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Xia G, Song E, Kong Q, Li X. Arthroscopic-assisted uni-portal ligament flavum sparing bone anchoring annular suture technique for lumbar disc herniation: A case report and literature review. Medicine (Baltimore) 2024; 103:e39763. [PMID: 39331904 PMCID: PMC11441953 DOI: 10.1097/md.0000000000039763] [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: 06/10/2024] [Accepted: 08/30/2024] [Indexed: 09/29/2024] Open
Abstract
RATIONALE Lumbar disc herniation (LDH) manifests in diverse forms. If the nucleus pulposus or endplate tissues protrudes, the location of annular tears also varies, which poses various challenges for the annular suture technique. Tears at the annular attachment area at the edge of the vertebral body (cephalad or caudad) are considered a prohibitively challenging area for annular suturing. PATIENT CONCERNS A 37-year-old woman presented with a gradual onset of symptoms, experiencing leg pain and numbness over the left leg for 1 year before presentation. The pain radiated to the left S1 dermatome. Despite undergoing continuous medical therapy for more than 6 months, her symptoms showed no improvement. The strength of the left plantar flexion in the ankle and great toe was rated at 4 out of 5. The straight leg-raising and strengthening tests were positive for the left sides. Lumbar computed tomography and magnetic resonance imaging revealed left-sided disc herniation at the L5-S1 level, and nerve root compression, confirming the diagnosis of LDH. DIAGNOSES The preoperative impression was LDH, intraoperative confirmation of a tear in the annular attachment area at the vertebral body edge. INTERVENTIONS This patient was treated with an arthroscopic-assisted uniportal spinal surgery (AUSS) technique focusing on ligament flavum (LF) preservation, protruding nucleus pulposus removal, nerve root decompression, and vertebral edge tear was then sutured using a bone anchoring annular suture with the Smile suture device. OUTCOMES This technique was performed successfully in a patient with LDH. Significant improvements were observed in postoperative pain and numbness, Visual Analog Scale, and Japanese Orthopaedic Association scores. No postoperative instability or complications were observed, with computed tomography and magnetic resonance imaging confirming complete decompression. To the best of our knowledge, this is the first used AUSS with LF preservation and bone anchoring annular suture technique for LDH. LESSONS This case study demonstrates the AUSS combined with LF preservation and the bone anchoring annular suture technique provides favorable clinical and imaging outcomes and is a safe and effective technique for the treatment of LDH.
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Affiliation(s)
- Gushang Xia
- Department of Orthopaedics, The People’s Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, China
| | - En Song
- Department of Sports Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qingli Kong
- Department of Orthopaedics, The People’s Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, China
| | - Xianglin Li
- Department of Orthopaedics, The People’s Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, China
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Than CA, Valiotis AK, Prottoy AR, Alexander KG, Alogakos M, Adra M, Smayra K, Curtis TJ, Kim GE, Nakanishi H, Dannawi Z. Discectomy for Lumbar Disc Herniation in Pediatric and Adolescent Populations: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e63880. [PMID: 39104990 PMCID: PMC11298768 DOI: 10.7759/cureus.63880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2024] [Indexed: 08/07/2024] Open
Abstract
Corroborative evidence for discectomy in pediatric or adolescent patients remains scarce, with this single-arm meta-analysis investigating discectomy for lumbar disc herniation (LDH) within this population. PubMed, Embase (Elsevier), CiNAHL, Cochrane Library, Scopus, and Web of Science were searched. Eligible studies reported pediatric patients under 21 years of age with a diagnosis of LDH that was treated surgically with discectomy. This review was registered in PROSPERO (ID: CRD42023463358). Twenty-two studies met the eligibility criteria (n=1182). Visual analog scale (VAS) scores for back pain at baseline were 5.34 (95% CI: 4.48, 6.20, I2=98.9%). Postoperative VAS back pain scores after 12 months were 0.88 (95% CI: 0.57, 1.19, I2=95.6%). VAS scores for leg pain at baseline were 7.03 (95% CI: 6.63, 7.43, I2=93.5%). Postoperative VAS leg pain scores after 12 months were 1.02 (95% CI: 0.68, 1.36, I2=97.0%). Oswestry disability index (ODI) scores at baseline were 55.46 (95% CI: 43.69, 67.24, I2=99.9%). Postoperative ODI scores after 12 months were 7.82 (95% CI: 4.95, 10.69, I2=99.4%). VAS back, VAS leg and ODI scores demonstrated a minimum clinically important difference (MCID) at all postoperative points. Perioperative outcomes demonstrated operative time as 85.71 mins (95% CI: 73.96, 97.46, I2=99.4%) and hospital length of stay as 3.81 days (95% CI: 3.20, 4.41, I2=98.5%). The postoperative reoperation rate at the same level was 0.01 (95% CI: <0.00, 0.02, I2=0%). Discectomy appears safe and effective in pediatric and adolescent patients suffering from LDH. The findings here provide groundwork for future randomized control trials against conservative measures to elaborate on optimal management and elucidate long-term outcomes.
