Name: laminectomy for the removal of thoracic ossification of the ligamentum flavum (tolf) using ultrasonic and conventional osteotomes
Uploaded: 2023-04-21T12:20:00.000+00:00
Duration: 7 min 12 s
Description: Watch this Scientific Journal Video about Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum TOLF Using Ultrasonic and Conventional Osteotomes at JoVE.com

Funding was provided by the Zhejiang Medical and Health Science and Technology project (project numbers: 2021433841 and 2023564481).

Ethical approval was obtained from the Medical Ethics Committee of the authors&#39; hospital. Informed consent was obtained from each patient.
1. Inclusion/exclusion criteria and preoperative preparation
<ol>
	<li>Include patients with the following preoperative symptoms: unable to walk steadily, numbness of the lower limbs, atrophy of the lower limbs, leg weakness, uncontrolled movement of the lower extremities, or sphincter dysfunction, etc., as well as signs and imaging data consistent with thoracic myelopathy.</li>
	<li>Exclude patients based on the following criteria: the presence of cervical spinal stenosis or lumbar spinal stenosis (confirmed by MRI), thoracic disk herniation or ossification of the posterior longitudinal ligament (confirmed by CT), fracture, or an infection or tumor of the spine.</li>
	<li>Place the patient in a prone position under general anesthesia.</li>
	<li>Conduct neurophysiological monitoring involving somatosensory evoked potentials (SSEPs) and motor-evoked potentials (MEPs) throughout the surgery.</li>
	<li>Identify the TOLF levels with the C-arm before the operation.</li>
</ol>
2. Incision and approach
<ol>
	<li>Disinfect the surgical area using povidone-iodine (PVP-I), and drape the area with sterile surgical towels.</li>
	<li>Identify the involved levels of the TOLF preoperatively using the C-arm X-ray machine.</li>
	<li>Make a longitudinal midline incision over the spinous processes using a scalpel, extending from the spinous process above to the spinous process below the level of the TOLF. 
	NOTE: One segment is about 10 cm long. The incision should extend from the spinous process above to the spinous process below the level of the TOLF.</li>
	<li>Expose the posterior bony structure, including the spinous processes, bilateral lamina, and zygapophyseal joints of the involved levels using a unipolar electrotome.</li>
	<li>Determine the pedicle screw entry points (the intersection between the midlines of the facet joint and transverse process). Insert pedicle marker pins to mark the pedicle screw entry points, and use these as a reference for the lateral border of the thoracic spinal cord.</li>
	<li>Define a rectangular decompression zone as the area between the midpoint of the facet joints bilaterally and between the inferior portions of the superior lamina (beneath the caudal edge of the pedicle, which can be located by the pedicle marker pins) and the superior portions of the inferior lamina (above the cranial edge of the pedicle) of the involved TOLF segments (Figure 3).</li>
</ol>
3. Decompression
<ol>
	<li>Remove the spinous processes, along with the supraspinous and interspinous ligaments, using a bone rongeur from the cranial to the caudal end of the decompression zone. Usually, maintain a part of the spinous process to help in removing the lamina.
	<ol>
		<li>Irrigate the incision with saline to identify bleeding sites, and block any bleeding sites with sterilized medical styptic gauge on the residual supraspinous.</li>
	</ol>
	</li>
	<li>Use an ultrasonic osteotome to cut the lamina horizontally on the cranial and the caudal ends of the decompression zone and longitudinally between the midpoint of the facet joints bilaterally. Perform the cutting until the surgeon feels the lamina has been cut through (The cutting can be done multiple times).</li>
	<li>Use a conventional osteotome to lever the lamina upward and turn it from side to side. A cracking sound of the bone indicates that the lamina has been completely cut off (Figure 4).</li>
	<li>After the lamina has been loosened, use one or two towel clamps to clamp the root of the spinous process, and elevate the entire lamina carefully. When there is adhesion between the ossified tissue and the dura mater, use a nerve dissector for disattachment.</li>
	<li>Trim the remaining articular process and the edge of the lamina on both sides with Kerrison rongeurs to ensure full decompression.</li>
</ol>
4. Internal fixation
<ol>
	<li>After thorough hemostasis with bipolar electrocoagulation and styptic cream, cover the dural surface with a gelatin sponge, or fluid gelatin, and neurosurgical sponge (e.g., Cottonoid). Then, replace the pedicle marker pins with pedicle screws.</li>
	<li>Connect the screws with titanium rods, and tighten the screw nuts.</li>
	<li>Mince the bone fragments from the vertebral lamina, and implant the fragments bilaterally between the transverse processes. Throughout the operation, achieve hemostasis using bipolar electrocoagulation and styptic cream.</li>
</ol>
5. Postoperative treatment
<ol>
	<li>Perform Jackson-Pratt drainage routinely for 24-48 h in patients without dural tears14. Administer dehydration management and neurotrophic medications after the operation.</li>
	<li>Administer intravenous methylprednisolone (40 mg) for 3 days.</li>
	<li>Instruct the patients to perform rehabilitation exercises to help functional recovery.</li>
</ol>

