1
|
Mao L, Wang K, Zhu W, Shen ZC, Zhang XJ, Xie ZY, Fan P, Shi H, Zhu B, Li L, Liu G, Ren Y, Wu XT. Repeat Surgery after Percutaneous Endoscopic Lumbar Discectomy for Adolescent Lumbar Disc Herniation: A Multicenter Observational Study. Orthop Surg 2024; 16:1336-1343. [PMID: 38654387 PMCID: PMC11144496 DOI: 10.1111/os.14042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE The reported date in the repeat surgical intervention for adolescent lumbar disc herniation (ALDH) after percutaneous endoscopic lumbar discectomy (PELD) was quite scarce. This study aims to introduce cases of repeat surgeries after PELD for ALDH and assess the incidence, chief causes, repeat surgery methods, and surgical outcomes of repeat surgeries after PELD for ALDH. METHODS A retrospective multicenter observational study was conducted on patients undergoing repeat surgeries after PELD for ALDH at four tertiary referral hospitals from January 2014 through August 2022. The incidence of repeat surgeries, chief causes, strategies for repeat surgeries, and timing of repeat surgeries were recorded and analyzed. The clinical outcomes were evaluated by the Numeric Rating Scales (NRS) scores and the modified MacNab criteria. Statistical analyses were performed with the Wilcoxon signed-rank test. RESULTS A total of 23 patients who underwent repeat surgeries after PELD for ALDH were included. The chief causes were re-herniation (homo-lateral re-herniation at the same level, new disc herniation of adjacent level). The repeat surgery methods were revision PELD, micro-endoscopic discectomy (MED), open discectomy and instrumented lumbar inter-body fusion. The NRS scores decreased significantly in follow-up evaluations and these scores demonstrated significant improvement at the last follow-up (p < 0.002). For the modified MacNab criteria, at the last follow-up, 18 patients (78.26%) had an excellent outcome, and the overall success rate was 86.95%. CONCLUSION This study's data suggest that young patients who underwent repeat surgery improved significantly compared to baseline. The chief cause was re-herniation. Revision PELD was the main surgical procedure, which provides satisfactory clinical results in young patients who underwent repeat surgeries.
Collapse
Affiliation(s)
- Lu Mao
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kun Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Weiye Zhu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Zi-Cong Shen
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xian-Jun Zhang
- Department of Orthopedics, The Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Zhi-Yang Xie
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Pan Fan
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Hang Shi
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bin Zhu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Lijun Li
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Guanyi Liu
- Department of Spine Surgery, Ningbo No. 6 Hospital, Ningbo, China
| | - Yingqing Ren
- Department of Spine Surgery, Yuyao People's Hospital, Ningbo, China
| | - Xiao-Tao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| |
Collapse
|
2
|
Mao L, Wang K, Huang Y, Wang F, Zhang R, Zhu B, Wu X. Transforaminal Endoscopic Lumbar Discectomy for Lumbosacral Junction Adolescent Lumbar Disc Herniation with High Iliac Crests. Orthop Surg 2022; 14:1715-1722. [PMID: 35768829 PMCID: PMC9363714 DOI: 10.1111/os.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the clinical results of transforaminal endoscopic lumbar discectomy for lumbosacral junction adolescent lumbar disc herniation with high iliac crest. Methods From February 2014 to September 2020, a retrospective analysis of 96 patients less than 21 years old with intervertebral disc herniation was carried out. We enrolled 44 patients diagnosed with lumbosacral junction disc herniation with high iliac crest who required transforaminal endoscopic lumbar discectomy. Pain in the back and the lower extremity was scored on Numeric Rating Scales (NRS) scores. Patient outcomes were graded as excellent, good, fair, and poor using modified MacNab criteria. The NRS scores before and after the operation were compared using the Wilcoxon two‐sample test. Results There were 30 male patients and 14 females. One patient underwent repeat surgery for an intervertebral disc pseudocyst. The NRS scores decreased significantly in both early and late follow‐up evaluations (p < 0.05). At the last follow‐up, 42 patients (95.45%) had an excellent outcome, one patient (2.27%) had a good outcome, and one patient (2.27%) had a fair outcome. The overall success rate was 97.7%. Conclusion This study's data suggest that targeted individualized foraminoplasty can effectively overcome the lumbosacral anatomical obstacles, and transforaminal endoscopic lumbar discectomy is an effective and valid option for lumbosacral junction adolescent lumbar disc herniation with high iliac crest.
Collapse
Affiliation(s)
- Lu Mao
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Kun Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yong Huang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Feng Wang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Rui Zhang
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bin Zhu
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaotao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| |
Collapse
|