Ipsilateral Pedicle Stress Fracture After Endoscopic Foraminal Decompression for Patient with Isthmic Spondylolisthesis

Nam, Woo Dong; Yoon, Young Sik; Kim, Nam Yeop; Hong, Chul Gie

doi:10.1016/j.wneu.2020.02.139

Cited by 6 publications

(5 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…IONM might be used more frequently in complicated cases such as scoliosis, spondylolisthesis, lumbar canal stenosis, or degenerative disk disease that require fusion surgery, which might lead to root damage. [34][35][36][37][38] The fact that these surgical indications were significantly higher in the IONM group supports the finding that there was a higher incidence of nerve root injury in the IONM group. Another possibility is that IONM detected more abnormal nerve/cord signals intraoperatively.…”

Section: Epidemiologysupporting

confidence: 69%

“…Paradoxically, our results showed that nerve root injury was significantly higher in the IONM group, and spinal cord injury was higher in the non-IONM group. IONM might be used more frequently in complicated cases such as scoliosis, spondylolisthesis, lumbar canal stenosis, or degenerative disk disease that require fusion surgery, which might lead to root damage 34–38 . The fact that these surgical indications were significantly higher in the IONM group supports the finding that there was a higher incidence of nerve root injury in the IONM group.…”

Section: Discussionmentioning

confidence: 80%

See 1 more Smart Citation

The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State

Dodo

Okano

Zelenty

et al. 2023

Spine

View full text Add to dashboard Cite

Study Design. Retrospective database analysis. Objective. To elucidate trends in the utilization of intraoperative neurophysiological monitoring (IONM) during elective lumbar surgery procedures and to investigate the association between the use of IONM and surgical outcomes. Background. The routine use of IONM in elective lumbar spine procedures has recently been called into question due to longer operative time, higher cost, and other substitute advanced technologies. Methods. The Statewide Planning and Research Cooperative System database was accessed to perform this retrospective study. The trends of IONM use for lumbar decompression and fusion procedures were investigated from 2007 to 2018. The association between IONM use and surgical outcomes was investigated from 2017 to 2018. Multivariable logistic regression analyses, as well as propensity score matching (PS-matching), were conducted to assess IONM association in neurological deficits reduction. Results. The utilization of IONM showed an increase in a linear fashion from 79 cases in 2007 to 6201 cases in 2018. A total of 34,592 (12,419 monitored and 22,173 unmonitored) patients were extracted, and 210 patients (0.6%) were reported for postoperative neurological deficits. Unadjusted comparisons demonstrated that the IONM group was associated with significantly fewer neurological complications. However, the multivariable analysis indicated that IONM was not a significant predictor of neurological injuries. After the PS-matching of 23,642 patients, the incidence of neurological deficits was not significantly different between IONM and non-IONM patients. Conclusion. The utilization of IONM for elective lumbar surgeries continues to gain popularity. Our results indicated that IONM use was not associated with a reduction in neurological deficits and will not support the routine use of IONM for all elective lumbar surgery.

show abstract

Section: Epidemiologysupporting

confidence: 69%

Section: Discussionmentioning

confidence: 80%

The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State

Dodo

Okano

Zelenty

et al. 2023

Spine

View full text Add to dashboard Cite

show abstract

“…In contrast, pedicle stress fractures after endoscopic decompression represent a rare condition and are only described on case study level for the transforaminal approach with foraminoplasty. 34 …”

Section: Discussionmentioning

confidence: 99%

“…17,33 In contrast, pedicle stress fractures after endoscopic decompression represent a rare condition and are only described on case study level for the transforaminal approach with foraminoplasty. 34 Currently, no biomechanical studies are available to investigate the effect of transpedicular access on pedicle stability. For the transforaminal approach, the influence of pedicle reduction on axial compression resistance was recently studied 25 and showed a median loss of resistance force compared with the intact side of 49% (90% worst case) for all pedicle reduction groups combined (10%-50% pedicle cross-section) compared 26% (63% case) for the transpedicular approach (8 and 6 mm drill diameter combined).…”

