1
|
Krishnan A, Murugan C, Panthackel M, Anil A, Degulmadi D, Mayi S, Rai RR, Dave MB, Narvekar M, Killekar R, Krishnan PA, Dave BR. Transforaminal Endoscopic Ventral Stenosis Decompression in Calcified Lumbar Disc Herniation: A Long Term Outcome in 79 Patients. World Neurosurg 2024; 186:e191-e205. [PMID: 38531475 DOI: 10.1016/j.wneu.2024.03.104] [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: 12/30/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Calcified lumbar disc herniations (CLDH) causing calcified ventral stenosis pose a therapeutic challenge to the treating surgeon due to their neural adhesions, location, and hardness. METHODS This retrospective study analyzed all the cases of CLDH/calcified ventral stenosis managed by transforaminal endoscopic lumbar discectomy with a minimum follow-up of 24 months. The preoperative images were analyzed for the level, migration; and grade (Lee's migration zones), and location (Michigan State University classification). Detailed surgical technique and intraoperative parameters including the duration of surgery and complications have been recorded. The clinical parameters including visual analog scale (VAS), Oswestry disability index (ODI), length of stay in hospital, days of return to basic work, and patient satisfaction index were analyzed. Postoperatively the images were analyzed for the adequacy of decompression. RESULTS The mean VAS for back pain and leg pain was 4.7 ± 2.6 (0-9), and 7.45 ± 2.2 (1-10), respectively. The mean preoperative ODI was 78.2 ± 13.2 (63.2-95.6). Nineteen patients (24%) had neurological deficits preoperatively. The mean duration of surgery was 90.5 ± 15.8 (58-131) minutes. Postoperative magnetic resonance imaging revealed adequate decompression in 97.5% (n = 77). The mean duration of hospital stay was 1.05 ± 0.22 (1-2) days, and the postoperative back and leg pain VAS was 1.14 ± 1.2 (0-3) (P < 0.05) and 1.7 ± 0.5 (0-6) (P < 0.05), respectively. The ODI at final follow-up was 6.5 ± 3.7 (2.2-18) (P < 0.05). Neurological recovery occurred in 17 (89.5%) patients and they returned to basic work/jobs in 19.5 ± 3.3 (14-26) days. The mean patient satisfaction index was 1.18 ± 0.47 (1-2) at a mean follow-up of 5.52 ± 2.91 (2-12.75) years. CONCLUSIONS Transforaminal endoscopic lumbar discectomy is a complete, safe, and efficacious procedure in patients with CLDH with earlier recovery considering the surgery is performed with the patient being awake.
Collapse
Affiliation(s)
- Ajay Krishnan
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India; Department of Spine Surgery, Bhavnagar Institute of Medical Science, Bhavnagar, Gujarat, India.
| | - Chandhan Murugan
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Mikeson Panthackel
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Abhijith Anil
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Devanand Degulmadi
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Shivanand Mayi
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Ravi Ranjan Rai
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Mirant B Dave
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Mrugank Narvekar
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Rohan Killekar
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Preety Ajay Krishnan
- Department of Radiodiagnosis, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India
| | - Bharat R Dave
- Department of Spine Surgery, Stavya Spine Hospital & Research Institute, Nr Nagari Hospital, Ahmedabad, Gujarat, India; Gujarat University, Ahmedabad, Gujarat, India
| |
Collapse
|
2
|
Gu G, Liu T, Guo H, Tang Y, Zhang S, Yang Z, Li Y, Yuan K. Treatment of L5-S1 Floating Calcified Lumbar Disc Herniation with Percutaneous Endoscopic Interlaminar Discectomy. Orthop Surg 2024; 16:620-627. [PMID: 38316417 PMCID: PMC10925508 DOI: 10.1111/os.14007] [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: 10/31/2023] [Revised: 01/10/2024] [Accepted: 01/11/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE The floating calcified tissue in floating calcified lumbar disc herniation (FCLDH) is hard and often adheres to the dura mater, which can easily cause nerve root damage during surgery, making the operation challenging. We proposed the classification of FCLDH and a new technique for removing floating calcified tissue and reported the clinical efficacy and safety of this new technique in clinical practice. METHODS From January 2019 to October 2021, 24 patients (13 males and 11 females, 46.4 ± 7.72 years) with L5-S1 floating calcified lumbar disc herniation were treated with percutaneous endoscopic interlaminar discectomy (PEID). According to FCLDH classification, a total of Type Ia: nine cases, Type Ib: five cases, Type IIa: four cases, and Type IIa: six cases were included. The visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded pre-operatively and 3 days postoperatively, 6 months postoperatively, and at the last follow-up. The postoperative curative effect was evaluated according to the modified MacNab criteria. Computed tomography (CT) and magnetic resonance imaging (MRI) of the lumbar spine were performed 3 days after surgery to evaluate the efficacy of the surgery. RESULTS All patients successfully underwent PEID. The VAS and ODI scores at 3 days postoperatively, 6 months postoperatively, and at the last follow-up were significantly improved and statistically significant compared to those of the preoperative period (p < 0.05). All the patients were followed up for 12-24 months (mean, 16.6 ± 4.6 months). At the last follow-up, according to the modified MacNab criteria, 15 cases were excellent, eight were good, and one was fair. The combined excellent and good rate was 95.83% (23/24). Postoperative review revealed that all floating calcified tissues were effectively removed and the nerve roots were adequately decompressed without complications such as cerebrospinal fluid leakage and lumbar spine infection. CONCLUSION The classification of FCLDH we proposed can well guide the selection of surgical plans. PEID combined with floating calcified tissue removal technology has good efficacy in the treatment of L5-S1 FCLDH, ensuring accurate removal of calcified tissue, reducing complications and improving the quality of life of affected individuals.
