Volume 22 Issue 2
Feb.  2024
Turn off MathJax
Article Contents
YANG Fan, AN Xiaolong, ZHOU Chengpei, ZHU Kailong, QIAN Jixian, QIAN Shu. New progress in minimally invasive surgical treatment of thoracic spinal stenosis[J]. Chinese Journal of General Practice, 2024, 22(2): 292-295. doi: 10.16766/j.cnki.issn.1674-4152.003387
Citation: YANG Fan, AN Xiaolong, ZHOU Chengpei, ZHU Kailong, QIAN Jixian, QIAN Shu. New progress in minimally invasive surgical treatment of thoracic spinal stenosis[J]. Chinese Journal of General Practice, 2024, 22(2): 292-295. doi: 10.16766/j.cnki.issn.1674-4152.003387

New progress in minimally invasive surgical treatment of thoracic spinal stenosis

doi: 10.16766/j.cnki.issn.1674-4152.003387
Funds:

 81871818

  • Received Date: 2023-03-14
    Available Online: 2024-03-27
  • Thoracic spinal stenosis is a group of clinical syndromes caused by a reduction in the effective cross-sectional area of the thoracic spinal canal. This reduction leads to compression of the spinal cord or nerve roots at the corresponding level due to various pathogenic factors including ossification of the ligament flavum, ossification of the posterior longitudinal ligament, thoracic disc herniation, osteophyte formation at the posterior edge of the vertebral body, and hyperplasia of the vertebral facet joint. Symptoms commonly observed in patients include lower limb numbness, weakness, and difficulty in walking. Although the incidence of thoracic spinal stenosis is lower compared with cervical and lumbar spinal stenosis, delayed diagnosis and treatment often result in a poor prognosis and significant burden on daily life. The traditional treatment method involves total laminectomy via a posterior median approach. However, this approach has drawbacks such as damage to the stability of the posterior column, increased bleeding, and a long postoperative recovery period. In recent years, chiropractors have been exploring the application and feasibility of minimally invasive techniques in the treatment of thoracic spinal stenosis, leading to significant advancements. These advancements include microendoscopic decompression technology, microscopes assisted decompression, percutaneous endoscopy, unilateral double-channel endoscopy in thoracic vertebral diseases, and the use of spinal navigation and robot assistance technologies. These techniques have improved the therapeutic efficacy of thoracic spinal stenosis, reduced trauma and complications, and enhanced the recovery of patients. Notably, percutaneous endoscopy and unilateral biportal endoscopy technologies have shown promising outcomes in the treatment of thoracic spinal stenosis. This article provides a comprehensive review of the research on minimally invasive surgical treatment for thoracic spinal stenosis.

     

  • loading
  • [1]
    中华医学会骨科学分会脊柱外科学组. 胸椎管狭窄症诊疗指南[J]. 中华骨科杂志, 2015, 35(1): 1-5. doi: 10.3760/cma.j.issn.0253-2352.2015.01.001

    Group of Spinal Surgery, Chinese Orthopaedic Society. Guidelines for the diagnosis and treatment of thoracic spinal stenosis[J]. Chinese Journal of Orthopaedics, 2015, 35(1): 1-5. doi: 10.3760/cma.j.issn.0253-2352.2015.01.001
    [2]
    MOON B J, KUH S U, KIM S, et al. Prevalence, distribution, and significance of incidental thoracic ossification of the ligamentum flavum in Korean patients with back or leg pain: MR-based cross sectional study[J]. J Korean Neurosurg Soc, 2015, 58(2): 112-118. doi: 10.3340/jkns.2015.58.2.112
    [3]
    MORI K, KASAHARA T, MIMURA T, et al. Prevalence, distribution, and morphology of thoracic ossification of the yellow ligament in Japanese[J]. Spine (Phila Pa 1976), 2013, 38(19): E1216-1222. DOI: 10.1097/BRS.0b013e31829e018b.
    [4]
    LANG N, YUAN H S, WANG H L, et al. Epidemiological survey of ossification of the ligamentum flavum in thoracic spine: CT imaging observation of 993 cases[J]. Eur Spine J, 2013, 22(4): 857-862. doi: 10.1007/s00586-012-2492-8
    [5]
    JHO H D. Endoscopic microscopic transpedicular thoracic discectomy. Technical note[J]. J Neurosurg, 1997, 87(1): 125-129. doi: 10.3171/jns.1997.87.1.0125
    [6]
    SMITH J S, EICHHOLZ K M, SHAFIZADEH S, et al. Minimally invasive thoracic microendoscopic diskectomy: surgical technique and case series[J]. World Neurosurg, 2013, 80(3-4): 421-427. doi: 10.1016/j.wneu.2012.05.031
    [7]
    IKUTA K, TARUKADO K, SENBA H, et al. Decompression procedure using a microendoscopic technique for thoracic myelopathy caused by ossification of the ligamentum flavum[J]. Minim Invasive Neurosurg, 2011, 54(5-6): 271-273.
    [8]
    BABA S, SHIBOI R, YOKOSUKA J, et al. Microendoscopic posterior decompression for treating thoracic myelopathy caused by ossification of the ligamentum flavum: case series[J]. Medicina, 2020, 56(12): 684. doi: 10.3390/medicina56120684
    [9]
    MURPHY M E, HAKIM J S, KEREZOUDIS P, et al. Micro vs. macrodiscectomy: does use of the microscope reduce complication rates?[J]. Clin Neurol Neurosurg, 2017, 152: 28-33. doi: 10.1016/j.clineuro.2016.11.010
    [10]
    REGEV G J, SALAME K, BEHRBALK E, et al. Minimally invasive transforaminal, thoracic microscopic discectomy: technical report and preliminary results and complications[J]. Spine J, 2012, 12(7): 570-576. doi: 10.1016/j.spinee.2012.07.001
    [11]
    陈会平. 经皮微通道显微镜手术治疗局灶性胸椎黄韧带的疗效观察及其影响因素分析[J]. 颈腰痛杂志, 2018, 39(1): 5-8. https://www.cnki.com.cn/Article/CJFDTOTAL-JYTZ201801001.htm

