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Li J, Chu X, Wan W, Du L, Xu B. Radiographic characteristics-based classification system for percutaneous endoscopic lumbar discectomy surgical approach selection in patients with L5-S1 disc herniation: a hierarchical clustering analysis. Quant Imaging Med Surg 2023; 13:8204-8217. [PMID: 38106320 PMCID: PMC10722082 DOI: 10.21037/qims-23-277] [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: 03/06/2023] [Accepted: 09/18/2023] [Indexed: 12/19/2023]
Abstract
Background No classification system exists for aiding the selection of surgical approaches in L5-S1 disc herniation when undergoing percutaneous endoscopic lumbar discectomy (PELD). We aimed to identify radiographic subtypes to aid the selection of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in patients with L5-S1 disc herniation via unsupervised hierarchical clustering analysis. Methods In this retrospective case-control study, we gathered 296 anteroposterior and lateral lumbar spine radiographs (dataset 1) from Tianjin Hospital between January 2016 and October 2021 for clustering analyses. Additionally, we analyzed 111 patients who underwent PEID or PETD for L5-S1 disc herniation at Tianjin Hospital from January 2016 to August 2022. We included patients with radicular leg pain or back pain associated with intra-canal disc herniation who failed in conservative treatments over 6 weeks. First, pair-wise Spearman correlation coefficients were calculated among plain radiographic metrics in dataset 1 to reveal the association among these radiographic metrics. Second, hierarchical clustering analysis was conducted to unsupervised cluster the plain films into several subtypes. Last, for each radiographic subtype, the intraoperative blood loss (IBL), operation time (OT), total operating room time (TORT) along with visual analogue scale (VAS) and Oswestry Disability Index (ODI) were compared between patients underwent PETD or PEID with age as covariates. Results This study yielded 3 main findings: (I) iliac height (IH) was negatively correlated with intervertebral foramen width (IFW), intervertebral foramen height (IFH), and intertransverse height (ITH) (R=-0.50, -0.42, and -0.46, all P<0.001), ITH was positively correlated with IFW and IFH (R=0.40 and 0.53, all P<0.001); (II) 2 lumbosacral radiographic subtypes were identified via hierarchical clustering analysis; (III) relative to subtype 1, the patients identified as subtype 2 exhibited lesser IBL, shorter OT, and shorter TORT following PETD (t=2.92, P=0.006; t=2.65, P=0.012; t=3.17, P=0.003). Conclusions The morphology pattern of the lumbosacral region affect the ease of different PELD procedures when performing percutaneous discectomy at the segment of L5-S1. Without considering the type of disc herniation, this classification system might aid spine surgeons in the selection of an appropriate surgical approach.
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Affiliation(s)
- Jie Li
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Xu Chu
- Department of Orthopedics, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Wentao Wan
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Lilong Du
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China
| | - Baoshan Xu
- Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, China
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Khaled H, Mehdi B, Mondher K. Symptomatic Extraforaminal Gas Cyst from Intradiscal Vacuum Phenomenon. Neurol India 2023; 71:811-812. [PMID: 37635535 DOI: 10.4103/0028-3886.383845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Hadhri Khaled
- Department of Orthopedics and Traumatology, Charles Nicolle's Hospital, Tunis, Tunisia
| | - Bellil Mehdi
- Department of Orthopedics and Traumatology, Charles Nicolle's Hospital, Tunis, Tunisia
| | - Kooli Mondher
- Department of Orthopedics and Traumatology, Charles Nicolle's Hospital, Tunis, Tunisia
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Wei Z, Lin Q, Zhang H, Zhang H, Ma X, Wang C. A rare gas-containing lumbar synovial cyst treated by percutaneous transforaminal endoscopic cystectomy: A case report and literature review. Front Surg 2023; 10:1095572. [PMID: 37025269 PMCID: PMC10070843 DOI: 10.3389/fsurg.2023.1095572] [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: 11/11/2022] [Accepted: 03/06/2023] [Indexed: 04/08/2023] Open
Abstract
Spinal synovial cysts are rare entities for which standard surgical strategies are inconsistent. Here, we present an uncommon intraspinal gas-containing synovial cyst treated by percutaneous transforaminal endoscopic cystectomy. A 52-year-old man presented with radicular pain and intermittent claudication that had persisted for one month. Computed tomography revealed an intraspinal cystic lesion anteromedial to the left L4-L5 articular joint and the center of the lesion manifested gas contents. A transforaminal endoscopic procedure was performed and confirmed as a safe and minimally invasive technique for gas-containing lumbar synovial cysts. It provides a valuable substitution and supplementation to open surgery.
