Pub Date : 2010-08-01Epub Date: 2010-12-03DOI: 10.1055/s-0030-1263108
R Sobottke, M Röllinghoff, J Siewe, U Schlegel, A Yagdiran, M Spangenberg, R Lesch, P Eysel, T Koy
Background: Interspinous stand-alone implants are inserted without open decompression to treat symptomatic lumbar spinal stenosis (LSS). The insertion procedure is technically simple, low-risk, and quick. However, the question remains whether the resulting clinical outcomes compare with those of microsurgical decompression, the gold standard.
Material and methods: This prospective, comparative study included all patients (n=36) with neurogenic intermittent claudication (NIC) secondary to LSS with symptoms improving in forward flexion treated operatively with either interspinous stand-alone spacer insertion (Aperius (®); Medtronic, Tolochenaz, Switzerland) (group 1) or microsurgical bilateral operative decompression (group 2) between February 2007 and November 2008. Data (patient data, operative data, COMI, SF-36 PCS and MCS, ODI, and walking tolerance) were collected preoperatively as well as at 6 weeks, at 3, 6, and 9 months, and at one year follow-up (FU). All patients had complete FU over 1 year.
Results: Compared to preoperative measurements, surgery led to improvements of all parameters in the entire collective as well as both individual groups. There were no statistically relevant differences between the 2 groups over the entire course of FU. However, improvements in the ODI and SF-36 MCS were not significant in group 1, in contrast to those of group 2. Also, although in group 1 the improvements in leg pain (VAS leg) were still significant (p<0.05) at 6 months, this was no longer the case at 1 year FU. In group 1 at 1 year FU an increase in leg pain was observed, while in group 2, minimal improvements continued. Walking tolerance was significantly improved at all FU times compared to preoperatively, regardless of group (p<0.01). At no time there was a significant difference between the groups. In group 1, admission and operative times were shorter and blood loss decreased. The complication rate was 0% in group 1 and 20% in group 2, however reoperation was required by 27.3% of group 1 patients and 0% of group 2.
Conclusion: Implantation of an interspinous stand-alone spacer yields clinical success comparable to open decompression, at least within the first year of FU. The 1-year conversion rate of 27.3% is, however, decidedly too high.
{"title":"Clinical outcomes and quality of life 1 year after open microsurgical decompression or implantation of an interspinous stand-alone spacer.","authors":"R Sobottke, M Röllinghoff, J Siewe, U Schlegel, A Yagdiran, M Spangenberg, R Lesch, P Eysel, T Koy","doi":"10.1055/s-0030-1263108","DOIUrl":"https://doi.org/10.1055/s-0030-1263108","url":null,"abstract":"<p><strong>Background: </strong>Interspinous stand-alone implants are inserted without open decompression to treat symptomatic lumbar spinal stenosis (LSS). The insertion procedure is technically simple, low-risk, and quick. However, the question remains whether the resulting clinical outcomes compare with those of microsurgical decompression, the gold standard.</p><p><strong>Material and methods: </strong>This prospective, comparative study included all patients (n=36) with neurogenic intermittent claudication (NIC) secondary to LSS with symptoms improving in forward flexion treated operatively with either interspinous stand-alone spacer insertion (Aperius (®); Medtronic, Tolochenaz, Switzerland) (group 1) or microsurgical bilateral operative decompression (group 2) between February 2007 and November 2008. Data (patient data, operative data, COMI, SF-36 PCS and MCS, ODI, and walking tolerance) were collected preoperatively as well as at 6 weeks, at 3, 6, and 9 months, and at one year follow-up (FU). All patients had complete FU over 1 year.</p><p><strong>Results: </strong>Compared to preoperative measurements, surgery led to improvements of all parameters in the entire collective as well as both individual groups. There were no statistically relevant differences between the 2 groups over the entire course of FU. However, improvements in the ODI and SF-36 MCS were not significant in group 1, in contrast to those of group 2. Also, although in group 1 the improvements in leg pain (VAS leg) were still significant (p<0.05) at 6 months, this was no longer the case at 1 year FU. In group 1 at 1 year FU an increase in leg pain was observed, while in group 2, minimal improvements continued. Walking tolerance was significantly improved at all FU times compared to preoperatively, regardless of group (p<0.01). At no time there was a significant difference between the groups. In group 1, admission and operative times were shorter and blood loss decreased. The complication rate was 0% in group 1 and 20% in group 2, however reoperation was required by 27.3% of group 1 patients and 0% of group 2.</p><p><strong>Conclusion: </strong>Implantation of an interspinous stand-alone spacer yields clinical success comparable to open decompression, at least within the first year of FU. The 1-year conversion rate of 27.3% is, however, decidedly too high.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1263108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29514891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-08-01Epub Date: 2010-12-03DOI: 10.1055/s-0030-1262812
M K Kasliwal, V K Anand, E Lavi, T H Schwartz
Background: Nasal glioma or glial heterotopia is a rare embryologic anomaly that heralds its presence shortly after birth or in childhood. Nasal glioma in an adult is very rare, often asymptomatic and the occurrence of nasal glioma in Meckel's cave in an adult has not been previously reported.
