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Lin A, Wang Y, Zhang H, Zhu K, Zhou D, Guo J, Zhao W, Zhou C, Ma X. Endoscopic Revision Strategies and Outcomes for Recurrent L4/5 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy. J Pain Res 2024; 17:761-770. [PMID: 38414800 PMCID: PMC10898476 DOI: 10.2147/jpr.s449949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/17/2024] [Indexed: 02/29/2024] Open
Abstract
Objective We explore the endoscopic revision and surgical techniques for L4/5 recurrent disc herniation (rLDH) after percutaneous endoscopic transforaminal discectomy (PETD). Methods A retrospective study was conducted. From January 2016 to September 2022, 96 patients who underwent percutaneous endoscopic lumbar discectomy for L4/5 rLDH after PETD were enrolled in the study. Based on the revision approach, the patients were divided into PETD group (57 cases) and percutaneous endoscopic interlaminar discectomy (PEID) group (39 cases). Visual Analogue Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and modified MacNab standard were recorded to evaluate the clinical outcomes. Results No significant differences were found in the demographic data and intraoperative blood loss between the two groups (P>0.05), but the time of operation and intraoperative X-ray fluoroscopy exposures in the PEID group were significantly less than that in the PETD group (P<0.05). The patients' postoperative clinical indexes gradually improved, and the VAS score, ODI index, and JOA score of the patients in both groups showed significant improvement compared with the preoperative period at the 1-week, 1-month, and 6-month postoperative follow-ups (P < 0.05). There was no serious complication observed during the follow-up. Conclusion For recurrent LDH after PETD of L4/5 segments, percutaneous endoscopic revision can achieve satisfactory results. Among them, PEID has a shorter operative and fluoroscopy time and allows avoidance of the scar that forms after the initial surgery, so it can be considered preferred when both procedures can remove the disk well. However, for some specific types of herniation, a detailed surgical strategy is required.
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Affiliation(s)
- Antao Lin
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Yan Wang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Hao Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Kai Zhu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Dan Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Jianwei Guo
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Wenhao Zhao
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Chuanli Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Xuexiao Ma
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
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Kapetanakis S, Floros E, Gkantsinikoudis N. Extreme cases in percutaneous transforaminal endoscopic surgery: case series and brief review of the literature. Br J Neurosurg 2024; 38:94-98. [PMID: 34187254 DOI: 10.1080/02688697.2021.1944981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Percutaneous transforaminal endoscopic decompression (PTED) is a minimally invasive method of surgical treatment of miscellaneous spinal conditions. We describe our experience with PTED in extreme cases of foraminal stenosis (FS) in adult degenerative scoliosis (ADS), recurrent foraminal stenosis (RFS) after previous open decompression surgery and adjacent segment disease (ASD) after previous lumbar fusion. METHODS Twenty-one (21) patients with FS encountered in the clinical framework of ADS (n = 6), previous open decompression surgery (n = 8) and ASD (n = 7) were prospectively reviewed. Patients were preoperatively assessed via clinical and radiologic evaluation. All patients underwent PTED in 2018-2019. Postoperative evaluation was conducted with clinical examination and evaluation of Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria in predetermined chronic intervals in a 1-2 years follow-up. RESULTS All patients were successfully managed with PTED. Operated levels were L3-L4 (19.0%), L4-L5 (52.4%) and L5-S1 (28.6%). No major perioperative complications were recorded. VAS and ODI scores were demonstrated to exhibit a clinically and statistically significant (p < 0.05) amelioration in all patients' categories directly postoperatively, which was preserved until the end of follow-up. Overall outcomes according to modified MacNab criteria were excellent in 12 patients (57.1%), good in 6 (28.6%) and fair in 3 (14.3%) patients. CONCLUSIONS PTED is safe and effective in extreme cases of FS encountered in patients with ADS, previous posterior open decompression surgery and ASD after previous spinal fusion.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
- Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece
| | - Evangelos Floros
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Trager RJ, Gliedt JA, Labak CM, Daniels CJ, Dusek JA. Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study. BMC Musculoskelet Disord 2024; 25:46. [PMID: 38200469 PMCID: PMC10777506 DOI: 10.1186/s12891-024-07166-x] [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: 08/11/2023] [Accepted: 01/02/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms. We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years' follow-up. METHODS We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023. We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. We used propensity matching to adjust for confounding variables associated with lumbar spine reoperation (e.g., age, body mass index, nicotine dependence), calculated risk ratios (RR), with 95% confidence intervals (CIs), and explored cumulative incidence of reoperation and the number of SMT follow-up visits. RESULTS Following propensity matching there were 378 patients per cohort (mean age 61 years). Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort (SMT: 7%; usual care: 13%), yielding an RR (95% CIs) of 0.55 (0.35-0.85; P = 0.0062). In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit (median = 6). CONCLUSIONS This study found that adults experiencing LSR at least one year after lumbar discectomy who received SMT were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT. While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance. We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture. REGISTRATION Open Science Framework ( https://osf.io/vgrwz ).
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Affiliation(s)
- Robert J Trager
- Connor Whole Health, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA.
| | - Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Collin M Labak
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Clinton J Daniels
- Rehabilitation Care Services, VA Puget Sound Health Care System, 9600 Veterans Drive, Tacoma, WA, 98493, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jeffery A Dusek
- Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
- Susan Samueli Integrative Health Institute, University of California, Irvine, CA, USA
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Li ZP, Liu LL, Liu H, Tan JH, Li XL, Xu Z, Ouyang ZH, Wang C, Yan YG, Xue JB. Radiologic Analysis of Causes of Early Recurrence After Percutaneous Endoscopic Transforaminal Discectomy. Global Spine J 2024; 14:113-121. [PMID: 35581748 PMCID: PMC10676163 DOI: 10.1177/21925682221096061] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To analyze the causes of and factors influencing early recurrence after TELD performed in the treatment of lumbar disc herniation. METHODS We included 285 patients with single-segment lumbar disc herniation treated using transforaminal endoscopy lumbar discectomy TELD from January 2017 to December 2019 at the First Affiliated Hospital of the University of South China. Patients were classified into early recurrence and non-early recurrence groups based on clinical symptoms and MRI reexamination. Imaging data (eg, disc height index (DHI), Pfirrman grades, base width, postoperative annulus-fibrosus tear size, cross-sectional area of the foramen (CSAF), etc.)were analyzed, and multivariate, binomial logistic regression was utilized to determine which factors were associated with early recurrence after TELD. RESULTS A total of 285 patients completed surgery and clinical follow-up, during which 19 patients relapsed within 6 months postsurgery, for an early recurrence rate of 6.7%. There were statistically significant differences between DHI, Pfirrman grades, base width, postoperative annulus-fibrosus tear size, herniation sites, CSAF and Modic changes between the early recurrence and non-early recurrence groups (P < .05). On multivariate logistic regression,the degree of disc degeneration (OR = .747, P = .037), CSAF (OR = 5.255, P = .006), degree of Modic change (OR = 1.831, P = .018) and base width of the herniation (OR = 4.942, P = .003) were significantly correlated with early recurrence after TELD. CONCLUSIONS Postoperative annulus-fibrosus tear size, DHI, and location of the disc herniation were associated with early recurrence after TELD. Increased base width of the herniation, severe disc degeneration, decreased CSAF and Modic change were risk factors for early recurrence after TELD.
