Background. Percutaneous endoscopic interlaminar discectomy (PEID) has achieved favorable effects in the treatment of lumbar disc herniation (LDH), as a new surgical procedure. With its wide range of applications, a series of complications related to the operation has gradually emerged. Objective. To describe the type, incidence and characteristics of the complications following PEID and to explore preventative and treatment measures. Study Design. Retrospective, observational study. Setting. A spine center affiliated with a large general hospital. Method. In total, 479 cases of patients with LDH received PEID, which was performed by an experienced spine surgeon between January 2010 and April 2013. Data concerning the complications were recorded. Result. All of the 479 cases successfully received the procedure. A total of 482 procedures were completed. The mean follow-up time was 44.3 months, ranging from 24 to 60 months. The average patient age was 47.8 years, ranging from 16 to 76 years. There were 29 (6.0%) related complications that emerged, including 3 cases (0.6%) of fragment omission, and the symptoms gradually eased following 3–6 weeks of conservative treatment; 2 cases (0.4%) of nerve root injury, and the patients recovered well following 1–3 months of taking neurotrophic drugs and functional exercise; 15 cases (3.1%) of paresthesia, and this condition gradually improved following 3–6 weeks of rehabilitation exercises and treatment with mecobalamin and pregabalin; and recurrence occurred in 9 cases (1.9%), and the condition was controlled in 4 of these cases by using a conservative method, while 5 of the cases underwent reoperation, including 3 traditional open surgeries and 2 PEID. Furthermore, the complication rate for the first 100 cases was 16%. This rate decreased to 3.4% (for cases 101–479), and the incidence of L4–5 (8.2%) was significantly higher than L5-S1 (4.5%). Limitations. This is a retrospective study, and some bias exists due to the single-center study design. Conclusion. PEID is a surgical approach, which has a low complication rate. Fragment omission, nerve root injury, paresthesia and recurrence are relatively common. Some effective measures can prevent and reduce the incidence of the complications, such as strict indications for surgery, a thorough action plan and skilled operation skills

Purpose of the study: The endoscopic transforaminal approach to the lumbar disc proposed by A.T. Yeung has achieved world-wide acceptance. The Yeung endoscopic spinal system (YESS) used with a specific instrument set enables direct magnified optical control of discectomy performed under local anesthesia and neurolepanalgesia in the outpatient setting. We began our experience in 2003 and report here the results obtained in a consecutive series of 100 patients reviewed retrospectively. Material and methods: The inclusion criteria were patients with lumbar disc herniation-related lumbosciatic or crural pain non-responsive to well conducted medical care (including epidural or periradicular injections) for at least three months. The patients also had to display a concordant clinical and radiographic picture with confirmation of the symptomatic level by discography. Exclusion criteria were: excluded herniation with a fragment which had migrated into the canal; caudia equina syndrome; lower limb paralysis with muscle force scored less than 3; advanced-stage degernerative central bony stenosis affecting the clinical expression; pregnancy. The levels treated were: L3–L4 (n=6), L4–L5 (n=72), and L5–S1 (n=22). Herniation was forminal and extraforaminal in 53 cases, posterolateral in 31, and median in 16. There was an associated constitutional central stenosis in ten cases and in thirteen others, herniation was a recurrence after conventional surgery. Results: One hundred patients were reviewed at mean 18 months (range 12–34 months) follow-up. There were no serious neurological, vascular, or infectious complications. According to the McNab criteria outcome was good for 71 cases, fair for 16 and poor for 13 with 11 requiring revision with conventional surgery. Patients with foraminal and extraforminal herniation accounted for more than half of our series and responded best to treatment (84.9% good outcome) compared with posterolateral herniation (48%) (p< 0.05). Patients with median herniation had an intermediary outcome (68% good results). The least satisfactory outcome was observed at the L5–S1 level (63% fair and poor outcome), but the difference did not reach statistical significance compared with the higher levels. In patients with recurrent herniation after conventional surgery, there were four cases of failure. Discussion: These results are less satisfactory than those found in the literature. This might be explained by the less satisfactory outcome obtained with posterolateral herniations, probably because more than halve had migrated, generally above the plane of the disc, which in our experience cannot be accessed via the transforaminal approach. In addition, comparison of our first 50 cases with the last 50 showed an improvement in outcome to a mean 82%, expressing a learning curve for this type of technique. The most frequent error early in our experience was to insert the working endoscopic canula too anteriorly compared with the disc. The point of insertion must be very lateral determined by the discography in order to enter at least 30° posterior to the posterior part of the disc. Progressive fine-tuning of patient selection also helped improve outcome. YESS improves the work of the intradiscal instruments which can be control by direct view, explaining the the better results compared with the older mechanical or automatic (blind) methods. YESS is a very effective alternative to chemonucleolysis since papaine is no longer available. Compared with other endoscopic techniques for disectomy via an interlaminar approach, YESS offers the possibility of treatment patients in an outpatient setting with a local anesthesia. In addition the quality of the visual control of the foramen is better. These methods can be used in association with intradiscal Holmium-Yag laser which can also be applied to the bony walls of the foramen for a widening foraminoplasty. This transformainal endoscopic approach also offers a way to perform an exclusively foraminoscopic spondylodesis using an intersomatic cage. Conclusion: YESS is an excellent technique for non-migrated subligament posterolateral foraminal and extraforaminal herniations where conventional access to the foramen is known to be very difficult

