopic view looking up obliquely.Results: Radiating pain in the right leg, back pain, leg hypesthesia, and ankle weakness improved. Conclusion: ICELF for the treatment of extraforaminal JFC can be an alternative surgical method to resolve symptomatic foraminal stenosis and the cyst simultaneously. The endoscopic system moves parallel to the exiting nerve root during ICELF, facilitating clear visualization of the cranial-dorsally or cranial-ventrally located extraforaminal JFCs. The entire cyst contour and the site of cyst-nerve root adhesion can be detected without nerve root retraction, and meticulous dissection is possible without violating the cystic wall.
      PubDate: Mon, 07 Mar 2022 00:00:01 +010
  • The History of Korean Minimally Invasive Spine Surgery Society (KOMISS)
           and Global Impact on ...

    • Abstract: Korea minimally invasive spine surgery society (KOMISS) celebrated its 20th anniversary this year in 2021. The society was established in 2002 for the purpose of research on novel techniques and instruments in the rapidly developing field of spine surgery, under the leadership of Professor Park, Chun Kun, the first president. Annual meetings have been held every year since. The advanced course focusing on endoscopic surgery was introduced in 2009, while international academic conferences and cadaver workshops have been held since 2012. In 2012, the first textbook was published. In 2015, KOMISS was promoted to an official society by integrating with the Korean Society for Minimally Invasive Spine Surgery, another Korean society for minimally invasive spine surgery (MIS). Additionally, in 2017, the Korean Research Society of Endoscopic Spine Surgery (KOSESS), a research group specialized in spinal endoscopic surgery, was established as its own society. Presently, in the face of the ongoing corona pandemic, there is continuous research efforts through online meetings. For the past 20 years, KOMISS has been educating Korean doctors on MIS surgery through various symposiums and hand on workshops, and has gradually established its ranks and expanded its scope around the world. Most importantly, among the many areas of minimally invasive spinal surgery, KOMISS has developed surgical techniques focusing on endoscopic spinal surgery above all else and has had an unrivaled impact worldwide. Consequently, pioneers and world-renowned surgeons of endoscopic spine surgery in KOMISS have inaugurated the era of endoscopic spine surgery as gold standard of care.
      PubDate: Fri, 04 Mar 2022 00:00:01 +010
  • Peri-operative Management and the Role of Minimally Invasive Spine Surgery
           in a Case of Hemophilia B

    • Abstract: Hemophilia A and B are rare X-chromosome-linked recessive bleeding disorders caused by mutations in the genes causing abnormalities of blood clotting factors VIII and IX, respectively. Surgery in these patients will require additional planning and interaction among the surgeon, anesthetist, and a hematologist because they inevitably result in bleeding, excessive blood loss, and other life-threatening complications. The authors present a case 62-year-old male with haemophilia B and progressive neurological claudication. On plain radiographs and MRI the patient had grade 1 spondylolisthesis with lumbar canal stenosis at L4-L5 with a VAS score of 8 and ODI score of 45 and was operated with MIS-TLIF with 22 mm diameter tubular retractor (METRx, Medtronics) and an operating microscope. Pre-operatively, the hematologist opinion was taken and the patient was optimised by maintaining the plasma factor peak level activity according to the WFH guidelines. The patient had uneventful peri-operative period. The total hospital stay is 16 days and a VAS score of 3 and ODI score of 12 after one-year follow-up and without any notable complications. Minimally invasive surgical techniques are a better option in hemophilia patients as these techniques provide the surgeon with an excellent magnification of the operative field, which enables the use of a smaller incision, better hemostasis, and facilitates less traumatic procedures.
      PubDate: Thu, 17 Feb 2022 00:00:01 +010
  • Tube-assisted Minimally Invasive versus Open Posterior Decompression for
           Multilevel ...

    • Abstract: Objective: There have been several reports of minimally invasive decompression for cervical canal stenosis and degenerative myelopathy. Most of these reports are for less than 4 levels and there have not been any comparative studies between Open and MIS cervical decompression for multilevel (
      PubDate: Mon, 14 Feb 2022 00:00:01 +010
  • Minimally Invasive Subaxial Cervical Pedicle Screw Placement with Routine
           Fluoroscopy: ...

