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Chen C, Ye W, Yu Z, Zheng X, Dai J, Ouyang J, Xiao D, Chang Y. Supplementary decompression and extended surgical time contribute to hidden blood loss In percutaneous endoscopic lumbar discectomy. Heliyon 2024; 10:e33503. [PMID: 39071675 PMCID: PMC11283102 DOI: 10.1016/j.heliyon.2024.e33503] [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: 04/05/2024] [Revised: 06/12/2024] [Accepted: 06/21/2024] [Indexed: 07/30/2024] Open
Abstract
Background It is widely believed that the Percutaneous endoscopic lumbar discectomy (PELD) is associated with minimal blood loss. However, significant perioperative hidden blood loss (HBL) is frequently unaccounted for. This study aimed to investigate HBL and peri-operative factors contributing to HBL in a series of individuals undergoing PELD. Method ology: A total of 156 consecutive patients with a mean age of 43.6 years (ranging from 18 to 80 years) who underwent PELD at our department from May 2019 to November 2020, were included in the study. Factors including gender, age, body mass index, symptom duration, operation approach/technique, operation duration, the presence of associated chronic diseases, and improvements in the Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score and the Oswestry Disability Index (ODI) were analyzed, and Gross's formula was applied to calculate blood loss, which was used to determine HBL. Results The average total blood loss (TBL) was 221.0 ± 126.2 mL, while the average HBL was 181.7 ± 119.0 mL (82.2 % of TBL). There was no statistically significant difference in HBL between the transverse surgical approach and the interlayer approach. Additionally, no significant differences were observed in improvements in VAS, JOA, and ODI scores between the two surgical approaches. However, the multivariate linear regression analysis revealed that longer surgical time and foraminal decompression were factors contributing to the increase in HBL, which subsequently led to the occurrence of post-operative anemia. Conclusion HBL is significant in PELD cases with long surgical time and lumbar foraminal decompression.
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Affiliation(s)
- Chong Chen
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Wenlin Ye
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Zhengran Yu
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoqing Zheng
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Jingxing Dai
- Guangdong Provincial Key Laboratory of Medical Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology & National Experimental Education Demonstration Center for Basic Medical Sciences & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jun Ouyang
- Guangdong Provincial Key Laboratory of Medical Biomechanics & Guangdong Engineering Research Center for Translation of Medical 3D Printing Application & National Virtual & Reality Experimental Education Center for Medical Morphology & National Experimental Education Demonstration Center for Basic Medical Sciences & National Key Discipline of Human Anatomy, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Dan Xiao
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yunbing Chang
- Department of Spine Surgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
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Li P, Shi Z, Jiang Y, Peng Z, Wang Y. Clinical Observation of 10-mm Endoscopic Minimally Invasive Interlaminar Decompression in the Treatment of Ossified Lumbar Spinal Stenosis. World Neurosurg 2024; 187:e129-e135. [PMID: 38621501 DOI: 10.1016/j.wneu.2024.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE This study aims to observe the safety and effectiveness of 10-mm endoscopic minimally invasive interlaminar decompression in the treatment of ossified lumbar spinal stenosis. METHODS The clinical data of 50 consecutive patients with ossified lumbar spinal stenosis were retrospectively analyzed. All patients underwent minimally invasive interlaminar decompression with 10-mm endoscope. Patient demographics, perioperative data, and clinical outcomes were recorded. Visual analog scale scores, Oswestry disability index scores, and modified Macnab criteria were used to assess clinical outcomes. The lateral recess angle, real spinal canal area, and effective intervertebral foramen area were used to assess the effect of decompression. RESULTS The mean age of all patients was 59.0 ± 12.3 years. The mean operative time and intraoperative blood loss were 43.7 ± 8.7 minutes and <20 ml, respectively. Two years after surgery, the leg pain Visual analog scale score decreased from 7.4 ± 1.0 to 1.6 ± 0.6 (P < 0.05) and the Oswestry disability index score decreased from 63.8 ± 7.6 to 21.7 ± 3.4 (P < 0.05). The lateral recess angle, real spinal canal area and effective intervertebral foramen area were significantly larger than before surgery (P < 0.05). The overall excellent and good rate at the last follow-up was 92.0% according to the modified Macnab criteria. CONCLUSIONS The 10-mm endoscopic minimally invasive interlaminar decompression can safely and effectively remove the ossification in the spinal canal and achieve adequate decompression in patients with ossified lumbar spinal stenosis.
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Affiliation(s)
- Pengfei Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Zhen Shi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yunduo Jiang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Zhibin Peng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China
| | - Yansong Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin Medical University, Harbin, China; NHC Key Laboratory of Cell Transplantation, Harbin Medical University, Harbin, China; Heilongjiang Provincial Key Laboratory of Hard Tissue Development and Regeneration, Harbin Medical University, Harbin, China.
