CNS Neurosurgery
February 14, 2025  

TRANSFORAMINAL FULL-ENDOSCOPIC SURGERY FOR LUMBAR FORAMINAL PATHOLOGIES: A COMPARATIVE CLINICAL EFFECTIVENESS STUDY 

Kosuke Sugiura, Cathryn Payne, Nguyen T. Tran, Jannik Leyendecker, John Ogunlade, Mary LaVanne, Peter Derman, Robert Quon, Albert Telfeian, Christoph Hofstetter; on behalf of the Endoscopic Spine Research Group (ESRG)

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This study evaluated patient-reported outcomes after transforaminal full-endoscopic spine surgery for lumbar foraminal conditions. Data from 83 patients across four medical centers showed significant improvements in low back pain, leg pain, and disability scores six months after surgery. Endoscopic discectomies and foraminotomies were effective for most lumbar foraminal pathologies, but vertical foraminal stenosis showed the lowest treatment response rate. Further research is needed to understand the effectiveness of decompression surgery for vertical foraminal stenosis.
DOI: 10.1227/neu.0000000000003337

The Spine Journal
December 3, 2024 

FULL-ENDOSCOPIC SPINAL DECOMPRESSION OR DISCECTOMY SHOW BENEFITS REGARDING 30-DAY READMISSION RATES WHEN COMPARED TO OTHER SPINE SURGERY TECHNIQUES: A PROPENSITY SCORE MATCHED ANALYSIS 

Jannik Leyendecker, Mark Mahan, Matthew C. Findlay, Tobias Prasse, Malin Koster, Lena Rumswinkel, Tara Shenker, Peer Eysel, Jan Bredow, Mark M. Zaki, Sanjay Konakondla, Osama N. Kashlan, Peter Derman, Albert Telfeian, Christoph Hofstetter, Endoscopic Spine Research Group (ESRG)
 

​"This study compares 30-day readmission rates and revision surgeries between patients undergoing full-endoscopic spine surgery (FESS) and traditional spine surgeries. The analysis included 908 FESS patients and a matched cohort of 73,906 non-FESS patients, revealing that FESS significantly reduced 30-day readmission rates (1.1% vs. 4.4%) and length of hospital stay. The rate of 30-day surgical revisions was similar between both groups. Multivariate analysis showed that FESS was strongly associated with reduced readmission rates. The study highlights FESS as a safer and more effective option, particularly for outpatient procedures, with further research needed for more complex cases."
DOI: 10.1016/j.spinee.2024.11.007

World Neurosurgery
September 13, 2024  

LUMBAR ENDOSCOPIC UNILATERAL LAMINECTOMY FOR BILATERAL DECOMPRESSION IN DEGENERATIVE SPONDYLOLISTHESIS

Rida Mitha, Mark A Mahan, Rujvee P Patel, Jhair Alejandro Colan, Jannik Leyendecker, Mark M Zaki, Edward Samir Harake, Varun Kathawate, Osama Kashlan, Sanjay Konakondla, Meng Huang, Galal A Elsayed, Daniel M Hafez, Brenton Pennicooke, Nitin Agarwal, Christoph P Hofstetter, John Ogunlade
 

"This study investigates the use of full endoscopic spine surgery for treating low-grade degenerative spondylolisthesis with severe stenosis in 73 patients. Patients underwent lumbar endoscopic unilateral laminectomy for bilateral decompression at six spine centers in North America, with follow-up at 3, 9, and 12 months. Results showed significant improvements in pain and disability scores, with 70 patients reporting symptom relief. No patients experienced progression of spondylolisthesis, indicating the procedure's safety and effectiveness. The authors suggest further studies are needed to compare this approach with traditional treatments."
DOI: 10.1016/j.wneu.2024.09.017

Science Translational Medicine
September 18, 2024  
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PERFUSION IMAGING METRICS AFTER ACUTE TRAUMATIC SPINAL CORD INJURY ARE ASSOCIATED WITH INJURY SEVERITY IN RATS AND HUMANS