Section: Biomechanical Considerationsmentioning

confidence: 99%

The Biomechanics of the Transpedicular Endoscopic Approach

Meisterhans,

Hagel,

Spirig

et al. 2023

Spine

View full text Add to dashboard Cite

Study Design. Biomechanical cadaveric study. Objective. The goal of this study was to analyze the effects of an endoscopic transpedicular approach with different drill diameters (6 and 8 mm) to compare them with the intact native side. In addition, the influence of bone quality on the resistance of the pedicle was investigated. Summary of Background Data. Clinical studies have repeatedly highlighted the benefits of endoscopic transpedicular decompression for down-migrated lumbar disc herniations. However, the biomechanical effects on pedicle stability have not been studied up to now. Methods. Twenty-four vertebras originating from four fresh-frozen cadavers were tested under uniaxial compression load in a ramp-to-failure test: (1) the tunneled pedicle on one side, and (2) the native pedicle on the other side. Twelve lumbar vertebrae were assigned to a drill diameter of 6 mm and the other 12 to a diameter of 8 mm. Results. The median ratio of sustained force for the operated side compared to the intact contralateral side is equal to 74% (63–88) for both drill diameters combined. An 8 mm transpedicular approach recorded an axial resistance of 77% (60–88) compared to the intact contralateral side (P=0.002). A 6 mm approach resulted in an axial resistance of 72% (66–84) compared to the intact opposite side (P=0.01). No significant difference between the two different drill diameters was recorded (P=1). For all 3 subgroups (intact, 8 mm, 6 mm) the HU-values and the absolute resistance force showed significant correlations (intact: ρ=0.859; P<0.001; 8 mm: ρ=0.902; P<0.001; 6 mm: ρ=0.835; P<0.001). Conclusion. Transpedicular approach significantly reduces the axial resistance force of the pedicle, which may lead to pedicle fracture. Bone quality correlated positively with the absolute resistance force of the pedicle, whereas the influence of the drill hole diameter plays only a limited role.

show abstract

“…Endoscopic decompression surgery via CIA continues to demonstrate promising results in radiculopathy in AIS; however, there are still potential complications we should beware of [ 27 ]. Although the CIA utilized the interlaminar space just like the conventional interlaminar approach, advancing the endoscope and instrument to the caudal foramen, and even the extraforaminal area, can be a totally different horizon.…”

Section: Limitationsmentioning

confidence: 99%

Enhancing endoscopic foraminal decompression in adult isthmic spondylolisthesis: the potential influence of lateral recess isthmic spur and our case series of an innovative craniocaudal interlaminar approach via unilateral biportal endoscopic spinal surgery

Kim

Hwang

et al. 2023

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background The NASS guideline cannot recommend any of the surgical treatment options toward adult isthmic spondylolisthesis (AIS) since 2014. After the introduction of endoscopic decompression, instead of treating the spondylolysis itself, treatment can specifically target the refractory radicular pain developed during the degeneration progress without devastating the peripheral soft tissue. However, we noticed that endoscopic transforaminal decompression seems to be less effective in AIS compared to other types of degenerative spondylolisthesis. Thus, we came up with a novel craniocaudal interlaminar approach, utilizing the proximal adjacent interlaminar space to perform bilateral decompression and observed the pathoanatomy of pars defect directly and tried to identify the cause of decompression failure. Methods From January 2022 to June 2022, 13 patients with AIS underwent endoscopic decompression via the endoscopic craniocaudal interlaminar approach and were followed up for at least 6 months. Visual Analogue Scale, Oswestry Disability Index and MacNab scores were recorded to monitor patients’ clinical recovery. All endoscopic procedures were recorded and reviewed to illustrate the pathoanatomy. Results Four patients required minor revision via the same technique. One of them required it due to incomplete isthmic spur resection, two due to neglected disc protrusion, and the other due to root subpedicular kinking in higher grade anterolisthesis. All patients’ clinical condition improved significantly subsequently. After reviewing the endoscopic video, we have observed that the hook-like, ragged spur originating from the isthmic defect extends beyond the region around the foramen. Instead, it extends proximally into the adjacent lateral recess, resulting in impingement along the fracture edge above the index foramen and, in some cases, even in the extraforaminal area. Conclusions The broad spanning isthmic spur extending to the proximal adjacent lateral recess might be the reason why the transforaminal approach yielded less satisfactory results due to the incomplete decompression result from approach related restriction. Our study demonstrated an optimistic outcome by applying decompression from the upper level. Therefore, we propose that the craniocaudal interlaminar approach might be a better route for decompression in adult isthmic spondylolisthesis.

show abstract

Ipsilateral Pedicle Stress Fracture After Endoscopic Foraminal Decompression for Patient with Isthmic Spondylolisthesis

Cited by 6 publications

References 17 publications

The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State

The Utilization of Intraoperative Neurophysiological Monitoring for Lumbar Decompression and Fusion Surgery in New York State

The Biomechanics of the Transpedicular Endoscopic Approach

Enhancing endoscopic foraminal decompression in adult isthmic spondylolisthesis: the potential influence of lateral recess isthmic spur and our case series of an innovative craniocaudal interlaminar approach via unilateral biportal endoscopic spinal surgery

Contact Info

Product

Resources

About