Preoperative Simulation of the Trajectory for L5/S1 Percutaneous Endoscopic Transforaminal Discectomy: A Novel Approach for Decision-Making

Transforaminal lumbar endoscopic discectomy: should we abandon it for L5-S1 foraminal and extraforaminal lumbar disc herniations? A prospective non-randomised study and literature review

PURPOSE

The aim of this study is to investigate the clinical outcomes of transforaminal lumbar endoscopic discectomy (TLED) in patients with L5-S1 lumbar disc herniation (LDH).

MATERIALS AND METHODS

Seventy-five consecutive individuals with diagnosed foraminal/extraforaminal L5-S1 LDH were included in this study. All patients underwent TLED, being subsequently evaluated in a 2-year follow-up period. Assessment was performed preoperatively and at 6 weeks and 3, 6, 12 and 24 months postoperatively. Visual Analogue Scale (distinctly applied for lower limb - VAS-LP and low back - VAS-BP pain) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire were implemented to assess pain and health-related quality of life (HRQoL) of enrolled individuals, respectively.

RESULTS

No major perioperative complications were observed. Recorded values of all studied indices were demonstrated to feature a clinically and statistically significant amelioration at 6 weeks, presenting lesser improvement at 3 months with subsequent stabilisation. VAS-LP and VAS-BP values were displayed to reach a plateau in 6 months postoperatively, whereas all parameters of SF-36 continued to present a statistically significant improvement until the end of follow-up at 2 years.

CONCLUSIONS

TLED represent a safe and efficient technique in terms of diminishing perceived pain and improving HRQoL in patients with L5-S1 LDHs. However, specific patient- and technique-related circumstances on the ground of low surgical experience may limit its effectiveness in these patients.

Deep Learning-Based Automated Magnetic Resonance Image Segmentation of the Lumbar Structure and Its Adjacent Structures at the L4/5 Level

(1) Background: This study aims to develop a deep learning model based on a 3D Deeplab V3+ network to automatically segment multiple structures from magnetic resonance (MR) images at the L4/5 level. (2) Methods: After data preprocessing, the modified 3D Deeplab V3+ network of the deep learning model was used for the automatic segmentation of multiple structures from MR images at the L4/5 level. We performed five-fold cross-validation to evaluate the performance of the deep learning model. Subsequently, the Dice Similarity Coefficient (DSC), precision, and recall were also used to assess the deep learning model's performance. Pearson's correlation coefficient analysis and the Wilcoxon signed-rank test were employed to compare the morphometric measurements of 3D reconstruction models generated by manual and automatic segmentation. (3) Results: The deep learning model obtained an overall average DSC of 0.886, an average precision of 0.899, and an average recall of 0.881 on the test sets. Furthermore, all morphometry-related measurements of 3D reconstruction models revealed no significant difference between ground truth and automatic segmentation. Strong linear relationships and correlations were also obtained in the morphometry-related measurements of 3D reconstruction models between ground truth and automated segmentation. (4) Conclusions: We found it feasible to perform automated segmentation of multiple structures from MR images, which would facilitate lumbar surgical evaluation by establishing 3D reconstruction models at the L4/5 level.

Transforaminal Endoscopic Lumbar Discectomy for Lumbosacral Junction Adolescent Lumbar Disc Herniation with High Iliac Crests

Objective

To investigate the clinical results of transforaminal endoscopic lumbar discectomy for lumbosacral junction adolescent lumbar disc herniation with high iliac crest.

Methods

From February 2014 to September 2020, a retrospective analysis of 96 patients less than 21 years old with intervertebral disc herniation was carried out. We enrolled 44 patients diagnosed with lumbosacral junction disc herniation with high iliac crest who required transforaminal endoscopic lumbar discectomy. Pain in the back and the lower extremity was scored on Numeric Rating Scales (NRS) scores. Patient outcomes were graded as excellent, good, fair, and poor using modified MacNab criteria. The NRS scores before and after the operation were compared using the Wilcoxon two‐sample test.

Results

There were 30 male patients and 14 females. One patient underwent repeat surgery for an intervertebral disc pseudocyst. The NRS scores decreased significantly in both early and late follow‐up evaluations (p < 0.05). At the last follow‐up, 42 patients (95.45%) had an excellent outcome, one patient (2.27%) had a good outcome, and one patient (2.27%) had a fair outcome. The overall success rate was 97.7%.

Conclusion

This study's data suggest that targeted individualized foraminoplasty can effectively overcome the lumbosacral anatomical obstacles, and transforaminal endoscopic lumbar discectomy is an effective and valid option for lumbosacral junction adolescent lumbar disc herniation with high iliac crest.