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Wang L, Wang T, Fan N, Yuan S, Du P, Si F, Wang A, Zang L. Clinical outcome of percutaneous endoscopic lumbar decompression in treatment of elderly patients with lumbar spinal stenosis: a matched retrospective study. INTERNATIONAL ORTHOPAEDICS 2024; 48:201-209. [PMID: 37632530 DOI: 10.1007/s00264-023-05947-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE This retrospective cohort study aimed to evaluate the efficacy and safety of percutaneous endoscopic lumbar decompression (PELD) in elderly patients with lumbar spinal stenosis (LSS). STUDY DESIGN A matched retrospective study. SETTING The research was conducted in Beijing Chaoyang Hospital, Capital Medical University, China. METHODS This study included patients treated with PELD for LSS from September 2016 to September 2020. Patients with LSS aged ≥ 80 years were screened according to the inclusion and exclusion criteria as the study group, and then the same number of patients with LSS aged 50-80 years were matched according to gender, stenosis type, and surgical segment as the control group. Preoperative patient status was assessed using the Charlson comorbidity index (CCI) and the American Society of Anesthesiologists (ASA) physical status classification score. Clinical outcomes were assessed using the visual analog scale (VAS), Oswestry Disability Index (ODI) scores, modified Macnab criteria, radiological parameters and complication rates. RESULTS A total of 624 LSS patients met the screening criteria between September 2016 and September 2020, with 47 LSS patients ≥ 80 years old serving as the study group. Forty-seven LSS patients aged 50-80 years were matched to the study group according to gender, stenosis type, and stenosis segment. The CCI score (1.77 ± 1.67) and ASA classification (2.62 ± 0.74) of the study group were significantly higher than the CCI score (0.66 ± 0.96) and ASA classification (1.28 ± 0.54) of the control group, and the difference was statistically significant. Compared with preoperative data, postoperative ODI, leg pain VAS scores and back pain VAS scores were significantly improved in both groups (p < 0.05). However, no significant difference was found between two groups in preoperative and postoperative ODI, leg pain VAS scores and back pain VAS scores (p > 0.05). The operation time and postoperative hospital stay in control group were significantly lower than those in study (p < 0.05), but there was no significant difference in blood loss between the two groups (p > 0.05). Besides, overall radiological parameters were comparable in elder and younger patients (p > 0.05), and disc height (DH), lumbar lordosis and segmental lordosis decreased after two year follow-up in both groups (p < 0.05). In addition, complication rates were similar between the two groups (p > 0.05), and no serious complications and deaths were found. LIMITATIONS Single-centre retrospective design, non-randomized sample, small sample size. CONCLUSION Although elderly LSS patients (≥ 80 years old) are less fit and have more comorbidities, satisfactory outcomes can be achieved with PELD, comparable to those of LSS patients < 80 years old, and without increased complications.
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Affiliation(s)
- Lei Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
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Zhang Y, Chu J, Xia Y, Xie Y, Zhang R, Chen X, Chen Z, Yao X. Research Trends of Percutaneous Endoscopic Lumbar Discectomy in the Treatment of Lumbar Disc Herniation Over the Past Decade: A Bibliometric Analysis. J Pain Res 2023; 16:3391-3404. [PMID: 37814606 PMCID: PMC10560474 DOI: 10.2147/jpr.s421837] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/27/2023] [Indexed: 10/11/2023] Open
Abstract
Objective This study aimed to explore the research trends of percutaneous endoscopic lumbar discectomy in treating lumbar disc herniation using bibliometrics over the past ten years. Methods Relevant publications on the clinical application of percutaneous endoscopic lumbar discectomy in lumbar disc herniation were searched in the Web of Science Core Collection. Subsequently, the characteristics of all these articles were collected. Visualizing data of annual publications, journals, cited journals, authors, cited authors, countries, institutions, keywords, and cited references was performed by using CiteSpace (6.1.R6). Results A total of 642 publications were extracted between 2013 and 2022. The number of publications peaked in the year 2020. The most prolific journal was World Neurosurgery (81), and Spine (597) as the cited journal was the most popular one. China (393) was the most prolific country, followed by South Korea (100). The institution with the most productivity was Tongji University (35). Yue Zhou (20) was the most prolific author, and Sebastian Ruetten (310) was the most cited author. The keyword "interlaminar" was top of research developments with the highest citation burst (8.69). "Lumbar disc herniation", "surgical technique", and "complication" were popular keywords. The surgical procedures and complications of percutaneous endoscopic lumbar discectomy have been the hot topics of recent research. Conclusion This study summarized the current situation and development trends of percutaneous endoscopic lumbar discectomy clinical research in the form of visualization, and these findings may help researchers explore new directions in the future.
