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Li Z, Yang H, Zhang Y, Han C, Liu Y, Guan L, Yang J, Hai Y, Pan A. Percutaneous endoscopic transforaminal discectomy and unilateral biportal endoscopic discectomy for lumbar disc herniation: a comparative analysis of learning curves. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2154-2165. [PMID: 38727735 DOI: 10.1007/s00586-024-08293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/14/2024] [Accepted: 04/29/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the learning curve of percutaneous endoscopic transforaminal discectomy (PETD) and interlaminar unilateral biportal endoscopic discectomy (UBED) in the treatment of lumbar disc herniation (LDH). METHODS Between 2018 and 2023, 120 consecutive patients with lumbar disc herniation (LDH) treated by endoscopic lumbar discectomy were retrospectively included. The PETD group comprised 87 cases, and the UBED group comprised 33 cases. Cumulative sum analysis was used to evaluate the learning curve, with the occurrence of complications or unresolved symptoms defined as surgical failure, and variables of different phases of the learning curve being compared. RESULTS The learning curve analysis identified the cutoff point at 40 cases in the PETD group and 15 cases in the UBED group. In the mastery phase, both PETD and UBED demonstrated a significant reduction in operation times (approximately 38 min for PTED and 49 min for UBED). In both PETD and UBED groups, the surgical failure rates during the learning and mastery phases showed no statistically significant differences. The visual analogue scale at the last follow-up was significantly lower than before surgery in both the PETD and UBED groups. CONCLUSION PETD and UBED surgery are effective in the treatment of LDH with a low incidence of complications. However, achieving mastery in PETD necessitates a learning curve of 40 cases, while UBED requires a minimum of 15 cases to reach proficiency.
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Affiliation(s)
- Zhangfu Li
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Honghao Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Yaoshen Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Chaofan Han
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Li Guan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Jincai Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China.
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China.
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China.
- Center for Spinal Deformity, Capital Medical University, Beijing, China.
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China.
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China.
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China.
- Center for Spinal Deformity, Capital Medical University, Beijing, China.
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Sang D, Guo J, Meng H, Zhang L, Sang H. Global Trends and Hotspots of Minimally Invasive Surgery in Lumbar Spinal Stenosis: A Bibliometric Analysis. J Pain Res 2024; 17:117-132. [PMID: 38196967 PMCID: PMC10775802 DOI: 10.2147/jpr.s440723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
Objective The popularity of minimally invasive surgery for lumbar spinal stenosis (LSS) has been steadily increasing worldwide. This study aims to conduct a comprehensive bibliometric analysis to identify global trends and hotspots in the research related to this surgical approach. Methods Select articles related to the field that were retrieved from the Web of Science Core Collection (WoSCC) between January 1, 1993 and December 31, 2022. Visualization of networks and in-depth bibliometric analyses, including the number of publications, countries/regions, institutions, journals, authors, keywords, and references, were conducted using VOSviewer and CiteSpace software. Results A total of 1197 papers were identified over a three-decade period, with the highest production year being 2022, which saw 171 papers published. The most prolific countries/regions were the United States (279) and Harvard Medical School (59). Among journals, Spine (3289 citations) was the most cited, while World Neurosurgery (98 publications) had the highest number of publications. Lewandrowski, Kai-Uwe (29 publications) wrote the most articles, and Ahn, Y (239 citations) ranked first among cited authors. The most frequently used keyword was "discectomy", but recent years have shown a strong emergence of keywords such as "microendoscopic decompressive laminotomy", "foraminotomy" and "classification". Conclusion The United States and China have emerged as leaders in the field of minimally invasive surgery for LSS. Endoscopic spinal surgery is recognized as a critical approach, with ongoing research focused on indications, potential complications, minimally invasive anatomical approaches, and outcomes. Furthermore, there is a strong emphasis on optimizing the surgical process, which has become a trending and hot spot in current research. The improvement of surgical techniques is at the forefront of advancements in this field.
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Affiliation(s)
- Dacheng Sang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wannan Medical College, Wuhu, Anhui, 241001, People’s Republic of China
| | - Jinyang Guo
- Department of Orthopaedic Surgery, Chifeng Clinical Medical College of Inner Mongolia Minzu University, Chifeng, Inner Mongolia, 024000, People’s Republic of China
| | - Hanlu Meng
- Department of Orthopaedic Surgery, Chifeng Clinical Medical College of Inner Mongolia Minzu University, Chifeng, Inner Mongolia, 024000, People’s Republic of China
| | - Luofei Zhang
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, 100000, People’s Republic of China
| | - Hongpeng Sang
- Department of Orthopaedic Surgery, Affiliated Hospital of Chifeng University, Chifeng, Inner Mongolia, 024000, People’s Republic of China
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Feng Z, Wu Y, Wu H, Jon TG, Yuan Y, Chen Z, Wang Y. A Modified Laminotomy for Interlaminar Endoscopic Lumbar Discectomy: Technical Report and Preliminary Results. Neurospine 2023; 20:1513-1523. [PMID: 38171317 PMCID: PMC10762391 DOI: 10.14245/ns.2346572.286] [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: 05/15/2023] [Revised: 07/11/2023] [Accepted: 07/18/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To introduce a technique of laminotomy using a common trephine to enlarge the interlaminar space at L4/5 segment for interlaminar endoscopic lumbar discectomy (IELD) and report the anatomical basis of this procedure, technical details, as well as primary clinical outcomes of a consecutive patient cohort with L4/5 lumbar disc herniation (LDH). METHODS On anteroposterior fluoroscopy, the intersection of the medial edge of the inferior articular process and the inferior endplate of L4 vertebra was taken as the target. Using a common trephine, laminotomy was performed to remove a big portion of the posterior wall of the canal under the guidance of endoscopy. From June 2018 to December 2021, the consecutive patients who underwent L4/5 IELD were prospectively studied. Clinical outcomes were assessed at the day before surgery, 1 day, 1 month, 3 months, 12 months after surgery, and the last follow-up. Numerical Rating Scale, Roland-Morris Disability Questionnaire (RMDQ), and MacNab criteria were used to evaluate back and leg pain, the quality of life, and clinical efficacy, respectively. RESULTS There were 64 men and 44 women, with an age of 50.3 ± 14.9 years. The operating time was 74.54 ± 17.42 minutes. The mean follow-up time was 32.7 ± 18.6 months (range, 12-64 months). The complications of IELD included numbness, neck pain, and recurrence. Both leg pain (6.2 ± 1.9 vs. 1.8 ± 0.8, p < 0.001) and back pain (3.1 ± 2.3 vs. 1.7 ± 0.9, p < 0.001) quickly improved after this procedure and maintained (1.1 ± 1.5, 1.1 ± 1.3) at final follow-up. Physical disability due to back pain, as assessed using RMDQ, was improved remarkably after surgery (15.0 ± 5.8 vs. 2.9 ± 4.1, p < 0.001). In addition, MacNab outcome grade was evaluated as good-to-excellent in 96 cases (88.9%). CONCLUSION A convenient technique of laminotomy using a common trephine was proposed for the L4/5 IELD. It can efficiently enlarge the interlaminar entry to perform endoscopic discectomy. This procedure is particularly suitable for treating LDH with concomitant lumbar spinal stenosis and migrated herniated disc.