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Affiliation(s)
- Christian A Than
- Biomedical Sciences, The University of Queensland, Brisbane, AUS
| | | | - Abid R Prottoy
- Neurosurgery, St George's University of London, London, GBR
| | | | - Marios Alogakos
- General Surgery, St George's University of London, London, GBR
| | - Maamoun Adra
- Orthopedics, St George's University of London, London, GBR
| | - Karen Smayra
- Radiology, St George's University of London, London, GBR
| | - Tom J Curtis
- Orthopedics, Frimley Health NHS Foundation Trust, Windsor, GBR
| | | | | | - Zaher Dannawi
- Spine Surgery, Mid and South Essex NHS Foundation Trust, London, GBR
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Liu Y, Zhang Q, Ji N, Wang J, Li J, Du J, Zhao J, Ouyang P, Qin J, Li H, Wang D. Stability simulation analysis of targeted puncture in L4/5 intervertebral space for PELD surgery. Front Bioeng Biotechnol 2024; 11:1298914. [PMID: 38260730 PMCID: PMC10800398 DOI: 10.3389/fbioe.2023.1298914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction: The application prospects of percutaneous endoscopic lumbar discectomy (PELD) as a minimally invasive spinal surgery method in the treatment of lumbar disc herniation are extensive. This study aims to find the optimal entry angle for the trephine at the L4/5 intervertebral space, which causes less lumbar damage and has greater postoperative stability. To achieve this, we conduct a three-dimensional simulated analysis of the degree of damage caused by targeted puncture-based trephine osteotomy on the lumbar spine. Methods: We gathered clinical CT data from patients to construct a lumbar model. This model was used to simulate and analyze the variations in trephine osteotomy volume resulting from targeted punctures at the L4/5 interspace. Furthermore, according to these variations in osteotomy volume, we created Finite Element Analysis (FEA) models specifically for the trephine osteotomy procedure. We then applied mechanical loads to conduct range of motion and von Mises stress analyses on the lumbar motion unit. Results: In percutaneous endoscopic interlaminar discectomy, the smallest osteotomy volume occurred with a 20° entry angle, close to the base of the spinous process. The volume increased at 30° and reached its largest at 40°. In percutaneous transforaminal endoscopic discectomy, the largest osteotomy volume was observed with a 50° entry angle, passing through the facet joints, with smaller volumes at 60° and the smallest at 70°. In FEA, M6 exhibited the most notable biomechanical decline, particularly during posterior extension and right rotation. M2 and M3 showed significant differences primarily in rotation, whereas the differences between M3 and M4 were most evident in posterior extension and right rotation. M5 displayed their highest stress levels primarily in posterior extension, with significant variations observed in right rotation alongside M4. Conclusion: The appropriate selection of entry sites can reduce lumbar damage and increase stability. We suggest employing targeted punctures at a 30° angle for PEID and at a 60° angle for PTED at the L4/5 intervertebral space. Additionally, reducing the degree of facet joint damage is crucial to enhance postoperative stability in lumbar vertebral motion units.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Haopeng Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Dong Wang
- Department of Orthopedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Bajaj A, Telfeian AE. Pediatric applications of endoscopic spine surgery. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Lewandrowski KU, Abraham I, Ramírez León JF, Soriano Sánchez JA, Dowling Á, Hellinger S, Freitas Ramos MR, Teixeira De Carvalho PS, Yeung C, Salari N, Yeung A. Differential Agnostic Effect Size Analysis of Lumbar Stenosis Surgeries. Int J Spine Surg 2022; 16:318-342. [PMID: 35444041 PMCID: PMC9930655 DOI: 10.14444/8222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
