Abstract


Failed back surgery syndrome (FBSS) is a complication of spinal surgery that results in severe and disabling back/leg pain. Epiduroscopy is a percutaneous minimally invasive surgical technique used in the treatment of lumbar radicular pain that enables both direct visualization of epidural adhesions in patients with FBSS and the mechanical release of fibrotic scars in the epidural space. Although the use of a balloon catheter during epiduroscopy can usually remove adhesions between the dura and the vertebrae, in the thickest areas of fibrosis, the use of a catheter with a molecular quantum resonance radiofrequency generator may resect hard epidural fibrotic obstructions. The aim of this study was to evaluate the efficacy and safety of this radiofrequency catheter in the treatment of severe epidural fibrotic scars.
Ninety-three patients with FBSS were enrolled in this study. In 49 cases, a thick area of fibrosis was visualized during epiduroscopy and the use of a balloon catheter could not remove the fibrotic scars. In all of these cases, we used a molecular quantum resonance radiofrequency catheter to remove dense fibrotic areas. Intraoperatively during epiduroscopy, we could directly visualize lysis of the fibrotic scars. Immediately after the procedure and at 1-month and 6-month follow-up, the patients reported significant pain reduction. Pain reduction and patient satisfaction were also reported at 12 months in all but 5 cases.
This study found a clinically relevant reduction of pain at 1 and 6 months after epiduroscopy in patients with FBSS. The use of a radiofrequency catheter is safe and effective in resection of hard and thick epidural scars.

Abstract


Anterior cervical diskectomy and fusion (ACDF) has evolved significantly in the last few years with the aim of enhancing effectiveness and safety while reducing hospitalization and healthcare-related costs. Transitioning from iliac crest autografts to allografts minimizes donor-site complications like pain, infections, and hematoma. Allograft options, such as polyetheretherketone (PEEK) and tantalum, vary in their osteoinductive properties and elastic modulus, influencing fusion rates, time, and the rate of subsidence. Recently introduced zero-profile cages offer bone fixation through screws, resulting in reduced blood loss, improved spinal alignment, and decreased complications like dysphagia and adjacent segment disease. Intraoperative neuromonitoring (IONM) has gained widespread use. The North American Spine Society (NASS) 2023 recommendations endorse IONM in cervical deformity corrections and myelopathy cases. Insufficient studies hinder clear radiculopathy recommendations, but emerging research supports IONM for patients at greater risk of C5 nerve root injury or positional injury. Advancements in hemostatic agents, such as gelatin sponges, oxidized cellulose, and fibrin sealants, contribute to safety by reducing postoperative hematoma rates and eliminating the need for drainage. Innovations like the exoscope, endoscope, and computed-tomography (CT) navigation have transformed surgical practices. Exoscopes are emerging as an alternative to microscopes, offering benefits like a smaller footprint, adjustable positioning, lower costs, and shared intraoperative views for educational purposes. The use of endoscope offers the possibility of performing a minimally invasive technique with improved results in terms of cosmesis and patient-perceived outcome. CT navigation can be useful in high-risk procedures, such as cervical plate placement for major instability. This paper provides an overview of cutting-edge technologies in ACDF surgery, emphasizing cage materials and designs, safety measures, and operating room advancements. It also highlights areas for future research, underlining the procedure’s continuous evolution.