Efficacy comparison between minimally invasive and conventional surgery for lumbar disc herniation in Chinese Han population: a meta-analysis

A digital anatomic investigation of the safe triangle areas for L1-5 percutaneous minimally invasive discectomy

PURPOSE

To reconstruct the three-dimensional safe triangle areas at L1-5 based on the computed tomography digital data, analyze the safe scopes for the puncture location and angles, and provide anatomic references for percutaneous lumbar discectomy.

METHODS

Computed tomography data from patients and control group were imported from the database and anatomical reference parameters were measured in Mimics software. The rebuilt model was rotated clockwise along the M-axis to measure the inscribed circle radius of the safe triangle at different angles. Based on the outer diameter of the largest cannula, the safe angles were calculated. The distances between points on the projection of safe triangle-inscribed circle and the upper lumbar spinous process were measured. Similarly, while the safe triangle was on the left side, the model was contra-rotated to measure all the parameters.

RESULTS

There was no significant difference between the patient and control group in both the least distance between the selected anatomical reference locations and the safe triangle-inscribed circle radius at L4-5. According to the series which had a largest cannula of 2.5 mm, the safe puncture angles increased with the descending disc levels. The optimal angles were 40°-45° for L1-2, 45°-50° for L2-3, 50° for L3-4, and 55° for L4-5 separately. The differences between genders in the distances of paired reference points were significant.

CONCLUSIONS

Individual safe localization of the percutaneous puncture could be obtained by analyzing the three-dimensional relationship between the puncture localization and anatomical landmarks.

A comparative study on short-term therapeutic effects of percutaneous transforaminal endoscopic discectomy and microendoscopic discectomy on lumbar disc herniation

Objective:

To find out the short-term effects of percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) on lumbar disc herniation (LDH).

Methods:

Ninety LDH patients treated in PLA Army General Hospital from July 2015 to July 2016 were selected and randomly divided into an MED group and a PTED group. Length of incision, amount of intraoperative bleeding, surgical time, number of times using intraoperative fluoroscopy, postoperative bedridden time, hospital stay, together with visual analogue scale (VAS) and Oswestry disability index (ODI) scores before surgery, three days, three months and six months after surgery were analyzed.

Results:

As regards the length of surgical incision, amount of bleeding, postoperative bedridden time and hospital stay, the PTED group was significantly superior to the MED group ((P=0.000, 0.000, 0.000, 0.001, respectively)). Compared with the PTED group, the MED group used less fluoroscopy and had shorter surgical time (P=0.001, 0.000, respectively). The postoperative VAS and ODI scores of both groups were significantly improved compared with those before surgery (P<0.000, 0.000, respectively). The short-term postoperative low back pain (LBP) VAS score of PTED group was lower than that of MED group (P=0.001). The two groups had similar leg pain (LP) VAS score three and six months after surgery, postoperative and follow-up LP VAS and ODI scores, and surgical improvement rate (P=0.093, 0.097, respectively).

Conclusion:

LDH was effectively treated by both PTED and MED. Compared with MED, PTED had less trauma, less blood loss, and faster recovery after surgery.

Evidence Based Medicine Review of Posterior Thoracolumbar Minimally Invasive Technology

Background

Evaluate the current evidence in meta-analyses on posterior thoracolumbar minimally invasive surgery techniques and outcomes for degenerative conditions.

Methods

A systematic review of the literature from 1950 to 2015.

Results

The review of the literature yielded 34 meta-analysis studies evaluating posterior thoracolumbar minimally invasive techniques and outcomes for degenerative conditions. There were 11 studies included which investigated minimally invasive surgery (MIS) versus open posterior lumbar decompressions. There were 14 studies included which investigated MIS versus open posterior lumbar interbody fusions. Finally, there were 9 studies focused on navigation techniques and radiation safety within MIS procedures.

Conclusions

There are 34 meta-analysis studies evaluating minimally invasive to open thoracolumbar surgery for degenerative disease. The studies show a trend toward decreased estimated blood loss, decreased length of stay, decreased complications, similar fusion rates, improved accuracy, and decreased radiation when minimally invasive techniques are used.

Risk Factors for Postoperative Pain Intensity in Patients Undergoing Lumbar Disc Surgery: A Systematic Review

OBJECTIVES

Pain relief has been shown to be the most frequently reported goal by patients undergoing lumbar disc surgery. There is a lack of systematic research investigating the course of postsurgical pain intensity and factors associated with postsurgical pain. This systematic review focuses on pain, the most prevalent symptom of a herniated disc as the primary outcome parameter. The aims of this review were (1) to examine how pain intensity changes over time in patients undergoing surgery for a lumbar herniated disc and (2) to identify socio-demographic, medical, occupational and psychological factors associated with pain intensity.

METHODS

Selection criteria were developed and search terms defined. The initial literature search was conducted in April 2015 and involved the following databases: Web of Science, Pubmed, PsycInfo and Pubpsych. The course of pain intensity and associated factors were analysed over the short-term (≤ 3 months after surgery), medium-term (> 3 months and < 12 months after surgery) and long-term (≥ 12 months after surgery).

RESULTS

From 371 abstracts, 85 full-text articles were reviewed, of which 21 studies were included. Visual analogue scales indicated that surgery helped the majority of patients experience significantly less pain. Recovery from disc surgery mainly occurred within the short-term period and later changes of pain intensity were minor. Postsurgical back and leg pain was predominantly associated with depression and disability. Preliminary positive evidence was found for somatization and mental well-being.

CONCLUSIONS

Patients scheduled for lumbar disc surgery should be selected carefully and need to be treated in a multimodal setting including psychological support.