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Affiliation(s)
- Ze-Peng Li
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, China
| | - Lu-Lu Liu
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, China
| | - Hao Liu
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, China
| | - Jing-Hua Tan
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, China
| | - Xue-Lin Li
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, China
| | - Zhun Xu
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, China
| | - Zhi-Hua Ouyang
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, China
| | - Cheng Wang
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, China
| | - Yi-Guo Yan
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, China
| | - Jing-Bo Xue
- Department of Spine Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, China
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Jiang L, Xie X, He R, Da J. Analysis of risk factors for post-operative recurrence after percutaneous endoscopic lumbar discectomy in patients with lumbar disc herniation: a meta-analysis. J Orthop Surg Res 2023; 18:935. [PMID: 38057884 DOI: 10.1186/s13018-023-04378-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND This study aimed to systematically evaluate risk factors for post-operative recurrence after percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). METHODS The eligible studies were retrieved from PubMed, Embase, and Web of Science databases. Quality assessment was performed. The effects of binary variables (sex, Modic change (MC), type 2 diabetes (T2DM), and smoking) on post-operative recurrence were evaluated as odds ratio (OR) and 95% confidence interval (CI). The effects of continuous variables (sagittal range of motion (SROM), body mass index (BMI), and age) were assessed as weighted mean difference (WMD) and 95% CI. Sensitivity analysis and publication bias were conducted to evaluate the reliability of pooled results. RESULTS Eight studies were included, and their methodological quality was medium. MC (OR (95% CI) = 3.88 (2.24-6.74), P < 0.001), smoking (OR (95% CI) = 1.87 (1.45, 2.42), P < 0.001), T2DM (OR (95% CI) = 1.61 (1.12, 2.31), P = 0.010), SROM (WMD (95% CI) = 2.33 (0.95, 3.70), P = 0.001), BMI (WMD (95% CI) = 1.68 (1.37, 1.99) kg/m2, P < 0.001), and age (WMD (95% CI) = 9.95 (5.05, 14.86) years, P < 0.001) were significantly related to post-operative recurrence in patients with LDH after PELD. Significant publication bias was not observed among studies in all outcome indicators. CONCLUSION Our findings reveal that high levels of age, BMI, and SROM, history of T2DM or smoking, or more MC may be correlated with post-operative recurrence after PELD.
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Affiliation(s)
- Lin Jiang
- Orthopaedics Department, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China
| | - Xin Xie
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Rongfang He
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China.
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Jun Da
- Orthopaedics Department, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China.
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China.
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Zhu F, Jia D, Zhang Y, Ning Y, Leng X, Feng C, Li C, Zhou Y, Huang B. Moderate to Severe Multifidus Fatty Atrophy is the Risk Factor for Recurrence After Microdiscectomy of Lumbar Disc Herniation. Neurospine 2023; 20:637-650. [PMID: 37401083 PMCID: PMC10323347 DOI: 10.14245/ns.2346054.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/30/2023] [Accepted: 05/11/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE We attempted to investigate the potential risk factors of recurrent lumbar disc herniation (rLDH) after tubular microdiscectomy. METHODS We retrospectively analyzed the data of patients who underwent tubular microdiscectomy. The clinical and radiological factors were compared between the patients with and without rLDH. RESULTS This study included 350 patients with lumbar disc herniation (LDH) who underwent tubular microdiscectomy. The overall recurrence rate was 5.7% (20 of 350). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) at the final follow-up significantly improved compared with those preoperatively. There was no significant difference in the preoperative VAS score and ODI between the rLDH and non-rLDH groups, while the leg pain VAS score and ODI of the rLDH group were significantly higher than those of the non-rLDH group at final follow-up. This suggested that rLDH patients had a worse prognosis than non-rLDH patients even after reoperation. There were no significant differences in sex, age, body mass index, diabetes, current smoking and drinking, disc height index, sagittal range of motion, facet orientation, facet tropism, Pfirrmann grade, Modic changes, interdisc kyphosis, and large LDH between the 2 groups. Univariate logistic regression analysis revealed that rLDH was associated with hypertension, multilevel microdiscectomy, and moderate-severe multifidus fatty atrophy (MFA). A multivariate logistic regression analysis indicated that MFA was the sole and strongest risk factor for rLDH after tubular microdiscectomy. CONCLUSION Moderate-severe MFA was a risk factor for rLDH after tubular microdiscectomy, which can serve as an important reference for surgeons in formulating surgical strategies and the assessment of prognosis.
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Affiliation(s)
- Fengzhao Zhu
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Dongqing Jia
- Department of Blood Transfusion, University-Town Hospital of Chongqing Medical University, Chongqing, China
| | - Yaqing Zhang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ya Ning
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Xue Leng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Chencheng Feng
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Bo Huang
- Department of Orthopedics, Xinqiao Hospital, Army Medical University, Chongqing, China
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7
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de Nijs L, Fomekong E, Raftopoulos C. Tubular Microdiscectomy for Recurrent Lumbar Disc Herniation: A Valuable Alternative to Endoscopic Techniques. World Neurosurg 2023; 173:e401-e407. [PMID: 36803687 DOI: 10.1016/j.wneu.2023.02.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/12/2023] [Indexed: 02/19/2023]
Abstract
OBJECTIVE The efficacy of tubular microdiscectomy (TMD) in the treatment of recurrent lumbar disc herniation (rLDH) is still unclear, especially compared with the endoscopic technique. We performed a retrospective study to analyze this question. METHODS We retrospectively included all patients with an rLDH confirmed by magnetic resonance imaging who underwent TMD between January 2012 and February 2019. The general data included sex, age, body mass index, level of rLDH, first surgical approach, reoperation interval, occurrence of dural leak, re-recurrence, and re-reoperation. The clinical outcome was evaluated using a visual analog scale for leg pain, and the modified MacNab criteria were used to evaluate patient satisfaction. RESULTS The visual analog scale score for leg pain was statistically significantly reduced from 7.46 preoperatively to 0.80 postoperatively (P < 0.00001), and the patient satisfaction was good or excellent in 85.7% of cases, according to the modified MacNab criteria. Complications occurred in 3 of the 15 included patients: 2 dural tears (13.3%) and 2 re-recurrence (13.3%), but none of the patients underwent a third surgical procedure. CONCLUSIONS TMD seems to be an efficient technique for the surgical treatment of leg pain caused by rLDH. In the literature, this technique seems to be at least as good as the endoscopic technique and is easier to master.
