Spin excitations in hole-overdoped iron-based superconductors

Understanding the overall features of magnetic excitation is essential for clarifying the mechanism of Cooper pair formation in iron-based superconductors. In particular, clarifying the relationship between magnetism and superconductivity is a central challenge because magnetism may play a key role in their exotic superconductivity. BaFe2As2 is one of ideal systems for such investigation because its superconductivity can be induced in several ways, allowing a comparative examination. Here we report a study on the spin fluctuations of the hole-overdoped iron-based superconductors Ba1-xKxFe2As2 (x = 0.5 and 1.0; Tc = 36 K and 3.4 K, respectively) over the entire Brillouin zone using inelastic neutron scattering. We find that their spin spectra consist of spin wave and chimney-like dispersions. The chimney-like dispersion can be attributed to the itinerant character of magnetism. The band width of the spin wave-like dispersion is almost constant from the non-doped to optimum-doped region, which is followed by a large reduction in the overdoped region. This suggests that the superconductivity is suppressed by the reduction of magnetic exchange couplings, indicating a strong relationship between magnetism and superconductivity in iron-based superconductors.

Intraoperative image updating for brain shift following dural opening

OBJECTIVE Preoperative magnetic resonance images (pMR) are typically coregistered to provide intraoperative navigation, the accuracy of which can be significantly compromised by brain deformation. In this study, the authors generated updated MR images (uMR) in the operating room (OR) to compensate for brain shift due to dural opening, and evaluated the accuracy and computational efficiency of the process. METHODS In 20 open cranial neurosurgical cases, a pair of intraoperative stereovision (iSV) images was acquired after dural opening to reconstruct a 3D profile of the exposed cortical surface. The iSV surface was registered with pMR to detect cortical displacements that were assimilated by a biomechanical model to estimate whole-brain nonrigid deformation and produce uMR in the OR. The uMR views were displayed on a commercial navigation system and compared side by side with the corresponding coregistered pMR. A tracked stylus was used to acquire coordinate locations of features on the cortical surface that served as independent positions for calculating target registration errors (TREs) for the coregistered uMR and pMR image volumes. RESULTS The uMR views were visually more accurate and well aligned with the iSV surface in terms of both geometry and texture compared with pMR where misalignment was evident. The average misfit between model estimates and measured displacements was 1.80 ± 0.35 mm, compared with the average initial misfit of 7.10 ± 2.78 mm between iSV and pMR, and the average TRE was 1.60 ± 0.43 mm across the 20 patients in the uMR image volume, compared with 7.31 ± 2.82 mm on average in the pMR cases. The iSV also proved to be accurate with an average error of 1.20 ± 0.37 mm. The overall computational time required to generate the uMR views was 7-8 minutes. CONCLUSIONS This study compensated for brain deformation caused by intraoperative dural opening using computational model-based assimilation of iSV cortical surface displacements. The uMR proved to be more accurate in terms of model-data misfit and TRE in the 20 patient cases evaluated relative to pMR. The computational time was acceptable (7-8 minutes) and the process caused minimal interruption of surgical workflow.

Brief Questionnaire Derived from PANSS Using a General Probability Model to Assess and Monitor the Clinical Features of Schizophrenia

AIM

Patients with schizophrenia require continuous treatment much longer than the duration of their hospitalization, which makes their family members essential in their medical care. However, the evaluation of the disease state could only be done by professionals. This prompted us to seek potent indicators of disease states that are understandable and easy to use for the patients' family.

METHOD

Specific items were firstly extracted from the total PANSS scale. Then 3 096 PANSS scores were analyzed using a nonlinear mixed-effects model (NONMEM). A questionnaire was subsequently developed for family members to assess and monitor the overall severity of schizophrenia. Finally this questionnaire was validated in 33 patients.

RESULTS

2 items (P1 and N4) were extracted from the 8 effective remission items according to the correlation coefficients between the total PANSS score and different combinations of items. P1N4 was defined as the sum of these 2 items. A model was then developed to describe the probability of PANSS≥60, with P1N4 as indicators. The results indicated that P1N4 could make a good predictor of the overall probability of PANSS≥60, which was independent of treatment. A brief questionnaire with 7 questions was developed based on the results. External validation results indicated the questionnaire's suitability for a good assessment.

CONCLUSION

Questionnaire developed based on P1 and N4 may facilitate the patients' family members to better understand the disease state and help to prevent relapse.