    • Abstract: Objective: Conventional cervical pedicle screw insertion necessitates extensive paraspinal muscle dissection and retraction in order to achieve the lateral to medial angulation needed to achieve the optimal screw trajectory. Minimally invasive transmuscular approach can comfortably achieve this angulation without significant injury to the midline structures and its musculo-ligamentous attachments.Methods: Minimally invasive cervical pedicle screws were inserted in 4 fresh frozen cadaveric specimens. Pre-procedure and post-procedure CT scans were done to assess the pedicle dimensions, suitability for screw insertion and integrity of the screws. The same technique was applied in a clinical cohort of six cases ' 3 cases of traumatic subluxation; one case of traumatic vertebral fracture and 2 cases of infective facet destruction (Koch
      PubDate: Mon, 14 Feb 2022 00:00:01 +010
  • Single-stage C6-7 ACDF with T1-2 Oblique Keyhole Transcorporeal Disectomy
           to Treat ...

    • Abstract: Symptomatic cervico-thoracic tandem disc herniation occurs very rarely. On the other hand, cervical disc herniations are common and may be treated via a variety of surgical procedures. Symptomatic upper thoracic disc herniations are extremely rare, and use of a surgical approach in their treatment is controversial due to the narrow operative space within which surgical procedures must be performed. We report an extremely rare case of symptomatic tandem C6-7 and T1-2 disc herniation successfully treated via single-stage, single-incision, C6-7 anterior cervical decompression and fusion, and T1-2 oblique keyhole transcorporeal discectomy. This is the first symptomatic cervico-thoracic tandem disc herniation with its treatment.
      PubDate: Mon, 24 Jan 2022 00:00:01 +010
  • Transforaminal Endoscopic Lumbar Discectomy with Foraminoplasty for
           Down-migrated Disc ...

    • Abstract: Objective: Full-endoscopic lumbar discectomy has evolved to be an alternative for the treatment of lumbar disc herniation. Regarding the techniques, the transforaminal approach remains the primary access. The indications of transforaminal endoscopic lumbar discectomy (TELD) have expanded following the evolution of the techniques, especially TELD with foraminoplasty. This study is to evaluate the efficacy of the TELD with foraminoplasty for downward migrated lumbar disc herniation.Methods: The authors conducted a retrospective study with prospectively collected data in a single center. The study enrolled patients with downward migrated lumbar disc herniation undergoing TELD with foraminoplasty from May 2009 to June 2018. All procedures were performed under local anesthesia. Patients' demographics, clinical outcomes, and satisfaction with surgery were recorded. Results: There were 126 patients included in the current study. The mean age was 50.7
      PubDate: Mon, 24 Jan 2022 00:00:01 +010
  • Efficiency of Spinal Anesthesia versus General Anesthesia for Minimal
           Invasive Single Level ...

    • Abstract: Objective: To evaluate the efficacy of spinal anesthesia in patients undergoing minimal invasive single level transforaminal lumbar interbody fusion surgery (MIS TLIF) and to compare the results with that of general anesthesia.Method: 178 patients were included in the study, 86 were in general anesthesia and 92 were in spinal anesthesia. Patients aged between 20 to 70 years who had undergone MIS-TLIF not responding to 6 weeks of conservative treatment were included. The routine steps of anesthesia for both general and spinal anesthesia were adhered. The VAS, blood loss, duration of surgery, time from entering operation theatre to time of incision, time of bandaging to exit from operation theatre, time of stay in Post Anesthesia Care Unit (PACU), nausea/vomiting, urinary retention, duration of stay in hospital, peri-operative complications were compiled and assessed. Appropriate statistical analysis was applied.Results: The mean time for entering the operation theatre to the incision; mean time from bandaging to the exit; mean PACU time and the mean hospital stay were significantly lower in the spinal anesthesia group (p
      PubDate: Tue, 18 Jan 2022 00:00:01 +010
  • Minimally Invasive en bloc Excision of Rare Hemorrhagic Discal Cysts Using
           Unilateral Biportal ...

    • Abstract: Hemorrhagic discal cyst (HDC) in the lumbosacral spine is a rare cause for low back pain and radiculopathy. Although there is no treatment guideline in the literatures, it is believed that the surgical excision showed better treatment results than the conservative treatment. In this report, we have two excellent treatment results from two patients with HDC using the minimally invasive unilateral biportal endoscopic (UBE) technique. Two patients with the rare HDC in their lumbosacral spines came to our clinic due to low back pain and severe sciatica after failure of conservative treatment. Both patients
      PubDate: Fri, 14 Jan 2022 00:00:01 +010
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Heriot-Watt University
Edinburgh, EH14 4AS, UK
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