Abstract. Introduction. FHL transfer for management of chronic Achilles' tendon ruptures is done both open and endoscopically. But there are no published studies comparing open and endoscopic results. Our study aims to compare them and determine the suitability of these methods. Materials and methods. Fourteen patients were treated endoscopically while 26 with an open technique. Of the 26, fourteen had an open Achilles tendon repair and FHL transfer while 12 has only open FHL transfer. All the endoscopic patients had only an FHL transfer. We compared demographics, complications of the procedure, recovery times, return to work and strength after 1 year. We noted ATRS at 6 months and 1 year for all three groups. We also conducted an MRI scan of three patients each of the three groups to determine the state of Achilles tendon and FHL tendon after 1 year of surgery. Results. There were similar complication rates for both the only FHL groups but the open FHL + Achilles' repair had more complications both for wound complications and saphenous neuropraxia. The recovery time, return to work and ATRS at 6 months was better for the endoscopic group as compared to both open groups. The strength and ATRS at 1 year were similar for all three groups. Conclusion. Endoscopic FHL transfer is safe and provides earlier return to work and better 6 months patient satisfaction then the open method. It also has less post op complications than open FHL + Achilles tendon repair, while maintains the same strength after 1 year

The aim of this prospective, randomised study is to compare outcomes within three groups of patients undergoing either open, one-portal or two-portal endoscopic carpal tunnel release. The study population consisted of 90 hands in 59 patients presenting with idiopathic carpal tunnel syndrome and symptom duration greater than 6 months, or those patients who had not gained satisfactory symptomatic relief from conservative treatments. Only patients with positive nerve conduction studies were included in the study. All patients were assessed using a standardised protocol which included a questionnaire on activities of daily living and symptoms experienced rated using a visual analogue scale. An examination followed which included; provocative tests; grip, pinch and abduction strengths; light touch; moving two-point discrimination; and vibration testing. Each patient was subsequently randomly allocated to one of the three surgical groups. All patients were assessed postoperatively, using a standa. We found no significant differences between the three surgical groups with regard to postoperative pain, level of satisfaction and objective return of grip and pinch strengths. The ability to perform activities of daily living postoperatively, however, was significantly reduced in the open technique group compared with patients treated with either endoscopic technique. There was also a significant difference in the time taken to return to work in the open group compared with both the endoscopic groups. No neurovascular complications occurred in our series. The only complications that occurred were in the open group and included; prolonged scar tenderness, severe post-operative bruising of the forearm, and infection

