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Yuan S, Wang A, Fan N, Du P, Wang T, Li J, Zhu W, Zang L. Recompression after percutaneous transforaminal endoscopic decompression for degenerative lumbar spinal stenosis: risk factors and outcomes of two different reoperation procedures. Front Surg 2024; 11:1392215. [PMID: 38978988 PMCID: PMC11228264 DOI: 10.3389/fsurg.2024.1392215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
Purpose To determine the risk factors for recompression after percutaneous transforaminal endoscopic decompression (PTED) for the treatment of degenerative lumbar spinal stenosis (DLSS) and compare the outcomes of PTED and posterior lumbar interbody fusion (PLIF) as revision surgery. Methods We retrospectively evaluated 820 consecutive DLSS patients who underwent PTED at our institution. 26 patients developed postoperative recompression and underwent reoperation. In total, 208 patients with satisfactory clinical outcomes were enrolled in the control group. The demographic and imaging data of each patient were recorded. Univariate and multivariate analyses were performed to assess risk factors for recompression. Additionally, patients with recompression were divided into PTED and PLIF groups according to the reoperation procedure. The clinical outcomes of the two groups were compared using independent-sample t-tests. Results The grade of surgical-level disc degeneration [odds ratio (OR): 2.551, p = 0.045] and the number of disc degeneration levels (OR: 11.985, p < 0.001) were independent risk factors for recompression after PTED. There was no significant difference in the visual analog score (VAS) and Oswestry disability index (ODI) two weeks postoperatively between the PTED and PLIF groups for surgical treatment. However, the mean VAS of back pain (14.1 vs. 20.5, p = 0.016) and ODI (16.0 vs. 21.8, p = 0.016) of patients in the PLIF group were smaller than those in the PTED group at the final follow-up. Conclusion More severe degeneration and degenerated levels indicate a higher recompression rate after PTED. Although both PTED and PLIF could achieve immediate relief postoperatively in the treatment of recompression, the final follow-up results showed that the outcome of PLIF appeared better than that of PTED.
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Affiliation(s)
- Shuo Yuan
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aobo Wang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ning Fan
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Du
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tianyi Wang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jian Li
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenyi Zhu
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Zang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Wang W, Cui Y, Sun X, Zhang H, Yin W, Cui X, Jiao W. Transforaminal posterior lumbar interbody fusion microscopic safe operating area: a three-dimensional model study based on computed tomography imaging. J Orthop Surg Res 2024; 19:342. [PMID: 38849945 PMCID: PMC11161984 DOI: 10.1186/s13018-024-04830-9] [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: 04/26/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Endoscopic spine lumbar interbody fusion (Endo-LIF) is well-regarded within the academic community. However, it presents challenges such as intraoperative disorientation, high rates of nerve damage, a steep learning curve, and prolonged surgical times, often occurring during the creation of the operative channel. Furthermore, the undefined safe operational zones under endoscopy continue to pose risks to surgical safety. We aimed to analyse the anatomical data of Kambin's triangle via CT imaging to define the parameters of the safe operating area for transforaminal posterior lumbar interbody fusion (TPLIF), providing crucial insights for clinical practice. METHODS We selected the L4-L5 intervertebral space. Using three-dimensional (3D), we identified Kambin's triangle and the endocircle within it, and recorded the position of point 'J' on the adjacent facet joint as the centre 'O' of the circle shifts by angle 'β.' The diameter of the inscribed circle 'd,' the abduction angle 'β,' and the distances 'L1' and 'L2' were measured from the trephine's edge to the exiting and traversing nerve roots, respectively. RESULTS Using a trephine with a diameter of 8 mm in TPLIF has a significant safety distance. The safe operating area under the TPLIF microscope was also clarified. CONCLUSIONS Through CT imaging research, combined with 3D simulation, we identified the anatomical data of the L4-L5 segment Kambin's triangle, to clarify the safe operation area under TPLIF. We propose a simple and easy positioning method and provide a novel surgical technique to establish working channels faster and reduce nerve damage rates. At the same time, according to this method, the Kambin's triangle anatomical data of the patient's lumbar spine diseased segments can be measured through CT 3D reconstruction of the lumbar spine, and individualised preoperative design can be conducted to select the appropriate specifications of visible trephine and supporting tools. This may effectively reduce the learning curve, shorten the time operation time, and improve surgical safety.
