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Zhang Y, Zhao W, Hu M, Liu X, Peng Q, Meng B, Yang S, Feng X, Zhang L. The Efficacy and Safety of Topical Saline Irrigation with Tranexamic Acid on Perioperative Blood Loss in Patients Treated with Percutaneous Endoscopic Interlaminar Diskectomy: A Retrospective Study. J Neurol Surg A Cent Eur Neurosurg 2024; 85:280-287. [PMID: 37586408 DOI: 10.1055/s-0043-1769127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is safe and effective in preventing bleeding during spinal surgery. However, there is currently no relevant research on the efficacy and safety of adding TXA to the saline irrigation fluid in percutaneous endoscopic interlaminar diskectomy (PEID). This study aimed to evaluate the efficacy and safety of topical saline irrigation with TXA for PEID in the treatment of lumbar disk herniation. METHODS In this single-center, retrospective cohort study, patients who underwent PEID for L5-S1 lumbar disk herniation were included and allocated to two groups according to whether they had been administered TXA. PEID was performed with saline irrigation fluid containing 0.33 g of TXA per 1 L of saline in the TXA group (n = 38). In the control group (n = 51), the saline irrigation fluid was injected with the same volume of normal saline. All PEIDs were performed by the same spine surgery team. The hidden blood loss (HBL), intraoperative blood loss (IBL), total blood loss (TBL), amount of fluid used, operation time, visual clarity, hospital stay, blood transfusion rate, coagulation index, and complication rate were compared between the two groups. RESULTS The TBL, HBL, and IBL in the TXA group were significantly lower than those of the control group. The postoperative hemoglobin in the TXA group was significantly higher than that of the control group. Visual clarity was significantly better and the operation time was significantly shorter in the TXA group. However, there was no significant difference in postoperative hematocrit, blood coagulation function, amount of fluid used, blood transfusion rate, and perioperative complications between the two groups. CONCLUSION In PEID, the addition of TXA to topical saline irrigating fluid can significantly reduce the HBL, IBL, and TBL. The addition of TXA to topical saline irrigating fluid can improve visual clarity in the surgery and reduce operation time, but it does not change the coagulation function or the complication rate.
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Affiliation(s)
- Yu Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Wenjie Zhao
- Graduate School of Dalian Medical University, Dalian, China
| | - Man Hu
- Graduate School of Dalian Medical University, Dalian, China
| | - Xin Liu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Qing Peng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Bo Meng
- Graduate School of Dalian Medical University, Dalian, China
| | - Sheng Yang
- Graduate School of Dalian Medical University, Dalian, China
| | - Xinmin Feng
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
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Qin L, Jiang X, Zhao S, Guo W, You D. A Comparison of Minimally Invasive Surgical Techniques and Standard Open Discectomy for Lumbar Disc Herniation: A Network Meta-analysis. Pain Physician 2024; 27:E305-E316. [PMID: 38506677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Lumbar disc herniation is a common spinal disease that causes low back pain; surgery is required when conservative treatment is ineffective. There is a growing demand for minimally invasive surgery in younger patient populations due to their fear of significant damage and a long recovery period following standard open discectomy. The development history of minimally invasive surgery is relatively short, and no gold standard has been established. OBJECTIVES We aimed to find, via a network meta-analysis, the best treatment for low back pain in younger patient populations. STUDY DESIGN Network meta-analysis. METHODS The PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Data quality was evaluated using RevMan 5.3 (The Nordic Cochrane Centre for The Cochrane Collaboration), while STATA 14.0 (StataCorp LLC) was used for the network meta-analysis and to merge data on the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, complication, blood loss, reoperation rate, and function score. RESULTS We included 50 randomized controlled trials, involving 7 interventions; heterogeneity and inconsistency were acceptable. Comparatively, microendoscopic discectomy and percutaneous endoscopic lumbar discectomy were the best surgical procedures from the aspects of VAS score and ODI score, while standard open discectomy was the worst one from the aspect of ODI score. Regarding complications, tubular discectomy was preferred with the fewest complications. Additionally, microendoscopic discectomy outperformed other surgical procedures in reducing blood loss and reoperation rate. LIMITATIONS First, follow-up data were not reported in all included studies, and the follow-up time varied from several months to 8 years, which affected the results accuracy of our study to some extent. Second, there were some nonsurgical factors that also affected the self-reported outcomes, such as rehabilitation and pain management, which also brought a certain bias in our study results. CONCLUSIONS Compared to standard open discectomy, minimally invasive surgical procedures not only achieve satisfactory efficacy, but also microendoscopic discectomy and percutaneous endoscopic lumbar discectomy can obtain a more satisfactory short-term VAS score and ODI score. Microendoscopic discectomy has significant advantages in blood loss and reoperation rate, and tubular discectomy has fewer postoperative complications.
