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Gao M, Shi G, He Z, Bao M, Zhang K, Li J, Li F, Zhu Y, Li X, Wang H. 3D digital anatomical measurements for clinical application of minimally invasive lumbar foraminal surgery in adolescents aged 12-21 years. Ann Anat 2024; 257:152344. [PMID: 39406313 DOI: 10.1016/j.aanat.2024.152344] [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: 09/18/2024] [Revised: 10/09/2024] [Accepted: 10/11/2024] [Indexed: 10/22/2024]
Abstract
OBJECTIVE The purpose of this study was to establish an anatomical foundation for minimally invasive lumbar spine surgery in adolescents by assessing the 3D anatomical parameters of the lumbar vertebrae in the age group of 12-21 years. METHODS We collected CT data from 90 adolescents and performed 3D reconstructions using Mimics 16.0 software. The dimensions assessed included the height and sagittal diameter of the intervertebral foramen, as well as the length and widths of the transverse and spinous processes. RESULTS The intervertebral foramen height exhibited variation corresponding to the vertebral level, being smallest at L5/S1 and largest at L3/4. The sagittal diameter of the intervertebral foramen increased with age, reaching a minimum at L1/2 and a maximum at L4/5. Significant gender differences were observed in the 12-14 age group, with females exhibiting larger measurements than males. The length and width of the transverse processes were maximal at L3 and L5, respectively. The spinous process length was greatest at L3 and smallest at L5, with notable gender differences present in the 12-14 and 19-21 age groups. CONCLUSION The study reveals that gender and age are significant factors influencing the anatomy of the adolescent lumbar spine, which is essential for the development of minimally invasive surgical techniques. Our findings contribute valuable insights for the design and surgical planning of spinal devices tailored to adolescents.
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Affiliation(s)
- Mingjie Gao
- Department of Human Anatomy,School of Basic Medicine,Inner Mongolia Medical University, Hohhot, Inner Mongolia 010010, China
| | - Guopeng Shi
- Department of Human Anatomy,School of Basic Medicine,Inner Mongolia Medical University, Hohhot, Inner Mongolia 010010, China
| | - Zhuoqun He
- Department of Human Anatomy,School of Basic Medicine,Inner Mongolia Medical University, Hohhot, Inner Mongolia 010010, China
| | - Malian Bao
- Anesthesiology Department, Inner Mongolia Fourth Hospital, Hohhot, Inner Mongolia 010000, China
| | - Kai Zhang
- Department of Orthopaedics, the Second Hospital of Ulanqab City, Ulanqab, Inner Mongolia 012000, China
| | - Jing Li
- Institute of Military Medicine, Academy of Military Sciences, Beijing 100071, China
| | - Feng Li
- Department of Spinal Surgery, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010000, China
| | - Yong Zhu
- Affiliated Cancer Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010000, China
| | - Xiaohe Li
- Department of Human Anatomy,School of Basic Medicine,Inner Mongolia Medical University, Hohhot, Inner Mongolia 010010, China.
| | - Haiyan Wang
- Department of Human Anatomy,School of Basic Medicine,Inner Mongolia Medical University, Hohhot, Inner Mongolia 010010, China.
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Li H, Xiao C, Pan H, Yang H, Lei Y, Wang H, Li S. Surgical Strategy for Lumbar Disc Herniation based on the MSU Classification: Percutaneous Endoscopic Lumbar Discectomy versus Transforaminal Lumbar Interbody Fusion: A 5-year Retrospective Study. Orthop Surg 2024; 16:1963-1973. [PMID: 38961670 PMCID: PMC11293921 DOI: 10.1111/os.14145] [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: 03/08/2024] [Revised: 06/01/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
OBJECTIVE Currently, there is no established guideline on whether to opt for percutaneous endoscopic lumbar discectomy (PELD) or traditional transforaminal lumbar interbody fusion (TLIF) surgery based on specific types of lumbar disc herniation (LDH). Based on the Michigan State University (MSU) classification system, this study conducted a medium- to long-term follow-up analysis of two surgical methods over 5 years for the first time, aiming to provide empirical evidence to assist in making more informed decisions before surgery for LDH treatment. METHODS This was a retrospective study that included 273 patients with single-level LDH who underwent PELD or TLIF treatment at our hospital between January 1, 2016, and December 31, 2018. Detailed metrics included preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 1-day, 1-week, 1-year, and 5-year follow-ups. Complications, recurrences, and 5-year postoperative modified MacNab criteria scores were also recorded. Statistical methods included independent sample t-tests, repeated measures analysis of variance (ANOVA), and χ2 tests. RESULTS Classified into seven groups according to the MSU classification, it was found that there was an improvement in the VAS and ODI scores at four postoperative follow-ups (p < 0.001). PELD showed better results than TLIF in reducing pain and improving the ODI scores in the classifications of 3B, 2B, and 2C (p < 0.05). TLIF demonstrated consistent superiority over PELD in 2A, 2AB, 3A, and 3AB classifications (p < 0.05). The total recurrence rate in the PELD group (11.05%) within 5 years after surgery was higher (p < 0.05) than that in the TLIF group (3.96%). These were mainly concentrated in the 2A, 2AB, 3A, and 3AB types. Moreover, the rate of excellent and good outcomes in the PELD was higher than in the TLIF but no significant difference (χ2 = 1.0568, p = 0.5895). CONCLUSION This study suggests that PELD and TLIF may relieve LDH, but have advantages under different MSU classifications. The MSU classification has specific guiding significance and could aid in the surgical selection of PELD or TLIF to achieve optimal treatment outcomes for patients with lumbar disc herniation.
