Regional variations in acceptance, and utilization of minimally invasive spinal surgery techniques among spine surgeons: results of a global survey

Lewandrowski, Kai‐Uwe; Soriano-Sánchez, José-Antonio; Zhang, Xifeng; León, Jorge Felipe Ramírez; Solís, Sergio Soriano; Ortíz, José Gabriel Rugeles; Martínez, Carolina Ramírez; Cuéllar, Gabriel Oswaldo Alonso; Liu, Kaixuan; Fu, Qiang; Silva, Marlon Sudário de Lima e; Carvalho, Paulo Sérgio Teixeira de; Hellinger, Stefan; Dowling, Álvaro; Prada, Nicholas; Choi, Gun; Datar, Girish; Yeung, Anthony T.

doi:10.21037/jss.2019.09.31

Cited by 31 publications

(25 citation statements)

References 57 publications

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“…1,2 The growing number of endoscopic spine surgeries also brings a higher awareness of the procedure's complications because those numbers are on the rise as well. 3 Although the overall complication rate with spinal endoscopy is relatively low and compares favorably when executed by expert surgeons, 4 variations in training and skill level as well as the selection of patients for increasingly more complex clinical problems may lead to a disproportionate increase in complications. 5 An unexpected dural tear is one of those accepted complications dreaded by most spine surgeons because it is technically challenging to manage through the small working channel of the endoscope, given the small size of the skin incision, 6,7 working area, and the limited number of endoscopic surgical instruments available to execute a meaningful watertight repair.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, we have taken a different approach to studying the problem-a research method we have applied previously. 1,3,5,15,16 A French group also used this approach in their study of currently practiced management of inciden-tal durotomy during lumbar surgery. 9 We decided to pool data from a large number of surgeons via an online survey application.…”

Section: Introductionmentioning

confidence: 99%

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Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management

et al. 2021

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Background: Incidental dural tears during lumbar endoscopy can be challenging to manage. There is limited literature on their appropriate management, risk factors, and the clinical consequences of this typically uncommon complication.Materials and Methods: To improve the statistical power of studying durotomy with lumbar endoscopy, we performed a retrospective survey study among endoscopic spine surgeons by email and chat groups on social media networks, including WhatsApp and WeChat. Descriptive and correlative statistics were done on the surgeons' recorded responses to multiple-choice questions. Surgeons were asked about their clinical experience with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, the decompression instruments they use, and incidental durotomy incidence with routine lumbar endoscopy.Results: There were 689 dural tears in 64 470 lumbar endoscopies, resulting in an incidental durotomy incidence of 1.07%. Seventy percent of the durotomies were reported by 20.4% of the surgeons. Eliminating these 19 outlier surgeons yielded an adjusted durotomy rate of 0.32. Endoscopic stenosis decompression (54.8%; P , .0001), rather than endoscopic discectomy (44.1%; 41/93), was significantly more associated with durotomy. Medium-sized dural tears (1-10 mm) were the most common (52.2%; 48/93). Small pinhole durotomies (less than 1 mm) were the second most common type (46.7%; 43/93). Rootlet herniations were seen by 46.2% (43/93) of responding surgeons. The posterior dural sac injury during the interlaminar approach (57%; 53/93) occurred more frequently than traversing nerve-root injuries (31.2%) or anterior dural sac (23.7%; 22/93). Exiting nerve-root injuries (10.8%;10/93) were less common. Over half of surgeons did not attempt any repair or closure (52.2%; 47/90). Forty percent (36/90) used sealants. Only 7.8% (7/ 90) of surgeons attempted an endoscopic repair or sutures (11.1%; 10/90). DuralSeal was the most commonly used brand of commercially available sealant used (42.7%; 35/82). However, other sealants such as Tisseal (15.9%; 13/82), Evicel (2.4%2/82), and additional no-brand sealants (38; 32/82) were also used. Nearly half of the patients (48.3%; 43/ 89) were treated with 24-48 hours of bed rest. The majority of participating surgeons (64%; 57/89) reported that the long-term outcome was unaffected. Only 18% of surgeons reported having seen the development of a postoperative cerebrospinal fluid (CSF)-fistula (18%;16/89). However, the absolute incidence of CSF fistula was only 0.025% (16/ 64 470). Severe radiculopathy with dysesthesia; sensory loss; and motor weakness in association with an incidental durotomy were reported by 12.4% (11/89), 3.4% (3/89), and 2.2% (2/89) of surgeons, respectively.Conclusions: The incidence of dural tears with lumbar endoscopy is about 1%. The incidence of durotomy is higher with the use of power drills and the interlaminar approach. Stenosis decompression that typically requires the more aggressive use of these po...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management

et al. 2021

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“…Over a similar epoch, MISS has also gained increasing traction. According to a recent global survey of nearly 300 spinal surgeons, most respondents (71%) regarded MISS as mainstream, while the majority (86%) practiced some form of MISS (Lewandrowski et al 2020). In parallel with this trend, based on patient surveys, most patients (80%) prefer MIS over open surgery, provided that long-term outcomes and complication risk are comparable (Narain et al 2018).…”

Section: Regional and Global Trends In Spinal Fusionmentioning

confidence: 99%

Posterior Approaches to the Thoracolumbar Spine: Open Versus MISS

Li¹,

Kam²

2020

Handbook of Spine Technology

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“…In the United States, endoscopic spinal surgery is being positioned by its prominent key opinion leaders to meet the need for simplified, less burdensome, and more cost-effective spinal decompression surgeries. 1,2 Strategies to deal with the increased demand for these types of procedures with the aging babyboomer population advancing into their retirement years is stressing the resource-strapped health care systems to a point where the stakeholders are being motivated to come up with better-valued solutions to avoid rationing of traditional open spine surgery. 3,4 Patients have also changed their stance on spine surgery seeking out spine surgeons who provide personalized spine care in the context relevant to the patients' complaints at the time when the care is delivered by treating validated pain generators rather than basing decision for surgical treatment on traditional image-based criteria.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

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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Regional variations in acceptance, and utilization of minimally invasive spinal surgery techniques among spine surgeons: results of a global survey

Cited by 31 publications

References 57 publications

Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management

Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management

Posterior Approaches to the Thoracolumbar Spine: Open Versus MISS

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

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