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Affiliation(s)
- Lu Qin
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China; Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Xiaoqian Jiang
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Shishun Zhao
- Center for Applied Statistical Research and College of Mathematics, Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Wenlai Guo
- Department of Hand Surgery, the Second Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
| | - Di You
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, People's Republic of China
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Yang K, Chen ZL, Chen YX, Ren LJ, Hou L. [Molecular mechanism of residual lumbago and leg pain after transforaminal endoscopic treatment of lumbar disc herniation]. Zhongguo Gu Shang 2024; 37:159-65. [PMID: 38425067 DOI: 10.12200/j.issn.1003-0034.20230558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To observe the residual of lumbago and leg pain with contained type (CT) and non-contained type (NCT) lumbar disc herniation (LDH) after transforaminal endoscopic treatment, and to explore the role of hypoxia-inducible factor-1α(HIF-1α) and transient receptor potential vanillate 1(TRPV1) pathway. METHODS A total of 68 single-segment LDH patients were selected from July 2021 to October 2022, including 44 males and 24 females;aged 26 to 67 years old with an average of(43.63±11.94) years old;course of disease was 4 to 36 (18.91±10.34) months;body mass index was (24.45±4.00) kg·m-2;there were 7 cases of L3,4 segments, 32 cases of L4,5 segments, and 29 cases of L5S1 segments. All of them were performed with percutaneous intervertebral endoscopic extraction of nucleus pulposus and were divided into contained group(CT group) and non-contained group (NCT group) with 34 cases respectively according to the integrity of outer layer of fibrous annulus observed during operation. A total of 17 patients who underwent open surgery for scoliosis or vertebral fracture were selected as control group, including 12 males and 5 females;aged 21 to 65 years old with an average of (39.41±12.80) years old;body mass index was (24.86±4.11) kg·m-2. The relative mRNA expression quantity of HIF-1α, TRPV1 in nucleus pulposus were measured by quantitative real-time PCR. The contents of neurokinin 1 receptor (NK1R), nerve growth factor (NGF), vascular endothelial growth factor (VEGF) in nucleus pulposus and the serum substance P (SP) and calcitonin gene-related peptide (CGRP) were detected by enzyme linked immunosorbent assay (ELISA). The threshold of lumbar tenderness was detected by a pressure pain meter. The degree of lumbago and lumbar function were evaluated by visual analog scale (VAS) and Oswestry disability index (ODI) separately. The residual rate of postoperative lumbago and leg pain was assessed. RESULTS The mRNA relative expression quantity of HIF-1α and TRPV1, and the contents of NK1R, NGF and VEGF in nucleus pulposus, and the levels of serum SP and CGRP before surgery in the NCT group were higher than those in the CT group(P<0.05), and those in the CT group were higher than the control group(P<0.05). At day 7 after surgery, the serum SP and CGRP levels, lumbago and leg pain VAS scores and lumbar ODI index in two LDH groups were lower than before surgery (P<0.05), and those in the NCT group were higher than the CT group(P<0.05), and the threshold of lumbar tenderness in the NCT group was lower than the CT group(P<0.05). The differences of lumbago and leg pain VAS scores, lumbar ODI index and lumbar tenderness threshold between preoperative and postoperative 7 days in the NCT group were lower than those in the CT group(P<0.05). The residual rate of lumbago and leg pain at 7 days after surgery in the NCT group was higher than that in the CT group(P<0.05). CONCLUSION HIF-1α and TRPV1 pathway promoted the excessive production of NGF, VEGF, NK1R in nucleus pulposus and serum neuropeptides SP and CGRP, which may lead to the higher residual rate of lumbago and leg pain with non-contained lumbar disc herniation postoperative.
