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Scullen T, Milburn J, Aria K, Mathkour M, Tubbs RS, Kalyvas J. The use of diffusion tensor imaging in spinal pathology: a comprehensive literature review. 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 2024:10.1007/s00586-024-08231-8. [PMID: 39014075 DOI: 10.1007/s00586-024-08231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 05/14/2023] [Accepted: 09/23/2023] [Indexed: 07/18/2024]
Abstract
STUDY DESIGN We reviewed the available literature systematically without meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. OBJECTIVE To evaluate contemporary literature on use of spinal diffusion tensor imaging(sDTI) in spinal pathology. BACKGROUND sDTI reveals the location and functional state of critical long tracts and is a potentially useful adjunct in disease management. METHODS Studies were included if they presented or discussed data from investigative or therapeutic procedures involving sDTI on human subjects in the setting of surgically amenable spinal pathology. Studies were excluded if they were (1) restricted to computational models investigating parameters using data not obtained clinically, (2) about cranial DTI methods, (3) about spinal pathology data not related to surgical management, (4) discussions or overviews of methods/techniques with minimal inclusion of objective experimental or clinical data. RESULTS Degenerative pathologies of interest were restricted to either cervical myelopathy (22/29,75.9%) or lumbar spondylosis 7/29,24.1%). Mass-occupying lesions included intradural pathology and discussed preoperative (7/9,77.8%) and intraoperative imaging(2/9,22.2%) as an adjunct to surgery 22.2%. Traumatic pathology focused on spinal cord injury prognosis and severity grading. CONCLUSIONS sDTI seems useful in surgical decision making and outcome measurements and in establishing clinical prognoses over a wide range of surgical pathologies. Further research is warranted with longer follow-up and larger population sizes in a prospective and controlled protocol.
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Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Ochsner Clinic Foundation, 1514 Jefferson Hwy, Jefferson, LA, 70112, USA.
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA, 70114, USA.
| | - James Milburn
- Department of Radiology, Ochsner Clinic Foundation, Jefferson, LA, 70121, USA
| | - Kevin Aria
- Department of Neurological Surgery, Ochsner Clinic Foundation, 1514 Jefferson Hwy, Jefferson, LA, 70112, USA
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA, 70114, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Ochsner Clinic Foundation, 1514 Jefferson Hwy, Jefferson, LA, 70112, USA
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA, 70114, USA
| | - R Shane Tubbs
- Department of Neurological Surgery, Tulane University School of Medicine, New Orleans, LA, 70114, USA
| | - James Kalyvas
- Department of Neurological Surgery, Ochsner Clinic Foundation, 1514 Jefferson Hwy, Jefferson, LA, 70112, USA
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Zhou T, Ma T, Gu Y, Zhang L, Che W, Wang Y. Percutaneous Transforaminal Endoscopic Surgery (PTES) for Treatment of Lumbar Degenerative Disease in Patients with Underlying Diseases: A Retrospective Cohort Study of 196 Cases. J Pain Res 2023; 16:1137-1147. [PMID: 37025953 PMCID: PMC10072145 DOI: 10.2147/jpr.s396993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023] Open
Abstract
Objective To evaluate the postoperative outcomes, safety and feasibility of percutaneous transforaminal endoscopic surgery (PTES) for the treatment of lumbar degenerative disease (LDD) in the patients with underlying diseases. Methods From June 2017 to April 2019, PTES was performed to treat 226 patients of single-level LDD. According to clinical background, the patients were divided into two groups. A total of 102 patients with underlying diseases were included in group A. The other 124 LDD patients without underlying diseases were included in group B. The occurrence of postoperative complications was recorded. Leg pain was assessed before, immediately, 1 month, 2 months, 3 months, 6 months, 1 year, and 2 years after PTES using VAS, and ODI before PTES and 2 years after PTES were recorded. The therapeutic quality (Excellent, Good, Moderate or Poor) was defined according to MacNab grade at 2-year follow-up. Results No aggravation of underlying diseases or serious complications was observed in all patients within 6 months after the operation. Altogether, 196 patients were followed up for more than 2 years, 89 patients in group A and 107 patients in group B. The VAS score of leg pain and ODI dropped significantly after surgery (P<0.001) in both groups. One case of group B received PTES again due to recurrence 52 months after surgery. According to MacNab, the excellent and good rate was 97.75% (87/89) in group A and 96.26% (103/107) in group B. In operative duration, frequency of intraoperative fluoroscopy, blood loss, incision length, hospital stay, VAS, ODI, and the excellent and good rate, there was no statistical difference between the two groups. Conclusion PTES is safe, effective and feasible for the treatment of LDD with underlying diseases, which is comparable to PTES for LDD without underlying diseases. The entrance point of PTES (Gu's Point) is located at the corner of the flat back turning to the lateral side. PTES is not only a minimally invasive surgical technique but also includes a postoperative care system for preventing LDD recurrence.
