Comparison of Neuroendoscopic and Microscopic Surgery for Unilateral Hemilaminectomy: Experience of a Single Institution

Abstract

ObjectiveThis study was designed to compare the safety and efficacy of unilateral hemilaminectomy conducted under complete neuroendoscopic visualization (UHNV) relative to unilateral hemilaminectomy under total microscopic visualization (UHMV) for the treatment of patients diagnosed with intraspinal tumors.MethodsIn total, 41 patients undergoing intraspinal tumor resection at Northern Jiangsu People's Hospital were included in this study, including 20 and 21 patients in the UHNV and UHMV groups, respectively. Intraoperative parameters including incision length, operative duration, number of vertebral laminae removed and intraoperative blood loss, as well as indicators of curative efficacy such as total tumor resection rates and postoperative symptom improvement rates, and safety indicators including complication rates, recurrence rates, spinal deformity rates, spinal instability incidence, and length of stay (LOS), were compared between the two groups.ResultsIn contrast to the UHMV group, patients in the UHNV group had a significantly shorter incision length and decreased intraoperative blood loss (P < 0.05), while the operative duration (P > 0.05) showed no statistical difference. Although the postoperative improvement and total tumor resection rates were enhanced, the difference was not statistically significant (P > 0.05). In comparison, the bedridden time and length of stay (LOS) were significantly shortened (P < 0.05) in the UHNV group. However, there were no significant differences in recurrence, incidence of complications, spinal deformity, and spinal instability (P > 0.05).ConclusionCollectively, our findings indicate that UHNV is not inferior to the UHMV approach. Moreover, due to its safe and minimally invasive nature, UHNV represents a promising alternative to UHMV as a treatment for patients with intradural extramedullary tumors.

Pure endoscopic minimally invasive surgery with a non‑expandable tubular retractor for intradural extramedullary spinal tumors

“…The current study reported a patient series with IDEM spinal tumors treated via pure endoscopic MISS with a parallel non-expandable tubular retractor, in which the patients achieved good outcomes. All patients improved significantly in the postoperative period and had no serious postoperative complications, which is comparable with the results of previous studies ( 14 , 17 , 25 , 26 ). Therefore, pure endoscopic MISS with a parallel non-expandable tubular retractor may be an effective and safe surgical strategy for IDEM spinal tumor resection.…”

“…Caballero-García et al ( 25 ) described the use of an endoscope and a Caspar system in MISS for IDEM spinal tumors. Similarly, Zeng et al ( 26 ) reported endoscopic MISS surgery for the removal of IDEM spinal lesions with a Williams retractor. Dhandapani and Karthigeyan ( 17 ) mainly used the X-tube and Quadrant retractor in pure endoscopic MISS to remove IDEM spinal lesions.…”

“…However, the endoscope can only provide two-dimensional images, which requires long-term training, experience accumulation and intraoperative instrument feedback to reconstruct three-dimensional (3D) images, putting forward higher requirements for surgeons ( 30 ). Although the microscope can provide 3D visualization, it is far away from the surgical area, which leads to serious light attenuation and cannot provide a close-up view of surgical details or panoramic visualization ( 26 ). These two auxiliary lighting vision systems have their advantages and limitations, and both have been proven to be effective and safe.…”

Hemilaminectomy for the removal of the spinal tumors: An analysis of 901 patients

“…Traditional laminectomies, which have been widely used in spinal surgery, are believed to provide adequate exposure to the spinal cord, nerve roots, and tumors, and thus may minimize intraoperative damage to the spinal cord ( 4 ). However, this procedure may result in persistent pain and spinal deformity after surgery due to the destruction of the posterior bony structures, supraspinal ligaments, interspinous ligaments, and paraspinal muscles bilaterally ( 5 ). Tarantino et al ( 6 ) recently reported that about 59.6% of patients experienced severe back or wound pain within a year after using the bilateral approach.…”

A meta-analysis of clinical effects of microscopic unilateral laminectomy bilateral decompression (ULBD) versus biportal endoscopic ULBD for lumbar canal stenosis

“…Compared to traditional open decompression surgery, minimally invasive microscopic unilateral laminectomy with bilateral decompression (ULBD) techniques can preserve more intact spinal structures, prevent postoperative instability, and minimize soft tissue injury (7)(8)(9), and it has favorable results in the treatment of LCS (10,11).…”