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Affiliation(s)
- Kun Yang
- Department of TCM, Jieshou People's Hospital of Anhui province, Jieshou 236000, Anhui, China
| | - Zi-Long Chen
- Department of TCM, Jieshou People's Hospital of Anhui province, Jieshou 236000, Anhui, China
| | - Yan-Xi Chen
- Department of TCM, Jieshou People's Hospital of Anhui province, Jieshou 236000, Anhui, China
| | - Li-Jun Ren
- Department of TCM, Jieshou People's Hospital of Anhui province, Jieshou 236000, Anhui, China
| | - Lei Hou
- Department of Rheumatology and Immunology, the Second Hospital Affiliated to Guizhou University of TCM, Guiyang 550003, Guizhou, China
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Abeeha UE, Chaudhary AM, Mughal A. Letter to the Editor: Analysis of the clinical efficacy of visualization of percutaneous endoscopic lumbar discectomy combined with annulus fibrosus suture in lumbar disc herniation. Neurosurg Rev 2024; 47:88. [PMID: 38372807 DOI: 10.1007/s10143-024-02321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/20/2024]
Affiliation(s)
- Umm E Abeeha
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Aira Mughal
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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Pan YH, Wan D, Wang Q, Shen WJ, Yang JR, Wang ZY, Cai ZL, Jiang S, Cao M. Association of spinal-pelvic parameters with recurrence of lumbar disc herniation after endoscopic surgery: a retrospective case-control study. Eur Spine J 2024; 33:444-452. [PMID: 38236278 DOI: 10.1007/s00586-023-08073-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/27/2023] [Accepted: 11/29/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE This study aimed to investigate the relationship between spinal-pelvic parameters and recurrence of lumbar disc herniation (rLDH) after percutaneous endoscopic lumbar discectomy (PELD) through a retrospective case-control study. METHODS Patients who underwent PELD for single-segment LDH at our hospital were included in this study. The relationship between sagittal balance parameters of the spine and recurrence was analysed through correlation analysis, and ROC curves were plotted. The baseline characteristics, sagittal balance parameters of the spine and radiological parameters of the case and control groups were compared, and the relationship between sagittal balance parameters of the spine and recurrence of rLDH after PELD was determined through univariate and multivariate logistic regression analysis. RESULTS Correlation analysis showed that PI and ∆PI-LL were negatively correlated with grouping (r = -0.090 and -0.120, respectively, P = 0.001 and 0.038). ROC curve analysis showed that the area under the curve (ROC-AUC) for predicting rLDH based on PI was 0.65 (CI95% = 0.598, 0.720), with a cut-off of 50.26°. The ROC-AUC for predicting rLDH based on ∆PI-LL was 0.56 (CI95% = 0.503, 0.634), with a cut-off of 28.21°. Multivariate logistic regression analysis showed that smoking status (OR = 2.667, P = 0.008), PI ≤ 50.26 (OR = 2.161, P = 0.009), ∆PI-LL ≤ 28.21 (OR = 3.185, P = 0.001) and presence of Modic changes (OR = 4.218, P = 0.001) were independent risk factors, while high DH (OR = 0.788, P = 0.001) was a protective factor. CONCLUSION PI < 50.26 and ∆PI-LL < 28.21 were risk factors for recurrence of lumbar disc herniation after spinal endoscopic surgery and had some predictive value for post-operative recurrence.