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Affiliation(s)
- Zhiyun Feng
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxu Wu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Honghao Wu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tae Gyong Jon
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Yuan
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhong Chen
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Calek AK, Tsagkaris C, Fasser MR, Widmer J, Hagel V, Farshad M. Biomechanical limitations of partial pediculectomy in endoscopic spine surgery. Spine J 2023; 23:1088-1095. [PMID: 36805375 DOI: 10.1016/j.spinee.2023.02.005] [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: 09/27/2022] [Revised: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND CONTEXT Transforaminal endoscopic decompression is an emerging minimally invasive surgical technique in spine surgery. The biomechanical effects and limitations of resections associated with this technique are scarce. PURPOSE The objective of this study was to analyze the effects of three different extents of reduction at the craniomedial pedicle (10%, 25%, and 50%) and to compare them with the intact native side. In addition, the influence of bone quality on the resistance of the pedicle after reduction was investigated. STUDY DESIGN Biomechanical cadaveric study. METHODS Thirty lumbar vertebrae originating from six fresh frozen cadavers were tested under uniaxial compression load in a ramp-to-failure test: (1) the reduced pedicle on one side, and (2) the native pedicle on the other side. Of the 30 lumbar vertebrae, ten were assigned to each reduction group (10%, 25%, and 50%). RESULTS On the intact side, the median axial compression force to failure was 593 N (442.4-785.8). A reduction of the pedicle by 10% of the cross-sectional area resulted in a decrease of the axial load resistance by 4% to 66% compared to the intact opposite side (p=.046). The median compression force to failure was 381.89 N (range: 336-662.1). A reduction by 25% resulted in a decrease of 7% to 71% (p=.001). The median compression force to failure was 333 N (265.1-397.3). A reduction by 50% resulted in a decrease of 39% to 90% (p<.001). The median compression force to failure was 200.9 N (192.3-283.9). At 10% pedicle reduction, the Hounsfield units (HU) value and the absolute force required to generate a pedicle fracture showed significant correlations (ρ=.872; p=.001). At 25%, a positive correlation between the two variables could still be identified (ρ=.603; p=.065). At 50%, no correlation was found (ρ=-.122; p=.738). CONCLUSION Resection of the inner, upper part of the pedicle significantly reduces the axial resistance force of the pedicle until a fracture occurs. CLINICAL SIGNIFICANCE The extent of pedicle reduction itself plays only a limited role: once the cortical bone in the pedicle region is compromised, significant loss of resistance to loading must be anticipated.
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Affiliation(s)
- Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
| | - Christos Tsagkaris
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland; Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Jonas Widmer
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland; Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Vincent Hagel
- Spine Center, Asklepios Klinik Lindau, Lindau, Germany
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
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Wu W, Yu R, Hao H, Yang K, Jiao G, Liu H. Visible trephine-based foraminoplasty in PTED leads to asymmetrical stress changes and instability in the surgical and adjacent segments: a finite element analysis. J Orthop Surg Res 2023; 18:431. [PMID: 37312161 DOI: 10.1186/s13018-023-03916-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023] Open
Abstract
This study aimed to construct a multi-segment lumbar finite element model (FEM) of PTED surgery to analyze the changes in stress and ROM after visible trephine-based foraminoplasty. The CT scans of a 35-year-old healthy male were used to develop a multi-segment lumbar FEM with Mimic, Geomagic Studio, Hypermesh and MSC.Patran. Different foraminoplasty was performed on the model, and these were grouped into normal group (A), the ventral resection group (B), the apex resection group (C), the ventral + apex + isthmus resection group (D), and the SAP + isthmus + lateral recess resection group (E). A vertical load of 500N and a torque of 10N·M were applied to the upper surface of the L3 vertebral body to simulate the biomechanical characteristics under the motion of flexion, extension, lateral bending, and rotation. The von Mises stress maps of the intervertebral f, vertebral body, facet joints, and the ROM of the L3-S1 intervertebral disk were calculated and analyzed. The changes of peak stress on the vertebral body for each group were not significant in the same motion state. Significant stress differences were observed in the L4/5 intervertebral disks, while no obvious stress changes were observed for the L3/4 and L5/S1 intervertebral disks. The stress of the L3/4 and L5/S1 facet joints decreased after L4/5 foraminoplasty, while the stress of L4/5 facet joints displayed an overall increasing trend. Significant asymmetrical stress changes of bilateral facet joints were observed in all three segments, particularly during bilateral rotation movements. The ROM of L3-S1 gradually increased from Group A to Group E, especially during flexion, left lateral bending, and right rotation, with the highest elevation observed for the L45 ROM. Our FEM indicated that enlarged resection and exposure of the articular surface could lead to significant asymmetrical stress changes in the bilateral facet joints and ROM instability of the surgical and adjacent segments. These findings suggested that unnecessary and excessive resection should be avoided in PTED to reduce the incidence of low back pain and the risk of postsurgical degeneration.
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Affiliation(s)
- Wenliang Wu
- Department of Spine Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road No.107, Jinan, 250012, People's Republic of China
- Department of Physician Training, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Ruixuan Yu
- Department of Spine Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road No.107, Jinan, 250012, People's Republic of China
| | - Hongkai Hao
- Department of Spine Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road No.107, Jinan, 250012, People's Republic of China
| | - Kaiyun Yang
- Institute of Stomatology, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Guangjun Jiao
- Department of Spine Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road No.107, Jinan, 250012, People's Republic of China
| | - Haichun Liu
- Department of Spine Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road No.107, Jinan, 250012, People's Republic of China.
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Clinical Characteristics of Minimal Lumbar Disc Herniation and Efficacy of Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach: A Retrospective Study. J Pers Med 2023; 13:jpm13030552. [PMID: 36983733 PMCID: PMC10054638 DOI: 10.3390/jpm13030552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Objective: To define the characteristics of Mini LDH, develop new diagnostic references and examine the clinical efficacy of percutaneous endoscopic lumbar discectomy via a transforaminal approach (TF-PELD) for it. Methods: A total of 72 patients who underwent TF-PELD with Mini LDH from September 2019 to October 2022 were enrolled in this retrospective study. The patients’ basic information, symptoms, number of outpatient visits, duration of conservative treatment, physical examination findings and so on were obtained from the medical records. Clinical effects of TF-PELD for Mini LDH were assessed by means of the following: the Visual Analog Scale (VAS) for low back pain (LBP) and leg pain, Oswestry Disability Index (ODI) for functional status assessment and Modified Mac Nab criteria for patient satisfaction. Results: Mini LDH have specific clinical characteristics and imaging features. All included patients achieved obvious pain relief after TF-PELD surgery. Pain scores were repeated at postoperative day 1 and 1, 3, 6, 12 and 24 months later. Results were statistically analyzed. The average VAS-Back, VAS-Leg and ODI scores were all significantly reduced at the first postoperative day and gradually decreased with the follow-up time continuing. In total, 66 out of 72 patients received an excellent or good recovery and no poor result was reported according to the Modified Mac Nab criteria. Conclusions: Mini LDH is a type of LDH with special characteristics and in need of correct diagnosis and active treatment in clinical work. TF-PELD was also found to be an effective procedure for the treatment of Mini LDH.
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Wang L, Wang T, Fan N, Yuan S, Du P, Si F, Wang A, Zang L. Efficacy of Repeat Percutaneous Endoscopic Lumbar Decompression for Reoperation of Lumbar Spinal Stenosis: A Retrospective Study. J Pain Res 2023; 16:177-186. [PMID: 36718399 PMCID: PMC9883990 DOI: 10.2147/jpr.s384916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Purpose To evaluate the efficacy of repeat percutaneous endoscopic lumbar decompression (PELD) in lumbar spinal stenosis (LSS) reoperation. Patients and Methods This study included patients with LSS who relapsed following treatment with PELD therapy between March 2017 and March 2020. Visual analog scale (VAS) scores and Oswestry Disability Index (ODI) were analyzed preoperatively, postoperatively at 3, 6, 12, and 24 months, and at final follow-up. The modified MacNab criteria were used to assess clinical effects. All complications were recorded. Results At a mean follow-up of 3 years, 24 patients with LSS who underwent repeat PELD were identified. The patients' mean operative time was 122.3±29.2 min, blood loss was 12.5±5.3 mL, and mean hospital stay was 7.0±1.9 days. VAS leg-pain score improved from 6.1±1.0 to 2.0±1.2 (P<0.001), VAS back-pain score improved from 6.2±0.8 to 2.1±1.1 (P<0.001), and ODI improved from 68.9±6.0 to 20.9±5.6 (P <0.001). According to the modified MacNab criteria, the good-to-excellent rate was 83.3%. Postoperative complications, including hematoma, nerve root injury, and dural injury, developed in four patients. Conclusion Repeat PELD for reoperation in patients with LSS has a good clinical effect, and is recommended in routine clinical practice. Careful intraoperative manipulation is recommended to prevent complications.
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Affiliation(s)
- Lei Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Lei Zang, Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, People’s Republic of China, Tel +86 13601252787, Email
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Wang Z, Tan Y, Fu K, Meng Z, Wang L. Minimally invasive trans-superior articular process percutaneous endoscopic lumbar discectomy with robot assistance. BMC Musculoskelet Disord 2022; 23:1144. [PMID: 36587190 PMCID: PMC9805262 DOI: 10.1186/s12891-022-06060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/06/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To compare the clinical outcomes of patients with lumbar disc herniation treated with robot-assisted percutaneous endoscopic lumbar discectomy (r-PELD) or conventional PELD under fluoroscopy guidance (f-PELD). METHODS Our study group included 55 patients, 22 in the r-PELD group and 33 in the f-PELD group. The following clinical and surgical outcomes were compared between the two groups: the visual analog scale for radiculopathy pain; Oswestry Disability Index; intraoperative volume of blood loss; frequency of fluoroscopy used during the procedure; and MacNab classification. The follow-up period was 6-8 months. RESULTS Compared with f-PELD, r-PELD was associated with a lower volume of intraoperative blood loss and frequency of fluoroscopy (p < 0.01). There were no differences in complications, MacNab classification, postoperative disability and leg pain, and duration of hospitalization between the two groups. CONCLUSION Based on our findings, r-PELD provides a safe and effective alternative to conventional PELD for the treatment of lumbar disc herniations, with the accuracy for placement of punctures lowering radiation exposure.
