1
|
Nurmukhametov R, De Jesus Encarnacion Ramirez M, Dosanov M, Medetbek A, Kudryakov S, Reyes Soto G, Ponce Espinoza CB, Mukengeshay JN, Mpoyi Cherubin T, Nikolenko V, Gushcha A, Sharif S, Montemurro N. Exploring Pathways for Pain Relief in Treatment and Management of Lumbar Foraminal Stenosis: A Review of the Literature. Brain Sci 2024; 14:740. [PMID: 39199435 PMCID: PMC11352478 DOI: 10.3390/brainsci14080740] [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: 05/18/2024] [Revised: 07/02/2024] [Accepted: 07/22/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND Lumbar foraminal stenosis (LFS) involves the narrowing of neural foramina, leading to nerve compression, significant lower back pain and radiculopathy, particularly in the aging population. Management includes physical therapy, medications and potentially invasive surgeries such as foraminotomy. Advances in diagnostic and treatment strategies are essential due to LFS's complexity and prevalence, which underscores the importance of a multidisciplinary approach in optimizing patient outcomes. METHOD This literature review on LFS employed a systematic methodology to gather and synthesize recent scientific data. A comprehensive search was conducted across PubMed, Scopus and Cochrane Library databases using specific keywords related to LFS. The search, restricted to English language articles from 1 January 2000 to 31 December 2023, focused on peer-reviewed articles, clinical trials and reviews. Due to the heterogeneity among the studies, data were qualitatively synthesized into themes related to diagnosis, treatment and pathophysiology. RESULTS This literature review on LFS analyzed 972 articles initially identified, from which 540 remained after removing duplicates. Following a rigorous screening process, 20 peer-reviewed articles met the inclusion criteria and were reviewed. These studies primarily focused on evaluating the diagnostic accuracy, treatment efficacy and pathophysiological insights into LFS. CONCLUSION The comprehensive review underscores the necessity for precise diagnostic and management strategies for LFS, highlighting the role of a multidisciplinary approach and the utility of a unified classification system in enhancing patient outcomes in the face of this condition's increasing prevalence.
Collapse
Affiliation(s)
- Renat Nurmukhametov
- 2nd National Clinical Centre, Federal State Budgetary Research Institution, Russian Research Center of Surgery Named after Academician B.V. Petrovsky, 103274 Moscow, Russia
- Department of Neurosurgery, Russian People’s Friendship University, 121359 Moscow, Russia
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, 103220 Moscow, Russia
| | | | - Medet Dosanov
- 2nd National Clinical Centre, Federal State Budgetary Research Institution, Russian Research Center of Surgery Named after Academician B.V. Petrovsky, 103274 Moscow, Russia
| | - Abakirov Medetbek
- 2nd National Clinical Centre, Federal State Budgetary Research Institution, Russian Research Center of Surgery Named after Academician B.V. Petrovsky, 103274 Moscow, Russia
| | - Stepan Kudryakov
- 2nd National Clinical Centre, Federal State Budgetary Research Institution, Russian Research Center of Surgery Named after Academician B.V. Petrovsky, 103274 Moscow, Russia
| | - Gervith Reyes Soto
- Department of Head and Neck, Unidad de Neurociencias, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Claudia B. Ponce Espinoza
- Department of Head and Neck, Unidad de Neurociencias, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | | | | | - Vladimir Nikolenko
- Department of Neurosurgery, Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of the Russian Federation, 103220 Moscow, Russia
| | - Artem Gushcha
- Department of Neurosurgery, Research Center of Neurology, 103220 Moscow, Russia
| | - Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi 16250, Pakistan
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), 56100 Pisa, Italy
| |
Collapse
|
2
|
