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Wu Z, Sun H, Zhang Y, Xiao L, Zhao Q. Biomechanical Finite Element Analysis of Percutaneous Endoscopic Lumbar Discectomy via a Transforaminal Approach. World Neurosurg 2024; 185:e291-e298. [PMID: 37898267 DOI: 10.1016/j.wneu.2023.10.108] [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: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE Based on the previously established 3-dimensional model, this study uses the finite element analytical method to observe the effects of superior articular process resection and intervertebral discectomy on the stress of the surgical segment under different motion states. METHODS A validated L3-S1 finite element model was modified for simulation. And on the basis of the normal lumbar spine model, the superior articular process and discs of different parts of L4-L5 were simulated for resection. The resection models were divided into 6 groups, and the stress characteristics of articular process and discs of the lumbar spine under different postoperative motion conditions were examined under the same loading conditions. RESULTS Simultaneous resection of the tip and base of the superior articular process increased the stress on the facet joint under various motion states compared with separate resections. In addition, the fewer herniated discs that are removed, the smaller the increase in facet joint stress. excision of the tip of the superior articular process caused a smaller stress increase in the facet joint than excision of the base under the forward bending and right-lateral flexion, and the opposite results were found under left-lateral flexion, posterior extension, and rotation. Resection of the tip of the superior articular process increases disc stress more than resection of the base of the superior articular process. CONCLUSIONS Select resection of the superior articular process base as much as possible to expose the target of the disc. And minimize annulus damage and disc removal.
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Affiliation(s)
- Zhongxuan Wu
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Hongzhou Sun
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Yu Zhang
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Liang Xiao
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Quanlai Zhao
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China.
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Li Q, Luan J, Lin Y, Kong M, Guo X, Zhao J. The effects of psychological distress after surgery in patients undergoing lumbar spinal fusion. BMC Musculoskelet Disord 2024; 25:289. [PMID: 38614982 PMCID: PMC11015628 DOI: 10.1186/s12891-024-07364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/20/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND The aim of this study was to evaluate the psychological distress pre-operatively, at 3, 6, and 12 months in patients who underwent lumbar spine fusion surgery. METHODS A total of 440 patients received instrumented lumbar spine fusion were enrolled. Psychological distress was evaluated using the Modified Somatic Perception Questionnaire (MSPQ) and the Modified Zung Depressive Index (ZDI). The results of lumbar fusion surgery were evaluated using the Oswestry Disability Index (ODI), the Japanese Orthopedic Association (JOA-29), and the visual analog scale (VAS). RESULTS Psychological distress was reported among 23% of patients and 7, 5.5, and 4.0% of the patients preoperatively, at 3, 6, and 12 months after lumbar surgery, respectively. The mean MSPQ score decreased from 8.78 (before surgery) to 4.30, 3.52, and 3.43 at 3, 6 and 12 months in after surgery, respectively, in patients with psychological distress patients (p < 0.001). The mean ZDI score decreased from 17.78 to 12.48, 10.35, and 9.61 (p < 0.001). The mean ODI score decreased from 22.91 to 11.78, 10.13, and 9.96 (P < 0.001). The mean JOA score increased from 13.65 to 22.30, 23.43, and 23.61 (P < 0.001). The mean low back pain (LBP) VAS score decreased from 4.48 to 1.96, 1.52, and 1.51 (P < 0.001); moreover, the mean leg pain (LP) VAS score decreased from 5.30 to 1.30, 1.04, and 1.03 (P < 0.001). CONCLUSIONS Patients with psychological distress may experience surgical intervention benefits equal to those of ordinary patients. Moreover, reduced pain and disability after surgical intervention may also alleviate psychological distress. Hence, we highly recommend that patients with psychological distress undergo surgical intervention as normal patients do, but appropriate screening measures and interventions are necessary.
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Affiliation(s)
- Qiang Li
- Department of Spine Surgery, Qingdao Municipal Hospital Group, No.5 Donghai Middle Road, Shinan District, Qingdao, 266000, China
| | - Jian Luan
- Department of Spine Surgery, Qingdao Municipal Hospital Group, No.5 Donghai Middle Road, Shinan District, Qingdao, 266000, China
| | - Yong Lin
- Department of Spine Surgery, Qingdao Municipal Hospital Group, No.5 Donghai Middle Road, Shinan District, Qingdao, 266000, China
| | - Meng Kong
- Department of Spine Surgery, Qingdao Municipal Hospital Group, No.5 Donghai Middle Road, Shinan District, Qingdao, 266000, China
| | - Xinhu Guo
- Department of Orthopaedics, Peking University Third Hospital, No.49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - Jindong Zhao
- Department of Spine Surgery, Qingdao Municipal Hospital Group, No.5 Donghai Middle Road, Shinan District, Qingdao, 266000, China.
