Transforaminal endoscopic decompression for thoracic spinal stenosis under local anesthesia

Jia, Zhiqiang; He, Xijing; Zhao, Li-Tao; Li, Sanqiang

doi:10.1007/s00586-018-5479-2

“…In recent years, with the development of endoscopic surgical equipment and technology, minimally invasive spinal surgeries can be performed with various endoscopic techniques for the lumbar, cervical, and thoracic regions [22][23][24]. There has been a growing body of literature that not only con rms the e cacy of the endoscopic technique but also underscores the advantages with respect to less morbidity and safer complications [3,4,[25][26][27][28][29]. Percutaneous endoscopic spinal surgeries for lumbar, cervical, and thoracic regions categorized according to the surgical approaches are as follows: transforaminal lumbar, interlaminar lumbar, anterior cervical, posterior cervical, posterior thoracic, and posterolateral thoracic [21,30].…”

Section: Discussionmentioning

confidence: 99%

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Fan

¹

,

Yuan

²

,

Du

³

et al. 2020

Preprint

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Background Transforaminal percutaneous endoscopic lumbar surgeries (PELS) for lumbar disc herniation and spinal stenosis are growing in popularity. However, there are some problems in the establishment of the working channel and foraminoplasty such as nerve and blood vessel injuries, more radiation exposure, and steeper learning curve. Rapid technological advancements have allowed robotic technology to assist surgeons in improving the accuracy and safety of surgeries. Therefore, the purpose of this study is to develop a robot-assisted system for transforaminal PELS, which can provide navigation and foraminoplasty. Methods The robot-assisted system consists of three systems: preoperative planning system, navigation system, and foraminoplasty system. In the preoperative planning system, 3D visualization of the surgical segment and surrounding tissues are realized using the multimodal image fusion technique of Computed tomography and Magnetic resonance imaging, and the working channel planning is carried out to reduce the risk for injury to vital blood vessels and nerves. In the navigation system, the robot can obtain visual perception ability from a visual receptor and automatically adjust the robotic platform and robot arm to the appropriate positions according to the patient’s position and preoperative plan. In addition, the robot can automatically register the surgical target through intraoperative fluoroscopy. After that, the robot will provide navigation using the 6 degree-of-freedom (DOF) robot arm according to the preoperative planning system and guide the surgeon to complete the establishment of the working channel. In the foraminoplasty system, according to the foraminoplasty planning in the preoperative planning system, the robot performs foraminoplasty automatically using the high speed burr at the end of the robot arm. The system can provide real-time feedback on the working status of the bur through multi-mode sensors such as multidimensional force, position, and acceleration. Finally, a prototype of the system is constructed and performance tests are conducted. Discussion Our study will develop a robot-assisted system to perform transforaminal PELS, and this robot-assisted system can also be used for other percutaneous endoscopic spinal surgeries such as interlaminar PELS and percutaneous endoscopic cervical and thoracic surgeries through further research. The development of this robot-assisted system can be of great significance. First, the robot can improve the accuracy and efficiency of endoscopic spinal surgeries. In addition, it can avoid multiple intraoperative fluoroscopies, minimize exposure to both patients and the surgical staff, shorten the operative time, and improve the learning curve of beginners, which is beneficial to the popularization of percutaneous endoscopic spinal surgeries.

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“…PED is less invasive than MED for selected patients with lumbar degenerative disease [ 19 , 20 ]. Jia [ 8 ] performed the PED for the treatment of one OLF case at T2/3. Miao [ 9 ] also reported successful PED in treating two cases with unilateral OLF at T9/10 and T3/4 using the PED with paramedian approach.…”

Section: Discussionmentioning

confidence: 99%

“…Based on improvements in optical technology and equipment, good outcomes and advantages of PED for lumbar degenerative disease have been used in recent years [ 6 , 7 ] . However, there were few reports of PED for the treatment of TSS [ 8 , 9 ]. The objective of this study was to compare the outcome of PED versus PDL for TSS.…”

Section: Introductionmentioning

confidence: 99%

A comparison study of percutaneous endoscopic decompression and posterior decompressive laminectomy in the treatment of thoracic spinal stenosis

