Preoperative Design for the Posterolateral Approach in Full-Endoscopic Spine Surgery for the Treatment of L5/S1 Lumbar Disc Herniation

Fujita, Muneyoshi; Kawano, Hirotaka; Kitagawa, Toshiki; Iwai, Hiroki; Takano, Yuichi; Inanami, Hirohiko; Koga, Hisashi

doi:10.14245/ns.1836316.158

Cited by 9 publications

(6 citation statements)

References 16 publications

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“…For FESS, the posterolateral approach (5-8 cm lateral from the midline) is suitable for L5/S1 extraforaminal stenosis. 38 ) We used a posterolateral approach for patients who were distinctly diagnosed with L5/S1 extraforaminal stenosis both electrophysiologically and radiologically. We realized the difficulty of making an accurate diagnosing, which is why L5/S1 extraforaminal stenosis is also referred to as “far-out syndrome” (FOS).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes of Lumbar Interbody Fusion and Full-endoscopic Laminectomy for L5 Radiculopathy Caused by Lumbar Foraminal Stenosis

Fujita

Inui

Oshima

et al. 2022

Neurol. Med. Chir.(Tokyo)

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This study compared the outcomes of microendoscopy-assisted lumbar interbody fusion (ME-LIF) and uniportal full-endoscopic laminectomy (FEL) for L5 radiculopathy caused by lumbar foraminal stenosis (LFS). ME-LIF was performed using an 18- to 20-mm tubular retractor and endoscope, and FEL via the translaminar approach (TLA) was performed at the dorsal part of the foramen using a 4.1-mm working channel endoscope. Patients with LFS treated using ME-LIF (n = 39) or FEL-TLA (n = 30) were retrospectively evaluated. Patients' background and operative data were collected. The 36-item Short Form Survey (SF-36), Oswestry Disability Index (ODI), and European Quality of Life-5 Dimension (EQ-5D) scores were recorded preoperatively and 2 years postoperatively. The background data of the two groups (ME-LIF and FEL-TLA) were similar. The mean operation times for ME-LIF and FEL-TLA were 110.7 and 65.2 min, respectively, and the mean length of hospital stay were 10.3 and 1.5 days, respectively. Reoperation was required for surgical site infection, and percutaneous pedicle screw malposition in three patients was treated using ME-LIF. During follow-up, second FEL-TLA and LIF were performed for recurrent L5 radiculopathy in one and three patients in the FEL-TLA group, respectively. Although the SF-36, ODI, and EQ-5D scores 2 years postoperatively improved in both groups, improvement in ODI scores was lower following FEL-TLA than following ME-LIF. FEL-TLA can be performed to treat patients with L5 radiculopathy caused by LFS. Although the ODI score improvement following FEL-TLA was unremarkable, FEL-TLA might be considered because of its better safety profile and minimal invasiveness than ME-LIF.

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Section: Discussionmentioning

confidence: 99%

Comparison of Outcomes of Lumbar Interbody Fusion and Full-endoscopic Laminectomy for L5 Radiculopathy Caused by Lumbar Foraminal Stenosis

Fujita

Inui

Oshima

et al. 2022

Neurol. Med. Chir.(Tokyo)

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“…During surgery, a fluoroscope was placed across the center of the operative table to ensure the appropriate timing of X-ray. The basic operative procedure for the posterolateral approach of uniportal FESS has been described previously [ 22 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

Full-Endoscopic Lumbar Interbody Fusion for Treating Lumbar Disc Degeneration Involving Disc Height Loss: Technical Report

