Lumbar vacuum disc, vertical instability, standalone endoscopic interbody fusion, and other treatments: an opinion based survey among minimally invasive spinal surgeons

Lewandrowski, Kai‐Uwe; Zhang, Xifeng; León, Jorge Felipe Ramírez; Carvalho, Paulo Sérgio Teixeira de; Hellinger, Stefan; Yeung, Anthony T.

doi:10.21037/jss.2019.11.02

Cited by 17 publications

(17 citation statements)

References 38 publications

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“…Independent risk factors for dural tears with lumbar endoscopy were stenosis decompression, the use of power burrs, and the interlaminar approach (P < 0.0001). 87 The most common type of durotomy encountered in the study was medium-sized (less than 10 mm) dural tears (52.2%), followed by small (less than 1 mm) pinhole durotomies (46.7%). These durotomies were associated with rootlet herniations 46.2% of the time.…”

Section: Durotomy Neural Injury and Learning Curvementioning

confidence: 84%

Difficulties, Challenges, and the Learning Curve of Avoiding Complications in Lumbar Endoscopic Spine Surgery

Lewandrowski

Telfeian

Hellinger³

et al. 2021

Int J Spine Surg

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Spinal endoscopy has the stigma of being reserved for only a few surgeons who can figure out how to master the steep learning curve and develop clinical practice settings where endoscopic spine surgery can thrive. In essence, endoscopic treatment of herniated discs specifically and nerve root compression in the lumbar spine in general amounts to replacing traditional open spine surgery protocols with spinal endoscopic surgery techniques. In doing so, the endoscopic spine surgeon must be confident that the degenerative spine's common painful problems can be handled with endoscopic spinal surgery techniques with at least comparable clinical results and complication rates. In this review article, the authors illustrate the difficulties and challenges of the endoscopic lumbar decompression procedure. In addition, they shed light on how to master the learning curve by systematically looking at all sides of the problem, ranging from the ergonomic aspects of the endoscopic platform and its instruments, surgical access planning, challenging clinical scenarios, complications, and sequelae, as well as the training gaps after postgraduate residency and fellowship programs.

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Section: Durotomy Neural Injury and Learning Curvementioning

confidence: 84%

Difficulties, Challenges, and the Learning Curve of Avoiding Complications in Lumbar Endoscopic Spine Surgery

Lewandrowski

Telfeian

Hellinger³

et al. 2021

Int J Spine Surg

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“…In terms of VP, VP was defined as the presence of gas in degenerated IVDs, which is associated with progressive IVD degeneration. In a survey targeted at spinal surgeons, Lewandrowski et al reported that many spinal surgeons considered radiographical VP to be associated with spinal instability [ 25 ]. In their clinical study, Liao et al also concluded that VP should be considered as a sign of spinal instability and treated accordingly [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

A High Body Mass Index and the Vacuum Phenomenon Upregulate Pain-Related Molecules in Human Degenerated Intervertebral Discs

Miyagi

Uchida

Inoue

et al. 2022

IJMS

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Animal studies suggest that pain-related-molecule upregulation in degenerated intervertebral discs (IVDs) potentially leads to low back pain (LBP). We hypothesized that IVD mechanical stress and axial loading contribute to discogenic LBP’s pathomechanism. This study aimed to elucidate the relationships among the clinical findings, radiographical findings, and pain-related-molecule expression in human degenerated IVDs. We harvested degenerated-IVD samples from 35 patients during spinal interbody fusion surgery. Pain-related molecules including tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-6, calcitonin gene-related peptide (CGRP), microsomal prostaglandin E synthase-1 (mPGES1), and nerve growth factor (NGF) were determined. We also recorded preoperative clinical findings including body mass index (BMI), Oswestry Disability Index (ODI), and radiographical findings including the vacuum phenomenon (VP) and spinal instability. Furthermore, we compared pain-related-molecule expression between the VP (−) and (+) groups. BMI was significantly correlated with the ODI, CGRP, and mPGES-1 levels. In the VP (+) group, mPGES-1 levels were significantly higher than in the VP (−) group. Additionally, CGRP and mPGES-1 were significantly correlated. Axial loading and mechanical stress correlated with CGRP and mPGES-1 expression and not with inflammatory cytokine or NGF expression. Therefore, axial loading and mechanical stress upregulate CGRP and mPGES-1 in human degenerated IVDs, potentially leading to chronic discogenic LBP.

