Spinal endoscopy: evidence, techniques, global trends, and future projections

Simpson, Andrew K.; Lightsey, Harry M.; Xiong, Grace; Crawford, Alexander M; Minamide, Akihito; Schoenfeld, Andrew J.

doi:10.1016/j.spinee.2021.07.004

Cited by 53 publications

(58 citation statements)

References 76 publications

(93 reference statements)

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“…Microendoscopy involves the use of a single working channel through which the endoscope and multiple instruments are passed and concurrently used 23. This technique permits smaller incisions, narrow surgical corridors and less tissue damage.…”

Section: Discussionmentioning

confidence: 99%

Microendoscopic decompression of conjoined lumbosacral nerve roots

et al. 2022

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Nerve root morphological variability is often incompletely appreciated on preoperative imaging and can complicate intraoperative decision-making. This case demonstrates the utility of spinal endoscopy in the visualisation and manipulation of conjoined nerve roots and includes procedural images to promote better understanding and awareness of this anatomical anomaly. A woman in her 50s presented with 1 year of progressive left S1 radiculopathy refractory to non-operative modalities. History and examination were notable for S1 dermatomal paresthesias, positive ipsilateral straight leg raise and grade 4/5 gastrocnemius strength. MRI demonstrated an L5–S1 left paracentral disc herniation causing severe lateral recess stenosis. Endoscopic decompression revealed conjoined lumbosacral nerve roots. Laminotomies and discectomy provided circumferential decompression. The patient experienced immediate and sustained relief of her preoperative radiculopathy as manifested in patient-reported outcome measures. Evolving endoscopic spine platforms provide novel visualisation of nerve root anomalies yielding new insight on safe and effective decompressive techniques.

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Section: Discussionmentioning

confidence: 99%

Microendoscopic decompression of conjoined lumbosacral nerve roots

et al. 2022

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“…For improved precision, Opto-BSCB can be applied together with magnetic resonance imaging (MRI) and micro-CT to perform image-guided delivery. Optical fibers can also be integrated with advanced spinal endoscopes (white light and fluorescence) to complete molecular image-guided BSCB opening (29, 30). Furthermore, Opto-BSCB also has the potential to be used for studying neuromodulation in combination with chemogenetics (31) or optogenetics (16).…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive delivery of peptides to the spinal cord for behavior modulation

Gao

David

Leong

et al. 2022

Preprint

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The blood-spinal cord barrier (BSCB) tightly regulates molecular transport from the blood to the spinal cord. Herein, we present a novel approach for transient modulation of BSCB permeability and localized delivery of peptides into the spinal cord for behavior modulation with high spatial resolution. This approach utilizes optical stimulation of vasculature-targeted nanoparticles and allows delivery of BSCB-nonpermeable molecules into the spinal cord without significant glial activation or impact on animal locomotor behavior. We demonstrate minimally invasive light delivery into the spinal cord using an optical fiber and BSCB permeability modulation in the lumbar region. Our method of BSCB modulation allows delivery of bombesin, a centrally-acting and itch-inducing peptide, into the spinal cord and induces a rapid and transient increase in itching behaviors in mice. This minimally invasive approach enables behavior modulation without genetic modifications and is promising for delivering a wide range of biologics into the spinal cord for behavior modulation and potentially therapy.Significance StatementSpinal cord diseases and disorders are common and cause significant disability, including chronic pain, paralysis, cognitive impairment, and mortality. The blood-spinal cord barrier is a considerable challenge for delivery by systemic therapeutic administration. We developed an optical approach for effectively and safely delivering molecules to the spinal cord to overcome this barrier. The fiberoptic method is minimally invasive and overcomes challenges that previous technologies face, including the complicated bone structure and standing waves that complicate BSCB opening using ultrasound. Optical stimulation offers unprecedented spatial resolution for the precise delivery in intricate spinal cord structures. Significantly, our approach modulates animal behavior (i.e., itch) without genetic modifications and demonstrates the potential for delivery of biologics such as peptides into the spinal cord.

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“…The adoption of arthroscopy, using small cameras and instruments placed inside joints, has transformed musculoskeletal care over the last several decades, allowing surgeons to provide the same anatomic solutions with less tissue dissection, resulting in lower requirements for inpatient care, reduced costs, and expedited recovery [ 8 ].…”

Section: Arthroscopymentioning

confidence: 99%

The Surgical Treatment of Osteoarthritis

Brumat

Kunšič

Novak

et al. 2022

Life

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Osteoarthritis is a degenerative condition affecting the whole joint with the underlying bone, representing a major source of pain, disability, and socioeconomic cost worldwide. Age is considered the strongest risk factor, albeit abnormal biomechanics, morphology, congenital abnormality, deformity, malalignment, limb-length discrepancy, lifestyle, and injury may further increase the risk of the development and progression of osteoarthritis as well. Pain and loss of function are the main clinical features that lead to treatment. Although early manifestations of osteoarthritis are amenable to lifestyle modification, adequate pain management, and physical therapy, disease advancement frequently requires surgical treatment. The symptomatic progression of osteoarthritis with radiographical confirmation can be addressed either with arthroscopic interventions, (joint) preservation techniques, or bone fusion procedures, whereas (joint) replacement is preferentially reserved for severe and end-stage disease. The surgical treatment aims at alleviating pain and disability while restoring native biomechanics. Miscellaneous surgical techniques for addressing osteoarthritis exist. Advanced computer-integrated surgical concepts allow for patient personalization and optimization of surgical treatment. The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. Contemporary computer-assisted orthopaedic surgery concepts are further elucidated.

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Spinal endoscopy: evidence, techniques, global trends, and future projections

Cited by 53 publications

References 76 publications

Microendoscopic decompression of conjoined lumbosacral nerve roots

Microendoscopic decompression of conjoined lumbosacral nerve roots

Minimally invasive delivery of peptides to the spinal cord for behavior modulation

The Surgical Treatment of Osteoarthritis

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