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Mizoguchi Y, Akasaka K, Suzuki K, Kimura F, Hall T, Ogihara S. Construct validation of the Japanese Core Outcome Measures Index and the impact of diseases on patient-reported outcome measures in preoperative patients with lumbar spinal stenosis and disk herniation: a single-center observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2198-2205. [PMID: 38679673 DOI: 10.1007/s00586-024-08148-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE The primary objective was to validate the construct validity of the Japanese Core Outcome Measures Index (COMI) in preoperative patients aged 60 years or older undergoing lumbar spine surgery for lumbar spinal stenosis (LSS) and lumbar disk herniation (LDH). Additionally, as a secondary aim, we explored the impact of these diseases on quality of life (QOL). METHODS The analysis included 199 preoperative patients aged 60 and above who were scheduled for lumbar spine surgery. To assess QOL, Japanese versions of the COMI, Oswestry Disability Index (ODI), EuroQol-5 Dimension-3 Level (EQ-5D-3L), and SF-12v2 were employed. The study assessed the validity of the COMI and compared demographic and clinical characteristics between the LSS (147 cases) and LDH (52 cases) groups. It used multivariate covariance analysis (MANCOVA) to examine the impact of diseases (LSS and LDH) on each patient-reported outcome measure while considering covariates. RESULTS Compared to the LSS group, the LDH group showed more difficulty with the COMI summary score (LSS/LDH [mean]: 6.9/8.1, p < 0.001), ODI score (46.8/57.4, p < 0.001), and EQ-5D utility (0.53/0.43, p < 0.001). The LDH group also reported more difficulties in the COMI-function, COMI-symptom-specific well-being, COMI-disability, ODI-personal care, ODI-social life, and SF-12v2-bodily pain subscales. MANCOVA demonstrated that these results were not influenced by covariates such as gender and medical history. CONCLUSIONS This study highlights the distinct impact of LSS and LDH on preoperative QOL in older patients undergoing lumbar spinal surgery. Tailored interventions are essential to address the specific challenges posed by these conditions and improve patient-centered outcomes and postoperative recovery.
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Affiliation(s)
- Yasuaki Mizoguchi
- Saitama Medical University Graduate School of Medicine, 981 Kawakado, Moroyama, Iruma, Saitama, 3500496, Japan
- Department of Rehabilitation, Kimura Orthopaedic Clinic, 689-7 Harajima, Kumagaya, Saitama, 3600811, Japan
| | - Kiyokazu Akasaka
- Saitama Medical University Graduate School of Medicine, 981 Kawakado, Moroyama, Iruma, Saitama, 3500496, Japan.
| | - Kenta Suzuki
- Department of Rehabilitation, Kimura Orthopaedic Clinic, 689-7 Harajima, Kumagaya, Saitama, 3600811, Japan
| | - Fumihiko Kimura
- Department of Rehabilitation, Kimura Orthopaedic Clinic, 689-7 Harajima, Kumagaya, Saitama, 3600811, Japan
| | - Toby Hall
- Curtin School of Allied Health, Curtin University, P.O. Box U1987, Perth, WA, 6845, Australia
| | - Satoshi Ogihara
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 3508550, Japan
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Tsujimoto T, Kanayama M, Fukada S, Oha F, Shimamura Y, Hasegawa Y, Hashimoto T, Kakutani K, Yurube T, Takeoka Y, Miyazaki K, Iwasaki N. Predictors of Persistent Postoperative Numbness Following Lumbar Fusion in Patients Older Than 75 Years: A Minimum 2-Year Follow-up. Neurospine 2024; 21:596-605. [PMID: 38955531 PMCID: PMC11224755 DOI: 10.14245/ns.2347312.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To evaluate the preoperative and perioperative predictors of persistent leg numbness following lumbar fusion in patients aged ≥ 75 years. METHODS This single-center retrospective study examined 304 patients aged ≥ 75 years who underwent lumbar fusion for lumbar degenerative disease (102 men, 202 women; mean age, 79.2 [75-90] years). The visual analogue scale (VAS) score for leg numbness was examined preoperatively and at 2 years postoperatively. The persistent leg numbness group included patients with a 2-year postoperative VAS score for leg numbness ≥ 5 points. The demographic data were also reviewed. A multivariate stepwise logistic regression analysis was performed for variables with univariate analysis values of p < 0.2 on univariate analysis. RESULTS In total, 71 patients (23.4%) experienced persistent postoperative leg numbness. Multivariate logistic regression analysis revealed that a history of lumbar decompression, longer symptom duration, and a preoperative VAS score for leg numbness ≥ 5 points were associated with greater postoperative persistent leg numbness following lumbar fusion. In contrast, other factors, such as sex, body mass index, vertebral fracture, diabetes mellitus, depression, symptom duration, dural injury, operative time, and estimated blood loss, were not. CONCLUSION A history of preoperative lumbar decompression, longer symptom duration, and greater preoperative VAS scores for leg numbness were preoperative predictors of persistent postoperative leg numbness following lumbar fusion in older patients. Although lumbar fusion is expected to improve leg numbness, surgeons should consider the surgical history, duration, and preoperative numbness intensity and explain the potential postoperative persistent leg numbness in advance.