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“…In the older patients, end-stage degenerative vacuum disc disease is routinely found during lumbar transforaminal endoscopy in up to 73% of patients over age 45, where there often is a collapsed vacuum disc without any structural integrity. [44][45][46][47][48] In those patients, an "inside-out" look inside the disc is a sensible step that provides more reliable long-term outcomes with fewer revision www.e-neurospine.org S41 surgeries. In younger patients, the authors are concerned with the propagation of progressive vertical disc collapse with the "inside-out" technique for which reason they routinely start the transforaminal decompression with the "outside-in" technique and only enter the intervertebral disc space if there is lack of structural integrity to improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…This hybrid of “outside-in” and “inside-out” may offer the surgeon the ability to perform a complete evaluation of the pain generators within the symptomatic lumbar motion segment and is to the authors of this article a more obvious choice in patients with advanced degenerative disc disease. In the older patients, end-stage degenerative vacuum disc disease is routinely found during lumbar transforaminal endoscopy in up to 73% of patients over age 45, where there often is a collapsed vacuum disc without any structural integrity [ 44 - 48 ]. In those patients, an “inside-out” look inside the disc is a sensible step that provides more reliable long-term outcomes with fewer revision surgeries.…”

Section: Discussionmentioning

confidence: 99%

Lumbar Endoscopic Bony and Soft Tissue Decompression With the Hybridized Inside-Out Approach: A Review And Technical Note

Lewandrowski

Yeung

2020

Neurospine

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This study aimed to showcase the authors' preferred technique of a hybrid of modern "inside-out" and "outside-in" endoscopic decompression. A case series of 411 patients consisting of 192 females (46.7%) and 219 males (53.3%) with an average age of 54.84 ± 16.32 years and an average of 43.2 ± 26.53 months are presented. Patients underwent surgery for low-grade spondylolisthesis (13 of 411, 3.2%), herniated disc (135 of 411, 32.8%), foraminal spinal stenosis (101 of 411, 24.6%), or a combination of the latter 2 conditions (162 of 411, 39.4%). The preoperative Oswestry Disability Index (ODI) and visual analogue scale (VAS) for leg pain were 49.8 ± 17.65 and 7.9 ± 1.55, respectively. Postoperative ODI and VAS leg were 12.2 ± 9.34 and 2.41 ± 5 1.55 at final follow-up (p < 0.0001). MacNab outcomes were excellent in 134 (32.6%), good in 228 (55.5%), fair in 40 (9.7%), and poor in 9 patients (2.2%), respectively. There was end-stage degenerative vacuum disc disease in 304 of the 411 patients (74%) of which had 37.5% had excellent and 50% good MacNab outcomes. Patients without vacuum discs had excellent and good 18.7% and 71.0% of the time. Direct visualization of pain generators in the epidural-and intradiscal space is the authors' preferred transforaminal decompression technique and is supported by their reliable clinical outcomes.

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Lumbar vacuum disc, vertical instability, standalone endoscopic interbody fusion, and other treatments: an opinion based survey among minimally invasive spinal surgeons

Cited by 17 publications

References 38 publications

Difficulties, Challenges, and the Learning Curve of Avoiding Complications in Lumbar Endoscopic Spine Surgery

Difficulties, Challenges, and the Learning Curve of Avoiding Complications in Lumbar Endoscopic Spine Surgery

A High Body Mass Index and the Vacuum Phenomenon Upregulate Pain-Related Molecules in Human Degenerated Intervertebral Discs

Lumbar Endoscopic Bony and Soft Tissue Decompression With the Hybridized Inside-Out Approach: A Review And Technical Note

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