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The authors have nothing to disclose.

Laminectomy is the conventional treatment method for thoracic ossified ligamentum flavum. However, the improper use of traditional bone-cutting equipment, such as high-speed drills and revolving burrs, can result in nerve thermal injury, grasping the soft tissue, tearing the dura mater, and mechanical injury15,16,17. An ultrasonic osteotome is a novel bone-cutting tool used for precise osteotomies. This device allows for bone di...

Thoracic ossification of the ligamentum flavum (TOLF) is one of the major causes of thoracic spinal stenosis and has been established as the primary cause of thoracic myelopathy1,2,3. TOLF is characterized by the replacement of the ligamentum flavum by ectopic new bone formation. The incidence of TOLF is as high as 36% in Japan and 63.9% in China. Most patients show slow progression to symptomatic thoracic canal stenosis or thoracic myelopathy4. Decompression is the only effective treatment for TOLF once it becomes symptomatic since conservative treatment is usually ineffective5.
Laminoplasty, laminectomy, and lamina fenestration are three surgical techniques that have been demonstrated to be effective for TOLF6,7,8. However, the surgical outcomes are not always satisfactory. The conventional methods can result in a high rate of perioperative complications such as dural laceration and/or iatrogenic spinal cord injury9,10. Therefore, it is important to develop a more efficient and secure surgical technique for TOLF.
Here, we describe in detail a method for laminectomy of the thoracic spine using an ultrasonic osteotome combined with a conventional osteotome to resect the lamina (Figure 1). An ultrasonic osteotome is a precision tool that uses ultrasonic oscillations in its blade to selectively cut mineralized tissue, preventing collateral tissue damage11. The technique presented herein is a relatively safe and easy-to-learn method that should be recommended for the treatment of TOLF.
An ultrasonic osteotomy system is designed to cut hard bone structures effectively while preserving soft tissues by converting the electrical input signal into vertically mechanical oscillations at an amplitude of 0-120 &#181;m and a frequency of 39 kHz. The system consists of a power unit, a handpiece, several tips, and a footswitch. An irrigation pump is also integrated into the system, and this delivers saline to the cutting edge to reduce local thermal necrosis.
Presented here is a case of 57 year old male patient who presented with lower limb weakness with unsteady walking for 3 years. The symptoms were more pronounced on the right side. Physical examination revealed that the patient&#39;s muscle strength grade12 was 5 (barely detectable weakness) for both the lower limbs. Additionally, numbness of the skin occurred when acupuncture was applied below the left inguinal plane, hypoesthesia was observed when needling the skin in the saddle area, the deep tendon reflexes were slightly increased in both lower limbs, and the Babinski sign13 was positive. X-ray, CT, and MRI showed thoracic ossification of the ligamentum flavum at T10-11. The preoperative data are presented in Figure 2.