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Affiliation(s)
- Hongtao Li
- Department of Spine SurgeryThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
| | - Changming Xiao
- Department of Spine SurgeryThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
| | - Hongyu Pan
- Department of Spine SurgeryThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
| | - Haomiao Yang
- Department of Spine SurgeryThe Nanjing TCM Hospital Affiliated to Nanjing University of Traditional Chinese MedicineNanjingChina
| | - Yang Lei
- Department of Spine SurgeryThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
| | - Haozhong Wang
- Department of Spine SurgeryThe Affiliated Traditional Chinese Medicine Hospital, Southwest Medical UniversityLuzhouChina
| | - Sen Li
- Division of Spine Surgery, Department of Orthopedic SurgeryNanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
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Huang Y, Wei S, Shen Y, Zhan S, Yi P, Tang X. A new technique for low back pain in lumbar disc herniation: percutaneous endoscopic lumbar discectomy combined with sinuvertebral nerve ablation. J Orthop Surg Res 2024; 19:341. [PMID: 38849922 PMCID: PMC11162081 DOI: 10.1186/s13018-024-04831-8] [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: 05/02/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has demonstrated efficacy in alleviating leg pain among patients with lumbar disc herniation. Nonetheless, residual back pain persists as a troubling issue for surgeons following the procedure. In the treatment of discogenic back pain, sinuvertebral nerve radiofrequency ablation has shown promising results. Nevertheless, the potential benefit of simultaneously implementing sinuvertebral nerve radiofrequency ablation during PELD surgery to address residual back pain has not been thoroughly investigated in current literature. METHODS This retrospective study reviewed Lumbar disc herniation (LDH) patients with low back pain who underwent combined PELD and sinuvertebral nerve ablation in our department between January 2021 and September 2023. Residual low back pain post-surgery was assessed and compared with existing literature. RESULTS A total of 80 patients, including 53 males and 27 females, were included in the study. Following surgical intervention, patients demonstrated remarkable improvements in pain and functional parameters. One month post-operatively, the VAS score for low back pain exhibited a 75% reduction (6.45 ± 1.3 to 1.61 ± 1.67), while the VAS score for leg pain decreased by 85% (7.89 ± 1.15 to 1.18 ± 1.26). Notably, the JOA score increased from 12.89 ± 5.48 to 25.35 ± 4.96, and the ODI score decreased form 59.48 ± 9.58 to 20.3 ± 5.37. These improvements were sustained at three months post-operatively. According to the modified Mac Nab criteria, the excellent and good rate was 88.75%. Residual low back pain is observed to be comparatively reduced compared to the findings documented in earlier literature. CONCLUSION The combination of percutaneous endoscopic lumbar discectomy and sinuvertebral nerve ablation demonstrates effective improvement in low back pain for LDH patients.
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Affiliation(s)
- Yanjun Huang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shangshu Wei
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yanzhu Shen
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sizheng Zhan
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China
| | - Ping Yi
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China
| | - Xiangsheng Tang
- Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, China.
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Hu Q, Wu W, Liu J, Xie S, Tang T. Predictive Factors for Residual Low Back Pain Following Percutaneous Endoscopic Lumbar Discectomy in Patients with Lumbar Disc Herniation. Med Sci Monit 2024; 30:e942231. [PMID: 38183217 PMCID: PMC10777582 DOI: 10.12659/msm.942231] [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: 08/20/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) is a mature and popular surgery for treatment of lumbar disc herniation (LDH). The main objective of our study was to identify risk factors for residual low back pain after PELD and to improve postoperative management. MATERIAL AND METHODS We retrospectively analyzed the clinical and imaging data of 251 patients who underwent PELD for LDH. We defined residual LBP as visual analog scale (VAS) score for LBP ≥3 at 2 years postoperatively, and severe LBP was defined as VAS for LBP ≥7.5. The clinical and imaging data were analyzed by comparing patients with VAS scores ≥3 and <3, and univariate analysis and multivariable logistic regression analysis were applied to predict the risk factors for residual LBP. RESULTS There were 56 (22.3%) patients with LBP VAS ≥3 at 2 years postoperatively. Multivariable logistic regression analysis demonstrated that severe baseline VAS for LBP (P<0.001), MCs type I (P=0.006), and severe fatty infiltration of the paravertebral muscles (P<0.001) were independent risk factors for residual LBP after PELD. CONCLUSIONS In patients with LDH, MCs type I, severe baseline LBP, and fatty infiltration of the paravertebral muscles were predictive factors for residual LBP after PELD. Our study suggests that spine surgeons should pay more attention to these imaging parameters, which may be a helpful indicator for the choice of surgical modality.