Zin Z. Khaing, Jannik, Leyendecker, Jennifer N. Harmon, Sananthan Sivakanthan, Lindsay N. Cates, Jeffrey E. Hydes, Melissa Krueger, Robb W. Glenny, Matthew Bruce, Christoph P. Hofstetter

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"This study investigated the use of contrast-enhanced ultrasound imaging to assess intraspinal vascular disruption following traumatic spinal cord injury (tSCI) in both a rodent model and a cohort of 27 patients. The findings revealed that metrics such as the perfusion area deficit and spinal perfusion index correlated with injury severity and functional recovery over time. These results suggest that intraoperative ultrasound-derived metrics may serve as valuable biomarkers for predicting outcomes after tSCI, though further research is needed to establish their reliability and prognostic capacity."
DOI: 10.1126/scitranslmed.adn4970

World Neurosurgery
August, 2024  
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ECONOMIC IMPLICATIONS OF DURAL TEARS IN LUMBAR MICRODISCECTOMIES: A RETROSPECTIVE, OBSERVATIONAL STUDY 

Tobias Prasse, Vincent Heck, Jannik Leyendecker, Christoph Hofstetter, Nikolaus Kernich, Peer Eysel, Jan Bredow

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"Dural tears (DTs) are a frequent complication after lumbar spine surgery. This paper sought to determine the incidence of DTs and the related impact on health care expenditures after lumbar discectomies."
DOI: 10.1016/j.wneu.2024.04.052

CNS Neurosurgery
June 20, 2024  
 
ENDOSCOPIC VERSUS TRADITIONAL THORACIC DISCECTOMY: A MULTICENTER RETROSPECTIVE CASE SERIES AND META-ANALYSIS

Nelson Sofoluke, Jannik Leyendecker, Sean Barber, Taylor Reardon, Eliana Bieler, Akshay Patel, Osama Kashlan, Jan Bredow, Peer Eysel, Raymond Gardocki, Saqid Hasan, Albert Telfeian, Christoph Hofstetter, Sanjay Konakondla on behalf of the Endoscopic Spine Research Group (ESRG)

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The aim of this study was to provide a comprehensive evaluation of potential benefits of Full endoscopic spine surgery for the treatment of thoracic disc herniation. This study reviewed literature on "thoracic disc herniation" and performed a meta-analysis of 3,190 patients, finding a 25% rate of perioperative complications and a 7% reoperation rate for traditional thoracic discectomy. In contrast, a retrospective evaluation of 41 patients undergoing full endoscopic thoracic discectomy (FESS) showed lower complication rates (9.7%), minimal blood loss (median of 5 mL), and a significantly shorter hospital stay (0.43 days). The results suggest that full endoscopic thoracic discectomy is a safe and effective treatment option for patients with symptomatic thoracic disc herniation.
DOI: 10.1227/neu.0000000000003034

Asian Spine Journal
June 18, 2023 
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SPINAL DEFORMITY, SURGERY AT THE CERVICOTHORACIC JUNCTION, AND AMERICAN SOCIETY OF ANESTHESIOLOGISTS CLASS INCREASE THE RISK OF POST-SURGICAL INTENSIVE CARE UNIT TREATMENT AFTER DORSAL SPINE SURGERY: A SINGLE-CENTER MULTIVARIATE ANALYSIS OF 962 PATIENTS

Jannik Leyendecker, Tobias Prasse, Ahmad Al Rahhal, Christoph Hofstetter, Wolfgang Wetsch, Peer Eysel, Jan Bredow​

