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Han C, Ren ZY, Jiang ZH, Luo YF. Cerebral complications after unilateral biportal endoscopic surgery: A case report. World J Clin Cases 2025; 13:101444. [DOI: 10.12998/wjcc.v13.i13.101444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 12/05/2024] [Accepted: 12/27/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND Unilateral biportal endoscopic (UBE) surgery has developed rapidly during the past decade. Continuous epidural space irrigation is generally considered the principal reason for cerebral complications following UBE surgery. We present a case of mental symptoms during the general anesthesia awakening period due to pneumocephalus.
CASE SUMMARY A 70-year-old woman with lumbar disc herniation underwent UBE surgery stably under general anesthesia. Uncontrollable hypertension occurred immediately after transfer to the postoperative care unit, accompanied by increased heart rate and tachypnea. During the recovery process, the patient responded to external stimuli but was confused and unable to complete command actions. Neck stiffness and significantly increased muscle strength on the left side indicated the presence of de-cerebrate rigidity. An urgent brain computed tomography scan showed pneumocephalus compressing the brainstem. After receiving analgesia and sedation treatment, the patient was conscious three hours later and recovered rapidly. She was discharged on the fifth postoperative day and followed up for 3 months with no surgical or brain complications.
CONCLUSION Cerebral complications emerging during the general anesthesia awakening period following UBE surgery are not entirely due to increased intracranial pressure. Pneumocephalus induced by dural injury may also be a potential cause.
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Affiliation(s)
- Chao Han
- Department of Anesthesiology, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, Jiangsu Province, China
| | - Zhan-Yun Ren
- Department of Neurology, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, Jiangsu Province, China
| | - Zhen-Huan Jiang
- Department of Orthopedics, The Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, Jiangsu Province, China
| | - Yi-Feng Luo
- Department of Radiology, the Affiliated Yixing Hospital of Jiangsu University, Yixing 214200, Jiangsu Province, China
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Wang QL, Chen JP, Peng YJ, Dai J, Liu XF, Yan J. Managing water dynamics for optimal outcomes in unilateral biportal endoscopic surgery: preliminary results in a new operative channel. BMC Musculoskelet Disord 2025; 26:394. [PMID: 40259277 PMCID: PMC12010544 DOI: 10.1186/s12891-025-08645-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/10/2025] [Indexed: 04/23/2025] Open
Abstract
BACKGROUND In recent years, unilateral biportal endoscopic (UBE) surgery has become one of the most popular minimally invasive spine surgeries. Unlike traditional open surgery, UBE surgery is performed in isotonic saline solution. Therefore, comprehending the water dynamics involved in UBE surgery is crucial. METHODS This prospective study involved 29 patients with single-level lumbar instability or degenerative disk disease who underwent UBE surgery between April 2021 and March 2022. Water flow pressure was measured using a disposable pressure transducer. Multifidus muscle MRI images were analyzed by ImageJ software at intervertebral disc levels. Perioperative blood loss was estimated by the Gross formula. The obtained data were then analyzed with independent t tests, chi-squared tests, and Pearson's correlation. RESULTS Height and weight were risk factors for increased water flow pressure during UBE surgery (r = 0.424, P = 0.022, r = 0.384, P = 0.040). The phenomenon of low water flow pressure led to escalations in perioperative total blood loss, hematocrit loss and hemoglobin loss (r = -0.369, P = 0.049, r = -0.424, P = 0.022, r = -0.405, P = 0.029). An excessive water flow pressure can worsen postoperative multifidus swelling and elevate the patient's leg pain visual analogue scale (VAS) score at 1 week (r = 0.442, P = 0.016, r = 0.394, P = 0.034). REGISTRATION Trial registration Chinese Clinical Trial Registry, registration number ChiCTR2300078497, date of registration: 11/12/2023. CONCLUSION Both low and high water flow pressures can have deleterious effects. The water flow pressure should be controlled within a reasonable range during UBE surgery.
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Affiliation(s)
- Qian-Liang Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, Jiangsu, 215004, China
| | - Jian-Peng Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, Jiangsu, 215004, China
| | - Yu-Jian Peng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, Jiangsu, 215004, China
| | - Jun Dai
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, Jiangsu, 215004, China
| | - Xiao-Feng Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, Jiangsu, 215004, China
| | - Jun Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, Jiangsu, 215004, China.
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Wang H, Xiao C, Zhang K, Xie M, Dai H. A retrospective study on the efficacy of unilateral biportal endoscopic discectomy treating lumbar disc herniation and concomitant grade I stable degenerative lumbar spondylolisthesis. BMC Musculoskelet Disord 2025; 26:347. [PMID: 40200317 PMCID: PMC11980254 DOI: 10.1186/s12891-025-08595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Accepted: 03/28/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND The purpose of this study was to retrospectively assess the clinical and radiographic outcomes of unilateral biportal endoscopic discectomy (UBED) in treating patients with single-level lumbar disc herniation (LDH) and concomitant grade I stable degenerative lumbar spondylolisthesis (DLS). METHODS We reviewed patients diagnosed with single-level LDH and concomitant grade I stable DLS who underwent UBED from June 2021 to June 2023. Preoperative and postoperative slippage percentage, disc height (DH), visual analogue scale (VAS) for back pain and leg radiation pain, and Oswestry disability index (ODI) were compared by a paired-sample test. Demographics and postoperative slip progression were recorded. RESULTS A total of 32 patients with a mean age of 72.16 ± 8.07 years were enrolled. 27 underwent L4/5 UBED, 4 underwent L5/S1 UBED, and 1 underwent L3/4 UBED. The postoperative mean vertebral slip percentage increased significantly and the mean DH at the surgical level decreased significantly at the last follow-up. VAS scores for back and leg pain reduced significantly after surgery, and ODI scores improved significantly postoperatively. Only one patient suffered postoperative slip progression. Two cases of postoperative cerebrospinal fluid leakage were reported. CONCLUSIONS The application of UBED to treat LDH and concomitant grade I stable DLS demonstrated effective pain relief and improved quality of life for patients, with a low incidence of postoperative slip progression. UBED is a safe and effective surgical technique for treating older patients with LDH and concomitant grade I stable DLS.
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Affiliation(s)
- Haozhong Wang
- Department of Orthopedic Surgery, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Changming Xiao
- Department of Orthopedic Surgery, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Kaiquan Zhang
- Department of Orthopedic Surgery, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Mingzhong Xie
- Department of Orthopedic Surgery, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Haoping Dai
- Department of Orthopedic Surgery, the Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan, China.
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Patel S, Khan MF, Gensler R, Brown NJ, Real M, Pennington Z, Khan MZ, Gendreau J, Sahyouni R, Pham MH. Applications of endoscopic techniques in spinal oncology: A systematic review of the contemporary literature. J Clin Neurosci 2025; 136:111232. [PMID: 40203797 DOI: 10.1016/j.jocn.2025.111232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2025] [Revised: 04/02/2025] [Accepted: 04/03/2025] [Indexed: 04/11/2025]
Abstract
INTRODUCTION At the time of its origination, endoscopic spine surgery (ESS) was introduced to advance minimally invasive spine surgical (MISS) techniques, aiming to reduce tissue traumatization and improve clinical outcomes. Initially, ESS was primarily applied to transforaminal diskectomies for treating low back pain and radiculopathy caused by lateral or posterolateral disc herniations. Early challenges included limited visualization, suboptimal camera systems, and restricted maneuverability of rigid endoscopes. Technological advancements, such as angled endoscopes and interlaminar approaches, have led to a broader adoption of ESS, particularly in Asian countries. As ESS gains traction in the United States, its potential applications continue to expand. This systematic review evaluates the safety and efficacy of ESS in the treatment of spinal column tumors. METHODS We conducted a systematic search across three databases following PRISMA guidelines to identify studies describing the use of spinal endoscopy for procedural or diagnostic management (e.g., biopsy) of spinal and vertebral column tumors, including both primary neoplasms and metastatic lesions. Studies were screened based on predefined inclusion and exclusion criteria, and relevant data were extracted for qualitative synthesis. RESULTS A total of 24 studies, encompassing 147 patients, met the inclusion criteria. The most commonly treated tumor types included schwannomas (37.4 %), spinal metastases (15.0 %), meningiomas (7.5 %), and osteoid osteomas (6.8 %). Tumors were most frequently located in the lumbar spine (38.8 %), followed by the thoracic (29.9 %), cervical (12.9 %), craniospinal junction (6.8 %), and sacral regions (6.1 %). Surgical outcomes demonstrated a high rate of neurological improvement (100 %) across all cases. Among studies reporting pain scores, postoperative Visual Analog Scale (VAS) scores showed consistent improvement. The mean follow-up duration was 13.6 ± 10.1 months. Complication rates were low (6.8 %), with transient radiculopathy, pseudomeningocele, and postoperative hematoma among the reported adverse events. The overall mortality rate was 10.9 %, primarily reflecting patients with metastatic disease rather than procedure-related deaths. CONCLUSION ESS has demonstrated its utility as a viable and effective option for managing select spinal metastases and intradural-extramedullary tumors of the spinal column. The technique offers minimally invasive access to tumors with low complication rates and meaningful clinical benefits, particularly for frail patients requiring palliative treatment. Future studies with larger cohorts and comparative analyses are needed to further validate ESS as a mainstream approach in spinal oncology.
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Affiliation(s)
- Saarang Patel
- Department of Biological Sciences, Seton Hall University, South Orange, NJ, USA
| | | | - Ryan Gensler
- Georgetown University School of Medicine, Washington, DC, USA.
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, San Diego, CA, USA
| | - Marcos Real
- Department of Neurological Surgery, University of California, San Diego, CA, USA
| | - Zach Pennington
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Julian Gendreau
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, San Diego, CA, USA
| | - Martin H Pham
- Department of Neurological Surgery, University of California, San Diego, CA, USA.