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Affiliation(s)
- Qianqin Hu
- First Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, PR China
| | - Wenjing Wu
- Third Department of Internal Medicine, Jiangxi Provincial Chest Hospital, Nanchang, Jiangxi, PR China
| | - Jiahao Liu
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Shuihua Xie
- First Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, PR China
| | - Tao Tang
- First Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, PR China
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Yu L, Zhu B, Dong H, Li X, Liu X, Yang Y, Yi Z. Does Immediate Postoperative Early Ambulation Affect Clinical Results of Full-Endoscopic Lumbar Discectomy? A Historical Control Study of Daytime Operation with a 8-Hour Hospital Stay versus Inpatient Operation. Orthop Surg 2023; 15:2354-2362. [PMID: 37519265 PMCID: PMC10475658 DOI: 10.1111/os.13814] [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: 12/29/2022] [Revised: 06/02/2023] [Accepted: 06/08/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE Full-endoscopic lumbar discectomy (FELD) is a popular operation for the treatment of lumbar disc herniation (LDH) and day surgery mode is increasingly popular. However, only a few studies have reported about day surgery patients undergoing Percutaneous endoscopic lumbar discectomy (PELD). This retrospective study was to evaluate and analyze the clinical outcomes of patients undergoing FELD for LDH as day surgery versus inpatient surgery. METHODS From January 2020 to January 2022, a retrospective analysis of LDH patients treated with FELD either in day surgery unit (within 8-h hospital stay) or inpatient unit was carried out. All these patients were followed-up for at least 12 months, and were categorized into a FELD-I (inpatient surgery) group or a FELD-D (day surgery) group, according to where the surgical procedures were performed. We assessed and compared the postoperative stand and walk time, postoperative hospitalization stays, time of return to work, modified MacNab criteria, willingness to recommend surgery, complications, revision rate, as well as the visual analogue scale (VAS) and the Oswestry disability index score (ODI). Student t-test was used for continuous variables and chi-square test or Fisher's exact test was used for categorical variables. RESULTS There was no statistically significant difference in demographic data and baseline characteristics between two groups. And no significant differences were found in MacNab criteria between two groups. Postoperative VAS and ODI scores at one-day postoperation and final follow-up both improved significantly in both groups, as compared to the preoperative data (p < 0.001). However, no significant difference was found between the two groups on the pre, postoperative, or the last follow-up score for VAS and ODI (p > 0.05). The postoperative first ambulation time and postoperative hospital stays was much longer in FELD-I group than FELD-D group (p < 0.001). However, there were no significant differences in the perioperative complications, revision rate as well as satisfaction rate between two groups (p > 0.05). The overall time of return to work of young patients (<60 years-old) in the FELD-D group was significantly shorter than that in the FELD-I group (p = 0.001). Patients in the FELD-D group were more likely to recommend this kind of surgical model. CONCLUSION These data suggest that FELD-D can be effectively performed as day surgery (within 8 h hospital stay). Early ambulation after FELD-D did not affect the clinical outcomes and the revision rates. Day surgery patients are more likely to recommend this surgery mode to other patients and younger patients may be able to return to work earlier.
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Affiliation(s)
- Lingjia Yu
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Bin Zhu
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Huajun Dong
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Xiang Li
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Xiaoguang Liu
- Department of OrthopedicsPeking University Third HospitalBeijingChina
| | - Yong Yang
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Zuling Yi
- Department of OrthopedicsBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
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Tang T, Liu J, Cao J, He D, Cheng X, Xie S. Risk Factors and Causes of Reoperation in Lumbar Disc Herniation Patients after Percutaneous Endoscopic Lumbar Discectomy: A Retrospective Case Series with a Minimum 2-Year Follow-Up. Med Sci Monit 2023; 29:e939844. [PMID: 37580900 PMCID: PMC10439676 DOI: 10.12659/msm.939844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 06/12/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has gained popularity as a minimally invasive surgery for treating lumbar disc herniation. However, there is limited research focusing on the reoperation rate and its associated factors. This study aims to investigate the rate of reoperation and identify the causes and risk factors for reoperation after PELD. MATERIAL AND METHODS We conducted a retrospective analysis of patients who underwent PELD (interlaminar and transforaminal approaches) at our hospital from November 2016 to May 2020. A matched case-control design was employed to identify relevant risk factors for reoperation, with a matching ratio of 1:3. Clinical characteristics and radiological parameters were compared, and univariate analysis was performed using independent samples t-test and chi-squared test. RESULTS Among the 435 patients included in the study, the reoperation rate for those with a minimum 2-year follow-up was 6.2% (27/435). The causes of reoperation and their respective rates were as follows: recurrence of lumbar disc herniation (3.2%, 14/435), incomplete decompression (1.8%, 8/435), persistent low back pain (0.7%, 3/435), and postoperative infection (0.5%, 2/435). Univariate analysis revealed that age (P=0.015), Pfirrmann grade IV-V (P=0.017), and lack of active straight leg raise exercises (P=0.026) were significantly associated with reoperation. Multiple logistic regression analysis indicated that age (P=0.001), Pfirrmann grade IV-V (P=0.033), and lack of active straight leg raise exercises postoperatively (P=0.003) were independent risk factors for reoperation after PELD. CONCLUSIONS The primary cause of reoperation in lumbar disc herniation patients after PELD was recurrence of the herniation. Additionally, severe disc degeneration, older age, and lack of active straight leg raise exercises were identified as significant risk factors associated with an increased reoperation rate.