Collapse
Grants
- 202201020295 Basic and Applied Basic Research in Jointly Funded Projects of City Schools (Institutes) Projects, China
- 2022 QNRC2 B11 Chinese Society of Traditional Chinese Medicine youth talent lifting project
- 2023B03J0379 Guangzhou Science and Technology Plan Project, China
- 202201020500 Application and foundation research project of Guangzhou, China
- 202201020533 Application and foundation research project of Guangzhou, China
- 20221146 Administration of Traditional Chinese Medicine of Guangdong Province, China
- 202003004 Administration of Traditional Chinese Medicine of Guangdong Province, China
- 20241091 Administration of Traditional Chinese Medicine of Guangdong Province, China
- 2021A1515012168 Natural Science Foundation of Guangdong Province, China
- 2019QN29 Innovation and strength project of The First Affiliated Hospital of Guangzhou University of Chinese Medicine
- 202102021040 Project of Guangzhou Science and Technology Department, China
- 2023.10 The Hospital Young and Middle aged Key Talent Cultivation Project of The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine
- 2020A1515110948 Basic and Applied Basic Research Fund Project in Guangdong Province, China
- Natural Science Foundation of Guangdong Province, China
Collapse
Affiliation(s)
- GuoNing Gu
- The First institute of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhouChina
| | - Teng Liu
- The First institute of Clinical Medicine, Guangzhou University of Chinese MedicineGuangzhouChina
| | - HuiZhi Guo
- Spine Surgery DepartmentThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - YongChao Tang
- Spine Surgery DepartmentThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - ShunCong Zhang
- Spine Surgery DepartmentThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - ZhiDong Yang
- Spine Surgery DepartmentThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - YongXian Li
- Spine Surgery DepartmentThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| | - Kai Yuan
- Spine Surgery DepartmentThe First Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhouChina
| |
Collapse
|
3
|
Kumar V, Bansal P, Dhillon M, Dhatt SS, Vatkar AJ. Surgical techniques and perioperative surgical outcomes after discectomy for calcified lumbar disc herniation: a review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:47-60. [PMID: 37659048 DOI: 10.1007/s00586-023-07914-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/03/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
INTRODUCTION Calcified lumbar disc herniation (CLDH) poses surgical challenges due to longstanding disease and adherence of herniated disc to the surrounding neural structures. The data regarding outcomes after surgery for CLDH are limited. This review was conducted to analyse the surgical techniques, perioperative findings and the postoperative clinical outcomes after surgery for CLDH. METHODS PRISMA guidelines were followed whilst conducting this systematic review and meta-analysis. The literature review was conducted on 3 databases (PubMed, EMBASE, and CINAHL). After thorough screening of all search results, 9 studies were shortlisted from which data were extracted and statistical analysis was done. Pooled analysis was done to ascertain the perioperative and postoperative outcomes after surgery for CLDH. Additional comparative analysis was done compared to CLDH with non-calcified lumbar disc herniation (NCLDH) cases. RESULTS We included 9 studies published between 2016 and 2022 in our review, 8 of these were retrospective. A total of 356 cases of CLDH were evaluated in these studies with a male preponderance (56.4%). Mean operative time was significantly lower in NCLDH cases compared to CLDH cases. The mean estimated blood loss showed a negative correlation with the percentage of males. Satisfactory clinical outcomes were observed in majority of patients. The risk of bias of the included studies was moderate to high. CONCLUSION Surgical difficulties in CLDH cases leads to increase in operative time compared to NCLDH. Good clinical outcomes can be obtained with careful planning; the focus of surgery should be on decompression of the neural structures rather than disc removal.
