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Purpose: To investigate whether a cocktail therapy of dexamethasone, ropivacaine, dexmedetomidine, and vitamin B12 can achieve satisfactory pain relief and promote early functional recovery after PPECD. Methods: Eighty single-level patients with CDH who received PPECD were retrospectively divided into two groups: the cocktail and control groups. Clinical data were recorded and evaluated by a dedicated physician who was not involved in the patient's treatment. The primary clinical outcomes included visual analog scores (VASs) for upper limber pain and neck disability index (NDI) scores. The follow-up time points were preoperatively and postoperative 1 week, 1 month, 3 months, 6 months, and 12 months. The modified MacNab criteria was used to evaluate the surgical effect of the last follow-up. Results: The follow-up data of 74 cases were complete, except 6 cases lost to follow-up. There was no significant difference between the two groups in demographics, duration of symptoms, operation stage (p > 0.05), and operation time (80.5 ± 5.5 vs. 81.5 ± 3.5 min). The VAS in the upper limbs pain was significantly higher postoperatively than preoperatively in both groups (p < 0.05). The cocktail group had a lower VAS than the control group 1 week postoperatively (p < 0.05); however, VAS not different between groups at the remaining time points. The NDI scores were significantly better postoperatively than preoperatively, and no significant differences were seen when comparing nodes at postoperative follow-up (p > 0.05). In the control group, two cases with foraminal stenosis were found to have unrelieved pain in the early postoperative period, but the pain was relieved at the final follow-up and did not convert to open decompression surgery. Conclusions: Cocktail treatment, in which a drug sustained-release material made of gelatin sponge was impregnated with dexamethasone, ropivacaine, dexmedetomidine and vitamin B12, facilitates pain relief and early postoperative recovery after PPECD. [ABSTRACT FROM AUTHOR]

Background: The optimal PECD surgical approach for cervical intervertebral disc herniation (CIVDH) remains controversial. The conventional posterior K-hole approach for PECD leads to damage of facet joint. Objectives: This article is to first describe a novel posterior lamina–hole approach of percutaneous endoscopic cervical discectomy (PECD) for CIVDH. The objective of this study is to evaluate the feasibility and short-term clinical effect of this approach. Methods: Single-center retrospective observational study of all patients managed with posterior percutaneous endoscopic cervical discectomy (PPECD) using the lamina–hole approach for symptomatic single-level CIVDH between January 2015 and January 2016. The clinical outcomes were evaluated with the visual analog scale, modified MacNab criteria and radiographical results. Results: Twelve patients (seven women, five men) were enrolled in the study. Positive clinical response for pain relief was achieved in these patients receiving PPECD through lamina–hole approach for CIVDH. Postoperative MRI showed complete removal of the disc material in all the patients, no failure due to residual fragment was observed. Conclusion: As an alternative surgical approach of PPECD, PPECD through lamina–hole approach is a novel access for CIVDH and may be considered a valid and safe therapeutic option for CIVDH. The advantages of this approach are not only providing a valid and secure access to herniated cervical intervertebral fragment but also avoiding the iatrogenic damage to the facet joint and relevant functional spinal unit (FSU). Theoretically, the potential of secondary degeneration of FSU is low. [ABSTRACT FROM AUTHOR]

Objective To examine the effects of anterior transcorporeal percutaneous endoscopic cervical diskectomy (ATPECD) for the treatment of single-level cervical intervertebral disk herniation (CIDH) with a focus on its safety, feasibility, clinical efficacy, and specific possible complications. Methods A series of 35 patients with symptomatic single-level CIDH were enrolled to be treated with ATPECD. Neck and arm pain was measured using the visual analog scale. Quality of life was measured using the bodily pain and physical function on the SF-36. The average disk height and vertical vertebral body height were recorded. Bone healing was evaluated on the basis of postoperative computed tomography. Results Successful removal of the herniated disk was confirmed in all 35 cases. At 2 years, the patients showed a significant treatment effect in the visual analog scale and body pain and physical function portions of the SF-36 (1.14 ± 0.60 vs. 7.62 ± 0.61, 63.92 ± 6.74 vs. 32.55 ± 6.80, and 82.14 ± 6.22 vs. 34.43 ± 4.50, respectively, P < 0.01). Mean preoperative disk height was 6.79 ± 0.37 mm, which decreased to 6.34 ± 0.46 mm 2 years post operation (6.6% decrease). Preoperative surgical vertebral body height also decreased from preoperation (15.79 ± 0.52 mm) to 2 years post operation (15.12 ± 0.38 mm) (4.2% decrease). Three surgery-related complications were observed (8.6%). Conclusions Preliminary clinical experience with ATPECD shows that it is safe, effective, feasible, and minimally invasive. Although it has some disadvantages, such as the need for repeated fluoroscopy, some minor complications, and nonsymptomatic disk height decreases, ATPECD can supplement minimally invasive surgeries in selected cases of CIDH. [ABSTRACT FROM AUTHOR]