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Affiliation(s)
- Takeru Tsujimoto
- Spine Center, Hakodate Central General Hospital, Hakodate, Japan
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Shotaro Fukada
- Spine Center, Hakodate Central General Hospital, Hakodate, Japan
| | - Fumihiro Oha
- Spine Center, Hakodate Central General Hospital, Hakodate, Japan
| | | | - Yuichi Hasegawa
- Spine Center, Hakodate Central General Hospital, Hakodate, Japan
| | | | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiki Takeoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Miyazaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Yu Y, Wang J, Wang L, Xing W, Xu X, Zhu T, Gong Q, Huang W. Prognostic factors for residual symptoms following percutaneous endoscopic lumbar discectomy. Neurosurg Rev 2024; 47:250. [PMID: 38814488 DOI: 10.1007/s10143-024-02486-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/15/2024] [Accepted: 05/25/2024] [Indexed: 05/31/2024]
Abstract
To explore the risk factors for residual symptoms following percutaneous endoscopic lumbar discectomy (PELD). A retrospective case-controlled study. From January 2015 to December 2020, consecutive patients who underwent PELD for lumbar disc herniation (LDH) in our department were retrospectively studied. All the patients were followed-up at least two years. Residual symptoms were analyzed for association with baseline data, clinical feature, physical examination, and radiographic characteristics, which were used to detected the risk factors. A total of 339 patients were included in this study, with a mean follow-up of 28.7 ± 3.6 months. Of the enrolled patients, 90 (26.5%) patients experienced residual low back pain (LBP), and 76 (22.4%) patients experienced leg numbness (LN). Multivariate logistic regression analysis revealed that intervertebral disc calcification on CT scans (odd ratio, 0.480; 95% confidence interval: 0.247 ~ 0.932; P < 0.05) was independent risk factor for postoperative residual LBP with odd ratio and longer symptom duration was risk factor for postoperative residual LN (odd ratio, 2.231; 95% confidence interval:1.066 ~ 4.671; P < 0.05). Residual symptoms following transforaminal endoscopic surgery are quite prevalent. Intervertebral disc calcification is a protective factor for residual low back pain, and a longer symptom duration is a risk factor for residual leg numbness.
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Affiliation(s)
- Yang Yu
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, People's Republic of China
| | - Jingming Wang
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, People's Republic of China
| | - Lei Wang
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, People's Republic of China
| | - Wenqiang Xing
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, People's Republic of China
| | - Xiaoduo Xu
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, People's Republic of China
| | - Tiantian Zhu
- Statistics Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, People's Republic of China
| | - Qinglei Gong
- Radiology Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, People's Republic of China
| | - Weimin Huang
- Orthopedic Department, 960 Hospital of People's Liberation Army, NO.25 Shifan Road, Jinan, Shandong, 250031, People's Republic of China.
