Objective The unilateral biportal endoscopic posterior cervical foraminotomy (UBE-PCF) has been recently adopted for unilateral radiating arm pain due to cervical herniated intervertebral disc or foraminal stenosis. We systematically meta-analyzed clinical outcomes and complications of the UBE-PCF and compared them with those of full-endoscopic PCF (FE-PCF).
Methods We systematically searched the PubMed, Embase, and Web of Science until February 29, 2024. Clinical outcomes and complications of the UBE-PCF and FE-PCF were collected and analyzed using the fixed-effect or random-effects model. Clinical outcomes of the UBE-PCF were compared with minimal clinically important difference (MCID) following PCF to evaluate the efficacy of UBE-PCF.
Results Ten studies were included in the meta-analysis. In the random-effects meta-analysis, the Neck Disability Index (NDI), visual analogue scale (VAS) neck, and VAS arm were significantly decreased after the UBE-PCF (p<0.001). The improvement of NDI, VAS neck, and VAS arm were significantly higher than MCID (p<0.05). The improvement of NDI, VAS neck, and VAS arm were not significantly different between the UBE-PCF and FE-PCF (p>0.05). Overall incidence of complications of the UBE-PCF was 6.2% (24 of 390). The most common complication was dura tear (2.1%, 8 of 390). The incidence in overall complications was not significantly different between the UBE-PCF and FE-PCF (p=0.813).
Conclusion We found that the UBE-PCF significantly improved clinical outcomes. Regarding clinical outcomes and complications, the UBE-PCF and FE-PCF were not significantly different. Therefore, the UBE-PCF would be an advantageous surgical option comparable to FE-PCF for unilateral radiating arm pain.
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Spinal epidural abscess is a rare disease that is less likely to occur in the cervical region. When it occurs here, cervical spondylodiscitis can develop. Surgical treatment is recommended because of possible life-threatening septic and neurological complications. We present a case of an 81-year-old man who suffered from right side paralysis and was subsequently diagnosed with a C4 to C7 epidural abscess. We utilized full endoscopic surgery for patient management. The traditional surgical methods for treating cervical epidural abscesses may cause spinal instability. There has only been one previous case report on the endoscopic-assisted method. Minimal invasive surgery by a full endoscopic method can be done with a small incision and is associated with minimal blood loss and muscle damage. This is the first report on cervical epidural abscess drainage utilization a full endoscopic method. We recommend this alternative minimally invasive method to manage cervical epidural abscess.
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Feasibility of Unilateral Approach for Bilateral Decompressive Endoscopic Spinal Surgery for Lumbar Stenosis to Improve Back and Leg Pain: A Consecutive Single-Center Series of 60 Patients Azizul Akram Salim, Abdul Halim Yusof, Joehaimey Johari, Mohd Imran Yusof Frontiers in Surgery.2020;[Epub] CrossRef
OBJECTIVE This retrospective study of 101 patients with symptomatic lumbar disc herniation (LDH) treated via percutaneous endoscopic surgery using the extreme lateral transforaminal approach (ELTFA) was performed to assess the clinical results and to determine the relationship between the location of the herniated disc fragment and surgical success. METHODS The operated levels were distributed as one case of L2-3, ten cases of L3-4, 83 cases of L4-5 and seven cases of L5-6. The clinical outcomes were assessed using visual analogue pain (VAS), Oswestry disability index (ODI) and MacNab's criteria. All assessments were performed one day prior to the operation, as well as three days and one month after the operation. RESULTS Mean preoperative back VAS (4.33+/-1.48) and leg VAS (6.29+/-2.72) were significantly decreased three days (1.43+/-1.48, 2.03+/-1.98, respectively) and one month (1.23+/-1.25, 1.89+/-1.72, respectively) postoperatively.
Mean preoperative ODI score was improved from 45.86+/-20.44% to 18.92+/-12.98% after three days and to 16.34+/-9.86% one month after operation. Twenty-three patients showed a vertical migration of the herniated disc of greater than 4 mm. There was no statistically significant difference between the extents of improvement in VAS or ODI score or between the degrees of vertical migration. According to MacNab's criteria assessment, the overall surgical success rate, as measured by surgeries classified as "excellent" and "good," was 89.8%. Surgical complications included seven patients with transient leg paresthesia, one patient with transient motor weakness and one patient with postoperative discitis. CONCLUSION This study demonstrates that percutaneous endoscopic surgery using ELTFA is an effective surgical endoscopic approach for selected LDH patients. This procedure is safe and could expand indications to vertically migrated discs.
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