<table><tbody><tr><td>C-arm X-ray machine</td><td>GE&amp;nbsp;</td><td>20192060063</td><td>/</td></tr><tr><td>Cera styptica</td><td>Johnson&amp;amp;Johnson (China) Medical Equipment Co., Ltd</td><td>W810T</td><td>/</td></tr><tr><td>Conventional osteotome</td><td>Suzhou qingniu medical instrument co.</td><td>10012.01</td><td>/</td></tr><tr><td>Cottonoids</td><td>Piaoan Holding Group Co., Ltd</td><td>20182640073</td><td>/</td></tr><tr><td>Fluid gelatin</td><td>Johnson&amp;amp;Johnson (China) Medical Equipment Co., Ltd</td><td>20183142459</td><td>/</td></tr><tr><td>Gelatin sponge</td><td>B.Braun Melsungen AG&amp;nbsp;</td><td>20163642299</td><td>/</td></tr><tr><td>Jackson&amp;ndash;Pratt drainage</td><td>Suzhou Weikang Medical Equipment Co., Ltd</td><td>20162140955</td><td>/</td></tr><tr><td>Kerrison Rongeurs</td><td>Jinzhong Medical Instruments Co., Ltd</td><td>2100888</td><td>/</td></tr><tr><td>Nerve dissector</td><td>Jinzhong Medical Instruments Co., Ltd</td><td>p23110</td><td>/</td></tr><tr><td>Pedicle screw</td><td>Medtronic</td><td>76446545</td><td>/</td></tr><tr><td>Towel clamps</td><td>KEWEIDUN</td><td>10058468134417&amp;nbsp;&amp;nbsp;&amp;nbsp;</td><td>/</td></tr><tr><td>Ultrasonic Osteotomy Surgical System</td><td>SMTP Technology Co.</td><td>FD880A</td><td>/</td></tr><tr><td>Unipolar/bipolar electrotome</td><td>Shanghai Hutong Electronics Co., Ltd&amp;nbsp;</td><td>20143251899</td><td>/</td></tr></tbody></table>

laminectomy for the removal of thoracic ossification of the ligamentum flavum (tolf) using ultrasonic and conventional osteotomes

Thoracic ossification of the ligamentum flavum (TOLF) is a common cause of progressive thoracic myelopathy. TOLF is typically treated with surgical decompression. A variety of surgical techniques, including laminoplasty, laminectomy, and lamina fenestration, are used for the effective treatment of TOLF. However, traditional methods are associated with a substantial risk of perioperative complications, including dural laceration and/or iatrogenic spinal cord injury. Therefore, it is important to develop an efficient and secure surgical technique for TOLF. Herein, we describe a method for laminectomyperformed at the thoracic spine using an ultrasonic osteotome combined with a conventional osteotome. This technique can reduce intraoperative complications. This is a relatively safe and easy-to-learn method that should be recommended for the treatment of TOLF.

Representative case results 
On the first postoperative day, the CT scans revealed that the ossification had been fully removed, and the spinal cord had been completely decompressed (Figure 5). The patient could walk steadily. The muscle strength of both lower limbs was 5. The patient was discharged 3 days after the operation.
A total of 71 patients were enrolled in the study. All surgeries were carried out satisfactorily. The mean duration o...

Watch this Scientific Journal Video about Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum TOLF Using Ultrasonic and Conventional Osteotomes at JoVE.com

Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum TOLF Using Ultrasonic and Conventional Osteotomes

We present a methodology for using an ultrasonic osteotome combined with a conventional osteotome for laminectomy in thoracic ossification of the ligamentum flavum. This is a relatively safe and easy-to-learn method that avoids the perioperative complications associated with the conventional method.

Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum (TOLF) Using Ultrasonic and Conventional Osteotomes

Thoracic ossification of the ligamentum flavum (TOLF) is a common cause of progressive thoracic myelopathy. TOLF is typically treated with surgical ...

laminectomy-for-removal-thoracic-ossification-ligamentum-flavum-tolf

Research

JoVE Journal

Medicine

2.5K Views.  Zhejiang University. We present a methodology for using an ultrasonic osteotome combined with a conventional osteotome for laminectomy in thoracic ossification of the ligamentum flavum. This is a relatively safe and easy-to-learn method that avoids the perioperative complications associated with the conventional method.

Video: Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum TOLF Using Ultrasonic and Conventional Osteotomes

Laminotomy for Lumbar Dorsal Root Ganglion Access and Injection in Swine

Dorsal root ganglia (DRG) are anatomically well defined structures that contain all primary sensory neurons below the head. This fact makes DRG attractive targets for injection of novel therapeutics aimed at treating chronic pain. In small animal models, laminectomy has been used to facilitate DRG injection because it involves surgical removal of the vertebral bone surrounding each DRG. We demonstrate a technique for intraganglionic injection of lumbar DRG in a large animal species, namely, swine. Laminotomy is performed to allow direct access to DRG using standard neurosurgical techniques, instruments, and materials. Compared with more extensive bone removal via laminectomy, we implement laminotomy to conserve spinal anatomy while achieving sufficient DRG access. Intraoperative progress of DRG injection is monitored using a non-toxic dye. Following euthanasia on post-operative day 21, the success of injection is determined by histology for intraganglionic distribution of 4&#39;,6-diamidino-2-phenylindole (DAPI). We inject a biologically inactive solution to demonstrate the protocol. This method could be applied in future preclinical studies to target therapeutic solutions to DRG. Our methodology should facilitate testing the translatability of intraganglionic small animal paradigms in a large animal species. Additionally, this protocol may serve as a key resource for those planning preclinical studies of DRG injection in swine.

We describe a method for laminotomy in swine that provides access to lumbar dorsal root ganglia (DRG) for intraganglionic injection. Injection progress is monitored intraoperatively and histologically confirmed up to 21 days after surgery. This protocol could be used for future preclinical studies involving DRG injection.

Dorsal root ganglia (DRG) are anatomically well defined structures that contain all primary sensory neurons below the head. This fact makes DRG attractive ...

Neuroscience

Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. Minimally invasive surgery (MIS) approaches have been applied to this technique with an associated decrease in estimated blood loss (EBL), length of hospital stay, and infection rates, while preserving outcomes with traditional open surgery. Previous MIS TLIF techniques involve significant fluoroscopy that subjects the patient, surgeon, and operating room staff to non-trivial levels of radiation exposure, particularly for complex multi-level procedures. We present a technique that utilizes an intraoperative computed tomography (CT) scan to aid in placement of pedicle screws, followed by traditional fluoroscopy for confirmation of cage placement. Patients are positioned in the standard fashion and a reference arc is placed in the posterior superior iliac spine (PSIS) followed by intraoperative CT scan. This allows for image-guidance-based placement of pedicle screws through a one-inch skin incision on each side. Unlike traditional MIS-TLIF that requires significant fluoroscopic imaging during this stage, the operation can now be performed without any additional radiation exposure to the patient or operating room staff. After completion of the facetectomy and discectomy, final TLIF cage placement is confirmed with fluoroscopy. This technique has the potential to decrease operative time and minimize total radiation exposure.

The purpose of this article is to provide image-guidance for minimally invasive transforaminal interbody fusion.

Transforaminal lumbar interbody fusion (TLIF) is commonly used for the treatment of spinal stenosis, degenerative disc disease, and spondylolisthesis. ...