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Affiliation(s)
- Yang Zhang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jiahao Chu
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yunfan Xia
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Yuepeng Xie
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Ruikun Zhang
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiaogang Chen
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhineng Chen
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
| | - Xinmiao Yao
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
- The Third Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China
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范 祚, 吴 晓, 郭 柱, 周 传, 陈 伯, 相 宏. [Comparison of effectiveness between unilateral biportal endoscopic lumbar interbody fusion and endoscopic transforaminal lumbar interbody fusion for lumbar spinal stenosis combined with intervertebral disc herniation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1098-1105. [PMID: 37718422 PMCID: PMC10505632 DOI: 10.7507/1002-1892.202303095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 09/19/2023]
Abstract
Objective To compare the effectiveness between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) in treatment of lumbar spinal stenosis combined with intervertebral disc herniation. Methods A clinical data of 64 patients with lumbar spinal stenosis and intervertebral disc herniation, who were admitted between April 2020 and November 2021 and met the selection criteria, was retrospectively analyzed. Among them, 30 patients were treated with ULIF (ULIF group) and 34 patients with Endo-TLIF (Endo-TLIF group). There was no significant difference in baseline data such as gender, age, disease duration, lesion segment, preoperative visual analogue scale (VAS) score of low back pain and leg pain, Oswestry disability index (ODI), spinal canal area, and intervertebral space height between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stays, and postoperative complications were compared between the two groups, as well as the VAS scores of low back pain and leg pain, ODI, and imaging measurement indicators (spinal canal area, intervertebral bone graft area, intervertebral space height, and degree of intervertebral fusion according to modified Brantigan score). Results Compared with the Endo-TLIF group, the ULIF group had shorter operation time, but had more intraoperative blood loss and longer hospital stays, with significant differences ( P<0.05). The cerebrospinal fluid leakage occurred in 2 cases of Endo-TLIF group and 1 case of ULIF group, and no other complication occurred. There was no significant difference in the incidence of complications between the two groups ( P>0.05). All patients in the two groups were followed up 12 months. The VAS scores of lower back pain and leg pain and ODI in the two groups significantly improved when compared with those before operation ( P<0.05), and there was no significant difference between different time points after operation ( P>0.05). And there was no significant difference between the two groups at each time point after operation ( P>0.05). Imaging examination showed that there was no significant difference between the two groups in the change of spinal canal area, the change of intervertebral space height, and intervertebral fusion rate at 6 and 12 months ( P>0.05). The intervertebral bone graft area in the ULIF group was significantly larger than that in the Endo-TLIF group ( P<0.05). Conclusion For the patients with lumbar spinal stenosis combined with intervertebral disc herniation, ULIF not only achieves similar effectiveness as Endo-TLIF, but also has advantages such as higher decompression efficiency, flexible surgical instrument operation, more thorough intraoperative intervertebral space management, and shorter operation time.
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Affiliation(s)
- 祚然 范
- 青岛大学附属医院脊柱外科(山东青岛 266003)Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266003, P. R. China
| | - 晓淋 吴
- 青岛大学附属医院脊柱外科(山东青岛 266003)Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266003, P. R. China
| | - 柱 郭
- 青岛大学附属医院脊柱外科(山东青岛 266003)Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266003, P. R. China
| | - 传利 周
- 青岛大学附属医院脊柱外科(山东青岛 266003)Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266003, P. R. China
| | - 伯华 陈
- 青岛大学附属医院脊柱外科(山东青岛 266003)Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266003, P. R. China
| | - 宏飞 相
- 青岛大学附属医院脊柱外科(山东青岛 266003)Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266003, P. R. China
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舒 涛, 吴 帝, 沈 茂. [Research progress of different minimally invasive spinal decompression in lumbar spinal stenosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:895-900. [PMID: 37460188 PMCID: PMC10352501 DOI: 10.7507/1002-1892.202303110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/01/2023] [Indexed: 07/20/2023]
Abstract
Objective To review the application and progress of different minimally invasive spinal decompression in the treatment of lumbar spinal stenosis (LSS). Methods The domestic and foreign literature on the application of different minimally invasive spinal decompression in the treatment of LSS was extensively reviewed, and the advantages, disadvantages, and complications of different surgical methods were summarized. Results At present, minimally invasive spinal decompression mainly includes microscopic bilateral decompression, microendoscopic decompression, percutaneous endoscopic lumbar decompression, unilateral biportal endoscopy, and so on. Compared with traditional open surgery, different minimally invasive spinal decompression techniques can reduce the operation time, intraoperative blood loss, and postoperative pain of patients, thereby reducing hospital stay and saving treatment costs. Conclusion The indications of different minimally invasive spinal decompression are different, but there are certain advantages and disadvantages. When patients have clear surgical indications, individualized treatment plans should be formulated according to the symptoms and signs of patients, combined with imaging manifestations.
