著者

Blumstein GIDEON Kento TAKEBAYASHI Takahiro INUI Yasushi OSHIMA Hiroki IWAI Hirohiko INANAMI Hisashi KOGA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2023-0073, (Released:2023-07-10)

参考文献数

21

被引用文献数

1

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This study aimed to compare the outcomes of microendoscopic cervical foraminotomy (MECF) versus full-endoscopic cervical foraminotomy (FECF) for treating cervical radiculopathy (CR).A retrospective study was performed on patients with CR treated using MECF (n = 35) or FECF (n = 89). A 16-mm tubular retractor and endoscope was used for MECF, while a 4.1-mm working channel endoscope was used for FECF. Patient background and operative data were collected. The numerical rating scale (NRS) and the Neck Disability Index scores were recorded preoperatively and at 1 year postoperatively. Postoperative subjective satisfaction was also assessed.Although the NRS, and NDI scores, as well as postoperative satisfaction at 1 year considerably improved in both groups, one of the background data (number of operated vertebral level) was significantly different. Therefore, we separately analyzed single- and two-level CR. In single-level CR, operation time, intraoperative bleeding, postoperative stay, NDI after 1 year, and reoperation rate were statistically superior in FECF group. In two-level CR, the postoperative stay was statistically superior in FECF group. Three postoperative hematomas were observed in the MECF group, while none was observed in the FECF group.Operative outcomes did not significantly differ between groups. We did not observe postoperative hematoma in FECF even without placement of a postoperative drain. Therefore, we recommend FECF as the first option for the treatment of CR as it has a better safety profile and is minimally invasive.

著者

Masashi Uehara Shota Ikegami Takashi Takizawa Hiroki Oba Noriaki Yokogawa Takeshi Sasagawa Kei Ando Hiroaki Nakashima Naoki Segi Toru Funayama Fumihiko Eto Akihiro Yamaji Kota Watanabe Satoshi Nori Kazuki Takeda Takeo Furuya Sumihisa Orita Hideaki Nakajima Tomohiro Yamada Tomohiko Hasegawa Yoshinori Terashima Ryosuke Hirota Hidenori Suzuki Yasuaki Imajo Hitoshi Tonomura Munehiro Sakata Ko Hashimoto Yoshito Onoda Kenichi Kawaguchi Yohei Haruta Nobuyuki Suzuki Kenji Kato Hiroshi Uei Hirokatsu Sawada Kazuo Nakanishi Kosuke Misaki Hidetomi Terai Koji Tamai Eiki Shirasawa Gen Inoue Kenichiro Kakutani Yuji Kakiuchi Katsuhito Kiyasu Hiroyuki Tominaga Hiroto Tokumoto Yoichi Iizuka Eiji Takasawa Koji Akeda Norihiko Takegami Haruki Funao Yasushi Oshima Takashi Kaito Daisuke Sakai Toshitaka Yoshii Tetsuro Ohba Bungo Otsuki Shoji Seki Masashi Miyazaki Masayuki Ishihara Seiji Okada Yasuchika Aoki Katsumi Harimaya Hideki Murakami Ken Ishii Seiji Ohtori Shiro Imagama Satoshi Kato

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

pp.2021-0183, (Released:2021-12-27)

被引用文献数

2

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Background: In elderly patients with cervical spinal cord injury, comorbidities such as cardiovascular and cerebrovascular diseases are common, with frequent administration of antiplatelet/anticoagulant (APAC) drugs. Such patients may bleed easily or unexpectedly during surgery despite prior withdrawal of APAC medication. Few reports have examined the precise relationship between intraoperative blood loss and history of APAC use regarding surgery for cervical spine injury in the elderly.The presentmulticenter database survey aimed to answer the question of whether the use of APAC drugs affected the amount of intraoperative blood loss in elderly patients with cervical spinal cord trauma.Methods: The case histories of 1512 patients with cervical spine injury at 33 institutes were retrospectively reviewed. After excluding cases without spinal surgery or known blood loss volume, 797 patients were enrolled. Blood volume loss was the outcome of interest. We calculated propensity scores using the inverse probability of treatment weighting (IPTW) method. As an alternative sensitivity analysis, linear mixed model analyses were conducted as well.Results: Of the 776 patients (mean age: 75.1 ± 6.4 years) eligible for IPTW calculation, 157 (20.2%) were taking APAC medications before the injury. After weighting, mean estimated blood loss was 204 mL for non-APAC patients and 215 mL for APAC patients. APAC use in elderly patients was not significantly associated with surgical blood loss according to the IPTW method with propensity scoring or linear mixed model analyses. Thus, it appeared possible to perform surgery expecting comparable blood loss in APAC and non-APAC cases.Conclusions: This multicenter study revealed no significant increase in surgical blood loss in elderly patients with cervical trauma taking APAC drugs. Surgeons may be able to prioritize patient background, complications, and preexisting conditions over APAC use before injury when examining the surgical indications for cervical spine trauma in the elderly.

