Pub Date : 2018-01-01DOI: 10.4172/2165-7939.1000414
A. Yeung, A. Roberts, P. Shin, Evan Rivers, A. Paterson
Progress within the various surgical fields has been facilitated by the use of minimally invasive procedures to achieve the same clinical outcomes as traditional techniques. Spine surgery is no different, and endoscopic spine surgery continues to demonstrate extensive applications while minimizing collateral tissue damage. Endoscopic spine surgery blends skill sets, technology, and clinical applications from both surgical spine and interventional spine. Clinicians from these fields have adopted endoscopic spine surgery. This has created a dilemma: there are now physicians providing surgical care who have not had formal spine surgical training. Some interventional spine practitioners are able to offer safe and effective endoscopic spine surgery, but training standards and practice standards are necessary for the field to progress. This article provides suggestions for a pragmatic approach to endoscopic spine surgery training and credentialing for physicians who practice interventional spine.
{"title":"Suggestions for a Practical and Progressive Approach to Endoscopic Spine Surgery Training and Privileges","authors":"A. Yeung, A. Roberts, P. Shin, Evan Rivers, A. Paterson","doi":"10.4172/2165-7939.1000414","DOIUrl":"https://doi.org/10.4172/2165-7939.1000414","url":null,"abstract":"Progress within the various surgical fields has been facilitated by the use of minimally invasive procedures to achieve the same clinical outcomes as traditional techniques. Spine surgery is no different, and endoscopic spine surgery continues to demonstrate extensive applications while minimizing collateral tissue damage. Endoscopic spine surgery blends skill sets, technology, and clinical applications from both surgical spine and interventional spine. Clinicians from these fields have adopted endoscopic spine surgery. This has created a dilemma: there are now physicians providing surgical care who have not had formal spine surgical training. Some interventional spine practitioners are able to offer safe and effective endoscopic spine surgery, but training standards and practice standards are necessary for the field to progress. This article provides suggestions for a pragmatic approach to endoscopic spine surgery training and credentialing for physicians who practice interventional spine.","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"7 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000414","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70770157","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 : 2018-01-01DOI: 10.4172/2165-7939.1000427
S. Moniz, Samuel J Duff, S. Punwar, D. Fick, Max P. Majedi, K. Jarvi
This article describes an innovative technique for effective analgesia and enhanced accuracy in placement of percutaneous sacroiliac screws in patients with unstable, posterior pelvic ring injuries. Our approach involves introducing radio-opaque contrast through an indwelling caudal epidural catheter to enhance existing computer navigation systems. This delineates the lumbosacral nerve roots to promote the safe and accurate placement of sacroiliac screws and concurrently provides effective analgesia. We describe the technique and our first cases. It can be used to supplement your current technique in placing sacroiliac joint screws and provide effective analgesia for our patients.
{"title":"Computer Navigated Percutaneous Sacroiliac Joint Screws Assisted by Caudal Epidural Contrast Injection","authors":"S. Moniz, Samuel J Duff, S. Punwar, D. Fick, Max P. Majedi, K. Jarvi","doi":"10.4172/2165-7939.1000427","DOIUrl":"https://doi.org/10.4172/2165-7939.1000427","url":null,"abstract":"This article describes an innovative technique for effective analgesia and enhanced accuracy in placement of percutaneous sacroiliac screws in patients with unstable, posterior pelvic ring injuries. Our approach involves introducing radio-opaque contrast through an indwelling caudal epidural catheter to enhance existing computer navigation systems. This delineates the lumbosacral nerve roots to promote the safe and accurate placement of sacroiliac screws and concurrently provides effective analgesia. We describe the technique and our first cases. It can be used to supplement your current technique in placing sacroiliac joint screws and provide effective analgesia for our patients.","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"07 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70771345","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 : 2018-01-01DOI: 10.4172/2165-7939.S7-010
Sohrab Gollogly, A. Yeung
Endoscopic spine has been routinely performed worldwide for nearly 30 years and there is an extensive body of peer reviewed literature that demonstrates clinical effectiveness [1-8]. The progression of surgical techniques for the treatment of spinal disease towards more effective, less invasive, and less costly care is influenced by academic, regulatory, financial, and consumer driven factors [9-11]. Inertia created by the current CPT based system for reimbursement for surgical services has delayed the development of endoscopic procedures for spinal surgery in the United States. This area of spine surgery has historically not seen the same investments in instrumentation, training, and techniques as other surgical subspecialties such as arthroscopic and laparoscopic surgery. The recent introduction of a CPT code for the reimbursement of endoscopic treatment of herniated discs and symptomatic spinal stenosis in the lumbar spine has resulted in an increased interest in this area of minimally invasive spine surgery. The appropriate standards for teaching endoscopic techniques in surgical training programs or adopting the same techniques into an established surgical practice have not been formally defined [12,13].