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Affiliation(s)
- Zongjiang Wang
- grid.411176.40000 0004 1758 0478Department of Spinal Surgery, Sunshine Union Hospital, No. 9000, Yingqian street, Gaoxin District, 261041 Weifang City, Shandong Province China
| | - Ying Tan
- grid.461885.6Department of Spinal Surgery, Weifang Traditional Chinese Medicine Hospital, 261041 Weifang, China
| | - Kai Fu
- grid.411176.40000 0004 1758 0478Department of Spinal Surgery, Sunshine Union Hospital, No. 9000, Yingqian street, Gaoxin District, 261041 Weifang City, Shandong Province China
| | - Zhaowu Meng
- grid.411176.40000 0004 1758 0478Department of Spinal Surgery, Sunshine Union Hospital, No. 9000, Yingqian street, Gaoxin District, 261041 Weifang City, Shandong Province China
| | - Liang Wang
- grid.411176.40000 0004 1758 0478Department of Spinal Surgery, Sunshine Union Hospital, No. 9000, Yingqian street, Gaoxin District, 261041 Weifang City, Shandong Province China
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Wang Z, Liu B, Ma X, Wang Y, Han W, Xiang L. lncRNA ZFAS1 promotes intervertebral disc degeneration by upregulating AAK1. Open Med (Wars) 2022; 17:1973-1986. [PMID: 36561842 PMCID: PMC9743196 DOI: 10.1515/med-2022-0530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 12/13/2022] Open
Abstract
We investigated the function of lncRNA zinc finger antisense 1 (ZFAS1) in intervertebral disc degeneration (IDD) progression in vitro and in vivo. Nucleus pulposus (NP) tissues were obtained from 20 patients with IDD. IL-1β was used to stimulate primary NP cells to establish the IDD models in vitro. Gene expression was determined by RT-qPCR. 5-Ethynyl-2'-deoxyuridine and flow cytometry were performed to determine cell proliferation and apoptosis, and western blotting was conducted to measure the apoptosis- and extracellular matrix (ECM)-related protein expression. Luciferase reporter assay was used to examine the interactions between the genes. We also investigated the effect of ZFAS1 in a mouse model of IDD induced by needle punctures. Our results showed that ZFAS1 expression was elevated in degenerative NP tissues and IL-1β-treated NP cells. ZFAS1 knockdown inhibited NP cell apoptosis and ECM degradation induced by IL-1β. Mechanically, ZFAS1 sponged miR-4711-5p and adaptor-associated kinase 1 (AAK1) was targeted by miR-4711-5p. Furthermore, AAK1 overexpression partially eliminated the impact of ZFAS1 depletion on NP cell proliferation, apoptosis, and ECM degradation. More importantly, the results of the in vivo studies confirmed the effect of silencing ZFAS1 on alleviating the symptoms of IDD mice. Overall, silencing ZFAS1 inhibits IDD progression by reducing NP cell apoptosis and ECM degradation through the miR-4711-5p/AAK1 axis.
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Affiliation(s)
- Zheng Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning, China
| | - Bin Liu
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning, China
| | - Xiangyu Ma
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning, China
| | - Yu Wang
- Department of Orthopedics, General Hospital of Northern Theater Command, Shenyang 110016, Liaoning, China
| | - Wenfeng Han
- Department of Orthopedics, General Hospital of Northern Theater Command, No. 83 Wenhua
Road, Shenyang 110016, Liaoning, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command, No. 83 Wenhua
Road, Shenyang 110016, Liaoning, China
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Wu B, Yang L, Fu C, Zhuo Y, Feng X, Xiong H. Global Trends and Hotspots in Endoscopic Discectomy: A Study Based on Bibliometric Analysis. Neurospine 2022; 19:1093-1107. [PMID: 36597660 PMCID: PMC9816580 DOI: 10.14245/ns.2244574.287] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/01/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE With the advancement of minimally invasive spine surgery, endoscopic discectomy (ED) has become a common technique for degenerative disease of the spine. The present study aimed to explore the knowledge structure, emerging trends, and future research hotspots in this field. METHODS All relevant publications on ED from 2002 to 2021 were extracted from the Web of Science databases. Key bibliometric indicators, including countries/regions, institutions, authors, journals, references, and keywords were calculated and evaluated using VOSviewer and CiteSpace software. RESULTS A total of 1,196 articles and reviews were included for analysis. The number of publications regarding ED increased yearly. From the quality and quantity viewpoint, China, South Korea, and the United States were the major contributors in this field. The most influential institution in the field of ED was Wooridul Spine Hospital. We identified 3,488 authors, among which Lee SH had the most significant number of papers, and Ruetten S was cocited most often. <World Neurosurgery was the journal with the most papers, and Spine was the most commonly cocited journal. Keywords were stratified into 4 clusters by VOSviewer software: cluster 1 (clinical outcomes of ED in the treatment of lumbar disc herniation); cluster 2 (surgical technique of percutaneous endoscopic lumbar discectomy); cluster 3 (clinical outcomes of ED in the treatment of lumbar spinal stenosis); and cluster 4 (clinical outcomes of percutaneous endoscopic cervical discectomy). Several topics including lateral recess stenosis, spinal stenosis, and reoperation were considered as the next hotspot in ED research. CONCLUSION ED research has gained considerable attention over the last 2 decades. Our bibliometric findings illuminate the publication trends and research hotspots of the ED field, which may provide useful references for scholars and decision-makers interested in this field.
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Affiliation(s)
- Boyu Wu
- Hunan University of Chinese Medicine, Changsha, China,Co-corresponding Author Boyu Wu Hunan University of Chinese Medicine, #300, Xueshi Road, Hanpu Science and Education Park, Yuelu District, Changsha, 410208, China
| | - Lei Yang
- Hunan University of Chinese Medicine, Changsha, China
| | - Chengwei Fu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yue Zhuo
- Hunan University of Chinese Medicine, Changsha, China
| | - Xiang Feng
- Hunan University of Chinese Medicine, Changsha, China
| | - Hui Xiong
- Hunan University of Chinese Medicine, Changsha, China,Corresponding Author Hui Xiong Hunan University of Chinese Medicine, #300, Xueshi Road, Hanpu Science and Education Park, Yuelu District, Changsha, 410208, China
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[Comparative analysis of unilateral biportal endoscopic discectomy, percutaneous endoscopic lumbar discectomy, and fenestration discectomy in treatment of lumbar disc herniation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1200-1206. [PMID: 36310455 PMCID: PMC9626273 DOI: 10.7507/1002-1892.202205129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the effectiveness of unilateral biportal endoscopic discectomy (UBED), percutaneous endoscopic lumbar discectomy (PELD), and traditional fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). METHODS The clinical data of 347 LDH patients who met the selection criteria and underwent discectomy between January 2017 and December 2021 were retrospectively analyzed. They were divided into FD group (160 cases), PELD group (86 cases), and UBED group (101 cases) according to operation methods. There was no significant difference in gender, age, surgical level distribution, disease duration, and preoperative visual analogue scale (VAS) score and Oswestry disability index (ODI) between groups ( P>0.05). The operation time, hospitalization stay, treatment cost, and incidence of surgery-related complications were recorded and compared between groups. The patients' pain and functional recovery were evaluated by VAS score and ODI before and after operation. RESULTS The operation time of FD group was significantly shorter than that of PELD group and UBED group, and the hospitalization stay was significantly longer than that of PELD group and UBED group ( P<0.05); there was no significant difference between PELD group and UBED group ( P>0.05). The treatment cost in UBED group was significantly higher than that in PELD group, and in PELD group than in FD group ( P<0.05). All the patients were followed up 6-24 months, with an average of 14.6 months. VAS score of lower extremity and ODI in 3 groups significantly improved after operation when compared with that before operation ( P<0.05). At 1 day after operation, VAS score of lower extremity of UBED group was significantly better than that in PELD group and FD group ( P<0.05), but there was no significant difference between PELD group and FD group ( P>0.05). There was no significant difference in VAS scores of lower extremity between the 3 groups at 1 and 3 months after operation ( P>0.05). The difference of ODI before and after operation in FD group and UBED group was slightly better than that in PELD group ( P<0.05), and there was no significant difference between FD group and UBED group ( P>0.05). Incidence of surgery-related complications in FD group (20.0%) was significantly higher than that in PELD group (12.8%) and UBED group (6.9%), and PELD group was significantly higher than UBED group ( P<0.05). All the incision infection occurred in FD group (12 cases), symptomatic disc cyst and myeloid hypertension-like occurred in 1 case each in PELD group. CONCLUSION UBED, PELD, and FD have similar effectiveness on lower extremity pain in early LDH. Compared with FD, UBED and PELD have the advantage of shorter hospitalization stay and fewer complications.