The purpose of this study was to compare the outcome and complications of endoscopic versus open release for the treatment of de Quervain’s tenosynovitis. Patients with this condition were randomised to undergo either endoscopic (n = 27) or open release (n = 25). Visual Analogue Scale (VAS) pain and Disabilities of Arm, Shoulder, and Hand (DASH) scores were measured at 12 and 24 weeks after surgery. Scar satisfaction was measured using a VAS scale. The mean pain and DASH scores improved significantly at 12 weeks and 24 weeks (p <  0.001) in both groups. The scores were marginally lower in the endoscopic group compared to the open group at 12 weeks (p = 0.012 and p = 0.002, respectively); however, only the DASH score showed a clinically important difference. There were no differences between the groups at 24 weeks. The mean VAS scar satisfaction score was higher in the endoscopic group at 24 weeks (p < 0.001). Transient superficial radial nerve injury occurred in three patients in the endoscopic group compared with nine in the open release group (p = 0.033). We conclude that endoscopic release for de Quervain’s tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release. Cite this article: Bone Joint J 2013;95-B:947–51

With the increase in the elderly population, there is a dramatic increase in the number of spinal fusions. Spinal fusion is usually performed in cases of primary instability. However it is also performed to prevent iatrogenic instability created during surgical treatment of spinal stenosis in most cases. In literature, up to 75% of adjacent segment disease (ASD) can be seen according to the follow-up time. 1. Although ASD manifests itself with pathologies such as instability, foraminal stenosis, disc herniation or central stenosis. 1,2. There are several reports in the literature regarding lumbar percutaneous transforaminal endoscopic interventions for lumbar foraminal stenosis or disc herniations. However, to the best our knowledge, there is no report about the treatment of central stenosis in ASD. In this study, we aimed to investigate the short-term results of unilateral biportal endoscopic decompressive laminotomy (UBEDL) technique in ASD cases with symptomatic central or lateral recess stenosis. The number of patients participating in the prospective study was 8. The mean follow-up was 6.9 (ranged 6 to 11) months. The mean age of the patients was 68 (5m, 3F). The development of ASD time after fusion was 30.6 months(ranged 19 to 42). Mean fused segments were 3 (ranged 2 to 8). Preoperative instability was present in 2 of the patients which was proven by dynamic lumbar x-rays. Preoperative mean VAS-back score was 7.8, VAS Leg score was 5.6. The preoperative mean JOA (Japanese Orthopaedic Association) score was 11.25. At 6th month follow-up, the mean VAS back score of the patients was 1, and the VAS leg score was 0.5. This improvement was statistically significant (p = 0.11 and 0.016, respectively). The mean JOA score at the 6th month was 22.6 and it was also statistically significant comparing preoperative JOA score(p = 0.011). The preoperative mean dural sac area measured in MR was 0.50 cm2, and it was measured as 2.1 cm. 2. at po 6 months.(p = 0.012). There was no progress in any patient's instability during follow-up. In orthopedic surgery, when implant related problems develop in any region of body (pseudoarthrosis, infection, adjacent fracture, etc.), it is generally treated by using more implants in its final operation. This approach is also widely used in spinal surgery. 3. However, it carries more risk in terms of devoloping ASD, infection or another complications. In the literature, endoscopic procedures have almost always been used in the treatment of ventral pathologies which constitute only 10%. In ASD, disease devolops as characterized by wide facet joint arthrosis and hypertrophied ligamentum flavum in the cranial segment and it is mostly presented both lateral recess and santal stenosis symptoms (39%). In this study, we found that UBEDL provides successful results in the treatment of patients without no more muscle and ligament damage in ASD cases with spinal stenosis. One of the most important advantages of UBE is its ability to access both ventral and dorsal pathologies by minimally invasive endoscopic aproach. I think endoscopic decompression also plays an important role in the absence of additional instability at postoperatively in patients. UBE which has already been described in the literature given successful results in most of the spinal degenerative diseases besides it can also be used in the treatment of ASD. Studies with longer follow-up and higher patient numbers will provide more accurate results

