Analysis of the clinical effects of transforaminal endoscopic discectomy on lumbar disk herniation combined with common peroneal nerve paralysis: a 2-year follow-up retrospective study on 32 patients

The treatment effect of posterior lumbar fusion surgery on patients suffering from lumbar disc herniation concurrent with peroneal nerve paralysis

Purpose

The purpose of this study is to investigate the clinical effect of posterior lumbar fusion surgery on patients who suffer from lumbar disc herniation concurrent with peroneal nerve paralysis.

Methods

The patients suffering from peroneal nerve paralysis and undergoing posterior lumbar fusion surgery between January 2012 and December 2019 were retrospectively reviewed. The data of the identified patients were then collected and processed. All patients were followed up post-operatively after discharge from the hospital. The data was analyzed in terms of Oswestry disability index (ODI), visual analogue scale (VAS) score, and relative lower-limb muscle strength.

Results

A total of 87 patients (52 males and 35 females) aged 54 ± 11 years met the inclusion criteria for this study. These patients stayed in hospital for 16 ± 6 days and were followed up for 81 ± 24 months. Data analysis showed that muscle strength of the tibialis anterior and extensor digitorum significantly recovered at the last follow-up with a grade of 3 (median), compared to grade 0 at admission (p < 0.001). Furthermore, the median VAS score decreased to 1 at the last follow-up from 6 at admission (p < 0.001), and the ODI greatly improved with 10% (median) at the last follow-up, while it was 58% at admission (p < 0.001). The ODI improvement rate was 60% on average at the last follow-up. Multivariate regression analysis regarding the ODI and muscle strength improvement rates showed that advanced age was a risk factor for postoperative recovery.

Conclusions

Most of the patients suffering from lumbar disc herniation concurrent with peroneal nerve paralysis can improve after undergoing posterior lumbar fusion surgery, but few can reach full recovery. Advanced age might be a risk factor that affects the prognosis of these patients after surgery.

Clinical efficacy of transforaminal endoscopic lumbar discectomy for lumbar degenerative diseases: A minimum 6-year follow-up

Background

Transforaminal Endoscopic Lumbar Discectomy (TELD) is widely applied for lumbar degenerative disease (LDDs) and satisfactory short-term outcomes have been achieved. However, the mid-term and long-term follow-up of this technique is still lacking.

Objective

To retrospectively analyze the mid-term clinical efficacy of TELD for single-level LDD and its effect on intervertebral disc degeneration with a minimum of 6-year follow-up.

Methods

64 patients with single-level LDDs (lumbar disc herniation, lumbar spinal stenosis) who underwent TELD under local anesthesia in our department from December 2014 to December 2015 were observed. Visual analog scale (VAS), Japanese Orthopaedic Association evaluation treatment (JOA) score and Oswestry Disability Index (ODI) were calculated and compared before operation, 3 months after operation, 6 months after operation, 1 year after operation and at the last follow-up. Disc Height (DH), disc range of motion (ROM) and disc degeneration on standard lumbar lateral radiographs before operation and at the last follow-up were determined. Recurrence rate and operation-related complications during follow-up were recorded.

Results

64 cases were followed up for 6.4 ± 0.1 years. There were no complications such as infection, epidural hematoma and nerve root injury. 1 patient (1.67%) was found to have dural rupture and cauda equina hernia during the operation. There were significant differences in VAS, JOA, ODI between preoperative and postoperative 3 months, 6 months, 1 year and last follow-up (P < 0 01), VAS, JOA, ODI at 3 months after operation were different from 6 months after operation (P < 0 05), and there were significant differences compared with preoperative, 1 year after operation and last follow up (P < 0 01). VAS, JOA and ODI at 6 months after operation were significantly different from those before operation (P < 0.01), but not significantly different from those at 1 year after operation and the last follow-up (P > 0.05). There was no significant difference in DH, ROM and the Pfirrmann grade of intervertebral disc preoperative and the last follow-up. During the follow-up period, 3 patients (4.69%) were recurrent, 13 patients (20.31%) had various degrees of postoperative dysesthesia (POD), and 3 patients (4.69%) had various degrees of muscle weakness.