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12
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Zhao Q, Xiao L, Wu Z, Liu C, Zhang Y. Comparison of the efficacy of fully endoscopic spine surgery using transforaminal and interlaminar approaches in the treatment of prolapsed lumbar 4/5 disc herniation. J Orthop Surg Res 2022; 17:391. [PMID: 35964096 PMCID: PMC9375331 DOI: 10.1186/s13018-022-03282-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background There is still much controversy about whether transforaminal or interlaminar fully endoscopic spine surgery can better treat lumbar 4/5 disc herniation. Therefore, this study intends to compare the clinical efficacy of fully endoscopic spine surgery through transforaminal and interlaminar approaches in the treatment of lumbar 4/5 disc herniation. Methods Seventy-six patients with lumbar 4/5 disc herniation admitted from March 2019 to June 2020 were divided into the transforaminal approach group (endoscopic transforaminal lumbar discectomy, ETLD; 54 cases) and the interlaminar approach group (endoscopic interlaminar lumbar discectomy, EILD; 22 cases) according to different surgical methods. The general clinical data and clinical evaluation scale of the patients were compared. Results The post-operative ODI and VAS scores were significantly better in the EILD group (P < 0.05). The VAS and ODI scores of patients with upper-shoulder and sub-axillary types in the EILD group were superior to those in the ETLD group (P < 0.05), while the VAS and ODI scores of patients with the pre-radicular type were better when they underwent ETLD rather than EILD (P < 0.05). Patients with Lee zone III type in the EILD group had better post-operative ODI scores than those in the ETLD group (P < 0.05), but there was no significant difference in VAS scores (P > 0.05). Patients with Lee zone IV type who underwent EILD had better VAS and ODI scores than those who underwent ETLD (P < 0.05). Conclusions For patients with a prolapsed intervertebral disc that belongs to the upper-shoulder type, sub-axillary type, or Lee III or IV type, EILD can achieve better outcomes.
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Affiliation(s)
- Quanlai Zhao
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Liang Xiao
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Zhongxuan Wu
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Chen Liu
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China
| | - Yu Zhang
- Department of Spine Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui, 241001, People's Republic of China.
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13
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Yuan AL, Shen X, Chen B. Treatment of Calcified Lumbar Disc Herniation by Intervertebral Foramen Remolding: A Retrospective Study. J Pain Res 2022; 15:1719-1728. [PMID: 35734509 PMCID: PMC9208632 DOI: 10.2147/jpr.s357033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose This study aimed to investigate the use of the percutaneous intervertebral foramen lens technology for secondary molding of the intervertebral foramen in the treatment of calcified lumbar discs. Methods The study included 104 patients who were divided into two groups. Group A comprised 50 patients with calcified lumbar disc herniation and group B comprised 54 patients with non-calcified lumbar disc herniation diagnosed by computed tomography and magnetic resonance imaging. Patients underwent a percutaneous endoscopic lumbar discectomy at our hospital from January 1, 2017, to December 31, 2019. Demographic characteristics before the surgery and perioperative outcomes were retrospectively reviewed. The treatment outcome was analyzed using the numerical rating scale (NRS) score, Oswestry Disability Index (ODI) score, and modified Macnab criteria. Results Patients in groups A and B showed significant improvement in both the NRS and ODI scores after the surgery and maintained relatively low ODI and NRS scores during subsequent follow-ups. According to the evaluation under the modified MacNab standard, the good–excellent rate of clinical efficacy was 94% in group A and 92.6% in group B at the 3 month follow-up. In group A, one patient developed neck pain during the surgery, which was diagnosed as spinal hypertension syndrome, and the surgery was suspended until the patient’s condition improved. No similar complications occurred in group B. In both the groups, no patient reported any dural leak, infection, or other related complications. Conclusion The use of transforaminal remolding technology can significantly improve the symptoms and dysfunction of patients with calcified and non calcified lumbar disc herniation. There are few intraoperative and postoperative complications and have little impact on vertebral stability. It can provide a reference for the treatment of special types of lumbar disc herniation.
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Affiliation(s)
- Ao-Lin Yuan
- Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei Province, People's Republic of China
| | - Xin Shen
- Breast and Thyroid Surgical Oncology, Hebei Medical University Second Affiliated Hospital, Shijiazhuang, Hebei Province, People's Republic of China
| | - Bin Chen
- Minimally Invasive Spine Surgery, Chengde Medical University Affiliated Hospital, Chengde, Hebei Province, People's Republic of China
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Lewandrowski KU, Abraham I, Ramírez León JF, Soriano Sánchez JA, Dowling Á, Hellinger S, Freitas Ramos MR, Teixeira De Carvalho PS, Yeung C, Salari N, Yeung A. Differential Agnostic Effect Size Analysis of Lumbar Stenosis Surgeries. Int J Spine Surg 2022; 16:318-342. [PMID: 35444041 PMCID: PMC9930655 DOI: 10.14444/8222] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
STUDY DESIGN A meta-analysis of 89 randomized prospective, prospective, and retrospective studies on spinal endoscopic surgery outcomes. OBJECTIVE The study aimed to provide familiar Oswestry Disability Index (ODI), visual analog scale (VAS) back, and VAS leg effect size (ES) data following endoscopic decompression for sciatica-type back and leg pain due to lumbar herniated disc, foraminal, or lateral recess spinal stenosis. BACKGROUND Higher-grade objective clinical outcome ES data are more suitable than lower-grade clinical evidence, including cross-sectional retrospective study outcomes or expert opinion to underpin the ongoing debate on whether or not to replace some of the traditional open and with other forms of minimally invasive spinal decompression surgeries such as the endoscopic technique. METHODS A systematic search of PubMed, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from 1 January 2000 to 31 December 2019 identified 89 eligible studies on lumbar endoscopic decompression surgery enrolling 23,290 patient samples using the ODI and VAS for back and leg pain used for the ES calculation. RESULTS There was an overall mean overall reduction of ODI of 46.25 (SD 6.10), VAS back decrease of 3.29 (SD 0.65), and VAS leg reduction of 5.77 (SD 0.66), respectively. Reference tables of familiar ODI, VAS back, and VAS leg show no significant impact of study design, follow-up, or patients' age on ES observed with these outcome instruments. There was no correlation of ES with long-term follow-up (P = 0.091). Spinal endoscopy produced an overall ODI ES of 0.92 extrapolated from 81 studies totaling 12,710 patient samples. Provided study comparisons to tubular retractor microdiscectomy and open laminectomy showed an ODI ES of 0.9 (2895 patients pooled from 16 studies) and 0.93 (1188 patients pooled from 5 studies). The corresponding VAS leg ES were 0.92 (12,631 endoscopy patients pooled from 81 studies), 0.92 (2348 microdiscectomy patients pooled from 15 studies), and 0.89 (1188 open laminectomy patients pooled from 5 studies). CONCLUSION Successful clinical outcomes can be achieved with various lumbar surgeries. ESs with endoscopic spinal surgery are on par with those found with open laminectomy and microsurgical decompression. CLINICAL RELEVANCE This article is a meta-analysis on the benefit overlap between lumbar endoscopy, microsurgical decompression, laminectomy, and lumbar decompression fusion. LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Kai-Uwe Lewandrowski
- Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, AZ, USA .,Department of Orthopaedic Surgery, Fundación Universitaria Sanitas, Bogotá, DC, Colombia.,Department of Orthopaedic Surgery, UNIRIO, Rio de Janeiro, Brazil
| | - Ivo Abraham
- Family and Community Medicine, Clinical Translational Sciences at the University of Arizona, Tucson, AZ 85721, USA,Centro de Cirugía de Mínima Invasión, CECIMIN - Clínica Reina Sofía, Bogotá, Colombia
| | - Jorge Felipe Ramírez León
- Centro de Cirugía de Mínima Invasión, CECIMIN - Clínica Reina Sofía, Bogotá, Colombia,Research Team, Centro de Columna, Bogotá, Colombia,Fundación Universitaria Sanitas, Bogotá, DC, Colombia
| | - José Antonio Soriano Sánchez
- Neurosurgeon and Minimally Invasive Spine Surgeon, Head of the Spine Clinic of The American-British Cowdray Medical Center I.A.P. Campus Santa Fe [Centro Médico ABC Campus Santa Fe], Santa Fe, Mexico
