Journal of Spine

Sclerosing epithelioid fibrosarcoma (SEF) is a singular entity, recognized as malignant fibroblastic sarcoma variant, which deviates from classic type due to the indolent progression and late metastasis. Typically occurring in middle aged adults, it presents a predilection for deep soft tissues, particularly skeletal muscle. It often involves the fascia or periosteum, and less frequently it may invade or arise from bone. Diagnosis and recognition are critical, as the generally bland appearance or when intraosseous similarity with an osteoid lesion, can lead to misdiagnosis. We herein present a case showing an unusual location and challenging radiological morphological and surgical features.

The role of robotics is gaining prominence as the technology of the future. In traditional spine surgery, accuracy of hardware placement, selection of ideal size and length of implanted screws and hardware for segmental fixation is desired and important even for experienced surgeons. Hardware placement in tight spaces is especially critical in the cervical and thoracic spine. Robotics will enhance patient safety as well as surgical results, for the protection of patients. By reducing surgical radiation exposure, it also protects patients as well as the surgeon and OR personnel. In endoscopic surgery, improving the accuracy of endoscopic trajectories with image guidance will also bring this aspect of MIS surgery to the surgical mainstream. Robotic techniques are evolving rapidly. Even in their current State of the Art, robotics offer significant advantages to the outpatient spinal surgeon by precise reproducible placement of hardware and endoscopes for minimally invasive approaches.

Background: The technique of transforaminal endoscopic spine surgery is being widely used for lumbar degenerative diseases. But the interlaminar endoscopic surgery, which is more familiar and easier to be operated for spine surgeons, is more easily applied by traditionally trained surgeons. Objective: We propose the technique of percutaneous endoscopic medial foraminal decompression through interlaminar approach for the treatment of lumbar disc herniation (LDH) and spinal stenosis (LSS), and to explore the safety and efficacy of using this technique clinically. Methods: Thirty-two LDH and eleven LSS patients received medial foraminal decompression surgery with 22.6 ± 7.9 months follow-up. Through interlaminar space, we are able to perform discectomy and lateral recess decompression to decompress the medial foraminal area. Clinical efficacy was assessed by calculating the scores of VAS, SF-36, and lumbar disease JOA and ODI respectively at preoperative, postoperative and the discharge period, 3-6 months postoperatively and the final follow-up time point when patients were considered having received maximum surgical benefit. Follow-up time period varied because of the patients' follow-up logistics in China serving a large referral area made it difficult for rural patients to return at established intervals for the study. Results: For both LDH and LSS patients, the observational indexes of the follow-up time points showed significant differences compared with those preoperatively (P<0.01). Surgical results were assessed according to JOA scores: 22 cases were excellent, 16 cases were good, and 5 cases were fair by modified MacNab criteria. The satisfaction rate of PEMFD was 88.37% during the follow-up period with the improvement of daily life quality. One patient had postoperative radiation calf pain and foot numbness, and another one had the dorsal remnant of the dural sac without symptom. Conclusion: The treatment for LDH and LSS with medial foraminal decompression is safe and effective with minimal tissue trauma, less surgical morbidity to the lumbar canal, with full decompression of nerve roots and the cauda equina. It is more similar to traditional open surgery and easier to achieve adequate canal decompression, especially for LSS.