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Affiliation(s)
- Tao Tang
- The First Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, PR China
| | - Jiahao Liu
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Jian Cao
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Dingwen He
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Xigao Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Shuihua Xie
- The First Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, PR China
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Gao W, Zhang W, Pan H, Wang D. Independent reliability and availability analyses of modified classification for migrated lumbar disc herniation. J Orthop Surg Res 2023; 18:201. [PMID: 36918988 PMCID: PMC10012434 DOI: 10.1186/s13018-023-03688-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The purpose of this study was to evaluate the reliability of modified classification system of migrated nucleus pulposus and its clinical application value. METHODS We retrieved 1000 lumbar MRI of different patients in Hangzhou Hospital of Traditional Chinese Medicine from January 2016 to December 2019 for interpretation, and screened 105 migrated lumbar MRI for inclusion in the study. Three spinal surgeons made classification according to the modified classification method. Two weeks later, the sorting data of the patients were shuffled and the classification was judged by three doctors again. The consistency and repeatability of the improved classification were evaluated by Kappa coefficient. The general data of the included patients were collected. The patients were followed up for 2 years, and the risk factors of surgical treatment of patients with migrated lumbar disc herniation were analyzed. The treatment plan, surgical approach, operation time, VAS score, ODI score and other relevant data of the included patients were collected to evaluate the guiding effect of the classification system on clinical practice. RESULTS In this study, the incidence of migrated lumbar disc herniation was about 10.5%, and most of the patients were male. Patients with higher BMI are more likely to develop this disease. Our study confirmed that the modified classification has moderate to high confidence. During the 2-year follow-up period, 66 patients (62.9%) were treated conservatively, and the patients with conservative treatment were mainly A2 and B2 type (59.1%). Thirty-nine patients (37.1%) underwent surgical treatment. The patients recovered well after operation, and the low back pain and ODI index were significantly improved at 1 year after operation (P < 0.05). We suggest that type A1 and B1 migrated nucleus pulposus can be removed by posterior approach. For type A2, B2, C1, C2, the lateral approach is recommended to remove the nucleus pulposus directly. Logistic regression and ROC analysis showed that disease duration (≥ 1 year) and BMI (≥ 24) maybe were risk factors for surgical treatment of patients with migrated lumbar disc herniation. CONCLUSION The modified classification has good reliability. In the current study, the experience level of spine surgeons does not affect the reliability of the classification system. Our study confirmed that this classification has a good reference value for guiding the treatment plan and the choice of surgical approach.
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Affiliation(s)
- Wenshuo Gao
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), No. 453 Tiyuchang Road, Xihu District, Hangzhou, 310000, Zhejiang Province, People's Republic of China
| | - Wei Zhang
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), No. 453 Tiyuchang Road, Xihu District, Hangzhou, 310000, Zhejiang Province, People's Republic of China
| | - Hao Pan
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), No. 453 Tiyuchang Road, Xihu District, Hangzhou, 310000, Zhejiang Province, People's Republic of China.
| | - Dong Wang
- Department of Orthopaedics, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), No. 453 Tiyuchang Road, Xihu District, Hangzhou, 310000, Zhejiang Province, People's Republic of China.
