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World Neurosurgery Aug 2020Spine surgery has evolved over centuries from first being practiced with Hippocratic boards and ladders to now being able to treat spinal pathologies with minimal tissue... (Review)
Review
Spine surgery has evolved over centuries from first being practiced with Hippocratic boards and ladders to now being able to treat spinal pathologies with minimal tissue invasion. With the advent of new imaging and surgical technologies, spine surgeries can now be performed minimally invasively with smaller incisions, less blood loss, quicker return to daily activities, and increased visualization. Modern minimally invasive procedures include percutaneous pedicle screw fixation techniques and minimally invasive lateral approach for lumbar interbody fusion (i.e., minimally invasive transforaminal lumbar interbody fusion, extreme lateral interbody fusion, oblique lateral interbody fusion) and midline lumbar fusion with cortical bone trajectory screws. Just as evolutions in surgical techniques have helped revolutionize the field of spine surgery, imaging technologies have also contributed significantly. The advent of computer image guidance has allowed spine surgeons to advance their ability to refine surgical techniques, increase the accuracy of spinal hardware placement, and reduce radiation exposure to the operating room staff. As the field of spine surgery looks to the future, many novel technologies are on the horizon, including robotic spine surgery, artificial intelligence, and machine learning to help improve preoperative planning, improve surgical execution, and optimize patient selection to ensure improved postoperative outcomes and patient satisfaction. As more spine surgeons begin incorporating these novel minimally invasive techniques into practice, the field of minimally invasive spine surgery will continue to innovate and evolve over the coming years.
Topics: Artificial Intelligence; Decompression, Surgical; Diskectomy; Diskectomy, Percutaneous; History, Ancient; Humans; Lumbar Vertebrae; Machine Learning; Minimally Invasive Surgical Procedures; Neuroendoscopy; Neurosurgical Procedures; Patient Satisfaction; Patient Selection; Robotic Surgical Procedures; Spinal Diseases; Spinal Fusion; Treatment Outcome
PubMed: 32434014
DOI: 10.1016/j.wneu.2020.05.071 -
Neurosurgery Clinics of North America Jan 2020Anterior cervical disc replacement (arthroplasty) has gained momentum over the past 2 decades. The ball-and-socket prosthesis design of arthroplasty has been shown to... (Review)
Review
Anterior cervical disc replacement (arthroplasty) has gained momentum over the past 2 decades. The ball-and-socket prosthesis design of arthroplasty has been shown to simulate normal motion in all 3 rotation planes at the level of surgery and replicates physiologic motion. Anterior cervical discectomy and fusion has been shown to be a safe and effective surgery over decades; cervical disc replacement counters some secondary effects owing to its preservation of segmental mobility, the potential to reduce adjacent segment degeneration, and the lack of plating or harvesting bone graft. The literature is growing in support of the success and longevity of arthroplasty.
Topics: Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Degeneration; Spinal Fusion; Total Disc Replacement
PubMed: 31739932
DOI: 10.1016/j.nec.2019.08.009 -
Neurosurgery Clinics of North America Jan 2020Full-endoscopic spine surgery has been developed to decrease approach-related morbidity and provide superior visualization. Using a working channel endoscope, lumbar... (Review)
Review
Full-endoscopic spine surgery has been developed to decrease approach-related morbidity and provide superior visualization. Using a working channel endoscope, lumbar disc herniations can be approached via two complementary corridors: the transforaminal approach and the interlaminar approach. Indications, contraindications, surgical technique, complications, and outcomes are discussed in this article. Multiple published studies have demonstrated the feasibility, safety, and efficacy of full-endoscopic lumbar discectomies. Emerging evidence suggests that full-endoscopic discectomies result in similar functional outcomes compared with microsurgical technique and are associated with shorter hospital stays, less opioid consumption, and fewer perioperative complications.
Topics: Diskectomy; Endoscopy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae
PubMed: 31739919
DOI: 10.1016/j.nec.2019.08.016 -
Journal of Orthopaedic Surgery and... Jan 2022Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while...
BACKGROUND
Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH.
METHODS
The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria.
RESULTS
The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups.
CONCLUSIONS
Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.
Topics: Adult; Aged; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Pain; Retrospective Studies; Treatment Outcome
PubMed: 35033143
DOI: 10.1186/s13018-022-02929-5 -
Current Opinion in Otolaryngology &... Dec 2022The purpose of this review is to summarize current evidence regarding dysphagia in anterior cervical spine surgeries (ACSS) and to present recent advances in evaluation... (Review)
Review
PURPOSE OF REVIEW
The purpose of this review is to summarize current evidence regarding dysphagia in anterior cervical spine surgeries (ACSS) and to present recent advances in evaluation and surgical technique.
RECENT FINDINGS
Various risk factors for dysphagia have been identified, and they include female sex, smoking history, prior surgery and cervical lordotic angle. EAT-10 is a validated tool for the assessment of individuals with dysphagia post-ACSS. Local intraoperative corticosteroid application significantly reduced the incidence and magnitude of dysphagia in four out of five studies that were reviewed. Individuals who had undergone cervical disc replacement (CDR) and revision surgery by a zero-profile anchored spacer (ROI-C) device experienced less dysphagia than those who had anterior cervical discectomy with fusion (ACDF). Videofluoroscopic swallow study (VFSS) after ACSS demonstrated pharyngeal weakness and increased posterior pharyngeal wall thickness, while no other abnormality was found.
