Development of Endoscopic Spine Surgery for Healthy Life: To Provide Spine Care for Better, for Worse, for Richer, for Poorer, in Sickness and in Health

Kim, Hyeun Sung; Wu, Pang Hung; Jang, Il‐Tae

doi:10.14245/ns.2040188.094

Cited by 13 publications

(16 citation statements)

References 34 publications

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“…In the early phase of development of lumbar endoscopic spine surgery, the focus was on removal of soft disc herniation through the working corridor of Kambin's triangle using transforaminal endoscopic approach 3) . With the introduction of the interlaminar approach, the range of conditions that can be treated by endoscopic spine surgery has expanded with exponential development of surgical equipment and techniques 6,8,15) . Endoscopic surgeons often work in well-defined anatomical corridors that provide a safe working zone for equipment to pass through to achieve targeted decompression and/or fusion.…”

Section: Discussionmentioning

confidence: 99%

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

Kim¹,

Kim²,

Wu³

et al. 2021

J Minim Invasive Spine Surg Tech

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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.

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Section: Discussionmentioning

confidence: 99%

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

Kim¹,

Kim²,

Wu³

et al. 2021

J Minim Invasive Spine Surg Tech

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“…There is a growing trend and demand for minimally invasive spine surgery and in particular endoscopic spine surgery 29) . The common goal of achieving maximal amount of benefit with the least amount of soft tissue damages is the main aim of endoscopic spine surgery 30,54) . The advantages of endoscopic spine surgery is provided by water irrigation surgery, improvements in visualization with magnification of spinal structures, safe delivery of energy and spinal instruments to target tissues to minimize collateral damages to tissues 13) .…”

Section: Introductionmentioning

confidence: 99%

Overview of Tips in Overcoming Learning Curve in Uniportal and Biportal Endoscopic Spine Surgery

Kim

Choi

et al. 2021

J Minim Invasive Spine Surg Tech

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There is increasing trend of spine surgeries performed with uniportal and biportal endoscopic spine surgery. Despite its good outcomes and supportive literature, the proportion of spine surgeons regularly doing endoscopic spine surgeries is relatively low. The main limitation is the steep learning curve in the early phase of endoscopic spine surgeries practice. There is paucity of literature in discussion of tips in overcoming these 2 schools of endoscopic spine surgery practice. In this tips and tricks overview, the authors highlights the key differences these 2 main school of endoscopic spine surgeries practice with specific discussions pertaining to "BIPORTALS": the areas of basic medium of surgery, instruments for visualization and working, placement of portal(s), outflow of fluids, route of approach, technical challenges, anatomical challenges, location of lens and light source and start point to work. A ladder of progression of endoscopic spine surgery is proposed to effectively ease into the practice of endoscopic spine surgery.

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“…With the evolution of endoscopic spine surgery, there are an increasing variety of endoscopic techniques being applied in lumbar spine surgery [ 1 , 2 ]. Both transforaminal and interlaminar approaches have been described to treat various degenerative conditions of the lumbar spine [ 3 , 4 , 5 , 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Two Methods (Inside-Out/Outside-In) Inferior Articular Process Resection for Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion: Technical Note

Kim

et al. 2021

Brain Sciences

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Objective: There is limited literature comparing the uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion outside-in approach (ETLIF (O)) with the inside-out approach (ETLIF (I)). Methods: Radiological evaluation was performed on disc height restoration and coronal wedging angle, and operation time (inferior articular process resection time/total operation time) and clinical evaluation were made. Result: 48 cases of inside-out and 38 cases of outside-in cases were included. Compared to inside-out, the outside-in approach had significantly less operative time required to resect inferior articular process: 36.55 ± 10.37, and total operative time: 87.45 ± 20.14 min compared to 49.83 ± 23.97 and 102.56 ± 36.53 min, respectively, for the inside-out approach, p < 0.05. Compared to the preoperative state, both cohorts achieved significant improvement of VAS and ODI at post-operative 1 week, 3 months and at final follow up. Both cohorts achieved statistically significant increased disc height with 5.00 ± 2.87 mm, 5.49 ± 2.33 mm and statistically significant improvement in coronal wedge angle with 1.76 ± 1.63°, 3.24 ± 2.92° in the inside-out and outside-in approaches respectively. Conclusions: Complete removal of inferior articular process is the key part of endoscopic fusion with two methods that can be applied: an inside-out approach or an outside-in approach. Comparing both techniques, the outside-in approach has a shorter operative time required for inferior articular process resection and total length of operation with similar good clinical and radiological outcomes.

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Development of Endoscopic Spine Surgery for Healthy Life: To Provide Spine Care for Better, for Worse, for Richer, for Poorer, in Sickness and in Health

Cited by 13 publications

References 34 publications

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

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

Overview of Tips in Overcoming Learning Curve in Uniportal and Biportal Endoscopic Spine Surgery

Evaluation of Two Methods (Inside-Out/Outside-In) Inferior Articular Process Resection for Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion: Technical Note

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