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"Direct decompression"

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"Direct decompression"

Original Articles

Microscope Assisted Direct Decompression Combined with Oblique Lumbar Interbody Fusion or Anterior Lumbar Interbody Fusion
Eun-Seok Son, Tae-Won Koo
J Adv Spine Surg 2021;11(2):45-52.   Published online December 31, 2021
Background
Oblique and anterior lumbar interbody fusion have been widely performed in the lumbar spinal disease but we cannot get a direct decompression effect with these procedure. Objective: The purpose of this study is to report clinical and imaging outcomes of microscope assisted direct decompression combined with oblique lumbar interbody fusion (OLIF) or anterior lumbar interbody fusion (ALIF).
Methods
Twelve patients who received microscope assisted direct decompression during OLIF or ALIF for lumbar spinal stenosis were enrolled. The OLIF was performed for the lesion upper than the L4-5 or in the case of multisegmental disease. The ALIF was performed for the lesion at the L5-S1. After anterior-approaching surgery, percutaneous fixation of pedicle screw was performed and we did not perform an additional decompression posteriorly in all cases. For the clinical outcomes, we evaluated short form 36 (SF-36), Oswestry disability index (ODI) score and visual analog scale (VAS) pain score. For the imaging outcomes, we obtained postoperative lumbar magnetic resonance imaging (MRI).
Results
The OLIF was performed for 9 patients and the ALIF was performed for 3 patients. In the clinical outcomes, SF-36 was improved from 25.40 to 69.83 and ODI score was also improved from 69.83 to 16.50. VAS pain score of back was improved from 4.3 to 1.6 and VAS pain score of leg was improved from 7.5 to 2.2. In the imaging outcomes, all patients had severe stenosis before surgery. After surgery the severity of the stenosis was reduced to mild state in 9 cases and moderate state in 3 cases postoperatively.
Conclusions
We could obtain the good clinical outcomes and effective decompression through microscope assisted direct decompression during OLIF or ALIF.
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Percutaneous Pedicle Screw Fixation in Spinal Metastasis: A Preliminary Study
Jae-Woo Park, Sang-Min Park, Choon-Ki Lee, Bong-Soon Chang, Sam Yeol Chang, Hyoungmin Kim
J Adv Spine Surg 2019;9(1):7-13.   Published online June 30, 2019
Objectives
The primary surgical goals when treating a spinal metastasis are usually pain relief and preservation of ambulatory function. Minimally invasive techniques have become popular, being associated with less morbidity and mortality than conventional open surgeries.
Materials and Methods
Between April 2012 and September 2016, 15 consecutive patients underwent percutaneous pedicle screw fixation (PPSF) to treat spinal metastases. We retrospectively analyzed prospectively collected data, including visual analog scale (VAS) pain scores, Frankel scale scores, and complications.
Results
Fifteen patients (8 males, 7 females; mean age 61 years) underwent surgery under general anesthesia. PPSF was performed on all patients, and two with poor bone quality underwent cement augmentation of the manipulated vertebra(e) just prior to pedicle screw insertion. Seven patients underwent fixation plus distraction (indirect decompression via ligamentotaxis) and two laminectomies (direct decompression) of the spinal cord. Two patients developed screw pullout requiring revision surgery. One patient died 7 days after surgery from liver cirrhosis and sepsis. All patients reported that pain was reduced after surgery. After surgery, 12 patients regained ambulatory capacity. Nine patients died during follow-up; the mean overall survival time was 14.1 months.
Conclusions
PPSF is a safe and minimally invasive palliative surgery option for patients with spinal metastases.
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Review Article

Interspinous Process Device
Jun-Yeong Seo
J Adv Spine Surg 2018;8(2):72-79.   Published online December 31, 2018
Interspinous process devices for spinal surgery are designed to keep the spine in a flexed position, to achieve indirect decompression of the mobile segment. Such devices have been fabricated using numerous materials and designs. In this study, the fundamental knowledge required for choosing an appropriate interspinous process device for spinal surgery was reviewed.
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Original Article
Combination of Minimally Invasive Spinal Surgery: Oblique Lumbar Interbody Fusion And Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis – Pilot Study
Ho-Jin Lee, Jae-Sung Ahn, Eugene J. Park, Youk-Sang Kwon
J Adv Spine Surg 2018;8(1):17-25.   Published online June 30, 2018
Objectives
We report the new minimally invasive technique and its clinical results of oblique lumbar interbody fusion (OLIF) combined with central decompression using biportal endoscopic spinal surgery (BESS). Summary of Literature Review: The OLIF procedure is one of the minimally invasive spine surgeries and is being frequently attempted recently to treat lumbar degenerative disease. It has been reported that it effectively decompresses foraminal stenotic lesions indirectly by inserting a large cage anteriorly, which reduces spondylolisthesis and widens the disc space. However, OLIF has limited effect for severe central canal stenosis, since it cannot achieve direct decompression. Therefore, authors report a new minimally invasive technique of OLIF combined with direct central decompression using BESS for severe central stenosis along with its clinical results as a pilot study.
Materials and Methods
For patients who were candidate for fusion surgery due to spondylolisthesis (more than one segment) or foraminal stenosis, authors performed OLIF and central decompression using BESS simultaneously, when the patients had concomitant severe central canal stenosis. From June to December, 2017, 8 patients (16 levels) were enrolled, the operative time, blood loss, complications and clinical results have been evaluated. The clinical results were analyzed by Visual analog scale (VAS) scores, Oswestry disability index (ODI) and Roland Morris Disability Questionnaire (RMDQ) of preoperative, 1month, 3month postoperative and final follow-up.
Results
Mean operative time and blood loss were 238.4 minutes and 173.3ml, respectively. In all cases, there were no operative complications, and mean follow-up period was 7.1 months. The mean back VAS, lower extremity VAS, ODI, and RMDQ at the final follow-up were improved from 5.4±2.4 to 2.0±0.9, 7.0±1.1 to 1.6±1.7, 64.2±11.8 to 44.2±10.6, and from 17.5±4.2 to 12.9±4.0.
Conclusion
A new combination technique of OLIF and BESS for direct decompression can be regarded as effective alternative procedure to treat the foraminal and central stenotic lesions of lumbar degenerative disease.
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