Endoscopic Transforaminal Lumbar Interbody Fusion With a Single Oblique PEEK Cage and Posterior Supplemental Fixation.

Background: To demonstrate the feasibility of an endoscopically assisted minimally invasive surgery transforaminal lumbar interbody fusion (MIS-TLIF) and to study clinical outcomes with the use of a static oblique bullet-shaped cannulated poly-ether-ether-ketone (PEEK) lumbar interbody fusion cage in conjunction with platelet enriched plasma infused allograft cancellous chips and posterior supplemental fixation.

Methods: In this retrospective study of 43 patients who underwent endoscopically assisted MIS-TLIF for spondylolisthesis (53.5%) and stenosis (46.

Expandable Interbody Fusion Cages: An Editorial on the Surgeon's Perspective on Recent Technological Advances and Their Biomechanical Implications.

Background: Expandable cages have gone through several iterations since they first appeared on the market in the early 2000s. Their development was prompted by some common problems associated with static interbody cages, including migration, expulsion, dural or neural traction injury, and pseudarthrosis.

Objective: To summarize current technological advances from earlier expandable lumbar interbody fusion devices to implants with vertical and medial-to-lateral expansion mechanisms.

Transforaminal Endoscopic Discectomy Combined With an Interspinous Process Distraction System for Spinal Stenosis.

Background: The combination of the percutaneous transforaminal endoscopic decompression (PTED) with an interspinous process distraction system (IPS) may offer additional benefit in the treatment of spinal stenosis in patients who have failed nonsurgical treatment.

Methods: We retrospectively reviewed the medical records of 33 patients diagnosed with lumbar stenosis and radiculopathy and treated them with transforaminal endoscopic lumbar decompression between 2013 and 2017. Primary outcome measures were modified Macnab as well as preoperative and postoperative visual analog scale (VAS) criteria and the Oswestry Disability Index (ODI).

Reliability Analysis of Deep Learning Algorithms for Reporting of Routine Lumbar MRI Scans.

Background: Artificial intelligence could provide more accurate magnetic resonance imaging (MRI) predictors of successful clinical outcomes in targeted spine care.

Objective: To analyze the level of agreement between lumbar MRI reports created by a deep learning neural network (RadBot) and the radiologists' MRI reading.

Methods: The compressive pathology definitions were extracted from the radiologist lumbar MRI reports from 65 patients with a total of 383 levels for the central canal: (0) no disc bulge/protrusion/canal stenosis, (1) disc bulge without canal stenosis, (2) disc bulge resulting in canal stenosis, and (3) disc herniation/protrusion/extrusion resulting in canal stenosis.

Current Concepts of Contemporary Expandable Lumbar Interbody Fusion Cage Designs, Part 1: An Editorial on Their Biomechanical Characteristics.

Background: Bidirectional expandable designs for lumbar interbody fusion cages are the latest iteration of expandable spacers employed to address some of the common problems inherent to static interbody fusion cages.

Objective: To describe the rationales for contemporary bidirectional, multimaterial expandable lumbar interbody fusion cage designs to achieve in situ expansion for maximum anterior column support while decreasing insertion size during minimal-access surgeries.

Methods: The authors summarize the current concepts behind expandable spinal fusion open architecture cage designs focusing on advanced minimally invasive spinal surgery techniques, such as endoscopy.

Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine.

(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root and its dorsal root ganglion (DRG) by manipulating the working cannula or endoscopic instruments may play a role.

Lumbar Endoscopic Bony and Soft Tissue Decompression With the Hybridized Inside-Out Approach: A Review And Technical Note.

This study aimed to showcase the authors' preferred technique of a hybrid of modern "inside-out" and "outside-in" endoscopic decompression. A case series of 411 patients consisting of 192 females (46.7%) and 219 males (53.

Transforaminal endoscopic decompression and uninstrumented allograft lumbar interbody fusion: A feasibility study in patients with end-stage vacuum degenerative disc disease.

Objective: The authors investigated the feasibility of a transforaminal endoscopic decompression and un-instrumented lumbar interbody fusion procedures with cancellous bone allograft in patients painful with end-stage degenerative vacuum disc disease.