White Matter Injury Susceptibility via Fiber Strain Evaluation Using Whole-Brain Tractography

Microscale brain injury studies suggest axonal elongation as a potential mechanism for diffuse axonal injury (DAI). Recent studies have begun to incorporate white matter (WM) structural anisotropy in injury analysis, with initial evidence suggesting improved injury prediction performance. In this study, we further develop a tractography-based approach to analyze fiber strains along the entire lengths of fibers from voxel- or anatomically constrained whole-brain tractography. This technique potentially extends previous element- or voxel-based methods that instead utilize WM fiber orientations averaged from typically coarse elements or voxels. Perhaps more importantly, incorporating tractography-based axonal structural information enables assessment of the overall injury risks to functionally important neural pathways and the anatomical regions they connect, which is not possible with previous methods. A DAI susceptibility index was also established to quantify voxel-wise WM local structural integrity and tract-wise damage of individual neural pathways. This "graded" injury susceptibility potentially extends the commonly employed treatment of injury as a simple binary condition. As an illustration, we evaluate the DAI susceptibilities of WM voxels and transcallosal fiber tracts in three idealized head impacts. Findings suggest the potential importance of the tractography-based approach for injury prediction. These efforts may enable future studies to correlate WM mechanical responses with neuroimaging, cognitive alteration, and concussion, and to reveal the relative vulnerabilities of neural pathways and identify the most vulnerable ones in real-world head impacts.

Augmenting Surgery via Multi-scale Modeling and Translational Systems Biology in the Era of Precision Medicine: A Multidisciplinary Perspective

In this era of tremendous technological capabilities and increased focus on improving clinical outcomes, decreasing costs, and increasing precision, there is a need for a more quantitative approach to the field of surgery. Multiscale computational modeling has the potential to bridge the gap to the emerging paradigms of Precision Medicine and Translational Systems Biology, in which quantitative metrics and data guide patient care through improved stratification, diagnosis, and therapy. Achievements by multiple groups have demonstrated the potential for (1) multiscale computational modeling, at a biological level, of diseases treated with surgery and the surgical procedure process at the level of the individual and the population; along with (2) patient-specific, computationally-enabled surgical planning, delivery, and guidance and robotically-augmented manipulation. In this perspective article, we discuss these concepts, and cite emerging examples from the fields of trauma, wound healing, and cardiac surgery.

Real-time, whole-brain, temporally resolved pressure responses in translational head impact

Theoretical debate still exists on the role of linear acceleration ( a lin) on the risk of brain injury. Recent injury metrics only consider head rotational acceleration ( a rot) but not a lin, despite that real-world on-field head impacts suggesting a lin significantly improves a concussion risk function. These controversial findings suggest a practical challenge in integrating theory and real-world experiment. Focusing on tissue-level mechanical responses estimated from finite-element (FE) models of the human head, rather than impact kinematics alone, may help address this debate. However, the substantial computational cost incurred (runtime and hardware) poses a significant barrier for their practical use. In this study, we established a real-time technique to estimate whole-brain a lin-induced pressures. Three hydrostatic atlas pressures corresponding to translational impacts (referred to as 'brain print') along the three major axes were pre-computed. For an arbitrary a lin profile at any instance in time, the atlas pressures were linearly scaled and then superimposed to estimate whole-brain responses. Using 12 publically available, independently measured or reconstructed real-world a lin profiles representative of a range of impact/injury scenarios, the technique was successfully validated (except for one case with an extremely short impulse of approx. 1 ms). The computational cost to estimate whole-brain pressure responses for an entire a lin profile was less than 0.1 s on a laptop versus typically hours on a high-end multicore computer. These findings suggest the potential of the simple, yet effective technique to enable future studies to focus on tissue-level brain responses, rather than solely relying on global head impact kinematics that have plagued early and contemporary brain injury research to date.

Efficacy comparison between minimally invasive and conventional surgery for lumbar disc herniation in Chinese Han population: a meta-analysis

This corrects the article DOI: 10.1038/sc.2014.98.

Intraoperative CT as a registration benchmark for intervertebral motion compensation in image-guided open spinal surgery

PURPOSE

An accurate and reliable benchmark of registration accuracy and intervertebral motion compensation is important for spinal image guidance. In this study, we evaluated the utility of intraoperative CT (iCT) in place of bone-implanted screws as the ground-truth registration and illustrated its use to benchmark the performance of intraoperative stereovision (iSV).