Dai Y, Li D, Wen X. Percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: an efficacy analysis. Am J Transl Res 2024; 16:829-837. [PMID: 38586101 PMCID: PMC10994797 DOI: 10.62347/uwid7065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/06/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE This retrospective study evaluated the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar disc herniation (LDH). METHODS Data of 107 LDH patients admitted to the People's Hospital of Pingyang between July 2019 and May 2023 were analyzed retrospectively, including 51 cases treated with conventional open discectomy (control group) and 56 cases undergoing PTED (research group). We compared curative effects, operation time, intraoperative blood loss (IBL), incision length, time until ambulation, hospital stay, pre- and post-treatment pain intensity, lumbar function, and complications. Pain intensity was measured using the the Visual Analogue Scale (VAS), and the lumbar function was assessed by the Oswestry Disability Index (ODI). In addition, the factors influencing the efficacy in LDH patients were analyzed. RESULTS The research group showed a statistically higher overall efficacy (P=0.034, χ2=4.479), longer operation time (P=0.002, t=3.114), less IBL (P<0.001, t=29.725), earlier ambulation (P<0.001, t=8.628), shorter hospital stay (P<0.001, t=8.628), and smaller incision length (P<0.001, t=15.948) than the control group. In addition, the postoperative VAS score (P<0.001, t=5.621) and ODI score (P<0.001, t=4.909) were reduced significantly after treatment and were lower in the research group than in the control group. The research group was also associated with a significantly lower overall complication rate (7.14% vs. 21.57%; P=0.032, χ2=4.608), including reduced incidence of lumbar spinal mobility limitation, incontinence, postoperative infection, and cauda equina syndrome. Furthermore, age, course of disease, and treatment method were strongly associated with the treatment efficacy in LDH patients. CONCLUSIONS PTED is more effective than conventional open discectomy for LDH treatment. It reduces IBL, shortens incision length, facilitates patient recovery, alleviates postoperative pain, improves lumbar function, and minimizes the risk of postoperative complications.
Collapse
Affiliation(s)
- Yusen Dai
- Department of Orthopedics, The People's Hospital of Pingyang Pingyang County, Wenzhou 325400, Zhejiang, China
| | - Daoyou Li
- Department of Orthopedics, The People's Hospital of Pingyang Pingyang County, Wenzhou 325400, Zhejiang, China
| | - Xile Wen
- Department of Orthopedics, The People's Hospital of Pingyang Pingyang County, Wenzhou 325400, Zhejiang, China
| |
Collapse
|
3
|
Segawa T, Iwai H, Inanami H, Takano Y, Yuzawa Y, Kaneko T, Taniguchi K, Yanagisawa K, Yokosuka J, Tominaga R, Nakamoto H, Sasaki K, Koga H. A new surgical method to treat intracanal lumbar disc herniation using the unilateral biportal endoscopic transforaminal approach: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2024; 7:CASE23608. [PMID: 38285977 PMCID: PMC10829258 DOI: 10.3171/case23608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/26/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Unilateral biportal endoscopic lumbar discectomy (UBELD) is a new minimally invasive spine surgery. The purpose of this study is to describe a new surgical method to treat intracanal lumbar disc herniation (LDH) using the unilateral biportal endoscopic transforaminal approach (UBE-TFA). The first 15 patients who had undergone UBELD for single-level LDH were included in this study. Operative time, intraoperative blood loss, postoperative stay, and intraoperative complications were recorded. The Oswestry Disability Index (ODI), numeric rating scale (NRS) score for leg pain, and modified MacNab criteria were assessed at 3 months postoperatively. OBSERVATIONS The mean operative time was 52.0 ± 13.8 minutes. The mean intraoperative blood loss was 10.5 ± 10.2 mL. The mean postoperative stay was 1.1 ± 0.3 days. There were no complications. The postoperative mean ODI was significantly improved from 44.9 ± 14.4 to 7.7 ± 11.2 at the final follow-up (p < 0.001). There was a significant decrease in the postoperative mean NRS score for leg pain, from 6.1 ± 1.9 to 0.8 ± 1.3 at the final follow-up (p < 0.001). Based on the modified MacNab criteria, good to excellent results were obtained in 86.7% of the patients. LESSONS We considered UBELD-TFA as not only one of the promising surgical methods for UBELD, but also a new surgical implementation of the TFA.