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Cheung JPY. A Commentary on "Far-Lateral Transforaminal Unilateral Biportal Endoscopic Lumbar Discectomy for Upper Lumbar Disc Herniations". Neurospine 2025; 22:28-29. [PMID: 40211510 PMCID: PMC12010836 DOI: 10.14245/ns.2550304.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2025] Open
Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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Stadler RD, Shrestha N, Dara G, Yu A, Kurapatti M, Etigunta S, Berman D, Lee J, Cho B, Cho SK. Rare Complications in Endoscopic Spinal Surgery: A Narrative Review of Unique Cases. Global Spine J 2025:21925682251319542. [PMID: 39963940 PMCID: PMC11836960 DOI: 10.1177/21925682251319542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2024] [Revised: 01/07/2025] [Accepted: 01/26/2025] [Indexed: 02/21/2025] Open
Abstract
STUDY DESIGN Narrative Review. OBJECTIVES Endoscopic spine surgery is becoming an increasingly popular approach to treat spinal disease due to its minimally invasive nature. Although certain adverse events are well-reported within the literature, there is a scarcity of information for complications that are rare but still potentially serious. The purpose of this study is to describe these rare complications of endoscopic spine surgery and discuss management and prevention strategies. METHODS A search was conducted in PubMed and Embase to review the literature for all adverse events following endoscopic spine surgery, with no restrictions on publication year. Cohort and case report studies describing infrequently reported complications were collected for analysis. RESULTS A total of 38 studies were included which described rare complications in 93 patients following endoscopic spine surgery. These included neurological events (seizure, pseudomeningocele, pneumocephalus, upper limb palsy), vascular events (hemorrhage, hematoma, arteriovenous fistula), mechanical events (cage migration, guidewire breakage), and additional events (discal pseudocyst, pulmonary edema, arrhythmia, total spinal anesthesia). CONCLUSIONS Endoscopic spine surgery is rapidly evolving and emerging as a popular alternative to conventional approaches. Though regarded as a generally safe form of surgery, it is imperative that surgeons are aware of all complications which may occur, even those that may be infrequently reported in the literature.
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Affiliation(s)
- Ryan D. Stadler
- Department of Orthopedics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Nancy Shrestha
- Department of Orthopedics, Chicago Medical School at Rosalind Franklin University, North Chicago, IL, USA
| | - Gabriel Dara
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alexander Yu
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark Kurapatti
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Suhas Etigunta
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Berman
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Lee
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian Cho
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lin CR, Tsai SHL, Yu TW, Lin PC, Tsai ZD, Lee KH, Fu TS, Lai PL, Tsai TT, Hu YH. Open posterior approach versus endoscopic approach for thoracic ligamentum flavum ossification: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2025; 34:380-403. [PMID: 38847817 DOI: 10.1007/s00586-024-08164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/01/2024] [Accepted: 01/25/2024] [Indexed: 01/24/2025]
Abstract
BACKGROUND Thoracic ossification of the ligamentum flavum (TOLF), a rare condition more prevalent in East Asia, is managed through open and endoscopic surgical approaches. Determining the superior surgical option remains unclear. This study assesses the safety and clinical outcomes associated with these approaches in TOLF patients. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic literature search up to August 5, 2023, across PubMed, Scopus, EMBASE, Web of Science, Cochrane, and ClinicalTrials.gov. We included randomized controlled trials and cohort studies reporting complication rates, mJOA (modified Japanese Orthopedic Association) scores, JOA scores, VAS (Visual Analog Scale) scores, or hospitalization duration for both open and endoscopic surgeries in TOLF patients. RESULTS We analyzed 37 studies encompassing 1,646 TOLF patients using a random-effects model. Our findings revealed a significant difference in complication rates (overall complication rates: 0.12; 95% CI: 0.07, 0.19; p < 0.01; I2: 69%; quality of evidence: moderate), with lower complication rates in the endoscopy group. However, no significant differences were observed in JOA scores (overall JOA: 8.35; 95% CI: 7.16, 9.54; p = 0.12; I2: 99%; quality of evidence: very low), VAS scores (overall VAS: 1.31; 95% CI: 1.03, 1.59; p = 0.35; I2: 91%; quality of evidence: very low), or hospitalization duration (hospital stay: 10.83 days; 95% CI: 6.86, 14.80; p = 0.35; I2: 91%; quality of evidence: very low) between the open and endoscopic groups. CONCLUSIONS This meta-analysis reports lower complication rates and improved postoperative mJOA scores for endoscopic surgery in TOLF patients compared to open surgery. It represents the first comprehensive evaluation of clinical outcomes and safety of different surgical approaches for TOLF patients. Further randomized controlled trials are essential to validate these findings.
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Affiliation(s)
- Chun-Ru Lin
- Department of Medical Education, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Guishan District, Taoyuan City, 333, Taiwan
| | - Sung Huang Laurent Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, and Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Ta-Wei Yu
- Department of Medical Education, Kaohsiung Veterans General Hospital, No.386, Dazhong 1 Rd., Zuoying District, Kaohsiung City, 813414, Taiwan
| | - Po-Cheng Lin
- School of Medicine, College of Medicine, Fu Jen Catholic University, 510, Zhongzheng Rd., Xinzhuang District, New Taipei City, 24205, Taiwan
| | - Zheng-Da Tsai
- School of Medicine, College of Medicine, Fu Jen Catholic University, 510, Zhongzheng Rd., Xinzhuang District, New Taipei City, 24205, Taiwan
| | - Kuo-Hao Lee
- School of Traditional Chinese Medicine, Chang Gung University, 259 Wen-Hwa 1 Road, Kwei-Shan Tao-Yuan, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Guishan District, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Taoyuan City, 333, Taiwan
| | - Po-Liang Lai
- Department of Orthopaedic Surgery, Guishan District, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Taoyuan City, 333, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Guishan District, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Taoyuan City, 333, Taiwan
| | - Yung-Hsueh Hu
- Department of Orthopaedic Surgery, Guishan District, Chang Gung Memorial Hospital, Linkou Branch, No. 5, Fuxing Street, Taoyuan City, 333, Taiwan.
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Mohamed AA, Alshaibi R, Faragalla S, Flynn G, Khan A, Sargent E, Mohamed Y, Moriconi C, Williams C, Karve Z, Colome D, Johansen PM, Lucke-Wold B. Less Is More: Evaluating the Benefits of Minimally Invasive Spinal Surgery. Life (Basel) 2024; 15:8. [PMID: 39859948 PMCID: PMC11767071 DOI: 10.3390/life15010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 12/18/2024] [Accepted: 12/19/2024] [Indexed: 01/27/2025] Open
Abstract
This review aims to explore the evolution, techniques, and outcomes of minimally invasive spine surgery (MISS) within the field of neurosurgery. We sought to address the increasing burden of spine degeneration in a rapidly aging population and the need for optimizing surgical management. This review explores various techniques in MISS, drawing upon evidence from retrospective studies, case series, systematic reviews, and technological advancements in neurosurgical spine treatment. Various approaches, including endonasal cervical, transoral cervical, transcervical, mini-open/percutaneous, tubular, and endoscopic techniques, provide alternatives for current approaches to a range of spinal pathologies. The main findings of this review highlight potential advantages of MISS over traditional open surgery, including reduced complications, shorter hospital stays, and improved patient outcomes. Our research underscores the importance of adopting MISS techniques to optimize patient care in neurosurgical spine treatment.
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Affiliation(s)
- Ali A. Mohamed
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
- College of Engineering and Computer Science, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Rakan Alshaibi
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Steven Faragalla
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Garrett Flynn
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Asad Khan
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Emma Sargent
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Youssef Mohamed
- College of Osteopathic Medicine, Kansas City University, Joplin, MO 64106, USA
| | - Camberly Moriconi
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Cooper Williams
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Zev Karve
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | - Daniel Colome
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA
| | | | - Brandon Lucke-Wold
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL 32611, USA
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He Y, Cheng Q, She J. Unilateral biportal endoscopic lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion for single-segment lumbar degenerative disease: a meta-analysis. BMC Musculoskelet Disord 2024; 25:938. [PMID: 39574056 PMCID: PMC11580209 DOI: 10.1186/s12891-024-08046-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 11/08/2024] [Indexed: 11/25/2024] Open
Abstract
BACKGROUND Minimally invasive spine surgery has seen rapid development in recent years. The purpose of this study was to evaluate the use of unilateral biportal endoscopic lumbar interbody fusion (ULIF) versus minimally invasive surgery transforaminal interbody fusion (MIS-TLIF) for the treatment of single-segment lumbar degenerative disease (LDD) through a systematic review and meta-analysis. METHODS In collaboration with various search terms, a comprehensive examination of the scientific literature was carried out using PubMed, China National Knowledge Infrastructure (CNKI), Wanfang, and other databases. A total of 9 studies were included retrospective cohort studies. RESULTS We observed statistically significant differences in intraoperative blood loss, total hospital stay, postoperative hospital stays, and 1-month postoperative Oswestry Disability Index (ODI) scores between the ULIF and MIS-TLIF groups, with the ULIF group being more dominant. MIS-TLIF group was statistically more advantageous in terms of operative time. There were no statistically significant differences in postoperative visual analogue scale (VAS) scores, 3-month postoperative and final ODI scores, excellent and good rate, complications, disc heights, and lumbar lordosis angle between the two groups. CONCLUSIONS Treatment of single-segment LDD with ULIF and MIS-TLIF is both safe and effective. ULIF has the advantage of less intraoperative blood loss, shorter total hospital stay, shorter postoperative hospital stay, and lower ODI scores at 1 month postoperatively compared to MIS-TLIF. There were no significant differences between ULIF and MIS-TLIF in the treatment of LDD in terms of postoperative VAS scores, 3-month postoperative and final ODI scores, satisfaction rates, fusion rates, complications, disc heights, and lumbar lordosis angle. MIS-TLIF has a shorter procedure time than ULIF.
