This article reports a case series evaluating the short-term clinical outcomes of full-endoscopic disc cleaning (FEDC), which is one of the most minimally invasive surgical procedures for treating chronic low back pain (CLBP) due to Modic changes (MCs). Seven patients who underwent FEDC at Tokushima University Hospital between 2019 and 2021, with postoperative clinical outcomes available over a follow-up period of more than 12 months, were included in the study. Six men and one woman underwent FEDC. The average age of the patients was 48.7 years with an average CLBP duration of 9.4 years. Five of these patients showed favorable outcomes, with reductions in LBP. The other 2 required revision surgery at the 12-month follow-up due to recurrent symptoms. One of the patients who required revision surgery was the oldest in this series, a 73-year-old woman with mixed signal changes including Modic type 3 at the anterior corner at L2–3 to L4–5 levels with spinal malalignment. Although disc block was immediately effective, pain reproduction on discography yielded unclear results. The clinical outcomes of this series suggest that FEDC may be particularly effective for patients with inflammatory type 1 and type 2 changes and less advanced degenerative changes. However, in cases involving more complex degeneration, such as type 3 changes or notable spinal deformities, CLBP may arise from multiple contributing factors beyond MCs alone, underscoring the importance of a thorough evaluation when determining surgical indications for FEDC.

Transforaminal full-endoscopic lumbar surgery is widely accepted as a method of treating lumbar conditions, such as disc herniation, spinal stenosis, and lumbar foraminal stenosis (LFS). This minimally invasive approach, often performed under local anesthesia, is ideal for older patients and those with significant comorbidities. Full-endoscopic lumbar foraminotomy (FELF) has shown high success rates and notable symptom relief for LFS. However, complications including postoperative dysesthesia, dural tears, restenosis, and scoliosis progression, especially at L5–S1 due to extensive facet joint resection, remain challenges. In such cases, lumbar fusion may be more appropriate. A unique anatomical feature, the "lateral kissing spine," is characterized by contact between the L5 transverse process and the sacral ala. This feature appears to mitigate scoliosis progression, regardless of the preoperative Cobb angle or bone resection extent during FELF. We report two L5–S1 foraminal stenosis cases treated with FELF under local anesthesia: one with a lateral kissing spine, showing no scoliosis progression, and another without it, demonstrating significant progression. A review of 11 additional cases supports the protective role of the lateral kissing spine against scoliosis, even in cases with severe preoperative Cobb angles. This study reviews the complications of FELF, focusing on scoliosis progression, and proposes indications for FELF, highlighting the importance of the lateral kissing spine in surgical decision-making.

The role of manipulation under anesthesia (MUA) without arthroscopic capsular release in patients with preoperative stiffness undergoing arthroscopic rotator cuff repair (ARCR) remains unclear. Additionally, the association between shoulder stiffness and tendon healing after ARCR is still controversial. This study aimed to compare the clinical outcomes and retear rates between patients with preoperative stiffness treated by MUA alone and those without stiffness. Methods: This retrospective study included 322 patients who underwent ARCR for full-thickness tears between January 2012 and May 2022 with a minimum 2 years of follow-up. Clinical outcomes—including passive range of motion (ROM); the Japanese Orthopedic Association (JOA) score; and the University of California, Los Angeles (UCLA) score—were assessed preoperatively and at 3, 6, 12, and 24 months postoperatively. Patients were divided into the stiffness group (MUA completed) and the non-stiffness group. Retears were evaluated using magnetic resonance imaging at 6 months postoperatively, and retear rates were analyzed by tear size (medium vs. large/massive). Results: Eighty-eight patients with stiffness and 234 without stiffness met the study inclusion criteria. Preoperative ROM, JOA, and UCLA scores were significantly lower in the stiffness group. Both groups showed significant improvements at final follow-up, with greater gains in the stiffness group. Final outcomes were comparable, except for external rotation. In medium-sized tears, the retear rate was significantly lower in the stiffness group (1.9%) than in the non-stiffness group (10.8%) (P=0.042). No significant difference was observed for large/massive tears. Conclusions: Patients with preoperative stiffness treated with MUA alone achieved comparable outcomes to those without stiffness, with improved tendon healing in medium-sized tears. Level of evidence: III

In the 2 decades or so since full-endoscopic spine surgery (FESS) was introduced, the procedure has advanced considerably. There are 2 major approaches of FESS, transforaminal (TF) and interlaminar. In this review article, we discuss the key strengths and merits of TF-FESS based on a literature search. First, the minimal invasiveness of the procedure allows for early return to work. Second, minimal invasiveness of the back muscles enables athletes to make a faster return to their previous competitive level. Third, the ability to perform TF-FESS under local anesthesia means it is suitable even in the elderly with poor general health.

Transforaminal full-endoscopic spine surgery (TF-FESS) is a minimally invasive surgical procedure that can be performed with only an 8-mm skin incision under local anesthesia. TF-FESS has been used to treat not only lumbar disc herniation, but also lumbar spinal stenosis. This paper describes transforaminal full-endoscopic lateral recess decompression. The best indication for this procedure is unilateral recess stenosis accompanied by transversing nerve root radiculopathy, with or without exiting nerve root radiculopathy. The skin entry point is about 6–8 cm from the midline, and the precise point is determined by preoperative planning. After local anesthesia, an 8-mm skin incision is made, and the cannula is placed on the surface of the superior articular process (SAP). Next, the SAP is resected from the pedicle to the tip using a high-speed drill to expose the facet joint space and flavum by the hand-down technique (gradually changing hand position to be downwards and moving the cannula inwards). After removing the flavum, the completely decompressed transversing nerve root can be clearly visualized and confirmed under fluoroscopy. Two hours postoperatively, patients can walk without restriction. Because this procedure requires the complete resection of the ventral side of the facet, it is also called full-endoscopic ventral facetectomy.