    CHEN H P. Efficacy of percutaneous microchannel microscopy in 68 cases of focal ossification of thoracic ligamentum flavum[J]. The Journal of Cervicodynia and Lumbodynia, 2018, 39(1): 5-8. https://www.cnki.com.cn/Article/CJFDTOTAL-JYTZ201801001.htm
    [12]
    王瑶, 李劲松, 陈友虎, 等. 显微镜微通道单侧入路治疗孤立型胸椎黄韧带骨化症[J]. 临床骨科杂志, 2021, 24(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-LCGK202101001.htm

    WANG Y, LI J S, CHEN Y H, et al. Microscopic microchannel unilateral approach in the treatment of isolated ossification of ligamentum flavum of thoracic vertebrae[J]. Journal of Clinical Orthopaedics, 2021, 24(1): 1-5. https://www.cnki.com.cn/Article/CJFDTOTAL-LCGK202101001.htm
    [13]
    JIA Z Q, HE X J, ZHAO L T, et al. Transforaminal endoscopic decompression for thoracic spinal stenosis under local anesthesia[J]. Eur Spine J, 2018, 27(S3): 465-471. doi: 10.1007/s00586-018-5479-2
    [14]
    AN B, LI X C, ZHOU C P, et al. Percutaneous full endoscopic posterior decompression of thoracic myelopathy caused by ossification of the ligamentum flavum[J]. Eur Spine J, 2019, 28(3): 492-501. doi: 10.1007/s00586-018-05866-2
    [15]
    LI X C, AN B, GAO H R, et al. Surgical results and prognostic factors following percutaneous full endoscopic posterior decompression for thoracic myelopathy caused by ossification of the ligamentum flavum[J]. Sci Rep, 2020, 10(1): 1305. doi: 10.1038/s41598-020-58198-x
    [16]
    CHENG X K, CHEN B. Percutaneous endoscopic thoracic decompression for thoracic spinal stenosis under local anesthesia[J]. World Neurosurg, 2020, 139: 488-494. doi: 10.1016/j.wneu.2020.04.199
    [17]
    SHEN J, TELFEIAN A E. Fully endoscopic 360° decompression surgery for thoracic spinal stenosis: technical note and report of 8 cases[J]. Pain Physician, 2020, 23(6): E659-E663.
    [18]
    XIN Z J, KONG W J, CAI M H, et al. Translaminar osseous channel-assisted full-endoscopic flavectomy decompression of thoracic myelopathy caused by ossification of the ligamentum flavum: surgical technique and results[J]. Pain Physician, 2020, 23(5): E475-E486.
    [19]
    PARK J H, JUN S G, JUNG J T, et al. Posterior percutaneous endoscopic cervical foraminotomy and diskectomy with unilateral biportal endoscopy[J]. Orthopedics, 2017, 40(5): E779-E783. DOI: 10.3928/01477447-20170531-02.
    [20]
    HEO D H, SHARMA S, PARK C K. Endoscopic treatment of extraforaminal entrapment of L5 nerve root (Far Out Syndrome) by unilateral biportal endoscopic approach: Technical Report and Preliminary Clinical Results[J]. Neurospine, 2019, 16(1): 130-137. doi: 10.14245/ns.1938026.013
    [21]
    QUILLO-OLVERA J, QUILLO-OLVERA D, QUILLO-RESÉNDIZ J, et al. Unilateral biportal endoscopic-guided transcorporeal vertebroplasty with neural decompression for treating a traumatic lumbar fracture of L5[J]. World Neurosurg, 2020, 144: 74-81. doi: 10.1016/j.wneu.2020.08.130
    [22]
    AN J W, LEE C W. Surgical treatment of extraforaminal gas-containing pseudocyst compressing L5 nerve root by using unilateral biportal endoscopy[J]. World Neurosurg, 2019, 124: 145-150. doi: 10.1016/j.wneu.2018.12.186
    [23]
    YUAN C H, WEN B J, LIN H K. Clinical analysis of minimally invasive percutaneous treatment of severe lumbar disc herniation with UBE two-channel endoscopy and foraminal single-channel endoscopy technique[J]. Oxid Med Cell Longev, 2022: 9264852. DOI: 10.1155/2022/9264852.
    [24]