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Bu J, Wang Z, Ma C, Gao J, Liu G, Pang L, He B, Dong M, Zhang Q, Lei Y, Xu L, Huang S, Li Y, Liu G. Postoperative MRI Findings Following PELD and Their Correlations with Clinical Prognosis are Investigated by Injecting Contrast into Annulus Fibrosus Intraoperatively. J Pain Res 2024; 17:381-392. [PMID: 38312505 PMCID: PMC10838106 DOI: 10.2147/jpr.s442224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/30/2023] [Indexed: 02/06/2024] Open
Abstract
Objective To validate whether a residual mass demonstrated on early postoperative MR after percutaneous endoscopic lumbar discectomy (PELD) is indeed an intraoperatively retained annulus fibrosus, and explore the correlation between imaging changes in the residual mass and clinical prognosis of patients. Methods A prospective study of 118 patients were included. During surgery, a contrast medium, Gadopentetate Dimeglumine, was injected around the ruptured annulus fibrosus. The intensity of the T2 signal, the size of the remaining mass (SR), and the cross-sectional area of the spinal canal (SCSA), VAS, and ODI were assessed at preoperative, 1-h (7-day), 6-month, and 12-month postoperative intervals. Based on VAS at 7 days post-surgery, patients were classified into either a non-remission group (Group A, VAS > 3) or a remission group (Group B, VAS ≤ 3). Results Six patients who developed recurrent LDH were excluded. A residual mass was detected on MRI 1 h after surgery in 94.6% (106/112). During one year of follow-up, 90.1% (101/112) of the patients displayed fibrous annulus remodeling, although 68.7% (77/112) still exhibited herniation. Significant differences were found in the ODI between Groups A and B one week after surgery (p < 0.001). However, no significant differences were observed in T2 signal intensity, SR, and SCSA at 1-h, 6-month and 12-month post-surgery (p > 0.05) between the two groups. In a multiple linear regression analysis, early postoperative ODI changes were associated with T2 signal (B = -10.22, sig < 0.05), long-term changes were associated with alterations in SR (B = 5.63, sig < 0.05) and SCSA (B = -0.13, sig < 0.05). Conclusion The residual mass observed in early postoperative MR images after PELD was the retained annulus fibrosus intraoperatively. Short-term changes in clinical symptoms after PELD were linked to T2 signal intensity, while long-term changes were associated with changes in SR and SCSA.
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Affiliation(s)
- Jinhui Bu
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, People's Republic of China
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Zhenfei Wang
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Chao Ma
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, People's Republic of China
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Juan Gao
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Guangpu Liu
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Libo Pang
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Bo He
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Minghui Dong
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Quan Zhang
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Yan Lei
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Long Xu
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Sen Huang
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Yuming Li
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Guangwang Liu
- Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, People's Republic of China
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou, People's Republic of China
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Shi L, Ji X, Tian F, Shi Y, Lou P. Risk factor of residual leg numbness after lumbar microdiscectomy for lumbar disc herniation. Medicine (Baltimore) 2023; 102:e35733. [PMID: 37904414 PMCID: PMC10615446 DOI: 10.1097/md.0000000000035733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023] Open
Abstract
Although patients with lumbar disc herniation (LDH) can achieve significant relief from lower back and leg pain after lumbar microdiscectomy, a few patients complain of discomfort due to residual leg numbness (RLN). This study aimed to identify potential risk factors for RLN after lumbar microdiscectomy. We prospectively collected and analyzed patients with LDH who underwent microdiscectomy between September 2016 and December 2020. All included patients had preoperative LN symptoms. Patients with RLN were defined as those with LN at the last follow-up. The relationships between RLN and sex, age, body mass index (BMI), current smoking status, diabetes mellitus, revision surgery, preoperative LN Numeric Rating Scale (NRS) score, duration of preoperative LN, RLN at discharge, sagittal range of motion (SROM), Modic change, disc Pfirrmann grade were analyzed. The RLN was observed in 33.5% (112/334) of patients at the last follow-up. No significant differences were observed in age, sex, BMI, current smoking status, or diabetes between the RLN and non-RLN groups. The preoperative LN NRS score, preoperative LN duration, rate of RLN at discharge, and revision surgery were significantly higher in the RLN group than those in the non-RLN group. Multivariate logistic regression analysis identified the preoperative LN NRS score, duration of preoperative LN, RLN at discharge, revision surgery, and SROM as risk factors for RLN in the long-term follow-up. Patients with higher preoperative LN NRS scores and SROM, longer preoperative LN duration, RLN at discharge, and revision surgery were more likely to experience RNL after lumbar microdiscectomy.