| | - Álvaro Dowling
- Department of Orthopaedic Surgery, USP, Ribeirão Preto, Brazil,Orthopaedic Spine Surgeon, Director of Endoscopic Spine Clinic, Santiago, Chile
| | - Stefan Hellinger
- Department of Orthopedic Surgery, Isar Hospital, Munich, Germany
| | - Max Rogério Freitas Ramos
- Orthopedics and Traumatology, Universidade Federal do Estado do Rio de Janeiro, UNIRIO, Rio de Janeiro, Brazil
| | | | | | - Nima Salari
- Desert Institute for Spine Care, Phoenix, AZ, USA
| | - Anthony Yeung
- Desert Institute for Spine Care, Phoenix, AZ, USA,Department of Neurosurgery Albuquerque, University of New Mexico School of Medicine, Albuquerque, NM, New Mexico
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Kapetanakis S, Gkantsinikoudis N, Charitoudis G. Full-Endoscopic Ventral Facetectomy vs Open Laminectomy for Lumbar Lateral Recess Stenosis: A Comparative Study and Brief Literature Review. Int J Spine Surg 2022; 16:361-372. [PMID: 35444044 PMCID: PMC9930662 DOI: 10.14444/8218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Lateral recess stenosis (LRS) represents a major etiology of pain and disability in recent years. The aim of the present study was to compare the clinical outcomes of full-endoscopic ventral facetectomy (FEVF) vs conventional open laminectomy (OL) for surgical treatment of lumbar LRS. METHODS Ninety individuals with diagnosed LRS according to clinical and radiological criteria were included in this study. Patients were appropriately classified into 2 distinct groups according to received treatment. Group A was constituted from 48 patients subjected to FEVF. Contrariwise, the 42 patients of Group B underwent OL. All patients were consecutively evaluated with particular clinical scores preoperatively and at 6 weeks, 3, months, 6 months, 12 months, and 2 years postoperatively. Clinical assessment was conducted with the visual analog scale for leg pain (VAS-LP) and back pain (VAS-BP) and with the Short-Form 36 (SF-36) medical questionnaire. RESULTS Values of all studied indices in both groups featured a major clinical improvement in 6 weeks with subsequent quantitatively minor albeit still statistically significant amelioration until the end of follow-up at 2 years. Comparative evaluation of recorded parameters between the 2 groups disclosed that VAS-BP, bodily pain, and role emotional indices of SF-36 were quantitatively and statistically differentiated in favor of Group A in 6 weeks, featuring an amelioration that persisted until the end of follow-up. Registered values of the other parameters were not found to demonstrate a quantitatively and clinically noteworthy differentiation between the 2 groups. CONCLUSIONS FEVF represents a feasible, safe, and beneficial alternative for surgical therapy of patients with LRS, featuring comparable outcomes with conventional OL. CLINICAL RELEVANCE Lumbar LRS represents a frequent entity with remarkable clinical sequelae. FEVF represents a novel, groundbreaking and minimally invasive technique that should be considered as a safe and efficacious alternative over conventional open surgery in specific patients with LRS. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece .,Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece
| | | | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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16
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Jiang HW, Chen CD, Zhan BS, Wang YL, Tang P, Jiang XS. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study. J Orthop Surg Res 2022; 17:30. [PMID: 35033143 PMCID: PMC8760683 DOI: 10.1186/s13018-022-02929-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH. Methods The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria. Results The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups. Conclusions Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.
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Affiliation(s)
- Hao-Wei Jiang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Cheng-Dong Chen
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Bi-Shui Zhan
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Yong-Li Wang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Pan Tang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Xue-Sheng Jiang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China.
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Giordan E, Billeci D, Del Verme J, Varrassi G, Coluzzi F. Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis. Pain Ther 2021; 10:1481-1495. [PMID: 34490586 PMCID: PMC8586101 DOI: 10.1007/s40122-021-00309-1] [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] [Received: 06/24/2021] [Accepted: 08/13/2021] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Spinal endoscopic techniques have recently been applied to complex degenerative conditions or failed back surgery syndrome. We performed a systematic review and meta-analysis to assess transforaminal endoscopic lumbar foraminotomy (TELF) outcomes and adverse event rates. We also analyzed the effectiveness of the technique for chronic pain after arthrodesis or previous spinal surgery. METHODS Multiple databases were searched for studies published in the English language, involving patients > 18 years old who underwent endoscopic foraminotomy. Outcomes included the rate of patients who showed "excellent" and "good" postoperative improvement, decreased leg pain, and improved Oswestry Disability Index (ODI) scores. Adverse events considered in the analysis included nerve root damage and intraoperative dural tear, the proportion of patients requiring revision surgery or recurrences, and infections. RESULTS A total of 14 studies, encompassing 600 patients, were identified. Approximately 85% of patients improved significantly after TELF, without significant differences among different groups (85% vs. 78%, respectively). Mean leg pain decreased an average of 5.2 points, and ODI scores improved by 41.2%. Patients with previous spine surgery or failed back surgery syndrome had higher postoperative leg dysesthesia rates after TELF (14% vs. 1%, respectively). CONCLUSION TELF is a useful and safe method to achieve decompression in foraminal stenosis. This technique is indicated in the elderly or patients with comorbidities. Preoperative planning is paramount in determining the foraminal size and endoscope trajectory. A diamond burr is recommended because it has an advantage over the regular endoscopic shaver in bleeding control and complication avoidance.
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Affiliation(s)
- Enrico Giordan
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Via Piazzale 1, 31100, Treviso, Veneto, Italy.
| | - Domenico Billeci
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Via Piazzale 1, 31100 Treviso, Veneto Italy
| | - Jacopo Del Verme
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Via Piazzale 1, 31100 Treviso, Veneto Italy
| | | | - Flaminia Coluzzi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Latina, Italy ,Sant’Andrea University Hospital, Rome, Italy
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Ouyang ZH, Tang M, Li HW, Zou MX, Li XL, Wang WJ, Yan YG. Full-Endoscopic Foraminoplasty Using a Visualized Bone Reamer in the Treatment of Lumbar Disc Herniation: A Retrospective Study of 80 Cases. World Neurosurg 2021; 149:e292-e297. [PMID: 33609764 DOI: 10.1016/j.wneu.2021.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has been widely used, before which foraminoplasty is necessary to widen the foramen for subsequent procedures. However, the learning curve of this technology is high, as the use of traditional reamers requires repeated intraoperative fluoroscopy. We sought to compare the clinical outcomes by using the visualized and traditional reamers in PELD foraminoplasty for the treatment of lumbar disc herniation. METHODS Eighty patients with lumbar disc herniation who were treated with PELD between 1 January 2017 and 1 January 2019 were retrospectively reviewed. The patients were randomly divided into 2 groups (40 patients in the Visualized Bone Reamer group) and (40 patients in the Traditional Bone Reamer group). Intraoperative fluoroscopy time, cannulation introduction time, visual analog scale, and Macnab criteria score were compared between the 2 groups. RESULTS The mean follow-up durations were 17.41 ± 1.47 and 18.37 ± 1.69 months in the visualized and traditional groups, respectively. The average cannulation introduction time and intraoperative fluoroscopy times in the visualized group is significantly lower than those in traditional group (29.20 ± 3.31 vs. 39.85 ± 3.98 minutes, P < 0.001; and 12.30 ± 2.38 vs. 20.65 ±3.51 seconds, P < 0.001, respectively). One patient in the traditional group required reoperation, and no complications occurred in the visualized group. There were no severe durotomies or vascular or visceral injuries. CONCLUSIONS Full-endoscopic foraminoplasty using a visualized reamer is safe and effective and can decrease intraoperative fluoroscopy time in PELD.