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Affiliation(s)
- 涛 舒
- 贵州医科大学临床医学院(贵阳 550004)Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
| | - 帝求 吴
- 贵州医科大学临床医学院(贵阳 550004)Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
| | - 茂 沈
- 贵州医科大学临床医学院(贵阳 550004)Guizhou Medical University, School of Clinical Medicine, Guiyang Guizhou, 550004, P. R. China
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Cheng X, Wu Y, Chen B, Tang J. A Comparative Study of Unilateral Biportal Endoscopic Decompression and Percutaneous Transforaminal Endoscopic Decompression for Geriatric Patients with Lumbar Lateral Recess Stenosis. J Pain Res 2023; 16:2241-2249. [PMID: 37409162 PMCID: PMC10319288 DOI: 10.2147/jpr.s413502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose The purpose of this research was to compare the efficacy of unilateral biportal endoscopic decompression (UBE) and percutaneous transforaminal endoscopic decompression (PTED) in the treatment of elderly patients with single-level lumbar lateral recess stenosis (LRS). Materials and Methods Data from January 2020 to March 2022 were analyzed. Thirty-eight patients in the PTED group and thirty-nine patients in the UBE group completed the minimum 12-month follow-up. The demographic data and perioperative outcomes were reviewed. Clinical outcomes were evaluated using the VAS for back and leg pain, the Oswestry Disability Index (ODI), and the modified MacNab criteria. Results Both groups of patients completed surgery and a one-year follow-up. There was no significant difference between the two groups in demographics data. UBE has the advantage in operative duration and X-ray time; as far as incision length, blood loss, and drainage volume are concerned, PTED is advantageous. Under the modified MacNab criteria, UBE exhibited a good-to-excellent rate similar to that of PTED (84.6% vs 81.6%, P>0.05). There were no significant differences at any point in time between UBE and PTED with respect to ODI, VAS, or back pain scores (P>0.05). UBE and PTED did not differ significantly in terms of complications. Conclusion Both PTED and UBE achieved favorable outcomes in single-level LRS. For operative time and X-ray times, UBE is more advantageous, while PTED offers better estimates of blood loss, incision length, and drainage volume.
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Affiliation(s)
- Xiaokang Cheng
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China
- Department of Orthopedics, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, People’s Republic of China
| | - Yuxuan Wu
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China
| | - Bin Chen
- Department of Orthopedics, The Affiliated Hospital of Chengde Medical University, Chengde, 067000, People’s Republic of China
| | - Jiagang Tang
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People’s Republic of China
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Wang L, Wang T, Fan N, Yuan S, Du P, Si F, Wang A, Zang L. Efficacy of Repeat Percutaneous Endoscopic Lumbar Decompression for Reoperation of Lumbar Spinal Stenosis: A Retrospective Study. J Pain Res 2023; 16:177-186. [PMID: 36718399 PMCID: PMC9883990 DOI: 10.2147/jpr.s384916] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Purpose To evaluate the efficacy of repeat percutaneous endoscopic lumbar decompression (PELD) in lumbar spinal stenosis (LSS) reoperation. Patients and Methods This study included patients with LSS who relapsed following treatment with PELD therapy between March 2017 and March 2020. Visual analog scale (VAS) scores and Oswestry Disability Index (ODI) were analyzed preoperatively, postoperatively at 3, 6, 12, and 24 months, and at final follow-up. The modified MacNab criteria were used to assess clinical effects. All complications were recorded. Results At a mean follow-up of 3 years, 24 patients with LSS who underwent repeat PELD were identified. The patients' mean operative time was 122.3±29.2 min, blood loss was 12.5±5.3 mL, and mean hospital stay was 7.0±1.9 days. VAS leg-pain score improved from 6.1±1.0 to 2.0±1.2 (P<0.001), VAS back-pain score improved from 6.2±0.8 to 2.1±1.1 (P<0.001), and ODI improved from 68.9±6.0 to 20.9±5.6 (P <0.001). According to the modified MacNab criteria, the good-to-excellent rate was 83.3%. Postoperative complications, including hematoma, nerve root injury, and dural injury, developed in four patients. Conclusion Repeat PELD for reoperation in patients with LSS has a good clinical effect, and is recommended in routine clinical practice. Careful intraoperative manipulation is recommended to prevent complications.