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Li J, Xing G, Lu P, Ding Y. Paravertebral Muscular Neurophysiological Function as an Independent Outcome Predictor of Recurring Herniation/Low Back Pain after Radiofrequency Ablation: A Prospective Follow-Up and Case-Control Study Based on Surface Electromyography. Orthop Surg 2024; 16:724-732. [PMID: 38183345 PMCID: PMC10925511 DOI: 10.1111/os.13981] [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: 09/04/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE Spinal endoscopy radiofrequency is a minimally invasive technique for lumbar disc herniation (LDH) and low back pain (LBP). However, recurring LDH/LBP following spinal endoscopy radiofrequency is a significant problem. Paravertebral musculature plays a crucial role in spine stability and motor function, and the purpose of the present study was to identify whether patients' baseline lumbar muscular electrophysiological function could be a predictor of recurring LDH/LBP. METHODS This was a prospective follow-up and case-control study focusing on elderly patients with LDH who were treated in our department between January 1, 2018, and October 31, 2021. The end of follow-up was recurring LBP, recurring LDH, death, missing to follow-up or 2 years postoperation. The surface electromyography test was performed before the endoscopy C-arm radiofrequency (ECRF) operation to detect the flexion-relaxation ratio (FRR) of the lumbar multifidus (FRRLM ) and the longissimus erector spinae (FRRES ), and the other baseline parameters included the general characteristics, the visual analogue scale, the Japanese Orthopaedic Association score, and the Oswestry Disability Index. Intergroup comparisons were performed by independent t-test and χ2 -test, and further binary logistic regression analysis was performed. RESULTS Fifty-four patients completed the 2-year follow-up and were retrospectively divided into a recurring LDH/LBP group (Group R) (n = 21) and a no recurring group (Group N) (n = 33) according to their clinical outcomes. FRRLM and FRRES in Group N were much higher than those in Group R (p < 0.001, p = 0.009). Logistic regression analysis showed that only the FRRLM (odds ratio [OR] = 0.123, p = 0.011) and FRRES (OR = 0.115, p = 0.036) were independent factors associated with the ECRF outcome. CONCLUSIONS Lumbar disc herniation patients' baseline FRRLM and FRRES are independent outcome predictors of recurring LDH/LBP after ECRF. For every unit increase in baseline FRRLM , the risk of recurring LDH/LBP is decreased by 87.7%, and for every unit increase in baseline FRRES , the risk of recurring LDH/LBP is decreased by 88.5%.
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Affiliation(s)
- Jian Li
- Department of OrthopaedicsChina Aerospace Science & Industry Corporation Hospital 731BeijingChina
- Department of OrthopaedicsThe Third Medical Center of PLA General HospitalBeijingChina
| | - Gengyan Xing
- Department of OrthopaedicsThe Third Medical Center of PLA General HospitalBeijingChina
| | - Pengfei Lu
- Department of OrthopaedicsThe People's Hospital of Changshou ChongqingChongqingChina
| | - Yi Ding
- Department of OrthopaedicsThe Third Medical Center of PLA General HospitalBeijingChina
- Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation Technical AidsBeijingChina
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Zhang ZH, Du Q, Wu FJ, Liao WB. Optimal approach for total endoscopic discectomy and its effect on lumbar and leg function in patients with disc herniation. World J Clin Cases 2022; 10:12928-12935. [PMID: 36569011 PMCID: PMC9782947 DOI: 10.12998/wjcc.v10.i35.12928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Disc herniation (DH) is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus. It is a common cause of lumbar and leg pains. Substantial advancements have been made to determine the cause of DH and to ensure accurate diagnosis, imaging, and treatment of this condition. Total endoscopic discectomy is an alternative surgical technique that is less invasive.
AIM To study the optimal approach for a total endoscopic discectomy and its influence on lumbar and leg function in DH patients.