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Affiliation(s)
- Zhi-Hua Ouyang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Ming Tang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Hong-Wei Li
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Ming-Xiang Zou
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Xue-Lin Li
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Wen-Jun Wang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Yi-Guo Yan
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China.
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Chen C, Ma X, Zhao D, Yang H, Xu B, Wang Z, Yang Q. Full Endoscopic Lumbar Foraminoplasty with Periendoscopic Visualized Trephine Technique for Lumbar Disc Herniation with Migration and/or Foraminal or Lateral Recess Stenosis. World Neurosurg 2021; 148:e658-e666. [PMID: 33515794 DOI: 10.1016/j.wneu.2021.01.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/14/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To introduce a newly designed periendoscopic visualized trephine system for foraminoplasty in treating lumbar disc herniation with migration and/or foraminal or lateral recess stenosis, and report early clinical outcomes evaluated by the Patient-Reported Outcomes Measurement Information System (PROMIS). METHODS A total of 25 patients who underwent transforaminal endoscopic lumbar discectomy with foraminoplasty using a periendoscopic visualized trephine from June 2019 to January 2020 were retrospectively reviewed. PROMIS pain interference and physical function were selected as outcome measures. RESULTS The average age of the 25 patients (16 males, 9 females) was 32.0 ± 7.5 years (20-48 years). All patients were successfully followed up with the mean time of 10.1 ± 2.8 months (6-12 months). PROMIS pain interference scores decreased significantly from mean 67.0 ± 3.4 preoperatively to 37.5 ± 5.4 at the final follow-up (P < 0.01), and PROMIS physical function scores improved significantly from mean 29.2 ± 5.5 preoperatively to 59.3 ± 3.7 at the final follow-up (P < 0.01). No neural or vascular complication occurred. CONCLUSION Full endoscopic lumbar foraminoplasty with a periendoscopic visualized trephine technique is safe and effective for treating lumbar disc herniation with migration and/or lateral recess or foraminal stenosis, with improved flexibility and convenience and decreased radiation exposure.
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Affiliation(s)
- Chao Chen
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xinlong Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Dong Zhao
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Haiyun Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Baoshan Xu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zheng Wang
- Department of Orthopedics, No.1 Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, Tianjin, China.
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Clinical Outcomes of "U" Route Transforaminal Percutaneous Endoscopic Lumbar Discectomy in Chronic Pain Patients with Lumbar Spinal Stenosis Combined with Disc Herniation. Pain Res Manag 2021; 2021:6657463. [PMID: 33532011 PMCID: PMC7837780 DOI: 10.1155/2021/6657463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
Introduction “U” route transforaminal percutaneous endoscopic lumbar discectomy (PELD) was introduced for lumbar spinal stenosis (LSS) combined with disc herniation (DH) treatment. This study aims to explore the efficacy and safety of “U” route PELD on chronic pain patients with LSS combined with DH. Methods Degenerative LSS combined with DH patients who underwent “U” route PELD were reexamined, and 80 patients were recruited and followed up for 2 years. The other 80 healthy individuals who were age- and sex-matched to the patients without chronic pain were enrolled as healthy controls. Minimum dura sac cross-sectional area (mDCSA) by MRI, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab outcomes were assessed. Emotional evaluation of pain catastrophizing and depression was documented with Pain Catastrophizing Scale (PCS) and Beck Depression Inventory (BDI), respectively, for patients before and after surgery and healthy individuals. Results All patients were of the age range from 47 to 85 years, with an average of 59.5 ± 9.76 years. Symptoms duration was 114.6 ± 22.77 months, operation time was 87.7 ± 25.20 minutes, and the average hospital stay was 5.8 ± 2.81 days. Four patients quit, and hence, a total of 76 patients completed the follow-up. The results indicated that mDCSA was improved significantly after operation (p < 0.001), either low back and leg VAS or ODI decreased over time (p < 0.001), and the excellent-to-good rate was improved from 88.75% to 93.42% during postoperative 2 years (p < 0.05). Complications of dural tear, nerve root, or dysesthesia were reported in 5 patients, and all recovered after conservative therapy. The scores of pain catastrophizing were reduced after operation (p < 0.001), but no significance of BDI was found between patients and healthy controls (p > 0.05). Conclusions The “U” route PELD seems an alternative to LSS combined with DH treatment, which might reach a better decompression and effectively improve chronic pain conditions. Still, the complications were potential and required further consideration.
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Wu B, Xiong C, Huang B, Zhao D, Yao Z, Yao Y, Xu F, Kang H. Clinical outcomes of transforaminal endoscopic lateral recess decompression by using the visualized drilled foraminoplasty and visualized reamed foraminoplasty: a comparison study. BMC Musculoskelet Disord 2020; 21:829. [PMID: 33302913 PMCID: PMC7727179 DOI: 10.1186/s12891-020-03849-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/30/2020] [Indexed: 01/13/2023] Open
Abstract
Background Lateral recess stenosis (LRS) is a common degenerative disease in the elderly. Since the rise of comorbidity is associated with increasing age, transforaminal endoscopic lateral recess decompression (TE-LRD) is advocated. The objective of this study was to compare the clinical outcomes of TE-LRD in patients with LRS via visualized drilled foraminoplasty (VDF) or visualized reamed foraminoplasty (VRF) technique. Methods A total of 45 and 42 consecutive patients with limp or unilateral radiculopathy symptoms underwent TE-LRD using the VDF and VRF technique, respectively. The radiation exposure and operation time, time to return to work, and complications were compared between two groups. Their clinical outcomes were evaluated with the visual analogue scale (VAS) leg pain score, VAS back pain score, Oswestry Disability Index (ODI) and modified MacNab’s criteria. Results The average values of radiation exposure and operative time in the VDF group were significantly higher than those in the VRF group (P < 0.05). The postoperative VAS and ODI scores in both groups were significantly improved compared with those before the operation (P < 0.05). In addition, the VAS score of the leg pain and ODI score in the VRF group were significantly lower than those in the VDF group at the 1-week follow-up (P < 0.05). The good-to-excellent rates of the VDF group and VRF group were 88.89 and 90.48%, respectively, whereas the complication occurrence rates were 6.67 and 4.76% in the VDF group and VRF group, respectively. Conclusions TE-LRD performed by using VRF technique can be applied to treat LRS safely and effectively with short radiation exposure and operation time. This technique was comparable to the VDF technique with improved VAS leg pain and ODI scores in the short period after the operation. However, potential complications and risks still need to be considered.
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Affiliation(s)
- Boyu Wu
- Orthopaedic Department, General Hospital of Central Theater Command of PLA, Wuhan, 430070, China.,The Second Clinical College of Chinese Medicine, Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Chengjie Xiong
- Orthopaedic Department, General Hospital of Central Theater Command of PLA, Wuhan, 430070, China
| | - Biwang Huang
- Orthopaedic Department, General Hospital of Central Theater Command of PLA, Wuhan, 430070, China
| | - Dongdong Zhao
- Orthopaedic Department, General Hospital of Central Theater Command of PLA, Wuhan, 430070, China
| | - Zhipeng Yao
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 51000, China
| | - Yawei Yao
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 51000, China
| | - Feng Xu
- Orthopaedic Department, General Hospital of Central Theater Command of PLA, Wuhan, 430070, China.
| | - Hui Kang
- Orthopaedic Department, General Hospital of Central Theater Command of PLA, Wuhan, 430070, China.