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Affiliation(s)
- Liang Shi
- Department of Orthopedics, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Hubei province, China
| | - Xianqun Ji
- Department of Orthopedics, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Hubei province, China
| | - Fangtao Tian
- Department of Orthopedics, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Hubei province, China
| | - Yihua Shi
- Department of Orthopedics, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Hubei province, China
| | - Pan Lou
- Department of Spine Surgery, Jingmen Central Hospital (Formerly The First People’s Hospital of Jingmen), Hubei province, China
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Sheng Y, Li J, Chen L, Geng M, Fen J, Sun S, Sun J. Delta large-channel technique versus microscopy-assisted laminar fenestration decompression for lumbar spinal stenosis: a one-year prospective cohort study. BMC Musculoskelet Disord 2023; 24:43. [PMID: 36653778 PMCID: PMC9850816 DOI: 10.1186/s12891-023-06143-0] [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: 09/25/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE When it comes to treating lumbar spinal stenosis (LSS), a procedure known as microscope-assisted fenestration decompression has expediently become the gold standard. With the advancement of spinal endoscopy, the Delta large-channel approach has shown promising clinical outcomes in the management of lumbar spinal stenosis. However, case studies of this method being used to treat lumbar spinal stenosis are still uncommon. The purpose of this research was to examine how well microscopy-assisted laminectomy and the Delta large-channel approach work in treating LSS in the clinic. METHODS From May 2018 to June 2020, 149 patients diagnosed with LSS were divided into 80 patients in Delta large-channel technique groups (FE group) and 69 patients in microscope groups (Micro group). Lower back and lower limb pain were measured using the visual analogue scale (VAS-LBP and VAS-LP), while lower limb numbness was evaluated using the 11-point numerical rating scale (NRS-LN); modified Oswestry Disability Index (ODI) was used to evaluate the quality of life, and modified MacNab criteria were used to assess the clinical efficacy before surgery and at one week, three months, six months, and 12 months after surgery. All patients had single-level lumbar spinal stenosis, and clinical data such as hospital stay, operation time, intraoperative blood loss were statistically analyzed. RESULTS Finally, 111 patients (62 in FE group and 49 in Micro group) completed follow-up. Compared with preoperative results, postoperative VAS-LBP, VAS-LP, NRS-LN score and modified ODI score were significantly improved in 2 groups (P < 0.05), but there was no significant difference in postoperative follow-up at each time point (P > 0.05), Except 1 week after surgery, VAS-LBP in FE group was lower than that in Micro group (P < 0.05). It is noteworthy that the FE group had a shorter hospital stay, less intraoperative blood loss, and a quicker time of getting out of bed when compared with the microscope group,but the operation time was just the opposite (P < 0.05). The excellent and good rate was 83.87% in FE group and 85.71% in Micro group (P > 0.05). CONCLUSIONS Both microscope-assisted laminar fenestration decompression and Delta large-channel procedures provide satisfactory treatment outcomes, however the Delta large-channel approach has some potential advantages for the treatment of LSS, including quicker recovery and sooner reduced VAS-LBP. Long-term consequences, however, will necessitate additional follow-up and research.
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Affiliation(s)
- Yuehang Sheng
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Jing Li
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Lei Chen
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Minghao Geng
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Jing Fen
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Shaodong Sun
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
| | - Jianhua Sun
- grid.411680.a0000 0001 0514 4044Department of Spinal Surgery, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, 832000 China
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Zhang W, Liu H, Le X, Song K, Yang F, Cui Z, Zhao W. Acupuncture for postoperative pain of lumbar disc herniation: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32016. [PMID: 36626470 PMCID: PMC9750534 DOI: 10.1097/md.0000000000032016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Evidence for the effects of acupuncture on postoperative pain of Lumbar disc herniation (LDH) is inconsistent. We conducted this systematic review and meta-analysis to evaluate the efficacy of acupuncture for postoperative pain of LDH. METHODS We performed a comprehensive search on PubMed, Embase, Web of Science, Cochrane Central, and four Chinese databases (CNKI, Wan Fang, CBMdisc, and VIP) for articles published before September 2021. The data extraction table was made for the ten included studies, and the risk of bias was assessed using the Cochrane collaboration tool, followed by statistical analysis using RevMan 5.3. RESULTS A total of ten studies involving 838patients were included. The statistical meta-analysis showed that acupuncture treatment was significantly better than drugs in improving cure rate (OR = 2.24, 95% CI = [1.58, 3.19], P < .00001) and the total effectiveness rate (OR = 4.85, 95% CI = [2.59, 9.08], P < .00001). And the results from the meta-analysis showed that acupuncture group was superior to control group in debasing visual analog scale score (MD = -1.26, 95% CI = [-1.72, -0.79], P < .00001) and improving Japanese Orthopaedic Association score (MD = 4.21, 95% CI = [1.53, 6.90], P < .00001). In addition, acupuncture was statistically significantly better than drugs (OR = 0.27, 95% CI = [0.11, 0.62], P = .002) in the incidence of adverse events, However, there was no statistically significant difference between acupuncture and rehabilitation (OR = 0.36, 95% CI = [0.07, 1.98], P = .24). CONCLUSION Acupuncture is an effective and safe treatment for postoperative pain of LDH. It can be recommended to manage patients with postoperative pain of LDH. However, considering the unsatisfactory quality of the included studies, more high-quality randomized controlled trials with a large sample size are needed to elucidate this issue.