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Affiliation(s)
- Yu-Hao Pan
- Spinal Surgery Department, Sichuan Orthopaedic Hospital, Chengdu, Sichuan, China
| | - Dun Wan
- Spinal Surgery Department, Sichuan Orthopaedic Hospital, Chengdu, Sichuan, China.
| | - Qi Wang
- Chengdu Sport University, Chengdu, Sichuan, China
| | - Wen-Jun Shen
- Chengdu Sport University, Chengdu, Sichuan, China
| | - Jin-Rui Yang
- Chengdu Sport University, Chengdu, Sichuan, China
| | | | - Zong-Lin Cai
- Spinal Surgery Department, Sichuan Orthopaedic Hospital, Chengdu, Sichuan, China
| | - Shui Jiang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Min Cao
- Spinal Surgery Department, Sichuan Orthopaedic Hospital, Chengdu, Sichuan, China
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He X, Yin H, Wang Y, Qiu T, Zeng K, Liu J. Study on early efficacy of UBED and PEID in the treatment of L5/S1 intervertebral disc herniation. MINIM INVASIV THER 2024; 33:43-50. [PMID: 37946501 DOI: 10.1080/13645706.2023.2278059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION This study aimed to compare early efficacy of UBED and PEID in the treatment of L5/S1 IDH. MATERIAL AND METHODS Forty-two patients who underwent surgical treatment for L5/S1 IDH were divided into two groups: UBED and PEID. Operation time, complications, VAS/ODI score were recorded. MacNab evaluation was completed one and three months postoperatively. RESULTS All patients were successfully operated without infection, nerve injury, or huge hematoma in the spinal canal. There were no significant differences in operation time and hospitalization days between the two groups (p > 0.05). All patients were followed up after the operation and low back/leg pain was significantly reduced. VAS for low back pain, VAS for leg pain, ODI scores in both groups one and three months after the operation were significantly lower than pre-operation (p < 0.05). There were no significant differences between one and three months after the operation in both groups (p > 0.05). There were no significant differences in VAS for low back pain, leg pain, ODI score, and overall efficacy between the two groups one and three months post-operation (p > 0.05). CONCLUSION UBED and PEID have very good early efficacy in treating L5/S1 IDH. Because UBED has a wider vision field and more flexible operation, it can be used as a useful complement to PEID.
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Affiliation(s)
- Xian He
- Department of Minimally Invasive Spine Surgery, Panyu Hospital of Chinese Medicine, Guangzhou, China
| | - Haidong Yin
- Department of Minimally Invasive Spine Surgery, Panyu Hospital of Chinese Medicine, Guangzhou, China
| | - Yantao Wang
- Department of Minimally Invasive Spine Surgery, Panyu Hospital of Chinese Medicine, Guangzhou, China
| | - Taibin Qiu
- Department of Minimally Invasive Spine Surgery, Panyu Hospital of Chinese Medicine, Guangzhou, China
| | - Kunhua Zeng
- Department of Minimally Invasive Spine Surgery, Panyu Hospital of Chinese Medicine, Guangzhou, China
| | - Juncheng Liu
- Department of Minimally Invasive Spine Surgery, Panyu Hospital of Chinese Medicine, Guangzhou, China
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Zhang J, Yuan Y, Gao H, Liao B, Qian J, Yan X. Comparative study on the technique and efficacy of microscope-assisted MI-TLIF and naked-eye MI-TLIF in lumbar revision surgery. J Orthop Surg Res 2024; 19:101. [PMID: 38297343 PMCID: PMC10832101 DOI: 10.1186/s13018-024-04591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/28/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Lumbar revision surgery can be performed by simple lumbar nerve decompression or lumbar interbody fusion, including percutaneous endoscopic lumbar discectomy, transforaminal lumbar interbody fusion (TLIF), etc. However, lumbar revision surgery is very difficult in surgical operation. We sought to explore the technique safety and efficacy of microscope-assisted minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) in lumbar revision surgery. METHODS Cases of postoperative recurrence following lumbar spine surgery (n = 63) treated from December 2016 to July 2021 were retrospectively analyzed, including 24 cases of microscope-assisted MI-TLIF (microscopic group) and 39 cases of naked-eye MI-TLIF (naked-eye group). The operation time, intraoperative blood loss, incision length, postoperative drainage, length of hospital stay, initial operation, and visual analog score (VAS) of low back and leg pain before and at 7 days and 3 months after the operation and the last follow-up were compared between the two groups. The Oswestry Dysfunction Index (ODI) and the