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Affiliation(s)
- Wei Wang
- Department of Orthopaedic, Fuyang Hospital Affiliated with Bengbu Medical University (Fuyang People's Hospital), Fuyang, China
| | - Yukai Cui
- Department of Orthopaedic, Fuyang Hospital Affiliated with Anhui Medical University (Fuyang People's Hospital), Fuyang, China
| | - Xiaohao Sun
- Department of Orthopaedic, Fuyang Hospital Affiliated with Anhui Medical University (Fuyang People's Hospital), Fuyang, China
| | - Haoran Zhang
- Department of Orthopaedic, Fuyang Hospital Affiliated with Anhui Medical University (Fuyang People's Hospital), Fuyang, China
| | - Wen Yin
- Department of Orthopaedic, Fuyang Hospital Affiliated with Anhui Medical University (Fuyang People's Hospital), Fuyang, China
- Department of Orthopaedic, Anhui Provincial Clinical Medical Research Center for Spinal Deformities, Fuyang, China
| | - Xilong Cui
- School of Mechatronics Engineering and Automation, Shanghai University, 333 Nanchen Road, Shanghai, 200072, China.
- Department of Orthopaedic, Anhui Provincial Clinical Medical Research Center for Spinal Deformities, Fuyang, China.
| | - Wei Jiao
- Department of Orthopaedic, Fuyang Hospital Affiliated with Bengbu Medical University (Fuyang People's Hospital), Fuyang, China.
- Department of Orthopaedic, Fuyang Hospital Affiliated with Anhui Medical University (Fuyang People's Hospital), Fuyang, China.
- Department of Orthopaedic, Anhui Provincial Clinical Medical Research Center for Spinal Deformities, Fuyang, China.
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Gao W, Wang X, Chen Y, Liu G, Hou P, Guo C, Yang X, Hao Y. Long-term efficacy of Waveflex semi-rigid-dynamic-internal-fixation system in delaying intervertebral disc degeneration at adjacent segments and improving spinal sagittal imbalance. Sci Rep 2024; 14:10437. [PMID: 38714766 PMCID: PMC11076526 DOI: 10.1038/s41598-024-60940-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 04/29/2024] [Indexed: 05/10/2024] Open
Abstract
The Waveflex semi-rigid-dynamic-internal-fixation system shows good short-term effects in the treatment of lumbar degenerative diseases, but there are few long-term follow-up studies, especially for recovery of sagittal balance. Fifty patients with lumbar degenerative diseases treated from January 2016 to October 2017 were retrospectively analysed: 25 patients treated with Waveflex semi-rigid-dynamic-internal-fixation system (Waveflex group) and 25 patients treated with double-segment PLIF (PLIF group). Clinical efficacy was evaluated by Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI). Imaging data before surgery and at 3 months, 1 year, and 5 years postoperatively was used for imaging indicator assessment. Local disc degeneration of the cephalic adjacent segment (including disc height index (DHI), intervertebral foramen height (IFH), and range of motion (ROM)) and overall spinal motor function (including lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and |PI-LL|) were analysed. Regarding clinical efficacy, comparison of VAS and ODI scores between the Waveflex and PLIF groups showed no significant preoperative or postoperative differences. The comparison of the objective imaging indicators showed no significant differences in the DHI, IFH, LL, |PI-LL|, and SS values between the Waveflex and PLIF groups preoperatively and 3 months postoperatively (P > 0.05). These values were significantly different at 1 and 5 years postoperatively (P < 0.05), and the Waveflex group showed better ROM values than those of the PLIF group (P < 0.05). PI values were not significantly different between the groups, but PT showed a significant improvement in the Waveflex group 5 years postoperatively (P < 0.05). The Waveflex semi-rigid dynamic fixation system can effectively reduce the probability of intervertebral disc degeneration in upper adjacent segments. Simultaneously, patients in the Waveflex group showed postoperative improvements in LL, spinal sagittal imbalance, and quality of life.