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A clinical nomogram for predicting the residual low back pain after percutaneous endoscopic surgery for lumbar disc herniation. INTERNATIONAL ORTHOPAEDICS 2023; 47:819-830. [PMID: 36542140 DOI: 10.1007/s00264-022-05658-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Current findings suggest that minimally percutaneous endoscopic lumbar discectomy (PELD) is a practical therapeutic approach for lumbar disc herniation (LDH). However, some patients still end up with residual low back pain, even after surgery. Our study aims to construct and validate a nomogram to predict residual low back pain after PELD. METHODS The medical records of 355 LDH patients admitted to the author's hospital were retrospectively analyzed between January 2019 and December 2021. The patients were randomly divided into two groups with a ratio of 7:3, namely a modelling group and a validation group. The univariable logistics and multivariable regression methods were used to screen the independent risk factors. A nomogram was then drawn using independent risk factors selected from the univariable and multivariable regression analyses. The concordance index (C-index), the receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve analysis were used to evaluate the nomogram's performance. Finally, the accuracy of the nomogram was verified by a validation cohort. RESULTS 36.6% (130/355) of patients showed low back pain after percutaneous endoscopic lumbar discectomy, while 63.4% (225/355) showed no symptoms. Multivariable logistical regression analysis showed that Modic change (p < 0.05, OR = 1.813), fatty infiltration of the paravertebral muscle (p < 0.05, OR = 2.935), and edema of lumbodorsal fascia (p = 0.049, OR = 1.611) were significant risk factors for post-operative residual back pain. Moreover, the C-index of the predictive nomogram was 0.743 (0.681-0.805), the area under the receiver operating characteristic curve (AUC) value was 0.739, and the DCA results exhibit a net benefit between 0.16 and 0.66. The above internal validation methods demonstrate the nomogram's good predictive capability. CONCLUSION Each variable in the model had a quantitatively corresponding risk score, which can be used in predicting residual low back pain after PELD.
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Shen SC, Chen HC, Tsou HK, Lin RH, Shih YT, Huang CW, Tang CL, Chen HT, Chang CC, Tzeng CY. Percutaneous endoscopic lumbar discectomy for L5-S1 disc herniation based on image analysis and clinical findings: A retrospective review of 345 cases. Medicine (Baltimore) 2023; 102:e32832. [PMID: 36749265 PMCID: PMC9901959 DOI: 10.1097/md.0000000000032832] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The effect of spinal anatomical anomalies on the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for disc herniation repair is unclear. This retrospective review aims to assess the safety and effectiveness of PELD for treating L5-S1 disc herniation with a range of characteristics and to determine the prevalence of lumbosacral transitional vertebrae (LSTV) anatomical anomalies to facilitate pre-surgical planning. From July 2005 to June 2019, 345 patients with L5-S1 disc herniations were treated with PELD. The primary outcome was 1-year postoperative visual analogue scale scores for low back and lower limb pain. The secondary outcomes included the surgical approach used, lumbosacral bony anomalies, presence of a ruptured disc or severely calcified disc, pediatric lumbar disc herniation, recurrent disc herniation management, and the long-term outcome. visual analogue scale scores for most patients were significantly improved after surgery. The prevalence of LSTVs was 4.05% (14/345 patients) in lumbar sacralization and 7.53% (26/345 patients) in sacral lumbarization. The prevalence of ruptured and severely calcified discs was 18.55% (64/345) and 5.79% (20/345), respectively. The prevalence of pediatric lumbar disc herniation was 2.02% (7/345). The recurrence rate was 4.34% (15/345). Two durotomy cases without sequelae and 8 cases of lower limb dysesthesia lasting longer than 3 months postoperatively were reported. PELD is safe and effective for treating L5-S1 disc herniation, including cases complicated by calcified lumbar disc herniation, disc rupture with migration, and the presence of LSTV. Appropriate imaging is essential to identify case-specific factors, including the prevalent LSTV anatomical anomalies, before surgery.
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Affiliation(s)
- Shih-Chieh Shen
- Department of Surgery, Tri-Service General Hospital Songshan Branch, National, Defense Medical Center, Taiwan, R.O.C
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taiwan, R.O.C
| | - Hung-Chieh Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, R.O.C
| | - Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County, Taiwan, R.O.C
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan, R.O.C
- College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, R.O.C
- * Correspondence: Hsi-Kai Tsou, Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sec. 4, Taichung, Taiwan 40705, R.O.C (e-mail: )
| | - Ruei-Hong Lin
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Yu-Tung Shih
- Department of Neurosurgery, Jen-Ai Hospital, Taichung, Taiwan, R.O.C
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan, R.O.C
| | - Chih-Wei Huang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Chien-Lun Tang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
| | - Hsien-Te Chen
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan, R.O.C
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
- Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Chien-Chun Chang
- Department of Orthopedic Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
- Spine Center, China Medical University Hospital, China Medical University, Taichung, Taiwan, R.O.C
| | - Chung-Yuh Tzeng
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
- Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua County, Taiwan, R.O.C
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10
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Wu H, Li T, Cao J, He D, Wu T, Liu J, Yuan J, Cheng X. Does Percutaneous Endoscopic Lumbar Discectomy for Adolescent Posterior Ring Apophysis Fracture Accompanied with Lumbar Disc Herniation Have Better Outcome Than Lumbar Disc Herniation Alone? J Pain Res 2023; 16:911-919. [PMID: 36960466 PMCID: PMC10028304 DOI: 10.2147/jpr.s380945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Objective This study aims to compare the efficacy of percutaneous endoscopic lumbar discectomy (PELD) in treating adolescent posterior ring apophysis fracture (APRAF) accompanied by lumbar disc herniation (LDH) and lumbar disc herniation alone. Methods Herein we present a case series of adolescent patients who underwent PELD surgery from June 2017 to September 2021. All patients were divided into two distinct groups (ie Group A and B), based on their preoperative Computed tomography (CT) scans. Group A included patients with PRAF (type III) accompanied by LDH. Group B patients had LDH alone. The general clinical characteristics, clinical outcomes, and complications in patients from the two groups were assessed and compared. Results Compared to before surgery, the back and leg visual analog scores (VAS) and Oswestry Disability Index (ODI) were markedly improved in both groups' patients at all follow-ups. Notably, no significant differences were observed in the back and leg VAS scores, and ODI values between the two groups at different time points after surgery. The mean intraoperative blood loss was significantly lower in Group B, relative to Group A. The mean operation time was significantly shorter in Group B, compared to Group A. There was no statistically significant difference in complication and recurrence rates between the two groups. Conclusion APRAF (type III) accompanied by LDH and LDH alone can obtain roughly equal surgical effects through PELD surgery and turns out to be a safe and effective surgical approach.