Collapse
Affiliation(s)
- Tomohide Segawa
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hiroki Iwai
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan; and
| | - Hirohiko Inanami
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan; and
| | - Yuichi Takano
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
| | - Yohei Yuzawa
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Takeshi Kaneko
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Kenta Taniguchi
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Kazuyoshi Yanagisawa
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
| | - Junichi Yokosuka
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Ryoji Tominaga
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Katsuyuki Sasaki
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hisashi Koga
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan; and
| |
Collapse
|
4
|
Lou X, Chen P, Shen J, Chen J, Ge Y, Ji W. Why does such a cyst appear after unilateral biportal endoscopy surgery: A case report and literature review. Medicine (Baltimore) 2023; 102:e36665. [PMID: 38115266 PMCID: PMC10727571 DOI: 10.1097/md.0000000000036665] [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: 09/19/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Unilateral biportal endoscopy (UBE) has been widely and skillfully used in the treatment of lumbar disc herniation and spinal canal stenosis. UBE surgery also brings some complications, such as dural tear, epidural hematoma, residual nucleus pulposus, etc. And we found a rare case of arachnoid cyst after UBE. CASE PRESENTATION A 48 years old female who had a history of cholecystectomy, nephrolithiasis, hyperthyroidism, chronic atrophic gastritis, and colonic polyps with several years of low back pain and numbness in both lower limbs was found have arachnoid cyst 3 years after UBE operation. We hope that we can give a new aspect of complication after the UBE treatment in the future. CONCLUSION We believe that the postoperative hypertension and the lack of postoperative back muscle strength training and some personal factors are the possible reasons for the arachnoid cyst in this case.
Collapse
Affiliation(s)
- Xiulong Lou
- Zhejiang Chinese Medical University, Hangzhou, China
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Penglei Chen
- Zhejiang Chinese Medical University, Hangzhou, China
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing Shen
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jie Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yuying Ge
- Zhejiang Chinese Medical University, Hangzhou, China
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - WeiFeng Ji
- Zhejiang Chinese Medical University, Hangzhou, China
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
5
|
Xin JH, Che JJ, Wang Z, Chen YM, Leng B, Wang DL. Effectiveness and safety of interspinous spacer versus decompressive surgery for lumbar spinal stenosis: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e36048. [PMID: 37986330 PMCID: PMC10659713 DOI: 10.1097/md.0000000000036048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
STUDY DESIGN A meta-analysis of randomized controlled trials. OBJECTIVE Our meta-analysis was conducted to investigate whether interspinous spacer (IS) results in better performance for patients with lumbar spinal stenosis (LSS) when compared with decompressive surgery (DS). BACKGROUND DATA DS and IS are common surgeries for the treatment of LSS. However, controversy remains as to whether the IS is superior to DS. METHODS We comprehensively searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for prospective randomized controlled trials that compared IS versus DS for LSS. The retrieved results were last updated on July 30, 2023. RESULTS Eight studies involving 852 individuals were included in the meta-analysis. The pooled data indicated that IS was superior to DS considering shorter operation time (P = .003), lower dural violation rate (P = .002), better Zurich Claudication Questionnaire Physical function score (P = .03), and smaller foraminal height decrease (P = .004), but inferior to DS considering the higher rate of reoperation (P < .0001). There was no significant difference between the 2 groups regarding hospital stay (P = .26), blood loss (P = .23), spinous process fracture (P = .09), disc height decrease (P = .87), VAS leg pain score (P = .43), VAS back pain score (P = .26), Oswestry Disability Index score (P = .08), and Zurich Claudication Questionnaire symptom severity (P = .50). CONCLUSIONS In summary, we considered that IS had similar effects with DS in hospital stay, blood loss, spinous process fracture, disc height decrease, VAS score, Oswestry Disability Index score, and Zurich Claudication Questionnaire Symptom severity, and was better in some indices such as operation time, dural violation, Zurich Claudication Questionnaire Physical function, and foraminal height decrease than DS. However, due to the higher rate of reoperation in the IS group, we considered that both IS and DS were acceptable strategies for treating LSS. As a novel technique, further well-designed studies with longer-term follow-up are needed to evaluate the effectiveness and safety of IS.
