Background: Computer- and robotic-assisted total knee replacement procedures have been shown to improve the accuracy of the implant size. It also allows dynamic confirmation of the implant and limb alignment during total knee arthroplasty (TKA). The major inhibition of the arthroplasty surgeon in adapting to the robotic-assisted TKA (RA-TKA) is the extra time spent during the registration process and milling of the bone with the robot. The aim of the study was to ascertain the extra time spent during these 2 steps as compared to the conventional TKA (C-TKA). Methods: It is a prospective study involving 30 patients each in the conventional TKA and RA-TKA operated by the same surgical team. The patients were given a choice between the C-TKA and RA-TKA and consecutive 30 cases in each group were studied by an independent observer. In the C-TKA group, the time for the application of appropriate zigs and execution of the bone cuts and soft-tissue release was recorded whereas in the RA-TKA group, the time taken for fixation of the tibial and femoral arrays and bone registration and bone milling with robot and required soft-tissue release was measured. Results: The preoperative patient characteristics were the same in both groups. The time taken in the C-TKA and RA-TKA groups was 24.77 ± 1.92 minutes and 25.03 ± 3.27 minutes, respectively, which is statistically insignificant (p = 0.709). Conclusions The study findings show that RA-TKA does not take additional time than C-TKA.

Objective: Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive surgical procedure used to treat herniated disc fragments in the hidden zone of MacNab. This study aimed to investigate the efficacy, advantages, and safety of TPED for superiorly migrated lumbar disc herniation in the hidden zone of MacNab, focusing on patients with isolated causative factors such as prolapsed discs. Methods: A cohort of patients with clinical conditions involving isolated causative factors of herniated discs in the hidden zone of MacNab were selected for TPED. Patients with conditions contributing to clinical symptoms were excluded. Twelve patients with hidden-zone disc herniations underwent TPED. Under fluoroscopic guidance, precise skin markings were performed, followed by chromodiscography and epidurography. A nonstandard floating approach was utilized for TPED. The assessment of patients included visual analogue scale and Oswestry Disability Index scores. The outcomes were evaluated based on the modified MacNab criteria after 12 months. Results: Successful removal of the herniated fragments was achieved in all 12 cases of hidden-zone disc herniations that underwent TPED. According to the modified MacNab criteria, 11 out of 12 patients achieved excellent outcomes, while one patient attained a good outcome. Conclusions The transforaminal approach in TPED was confirmed to be a highly effective and minimally invasive technique for managing hidden-zone disc herniations. The procedure yielded satisfactory to excellent results, accompanied by a significantly shorter rehabilitation period and minimal blood loss. Importantly, the pars interarticularis and lamina remain fully intact with the transforaminal approach.

Cervical myeloradiculopathy is a debilitating condition characterized by progressive spinal cord dysfunction commonly caused by degenerative changes in the cervical spine. It typically exhibits an insidious onset and progressive functional decline, along with multiple exiting nerve root entrapments bilaterally in some patients. Traditional surgical interventions, such as discectomy and fusion, are associated with some complications and limitations. Unilateral biportal endoscopic (UBE) decompression can have significant advantages over traditional techniques when cervical central and bilateral foraminal decompression is required. In this case report and technical note, we describe our experience with this novel surgical technique for the treatment of cervical myelopathy. A 67-year-old patient presented with progressive neck pain; bilateral upper extremity radiculopathy; loss of power and sensation in the C5, C6, and C7 nerve root distribution; gait imbalance, and spasticity. Magnetic resonance imaging revealed multilevel cervical spondylosis with central canal and bilateral foraminal stenosis. The patient underwent UBE central and bilateral foraminal decompression. At a 9-month follow-up visit, he was able to walk unassisted, his reflexes had returned to normal, no spasticity was observed, and he had good grip strength in both hands. This is a novel technique of UBE decompression with bilateral foraminotomy at the C4–5, C5–6, and C6–7 levels and laminectomy named “the floating tip technique.” The procedure involved bilateral 3-level lamino-foraminotomy and hemilaminotomy on both C5 and C6. A hemilamina was removed on the opposite sides, and flavectomy was performed. Postoperative computed tomography findings showed an intact, complete muscular mass with an intact central spinous process. Therefore, this method was labelled the “floating tip technique.”