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Affiliation(s)
- Yanxing He
- Department of Orthopaedics, Ninth Hospital of Xi'an, 151 East Section of South Second Ring Road, Xi'an, 710054, China
| | - Qianyue Cheng
- Department of Orthopaedics, Ninth Hospital of Xi'an, 151 East Section of South Second Ring Road, Xi'an, 710054, China
| | - Jiang She
- Department of Orthopaedics, Ninth Hospital of Xi'an, 151 East Section of South Second Ring Road, Xi'an, 710054, China.
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Yang YF, Yu JC, Zhu ZW, Li YW, Xiao Z, Zhi CG, Xie Z, Kang YJ, Li J, Zhou B. Comparison of clinical outcomes and cost-utility between unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for single-level lumbar disc herniation: a retrospective matched controlled study. J Orthop Surg Res 2024; 19:755. [PMID: 39543612 PMCID: PMC11562584 DOI: 10.1186/s13018-024-05231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Accepted: 11/02/2024] [Indexed: 11/17/2024] Open
Abstract
OBJECTIVE This study aimed to compare the efficacy and cost-utility of unilateral biportal endoscopy (UBE) versus percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of single-level lumbar disc herniation (LDH). METHODS A retrospective analysis was conducted on 99 patients who underwent either UBE (n = 33) or PEID (n = 66) between July 2022 and December 2023 at the Second Xiangya Hospital. Patients were matched 1:2 based on age, sex, and surgery level to ensure comparability. Clinical outcomes were assessed using Visual Analog Scale (VAS), European Quality of Life-5 Dimensions (EQ-5D), and Oswestry Disability Index (ODI) scores, with quality-adjusted life years (QALYs) calculated for cost-utility analysis. Hospitalization costs were analyzed, and the incremental cost-utility ratio (ICER) was determined. RESULTS Both UBE and PEID groups demonstrated significant postoperative improvements in VAS, EQ-5D, and ODI scores (p < 0.05). The operative time, blood loss and nursing cost were significantly higher for UBE compared to PEID (p < 0.05). UBE has higher gained QALY and overall costs, but the differences are not statistically significant (p = 0.643 for QALY, p = 0.327 for costs). The Incremental Cost-Effectiveness Ratio (ICER) for UBE compared to PEID was calculated to be $354.5 per QALY gained, indicating that for each additional QALY gained through UBE, an additional cost of $354.5 is incurred compared to PEID. CONCLUSION In our single-center study conducted in China, both the UBE and PEID procedures have demonstrated comparable short-term efficacy in alleviating pain and improving functional ability in patients with single-level LDH. UBE procedure demonstrates greater cost-utility than the PEID procedure in cost-utility analysis, despite its longer operative time, higher nursing costs and greater blood loss.
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Affiliation(s)
- Yi-Fan Yang
- Department of Orthopaedics Surgery, west china hospital, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China, 410011, No. 139 Renminzhong Road, Hunan
| | - Jun-Cheng Yu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China, 410011, No. 139 Renminzhong Road, Hunan
| | - Zhi-Wei Zhu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China, 410011, No. 139 Renminzhong Road, Hunan
| | - Ya-Wei Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China, 410011, No. 139 Renminzhong Road, Hunan
| | - Zhen Xiao
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China, 410011, No. 139 Renminzhong Road, Hunan
| | - Cong-Gang Zhi
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China, 410011, No. 139 Renminzhong Road, Hunan
| | - Zhong Xie
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China, 410011, No. 139 Renminzhong Road, Hunan
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Yi-Jun Kang
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China, 410011, No. 139 Renminzhong Road, Hunan
| | - Jian Li
- Department of Orthopaedics Surgery, west china hospital, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, China
| | - Bin Zhou
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China, 410011, No. 139 Renminzhong Road, Hunan.
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Hu S, Zhang J, Zeng W, Zhu Z, Wang S, Lin Z, Shi B. Imaging anatomy study related to unilateral biportal endoscopic lumbar spine surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:4368-4377. [PMID: 38683383 DOI: 10.1007/s00586-024-08270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/22/2024] [Accepted: 04/08/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE To provide lumbar spine anatomical parameters relevant to the UBE technique and explore their intraoperative application. METHODS CT imaging data processed by Mimics for parametric measurements, including laminar abduction angle (LAA), laminar slope angle (LSA), minimum laminar height (MLH), distance between the inferior margin of the lamina and attachment of the ligamentum flavum onto the cephalad lamina (DLL), distance between the initial point and the middle of the articular process (DIA), and distance from the inferior margin of the lamina to the inferior border of the vertebral body (DLV), and were manually measured. RESULTS LAA and DIA gradually increase from L1 to L5. At L1, the DIA is approximately the length of 2 drill bits with a diameter of 3 mm (male: 7.77 ± 1.39 mm, female: 7.22 ± 1.09 mm), while at L5, it can reach the length of 4-5 drill bits (male: 14.96 ± 2.24 mm, female: 13.67 ± 2.33 mm). MLH, DLL, and DLV reach their maximum values at the L3 and decrease toward the cranial and caudal ends. The DLL is smallest at L5 (male: 9.58 ± 1.90 mm, female: 9.38 ± 2.14 mm), equivalent to the length of 3 drill bits, while the DLL at L3 is the length of 4-5 drill bits (male: 14.17 ± 2.13 mm, female: 14.01 ± 2.07 mm). CONCLUSION Referring to the drill diameter during surgery can mark the extent of laminotomy. The characteristics of vertebral plate angles at different lumbar levels can provide references for preoperative incision design.
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Affiliation(s)
- Shengxuan Hu
- Department of Spine Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China
| | - Jingwen Zhang
- Department of Spine Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China
| | - Weibo Zeng
- Department of Spine Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China
| | - Zhemin Zhu
- Department of Spine Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China
| | - Shuai Wang
- Department of Spine Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China
| | - Zhaowei Lin
- Department of Joint Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
| | - Benchao Shi
- Department of Spine Surgery, Zhujiang Hospital, Southern Medical University, 253 Gongye Road, Guangzhou, 510282, China.
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Yang L, Yu T, Jiao J, Hou T, Wang Y, Zhao B, Wu M, Jiang W. Comprehensive Analysis of UBE-Related Complications: Prevention and Management Strategies from 4685 Patients. Med Sci Monit 2024; 30:e944018. [PMID: 39385451 PMCID: PMC11476038 DOI: 10.12659/msm.944018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 08/13/2024] [Indexed: 10/12/2024] Open
Abstract
Unilateral biportal endoscopy (UBE) surgery is a minimally invasive approach for treatment of spinal disorders, which usually requires creation of a working and viewing channel on 1 side. The UBE technique has developed rapidly in China in recent years, and many spine surgeons have started to apply it and have shared the initial clinical research results many times at minimally invasive spine conferences. Unfortunately, these studies actually translated into fewer publications. In addition, most patients have good outcomes after UBE surgery, but a minority still experience UBE surgery-related complications, including epidural hematoma, dural sac tears, retroperitoneal effusions, inadequate decompression, postoperative back pain and headache, early recurrence, iatrogenic spinal instability, anemia, and infection, which can prolong hospital stay and seriously affect patient satisfaction. Therefore, this article reviews the complications of UBE surgery for lumbar degenerative diseases and discusses ways to prevent and handle complications associated with UBE to help spine surgeons make smart treatment decisions.
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Easthardt M, Zakko P, Jawad A, Lee M, Park D. Biportal Endoscopic Spine Surgery for Lumbar Laminectomy and Diskectomy: Postoperative Outcomes and Surgical Learning Curve, a Single US Surgeon's Experience. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202408000-00013. [PMID: 39162736 PMCID: PMC11335333 DOI: 10.5435/jaaosglobal-d-23-00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/30/2024] [Accepted: 05/17/2024] [Indexed: 08/21/2024]
Abstract
INTRODUCTION Biportal endoscopic spine surgery (BESS) has gained traction for lumbar laminectomy and diskectomy. To justify the transition to BESS, outcomes and the surgical learning curve should be known. This study evaluates rates of complications with BESS and how these rates change with increased surgeon experience. METHODS A single surgeon's consecutive patients who underwent BESS were evaluated. Patients older than 18 years who underwent BESS for lumbar laminectomy and diskectomy were included. Patients with previous spine surgery, multiple levels, or BESS for fusion were excluded. Demographics, length of surgery, intraoperative complications, postoperative complications, and revision surgery were recorded. The learning phase group and mastery phase group were based on a cumulative summation analysis based on surgical time. RESULTS A total of 63 patients, with 31 and 32 patients in the learning and mastery group, respectively, were included. Surgical time decreased from 87 to 52 minutes in the mastery phase. Conversion to open decreased from 3 to 0 cases (P = 0.1803), intraoperative complications decreased from 3 to 0 (P = 0.1803), postoperative complications decreased from 7 to 2 (P = 0.017), and rates of revision surgery decreased from 4 to 1 (P = 0.4233). CONCLUSION This study suggests a learning curve of 31 cases for adequate performance of BESS for lumbar laminectomy and diskectomy.