SUMMARY
Different technique variations can reduce dysphagia severity in individuals undergoing ACSS. Surgeons are encouraged to continue performing randomized control studies to assist in choosing the most favourable technique for the patient.
Topics: Female; Humans; Deglutition Disorders; Cervical Vertebrae; Postoperative Complications; Diskectomy; Spinal Fusion; Treatment Outcome
PubMed: 36004798
DOI: 10.1097/MOO.0000000000000845 -
Spine Dec 2019
Topics: Anesthesia, General; Diskectomy; Endoscopy; Lumbar Vertebrae
PubMed: 31725690
DOI: 10.1097/BRS.0000000000003261 -
Spine Dec 2019
Topics: Anesthesia, General; Diskectomy; Endoscopy; Lumbar Vertebrae
PubMed: 31725691
DOI: 10.1097/BRS.0000000000003262 -
Acta Neurochirurgica. Supplement 2023Anterior cervical discectomy and fusion (ACDF) is the most common surgery performed on the cervical spine, and the number of its cases has tripled over the last two... (Review)
Review
Anterior cervical discectomy and fusion (ACDF) is the most common surgery performed on the cervical spine, and the number of its cases has tripled over the last two decades. Although this intervention is typically safe and effective, it carries an inherent complication risk, which should not be underestimated. Improvements in surgical techniques and advances in interbody fusion devices and plating systems have certainly reduced the rate of postoperative morbidity, but despite such progress, surgeons need to beware consistently of the potential complications, inform the patient of their possibility, and have a management strategy as they develop. This review discusses postoperative morbidity encountered in recently reported large studies on ACDF and highlights the senior author's own single-surgeon experience with 2579 such procedures performed between 1998 and 2017. In his clinical series, which is the largest one reported to date, the overall complication rate was 7.0% (180 cases), and dysphagia (1.9% of cases), graft/hardware failures (1.3% of cases), and postoperative hematomas (0.9% of cases) were noted most frequently. Understanding of the risk and clinical impact of complications after ACDF is very important and every effort should be put on their possible avoidance and on appropriate management when they do occur.
Topics: Humans; Retrospective Studies; Postoperative Complications; Diskectomy; Spinal Fusion; Cervical Vertebrae; Treatment Outcome
PubMed: 37548736
DOI: 10.1007/978-3-030-12887-6_20 -
World Neurosurgery Apr 2022Innovations in spinal endoscopy technology and technique have broadened their applications during the past 10 years. Smaller outer-diameter working-channel endoscopes...
Innovations in spinal endoscopy technology and technique have broadened their applications during the past 10 years. Smaller outer-diameter working-channel endoscopes have permitted safe usage in the cervical spine for full endoscopic decompressions. Endoscopic fusions have now been widely reported, leveraging compatible instrumentation for disc preparation and expandable interbody grafts. This ultra-minimally invasive technique has also enabled the performance of fusion procedures in awake patients under monitored anesthesia care, affording speedier recovery and treatment options for those unable to undergo general anesthesia. Revision surgery after open or minimally invasive posterior discectomy or instrumentation can now be performed with endoscopic techniques, which often leverage the transforaminal approach to avoid scar tissue and adhesions. These procedures, among other endoscopic surgeries, are now being increasingly performed in ambulatory surgery centers, as safe outcomes, economic benefits to the healthcare system, and patients' desire to recover at home are becoming more apparent. Finally, the standardization of endoscopic terminology, which has long been a confounder to proper communication and education in this field, has recently been addressed by leading experts in a consensus document, which will serve as the foundation for future collaborative advancements.
Topics: Cervical Vertebrae; Diskectomy; Endoscopes; Endoscopy, Gastrointestinal; Humans; Lumbar Vertebrae
PubMed: 35364672
DOI: 10.1016/j.wneu.2021.11.099 -
World Neurosurgery Jan 2022Cervical disk protrusion is a common pathology. Anterior diskectomy and fusion is considered the gold standard of treatment, although anterior arthroplasty has gained...
Cervical disk protrusion is a common pathology. Anterior diskectomy and fusion is considered the gold standard of treatment, although anterior arthroplasty has gained some acceptance in the past decade as an alternative. Posterior cervical minimally invasive diskectomy is a rarely used technique, and there is less literature discussing this procedure. We have found this technique to be useful in lateral, soft disk herniations not ventral to the cord or mineralized. This avoids an anterior approach with risk to the cervical viscera, the dysphagia associated with an anterior approach, the need for expensive implanted instrumentation, and the need for prolonged activity restrictions after an anterior approach. We include a Video 1 documenting the technique of minimally invasive posterior cervical diskectomy (anatomic landmarks of interest are labeled at several points during the video). This is achieved prone on an OSI Jackson table (Mizuho OSI, Union City, California, USA) without skeletal fixation. A stepwise technique is used to advance an 18-mm tube retractor into contact with the facet and lateral lamina. A 5-mm smooth diamond drill is used to perform a foraminotomy. To avoid nerve root or spinal cord manipulation, it is often necessary to remove some of the rostral aspect of the inferior pedicle to gain access to the axilla and disk protrusion. The procedure is rapid, well tolerated, and performed as outpatient, and it results in a rapid return to normal activity.
Topics: Diskectomy; Humans; Intervertebral Disc Displacement; Minimally Invasive Surgical Procedures
PubMed: 34757020
DOI: 10.1016/j.wneu.2021.10.077