Japanese Orthopaedic Association (JOA) scores before and after the operation and the Bridwell interbody fusion grades at 1 year were compared. The independent t tests, Mann-Whitney U tests, and Chi-square tests were used for analysis. RESULTS All 63 patients were successfully treated by operation and were followed up for an average of 31.5 ± 8.6 months (range 12-48 months). The two groups had no significant difference in sex, age, incision length, initial operation, or operative segment (P > 0.05). There was no significance in operation time, VAS score, ODI score, and JOA score of low back pain or Bridwell interbody fusion grade between the two groups (P > 0.05). Significant differences in intraoperative blood loss, postoperative drainage, and the lengths of hospital stay were observed between the two groups (P < 0.05). Cerebrospinal fluid leakage (n = 2), edema of nerve roots (n = 2), and incision infection (n = 1) were observed in the naked-eye group. There were no complications in the microscopic group, such as cerebrospinal fluid leakage, edema of nerve roots, and incision infection. CONCLUSION Although microscope-assisted MI-TLIF and naked-eye MI-TLIF are both effective during lumbar revision surgery, microscope-assisted MI-TLIF brings less trauma, less bleeding, shorter postoperative hospital stay, and faster recovery. Unlike traditional surgery, microscope-assisted MI-TLIF provides a clear visual field, adequate hemostasis, and nerve decompression.
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Affiliation(s)
- JiaHuan Zhang
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
- Xi'an Medical University, Xi'an, 710054, China
| | - YiFang Yuan
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - HaoRan Gao
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Bo Liao
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - JiXian Qian
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - XiaoDong Yan
- Department of Orthopeadics, Tangdu Hospital, Fourth Military Medical University, No.569, Xinsi Road, Xi'an, 710038, Shaanxi, China.
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Kim SY, Lim YC, Seo BK, Nam D, Ha IH, Lee YS, Lee YJ. A study on the 10-year trend of surgeries performed for lumbar disc herniation and comparative analysis of prescribed opioid analgesics and hospitalization duration: 2010-2019 HIRA NPS Data. BMC Musculoskelet Disord 2024; 25:65. [PMID: 38218767 PMCID: PMC10787428 DOI: 10.1186/s12891-024-07167-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND This study, utilizing the claims data from the Health Insurance Review and Assessment Service of Korea, aimed to examine the 10-year (2010-2019) trends in various types of lumbar spine surgeries performed on patients diagnosed with lumbar herniated intervertebral disc (HIVD), and the current status of opioid prescriptions, as well as the duration of postoperative hospital stays based on the type of surgery performed. METHOD This retrospective cross-sectional study examined patients with one or more national health insurance claims carrying a primary or secondary diagnosis of HIVD (ICD-10 codes: M511, M518, M519) over a 10-year period (2010-2019). From the patients undergoing lumbar spine surgery, we selected those who did not require reoperation within 30 days following the initial lumbar surgery. Our final study sample comprised patients who underwent only one type of surgery. RESULTS Among the patients diagnosed with HIVD and subsequently undergoing lumbar surgery between 2010 and 2019, a slight downward trend was observed in those undergoing open discectomy (OD); however, OD persistently accounted for the highest proportion over the 10 years. Percutaneous endoscopic lumbar discectomy (PELD) demonstrated a consistent upward trend from 2016 to 2018. When inspecting trends, we noted a consistent escalation over the decade in the postoperative opioid prescription rates of strong opioids (50.7% in 2010 to 77.8% in 2019) and tramadol (50.9% in 2010 to 76.8% in 2019). Analyzing these trends by surgery type, spinal fusion exhibited a slightly higher rate of opioid prescriptions than other lumbar surgeries. Regarding the length of postoperative hospital stays, patients undergoing PELD recorded the shortest stay (7.04 ± 6.78 days), while spinal fusion necessitated the longest (20.14 ± 12.18 days). CONCLUSION This study analyzed the trends in types of lumbar spine surgeries, opioid analgesic prescriptions, and length of hospital stays over 10 years (2010-2019) among patients with HIVD in Korea. Our data and findings provide valuable evidence that may prove beneficial for clinicians and researchers involved in HIVD-related practices.