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Wu B, Xiong C, Tan L, Zhao D, Xu F, Kang H. Clinical outcomes of MED and iLESSYS ® Delta for the treatment of lumbar central spinal stenosis and lateral recess stenosis: A comparison study. Exp Ther Med 2020; 20:252. [PMID: 33178350 PMCID: PMC7651884 DOI: 10.3892/etm.2020.9382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 06/17/2020] [Indexed: 12/25/2022] Open
Abstract
Microendoscopic discectomy (MED) is an established procedure used to treat lumbar central spinal stenosis (LCSS) and lateral recess stenosis (LRS). The Interlaminar Endoscopic Surgical System iLESSYS® Delta approach has been developed from the traditional interlaminar endoscopic technique for the treatment of LCSS and LRS. In the present study, MED was used as a reference to evaluate this newly developed approach. A total of 82 and 52 patients with radicular leg pain and/or neurogenic claudication symptoms were treated by spinal canal decompression using the MED or iLESSYS® Delta approach, respectively. The clinical outcomes of the patients were analyzed using the Modified MacNab's criteria, visual analogue scale (VAS) leg pain score, VAS back pain score and the Oswestry Disability Index (ODI) score. Finally, the effectiveness of the decompression was evaluated on a cross-sectional area of the dural sac (CSAD) at the disc level. The incision length in the iLESSYS® Delta group was significantly decreased compared with the MED group (P<0.05); however, the duration of the operation in the iLESSYS® Delta group was significantly longer compared with the MED group (P<0.05). The VAS score of the back and ODI score in the iLESSYS® Delta group were significantly decreased compared with the MED group at the 1-week follow-up (P<0.0125). The postoperative CSAD was also significantly increased in both groups compared with before the operation (P<0.05); however, there were no significant differences in the postoperative CSAD between the two groups. The good-to-excellent rates of the MED and iLESSYS® Delta approach were 89.0 and 90.4%, respectively, whereas the complication rates of the MED and iLESSYS® Delta system were 3.66 and 3.85% in the two groups, respectively. In conclusion, the iLESSYS® Delta approach was identified to be comparable with the MED approach for treating LCSS and LRS, demonstrating both precise and limited decompression. In addition, the iLESSYS® Delta approach may reduce the short-term back pain and promote faster recovery compared with the MED.
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Affiliation(s)
- Boyu Wu
- The First Clinical College, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Chengjie Xiong
- Department of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, Hubei 430070, P.R. China
| | - Linying Tan
- The First Clinical College, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Dongdong Zhao
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, Hubei 430070, P.R. China
| | - Hui Kang
- Department of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, Hubei 430070, P.R. China
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Youngblood MW, Ganju A. Commentary: Lumbar Lateral Recess Decompression: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2020; 19:E543-E545. [PMID: 32945858 DOI: 10.1093/ons/opaa257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/27/2020] [Indexed: 01/03/2023] Open
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Feng WL, Yang JS, Wei D, Gong HL, Xi Y, Lv HQ, Wang XG, Xia B, Wei JM. Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study. J Orthop Surg Res 2020; 15:413. [PMID: 32933553 PMCID: PMC7493882 DOI: 10.1186/s13018-020-01939-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND During the process of shearing the ligamentum flavum, rotating the working channel, and manipulating the annulus fibrosis, the sinuvertebral nerve and the spinal nerve root can be irritated, inducing intolerable back and leg pain. Thus, general anesthesia is recommended and well accepted by most surgeons when performing percutaneous endoscopic lumbar discectomy (PELD) via the interlaminar approach. The aim of our study was to explore the efficacy and safety of percutaneous endoscopy interlaminar lumbar discectomy with gradient local anesthesia (LA) in patients with L5/S1 disc herniation. METHODS This retrospective study was conducted between December 2017 and June 2018. The study included 50 consecutive patients who met the study criteria, had single-level L5/S1 disc herniation, and underwent PELD via the interlaminar approach under gradient LA. Different concentrations of local anesthetic compound (LAC) were injected into different tissues inside and outside the ligamentum flavum to complete gradient LA. The evaluation criteria included the intraoperative satisfaction score, visual analog scale (VAS) score, Oswestry Disability Index (ODI), complications, and adverse reactions. RESULTS The intraoperative satisfaction score was consistently over 7, with an average score of 9.3 ± 0.7, indicating that LAC can achieve satisfactory pain control throughout the PELD operation without additional anesthesia. The postoperative VAS score and ODI were dramatically improved at each follow-up interval (P < 0.001, respectively). There was no serious complication such as dural rupture caused by puncture, dural laceration caused by manipulation under endoscopy, total spinal anesthesia, iatrogenic nerve root injury, epidural hematoma, infections, or local anesthetic-related adverse reactions. Three patients experienced transient postoperative dysesthesia of the lower limbs that gradually recovered within 24 h. CONCLUSIONS Gradient local anesthesia can satisfactorily and safely control intraoperative pain during the PELD via the interlaminar approach. It can not only improve intraoperative satisfaction, but also reduce local anesthesia-related adverse reactions and surgery-related complications.
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Affiliation(s)
- Wan-Li Feng
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, People's Republic of China
| | - Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, People's Republic of China
| | - Dongmei Wei
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Han-Lin Gong
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Xi
- Department of Orthopaedics, Tongchuan People's Hospital, Tongchuan, Shaanxi, People's Republic of China
| | - Hui-Qiang Lv
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, People's Republic of China
| | - Xin-Gang Wang
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, People's Republic of China
| | - Bin Xia
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, People's Republic of China
| | - Jian-Min Wei
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, People's Republic of China.
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Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine. Brain Sci 2020; 10:brainsci10080522. [PMID: 32764525 PMCID: PMC7465602 DOI: 10.3390/brainsci10080522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 12/20/2022] Open
Abstract
(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root and its dorsal root ganglion (DRG) by manipulating the working cannula or endoscopic instruments may play a role. (2) Objective: To assess whether intraoperative neurophysiological monitoring can help prevent nerve root injury by identifying neurophysiological events during the initial placement of the endoscopic working cannula and the directly visualized video endoscopic procedure. (3) Methods: The authors performed a retrospective chart review of 65 (35 female and 30 male) patients who underwent transforaminal endoscopic decompression for failed non-operative treatment of lumbar disc herniation from 2012 to 2020. The patients’ age ranged from 22 to 86 years, with an average of 51.75 years. Patients in the experimental group (32 patients) had intraoperative neurophysiological monitoring recordings using sensory evoked (SSEP), and transcranial motor evoked potentials (TCEP), those in the control group (32 patients) did not. The SSEP and TCMEP data were analyzed and correlated to the postoperative course, including dysesthesia and clinical outcomes using modified Macnab criteria, Oswestry disability index (ODI), visual analog scale (VAS) for leg and back pain. (4) Results: The surgical levels were L4/L5 in 44.6%, L5/S1 in 23.1%, and L3/L4 in 9.2%. Of the 65 patients, 56.9% (37/65) had surgery on the left, 36.9% (24/65) on the right, and the remaining 6.2% (4/65) underwent bilateral decompression. Postoperative dysesthesia occurred in 2 patients in the experimental and six patients in the control group. In the experimental neuromonitoring group, there was electrodiagnostic evidence of compression of the exiting nerve root’s DRG in 24 (72.7%) of the 32 patients after initial transforaminal placement of the working cannula. A 5% or more decrease and a 50% or more decrease in amplitude of SSEPs and TCEPs recordings of the exiting nerve root were resolved by repositioning the working cannula or by pausing the root manipulation until recovery to baseline, which typically occurred within an average of 1.15 min. In 15 of the 24 patients with such latency and amplitude changes, a foraminoplasty was performed before advancing the endoscopic working cannula via the transforaminal approach into the neuroforamen to avoid an impeding nerve root injury and postoperative dysesthesia. (5) Conclusion: Neuromonitoring enabled the intraoperative diagnosis of DRG compression during the initial transforaminal placement of the endoscopic working cannula. Future studies with more statistical power will have to investigate whether employing neuromonitoring to avoid intraoperative compression of the exiting nerve root is predictive of lower postoperative dysesthesia rates in patients undergoing videoendoscopic transforaminal discectomy.
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Wu PH, Kim HS, Jang IT. A Narrative Review of Development of Full-Endoscopic Lumbar Spine Surgery. Neurospine 2020; 17:S20-S33. [PMID: 32746515 PMCID: PMC7410380 DOI: 10.14245/ns.2040116.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/28/2020] [Indexed: 12/15/2022] Open
Abstract
In the first phase of development of lumbar endoscopic spine surgery, the focus was on removal of soft disc material through the working corridor of Kambin’s triangle using transforaminal endoscopic lumbar discectomy. With the introduction of the interlaminar approach and increased interest from both industry and surgeons, there has been an exponential development of endoscopic surgical equipment and a corresponding expansion of endoscopic techniques. Endoscopic treatment strategies are applied to conditions ranging from contained prolapsed intervertebral discs to noncontained migrated herniated discs, hard calcified discs, spinal stenosis in the central or lateral recess and the foraminal and extraforaminal region, and other combinations of degenerative conditions requiring decompression or fusion surgery. The further expansion of endoscopic surgical management involving complicated spinal cases and the final quartet of trauma, infections, tumors, and possibly deformities could be the future stage of endoscopic spine surgery development. This article covers the full range of current treatment strategies and presents possible future developments of endoscopic spine surgery for the management of lumbar spinal conditions.
