Effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Yin , CAI Peng ,  KONG Qingquan , SONG Yueming

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

KONG Qingquan, Email: kongspine@126.com

Keywords：

Percutaneous endoscopic spine surgery; intraspinal ossification; minimal invasive; lumbar disc herniation; lumbar spinal stenosis

DOI：

10.7507/1002-1892.201705108

Video：

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Objective To investigate the feasibility, effectiveness, and security of percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification. Methods Between July 2008 and June 2016, 96 patients with lumbar spine disorders (lumbar disc herniation or lumbar spinal stenosis) with intraspinal ossification were treated with percutaneous endoscopic spine surgery. There were 59 males and 37 females, aged from 13 to 57 years (mean, 29.5 years). The disease duration was 3-51 months (mean, 18.2 months). Fifty-one cases had trauma history. Ninety-two cases were single segmental unilateral symptom, 4 cases were bilateral symptom. The ossification property was posterior ring apophysis separation in 89 cases, and ossification of the fibrous ring or posterior longitudinal ligament in 7 cases. There were 32 cases of lateral type, 13 cases of central type, and 51 cases of mixed type. The pressure factors, such as nucleus pulposus, hyperplasia of the yellow ligament, joint capsule, or articular osteophyma, were removed under the microscope. Local anesthesia or continuous epidural anesthesia was performed in the transforaminal approach with 50 cases, and continuous epidural anesthesia or general anesthesia was performed in the interlaminar approach with 46 cases. The visual analogue scale (VAS) score was used to evaluate the degree of leg pain preoperatively and at last follow-up. The effectiveness was evaluated at last follow-up according to the modified Macnab criteria. Results All patients were successfully operated. Via transforaminal approach, the mean operation time was 53 minutes and the mean intraoperative fluoroscopy times was 8 times; and via interlaminar approach was 58 minutes and 3 times, respectively. The mean bed rest time after operation was 6.5 hours and the mean hospitalization time was 4.7 days. All patients were followed up 6-18 months (median, 11 months). Postoperative lumbar CT scan and three-dimensional reconstruction after 3 days of operation showed that ossification tissues of 26 cases were not resected, 12 cases were resected partly, and 49 cases were resected completely. Postoperative lumbar MRI after 3 months of operation showed that spinal cord and nerve root were not compressed. At last follow-up, VAS score of leg pain was 0.7±1.1, which was significantly lower than preoperative score (5.8±1.1) (t=1.987, P=0.025). At last follow-up, according to modified Macnab criteria, the results were excellent in 87 cases, good in 5 cases, and fair in 4 cases, and the excellent and good rate was 95.8%. Conclusion Percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification is an effective, safe, and minimal invasive alternative, and the short-term effectiveness is reliable. Accounting for the treatment of intraspinal ossification, comprehensive analysis should be made by combining clinical symptoms, imaging characteristics, and risk assessment.

Citation： LIU Yin, CAI Peng, KONG Qingquan, SONG Yueming. Effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(11): 1326-1333. doi: 10.7507/1002-1892.201705108 Copy

