Objective To evaluate the feasibility, safety, and early effectiveness of percutaneous endoscopic thoracic spine surgery via the trench technique for ventral decompression in central calcified thoracic disc herniation (CCTDH) and thoracic ossification of the posterior longitudinal ligament (T-OPLL). MethodsSeven patients with single-segment CCTDH or T-OPLL admitted between June 2017 and May 2020 and meeting the selection criteria were retrospectively analyzed. There were 3 males and 4 females with an average age of 51.7 years ranging from 41 to 62 years. There were 2 patients with T-OPLL (T1, 2 in 2 cases) and 5 patients with CCTDH (T1, 2 in 1 case, T7, 8 in 1 case, T10, 11 in 2 cases, T11, 12 in 1 case). Five patients with thoracic axial pain and intercostal neuralgia had a preoperative visual analogue scale (VAS) score of 6.0 (5.0, 6.5), and 7 patients had a preoperative Japanese Orthopaedic Association (JOA) score of 21 (21.0, 22.0). Transforaminal approach was used in 4 cases and transpedicular approach in 3 cases. Ventral decompression of thoracic spinal cord was performed by thoracic endoscopy combined with trench technique. The operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications were recorded. Thoracic spine CT and MRI were performed preoperatively and postoperatively to evaluate the surgical decompression, VAS score was used to evaluate the pain of thoracic back and lower limbs, and JOA score was used to evaluate the functional recovery. Modified MacNab criteria was used to evaluate the effectiveness. ResultsAll surgeries were successfully completed. The operation time ranged from 60 to 100 minutes, with an average of 80.4 minutes; the intraoperative blood loss ranged from 40 to 75 mL, with an average of 57.1 mL; the postoperative hospital stay ranged from 4 to 7 days, with an average of 5.4 days. CT and MRI examinations indicated that the decompression was adequate. All 7 patients were followed up 3-22 months, with an average of 13.3 months. One case developed postoperative wound infection, and 1 case developed pneumonia; the remaining patients did not have any complications such as wound infection or cerebrospinal fluid leakage. Five patients with thoracic axial pain and intercostal neuralgia had VAS scores of 2.0 (1.5, 2.5) at 1 day after operation and 2.0 (1.0, 2.0) at last follow-up, both of which were significantly lower than the preoperative scores (P<0.05). At 1 day after operation, the JOA scores for all 7 patients were 22.0 (21.0, 24.0), which showed no significant difference compared to the preoperative score (P>0.05); however, at last follow-up, the score improved to 24.0 (24.0, 26.0), which was significant compared to the preoperative scores (P<0.05). At last follow-up, the effectiveness was assessed using the modified MacNab criteria, the results were excellent in 2 cases, good in 3 cases, fair in 2 cases, and the excellent and good rate was 71.4%.ConclusionUsing the trench technique, percutaneous endoscopic thoracic spine surgery can achieve the ventral decompression in CCTDH and T-OPLL, providing a new approach for surgical treatment of CCTDH and T-OPLL.
ObjectiveTo investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach.MethodsAccording to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C3, 4 in 2 cases, C4, 5 in 8 cases, C5, 6 in 9 cases, and C6, 7 in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated.ResultsFull-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation (P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one (t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation (t=0.881, P=0.421).ConclusionFull-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results.
ObjectiveTo investigate the clinical feasibility, safety, and effectiveness of posterior percutaneous endoscopy via vertical anchor technique combined with trench technique for single-segmental central cervical disc herniation.MethodsBetween July 2017 and August 2019, 13 patients with the single-segmental central cervical disc herniation suffering from various neurologic deficits were treated with posterior percutaneous endoscopy via vertical anchor technique combined with trench technique. There were 6 males and 7 females with an average age of 50.5 years (range, 43-64 years). Disease duration ranged from 3 to 17 months (mean, 9.2 months). The clinical symptoms of 5 cases were mainly neck pain, radiculopathy, and numbness in upper limbs, and the visual analogue scale (VAS) score was 6.60±0.55. The clinical symptoms of 8 cases were myelopathy including upper extremities numbness, weakness, and trouble walking, and the modified Japanese Orthopedic Association (mJOA) score was 12.75±0.71. The surgery-related complications, operation time, and intraoperative blood loss were recorded, and the results of clinical symptoms were measured by VAS scores and mJOA scores.ResultsAll procedures were completed successfully, no severe complications such as dural tears or cerebrospinal fluid leakage occurred. The operation time ranged from 83 to 164 minutes (mean, 101.2 minutes). The intraoperative blood loss was 25-50 mL (mean, 33.1 mL). After operation, 12 of 13 cases were followed up 10-24 months (mean, 17.6 months). The VAS scores of patients with preoperative pain symptoms were 2.40±0.55 on the first day after operation and 1.80±0.45 at last follow-up, which were significantly lower than those before operation (P<0.05). The mJOA scores of patients with the symptoms of spinal cord injury were 12.63±0.52 on the first day after operation and 14.29±0.95 at last follow-up, and the score at last follow-up was significantly higher than that before operation (P<0.05). Acute extremities weakness occurred for the postoperative hematoma formation in 1 case (disc herniation at C4, 5) presented with myelopathy preoperatively, and muscle strength was recovered after the clearance of hematoma and spinal cord decompression under percutaneous endoscopy.ConclusionPosterior percutaneous endoscopy via vertical anchor technique and trench technique for single-segmental central cervical disc herniation was clinical feasible, safe, and effective, and could be an alternative approach to the treatment of central cervical disc herniation.