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Affiliation(s)
- Loïc de Nijs
- Department of Neurosurgery, Saint-Luc Universitary Hospital, Brussels, Belgium.
| | - Edward Fomekong
- Department of Neurosurgery, Saint-Luc Universitary Hospital, Brussels, Belgium
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He H, Ma J, Xiong C, Wei T, Tang A, Chen Y, Xu F. Development and Validation of a Nomogram to Predict the Risk of Lumbar Disk Reherniation within 2 Years After Percutaneous Endoscopic Lumbar Discectomy. World Neurosurg 2023; 172:e349-e356. [PMID: 36640832 DOI: 10.1016/j.wneu.2023.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To develop and validate a nomogram for predicting recurrent lumbar disk herniation (LDH) within 2 years after percutaneous endoscopic lumbar discectomy. METHODS Information on patients' LDH was collected from 1 medical center between January 2015 and September 2020. The LASSO (least absolute shrinkage and selection operator) method was applied to select the most significant risk factors. A multivariate logistic regression analysis was used to develop a predictive model incorporating the possible factors selected by the LASSO regression model. The discriminant, corrected, and clinically useful prediction models were evaluated using consistency index (C-index), receiver operating characteristic curve, calibration curves, and decision curve analysis. Internal validation of clinical predictive power was also assessed by bootstrap validation. RESULTS A total of 690 patients with LDH were included in this study. Sixty-three patients experienced recurrence within 2 years whereas 627 experienced no recurrence. The nomogram predictors included age, body mass index, Modic change, Pfirrmann grade, and sagittal range of motion. The model had good discrimination power, with a reliable C-index of 0.868 (95% confidence interval, 0.822-0.913) and interval validation confirmed a higher C-index value of 0.846. The area under the receiver operating characteristic curve was 0.868, indicating a good predictive value. The decision curve analysis indicated that it was clinically feasible to use the predictive recurrence nomogram model. CONCLUSIONS We developed and validated a new accurate and effective nomogram for predicting recurrent LDH within 2 years after percutaneous endoscopic lumbar discectomy. Age, body mass index, Modic change, Pfirrmann grade, and sagittal range of motion were significant features for predicting rLDH.
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Affiliation(s)
- Hang He
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Jun Ma
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Chengjie Xiong
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Tanjun Wei
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Aolin Tang
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Yongkang Chen
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Feng Xu
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China.
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Wu H, Hu S, Liu J, He D, Chen Q, Cheng X. Risk Factors Involved in the Early and Medium-Term Poor Outcomes of Percutaneous Endoscopic Transforaminal Discectomy: A Single-Center Experience. J Pain Res 2022; 15:2927-2938. [PMID: 36132995 PMCID: PMC9484800 DOI: 10.2147/jpr.s380946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the risk factors involved in the early and medium-term poor outcomes of percutaneous endoscopic transforaminal discectomy (PETD) treatment of lumbar disc herniation (LDH) at the L4-5 level. Methods Between January 2015 and May 2020, we recruited 148 LDH patients at the L4-5 level who underwent PETD surgery. The patients were divided into Groups A and B, according to the surgical outcomes. Good and excellent outcomes were categorized into Group A, and generally good and poor outcomes were categorized into Group B. Clinical parameters (age, gender, symptom duration, hospital stay, operation time, blood loss, straight-leg raising (SLR), visual analog scale (VAS), Oswestry Disability Index (ODI) score and modified MacNab criteria) and radiologic parameters (foraminal height (FH), intervertebral height index (IHI), intervertebral angle (IVA), sagittal range of motion (sROM), and lumbar lordosis (LL)) were collected and analyzed using univariate and multiple logistic regression analyses. Results At the 6-month follow-up post operation, univariate analysis revealed that the symptom duration, SLR, IHI, and sROM were strongly associated with poor outcomes. However, multiple logistic regression analysis demonstrated that prolonged symptom duration, large SLR angel, and large sROM were independent risk factors for poor outcomes. At the 2-year follow-up post operation, univariate analysis suggested that advanced age, prolonged symptom duration, large preoperative VAS score, small FH, small IHI, and large sROM were potential risk factors for poor outcomes. However, multiple logistic regression analysis demonstrated that prolonged symptom duration, small IHI, and large sROM were independent risk factors for poor outcomes. Conclusion Our study demonstrated that prolonged symptom duration, large SLR angel, and large sROM were independent risk factors for poor outcomes immediately following PETD at the L4-5 level. However, prolonged symptom duration, small IHI, and large sROM were independent risk factors for poor outcomes at medium-term post PETD at the L4-5 level.