Case report: The authors encountered a case of an incidentally diagnosed Meckel's cave nasal glioma in a 40-year-old male which was successfully excised by an endonasal endoscopic transmaxillary transpterygoid approach.
Conclusion: The occurrence of a nasal glioma in Meckel's cave an adult is very rare. Considering the deep skull base location, endonasal endoscopic surgery provides a minimal access technique to reach this location with excellent results.
{"title":"Endoscopic management of a rare case of nasal glioma in Meckel's cave in an adult: case report.","authors":"M K Kasliwal, V K Anand, E Lavi, T H Schwartz","doi":"10.1055/s-0030-1262812","DOIUrl":"https://doi.org/10.1055/s-0030-1262812","url":null,"abstract":"<p><strong>Background: </strong>Nasal glioma or glial heterotopia is a rare embryologic anomaly that heralds its presence shortly after birth or in childhood. Nasal glioma in an adult is very rare, often asymptomatic and the occurrence of nasal glioma in Meckel's cave in an adult has not been previously reported.</p><p><strong>Case report: </strong>The authors encountered a case of an incidentally diagnosed Meckel's cave nasal glioma in a 40-year-old male which was successfully excised by an endonasal endoscopic transmaxillary transpterygoid approach.</p><p><strong>Conclusion: </strong>The occurrence of a nasal glioma in Meckel's cave an adult is very rare. Considering the deep skull base location, endonasal endoscopic surgery provides a minimal access technique to reach this location with excellent results.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1262812","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29514892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-08-01Epub Date: 2010-12-03DOI: 10.1055/s-0030-1268415
J Baldauf, M J Fritsch, J Oertel, M R Gaab, H Schröder
Background: The purpose of this study was to analyze the value of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction or infection.
Methods: ETV was performed in 263 patients in Greifswald between 1993 and 2008. We reviewed the data of all patients with previous shunts who underwent ETV instead of shunt revision. The procedure was successful when subsequent shunt implantation was avoided.
Results: Neuroendoscopy was performed in 30/31 previously shunted patients. The average age of the patients was 26.4 years ranging from 6 months to 69 years (male/female ratio: 18/12). The primary cause of hydrocephalus was aqueductal stenosis in 11, myelomeningocele in 5, posthemorrhagic in 5, postmeningitic in 3, tumor-related obstruction in 2, supracerebellar arachnoid cyst in 2, posttraumatic in 1 and a complex congenital hydrocephalus in 1. ETV was successful in 18 patients (60%) with a mean follow-up period of 51 months. 12 patients (40%) did not benefit from ETV and required a permanent shunt. 11 of them received the shunt within 3 months after failed ETV. ETV failed in all children <2 years of age. A benefit of ETV without subsequent shunt procedures was recognized in 18/27 (66.7%) with an obstructive and 0/3 (0%) patients with a communicating cause of the hydrocephalus. Complications occurred in 2 patients (6.7%).