    WANG B, HE P, LIU X W, et al. Complications of unilateral biportal endoscopic spinal surgery for lumbar spinal stenosis: a systematic review of the literature and meta-analysis of Single-arm studies[J]. Orthop Surg, 2023, 15(1): 3-15. doi: 10.1111/os.13437
    [25]
    LI X B, LIU J, LIU Z W. Comparison of the results of open PLIF versus UBE PLIF in lumbar spinal stenosis: postoperative adjacent segment instability is lesser in UBE[J]. J Orthop Surg Res, 2023, 18(1): 543. doi: 10.1186/s13018-023-04038-3
    [26]
    KANG M S, CHUNG H J, YOU K H, et al. How i do it: biportal endoscopic thoracic decompression for ossification of the ligamentum flavum[J]. Acta Neurochir, 2022, 164(1): 43-47. doi: 10.1007/s00701-021-05031-7
    [27]
    CHESNEY K, TRIANO M, DOWLATI E, et al. Cirq robotic arm-assisted transpedicular instrumentation with intraoperative navigation: technical note and case series with 714 thoracolumbar screws[J]. J Robot Surg, 2022, 16(4): 893-893. doi: 10.1007/s11701-021-01313-5
    [28]
    JAIN D, MANNING J, LORD E, et al. Initial single-institution experience with a novel robotic-navigation system for thoracolumbar pedicle screw and pelvic screw placement with 643 screws[J]. Int J Spine Surg, 2019, 13(5): 459-463. doi: 10.14444/6060
    [29]
    TIAN W, WENG C, LIU B, et al. Intraoperative 3-dimensional navigation and ultrasonography during posterior decompression with instrumented fusion for ossification of the posterior longitudinal ligament in the thoracic spine[J]. J Spinal Disord Tech, 2013, 26(6): E227-E234. doi: 10.1097/BSD.0b013e318286ba39
    [30]
    KOLCUN J P G, WANG M Y. Endoscopic treatment of thoracic discitis with robotic access: a case report merging two cutting-edge technologies[J]. World Neurosurg, 2019, 126: 418-422. doi: 10.1016/j.wneu.2019.03.036
    [31]
    LI Q, DU Z J, YU H J. Precise laminae segmentation based on neural network for robot-assisted decompressive laminectomy[J]. Comput Methods Programs in Biomed, 2021, 209: 106333. DOI: 10.1016/j.cmpb.2021.106333.
    [32]
    SUN Y, JIANG Z, QI X, et al. Robot-assisted decompressive laminectomy planning based on 3D medical image[J]. IEEE Access, 2018, 6: 22557-22569. DOI: 10.1109/ACCESS.2018.2828641
    [33]
    MOLINA C A, PHILLIPS F M, COLMAN M W, et al. A cadaveric precision and accuracy analysis of augmented reality-mediated percutaneous pedicle implant insertion[J]. J Neurosurg Spine, 2020, 34(2): 316-324.
    [34]
    芦怀旺, 田霖, 胡鹏, 等. 单侧双通道内镜治疗单责任节段腰椎管狭窄症的短期临床疗效分析[J]. 中华全科医学, 2023, 21(3): 413-416. doi: 10.16766/j.cnki.issn.1674-4152.002896

    LU H W, TIAN L, HU P, et al. Short-term clinical effect analysis of unilateral biportal endoscopic surgery for of single responsible segment lumbar spinal stenosis[J]. Chinese Journal of General Practice, 2023, 21(3): 413-416. doi: 10.16766/j.cnki.issn.1674-4152.002896
    [35]
    韩康, 谭树森, 张政, 等. 靶向破黄法在单侧双通道脊柱内镜技术治疗腰椎间盘突出症中的临床疗效[J]. 中华全科医学, 2023, 21(4): 560-564, 571. doi: 10.16766/j.cnki.issn.1674-4152.002930

    HAN K, TIAN S S, ZHANG Z, et al. Clinical analysis of targeted broken ligamentum flavum method of unilateral biportal endoscopy in the treatment of lumbar spinal stenosis[J]. Chinese Journal of General Practice, 2023, 21(4): 560-564, 571. doi: 10.16766/j.cnki.issn.1674-4152.002930
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Article Metrics

    Article views (89) PDF downloads(8) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return