What Are the Advantages of spine endoscope bone graft pusher？

A herniated disc can cause back or neck pain, arm or leg discomfort and can advance into more complicated syndromes such as radiculopathy, sciatica, or myelopathy. Pain originating in a damaged disc is called &#;discogenic&#; pain.

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There are 23 intervertebral discs in the spinal column. These discs are soft tissue joints composed of a hydraulic gelatinous core called the nucleus pulposus encased within a firm outer collagen wall termed the annulus fibrosus. 

The discs protect the spinal vertebrae and nerves from sudden impact and absorb shock from spine movements like bending, jumping, and twisting. 

Unfortunately, the disc's outer wall, the annulus fibrosus, can develop traumatic tears (annular tear), allowing the jelly-like nucleus pulposus to push backward out of the tear into the spinal canal or neural foramen. 

The part of the jelly nucleus pulposus that pushes out through the tear is called the herniation. In many cases, this hernia can impinge on a nerve, giving rise to inflammation and irritation of the affected nerve.

Spinal stenosis occurs when, usually due to the age of the body, the spinal canal narrows and puts pressure on the important spinal nerves. Spinal stenosis is called cervical stenosis when it occurs in the neck area, thoracic stenosis in the middle to the upper part of the back, and lumbar stenosis in the lower back area. 

Narrowing can happen for several reasons, such as ligaments and cartilage thickening in the canal or excessive bone growth, causing the opening to become more slender over time. The risk of this problem increases as a patient passes 50 years of age, due in part to years of stress on the spine and the tendency of tissue and bone to become less sturdy or flexible with decades of repeated use. 

Bone disease or spinal injury may also contribute to stenosis of the spine in patients of any age.

This is a type of endoscopic spine surgery performed on patients who suffer from a herniated disc. Microdiscectomy involves removing the herniated material that causes the pain. 

Microdiscectomy was first performed on a herniated disc in the s, and since then, there have been significant advancements in technology and how the procedure is performed.

The procedure for microdiscectomy is straightforward and aims to: 

• Remove the excess disc tissue that irritates the spinal nerves.
• Relieve inflammation.
• Treat any symptoms the patient may have.

The procedure is done with the patient lying face down and under general anesthesia. During the procedure, the patient is unconscious and feels nothing.

The process for microdiscectomy includes the following:

• The surgeon makes an incision of 1-2 inches directly over the affected area.
• The surgeon uses an endoscope to inspect the affected area.
• Next, the surgeon will remove the intruding herniated tissue that puts pressure on the nerve using specific surgical tools. They will also remove some of the bone that protects the root nerve if necessary.
• They will then remove the tools and tubes used and close the incision with sutures.
• You will then be moved to the recovery room, where you can gently come around from your anesthesia.

To get started, Deuk Laser Disc Repair requires a very small incision, less than a quarter-inch long. A cylindrical rod called a dilator is inserted in the small opening to gently spread the muscle to create a small passage and guide through which the surgery is performed endoscopically. 

The tip of the dilator is advanced into the symptomatic disc through the tear in the annulus where the herniation originates, and a tube called the retractor slides over the dilator and is carefully positioned into the painful disc. The rest of the entire Deuk laser disc repair surgery will occur inside this narrow tube.

To access the spine, an endoscopic camera is inserted into the tubular retractor to allow the surgeon to guide the laser inside each symptomatic disc. This process ensures that bones and surrounding tissues are not damaged, unlike traditional spinal fusions, microdiscectomy, and artificial discs.

The Holmium YAG laser used in the Deuk laser disc repair is manipulated accurately with millimeter precision under endoscopic visualization to remove only painful inflammatory tissue from the disc. The laser is precisely used to remove damaged disc material that is causing the pain. 

Once the laser has removed the inflamed, painful part of the annular tear and the herniated nucleus pulposus, the endoscope and tubular retractor are removed, leaving less than one-quarter inch incision in the skin, which can be closed with a single stitch and a band-aid. 

The total time for the Deuk laser disc repair surgery is one hour, and the patient is in recovery for about 45 to 60 minutes before being released to go home. Hospitalization is not needed, and the risks of hospital-based surgery are avoided. 

Also, with the Deuk laser disc repair, there&#;s no loss of normal movement, and the flexibility of the disc and joint is preserved. With endoscopic Deuk laser disc repair, there is no fusion, metal implants, or biological material added to the spine. The procedure is all-natural, allowing your body to heal the herniated or bulging disc.

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After the surgery, the Deuk laser disc repair patient is back home, enjoying life with a speedy recovery allowing normal activities without pain. Another advantage of Deuk laser disc repair is that no opioids or powerful narcotic painkillers are needed after surgery. 