Conclusions: ETV is a potential treatment option when shunts fail in patients with obstructive hydrocephalus. If MR imaging shows no obstruction, a shunt revision is recommended. Patients with a posthemorrhagic and postmeningitic hydrocephalus are poor candidates for ETV.
{"title":"Value of endoscopic third ventriculostomy instead of shunt revision.","authors":"J Baldauf, M J Fritsch, J Oertel, M R Gaab, H Schröder","doi":"10.1055/s-0030-1268415","DOIUrl":"https://doi.org/10.1055/s-0030-1268415","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to analyze the value of endoscopic third ventriculostomy (ETV) in patients with shunt malfunction or infection.</p><p><strong>Methods: </strong>ETV was performed in 263 patients in Greifswald between 1993 and 2008. We reviewed the data of all patients with previous shunts who underwent ETV instead of shunt revision. The procedure was successful when subsequent shunt implantation was avoided.</p><p><strong>Results: </strong>Neuroendoscopy was performed in 30/31 previously shunted patients. The average age of the patients was 26.4 years ranging from 6 months to 69 years (male/female ratio: 18/12). The primary cause of hydrocephalus was aqueductal stenosis in 11, myelomeningocele in 5, posthemorrhagic in 5, postmeningitic in 3, tumor-related obstruction in 2, supracerebellar arachnoid cyst in 2, posttraumatic in 1 and a complex congenital hydrocephalus in 1. ETV was successful in 18 patients (60%) with a mean follow-up period of 51 months. 12 patients (40%) did not benefit from ETV and required a permanent shunt. 11 of them received the shunt within 3 months after failed ETV. ETV failed in all children <2 years of age. A benefit of ETV without subsequent shunt procedures was recognized in 18/27 (66.7%) with an obstructive and 0/3 (0%) patients with a communicating cause of the hydrocephalus. Complications occurred in 2 patients (6.7%).</p><p><strong>Conclusions: </strong>ETV is a potential treatment option when shunts fail in patients with obstructive hydrocephalus. If MR imaging shows no obstruction, a shunt revision is recommended. Patients with a posthemorrhagic and postmeningitic hydrocephalus are poor candidates for ETV.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1268415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29514887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Minimally invasive approach for far lateral disc herniations: results from 20 patients.","authors":"J-M Voyadzis, V C Gala, F A Sandhu, R G Fessler","doi":"10.1055/s-0030-1249102","DOIUrl":"https://doi.org/10.1055/s-0030-1249102","url":null,"abstract":"Background: Method: Results and Discussion:","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1249102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29281005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01Epub Date: 2010-08-31DOI: 10.1055/s-0030-1249703
J S Kim, S H Lee, J Y Seong, K H Kim, B Jung
Background: When the transthoracic approach is used for the treatment of a thoracic ossified posterior longitudinal ligament (OPLL), there could be a lot of operative risks, morbidity, and mortality for the patient.
Case report: A 65-year-old female manifested back pain and tingling sensations in both legs due to OPLL at the T6-7 level. A thoracoscopic procedure was performed to remove the OPLL, achieving complete decompression of thoracic cord. The symptoms were relieved and the patient was discharged on the sixth day after the operation.
Conclusions: A minimally invasive procedure using the thoracoscopic technique could be a good alternative option in selected cases when a conventional transthoracic approach is impossible due to the patient's general condition.