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Affiliation(s)
- Matthew Easthardt
- From the Department of Orthopaedic Surgery, Oakland University William Beaumont School of Medicine, Auburn Hills, MI (Dr. Easthardt, Dr. Zakko, Dr. Jawad, and Dr. Park); the Department of Orthopaedic Surgery, Beaumont Health System - Royal Oak, MI (Dr. Easthardt, Dr. Zakko, Dr. Jawad, and Dr. Park); and the Michigan Orthopaedic Surgeons, Southfield, MI (Mr. Lee and Dr. Park)
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Antonacci CL, Zeng FR, Ford B, Wellington I, Kia C, Zhou H. A narrative review of endoscopic spine surgery: history, indications, uses, and future directions. JOURNAL OF SPINE SURGERY (HONG KONG) 2024; 10:295-304. [PMID: 38974485 PMCID: PMC11224785 DOI: 10.21037/jss-23-112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/12/2024] [Indexed: 07/09/2024]
Abstract
Background and Objective The concept of endoscopic surgery began in the 1930s and has since undergone numerous advancements in both technology and surgical indications. Its main benefit is providing the opportunity to perform surgery while minimizing disruption to surrounding structures. The purpose of this review is to summarize the history, uses, and future directions for spine endoscopic surgery. Methods A review of national databases was performing using key terms "endoscopic", "spine" and "surgery" for literature from 1900 to 2023. Studies that aimed to describe the utilities of endoscopic surgeries, associated outcomes, limitations, and future directions were included. Studies that were not in English were excluded. Key Content and Findings This review includes a brief overview of the history of endoscopic surgery and its current two main approaches, transforaminal and interlaminar approaches. It then summarizes the main indications and utilization of endoscopic surgery in the lumbar, cervical and thoracic spine, as well as expansion in managing spine tumors, infections, and outpatient surgical cases. Conclusions There are many rising indications and uses for endoscopic spine surgery in nearly every aspect of the spine. Compared to conventional spine surgery, there is early evidence showing endoscopic surgery is associated with less post-operative pain, shorter hospital stays, and possibly quicker recovery times. As current trends in spine surgery move towards minimally invasive techniques, it is anticipated that the use of endoscopic surgery will continue to expand.
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Affiliation(s)
| | - Francine R. Zeng
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Brian Ford
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Ian Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Cameron Kia
- Orthopedic Associates of Hartford, Bone and Joint Institute, Hartford, CT, USA
| | - Hanbing Zhou
- Orthopedic Associates of Hartford, Bone and Joint Institute, Hartford, CT, USA
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Feng Z, Zhao Z, Cui W, Meng X, Hai Y. Unilateral biportal endoscopic discectomy versus microdiscectomy for lumbar disc herniation: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2139-2153. [PMID: 38388729 DOI: 10.1007/s00586-023-08116-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/16/2023] [Accepted: 12/21/2023] [Indexed: 02/24/2024]
Abstract
PURPOSE This study aimed to compare unilateral biportal endoscopic discectomy (UBED) with microdiscectomy (MD) for treating lumbar disk herniation (LDH). METHODS A comprehensive literature search was conducted in the Embase, PubMed, Cochrane Library, CNKI, and Web of Science databases from database inception to April 2023 to identify studies comparing UBED and MD for treating LDH. This study evaluated the visual analog scale (VAS) score, Oswestry disability index (ODI), Macnab scores, operation time, estimated blood loss, hospital stay, and complications, estimated blood loss, visual analog scale (VAS) score, Oswestry disability index (ODI), and Macnab scores at various pre- and post-surgery stages. The meta-analysis was performed using RevMan 5.4 software. RESULTS The meta-analysis included 9 distinct studies with a total of 1001 patients. The VAS scores for low back pain showed no significant differences between the groups at postoperative 1-3 months (P = 0.09) and final follow-up (P = 0.13); however, the UBED group had lower VAS scores at postoperative 1-3 days (P = 0.02). There were no significant differences in leg pain VAS scores at baseline (P = 0.05), postoperative 1-3 days (P = 0.24), postoperative 1-3 months (P = 0.78), or at the final follow-up (P = 0.43). ODI comparisons revealed no significant differences preoperatively (P = 0.83), at postoperative 1 week (P = 0.47), or postoperative 1-3 months (P = 0.13), and the UBED group demonstrated better ODI at the final follow-up (P = 0.03). The UBED group also exhibited a shorter mean operative time (P = 0.03), significantly shorter hospital stay (P < 0.00001), and less estimated blood loss (P = 0.0002). Complications and modified MacNab scores showed no significant differences between the groups (P = 0.56 and P = 0.05, respectively). CONCLUSION The evidence revealed no significant differences in efficacy between UBED and MD for LDH treatment. However, UBED may offer potential benefits such as shorter hospital stays, lower estimated blood loss, and comparable complication rates.
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Affiliation(s)
- Zihe Feng
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Rd, No. 8, Chaoyang District, Beijing, 100020, China
| | - Zhiheng Zhao
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Rd, No. 8, Chaoyang District, Beijing, 100020, China
| | - Wei Cui
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Rd, No. 8, Chaoyang District, Beijing, 100020, China
| | - Xianglong Meng
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Rd, No. 8, Chaoyang District, Beijing, 100020, China.
| | - Yong Hai
- Department of Orthopaedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Gongti South Rd, No. 8, Chaoyang District, Beijing, 100020, China.
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Jia D, Qiao X, Wang X, Li S, Li Q, Hao Y, Peng X. Early efficacy observation of the unilateral biportal endoscopic technique in the treatment of multi-level lumbar spinal stenosis. J Orthop Surg Res 2024; 19:117. [PMID: 38310279 PMCID: PMC10838451 DOI: 10.1186/s13018-024-04575-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 01/22/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND To explore the early curative effect of unilateral biportal endoscopy (UBE) in the treatment of multi-level lumbar spinal stenosis with the help of multiple small incisions. METHODS A retrospective analysis was performed on 26 patients with multi-level lumbar spinal stenosis treated by UBE in our hospital from August 1, 2021, to March 1, 2022. We collect patients' basic medical records and independently design surgical incisions. The visual analog score (VAS) and Oswestry Disability Index (ODI) were compared before surgery, 7 days after surgery and 6 months after surgery. Spinal canal diameters on CT were compared before surgery and 7 days after surgery. The modified MacNab standard was used to evaluate the efficacy satisfaction at 6 months after operation. RESULTS In this study, 26 patients were operated according to the predetermined surgical plan. The operative time was 145 ± 40.11 min, the intraoperative blood loss was 156.25 ± 44.32 ml, and the postoperative hospital stay was 4.79 ± 1.31 days. The VAS scores of postoperative lumbago and leg pain were lower than those before surgery (P < 0.05). The postoperative ODI score was significantly different from that before surgery (P < 0.05). The postoperative CT sagittal diameter was significantly different from that before surgery (P < 0.05). The curative effect of modified MacNab was 76.92% when followed up 7 days after surgery. The curative effect of modified MacNab was 92.31% when followed up 6 months after surgery, which was significantly improved compared with 7 days after surgery. CONCLUSION Under multiple small incision channels, UBE can effectively treat multi-level lumbar spinal stenosis, significantly relieve the clinical symptoms of patients, and significantly improve the quality of life of patients. It is a safe and feasible minimally invasive surgical treatment method for multi-level lumbar spinal stenosis.
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Affiliation(s)
- Dingding Jia
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Xin Qiao
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Xuepan Wang
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Shaoqing Li
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Qiang Li
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Yunbing Hao
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China
| | - Xiangping Peng
- Department of Orthopedic Surgery, Orthopedic Hospital of Xingtai, 202 Bayi Street, Xingtai, 054000, China.
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Han H, Song Y, Li Y, Zhou H, Fu Y, Li J. Short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion versus minimally invasive transforaminal lumbar interbody fusion in the treatment of lumbar degenerative diseases: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:656. [PMID: 37667363 PMCID: PMC10476308 DOI: 10.1186/s13018-023-04138-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The aim of this study was to comprehensively evaluate the short-term clinical efficacy and safety of unilateral biportal endoscopic transforaminal lumbar interbody fusion (UBE-TLIF) versus minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the treatment of lumbar degenerative diseases by meta-analysis. METHODS A computer-based search of PubMed, Embase, Web of Science, Cochrane Database, China National Knowledge Infrastructure (CNKI), Wanfang Database, and Chinese Science and Technology Journal Database (VIP) was conducted from the inception of the each database to April 2023. The searched literature was then screened according to strict inclusion and exclusion criteria. The critical data were extracted and analyzed using Review Manager software5.4.1. Pooled effects were calculated on the basis of data attributes by mean difference (MD) or odds ratio (OR) with 95% confidence interval (CI). The Newcastle-Ottawa Scale was used to assess the quality of the studies. RESULTS A total of 13 studies and 949 patients met the inclusion criteria for this meta-analysis, 445 in the UBE-LIF group and 504 in the MIS-TLIF group. UBE-TLIF was superior to MIS-TLIF in terms of intraoperative blood flow, postoperative drainage flow, duration of hospital stay, VAS score for low back pain and ODI score, but the operative time was longer than MIS-TLIF group. There were no significant differences between the two groups in terms of total complication rate, modified Macnab grading criteria, fusion rate, VAS score of leg pain, lumbar lordosis, intervertebral disk height. CONCLUSION Both UBE-TLIF and MIS-TLIF are effective surgical modalities for the treatment of degenerative lumbar spine diseases. They have similar treatment outcomes, but UBE-TLIF has the advantages of less intraoperative blood loss, shorter postoperative hospital stay, and faster recovery. TRIAL REGISTRATION This study has been registered at INPLASY.COM (No. INPLASY202320087).
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Affiliation(s)
- Hao Han
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Orthopaedics, Xuzhou Central Hospital, Affiliation Xuzhou Clinical College of Xuzhou Medical University, Jiefang South Road No. 199, Xuzhou, 221009, Jiangsu, China
| | - Yifan Song
- Graduate School of Bengbu Medical College, Bengbu, Anhui, China
- Department of Orthopaedics, Xuzhou Central Hospital, Affiliation Xuzhou Clinical College of Xuzhou Medical University, Jiefang South Road No. 199, Xuzhou, 221009, Jiangsu, China
| | - Yiming Li
- Department of Orthopaedics, Xuzhou Central Hospital, Affiliation Xuzhou Clinical College of Xuzhou Medical University, Jiefang South Road No. 199, Xuzhou, 221009, Jiangsu, China
| | - Hengcai Zhou
- Department of Orthopaedics, Xuzhou Central Hospital, Affiliation Xuzhou Clinical College of Xuzhou Medical University, Jiefang South Road No. 199, Xuzhou, 221009, Jiangsu, China
| | - Yufei Fu
- Department of Medical Imaging, Xuzhou Central Hospital, Xuzhou Clinical College of Xuzhou Medical University, Jiefang South Road No. 199, Xuzhou, 221009, Jiangsu, China
| | - Jie Li
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China.
