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Than CA, Valiotis AK, Prottoy AR, Alexander KG, Alogakos M, Adra M, Smayra K, Curtis TJ, Kim GE, Nakanishi H, Dannawi Z. Discectomy for Lumbar Disc Herniation in Pediatric and Adolescent Populations: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e63880. [PMID: 39104990 PMCID: PMC11298768 DOI: 10.7759/cureus.63880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 08/07/2024] Open
Abstract
Corroborative evidence for discectomy in pediatric or adolescent patients remains scarce, with this single-arm meta-analysis investigating discectomy for lumbar disc herniation (LDH) within this population. PubMed, Embase (Elsevier), CiNAHL, Cochrane Library, Scopus, and Web of Science were searched. Eligible studies reported pediatric patients under 21 years of age with a diagnosis of LDH that was treated surgically with discectomy. This review was registered in PROSPERO (ID: CRD42023463358). Twenty-two studies met the eligibility criteria (n=1182). Visual analog scale (VAS) scores for back pain at baseline were 5.34 (95% CI: 4.48, 6.20, I2=98.9%). Postoperative VAS back pain scores after 12 months were 0.88 (95% CI: 0.57, 1.19, I2=95.6%). VAS scores for leg pain at baseline were 7.03 (95% CI: 6.63, 7.43, I2=93.5%). Postoperative VAS leg pain scores after 12 months were 1.02 (95% CI: 0.68, 1.36, I2=97.0%). Oswestry disability index (ODI) scores at baseline were 55.46 (95% CI: 43.69, 67.24, I2=99.9%). Postoperative ODI scores after 12 months were 7.82 (95% CI: 4.95, 10.69, I2=99.4%). VAS back, VAS leg and ODI scores demonstrated a minimum clinically important difference (MCID) at all postoperative points. Perioperative outcomes demonstrated operative time as 85.71 mins (95% CI: 73.96, 97.46, I2=99.4%) and hospital length of stay as 3.81 days (95% CI: 3.20, 4.41, I2=98.5%). The postoperative reoperation rate at the same level was 0.01 (95% CI: <0.00, 0.02, I2=0%). Discectomy appears safe and effective in pediatric and adolescent patients suffering from LDH. The findings here provide groundwork for future randomized control trials against conservative measures to elaborate on optimal management and elucidate long-term outcomes.
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Affiliation(s)
- Christian A Than
- Biomedical Sciences, The University of Queensland, Brisbane, AUS
| | | | - Abid R Prottoy
- Neurosurgery, St George's University of London, London, GBR
| | | | - Marios Alogakos
- General Surgery, St George's University of London, London, GBR
| | - Maamoun Adra
- Orthopedics, St George's University of London, London, GBR
| | - Karen Smayra
- Radiology, St George's University of London, London, GBR
| | - Tom J Curtis
- Orthopedics, Frimley Health NHS Foundation Trust, Windsor, GBR
| | | | | | - Zaher Dannawi
- Spine Surgery, Mid and South Essex NHS Foundation Trust, London, GBR
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Mao L, Wang K, Zhu W, Shen ZC, Zhang XJ, Xie ZY, Fan P, Shi H, Zhu B, Li L, Liu G, Ren Y, Wu XT. Repeat Surgery after Percutaneous Endoscopic Lumbar Discectomy for Adolescent Lumbar Disc Herniation: A Multicenter Observational Study. Orthop Surg 2024; 16:1336-1343. [PMID: 38654387 PMCID: PMC11144496 DOI: 10.1111/os.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE The reported date in the repeat surgical intervention for adolescent lumbar disc herniation (ALDH) after percutaneous endoscopic lumbar discectomy (PELD) was quite scarce. This study aims to introduce cases of repeat surgeries after PELD for ALDH and assess the incidence, chief causes, repeat surgery methods, and surgical outcomes of repeat surgeries after PELD for ALDH. METHODS A retrospective multicenter observational study was conducted on patients undergoing repeat surgeries after PELD for ALDH at four tertiary referral hospitals from January 2014 through August 2022. The incidence of repeat surgeries, chief causes, strategies for repeat surgeries, and timing of repeat surgeries were recorded and analyzed. The clinical outcomes were evaluated by the Numeric Rating Scales (NRS) scores and the modified MacNab criteria. Statistical analyses were performed with the Wilcoxon signed-rank test. RESULTS A total of 23 patients who underwent repeat surgeries after PELD for ALDH were included. The chief causes were re-herniation (homo-lateral re-herniation at the same level, new disc herniation of adjacent level). The repeat surgery methods were revision PELD, micro-endoscopic discectomy (MED), open discectomy and instrumented lumbar inter-body fusion. The NRS scores decreased significantly in follow-up evaluations and these scores demonstrated significant improvement at the last follow-up (p < 0.002). For the modified MacNab criteria, at the last follow-up, 18 patients (78.26%) had an excellent outcome, and the overall success rate was 86.95%. CONCLUSION This study's data suggest that young patients who underwent repeat surgery improved significantly compared to baseline. The chief cause was re-herniation. Revision PELD was the main surgical procedure, which provides satisfactory clinical results in young patients who underwent repeat surgeries.