METHODS

A template-based, multi-body registration scheme was developed to individually segment and pair corresponding vertebrae between preoperative CT and iCT of the spine. Intervertebral motion was determined from the resulting vertebral pair-wise registrations. The accuracy of the image-driven registration was evaluated using surface-to-surface distance error (SDE) based on segmented bony features and was independently verified using point-to-point target registration error (TRE) computed from bone-implanted mini-screws. Both SDE and TRE were used to assess the compensation accuracy using iSV.

RESULTS

The iCT-based technique was evaluated on four explanted porcine spines (20 vertebral pairs) with artificially induced motion. We report a registration accuracy of 0.57 [Formula: see text] 0.32 mm (range 0.34-1.14 mm) and 0.29 [Formula: see text] 0.15 mm (range 0.14-0.78 mm) in SDE and TRE, respectively, for all vertebrae pooled, with an average intervertebral rotation of [Formula: see text] (range 1.5[Formula: see text]-7.9[Formula: see text]). The iSV-based compensation accuracy for one sample (four vertebrae) was 1.32 [Formula: see text] 0.19 mm and 1.72 [Formula: see text] 0.55 mm in SDE and TRE, respectively, exceeding the recommended accuracy of 2 mm.

CONCLUSION

This study demonstrates the effectiveness of iCT in place of invasive fiducials as a registration ground truth. These findings are important for future development of on-demand spinal image guidance using radiation-free images such as stereovision and ultrasound on human subjects.

Patient Registration Using Intraoperative Stereovision in Image-guided Open Spinal Surgery

Despite its widespread availability and success in open cranial neurosurgery, image-guidance technology remains more limited in use in open spinal procedures, in large part, because of patient registration challenges. In this study, we evaluated the feasibility of using intraoperative stereovision (iSV) for accurate, efficient, and robust patient registration in an open spinal fusion surgery. Geometrical surfaces of exposed vertebrae were first reconstructed from iSV. A classical multistart registration was then executed between point clouds generated from iSV and preoperative computed tomography images of the spine. With two pairs of feature points manually identified to facilitate the registration, an average registration accuracy of 1.43 mm in terms of surface-to-surface distance error was achieved in eight patient cases using a single iSV image pair sampling 2-3 vertebral segments. The iSV registration error was consistently smaller than the conventional landmark approach for every case (average of 2.02 mm with the same error metric). The large capture ranges (average of 23.8 mm in translation and 46.0° in rotation) found in the iSV patient registration suggest the technique may offer sufficient robustness for practical application in the operating room. Although some manual effort was still necessary, the manually-derived inputs for iSV registration only needed to be approximate as opposed to be precise and accurate for the manual efforts required in landmark registration. The total computational cost of the iSV registration was 1.5 min on average, significantly less than the typical ∼30 min required for the landmark approach. These findings support the clinical feasibility of iSV to offer accurate, efficient, and robust patient registration in open spinal surgery, and therefore, its potential to further increase the adoption of image guidance in this surgical specialty.

Intraoperative fiducial-less patient registration using volumetric 3D ultrasound: a prospective series of 32 neurosurgical cases

OBJECT

Fiducial-based registration (FBR) is used widely for patient registration in image-guided neurosurgery. The authors of this study have developed an automatic fiducial-less registration (FLR) technique to find the patient-to-image transformation by directly registering 3D ultrasound (3DUS) with MR images without incorporating prior information. The purpose of the study was to evaluate the performance of the FLR technique when used prospectively in the operating room and to compare it with conventional FBR.

METHODS

In 32 surgical patients who underwent conventional FBR, preoperative T1-weighted MR images (pMR) with attached fiducial markers were acquired prior to surgery. After craniotomy but before dural opening, a set of 3DUS images of the brain volume was acquired. A 2-step registration process was executed immediately after image acquisition: 1) the cortical surfaces from pMR and 3DUS were segmented, and a multistart sum-of-squared-intensity-difference registration was executed to find an initial alignment between down-sampled binary pMR and 3DUS volumes; and 2) the alignment was further refined by a mutual information-based registration between full-resolution grayscale pMR and 3DUS images, and a patient-to-image transformation was subsequently extracted.