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Affiliation(s)
- Ziran Wei
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qian Lin
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hao Zhang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haoyun Zhang
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuexiao Ma
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Correspondence: Chao Wang ; Xuexiao Ma
| | - Chao Wang
- Department of Spine Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Correspondence: Chao Wang ; Xuexiao Ma
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Saleemi M, Abrar S, Dherijha MSA, George KJ. A postoperative complication of lumbar discectomy: A discal/annular cyst. Surg Neurol Int 2022; 13:572. [PMID: 36600759 PMCID: PMC9805644 DOI: 10.25259/sni_947_2022] [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: 10/13/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background A postoperative discal/annular cyst following lumbar discectomy may reproduce the symptoms/signs of a recurrent lumbar disc herniation (i.e., back pain and radiculopathy). Case Description A 21-year-old rugby player developed leg pain after an uncomplicated lumbar microdiscectomy. The repeat lumbar magnetic resonance imaging confirmed a postoperative lumbar annular/ discal cyst, for which he underwent repeat surgery. The diagnosis was further confirmed histopathologically at surgery. Conclusion Although rare, postoperative discal/annular cysts may be potential causes of recurrent postoperative pain and lumbar radiculopathy mimicking recurrent disc herniations.
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Affiliation(s)
- M Saleemi
- Corresponding author: M Saleemi, Department of Neurosurgery, Salford Royal Foundation Trust, Manchester, United Kingdom.
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Şakir Ekşi M, Ece Özcan-Ekşi E, Orhun Ö, Akkaş A, Harun Yaşar A, Zarbizada M, Canbolat Ç, Güdük M, Bozkurt B, İmre Usseli M, Erşen-Danyeli A, Hamit Aytar M, Kalelioğlu M, Özgen S, Necmettin Pamir M, Benzel EC. Could gas-filled pseudocyst mimick extruded disc herniation? J Clin Neurosci 2021; 93:147-154. [PMID: 34656239 DOI: 10.1016/j.jocn.2021.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/27/2021] [Accepted: 09/09/2021] [Indexed: 12/21/2022]
Abstract
There are case reports and small case series in the literature reporting gas-filled pseudocysts (GFP). However, a systematic review presenting overall view of the disease and its management is still lacking. In the present study, we aimed to make a systematic review of GFP cases, and present an exemplary case of ours. Our second aim was to discuss current theories for pathogenesis of GFP. A systematic review of GFP was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Two large-scaled data search engines were used. A total of 53 articles were retrieved from the literature and presented with an exemplary case of ours. Mean age of the historical cohort was 59.47 years. There were 66 male (54.1%) and 56 female (45.9%) patients. The most prevalent clinical presentation was radicular sign/symptom in lower limbs with (29.1%) or without low back pain (LBP) (67%). Gas-filled pseudocyst has most commonly been diagnosed at the lower lumbar spine (L4-L5, 45.3%; L5-S1, 37.7%). Surgery was the treatment of choice in most of the patients (80%). In the whole cohort, 79.1% of the patients had complete recovery. Gas-filled pseudocysts are rarely observed in daily practice. They present mostly in men at the age of 60s. Precise differential diagnosis determination using appropriate imaging would help clinicians treat the patients properly. Gas-filled pseudocysts should be treated similarly to other spinal pathologies causing nerve root compression.
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Affiliation(s)
- Murat Şakir Ekşi
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey.
| | - Emel Ece Özcan-Ekşi
- Bahçeşehir University, School of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Ömer Orhun
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Istanbul, Turkey
| | - Alper Akkaş
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Ahmet Harun Yaşar
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Maftun Zarbizada
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Çağrı Canbolat
- Memorial Hizmet Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Mustafa Güdük
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Baran Bozkurt
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Murat İmre Usseli
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Ayça Erşen-Danyeli
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Pathology, Istanbul, Turkey
| | - Murat Hamit Aytar
- Acıbadem Healthcare Group, Acıbadem Kozyatağı Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Müfit Kalelioğlu
- Acıbadem Healthcare Group, Acıbadem Altunizade Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - Serdar Özgen
- Acıbadem Healthcare Group, Acıbadem Maslak Hospital, Neurosurgery Clinic, Istanbul, Turkey
| | - M Necmettin Pamir
- Acıbadem Mehmet Ali Aydınlar University, School of Medicine, Department of Neurosurgery, Istanbul, Turkey
| | - Edward C Benzel
- Cleveland Clinic Foundation, Department of Neurosurgery, Cleveland, OH, USA
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