Clinical Results And Review of Techniques of Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression (LE-ULBD) for Lumbar Stenosis

Uniportal Lumbar Endoscopic decompression can be performed through transforaminal and interlaminar route. Interlaminar lumbar endoscopic unilateral laminotomy for bilateral decompression allows good decompression of central and lateral recess of the stenotic lumbar spine region. Both over the top decompression approach and under the ligamentum flavum decompression approach method has been recently described with differing principles and approaches despite achieving the same target in decompression of spinal canal through uniportal interlaminar endoscopic route. The authors aim to share their experience and thoughts on the 2 described approaches. Retrospective clinical cohort evaluation of patients who underwent LEULBD were performed from January 2018 to December 2019 The cohort of 278 cases of LEULBD with mean age of 64 years old were evaluated. Complication rate is 3.6% and reoperation was 3.6%, mean VAS improvement at 1 weeks, 3 months and final follow up were 3.06±0.66, 2.50±0.86 and 2.17±0.91 respectively, p<0.001 and ODI improvement at 1 weeks, 3 months and final follow up were 31.87±5.02, 27.91±6.31 and 25.32±6.44 respectively. Lumbar Endoscopic Unilateral Laminotomy Bilateral Decompression could achieve good clinical outcomes and low rate of complications with thorough understanding of endoscopic anatomy

Rationale of Endoscopic Spine Surgery: A New Paradigm Shift In Spine Surgery From Patient’s benefits to Public Interest In This New Era of Pandemic

Advancement of technology and surgical skills act in synergy to lead to exploration of new solutions in spine surgery. One of the key areas of spine innovation is endoscopic spine surgery and its application to a broader spectrum of conditions with the aim of reducing perioperative morbidities, soft tissue and bony conservation and yet achieving long term target outcomes of gold standard traditional open spine surgery. Twenty first century marks the new century of opportunities and challenges, in the face of threat of Coronavirus pandemic and difficult circumstances in hospital bed management and limitation in medical resources, minimally invasiveness is evolving from individual patients’ benefits to public interest

Uniportal Endoscopic Lateral to Medial Direction Transforaminal Lumbar Interbody Fusion: A Case Report and Technical Guide for Navigating Through Landmarks in Left Lumbar 4/5 Post Laminotomy Revision Lumbar Fusion Surgery

Post lumbar laminotomy anatomical changes can be disorienting to uniportal spinal endoscopist. This which led to many open conversionconversion to open surgery to verify landmarks. Isthmus tends not to be violated inis usually preserved in laminotomy and it can be used as a useful landmark for endoscopic fusion surgery. Unlike tubular microscopic surgery, endoscope possess more mobility; conveniently navigating through the identifiable anatomical landmarks in revision surgery with minimal fluroscopy. Uniportal Endoscopic Lateral to Medial Direction Transforaminal Lumbar Interbody Fusion, is a useful revision surgery technique with isthmus as reference point, it had not been described in literature. Case Presentation A 66 years old lady with two previous lumbar decompressive surgery to left L4/5 presented with neurogenic claudication and instability. She was diagnosis was to have L4/5 post-surgical spondylolisthesis with stenosis. She Informed consent was obtained consented for left L4/5 revision uniportal endoscopic lateral to medial direction transforaminal lumbar interbody fusion, Endo (LM)-TLIF. Procedure started with drilling isthmus with from lateral to medial direction using exploratory bone drilling dissection technique to decompress and explore residual bony anatomical landmark. With proper definition of anatomical margins of intervertebral disc space, endoscopic guided discectomy, end plate preparation, cage and percutaneous pedicle screws insertion were done with aid of fluoroscopy and endoscopy to perform spinal fusion. Patient did well post operatively without any intraoperative complication.Conclusion Endo (LM)-TLIF is a viable, safe and efficacious method to explore a potentially challenging post-surgical anatomy around spinal canal in revision lumbar fusio