RESULTS

To assess the accuracy of the FLR technique, the following were quantified: 1) the fiducial distance error (FDE); and 2) the target registration error (TRE) at anterior commissure and posterior commissure locations; these were compared with conventional FBR. The results showed that although the average FDE (6.42 ± 2.05 mm) was higher than the fiducial registration error (FRE) from FBR (3.42 ± 1.37 mm), the overall TRE of FLR (2.51 ± 0.93 mm) was lower than that of FBR (5.48 ± 1.81 mm). The results agreed with the intent of the 2 registration techniques: FBR is designed to minimize the FRE, whereas FLR is designed to optimize feature alignment and hence minimize TRE. The overall computational cost of FLR was approximately 4-5 minutes and minimal user interaction was required.

CONCLUSIONS

Because the FLR method directly registers 3DUS with MR by matching internal image features, it proved to be more accurate than FBR in terms of TRE in the 32 patients evaluated in this study. The overall efficiency of FLR in terms of the time and personnel involved is also improved relative to FBR in the operating room, and the method does not require additional image scans immediately prior to surgery. The performance of FLR and these results suggest potential for broad clinical application.

Stereovision to MR image registration for cortical surface displacement mapping to enhance image-guided neurosurgery

PURPOSE

A surface registration method is presented to align intraoperative stereovision (iSV) with preoperative magnetic resonance (pMR) images, which utilizes both geometry and texture information to extract tissue displacements as part of the overall process of compensating for intraoperative brain deformation in order to maintain accurate neuronavigational image guidance during surgery.

METHODS

A sum-of-squared-difference rigid image registration was first executed to detect lateral shift of the cortical surface and was followed by a mutual-information-based block matching method to detect local nonrigid deformation caused by distention or collapse of the cortical surface. Ten (N = 10) surgical cases were evaluated in which an independent point measurement of a dominant cortical surface feature location was recorded with a tracked stylus in each case and compared to its surface-registered counterpart. The full three-dimensional (3D) displacement field was also extracted to drive a biomechanical brain deformation model, the results of which were reconciled with the reconstructed iSV surface as another form of evaluation.

RESULTS

Differences between the tracked stylus coordinates of cortical surface features and their surface-registered locations were 1.94 ± 0.59 mm on average across the ten cases. When the complete displacement map derived from surface registration was utilized, the resulting images generated from mechanical model updates were consistent in terms of both geometry (1-2 mm of model misfit) and texture, and were generated with less than 10 min of computational time. Analysis of the surface-registered 3D displacements indicate that the magnitude of motion ranged from 4.03 to 9.79 mm in the ten patient cases, and the amount of lateral shift was not related statistically to the direction of gravity (p = 0.73 ≫ 0.05) or the craniotomy size (p = 0.48 ≫ 0.05) at the beginning of surgery.

CONCLUSIONS

The iSV-pMR surface registration method utilizes texture and geometry information to extract both global lateral shift and local nonrigid movement of the cortical surface in 3D. The results suggest small differences exist in surface-registered locations when compared to positions measured independently with a coregistered stylus and when the full iSV surface was aligned with model-updated MR. The effectiveness and efficiency of the registration method is also minimally disruptive to surgical workflow.

Computer-aided analysis with Image J for quantitatively assessing psoriatic lesion area

BACKGROUND/AIMS

Body surface area is important in determining the severity of psoriasis. However, objective, reliable, and practical method is still in need for this purpose. We performed a computer image analysis (CIA) of psoriatic area using the image J freeware to determine whether this method could be used for objective evaluation of psoriatic area.

METHODS

Fifteen psoriasis patients were randomized to be treated with adalimumab or placebo in a clinical trial. At each visit, the psoriasis area of each body site was estimated by two physicians (E-method), and standard photographs were taken. The psoriasis area in the pictures was assessed with CIA using semi-automatic threshold selection (T-method), or manual selection (M-method, gold standard). The results assessed by the three methods were analyzed with reliability and affecting factors evaluated.

RESULTS

Both T- and E-method correlated strongly with M-method, and T-method had a slightly stronger correlation with M-method. Both T- and E-methods had a good consistency between the evaluators. All the three methods were able to detect the change in the psoriatic area after treatment, while the E-method tends to overestimate.

CONCLUSION

The CIA with image J freeware is reliable and practicable in quantitatively assessing the lesional of psoriasis area.