Cheng

¹

,

Bian

²

,

Liu

³

et al. 2020

BMC Musculoskelet Disord

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Background Percutaneous endoscopic decompression (PED) is considered a minimally invasive and safe procedure in lumbar degenerative disease. Few authors report the success of PED for thoracic spinal stenosis (TSS) with thoracic myelopathy. The objective of this study was to compare the outcome of PED versus posterior decompressive laminectomy (PDL) for TSS. Methods We retrospectively reviewed 30 consecutive patients who underwent surgery for single-level TSS from January 1, 2015 to May 1, 2019.These patients were divided into PED (n = 16) and PDL(n = 14) group. Preoperative demographic characteristics and perioperative outcomes were reviewed. Pre- and postoperative neurological status was evaluated using the modified Japanese Orthopaedic Association (mJOA) score and the recovery rate (RR). Results The patients’ mean age was 57.3 years (27–76) in PED group and 58.8 years (34–77) in PDL group. No statistical difference was found between two groups with regards to neurological status at pre-operative and final follow-up. The RR in PED group achieved the same improvement as PDL group (87.5% vs 85.7%, P > 0.05), while the PED brought advantages in operative time(m) (86.4 vs 132.1, p < 0.05), blood loss (mL) (18.21 vs 228.57, p < 0.05),drainage volume(mL) (15.5 vs 601.4, p < 0.05), and hospital stay (d) (3.6 vs 5.6, p < 0.05). Conclusions Both PED and PDL showed favorable outcome in the treatment of TSS. Besides, PED had advantages in reducing traumatization. In terms of perioperative quality of life, PED could be an efficient supplement to traditional posterior decompressive laminectomy in patients with TSS.

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“…In recent years, with the development of endoscopic surgical equipment and technology, minimally invasive spinal surgeries can be performed with various endoscopic techniques for the lumbar, cervical, and thoracic regions [23][24][25]. There has been a growing body of literature that not only con rms the e cacy of the endoscopic technique but also underscores the advantages with respect to less morbidity and safer complications [3,4,[26][27][28][29][30]. Percutaneous endoscopic spinal surgeries for lumbar, cervical, and thoracic regions categorized according to the surgical approaches are as follows: transforaminal lumbar, interlaminar lumbar, anterior cervical, posterior cervical, posterior thoracic, and posterolateral thoracic [23,31].…”

Section: Discussionmentioning

confidence: 99%

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Fan

¹

,

Yuan

²

,

Du

³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Transforaminal percutaneous endoscopic lumbar surgeries (PELS) for lumbar disc herniation and spinal stenosis are growing in popularity. However, there are some problems in the establishment of the working channel and foraminoplasty such as nerve and blood vessel injuries, more radiation exposure, and steeper learning curve. Rapid technological advancements have allowed robotic technology to assist surgeons in improving the accuracy and safety of surgeries. Therefore, the purpose of this study is to develop a robot-assisted system for transforaminal PELS, which can provide navigation and foraminoplasty. Methods The robot-assisted system consists of three systems: preoperative planning system, navigation system, and foraminoplasty system. In the preoperative planning system, 3D visualization of the surgical segment and surrounding tissues are realized using the multimodal image fusion technique of Computed tomography and Magnetic resonance imaging, and the working channel planning is carried out to reduce the risk for injury to vital blood vessels and nerves. In the navigation system, the robot can obtain visual perception ability from a visual receptor and automatically adjust the robotic platform and robot arm to the appropriate positions according to the patient’s position and preoperative plan. In addition, the robot can automatically register the surgical target through intraoperative fluoroscopy. After that, the robot will provide navigation using the 6 degree-of-freedom (DOF) robot arm according to the preoperative planning system and guide the surgeon to complete the establishment of the working channel. In the foraminoplasty system, according to the foraminoplasty planning in the preoperative planning system, the robot performs foraminoplasty automatically using the high speed burr at the end of the robot arm. The system can provide real-time feedback on the working status of the bur through multi-mode sensors such as multidimensional force, position, and acceleration. Finally, a prototype of the system is constructed and performance tests are conducted. Discussion Our study will develop a robot-assisted system to perform transforaminal PELS, and this robot-assisted system can also be used for other percutaneous endoscopic spinal surgeries such as interlaminar PELS and percutaneous endoscopic cervical and thoracic surgeries through further research. The development of this robot-assisted system can be of great significance. First, the robot can improve the accuracy and efficiency of endoscopic spinal surgeries. In addition, it can avoid multiple intraoperative fluoroscopies, minimize exposure to both patients and the surgical staff, shorten the operative time, and improve the learning curve of beginners, which is beneficial to the popularization of percutaneous endoscopic spinal surgeries.

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Transforaminal endoscopic decompression for thoracic spinal stenosis under local anesthesia

Cited by 33 publications

References 16 publications

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

A comparison study of percutaneous endoscopic decompression and posterior decompressive laminectomy in the treatment of thoracic spinal stenosis

Design of a robot-assisted system for transforaminal percutaneous endoscopic lumbar surgeries: study protocol

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