1.	Spetzger U, vonSchilling A, Winkler G, et al. The past, present and future of minimally invasive spine surgery: a review and speculative outlook. Minim Invasive Ther Allied Technol, 2013, 22(4): 227-241.
2.	Telfeian AE, Veeravagu A, Oyelese AA, et al. A brief history of endoscopic spine surgery.Neurosurg Focus, 2016, 40(2): E2.
3.	Hirai T, Yoshii T, Iwanami A, et al. Prevalence and distribution of ossified lesions in the whole spine of patients with cervical ossification of the posterior longitudinal ligament a multicenter study (JOSL CT study). PLoS One, 2016, 11(8): e0160117.
4.	Akhaddar A, Belfquih H, Oukabli M, et al. Posterior ring apophysis separation combined with lumbar disc herniation in adults: a 10-year experience in the surgical management of 87 cases: Clinical article. J Neurosurg Spine, 2011, 14(4): 475-483.
5.	Spivak JM. Current concepts review-degenerative lumbar spinal stenosis. J Bone Joint Surg (Am), 1998, 80(7): 1053-1066.
6.	Macnab I. Negative disc exploration. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
7.	Huang PY, Yeh LR, Tzeng WS, et al. Imaging features of posterior limbus vertebrae.Clin Imaging, 2012, 36(6): 797-802.
8.	Nakajima M, Takahashi A, Tsuji T, et al. A genome-wide association study identifies susceptibility loci for ossification of the posterior longitudinal ligament of the spine. Nat Genet, 2014, 46(9): 1012-1016.
9.	Bae JS, Rhee WT, Kim WJ, et al. Clinical and radiologic analysis of posterior apophyseal ring separation associated with lumbar disc herniation. J Korean Neurosurg Soc, 2013, 53(3): 145-149.
10.	Izumi T, Hirano T, Watanabe K, et al. Three-dimensional evaluation of volume change in ossification of the posterior longitudinal ligament of the cervical spine using computed tomography. Eur Spine J, 2013, 22(11): 2569-2574.
11.	Guo JJ, Luk KD, Karppinen J, et al. Prevalence, distribution, and morphology of ossification of the ligamentumflavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans. Spine (Phila Pa 1976), 2010, 35(1): 51-56.
12.	Wu X, Ma W, Du H, et al.A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation.Eur Spine J, 2013, 22(3): 475-488.
13.	Yamauchi K, Hioki A, Fushimi K, et al. Lumbar Disc Herniation with End-Plate Fracture and Secondary Ossification Mimicking an Epidural Tumor: A Case Report. Open J Orthop, 2013, 3(2): 102-105.
14.	Nakamura K, Yokoyama Y, Wada A, et al. A Case of Acute CaudaEquina Syndrome for Combined Lumbar Ossification of the Posterior Longitudinal and Yellow Ligament. Open J Orthop, 2014, 4: 145-149.
15.	Miwa T, Sakaura H, Yamashita T, et al. Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion.Eur Spine J,2013,22(12): 2864-2868.
16.	黄保华, 袁振超, 周先明, 等. 腰椎椎体后缘离断症两种不同的手术方法疗效比较. 中国内镜杂志, 2015, 21(1): 42-45.
17.	Huang J, Yan H, Jian F, et al. Numerical analysis of the influence of nucleus pulposus removal on the biomechanical behavior of a lumbar motion segment. Comput Methods Biomech Biomed Engin, 2015, 18(14): 1516-1524.
18.	Okumura T, Ebisawa K, Ohhira M, et al. Chronic right lower abdominal pain due to lumbar ossification of the posterior longitudinal ligament. Am J Gastroenterol, 2012, 107(1): 142-143.
19.	Morimoto M, Higashino K, Katoh S, et al. A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation. Case Rep Orthop, 2016,10(7): 1007-1013.
20.	关家文, 张洪涛, 孙海涛, 等.椎管内骨化腰椎间盘突出症的影像分析与内镜治疗. 中国矫形外科杂志, 2016, 24(21): 1932-1937.
21.	Shirado O, Yamazaki Y, Takeda N, et al. Lumbar disc herniation associated with separation of the ring apophysis: is removal of the detached apophyses mandatory to achieve satisfactory results? Clin Orthop Relat Res, 2005, (431): 120-128.