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Affiliation(s)
- Hui Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Tao Li
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Jian Cao
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Dingwen He
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Tianlong Wu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Jiahao Liu
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Jinghong Yuan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Xigao Cheng
- Department of Orthopaedic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
- Correspondence: Xigao Cheng, Department of Orthopaedics Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China, 330006, Email
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11
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Alhashash M, Gendy H, Shousha M. Extra-laminar microscopic-assisted percutaneous nucleotomy (EL-MAPN) for the treatment of foraminal lumbar disc prolapse, a modified minimally invasive approach. Arch Orthop Trauma Surg 2022; 142:2405-2411. [PMID: 33677658 DOI: 10.1007/s00402-021-03846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE In this work, a modification of the percutaneous surgical approach for removing the lumbar foraminal disc prolapse is introduced. MATERIAL AND METHODS A prospective study was performed. The indication for surgery was foraminal disc prolapse presenting with acute motor or persistent sensory radiculopathy. MRI and X-ray of the lumbar spine were performed. VAS and ODI were recorded. The operation was done under general anesthesia. A needle was inserted for level-localization using C-arm. A 1.5 cm para-median skin incision was performed. A gradual dilatation using trocars was followed by the insertion of a tubular system. Under direct vision using the operative microscope, the lateral edge of the lamina was identified. A small, hooked probe was inserted in the foramen, and its position was documented fluoroscopically. With the help of the microscope, the triad consisting of Pedicle, Nerve root, and Prolapse "PNP" was identified. The nerve root was mobilized, and the prolapsed disc was removed. RESULTS The study included 50 patients, 26 females, and 24 males. The mean follow-up was 18 months. The mean operative time was 65 min. The mean blood loss was 105 ml. The mean VAS improved from 7.8 ± 2.3 preoperatively to 0.8 ± 0.3 after one year (p = 0.001). Mean ODI improved from 28 ± 10.4 to 4 ± 2.3 after one year (p = 0.02). A recurrent disc occurred in 2 patients and was revised in the same technique. CONCLUSION EL-MAPN represents a minimally invasive approach for foraminal disc prolapse removal under direct visual control avoiding injury to the facet joint or pars interarticularis.
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Affiliation(s)
- Mohamed Alhashash
- Department of Spine Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Germany. .,Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt.
| | - Hani Gendy
- Department of Spine Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Germany
| | - Mootaz Shousha
- Department of Spine Surgery, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437, Bad Berka, Germany.,Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt
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12
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Fu Y, Yan YC, Ru XL, Qu HB. Analysis of Chronic Low Back Pain Caused by Lumbar Microinstability After Percutaneous Endoscopic Transforaminal Discectomy: A Retrospective Study. J Pain Res 2022; 15:2821-2831. [PMID: 36120089 PMCID: PMC9480581 DOI: 10.2147/jpr.s380060] [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: 07/10/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Chronic low back pain (CLBP) after percutaneous endoscopic transforaminal discectomy (PTED) surgery may be caused by preoperative lumbar microinstability (MI). However, there is a paucity of research on the relationship between lumbar microinstability and chronic low back pain. The purpose of this article is to assess the preoperative radiographic characteristics of patients and evaluate the effects of lumbar microinstability on patient-reported outcomes among single-level lumbar disc herniation (LDH) patients who underwent PTED. Methods This study retrospectively reviewed the radiographic characteristics of a consecutive series of 127 patients with low back pain and leg pain caused by single-level LDH underwent PTED from August 2018 to March 2021. They were divided into three groups according to the radiographic parameters: the stable group (Group S), the dysfunctional group (Group D), and the microinstability group (Group M). The visual analogue scale (VAS) scores for leg and low back pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Logistic regression analysis was used to identify independent risk factors for CLBP. Results Compared with Group D and Group S, Group M had the highest ODI scores (P < 0.01) and VAS scores (low back pain) (P < 0.01) after 1 year, while there were no significant differences in the VAS scores for leg pain at different time points after surgery (P > 0.05). In addition, the logistic regression analysis results regarding CLBP revealed that muscle fatty degeneration on MRI (95% CI, 1.20-8.51, P = 0.02), and facet tropism (95% CI, 1.39 -11.37, P = 0.01) may be independent risk factors. Conclusion Patients with lumbar microinstability may have CLBP after PTED, so patients with lumbar microinstability may need to take internal fixation surgery to solve their symptoms.