{"title":"Video-assisted thoracoscopic removal of ossified posterior longitudinal ligament (OPLL) in the thoracic spine: a case report.","authors":"J S Kim, S H Lee, J Y Seong, K H Kim, B Jung","doi":"10.1055/s-0030-1249703","DOIUrl":"https://doi.org/10.1055/s-0030-1249703","url":null,"abstract":"<p><strong>Background: </strong>When the transthoracic approach is used for the treatment of a thoracic ossified posterior longitudinal ligament (OPLL), there could be a lot of operative risks, morbidity, and mortality for the patient.</p><p><strong>Case report: </strong>A 65-year-old female manifested back pain and tingling sensations in both legs due to OPLL at the T6-7 level. A thoracoscopic procedure was performed to remove the OPLL, achieving complete decompression of thoracic cord. The symptoms were relieved and the patient was discharged on the sixth day after the operation.</p><p><strong>Conclusions: </strong>A minimally invasive procedure using the thoracoscopic technique could be a good alternative option in selected cases when a conventional transthoracic approach is impossible due to the patient's general condition.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1249703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29281008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01Epub Date: 2010-08-31DOI: 10.1055/s-0030-1263202
P Tanner
A new volume in the Minimally Invasive Orthopaedic Surgery series, Minimally Invasive Spine Surgery weighs the pros and cons of today’s open versus minimally invasive techniques, allowing you to choose the approaches that will best meet your patients’ needs. In each chapter, accomplished experts describe the advantages, indications, setup, technical aspects, and problem areas associated with a given minimally invasive procedure, including critiques from surgeons who favor a standard open approach – to give you a balanced, objective foundation for surgical decision making.
{"title":"Minimally invasive spine surgery.","authors":"P Tanner","doi":"10.1055/s-0030-1263202","DOIUrl":"https://doi.org/10.1055/s-0030-1263202","url":null,"abstract":"A new volume in the Minimally Invasive Orthopaedic Surgery series, Minimally Invasive Spine Surgery weighs the pros and cons of today’s open versus minimally invasive techniques, allowing you to choose the approaches that will best meet your patients’ needs. In each chapter, accomplished experts describe the advantages, indications, setup, technical aspects, and problem areas associated with a given minimally invasive procedure, including critiques from surgeons who favor a standard open approach – to give you a balanced, objective foundation for surgical decision making.","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1263202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29277806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01Epub Date: 2010-08-31DOI: 10.1055/s-0030-1262810
T Oktenoglu, A F Ozer, M Sasani, T Kaner, N Canbulat, O Ercelen, A C Sarioglu
Background: A prospective pilot study was designed to evaluate the role of a posterior dynamic stabilization technique in the surgical treatment of degenerative disc disease. Posterior dynamic stabilization with a hinged screw is a new concept in the surgical treatment of degenerative disc disease of the lumbar spine. The traditional surgical treatment is to apply a fusion procedure. However, numerous reports showed unsatisfactory clinical outcomes even when patients have satisfactory radiological outcomes following fusion procedures.
Material and methods: The study included patients who were surgically treated with a dynamic stabilization technique due to painful degenerative disc disease. Clinical and radiological findings for the 20 participating patients were analyzed in a 2-year follow-up study. Preoperative and postoperative data at the 3 (rd), 12 (th) and 24 (th) month were collected for both clinical and radiological outcomes. Statistical analyses between preoperative and postoperative data were performed using the Wilcoxon test.
Results: The clinical outcome measurements (VAS, ODI) showed significant improvement in all postoperative measurements compared to preoperative values. The mean preoperative visual analogue score (VAS, 7.9) and Oswestry Disability Index (ODI 59.2) significantly decreased to 0.8 for VAS and 9.2 for ODI, at 2 years post-operation (p<0.05). The radiological studies showed no significant changes between pre- and postoperative values, in all parameters. There was no mortality or morbidity.
Conclusions: The results of this pilot study are encouraging. Dynamic stabilization may be an effective technique in the surgical treatment of painful degenerative disc disease. A larger series study, with longer follow-up periods and with control groups is needed to determine the success and safety of posterior dynamic stabilization in the surgical treatment of degenerative disc disease.