Collapse
Affiliation(s)
- Vishal Kumar
- Department of Orthopaedics, AIIMS, Deoghar, India
| | - Parth Bansal
- Department of Orthopaedics, PGIMER, Chandigarh, India.
| | - Mehar Dhillon
- Department of Orthopaedics, PGIMER, Chandigarh, India
| | | | | |
Collapse
|
4
|
Cheng Y, Zhang Q, Li Y, Chen X, Wu H. Percutaneous endoscopic interlaminar discectomy for L5-S1 calcified lumbar disc herniation: A retrospective study. Front Surg 2022; 9:998231. [PMID: 36211293 PMCID: PMC9537603 DOI: 10.3389/fsurg.2022.998231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCalcified lumbar disc herniation (CLDH) is considered to be a special type of lumbar disc herniation (LDH). Percutaneous endoscopic interlaminar discectomy (PEID), with safety and efficacy, has been proved to be a minimally invasive surgery for LDH. However, there are few studies on PEID in the treatment of CLDH at the L5-S1 level. This study aimed to analyze the clinical efficacy of PEID for L5-S1 CLDH.MethodsFrom August 2016 to April 2020, we retrospectively analyzed 28 consecutive patients (17 males and 11 females) with L5-S1 CLDH treated with PEID at our institution. All the patients were monitored for more than 1 year postoperatively. The demographic characteristics, surgical results, and clinical outcomes estimated by the visual analog scale (VAS) for leg pain, the Oswestry disability index (ODI), and the modified MacNab criteria were collected.ResultsAll patients successfully underwent PEID. The mean operative time and intraoperative blood loss were 65.36 ± 5.26 min and 13.21 ± 4.35 ml, respectively. The VAS for leg pain and ODI scores improved remarkably from 7.54 ± 0.96 to 1.50 ± 0.51 (P < 0.05) and from 69.29 ± 9.91 to 17.43 ± 3.69 (P < 0.05) a year after operation, respectively. According to the modified MacNab criteria of the last follow-up, the excellent and good rates are 92.86%. Two of the patients had complications, one had nerve root injury and the other had postoperative dysesthesia.ConclusionsPEID achieved good clinical outcomes in the treatment of L5-S1 CLDH, and it was a safe and effective minimally invasive surgery for L5-S1 CLDH.
Collapse
Affiliation(s)
- Yuanpei Cheng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qianru Zhang
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yongbo Li
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xipeng Chen
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Han Wu
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- Correspondence: Han Wu
| |
Collapse
|
5
|
Zhao Q, Xiao L, Wu Z, Liu C, Zhang Y. Comparison of the efficacy of fully endoscopic spine surgery using transforaminal and interlaminar approaches in the treatment of prolapsed lumbar 4/5 disc herniation. J Orthop Surg Res 2022; 17:391. [PMID: 35964096 PMCID: PMC9375331 DOI: 10.1186/s13018-022-03282-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background There is still much controversy about whether transforaminal or interlaminar fully endoscopic spine surgery can better treat lumbar 4/5 disc herniation. Therefore, this study intends to compare the clinical efficacy of fully endoscopic spine surgery through transforaminal and interlaminar approaches in the treatment of lumbar 4/5 disc herniation. Methods Seventy-six patients with lumbar 4/5 disc herniation admitted from March 2019 to June 2020 were divided into the transforaminal approach group (endoscopic transforaminal lumbar discectomy, ETLD; 54 cases) and the interlaminar approach group (endoscopic interlaminar lumbar discectomy, EILD; 22 cases) according to different surgical methods. The general clinical data and clinical evaluation scale of the patients were compared. Results The post-operative ODI and VAS scores were significantly better in the EILD group (P < 0.05). The VAS and ODI scores of patients with upper-shoulder and sub-axillary types in the EILD group were superior to those in the ETLD group (P < 0.05), while the VAS and ODI scores of patients with the pre-radicular type were better when they underwent ETLD rather than EILD (P < 0.05). Patients with Lee zone III type in the EILD group had better post-operative ODI scores than those in the ETLD group (P < 0.05), but there was no significant difference in VAS scores (P > 0.05). Patients with Lee zone IV type who underwent EILD had better VAS and ODI scores than those who underwent ETLD (P < 0.05). Conclusions For patients with a prolapsed intervertebral disc that belongs to the upper-shoulder type, sub-axillary type, or Lee III or IV type, EILD can achieve better outcomes.
