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Hard or calcified discs are often adherent to surrounding nerve tissue. The whole herniated disc is difficult to remove by pulling part of the hernia mass, which makes obtaining good results through endoscopic treatment difficult. The purpose of this study was to describe the details of the transforaminal endoscopic lumbar discectomy technique for a hard or calcified disc and report the clinical results.From October 2016 to June 2019, 43 consecutive cases diagnosed as hard or calcified lumbar disc herniation at our institution and treated with transforaminal endoscopic discectomy were evaluated. Endoscopic decompression was performed in patients with hard or calcified lumbar disc herniation.The preoperative visual analog scale score for leg pain (mean ± standard deviation) was 7.09 ± 1.74. The score improved to 2.55 ± 1.35 at 1 week postoperatively, 1.88 ± 1.29 at 4 weeks postoperatively, and 1.58 ± 1.0 at 26 weeks postoperatively (P0.01 for all). The preoperative Oswestry Disability Index (mean ± standard deviation) was 55.4 ± 23.04, which improved to 30.89 ± 13.64 at 1 week postoperatively, 23.08 ± 11.64 at 4 weeks postoperatively, and 16.42 ± 9.76 at 26 weeks postoperatively (P0.01 for all). Two patients developed a dural laceration. Both patients were discharged after several hours of observation. None of the patients had postoperative infection, epidural hematoma, or delayed neurological deterioration.Transforaminal endoscopic discectomy could be an effective treatment method for a selected group of patients with hard or calcified lumbar disc herniation.

Background Minimally invasive oblique lumbar interbody fusion (OLIF) techniques generally rely on deformity correction to achieve indirect neural decompression. However, indirect neural decompression will not always be sufficient. Thus, a second procedure, such as posterior direct decompression, will be added for full decompression, increasing the surgical morbidity and healthcare costs. We have described a technique of direct anterior microscopic neural decompression combined with OLIF. Methods We report our surgical technique of anterior lumbar neural microscopic decompression with OLIF with patients in the lateral position. We also report the cases of 3 patients treated from March 2018 to June 2018. Results Three patients underwent anterior microscopic neural decompression combined with OLIF in the lateral position. All 3 patients achieved clinically and radiologically significant neural decompression and deformity correction. No perioperative complications developed. Conclusion Direct anterior microscopic neural decompression is feasible and safe in selected patients undergoing OLIF.

Background Despite its growing popularity, no comparative studies have explored the minimum clinically important difference (MCID) of health-related quality of life scores following lumbar interbody fusion (LIF) performed on a single-level adult low-grade isthmic spondylolisthesis (LGIS). Objective The purpose of this study is to investigate factors related to MCID of health-related quality of life scores following instrumented LIF performed on a single-level adult LGIS. Methods Consecutive patients who underwent instrumented LIF for single-level LGIS were reviewed. The inclusion criteria were adult patients who underwent L4-5 or L5-S1, underwent anterior lumbar interbody fusion or transforaminal lumbar interbody fusion with a posterior screw fixation, and had a minimum 36-month postoperative follow-up period. MCID was defined as having an improved score of visual analog scale (VAS) back and leg pain >3 and Oswestry Disability Index (ODI) >12. Patients were subdivided into groups named “achievement” (A) and “nonachievement” (N) depending on their postoperative MCID for each health-related quality of life score category. Results One-hundred and five patients met the inclusion criteria. The overall achievement of MCID for VAS back, leg, and ODI was 80%, 73.3%, and 82.9%. MCID-VAS leg and ODI were less achieved at the L5-S1 level than at the L4-5 level. Postoperatively, disk height was higher and segmental lordosis (SL) was lower in group A of MCID-VAS leg. SL was lower in group A of MCID-ODI. Conclusions We postulate that excessive SL does not affect lumbar lordosis; rather, it can result in lowering posterior disk height. The decrease in posterior DH may lead to a decreased foraminal height that, in turn, can lead to nerve root compression. Proper restoration of disk height and bone fusion is more important than restoration of more segmental lordosis or slip reduction for isthmic spondylolisthesis.

Transforaminal endoscopic treatment has been reported to be an effective treatment option in patients with lumbar disc herniation. However, it is rarely performed for spinal stenosis because of the limitation of endoscopic working mobility caused by the exiting nerve root and foraminous bony structure. The objective of this study was to describe a novel transforaminal endoscopic decompression technique for spinal stenosis and report the clinical results.From October 2015 to October 2016, 30 consecutive cases were diagnosed as lateral recess stenosis in our institution and underwent transforaminal endoscopic decompression. Visual analog scale (VAS) of back and leg pain and the Oswestry Disability Index (ODI) were measured preoperatively and at follow-up.The mean ± SD value of preoperative VAS leg pain score was 7.6 ± 1.17. The score improved to 2.2 ± 1.11 at 1 week postoperatively, 1.73 ± 0.96 at 4 weeks postoperatively, and 1.63 ± 0.95 at 26 weeks postoperatively (P0.01). The mean ± SD value of the preoperative ODI score was 65.69 ± 14.22. The score improved to 24.29 ± 11.89 at 1 week postoperatively, 21.25 ± 9.25 at 4 weeks postoperatively, and 15.62 ± 10.49 at 26 weeks postoperatively (P0.01). There were no patients with postoperative infection, dural tear, delayed neurologic deterioration, or conversion to open surgery.Transforaminal endoscopic decompression under local anesthesia could be an effective treatment method for the selected group of patients with spinal stenosis.

Objective Chronic low back pain (CLBP) often causes disabling pain that impairs a patient's quality of life. Surgical treatment is recommended for patients who do not respond to conservative treatments lasting more than 6 months. The purpose of this study is to present results after the use of an interlaminar dynamic spacer for CLBP. Methods We enrolled consecutive patients with CLBP irresponsive to more than 6 months of conservative treatment into the present study. Included patients underwent an interlaminar dynamic spacer insertion without direct decompression. We assessed radiographic parameters and health-related quality of life (HRQoL) data included visual analog scale back/leg pain and Oswestry Disability Index scores. Substantial clinical benefit achievement was assessed. Results Thirty-five patients (average age, 47.8 years; 21 female) were included. The mean preoperative symptom duration was 29.6 months. Surgeries involved 1-level (n = 18) and 2-levels (n = 17) procedures. Operative levels included L4-5 (n = 8), L5-S1 (n = 10), L3-4-5 (n-2), and L4-5-S1 (n = 15). The average follow-up period was 16.6 months. After the procedure, all radiographic parameters (including disc height, segmental extension angle, and foraminal area) improved significantly. All preoperative HRQoL parameters improved significantly at the final follow-up. Substantial clinical benefit achievement was observed in 75.8% of the cases on the Oswestry Disability Index, and in 72.7% and 84.8% of the cases on the visual analog scale back and leg pain, respectively. Conclusions An interlaminar dynamic spacer significantly improves HRQoL scores in patients with CLBP who do not respond to conservative treatment. Although encouraging, these results should be confirmed with studies assessing a larger cohort and a longer follow-up.