Percutaneous endoscopic unilateral laminotomy and bilateral decompression under 3D real-time image-guided navigation for spinal stenosis in degenerative lumbar kyphoscoliosis patients: an innovative preliminary study.
Decompression alone
Endoscopic surgery
Kyphoscoliosis
Lumbar spine
Navigation
Spinal stenosis
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
10 Nov 2020
10 Nov 2020
Historique:
received:
05
07
2020
accepted:
26
10
2020
entrez:
11
11
2020
pubmed:
12
11
2020
medline:
15
5
2021
Statut:
epublish
Résumé
The aim of this study is to introduce a new method of percutaneous endoscopic decompression under 3D real-time image-guided navigation for spinal stenosis in degenerative kyphoscoliosis patients without instability or those who with multiple comorbidities. Decompression alone using endoscope for kyphoscoliosis patient is technical demanding and may result in unnecessary bone destruction leading to further instability. The O-arm/StealthStation system is popular for its ability to provide automated registration with intraoperative, postpositioning computed tomography (CT) which results in superior accuracy in spine surgery. In this study, we presented four cases. All patients were over seventy years old female with variable degrees of kyphoscoliosis and multiple comorbidities who could not endure major spine fusion surgery. Percutaneous endoscopic unilateral laminotomy and bilateral decompression under 3D real-time image-guided navigation were successfully performed. Patients' demographics, image study parameters, and outcome measurements including pre- and post-operative serial Visual analog scale (VAS), and Oswestry Disability Index (ODI) were well documented. The follow-up time was 1 year. Pre- and post-operative MRI showed average dural sac cross sectional area (DSCSA) improved from 81.62 (range 67.34-89.07) to 153.27 (range 127.96-189.73). Preoperative neurological symptoms including radicular leg pain improved postoperatively. The mean ODI (%) were 85 (range 82.5-90) at initial visit, 35.875 (range 25-51) at 1 month post-operatively, 26.875 (range 22.5-35) at 6 months post-operatively and 22.5 (range 17.5-30) at 12 months post-operatively (p < 0.05). The mean VAS score were 9 (range 8-10) at initial visit, 2.25 (range 2-3) at 1 month post-operatively, 1.75 (range 1-2) at 6 months post-operatively and 0.25 (range 0-1) at 12 months post-operatively (p < 0.05). There was no surgery-related complication. To the best of our knowledge, this is the first preliminary study of percutaneous endoscopic laminotomy under O-arm navigation with successful outcomes. The innovative technique may serve as a promising solution in treating spinal stenosis patients with lumbar kyphoscoliosis and multiple comorbidities.
Sections du résumé
BACKGROUND
BACKGROUND
The aim of this study is to introduce a new method of percutaneous endoscopic decompression under 3D real-time image-guided navigation for spinal stenosis in degenerative kyphoscoliosis patients without instability or those who with multiple comorbidities. Decompression alone using endoscope for kyphoscoliosis patient is technical demanding and may result in unnecessary bone destruction leading to further instability. The O-arm/StealthStation system is popular for its ability to provide automated registration with intraoperative, postpositioning computed tomography (CT) which results in superior accuracy in spine surgery.
METHODS
METHODS
In this study, we presented four cases. All patients were over seventy years old female with variable degrees of kyphoscoliosis and multiple comorbidities who could not endure major spine fusion surgery. Percutaneous endoscopic unilateral laminotomy and bilateral decompression under 3D real-time image-guided navigation were successfully performed. Patients' demographics, image study parameters, and outcome measurements including pre- and post-operative serial Visual analog scale (VAS), and Oswestry Disability Index (ODI) were well documented. The follow-up time was 1 year.