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Affiliation(s)
- Wenxin Gao
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiaoying Wang
- Jinan Vocational College of Nursing, Jinan, Shandon, China
| | - Yungang Chen
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Guoyan Liu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, Shandong, China
| | - Pengfei Hou
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, Shandong, China
| | - Cunliang Guo
- Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xu Yang
- Qingzhou People's Hospital, Weifang, Shandong, China
| | - Yanke Hao
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, 16369 Jingshi Road, Jinan, Shandong, China.
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Zhou Y, Zhou C, Li Q, Cai L, Kou B, Fang W, Yao Z, Wei M, Zhang S, Liu W. Efficacy of PE-PLIF with a novel ULBD approach for lumbar degeneration diseases: a large-channel endoscopic retrospective study. J Orthop Surg Res 2024; 19:269. [PMID: 38685055 PMCID: PMC11057128 DOI: 10.1186/s13018-024-04755-3] [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: 01/19/2024] [Accepted: 04/20/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE This study aims to assess the effectiveness of Percutaneous Endoscopic Posterior Lumbar Interbody Fusion (PE-PLIF) combined with a novel Unilateral Laminotomy for Bilateral Decompression (ULBD) approach using a large-channel endoscope in treating Lumbar Degenerative Diseases (LDD). METHODS This retrospective analysis evaluates 41 LDD patients treated with PE-PLIF and ULBD from January 2021 to June 2023. A novel ULBD approach, called 'Non-touch Over-Top' technique, was utilized in this study. We compared preoperative and postoperative metrics such as demographic data, Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), Japanese Orthopedic Association (JOA) score, surgical details, and radiographic changes. RESULTS The average follow-up duration was 14.41 ± 2.86 months. Notable improvements were observed postoperatively in VAS scores for back and leg pain (from 5.56 ± 0.20 and 6.95 ± 0.24 to 0.20 ± 0.06 and 0.12 ± 0.05), ODI (from 58.68 ± 0.80% to 8.10 ± 0.49%), and JOA scores (from 9.37 ± 0.37 to 25.07 ± 0.38). Radiographic measurements showed significant improvements in lumbar and segmental lordosis angles, disc height, and spinal canal area. A high fusion rate (97.56% at 6 months, 100% at 12 months) and a low cage subsidence rate (2.44%) were noted. CONCLUSIONS PE-PLIF combined with the novel ULBD technique via a large-channel endoscope offers significant short-term benefits for LDD management. The procedure effectively expands spinal canal volume, decompresses nerve structures, improves lumbar alignment, and stabilizes the spine. Notably, it improves patients' quality of life and minimizes complications, highlighting its potential as a promising LDD treatment option.