Background Currently, anterior transdiscal access and posterior interlaminar approach are the main approaches for percutaneous endoscopic cervical discectomy (PECD). To overcome access shortcomings, we previously described a novel anterior endoscopic transcorporeal approach on a migrated cervical disc. We innovatively introduced bone wax into endoscopic surgery to aid hemostasis and facilitate the process of drilling an intracorporeal tunnel. Methods Five patients with cervical intervertebral disc herniation (CIDH) were treated by PECD via the anterior transcorporeal approach. During the operation, we marked the punctured tunnel with bone wax containing indigo carmine as a guide and smeared bone wax on the endoscopic burr to aid hemostasis. Results A satisfactory clinical outcome was observed in all 5 patients postoperatively; pain and neurologic condition were dramatically improved. Surgery-related complications, such as esophageal injury, vascular rupture, hematoma, intervertebral disc infection, or postoperative headache, were not encountered. A computed tomography scan was used to observe the process of bone healing. At 3-month postoperative follow-up, the bone defect within the drilling tunnel had partially shrank and was completely healed at 6 months postoperatively. Conclusions The anterior endoscopic transcorporeal approach for PECD is a novel, valuable alternative for the treatment of CIDH. Bone wax could indeed facilitate the operation by guiding the drilling process and instantly controlling the bleeding without obvious interference with bone healing. Long-term follow-up is warranted in further clinical studies. Highlights • A transcorporeal approach to remove a herniated disc at the C4-5 level under endoscopy is introduced. • Bone wax was introduced into endoscopic surgery to aid hemostasis and facilitate the process of drilling a tunnel. • Satisfactory clinical outcome was observed in all 5 patients postoperatively, with improved pain and neurologic condition. • With the process of osteogenesis, a phenomenon of self-repair was observed in the bone defect within the drill tunnel. • Because injury to the residual disc is mild, the probability of further intervertebral space collapsing is low. [ABSTRACT FROM AUTHOR]

Objective We sought to preliminarily explore the efficacy and safety of percutaneous endoscopic spinal surgery for epidural cement leakage. We report a case series of patients who underwent percutaneous retrieval of leaked epidural cement and achieved spinal decompression under endoscopy. Methods Five patients with neurologic impairment due to epidural cement leakage after percutaneous vertebroplasty were treated with percutaneous endoscopic spinal decompression. Computed tomography reconstruction and 3-dimensional imaging were used to evaluate the extruded material. During follow-up at 3, 6, and 12 months postoperatively, all patients were advised to undergo plain radiograph and computed tomography examinations. Results The leaked epidural cement was successfully removed in all patients under percutaneous endoscopy through a unilateral or bilateral approach. At the 12-month follow-up, the visual analog scale score of all patients improved. In addition, the neurologic function of each patient improved to at least 1 grade level, as evaluated using the American Spinal Injury Association. According to the modified MacNab criteria, 2 patients had excellent recovery, whereas the other 3 patients had good recovery. Conclusions We described a novel and minimally invasive procedure to ameliorate intractable epidural cement extrusion. As an alternative to conventional laminectomy, percutaneous endoscopic retrieval achieved the targeted decompression without damaging the posterior lamina. Moreover, the whole operation was performed under regional anesthesia accompanied with dexmedetomidine sedation, allowed real-time neural function evaluation, and had lower risks of anesthesia-related complications, compared with general anesthesia. Highlights • Generally, an urgent and extensive laminectomy was required to thoroughly remove the intraspinal extravasated comment. • Percutaneous endoscopic retrieval could achieve targeted decompression without damaging the posterior lamina. • It is not only capable of being monitored for efficacy but also avoids the risks associated with general anesthesia. [ABSTRACT FROM AUTHOR]

Juxtafacet cysts (JFCs) include both synovial and ganglion cysts adjacent to a spinal facet joint or arising from the ligamentum flavum of the spinal facet joints. Various treatments have been proposed; however, a surgical approach appears to be most effective. The aim of this study was to review patients with lumbar JFCs treated using a full endoscopic approach and elaborate the details of the surgical routes and techniques and their merits and pitfalls. All patients with lumbar JFCs underwent complete endoscopic cyst removal. Muscle power, visual analog scale score, modified MacNab criteria score, and magnetic resonance imaging were assessed during follow-up. The study enrolled 8 patients. Five patients received an interlaminar approach, 2 patients received a transforaminal approach, and 1 patient received a transfacet approach. Visual analog scale scores decreased from a mean of 7.75 (range, 5–10) before surgery to 0.625 (range, 0–2) after surgery, and modified MacNab criteria score ranged from good to excellent after surgery. No neurologic injuries were observed. JFCs could be effectively treated by full endoscopic surgery. The type of approach should be based on the anatomic site of the lesion and the condition of the patient. The interlaminar approach is appropriate for cysts located in the lower segment with larger interlaminar space. The transforaminal or transfacet approach is preferred for patients for whom general anesthesia is a high risk. [ABSTRACT FROM AUTHOR]

Background The incidence of spinal epidural hematoma (SEH) is estimated to be 1 per 1,000,000 patients per year; SEH can be classified as idiopathic, spontaneous, and secondary. The cause of spontaneous SEH is uncertain but it may be associated with minor trauma. SEH can compress surrounding structures, shown by clinical symptoms and signs that affect the spinal cord or nerve roots. Surgical treatment may be considered if medical treatment fails. Case Description A 26-year-old man presented with lower back pain and significant radicular symptoms on the left side for a week. He denied previous lumbar trauma or the use of anticoagulation drugs. We used the full-endoscopic transforaminal approach (extraforaminal technique) to remove the SEH under local anesthesia. The patient was discharged home 2 days after surgery and the radicular pain disappeared completely. Three months later, follow-up magnetic resonance imaging showed that the dark-brown lesion had been totally removed. Conclusions Spontaneous SEHs are uncommon. Although lumbar laminectomy is the mainstream treatment in those with neurologic deficits caused by epidural hematomas, the percutaneous full-endoscopic transforaminal approach may be an option for certain SEHs. [ABSTRACT FROM AUTHOR]