Lumbar Spine

Hybridized Inside-Out/Outside-In Approach for Treatment of Endstage Vacuum Degenerative Lumbar Disc Disease

Author(s): Kai-Uwe Lewandrowski* and Anthony Yeung

Pp: 105-122 (18)

DOI: 10.2174/9789815051537122020008

* (Excluding Mailing and Handling)

Abstract

Commonly employed transforaminal decompression techniques may use the “inside-out” and “outside-in” technique, not as a standalone technique, but as a combined technique that considers different surgical philosophies. The inside-out technique calls for an initial emphasis on visualization of the intradiscal cavity with the endoscope by advancing the working cannula inside the lumbar intervertebral disc for intradiscal examination when appropriate. In contrast, the outside-in approach places it initially into the neuroforamen and lateral recess. The authors present an illustrative case series of 411 patients in whom they employed a hybridization of these two techniques because they found it to be more reliable in cases of end-stage degenerative vacuum disc disease. The study group consisted of 192 (46.7%) females and 219 (53.3%) males with an average age of 54.84 ± 16.32. The average follow-up of 43.2 ± 26.53 months. Patients underwent surgery for herniated disc (135/411;32.8%), foraminal spinal stenosis (101/411;24.6%), a combination of the latter two conditions (162/411;39.4%), or low-grade spondylolisthesis (13/411;3.2%). Results of our clinical series showed a significant reduction of preoperative ODI and VAS for leg pain of 49.8 ± 17.65, and 7.9 ± 1.55 to postoperatively 12.2 ± 9.34, and 2.41 ±5 1.55 at final follow-up (p 0.0001), respectively. Macnab outcomes were Excellent in 134 (32.6%), Good in 228 (55.5%), Fair in 40 (9.7%), and Poor in 9 (2.2%) patients, respectively. There was end-stage degenerative vacuum disc disease in 304 (74%) of the 411 patients; 37.5% had Excellent and 50% Good Macnab outcomes.

Patients without vacuum discs had Excellent and Good 18.7% and 71.% of the time. With our hybridized technique, patients with end-stage degenerative vacuum disc disease did very well with the endoscopic decompression procedure. Improved clinical outcomes may be obtained with the direct visualization of pain generators in the epidural- and intradiscal space. It is the authors’ preferred transforaminal decompression technique


Keywords: Clinical outcomes, Inside-out, Outside-In, Transforaminal endoscopy

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      • 11. app/Models/ContentAccess.php:647
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 222027364 and j.to_ip >=222027364 )) and ((j.from_date <= 1739988816 and j.to_date >= 1739988816 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16866) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 222027364 and j.to_ip >=222027364 )) and ((j.from_date <= 1739988816 and j.to_date >= 1739988816 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16866) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 222027364 and j.to_ip >=222027364 )) and ((j.from_date <= 1739988816 and j.to_date >= 1739988816 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 16866)
      810μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 3335 and `b`.`banner_from_date` <= 1739988816 and `b`.`banner_to_date` >= 1739988816 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.33msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 3335
      • 3: 1739988816
      • 4: 1739988816
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='30de97a21f7de26a82b9d21fe64829af'
      280μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    4Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        NTukNe0m50QrFM9kHMEnh6xEE3V5pUD4IlzAHqaC
        uc_cart_id
        30de97a21f7de26a82b9d21fe64829af
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/16866" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/16866
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
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        response_headers
        0 of 0
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        ClearShow all
        Date ↕MethodURLData
        #12025-02-19 18:13:36GET/chapter/16866112196