METHODS This prospective study enrolled 120 patients with lumbar DH who were treated in our hospital from February 2018 to January 2021. All patients were randomly divided into the following two groups: The observation group, comprising 62 patients who underwent surgery using the interlaminar approach, and the control group, comprising 58 patients who were operated through the foramina approach. The treatment effects, perioperative indicators, functional recovery, pain, and quality of life were compared between the two groups.
RESULTS The treatment effect in the observation group (93.55%) was significantly better than that in the control group (77.59%). There was no difference in the operative time and intraoperative blood loss amount between the two groups (P > 0.05). The hospitalization time of the observation group (4.34 ± 1.33 d) was significantly shorter than that of the control group (5.38 ± 1.57 days) (P < 0.05). The Japanese Orthopaedic Association and Oswestry Disability Index scores decreased significantly in both groups after treatment, but the scores were lower in the observation group than in the control group. The visual analog scale scores of the lower back and legs of the two groups were significantly reduced after treatment, but scores were lower in the observation group (2.18 ± 0.88 in the lower back and 1.42 ± 0.50 in the leg) than in the control group (3.53 ± 0.50 in the lower back and 2.21 ± 0.52 in the leg). A short form of the Arthritis Impact Measurement Scales 2 measurement scale (AIMS2-SF) score and Barthel index of the lower back of the two groups increased significantly after treatment, with the observation group having a significantly higher AIMS2-SF score (95.16 ± 1.74) and Barthel index (97.29 ± 1.75) than the control group (84.95 ± 2.14 and 89.16 ± 2.71, respectively) (P < 0.05).
CONCLUSION Through total endoscopic discectomy with the interlaminar approach, the degree of pain in the waist and leg was reduced, and the lumbar function considerably recovered.
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Affiliation(s)
- Zi-Han Zhang
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Qian Du
- Department of Orthopaedics, The Second Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Fu-Jun Wu
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
| | - Wen-Bo Liao
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
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Zhang Y, Wu J, Qin Z, Deng Y, Li M, Li Y. Clinical Features and Management of Seizure After Percutaneous Endoscopic Spine Surgery: A Retrospective Case Series Analysis. World Neurosurg 2022; 167:e891-e903. [PMID: 36041725 DOI: 10.1016/j.wneu.2022.08.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To describe the perioperative clinical features, management, and outcomes of patients with seizure after percutaneous endoscopic spine surgery (PESS). METHODS Patients who experienced seizure after PESS in a tertiary orthopedic hospital between January 2016 and June 2022 were retrospectively recruited, and patient charts were reviewed. RESULTS Twenty-nine patients were recruited, and the incidence of seizure after PESS was 0.52%. The operation time was 110.0 minutes (interquartile range [IQR], 82.5-235.0 minutes) and the irrigation speed was 109.0 mL/minute (IQR, 86.5-145.5 mL/minute). Definitive dural tears were reported in 15 patients (51.7%). In addition to agitation and myotonia, significant increased respiratory rate (29.9 ± 6.5 breaths/minute), tachycardia (112.1 ± 20.6 beats/minute), and hypertension (systolic, 189.5 ± 21.9 mm Hg; diastolic, 98.3 ± 10.6 mm Hg) were observed. Arterial blood gas analysis showed hypocapnia, metabolic acidosis, and hyperlactatemia. All patients received analgesia and sedation as well as hyperosmolar therapy. The estimated duration of seizure was 3.0 hours (IQR, 2.5-4.0 hours) and the postoperative length of hospital stay was 3.0 (IQR, 3.0-5.5) days. The Japanese Orthopaedic Association score and visual analog scale score improved markedly within 6 months after surgery. CONCLUSIONS Despite the low incidence and short duration, seizure after PESS should be considered a critical and urgent syndrome. Management strategies for seizure mainly involve intensive care, securing the airway, analgesia and sedation, hyperosmolar therapy, and negative fluid balance. No significant adverse effects of seizure on clinical outcomes were observed during 6 months of follow-up.