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Affiliation(s)
- Lu Mao
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kun Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Weiye Zhu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zi-Cong Shen
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xian-Jun Zhang
- Department of Orthopedics, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Zhi-Yang Xie
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Pan Fan
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hang Shi
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bin Zhu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lijun Li
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Guanyi Liu
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Yingqing Ren
- Department of Spine Surgery, Yuyao People's Hospital, Ningbo, China
| | - Xiao-Tao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Qu L, Wang Y, Wang F, Zhang S. Surgical outcomes of percutaneous endoscopic lumbar discectomy in obese adolescents with lumbar disc herniation. BMC Musculoskelet Disord 2023; 24:710. [PMID: 37674144 PMCID: PMC10483719 DOI: 10.1186/s12891-023-06842-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
In recent years, with improved living standards, adolescent obesity has been increasingly studied. The incidence of lumbar disc herniation (LDH) in obese adolescents is increasing yearly. No clinical studies have reported the use of percutaneous endoscopic lumbar discectomy (PELD) in obese adolescent lumbar disc herniation (ALDH) patients. This study evaluated the preliminary surgical outcomes of PELD in obese ALDH patients. Fifty-one ALDH patients underwent single-level PELD surgery between January 2014 and January 2020. Patients were divided into an obese group and a normal group. Patient characteristics and surgical variables were compared between the two groups. The VAS, ODI, and SF-36 scales were used preoperatively and postoperatively to evaluate the clinical efficacy. In this study, 19 patients were included in the obese group, and 28 were included in the normal group. There was no significant difference in age, sex, duration of low back pain, duration of leg pain, or operative level between the obese and normal groups preoperatively. The obese group had a longer operative time (OT) (101.9 ± 9.0 min vs. 84.3 ± 11.0 min, P < 0.001), more fluoroscopy exposures (41.0 ± 5.8 vs. 31.6 ± 7.0, P < 0.001) and a longer time to ambulation (29.9 ± 4.0 vs. 25.0 ± 2.9, p < 0.001) than the normal group. The groups did not significantly differ in complications. The VAS score for back and leg pain and the ODI and SF-36 score for functional status improved significantly postoperatively. The PELD procedure is a safe and feasible method for treating LDH in obese adolescents. Obese ALDH patients require a longer OT, more fluoroscopy exposures and a longer time to get out of bed than normal ALDH patients. However, PELD yields similar clinical outcomes in obese and normal ALDH patients.
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Affiliation(s)
- Lianjun Qu
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
- Department of Orthopedic Surgery, Sunshine Union Hospital, Weifang, Shandong Province China
| | - Yongli Wang
- Department of Anesthesiology, 80th Group Army Hospital, Weifang, Shandong Province China
| | - Fei Wang
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
| | - Songou Zhang
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
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El-Qadi M, Thabit MA, Eissa E, Aziz AAFA, Kamel R. Adolescent Lumbar Intervertebral Disc Herniation: Conservative versus Surgical Treatment. Open Access Maced J Med Sci 2023. [DOI: 10.3889/oamjms.2023.11159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND: Lumbar disc herniation (LDH) in adolescents is relatively a rare condition among those cases presented with low back pain. Trauma and genetics are the most common predisposing factors. Furthermore, the clinical presentations differ from those of the adults. Back pain is not all marked in adolescent patients.
