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Three-dimensional high-definition exoscope (Kestrel View II) in anterior cervical discectomy and fusion: a valid alternative to operative microscope-assisted surgery

  • Original Article - Spine degenerative
  • Published:
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Abstract

Background

Operative microscope (OM) has greatly advanced modern spine surgery, but remains limited by several drawbacks. Therefore, a three-dimensional (3D) high-definition (HD) exoscope (EX) (Kestrel View II, Mataka Kohli, Japan) system has been developed and used as an alternative to the OM. The aim of this study was to assess and compare the perioperative data and clinical outcomes of anterior cervical discectomy and fusion (ACDF) procedure with either an EX or OM.

Methods

Forty-eight patients with cervical spondylotic myelopathy (CSM) underwent ACDF assisted by the EX or OM between January 2019 and December 2019. We collected and compared data on operative time, intraoperative bleeding, postoperative hospitalization stay, complications, and clinical outcomes between the two groups. The clinical outcomes were evaluated by using visual analogue scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, the recovery rate of JOA scores, and Odom criteria.

Results

The operative time in the EX group was significantly shorter than that in the OM group (P < 0.05). The VAS and JOA scores were significantly improved in both groups after surgery (P < 0.05). In addition, the VAS scores in the EX group were significantly lower than those in the OM group at 1 week postoperatively (P < 0.05). The good-to-excellent outcome rates were 90.48 and 88.89% in the EX group and OM group, respectively, whereas the complication occurrence rates of the EX group and OM group were 4.76 and 11.11%, respectively.

Conclusions

EX-assisted and OM-assisted ACDF resulted in similar clinical outcomes for CSM, while EX-assisted surgery may be related to a short operative time and fewer complications.

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Abbreviations

OM:

Operative microscope

3D:

Three-dimensional

HD:

High-definition

EX:

Exoscope

ACDF:

Anterior cervical discectomy and fusion

VAS:

Visual analogue scale

JOA:

Japanese Orthopedic Association

CSM:

Cervical spondylotic myelopathy

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Acknowledgements

F.X. designed the study and performed the operations. Y.W.Y. and C.J.X. were involved in drafting the manuscript or revising it critically for important intellectual content. Y.W.Y., C.J.X., T.J.W., Z.P.Y., and F.Q.Z. collected the data. Y.W.Y. analyzed the data and performed the statistics. All authors read and approved the final version of the manuscript.

Funding

The current study was funded by the Wuhan Municipal Science and Technology Bureau (grant no. 2019020701011423).

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    Authors and Affiliations

    1. Orthopaedic Department, General Hospital of Central Theater Command of PLA, #627 Wuluo Road, Wuchang District, 43007, Wuhan, China

      Yawei Yao, Chengjie Xiong, Tanjun Wei, Zhipeng Yao, Fangqiang Zhu & Feng Xu

    2. The First School of Clinical Medicine, Southern Medical University, #1023-1063, South Shatai Road, Baiyun District, 51000, Guangzhou, China

      Yawei Yao, Zhipeng Yao & Feng Xu

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    1. Yawei Yao
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    Correspondence to Chengjie Xiong or Feng Xu.

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    All patients had been followed up for at least 12 months. All protocols were approved by the Ethics Committee of General Hospital of Central Theater Command and were performed in compliance with the Helsinki Declaration.

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    Comments

    This paper nicely demonstrates advantages of 3D digital exoscope in ACDF surgery compared to conventional modern surgical microscope. There was no real difference in clinical outcome. But the authors list several parameters where they feel theexoscope helped their work.

    Martin Lehecka

    Helsiniki, Finland

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    Yao, Y., Xiong, C., Wei, T. et al. Three-dimensional high-definition exoscope (Kestrel View II) in anterior cervical discectomy and fusion: a valid alternative to operative microscope-assisted surgery. Acta Neurochir 163, 3287–3296 (2021). https://doi.org/10.1007/s00701-021-04997-8

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