RESULTS
RESULTS
Pre- and post-operative MRI showed average dural sac cross sectional area (DSCSA) improved from 81.62 (range 67.34-89.07) to 153.27 (range 127.96-189.73). Preoperative neurological symptoms including radicular leg pain improved postoperatively. The mean ODI (%) were 85 (range 82.5-90) at initial visit, 35.875 (range 25-51) at 1 month post-operatively, 26.875 (range 22.5-35) at 6 months post-operatively and 22.5 (range 17.5-30) at 12 months post-operatively (p < 0.05). The mean VAS score were 9 (range 8-10) at initial visit, 2.25 (range 2-3) at 1 month post-operatively, 1.75 (range 1-2) at 6 months post-operatively and 0.25 (range 0-1) at 12 months post-operatively (p < 0.05). There was no surgery-related complication.
CONCLUSIONS
CONCLUSIONS
To the best of our knowledge, this is the first preliminary study of percutaneous endoscopic laminotomy under O-arm navigation with successful outcomes. The innovative technique may serve as a promising solution in treating spinal stenosis patients with lumbar kyphoscoliosis and multiple comorbidities.
Identifiants
pubmed: 33172435
doi: 10.1186/s12891-020-03745-w
pii: 10.1186/s12891-020-03745-w
pmc: PMC7656687
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
734Références
Spine (Phila Pa 1976). 2012 May 1;37(10):E609-16
pubmed: 22158059
World Neurosurg. 2020 Mar;135:197-204
pubmed: 31706972
Neurosurg Rev. 2013 Jan;36(1):157-62; discussion 162
pubmed: 22956149
Eur Spine J. 2017 Feb;26(2):404-413
pubmed: 27421276
J Neurosurg Spine. 2015 Apr;22(4):339-52
pubmed: 25635635
Eur Spine J. 2017 Feb;26(2):414-419
pubmed: 27272494
Br J Neurosurg. 2017 Apr;31(2):205-208
pubmed: 27548310
Spine (Phila Pa 1976). 2011 Feb 1;36(3):219-29
pubmed: 21124260
Eur Spine J. 2008 May;17(5):650-6
pubmed: 18270753
Clin Orthop Relat Res. 2014 Jun;472(6):1824-30
pubmed: 24307067
Spine (Phila Pa 1976). 2015 Jan 15;40(2):63-76
pubmed: 25569524
Neurosurgery. 2013 Oct;73(4):559-68
pubmed: 23756751
J Spine Surg. 2016 Mar;2(1):52-8
pubmed: 27683696
Clin Neurol Neurosurg. 2013 Mar;115(3):342-5
pubmed: 22673041
Neurospine. 2019 Mar;16(1):41-51
pubmed: 30943706
Spine (Phila Pa 1976). 2010 Feb 1;35(3):298-305
pubmed: 20075768
N Engl J Med. 2016 Apr 14;374(15):1424-34
pubmed: 27074067
BMJ. 2015 Apr 01;350:h1603
pubmed: 25833966
N Engl J Med. 2016 Apr 14;374(15):1413-23
pubmed: 27074066
N Engl J Med. 2014 Jul 3;371(1):11-21
pubmed: 24988555
J Clin Neurosci. 2016 Nov;33:19-27
pubmed: 27475315
J Neurosurg Spine. 2014 Jul;21(1):54-61
pubmed: 24980586
N Engl J Med. 2008 Feb 21;358(8):794-810
pubmed: 18287602
Spine J. 2019 Oct;19(10):1633-1639
pubmed: 31195133
J Clin Neurosci. 2012 Aug;19(8):1137-43
pubmed: 22721892
Arch Orthop Trauma Surg. 2017 May;137(5):637-650
pubmed: 28361467
Asian Spine J. 2014 Aug;8(4):521-30
pubmed: 25187873
Exp Ther Med. 2020 Feb;19(2):1417-1424
pubmed: 32010317
Clin Orthop Surg. 2018 Sep;10(3):328-336
pubmed: 30174809
World Neurosurg. 2019 Jul;127:e39-e48
pubmed: 30802551
Biomed Res Int. 2019 Mar 24;2019:6078469
pubmed: 31019969
Eur Spine J. 2017 Mar;26(3):750-753
pubmed: 27844231
Cureus. 2018 Aug 13;10(8):e3135
pubmed: 30345192
Neurosurg Focus. 2014 Mar;36(3):E3
pubmed: 24580004