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Affiliation(s)
- Pang Hung Wu
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Korea.,National University Health System, JurongHealth Campus, Orthopaedic Surgery, Singapore
| | | | - Il-Tae Jang
- Nanoori Gangnam Hospital, Spine Surgery, Seoul, Korea
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Yu Y, Zhou Q, Xie YZ, Wang XL, Fan XH, Gu DW, Huang X, Wu WD. Effect of Percutaneous Endoscopic Lumbar Foraminoplasty of Different Facet Joint Portions on Lumbar Biomechanics: A Finite Element Analysis. Orthop Surg 2020; 12:1277-1284. [PMID: 32643308 PMCID: PMC7454218 DOI: 10.1111/os.12740] [Citation(s) in RCA: 8] [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: 12/11/2019] [Revised: 05/13/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the influence of percutaneous endoscopic lumbar foraminoplasty of different facet joint portions on segmental range of motion (ROM) and intradiscal pressure (IDP) of L3/L4 and L4/L5 motion segments by establishing three dimensional finite element (FE) model. Method Computed tomography images of a male adult volunteer of appropriate age and in good condition both mentally and physically. Obtained data was used in this study from July 2020 to December 2020, and an intact L3–5 three dimensional finite element model was successfully constructed using ANSYS and MIMICS software (model M1). The M1 was modified to simulate the foraminoplasty of different facet joint portions, with unilateral cylindrical excision (diameter = 0.75 cm) performed on the tip (model M2) and the base (model M3) of right L5 superior facet elements along with surrounding capsular ligaments, respectively. Under the same loading conditions, the ROM and IDP of L3/4 and L4/L5 segments in states of forward flexion, backward extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation were all compared. Result Compared with the intact model in backward extension, M2 increased the ROM of L4/5 segment by 9.4% and IDP by 11.7%, while the ROM and IDP of M3 changed only slightly. In right axial rotation, M2 and M3 increased the ROM of L4/5 segment by 17.9% and by 3.6%, respectively. In left axial rotation, M2 and M3 increased the ROM of L4/L5 segment by 7.14% and 3.6%, respectively. As for other states including forward flexion, left lateral bending, right lateral bending, the ROM and IDP were not significantly distinct between these two models. While focusing on L3/L4 segment, obviously changes in the ROM and IDP have not been presented and neither M2 nor M3 changed in any loading condition. Conclusion This study provides evidence that the base‐facet foraminoplasty of L5 superior facet provided a higher segmental stability compared with the tip‐facet foraminoplasty in flexion and axial rotation. Meanwhile, it also shows the two types of foraminoplasty make few differences to the L4/5 segmental biomechanics. Besides, it does not appear to impact the stability of L3/L4 in six states of forward flexion, backward extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation when superior facet of L5 was partially removed. These findings might be useful in understanding biomechanics of the lumbar spine after foraminoplasty performed on different portions of the facet, thus providing endoscopic surgeons a better reference for operational approach to maintain the function and mobility of the spine.
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Affiliation(s)
- Yang Yu
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qun Zhou
- Institution of Nurseury, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi-Zhou Xie
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin-Ling Wang
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-Hong Fan
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dang-Wei Gu
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xue Huang
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei-Dong Wu
- Institution of Nurseury, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Biomechanics Laboratory, Southern Medical University, Guangzhou, China
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杨 俊, 楚 磊, 邓 忠, Kai-Xuan L, 邓 锐, 陈 浩, 刘 鹏, 刘 团, 荣 雪, 郝 定. [Clinical study of single-level cervical disc herniation treated by full-endoscopic decompression via anterior transcorporeal approach]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:543-549. [PMID: 32410418 PMCID: PMC8171849 DOI: 10.7507/1002-1892.201905118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 02/27/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach. METHODS According to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C 3, 4 in 2 cases, C 4, 5 in 8 cases, C 5, 6 in 9 cases, and C 6, 7 in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated. RESULTS Full-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation ( P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one ( t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation ( t=0.881, P=0.421). CONCLUSION Full-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results.
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Affiliation(s)
- 俊松 杨
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 磊 楚
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 忠良 邓
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - Liu Kai-Xuan
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 锐 邓
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 浩 陈
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 鹏 刘
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 团江 刘
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 雪芹 荣
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 定均 郝
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
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Lin YP, Wang SL, Hu WX, Chen BL, Du YX, Zhao S, Rao SY, Su GY, Lin R, Chen S, Liu JG, Yang YF, Wen Y, Liang YH, Li YJ. Percutaneous Full-Endoscopic Lumbar Foraminoplasty and Decompression by Using a Visualization Reamer for Lumbar Lateral Recess and Foraminal Stenosis in Elderly Patients. World Neurosurg 2020; 136:e83-e89. [DOI: 10.1016/j.wneu.2019.10.123] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
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Percutaneous Endoscopic Transforaminal Discectomy versus Conventional Open Lumbar Discectomy for Upper Lumbar Disc Herniation: A Comparative Cohort Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1852070. [PMID: 32190653 PMCID: PMC7072112 DOI: 10.1155/2020/1852070] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 01/31/2023]
Abstract
Background Percutaneous endoscopic transforaminal discectomy (PETD) is regarded as a viable alternative option for upper lumbar disc herniation (LDH). However, few studies have evaluated PETD for upper LDH, and no study has compared the advantages of endoscopic procedures versus conventional surgery. The present study was aimed at comparing the surgical outcome and safety of PETD versus conventional open lumbar discectomy in the treatment of upper LDH. Methods Data from 42 patients treated for upper LDH from July 2015 to July 2018 were retrospectively analyzed, including 21 patients treated with PETD (PETD group) and 21 patients treated with conventional posterior lumbar discectomy (open group). The two groups were compared regarding demographic information, physical examination, radiological evaluations, and perioperative indicators. The clinical outcomes were assessed in accordance with the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified MacNab criteria. Results The postoperative ODI and VAS scores were significantly improved in both groups compared with the preoperative baseline values (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate ( Conclusions PETD has a similar outcome to the conventional surgical method for the treatment of upper LDH but provides the typical advantages of minimally invasive procedures such as reduced iatrogenic injury, minimal activity restrictions, and accelerated ambulation recovery postoperatively.
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Zhan S, Wang K, Song Y, Li S, Yin H, Luo R, Liao Z, Wu X, Zhang Y, Yang C. Long non-coding RNA HOTAIR modulates intervertebral disc degenerative changes via Wnt/β-catenin pathway. Arthritis Res Ther 2019; 21:201. [PMID: 31481088 PMCID: PMC6724301 DOI: 10.1186/s13075-019-1986-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 08/23/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Intervertebral disc degeneration (IDD) has a complicated and enigmatic pathogenic process. Accumulating evidence shows that long non-coding RNAs (LncRNAs) play a role in the pathogenesis of IDD. This study aimed to investigate the expression and role of the LncRNA HOTAIR in IDD pathogenesis. METHODS Nucleus pulposus (NP) tissue samples from 10 patients with idiopathic scoliosis and 10 patients with lumbar disc herniation were collected. qRT-PCR was used to assess the expression of HOTAIR and ECM-related genes; western blotting was used to detect the expression of senescence biomarkers, apoptosis-related proteins, and Wnt/β-catenin pathway; flow cytometry was used to detect apoptosis; and the MTT assay was used to determine cell proliferation. Moreover, a classic needle-punctured rat tail model was used to investigate the role of HOTAIR in IDD in vivo. RESULTS The results showed that the expression of HOTAIR significantly increased during IDD progression. The overexpression of HOTAIR was found to induce nucleus pulposus (NP) cell senescence, apoptosis, and extracellular matrix (ECM) degradation. HOTAIR silencing by RNA interference in NP cells prevented interleukin-1β-induced NP cell senescence, apoptosis, and ECM degradation. Furthermore, we found that the Wnt/β-catenin pathway played a role in regulating HOTAIR to induce these changes in NP cells. Moreover, HOTAIR inhibition in a rat model effectively attenuated IDD symptoms in vivo. CONCLUSIONS Our findings confirmed that HOTAIR promoted NP cell senescence, apoptosis, and ECM degradation via the activation of the Wnt/β-catenin pathway, while silencing HOTAIR attenuated this degeneration process, indicating a potential therapeutic target against IDD.
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Affiliation(s)
- Shengfeng Zhan
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.,Department of Orthopaedics, Enshi Center Hospital, Enshi, China
| | - Kun Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu Song
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huipeng Yin
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Rongjin Luo
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhiwei Liao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xinghuo Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yukun Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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