机构：[1]Center for Advanced Spine Care of Southern Arizona, Tucson, AZ 85712, USA[2]Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 111321, Colombia[3]Department of Orthopedics at Hospital Universitário Gaffree Guinle Universidade Federal do Estado do Rio de Janeiro, R. Mariz e Barros, 775-Maracanã, Rio de Janeiro 20270-004, Brazil[4]Brain Technology and Innovation Park, Pacific Palisades, CA 90272, USA[5]Desert Institute for Spine Care, 1635 E Myrtle Ave Suite 400, Phoenix, AZ 85020, USA[6]Department of Neurosurgery, University of New Mexico School of Medicine, 915 Camino de Salud NE Albuquerque, Albuquerque, NM 87106, USA[7]Advanced Orthopedics, 499 East Central Parkway, Altamonte Springs, FL 32701, USA[8]Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215031, China[9]Minimally Invasive Spine Center Bogotá D.C. Colombia, Reina Sofía Clinic Bogotá D.C. Colombia, Bogotá 110141, Colombia[10]Spine Clinic, The American-Bitish Cowdray Medical Center I.A.P, Campus Santa Fe, Mexico City 05370, Mexico[11]Department of General and Specialized Surgery, Gaffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20000-000, Brazil[12]Good Doctor Teun Teun Spine Hospital, Seoul 775 , Republic of Korea[13]Torres Médicas Hospital Metropolitano, San Gabriel y Nicolás Arteta Torre Médica 3, Piso 5, Quito 170521, Ecuador[14]DWS Spine Clinic Center, CENTRO EL ALBA-Cam. El Alba 9500, Of. A402, Región Metropolitana, Las Condes 9550000, Chile[15]Department of Orthopaedic Surgery, Faculdade de Medicina de Ribeirão Preto (FMRP) da Universidade de São Paulo (USP), Ribeirão Preto 14040-900, Brazil[16]Hospital Obrero N1, C. Lucas Jaimes 76, La Paz 0201-0220, Bolivia[17]Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 731, Republic of Korea[18]Department of Neurosurgery, Nanoori Hospital Gangnam Hospital, Seoul 731, Republic of Korea[19]Department of Orthopaedic Surgery, West China Hospital Sichuan University, Chengdu 610041, China四川大学华西医院[20]Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215005, China[21]Santa Fe Foundation and Instituto Roosevelt, Bogotá 110311, Colombia[22]Centro de Cirugía Mínima Invasiva—CECIMIN, Avenida Carrera 45 # 104–76, Bogotá 0819, Colombia[23]Department of Neurosurgery, Pain and Spine Minimally Invasive Surgery Service at Gaffree Guinle University Hospital, Rio de Janeiro 20270-004, Brazil[24]Department of Orthopaedic Surgery, Espalda Saludable, Hospital Angeles Tijuana, Tijuana 22010, Mexico[25]Department of Spine Surgery, Hospital de Ortopedia, UMAE “Dr. Victorio de la Fuente Narvaez”, Ciudad de México 07760, Mexico[26]Department of Spine Surgery, Hospital Ángeles Universidad, Av Universidad 1080, Col Xoco, Del Benito Juárez, Ciudad de México 03339, Mexico[27]Department of Neurosurgery, Palmetto Steward General Hospital, South Miami, FL 33143, USA[28]Center for Neurological Diseases, Bolivian Spine Association, Spine Chapter of Latin American Federation of Neurosurgery Societies, Public University of El Alto, La Paz 0201-0220, Bolivia[29]Santa Casa Spine Center, São Paulo 09015-000, Brazil[30]Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 31270-901, Brazil[31]Instituto Nacional Traumato-Ortopedia-INTO, Rio de Janeiro 20940-070, Brazil[32]Department of Orthopaedic Surgery, University of São Paulo (USP), São Paulo 05508-060, Brazil[33]Instituto de Patologia da Coluna (IPC), Faculdade de Medicina de Ribeirão Preto (FMRP) da Universidade de São Paulo (USP), São Paulo 14040-900, Brazil[34]Department of Orthopaedic Surgery, Hospital da Restauração, Recife 52171-011, Brazil[35]Hospital das Clínicas of Ribeirao Preto Medical School, Sao Paulo University, Ribeirão Preto 14040-900, Brazil[36]The USC Caruso Department of Otolaryngology-Head and Neck Surgery, USC Keck School of Medicine, Los Angeles, CA 90033, USA[37]USC-Norris Comprehensive Cancer Center, Los Angeles, CA 90033, USA[38]World Brain Mapping Foundation (WBMF), Pacific Palisades, CA 90272, USA[39]Society for Brain Mapping and Therapeutics (SBMT), Pacific Palisades, CA 90272, USA[40]National Center for Nano Bio Electronic (NCNBE), Los Angeles, CA 90272, USA