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"This single-center study analyzed data from 962 patients undergoing dorsal spine surgery at a tertiary care university hospital between 2009 and 2019 to identify preoperative risk factors for ICU admission post-surgery. The results showed an overall ICU admission rate of 30.4%, with significant associations for surgeries at the cervicothoracic junction (odds ratio [OR] 8.86) and for spinal deformity treatment (OR 7.7), among other factors. Additional risk factors included cervical procedures (OR 3.29), higher ASA class (OR 2.74), spondylodiscitis (OR 2.47), multi-level fusions (OR 1.94), and age over 75 years (OR 1.33)."
DOI: 10.31616/asj.2023.0093

medRxiv
January 4, 2024  
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CONTRAST-ENHANCED ULTRASOUND FOR ASSESSING TISSUE PERFUSION AND PREDICTING FUNCTIONAL RECOVERY FOLLOWING ACUTE TRAUMATIC SPINAL INJURY: TRANSLATION FROM RAT MODEL TO HUMANS 

Zin Z. Khaing, Jannik Leyendecker, Jennifer N. Harmon, Sananthan Sivakanthan, Lindsay N. Cates, Jeffrey E. Hydes, Melissa Krueger, Robb W. Glenny, Matthew Bruce, Christoph P. Hofstetter
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"This paper introduces a novel biomarker utilizing contrast-enhanced ultrasound in humans and rats that accurately predicts injury severity after traumatic spinal cord injury based on tissue perfusion."
DOI: https://doi.org/10.1101/2024.01.04.24300837

Scientific Reports
December 19, 2022
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QUANTITATIVE TISSUE PERFUSION IMAGING USING NONLINEAR ULTRASOUND LOCALIZATION MICROSCOPY 

Jennifer N. Harmon , Zin Z. Khaing, Jeffrey E. Hyde, Christoph P. Hofstetter, Charles Tremblay-Darveau, and Matthew F. Bruce

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The study introduces nonlinear ultrasound localization microscopy (ULM), a novel technique enhancing vascular imaging beyond the classical diffraction limit by utilizing microbubble contrast agents. Unlike conventional methods, nonlinear ULM enables visualization of blood flow at the tissue perfusion level, offering improved resolution and quantitative features for assessing microcirculatory flow. Using rat spinal cord models, nonlinear ULM demonstrates superior resolution in smaller branching vasculature and enables the investigation and potential quantification of tissue perfusion, a critical aspect of blood flow assessment. 
DOI: ​10.1038/s41598-022-24986-w

Toxins
November 10, 2022
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EARLY DETRUSOR APPLICATION OF BOTULINUM TOXIN A RESULTS IN REDUCED BLADDER HYPERTROPHY AND FIBROSIS AFTER SPINAL CORD INJURY IN A RODENT MODEL 

Juliana Y. Bushnell, Lindsay N. Cates, Jeffrey E. Hyde, Christoph P. Hofstetter, Claire C. Yang, Zin Z. Khaing

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In a rodent model of spinal cord injury (SCI), early bladder chemodenervation with botulinum toxin A (BoNT-A) resulted in reduced bladder weight and thinner bladder walls compared to saline injection. Histological analysis showed that BoNT-A-treated bladders had collagen organization similar to uninjured bladders, suggesting that detrusor chemodenervation following SCI preserves bladder tissue integrity by mitigating detrusor fibrosis and hypertrophy. 
DOI: 10.3390/toxins14110777

Ultrasound in Medicine and Biology
August 1, 2022 
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BLOOD FLOW CHANGES ASSOCIATED WITH SPINAL CORD INJURY ASSESSED BY NON-LINEAR DOPPLER CONTRAST-ENHANCED ULTRASOUND

Matthew Bruce, Dane Dewees, Jennifer N. Harmon, Lindsay Cates, Zin Z. Khaing, and Christoph P. Hofstetter 

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The study demonstrates the clinical utility of contrast-enhanced ultrasound (CEUS) in assessing acute and chronic blood flow changes in contused spinal cords, using higher imaging frequencies (15 MHz) to simultaneously visualize micro- and macrocirculations. Significant differences in perfusion deficit and microbubble arrival time were observed between moderate and severe injuries, with acute morphological changes in central sulcal arteries correlating with chronic locomotive function and histological estimates of spared spinal cord tissue. 
DOI: 10.1016/j.ultrasmedbio.2022.03.004