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Affiliation(s)
- Lei Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Lei Zang, Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, 5 JingYuan Road, Shijingshan District, Beijing, 100043, People’s Republic of China, Tel +86 13601252787, Email
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Fan X, He Q, Yi C, Zhao W, Xu D, Peng G, Liu F, Cheng L. Application of a new body surface-assisting puncture device in percutaneous transforaminal endoscopic lumbar discectomy. BMC Musculoskelet Disord 2022; 23:1067. [PMID: 36471305 PMCID: PMC9724357 DOI: 10.1186/s12891-022-05985-4] [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: 09/04/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Accurate puncture and localization are critical for percutaneous transforaminal endoscopic lumbar discectomy surgery. However, several punctures are often required, followed by X-ray fluoroscopy, which can increase surgical risk and complications. The aim of this study was to demonstrate a new body surface-assisting puncture device that can be used in percutaneous transforaminal endoscopic lumbar discectomy and to assess its clinical effectiveness. METHODS Three hundred and forty-four patients were treated with percutaneous transforaminal endoscopic lumbar discectomy surgery in the Spinal Surgery Department of Taian City Central Hospital, China, between January 2020 and February 2022. Of these, 162 patients (the locator group) were punctured using a body surface-assisting puncture device while and 182 patients (the control group) were punctured using the traditional blind puncture method. The number of punctures, radiation dose during X-ray fluoroscopy, operation time, and surgical complications were compared between the two groups. RESULTS The average number of punctures was 2.15 ± 1.10 in the locator group which was significantly lower than that in the control group (5.30 ± 1.74; P < 0.001). The average X-ray fluoroscopy radiation dose in the locator group was significantly lower at 2.34 ± 0.99 mGy, compared with 5.13 ± 1.29 mGy in the control group (P < 0.001). The mean operation time was also significantly less in locator group (47.06 ± 5.12 vs. 62.47 ± 5.44 min; P = 0.008). No significant differences in surgical complications were found between the two groups (P > 0.05). CONCLUSION The use of a new body surface-assisting puncture device in percutaneous transforaminal endoscopic lumbar discectomy surgery can significantly reduce the number of punctures and X-ray fluoroscopy radiation dose, as well as shortening the operation time, without increasing surgical complications. This device is cheap, easy to operate, and suitable for all hospitals and spine surgeons, especially for small hospitals, with also no extra costs for patients.
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Affiliation(s)
- Xincheng Fan
- Department of Orthopedic Surgery, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, 107 Wenhuaxi Road, 250012 Jinan, Shandong China ,grid.410645.20000 0001 0455 0905Department of Orthopedic Surgery, The Affiliated Taian City Central Hospital of Qingdao University, 271000 Taian, Shandong China
| | - Qiting He
- Department of Orthopedic Surgery, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, 107 Wenhuaxi Road, 250012 Jinan, Shandong China
| | - Chaofan Yi
- grid.410645.20000 0001 0455 0905Department of Orthopedic Surgery, The Affiliated Taian City Central Hospital of Qingdao University, 271000 Taian, Shandong China
| | - Wei Zhao
- grid.410645.20000 0001 0455 0905Department of Orthopedic Surgery, The Affiliated Taian City Central Hospital of Qingdao University, 271000 Taian, Shandong China
| | - Derui Xu
- grid.410645.20000 0001 0455 0905Department of Orthopedic Surgery, The Affiliated Taian City Central Hospital of Qingdao University, 271000 Taian, Shandong China
| | - Guoqing Peng
- grid.410645.20000 0001 0455 0905Department of Orthopedic Surgery, The Affiliated Taian City Central Hospital of Qingdao University, 271000 Taian, Shandong China
| | - Feng Liu
- grid.410645.20000 0001 0455 0905Department of Orthopedic Surgery, The Affiliated Taian City Central Hospital of Qingdao University, 271000 Taian, Shandong China
| | - Lei Cheng
- Department of Orthopedic Surgery, Cheeloo College of Medicine, Qilu Hospital of Shandong University, Shandong University, 107 Wenhuaxi Road, 250012 Jinan, Shandong China
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Xie YZ, Shi Y, Zhou Q, Feng CQ, Zhou Y, Li T, Yu Y, Fan XH. Comparison of the safety and efficacy of unilateral biportal endoscopic lumbar interbody fusion and uniportal endoscopic lumbar interbody fusion: a 1-year follow-up. J Orthop Surg Res 2022; 17:360. [PMID: 35870934 PMCID: PMC9308319 DOI: 10.1186/s13018-022-03249-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
Objectives To compare the short-term outcomes of unilateral biportal endoscopic lumbar interbody fusion (BLIF) and uniportal endoscopic lumbar interbody fusion (ULIF). Methods Sixty patients diagnosed with L4/5 spinal stenosis who underwent BLIF and ULIF were included (30 in each group). Clinical evaluation was performed preoperatively and postoperatively in the 1st week, 1st month, and 1st year. Factors such as the visual analogue score (VAS), Oswestry Disability Index (ODI), operative time, surgical complications, and radiological outcomes (fusion rate, screw loosening, and cage subsidence) were compared between the two groups. Results All patients showed improved mean VAS and ODI at all three postoperative follow-ups, and no statistically significant differences were detected between the BLIF and ULIF groups. The mean operative time in the BLIF group was shorter than that in the ULIF group. Nerve root injury occurred in two patients in the BLIF group, while leakage of cerebrospinal fluid occurred in one patient in the ULIF group. All adverse events were treated adequately prior to discharge. The fusion rates with definite and probable grades were significantly higher in the BLIF group than that in the ULIF group. One case of cage subsidence with no screw loosening occurred in each group. Conclusion Both BLIF and ULIF are safe and effective surgical techniques. Compared with ULIF, BLIF has the advantages of shorter operative time and a higher fusion rate. Other merits of BLIF include a wider surgical field, greater maneuverability of instruments, visibility during cage implantation, and transverse orientation of the cage.