- Graduate School of Bengbu Medical College, Bengbu, Anhui, China.
- Department of Orthopaedics, Xuzhou Central Hospital, Affiliation Xuzhou Clinical College of Xuzhou Medical University, Jiefang South Road No. 199, Xuzhou, 221009, Jiangsu, China.
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Jitpakdee K, Liu Y, Heo DH, Kotheeranurak V, Suvithayasiri S, Kim JS. Minimally invasive endoscopy in spine surgery: where are we now? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2755-2768. [PMID: 36856868 DOI: 10.1007/s00586-023-07622-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Endoscopic spine surgery (ESS) is a minimally invasive surgical technique that offers comparable efficacy and safety with less collateral damage compared to conventional surgery. To achieve clinical success, it is imperative to stay abreast of technological advancements, modern surgical instruments and technique, and updated evidence. PURPOSES To provide a comprehensive review and updates of ESS including the nomenclature, technical evolution, bibliometric analysis of evidence, recent changes in the spine communities, the prevailing of biportal endoscopy, and the future of endoscopic spine surgery. METHODS We conducted a comprehensive review of the literature on ESS for the mentioned topics from January 1989 to November 2022. Three major electronic databases were searched, including MEDLINE, Scopus, and Embase. Covidence Systematic Review was used to organize the eligible records. Two independent reviewers screened the articles for relevance. RESULTS In total, 312 articles were finally included for review. We found various use of nomenclatures in the field of ESS publication. To address this issue, we proposed the use of distinct terms to describe the biportal and uniportal techniques, as well as their specific approaches. In the realm of technical advancement, ESS has rapidly evolved from addressing disc herniation and spinal stenosis to encompassing endoscopic fusion, along with technological innovations such as navigation, robotics, and augmented reality. According to bibliometric analysis, China, South Korea, and the USA have accounted for almost three-quarters of total publications. The studies of the biportal endoscopy are becoming increasingly popular in South Korea where the top ten most-cited articles have been published. The biportal endoscopy technique is relatively simple to adopt, as it relies on a more familiar approach, requires less expensive instruments, has a shorter learning curve, and is also well-suited for interbody fusion. The uniportal approach provided the smallest area of soft tissue dissection. While robotics and augmented reality in ESS are not widely embraced, the use of navigation in ESS is expected to become more streamlined, particularly with the emergence of recent electromagnetic-based navigation technologies. CONCLUSIONS In this paper, we provide a comprehensive overview of the evolution of ESS, as well as an updated summary of current trends in the field, including the biportal and uniportal approaches. Additionally, we summarize the nomenclature used in ESS, present a bibliometric analysis of the field, and discuss future directions for the advancement of the field.
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Affiliation(s)
- Khanathip Jitpakdee
- Spine Unit, Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Chonburi, Thailand
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yanting Liu
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong Hwa Heo
- Endoscopic Spine Surgery Center, Neurosurgery, Champodonamu Spine Hospital, Seoul, South Korea
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Siravich Suvithayasiri
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
- Orthopaedic and Musculoskeletal Centre, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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舒 涛, 吴 帝, 沈 茂. [Research progress of different minimally invasive spinal decompression in lumbar spinal stenosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:895-900. [PMID: 37460188 PMCID: PMC10352501 DOI: 10.7507/1002-1892.202303110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/01/2023] [Indexed: 07/20/2023]
Abstract
Objective To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS). Methods The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized. Results At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs. Conclusion The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.
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Affiliation(s)
- 涛 舒
- 贵州医科大学临床医学院（贵阳 550004）Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
| | - 帝求 吴
- 贵州医科大学临床医学院（贵阳 550004）Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
| | - 茂 沈
- 贵州医科大学临床医学院（贵阳 550004）Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
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Wang YP, Qin SL, Yang S, Xu YF, Han PF. Efficacy and safety of unilateral biportal endoscopy compared with microscopic decompression in the treatment of lumbar spinal stenosis: A systematic review and updated meta‑analysis. Exp Ther Med 2023; 26:309. [PMID: 37273751 PMCID: PMC10236128 DOI: 10.3892/etm.2023.12008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
The incidence of lumbar spinal stenosis is increasing annually, and with an ever-aging population and longer life expectancies, this trend will further continue. It is hoped that a more effective treatment can be found so that the patients can be relieved of their pain. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of unilateral biportal endoscopic surgery (UBE) and microscopic decompression surgery (MD) for the treatment of lumbar spinal stenosis. A literature search of related studies published until April 2022 was performed using PubMed, EMBASE, Cochrane Library, Web of Science, ClinicalTrials.gov, Google Scholar, China National Knowledge Infrastructure (CNKI), and other databases. After filtering of references, 12 eligible studies were identified that compared UBE with MD as a treatment for lumbar spinal stenosis. Data were extracted and analysed using R. A total of 12 articles (four randomized controlled and eight cohort studies) were included, with a total of 1,067 patients: 250 men and 249 women in the UBE group and 290 men and 278 women in the MD group. The meta-analysis showed that the mean intraoperative blood loss in the UBE group [standardized mean difference (SMD)=-2.10, 95% confidence interval (CI) (-3.97, -0.23), P=0.03] was lower than that in the MD group. The postoperative Visual analogue scale (VAS) score for back pain [SMD=-0.52, 95% CI (-0.76, -0.27), P<0.01], leg pain [SMD=-0.30, 95% CI (-0.51, -0.08), P<0.01], postoperative Oswestry disability index [(ODI); SMD=-0.25, 95% CI (-0.48, -0.03), P=0.03], and postoperative C-reactive protein [(CRP); odds ratio (OR)=-0.92, 95% CI (-1.80, 0.03), P=0.04] were lower than those in the MD group. Complications (OR=0.60, 95% CI (0.37, 0.98), P=0.04) and hospital stay (SMD=-1.84, 95% CI (-2.85, 0.83), P <0.01] were also lesser in the UBE group than in the MD group. UBE was preferable to that in the MD group according to the modified MacNab score [OR=2.28, 95% CI (1.28, 4.06), P<0.01]. No significant differences were observed in the operation times between the groups. UBE surgery was found to be a better option for the treatment of lumbar spinal stenosis than MD surgery.
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Affiliation(s)
- Yue-Peng Wang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
- Department of Orthopaedics, Pinggu Hospital of Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 101200, P.R. China
| | - Shi-Lei Qin
- Department of Orthopaedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
| | - Su Yang
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
| | - Yun-Feng Xu
- Department of Orthopaedics, Changzhi Yunfeng Hospital, Changzhi, Shanxi 046000, P.R. China
| | - Peng-Fei Han
- Department of Orthopaedics, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi 046000, P.R. China
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21
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Huang X, Wang W, Chen G, Guan X, Zhou Y, Tang Y. Comparison of surgical invasiveness, hidden blood loss, and clinical outcome between unilateral biportal endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative disease: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:274. [PMID: 37038129 PMCID: PMC10088165 DOI: 10.1186/s12891-023-06374-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/26/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND Currently, hidden blood loss (HBL) has been paid more and more attention by spine surgeons. Simultaneously, it has been the effort of spine surgeons to explore more advantages of minimally invasive surgery. More and more articles have compared unilateral biportal endoscopic lumbar interbody fusion (BE-LIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). But so far, there is no HBL comparison between BE-LIF and MIS-TLIF. This study aims to compare the surgical invasiveness, hidden blood loss, and clinical outcome of BE-LIF and MIS-TLIF and to provide insight regarding minimally invasive surgery for lumbar degenerative disease (LDD). METHODS We enrolled 103 eligible patients with LDD who underwent BE-LIF (n = 46) and MIS-TLIF (n = 57) during August 2020-March 2021. We collected data, including demographics, perioperative haematocrit, operative and postoperative hospital times, serum creatine kinase (CK) and C-reactive protein (CRP) levels, and hospitalization costs. Total and hidden blood loss was calculated. Clinical outcomes were assessed using a visual analogue scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), modified MacNab criteria, fusion rate, and complications. RESULTS Basic demographics and surgical data were comparable. The CRP and CK levels were generally lower in the BE-LIF than in the MIS-TLIF group, especially CRP levels on postoperative day (POD) three and CK levels on POD one. True total blood loss, postoperative blood loss, and hidden blood loss were significantly reduced in the BE-LIF group compared with the MIS-TLIF group. Postoperative hospital times was statistically significantly shorter in the BE-LIF group. The VAS pain and ODI scores improved in both groups. At three days and one month, the VAS lower back pain scores were significantly better after BE-LIF. Clinical outcomes did not otherwise differ between groups. CONCLUSIONS Compared with MIS-TLIF, BE-LIF has similar medium and short-term clinical outcomes. However, it is better regarding surgical trauma, early lower back pain, total and hidden blood loss, and recovery time. BE-LIF is an adequate option for selected LDD.
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Affiliation(s)
- Xinle Huang
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Wenkai Wang
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Guangxing Chen
- Center for Joint Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xiangchen Guan
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China.
| | - Yu Tang
- Department of Orthopaedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China.
