Sciatica-Related Spinal Imbalance in Lumbar Disc Herniation Patients: Radiological Characteristics and Recovery Following Endoscopic Discectomy

Characteristics of Sciatic Scoliotic List in Lumbar Disc Herniation

STUDY DESIGN

Retrospective radiological study.

OBJECTIVES

Physical examination reveals sciatic scoliotic list (SSL) in some patients with lumbar disc herniation (LDH). We aimed to evaluate the coronal and sagittal parameters of the SSL curve, describe their characteristics, and establish a new classification system.

METHODS

We retrospectively reviewed 230 patients (SSL group = 96; non-SSL group = 134) diagnosed with single-segment LDH from January 2018 to December 2020. The control group comprised 70 healthy volunteers. Radiographic parameters were compared between the groups.

RESULTS

In the SSL group, the Cobb's angle was 12.5 ± 5.3° (4.2-31.2), trunk shift 26.2 ± 17.9 mm (.0-88.2 mm), and apical vertebral translation 31.7 ± 16.0 mm (1.18-8.58 mm). Further, 62.5% of patients had L4/5 disc herniation, 76.0% had disc herniation at the convex side of the lumbosacral scoliosis, and 81.3% had disc herniation at the opposite side of the trunk shift. Compared to the control group, lumbar lordosis and thoracic kyphosis decreased, pelvic tilt increased, and the sagittal vertical axis moved forward in the other patients. The sagittal imbalance in the SSL group exacerbated. Using the positional relationship between vertebrae and the central sacral vertical line (CSVL), we identified two main SSL patterns with which 95.8% of the patients were defined as Type 1.

CONCLUSIONS

The SSL curve is characterized by a long thoracic or thoracolumbar curve, with a relatively straight sagittal profile and little rotation. Further, the lumbar and thoracic vertebrae shifts are on the same side as the CSVL. These features of the SSL curve differentiate it from other types of structural scoliosis.

Percutaneous endoscopic lumbar discectomy for single and double segment lumbar disc herniation with sciatic scoliosis in adults: a retrospective study

OBJECTIVE

Sciatic scoliosis can be seen in patients with lumbar disc herniation. Percutaneous endoscopic lumbar discectomy (PELD) is a common surgical method for the treatment of lumbar disc herniation. The difference between single-segment lumbar disc herniation and double-segment lumbar disc herniation with Sciatic Scoliosis in adults after PELD needs further study. The aim of this study was to compare the imaging features of single-segment and double-segment lumbar disc herniation with Sciatic Scoliosis in adults and to further explore the clinical outcomes of functional improvement and scoliosis imaging parameters of the two groups after PELD.

METHODS

Adult patients with lumbar disc herniation with sciatic scoliosis who received PELD from January 2019 to June 2022 were analyzed retrospectively. According to the number of operative segments, the patients were divided into a single-segment group and a double-segment group. Perioperative parameters were observed and compared between the two groups. The Visual Analogue Scale (VAS) score, Oswestry dysfunction index (ODI), Japanese Orthopaedic Association scores (JOA) and imaging parameters of the two groups were recorded and compared before the operation and during the follow-up.

RESULTS

A total of 53 patients with single segments and 21 patients with double segments were included in this study. During the follow-up, the VAS score, ODI index and JOA score of the two groups were significantly improved as compared with those before the operation(P < 0. 05). Ninety-two point five percent of single-segment patients and 90.5% of double segment patients returned to normal scoliosis within 12 months after the operation. The operation time, number of intraoperative fluoroscopy times and the amount of intraoperative blood loss in single-segment patients were better than those in double-segment group(P < 0. 05). At the last follow-up, the AVT, CBD and SVA in the double-segment group were 5.2 ± 2.3, 5.1 ± 1.0 and 12.2 ± 3.0 mm, respectively, which were higher than those in the single-segment group (1.9 ± 0.4, 1.1 ± 1.6 and 3.9 ± 2.1 mm) (P < 0. 05).

CONCLUSION

PELD is an effective treatment for single-segment and double-segment lumbar disc herniation with Sciatic scoliosis. Double-segment patients can enjoy similar clinical efficacy to single-segment patients, avoiding complications caused by decompression, fusion, and internal fixation. Scoliosis was corrected spontaneously within 12 months after operation, and the sagittal curve was significantly improved in both groups. The improvement of coronal and sagittal balance in double -segment patients may take longer.

Utilizing pre- and postoperative radiological parameters to predict surgical outcomes following untethering for tethered cord syndrome in a pediatric population

OBJECTIVE

Tethered cord syndrome (TCS) can lead to significant downstream neurological deficits including gait deterioration, incontinence, and often unexplained chronic low-back pain. Surgical intervention may relieve symptoms, but there are no defined radiological parameters associated with surgical outcomes and functional status. The authors aimed to define pre- and postoperative radiological parameters for assessing surgical outcomes in TCS.

METHODS

The authors performed a single-center retrospective review of all pediatric patients treated for TCS between 2016 and 2021. Patient baseline characteristics and operative metrics included age, sex, level of conus, level of procedure, tethering pathology, symptoms at presentation, complications, improvement of symptoms, and reoperation rate. MRI measurements included pre- and postoperative anterior canal distance (ACD) and bending angle (BA).

RESULTS

Thirty-three pediatric patients were identified who underwent untethering of the spinal cord and had pre- and postoperative MRI between 2016 and 2021. The mean patient age was 5.64 ± 5.33 years. Twenty patients (60.60%) were female. Regarding the site of untethering, 31 procedures (93.93%) were performed at the lumbosacral region and 2 (6.06%) were performed at the thoracolumbar region. The conus medullaris was found above L3 in 21.21% of patients. Postoperatively, 18.18% of patients experienced complications, 48.48% showed improvement in their symptoms, and 48.48% were equivocal or had persistent symptoms. The mean preoperative ACD0 (measured from the posterior vertebral body margin [middle] to the anterior margin of the conus medullaris) was 6.15 ± 3.18 mm, the postoperative ACD0 was 2.25 ± 2.72 mm, and the average change in ACD0 was -0.90 ± 1.31 mm. The mean preoperative BA was 26.00° ± 11.56°, the mean postoperative BA was 15.92° ± 9.81°, and the average change in BA was -10.08° ± 8.80°. An optimal cutoff value for preoperative BA to predict reoperation in pediatric patients with complex TCS undergoing surgery was ≥ 31.70° (area under the curve = 0.83).

CONCLUSIONS

In surgically treated patients with TCS, certain preoperative radiological parameters may be important in predicting postoperative surgical outcomes; these parameters can be evaluated and reported to indicate patients at high risk for complications. Further prospective multicenter research is warranted to offer robust evidence of association of patient outcomes with preoperative radiological parameters in TCS.