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Affiliation(s)
- Sang Yoon Kim
- Jaseng Hospital of Korean Medicine, 536 Gangnam-daero, Gangnam-gu, Seoul, 06110, Republic of Korea
| | - Yu-Cheol Lim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 2F, 540 Gangnam-daero, Gangnam-gu, Seoul, 06110, Republic of Korea
| | - Byung-Kwan Seo
- Department of Acupuncture and Moxibustion, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, 05278, Republic of Korea
| | - Dongwoo Nam
- Department of Acupuncture and Moxibustion, Kyung Hee University, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 2F, 540 Gangnam-daero, Gangnam-gu, Seoul, 06110, Republic of Korea
| | - Ye-Seul Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 2F, 540 Gangnam-daero, Gangnam-gu, Seoul, 06110, Republic of Korea.
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 2F, 540 Gangnam-daero, Gangnam-gu, Seoul, 06110, Republic of Korea.
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Sun J, Wang J, Wu R, Zhao Z, Fan B, Cai J, Feng F. Comparison of bone reamer and trephine for foraminoplasty in percutaneous endoscopic lumbar discectomy based on 3D slicer and Digimizer software. J Orthop Surg Res 2024; 19:55. [PMID: 38217013 PMCID: PMC10785399 DOI: 10.1186/s13018-023-04270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/07/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE To explore the applicability of bone reamer and trephine for foraminoscopy in percutaneous endoscopic lumbar discectomy (PELD), and to provide a theoretical basis for foraminoplasty options in clinical practice. METHODS This study was a prospective cohort study. Sixty-three consecutive patients who underwent PELD for lumbar disc herniation between May 2021 and July 2022 were analysed. Foraminoplasty were performed by bone reamer or trephine. The amount of bone removed and the foramen area enlarged during foraminoplasty by both tools were measured by 3D slicer and Digimizer software, and the numbers of fluoroscopic views were recorded. RESULTS The bone reamer removed less bone in the Superior Articular Process (SAP) than the trephine (t = 17.507, P < 0.001), and the area enlarged by the bone reamer was smaller than that of the trephine (t = 10.042, P = 0.002). The overall numbers of fluoroscopic views were significantly more in the bone reamer group than in the trephine group (t = 19.003, P < 0.001). In the bone reamer group, when the area of preoperative (FPZ) was no less than 54.55 mm2, the mean number of fluoroscopic views significantly decreased (t = 14.443, P = 0.001). CONCLUSION Bone reamer was safer and trephine was more efficient for foraminoscopy in PELD. An area of preoperative (FPZ) of 54.55 mm2 can be used as a critical value: bone reamer reduced the risk for cases above the value, while trephine improved the efficiency for cases less than the value.
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Affiliation(s)
- Jiewei Sun
- Cardiothoracic Surgery Department, The First People's Hospital of Fuyang, No. 429, Beihuan Road, Fuchun Street, Fuyang District, Hangzhou, 311400, Zhejiang, China
| | - Jun Wang
- The orthopaedic, Xiaoshan Hospital Affiliated to Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Ruiji Wu
- Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310005, Zhejiang, China
| | - Zhi Zhao
- The orthopaedic, Xiaoshan Hospital Affiliated to Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Bingkai Fan
- The orthopaedic, Xiaoshan Hospital Affiliated to Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Jie Cai
- The orthopaedic, Xiaoshan Hospital Affiliated to Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Fabo Feng
- Center for Plastic and Reconstructive Surgery, Department of Orthopedics, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China.