{"title":"Endoscopic Spine Surgery: Navigating the Learning Curve","authors":"Sohrab Gollogly, A. Yeung","doi":"10.4172/2165-7939.S7-010","DOIUrl":"https://doi.org/10.4172/2165-7939.S7-010","url":null,"abstract":"Endoscopic spine has been routinely performed worldwide for nearly 30 years and there is an extensive body of peer reviewed literature that demonstrates clinical effectiveness [1-8]. The progression of surgical techniques for the treatment of spinal disease towards more effective, less invasive, and less costly care is influenced by academic, regulatory, financial, and consumer driven factors [9-11]. Inertia created by the current CPT based system for reimbursement for surgical services has delayed the development of endoscopic procedures for spinal surgery in the United States. This area of spine surgery has historically not seen the same investments in instrumentation, training, and techniques as other surgical subspecialties such as arthroscopic and laparoscopic surgery. The recent introduction of a CPT code for the reimbursement of endoscopic treatment of herniated discs and symptomatic spinal stenosis in the lumbar spine has resulted in an increased interest in this area of minimally invasive spine surgery. The appropriate standards for teaching endoscopic techniques in surgical training programs or adopting the same techniques into an established surgical practice have not been formally defined [12,13].","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"01 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.S7-010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70776133","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 : 2018-01-01DOI: 10.4172/2165-7939.1000E129
J. Yue
{"title":"Preface to Special Issue Minimally Invasive Surgery Spine-II","authors":"J. Yue","doi":"10.4172/2165-7939.1000E129","DOIUrl":"https://doi.org/10.4172/2165-7939.1000E129","url":null,"abstract":"","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"07 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000E129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70772685","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 : 2018-01-01DOI: 10.4172/2165-7939.s7-014
Mohsen Ghiassi
Figure 2: Filling the balloon with contrast agent. great importance. Operative stabilization using a minimally invasive procedure called balloon kyphoplasty has been one of the established methods for years. Balloon kyphoplasty provides a good and efficient pain relief with faster mobilization of patients and thus avoiding a need for care mit fast return the patients home. The surgery lasts between 30 to 60 minutes under general anesthesia. In some cases it is also possible in local anesthesia (Figures 1-8).
{"title":"Surgical Procedure of Balloon Kyphoplasty and Cement Injection in Osteoporotic Vertebral Body Fractures","authors":"Mohsen Ghiassi","doi":"10.4172/2165-7939.s7-014","DOIUrl":"https://doi.org/10.4172/2165-7939.s7-014","url":null,"abstract":"Figure 2: Filling the balloon with contrast agent. great importance. Operative stabilization using a minimally invasive procedure called balloon kyphoplasty has been one of the established methods for years. Balloon kyphoplasty provides a good and efficient pain relief with faster mobilization of patients and thus avoiding a need for care mit fast return the patients home. The surgery lasts between 30 to 60 minutes under general anesthesia. In some cases it is also possible in local anesthesia (Figures 1-8).","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"01 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.s7-014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70776257","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 : 2018-01-01DOI: 10.4172/2165-7939.S7-012
Bernard Lee
Mechanical low back pain conditions have been traditionally treated with open surgical spinal decompression. The approach to the spine has evolved towards using minimally invasive techniques, previously microdiscectomy and now endoscopic spine surgery (ESS). ESS has bridged the gap between the frustrations of conservative measures with opioid medications to open surgery with inherent surgical and anaesthetic risks. ESS offers a direct aware state means of localizing and treating neuro-claudicant back pain, referred pain and weakness associated with stenosis that fail to respond to rehabilitation, pain management or surgery. In this letter to the editor, I discuss the endoscopic spinal decompression from an interventional spine in view of a physician’s perspective.