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Affiliation(s)
- Weidong Zhang
- Changchun University of Chinese Medicine, Changchun, China
| | - Huan Liu
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, China
| | - Xuezhen Le
- The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Kunyu Song
- Changchun University of Chinese Medicine, Changchun, China
| | - Fo Yang
- Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, China
| | - Zhenhai Cui
- The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Wenhai Zhao
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
- * Correspondence: Wenhai Zhao, Affiliated Hospital of Changchun University of Chinese Medicine, 1478 Gongnong Road, Changchun, Jilin 130021, China (e-mail: )
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Risk Factors in the Prediction of Leg Numbness after Spinal Endoscopic Surgery: Evaluation and Development of a Nomogram. BIOMED RESEARCH INTERNATIONAL 2022; 2022:9502749. [PMID: 36398068 PMCID: PMC9666014 DOI: 10.1155/2022/9502749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
Purpose This study aims at constructing a clinical predictive model that predicted the risk factors for leg numbness after spinal endoscopic surgery. Methods We collected the clinical data of patients, including general information, imaging parameters, and clinical score, from our hospital's electronic database. Based on the postoperative leg numbness visual analog scale (LN-VAS), the clinical data were divided into the leg numbness group (≥25) and the improvement group (<25). All parameters were included in the least absolute shrinkage and selection operator (LASSO) regression analysis, while the parameters with the area under the curve (AUC) greater than 0.7 were selected to construct nomograms. Furthermore, the accuracy and validity of the model were evaluated using the C-index, decision curve analysis (DCA), calibration curve, and receiver operating characteristic curve (ROC). Results A total of 73 patients' clinical data were included in the training set, where 51 patients were assigned to the improvement group and 22 to the leg numbness group. The nomogram was constructed using four selected parameters, including symptom duration, lumbar spinal stenosis (LSS), pelvic incidence (PI), and preoperative low back pain visual analog scale (LBP-VAS). The nomogram predictions were found to range between 0.01 and 0.99. The values of the C-index, AUC, and internally validated C-index were 0.96, 0.96, and 0.94, respectively. Our result showed that the clinical net benefit of the nomogram ranged between 0.01 and 0.99. Conclusion Our clinical prediction model demonstrated high predictive ability and clinical validity. Moreover, we found that symptom duration, LSS, PI, and preoperative LBP-VAS were the predictive risk factors for leg numbness after spinal endoscopic surgery.
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Usage of intelligent medical aided diagnosis system under the deep convolutional neural network in lumbar disc herniation. Appl Soft Comput 2021. [DOI: 10.1016/j.asoc.2021.107674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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d'Ercole M, Innocenzi G, Ricciardi F, Bistazzoni S. Prognostic Value of Michigan State University (MSU) Classification for Lumbar Disc Herniation: Is It Suitable for Surgical Selection? Int J Spine Surg 2021; 15:466-470. [PMID: 33963037 DOI: 10.14444/8068] [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] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) is the most common cause of radiculopathy; patients with severe pain refractory to conservative management or neurological deficits are candidates to surgical procedures. Michigan State University (MSU) classification is a radiological codification considering both the size of the LDH and its medial to lateral location on the axial plane. The purpose of this retrospective study is to identify which kind of LDH, according to the MSU scheme, is more likely to cause a motor deficit. METHODS We performed a retrospective analysis on data obtained from 114 patients treated with 117 lumbar microdiscectomies after failure of non-operative care. All patients underwent neurological and functional evaluation before and after surgery according to the following: Oswestry Disability Index, visual analog scale, and Japanese Orthopaedic Association back pain evaluation questionnaire. Magnetic resonance imaging proved that disc herniation was classified according to the MSU scheme and was correlated with motor disturbances expressed according to Medical Research Council grade. RESULTS Statistical analysis showed a significant correlation between the lateral location of disc herniation (preforaminal and extraforaminal LDH, respectively MSU B and MSU C) and the grade of muscle weakness, given that the LDH in these locations poorly responded to medical therapy and was at higher risk for motor deficit onset; no significant correlation with the size was observed. CONCLUSIONS Beyond standardization of radiologic description, MSU classification proved to be useful in definition of prognosis and possibly in selection of surgical candidates. However, these data should be confirmed by prospective studies on a larger sample of patients, also including those under way for conservative treatment.
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Affiliation(s)
- Manuela d'Ercole
- Department of Neurosurgery, Fondazione Policlinico Universitario "A. Gemelli," Università Cattolica del Sacro Cuore, Roma, Italy
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