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Affiliation(s)
- Hui Wu
- Department of Orthopaedics, the Second Affiliated Hospital of Nanchang University, Nanchang city, Jiangxi Province, 330006, People's Republic of China
| | - Shen Hu
- Department of Orthopaedics, the Second Affiliated Hospital of Nanchang University, Nanchang city, Jiangxi Province, 330006, People's Republic of China
| | - Jiahao Liu
- Department of Orthopaedics, the Second Affiliated Hospital of Nanchang University, Nanchang city, Jiangxi Province, 330006, People's Republic of China
| | - Dingwen He
- Department of Orthopaedics, the Second Affiliated Hospital of Nanchang University, Nanchang city, Jiangxi Province, 330006, People's Republic of China
| | - Qi Chen
- Department of Orthopaedics, the Second Affiliated Hospital of Nanchang University, Nanchang city, Jiangxi Province, 330006, People's Republic of China
| | - Xigao Cheng
- Department of Orthopaedics, the Second Affiliated Hospital of Nanchang University, Nanchang city, Jiangxi Province, 330006, People's Republic of China
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10
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Percutaneous Endoscopic Lumbar Discectomy for the Treatment of Recurrent Lumbar Disc Herniation: A Meta-analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6488674. [PMID: 36124069 PMCID: PMC9482522 DOI: 10.1155/2022/6488674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/23/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
Objective. To evaluate the incidence and safety of clinical complications associated with percutaneous endoscopic lumbar discectomy (PELD) for the treatment of recurrent lumbar disc herniation (RLDH) by meta-analysis. Methods. PubMed, Embase, The Cochrane Library, and Web of Science electronic databases were searched for clinical studies on complications related to the treatment of RLDH with PELD. The search time extended from the databases’ inception until May 2021. RevMan5.4 software was used for meta-analysis after two researchers independently scanned the literature, gathered data, and assessed the bias risk of the included studies. Results. A total of 8 clinical studies, including 1 randomized controlled trial and 7 cohort studies including 906 individuals, were included. According to the results of the meta-analysis, the overall complications (
, 95% CI: 0.04-0.83,
) and dural tear rates (
, 95% CI: 0.01-0.92,
) of PELD were lower than those of traditional fenestration nucleus pulposus removal. Moreover, the PELD group had a greater recurrence rate compared to the MIS-TLIF group (
, 95% CI: 3.68-105.62,
), and the difference was statistically significant. However, compared with MED and MIS-TLIF, there were no significant differences in the incidence of overall complications, dural tear, nerve root injury, and incomplete nucleus pulposus removal (
). Conclusion. PELD is an effective and safe method for the treatment of recurrent lumbar disc herniation, with a lower incidence of complications and higher safety profile than traditional fenestration nucleus pulposus removal.
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11
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Tang Y, Liu Z, Liu H, Zhang J, Zhu X, Qian Z, Yang H, Mao H, Zhang K, Chen H, Chen K. A comparative study of single and double incision for L4/5 and L5/S1 double-level percutaneous interlaminar lumbar discectomy. Front Surg 2022; 9:955987. [PMID: 36111227 PMCID: PMC9468222 DOI: 10.3389/fsurg.2022.955987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThis study aims to investigate the clinical outcome of single and double incision for double-level percutaneous interlaminar lumbar discectomyMethodsA retrospective analysis was performed involving patients with L4/5 and L5/S1 double-level lumbar disc herniation who received percutaneous interlaminar lumbar discectomy (PEID) in our hospital from January 2017 to December 2020. These enrolled patients were divided into single- and double-incision groups, with 25 patients in each group. We compared the incision length, operation time, fluoroscopy times, and length of hospital stay between the two groups. Meanwhile, the postoperative visual analogue scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopedic Association score (JOA), and modified MacNab standard were used to evaluate the outcomes of the patients within the two groups.ResultsIt showed that the single-incision group performed better than double-incision group in incision length, operation time, and fluoroscopy times (P < 0.001). The VAS score, JOA score, and ODI index in the two groups were significantly decreased at the time points of postsurgery, 1 month after surgery, and the last follow-up (P < 0.01), but there was no statistical significance between the two groups involving above parameters (P > 0.05). At the last follow-up, the excellent and good rates of MacNab efficacy in the two groups were 92% and 88%, respectively, but no significant difference was observed between the two groups (P > 0.05).ConclusionBoth the single- and double-incision approaches are effective and safe for managing L4/5 and L5/S1 double-level LDH. Single-incision PEID for treating L4/5 and L5/S1 double-segment lumbar disc herniation has advantages of less trauma, fewer intraoperative fluoroscopy times, and shorter operation time, as compared to double-incision PEID. However, the operation of double-segment LDH through a single laminar incision is difficult, the learning curve is steep, and professional skill is highly required. Importantly, the surgical indications should be strictly grasped.
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Affiliation(s)
- Yingchuang Tang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zixiang Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junxin Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoyu Zhu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhonglai Qian
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Haiqing Mao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Kangwu Chen Hao Chen Kai Zhang
| | - Hao Chen
- Department of Orthopedic Surgery, Affiliated Hospital of Yangzhou University, Yangzhou, China
- Correspondence: Kangwu Chen Hao Chen Kai Zhang
| | - Kangwu Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
- Correspondence: Kangwu Chen Hao Chen Kai Zhang
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12
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Lu H, Yao Y, Shi L. Percutaneous Endoscopic Lumbar Discectomy for Recurrent Lumbar Disc Herniation: An Updated Systematic Review and Meta-Analysis. Indian J Orthop 2022; 56:983-995. [PMID: 35669028 PMCID: PMC9123128 DOI: 10.1007/s43465-022-00636-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 04/02/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This meta-analysis evaluated surgical outcomes following endoscopic or conventional discectomy for recurrent lumbar disc herniation. METHODS Medline, Cochrane, EMBASE, and Google Scholar were search until October 16, 2016 using these terms: recurrent lumbar disc herniation, endoscopic surgery, and discectomy. Randomized controlled trials (RCTs), prospective, retrospective, and cohort studies were eligible for inclusion. Pooled difference in mean (PDM) with 95% confidence interval (CIs) or relative risks (RRs) were calculated using fixed-effects methods. RESULTS One RCT and 15 studies were included with a total of 820 patients. Patients received endoscopic surgery experienced shorter operation time than those received conventional surgery (PDM: -52.01, 95% CI: -76.84 to -27.18, P < 0.001). A significantly lower risk in complication was displayed in patients received endoscopic surgery compared to those received conventional surgery (RR: 0.209, 95% CI: 0.076-0.581, P = 0.003). No significant difference in the improvement in VAS (PDM: -2.19, 95% CI: -5.78 to 1.39, P = 0.231), length of stay (PDM: -6.44, 95% CI: -13.76 to 0.89, P = 0.085) and re-recurrence rate (PDM: 0.88, 95% CI: 0.22-3.50, P = 0.861) between groups. CONCLUSIONS Endoscopic and conventional discectomy reduced patient pain comparably, but endoscopic discectomy had significantly lower operation time and lower risk in complications, which may impact other outcomes such as recovery and healthcare costs. More studies are needed to confirm our findings. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-022-00636-1.