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Affiliation(s)
- Ying Zhang
- Intensive Care Unit, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, PR China
| | - Ji Wu
- Department of Spinal Surgery, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, PR China
| | - Zhijun Qin
- Intensive Care Unit, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, PR China.
| | - Yang Deng
- Intensive Care Unit, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, PR China
| | - Man Li
- Department of Anesthesiology, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, PR China
| | - Yue Li
- Department of Spinal Surgery, Sichuan Province Orthopedic Hospital, Chengdu, Sichuan, PR China
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6
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Mao L, Wang K, Huang Y, Wang F, Zhang R, Zhu B, Wu X. Transforaminal Endoscopic Lumbar Discectomy for Lumbosacral Junction Adolescent Lumbar Disc Herniation with High Iliac Crests. Orthop Surg 2022; 14:1715-1722. [PMID: 35768829 PMCID: PMC9363714 DOI: 10.1111/os.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the clinical results of transforaminal endoscopic lumbar discectomy for lumbosacral junction adolescent lumbar disc herniation with high iliac crest. Methods From February 2014 to September 2020, a retrospective analysis of 96 patients less than 21 years old with intervertebral disc herniation was carried out. We enrolled 44 patients diagnosed with lumbosacral junction disc herniation with high iliac crest who required transforaminal endoscopic lumbar discectomy. Pain in the back and the lower extremity was scored on Numeric Rating Scales (NRS) scores. Patient outcomes were graded as excellent, good, fair, and poor using modified MacNab criteria. The NRS scores before and after the operation were compared using the Wilcoxon two‐sample test. Results There were 30 male patients and 14 females. One patient underwent repeat surgery for an intervertebral disc pseudocyst. The NRS scores decreased significantly in both early and late follow‐up evaluations (p < 0.05). At the last follow‐up, 42 patients (95.45%) had an excellent outcome, one patient (2.27%) had a good outcome, and one patient (2.27%) had a fair outcome. The overall success rate was 97.7%. Conclusion This study's data suggest that targeted individualized foraminoplasty can effectively overcome the lumbosacral anatomical obstacles, and transforaminal endoscopic lumbar discectomy is an effective and valid option for lumbosacral junction adolescent lumbar disc herniation with high iliac crest.
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Affiliation(s)
- Lu Mao
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kun Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yong Huang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Feng Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Rui Zhang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bin Zhu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaotao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Yang L, Pan YL, Liu CZ, Guo DX, Zhao X. A retrospective comparative study of local anesthesia only and local anesthesia with sedation for percutaneous endoscopic lumbar discectomy. Sci Rep 2022; 12:7427. [PMID: 35523922 PMCID: PMC9076919 DOI: 10.1038/s41598-022-11393-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 04/20/2022] [Indexed: 12/28/2022] Open
Abstract
It is still an unsolved problem to achieve both immediate intraoperative feedback and satisfactory surgical experience in percutaneous endoscopic lumbar discectomy under local anesthesia for lumbar disk herniation (LDH) patients. Herein, we compared the analgesic and sedative effects of local anesthesia alone and local anesthesia with conscious sedation in LDH patients during percutaneous endoscopic lumbar discectomy. Ninety-two LDH patients were enrolled and divided into the following groups: control group (Con Group), dexmedetomidine group (Dex Group), oxycodone group (Oxy Group), and dexmedetomidine + oxycodone group (Dex + Oxy Group). Various signs, including mean arterial pressure (MAP), heart rate (HR), pulse oximeter oxygen saturation (SpO2) and Ramsay score, were compared before anesthesia (T1), working cannula establishment (T2), nucleus pulposus removal (T3), and immediately postoperation (T4). Clinical outcomes, including VAS score, operation time, hospitalization period, Macnab criteria, and SF-36 score, were also evaluated. The Dex + Oxy Group showed the most stable MAP and HR at T2 and T3 in all groups. The clinical outcomes, such as VAS, hospitalization period, Macnab criteria, and SF-36 score, have no significant differences among groups (p > 0.05). Local anesthesia combined with conscious sedation is a safe and effective method to improve the surgical experience and achieve satisfying clinical outcomes for LDH patients during percutaneous endoscopic lumbar discectomy.
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Affiliation(s)
- Liu Yang
- Department of Spinal Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, Henan Province, China
| | - Yu-Lin Pan
- Department of Spinal Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, Henan Province, China
| | - Chun-Zhi Liu
- Department of Spinal Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, Henan Province, China
| | - De-Xin Guo
- Department of Spinal Surgery, Zhengzhou Orthopaedic Hospital, Zhengzhou, Henan Province, China
| | - Xin Zhao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, Jilin Province, China.