Purpose of the study: The cervicobrachial outlet syndrome is an anatomic and clinical entity related to intermittent or permanent compression of the brachial plexus trunks, and/or the subclavian artery and vein as they pass through six successive spaces in the thoracic cervicobrachial outlet, including the intercostoscalenic space. The purpose of this work was to evaluate the feasibility of endoscopic exploration of the infra-clavicular portion of the outlet and the options for therapeutic interscalenic release. Material and methods: Cadaver study of 12 shoulders: 3 male, 3 female. dissection of the supra and infra-clavicular region (n=3) to identify zones of potential impingement and determine the structures constituting the outlet;. dissections (n=2) centred on the different zones considered as potential endoscopic portals;. endoscopies (n=2) via a supra-lateral clavicular approach followed by dissection;. endoscopies (n=2) via a supra-lateral clavicular approach followed by dissection with insertion of landmarks then a new endoscopy;. Endoscopies (n=3) via a supra-lateral clavicular approach to achieve intercalenic release followed by control dissection. Results: The medial and lateral clavicular approaches identified two zones of less risk considering the proximity of the neck vessels and the phrenic and suprascapular nerves. A first, it was difficult to localize the brachial plexus endoscopically. This was achieved after dissection and insertion of landmarks. Five endoscopic procedures had to be performed to localize the plexus and starte the interscalenic release. Minute identification of the entry points for the trocars, as a perfect orientation of the instruments was necessary to achieve the procedure. The control dissections did not identify any vessel or nerve injury. Discussion: Few data in the literature examine the question of endoscopic interscalenic release. Unlike Krishnan and Pinzer, we found that endoscopic exploration of the outlet at possible, but difficult, procedure. Use of an arthropump remains to be evaluated because of the distension and impregnation of the tissues. Insufflations with CO2 might be an alternative. Conclusion: To our knowledge, a supra-clavicular approach for endoscopic exploration of the brachial plexus has not been described. Exploration of the outlet via this approach might be a less invasive procedure than conventional surgery. Complementary research is necessary to evaluate the morbidity of the different techniques

This pilot study analysed the outcome of open versus endoscopic curettage and bone grafting for the treatment of simple calcaneal bone cysts. A total of 26 patients were evaluated into two equal groups: group 1 was treated with traditional open curettage and bone grafting and group 2 was treated with endoscopic curettage and percutaneous bone grafting. Cyst size, operating time, length of stay, time to healing, complications, further surgery and radiological healing were recorded and differences were statistically compared. The mean age of the patients was 22.9 years (18 to 28) and the mean follow-up was 28.7 months (24 to 36). There were no statistically significant differences in regard to age of patients, cyst size and the follow-up periods in the two groups. The operating time and mean length of stay of group 2 patients was significantly shorter than group 1 patients (p <  0.001). The time to healing was similar in the two groups. The overall success rates for groups 1 and 2 were 92.3% (12 of 13) and 100% (13 of 13), respectively, and there were no statistically significant differences regarding radiological healing. This pilot study suggests that endoscopic curettage and percutaneous grafting is a simple and safe form of treatment, with similar results to those following open treatment

This study evaluates the results of Endoscopic Foraminoplasty on 30 consecutive patients followed for a minimum of 2 years. The objective has been to assess the efficacy of endoscopic aware state pain source definition combined with endoscopic decompression of the foramen, mobilisation and neurolysis of the exiting and transiting nerves and ablation of osteophytes in patients with spondylolytic spondylolisthesis. This prospective study involved Endoscopic Foraminoplasty performed on 16 males, and 14 females with an average age of 46 years (36–72 years). They were followed for an average period of 34 months (28–41 months). One-hundred percent cohort integrity was maintained at the final follow up. Results were analysed using the percentage change in Oswestry Disability Index, and percentage change in visual analogue pain (VAP) scores. Using a percentage change in Oswestry Disability Index of 50 or more to determine good and excellent outcomes, 75% (22 out of 30) exceed this value with five (17%) having 100% benefit for the procedure. These results indicate that Endoscopic Laser Foraminoplasty provides a minimalist means of exploring the extra-foraminal zone, the listhetic defect, the foramen and its contents, and the epidural space and performing decompression, discectomy, osteophytectomy, perineural neurolysis in patients with spondylolytic-spondylolisthes. Done in an aware state, it serves to identify and localise the source of pain generation