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Affiliation(s)
- Honghui Lu
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, 5 Haiyuncang, Dongcheng District, Beijing, 100700 China
| | - Yu Yao
- Department of Orthopaedics, Hospital of Chinese Armed Police Beijing Corps, Beijing, China
| | - Ligang Shi
- Department of Orthopaedics, Aerospace Center Hospital, Beijing, China
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13
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Hua W, Ke W, Wang B, Xiang Q, Zhang Y, Wu X, Li S, Wang K, Zeng X, Gao Y, Yang S, Xiao B, Yang C. Comparison of the Clinical Outcomes of Full-Endoscopic Visualized Foraminoplasty and Discectomy Versus Microdiscectomy for Lumbar Disc Herniation. Orthop Surg 2021; 14:280-289. [PMID: 34914186 PMCID: PMC8867436 DOI: 10.1111/os.13087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/15/2021] [Accepted: 05/10/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This retrospective case-control study aimed to evaluate and compare the clinical outcomes of full-endoscopic visualized foraminoplasty and discectomy (FEVFD) with microdiscectomy (MD) for lumbar disc herniation (LDH). METHODS Data from 198 patients who presented with LDH between January 2016 and December 2017 treated by either FEVFD or MD were retrospectively analyzed. The inclusion criteria were single-level LDH, unilateral radiating leg pain with or without positive Lasegue's sign, and failure of standard conservative treatment for at least 12 weeks. The patients were categorized into an FEVFD group (n = 102) or an MD group (n = 96), according to the surgical procedure performed. Operative time, time in bed after surgery, postoperative hospitalization time, complications, and reoperations were recorded. Visual analog scales (VAS) for leg and back pain, Oswestry Disability index (ODI), 36-Item Short-Form Health Survey physical function (SF36-PF), and bodily pain (SF36-BP) scores were assessed and compared between the two groups. RESULTS The demographic data and baseline characteristics of the two groups were not significantly different. Operative time for the FEVFD group (73.82 ± 20.73 min) was longer than that for the MD group (64.74 ± 17.37 min) (P = 0.003), and fluoroscopy time for the FEVFD group (1.71 ± 0.58s) was longer than that for the MD group (1.30 ± 0.33s) (P < 0.001). However, time in bed experienced in the FEVFD group (8.51 ± 2.10 h) was less than that in the MD group (9.24 ± 2.01 h) (P = 0.014), and postoperative hospitalization time experienced in the FEVFD group (2.89 ± 0.83d) was also shorter than that in the MD group (4.94 ± 1.35d) (P < 0.001). All patients completed 24 months of follow-up. Postoperative scores at each follow-up for the VAS for leg and back pain, ODI, SF36-PF, and SF36-BP all improved significantly for both groups, as compared to the preoperative data (P < 0.05). The mean preoperative and postoperative scores for the VAS for leg and back pain, ODI, SF36-PF, and SF36-BP were not significantly different between the two groups. According to the modified MacNab criteria, the outcomes of the procedures were rated as excellent or good by 92.16% and 93.75% of the patients in the FEVFD and MD groups, respectively. One patient suffered a nerve root injury during the discectomy, one patient suffered from a dural tear, and two patients suffered from a residual herniation in the FEVFD group. One patient in the MD group suffered from poor wound healing. Moreover, recurrence happened in two cases in the FEVFD group, and in one case in the MD group. CONCLUSION FEVFD and MD are both reliable techniques for the treatment of symptomatic LDH. FEVFD resulted in a more rapid recovery and equivalent clinical outcomes after 24 months of follow-up.
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Affiliation(s)
- Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wencan Ke
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingjin Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Xiang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yukun Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinghuo Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianlin Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Gao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuhua Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baojun Xiao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Li Y, Wang B, Li H, Chang X, Wu Y, Hu Z, Liu C, Gao X, Zhang Y, Liu H, Li Y, Li C. Adjuvant surgical decision-making system for lumbar intervertebral disc herniation after percutaneous endoscopic lumber discectomy: a retrospective nonlinear multiple logistic regression prediction model based on a large sample. Spine J 2021; 21:2035-2048. [PMID: 34298160 DOI: 10.1016/j.spinee.2021.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Lumbar disc herniation (LDH) is a common condition that can affects an individual' quality of life. In patients for whom conservative treatment is ineffective after 3 months, surgical treatment, such as percutaneous endoscopic lumbar discectomy (PELD), is recommended. Because PELD is minimally invasive and produces thorough nerve root decompression, both surgeons and patients often prefer it to other techniques. PURPOSE Surgeons find it challenging to prevent postoperative recurrent LDH (rLDH) when they use PELD. We created and verified a model for evaluating patients' recurrence risk factors before surgery so that surgeons can choose other surgical techniques when necessary. STUDY DESIGN Retrospective study. PATIENT SAMPLE One thousand eight hundred seven patients who underwent PELD at our hospital between 2012 and 2015 were enrolled. OUTCOME MEASURE The main outcome measure was rLDH at any follow-up time point. METHODS Data were retrospectively analyzed for 1807 patients who underwent PELD at our hospital at some point between 2012 and 2015; all patients had been monitored for at least 5 years after surgery. They were divided into a recurrence group and a nonrecurrence group. Clinical and radiological risk factors were assessed over time to determine their correlations with recurrence and to exclude less important factors. A nonlinear multivariate logistic regression model was established to predict the recurrence rate before surgery. RESULTS A total of 1706 patients were monitored after PELD; data were missing for 101 additional patients. The total recurrence rate was 10.38%, and the most common time from surgery to recurrence was 1 year. Ten risk factors were assessed and included in the analysis. Regarding clinical risk factors, patients with hypertension (p < .001; correlation coefficient R [R] = 0.235; odds ratio [OR] = 4.749), diabetes (p < .001; R = 0.381; OR = 16.797), a history of smoking (p < .001; R = 0.347; OR = 9.012), and a history of performing intense physical labor (p < .001; R = 0.409; OR = 19.592) had a higher recurrence rate. Regarding radiological risk factors, patients with disc degeneration (Pfirrmann grade III) (p < .001; R = 0.228; OR = 4.919), Modic changes (level 2) (p < .001; R = 0.309; OR = 7.934), herniation in the form of extrusion (p < .001; R = 0.365; OR = 12.228), a higher disc height index (DHI) (p < .001; R = 0.336), and a larger segmental range of motion (p < .001; R = 0.243) had a higher recurrence rate. When the lumbar motion angle was negative (p < .001; R = 0.318; OR = 13.680), the recurrence rate was high. The overall accuracy of the final model was 97.6% (1665 of 1706). The recognition rate for non-rLDH cases was 99.0% (1514 of 1529), and the rate for rLDH cases was 85.3% (151 of 177); the AUC was 0.9315. A simple model was used. For those patients with postoperative trauma (p < .001; R = 0.382; OR = 13.680), a comparison model was established, and the corresponding recurrence rate was 23.0% ± 25.0% (0-76%). CONCLUSIONS A large cohort of patients underwent long-term monitoring, and 11 risk factors were verified for assessing each patient's risks before surgery to predict the postoperative recurrence of LDH following PELD. The risk of recurrence may be effectively reduced with the use of alternative surgical techniques in high risk cases.