Group-wise evaluation and comparison of white matter fiber strain and maximum principal strain in sports-related concussion

Sports-related concussion is a major public health problem in the United States and yet its biomechanical mechanisms remain unclear. In vitro studies demonstrate axonal elongation as a potential injury mechanism; however, current response-based injury predictors (e.g., maximum principal strain, ε(ep)) typically do not incorporate axonal orientations. We investigated the significance of white matter (WM) fiber orientation in strain estimation and compared fiber strain (ε(n)) with ε(ep) for 11 athletes with a clinical diagnosis of concussion. Geometrically accurate subject-specific head models with high mesh quality were created based on the Dartmouth Head Injury Model (DHIM), which was successfully validated (performance categorized as "good" to "excellent"). For WM regions estimated to be exposed to high strains using a range of injury thresholds (0.09-0.28), substantial differences existed between ε(n) and ε(ep) in both distribution (Dice coefficient of 0.13-0.33) and extent (∼ 5-10-fold differences), especially at higher threshold levels and higher rotational acceleration magnitudes. For example, an average of 3.2% vs. 29.8% of WM was predicted above an optimal threshold of 0.18 established from an in vivo animal study using ε(n) and ε(ep), respectively, with an average Dice coefficient of 0.14. The distribution of WM regions with high ε(n) was consistent with typical heterogeneous patterns of WM disruptions in diffuse axonal injury, and the group-wise extent at the optimal threshold matched well with the percentage of WM voxels experiencing significant longitudinal changes of fractional anisotropy and mean diffusivity (3.2% and 3.44%, respectively) found from a separate independent study. These results suggest the significance of incorporating WM microstructural anisotropy in future brain injury studies.

Brain pressure responses in translational head impact: a dimensional analysis and a further computational study

Brain pressure responses resulting from translational head impact are typically related to focal injuries at the coup and contrecoup sites. Despite significant efforts characterizing brain pressure responses using experimental and modeling approaches, a thorough investigation of the key controlling parameters appears lacking. In this study, we identified three parameters specific and important for brain pressure responses induced by isolated linear acceleration a(lin) via a dimensional analysis: a(lin) itself (magnitude and directionality), brain size and shape. These findings were verified using our recently developed Dartmouth Head Injury Model (DHIM). Applying a(lin) to the rigid skull, we found that the temporal profile of the given a(lin) directly determined that of pressure. Brain pressure was also found to be linearly proportional to brain size and dependent on impact direction. In addition, we investigated perturbations to brain pressure responses as a result of non-rigid skull deformation. Finally, DHIM pressure responses were quantitatively validated against two representative cadaveric head impacts (categorized as "good" to "excellent" in performance). These results suggest that both the magnitude and directionality of a(lin) as well as brain size and shape should be considered when interpreting brain pressure responses. Further, a model validated against pressure responses alone is not sufficient to ensure its fidelity in strain-related responses. These findings provide important insights into brain pressure responses in translational head impact and the resulting risk of pressure-induced injury. In addition, they establish the feasibility of creating a pre-computed atlas for real-time tissue-level pressure responses without a direct simulation in the future.

Parametric comparisons of intracranial mechanical responses from three validated finite element models of the human head

A number of human head finite element (FE) models have been developed from different research groups over the years to study the mechanisms of traumatic brain injury. These models can vary substantially in model features and parameters, making it important to evaluate whether simulation results from one model are readily comparable with another, and whether response-based injury thresholds established from a specific model can be generalized when a different model is employed. The purpose of this study is to parametrically compare regional brain mechanical responses from three validated head FE models to test the hypothesis that regional brain responses are dependent on the specific head model employed as well as the region of interest (ROI). The Dartmouth Scaled and Normalized Model (DSNM), the Simulated Injury Monitor (SIMon), and the Wayne State University Head Injury Model (WSUHIM) were selected for comparisons. For model input, 144 unique kinematic conditions were created to represent the range of head impacts sustained by male collegiate hockey players during play. These impacts encompass the 50th, 95th, and 99th percentile peak linear and rotational accelerations at 16 impact locations around the head. Five mechanical variables (strain, strain rate, strain × strain rate, stress, and pressure) in seven ROIs reported from the FE models were compared using Generalized Estimating Equation statistical models. Highly significant differences existed among FE models for nearly all output variables and ROIs. The WSUHIM produced substantially higher peak values for almost all output variables regardless of the ROI compared to the DSNM and SIMon models (p < 0.05). DSNM also produced significantly different stress and pressure compared with SIMon for all ROIs (p < 0.05), but such differences were not consistent across ROIs for other variables. Regardless of FE model, most output variables were highly correlated with linear and rotational peak accelerations. The significant disparities in regional brain responses across head models regardless of the output variables strongly suggest that model-predicted brain responses from one study should not be extended to other studies in which a different model is utilized. Consequently, response-based injury tolerance thresholds from a specific model should not be generalized to other studies either in which a different model is used. However, the similar relationships between regional responses and the linear/rotational peak accelerations suggest that each FE model can be used independently to assess regional brain responses to impact simulations in order to perform statistical correlations with medical images and/or well-selected experiments with documented injury findings.