Introduction: Endoscopic techniques are an established technique for anterior correction and instrumentation of thoracic scoliosis. Deterioration in respiratory function post thoracotomy for has been cited as a disadvantage of anterior approaches and led certain authors to recommend posterior methods. 1. Endoscopic techniques may reduce respiratory complications and respiratory compromise in both the short and long term. Methods: Thirty eight patients, 7 male 31 female, mean age 17.3 yrs (11– 37yrs) have undergone endoscopic scoliosis surgery under the senior author. Indication for surgery was idiopathic scoliosis 36 and an underlying syrinx 2. All patients undergoing endoscopic scoliosis surgery have a standard preoperative assessment including respiratory function tests (RFTs). All patients have been followed up prospectively (mean 15 months, range 3 – 33 months) and standard data recorded. As part of this study we are in the process of performing follow up RFTs on all patients. Results: Preoperatively no significant respiratory function compromise attributable to the scoliosis has been detected. Mean duration of intercostal drain was 2 days, one patient requiring reinsertion for a recurrent pneumothorax. No other major respiratory complication occurred. On average patients were fully mobile by day five and mean hospital stay was 6 days (4–10 days). Provisional RFTs postoperatively have shown no significant change. Discussion: Our provisional results indicate that endoscopic scoliosis correction and instrumentation does not lead early respiratory complications or to a significant deterioration in respiratory function of the patient

INTRODUCTION: Endoscopic techniques are an established technique for anterior correction and instrumentation of thoracic scoliosis. Deterioration in respiratory function post thoracotomy has been cited as a disadvantage of anterior approaches and led certain authors to recommend posterior methods. 1. Endoscopic techniques may reduce respiratory complications and respiratory compromise in both the short and long term. METHODS: Thirty eight patients, seven male 31 female, mean age 17.3 years (11– 37 years) have undergone endoscopic scoliosis surgery under the senior author. Indication for surgery was idiopathic scoliosis 36 and an underlying syrinx 2. All patients undergoing endoscopic scoliosis surgery have a standard pre-operative assessment including respiratory function tests (RFTs). All patients have been followed up prospectively (mean 15 months, range 3 – 33 months) and standard data recorded. As part of this study we are in the process of performing follow up RFTs on all patients. RESULTS: Pre-operatively no significant respiratory function compromise attributable to the scoliosis has been detected. Mean duration of intercostal drain was two days, one patient requiring reinsertion for a recurrent pneumothorax. No other major respiratory complication occurred. On average patients were fully mobile by day five and mean hospital stay was six days (4–10 days). Provisional RFTs post-operatively have shown no significant change. DISCUSSION: Our provisional results indicate that endoscopic scoliosis correction and instrumentation do not lead to early respiratory complications or to a significant deterioration in respiratory function of the patient

Introduction The use of anterior techniques to address scoliosis is well established. The method employed is dependent on the curve type, degree and the institution. There are apparent immediate perioperative advantages of an endoscopic technique over an open thoracotomy. In addition, endoscopic instrumentation and fusion has become accepted as a reliable method to address thoracic scoliosis. Methods 101 patients have undergone anterior endoscopic instrumented correction for scoliosis at the Mater Children’s Hospital, Brisbane between 2000 and 2005. In 2002, a case series study was established to assess perioperative aspects. The majority of patients were entered into a database prospectively. A total of 83 patients were included in the study at the point of data analysis for this paper. The perioperative factors considered were: Theatre times; Blood management; Mobility; and Complications. Results The mean age was 16 years. 75 curves were adolescent idiopathic. Eight curves were in neuromuscular patients. The majority, 59 (79%) were Lenke Type 1 curves. Operating times were divided into anaesthetic, surgical and X-ray. There was a mean reduction in anaesthetic time between the first and last 20 cases of 22 minutes (p=0.20). For X-ray this was 73 seconds (p< 0.001). The mean surgical time was 288 minutes. The mean reduction in surgical time was 76 minutes (p< 0.001). A scatter plot was also performed of surgical time versus case number. The surgical time has an apparent plateau after approximately 30 cases. This may suggest a learning curve of this number. The mean intra-operative blood loss was 380mls with no allogenic transfusions. The mean length of stay was 5.8 days. There was an overall perioperative complication rate of 12%. There were six reinsertions of ICC, one conversion to an open thoracotomy, two postoperative chest infections and one patient requiring re-intubation in intensive care due to narcosis. There were no subsequent problems for these patients with perioperative complications. Discussion The use of endoscopic techniques to address scoliosis is employed in centres specializing in spinal deformity. The results above are comparable to those previously reported for both open and endoscopic anterior techniques. The results outlined demonstrate this to be a safe method regarding the perioperative morbidity and complications associated with the procedure

