Browsing by Author "Kotheeranurak V."

Filter results by typing the first few letters
Now showing 1 - 5 of 5
  • No Thumbnail Available
    ItemMetadata only
    “Platelet-Rich Plasma” epidural injection an emerging strategy in lumbar disc herniation: a Randomized Controlled Trial
    (2023-12-01) Wongjarupong A.; Pairuchvej S.; Laohapornsvan P.; Kotheeranurak V.; Jitpakdee K.; Yeekian C.; Chanplakorn P.; Mahidol University
    Background: Lumbar herniated disc (HNP) is mainly treated by conservative management. Epidural steroid injection (ESI) has been an option to treat failed cases prior to surgery. Triamcinolone has been widely used due to its efficacy in bringing about pain reduction for up to three months. However, several reports have shown some severe adverse events. Platelet-rich plasma (PRP) is made from blood through centrifugation. Several studies supported the potential short to long-term effects, and safety of PRP injection in treating HNP. The study objective was to evaluate the efficacy of PRP in treatment of single-level lumbar HNP in comparison to triamcinolone. Methods: Thirty patients were treated by transforaminal epidural injections. PRP was obtained from 24 ml venous blood through standardized double-spin protocol. Participants included fifteen patients each being in triamcinolone and PRP groups. The same postoperative protocols and medications were applied. The visual analogue scale of leg (LegVAS), collected at baseline, 2, 6, 12, and 24 weeks, was the primary outcome. The BackVAS, Oswestry Disability Index (ODI), adverse event, and treatment failure were the secondary endpoints. Results: Platelet ratio of PRP in fifteen patients was 2.86 ± 0.85. Patients treated by PRP injections showed statistically and clinically significant reduction in LegVAS at 6, 12, and 24 weeks, and in ODI at 24 weeks. It demonstrated comparable results on other aspects. No adverse event occurred in either group. Conclusion: Noncommercial epidural double-spin PRP yielded superior results to triamcinolone. Due to its efficacy and safety, the procedure is recommended in treating single level lumbar HNP. Trial registration: NCT, NCT05234840. Registered 1 January 2019, https://clinicaltrials.gov/ct2/show/record/NCT05234840 .
  • No Thumbnail Available
    ItemMetadata only
    Predictive parameters for successful indirect decompression of the lateral lumbar interbody fusion (LLIF) surgery
    (2022-12-01) Yingsakmongkol W.; Laokomen S.; Jitpakdee K.; Lin G.X.; Limthongkul W.; Singhatanadgige W.; Kotheeranurak V.; Mahidol University
    Background: Preoperative radiographic parameters in selecting the best surgical candidates for indirect decompression in the lateral lumbar interbody fusion (LLIF) surgery is considered one of the important concerns; there is a paucity of literature concerning this topic. This study aimed to find preoperative radiographic parameters that correlate with successful indirect decompression. Methods: We retrospectively reviewed patients who underwent LLIF surgery for various degenerative spine diseases at our institute. All patients included in the study had completed radiographs with preoperative and postoperative magnetic resonance imaging (MRI) within 3 months after surgery. Patients were categorized into success and failed indirect decompression using the cross-sectional area for pre and postoperative MRI scans. Various parameters were used to find an association for successful indirect decompression. Results: Sixty patients were included in our study with a total of 77 levels. Over two-thirds of patients (41/60, 68.3%) underwent oblique lateral lumbar interbody fusion or extreme lateral lumbar interbody fusion with posterior screw fixation. Of the 77 levels for which LLIF was performed, successful indirect decompression was attained in 38 levels and failed indirect decompression in 39 levels (49.3% success rate). Five parameters were significantly different between the success group and failed group. Only the cross-sectional area of the thecal sac (CSA) was significantly different as determined by a binary logistic mixed-effect regression model. Adding cut-point value to ROC curve of CSA, if CSA ≤ 106.97 mm2, it resulted in 82.14% sensitivity, and 72.41% specificity. Conclusion: LLIF showed significant improvement in average postoperative parameters. However, the cross-sectional area of the thecal sac (CSA) was the only parameter that inversely correlated with successful indirect decompression with LLIF. We concluded that even patients with severe spinal canal stenosis are good candidates for LLIF surgery owing to its indirect decompression.
  • No Thumbnail Available
    ItemMetadata only
    Surgeons' Perspective, Learning Curve, Motivation, and Obstacles of Full-Endoscopic Spine Surgery in Thailand: Results from A Nationwide Survey
    (2022-01-01) Kotheeranurak V.; Liawrungrueang W.; Kuansongtham V.; Sriphirom P.; Bamrungthin N.; Keorochana G.; Pruttikul P.; Limthongkul W.; Singhatanadgige W.; Pongmanee S.; Arunakul R.; Ruangchainikom M.; Sasiprapha P.; Chitragarn R.; Pairuchvej S.; Tanasansomboon T.; Jitpakdee K.; Mahidol University
    Objective. To report a nationwide survey of the endoscopic spine surgeons across Thailand. Furthermore, the survey will be focused on the perspective of experience, learning curve, motivations, and obstacles at the beginning of their practices. Materials and Methods. The online survey consisting of 16 items was distributed to spine surgeons who are performing endoscopic spine surgery in Thailand via the Google forms web-based questionnaire to investigate participants' demographics, backgrounds, experience in endoscopic spine surgery, motivations, obstacles, and future perspectives. The data was recorded from January 7, 2020 to January 21, 2022. Descriptive statistics were used for analysis. Results. A total of 42 surveys were submitted by 6 neurosurgeons (14.3%) and 36 orthopedic surgeons (85.7%). From the surgeons' perspective, the average number of cases that should be performed until one feels confident, consistently good outcomes, and has minimal complications was 27.44±32.46 cases. For surgeons who starting the endoscopic spine practice, at least 3 workshop participation is needed. Personal interest (39 selected responses) and trending marketing or business purpose (25 selected responses) were the primary motivators for endoscopic spine surgery implementation. Lack of support (18 selected responses) and afraid of complications (16 selected responses) were pertinent obstacles to endoscopic spine surgery implementation. Conclusions. The trend of endoscopic spine surgery has continued to grow in Thailand, shown by the rate of implementation of endoscopic spine surgery reported by Thai spine surgeons. The number of appropriate cases until one feels confident was around 28 cases. The primary motivator and obstacles were personal interest and lack of support.
