Neurospine最新文献

Objective: This study aims to evaluate the clinical benefits of the integrated optical and magnetic surgical navigation system in assisting transforaminal endoscopic lumbar discectomy (TELD) for the treatment of lumbar disc herniation (LDH).

Methods: A retrospective analysis was conducted on patients who underwent TELD for LDH at our hospital from November 2022 to December 2023. Patients treated with the integrated optical and magnetic surgical navigation system were defined as the navigation-guided transforaminal endoscopic lumbar discectomy (Ng-TELD) group (30 cases), while those treated with the conventional X-ray fluoroscopy method were defined as the control group (31 cases). Record and compare baseline characteristics, surgical parameters, efficacy indicators, and adverse events between the two patient groups.

Results: The average follow-up duration for the 61 patients was 11.8 months. Postoperatively, both groups exhibited significant relief from back and leg pain, which continued to improve over time. At the final follow-up, patients' lumbar function and quality of life had significantly improved compared to preoperative levels (P < 0.05). The Ng-TELD group had significantly shorter total operation time (58.43±12.37 vs. 83.23 ± 25.90 min), catheter placement time (5.83 ± 1.09 vs. 15.94 ± 3.00 min), decompression time (47.17 ± 11.98 vs. 67.29 ± 24.23 min), and fewer intraoperative fluoroscopies (3.20 ± 1.45 vs. 16.58 ± 4.25) compared to the control group (P < 0.05). There were no significant differences between the groups in terms of efficacy evaluation indicators and hospital stay. At the final follow-up, the excellent and good rate of surgical outcomes assessed by the MacNab criteria was 98.4%, and the overall adverse event rate was 8.2%, with no statistically significant differences between the groups (P > 0.05).

Conclusion: This study demonstrates that the integrated optical and magnetic surgical navigation system can reduce the complexity of TELD, shorten operation time, and minimize radiation exposure for the surgeon, highlighting its promising clinical potential.

Objective: Spinal Cord Injury (SCI) leads to severe motor and sensory deficits, with limited treatment options. This study investigates how methylprednisolone-loaded nanoparticles (MP-NPs) modulate SCI repair by targeting Solute Carrier Family 16 Member 3 (SLC16A3) and reshaping the macrophage-inflammatory microenvironment.

Methods: Transcriptome data were analyzed to identify differentially expressed genes (DEGs) associated with SCI. Immune infiltration and WGCNA analyses identified genes linked to M2 macrophage polarization, pinpointing SLC16A3 as a key regulatory factor. MP-NPs were synthesized, characterized, and tested for their effects on macrophage polarization, neuronal protection, and SCI recovery in rats.

Results: We identified 612 DEGs related to inflammation and immune response in SCI. SLC16A3, upregulated in SCI, was downregulated by MP-NPs. In vitro, MP-NPs promoted M2 macrophage polarization, enhanced neuronal survival, and supported neural stem cell (NSC) differentiation. In vivo, MP-NPs significantly improved motor recovery, reduced inflammation, and facilitated neural repair in SCI rats.

Conclusion: MP-NPs downregulate SLC16A3 and modulate the macrophage-inflammatory environment, promoting neural repair and functional recovery in SCI, offering a promising therapeutic strategy.

Objective: This study aimed to elucidate the hand function recovery capacity of Degenerative Cervical Myelopathy (DCM) patients with different severities of hand dexterity impairment.

Methods: Hand functional outcome measures such as the 10s-G&R test, modified Japanese Orthopedic Association (mJOA) upper extremity score and Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ) Upper Extremity Function were collected before surgery and at the 1-year follow-up. A total of 102 DCM patients were categorized into Mild, Moderate and Severe group based on the preoperative 10s-G&R test result. Hand functional parameters were compared across the three groups. Multivariate linear regression was conducted to explore predictive factors. Receiver Operating Characteristic (ROC) curve analysis was performed to assess the predictive efficacy of the preoperative 10s-G&R test and establish the cut-off value for incomplete recovery of hand dexterity.