AIM: This study was subjected to discuss the etiology, diagnosis and treatment modalities, and the variable outcomes for both medical and surgical treatment of LDH in adolescents.
PATIENTS AND METHODS: This prospective study was conducted on 20 patients (12 males, eight females) age range 10–19 years presenting with LDH, managed and treated conservatively and/or surgically in Neurosurgery Department at Kasr Al Ainy School of medicine, Cairo University in the period from October 2015 to September 2016 with 12-month follow-up period.
RESULTS: In our study, 12 patients (60%) gave a positive family history, also nine cases (45%) had a history of back trauma before affection with LDH. All the cases (100%) were presented with sciatic pain while only half of them had low back pain, also two cases with motor deficit. After performing magnetic resonance imaging of lumbosacral spine, L5-S1 disc level was the most common level affected. All the patients were subjected to medical treatment which was effective in 40% of the cases and surgical treatment was the only curative method in 12 cases (60%). In this study, the outcome was excellent in 90% of cases where significant to complete relief of pain and significant improvement in the neurological deficits was achieved.
CONCLUSION: Conservative treatment is less effective for adolescent LDH patients as compared with adults, even though it remains the fi rst-line treatment for adolescent LDH.
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Bajaj A, Telfeian AE. Pediatric applications of endoscopic spine surgery. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Balafif F, Faris M, Subagio EA, Bajamal AH, Kusumadewi A. Lumbar disc herniation in a 15-year-old girl: A case report. Int J Surg Case Rep 2022; 98:107560. [PMID: 36057249 PMCID: PMC9482986 DOI: 10.1016/j.ijscr.2022.107560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/23/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Fachriy Balafif
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Muhammad Faris
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia; Department of Neurosurgery, Adi Husada Undaan Hospital, Surabaya, East Java, Indonesia.
| | - Eko Agus Subagio
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, Indonesia
| | - Annie Kusumadewi
- Department of Pediatrics, Adi Husada Undaan Hospital, Surabaya, East Java, Indonesia
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Incidence and temporal changes in lumbar degeneration and low back pain in child and adolescent weightlifters: A prospective 5-year cohort study. PLoS One 2022; 17:e0270046. [PMID: 35767547 PMCID: PMC9242517 DOI: 10.1371/journal.pone.0270046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 06/02/2022] [Indexed: 11/19/2022] Open
Abstract
This study was conducted to investigate the incidence of lumbar degeneration findings and low back pain (LBP) in children and adolescent weightlifters using magnetic resonance imaging (MRI) and medical questionnaires over a 5-year period. Moreover, we aimed to reveal the temporal changes in the lumbar vertebrae caused by long-term weightlifting training during the growth period. Twelve children and adolescent weightlifters who participated in weightlifting for >2 years (six boys, six girls, 11.4±2.0 years) were enrolled. Participants underwent annual medical questionnaire surveys, including data on practice frequency, competition history, presence of LBP, and lumbar examinations using MRI during the 5-year follow-up. Lumbar disc degeneration was detected in all the participants after 4 years, and lumbar disc herniation findings were detected in 33% of participants after 5 years; one underwent herniotomy during the follow-up period. Lumbar spondylolysis was detected in 58% of patients at 5 years. Although there were three participants who had LBP in the final year, none had LBP that prevented them from returning to weightlifting. This 5-year cohort study of 12 children and adolescent weightlifters detected lumbar degeneration in all participants. High frequency weightlifting training over a long period during the growth period may increase the risk of developing current and future LBP.
