Percutaneous Full Endoscopic Ligamentum Flavum Splitting Interlaminar Approach for Removal of Dorsally Migrated Lumbar Disc Herniation: A case Report with Technical Note

Treatment of dorsally migrated lumbar disc described so far commonly in present literature is removal by open technique through hemi or complete laminectomy or by use of microsurgical technique or by partial use of endoscope without use of irrigation system. We present a case of dorsally migrated disc herniation treated safely with good outcome by Percutaneous Full Endoscopic Ligamentum Flavum Splitting Interlaminar Approach. A 60 years old man presented with subacute onset of back pain and right leg radiating pain with weakness of right great toe dorsiflexion and diagnosed as a case of dorsally migrated L4-5 disc herniation was treated with this technique. He had also subtle instability at that level.His pain resolved immediately after surgery. Weakness of right great toe also resolved gradually in 2 months. Postoperative X-ray showed no further instability. Postoperative MRI revealed complete removal of disc with resolution of cauda equina compression. No complication was noted related to this technique. This new technique ultimately preserves motion segment while simultaneously addressing symptomatic pathology of dorsally migrated HNP with added benefits of minimally invasive spine surgery

Radical prostatectomy versus radiotherapy as local therapy for primary tumors in patients with oligometastatic prostate cancer

IntroductionWe compared radical prostatectomy (RP) and radiotherapy (RT) as local therapies for primary tumors and examined their associations with survival outcomes and urinary tract complications in patients with oligometastatic prostate cancer (omPC).MethodsWe evaluated the data of 85 patients diagnosed with omPC who underwent local therapy for primary tumors between January 2008 and December 2018. Of the 85 patients, 31 underwent prostate RT, while 54 underwent RP. Oligometastatic disease was defined as the presence of fewer than five metastatic lesions without visceral metastasis. Urinary tract complications, progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated using the Kaplan–Meier method and Cox regression analyses. ResultsPatients treated with RT showed higher prostate-specific antigen levels. There was no significant difference in the 5-year PFS (52.5% vs. 37.9%, p=0.351), CSS (67.6% vs. 84.7%, p=0.473), or OS (63.6% vs. 73.8%, p=0.897) between the RT and RP groups. In the multivariate analyses, the type of local therapy was not associated with PFS (hazard ratio [HR]=1.334, p=0.356), CSS (HR=0.744, p=0.475), or OS (HR=0.953, p=0.897). ConclusionTherefore, RP seems to be a possible treatment option for patients with omPC, exhibiting oncologic outcomes comparable to those with RT

Get Ready for 100 Years of Active Spine Life Using Percutaneous Endoscopic Spine Surgery (PESS)

Lumbar spinal stenosis is the most common indication for spinal surgery in patients older than 65 years. After the introduction of Kambin's safety triangle, percutaneous endoscopic spine surgery has started through transforaminal approach for discectomy and is now being extended to spinal stenosis through interlaminar approach, which is an important part of the degenerative spinal disease. With the increase in human longevity, the development of effective treatment for degenerative diseases is inevitable, and future percutaneous endoscopic spine surgery (PESS) will play a very important role in maintaining the health of this ‘super-aged’ population. Endoscopic techniques impart minimal approach related disruption of normal spinal anatomy and function while concomitantly increasing functional visualization and correction of degenerative stenosis. Advantages of full endoscopic spine surgeries are less soft tissue dissection, less blood loss, reduced hospital admission days, early functional recovery and enhancement in the quality of life. With proper training and advancement in equipment and technologies, percutaneous endoscopic spine surgery will be able to successfully treat the aging spine

Realizable Minimally Invasive 1-Day Lumbar Interbody Fusion Surgery: No General Anesthesia, No Hemovac Insertion, No Skin Suture Surgery, and Early Ambulation

Objective The lumbar interbody fusion surgery, patients commonly have severe pain, requiring adequate bed rest for a long time. We performed a 1-day minimally invasive spine (MIS) lumbar interbody fusion that required no hemovac insertion and no skin suture and led to early ambulation. Here, we report the surgical procedure and results. Methods This study was designed as a retrospective review. From January 2013 to August 2014, 49 patients who received the MIS TLIF for 1-day MIS lumbar interbody fusion surgery were included in this study. The surgical procedures performed were as follows: (1) epidural catheter insertion; (2) midline subdermal dissection procedure; (3) MIS TLIF; (4) bleeding control procedure; (5) percutaneous transpedicular screwing; (6) tight subdermal plan suture; (7) skin sealing procedures. Postoperatively, wound dressing was not needed. Epidural catheter was removed on the second day after the operation. Results Average intraoperative bleeding was 128.6 mL per level. The average operation time was 78.9 min. per level. An average midline skin incision was 2.8 cm per level. The possible ambulation time was 0.94±0.88 day. The discharge time after antibiotic injection for 3 days was 4.88±1.51 days. In the corresponding order of preoperative and immediate postoperative, 3-month, 6-month, and final follow-up, Postoperative VAS (back), VAS (leg) and ODI improved significantly immediate postoperatively (p<0.0001). Postoperatively, there was no cases of revision due to hematoma. Conclusion The results indicated good clinical results of the 1-day minimally invasive lumbar interbody fusion surgery, without any serious complications

Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Foraminal Disc Herniation with Superior Migration using Contralateral Interlaminar Approach: A Technical Case Report

In cases of L5-S1 foraminal disc herniation with superior migration, it is very difficult to access using rigid endoscope. We attempted a percutaneous endoscopic lumbar discectomy (PELD) via a contralateral interlaminar approach to remove the symptomatic disc and preserve the functional structures. Between January 2013 and January 2014, five patients who received PELD for the disc herniation via the approach were included in this study. Through the approach, we could expose the exiting nerve root without structural damage. We confirmed the appropriate decompression of the lesion with an immediate postoperative MRI, and the clinical outcome was evaluated using a visual analog scale (VAS) score. In all cases, the herniation was removed appropriately. The mean pre-operative VAS score was decreased at the post-operative state, from 7.8±0.84 to 1.4±0.55. We obtained excellent clinical outcomes in treating the migrated disc herniation at the level using PELD via a contralateral interlaminar approach

Safety and Efficacy of Endoscopic Posterior Cervical Discectomy and Foraminotomy Using Three-Point Plaster Traction Technique

The endoscopic posterior cervical foraminotomy and discectomy have been continuously developed and are considered widely performed minimally invasive procedures while maximally preserving patients’ anatomical structures. In posterior cervical spine surgery, the Mayfield head clamp is commonly used to provide a rigid, stable position of the head throughout the procedure. The use of the Mayfield head clamp has been associated with skull fractures, lacerations, air embolisms and epidural hematoma. However, we have performed 12 surgeries without Mayfield head clamp, in order to reduce the amount of equipment preparation needed and the additional risk of complications resulting from skeletal traction during surgery. These 12 patients were operated between January 2016 and February 2017 with full-endoscopic posterior discectomy or foraminotomy for posterolateral disc herniation or foraminal stenosis by osteophytes. In all 12 patients, preoperative average VAS scores were 7.67±1.4 for the neck and 8.33±1.1 for the arm, while postoperative VAS scores were 1.8±0.7 for the neck and 1.4±2 for the arm. All patients underwent a 6-month follow-up, during which improvement in VAS scores was maintained. There was no compromise in endoscopic view during surgery due to our positioning technique. Our results show that posterior cervical endoscopic spine surgery can be performed safely and effectively with three-point plaster traction technique without risks associated with skeletal traction