From the appearing of the first works of R. Judet, E. Letournel, M. Tile up to this day, the methods of pelvic surgery changed cardinally. These operations are technically complicated and accompanied by blood loss. That’s why the low-invasive surgical methods including endoscopic approach are perspective. The endoscopic methods of reposition and osteosynthesis offer advantages which are expressed in increasing of injury visualization, reduction of surgical incisions and fast postoperative restoration. A surgeon using the method of osteosynthesis needs endoscopic skills and thorough knowledge of standard surgical approaches. We have the experience of the treatment of 12 patients. We consider that the indications for these operations are not only a type of pelvic injury, but also anatomico-technical moment: an opportunity of creating of workspace. We have 2 techniques:. endoscopic osteosynthesis with using of pelvioscope;. optical endoscopic osteosynthesis. In any case, it is necessary to create the workspace from a small incision above the injury region by the method of tissue pneumotization. Fracture reposition is realized using a fracture table and reducing attachments. Osteosynthesis is immediately carried out with both standard and original steel constructions using the special tools that we developed and produced (ports, drill, screwdrivers etc.). The intraoperative blood loss was not more than 150 ml in all cases and in the postoperative period in drains–not more than 100 ml. The promotion of the patients was realized by the standard methods. There were no complications. The good functional result was in all cases. We think that further development of such techniques will allow to activate pelvic surgery on the new qualitative level

We performed a prospective study to examine the influence of the patient’s position on the location of the abdominal organs, to investigate the possibility of a true lateral approach for transforaminal endoscopic lumbar discectomy. Pre-operative abdominal CT scans were taken in 20 patients who underwent endoscopic lumbar discectomy. Axial images in parallel planes of each intervertebral disc from L1 to L5 were achieved in both supine and prone positions. The most horizontal approach angles possible to avoid injury to the abdominal organs were measured. The results demonstrated that the safe approach angles were significantly less (i.e., more horizontal) in the prone than in the supine position. Obstacles to a more lateral approach were mainly the liver, the spleen and the kidneys at L1/2 (39 of 40, 97.5%) and L2/3 (28 of 40, 70.0%), and the intestines at L3/4 (33 of 40, 82.5%) and L4/5 (30 of 30, 100%). A true lateral approach from each side was possible for 30 of the 40 discs at L3/4 (75%) and 23 of the 30 discs at L4/5 (76.7%). We concluded that a more horizontal approach for transforaminal endoscopic lumbar discectomy is possible in the prone position but not in the supine. Prone abdominal CT is more helpful in determining the trajectory of the endoscope. While a true lateral approach is feasible in many patients, our study shows it is not universally applicable.