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Contraindications and Complications of Full Endoscopic Lumbar Decompression for Lumbar Spinal Stenosis: A Systematic Review. World Neurosurg 2022; 168:398-410. [DOI: 10.1016/j.wneu.2022.07.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 12/15/2022]
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12
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Liang X, Wang Y, Yue Y, Li Y, Meng C. Whether Out-of-Bed Activity Restriction in the Early Postoperative Period of PELD Is Beneficial to Therapeutic Efficacy or Reduce Recurrence. Front Surg 2022; 9:860140. [PMID: 35615646 PMCID: PMC9124801 DOI: 10.3389/fsurg.2022.860140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/14/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To detect the influences of postoperative out-of-bed activity restriction on recurrence rate, low back and leg pain, functional rehabilitation after percutaneous endoscopic lumbar discectomy (PELD). Methods In this research, 213 patients with lumbar intervertebral disc herniation (LDH) who underwent PELD were divided into the out-of-bed activity restriction group and out-of-bed activity non-restriction group. The visual analog scale (VAS) and Oswestry disability index (ODI) scores were used to evaluate postoperative clinical efficacy at 1 and 3 months after the operation, and to count the recurrence rates. All of these operations were performed between August 2017 and July 2020, and they were followed in the outpatient department for 12 months at least. Results Both of the groups showed significantly lower VAS and higher ODI scores at 1 month and 3 months post-operation, respectively, when compared with pre-operation. At 1 month after the operation, the restriction group performed lower VAS scores of low back pain compared with the non-restriction group, but this advantage disappeared at 3months post-operation. However, there was no statistical difference in the VAS scores of leg pain and ODI scores between the two groups, neither at 1 nor 3 months after the surgery. The recurrence rate is significantly lower in the restriction group than in the non-restriction group at a 12-month follow-up after the surgery. Conclusion Out-of-bed activity restriction in the early postoperative period of PELD could reduce LDH recurrence effectively, and it may relieve the low back pain to some extent. It has no benefit in the recovery of leg pain and functional rehabilitation.
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Affiliation(s)
- Xiao Liang
- Affiliated Hospital of Jining Medical University, Jining, China
| | - Yexin Wang
- Affiliated Hospital of Jining Medical University, Jining, China
| | | | - Yanpeng Li
- Affiliated Hospital of Jining Medical University, Jining, China
| | - Chunyang Meng
- Affiliated Hospital of Jining Medical University, Jining, China
- *Correspondence: Chunyang Meng
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Fan N, Yuan S, Du P, Wu Q, Wang T, Wang A, Li J, Kong X, Zhu W, Zang L. Complications and risk factors of percutaneous endoscopic transforaminal discectomy in the treatment of lumbar spinal stenosis. BMC Musculoskelet Disord 2021; 22:1041. [PMID: 34911532 PMCID: PMC8672468 DOI: 10.1186/s12891-021-04940-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/03/2021] [Indexed: 04/04/2023] Open
Abstract
Background With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years. Few studies have focused on the complications associated with the treatment of LSS using percutaneous endoscopic lumbar discectomy (PELD). This study aimed to summarize the complications of PETD and identify the associated risk factors. Methods Complications in a total of 738 consecutive LSS patients who underwent single-level PETD were retrospectively recorded and analyzed between January 2016 and July 2020. In addition, a matched case-control study was designed, and according to the date of operation, the control group was matched with patients without complications, with a matching ratio of 1:3. Demographic parameters included age, sex, BMI, smoking and drinking status, comorbidity, and surgical level. The radiological parameters included grade of surgical-level disc degeneration, number of degenerative lumbar discs, grade of lumbar spinal stenosis, degenerative lumbar scoliosis, lumbar lordosis, disc angle, and disc height index. Univariate analysis was performed using independent samples t-test and chi-squared test. Results The incidence of different types of complications was 9.76% (72/738). The complications and occurrence rates were as follows: recurrence of LSS (rLSS), 2.30% (17/738); persistent lumbosacral or lower extremity pain, 3.79% (28/738); dural tear, 1.90% (14/738); incomplete decompression, 0.81% (6/738); surgical site infection, 0.41% (3/738); epidural hematoma, 0.27% (2/738); and intraoperative posterior neck pain, 0.27% (2/738). Univariate analysis demonstrated that age, the grade of surgical-level disc degeneration (P < 0.001) and the number of disc degeneration levels (P = 0.004) were significantly related to the complications. Conclusion Complications in the treatment of LSS using PELD included rLSS, persistent pain of the lumbosacral or lower extremity, dural tear, incomplete decompression, surgical site infection, epidural hematoma, and intraoperative posterior neck pain. In addition, old age, severe grade of surgical-level disc degeneration and more disc degeneration levels significantly increased the incidence of complications.