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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22
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Ju CI, Lee SM. Complications and Management of Endoscopic Spinal Surgery. Neurospine 2023; 20:56-77. [PMID: 37016854 PMCID: PMC10080410 DOI: 10.14245/ns.2346226.113] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
In the past, the use of endoscopic spine surgery was limited to intervertebral discectomy; however, it has recently become possible to treat various spinal degenerative diseases, such as spinal stenosis and foraminal stenosis, and the treatment range has also expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spine surgery develops and its indications widen, more diverse and advanced surgical techniques are being introduced, and the complications of endoscopic spine surgery are also increasing accordingly. We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and key words were set as “endoscopic spinal surgery,” “endoscopic cervical foramoinotomy,” “PECD,” “percutaneous transforaminal discectomy,” “percutaneous endoscopic interlaminar discectomy,” “PELD,” “PETD,” “PEID,” “YESS” and “TESSYS.” We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic lumbar surgery was divided into full endoscopic interlaminar and transforaminal approaches and a unilateral biportal approach. We performed a comprehensive review of available literature on complications of endoscopic spinal surgery. This study particularly focused on the prevention of complications. Regardless of the surgical methods, the most common complications related to endoscopic spinal surgery include dural tears and perioperative hematoma. transient dysesthesia, nerve root injury and recurrence. However, Endoscopic spinal surgery, including full endoscopic transforaminal and interlaminar and unilateral biportal approaches, is a safe and effective a treatment for lumbar as well as cervical and thoracic spinal diseases such as disc herniation, lumbar spinal stenosis, foraminal stenosis and recurrent disc herniation.
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Affiliation(s)
- Chang Il Ju
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
- Corresponding Author Chang Il Ju Department of Neurosurgery, College of Medicine, Chosun University, 365 Pilmun-daero, Dong-gu, Gwangju 61453, Korea
| | - Seung Myung Lee
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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23
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Xie Y, Mei X, Liu S, Fiani B, Fan X, Yu Y. Postoperative Intracranial Hemorrhage after an Endoscopic L5-S1 Laminectomy and Discectomy: A Case Report and Literature Review. J Pers Med 2023; 13:196. [PMID: 36836431 PMCID: PMC9958620 DOI: 10.3390/jpm13020196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/05/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Postoperative intracranial hemorrhage (PIH) is a fairly rare but catastrophic perioperative complication following lumbar spine surgery. This is a case report of a 54-year-old male patient who experienced PIH 2 h after an endoscopic L5-S1 laminectomy and discectomy. CASE PRESENTATION A 54-year-old male patient presented with right L5-S1 radiculopathy that corresponded with the picture revealed in medical imaging and the signs seen upon physical examination. Subsequently, he underwent endoscopic L5-S1 laminectomy and discectomy. The patient presented with idiopathic unconsciousness and limb twitching 2 h after surgery. An emergency cranial CT scan was obtained which demonstrated intracranial hemorrhage. Following an emergency consultation with the Department of Neurology and Neurosurgery, the patient underwent an emergency interventional thrombectomy as per their orders. The surgery was performed successfully. However, the patient's situation did not improve and he died on the second postoperative day. CONCLUSION PIH after spinal endoscopic surgery is a rare but horrible complication. Several factors could lead to PIH. However, in this patient, the cause of PIH might be attributed to the long operation time combined with cerebrospinal fluid (CSF) leakage. Great attention should be attached to the issue of PIH development in spinal endoscopic procedures due to constant irrigation. This study aims to highlight the issue of PIH following endoscopic spinal surgery by presenting a case report of a patient who died despite successful surgery.
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Affiliation(s)
- Yizhou Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-er-qiao Road, Chengdu 610072, China
| | - Xi Mei
- Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-er-qiao Road, Chengdu 610072, China
| | - Shanyu Liu
- Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-er-qiao Road, Chengdu 610072, China
| | - Brian Fiani
- Department of Neurological Surgery, Weill Cornell Medical College-New York Presbyterian, New York, NY 10065, USA
| | - Xiaohong Fan
- Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-er-qiao Road, Chengdu 610072, China
| | - Yang Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, No.39 Shi-er-qiao Road, Chengdu 610072, China
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Wang L, Li C, Han K, Chen Y, Qi L, Liu X. Comparison of Clinical Outcomes and Muscle Invasiveness between Unilateral Biportal Endoscopic Discectomy and Percutaneous Endoscopic Interlaminar Discectomy for Lumbar Disc Herniation at L5/S1 Level. Orthop Surg 2023; 15:695-703. [PMID: 36597673 PMCID: PMC9977580 DOI: 10.1111/os.13627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Both unilateral biportal endoscopic discectomy (UBED) and percutaneous endoscopic interlaminar discectomy (PEID) could achieve favorable outcomes for lumbar disc herniation (LDH). There are limited studies comparing the two different methods of endoscopic discectomy. The objective was to comprehensively compare the clinical outcome and muscle invasiveness of UBED and PEID for the treatment of LDH at L5/S1 level with at least 1-year follow-up. METHODS The retrospective cohort study enrolled 106 LDH patients of L5/S1 level from January 2018 to December 2020. There were 51 patients who underwent UBED (22 males and 29 females, 43.8 ± 14.2 years old) and 55 patients underwent PEID (28 males and 27 females, 42.3 ± 13.8 years old). Clinical outcomes and surgical invasiveness were compared between the two groups for at least 1 year follow-up. Clinical outcomes included visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), complications, recurrence of LDH, intraoperative anesthesia time, operative time, number of intraoperative fluoroscopies, and postoperative length of stay. Surgical invasiveness was evaluated with serum CPK level and change rate of lean multifidus cross-sectional area (LMCSA). Independent-sample t test and paired sample t test were used to compare continuous data. Chi-square test and Fisher's precision probability tests were used to analyze the categorical data. RESULTS Both groups achieved favorable clinical outcomes at the last follow-up, including VAS and ODI (all Ps <0.05). The intraoperative anesthesia time for UBED was longer, but with no difference of operative time. As for intraoperative fluoroscopy times (2.5 vs 2.4), postoperative length of stay (2.1 vs 2.0 days), postoperative complications (5.9% vs 3.6%), there were also no significant difference. The serum CPK level and change rate of LMCSA for UBED was higher than PEID at postoperative 1st day. At the last follow-up, there was no significant difference in the change rate of LMCSA between the two groups (P = 0.096). CONCLUSIONS Both UBED and PEID could achieve favorable clinical outcomes for the treatment of L5/S1 LDH. Despite UBED is more invasive, the radiological manifestation of paraspinal muscle invasiveness was equal at last follow-up with at least 1 year. UBED is a safe and innovative alternative choice for treatment of LDH at L5/S1 level.
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Affiliation(s)
- Liang Wang
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina,Cheeloo College of MedicineShandong UniversityJinanShandongChina
| | - Chao Li
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina
| | - Kaifei Han
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina
| | - Yongqin Chen
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina
| | - Lei Qi
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina
| | - Xinyu Liu
- Department of Orthopaedic SurgeryQilu Hospital of Shandong UniversityJinanShandongChina
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25
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Zhang Q, Wei Y, Wen L, Tan C, Li X, Li B. An overview of lumbar anatomy with an emphasis on unilateral biportal endoscopic techniques: A review. Medicine (Baltimore) 2022; 101:e31809. [PMID: 36482646 PMCID: PMC9726330 DOI: 10.1097/md.0000000000031809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Unilateral biportal endoscopy (UBE) is a major surgical technique used to treat degenerative lumbar diseases. The UBE technique has the advantages of flexible operation, high efficiency, and a large observation and operation space. However, as a typical representative of minimally invasive techniques, UBE still needs to complete a wide range of decompression and tissue resection in a narrow working space, resulting in many surgery-associated injuries. Therefore, it is necessary to reduce complications by familiarity with the anatomy of the lumbar spine. Based on the UBE technique, this review article provides historical and current information on the anatomical structures of the lumbar vertebrae, such as the articular process, pedicle, lamina, ligamentum flavum, nerve root, intervertebral disc, and artery supply.
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Affiliation(s)
- Qiang Zhang
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
| | - Yongan Wei
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
| | - Li Wen
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
| | - Chang Tan
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
| | - Xinzhi Li
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
- * Correspondence: Xinzhi Li and Bo Li, Department of Orthopedics, China Three Gorges University, Renhe Hospital, No. 410 Yiling Road, Yi Chang 443008, China (e-mails: ; )
| | - Bo Li
- Department of Orthopedics, China Three Gorges University, Renhe Hospital, Yi Chang, China
- * Correspondence: Xinzhi Li and Bo Li, Department of Orthopedics, China Three Gorges University, Renhe Hospital, No. 410 Yiling Road, Yi Chang 443008, China (e-mails: ; )
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26
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Wang B, He P, Liu X, Wu Z, Xu B. Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Systematic Review of the Literature and Meta-analysis of Single-arm Studies. Orthop Surg 2022; 15:3-15. [PMID: 36394088 PMCID: PMC9837251 DOI: 10.1111/os.13437] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 06/18/2022] [Accepted: 07/06/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This article aims to summarize the incidence of these complications through a meta-analysis, analyze the causes of complications and provide clinical promotion and recommendations. METHODS Databases and retrieval platform including PubMed, Web of science, Springer link, Cochrane clinical trials, ProQuest, ScienceDirect, Europe PMC, Wiley online, OVID, Clinical trials, CNKI and WanFang, and supplement the literature through Google Scholar, collect all the unilateral biportal endoscopy (UBE) controlled trials and non-controlled trials of UBE in the treatment of lumbar spinal stenosis (LSS). The search time limit is from January 1, 2000 to December 25, 2021. After two reviewers independently screened the literature, extracted data and evaluated the risk of bias in the included studies, meta-analysis was performed using Stata 15.1 software. RESULTS Finally, 24 studies were included, including 999 patients. The results of a single-arm rate meta-analysis showed that the overall complication rate of UBE treatment of LSS was 6.27% [95% CI (0.0412, 0.0876)], and the incidence of dural tear was 2.49% [95% CI (0.0133, 0.0390)], the incidence of transient paresthesia was 0.14% [95% CI (0.0000, 0.0072)], the incidence of postoperative spinal epidural hematoma was 0.27% [95% CI (0.0000, 0.0096)], the incidence of postop headache, inadequate decompression, root injury and infection was 0.00%. CONCLUSION Current evidence shows that the complication rate of UBE in the treatment of LSS is low, mainly due to dural tears. Limited by the number and quality of included studies, the above conclusions still need to be confirmed by more studies.
