Seminars in Spine Surgery最新文献

Objective

Unilateral Biportal Endoscopic decompression via interlaminar approach is an evolving minimally invasive technique to decompress the neural structures from either due to degenerative lumbar canal stenosis or herniated disc. The current study aims to highlight technical aspects of this procedure for safe and better clinical outcomes.

Findings

Unilateral Biportal Endoscopy via interlaminar approach provides an excellent magnified and illuminated surgical field to satisfactorily decompress not only ipsilateral but contralateral side also. Dural tear and epidural hematomas are known complications; however, the incidence is low.

Conclusion

Unilateral Biportal Endoscopic decompression via interlaminar approach can safely and effectively decompress neural elements without destabilizing spine.

Spine surgery has witnessed significant advancements in endoscopic techniques over the past several decades. Compared to open approaches, endoscopic spine surgery allows for minimal tissue dissection, blood loss, and hospital stay, while optimizing early functional recovery. Recent improvements in instrumentation have enabled endoscopic techniques to address a larger range of degenerative pathology. However, regulatory barriers and specialized training are thought to underlie the purportedly steep learning curve, which hinders the widespread implementation of endoscopy in clinical practice. This review aims to provide an overview of endoscopic spine surgery and discuss its learning curve relative to other minimally invasive techniques.

Historically, anterior cervical discectomy and fusion (ACDF) has been the preferred surgical technique to address myelopathy and radiculopathy due to cervical spine intervertebral disc disease. Continued design improvements and theoretical biomechanical advantages to cervical disc arthroplasty over the last decade have made cervical disc arthroplasty an appealing alternative to ACDF, especially in younger patient populations without significant spondylosis who may wish to preserve neck motion. This narrative review will discuss the recent advances in cervical disc arthroplasty in regard to material composition, overall design and resultant degrees of freedom of the devices, the potential sparing of neck range of motion, and the theoretical biomechanical advantages of an arthroplasty compared to an ACDF.

Posterior cervical foraminotomy is a commonly performed procedure to address cervical radiculopathy through direct decompression of the neural foramen by partially resecting the dorsal aspect of the facet joint. The procedure is an alternative to anterior cervical approaches such as anterior cervical discectomy and fusion and cervical disc arthroplasty, which require complete discectomy to address foraminal stenosis that cause cervical radiculopathy. The procedure has evolved from open to minimally invasive techniques including endoscopic methods, which has recently increased in interest by spine surgeons. This review discusses the currently existing endoscopic techniques for cervical posterior foraminotomy and synthesizes the existing literature.

Endoscopic surgical options for treating thoracic spinal cord compression are discussed with two case reports, with emphasis on indications/contraindications and surgical techniques.

Endoscopic spine surgery (ESS) has proved to have similar clinical outcomes to those obtained with conventional surgical open options to decompress neural elements. Advantages such as less postoperative pain, intraoperative bleeding, postoperative opioid consumption, earlier mobilization, and shorter hospital stays are related to ESS. However, these techniques are also associated with risks of potentially catastrophic complications. This narrative review discusses the most common complications in full-endoscopy: dural injury, insufficient decompression and recurrence, postoperative epidural hematoma, postoperative dysesthesia, and infection. Moreover, practical advice to prevent and manage them has added to each complication.

Spinal endoscopic approaches, full-endoscopic or biportal, allow for access to various lumbar foraminal pathologies while preserving the integrity of back muscles and facet joints. These minimal invasive procedures can eliminate the need for wide decompressions potentially decreasing the need for instrumented fusion. Early symptomatic recurrence most often arises due to inadequate decompression. Understanding the intricacies of foraminal pathology rather than assuming continued post-surgical pain is a result of spinal instability can change the paradigm of endoscopic spine surgery from endoscopic assisted fusion to true minimally invasive surgery. Surgeons should think whether early revision of spinal decompression could arise from insufficient foraminal decompression. This paper aims to elucidate the reader on foraminal pathoanatomy allowing the surgeon to understand when sufficient decompression is achieved and inform the surgeon on the technical aspects of surgery to minimize iatrogenic instability and incidental complications.

Objective

While there is increasing interest in endoscopic lumbar decompression, widespread adoption has been slowed in part due to the steep learning curve and lack of exposure in many formalized training programs. The objective of this article is to familiarize surgeons with the indications, surgical technique, and outcomes for uniportal endoscopic lumbar decompression via the interlaminar and transforaminal approaches.

Findings

Uniportal endoscopic techniques are growing in popularity as the literature demonstrates that they are safe and effective. Endoscopic approaches allow for rapid functional recovery with reduced morbidity compared to open and MIS techniques.

Conclusions

Endoscopic interlaminar and transforaminal techniques are safe and effective with at least non-inferior long-term outcomes and faster recovery compared to traditional open and MIS counterparts.