Transforaminal Percutaneous Endoscopic Decompression for Lower Thoracic Spinal Stenosis

Guo, Chuan; Zhu, Daiwen; Kong, Qingquan; Zhang, Lifeng; Wang, Yu; Yang, Jing; Yan, Yuqing; Wu, Hao; Peng, Zhiyu

doi:10.1016/j.wneu.2019.04.186

Cited by 17 publications

(12 citation statements)

References 58 publications

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“…The neurological complication rate was 1.4%, which is much lower than for traditional PTED surgery (12.4%) [ 25 ]. In the establishment of the working channel procedure, we used the “step-by-step” technique instead of the “one-step” technique [ 19 , 21 ] to avoid any iatrogenic pressure on the spinal canal during the working channel insertion. Wagner et al applied this working channel establishing technique to a 31-year-old female with T8-9 disc herniation.…”

Section: Discussionmentioning

confidence: 99%

Full-Endoscopic Transforaminal Ventral Decompression for Symptomatic Thoracic Disc Herniation with or without Calcification: Technical Notes and Case Series

Gao

Wei

et al. 2021

Pain Research and Management

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Background. Symptomatic thoracic disc herniation is a challenge in spinal surgery, especially for cases with calcification. Traditional open operation has a high complication rate. The authors introduced a modified full-endoscopic transforaminal ventral decompression technique in this study and evaluated its imaging and clinical outcomes. Materials and Methods. Eleven patients with symptomatic thoracic disc herniation who underwent full-endoscopic transforaminal ventral decompression in a single medical center were enrolled. The surgical technique was performed as described in detail. Dilator sliding punching, endoscope-monitored foraminoplasty, and base cutting through the “safe triangle zone” are the key points of the technique. Clinical outcomes were assessed by the modified Japanese Orthopedic Association (mJOA) score for neurological improvement and the visual analogy score (VAS) for thoracic and leg pain. The operation time, hospital stay, and complications were also analyzed. Results. Postoperative magnetic resonance imaging (MRI) revealed good decompression of the spinal cord. The mJOA improved from 7.4 (range: 5–10) to 10.2 (range: 9–11). Axial thoracic pain improved in 8 of 9 patients. Leg pain and thoracic radicular pain improved in all patients. No complications were observed. The average operation time was 136 minutes (range: 70–180 minutes). The average length of hospital stay was 5.3 days (range: 2–8 days). Conclusion. Minimally invasive full-endoscopic transforaminal ventral decompression for the treatment of symptomatic thoracic disc herniation with or without calcification is feasible and may be another option for this challenging spine disease.

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Section: Discussionmentioning

confidence: 99%

Full-Endoscopic Transforaminal Ventral Decompression for Symptomatic Thoracic Disc Herniation with or without Calcification: Technical Notes and Case Series

Gao

Wei

et al. 2021

Pain Research and Management

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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 – 25 ]. There has been a growing body of literature that not only confirms the efficacy of the endoscopic technique but also underscores the advantages with respect to less morbidity and safer complications [ 3 , 4 , 26 – 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

Yuan

et al. 2020

J Orthop Surg Res

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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 levels 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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“…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

Yuan

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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Transforaminal Percutaneous Endoscopic Decompression for Lower Thoracic Spinal Stenosis

Cited by 17 publications

References 58 publications

Full-Endoscopic Transforaminal Ventral Decompression for Symptomatic Thoracic Disc Herniation with or without Calcification: Technical Notes and Case Series

Full-Endoscopic Transforaminal Ventral Decompression for Symptomatic Thoracic Disc Herniation with or without Calcification: Technical Notes and Case Series

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

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