Collapse
Affiliation(s)
- Jian-Hai Xin
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Jia-Ju Che
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Zhe Wang
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Yu-Ming Chen
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Bing Leng
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Da-Lin Wang
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| |
Collapse
|
6
|
Lin L, Ke ZY, Chu L, Cheng Y, Zhao GS, Zhong D, Cai X, Chen XL. Full-endoscopic lumbar discectomy via lateral superior articular process approach for treating far lateral lumbar disc herniation: a retrospective study and technical note. INTERNATIONAL ORTHOPAEDICS 2023; 47:2843-2850. [PMID: 37632529 DOI: 10.1007/s00264-023-05937-0] [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: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE This study aims to evaluate the efficacy and safety of the full-endoscopic lumbar discectomy (FELD) via lateral superior articular process (LSAP) approach and full-endoscopic transforaminal discectomy (FETD) for treating far lateral lumbar disk herniation (FFLDH). METHODS From January 2020 to June 2022, patients who were diagnosed as FLLDH underwent the FELD via LSAP approach or FETD. The operation time, estimated blood loss, length of hospital stays, and complications were recorded. The visual analog scale (VAS) for back pain, VAS for leg pain, and the Oswestry Disability Index (ODI) scores was measured during preoperative and postoperative follow-up. RESULTS Thirty-two patients were enrolled in this study, of which 12 patients were treated with the FELD via LSAP approach (LSAP-FELD group) and 20 patients underwent FETD (FETD group). The LSAP-FELD group exhibited significantly shorter operation times and hospital stays compared to the FETD group, while no statistically significant differences were observed in intraoperative blood loss and complication rates. There were no significant differences in the VAS for back pain, the VAS for leg pain, and the ODI score between the two groups preoperatively and three days, three months, and the last follow-up postoperatively. CONCLUSIONS Both the FELD via LSAP approach and FETD have demonstrated favourable clinical efficacy in the treatment of FLLDH. Notably, the FELD via LSAP approach shows the advantages of shorter operation time and hospital stays.
Collapse
Affiliation(s)
- Lu Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
- Pain Medical Center, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Zhen-Yong Ke
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Lei Chu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
- Pain Medical Center, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Yun Cheng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Guo-Sheng Zhao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Dian Zhong
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Xin Cai
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Xiao-Lin Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China.
| |
Collapse
|
7
|
Kawahara T, Atsuchi M, Arita K, Fujio S, Higa N, Hanaya R. Paravertebral Cerebrospinal Fluid Exudation in Young Women with Postdural Puncture Headache: A Hypothetical Interpretation based on Anatomical Study on Intervertebral Foramen. Asian J Neurosurg 2023; 18:117-124. [PMID: 37056874 PMCID: PMC10089746 DOI: 10.1055/s-0043-1763526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background Postdural puncture headache (PDPH) is defined as a prolonged orthostatic headache secondary to a lumbar puncture. The mechanism underlying this unpleasant complication and the reasons explaining its higher incidence in the young are not well understood. Here, we speculate on the mechanisms underlying PDPH based on spinal magnetic resonance imaging (MRI) in patients with PDPH and an anatomical study on the size of the intervertebral foramen.
Methods Brain and spinal MRI findings were examined in two young women with PDPH. The relationship between age and size of the intervertebral foramen on computed tomography was assessed in 25 female volunteers (22–89 years old) without spinal disease.
Results The causative interventions leading to PDPH were epidural anesthesia for painless delivery in a 28-year-old woman and lumbar puncture for examination of the cerebrospinal fluid (CSF) in a 17-year-old woman. These two patients developed severe orthostatic hypotension following the procedure. Brain MRI showed signs of intracranial hypotension, including subdural effusion, in one patient, but no abnormality in the other. Spinal MRI revealed an anterior shift of the spinal cord at the thoracic level and CSF exudation into the paravertebral space at the lumbar level. Treatment involving an epidural blood patch in one patient and strict bed rest with sufficient hydration in the second led to improvement of symptoms and reduction of paravertebral CSF exudation. The size of the intervertebral foramen at the L2–3 level in the 25 volunteers showed a decrease in an age-dependent manner (Spearman's rho −0.8751, p < 0.001).