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Affiliation(s)
| | | | | | - Lei Cai
- Wuhan Fourth Hospital, Wuhan, China
| | | | | | - Zhi Yao
- Wuhan Fourth Hospital, Wuhan, China
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Kpegeol CK, Jain VS, Ansari D, Ammanuel SG, Page PS, Josiah DT. Surgical site infection rates in open versus endoscopic lumbar spinal decompression surgery: A retrospective cohort study. World Neurosurg X 2024; 22:100347. [PMID: 38440381 PMCID: PMC10911845 DOI: 10.1016/j.wnsx.2024.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/04/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
Background Lumbar decompression is a commonly performed procedure for the operative management of several degenerative lumbar spinal pathologies. Although open approaches are considered the traditional method, endoscopic techniques represent a relatively novel, less-invasive option to achieve neural element decompression. Here within, we examine if the use of endoscopic techniques decreases the risk of post operative infections. Methods We performed a retrospective cohort analysis to directly compare patients who underwent either open or endoscopic lumbar decompression at a single institution. Rates of postoperative outcomes such as surgical site infection, hospital length of stay, estimated blood loss, and others were compared between the two treatment groups. A multivariate logistic regression model was constructed using patient comorbidities and procedural characteristics to identify the risk factors for surgical site infection. Results 150 patients were identified as undergoing lumbar spine decompression surgeries that met inclusion criteria for the study, of whom 108 (72.0%) underwent open and 61 (28.0%) underwent endoscopic approaches. Unpaired analysis revealed positive associations between operative duration, estimated blood loss, drain placement rates. Multivariate logistic regression did not reveal an association between surgical approach (open versus endoscopic) and the development of surgical site infection. Conclusions Surgical site infections following endoscopic lumbar spine decompression are relatively uncommon, however, after adjusting for baseline differences between patient populations, surgical approach does not independently predict the development of postoperative infection.
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Affiliation(s)
| | | | - Darius Ansari
- Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, 53792, USA
| | - Simon G. Ammanuel
- Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, 53792, USA
| | - Paul S. Page
- Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, 53792, USA
| | - Darnell T. Josiah
- Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, 53792, USA
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Rosner HL, Tran O, Vajdi T, Vijjeswarapu MA. Comparison analysis of safety outcomes and the rate of subsequent spinal procedures between interspinous spacer without decompression versus minimally invasive lumbar decompression. Reg Anesth Pain Med 2024; 49:30-35. [PMID: 37247945 PMCID: PMC10850670 DOI: 10.1136/rapm-2022-104236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/25/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Treatment for degenerative lumbar spinal stenosis (LSS) typically begins with conservative care and progresses to minimally invasive procedures, including interspinous spacer without decompression or fusion (ISD) or minimally invasive lumbar decompression (MILD). This study examined safety outcomes and the rate of subsequent spinal procedures among LSS patients receiving an ISD versus MILD as the first surgical intervention. METHODS 100% Medicare Standard Analytical Files were used to identify patients with an ISD or MILD (first procedure=index date) from 2017 to 2021. ISD and MILD patients were matched 1:1 using propensity score matching based on demographics and clinical characteristics. Safety outcomes and subsequent spinal procedures were captured from index date until end of follow-up. Cox models were used to analyze rates of subsequent surgical interventions, LSS-related interventions, open decompression, fusion, ISD, and MILD. Cox models were used to assess postoperative complications during follow-up and logistic regression to analyze life-threatening complications within 30 days of index procedure. RESULTS A total of 3682 ISD and 5499 MILD patients were identified. After matching, 3614 from each group were included in the analysis (mean age=74 years, mean follow-up=20.0 months). The risk of undergoing any intervention, LSS-related intervention, open decompression, and MILD were 21%, 28%, 21%, and 81% lower among ISD compared with MILD patients. Multivariate analyses showed no significant differences in the risk of undergoing fusion or ISD, experiencing postoperative complications, or life-threatening complications (all p≥0.241) between the cohorts. CONCLUSIONS These results showed ISD and MILD procedures have an equivalent safety profile. However, ISDs demonstrated lower rates of open decompression and MILD.