Collapse
Affiliation(s)
- Quanlai Zhao
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Liang Xiao
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Zhongxuan Wu
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Chen Liu
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Yu Zhang
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China.
| |
Collapse
|
6
|
Full Endoscopic Surgery for Thoracic Pathology: Next Step after Mastering Lumbar and Cervical Endoscopic Spine Surgery? BIOMED RESEARCH INTERNATIONAL 2022; 2022:8345736. [PMID: 35615011 PMCID: PMC9126676 DOI: 10.1155/2022/8345736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/03/2022] [Indexed: 11/18/2022]
Abstract
Thoracic disc herniation and stenosis are relatively rare, and various symptoms make them difficult to diagnose. Due to the complexity of neural and vascular structure, surgical treatment of thoracic pathology is challenging. Endoscopic spine surgery is an emerging minimally invasive surgical option. Based on wide experience on the cervical and lumbar spine, an endoscopic approach for the thoracic pathology can be performed beyond the learning curve. Transforaminal approach for thoracic disc herniation, endoscopic unilateral approach, and bilateral decompression for thoracic stenosis have been reported as favorable and safe surgical options. In the present study, the authors described the detailed surgical procedure as well as tips and tricks.
Collapse
|
7
|
Zhu G, Xu Y, Cui J, Tang J, Ren H, De L, Jiang X. Cave-in Decompression Technique in Percutaneous Endoscopic Transforaminal Discectomy for Ossification Occupation in Lumbar Spinal Canal: A retrospective analysis of 23 cases. Neurochirurgie 2022; 68:498-503. [PMID: 35477015 DOI: 10.1016/j.neuchi.2022.03.006] [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: 01/13/2022] [Revised: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECT Percutaneous endoscopic transforaminal discectomy (PETD) for the treatment of ossification occupation of the lumbar spinal canal is technically demanding. The purpose of this study was to describe an endoscopic cave-in decompression technique in PETD for ossification occupation of the lumbar spinal canal and to report the clinical results. METHODS From May 2018 to June 2020, 23 consecutive cases, diagnosed in our institution as ventral ossification in the lumbar spinal canal and treated with PETD, were evaluated. The endoscopic cave-in decompression technique was performed. We analyzed the clinical outcomes on a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Perioperative data and complications rate were also recorded. RESULTS Mean follow-up was 15.7 ± 2.8 months. Mean preoperative VAS score for low-back pain was 5.65 ± 1.43, and decreased to 0.57 ± 0.5 at final follow-up. Mean preoperative VAS score for leg pain was 5.48 ± 1.38, and decreased to 0.56 ± 0.5 at final follow-up. Mean preoperative ODI score decreased from 33.04 ± 5.28 preoperatively to 8.7 ± 2.54 at last follow-up. One patient experienced transient postoperative hypoesthesia, and 1 developed a mild transient decline in muscle strength; both recovered progressively. Postoperative CT and MRI showed that the ossification was effectively removed and the nerve root and dural mater was completely decompressed in all cases. CONCLUSION The endoscopic cave-in decompression technique in PETD is a safe and effective treatment method for selected patients with ossification occupation of the lumbar spinal canal.
Collapse
Affiliation(s)
- Guangye Zhu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Yuerong Xu
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Jianchao Cui
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Jingjing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Hui Ren
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Liang De
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 510405 Guangzhou, China.
| |
Collapse
|
8
|
Cheng YP, Cheng XK, Wu H. A comparative study of percutaneous endoscopic interlaminar discectomy and transforaminal discectomy for L5-S1 calcified lumbar disc herniation. BMC Musculoskelet Disord 2022; 23:244. [PMID: 35279101 PMCID: PMC8917767 DOI: 10.1186/s12891-022-05186-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 03/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background Percutaneous endoscopic lumbar discectomy (PELD) is a relatively safe and effective minimally invasive surgery in the treatment of calcified lumbar disc herniation (CLDH). However, studies on percutaneous endoscopic interlaminar discectomy (PEID) and percutaneous endoscopic transforaminal discectomy (PETD) for CLDH have rarely been reported. This research aimed to compare the clinical efficacy of PEID and PETD for L5-S1 CLDH. Methods We retrospectively analyzed 54 consecutive patients with L5-S1 CLDH treated with PELD at our institution from August 2016 to August 2020. Patients were divided into PEID group (n = 28) and PETD (n = 26) group according to the surgical methods. The demographic characteristics and surgical results of the two groups were compared. Clinical outcomes were estimated by the visual analog scale (VAS) for leg pain, Oswestry disability index (ODI) and modified MacNab criteria. Results All patients were successfully operated on by PEID or PETD. No significant differences in the demographic characteristics, intraoperative blood loss, postoperative hospital stay and complication rate were noted between the PEID and PETD groups. The excellent and good rates in the PEID group were similar to those in the PETD group (89.29% vs 88.46%, P = 1.000), whereas the PEID group exhibited superior results for operative time (min) (64.61 ± 5.60 vs 85.58 ± 8.52, P < 0.001) and fluoroscopy times (n) (2.93 ± 0.90 vs 13.35 ± 2.30, P < 0.001) compared with the PETD group. Conclusions PEID has achieved good clinical efficacy as PETD for L5-S1 CLDH. Compared with PETD, PEID has the advantages of shorter operative time and a reduced number of fluoroscopy times in the treatment of CLDH.
