Two-level percutaneous endoscopic lumbar discectomy for highly migrated upper lumbar disc herniation: A case report

Deep Learning-Based Denoised MRI Images for Correlation Analysis between Lumbar Facet Joint and Lumbar Disc Herniation in Spine Surgery

This work aimed to explore the relationship between spine surgery lumbar facet joint (LFJ) and lumbar disc herniation (LDH) via compressed sensing algorithm-based MRI images to analyze the clinical symptoms of patients with residual neurological symptoms after LDH. Under weighted BM3D denoising, Epigraph method was introduced to establish the novel CSMRI reconstruction algorithm (BEMRI). 127 patients with LDH were taken as the research objects. The BEMRI algorithm was compared with others regarding peak signal-to-noise ratio (PSNR) and structural similarity index (SSIM). Patients' bilateral LFJ angles were compared. The relationships between LFJ angles, lumbar disc degeneration, and LFJ degeneration were analyzed. It turned out that the PSNR and SSIM of BEMRI algorithm were evidently superior to those of other algorithms. The proportion of patients with grade IV degeneration was at most 31.76%. Lumbar disc grading was positively correlated with change grading of LFJ degeneration (P < 0.001). LFJ asymmetry was positively correlated with LFJ degeneration grade and LDH (P < 0.001). Incidence of residual neurological symptoms in patients aged 61–70 years was as high as 63.77%. The proportion of patients with severe urinary excretion disorders was 71.96%. Therefore, the BEMRI algorithm improved the quality of MRI images. Degeneration of LDH was positively correlated with degeneration of LFJ. Asymmetry of LFJ was notably positively correlated with the degeneration of LFJ and LDH. Patients aged 61–70 years had a high incidence of residual neurological symptoms after surgery, most of which were manifested as urinary excretion disorders.

Surgical outcomes of decompression alone versus transpedicular screw fixation for upper lumbar disc herniation

Background

Surgical outcomes of upper lumbar disc herniations (ULDHs) including T12-L1, L1-L2, and L2-L3 levels are characteristically less favorable and more unpredictable.

Objectives

This study was conducted to compare the surgical outcomes of decompression alone versus decompression combined with transpedicular screw fixation in treating upper lumbar disc herniation.

Methods

This retrospective cohort study was carried out at Neurosurgery Departments, Tanta University. The study included 46 patients with a symptomatic high lumbar herniated disc at T12-L1, L1-L2, and L2-L3 levels. The enrolled patients were divided into two groups depending on whether they were operated on via decompression and partial medial facetectomy (group 1, 22 patients) or via the previous maneuver plus transpedicular screw fixation (group 2, 24 patients). All patients were medically evaluated immediately after the operation; then, they were followed up at the 3rd and the 6th months following surgery. Patients’ outcomes were assessed by visual analogue score (VAS) and Oswestry Disability Index (ODI) scores.

Results

Median VAS scores in each group revealed significant reduction immediately following surgery and at each of 7 days, 3 months, and 6 months in comparison with the preoperative VAS score (p<0.001). Furthermore, each group showed significant stepwise reduction in the median ODI score at the 3rd and the 6th months postoperative compared to the preoperative ODI score (group 1 = 68.0, 19.0, 15.0; p< 0.001 and group 2 = 66.5, 20.0, 15.0; p< 0.001), with no significant differences between both groups (p> 0.05).

Conclusions

Both standalone decompression and decompression combined with transpedicular screw fixation revealed comparable favorable outcomes in patients with ULDH.

Percutaneous Isthmus Foraminoplasty and Full-Endoscopic Lumbar Discectomy for Very Highly Upmigrated Lumbar Disc Herniation: Technique Notes and 2 Years Follow-Up

OBJECTIVE

To report the technical notes and clinical outcome of percutaneous isthmus foraminoplasty and full-endoscopic lumbar discectomy (PIF-FELD) for the treatment of very highly upmigrated lumbar disc herniation (VHUM-LDH).

PATIENTS AND METHODS

From January 2014 to December 2017, 16 patients with VHUM-LDH underwent PIF-FELD surgery. A 10-mm-diameter semi-open foraminoplasty was performed on the dorsal side of the upper intervertebral foramen with lateral isthmus resection by a safe trephine system, in which the facet joint was not injured. Full-endoscopic transforaminal fragmentectomy in the spinal canal and discectomy in the intervertebral space were performed simultaneously. Magnetic resonance imaging of the lumbar spine was reexamined on the second day and 3 months after the operation to evaluate the completeness of the disc fragmentectomy and nerve decompression. The patients were followed up on the visual analog scale (VAS) of lumbar pain and leg pain and Oswestry Disability Index on the second day, 3 months, 6 months, 1 year, and 2 years after operation. The MacNab score and nerve root function recovery were evaluated at 2 years postoperative follow-up.

RESULTS

All operations were successfully completed without any change in the surgical method. During the operation, 5 patients were found to have a single sequestered fragment, and the remaining 11 patients had multiple sequestered fragments. There were no complications (e.g., dural tear and nerve injury) during the operation, and no complications (e.g., infection, cerebrospinal fluid leakage, exacerbation of nerve root function injury, and recurrence of intervertebral disc herniation) occurred. Postoperative reexamination of lumbar magnetic resonance imaging in all patients showed complete disc fragmentectomy and adequate nerve decompression. The postoperative low back pain VAS and leg pain VAS scores and Oswestry Disability Index on the second day, 3 months, 6 months, 1 year, and 2 years after operation were significantly improved compared with preoperatively (P < 0.01). At 2 years follow-up, the sensation and muscular strength of the affected nerve root innervation area were significantly restored (P < 0.05), but tendon reflex function was not significantly restored (P > 0.05). At 2 years follow-up, MacNab scores included 6 excellent, 9 good, and 1 fair.

CONCLUSIONS

PIF-FELD is a safe and effective minimally invasive spine surgery technique for VHUM-LDH.