Harakuni¹,

Iwai²,

Oshima

et al. 2020

Medicina

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Background and Objectives: Lumbar disc degeneration (LDD) is the main cause of lower back pain and leads to corresponding disc height loss. Although lumbar interbody fusion (LIF) is commonly used for treating LDD, several different treatment strategies are available. We performed a minimally invasive full-endoscopic LIF (FELIF) using a uniportal full-endoscopic system. Materials and Methods: FELIF was performed for 12 patients with LDD with disc-height loss using a 4.1 mm working channel endoscope and a newly developed slider for cage insertion. The mean age of the patients was 68.3 years; the patients presented with single vertebral level involvement. The Brandner’s disc index was used for evaluating the postoperative increase in the disc height. Preoperative and postoperative leg pain was evaluated using the numerical rating scale (NRS) score. Results: The mean operation time for FELIF was 109.4 min. The mean duration of hospital stay after FELIF was 7.7 days. There were no operative and postoperative complications, even without drainage during the mean follow-up period of 6.2 months (range, 2–10 months). The Brandner’s disc index improved statistically significant (p > 0.01). The mean preoperative and postoperative NRS scores were 6.5 and 1.2, respectively. Conclusions: FELIF using a 4.1 mm working channel endoscope can be used for treating LDD with disc height loss. Radiculopathy caused by foraminal stenosis was the most suitable operative indication for FELIF.

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“…26,28 However, this contradicts the fact that L5-S1 has, in general, the largest Kambin's triangle area among the lumbar levels, illustrating the need for further studies evaluating specific approaches into that disc space. 29…”

Section: Importance Of Proper Sizing For Preoperative and Operative P...mentioning

confidence: 99%

“…This may be the reason that many endoscopic experts have discouraged percutaneous entrance into the disc at L5-S1 without foraminoplasty. 27,29…”

Section: Presence Of Pathology Can Affect the Dimensions Of Kambin's ...mentioning

confidence: 99%

How dimensions can guide surgical planning and training: a systematic review of Kambin’s triangle

Kouam

Tabarestani

Sykes

et al. 2023

Neurosurgical Focus

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OBJECTIVE The authors sought to analyze the current literature to determine dimensional trends across the lumbar levels of Kambin’s triangle, clarify the role of imaging techniques for preoperative planning, and understand the effect of inclusion of the superior articular process (SAP). This compiled knowledge of the triangle is needed to perform successful procedures, reduce nerve root injuries, and help guide surgeons in training. METHODS The authors performed a search of multiple databases using combinations of keywords: Kambin’s triangle, size, measurement, safe triangle, and bony triangle. Articles were included if their main findings included measurement of Kambin’s triangle. The PubMed, Scopus, Ovid, Cochrane, Embase, and Medline databases were systematically searched for English-language articles with no time frame restrictions through July 2022. RESULTS Eight studies comprising 132 patients or cadavers were included in the study. The mean ± SD age was 66.69 ± 9.6 years, and 53% of patients were male. Overall, the size of Kambin’s triangle increased in area moving down vertebral levels, with L5–S1 being the largest (133.59 ± 4.36 mm2). This trend followed a linear regression model when SAP was kept (p = 0.008) and removed (p = 0.003). There was also a considerable increase in the size of Kambin’s triangle if the SAP was removed. CONCLUSIONS Here, the authors have provided the first reported systematic review of the literature of Kambin’s triangle, its measurements at each lumbar level, and key areas of debate related to the definition of the working safe zone. These findings indicate that CT is heavily utilized for imaging of the safe zone, the area of Kambin’s triangle tends to increase caudally, and variation exists between patients. Future studies should focus on using advanced imaging techniques for preoperative planning and establishing guidelines for surgeons.

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Preoperative Design for the Posterolateral Approach in Full-Endoscopic Spine Surgery for the Treatment of L5/S1 Lumbar Disc Herniation

Cited by 9 publications

References 16 publications

Comparison of Outcomes of Lumbar Interbody Fusion and Full-endoscopic Laminectomy for L5 Radiculopathy Caused by Lumbar Foraminal Stenosis

Comparison of Outcomes of Lumbar Interbody Fusion and Full-endoscopic Laminectomy for L5 Radiculopathy Caused by Lumbar Foraminal Stenosis

Full-Endoscopic Lumbar Interbody Fusion for Treating Lumbar Disc Degeneration Involving Disc Height Loss: Technical Report

How dimensions can guide surgical planning and training: a systematic review of Kambin’s triangle

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