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Affiliation(s)
- Bin Wang
- Department of OrthopedicsJingling Hospital, Medicine College, Nanjing UniversityNanjingChina
| | - Peng He
- Department of OrthopedicsJingling Hospital, Medicine College, Nanjing UniversityNanjingChina
| | - Xiowei Liu
- Department of OrthopedicsJingling Hospital, Medicine College, Nanjing UniversityNanjingChina
| | - Zhengfang Wu
- Department of OrthopedicsJingling Hospital, Medicine College, Nanjing UniversityNanjingChina
| | - Bin Xu
- Department of OrthopedicsJingling Hospital, Medicine College, Nanjing UniversityNanjingChina
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27
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Xu WB, Kotheeranurak V, Zhang HL, Chen ZX, Wu HJ, Chen CM, Lin GX, Rui G. Is Biportal Endoscopic Spine Surgery More Advantageous Than Uniportal for the Treatment of Lumbar Degenerative Disease? A Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1523. [PMID: 36363480 PMCID: PMC9698221 DOI: 10.3390/medicina58111523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/24/2022] [Accepted: 10/21/2022] [Indexed: 01/25/2023]
Abstract
Background and Objectives: To estimate the clinical outcomes of uniportal and biportal full-endoscopic spine surgery for the treatment of lumbar degenerative disease (LDD), and to provide the latest evidence for clinical selection. Materials and Methods: Relevant literatures published in PubMed, Web of Science, Embase, CNKI, and WanFang Database before 21 November 2021 were searched systematically. Two researchers independently screened the studies, extracted data, and evaluated the risk of bias of the included studies. The systematic review and meta-analysis were performed using the Review Manager software (version 5.4; The Cochrane Collaboration). Results: A total of seven studies were included in this meta-analysis, including 198 patients in a uniportal endoscopy group and 185 patients in a biportal endoscopy group. The results of this meta-analysis demonstrated that the biportal endoscopy group experienced less intraoperative estimated blood loss (WMD = -2.54, 95%CI [-4.48, -0.60], p = 0.01), while the uniportal endoscopy group displayed significantly better recovery results in Visual Analog Scale (VAS) assessments of the back within 3 days of surgery (WMD = 0.69, 95%CI [0.02, 1.37], p = 0.04). However, no significant differences in operation time, length of hospital stay, complication rates, Oswestry Disability Index (ODI) (within 3 months), ODI (last follow-up), VAS for back (within 3 months), VAS for back (last follow-up), and VAS for leg (within 3 days, within 3 months, last follow-up) were identified between the two groups. Conclusions: According to our meta-analysis, patients who underwent the uniportal endoscopic procedure had more significant early postoperative back pain relief than those who underwent the biportal endoscopic procedure. Nevertheless, both surgical techniques are safe and effective.
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Affiliation(s)
- Wen-Bin Xu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361000, China
| | - Vit Kotheeranurak
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok 10330, Thailand
| | - Huang-Lin Zhang
- The Third Clinical Medical College, Fujian Medical University, Fuzhou 350122, China
| | - Zhang-Xin Chen
- Department of Orthopedics, Affiliated Dongnan Hospital of Xiamen University, Xiamen University, Zhangzhou 363000, China
| | - Hua-Jian Wu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361000, China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua 500209, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung 41170, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361000, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou 350122, China
| | - Gang Rui
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361000, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou 350122, China
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张 玉, 田 霖, 胡 鹏, 芦 怀. [Research progress of unilateral biportal endoscopy technique in treatment of lumbar related diseases]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1234-1240. [PMID: 36310460 PMCID: PMC9626282 DOI: 10.7507/1002-1892.202205087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/14/2022] [Indexed: 01/24/2023]
Abstract
Objective To review the application and research progress of unilateral biportal endoscopy (UBE) technique in the treatment of lumbar related diseases. Methods The domestic and foreign literature on the application of UBE technique in the treatment of lumbar related diseases was extensively consulted, and the development history, clinical application, operation points and precautions, related complications and adverse reactions, advantages and disadvantages of the technique were reviewed. Results As a minimally invasive technique developed in recent years, UBE technique is effective in the treatment of lumbar spinal stenosis caused by different causes, with satisfactory decompression effect, less damage, and good lumbar stability. UBE technique has significant advantages over open surgery and microscopy-assisted surgery in the treatment of lumbar disc herniation. In the treatment of lumbar spondylolisthesis, the postoperative trauma of UBE technique is less than that of conventional surgery, and the fusion rate is satisfactory. There are also complications such as spinal cord injury, spinal epidural hematoma, incomplete decompression or recurrence, nerve root irritation symptoms, and postoperative infection in the treatment of lumbar related diseases with UBE technique. Detailed preoperative planning is essential for patients with lumbar related diseases who are suitable for UBE surgery. Conclusion UBE technique is easy to operate, has a gentle learning curve, can use conventional instruments, and has definite effectiveness. It is suitable for a variety of lumbar related diseases, but there are some defects and deficiencies.
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Affiliation(s)
- 玉红 张
- 滨州医学院附属医院脊柱外科（山东滨州 256603）Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 霖 田
- 滨州医学院附属医院脊柱外科（山东滨州 256603）Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 鹏 胡
- 滨州医学院附属医院脊柱外科（山东滨州 256603）Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
| | - 怀旺 芦
- 滨州医学院附属医院脊柱外科（山东滨州 256603）Department of Spinal Surgery, Binzhou Medical University Hospital, Binzhou Shandong, 256603, P. R. China
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Zuo R, Jiang Y, Ma M, Yuan S, Li J, Liu C, Zhang J. The clinical efficacy of biportal endoscopy is comparable to that of uniportal endoscopy via the interlaminar approach for the treatment of L5/S1 lumbar disc herniation. Front Surg 2022; 9:1014033. [PMID: 36238864 PMCID: PMC9553067 DOI: 10.3389/fsurg.2022.1014033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/13/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the clinical outcomes of unilateral biportal endoscopy/biportal endoscopic spinal surgery (UBE/BESS) via the posterior approach with those of interlaminar endoscopic lumbar discectomy (IELD) for the treatment of L5/S1 lumbar disc herniation. Methods We collected the clinical data of patients with L5/S1 lumbar disc herniation who had undergone endoscopic surgery at our center from January 2020 to July 2021, and 92 patients were included. They were divided into UBE/BESS (n = 42) and IELD (n = 50) groups. The incision length, operative time (overall operative, extracanal operative, and intracanal decompression times), intraoperative radiation exposure dose, changes in hemoglobin before and after surgery, postoperative hospital stay, visual analog scale (VAS) score for low back pain and leg, and Oswestry disability index (ODI) were statistically analyzed. Results One case incurred dural tear in the UBE/BESS group, and one case developed recurrence in the IELD group. Postoperatively, the VAS score and ODI index decreased significantly in both groups (P < 0.01). VAS and ODI scores (preoperative as well as 3 days, 3 months, 6 months, and 12 months after surgery), the overall operative time, and postoperative hospital stay were not significantly different between the two groups (P > 0.05). No statistical difference in intraoperative radiation exposure dose was noted between the two groups (P > 0.05). The surgical incision length was greater in the UBE/BESS group (P < 0.01), and pre- and postoperative hemoglobin changes were more pronounced in the UBE/BESS group (P < 0.01). The UBE/BESS group had a longer extracanal operative time and shorter intracanal decompression time (P < 0.01). Conclusions The clinical efficacy of UBE/BESS for L5/S1 lumbar disc herniation is comparable to that of IELD. Intraoperative radiation exposure doses were similar in both techniques. UBE/BESS required more time to identify tissue structures and a larger working space when operating outside the spinal canal; however, the efficiency of nucleus pulposus removal and nerve root release inside the spinal canal superseded that in IELD. Furthermore, the surgical incision in the UBE/BESS technique was longer, with greater actual blood loss during surgery, thus rendering UBE/BESS inferior to the IELD technique in terms of surgical trauma. Nonetheless, no significant difference was noted between the two techniques in the postoperative recovery time of patients.
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Huang X, Gong J, Liu H, Shi Z, Wang W, Chen S, Shi X, Li C, Tang Y, Zhou Y. Unilateral biportal endoscopic lumbar interbody fusion assisted by intraoperative O-arm total navigation for lumbar degenerative disease: A retrospective study. Front Surg 2022; 9:1026952. [PMID: 36211257 PMCID: PMC9539070 DOI: 10.3389/fsurg.2022.1026952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/12/2022] [Indexed: 12/01/2022] Open
Abstract
Background Recently, unilateral biportal endoscopic lumbar interbody fusion (BE-LIF) has been successfully applied for degenerative diseases of the lumbar spine, with good clinical results reported. However, the drawbacks include radiation exposure, limited field of view, and steep learning curves. Objective This retrospective study aimed to compare the results between navigation and non-navigation groups and explore the benefits of BE-LIF assisted by intraoperative O-arm total navigation. Methods A total of 44 patients were retrospectively analyzed from August 2020 to June 2021. Perioperative data were collected, including operative time, estimated intraoperative blood loss, postoperative drainage, postoperative hospital stay, radiation dose, and duration of radiation exposure. In addition, clinical outcomes were evaluated using postoperative data, such as the Oswestry Disability Index (ODI), visual analog scale (VAS), modified MacNab criteria, Postoperative complications and fusion rate. Results The non-navigation and navigation groups included 23 and 21 patients, respectively. All the patients were followed up for at least 12 months. No significant differences were noted in the estimated intraoperative blood loss, postoperative drainage, postoperative hospital stay, fusion rate, or perioperative complications between the two groups. The radiation dose was significantly lower in the navigation group than in the non-navigation group. The average total operation time in the navigation group was lower than that in the non-navigation group (P < 0.01). All clinical outcomes showed improvement at different time points postoperatively, with no significant difference noted between the two groups (P > 0.05). Conclusions Compared with the non-navigation approach, O-arm total navigation assistive BE-LIF technology not only has similar clinical results, but also can provide accurate intraoperative guidance and help spinal surgeons achieve accurate decompression. Furthermore, it can reduce radiation exposure to surgeons and operation time, which improve the efficiency and safety of surgery.