{"title":"Posterior dynamic stabilization in the treatment of lumbar degenerative disc disease: 2-year follow-up.","authors":"T Oktenoglu, A F Ozer, M Sasani, T Kaner, N Canbulat, O Ercelen, A C Sarioglu","doi":"10.1055/s-0030-1262810","DOIUrl":"https://doi.org/10.1055/s-0030-1262810","url":null,"abstract":"<p><strong>Background: </strong>A prospective pilot study was designed to evaluate the role of a posterior dynamic stabilization technique in the surgical treatment of degenerative disc disease. Posterior dynamic stabilization with a hinged screw is a new concept in the surgical treatment of degenerative disc disease of the lumbar spine. The traditional surgical treatment is to apply a fusion procedure. However, numerous reports showed unsatisfactory clinical outcomes even when patients have satisfactory radiological outcomes following fusion procedures.</p><p><strong>Material and methods: </strong>The study included patients who were surgically treated with a dynamic stabilization technique due to painful degenerative disc disease. Clinical and radiological findings for the 20 participating patients were analyzed in a 2-year follow-up study. Preoperative and postoperative data at the 3 (rd), 12 (th) and 24 (th) month were collected for both clinical and radiological outcomes. Statistical analyses between preoperative and postoperative data were performed using the Wilcoxon test.</p><p><strong>Results: </strong>The clinical outcome measurements (VAS, ODI) showed significant improvement in all postoperative measurements compared to preoperative values. The mean preoperative visual analogue score (VAS, 7.9) and Oswestry Disability Index (ODI 59.2) significantly decreased to 0.8 for VAS and 9.2 for ODI, at 2 years post-operation (p<0.05). The radiological studies showed no significant changes between pre- and postoperative values, in all parameters. There was no mortality or morbidity.</p><p><strong>Conclusions: </strong>The results of this pilot study are encouraging. Dynamic stabilization may be an effective technique in the surgical treatment of painful degenerative disc disease. A larger series study, with longer follow-up periods and with control groups is needed to determine the success and safety of posterior dynamic stabilization in the surgical treatment of degenerative disc disease.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1262810","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29281003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01Epub Date: 2010-09-07DOI: 10.1055/s-0030-1263198
Roger Härtl
Arts MP et al. Tubular Discectomy vs. Conventional Microdiscectomy ... Minim Invas Neurosurg 2010; 53: 95–96 the underlying hypothesis for this study was fl awed. A meaningful trial would have compared surgical procedures where diff erences in surgical technique are likely to actually make a clinically relevant diff erence – for tubular surgery this would be a comparison between tubular lumbar fusion vs. open surgery, as has been shown by several case series and comparative studies [3 – 11] . For example, a recent study from Asia demonstrated signifi cantly reduced muscle injury in a group of patients undergoing MISS fusion vs. those undergoing open surgery [12] . The lack of benefi t from tubular discectomy over conventional surgery does not mean that tubular surgery would not have a signifi cant advantage when comparing potentially much more invasive procedures. The concerning fi nding in the present study was that patients undergoing tubular discectomy actually did worse than conventional surgery in regards to selfreported leg and back pain and recovery. The authors are not able to explain this surprising result. They state that the length of the incision was the same in both groups; also other parameters such as the amount of disc removed and blood loss were very similar between groups. The main stated diff erence was the fact that the tubular procedures were done using the operating microscope while surgical loops (providing less magnifi cation) were used primarily for the conventional discectomy. It appears unlikely to us that the use of the microscope with tubular discectomy should be associated with a worse outcome, as their study suggests. Assuming that patients are adequately randomized between groups some of the reasons for worse surgical outcome could be problems with surgeon experience / level of training and limited or inadequate surgical exposure / visualization of the pathology at the time of surgery. Both these concerns cannot be excluded in this manuscript and actually seem likely. The authors state that the “ participating neurosurgeons had broad experience in both techniques ” . In our experience this is unlikely since most surgeons decide at some point in their career to go with either one or the other surgical technique. As demonstrated in our publications a signifi cant learning curve is associated with tubular discectomy and it seems unlikely that surgeons would go back and forth between surgical techniques (1,2). The fact that tubular discectomies took Comment to the article:
{"title":"Comment to the article: \"Tubular diskectomy vs conventional microdiskectomy for sciatica: a randomized controlled trial\".","authors":"Roger Härtl","doi":"10.1055/s-0030-1263198","DOIUrl":"https://doi.org/10.1055/s-0030-1263198","url":null,"abstract":"Arts MP et al. Tubular Discectomy vs. Conventional Microdiscectomy ... Minim Invas Neurosurg 2010; 53: 95–96 the underlying hypothesis for this study was fl awed. A meaningful trial would have compared surgical procedures where diff erences in surgical technique are likely to actually make a clinically relevant diff erence – for tubular surgery this would be a comparison between tubular lumbar fusion vs. open surgery, as has been shown by several case series and comparative studies [3 – 11] . For example, a recent study from Asia demonstrated signifi cantly reduced muscle injury in a group of patients undergoing MISS fusion vs. those undergoing open surgery [12] . The lack of benefi t from tubular discectomy over conventional surgery does not mean that tubular surgery would not have a signifi cant advantage when comparing potentially much more invasive procedures. The concerning fi nding in the present study was that patients undergoing tubular discectomy actually did worse than conventional surgery in regards to selfreported leg and back pain and recovery. The authors are not able to explain this surprising result. They state that the length of the incision was the same in both groups; also other parameters such as the amount of disc removed and blood loss were very similar between groups. The main stated diff erence was the fact that the tubular procedures were done using the operating microscope while surgical loops (providing less magnifi cation) were used primarily for the conventional discectomy. It appears unlikely to us that the use of the microscope with tubular discectomy should be associated with a worse outcome, as their study suggests. Assuming that patients are adequately randomized between groups some of the reasons for worse surgical outcome could be problems with surgeon experience / level of training and limited or inadequate surgical exposure / visualization of the pathology at the time of surgery. Both these concerns cannot be excluded in this manuscript and actually seem likely. The authors state that the “ participating neurosurgeons had broad experience in both techniques ” . In our experience this is unlikely since most surgeons decide at some point in their career to go with either one or the other surgical technique. As demonstrated in our publications a signifi cant learning curve is associated with tubular discectomy and it seems unlikely that surgeons would go back and forth between surgical techniques (1,2). The fact that tubular discectomies took Comment to the article:","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1263198","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29292563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arts MP et al. Tubular Discectomy vs. Conventional Microdiscectomy ... Minim Invas Neurosurg 2010; 53: 96 The fact that tubular discectomy was not superior to conventional surgery was not due to inexperience of surgeons, as H ä rtl and colleagues suggest. Surgeons needed to perform at least 15 procedures before they could participate in our trial [1] . Moreover, we found a tendency of worse results in more experienced surgeons. We strongly disagree with the suggestion to exclude the patients with recurrent disk herniation from primary analysis. First, in an intention-to-treat analysis, by defi nition, the primary endpoint should include all patients with all possible reasons for an unfavourable outcome. Moreover, recurrent disk herniation might very well be an important reason for diff erence in pain scores between the groups. To decide on new guidelines, the fi nal clinical result of both groups, including all its determinants, is crucial. In our opinion, excluding these patients would certainly bias the primary outcome. We agree with the statement that ‘ the lack of benefi t from tubular discectomy over conventional surgery does not mean that tubular surgery would not have a signifi cant advantage when comparing potentially much more invasive proceReply to the comment of R. H ä rtl:
{"title":"Reply to the comment of R. Härtl:","authors":"M. Arts, W. Peul","doi":"10.1055/s-0030-1266154","DOIUrl":"https://doi.org/10.1055/s-0030-1266154","url":null,"abstract":"Arts MP et al. Tubular Discectomy vs. Conventional Microdiscectomy ... Minim Invas Neurosurg 2010; 53: 96 The fact that tubular discectomy was not superior to conventional surgery was not due to inexperience of surgeons, as H ä rtl and colleagues suggest. Surgeons needed to perform at least 15 procedures before they could participate in our trial [1] . Moreover, we found a tendency of worse results in more experienced surgeons. We strongly disagree with the suggestion to exclude the patients with recurrent disk herniation from primary analysis. First, in an intention-to-treat analysis, by defi nition, the primary endpoint should include all patients with all possible reasons for an unfavourable outcome. Moreover, recurrent disk herniation might very well be an important reason for diff erence in pain scores between the groups. To decide on new guidelines, the fi nal clinical result of both groups, including all its determinants, is crucial. In our opinion, excluding these patients would certainly bias the primary outcome. We agree with the statement that ‘ the lack of benefi t from tubular discectomy over conventional surgery does not mean that tubular surgery would not have a signifi cant advantage when comparing potentially much more invasive proceReply to the comment of R. H ä rtl:","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82419867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-06-01Epub Date: 2010-08-31DOI: 10.1055/s-0030-1262811
M Philipps, J Oertel
Background: Spinal endoscopy is still under controversial discussion. An often acclaimed critic is the poor endoscopic image quality in comparison with the microscope. Since high-definition digital cameras have recently been introduced into spinal neuroendoscopy, the aim of the current study is to examine whether superior image quality has a relevant impact on intraoperativen orientation.