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Affiliation(s)
- Yang Fu
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ying-Chao Yan
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xuan-Liang Ru
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hang-Bo Qu
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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13
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Raak CK, Scharbrodt W, Berger B, Büssing A, Schönenberg-Tu A, Martin DD, Robens S, Ostermann T. Hypericum perforatum to Improve Postoperative Pain Outcome After Monosegmental Spinal Sequestrectomy (HYPOS): Results of a Randomized, Double-Blind, Placebo-Controlled Trial. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:407-417. [PMID: 35171041 DOI: 10.1089/jicm.2021.0389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Introduction: Patients undergoing lumbar spine surgery often suffer from severe radicular postoperative pain leading to the prescription of high-dose opioids. In Integrative Medicine, Hypericum perforatum is known as a remedy to relieve pain caused by nerve damage. Objectives: This trial investigated whether homeopathic Hypericum leads to a reduction in postoperative pain and a decrease in pain medication compared with placebo. Design: Randomized double blind, monocentric, placebo controlled clinical trial. Settings/Location: Department of Neurosurgery, Community Hospital Herdecke. Subjects: Inpatients undergoing lumbar sequestrectomy surgery. Interventions: Homeopathic treatment versus placebo in addition to usual pain management. Outcomes Measures: Primary endpoint was pain relief measured with a visual analog scale. Secondary endpoints were the reduction of inpatient postoperative analgesic medication and change in sensory and affective pain perception. Results: Baseline characteristics were comparable between the groups. Pain perception between baseline and day 3 did not significantly differ between the study arms. With respect to pain medication, total morphine equivalent doses did not differ significantly. However, a statistical trend and a moderate effect (d = 0.432) in the decrease of pain medication consumption in favor of the Hypericum group was observed. Conclusion: This is the first trial of homeopathy that evaluated the efficacy of Hypericum C200 after lumbar monosegmental spinal sequestrectomy. Although no significant differences between the groups could be shown, we found that patients who took potentiated Hypericum in addition to usual pain management showed lower consumption of analgesics. Further investigations, especially with regard to pain medication, should follow to better classify the described analgesic reduction. Clinical Trial Registration Number: German Clinical Trials Register No: DRKS00007913.
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Affiliation(s)
- Christa K Raak
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany.,Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, Herdecke, Germany
| | - Wolfram Scharbrodt
- Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, Herdecke, Germany
| | - Bettina Berger
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Arndt Büssing
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Anna Schönenberg-Tu
- Integrative Neuromedicine, Community Hospital Herdecke, Witten/Herdecke University, Herdecke, Germany
| | - David D Martin
- Institute of Integrative Medicine, Witten/Herdecke University, Herdecke, Germany
| | - Sibylle Robens
- Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Witten, Germany
| | - Thomas Ostermann
- Chair of Research Methodology and Statistics in Psychology, Witten/Herdecke University, Witten, Germany
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14
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Chen B, Du Z. Neurological safety of spinal surgery for nucleus pulposus removal under spinal endoscopic imaging guided by inter laminar spine. Pak J Med Sci 2021; 37:1667-1671. [PMID: 34712303 PMCID: PMC8520364 DOI: 10.12669/pjms.37.6-wit.4880] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/10/2021] [Accepted: 07/03/2021] [Indexed: 11/15/2022] Open
Abstract
Objective To explore the technical points, approach selection and short-term clinical efficacy of PELD through the intervertebral foramina or interlaminar approach in the treatment of highly shifted LDH. Methods From September 2018 to June 2020, 19 patients with highly shifted LDH were treated with PELD in The First Hospital of Yulin. It included, 10 males and 9 females; aged 34 to 69 years, with an average of 48 years. Thirteen cases were shifted to the caudal side, and six cases were shifted to the head side. The responsible segments included L3/41 cases, L4/511 cases, and L5/S17 cases. All patients had symptoms of low back and leg pain. The Sowerby dysfunction index (ODI) was 63.5%±10.7% before surgery. The visual analogue scale of pain (VAS) was low back pain (5.2±2.1) and leg pain (7.1±2.4). 14 cases used transforaminal approach, and 5 cases used translaminar approach. Results All cases completed the operation successfully, the operation time was 60~110min, with an average of 70 minutes. The follow-up time ranged from 6 to 42 months, with an average of 20.8 months. At the last follow-up, ODI was 10.8%±6.8%, VAS back pain score (2.1±1.1) and leg pain score (1.8±0.9). Compared with preoperative, ODI and VAS scores were significantly decreased (P<0.05). The results of Mac Nab method were 14 excellent, four good, and one fair. During the follow-up period, one patient's leg pain symptoms recurred seven days after operation. No further hernia was found under intervertebral foramen. The symptoms disappeared after two weeks of symptomatic treatment such as swelling and analgesia, and he was discharged. No perioperative complications such as infection and nerve root injury occurred. Conclusion When PELD is used to treat high-displacement LDH, the choice of transforaminal approach or interlaminar approach needs to be personalized according to the LDH segment and the direction of displacement.