Open spine surgeries like microdiscectomy, laminectomy, artificial disc replacement, and fusion cause so much internal trauma that patients are in severe pain after surgery and must take painkillers for weeks after their surgery but not with Deuk laser disc repair.

Here&#;s what one of our patients had to say one hour after Deuk Laser Disc Repair:

1. Introduction

Benign spinal lesions include aneurysmal bone cysts, osteoid osteomas, and fibrous dysplasia, which tend to occur in the thoracic and lumbar spine. The incidence is low, accounting for approximately 1% of primary bone tumors [1,2]. They are usually found incidentally during physical examination, but local pain, nerve compression, and spinal deformity may also occur as the disease progresses [3]. Patients with benign spinal lesions that are asymptomatic and not suspected of malignant or aggressive behavior can be followed up periodically to observe the progression of the lesion. If the lesion is symptomatic, causing pain, compression of adjacent nerves, or even spinal deformity, surgical treatment is required [4].

The management of benign spinal lesions is still a challenge for clinicians due to a lack of evidence-based treatment strategies. Regular follow-up observations are indicated for asymptomatic patients with minor bone damage. However, in patients with symptomatic benign lesions, benign spinal lesions, although not metastatic, can lead to severe neurological deficits and often require surgical intervention [5]. The main surgical method for benign spinal lesions is the resection of lesion tissue and stability reconstruction. Because the spine is positioned far away from the body surface and the surrounding anatomical structures are complex, extensive soft tissue dissection is required, resulting in greater trauma, which can damage the normal physiology of the spine and lead to a series of complications.

Our team adopted &#;vertical anchoring technology&#; in the beginning of this surgery, which allows clinicians to safely and accurately reach the lesion site, providing a safe and effective minimally invasive surgical route [6,7]. In this method, we use a high-speed grinding drill under a full endoscope to grind the lesion down to the normal bone on the inner wall of the tumor cavity, use a radio frequency electrode to carry out internal thermal ablation of the lesion, and use concentrated iodophor and anhydrous ethanol to carry out chemical treatment of the tumor cavity, so as to minimize recurrence and damage to the normal spinal structure [8]. In the last step of the surgery, the cavity is filled with allogenic bone. In this study, we propose technical notes and short-term follow-up reports to illustrate the method of treating benign spinal diseases with full endoscopy combined with allogeneic bone transplantation.

3. Results

A total of 15 patients (6 males and 9 females; mean age 21.8 ± 4.3 years) were recruited from January and were included in this study. The mean follow-up time was 18.0 ± 5.1 months. All 15 patients had benign spinal lesions that were treated with full endoscopy combined with allogeneic bone grafting. Three patients had aneurysmal bone cysts, eight patients had osteoid osteoma, and four patients had fibrous dysplasia (Table 1).

Table 1.

Characteristic Value Mean age (years) 21.8 ± 4.3 Sex M 6 F 9 Mean follow-up period (months) 18.0 ± 5.1 Diagnosis aneurysmal bone cyst 3 osteoid osteoma 8 fibrous dysplasia 4 Mean estimated blood loss (mL) 16.7 ± 6.9 Mean operative time (min) 63.3 ± 7.2 Postoperative complications Numbness 0

VAS scores improved significantly after surgery. The VAS scores decreased from 3.07 ± 0.70 preoperatively to 0.33 ± 0.49 at the last follow-up visit (p < 0.05). No patients had disease recurrence during postoperative follow-up. The mean total blood loss (including drainage blood) was 16.67 ± 6.98 mL. The mean operative time was 63.33 ± 7.23 min (Table 2).

Table 2.

Diagnosis Location/WBB Classification Age/
Gender Conservative Treatment Time Visual Analog Scale Operative Time Estimated Blood Loss Follow-Up Period Recurrence Visual Analog Scale Score at Last Follow-Up ABC T12/sectors4-5, layer C 17/F 3M 4 55 10 18M N 1 ABC T10/sectors4-6, layer C 28/F 4M 3 70 15 24M N 0 ABC T1/sectors7-8, layer C 20/M 2M 4 50 15 18M N 1 OO T11/sectors4-5, layer C 22/F 2M 3 70 10 18M N 0 OO T12/sectors7-9, layer C 18/M 3M 2 65 10 18M N 0 OO T8/sectors7-8, layer C 21/F 5M 3 55 10 12M N 1 OO L2/sectors4-5, layer C 25/F 8M 4 60 20 18M N 0 OO L2/sectors4-5, layer C 30/F 2M 3 65 20 12M N 1 OO L3/sectors4-6, layer C 19/M 12M 3 75 20 24M N 0 OO L4/sectors5-6, layer C 19/F 12M 2 65 30 12M N 0 OO L4/sectors4-5, layer C 22/M 14M 2 70 30 24M N 0 FD T8/sectors4-5, layer C 23/M 10M 3 55 10 18M N 0 FD T11/sectors4-5, layer C 19/F 5M 3 60 10 12M N 0 FD L3/sectors4-5, layer C 16/F 3M 4 65 20 18M N 0 FD L5/sectors8-9, layer C 28/M 2M 3 70 20 24M N 1

No patients developed numbness in the corresponding segmental distribution after surgery, none of the patients had serious postoperative complications, and none had focal recurrence requiring reoperation during follow-up. At the last follow-up, all 15 patients were satisfied with the bone graft filling.