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Mao L, Wang K, Huang Y, Wang F, Zhang R, Zhu B, Wu X. Transforaminal Endoscopic Lumbar Discectomy for Lumbosacral Junction Adolescent Lumbar Disc Herniation with High Iliac Crests. Orthop Surg 2022; 14:1715-1722. [PMID: 35768829 PMCID: PMC9363714 DOI: 10.1111/os.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the clinical results of transforaminal endoscopic lumbar discectomy for lumbosacral junction adolescent lumbar disc herniation with high iliac crest. Methods From February 2014 to September 2020, a retrospective analysis of 96 patients less than 21 years old with intervertebral disc herniation was carried out. We enrolled 44 patients diagnosed with lumbosacral junction disc herniation with high iliac crest who required transforaminal endoscopic lumbar discectomy. Pain in the back and the lower extremity was scored on Numeric Rating Scales (NRS) scores. Patient outcomes were graded as excellent, good, fair, and poor using modified MacNab criteria. The NRS scores before and after the operation were compared using the Wilcoxon two‐sample test. Results There were 30 male patients and 14 females. One patient underwent repeat surgery for an intervertebral disc pseudocyst. The NRS scores decreased significantly in both early and late follow‐up evaluations (p < 0.05). At the last follow‐up, 42 patients (95.45%) had an excellent outcome, one patient (2.27%) had a good outcome, and one patient (2.27%) had a fair outcome. The overall success rate was 97.7%. Conclusion This study's data suggest that targeted individualized foraminoplasty can effectively overcome the lumbosacral anatomical obstacles, and transforaminal endoscopic lumbar discectomy is an effective and valid option for lumbosacral junction adolescent lumbar disc herniation with high iliac crest.
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Affiliation(s)
- Lu Mao
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kun Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yong Huang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Feng Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Rui Zhang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bin Zhu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaotao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Comparison of PLIF and TLIF in the Treatment of LDH Complicated with Spinal Stenosis. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:9743283. [PMID: 35378938 PMCID: PMC8976646 DOI: 10.1155/2022/9743283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Abstract
Objective The purpose was to compare the clinical effects of posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) in the treatment of lumbar disc herniation (LDH) complicated with spinal stenosis. Methods 96 LDH patients complicated with spinal stenosis treated in our hospital (April 2018–April 2020) were chosen as the subjects, and split into the PLIF group and the TLIF group according to different surgical approaches, with 48 cases in each group. The clinical effects of the two groups were compared. Results There was no significant difference in hospitalization time between the two groups (P > 0.05). Compared with the PLIF group, the TLIF group had obviously shorter operation time and greatly lesser intraoperative blood loss (P < 0.05). The Numerical Rating Scale (NRS) scores of lower limb pain and low back pain in the two groups at 3 months after surgery were significantly lower than those before surgery (P < 0.001). The Japanese Orthopaedic Association (JOA) scores of the two groups at 3 months after surgery were significantly higher than those before surgery (P < 0.001). The Spitzer Quality of Life Index (SQLI) scores of the two groups at 3 months after surgery were significantly higher than those before surgery (P < 0.001). Conclusion The two surgical approaches have similar efficacy in treating LDH complicated with spinal stenosis. However, PLIF is better than TLIF in terms of operation time and intraoperative blood loss, which should be adopted as the preferred surgical scheme.
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Paediatric lumbar disc herniation presenting as pseudo flexion deformity of the hip and knee: A case report. JOURNAL OF ORTHOPAEDIC REPORTS 2022. [DOI: 10.1016/j.jorep.2022.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Prognosis Evaluation of MRI Combined with Magnetic Resonance Myelography on Lumbar Disc Herniation after Transforaminal Endoscopic Discectomy. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2895575. [PMID: 35237339 PMCID: PMC8885245 DOI: 10.1155/2022/2895575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/18/2022]
Abstract
Objective This study sets out to investigate the role of magnetic resonance imaging (MRI) combined with magnetic resonance myelography (MRM) in patients after percutaneous transforaminal endoscopic discectomy (PTED) and to evaluate its value in postoperative rehabilitation. Methods The clinical date of 96 patients with lumbar disc herniation (LDH) after PTED was retrospectively analyzed. The enrolled patients were divided into MRI group (n = 32) and MRI + MRM group (n = 64) according to whether MRM was performed. The nerve root sleeve (morphology, deformation) and dural indentation, intervertebral space height (ISH), intervertebral space angle (ISA), degree of pain (Visual Analogue Scale (VAS)), vertebral function (Japanese Orthopaedic Association (JOA)), and long-term recurrence were compared between the two groups. Results Compared with the MRI group, the MRI + MRM group better displayed nerve root morphology, sheath sleeve deformation, and dural indentation. Both MRI and MRI + MRM showed ISH and ISA changes well. Compared with the MRI group, the MRI + MRM group had a significantly lower VAS score for lumbar and leg pain, a significantly higher JOA score, and a significantly lower 2-year recurrence rate. Conclusion MRM combined with MRI is more beneficial to improve the prognosis of LDH patients after PTED.