Patients & Methods: Twenty-nine patients who underwent endoscopic transforaminal foraminal and lateral recess decompression and direct intraoperative endoscopic visualization of a painful, hollow collapsed, rigid intervertebral disc space were grafted with cancellous allograft chips. In addition to the radiographic assessment of fusion, patients were followed for a minimum of 2 years postoperatively, and clinical outcomes were evaluated with VAS, ODI, and modified MacNab criteria.

Minimal Clinically Important Difference in Patient-Reported Outcome Measures with the Transforaminal Endoscopic Decompression for Lateral Recess and Foraminal Stenosis.

Background: Patient-reported outcome measures (PROMs) have become widely used to better measure patients' judgment of treatment benefits from surgical spine care. The concept of determining the minimal clinically important differences (MCIDs) of PROMs is aimed at assessing the benefits of lumbar spine care that are meaningful to the patient. The goal of this study was to validate the utility of MCIDs of the visual analog score (VAS) and Oswestry Disability Index (ODI) in patients with sciatica-type low back and leg pain due to lateral recess and foraminal stenosis who were treated with directly visualized transforaminal outpatient endoscopic decompression.

Indication and Contraindication of Endoscopic Transforaminal Lumbar Decompression.

Background: The indications and contraindications to the endoscopic transforaminal approach for lumbar spinal stenosis are not well defined.

Methods: We performed a Kaplan-Meier durability survival analysis of patients with the following types of spinal stenosis: type I, central canal; type II, lateral recess; type III, foraminal; and type IV, extraforaminal. The 304 patients comprised 140 men and 164 women, with an average age of 51.

Subsidence induced recurrent radiculopathy after staged two-level standalone endoscopic lumbar interbody fusion with a threaded cylindrical cage: a case report.

We report a case of subsidence induced recurrence of unilateral L5 and S1 radiculopathy six months following a successful staged two-level endoscopic standalone lumbar interbody fusion using the VARILIF-L™ device. The patient was a 64-year-old female who first underwent outpatient endoscopic fusion L4/5 for failed non-operative care of Grade I spondylolisthesis. Within 11 months from the L4/5 index procedure, she developed symptomatic adjacent segment disease stemming from the L5/S1 level.

Standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a threaded cylindrical peek cage: report of two cases.

We report two cases of a standalone lordotic endoscopic wedge lumbar interbody fusion (LEW-LIF™) with a stress-neutral non-expandable cylindrical threaded polyether ether ketone (PEEK) interbody fusion implant. Patients underwent full-endoscopic transforaminal decompression and fusion for symptomatic lateral recess stenosis due to disc herniation, and hypertrophy of the facet joint complex and ligamentum flavum and no more than grade I spondylolisthesis. Lumbar interbody fusion with cages traditionally calls for posterior supplemental fixation with pedicle screws for added stability.

Regional variations in acceptance, and utilization of minimally invasive spinal surgery techniques among spine surgeons: results of a global survey.

Background: Regional differences in acceptance and utilization of MISST by spine surgeons may have an impact on clinical decision-making and the surgical treatment of common degenerative conditions of the lumbar spine. The purpose of this study was to analyze the acceptance and utilization of various minimally invasive spinal surgery techniques (MISST) by spinal surgeons the world over.

Methods: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin.

Surgeon motivation, and obstacles to the implementation of minimally invasive spinal surgery techniques.

Background: This study aimed to analyze the motivators and obstacles to the implementation of minimally invasive spinal surgery techniques (MISST) by spinal surgeons. Motivators and detractors may impact the availability of MISST to patients and drive spine surgeons' clinical decision-making in the treatment of common degenerative conditions of the lumbar spine.

Methods: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin.

Surgeon training and clinical implementation of spinal endoscopy in routine practice: results of a global survey.

Background: Training of spine surgeons may impact the availability of contemporary minimally invasive spinal surgery (MIS) to patients and drive spine surgeons' clinical decision-making when applying minimally invasive spinal surgery techniques (MISST) to the treatment of common degenerative conditions of the lumbar spine. Training requirements and implementation of privileges vary in different parts of the world. The purpose of this study was to analyze the training in relation to practice patterns of surgeons who perform lumbar endoscopic spinal surgery the world over.