PURPOSE: The aim of this study was to elucidate whether intrasynovial corticosteroid injections for trigger digit reduced the volume of the tendon and pulley on high-resolution ultrasonography. METHODS: Twenty-three digits of 20 patients with trigger digit were included. Each affected finger was graded clinically according to the following classification: grade I for pre-triggering, grade II for active triggering, grade III for passive triggering, and grade IV for presence of contracture. Axial ultrasound examinations were performed before an intrasynovial corticosteroid injection and at an average of 31 days after the injection. The transverse diameter, thickness, and cross-sectional area of the tendon and the thickness of the pulley were measured by two independent, blinded researchers. RESULTS: At least 1 grade of improvement was achieved in this study group by the time of the second examination. The transverse diameter and cross-sectional area of the tendon and the thickness of the pulley significantly decreased (P < 0.05). CONCLUSION: The injection of a single dose of betamethasone improved clinical symptoms by reducing the volume of both the tendon and pulley, which may be related to the fact that tendon and pulley ruptures are delayed by corticosteroid injections.
Adrenal Cortex Hormones ; Betamethasone* ; Classification ; Contracture ; Fingers ; Humans ; Rupture ; Tendons* ; Trigger Finger Disorder* ; Ultrasonography*

STUDY DESIGN: Prospective study. PURPOSE: During fluoroscopically guided spinal procedure, the hands of spinal surgeons are placed close to the field of radiation and may be exposed to ionizing radiation. This study directly measured the radiation exposure to the hand of a spinal interventionalist during fluoroscopically guided procedures. OVERVIEW OF LITERATURE: Fluoroscopically guided spinal procedures have been reported to be a cause for concern due to the radiation exposure to which their operators are exposed. METHODS: This prospective study evaluated the radiation exposure of the hand of one spinal interventionalist during 52 consecutive fluoroscopic spinal procedures over a 3-month period. The interventionalist wore three real-time dosimeters secured to the right forearm, under the lead apron over the chest, and outside the lead apron over the chest. Additionally, one radiophotoluminescence glass dosimeter was placed under the lead apron over the left chest and one ring radiophotoluminescence glass dosimeter was worn on the right thumb. The duration of exposure and radiation dose were measured for each procedure. RESULTS: The average radiation exposure dose per procedure was 14.9 µSv, 125.6 µSv, and 200.1 µSv, inside the lead apron over the chest, outside the lead apron over the chest, and on the right forearm, respectively. Over the 3-month period, the protected radiophotoluminescence glass dosimeter over the left chest recorded less than the minimum reportable dose, whereas the radiophotoluminescence glass ring dosimeter recorded 368 mSv for the thumb. CONCLUSIONS: Our findings indicated that the cumulative radiation dose measured at the dominant hand may exceed the annual dose limit specified by the International Commission on Radiological Protection. Spinal interventionalists should take special care to limit the duration of fluoroscopy and radiation exposure.
Fingers ; Fluoroscopy ; Forearm ; Glass ; Hand* ; Prospective Studies ; Radiation Exposure* ; Radiation, Ionizing ; Surgeons ; Thorax ; Thumb

STUDY DESIGN: A radiologic study of sacropelvic morphology and vacuum phenomenon of sacroiliac joint in subjects unrelated to low back pain. PURPOSE: The aim of this study is to describe the relationship between sacropelvic morphology and vacuum phenomenon of the sacroiliac joint. OVERVIEW OF LITERATURE: Lumbopelvic alignment and sacropelvic morphology are associated with the pathomechanisms of various spinal disorders. The vacuum phenomena of the sacroiliac joint (SJVP) are often observed in clinical practice, but the relationships between these phenomena and sacropelvic morphology have not been investigated. This study examined the prevalence of SJVP in computed tomography (CT) images and the relationship between sacropelvic morphology and SJVP. METHODS: We analyzed multiplanar CT images of 93 subjects (59 men, 34 women). Pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL) were measured using the three-dimensional reconstruction method. The prevalence of SJVP in multiplanar CT images were reviewed. Roland-Morris Disability Questionnaire (RDQ) scores and the modified Japanese Orthopedic Association (JOA) score, which focuses on subjective symptoms and restriction of activities of daily living, were also obtained from all the subjects. RESULTS: Thirty-six of the 93 subjects had SJVP (39%), with marked female predominance (91% women, 8.5% men). Men with SJVP had significantly lower PI than men without SJVP (35.1° vs. 46.3°, p<0.05). There was no correlation between SJVP and the modified JOA or RDQ scores. CONCLUSIONS: These data suggest that differences in sacropelvic morphology can influence the biomechanical environment and contribute to SJVP in men. Presence of SJVP did not affect JOA or RDQ scores.
Activities of Daily Living ; Animals ; Asian Continental Ancestry Group ; Female ; Humans ; Incidence ; Lordosis ; Low Back Pain ; Lumbosacral Region ; Male ; Methods ; Orthopedics ; Pelvis ; Prevalence ; Sacroiliac Joint* ; Vacuum*