{"title":"Endoscopic Spinal Decompression from an Interventional Spine Physician's Perspective","authors":"Bernard Lee","doi":"10.4172/2165-7939.S7-012","DOIUrl":"https://doi.org/10.4172/2165-7939.S7-012","url":null,"abstract":"Mechanical low back pain conditions have been traditionally treated with open surgical spinal decompression. The approach to the spine has evolved towards using minimally invasive techniques, previously microdiscectomy and now endoscopic spine surgery (ESS). ESS has bridged the gap between the frustrations of conservative measures with opioid medications to open surgery with inherent surgical and anaesthetic risks. ESS offers a direct aware state means of localizing and treating neuro-claudicant back pain, referred pain and weakness associated with stenosis that fail to respond to rehabilitation, pain management or surgery. In this letter to the editor, I discuss the endoscopic spinal decompression from an interventional spine in view of a physician’s perspective.","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"01 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.S7-012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70776331","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 : 2018-01-01DOI: 10.4172/2165-7939.1000421
J. Yeung, Jin-hui Shi, Huilin Yang, Hansen A. Yuan, Simon Turner, H. Seim, A. Yeung
Background: Discs are avascular oxygen and nutrients are diffused from capillaries in endplates into thick discs. Calcified layers begin to fortify the cartilaginous endplates around age 16, (1) Blocking many capillaries, (2) Reducing diffusion depths, (3) Causing starvation and hypoxia in the mid-disc layer. Starvation triggers enzymatic degradation of proteoglycans in mid-disc layer, leading to desiccation and voids in nucleus, and fissure in annulus. Hypoxia triggers production inflammatory cytokines and lactic acid, leading to pH 5.5-6.5 in mid-disc layer, 5-50X acidity of blood plasma. Lactic acid leaks through the annulus fissure to cause discogenic pain from lactic acid burn, as shown in figure. Conversely, disc matrixes near superior and inferior endplates are in the diffusion zones of bicarbonate (pH buffer), oxygen and nutrients from body circulation, and have neutral pH 7.2. Proposed intervention: Percutaneous Disc Scaffold (PDS) is a multi-spiral fluid absorbing filament, a braided nylon #3 suture, for bridging between diffusion zones near superior and inferior endplates to re-establish interstitial fluid exchange between the mid-disc and body circulation. Bicarbonate in blood plasma neutralizes the lactic acid. Oxygen inhibits hypoxic inflammation and is essential to biosynthesize the most water-retaining chondroitin sulfate in proteoglycans. Constant supply of nutrients relieves starvation. Methods: In-vitro and in-vivo studies are used to verify the intended use, safety and efficacy of the PDS. (1) Fluid transport through the #3 braided nylon sutures is verified by capillary action of drawing pork blood. (2) Lactic acid neutralization is verified by titration with fresh pork blood. (3) Safety is verified in sheep discs by histology on tissue response at euthanized time point 1, 3, 12 and 30 months. (4) Efficacy is verified in a pilot clinical study after confirming discogenic pain. PDS is implanted through the discography needle. Visual Analog Pain Score (VAS) and Oswestry Disability Index (ODI) are used to evaluate therapeutic efficacy of PDS at 1-week, 3-12 and 24-months. Results: (1) Fluid transport through the #3 braided nylon sutures as PDS is demonstrated by capillary action of drawing pork blood 10.3 ± 1.2 cm against gravity. (2) Approximately 0.51-1.51 cc of pork blood is required to neutralize 1 cc of 2-6 mM lactic-acid, common concentration in painful disc. (3) PDS is inert, elicited no immune response in sheep discs euthanized at 1, 3, 12 and 30-months. (4) Baseline or pre-PDS VAS was 6.1 ± 1.6, and 2-Year VAS after PDS is 1.2 ± 0.7. Baseline ODI was 37.9 ± 15.1%, and 2-Year ODI is 9.8 ± 5.1%. Conclusion: Acid-base neutralization is instantaneous, which may be the reason for rapid reduction of discogenic pain from lactic acid burn. *Corresponding author: Jeff Yeung, MS, Aleeva Medical Inc, San Jose, CA, USA, Tel: 408-464-7431; E-mail: aleevamed@gmail.com Huilin Yang, MD, PhD, Professor and Chairman, Department of Orthope