In all of these cases, we present a typical case of a patient with a T12 vertebral benign lesion who was treated with a percutaneous endoscopy combined with allogeneic bone grafting in . The patient, a 17-year-old female, was admitted to the hospital with &#;back pain for 3 years and T12 vertebral lesion for 1 year&#;. The patient had persistent nonmechanical pain in the lower back as the main symptom (VAS score 4), without spinal cord or nerve involvement, with a long duration of disease and poor relief with conservative treatment. Preoperative imaging suggested a benign osteolytic lesion in the T12 vertebral body, located within the C level of Weinstein-Boriani-Biagini (WBB) classification 4&#;5 (Figure 3 and Figure 4) [9]. A preoperative spinal instability neoplastic score (SINS) score of 7 (3 for lesion located at the junction, 1 for nonmechanical pain, 2 for osteolytic lesion, 0 for spinal sequence alignment, 0 for no vertebral body collapse and <50% vertebral involvement, and 1 for accessory involvement on one side) was determined in the assessment of acceptable spinal instability [10]. Full spinal endoscopic scraping of the T12 vertebral body lesion and allograft bone grafting were performed under general anesthesia in July .

No tumor cells were found in the postoperative pathology results, and a diagnosis of aneurysmal bone cyst (ABC) was made by combining the imaging examination and clinical manifestations (Figure 5). The review imaging suggested complete scraping of the lesion and good placement of the bone graft. Six months postoperatively, imaging suggested good healing of the bone graft without recurrence (Figure 6). In this study, preoperative and postoperative images of some patients with benign spinal lesions, as shown in Supplementary Figure S1, showed successful bone grafting without recurrence.

At the 18-months postoperative follow-up, there was complete relief of back pain, a SINS score of 0, and good spine stability (Supplementary Figures S1&#;S3).

4. Discussion

Although aneurysmal bone cysts, osteoid osteomas, benign fibrous histiocytomas, and fibrous dysplasia are considered benign lesions, they are potentially aggressive and can lead to destruction of the bone and surrounding soft tissues [11]. Patients with benign spinal lesions that are asymptomatic and not suspected of malignant or aggressive behavior can be followed up periodically to observe lesion progression. If the lesion is symptomatic, causing pain, compressing adjacent nerves, or is even a spinal deformity, then surgical treatment is usually required. In the case of aneurysmal bone cysts within the vertebral body, due to the presence of important nerves, blood vessels, and other structures in the surrounding area, surgery is most often performed by removing the vertebral body in pieces or in its entirety. This involves extensive soft tissue debridement and stability reconstruction, which is traumatic and disrupts the normal physiological structure of the spine, so the development of a minimally invasive surgical approach represents a breakthrough in solving these problems.

With the development of spinal endoscopic techniques in recent years, the indications have expanded from degenerative spinal diseases to spinal infections and even spinal neoplastic diseases [12,13,14]. Depending on the number and size of working channels, spinal endoscopy can be divided into several different systems, including microendoscopic and percutaneous endoscopic surgery. Mehmet Zileli et al. used microendoscopic surgery for the treatment of osteoid osteoma of the C2 vertebral body, performing intraoperative lesion removal followed by fixation of the vertebral body using an internal fixation device. Three years of postoperative follow-up showed good cervical spine motion and complete recovery, which validated the feasibility of endoscopic surgical treatment in these cases [15]. In , Shibuya et al. first reported a case of symptomatic benign spinal lesions of the lumbar spine treated using full spinal endoscopy [16]. The patient, who had predominantly localized pain symptoms and no spinal cord or neurological impairment, underwent full endoscopic debridement of the lesion and implantation of hydroxymethylapatite. In , Xie et al. reported 11 cases of symptomatic benign spinal lesions of the lumbar and sacral spine treated with full spinal endoscopy, and all patients showed symptomatic relief with no recurrence during 1&#;3 years of follow-up [17]. In , Kotheeranurak et al. reported treatment of a case of osteoid osteoma of the L3 vertebral body with no recurrence at 2 years follow-up [18].