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Affiliation(s)
- Howard L Rosner
- Pain Medicine, Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Oth Tran
- Health Economics, Boston Scientific Corp, Valencia, California, USA
| | - Tina Vajdi
- Pain Medicine, Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Mary A Vijjeswarapu
- Pain Medicine, Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Pholprajug P, Kotheeranurak V, Liu Y, Kim JS. The Endoscopic Lumbar Interbody Fusion: A Narrative Review, and Future Perspective. Neurospine 2023; 20:1224-1245. [PMID: 38171291 PMCID: PMC10762387 DOI: 10.14245/ns.2346888.444] [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: 08/27/2023] [Revised: 09/21/2023] [Accepted: 10/10/2023] [Indexed: 01/05/2024] Open
Abstract
Lumbar interbody fusion stands as a preferred surgical solution for degenerative lumbar spine diseases. The procedure primarily aims to establish lumbar segment stability, directly addressing patient symptoms associated with spinal complications. Traditional open surgery, though effective, is linked with notable morbidities and extended recovery time. To mitigate these concerns, minimally invasive surgery (MIS) has garnered significant popularity, presenting an appealing alternative with numerous benefits such as reduced soft tissue trauma, decreased blood loss, and expedited recovery. Among MIS procedures, full endoscopic spinal surgery, characterized by its minimal invasiveness, holds the potential to further minimize morbidities while enhancing surgical outcomes. Endoscopic lumbar interbody fusion, a novel procedure within this paradigm, has gained attention for offering advantages comparable to those of minimally invasive transforaminal lumbar interbody fusion. However, the safety, efficacy, and associated surgical techniques and instrument design of this method continue to be subjects of ongoing debate. This paper critically reviews current evidence on the safety, efficacy, and advantages of endoscopic lumbar spinal interbody fusion, examining whether it could indeed supersede existing mainstream techniques.
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Affiliation(s)
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Yanting Liu
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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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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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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Yin P, Ding Y, Zhou L, Xu C, Gao H, Pang D, Hai Y, Yang J. Innovative Percutaneous Endoscopic Transforaminal Lumbar Interbody Fusion of Lumbar Spinal Stenosis with Degenerative Instability: A Non-Randomized Clinical Trial. J Pain Res 2021; 14:3685-3693. [PMID: 34880673 PMCID: PMC8648278 DOI: 10.2147/jpr.s340004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/24/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Lumbar spinal stenosis (LSS) with instability is most common lumbar degenerative diseases for people with low back pain. The objective of this study was to compared the clinical effects for the treatment of lumbar spinal stenosis (LSS) with degenerative instability between the innovative percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) technique and posterior lumbar interbody fusion (PLIF) technique. Patients and Methods Between April 2019 and April 2020, 114 patients with single-segment LSS were prospectively included in our study (ChiCTR1900022492). Visual Analogue Scale (VAS) on lumbar and leg pain (VAS-LBP, VAS-LP), Oswestry Disability Index (ODI), serum creatine kinase (CK), the maximal cross-sectional area of multifidus muscle (Max-CSA) and the peak intensity of sulphur hexafluoride microbubble contrast agent (PI) around the surgical incision by contrast-enhanced ultrasonography were evaluated preoperatively, post-operatively and at regular follow-up. Results All patients were followed up. The VAS-LBP, VAS-LP, ODI after operation were improved significantly compared to these data before operation in all the patients (P<0.05). The VAS-LBP at 1 weeks, 3 months after operation in PE-TLIF group were significantly lower than these in PLIF group (P<0.05). The injury degree of multifidus muscle evaluated by MAX-CSA and PI was significantly less in PE-TLIF group after operation (P<0.05). There was no significant difference on the complication rate between these two groups (P>0.05). Conclusion Our results presented PE-TLIF technique could obtain comparable effective outcomes as conventional PLIF for the treatment of LSS with degenerative instability. The patients with PE-TLIF had less muscle injury, less pain and quicker postoperative rehabilitation.
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Affiliation(s)
- Peng Yin
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, People's Republic of China
| | - Yi Ding
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, People's Republic of China
| | - Lijin Zhou
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, People's Republic of China
| | - Chunyang Xu
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, People's Republic of China
| | - Haifeng Gao
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, People's Republic of China
| | - Daming Pang
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, People's Republic of China
| | - Yong Hai
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, People's Republic of China
| | - Jincai Yang
- Department of Orthopaedics, Beijing Chao-Yang Hospital, China Capital Medical University, Beijing, People's Republic of China
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