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Zhang J, Li Q, Du Y, Yan Z, Chen L, Wang L. Efficacy Analysis of Percutaneous Endoscopic Spinal Surgery for Young Patients with Discogenic Low Back Pain. J Pain Res 2022; 15:665-674. [PMID: 35264884 PMCID: PMC8901256 DOI: 10.2147/jpr.s351296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the application value of percutaneous endoscopic spinal surgery for young patients with discogenic low back pain (DLBP) and to judge its clinical efficacy. Methods We retrospectively analyzed young patients with single-segment discogenic lumbago from July 2018 to June 2020 in our department who underwent percutaneous endoscopic surgery according to the inclusion and exclusion criteria. We finally enrolled 20 patients. The follow-up time was 6–30 months. In all patients, we recorded the visual analog scale (VAS) score for waist pain and the Oswestry Disability Index (ODI) preoperatively, immediately postoperatively and at the last follow-up. We used the modified MacNab criteria to assess the curative effect at the last follow-up. Results All 20 patients underwent successful operations without complications. No recurrence was observed during follow-up. The VAS score of low back pain was 5.05±1.19 points before surgery, 1.50±051 points immediately after surgery, and 1.10±0.72 points at the last follow-up (P < 0.05 preoperative vs both postoperative). At the last follow-up, the VAS scores of all 20 patients were ≤2, and 4 patients had no pain. The ODI was 46.66±7.03% before surgery, 9.78±4.05% immediately after surgery, and 4.11±3.18% at the last (P < 0.05, preoperative vs both postoperative). According to the evaluation under the modified MacNab standard, the good–excellent rate of clinical efficacy at the last follow-up was 95%. Conclusion Percutaneous endoscopic spinal surgery can significantly improve the symptoms and dysfunction of young patients with DLBP and has little effect on the biomechanical stability of the lumbar spine. This surgery has great clinical application value.
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Affiliation(s)
- Jianan Zhang
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Qichang Li
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Yu Du
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Zhengjian Yan
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
| | - Liang Chen
- Department of Musculoskeletal Tumor, Chongqing University Cancer Hospital & Chongqing Cancer Institute & Chongqing Cancer Hospital, Chongqing, 400030, People’s Republic of China
| | - Liyuan Wang
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China
- Correspondence: Liyuan Wang, Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People’s Republic of China, Tel +89-13648380803, Email
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9
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Li P, Yang F, Tong Y, Chen Y, Song Y. Comparison of Percutaneous Transforaminal Endoscopic Decompression and Transforaminal Lumbar Interbody Fusion in the Treatment of Single-Level Lumbar Disc Herniation with Modic Type I Changes. J Pain Res 2021; 14:3511-3517. [PMID: 34785948 PMCID: PMC8590533 DOI: 10.2147/jpr.s338342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022] Open
Abstract
Background Modic changes (MC) are generally considered to be related to degenerative disc disease, and there is no uniform standard for surgical methods for lumbar disc herniation (LDH) accompanied by Modic type I changes (MC I). The purpose of this study was to observe the clinical results of percutaneous transforaminal endoscopic decompression (PTED) and transforaminal lumbar interbody fusion (TLIF) for treatment of LDH accompanied by MC I. Methods Of the 53 consecutive patients included, 29 underwent PTED and 24 underwent TLIF. All patients were followed up for at least 24 months. Preoperative demographic characteristics, perioperative outcomes, and clinical outcomes were recorded. Visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, and modified Macnab criteria were used to assess clinical results. Results The mean age was 53.7±9.2 years in the PTED group and 53.6±9.6 years in the TLIF group. The scores of VAS legs, VAS back and ODI in the two groups after operation were significantly improved compared with those before operation (P<0.05). Notably, the VAS back pain score and ODI in the PTED group showed an increasing trend with time. And the VAS back pain scores and ODI of the two groups were statistically different at 1 year and 2 years postoperatively (P<0.05). In addition, compared with the TLIF group, the PTED group showed less operation time, blood loss, and postoperative hospital stay (P<0.05). At the final follow-up, the excellent rates were 91.7% and 86.2% in the fusion and PTED groups, respectively. Conclusion Both PTED and TLIF procedures significantly improved the clinical symptoms of single-level LDH patients with MC I. Compared with TLIF, MC I may affect the improvement of low back pain and functional status after PTED.