Journal of Neurotrauma
March 15, 2021
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EFFECT OF DUROTOMY VERSUS MYELOTOMY ON TISSUE SPARING AND FUNCTIONAL OUTCOME AFTER SPINAL CORD INJURY

Zin Z. Khaing, Lindsay N. Cates, Dane M. Dewees, Jeffrey E. Hyde, Ashley Gaing, Zeinab Birjandian, and Christoph P. Hofstetter​

The study compares the effects of durotomy alone and durotomy plus myelotomy in a rodent model of acute thoracic traumatic spinal cord injury (tSCI). Both surgical approaches effectively reduce elevated intraspinal pressure and promote tissue sparing, with durotomy plus myelotomy showing superior results in spinal tissue preservation and motor neuron preservation. While both surgeries contribute to locomotor function recovery, durotomy alone benefits bladder and Ladder Walk performance, suggesting a need for biomarkers to identify optimal surgical strategies for specific spinal cord injuries. 
DOI: https://doi.org/10.1089/neu.2020.7297

Military Medicine
February 19, 2020
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CONTRAST-ENHANCED ULTRASOUND FOR ASSESSMENT OF LOCAL HEMODYNAMIC CHANGES FOLLOWING A RODENT CONTUSION SPINAL CORD INJURY

Zin Z. Khaing, Lindsay N. Cates, Jeffrey Hyde, Dane M. Dewees, Ryan Hammond, Matthew Bruce, Christoph P. Hofstetter

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CEUS imaging showed that traumatic SCI results in an area with significant loss of perfusion, which increased during the first hour after injury, structural alterations of the spinal cord vasculature, and significant slowing of arterial blood flow velocities around the injury epicenter.
DOI: 10.1093/milmed/usz296

Spinal Cord
January 21, 2020
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TRANSCUTANEOUS CONTRAST-ENHANCED ULTRASOUND IMAGING OF THE POST-TRAUMATIC SPINAL CORD

Zin Z. Khaing, Lindsay N. Cates, Jeffrey E. Hyde, Ryan Hammond, Matthew Bruce, Christoph P. Hofstetter

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"This study aims to test whether the blood flow within the contused spinal cord can be assessed in a rodent model via the acoustic window of the laminectomy utilizing transcutaneous ultrasound. We report that transcutaneous ultrasound allows for measurements and longitudinal monitoring of local hemodynamic changes in a rodent SCI model."
DOI: 10.1038/s41393-020-0415-9

Journal of Neurosurgery
September 19, 2018
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CONTRAST-ENHANCED ULTRASOUND TO VISUALIZE HEMODYNAMIC CHANGES AFTER RODENT SPINAL CORD INJURY

Zin Z. Khaing, Lindsay N. Cates, Dane M. Dewees, Alexander Hannah, Pierre Mourad, Matthew Bruce, and Christoph P. Hofstetter

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"In our current report, we introduce ultrafast CEUS Doppler for monitoring of spinal vascular structure and function in real time. Development and clinical implementation of this type of imaging could have a significant impact on the care of patients with tSCI."
DOI: 10.3171/2018.1.SPINE171202

Journal of Neurotrauma
February 1, 2017
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TEMPORAL AND SPATIAL EVOLUTION OF RAISED INTRASPINAL PRESSURE AFTER TRAUMATIC SPINAL CORD INJURY

Zin Z. Khaing, Lindsay N. Cates, Amanda E. Fischedick, Abbi M. McClintic, Pierre D. Mourad, and Christoph P. Hofstetter

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"Here, we report on the temporal and spatial patterns of elevated ISP following a moderate rodent contusion SCI.  Our findings suggest that a rat contusion SCI model in combination with novel micro-catheters allows for direct measurement of ISP after SCI. Similarly to traumatic brain injury, raised tissue pressure is likely to have detrimental effects on spontaneous recovery following SCI."
DOI: 10.1089/neu.2016.4490