Cortical surface shift estimation using stereovision and optical flow motion tracking via projection image registration

Stereovision is an important intraoperative imaging technique that captures the exposed parenchymal surface noninvasively during open cranial surgery. Estimating cortical surface shift efficiently and accurately is critical to compensate for brain deformation in the operating room (OR). In this study, we present an automatic and robust registration technique based on optical flow (OF) motion tracking to compensate for cortical surface displacement throughout surgery. Stereo images of the cortical surface were acquired at multiple time points after dural opening to reconstruct three-dimensional (3D) texture intensity-encoded cortical surfaces. A local coordinate system was established with its z-axis parallel to the average surface normal direction of the reconstructed cortical surface immediately after dural opening in order to produce two-dimensional (2D) projection images. A dense displacement field between the two projection images was determined directly from OF motion tracking without the need for feature identification or tracking. The starting and end points of the displacement vectors on the two cortical surfaces were then obtained following spatial mapping inversion to produce the full 3D displacement of the exposed cortical surface. We evaluated the technique with images obtained from digital phantoms and 18 surgical cases - 10 of which involved independent measurements of feature locations acquired with a tracked stylus for accuracy comparisons, and 8 others of which 4 involved stereo image acquisitions at three or more time points during surgery to illustrate utility throughout a procedure. Results from the digital phantom images were very accurate (0.05 pixels). In the 10 surgical cases with independently digitized point locations, the average agreement between feature coordinates derived from the cortical surface reconstructions was 1.7-2.1mm relative to those determined with the tracked stylus probe. The agreement in feature displacement tracking was also comparable to tracked probe data (difference in displacement magnitude was <1mm on average). The average magnitude of cortical surface displacement was 7.9 ± 5.7 mm (range 0.3-24.4 mm) in all patient cases with the displacement components along gravity being 5.2 ± 6.0 mm relative to the lateral movement of 2.4 ± 1.6 mm. Thus, our technique appears to be sufficiently accurate and computationally efficiency (typically ∼15 s), for applications in the OR.

Efficacy comparison between minimally invasive and conventional surgery for lumbar disc herniation in Chinese Han population: a meta-analysis

STUDY DESIGN

The pooled data were analyzed using RevMan 5.2 software.

OBJECTIVES

The aim was to compare the efficacy of minimally invasive and conventional surgery for lumbar disc herniation (LDH) in Chinese Han population.

SETTING

China.

METHODS

An electronic search up to November 2013 was performed to retrieve all relevant articles. The overall standardized mean difference (SMD) for continuous outcomes and odds ratio (OR) for dichotomous variables as well as their 95% confidence intervals (CIs) were calculated to compare the efficacy of minimally invasive and conventional surgery.

RESULTS

A total of 23 studies involving 1913 patients treated by minimally invasive surgery and 2295 patients treated by conversational surgery were included in this meta-analysis. The overall estimate indicated that minimally invasive surgery could significantly decrease the hospitalization time (SMD = -2.03, 95% CI, -2.49 to 1.56, P < 0.0001), blood loss (SMD = -2.65, 95% CI -3.33 to 1.97, P < 0.0001), incision length (SMD = -3.57, 95% CI, -4.39 to 2.75, P < 0.0001), recurrence rate (odds ratio (OR) = 0.22, 95 CI: 0.08-0.60, P = 0.003) and complications (OR = 0.47, 95% CI: 0.25-0.92, P = 0.03) and increase the postoperative excellent rate (OR = 1.82, 95% CI, 1.44-2.31, P < 0.0001) compared with conventional surgery. In addition, the pooled data showed that there was no statistically significant difference in the operative time (SMD = -0.58, 95% CI, -1.32 to 0.15, P = 0.12) between LDH patients treated by minimally invasive and conventional surgery.

CONCLUSION

In conclusion, minimally invasive surgery was a more safe and effective treatment for treating LDH in Chinese Han population when compared with conventional surgery.