C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 level (OLIF51) is technically difficult because of the anatomical structures. We present a novel simultaneous technique of OLIF51 with percutaneous pedicle screw fixation without fluoroscopy. The patient is placed in a right lateral decubitus position. A percutaneous reference pin is inserted into the right sacroiliac joint. An O-arm scan is performed, and 3D reconstructed images are transmitted to the spinal navigation system. A 4 cm oblique skin incision is made under navigation guidance along the pelvis. The internal/external and transverse abdominal muscles are divided along the muscle fibers, protecting the iliohypogastric and ilioinguinal nerves. Using a retroperitoneal approach, the left common iliac vessels are identified. Special muscle retractors with illumination are used to expose the L5-S1 intervertebral disc. After disc preparation with navigated instruments, the disc space is distracted with navigated trials. Autogenous bone and demineralized bone material are then inserted into the cage hole. The OLIF51 cage is inserted into the disc space with the help of a mallet. Simultaneously, percutaneous pedicle screws are inserted by another surgeon without changing the lateral decubitus position of the patient.
In conclusion, C-arm-free OLIF51 and simultaneous percutaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This novel technique reduces surgical time and radiation hazards.

C-arm-free oblique lumbar interbody fusion at the L5-S1 level (OLIF51) and simultaneous pedicle screw fixation are performed in a lateral position under navigation guidance. This technique does not expose the surgeon or operating staff to radiation hazards.

Oblique lumbar interbody fusion (OLIF) is an established technique for the indirect decompression of lumbar canal stenosis. However, OLIF at the L5-S1 ...

Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may cause severe thoracolumbar kyphotic deformity, often accompanied by intractable low back pain or compression of the spinal cord, leading to severe neurological symptoms or even paralysis. If conservative treatment cannot relieve the symptoms or correct the deformities, surgical treatment is usually needed. For severe kyphotic deformity, reconstruction of the physiological curvature and rigid fixation determine the prognosis of the patients. Osteotomy and orthopedics are the standard procedure for deformities with severe compression of the front and middle column, but the trauma to the patients is high, with a long operation time and massive blood loss. To avoid these disadvantages, we have developed a modified technique to remove the diseased vertebra unilaterally. In this technique, we use a modified trephine to resect the vertebral columns like in the pedicle screw technique by adding a locking instrument that can restrict the trephine to lower the risk of osteotomy and shorten the surgery time and blood loss.

We describe a modified technique for resecting the posterior vertebral column unilaterally based on a modified trephine for patients with thoracolumbar kyphotic deformity.

Old compression vertebrae fracture or congenital kyphoscoliosis with abnormal vertebral body development and other diseases that invade the spine may ...

Application of the O-arm Intraoperative Imaging System to Assist Anterior Cervical Screw Fixation for Odontoid Fractures

Odontoid fractures account for a large proportion of cervical spine fractures in the elderly, causing pain in the occiput and the back of the neck and restricting neck movement. Anterior cervical screw fixation is a common surgical procedure to treat odontoid fractures. Due to the special location and complex anatomy of the odontoid, surgeons need to perform intraoperative fluoroscopies repeatedly to ensure correct screw position and avoid damage to the peripheral nerves and vessels of the odontoid. The traditional anterior cervical screw fixation is usually conducted with the assistance of a C-arm. However, compared to the C-arm, an O-arm intraoperative imaging system can provide 3D images during surgery, which improves the accuracy of screw placement. This study retrospectively analyzed patients with anterior cervical odontoid fractures treated in our hospital. The application of the O-arm intraoperative imaging system for assisting screw placement in the treatment of odontoid fractures can reduce intraoperative blood loss, operation time, and trauma to the patients.

This study describes the application of the O-arm intraoperative imaging system in odontoid fractures.

Odontoid fractures account for a large proportion of cervical spine fractures in the elderly, causing pain in the occiput and the back of the neck and ...