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Affiliation(s)
- Xinle Huang
- Department of Orthopedics, Xinqiao Hospital, Army Millitary Medical University, Chongqing, China
| | - Junfeng Gong
- Department of Orthopedics, Xinqiao Hospital, Army Millitary Medical University, Chongqing, China
| | - Huan Liu
- Department of Orthopedics, Xinqiao Hospital, Army Millitary Medical University, Chongqing, China
| | - Zegang Shi
- Department of Orthopedics, Xinqiao Hospital, Army Millitary Medical University, Chongqing, China
| | - Wenkai Wang
- Department of Orthopedics, Xinqiao Hospital, Army Millitary Medical University, Chongqing, China
| | - Shuai Chen
- Department of Orthopedics, Xinqiao Hospital, Army Millitary Medical University, Chongqing, China
| | - Xiaobing Shi
- Department of Orthopedics, Xinqiao Hospital, Army Millitary Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Millitary Medical University, Chongqing, China
| | - Yu Tang
- Department of Orthopedics, Xinqiao Hospital, Army Millitary Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Millitary Medical University, Chongqing, China
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Zhu MT, Li K, Hu BS, Chen CM, Lin GX. Mapping knowledge structure and themes trends in unilateral biportal endoscopic spine surgery: A bibliometric analysis. Front Surg 2022; 9:976708. [PMID: 36157413 PMCID: PMC9489928 DOI: 10.3389/fsurg.2022.976708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
Background The numerous benefits of unilateral biportal endoscopic (UBE) spine surgery have attracted the attention of many researchers, and a considerable number of relevant clinical studies have been published. However, global research trends in the field of UBE have received little attention. The purpose of this study was to apply bibliometric method to analyze the UBE-related publications to obtain an overview of the research trends in the field of UBE, as well as research hotspots and trends. Methods Web of Science database was searched for articles published until January 31, 2022. CiteSpace was used to analyze the data, which provided graphical knowledge maps. The following factors were applied to all literature: number of publications, distribution, h-index, institutions, journals, authors, and keywords. Results Seventy-three articles were identified. Since 2019, there has been a significant increase in the number of UBE-related publications. The country with the largest number of articles was South Korea (72.6%), followed by China (9.6%), Japan (4.1%), and Egypt (4.1%). South Korea had the highest h-index (16), followed by China (2), Japan (1), and Egypt (1). Leon Wiltse Memorial Hospital was the organization that produced the most papers (12 publications). Heo DH was the most productive author (16 papers) and was the most cited author (35 times). World Neurosurgery published the most papers on UBE (23.3%). The main research hotspots were spinal diseases, decompression, complications, learning curve, and interbody fusion. In addition, the recent concerns were “learning curve,” “interbody fusion,” “management,” and “dural tear.” Conclusions The quantity of publications on UBE research will increase, and South Korea being the major contributor and most prominent country in this field. The findings of our study will provide researchers with practical information on the field of UBE, and identification of mainstream research directions and recent hotspots.
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Affiliation(s)
- Ming-Tao Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Kunrong Li
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Bao-Shan Hu
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- Department of Leisure Industry Management, National Chin-Yi University of Technology, Taichung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, China
- Correspondence: Guang-Xun Lin
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Librianto D, Ipang F, Saleh I, Srie Utami W, Aprilya D, Nurhayati R, Imran D. Comparison of Microscopic Decompression and Biportal Endoscopic Spinal Surgery in the Treatment of Lumbar Canal Stenosis and Herniated Disc: A One-year Follow-up. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Backgrounds. Microscopic decompression (MD) has been widely used as an alternative to open decompression. Lately, biportal endoscopic spinal surgery (BESS) - a new approach in minimal-invasive spinal surgery – has also been used with good results. Although both groups can achieve adequate lumbar decompression, there is still a lack of evidence regarding their comparison. We aim to compare the outcomes of both techniques in a one-year follow-up.
Methods. This is a retrospective study in 100 consecutive patients with symptomatic lumbar spine compression due to herniated nucleus pulposus (HNP) and lumbar canal stenosis (LCS) that was treated by either BESS or MD. Clinical evaluations using Visual Analog Score (VAS), Oswestry Disability Index (ODI), and SF-36 questionnaire were obtained. Objective data such as surgery duration, amount of postoperative drain production, and hospital length of stay were collected. Complications were noted throughout the follow-up time.
Results. The BESS group had a significantly lesser surgical duration, drain production, and length of stay. At one year follow-up, both groups achieved significant improvement in VAS, ODI, and SF-36 compared to the preoperative condition. Complications were not observed in the BESS group.
Conclusions. Both procedures were comparably effective to treat lumbar stenosis. Although this study shows superiority with BESS technique in immediate and long-term follow-up, the final choice may depend on the surgeon's preference
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Wang H, Wang K, Lv B, Li W, Fan T, Zhao J, Kang M, Dong R, Qu Y. Analysis of risk factors for perioperative hidden blood loss in unilateral biportal endoscopic spine surgery: a retrospective multicenter study. J Orthop Surg Res 2021; 16:559. [PMID: 34526051 PMCID: PMC8442349 DOI: 10.1186/s13018-021-02698-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/29/2021] [Indexed: 02/08/2023] Open
Abstract
Background Hidden blood loss (HBL) represents an important complication of unilateral biportal endoscopic (UBE) spine surgery. This study aimed to evaluate HBL and its possible risk factors among patients undergoing UBE surgery for lumbar degenerative diseases. Methods This multicentric retrospective study was conducted in 3 different medical centers between July 2020 and April 2021. Data of patients who underwent UBE surgery were extracted by electronic medical record system. The patient’s demographic characteristics and blood loss-related parameters were recorded. We calculated the amount of HBL and explored the association between patient’s characteristics and HBL using Pearson or Spearman correlation analysis. Multivariate linear regression analysis was conducted to identify independent risk factors of HBL. Results A total of 136 patients (55 females and 81 males, age range 43 to 74 years) were included in this study. A substantial amount of HBL (469.5 ± 195.3 ml, 57.6% of TBL, total blood loss) occurred following UBE surgery. Multiple linear regression analysis indicated that the risk factors of HBL were as follows: age (P = 0.000), number of fusion levels (P = 0.015), American Society of Anesthesiologists (ASA) classification (P = 0.046), surgery time (P = 0.017), patient’s blood volume (PBV, P = 0.026), total blood loss (TBL, P = 0.001), postoperative (i.e., day 2 or 3) hematocrit (Hct, P = 0.034), Hct loss (P = 0.005), and fibrinogen (P = 0.028). Conclusions A certain amount of HBL occurs in UBE surgery and cannot be ignored in daily clinical practice. The age, number of fusion levels, ASA classification, surgery time, PBV, TBL, postoperative Hct, Hct loss, and fibrinogen are independent risk factors for HBL.
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Affiliation(s)
- Haosheng Wang
- Department of Orthopedics, Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China
| | - Kai Wang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Bin Lv
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, People's Republic of China
| | - Wenle Li
- Department of Orthopedics, Liuzhou People's Hospital, Liuzhou, Guangxi Province, People's Republic of China
| | - Tingting Fan
- Department of Endocrinology, Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Jianwu Zhao
- Department of Orthopedics, Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China
| | - Mingyang Kang
- Department of Orthopedics, Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China
| | - Rongpeng Dong
- Department of Orthopedics, Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China
| | - Yang Qu
- Department of Orthopedics, Second Hospital of Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin Province, People's Republic of China.
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Ahn DK, Lee JS, Shin WS, Kim S, Jung J. Postoperative spinal epidural hematoma in a biportal endoscopic spine surgery. Medicine (Baltimore) 2021; 100:e24685. [PMID: 33578600 PMCID: PMC10545396 DOI: 10.1097/md.0000000000024685] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/07/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Biportal endoscopic spine surgery (BESS) is extending its application to most kind of spine surgeries. Postoperative spinal epidural hematoma (POSEH) is one of the major concerns of this emerging technique. Through this study we aim to investigate the incidence of POSEH in BESS comparing to a conventional spine surgery (CSS).The patients who underwent a non-fusion decompressive spine surgery due to degenerative lumbar spinal stenosis (LSS) or herniated lumbar disc (HLD) or both between January 2015 and March 2019 were reviewed retrospectively. The incidence of clinical POSEH that demanded a revision surgery for hematoma evacuation was compared between CSS and BESS. As a second endpoint, the morphometric degree of POSEH was compared between the two groups. The maximal compression of cauda equina by POSEH was measured by 4 grade scale at the T2 axial image and the neurological state was evaluated by 5 grade scale. The indication of hematoma evacuation was more than hG3 with more than nG1. As a subgroup analysis, risk factors of POSEH in BESS were investigated.The 2 groups were homogenous in age, sex, number and level of operated segments. There was significant difference in the incidence of symptomatic POSEH as 2/142 (1.4%) in CSS and 8/95 (8.4%) in BESS (P = .016). The radiological thecal sac compression by hematoma was hG1 65 (61.3%), hG2 35 (33.0%), hG3 5 (4.7%), hG4 1 (0.9%) cases in CSS and hG1 33 (39.8%), hG2 25 (30.1%), hG3 22 (26.5%), hG4 3 cases (3.6%) in BESS. The difference was significant (P < .001). In BESS subgroup analysis, the risk factor of high grade POSEH was bilateral laminectomy (OR = 8.893, P = .023).The incidence of clinical and morphometric POSEH was higher in BESS. In BESS, POSEH developed more frequently in bilateral laminectomy than unilateral laminectomy.
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