Our research team has extensive experience in endoscopic procedures using full spinal endoscopy for degenerative spinal diseases [19,20,21,22,23]. We were aware of the various advantages of endoscopy, such as visualization of the operation, minimal surgical trauma, and rapid recovery, so we began to apply our endoscopic technique to benign spinal lesions. The treatment of benign spinal lesions focuses on removing focal tissue and reducing residual lesions, thereby reducing the probability of recurrence. Therefore, accurate puncture localization and surgical manipulation are important to reduce the harm caused to the patient by the procedure. Our team adopted the &#;vertical anchoring technique&#; for full spinal endoscopic surgery, which provides a safe and effective minimally invasive surgical approach by safely and accurately reaching the lesion [6,7]. The &#;anchoring technique&#; is a puncture technique that aids in the establishment of a working channel, which was first applied to the cervical spine and reported by our team in . During endoscopic access establishment, a 2 mm Kirschner needle is used to puncture and anchor the bone surface at the target location, and a circular saw is placed along the Kirschner needle puncture path to mark the bone surface. The &#;target point&#; (consisting of the central &#;point&#; anchored by the Kirschner pin and the &#;ring&#; marked by the ring saw) is visible under the endoscope. This technique has been routinely used in full endoscopic surgery for degenerative diseases of the cervical and lumbar spine, and has two main advantages. One is that the kerfing needle is anchored on the bone surface during the establishment of the working channel, which can fix the working channel and avoid channel slippage, so as to reduce the number of fluoroscopic views required during the establishment of the working channel. Secondly, marking the &#;target point&#; under the endoscope can help the operator to quickly identify the target area and enhance the safety of the surgery. In the treatment of degenerative cervical spine diseases, endoscopic surgery combined with this anchoring technique shortens the operative time and reduces the number of intraoperative fluoroscopies compared to conventional endoscopic surgery, and has comparable efficacy to conventional endoscopic surgery.

The goals of treatment for benign spinal lesions are to improve symptoms, obtain a histological diagnosis, and prevent recurrence of the disease. Gibbs et al. concluded that complete removal of the surface of the tumor cavity to normal bone is necessary for recurrence prevention [24]. Xie et al. used full spinal endoscopy combined with radiofrequency to manage lesions, and all patients in their study showed symptomatic relief and no recurrence during follow-up [17]. High temperatures reduce tumor recurrence; therefore, in all our cases, after grinding the lining of the tumor cavity to normal bone, radiofrequency electrodes were used to ablate the cavity of tumor for 5&#;10 min. Ulici et al. reported that the treatment of aneurysmal bone cysts with anhydrous alcohol injection reduced the tumor lesions, suggesting that the foreign body inflammatory response was induced by anhydrous alcohol and that this indirectly stopped the process of ABC through vascular thrombosis and tissue ischemia [25]. Intraoperative iodine volts were also used to flush the focal tissue within the vertebral body, as free iodine in iodine volts can prevent surgical infection [26]. The above steps minimized the possibility of recurrence and surgical complications.

This was a retrospective study. The main symptom of all patients was back pain, so we considered that use of VAS scores was a simple and effective means to evaluate the effect of surgery. The VAS scores decreased from 3.07 ± 0.70 preoperatively to 0.33 ± 0.49 at the last follow-up visit (p < 0.05). According to this study, endoscopic surgery has less bleeding (average total blood loss was 16.67 ± 6.98 mL) and shorter operation time (average operation time was 63.33 ± 7.23 min). No patients developed numbness in the corresponding segmental distribution after surgery, none of the patients had serious postoperative complications, and none had focal recurrence during follow-up requiring reoperation. All 15 patients had no recurrence during the follow-up, and the pain symptoms were relieved satisfactorily.

Although fillers were not used after endoscopic treatment of the lesion in the study of Xie et al. [17], Shibuya et al. used hydroxyapatite for filling [16]. In our procedure, we filled with an allogeneic bone graft after removing the diseased tissue from the vertebral body. We believe that intravertebral bone grafting is necessary to increase the strength and stability of the vertebral body and reduce the risk of postoperative pathological fractures. Related studies have concluded that homogeneous allogeneic bone has the exact same composition, structure, and biomechanical properties as the patient&#;s own bone, which cannot be replicated by artificial bone [27]. In this study, all 15 patients who were followed up showed satisfactory bone grafts, which also showed that allogeneic bone was suitable for this technique.

Although our technology has achieved positive short-term results in the treatment of benign lesions of the spine, it still has some limitations. Not all patients are suitable for this technology, and it is applicable to small spinal lesions and mild nerve compression. However, open surgery is still needed for large tumors and severe nerve compression. Endoscopic surgery requires experienced doctors, and there may be problems associated with radiation exposure. A prospective, multicenter, and long-term study is needed to further explore the safety and effectiveness of the protocol.

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