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Affiliation(s)
- Yueyang Li
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Bo Wang
- School of microelectronics and communication engineering, Chongqing University, China
| | - Haiyin Li
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Xian Chang
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Yu Wu
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Zhilei Hu
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Chenhao Liu
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Xiaoxin Gao
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Yuyao Zhang
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Huan Liu
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China
| | - Yongming Li
- School of microelectronics and communication engineering, Chongqing University, China.
| | - Changqing Li
- Department of Orthopedics, Army Medical University, Chongqing, People's Republic of China.
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15
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Zhao C, Zhang H, Wang Y, Xu D, Han S, Meng S, Han J, Liu H, Zhou C, Ma X. Nomograms for Predicting Recurrent Herniation in PETD with Preoperative Radiological Factors. J Pain Res 2021; 14:2095-2109. [PMID: 34276226 PMCID: PMC8277456 DOI: 10.2147/jpr.s312224] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/30/2021] [Indexed: 12/05/2022] Open
Abstract
Purpose To investigate the preoperative radiological risk factors for recurrent lumbar disc herniation (rLDH) within 1 year after percutaneous endoscopic transforaminal discectomy (PETD). Patients and Methods A retrospective case–control study was conducted. Between January 2013 and November 2019, a total of 1210 patients with single-level L4/5 LDH who underwent PETD were enrolled in the present study. In total, 62 rLDH patients were diagnosed and collected based on the clinical and radiological manifestations, and 224 non-rLDH controls were selected from the remaining 1148 patients. Preoperative radiological parameters were collected and measured. An age threshold to distinguish patients into subgroups was established using the Youden index. The relationships between the risk factors and rLDH were evaluated by univariate and multivariate analyses in two subgroups. Predictive models were established based on logistic analysis. The area under the curve (AUC) of receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA) were used to assess the predictive models. Results In the present study, logistic analysis identified six significant predictors associated with rLDH in the young group: superior endplate concave angle (ECA), sacral slope, Modic changes, sagittal range of motion (sROM), extension intervertebral angle (IVA), and lumbar lordosis. Four significant predictors were identified in the elderly group: disc height index (DHI), retrolisthesis (posterior spondylolisthesis), sROM, and extension IVA. Validation of both models demonstrated excellent model discrimination (AUC= 0.940 and 0.946, respectively). DCA also showed excellent clinical utility and benefits. Conclusion The nomograms that we constructed could accurately predict individual patient recurrence risk. Individualized measures should be taken for patients of different ages with the above risk factors, and tailored postoperative surveillance of patients who underwent PETD can be planned.
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Affiliation(s)
- Chong Zhao
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Hao Zhang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Yan Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Derong Xu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Shuo Han
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Shengwei Meng
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Jialuo Han
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Houchen Liu
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Chuanli Zhou
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Xuexiao Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
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16
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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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17
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Liu L, Xue H, Jiang L, Chen H, Chen L, Xie S, Wang D, Zhao M. Comparison of Percutaneous Transforaminal Endoscopic Discectomy and Microscope-Assisted Tubular Discectomy for Lumbar Disc Herniation. Orthop Surg 2021; 13:1587-1595. [PMID: 34109744 PMCID: PMC8313144 DOI: 10.1111/os.12909] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/21/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022] Open
Abstract
Objective The aim of the present study was to compare the clinical outcomes and quality of life following percutaneous transforaminal endoscopic discectomy (PTED) and microscope‐assisted tubular discectomy (MTD) for lumbar disc herniation (LDH). Methods This study had a retrospective design. From June 2017 to June 2018, the clinical data of 120 patients with LDH treated with PTED (60 cases, PTED group) and MTD (60 cases, MTD group) were analyzed and followed up for at least 20 months. There were 59 men and 61 women. Patients were aged between 22 and 80 years. The operation time, intraoperative blood loss, incision length, frequency of intraoperative fluoroscopy, cost, hospital stay, types of herniated discs, complications, and clinical outcomes were evaluated. Clinical outcomes were assessed using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified Macnab criteria. Short‐Form 36 (SF‐36) and the EQ‐5D‐5L were used to evaluate the quality of life of patients. The data between the two groups were compared by independent sample t‐tests. Multiple comparisons between samples were analyzed by analysis of variance. Results Compared with the MTD group, the PTED group had shorter incision length (9.20 ± 1.19 mm vs 26.38 ± 1.82 mm), less intraoperative blood loss (18.00 ± 4.97 mL vs 39.83 ± 6.51 mL), and shorter hospital stay (5.42 ± 5.08 days vs 10.58 ± 3.69 days) (P = 0.00). PTED was much more appropriate for foraminal and extraforaminal disc herniation. The incidence of paresthesia was lower in the PTED group (6.67% vs 16.67%). At each follow up, the VAS and ODI scores of all patients were significantly improved compared with those before surgery (P = 0.00). At 3 days postoperatively, the lumbar VAS score of the PTED group was significantly lower (1.58 ± 1.00 vs 2.37 ± 1.10, P = 0.00). The excellent rate of the PTED group reached 91.67%, and that of the MTD group reached 93.33%. Compared with the preoperative SF‐36 scores for physiological function, mental health, and social function, the postoperative scores were significantly improved in both groups (P = 0.00). The EQ‐5D‐5L in the PTED group increased from 0.30 ± 0.17 before the operation to 0.69 ± 0.13 after 6 months of follow up (P = 0.00) and 0.73 ± 0.14 after 20 months of follow up. The EQ‐5D‐5L in the MTD group increased from 0.28 ± 0.17 before the operation to 0.68 ± 0.13 after a 6‐month follow up (P = 0.00), and 0.73 ± 0.12 after a 20‐month follow up. Conclusion Although both PTED and MTD are effective for LDH, PTED is much more appropriate for various types of LDH and has the advantages of the low incidence of low back pain, fewer complications, and early recovery.