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Affiliation(s)
- Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jian Li
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Kong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenyi Zhu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Zhang Y, Zhu H, Zhou Z, Wu J, Sun Y, Shen X, Li C. Comparison Between Percutaneous Transforaminal Endoscopic Discectomy and Fenestration in the Treatment of Degenerative Lumbar Spinal Stenosis. Med Sci Monit 2020; 26:e926631. [PMID: 33035202 PMCID: PMC7552888 DOI: 10.12659/msm.926631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to investigate the therapeutic and prognostic effects of percutaneous transforaminal endoscopic decompression (PTED) for degenerative lumbar spinal stenosis (DLSS). Material/Methods One hundred eighty-eight patients with DLSS were randomly divided into the fenestration and the PTED group for decompression treatment. Operative time, incision length, amount of blood loss, length of hospitalization, and rates of complications in the 2 groups were compared. All patients underwent computed tomography (CT) scanning and magnetic resonance imaging (MRI) on the first postoperative day. All patients were assessed preoperatively and the treatment effects at 3, 6, and 12 months postoperatively were evaluated using visual analog scale (VAS), Japanese Orthopedic Association Score (JOA) and Oswestry Disability Index (ODI). The modified MacNab criteria were used to assess patient satisfaction 1 year after surgery at the last follow-up. Results Patients who underwent PTED had shorter incisions, less blood loss, and shorter hospital stays than those in the fenestration group, but operative times and complication rates were similar in the 2 groups. Moreover, CT scanning and MRI revealed similar treatment effects in the 2 groups. Compared with preoperative status, improvements in VAS, ODI, and JOA scores occurred at different times after surgery in the 2 groups. In particular, all 3 scores in the PTED group were higher than those in the fenestration group at 3 and 6 months postoperatively. There were no significant differences in MacNab scores between the 2 groups. Conclusions PTED is safer and more effective than traditional fenestration for management of DLSS.
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Affiliation(s)
- Yang Zhang
- Department of Bone Surgery, Yangzhou Hongquan Hospital, Yangzhou, Jiangsu, China (mainland)
| | - Hengjie Zhu
- Department of Bone Surgery, Yangzhou Hongquan Hospital, Yangzhou, Jiangsu, China (mainland)
| | - Zheng Zhou
- Department of Bone Surgery, Yangzhou Hongquan Hospital, Yangzhou, Jiangsu, China (mainland)
| | - Jixiang Wu
- Department of Bone Surgery, Yangzhou Hongquan Hospital, Yangzhou, Jiangsu, China (mainland)
| | - Yinming Sun
- Department of Bone Surgery, Yangzhou Hongquan Hospital, Yangzhou, Jiangsu, China (mainland)
| | - Xiang Shen
- Department of Bone Surgery, Yangzhou Hongquan Hospital, Yangzhou, Jiangsu, China (mainland)
| | - Chengcun Li
- Department of Bone Surgery, Yangzhou Hongquan Hospital, Yangzhou, Jiangsu, China (mainland)
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Li H, Ou Y, Xie F, Liang W, Tian G, Li H. Linical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients: a retrospective study. J Orthop Surg Res 2020; 15:441. [PMID: 32972436 PMCID: PMC7517816 DOI: 10.1186/s13018-020-01968-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/15/2020] [Indexed: 12/04/2022] Open
Abstract
Background Although percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (ages 65–74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P < 0.05). No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups. Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P > 0.05). Conclusion PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery. Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.