Introduction. Patients with hip abductor tendon tears amenable to endoscopic repair tend to be severely disabled and older. However, low preop baseline patient reported outcome (PRO) and advancing age are each often reported to be a harbinger of poor result with hip arthroscopy. Thus, the purpose of this study is to report the demographic makeup of this population and how these patients faired in terms of preop scores and reaching both Minimal Clinically Important Difference (MCID) and Substantial Clinical Benefit (SCB). Methods. Sixty-six consecutive hips in 64 patients (2 bilateral) undergoing endoscopic abductor tendon repair with a hollow core bioabsorbable suture anchor and having achieved two-year follow-up were prospectively assessed with modified Harris Hip Score (mHHS) and international Hip Outcome Tool (iHOT) scores. The MCID for patients undergoing hip arthroscopy has previously been determined as 8 for the mHHS and 13 for the iHOT. SCB has been determined as 20 for the mHHS and 28 for the iHOT. Subgroups were compared using the independent samples t-test. Results. The average age was 57 years (range 22–83 years) with 59 females and 5 males. Post-operative follow-up averaged 28 months (range 24–60). There were 33 full-thickness and 33 partial-thickness tears; 39 gluteus medius tears, 25 medius and minimus tears, and 2 isolated minimus tears. Among the 66 hips, the average preop mHHS was 48.8 with 98.5% achieving MCID and 93.8% SCB. Among 60 hips that had complete iHOT data, the average preop score was 30.0 with 98.3% achieving MCID and 88.3% SCB. There were no complications. One patient underwent repeat arthroscopy for joint debridement at 12 months following abductor repair, and one subsequently underwent total hip replacement at 11 months following repair. There was no statistically significant difference between subgroups of full thickness/partial thickness tears, or single/two tendon tears. Conclusion. This report of endoscopic abductor tendon repair represents a heterogeneous group of single and two tendon involvement with partial and full thickness tears. Collectively these patients can respond exceptionally well in terms of MCID (98.5% mHHS; 98.3% iHOT) and SCB (93.8% mHHS; 88.3% iHOT), even in the presence of low preop baseline scores (average 48.8 mHHS; 30 iHOT) and older age (average 57 years). For any tables or figures, please contact the authors directly

Introduction: Endoscopic techniques are an established method for anterior correction and instrumentation of thoracic scoliosis. Deterioration in respiratory function for up to two years following a thoracotomy . 1. has been cited as a disadvantage of anterior approaches and has led certain authors to recommend posterior approaches. . 2. This prospective study establishes the pattern of change in respiratory function in patients during the first 12 months following endoscopic scoliosis surgery. Methods: 67 patients have undergone endoscopic scoliosis correction performed by the senior author (GNA). The patients were intubated with a double lumen tube. The lung was deflated on the ipsilateral side to the spinal correction and instrumentation throughout the procedure. A chest drain was inserted per operatively and removed on day two post-operation. All the patients underwent respiratory function tests (RFTs) as part of the preoperative workup. These included absolute and predicted FVC, as well as absolute and predicted FEV1.Thirty patients underwent postoperative RFTs for the purpose of this study. 10 patients had RFTs at 12 months following surgery. A further 20 patients had repeat RFTs scheduled at 3 months, 6 months and 12 months post operatively. Results: The RFTs of all 10 patients within the initial group had returned to their preoperative level at twelve months The RFTs of the further 20 patients showed a reduction in all parameters at the 3 month period post-operation but these had shown improvement at the 6 month period. The results are indicated for pre-op, 3months, 6 months and 12 months respectively. FVC 2.82, 2.51, 2.84 and 3.10 FVC% predicted 82.2%, 70.6%, 79.0% and 89.4%. FEV1 2.48, 2.23, 2.49 and 2.67 FEV% predicted 75.3%, 67.3%, 75.1% and 79.6. Discussion: The provisional results have shown that there is a reduction in the respiratory function in the immediate post-operative period following endoscopic scoliosis correction, but this does not lead to serious respiratory compromise. The respiratory function returns to the preoperative level at 12 months, showing there is no long-term deterioration of respiratory function following endoscopic correction and instrumentation

Objectives: To assess the efficacy and outcome of endoscopic aware state pain source definition combined with endoscopic decompression of the foramen, mobilisation and neurolysis of the exiting and transiting nerves and ablation of osteophytes in patients with spondylolytic spondylolisthesis followed for a minimum of two years. Design: This prospective study determined the outcome of endoscopic foraminal decompression in symptomatic spondylolytic-spondylolisthesis. Subjects: Sixteen males, and fourteen females with an average age of 46 years. Outcome measures: Results were analysed using the percentage change in Oswestry Disability Index, and percentage change in visual analogue pain (VAP) scores. Results: One hundred percent cohort integrity was maintained at the final follow up. Using a percentage change in Oswestry Disability Index of 50 or more to determine good and excellent outcomes, 75% (22 out of 30) exceeded this value with five (17%) having 100% benefit for the procedure. Conclusion: These results indicate that Endoscopic Laser Foraminoplasty provides a minimalist means of exploring the extraforaminal zone, the lytic defect, the foramen, its contents, and the epidural space and performing decompression, discectomy, osteophytectomy, perineural neurolysis in patients with spondylolytic spondylolisthes. Done in an aware state, it serves to identify and localise the source of pain generation