Collapse
|
9
|
Shi Y, Xie YZ, Zhou Q, Yu Y, Fan XH. The biomechanical effect of the relevant segments after facet-disectomy in different diameters under posterior lumbar percutaneous endoscopes: a three-dimensional finite element analysis. J Orthop Surg Res 2021; 16:593. [PMID: 34649582 PMCID: PMC8515756 DOI: 10.1186/s13018-021-02733-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/16/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the biomechanical influence after percutaneous endoscopic lumbar facetectomy in different diameters on segmental range of motion (ROM) and intradiscal pressure (IDP) of the relevant segments by establishing three dimensional finite element (FE) model. METHODS An intact L3-5 model was successfully constructed from the CT of a healthy volunteer as Model A (MA). The Model B (MB), Model C (MC) and Model D (MD) were obtained through facetectomy on L4 inferior facet in diameters 7.5 mm, 10 mm and 15 mm on MA for simulation. The ROM and IDP of L3/4 and L4/5 of four models were all compared in forward flexion, backward extension, left and right bending, left and right rotation. RESULTS Compared with MA, the ROM of L4/5 of MB, MC and MD all increased. MD changed more significantly than MB and MC in backward extension, right bending and right rotation. But that of MB and MC on L3/4 had no prominent change, while MD had a slight increase in backward extension. The IDP of MB and MC on L4/5 in six states was similar to MA, yet MD increased obviously in backward extension, right bending, left and right rotation. The IDP on L3/4 of MB and MC was resemble to MA in six conditions, nevertheless MD increased slightly only in backward extension. CONCLUSION Compared with the facetectomy in diameters 7.5 mm and 10 mm, the mechanical effect brought by facetectomy in diameter 15 mm on the operating segment changed more significantly, and had a corresponding effect on the adjacent segments.
Collapse
Affiliation(s)
- Yin Shi
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Yi-Zhou Xie
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Qun Zhou
- Chengdu University of Traditional Chinese Medicine, No. 1166 Liu-tai Avenue, Chengdu, 611137 Sichuan Province People’s Republic of China
| | - Yang Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072 Sichuan Province People’s Republic of China
| | - Xiao-Hong Fan
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, Chengdu, 610072 Sichuan Province People’s Republic of China
| |
Collapse
|
10
|
Gennari A, Tarabay B, Boubez G, Wang Z, Shedid D, Yuh SJ. Minimally Invasive Contralateral Over-the-Top Approach for Lumbar Calcified Foraminal Lesions: A Technical Note. World Neurosurg 2021; 155:77-81. [PMID: 34416383 DOI: 10.1016/j.wneu.2021.08.025] [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: 07/06/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Various surgical techniques have been described to address intraforaminal/extraforaminal lumbar lesions. They vary from the classic posterior open approaches to minimally invasive techniques with tubular retractors and even endoscopy. These lesions have been approached from either an ipsilateral or a contralateral approach. Only a few reports have described a contralateral minimally invasive tubular approach to address these lesions. However, none of them have been able to address calcified pathologies. METHOD We used a contralateral tubular approach to remove the calcified disc herniations in 2 patients presenting with radiculopathy secondary to a calcified intraforaminal L5-S1 disc herniation. RESULTS Early clinical and radiological outcomes were positive. No perioperative complications occurred. CONCLUSIONS To our knowledge, this is the first report of the expanded use of fixed tubular retractors to address calcified lumbar intraforaminal disc herniations. This approach allows a satisfactory access and view of the contralateral foramen and offending lesion. It permits a wide decompression while preserving the facet joint and thus prevents iatrogenic instability. It can also avoid the iliac crest, which does not allow an ipsilateral extraforaminal approach at the L5-S1 level. This approach is a safe and effective way to treat this specific pathology.
Collapse
Affiliation(s)
- Antoine Gennari
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
| | - Bilal Tarabay
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Ghassan Boubez
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Zhi Wang
- Division of Orthopedics, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Daniel Shedid
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sung-Joo Yuh
- Division of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|