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Yu H, Zhu B, Song Q, Liu X. Evaluation of full-endoscopic lumbar discectomy in the treatment of obese adolescents with lumbar disc herniation: a retrospective study. BMC Musculoskelet Disord 2021; 22:562. [PMID: 34147091 PMCID: PMC8214765 DOI: 10.1186/s12891-021-04449-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023] Open
Abstract
Background Obese patients are at risk of complications after spinal surgery. Full-endoscopic lumbar discectomy (FELD) has advantages over conventional open surgery in the treatment of obese adult patients with lumbar disc herniation (LDH) because it can decrease perioperative complications and enhance the degree of patient satisfaction. However, no clinical studies have evaluated the efficacy of FELD in obese adolescents with LDH (ALDH). This study aimed to evaluate the efficacy of FELD for the treatment of obese ALDH. Methods We retrospectively collected clinical data from 208 patients with single-segment ALDH who underwent FELD in our hospital between January 2015 and December 2019. According to the WHO classification of obesity, the patients were divided into obese (BMI ≥30 kg/m2) and non-obese (BMI < 30 kg/m2) groups (control group). Based on the preoperative baseline data of the two groups, propensity score matching was performed to select patients from these groups for a comparative study. Perioperative data included operative time, intraoperative blood loss, and length of postoperative hospitalization. The visual analog scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria were recorded as the main indicators of the surgical outcome. Recurrence rate and incidence of complications were recorded as minor indicators. Results Twenty-eight patients and 80 patients were included in the obese and non-obese groups, respectively, after 1:4 propensity score matching. Both groups showed improvements in VAS and ODI scores after surgery and at each follow-up time point (p < 0.05). However, there was no significant statistical difference in the surgical outcomes between the two groups at each follow-up time point (p > 0.05). The differences in operative time, intraoperative blood loss, and length of postoperative hospitalization were not statistically significant between the two groups (p > 0.05). Conclusion FELD is a safe and effective minimally invasive technique for treating obese patients with ALDH. The efficacy of FELD in obese and non-obese patients with ALDH was comparable.
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Affiliation(s)
- Haijiang Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Bin Zhu
- Department of Orthopedics, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Qingpeng Song
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.
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Wang YD, A RN, Xu YY, Li ZJ, Jin F, Wu C, Zhang YF, He YJ, Gao MJ, Guan HH, Dai LN, Wang HY, Li XH. Three-dimensional digital measurement of the facet joint in normal and lumbar intervertebral disc herniation aged 13-18 years. Asian J Surg 2021; 45:269-276. [PMID: 34158200 DOI: 10.1016/j.asjsur.2021.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Lumbar facet joint is an important element of spinal "three-joint complex". Whether there is a relationship between strange structure of facet joint and adolescent lumbar disc herniation (ALDH) is nonetheless controversial, and the current research is mainly centered on adults. OBJECTIVE To find out the normal lumbar facet joints between 13 and 18 years old to provide anatomical basis for early diagnosis and therapy of lumbar disc herniation. METHODS CT imaging information of 32 sufferers with lumbar disc herniation aged from 13 to 18 years old in Inner Mongolia have been collected as the ALDH group, and 62 wholesome subjects in the equal period had been chosen as the normal group. Uncooked records of continuous scanning lumbar tomography pix were imported into MIMICS 21.0 for evaluation and size in DICOM format. The parameters include facet joint height, facet joint width, et al. RESULTS 1. The left and right transverse angle of L5S1 segment in the ALDH group were (52.41 ± 9.2) ° and (55.99 ± 10.91) ° (P < 0.05), and the differences were statistically significant. The right side is larger than the left side. 2. Facet joint thickness in L3-L5 segment of the normal group was significantly higher than that of male (1.63 ± 0.32) mm than that of female (1.38 ± 0.25) mm; In 16-18 years old group, comparison of facet joint cross-sectional area was statistically significant (22.1 ± 3.04) mm2 in male than (18.92 ± 3.71) mm2 in female. 3. In comparison between normal and ALDH group, there was significant difference in L3-4 transverse angle (P < 0.05), L4-5 facet joint height and facet joint thickness (P < 0.05), L5S1 facet joint thickness and transverse angle (P < 0.05). CONCLUSION When ALDH occurs in the L5S1 segment, there is a substantial difference between the left and right sides of the transverse angle, and there is a difference in the thickness and the facet joint cross-sectional area between males and females, which is generally larger in males than in females. Facet joint height is larger, transverse angle of left and right is asymmetric, inferior articular process is larger, and facet joint thickness is smaller can indicate that lumbar disc herniation is effortless to occur.