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Affiliation(s)
- Lantao Liu
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Hui Xue
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Lianghai Jiang
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Hao Chen
- Graduate School, Dalian Medical University, Dalian, China
| | - Longwei Chen
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Siyu Xie
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Dechun Wang
- Department of Spinal Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Mingwei Zhao
- Department of Spinal Surgery, Qingdao Chest Hospital, Qingdao, China
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18
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Kong M, Xu D, Gao C, Zhu K, Han S, Zhang H, Zhou C, Ma X. Risk Factors for Recurrent L4-5 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy: A Retrospective Analysis of 654 Cases. Risk Manag Healthc Policy 2020; 13:3051-3065. [PMID: 33376428 PMCID: PMC7755338 DOI: 10.2147/rmhp.s287976] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background Percutaneous endoscopic lumbar discectomy (PELD) is an increasingly applied minimally invasive procedure that has several advantages in the treatment of lumbar disc herniation (LDH). However, recurrent LDH (rLDH) has become a concerning postoperative complication. It remains difficult to establish a consensus and draw reliable conclusions regarding the risk factors for rLDH. Purpose This retrospective study aimed to investigate the risk factors associated with rLDH at the L4-5 level after percutaneous endoscopic transforaminal discectomy (PETD). Methods A total of 654 patients who underwent the PETD procedure at the L4-5 level from October 2013 to January 2020 were divided into a recurrence (R) group (n=46) and a nonrecurrence (N) group (n=608). Demographic and clinical data and imaging parameters were collected and analyzed using univariate and multiple regression analyses. Results The current study found a 7% rate of rLDH at the L4/5 level after successful PETD. Univariate analysis showed that older age, high BMI, diabetes mellitus history, smoking, large physical load intensity, moderate disc degeneration, small muscle-disc ratio (M/D), more fat infiltration, large sagittal range of motion (sROM), scoliosis, small disc height index (DHI), small intervertebral space angle (ISA), and small lumbar lordosis (LL) were potential risk factors (P < 0.10) for LDH recurrence after PETD at the L4-5 level. Multivariate analysis suggested that high BMI, large physical load intensity, moderate disc degeneration, small M/D, more fat infiltration, large sROM, small ISA, and small LL were independent significant risk factors for recurrence of LDH after PETD. Conclusion Consideration of disc degeneration, M/D, fat infiltration of the paravertebral muscles, sROM, ISA, LL, BMI, and physical load intensity prior to surgical intervention may contribute to the prevention of rLDH following PETD and lead to a more satisfactory operative outcome and the development of a reasonable rehabilitation program after discharge.
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Affiliation(s)
- Meng Kong
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China.,Department of Medicine, Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China
| | - Derong Xu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China
| | - Changtong Gao
- Minimally Invasive Interventional Therapy Center, Qingdao Municipal Hospital, Qing'dao, Shandong Province 266000, People's Republic of China
| | - Kai Zhu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China
| | - Shuo Han
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China.,Department of Medicine, Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China
| | - Hao Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China.,Department of Medicine, Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China
| | - Chuanli Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China
| | - Xuexiao Ma
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qing'dao, Shandong Province 266000, People's Republic of China
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Younus A, Kelly A, Lekgwara P. Full-endoscopic lumbar foraminoplasty and discectomy to manage a recurrent disc in a patient with previous percutaneous lumbo-sacral stabilization - A case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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20
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Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disc Herniation: Two-Year Results of a Randomized Controlled Trial. Spine (Phila Pa 1976) 2020; 45:493-503. [PMID: 31703056 DOI: 10.1097/brs.0000000000003314] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective randomized controlled study. OBJECTIVE To clarify whether percutaneous transforaminal endoscopic discectomy (PTED) has better clinical outcomes and less surgical trauma compared with microendoscopic discectomy (MED). SUMMARY OF BACKGROUND DATA Two kinds of minimally invasive spine surgeries, PTED and MED, are now widely used for the treatment of lumbar disc herniation (LDH). It is still a controversial issue to choose the proper surgical approach. METHODS In this single-center, open-label, randomized controlled trial, patients were included if they had persistent signs and symptoms of radiculopathy with corresponding imaging-confirmed LDH, and were randomly allocated to PTED or MED group. The primary outcome was the score of Oswestry Disability Index (ODI) and the secondary outcomes included the score of Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain and physical function scales, European Quality of Life-5 Dimensions, and Visual Analogue Scales for back pain and leg pain. RESULTS A total of 250 participants were randomly assigned to two treatment groups, 241 of that received the specific surgical procedure. Two hundred twenty-two patients (92.1%) have completed the 2-year follow-up. Both the primary and secondary outcomes did not differ significantly between the two treatment groups at each prespecified follow-up time (P > 0.05). For PTED, the postoperative improvement of ODI score in the median herniation subgroup was less compared with paramedian subgroup. For MED, less improvement of ODI score was found in far-lateral herniation subgroup compared with paramedian subgroup. Total complication rate over the course of 2 year was 13.44% in PTED group and 15.57% in MED group (P = 0.639). Ten cases (8.40%) in PTED group and five cases (4.10%) in MED group suffered from residue/recurrence of herniation, for which reoperation was required. CONCLUSION Over the 2-year follow-up period, PTED did not show superior clinical outcomes and did not appear to be safer procedure for patients with LDH compared with MED. PTED had inferior results for median disc herniation, whereas MED did not appear to be the best option for far-lateral disc herniation. LEVEL OF EVIDENCE 2.
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Yu C, Zhan X, Liu C, Liao S, Xu J, Liang T, Zhang Z, Chen J. Risk Factors for Recurrent L5-S1 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy: A Retrospective Study. Med Sci Monit 2020; 26:e919888. [PMID: 32210223 PMCID: PMC7133417 DOI: 10.12659/msm.919888] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background This retrospective study aimed to investigate the risk factors associated with the recurrence of L5–S1 disc herniation after percutaneous endoscopic transforaminal discectomy (PETD). Material/Methods There were 484 patients L5–S1 disc herniation who underwent PETD who were divided into the recurrence group (n=46) and the non-recurrence group (n=438). Transforaminal endoscopic approaches included modifications of the Yeung endoscopy spine system (YESS) (the intraforaminal intradiscal approach) and the transforaminal endoscopic spine system (TESSYS) (intraforaminal extradiscal approach). Demographic and clinical characteristics and imaging data were analyzed. The two study groups were compared to determine the factors associated with the recurrence of L5–S1 disc herniation. The patients underwent postoperative follow-up for between one and four years. Results At follow-up, 9.504% of patients (46/484) with the recurrence of L5–S1 disc herniation following PETD when compared with the non-recurrence group showed no significant difference for time to return to work, gender, history of diabetes mellitus, trauma, duration of symptoms, smoking and alcohol history, hypertension, location of disc herniation, transverse process length, intervertebral space height, and pelvic incidence angle (P>0.05). However, age, body mass index (BMI), the degree of disc degeneration, sagittal range of motion, lumbar lordosis angle, and sacral slope were significantly associated with the recurrence of L5–S1 disc herniation following PETD (P<0.05). Logistic regression analysis supported these main associations. Conclusions The recurrence of L5–S1 disc herniation following PETD was significantly associated with increased age and BMI, more severe disc degeneration, increased sagittal range of motion, increased lumbar lordosis, and sacral slope.