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Affiliation(s)
- Tianyao Zhou
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032, People’s Republic of China
- Shanghai Southwest Spine Surgery Center, Shanghai, 200032, People’s Republic of China
| | - Tianle Ma
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032, People’s Republic of China
- Shanghai Southwest Spine Surgery Center, Shanghai, 200032, People’s Republic of China
| | - Yutong Gu
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032, People’s Republic of China
- Shanghai Southwest Spine Surgery Center, Shanghai, 200032, People’s Republic of China
- Correspondence: Yutong Gu, Email
| | - Liang Zhang
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032, People’s Republic of China
| | - Wu Che
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032, People’s Republic of China
| | - Yichao Wang
- Department of Orthopedic Surgery, Zhongshan Hospital Fudan University, Shanghai, 200032, People’s Republic of China
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El Basset ASA, Saeed AHM, Tawfik MH, El Hady MSA. Value of diffusion tensor imaging and tractography in unilateral lumbar disc prolapse. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-020-00380-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Conventional MR imaging is not enough for evaluation of symptomatic foraminal stenosis, because there is high incidence of false-positive results in asymptomatic elderly patients. Conventional MR cannot quantitatively assess the severity of the nerve lesion. DTI is a non-invasive way to effectively trace the nerve fiber bundle and quantitatively evaluate the nerve injury. DTI with fiber tracking may describe abnormalities beyond the resolution of conventional MR techniques. The aim of this work was to compare between the mean values of diffusion parameters such as fractional anisotropy and apparent diffusion coefficient of the compressed lumbar spinal nerve roots and of the contralateral normal nerve roots. Correlate these parameters with the severity of neurological symptoms. This is a prospective study that was conducted on 50 patients with symptomatic unilateral posterolateral lumbar disc prolapse at a university hospital. They were investigated with diffusion tensor imaging with tractography on a 1.5-T MR. The changes in the mean fractional anisotropy and apparent diffusion coefficient values of the compressed nerves and the relationship between these changes and the severity of the neurological side effects using Japanese Orthopedic Association score and visual analogue scale were investigated.
Results
The mean fractional anisotropy values were significantly lower (p ≤ 0.001), and mean apparent diffusion coefficient values were significantly higher (p ≤ 0.001) in compressed nerves than in contralateral intact nerves. There were strong correlations between the DTI parameters and the severity of the neurological symptoms as assessed using the Japanese Orthopedic Association score and the visual analogue scale.
Conclusion
In patients with lumbar disc prolapse, radicular diffusion parameters are affected in the compressed roots in comparison to the healthy roots and this affection is correlated with the degree of prolapse and with the severity of neurological symptoms. DTI with fiber tracking provide clinically relevant information and describe abnormalities beyond the resolution of conventional MR techniques.