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Affiliation(s)
- Hua Li
- Department of Spine Surgery, Guangxi Orthopedics and Traumatology Hospital, Nanning, China
| | - Yufu Ou
- Department of Orthopaedics, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Furong Xie
- Department of Spine Surgery, Guangxi Orthopedics and Traumatology Hospital, Nanning, China
| | - Weiguo Liang
- Department of Spine Surgery, Guangxi Orthopedics and Traumatology Hospital, Nanning, China
| | - Gang Tian
- Department of Spine Surgery, Guangxi Orthopedics and Traumatology Hospital, Nanning, China
| | - Hongyu Li
- Department of Spine Surgery, Guangxi Orthopedics and Traumatology Hospital, Nanning, China.
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Cheng XK, Chen B. Percutaneous Transforaminal Endoscopic Decompression for Geriatric Patients with Central Spinal Stenosis and Degenerative Lumbar Spondylolisthesis: A Novel Surgical Technique and Clinical Outcomes. Clin Interv Aging 2020; 15:1213-1219. [PMID: 32821088 PMCID: PMC7419630 DOI: 10.2147/cia.s258702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Percutaneous transforaminal endoscopic decompression (PTED) is an ultra-minimally invasive surgical option for patients that does not involve the same amount of destabilizing facet joint removal as a traditional laminectomy. The objective of this study was to describe the procedure of PTED under local anesthesia for geriatric patients with central spinal stenosis and degenerative lumbar spondylolisthesis (CSS-DLS). Materials and Methods From January 2016 to December 2018, 30 consecutive geriatric patients who underwent surgery for single-level CSS-DLS were retrospectively reviewed. All patients were followed for at least 12 months (12–24 months). The visual analog scale (VAS) scores, Oswestry disability index (ODI) scores and modified MacNab criteria were used to evaluate the clinical results. Results The mean age was 73.1±6.0 years. Follow-up ranged from 12 to 36 months. The mean±SD values of the preoperative VAS for leg pain and ODI were 7.4±1.0 and 67.2±8.4, respectively. The values improved to 2.2±1.1 and 19.9±8.1 at 12 months postoperatively. The outcomes of the modified MacNab criteria showed that 93.3% of patients obtained a good-to-excellent rate. The percent slippage of spondylolisthesis before surgery (13.8±2.5%) and at the end of follow-up (14.0±2.5%) was not significantly different. Conclusion PTED under local anesthesia could be a useful supplement to traditional decompression in geriatric patients with CSS-DLS.
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Affiliation(s)
- Xiao-Kang Cheng
- Orthopaedic Department, Chengde Medical University Affiliated Hospital, Chengde 067000, Hebei, People's Republic of China
| | - Bin Chen
- Orthopaedic Department, Chengde Medical University Affiliated Hospital, Chengde 067000, Hebei, People's Republic of China
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Yang F, Chen R, Gu D, Ye Q, Liu W, Qi J, Xu K, Fan X. Clinical Comparison of Full-Endoscopic and Microscopic Unilateral Laminotomy for Bilateral Decompression in the Treatment of Elderly Lumbar Spinal stenosis: A Retrospective Study with 12-Month Follow-Up. J Pain Res 2020; 13:1377-1384. [PMID: 32606904 PMCID: PMC7295456 DOI: 10.2147/jpr.s254275] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/22/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose Although lumbar spinal stenosis (LSS) is the most common spinal disease in the elderly, there is still a confusion about the appropriate surgical treatment strategy. The aim of this study was to compare the safety and efficacy of full-endoscopic and microscopic unilateral laminotomy for bilateral decompression (ULBD) for LSS in elderly patients. Patients and Methods A retrospective analysis of 61 consecutive elderly patients with LSS who underwent either full-endoscopic (FE group) or microscopic (Micro group) unilateral laminotomy for bilateral decompression was performed. Clinical data were assessed before 2 weeks, 3 months, 6 months and 12 months after surgery using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI) and the modified MacNab criteria. Results There are no significant differences in VAS (back and leg) and ODI between the two groups. However, the VAS back pain in the FE group was significantly improved compared to the Micro group at 2 weeks. The rate of excellent or good outcomes was 87.88% and 85.71% in the FE and Micro group, respectively (P>0.05). The hospital stay and early ambulation in FE group were shorter than those in Micro group, but the operation time was longer (P<0.05). The complications between the FE group (18.18%) and the Micro group (17.86%) were minor (P>0.05). Conclusion Both full-endoscopic and microscopic decompression have achieved favorable clinical results in treating elderly lumbar spinal stenosis, and the complications are minor. Full-endoscopic decompression has the advantages of small incision and rapid recovery, which can be used as an alternative for the treatment of lumbar spinal stenosis, especially the elderly with comorbidities.
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Affiliation(s)
- Fei Yang
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Rigao Chen
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Dangwei Gu
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Qingqing Ye
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Wei Liu
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Jianhua Qi
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Kai Xu
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
| | - Xiaohong Fan
- Department of Spine Surgery, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China
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