Advantages of Revision Transforaminal Full-Endoscopic Spine Surgery in Patients who have Previously Undergone Posterior Spine Surgery

Abstract

Revision lumbar spine surgery via a posterior approach is more challenging than primary surgery because of epidural or perineural scar tissue. It demands more extensive removal of the posterior structures to confirm intact bony landmarks and could cause iatrogenic instability postoperatively; therefore, fusion surgery is often selected. However, adjacent segment disease after fusion surgery could be a problem, and further exposure of the posterior muscles could result in multiple operated back syndrome. To address these problems, we now perform transforaminal full-endoscopic spine surgery (TF-FES) as revision surgery in patients who have previously undergone posterior lumbar surgery. There have been several reports on the advantages of TF-FES, which include feasibility of local anesthesia, minimal invasiveness to posterior structures, and less scar tissue with fewer adhesions. To assess the clinical outcomes of revision TF-FES and outline its advantages. Forty-eight consecutive patients who underwent revision TF-FES (at 60 levels) under local anesthesia. Clinical outcomes of TF-FES performed as revision surgery in patients with a history of posterior lumbar spine surgery. Intraoperative blood loss, operating time, and complication rate were evaluated. Postoperative outcomes were assessed using the modified Macnab criteria and visual analog scale (VAS) scores for leg pain, back pain, and leg numbness. We also compared the outcome of revision FES with that of primary FES. Mean operating time was 70.5±14.4 (52–106) min. Blood loss was unmeasurable. The clinical outcomes were rated as excellent at 16 levels (26.7%), good at 28 (46.7%), fair in 10 (16.7%), and poor at 6 (10.0%). The mean preoperative VAS score was 6.0±2.6 for back pain, 6.8±2.4 for leg pain, and 6.3±2.8 for leg numbness. At the final follow-up, the mean postoperative VAS scores for were 4.3±2.5, 3.8±2.6, and 4.6±3.2, respectively. VAS scores for all three parameters were significantly improved (p<0.05). There was no significant difference in operating time, intraoperative blood loss, or the complication rate between revision FES and primary FES. Clinical outcomes of revision TF-FES in patients with a history of posterior lumbar spine surgery were acceptable (excellent and good in 73.4% of cases). TF-FES can preserve the posterior structures and avoid scar tissue and adhesions. Therefore, TF-FES could be an effective procedure for patients who have previously undergone posterior lumbar spine surgery.

A Trans-pedicle Approach to Avoid Exiting Nerve Root Injury in Full-Endoscopic Transforaminal Decompression: A Case Report

“…First, by using the bony landmark at the lower pedicle, the process can be easily standardized, particularly for revision surgeries. Yagi et al reported variations in the accessing process depending on the severity of foraminal stenosis in revision surgeries [8]. In contrast, our proposed trans-pedicle approach demonstrates less variation and is easily applicable across cases.…”

Preliminary Results of The Treatment for Failed Back Surgery Syndrome by Full Endoscopic Approach at Saint Paul General Hospital, in Hanoi, Vietnam

“…In our series, we first treated all patients conservatively, with at least 2 selective nerve infiltrations under CT guidance to accurately identify the pain generator before considering operative interventions such as opening and endoscopic surgery. Opening resurgery for FBSS patients carries the potential risk of serious complications such as nerve damage, dura mater tear, delayed wound healing, infection, adjacent laminar degeneration, bone nonunion, bleeding, and many other complications [5]. For the above reasons, the minimally invasive nature, precise access, and effectiveness of endoscopic surgery are necessary in treating patients with FBSS, especially elderly patients.…”

“…In such a situation, there is a requirement for minimally invasive intervention; full-endoscopic spine surgery (FESS) can meet this requirement, and there are cases where it can be performed under local anesthesia [4]. Also, compared to open surgery, FESS allows precise access to the location of the nerve structure that needs to be released while being able to pass through adherent fibrous tissue easily [5,6]. For these reasons, reoperation in patients with FBSS is more feasible and less risky.…”

Evolution, Current Trends, and Latest Advances of Endoscopic Spine Surgery

“…When used for revision spine surgery, TELF and TELD are associated with minimal blood loss, lesser scar tissue formation, and similar operating time compared to primary spine surgeries [ 45 , 46 ]. In addition to other advantages of this technique, such as shorter operation time, minimal blood loss, and less muscle trauma, there are several published reports of transforaminal endoscopic spine surgery performed in awake patients under local anesthesia [ 47 , 48 ].…”