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Kapetanakis S, Gkantsinikoudis N, Charitoudis G. Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation: Original Study and Review of the Literature. Am J Sports Med 2021; 49:3234-3241. [PMID: 34491150 DOI: 10.1177/03635465211032612] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lumbar disc herniation (LDH) represents a frequent clinical entity in athletes. Surgical treatment of LDH with endoscopic spine surgical techniques has been proposed as a feasible alternative in these patients. PURPOSE To study the particular outcomes of percutaneous transforaminal endoscopic discectomy (PTED) in competitive elite athletes with surgically treatable LDH. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 55 competitive elite athletes with diagnosed LDH based on clinical and radiologic criteria were enrolled in this prospectively designed study. All patients underwent successful PTED. Clinical evaluation was conducted with the well-established visual analog scale for lower limb and low back pain separately. The 36-Item Short Form Health Survey (SF-36) was implemented for health-related quality of life analysis. Patients were assessed preoperatively and at regular postoperative intervals: 6 weeks and 3, 6, and 12 months, as well as 2 years. RESULTS Operated levels were L3-L4 (5.5%), L4-L5 (69.1%), and L5-S1 (25.4%). No major perioperative complications were observed. All patients successfully reached the end of follow-up at 2 years. Both visual analog scale scores (lower limb and low back pain) showed clinically and statistically significant improvement at 6 weeks postoperatively, with subsequent minor improvement and stabilization. All recorded SF-36 parameters demonstrated major clinical amelioration at 6 weeks, with subsequent minor but constant statistically significant improvement until the end of follow-up. Comparative evaluation of the SF-36 revealed that the physical function, bodily pain, role-emotional, and mental health parameters showed quantitatively greater improvement in comparison with rest indices. CONCLUSION PTED constitutes a feasible and effective technique for surgical management of LDH in athletes, providing favorable outcomes in terms of postoperative pain and health-related quality of life. Proper performance of technique for specific cases of L5-S1 LDH may be more challenging, and these cases should be evaluated selectively for suitability for this procedure.
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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
| | | | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Hao J, Cheng J, Xue H, Zhang F. Clinical comparison of unilateral biportal endoscopic discectomy with percutaneous endoscopic lumbar discectomy for single l4/5-level lumbar disk herniation. Pain Pract 2021; 22:191-199. [PMID: 34529888 DOI: 10.1111/papr.13078] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/28/2021] [Accepted: 09/10/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this research was to investigate the outcomes between unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the single L4/5-level lumbar disk herniation (sLDH). METHODS From January 2018 to January 2021, a total of 40 patients with sLDH were retrospectively analyzed in this study. All the patients had received spinal surgeries in Affiliated Hospital of Nantong University and Affiliated Nantong Hospital 3 of Nantong University. Among them, 20 patients were treated with PELD (PELD group), and 20 patients were treated with UBE discectomy (UBE group). Postoperative length of hospital stay, estimated blood loss, operation time, and clinical complications of the patients were compared between the two groups. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were measured before surgeries and 3 days, 1, and 6 months after surgeries. RESULTS Compared with the UBE group, the PELD group had obviously less intraoperative blood loss, shorter operative time, and shorter hospital stay. The differences in the rate of complications were not statistically significant between the two groups. The VAS score and the ODI score of the two groups had a great reduction after operation. In addition, both the groups had satisfactory clinical outcome; the VAS score and ODI of the PELD group decreased more obviously. CONCLUSION The UBE for sLDH yielded similar clinical outcomes to PELD as minimally invasive surgeries; however, PELD is superior to UBE in terms of intraoperative blood loss, operative time, postoperative hospitalization, and short-term postoperative pain relief. The advantages and disadvantages of the two surgeries should be circumspectly balanced when evaluating a patient for a minimally invasive surgery for sLDH, selecting the most appropriate surgical method for patients.