著者

Kento TAKEBAYASHI Yasushi OSHIMA Muneyoshi FUJITA Takahiro INUI Hiroki IWAI Hirohiko INANAMI Hisashi KOGA

出版者

The Japan Neurosurgical Society

雑誌

Neurologia medico-chirurgica (ISSN:04708105)

巻号頁・発行日

pp.2022-0357, (Released:2023-05-11)

参考文献数

28

被引用文献数

2

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This study aims to compare the outcomes of interlaminar and transforaminal approaches for full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation (LDH).A retrospective study of patients with L4/5 LDH treated with interlaminar endoscopic lumbar discectomy (IELD, n = 19) or transforaminal endoscopic lumbar discectomy (TELD, n = 105) was conducted. Patient background, radiological findings, and operative data were collected. Oswestry Disability Index (ODI) and European Quality of Life-5 Dimension (EQ-5D) scores were recorded preoperatively and 1 and 2 years postoperatively.Although ODI and EQ-5D scores 1 and 2 years postoperatively improved statistically in the IELD and TELD groups, there were no statistical differences between the groups. IELD was predominantly performed in patients who were taller and heavier. The mean operative times and the frequency of laminectomy for IELD and TELD were 67.2 and 44.6 min and 63.2 and 17.1%, respectively (P < 0.001). The radiological findings showed that the concave configuration of the L4 lamina, interlaminar space width, and foraminal width were statistically different between the groups. There were no complications in either of the groups. Reoperation was required for recurrence in two and five patients in the IELD and TELD groups (P = 0.29), respectively.Operative outcomes were identical between the two groups. Although the operative time was longer in the IELD group, both approaches were safely and effectively performed. Depending on the patient's physique and preoperative radiological findings, the more suitable approach for L4/5 LDH should be chosen.

著者

Mitsuru Yagi Nobuyuki Fujita Tomohiko Hasegawa Gen Inoue Yoshihisa Kotani Seiji Ohtori Sumihisa Orita Yasushi Oshima Daisuke Sakai Toshinori Sakai Hiroshi Taneichi Daisuke Togawa Kazuo Nakanishi Hiroaki Nakashima Toshitaka Yoshii Masaya Nakamura Motoki Iwasaki Masahiko Watanabe Hirotaka Haro Tokumi Kanemura Naobumi Hosogane New Technology Assessment Committee of The Japanese Society for Spine Surgery and Related Research

出版者

The Japanese Society for Spine Surgery and Related Research

雑誌

Spine Surgery and Related Research (ISSN:2432261X)

巻号頁・発行日

pp.2022-0194, (Released:2022-12-12)

被引用文献数

1

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IntroductionLateral lumbar interbody fusion (LLIF) has been introduced in Japan in 2013. Despite the effectiveness of this procedure, several considerable complications have been reported. This study reported the results of a nationwide survey performed by the Japanese Society for Spine Surgery and Related Research (JSSR) on the complications associated with LLIF performed in Japan.MethodsJSSR members conducted a web-based survey following LLIF between 2015 and 2020. Any complications meeting the following criteria were included: (1) major vessel, (2) urinary tract, (3) renal, (4) visceral organ, (5) lung, (6) vertebral, (7) nerve, and (8) anterior longitudinal ligament injury; (9) weakness of psoas; (10) motor and (11) sensory deficit; (12) surgical site infection; and (13) other complications. The complications were analyzed in all LLIF patients, and the differences in incidence and type of complications between the transpsoas (TP) and prepsoas (PP) approaches were compared.ResultsAmong the 13,245 LLIF patients (TP 6,198 patients [47%] and PP 7,047 patients [53%]), 389 complications occurred in 366 (2.76%) patients. The most common complication was sensory deficit (0.5%), followed by motor deficit (0.43%) and weakness of psoas muscle (0.22%). Among the patient cohort, 100 patients (0.74%) required revision surgery during the survey period. Almost half of the complications developed in patients with spinal deformity (183 patients [47.0%]). Four patients (0.03%) died from complications. Statistically more frequent complications occurred in the TP approach than in the PP approach (TP vs. PP, 220 patients [3.55%] vs. 169 patients [2.40%]; p < 0.001).ConclusionsThe overall complication rate was 2.76%, and 0.74% of the patients required revision surgery because of complications. Four patients died from complications. LLIF may be beneficial for degenerative lumbar conditions with acceptable complications; however, the indication for spinal deformity should be carefully determined by the experience of the surgeon and the extent of the deformity.