  • No Thumbnail Available
    ItemMetadata only
    Thai Expert Consensus on Bone Health Optimization for Instrumented Spine Surgery
    (2025-12-01) Singhatanadgige W.; Valleenukul T.; Limthongkul W.; Ruangchainikom M.; Chaiyamongkol W.; Chitragran R.; Pongmanee S.; Siribumrungwong K.; Lertudomphonwanit T.; Kotheeranurak V.; Pluemvitayaporn T.; Tanasansomboon T.; Petcharapiruch S.; Changsatja S.; Yingsakmongkol W.; Singhatanadgige W.; Mahidol University
    Objective: To develop consensus-based guidance for bone health optimization in instrumented spine surgery, specifically addressing the limited guidance available in the Thai context. Methods: The study utilized a modified Delphi technique, engaging 10 orthopedic surgeons from Thailand with expertise in complex spine surgery and osteoporosis management. A targeted literature review was conducted, followed by 2 online surveys and a face-to- face consensus meeting to develop and refine the statements. Twenty-five main statements and 45 substatements that focused on patient evaluation, assessment tools, and risk stratification were drafted for the panel’s deliberation. Results: There was unanimous agreement on the necessity of evaluating bone health before instrumented spine surgery in patients aged ≥60 years, while evaluation was considered optional for those aged 50 to 59 years. The panelists supported using the fracture risk assessment tool score for clinical evaluation and recommended using several assessment tools, including dual-energy x-ray absorptiometry scans for specific age groups, Computed Tomography Hounsfield Unit, Trabecular Bone Score, and vertebral fracture assessment for bone health evaluation if available. Treatment recommendations included bone-forming agents as the first-line therapy for patients at high risk and very high risk and specialized surgical techniques for patients at very high risk. Surgical delay of at least 3 months should also be considered for patients at very high risk/with severe osteoporosis who have been scheduled for instrumented spine surgery. Conclusion: This guidance includes patient screening, evaluation, and treatment for patients with poor bone health based on risk stratification, including normal/low risk, osteopenia/intermediate risk, osteoporosis/high risk, and severe osteoporosis/ very high risk. Spine surgeons should be aware of poor bone health and consider bone health optimization to improve surgical outcomes and prevent osteoporosis-related complications. Clinical Relevance: Bone health optimization is crucial for instrumented spine surgery. Spine surgeons should consider bone health optimization guidance, including patient screening for poor bone health, assessment tools for evaluating bone health, and treatment for patients with poor bone health, to improve surgical results and minimize poor bone health-related complications. Level of Evidence: 5.
  • No Thumbnail Available
    ItemMetadata only
    The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries
    (2023-06-01) Suvithayasiri S.; Kim Y.J.; Liu Y.; Trathitephun W.; Asawasaksakul A.; Quillo-Olvera J.; Kotheeranurak V.; Chagas H.; Valencia C.C.; Serra M.V.; Van Isseldyk F.; Lee L.H.; Chen C.M.; Lokhande P.; Park S.M.; Jitpakdee K.; Patel K.K.; Kim J.H.; Mahatthanatrakul A.; Luksanapruksa P.; Wilartratsami S.; Kim J.S.; Mahidol University
    Objective: We aim to report the outcomes and feasibility of endoscopic spine surgery used to treat symptomatic spinal metastases patients. This is the most extensive series of spinal metastases patients who underwent endoscopic spine surgery. Methods: A worldwide collaborative network group of endoscopic spine surgeons, named ‘ESSSORG,’ was established. Patients diagnosed with spinal metastases who underwent endoscopic spine surgery from 2012 to 2022 were retrospectively reviewed. All related patient data and clinical outcomes were gathered and analyzed before the surgery and the follow-time period of 2 weeks, 1 month, 3 months, and 6 months. Results: A total of 29 patients from South Korea, Thailand, Taiwan, Mexico, Brazil, Ar-gentina, Chile, and India, were included. The mean age was 59.59 years, and 11 of them were female. The total number of decompressed levels was 40. The technique was relatively equal (15 uniportal; 14 biportal). The average length of admission was 4.41 days. Of all patients with an American Spinal Injury Association Impairment Scale of D or lower before surgery, 62.06% reported having at least one recovery grade after the surgery. Almost all clinical outcomes parameters statistically significantly improved and maintained from 2 weeks to 6 months after the surgery. Few surgical-related complications (4 cases) were reported. Conclusion: Endoscopic spine surgery is a valid option for treating spinal metastases patients as it could yield comparable results to other minimally invasive spine surgery tech-niques. As the aim is to improve the quality of life, this procedure is valuable and holds val-ue in palliative oncologic spine surgery.