Conclusion

TELD has a satisfactory mid-term efficacy, and has no significant effect on the DH, the stability of the intervertebral disc space, or on intervertebral disc degeneration. However, as expected, TELD was associated with some complications including recurrent disc herniation and POD.

Full-Endoscopic Lumbar Decompression with Minimal Nerve Root Retraction for Impending Neurologic Deficit in Degenerative Lumbar Spine Diseases

OBJECTIVES

 The aim of this retrospective case study was to analyze the outcomes of minimal nerve root retraction in patients with impending neurologic deficit in degenerative lumbar spine disease using the full-endoscopic spine surgery.

MATERIALS AND METHODS

 Thirty-seven consecutive patients with impending neurologic deficit underwent endoscopic spine surgery through either the transforaminal or the interlaminar approach. Their clinical outcomes were evaluated with visual analog scale (VAS) leg pain score, Oswestry Disability Index (ODI), and MacNab's criteria. The outcome of motor deficitis was evaluated with the Medical Research Council (MRC) grade. Completeness of decompression was documented with a postoperative magnetic resonance imaging (MRI) and computed tomography (CT) scan.

RESULTS

 A total of 40 lumbar levels of 37 patients were operated, VAS score of the leg improved from 7.7 ± 1 to 1.9 ± 0.6 (p < 0.0001). ODI score improved from 74.7 ± 6.5 to 25.4 ± 3.49 (p < 0.0001). Motor weakness improved significantly immediately after surgery. The mean MRC grade increased to 1.97, 3.65, 4.41, and 4.76 preoperatively, at 1 week, at 3 months, and at the final follow-up, respectively, and all the patients with foot drop and cauda equina syndrome symptom recovered completely. One patient with great toe drop recovered partially to MRC grade 3. Mean follow-up of the study was 13.3 ± 6.1 months. According to MacNab's criteria, 30 patients (80.1%) had good and 7 patients (18.9%) had excellent results. Three patients required revision surgery.

CONCLUSIONS

 Minimal nerve root retraction during full-endoscopic spine surgery is safe and effective for treatment of the impending neurologic deficit. We could achieve a thorough decompression of the affected nerve root with acceptable clinical outcome and minimal postoperative morbidity.

Residual leg numbness after endoscopic discectomy treatment of lumbar disc herniation

Background

Transforaminal endoscopic discectomy was popular in the treatment of lumbar disc herniation. Previous study focuses on the leg pain of disc herniation, and little study concern the residual leg numbness after surgery. The purposes of this study were to evaluate the clinical outcomes of transforaminal endoscopic discectomy in the treatment of lumbar disc herniation with leg pain and numbness.

Methods

Patients with one level lumbar disc herniation who had transforaminal endoscopic lumbar discectomy from June 2016 to July 2019 were categorized into two groups according to the leg numbness. 293 patients initially fulfilled the study criteria, and 27 patients were lost to follow-up. Of the remaining 266 patients available for analysis, 81 cases with leg numbness and pain (A group), and 185 cases with leg pain (B). Endoscopic transforaminal lumbar discectomy was performed, and the clinical outcomes of blood loss, operation times, hospital stay days, pain (Visual Analog Scale, VAS-pain), numbness (VAS-numbness), functional disability (Oswestry Disability Index, ODI), and the disk height and intervertebral foramen height were recorded.

Results

All patients with pain and numbness pre-operation in group A, complain of leg numbness during or just after walking or standing not diminished after surgery in group A, and no one complain numbness after surgery in group B. The pain index and ODI score were better than preoperational in all patients (P < 0.01), and no significant difference between two groups (P > 0.05). The postoperative disk and foramen height were no significant difference compare to preoperative in all patients (P > 0.05), and no significant difference between two groups (P > 0.05). The leg numbness symptoms last longer in central disc herniation patients (10.4 ± 2.2 months) than in paracentral (6.3 ± 2.1 months) and foraminal disc herniation patients (5.6 ± 2.3 months) after surgery (P < 0.01).

Conclusions

Based on the results of this study, transforaminal endoscopic lumbar discectomy was effective and safe procedures in the treatment of disc herniation with leg pain and numbness. The leg numbness symptoms last longer in central disc herniation patients than in paracentral and foraminal disc herniation patients after surgery.