STUDY DESIGN A meta-analysis of 89 randomized prospective, prospective, and retrospective studies on spinal endoscopic surgery outcomes. OBJECTIVE The study aimed to provide familiar Oswestry Disability Index (ODI), visual analog scale (VAS) back, and VAS leg effect size (ES) data following endoscopic decompression for sciatica-type back and leg pain due to lumbar herniated disc, foraminal, or lateral recess spinal stenosis. BACKGROUND Higher-grade objective clinical outcome ES data are more suitable than lower-grade clinical evidence, including cross-sectional retrospective study outcomes or expert opinion to underpin the ongoing debate on whether or not to replace some of the traditional open and with other forms of minimally invasive spinal decompression surgeries such as the endoscopic technique. METHODS A systematic search of PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1 January 2000 to 31 December 2019 identified 89 eligible studies on lumbar endoscopic decompression surgery enrolling 23,290 patient samples using the ODI and VAS for back and leg pain used for the ES calculation. RESULTS There was an overall mean overall reduction of ODI of 46.25 (SD 6.10), VAS back decrease of 3.29 (SD 0.65), and VAS leg reduction of 5.77 (SD 0.66), respectively. Reference tables of familiar ODI, VAS back, and VAS leg show no significant impact of study design, follow-up, or patients' age on ES observed with these outcome instruments. There was no correlation of ES with long-term follow-up (P = 0.091). Spinal endoscopy produced an overall ODI ES of 0.92 extrapolated from 81 studies totaling 12,710 patient samples. Provided study comparisons to tubular retractor microdiscectomy and open laminectomy showed an ODI ES of 0.9 (2895 patients pooled from 16 studies) and 0.93 (1188 patients pooled from 5 studies). The corresponding VAS leg ES were 0.92 (12,631 endoscopy patients pooled from 81 studies), 0.92 (2348 microdiscectomy patients pooled from 15 studies), and 0.89 (1188 open laminectomy patients pooled from 5 studies). CONCLUSION Successful clinical outcomes can be achieved with various lumbar surgeries. ESs with endoscopic spinal surgery are on par with those found with open laminectomy and microsurgical decompression. CLINICAL RELEVANCE This article is a meta-analysis on the benefit overlap between lumbar endoscopy, microsurgical decompression, laminectomy, and lumbar decompression fusion. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, AZ, USA .,Department of Orthopaedic Surgery, Fundación Universitaria Sanitas, Bogotá, DC, Colombia.,Department of Orthopaedic Surgery, UNIRIO, Rio de Janeiro, Brazil
| | - Ivo Abraham
- Family and Community Medicine, Clinical Translational Sciences at the University of Arizona, Tucson, AZ 85721, USA,Centro de Cirugía de Mínima Invasión, CECIMIN - Clínica Reina Sofía, Bogotá, Colombia
| | - Jorge Felipe Ramírez León
- Centro de Cirugía de Mínima Invasión, CECIMIN - Clínica Reina Sofía, Bogotá, Colombia,Research Team, Centro de Columna, Bogotá, Colombia,Fundación Universitaria Sanitas, Bogotá, DC, Colombia
| | - José Antonio Soriano Sánchez
- Neurosurgeon and Minimally Invasive Spine Surgeon, Head of the Spine Clinic of The American-British Cowdray Medical Center I.A.P. Campus Santa Fe [Centro Médico ABC Campus Santa Fe], Santa Fe, Mexico
| | - Álvaro Dowling
- Department of Orthopaedic Surgery, USP, Ribeirão Preto, Brazil,Orthopaedic Spine Surgeon, Director of Endoscopic Spine Clinic, Santiago, Chile
| | - Stefan Hellinger
- Department of Orthopedic Surgery, Isar Hospital, Munich, Germany
| | - Max Rogério Freitas Ramos
- Orthopedics and Traumatology, Universidade Federal do Estado do Rio de Janeiro, UNIRIO, Rio de Janeiro, Brazil
| | | | | | - Nima Salari
- Desert Institute for Spine Care, Phoenix, AZ, USA
| | - Anthony Yeung
- Desert Institute for Spine Care, Phoenix, AZ, USA,Department of Neurosurgery Albuquerque, University of New Mexico School of Medicine, Albuquerque, NM, New Mexico
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Song Y, Li C, Guan J, Li C, Wu H, Cheng X, Ling B, Zhang J. Outcomes of epidural steroids following percutaneous transforaminal endoscopic discectomy: a meta-analysis and systematic review. Korean J Pain 2022; 35:97-105. [PMID: 34966016 PMCID: PMC8728551 DOI: 10.3344/kjp.2022.35.1.97] [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: 08/24/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 11/06/2022] Open
Abstract
Background Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results A total of 451 patients were included in three randomized and two non-randomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.