Full-Endoscopic Decompression for Thoracic Ossification of the Ligamentum Flavum Combined with Dural Ossification

Ossification of the ligamentum flavum (OLF) can result in spinal stenosis. Thoracic spinal cord compression due to spinal stenosis is a common cause of progressive thoracic myelopathy in Asian countries. The incidence of complications is high in open decompression surgeries for thoracic OLF. With dural ossification (DO), the risk of complications is even higher in thoracic OLF. We introduce a full-endoscopic decompression surgery for thoracic OLF combined with DO under local anesthesia. Hemilaminectomy is performed using a high-speed burr under the endoscopy first, and then decompression of the contralateral spinal canal is completed using an "over the top" technique. DO resection uses the eggshell technique; after the base of the DO is cut from the lamina, forceps or lamina rongeurs are typically used for removal. The dural defect left after resection does not need repair. Neurological function was improved, and no complications such as hematoma or neck pain occurred. On imaging, no pseudodural cyst, cerebrospinal fluid leakage, or wound complications were observed after the operation. Endoscopic surgery causes less damage to the posterior ligament complex, so no cases of persistent back pain complaints or secondary internal fixation requirements were found in this study. Full-endoscopic decompression can achieve good imaging and clinical effects in the treatment of thoracic OLF with DO.

We describe a minimally invasive surgery using a full-endoscopy system for the single segmental thoracic ossification of the ligamentum flavum, combined with dural ossification, at Hebei General Hospital.

Ossification of the ligamentum flavum (OLF) can result in spinal stenosis. Thoracic spinal cord compression due to spinal stenosis is a common cause of ...

Full-Endoscopic Interlaminar Approach for Decompression of Lateral Recess Stenosis

For lateral recess stenosis, extensive decompression with laminectomy is still performed in most centers. However, tissue-sparing surgeries are becoming more common. Full-endoscopic spinal surgeries have the advantages of being less invasive and offering a shorter recovery time. Here, we describe the technique of the full-endoscopic interlaminar approach for the decompression of lateral recess stenosis. The full-endoscopic interlaminar approach for the lateral recess stenosis procedure took approximately 51 min (range of 39-66 min). Blood loss could not be measured due to continuous irrigation. However, no drainage was required. There were no dura mater injuries reported in our institution. Furthermore, there were no injuries to the nerves, no cauda equine syndrome, and no hematoma formation. The patients were mobilized on the same day as surgery and discharged the next day. Therefore, the full-endoscopic technique for lateral recess stenosis decompression is a feasible procedure that lowers the operational time, complications, traumatization, and rehabilitation duration.

Technical advances and increased experience in full-endoscopic spinal surgeries enable these procedures to be performed with minimal incision, muscle retraction, and bone removal.

For lateral recess stenosis, extensive decompression with laminectomy is still performed in most centers. However, tissue-sparing surgeries are becoming ...

A 3-Channel Endoscopic Technique for Lumbar Stenosis and Contralateral Herniation

The Third Channel-Assisted Unilateral Biportal Endoscopic Technique for Lumbar Spinal Stenosis Combined with Contralateral Disc Herniation

Unilateral biportal endoscopic (UBE) spine surgery is an emerging minimally invasive surgical (MIS) technique that has gained popularity for treating lumbar spinal stenosis, particularly in Eastern Asia. The traditional UBE technique, with two portals on one side, can achieve successful unilateral laminotomy for bilateral decompression (ULBD) and, therefore, demonstrates favorable clinical outcomes. However, in the case of lumbar spinal stenosis combined with contralateral disc herniation, it is very difficult to remove the contralateral disc herniation, especially the loose disc fragment within the deep disc. Here, a third channel of the traditional UBE technique was developed to do the discectomy within the ipsilateral endoscopic vision, with which the instruments can go vertically into the contralateral disc, allowing easy discectomy. This technique can not only achieve adequate decompression of the bilateral spinal canal but also effectively remove contralateral herniated disc fragments. This technique avoids performing another UBE procedure on the opposite side, which can potentially shorten the duration of the operation, minimize blood loss and tissue damage, and ensure sufficient neural decompression. This paper will introduce the indications and surgical operation procedures, as well as present a classical case report and follow-up data, to facilitate the application of the third channel-assisted UBE (T-UBE) technique for spine surgeons.