Material and methods: A lumbar endoscopic discectomy was recorded simultaneously in High-Definition resolution (HD) and Standard-Definition resolution (SD). 10 experienced spinal surgeons were asked to identify predefined as well as not predefined anatomic structures in HD and SD resolution. Additionally, the video quality was rated with grades from 1 ("very good") to 6 ("poor").
Results: Out of 14 predefined structures an average of 7.8+/-3.3 structures (55.71%) were identified in HD, 4.4+/-3.2 structures (31.43%) in SD (p=0.03). Out of 14 not predefined anatomical structures, 5.9+/-3.6 were correctly identified in HD, 2.6+/-2.5 in SD (p=0.05). Misinterpretation of structures occurred in 1.4+/-1 cases in HD, compared to 3+/-2.2 in SD (p=0.05). Subjective impression of video quality was rated 2.2 ("good") for HD, 3.0 ("satisfactory") for SD (p=0.03).
Conclusion: HD in endoscopic discectomy accounts for a significantly more reliable identification of anatomic structures in freeze-images in comparison with standard definition images. Additionally, the subjective impression of video quality is significantly better in HD. This superior identification of structures might contribute to improve intraoperative orientation in endoscopic neurosurgery using high definition quality technology.
{"title":"High-definition imaging in spinal neuroendoscopy.","authors":"M Philipps, J Oertel","doi":"10.1055/s-0030-1262811","DOIUrl":"https://doi.org/10.1055/s-0030-1262811","url":null,"abstract":"<p><strong>Background: </strong>Spinal endoscopy is still under controversial discussion. An often acclaimed critic is the poor endoscopic image quality in comparison with the microscope. Since high-definition digital cameras have recently been introduced into spinal neuroendoscopy, the aim of the current study is to examine whether superior image quality has a relevant impact on intraoperativen orientation.</p><p><strong>Material and methods: </strong>A lumbar endoscopic discectomy was recorded simultaneously in High-Definition resolution (HD) and Standard-Definition resolution (SD). 10 experienced spinal surgeons were asked to identify predefined as well as not predefined anatomic structures in HD and SD resolution. Additionally, the video quality was rated with grades from 1 (\"very good\") to 6 (\"poor\").</p><p><strong>Results: </strong>Out of 14 predefined structures an average of 7.8+/-3.3 structures (55.71%) were identified in HD, 4.4+/-3.2 structures (31.43%) in SD (p=0.03). Out of 14 not predefined anatomical structures, 5.9+/-3.6 were correctly identified in HD, 2.6+/-2.5 in SD (p=0.05). Misinterpretation of structures occurred in 1.4+/-1 cases in HD, compared to 3+/-2.2 in SD (p=0.05). Subjective impression of video quality was rated 2.2 (\"good\") for HD, 3.0 (\"satisfactory\") for SD (p=0.03).</p><p><strong>Conclusion: </strong>HD in endoscopic discectomy accounts for a significantly more reliable identification of anatomic structures in freeze-images in comparison with standard definition images. Additionally, the subjective impression of video quality is significantly better in HD. This superior identification of structures might contribute to improve intraoperative orientation in endoscopic neurosurgery using high definition quality technology.</p>","PeriodicalId":49808,"journal":{"name":"Minimally Invasive Neurosurgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2010-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0030-1262811","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29282063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}