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Affiliation(s)
- Jie Hao
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, China
| | - Jiaqi Cheng
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, China.,Medical School of Nantong University, Nantong, China
| | - Huawei Xue
- Department of Orthopedics, Third Affiliated Hospital of Nantong University, Nantong, China
| | - Feng Zhang
- Department of Orthopedics, Affiliated Hospital of Nantong University, Nantong, China
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d'Ercole M, Innocenzi G, Ricciardi F, Bistazzoni S. Prognostic Value of Michigan State University (MSU) Classification for Lumbar Disc Herniation: Is It Suitable for Surgical Selection? Int J Spine Surg 2021; 15:466-470. [PMID: 33963037 DOI: 10.14444/8068] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) is the most common cause of radiculopathy; patients with severe pain refractory to conservative management or neurological deficits are candidates to surgical procedures. Michigan State University (MSU) classification is a radiological codification considering both the size of the LDH and its medial to lateral location on the axial plane. The purpose of this retrospective study is to identify which kind of LDH, according to the MSU scheme, is more likely to cause a motor deficit. METHODS We performed a retrospective analysis on data obtained from 114 patients treated with 117 lumbar microdiscectomies after failure of non-operative care. All patients underwent neurological and functional evaluation before and after surgery according to the following: Oswestry Disability Index, visual analog scale, and Japanese Orthopaedic Association back pain evaluation questionnaire. Magnetic resonance imaging proved that disc herniation was classified according to the MSU scheme and was correlated with motor disturbances expressed according to Medical Research Council grade. RESULTS Statistical analysis showed a significant correlation between the lateral location of disc herniation (preforaminal and extraforaminal LDH, respectively MSU B and MSU C) and the grade of muscle weakness, given that the LDH in these locations poorly responded to medical therapy and was at higher risk for motor deficit onset; no significant correlation with the size was observed. CONCLUSIONS Beyond standardization of radiologic description, MSU classification proved to be useful in definition of prognosis and possibly in selection of surgical candidates. However, these data should be confirmed by prospective studies on a larger sample of patients, also including those under way for conservative treatment.
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Affiliation(s)
- Manuela d'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli," Università Cattolica del Sacro Cuore, Roma, Italy
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Wei FL, Gao H, Yan X, Yuan Y, Qian S, Gao Q, Guo S, Xue W, Qian J, Zhou C. Comparison of postoperative outcomes between patients with positive and negative straight leg raising tests who underwent full-endoscopic transforaminal lumbar discectomy. Sci Rep 2020; 10:16516. [PMID: 33020550 PMCID: PMC7536236 DOI: 10.1038/s41598-020-73357-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/19/2020] [Indexed: 11/09/2022] Open
Abstract
Full-endoscopic transforaminal lumbar discectomy (FETD) is increasingly used in patients with lumbar disc herniation (LDH). There is little knowledge on the related factors, including the straight leg raising test (SLR), that influence the operation. Consecutive patients with LDH who came to our hospital from August 2015 to September 2016 and underwent FETD surgery were included. Four kinds of scores, including the VAS (lumbar/leg), ODI and JOA values, were measured and reassessed after FETD to assess the surgical outcomes. There was a statistically significant difference between the scores before surgery and at each postoperative follow-up. In addition, the increase in the JOA score postoperatively was statistically significant compared with that before surgery. There were statistically significant differences among the three subpopulations [patients considered SLR positive (0°-30°), SLR positive (31°-60°) and SLR negative (61°-)] in the changes in the VAS (leg), ODI and JOA values. However, there were no statistically significant differences among the three subpopulations [patients considered SLR positive (0°-30°), SLR positive (31°-60°) and SLR negative (61°-)] in the changes in VAS score (lumbar). FETD showed great effectiveness in treating patients with lumbar disc herniation. Patients who were SLR negative may receive greater benefit from FETD.
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Affiliation(s)
- Fei-Long Wei
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Haoran Gao
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Xiaodong Yan
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Yifang Yuan
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Shu Qian
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Quanyou Gao
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Shikong Guo
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Weigao Xue
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Jixian Qian
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China.
| | - Chengpei Zhou
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China.
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