Pain generator-based lumbar spinal decompression surgery is the backbone of modern spine care. In contrast to traditional image-based medical necessity criteria for spinal surgery, assessing the severity of neural element encroachment, instability, and deformity, staged management of common painful degenerative lumbar spine conditions is likely to be more durable and cost-effective. Targeting validated pain generators can be accomplished with simplified decompression procedures associated with lower perioperative complications and long-term revision rates. In this perspective article, the authors summarize the current concepts of successful management of spinal stenosis patients with modern transforaminal endoscopic and translaminar minimally invasive spinal surgery techniques. They represent the consensus statements of 14 international surgeon societies, who have worked in collaborative teams in an open peer-review model based on a systematic review of the existing literature and grading the strength of its clinical evidence. The authors found that personalized clinical care protocols for lumbar spinal stenosis rooted in validated pain generators can successfully treat most patients with sciatica-type back and leg pain including those who fail to meet traditional image-based medical necessity criteria for surgery since nearly half of the surgically treated pain generators are not shown on the preoperative MRI scan. Common pain generators in the lumbar spine include (a) an inflamed disc, (b) an inflamed nerve, (c) a hypervascular scar, (d) a hypertrophied superior articular process (SAP) and ligamentum flavum, (e) a tender capsule, (f) an impacting facet margin, (g) a superior foraminal facet osteophyte and cyst, (h) a superior foraminal ligament impingement, (i) a hidden shoulder osteophyte. The position of the key opinion authors of the perspective article is that further clinical research will continue to validate pain generator-based treatment protocols for lumbar spinal stenosis. The endoscopic technology platform enables spine surgeons to directly visualize pain generators, forming the basis for more simplified targeted surgical pain management therapies. Limitations of this care model are dictated by appropriate patient selection and mastering the learning curve of modern MIS procedures. Decompensated deformity and instability will likely continue to be treated with open corrective surgery. Vertically integrated outpatient spine care programs are the most suitable setting for executing such pain generator-focused programs.
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外文
PubmedID：
中科院(CAS)分区：
出版当年[2023]版：
大类|3 区医学
小类|3 区医学：内科4 区卫生保健与服务
最新[2023]版：
大类|3 区医学
小类|3 区医学：内科4 区卫生保健与服务
第一作者：
第一作者机构：[1]Center for Advanced Spine Care of Southern Arizona, Tucson, AZ 85712, USA[2]Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 111321, Colombia[3]Department of Orthopedics at Hospital Universitário Gaffree Guinle Universidade Federal do Estado do Rio de Janeiro, R. Mariz e Barros, 775-Maracanã, Rio de Janeiro 20270-004, Brazil[4]Brain Technology and Innovation Park, Pacific Palisades, CA 90272, USA
通讯作者：
通讯机构：[1]Center for Advanced Spine Care of Southern Arizona, Tucson, AZ 85712, USA[2]Department of Orthopaedics, Fundación Universitaria Sanitas, Bogotá 111321, Colombia[3]Department of Orthopedics at Hospital Universitário Gaffree Guinle Universidade Federal do Estado do Rio de Janeiro, R. Mariz e Barros, 775-Maracanã, Rio de Janeiro 20270-004, Brazil[4]Brain Technology and Innovation Park, Pacific Palisades, CA 90272, USA
推荐引用方式(GB/T 7714)：
Lewandrowski Kai-Uwe,Yeung Anthony,Lorio Morgan P,et al.Personalized Interventional Surgery of the Lumbar Spine: A Perspective on Minimally Invasive and Neuroendoscopic Decompression for Spinal Stenosis[J].Journal of personalized medicine.2023,13(5):doi:10.3390/jpm13050710.
APA：
Lewandrowski Kai-Uwe,Yeung Anthony,Lorio Morgan P,Yang Huilin,n Jorge Felipe...&Kateb Babak.(2023).Personalized Interventional Surgery of the Lumbar Spine: A Perspective on Minimally Invasive and Neuroendoscopic Decompression for Spinal Stenosis.Journal of personalized medicine,13,(5)
MLA：
Lewandrowski Kai-Uwe,et al."Personalized Interventional Surgery of the Lumbar Spine: A Perspective on Minimally Invasive and Neuroendoscopic Decompression for Spinal Stenosis".Journal of personalized medicine 13..5(2023)