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Affiliation(s)
- Yi-Dan Wang
- Graduate School of Inner Mongolia Medical University, Hohhot, 010110, PR China
| | - Ru-Na A
- College of Mongolian Medicine, Inner Mongolia Medical University, Hohhot, 010110, PR China
| | - Yang-Yang Xu
- Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China
| | - Zhi-Jun Li
- Department of Anatomy, College of Basic Medicine, Inner Mongolia Medical University, Hohhot, 010110, PR China
| | - Feng Jin
- Department of Imaging, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010110, PR China
| | - Chao Wu
- Graduate School of Inner Mongolia Medical University, Hohhot, 010110, PR China; Imaging Department of Baotou Central Hospital, Baotou, 014000, PR China
| | - Yun-Feng Zhang
- Department of Imaging, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010055, PR China
| | - Yu-Jie He
- Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China
| | - Ming-Jie Gao
- Graduate School of Inner Mongolia Medical University, Hohhot, 010110, PR China; Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China
| | - Huan-Huan Guan
- Graduate School of Inner Mongolia Medical University, Hohhot, 010110, PR China
| | - Li-Na Dai
- Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China
| | - Hai-Yan Wang
- Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China.
| | - Xiao-He Li
- Department of Physiatry, Changzhi People's Hospital, Changzhi, 046000, PR China.
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Yang X, Cheng X, Liu Q, Zhang C, Song Y. The response surface method-genetic algorithm for identification of the lumbar intervertebral disc material parameters. Comput Biol Med 2020; 124:103920. [PMID: 32768715 DOI: 10.1016/j.compbiomed.2020.103920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
Long-term compressive load on the lumbar intervertebral disc (IVD) might lead to lumbar IVD herniation. Exploring the material parameters of normal and degenerative enucleated IVDs is the basis for studying their mechanical behavior. According to the inverse analysis principle of the parameter estimation, an optimization method was proposed to identify the parameters of the porous material of the lumbar IVD based on finite element inverse analysis. The poroelastic finite element models were established in line with the compression creep experiment. The material parameters were combined by Box-Behnken design (BBD), and the response surface (RS) models were constructed using a quadratic polynomial with cross terms and optimized by genetic algorithm (GA). The results showed that the simulation result of the best material parameter combination had a good agreement with the experiment. Compared with the normal lumbar IVD, the elastic modulus and permeability decreased, and Poisson's ratio increased for the enucleated disk, resulting in a significant difference in mechanical properties. The algorithm used in this study can reduce the parameter identification error compared with only the RS method, and decrease the number of finite element simulations compared with only the GA.
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Affiliation(s)
- XiuPing Yang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, PR China; National Demonstration Center for Experimental Mechanical and Electrical Engineering Education, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, PR China.
| | - XiaoMin Cheng
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, PR China
| | - Qing Liu
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, PR China
| | - ChunQiu Zhang
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, PR China
| | - Yang Song
- Tianjin Key Laboratory for Advanced Mechatronic System Design and Intelligent Control, School of Mechanical Engineering, Tianjin University of Technology, Tianjin, 300384, PR China.
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