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Affiliation(s)
- Yinghao Song
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Changxi Li
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Jingjing Guan
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Cheng Li
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Haisheng Wu
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Xinzhi Cheng
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Bingyu Ling
- Department of Emergency, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Jinglang Zhang
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
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Lumbosacral Transitional Vertebrae in Adolescents: Effects on the Short-Term Outcomes of Percutaneous Endoscopic Lumbar Discectomy. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9911579. [PMID: 34337062 PMCID: PMC8292041 DOI: 10.1155/2021/9911579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/03/2021] [Indexed: 12/02/2022]
Abstract
Objective To investigate whether lumbosacral transitional vertebrae (LSTV) affects the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) in adolescent patients with lumbar disc herniation (LDH). Methods This was a retrospective study with two groups. Group A was made up of 22 adolescent LDH patients with LSTV (18 males and 4 females). Group B was made up of 44 adolescent LDH patients without LSTV (36 males and 4 females), who were matched to group A for age, sex, and body mass index. All patients underwent PELD at the L4/5 or L5/S1 single level and were followed up at 18 months after surgery. We identified LSTV on radiographs and computed tomography and assessed the imaging characteristics of all patients. Outcomes were evaluated through a numerical rating scale (NRS), the Oswestry Disability Index (ODI), the modified MacNab grading system, and the incidence of additional lumbar surgery. Results At 18 months after PELD, both groups had significant improvements in the mean NRS scores of low back pain (LBP) or leg pain and the ODI scores. In terms of the MacNab criteria, 90.9% in group A and 93.2% in group B showed excellent or good outcomes. The mean NRS scores of LBP or leg pain, ODI score, and MacNab grade after surgery were not significantly different between the 2 groups. Two patients (one patient had a recurrence; one patient had a new lumbar disc herniation) in group A and 3 patients (one patient had a recurrence; two patients had new lumbar disc herniations) in group B underwent additional lumbar surgery. Conclusions Our study suggests that in terms of pain relief, life function improvement, and the incidence of additional lumbar surgery, LSTV has no effect on the short-term clinical outcomes of PELD in adolescents. A new lumbar disc herniation is an important reason for additional surgery in adolescents, regardless of the LSTV status.
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Biomechanical Model Study of the Effect of Partial Facetectomy on Lumbar Stability Under Percutaneous Endoscopy. World Neurosurg 2020; 139:e255-e264. [DOI: 10.1016/j.wneu.2020.03.190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/20/2022]
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Ye X, Jiang H, Wang Y, Ji Y, Jiang X. A correlative studies between osteoporosis and blood cell composition: Implications for auxiliary diagnosis of osteoporosis. Medicine (Baltimore) 2020; 99:e20864. [PMID: 32590789 PMCID: PMC7328927 DOI: 10.1097/md.0000000000020864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/02/2020] [Accepted: 05/21/2020] [Indexed: 02/02/2023] Open
Abstract
Osteoporosis is defined as a metabolic skeletal disease characterized by a decrease of the bone mass per unit volume, caused by a variety of reasons. Increasing evidence indicate that the host inflammatory response was correlated with the occurrence and development of osteoporosis, and it has been recognized that T lymphocytes and B lymphocytes play a critical role in pathogenesis of inflammatory bone disease. Between January 2018 and December 2018, retrospective analysis of 487 patients (exclusion of patients with recent infections and hematologic disorders whose leukocyte counts or classifications are markedly abnormal) who underwent bone mineral density (BMD) examinations in Huzhou Central Hospital. The patients were divided into normal bone density group, osteopenia group, and osteoporosis group according to the T score of BMD in the left femoral neck, respectively. Statistics of the lymphocyte ratio and the monocyte ratio in the blood routine examination results during the same period were performed so as to make a comparison of the differences among the groups. The correlation of the lymphocyte ratio and monocyte ratio with the T score of BMD in the left femoral neck was also analyzed. The difference between neutrocyte ratio lymphocyte ratio and the monocyte ratio was statistically significant in both males and females among the normal bone density group, osteopenia group and osteoporosis group (P < .01 or P < .05). Inflammation plays an important role in the progression of osteoporosis. By monitoring these three indicators in blood routine examination, early intervention for osteoporosis may become possible.