Results: At the 1-year follow-up, significant improvements were observed in all hand functional parameters across all three groups. However, the incomplete recovery rates of the Mild/Moderate/Severe group were 26.67%, 46.88%, and 57.50%, respectively (P<0.05). Multivariate regression revealed that preoperative 10s-G&R test result, age, Hoffmann's sign, duration of symptom, and mJOA Upper score serve as significant predictors for postoperative 10s-G&R test outcomes. Patients with a preoperative 10s-G&R test < 15 cycles have a 1.9 times higher risk of incomplete recovery of hand function (P = 0.005).

Conclusion: Most patients, regardless of their preoperative hand function, exhibit potential for improvement in hand dexterity. However, worse initial hand dexterity correlates with poorer outcomes.

To demonstrate the preoperative workup, surgical planning and execution of transforaminal endoscopic thoracic discectomy (TETD) for a giant calcified disc herniation. Surgeries for symptomatic thoracic disc herniations are rare and challenging. The main goal is to achieve sufficient decompression with minimal manipulation of the spinal cord. Conventional surgical techniques may have significant approach-related morbidities and often require additional stabilization. The full endoscopic transforaminal technique is the least invasive approach so far. A 73-year-old female patient with progressive gait disturbance and paraparesis received radiological imaging which revealed a giant calcified thoracic disc herniation at the level T11-12. The preoperative workup, planning and execution of TETD is demonstrated in detail. This report represents a typical educational case of a giant calcified thoracic disc herniation, treated by TETD.

Objective: To analyze the predictive factors for neck pain and cervical spine function after laminoplasty for degenerative cervical myelopathy (DCM) using K-means for longitudinal data (KML).

Methods: In this prospective cohort study, we collected clinical and radiographic data from patients with DCM who underwent cervical laminoplasty. A novel index of surgical outcome, "neck function," which comprises neck pain and cervical spine function according to the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire, was proposed. We treated surgical outcomes as longitudinal rather than cross-sectional data and used KML for analysis. Patients were categorized as having good or poor outcomes based on the KML graph of neck pain and cervical spine function.

Results: From 2016 to 2020, 104 patients underwent laminoplasty for DCM; however, 35 patients were excluded because of loss to follow-up or incomplete data. The authors found that central canal stenosis (odds ratio [OR], 17.93; 95% confidence interval [CI], 1.26-254.73; p=0.03) and preoperative neck pain (OR per 1 point increase=1.49; 95% CI, 1.12-1.99; p=0.006) were 2 negative predictive factors and that a positive K-line during flexion was a positive predictive factor (OR, 0.11; 95% CI, 0.01-0.87; p=0.036) for neck function after laminoplasty.

Conclusion: Central canal stenosis, preoperative neck pain and a K-line during flexion were found to be predictive of postoperative neck pain and cervical spine function after laminoplasty. To achieve better surgical outcomes for neck function, the authors suggest the utilization of these determinants as a guiding framework for the selection of surgical approaches for DCM.

Objective: Lumbar disc herniation (LDH) represents an increasingly encountered condition in patients with rheumatoid arthritis (RA). The aim of the present study is to assess the progress of health-related quality of life following transforaminal endoscopic lumbar discectomy (TELD) for LDH in patients suffering from RA.

Methods: Seventy-four patients, scheduled to undergo elective TELD for LDH, were prospectively enrolled in the study. Group A included 36 otherwise healthy individuals and group B 38 patients complementarily diagnosed with RA according to the 2010 ACR/EULAR (American College of Rheumatology/European League Against Rheumatism) criteria. The Medical Outcomes Study 36-item Short Form health survey (SF-36) was selected for the outcome assessment at baseline and postoperatively, at selected intervals at 6 weeks, 3, 6, and 12 months postoperatively.

Results: Group A presented statistically significantly higher scores in all SF-36 domains and all selected intervals (p<0.001), except for mental health parameter. All aspects of SF-36 questionnaire significantly improved postoperatively (p<0.001) and in each group independently. Nevertheless, the absolute improvement between consecutive time intervals did not differ significantly between the 2 groups.