{"title":"Discogenic Pain Relief by Re-Establishing Fluid Exchange between Disc and Circulation","authors":"J. Yeung, Jin-hui Shi, Huilin Yang, Hansen A. Yuan, Simon Turner, H. Seim, A. Yeung","doi":"10.4172/2165-7939.1000421","DOIUrl":"https://doi.org/10.4172/2165-7939.1000421","url":null,"abstract":"Background: Discs are avascular oxygen and nutrients are diffused from capillaries in endplates into thick discs. Calcified layers begin to fortify the cartilaginous endplates around age 16, (1) Blocking many capillaries, (2) Reducing diffusion depths, (3) Causing starvation and hypoxia in the mid-disc layer. Starvation triggers enzymatic degradation of proteoglycans in mid-disc layer, leading to desiccation and voids in nucleus, and fissure in annulus. Hypoxia triggers production inflammatory cytokines and lactic acid, leading to pH 5.5-6.5 in mid-disc layer, 5-50X acidity of blood plasma. Lactic acid leaks through the annulus fissure to cause discogenic pain from lactic acid burn, as shown in figure. Conversely, disc matrixes near superior and inferior endplates are in the diffusion zones of bicarbonate (pH buffer), oxygen and nutrients from body circulation, and have neutral pH 7.2. Proposed intervention: Percutaneous Disc Scaffold (PDS) is a multi-spiral fluid absorbing filament, a braided nylon #3 suture, for bridging between diffusion zones near superior and inferior endplates to re-establish interstitial fluid exchange between the mid-disc and body circulation. Bicarbonate in blood plasma neutralizes the lactic acid. Oxygen inhibits hypoxic inflammation and is essential to biosynthesize the most water-retaining chondroitin sulfate in proteoglycans. Constant supply of nutrients relieves starvation. Methods: In-vitro and in-vivo studies are used to verify the intended use, safety and efficacy of the PDS. (1) Fluid transport through the #3 braided nylon sutures is verified by capillary action of drawing pork blood. (2) Lactic acid neutralization is verified by titration with fresh pork blood. (3) Safety is verified in sheep discs by histology on tissue response at euthanized time point 1, 3, 12 and 30 months. (4) Efficacy is verified in a pilot clinical study after confirming discogenic pain. PDS is implanted through the discography needle. Visual Analog Pain Score (VAS) and Oswestry Disability Index (ODI) are used to evaluate therapeutic efficacy of PDS at 1-week, 3-12 and 24-months. Results: (1) Fluid transport through the #3 braided nylon sutures as PDS is demonstrated by capillary action of drawing pork blood 10.3 ± 1.2 cm against gravity. (2) Approximately 0.51-1.51 cc of pork blood is required to neutralize 1 cc of 2-6 mM lactic-acid, common concentration in painful disc. (3) PDS is inert, elicited no immune response in sheep discs euthanized at 1, 3, 12 and 30-months. (4) Baseline or pre-PDS VAS was 6.1 ± 1.6, and 2-Year VAS after PDS is 1.2 ± 0.7. Baseline ODI was 37.9 ± 15.1%, and 2-Year ODI is 9.8 ± 5.1%. Conclusion: Acid-base neutralization is instantaneous, which may be the reason for rapid reduction of discogenic pain from lactic acid burn. *Corresponding author: Jeff Yeung, MS, Aleeva Medical Inc, San Jose, CA, USA, Tel: 408-464-7431; E-mail: aleevamed@gmail.com Huilin Yang, MD, PhD, Professor and Chairman, Department of Orthope","PeriodicalId":89593,"journal":{"name":"Journal of spine","volume":"07 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4172/2165-7939.1000421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70770473","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}
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