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Affiliation(s)
- Pengfei Li
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People's Republic of China
| | - Fengkai Yang
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People's Republic of China
| | - Yuexin Tong
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People's Republic of China
| | - Ying Chen
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People's Republic of China
| | - Youxin Song
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, 067000, People's Republic of China
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10
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Li P, Yang F, Chen Y, Song Y. Percutaneous transforaminal endoscopic discectomy for different types of lumbar disc herniation: A retrospective study. J Int Med Res 2021; 49:3000605211055045. [PMID: 34706589 PMCID: PMC8558600 DOI: 10.1177/03000605211055045] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To introduce the concept of ‘nerve root as the core’ and to investigate the surgical procedure and curative effect of percutaneous translaminar endoscopic discectomy (PTED) surgery in the treatment of different types of lumbar disc herniation (LDH). Methods This retrospective study analysed the clinical data from patients with LDH that underwent single-segment PTED surgery. They were divided into three groups based on LDH location: central canal zone group, lateral recess zone group and foraminal/far lateral zone group. Different working cannula placement methods were used for the different types of LDH. All patients were followed for at least 12 months. Clinical and follow-up data were compared between the three groups. Results A total of 130 patients were enrolled in the study: 44 (33.8%) in the central canal zone group, 72 (55.4%) in the lateral recess zone group and 14 (10.8%) in the foraminal/far lateral zone group. All three groups of patients achieved good postoperative results. The improvements in leg pain and disability were most marked in the first postoperative month in all three groups. Conclusion PTED achieved adequate decompression for different types of LDH. The concept of ‘nerve root as the core’ facilitated the accurate placement of the working cannula.
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Affiliation(s)
- Pengfei Li
- Department of Graduate School, Chengde Medical University, Chengde, Hebei Province, China.,Department of Orthopaedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
| | - Fengkai Yang
- Department of Graduate School, Chengde Medical University, Chengde, Hebei Province, China.,Department of Orthopaedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
| | - Ying Chen
- Department of Graduate School, Chengde Medical University, Chengde, Hebei Province, China.,Department of Rehabilitation, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
| | - Youxin Song
- Department of Orthopaedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
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Mao L, Zhu B, Wu XT. One-Stage Percutaneous Endoscopic Lumbar Discectomy for Symptomatic Double-Level Contiguous Adolescent Lumbar Disc Herniation. Orthop Surg 2021; 13:1532-1539. [PMID: 34080296 PMCID: PMC8313176 DOI: 10.1111/os.13097] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/21/2022] Open
Abstract
Objective To assess the clinical efficacy of one‐stage percutaneous endoscopic lumbar discectomy (PELD) for symptomatic double‐level contiguous adolescent lumbar disc herniation (ALDH). Methods This retrospective study included 16 patients who presented with back and/or leg pain due to double‐level disc herniation underwent PELD for symptomatic lumbar disc herniation (0.27%,16/5877) from January 2014 to September 2019. After follow‐up period of 17.3 months in average, numeric rating scale (NRS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results. Quantitative data were expressed as mean standard deviation (SD) and the data for the variation in the NRS scores before and after the operation were compared using the Wilcoxon two‐sample test. Analyses were performed with IBM SPSS Statistics for Windows, version 19.0 (IBM, Armonk, NY, USA). Values of P < 0.05 were considered significantly different. Results There were 11 male and 5 female patients, with an average age of 19.3 years (range, 15–22 years). One case affected the L2‐ L3 /L3‐L4 level, seven cases affected the L3‐ L4 /L4‐ L5 level, and eight cases affected the L4‐ L5 /L5‐S1 level. The NRS scores decreased significantly in both early and late follow‐up evaluations and these scores demonstrated significant improvement in late follow‐up (P < 0.05). For the modified Macnab criteria, the final outcome results were excellent in 14 patients (87.5%), good in 1 patient (6.25%), fair in 1 patient (6.25%), and the overall success rate was 93.75%. Conclusion This study's data suggest that one‐stage PELD is promising treatment strategy for selected symptomatic double‐level contiguous adolescent lumbar disc herniation.
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Affiliation(s)
- Lu Mao
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bin Zhu
- Pain medicine Center, Peking University Third Hospital, Beijing, China
| | - Xiao-Tao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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