Incidental Durotomy During Endoscopic Stenosis Lumbar Decompression: Incidence, Classification, and Proposed Management Strategies

Kim, Hyeun Sung; Raorane, Harshavardhan Dilip; Wu, Pang Hung; Heo, Dong Hwa; Sharma, Sagar; Jang, Il‐Tae

doi:10.1016/j.wneu.2020.01.242

Cited by 60 publications

(47 citation statements)

References 26 publications

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“…In terms of clinical evaluation, we had one incidental durotomy during the procedure in 30 levels (3.3%), which required dural patch blocking repair [ 20 ]. No revision surgery was required for this patient, who had incidental durotomy without neurological sequelae and was allowed to mobilize post-operatively day two.…”

Section: Resultsmentioning

confidence: 99%

“…There was one case of incidental durotomy in our series. In that patient, there was no significant sequelae after the dura patch blocking repair [ 20 ]. This incidental durotomy rate is comparable to the incidental durotomy rate of other endoscopic techniques (0–8.6%), despite the significant neural adhesion and collapsed disc space in our series [ 20 , 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note

Kim

Lee

et al. 2020

Brain Sciences

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Background: Severe collapsed disc secondary to degenerative spinal conditions leads to significant foraminal stenosis. We hypothesized that uniportal posterolateral transforaminal lumbar interbody fusion with endoscopic disc drilling technique could be safely applied to the collapsed disc space to improve patients’ pain score, restore disc height, and correct the segmental angular parameters. Methods: We included patients who met the indication criteria for lumbar fusion and underwent uniportal full endoscopic posterolateral transforaminal lumbar interbody fusion with pre-operative Computer Tomography mid disc height of less than or equal to 5 mm and MRI of Grade 3 Foraminal Stenosis. Visual analogue scale and computer tomography pre-operative and post-operative sagittal disc height in the anterior, middle and posterior part of the disc; sagittal focal segmental angle; mid coronal disc height and coronal wedge angles were evaluated. Results: 30 levels of Endo-TLIF were included, with a mean follow up of 12 months. The mean improvement in decreasing pain score was 2.5 ± 1.1, 3.2 ± 0.9 and 4.3 ± 1.0 at 1 week post operation, 3 months post operation and at final follow up, respectively, p < 0.05. There was significant increase in mid sagittal computer tomographic anterior, middle and posterior disc height of 6.99 ± 2.30, 6.28 ± 1.44, 5.12 ± 1.79 mm respectively, p < 0.05. CT mid coronal disc height showed an increase of 7.13 ± 1.90 mm, p < 0.05. There was a significant improvement in the CT coronal wedge angle of 2.35 ± 4.73 and the CT segmental focal sagittal angle of 1.98 ± 4.69, p < 0.05. Conclusion: Application of Uniportal Endoscopic Posterolateral Lumbar Interbody Fusion in patients with severe foraminal stenosis secondary to severe collapsed disc space significantly relieved patients’ pain and restored disc height without early subsidence or exiting nerve root dysesthesia in our cohort of patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note

Kim

Lee

et al. 2020

Brain Sciences

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“…Incidental durotomy in our LE-ULBD series was small and only required patch blocking dural repair. 33 Keeping the deep layer of ligamentum flavum intact till last part of surgery also keeps the epidural bleeding till the last part of procedure. As epidural bleeding obscures the endoscopic viewing, which may require higher irrigation pressure, causing unwanted side effects of headache, neckache, and even seizure.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression Outside-In Approach: A Proctorship Guideline With 12 Steps of Effectiveness and Safety

Kim

Jang

2020

Neurospine

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Minimally invasive spinal surgery in particular lumbar endoscopic unilateral laminotomy with bilateral decompression becomes popular as it can be performed with regional anesthesia, soft tissue damages are minimized as endoscopic visualization and instruments can be brought close to operating area bypassing much of the intervening soft tissues for sufficient spinal decompression with ligamentum flavum resection despite less bony resection compared to open surgery. Overall, when well executed, it preserves spinal stability. Outside-in technique of decompression is also known as over the top decompression in minimally invasive literature. It involves maintaining deep layer of ligamentum flavum integrity till satisfactory bony decompression is achieved. Deep layer of ligamentum flavum is removed as final step of decompression. Preservation of the deep layer of ligamentum flavum protects the neural elements, allowing drills and sharp equipment to be used safely to perform bony decompression.In this study, we demonstrate the technical details of outside-in approach lumbar endoscopic unilateral laminotomy with bilateral decompression (LE-ULBD). LE-ULBD Outside-in Technique is an effective and safe procedure in relieving lumbar spinal stenosis with favorable results with a follow-up for more than 1 year.

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“…23 However, amid the optimism regarding the expansion of indications for endoscopic spine surgery to encompass increasingly challenging cases, one needs to be cautious of the potential complications of endoscopic surgery, such as incidental durotomy, neurological sequelae, and inadequate decompression, all of which are confounded by a steep learning curve. [24][25][26]…”

Section: For Worse Case Scenarios (Revision Surgery Complications Amentioning

confidence: 99%

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

Jang

2020

Neurospine

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Incidental Durotomy During Endoscopic Stenosis Lumbar Decompression: Incidence, Classification, and Proposed Management Strategies

Cited by 60 publications

References 26 publications

Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note

Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note

Lumbar Endoscopic Unilateral Laminotomy for Bilateral Decompression Outside-In Approach: A Proctorship Guideline With 12 Steps of Effectiveness and Safety

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

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