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
-
Obesity is associated with increased surgical complexity and postoperative complications in spine surgery. Minimally invasive procedures have been shown to lessen some of the increased risk in obese patients. This study investigated whether utilization of a working channel endoscope can further mitigate obesity-associated challenges in spinal surgery. ⋯ Full-endoscopic unilateral laminotomies for bilateral decompression are safe and effective in both non-obese and obese patients. The use of an endoscope can partially mitigate obesity-related morbidity in lumbar decompression. However, obesity is significantly related to increased postoperative analgesic use.
-
Decompression of spinal stenosis represents one of the most commonly performed procedures in spine surgery. With constantly increasing patient age and changing demographics, reducing the invasiveness of surgical procedures has become increasingly important. Over the past decades, microsurgical decompression has been established as a gold standard technique for the surgical treatment of spinal stenosis. ⋯ Advantages included smaller skin incisions, reduced collateral tissue damage, less blood loss, lower infection rates and wound healing problems, shorter hospital stay, and multiple others, as widely known across various MIS techniques. For the same reasons as outlined above, the introduction of full-endoscopic surgical techniques aims to further reduce the invasiveness of surgical interventions. The present manuscript provides a delineation of the surgical technique of LE-ULBD (Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression), gives an overview on the current state of literature, and aims to put this surgery into context with other currently available decompression techniques.
-
While anterior cervical discectomy and fusion as well as cervical disk arthroplasty are gold standard treatments for the surgical treatment of cervical radiculopathy, posterior endoscopic cervical foraminotomy (PECF) as a substitute procedure is gaining popularity. To date, studies investigating the number of surgeries needed to achieve proficiency in this procedure are lacking. The purpose of the study is to examine the learning curve for PECF. ⋯ PECF is an advanced endoscopic technique with an initial improvement in operative time that occurred after as few as 8 cases to as many as 28 cases in this series. A second learning curve may occur with additional cases. Patient-reported outcomes improve following surgery, and these outcomes are independent of the surgeon's position on the learning curve. Fluoroscopy use does not change significantly along the learning curve. PECF is a safe and effective technique that current and future spine surgeons should consider as part of their armamentarium.