Introduction and Objectives: Carpal tunnel syndrome (CTS) is the most frequent compressive neuropathy, it is seen in 1% of the general population. It mainly affects women between 40 and 60 years of age, and it is frequently bilateral. There are a variety of surgical techniques for its treatment, both open and endoscopic. The aim of this study is to compare the efficacy of the mini-incision and endoscopic techniques in the relief of symptoms and resumption of daily living activities; to assess risks and complications; and to determine the efficiency of each technique. Materials and Methods: We compared 2 groups of 58 individuals, with idiopathic CTS, with a minimum 2 year follow-up The patients in group 1 were operated endoscopically, those in group 2 were operated using a minimally invasive technique; in both cases the median nerve was anesthetized. We described both surgical techniques. We applied a modified DASH test. Results: There were no immediate or late complications or reoperations in any of the patients in either group. In group II 20% of the patients reported discomfort at the site of the scar on their first follow-up exam, this was not present 1 year after surgery. There was a slight subjective loss of force in 5% of the patients, with no differences between groups. The mean time of return to work was 21 days in both groups. All patients reported that they were satisfied with the results. Discussion and Conclusions: Both techniques leave a minimal scar and have little morbidity. Endoscopic surgery requires a greater learning curve and has greater potential risks. The greater economic cost of this technique and the operating room time it requires lead us to prefer the use of the mini-incision technique for the treatment of TCS

Introduction. Although the majority of patients with plantar fasciitis respond to non- surgical management, between 5 and 10% of patients require surgical intervention. The aim of this study is to compare the results of open plantar fascia release with the results following a less invasive endoscopic release. Methods. A consecutive series of patients who underwent open plantar fascia release (group one) was compared to a similar group who underwent endoscopic plantar fascia release (group two). Each patient was assessed retrospectively using the American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score. In addition, the patient's overall satisfaction with the procedure, time taken to return to full activity, and the complication rate was determined. Finally, pre- and post-operative radiographs were assessed for arch collapse in group two. Results. The demographics of the two groups were comparable. Group one contained 36 patients (38 ft) and group two contained 66 patients (70 ft). The mean follow up for both groups was 22 months. The mean AOFAS score for each group was comparable pre-operatively, however the post-operative score was significantly better for group two. The time taken to return to full activities was significantly quicker in the endoscopic group, and post-operative pain levels and satisfaction rates were also significantly better. Radiographs demonstrated no arch collapse in group two following the procedure. Conclusions. When surgery for plantar fasciitis is indicated, the results of this study have demonstrated an endoscopic approach offers a safe alternative to an open procedure. Furthermore, endoscopic release is associated with an accelerate activities and a higher patient satisfaction rate

Introduction Ulnar nerve entrapment is the second commonest upper limb nerve entrapment syndrome. The purpose of this study was to determine the safety and efficacy of the Agee endoscopic system in ulnar nerve decompression at the elbow. This is the first report of its use in the elbow. Methods Six preserved cadaveric elbow specimens were used. One surgeon performed the endoscopic releases via a three centimetre longitudinal incision between the medial epicondyle and olecranon. All six specimens were examined independently with loupe magnification. This was done by extending the original incision to 20 cm. The ulnar nerve was assessed with regard to adequate decompression. The branching of the ulnar nerve at the elbow, as well as the presevation of these branches after the endoscopic procedure, was also studied. Results In all six specimens, the arcade of Struthers, the cubital tunnel retinaculum, and the flexor carpiulnaris aponeurosis were completely divided. There were an average of three motor branches to flexor carpiulnaris at a mean position of 21 mm distal to the medial epicondyle. Most of these were on the radial side of the nerve. The ulnar nerve was also found to give one to two sensory branches, at a mean position of nine millimetres proximal to the medial epicondyle. All the motor and sensory branches were found to be intact after the endoscopic procedure. Conclusions This study shows that the Agee endoscopic system is both safe and effective. It is a relatively simple procedure but cadaveric practice is recommended to obtain familiarity with the technique and the endoscopic view of the anatomy