Conclusion: Patients diagnosed with RA who undergo TELD for LDH demonstrate statistically significant improvement in their health status, as measured by SF-36 questionnaire, one year after the procedure. This improvement is comparable with normal individuals.

The main aim of this video article is to demonstrate the combined use of O-arm navigation and unilateral biportal endoscopy (UBE) to manage far-out syndrome (FOS). In FOS there is entrapment and compression of the fifth lumbar nerve beyond the foramen and between L5 transverse process and the sacral ala at the lumbosacral junction. Conventional microscopic decompression using a paraspinal approach had been the gold standard for its management. However, the surgery is technically challenging due to the deep location of the pathology and intricate anatomy of extraforaminal space. There have been some published reports of unsatisfactory outcomes with microscopic decompression for FOS. We decided to integrate navigation with UBE to increase precision for the management of FOS. A 70-year-old female presented to us with chief complaint of left lower limb radiculopathy since 1 year. She also complained of numbness and paresthesias in her left leg and foot. She was unable to walk for more than 10 minutes due to pain. Her magnetic resonance imaging scan revealed compression of left L5 nerve root in the extraforaminal region. UBE decompression via paraspinal approach was performed for her under O-arm navigation. She experienced immediate relief of her symptoms in the postoperative period. O-arm-navigation-guided UBE is an effective and safer alternative to microsurgical decompression for the management of FOS. This video demonstrates the step-by-step implementation of O-arm navigation with endoscopy and its precise execution.

We present a novel technique to approach far lateral lumbar pathologies using a bitubular, biportal endoscopic system and a paramedian approach. Background: Conventional approaches for lumbar far lateral discectomy range from open approaches to newer minimally invasive approaches such as tubular discectomy and single portal endoscopic discectomy. We present a case of a patient suffering with a left L3-4 and left L4-5 extraforaminal disc herniation who was treated successfully with a left sided bitubular, biportal endoscopic 2 level far lateral discectomy. A paramedian 'bitubular' biportal endoscopic approach is safe and effective for far lateral lumbar pathologies with excellent visualisation due to good outflow of irrigation fluid.

Objective: Uniportal full-endoscopic transforaminal lumbar interbody fusion (FE-TLIF) carries a unique risk of nerve traction and abrasion injury during cage insertion. This study aims to evaluate the clinical efficacy of the GUARD technique and delayed ligamentum flavectomy in reducing postoperative radicular pain and neurapraxia in patients undergoing uniportal FE-TLIF.

Methods: A retrospective analysis was conducted on 45 patients with an average age of 53.9±12.4 years who underwent either FE facet-sparing TLIF (FE fs-TLIF) or FE facet-resecting TLIF (FE fr-TLIF). Patients were divided into 2 groups: the sentinel group (21 patients) using traditional sentinel pin techniques, and the GUARD group (24 patients) using the GUARD technique with delayed ligamentum flavectomy. Patient-reported outcomes included the visual analogue scale (VAS) for leg and back pain, and Oswestry Disability Index. Complication rates, including incidental durotomy, postoperative neurapraxia, and hematoma, were also documented.

Results: Postoperative radicular pain in the legs was significantly reduced at 6 weeks in the GUARD group compared to the sentinel group (VAS: 2.201 vs. 3.267, p=0.021). The incidence of postoperative neurapraxia was markedly lower in the GUARD group (0% vs. 19%, p=0.047). Both groups showed similar improvements in disc height, segmental lordosis, and lumbar lordosis at the 1-year follow-up, with no significant differences in endplate injury or fusion rates.

Conclusion: The GUARD technique and delayed ligamentum flavectomy significantly enhance patient safety by reducing postoperative radicular pain and neurapraxia without incurring additional costs. These techniques are easy to learn and integrate into existing surgical workflows, offering a valuable improvement for surgeons performing FE-TLIF procedures.