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Affiliation(s)
| | - Haowei Jiang
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, HuZhou, Zhejiang, China
| | - Yongli Wang
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, HuZhou, Zhejiang, China
| | - Yafeng Ji
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, HuZhou, Zhejiang, China
| | - Xuesheng Jiang
- Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital HuZhou University, HuZhou, Zhejiang, China
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Yan D, Zhang Z, Zhang Z. Residual leg numbness after endoscopic discectomy treatment of lumbar disc herniation. BMC Musculoskelet Disord 2020; 21:273. [PMID: 32340609 PMCID: PMC7187494 DOI: 10.1186/s12891-020-03302-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background Transforaminal endoscopic discectomy was popular in the treatment of lumbar disc herniation. Previous study focuses on the leg pain of disc herniation, and little study concern the residual leg numbness after surgery. The purposes of this study were to evaluate the clinical outcomes of transforaminal endoscopic discectomy in the treatment of lumbar disc herniation with leg pain and numbness. Methods Patients with one level lumbar disc herniation who had transforaminal endoscopic lumbar discectomy from June 2016 to July 2019 were categorized into two groups according to the leg numbness. 293 patients initially fulfilled the study criteria, and 27 patients were lost to follow-up. Of the remaining 266 patients available for analysis, 81 cases with leg numbness and pain (A group), and 185 cases with leg pain (B). Endoscopic transforaminal lumbar discectomy was performed, and the clinical outcomes of blood loss, operation times, hospital stay days, pain (Visual Analog Scale, VAS-pain), numbness (VAS-numbness), functional disability (Oswestry Disability Index, ODI), and the disk height and intervertebral foramen height were recorded. Results All patients with pain and numbness pre-operation in group A, complain of leg numbness during or just after walking or standing not diminished after surgery in group A, and no one complain numbness after surgery in group B. The pain index and ODI score were better than preoperational in all patients (P < 0.01), and no significant difference between two groups (P > 0.05). The postoperative disk and foramen height were no significant difference compare to preoperative in all patients (P > 0.05), and no significant difference between two groups (P > 0.05). The leg numbness symptoms last longer in central disc herniation patients (10.4 ± 2.2 months) than in paracentral (6.3 ± 2.1 months) and foraminal disc herniation patients (5.6 ± 2.3 months) after surgery (P < 0.01). Conclusions Based on the results of this study, transforaminal endoscopic lumbar discectomy was effective and safe procedures in the treatment of disc herniation with leg pain and numbness. The leg numbness symptoms last longer in central disc herniation patients than in paracentral and foraminal disc herniation patients after surgery.
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Affiliation(s)
- Denglu Yan
- Orthopedics department, First People's Hospital of Zhaoqing, Zhaoqing City, Guangdong Province, 526000, People's Republic of China.
| | - Zaiheng Zhang
- Orthopedics department, People's Hospital of Baoan, Shenzhen City, Guangdong Province, 518101, People's Republic of China
| | - Zhi Zhang
- Orthopedics department, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou City, Guangdong Province, 510150, People's Republic of China
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Sun J, Fang C, Gao F, Wei L, Qian J. Comparison of effectiveness and safety between epidural anesthesia vs local anesthesia for percutaneous transforaminal endoscopic discectomy: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e18629. [PMID: 31895822 PMCID: PMC6946500 DOI: 10.1097/md.0000000000018629] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To compare the effectiveness and safety of epidural anesthesia (EA) with those of local anesthesia (LA) for percutaneous transforaminal endoscopic discectomy (PTED) and provide reference data for clinical decision-making. METHODS We searched PubMed, Embase, the Cochrane library, Web of Science, Medline, ScienceDirect, and the China National Knowledge Infrastructure from inception to June 2019 in order to identify randomized and nonrandomized controlled trials comparing EA and LA for PTED. Studies assessing at least 2 of the following indicators were eligible: surgical duration, X-ray exposure time, satisfaction rate, visual analog scale (VAS) scores for pain, Oswestry Disability Index (ODI), and complications. Two assessors evaluated the quality of the literature using the Cochrane Handbook or Newcastle-Ottawa Scale. Meta-analysis was conducted using Review Manager 5.3.3 software. RESULTS Four randomized controlled trials and 4 retrospective cohort studies involving a total of 1000 patients were included. The LA and EA groups included 473 and 527 patients, respectively. Meta-analysis revealed significant intergroup differences in the intraoperative (P < .00001) and postoperative (P < .00001) lumbar VAS scores, intraoperative (P < .00001) and postoperative (P = .001) leg VAS scores, and anesthesia satisfaction rate (P < .00001), with EA being superior to LA in all aspects. There were no significant intergroup differences in the surgical duration, X-ray exposure time, postoperative ODI, and complication rate. CONCLUSION EA is as safe as LA and produces better anesthetic effects than does LA in patients undergoing PTED. Therefore, it should be promoted as a reliable anesthetic technique for PTED.
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Affiliation(s)
- Jian Sun
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Economic and Technological Development Zone of Hefei
| | - Chao Fang
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Economic and Technological Development Zone of Hefei
| | - Fei Gao
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China
| | - Laifu Wei
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China
| | - Jun Qian
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, Economic and Technological Development Zone of Hefei
- Department of Orthopedics and Spine Surgery, The First Affiliated Hospital of Anhui Medical University, Anhui Province, China
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