Is Asia truly a hotspot of contemporary minimally invasive and endoscopic spinal surgery?

Background: The purpose of this study was to analyze the training in relation to practice patterns of surgeons in Asia who perform lumbar endoscopic spinal surgery in comparison to surgeons the world over. The authors solicited responses to an online survey sent to spine surgeons.

Methods: Pearson Chi-Square measures, Kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances of responses in relation to surgeons' training using statistical package SPSS Version 25.

Virtual reality in spinal endoscopy: a paradigm shift in education to support spine surgeons.

Background: Minimally invasive spine surgery (MISS) and endoscopic spine surgery have continually evolving indications in the cervical, thoracic, and lumbar spine. Endoscopic spine surgery entails treatment of disc disease, stenosis, spondylolisthesis, radiculopathy, and deformity. MISS involves complex motor skills in regions of variable anatomy.

Navigating the learning curve of spinal endoscopy as an established traditionally trained spine surgeon.

Background: Traditionally trained spine surgeons may want to transition from open spinal surgeries to endoscopic decompressions. The aspiring endoscopic spine surgeon may have to overcome multiple hurdles to master a learning curve without readily available training. Replacing traditional time-proven open spinal surgeries with endoscopic decompression may put the surgeons' reputation at risk and have an additional negative impact on his or her practice due to reduced revenue.

Comparative study of curative effect of spinal endoscopic surgery and anterior cervical decompression for cervical spondylotic myelopathy.

Background: The aim of this study was to compare the clinical efficacy of endoscopic cervical spinal surgery with anterior cervical decompression and fusion (ACDF) in the treatment of cervical spondylotic myelopathy (CSM).

Methods: A total of forty-six CSM patients who were admitted to the Medical School of Chinese PLA and treated with endoscopic spine surgery or ACDF from January 2015 to June 2017 were collected. The patients were divided into the spinal endoscopy group and the ACDF group, according to the operation methods.

Surgical treatment of cervical radiculopathy using an anterior cervical endoscopic decompression.

Background: Anterior endoscopic cervical decompression with discectomy and foraminotomy is an alternative to open surgical treatment of unrelenting cervical radiculopathy (CR) in patients who have failed non-operative treatment. The purpose of the study is to present the clinical outcomes of patient with CR treated with an anterior endoscopic approach.

Methods: We reviewed the medical records of 293 patients diagnosed with CR and treated with an anterior endoscopic cervical decompression between 1997 and 2018.

Lumbar vacuum disc, vertical instability, standalone endoscopic interbody fusion, and other treatments: an opinion based survey among minimally invasive spinal surgeons.

Background: A diseased lumbar intervertebral vacuum disc void of any structurally intact tissue may be vertically unstable. A primary standalone endoscopic decompression and interbody fusion surgery in the treatment of vertical instability in patients with a vacuum disc may be a more reliable treatment than decompression alone.

Methods: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups on social media networks, including Facebook, WeChat, WhatsApp, and Linkedin.

Patient selection protocols for endoscopic transforaminal, interlaminar, and translaminar decompression of lumbar spinal stenosis.

Background: The indications of different endoscopic and endoscopically assisted translaminar approaches for lumbar spinal stenosis are not well-defined, and validated protocols for the use of the transforaminal over the interlaminar approach are lacking.

Methods: We performed a retrospective study employing an image-based patient stratification protocol of stenosis location (type I-central canal, type II-lateral recess, type III-foraminal, type IV-extraforaminal) and clinical outcomes on 249 patients consisting of 137 (55%) men and 112 (45%) women with an average age of 56.03±16.

Return to work and recovery time analysis after outpatient endoscopic lumbar transforaminal decompression surgery.

Background: This study aimed to analyze the return to work (RTW) and recovery time (RT) to narcotic independence following outpatient endoscopic decompression for contained lumbar herniated disc causing sciatica-type low back and leg pain.

Methods: A retrospective study of 442 patients with symptomatic contained lumbar herniated disc was treated with the transforaminal endoscopic decompression surgery. The mean follow-up was 33.