1. Spetzger U, vonSchilling A, Winkler G, et al. The past, present and future of minimally invasive spine surgery: a review and speculative outlook. Minim Invasive Ther Allied Technol, 2013, 22(4): 227-241.
2. Telfeian AE, Veeravagu A, Oyelese AA, et al. A brief history of endoscopic spine surgery.Neurosurg Focus, 2016, 40(2): E2.
3. Hirai T, Yoshii T, Iwanami A, et al. Prevalence and distribution of ossified lesions in the whole spine of patients with cervical ossification of the posterior longitudinal ligament a multicenter study (JOSL CT study). PLoS One, 2016, 11(8): e0160117.
4. Akhaddar A, Belfquih H, Oukabli M, et al. Posterior ring apophysis separation combined with lumbar disc herniation in adults: a 10-year experience in the surgical management of 87 cases: Clinical article. J Neurosurg Spine, 2011, 14(4): 475-483.
5. Spivak JM. Current concepts review-degenerative lumbar spinal stenosis. J Bone Joint Surg (Am), 1998, 80(7): 1053-1066.
6. Macnab I. Negative disc exploration. J Bone Joint Surg (Am), 1971, 53(5): 891-903.
7. Huang PY, Yeh LR, Tzeng WS, et al. Imaging features of posterior limbus vertebrae.Clin Imaging, 2012, 36(6): 797-802.
8. Nakajima M, Takahashi A, Tsuji T, et al. A genome-wide association study identifies susceptibility loci for ossification of the posterior longitudinal ligament of the spine. Nat Genet, 2014, 46(9): 1012-1016.
9. Bae JS, Rhee WT, Kim WJ, et al. Clinical and radiologic analysis of posterior apophyseal ring separation associated with lumbar disc herniation. J Korean Neurosurg Soc, 2013, 53(3): 145-149.
10. Izumi T, Hirano T, Watanabe K, et al. Three-dimensional evaluation of volume change in ossification of the posterior longitudinal ligament of the cervical spine using computed tomography. Eur Spine J, 2013, 22(11): 2569-2574.
11. Guo JJ, Luk KD, Karppinen J, et al. Prevalence, distribution, and morphology of ossification of the ligamentumflavum: a population study of one thousand seven hundred thirty-six magnetic resonance imaging scans. Spine (Phila Pa 1976), 2010, 35(1): 51-56.
12. Wu X, Ma W, Du H, et al.A review of current treatment of lumbar posterior ring apophysis fracture with lumbar disc herniation.Eur Spine J, 2013, 22(3): 475-488.
13. Yamauchi K, Hioki A, Fushimi K, et al. Lumbar Disc Herniation with End-Plate Fracture and Secondary Ossification Mimicking an Epidural Tumor: A Case Report. Open J Orthop, 2013, 3(2): 102-105.
14. Nakamura K, Yokoyama Y, Wada A, et al. A Case of Acute CaudaEquina Syndrome for Combined Lumbar Ossification of the Posterior Longitudinal and Yellow Ligament. Open J Orthop, 2014, 4: 145-149.
15. Miwa T, Sakaura H, Yamashita T, et al. Surgical outcomes of additional posterior lumbar interbody fusion for adjacent segment disease after single-level posterior lumbar interbody fusion.Eur Spine J,2013,22(12): 2864-2868.
16. 黄保华, 袁振超, 周先明, 等. 腰椎椎体后缘离断症两种不同的手术方法疗效比较. 中国内镜杂志, 2015, 21(1): 42-45.
17. Huang J, Yan H, Jian F, et al. Numerical analysis of the influence of nucleus pulposus removal on the biomechanical behavior of a lumbar motion segment. Comput Methods Biomech Biomed Engin, 2015, 18(14): 1516-1524.
18. Okumura T, Ebisawa K, Ohhira M, et al. Chronic right lower abdominal pain due to lumbar ossification of the posterior longitudinal ligament. Am J Gastroenterol, 2012, 107(1): 142-143.
19. Morimoto M, Higashino K, Katoh S, et al. A Rare Case of Progressive Palsy of the Lower Leg Caused by a Huge Lumbar Posterior Endplate Lesion after Recurrent Disc Herniation. Case Rep Orthop, 2016,10(7): 1007-1013.
20. 关家文, 张洪涛, 孙海涛, 等.椎管内骨化腰椎间盘突出症的影像分析与内镜治疗. 中国矫形外科杂志, 2016, 24(21): 1932-1937.
21. Shirado O, Yamazaki Y, Takeda N, et al. Lumbar disc herniation associated with separation of the ring apophysis: is removal of the detached apophyses mandatory to achieve satisfactory results? Clin Orthop Relat Res, 2005, (431): 120-128.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar spine disorders with intraspinal ossification

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