Expanded Indications of Full Endoscopic Spine Sugery

Treatment of spine surgeries has evolved from traditional surgeries to open surgeries. Endoscopic spine surgeries (ESS) and endoscope assisted surgeries along with microscopic and tubular surgeries has developed significantly over the last three decades. With improvement in the diagnostic methods it is now possible to find and differentiate the spinal pathologies. ESS was initially limited to the lumbar disc herniations (DH). But, now it can be used for cervical and thoracic DH. Minimized technical problems has been brought by evolutions in endoscopy, better optics, instruments, access, and safety. Similarly acquired knowledge and skills are being extrapolated to advanced indications in different spinal pathologies. Due to the further advantages of ESS within the ambit of minimal invasive spine surgeries, many misnomers are as well getting added. This confuses the new learners and potential patients as well. ESS should be classified for uniformity in reporting and common nomenclature like FESS (Full endoscopic spine surgery) should be used. It specifically refers to surgery through one working channel under irrigation with incorporated optics. This will make easier understanding for novice surgeons and general population. It will lead to standardised reporting of high quality clinical studies, trials, and meta-analysis for the publications. Rising misnomers and complex nomenclature of endoscopy is suggesting along with the exponential publications in last decade that ESS is entering into its golden era. This review is undertaken to throw light on the techniques, advances and literature review of only FESS and clear the misnomers. This review also describes the evolution of different techniques and goals that led to impeccable advances in the field of FESS. Further improvement of technologies and techniques in future will soon establish FESS as the Gold Standard in spine surgery

Anatomical Importance of Inner Ligamentum Flavum Parameters for Successful Endoscopic Lumbar Decompression Surgery

Objective Predicting the gross anatomy of the inner ligament flavum and surrounding interlaminar window is essential for sufficient neural decompression because endoscopic spine surgery is performed in a limited, narrow surgical corridor. This article aims to analyze the anatomical data of inner LF and interlaminar window on the 3D lumbar computed tomography (CT) for easy application to the endoscopic decompression surgery. Methods We measured nine parameters indicating the contour of inner LF and interlaminar window on 3D CT from 100 patients who were diagnosed with lumbar spinal stenosis or disc herniation. Inner LF angle, inner LF distance, inner LF volume, and inner foraminal ligament distance for inner LF contour; height, width, and lateral corner angle of interlaminar window contour were measured in five age groups consisted of twenty individuals from the 30s to the 70s. We then compared two age groups(ages 30–49 years, n=40; ages 60–79 years, n=40). Results In the old age group, the interlaminar window was changed to a smaller triangle shape representing decreased width and height and increased lateral corner angle. Inner LF volume, inner LF angle, inner LF distance were also reduced in the old age group. But these parameters have variations in levels with a significant difference. Uniportal endoscopic docking point has moved according to changed interlaminar window features more caudal and lateral direction. Inner LF angle could have used to decide the approach angle for endoscopic contralateral foraminotomy. Conclusion We found the changing features of these structures correlated with age and levels to help with endoscopic decompression surgery has a limited surgical corridor. The present study results may help the endoscopic surgeons decide the endoscopic docking site, the extent of bone drilling at the medial facet joint part, and the approach angle for contralateral lumbar foraminotomy

Recent Trends and Changes in the Endoscopic Spinal Surgery

In recent years, endoscopic spine surgeries have advanced dramatically. Endoscopic spine surgeries are expanding to not only the lumbar spine, but also thoracic and cervical spines. Indications for spinal endoscopic surgery have also been expanded. Central stenosis, lateral recess stenosis, and foraminal stenosis were included in surgical indications of endoscopy. Finally, endoscopic lumbar interbody fusion surgeries have been attempted

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

A Novel Technique of the Full Endoscopic Interlaminar Contralateral Approach for Symptomatic Extraforaminal Juxtafacet Cysts

Extraforaminal juxtafacet cyst is rare and present a surgical challenge due to its anatomical location. This study aimed to introduce the surgical technique of interlaminar contralateral endoscopic lumbar foraminotomy (ICELF) for extraforaminal juxtafacet cyst removal and reveal its approach-related benefits. The endoscope was docked on the ipsilateral spinolaminar junction and access the contralateral foraminal area through the contralateral sublaminar space created by the fine drilling. As the foraminal was enlarged by bony drilling, the endoscope was introduced deeper to the extraforaminal area without violation of the foraminal disc. Combined foraminal stenosis was also resolved while exploring the foraminal space. Subsequently, the extraforaminal cyst was safely and entirely removed while exposing the cyst-nerve root adhesion site with an endoscopic view looking up obliquely. Radiating pain in the right leg, back pain, leg hypesthesia, and ankle weakness improved. ICELF for the treatment of extraforaminal JFC can be an alternative surgical method to resolve symptomatic foraminal stenosis and the cyst simultaneously. The entire cyst contour and the site of cyst-nerve root adhesion can be detected without nerve root retraction, and meticulous dissection is possible without violating the cystic wall using the full endoscopic contralateral approach

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