Conclusion We suggest that CSF exudation from the epidural space of the vertebral canal to the paravertebral space through the intervertebral foramen, which is generally larger in the younger population, is the causative mechanism of PDPH.
Collapse
|
8
|
Huang S, Wang Z, Xu L, Bu J, He B, Xia M, Chen T, Gao J, Liu G, Niu R, Ma C, Liu G. Percutaneous endoscopic lumbar discectomy via the medial foraminal and interlaminar approaches: A comparative study with 2-year follow-up. Front Surg 2022; 9:990751. [PMID: 36406379 PMCID: PMC9666386 DOI: 10.3389/fsurg.2022.990751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/06/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the clinical effect of percutaneous endoscopic medial foraminal discectomy (PEMFD) in the treatment of lumbar disc herniation (LDH). METHODS We retrospectively examined and compared clinical data from 39 single-level LDH patients who underwent PEID and 47 who underwent PEMFD. All the patients were diagnosed with single-level LDH and were treated in Xuzhou Central Hospital for single-segmental lumbar disc herniation between June 2017 and December 2019. Collect and count surgical-related indicators, intraoperative bleeding volume and 24-hour postoperative drainage volume, lower extremity numbness Visual Analogue Scale (VAS), the pain VAS and lumbar Oswestry Disability Index (ODI) scores. RESULTS Intraoperative bleeding volume and 24-hour postoperative drainage volume were significantly lower in the PEMFD group (p < 0.05). Operation time and length of hospital stay did not significantly differ between the groups. Transient spinal cord injury and surgical site infection did not occur. Recurrence occurred in two patients in each group. Repeat surgery in these patients demonstrated remarkable epidural scarring in the PEID group patients; no scarring was evident in the PEMFD group patients. The numbness VAS score 72 h after surgery and the pain VAS and ODI scores 1 month after surgery significantly differed between groups; however, pain VAS and ODI scores 6, 12, and 24 months after surgery did not. At last follow-up, the modified MacNab criteria outcome did not significantly differ between the groups. CONCLUSION PEMFD and PEID have similar short- and medium-term outcomes. However, PEMFD has several advantages: simplicity, lower bleeding volume, and preservation of the LF.
Collapse
Affiliation(s)
- Sen Huang
- Department of Emergency Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China,Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Zhenfei Wang
- Department of Orthopedic Surgery, Graduate School of Bengbu Medical College, Bengbu, China
| | - Long Xu
- Department of Orthopedic Surgery, Graduate School of Bengbu Medical College, Bengbu, China
| | - Jinhui Bu
- Department of Orthopedic Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Bo He
- Department of Orthopedic Surgery, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Mengjiao Xia
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Tao Chen
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Juan Gao
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Guangpu Liu
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Ru Niu
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China
| | - Chao Ma
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China,Correspondence: Chao Ma Guangwang Liu
| | - Guangwang Liu
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital Affiliated to Nanjing University of Chinese Medicine, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou, China,Correspondence: Chao Ma Guangwang Liu
| |
Collapse
|
9
|
Xu J, Wang D, Liu J, Zhu C, Bao J, Gao W, Zhang W, Pan H. Learning Curve and Complications of Unilateral Biportal Endoscopy: Cumulative Sum and Risk-Adjusted Cumulative Sum Analysis. Neurospine 2022; 19:792-804. [PMID: 35996762 PMCID: PMC9537833 DOI: 10.14245/ns.2143116.558] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/18/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the learning curve and complications of unilateral biportal endoscopy (UBE) in the treatment of lumbar disc herniation (LDH) and lumbar spinal stenosis (LSS). METHODS This was a retrospective cohort analysis of 197 consecutive patients who received UBE unilateral laminotomy bilateral decompression (UBE-ULBD) or lumbar discectomy (UBE-LD) surgery, including 107 males and 90 females with an average age of 64.83 ± 14.29 years. Cumulative sum (CUSUM) and risk-adjusted cumulative sum analysis (RA-CUSUM) were used to evaluate the learning curve, with the occurrence of complications defined as surgical failure, and variables of different phase of the learning curve were compared. RESULTS The cutoff point of learning curve of UBE surgery was 54 cases according to CUSUM analysis. The learning curve of UBE-ULBD and UBE-LD were divided into 3 phases. The first cutoff points were 31 and 12 cases, and the second cutoff point were 67 and 32 cases respectively. With the progress of the learning curve, the operation time and postoperative hospital stays decreased. The visual analogue scale and Oswestry Disability Index at the last follow-up were significantly lower than that before surgery. The incidence of surgical failure was 6.11% and began to decrease after the 89th case based on RA-CUSUM analysis. The surgical failure rate decreased from 10.11% to 2.78 after the 89th case with significant different. CONCLUSION UBE surgery is effective in the treatment of LDH and LSS with low incidence of complications. But a learning curve of at least 54 cases still required for mastering UBE surgery.