Author Spotlight: Unveiling the Potential of TUBE Technique in Spinal Surgery

Here, we present the third channel-assisted UBE technique, which allows for the vertical removal of herniated disc fragments. This technique can effectively address the limitations of traditional UBE techniques. This article will systematically elaborate on this procedure.

Unilateral biportal endoscopic (UBE) spine surgery is an emerging minimally invasive surgical (MIS) technique that has gained popularity for treating ...

A Modified Eggshell Technique for Sclerosing Thoracic Disc Herniation

Sclerosing thoracic disc herniation refers to a condition in which the intervertebral disc in the thoracic region protrudes and becomes calcified, causing compression on the spinal cord and/or nerve roots. Sclerosing herniation of the thoracic disc poses a significant danger as it can lead to serious complications like paraplegia during or after surgery. Iatrogenic spinal cord injury is a common risk for individuals diagnosed with sclerosing thoracic disc herniation due to the inflexible protrusion of the sclerosing disc into the spinal canal and its adhesion to the ventral side of the dural sac. The challenging and crucial aspect of the surgery is how to safely and efficiently eliminate the hardened tissue. The eggshell method is a surgical procedure that addresses the kyphosis abnormality of the spinal column by excavating the vertebral body via the pedicles and subsequently inserting the kyphotic fracture block into the excavated vertebral body. In this article, a revised surgical method using the eggshell technique will be presented for the treatment of sclerosing thoracic disc herniation. The surgical procedure briefly involves hollowing out the anterior intervertebral space of the hardened disc tissue to create an eggshell-like structure, with the sclerotic tissue forming the posterior wall. Subsequently, the sclerotic disc tissue is pushed into the hollow intervertebral space to achieve complete decompression of the ventral spinal cord. The safety and effectiveness of this approach for treating sclerosing thoracic disc herniation have been confirmed.

This protocol introduces a modified eggshell surgical technique used for treating sclerosing thoracic disc herniation.

Sclerosing thoracic disc herniation refers to a condition in which the intervertebral disc in the thoracic region protrudes and becomes calcified, causing ...

Treating Lumbar Spinal Stenosis with a Minimally Invasive Spine Surgery

Percutaneous Endoscopic Unilateral-Approach Bilateral Decompression for Lumbar Spinal Stenosis

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ligaments. LSS encompasses central canal stenosis (CCS), lateral recess stenosis (LRS), and intervertebral foramen stenosis (IFS). The utilization of lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) has gained popularity in the treatment of CCS and LRS. This popularity is attributed to the rapid development of endoscopic instruments and the progress of endoscopic philosophy.
In this technical report, a detailed introduction to the steps and key points of LE-ULBD is provided. Simultaneously, a retrospective review of 132 consecutive patients who underwent LE-ULBD for central canal and/or lateral recess stenosis was conducted. The outcomes after more than two years of follow-up were assessed using the visual analogue score (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, and the modified MacNab criteria to evaluate surgical efficacy. All 132 patients underwent LE-ULBD successfully. Among them, 119 patients were rated as "excellent," while 13 patients were rated as "good" based on the modified MacNab criteria during the last follow-up. Incidental dural tears occurred in four cases, but there were no post-operative epidural hematomas or infections. The experience demonstrates that LE-ULBD is a less invasive, effective, and safe approach. It can be considered as an alternative option for treating patients with lumbar central canal stenosis and/or lateral recess stenosis.

Author Spotlight: Scope of LE-ULBD as a Safe, Effective, and Minimally Invasive Approach to Treat Lumbar Spinal Stenosis

The present protocol describes the steps and key points of lumbar endoscopic unilateral laminotomy for bilateral decompression for the treatment of degenerative lumbar spinal stenosis.

Lumbar spinal stenosis (LSS) involves the narrowing of the spinal canal due to degenerative changes in the vertebral joints, intervertebral discs, and ...