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Affiliation(s)
- Chaojie Yu
- Graduate School, Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Xinli Zhan
- Spine Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Chong Liu
- Spine Department, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Shian Liao
- Graduate School, Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Jinming Xu
- Graduate School, Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Tuo Liang
- Graduate School, Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Zide Zhang
- Graduate School, Guangxi Medical University, Nanning, Guangxi, China (mainland)
| | - Jiarui Chen
- Graduate School, Guangxi Medical University, Nanning, Guangxi, China (mainland)
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Choi Y, Kim CH, Rhee JM, Kuo CC, Lee U, Park SB, Lee CH, Yang SH, Kim KT, Chung CK. Longitudinal clinical outcomes after full-endoscopic lumbar discectomy for recurrent disc herniation after open discectomy. J Clin Neurosci 2020; 72:124-129. [PMID: 31948880 DOI: 10.1016/j.jocn.2019.12.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Full-endoscopic lumbar discectomy (FELD) is a minimally invasive surgical option for recurrent lumbar disc herniation (LDH). Nonetheless, patients' clinical outcomes may be poorer after surgery for recurrent LDH than for primary LDH. Therefore, we compared patients' longitudinal clinical outcomes after FELD for recurrent LDH or primary LDH. METHODS The medical records of patients who underwent FELD for primary LDH (group A) or recurrent LDH (group B) were retrospectively reviewed. The inclusion criteria were: 1) single-level LDH or recurrent LDH at L4-5 or L5-S1, 2) age ≤60 years, 3) previous open discectomy (group B), and 4) ≥6 months of follow-up. In total, 244 patients (group A, 211; group B, 33) were included. Clinical outcomes (Oswestry Disability Index [ODI]; visual analogue pain score for the back and leg [VAS-B] and [VAS-L]) over 24 months of follow-up were compared between groups with a linear mixed-effects model. RESULTS All clinical outcomes significantly improved from pre-operation to 3 months postoperatively (p < 0.01), and the improvement was maintained for 24 months postoperatively in both groups. The clinical outcomes of groups A and B were not significantly different during 24 months follow-up (ODI, p = 0.94; VAS-B, p = 0.11; and VAS-L, p = 0.48). The reoperation rate was 3.3% in group A and 3.0% in group B, but the overall complication rate was higher in group B (9.8%) than in group A (6.6%). CONCLUSION The longitudinal clinical outcomes after FELD for recurrent LDH may not be poor as feared. However, the higher complication rate in patients undergoing FELD for recurrent LDH should be noted.
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Affiliation(s)
- Yunhee Choi
- Medical Research Collaborating Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Department of Orthopaedic Surgery and Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
| | - John M Rhee
- Department of Orthopaedic Surgery and Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Calvin C Kuo
- Regional Spine Surgery Department, Kaiser Permanente, 3600 Broadway, Suite 15, Oakland, CA 94611, USA
| | - Urim Lee
- Human Brain Function Laboratory, Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University Boramae Hospital, Borame Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul 07061, South Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, South Korea; Department of Neurosurgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Clinical Research Institute, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Human Brain Function Laboratory, Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, South Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, South Korea
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Kshirsagar RS, Vu PQ, Liang J. Endoscopic versus external dacryocystorhinostomy: temporal and regional trends in the United States Medicare population. Orbit 2019; 38:453-460. [PMID: 30712428 DOI: 10.1080/01676830.2019.1572767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Abstract
Purpose: Endoscopic surgeries, such as dacryocystorhinostomy (DCR), are increasingly performed for orbital and lacrimal conditions. This study describes and compares recent trends in endoscopic DCR with open, or external, DCR in the United States (US). Methods: Medicare-Part-B National Summary data files were analyzed from 2000 to 2015 for temporal and geographic trends in endoscopic and external DCR. Medicare Physician and Other Supplier public use files detailing provider information were collected and analyzed from 2012 to 2015. Results: Between 2000 and 2015, the number of external DCRs remained relatively unchanged (8008 to 7086, -0.7% average annual growth), while the number of endoscopic DCRs steadily increased (881 to 1674, 4.6% average annual growth). The greatest number of endoscopic DCRs were performed in the South Atlantic region, whereas the Mountain region had the greatest number per capita. From 2000 to 2015, the average payment per procedure for external DCR was $526.63, compared with $512.45 for endoscopic DCR. Of endoscopic DCRs performed from 2012 to 2015, 831 (79%) were performed by Ophthalmology, 184 (18%) were performed by Otolaryngology, and the remainder by other subspecialties. Conclusions: The number of endoscopic DCR surgeries increased over the last 15 years while the number of external DCR surgeries remained stable and continued to surpass endoscopic procedures. While ophthalmologists perform the overwhelming majority of endoscopic DCR, otolaryngologists are performing a growing number.
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Affiliation(s)
- Rijul S Kshirsagar
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center Oakland , Oakland , CA , USA
| | - Priscilla Q Vu
- Department of Ophthalmology, Gavin Herbert Eye Institute, University of California, Irvine , Irvine , CA , USA
| | - Jonathan Liang
- Department of Head and Neck Surgery, Kaiser Permanente Medical Center Oakland , Oakland , CA , USA
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Kapetanakis S, Gkantsinikoudis N, Charitoudis G. The Role of Full-Endoscopic Lumbar Discectomy in Surgical Treatment of Recurrent Lumbar Disc Herniation: A Health-Related Quality of Life Approach. Neurospine 2019; 16:96-104. [PMID: 30943711 PMCID: PMC6449825 DOI: 10.14245/ns.1836334.167] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/17/2019] [Indexed: 12/17/2022] Open
Abstract
Objective To investigate the utility of full-endoscopic lumbar discectomy (FELD) in surgical treatment of recurrent lumbar disc herniation (RLDH).
Methods Forty-five patients were prospectively studied. All patients were subjected to FELD for RLDH. They were assessed preoperatively and in regular intervals at 6 weeks and 3 months, 6 months, and 12 months postoperatively. Evaluation was conducted with visual analogue scale for leg (VAS-LP) and low back (VAS-BP) pain. Short-Form 36 Health Survey Questionnaire was utilized for health-related quality of life assessment.
Results All studied parameters featured statistically significant amelioration at all follow-up intervals. Maximal improvement was in general at 6 weeks observed, with subsequent lesser improvement until 6 months and stabilization until the end of follow-up. Comparative assessment indicated that VAS-BP displayed quantitatively lower improvement, whereas physical function, bodily pain, and role-emotional parameters demonstrated greater amelioration.
Conclusion FELD is associated with a favorable impact in postoperative daily life of patients with RLDH.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.,Athens Medical Center, Athens, Greece
| | | | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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