Collapse
Affiliation(s)
- Jinchao Xu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Dong Wang
- Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jidan Liu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chengyue Zhu
- Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jianhang Bao
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wenshuo Gao
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China,Corresponding Author Wei Zhang Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, No. 453 Tiyuchang Road, Xihu District, Hangzhou City, Zhejiang Province, China
| | - Hao Pan
- Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China,Co-Corresponding Author Hao Pan Department of Orthopaedics, Hangzhou Traditional Chinese Medical Hospital Affiliated to Zhejiang Chinese Medical University, No. 453 Tiyuchang Road, Xihu District, Hangzhou City, Zhejiang Province, China
| |
Collapse
|
10
|
Yu Z, Lu Y, Li Y, An Y, Wang B. A one-step foraminoplasty via a large trephine in percutaneous endoscopic transforaminal discectomy for the treatment of lumbar disc herniation. PLoS One 2022; 17:e0268564. [PMID: 35609055 PMCID: PMC9128989 DOI: 10.1371/journal.pone.0268564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/03/2022] [Indexed: 11/26/2022] Open
Abstract
Background Transforaminal percutaneous endoscopic lumbar discectomy (PELD) is a widely used basic technique for lumbar disc herniation (LDH) with advantages including causing less trauma and fast recovery. The secure, efficient, and rapid enlargement of the intervertebral foramen is a key step in PELD procedures. However, the conventional multi-step trephine system for foraminoplasty involves complicated surgical procedures. In this study, we reported an improved one-step foraminoplasty via a large trephine with simplified surgical procedures, reduced radiation exposure, and shortened operative time. Methods 70 LDH patients who underwent PELD were retrospectively reviewed in this study. The conventional multi-step trephine system was used for foraminoplasty in 35 patients in the multi-step (MS) group, and the single large trephine was used in the other 35 patients in the one-step (OS) group. Indicators including the operative time, the time to establish the working cannula, intraoperative fluoroscopy times, the radiation dose, and postoperative complications were compared between the MS and OS group. Results The operative time and the time to establish the working cannula in the OS group was significantly shorter than that in the MS group (P < 0.01); intraoperative fluoroscopy times and the radiation dose in the OS group were significantly smaller than those in the MS group (P < 0.01). There was no statistical difference in the incidence of postoperative complications between the two groups (P > 0.05). The postoperative VAS scores and ODI scores (2 days and 3 months after the surgery) were significantly lower than the preoperative scores in both groups (P < 0.01), and there was no statistical difference in VAS scores or ODI scores between the two groups at the same time points (P > 0.05). Conclusions The one-step foraminoplasty via a single large trephine is an optimized technique evolving from the conventional multi-step foraminoplasty, showing significant superiority in simplified operation, shorted operative time, and reduced radiation exposure.
Collapse
Affiliation(s)
- Zhaoyu Yu
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
- Guangdong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, P.R. China
| | - Yao Lu
- Guangdong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, P.R. China
| | - Yong Li
- Guangdong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, P.R. China
| | - Yan An
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, P.R. China
- * E-mail: (BW); (YA)
| | - Bo Wang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, P.R. China
- * E-mail: (BW); (YA)
| |
Collapse
|