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Affiliation(s)
- Bin Chen
- Bin Chen, Master of Medicine, Associate Chief Physician, Department of Orthopaedics, Yulin No.2 Hospital, Yulin, 718000, Shaanxi, China
| | - Zengfeng Du
- Zengfeng Du, Master of Medicine, Associate Chief Physician, Department of Orthopaedics, The First Hospital of Yulin, Yulin, 718000, Shaanxi, China
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15
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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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Exploration of percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fracture as day surgery: a retrospective study. 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 2021; 30:2718-2725. [PMID: 34075472 DOI: 10.1007/s00586-021-06887-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/05/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The purpose of this retrospective study was to evaluate and compare the clinical outcomes of patients underwent PVP for OVCF as day surgery with the outcomes of patients managed as traditional inpatients. METHODS According to the selection criteria, patients who underwent PVP for single-segment thoracolumbar OVCF were included retrospectively in the day surgery procedure (DSP) group and the traditional inpatient procedure (TIP) group between April 2018 and September 2019. The visual analog scale score (VAS) and Oswestry Disability Index (ODI) score were recorded preoperatively and 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months after surgery. Duration of hospital stay, preoperative waiting time, hospital cost, and postoperative complications were recorded and analyzed. RESULTS A total of 335 patients (53 in DSP group; 282 in TIP group) were enrolled and completed 12-month follow-up. The mean duration of hospital stay, the mean preoperative waiting time, and the mean hospital costs were significant lower in the DSP group. The postoperative VAS and ODI scores in both groups were significantly improved after surgery. Moreover, both VAS and ODI scores at each follow-up stage were also significantly lower than the previous follow-up stage. However, the ODI score in the DSP group was significantly lower at 1-day, 1-week, 1-month, and 3-month follow-up, respectively. For cement leakage and secondary vertebral compression fractures, there was no statistical difference between the two groups. CONCLUSIONS We suggest that PVP for OVCFs in day surgery procedure is worthy of wide application.
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Wang A, Yu Z. Comparison of Percutaneous Endoscopic Lumbar Discectomy with Minimally Invasive Transforaminal Lumbar Interbody Fusion as a Revision Surgery for Recurrent Lumbar Disc Herniation after Percutaneous Endoscopic Lumbar Discectomy. Ther Clin Risk Manag 2020; 16:1185-1193. [PMID: 33363376 PMCID: PMC7754645 DOI: 10.2147/tcrm.s283652] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/09/2020] [Indexed: 01/21/2023] Open
Abstract
Objective The purpose of this study was to compare the outcomes between percutaneous endoscopic lumbar discectomy (PELD) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the revision surgery for recurrent lumbar disc herniation (rLDH) after PELD surgery. Patients and Methods A total of 46 patients with rLDH were retrospectively assessed in this study. All the patients had received a PELD in Peking University First Hospital between January 2015 and June 2019, before they underwent a revision surgery by either PELD (n=24) or MIS-TLIF (n=22). The preoperative data, perioperative conditions, complications, recurrence condition, and clinical outcomes of the patients were compared between the two groups. Results Compared to the MIS-TLIF group, the PELD group had significantly shorter operative time, less intraoperative hemorrhage, and shorter postoperative hospitalization, but higher recurrence rate (P<0.05). Complication rates were comparable between the two groups. Both groups had satisfactory clinical outcomes at a 12-month follow-up after the revision surgery. The PELD group also showed significantly lower visual analog scale (VAS) scores of back pain and Oswestry disability index (ODI) in one month after the revision surgery, whereas the difference was not detectable at six- and 12-month follow-ups. Conclusion Both PELD and MIS-TLIF are effective as a revision surgery for rLDH after primary PELD. PELD is superior to MIS-TLIF in terms of operative time amount of intraoperative hemorrhage and postoperative hospitalization. However, its higher postoperative recurrence rate must be considered and patients should be well informed, when making a decision between the two surgical approaches.
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Affiliation(s)
- Anqi Wang
- Department of Orthopedics, Peking University First Hospital, Peking, People's Republic of China
| | - Zhengrong Yu
- Department of Orthopedics, Peking University First Hospital, Peking, People's Republic of China
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