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Hu Q, Wu W, Liu J, Xie S, Tang T. Predictive Factors for Residual Low Back Pain Following Percutaneous Endoscopic Lumbar Discectomy in Patients with Lumbar Disc Herniation. Med Sci Monit 2024; 30:e942231. [PMID: 38183217 PMCID: PMC10777582 DOI: 10.12659/msm.942231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) is a mature and popular surgery for treatment of lumbar disc herniation (LDH). The main objective of our study was to identify risk factors for residual low back pain after PELD and to improve postoperative management. MATERIAL AND METHODS We retrospectively analyzed the clinical and imaging data of 251 patients who underwent PELD for LDH. We defined residual LBP as visual analog scale (VAS) score for LBP ≥3 at 2 years postoperatively, and severe LBP was defined as VAS for LBP ≥7.5. The clinical and imaging data were analyzed by comparing patients with VAS scores ≥3 and <3, and univariate analysis and multivariable logistic regression analysis were applied to predict the risk factors for residual LBP. RESULTS There were 56 (22.3%) patients with LBP VAS ≥3 at 2 years postoperatively. Multivariable logistic regression analysis demonstrated that severe baseline VAS for LBP (P<0.001), MCs type I (P=0.006), and severe fatty infiltration of the paravertebral muscles (P<0.001) were independent risk factors for residual LBP after PELD. CONCLUSIONS In patients with LDH, MCs type I, severe baseline LBP, and fatty infiltration of the paravertebral muscles were predictive factors for residual LBP after PELD. Our study suggests that spine surgeons should pay more attention to these imaging parameters, which may be a helpful indicator for the choice of surgical modality.
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Affiliation(s)
- Qianqin Hu
- First Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, PR China
| | - Wenjing Wu
- Third Department of Internal Medicine, Jiangxi Provincial Chest Hospital, Nanchang, Jiangxi, PR China
| | - Jiahao Liu
- Department of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, PR China
| | - Shuihua Xie
- First Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, PR China
| | - Tao Tang
- First Department of Orthopedics, Jiangxi Province Hospital of Integrated Chinese and Western Medicine, Nanchang, Jiangxi, PR China
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Zhou G, Liang Z, Gao F, Zhao L, Gao H, Xiao G, Xu J, Chen X, Song C. Percutaneous Endoscopic Lumbar Discectomy for Calcified Lumbar Disc Herniation: A Retrospective Cohort Study, Systematic Review and Meta-Analysis. Pain Physician 2024; 27:E1-E15. [PMID: 38285024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Calcified lumbar disc herniation (CLDH) is a subtype characterized by calcification, leading to increased surgical complexity. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique, but its effectiveness and complications in CLDH patients remain to be fully evaluated. OBJECTIVE To assess the effectiveness and complications of PELD in treating CLDH patients. STUDY DESIGN A retrospective cohort study combined with a systematic review and meta-analysis. SETTING Department of Pain Medicine, an affiliated hospital of a university. METHODS Data from patients who underwent PELD in our department between March 2020 and May 2021 were collected. Forty CLDH patients were included in the study group, and equally matched cases with uncalcified lumbar disc herniation (UCLDH) served as controls. A systematic search was conducted on October 5, 2022, using EMBASE, PubMed, Cochrane Library, the China Biology Medicine disk, the China National Knowledge Infrastructure, and the Wanfang databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A random-effects model was used to calculate pooled results. RESULTS Eighty patients were included in the retrospective cohort, and 41 studies were included in the meta-analysis. Both the retrospective cohort and meta-analysis consistently showed a significant decrease in visual analog scale (VAS) and Oswestry Disability Index (ODI) scores in the CLDH group after the operation. In the retrospective cohort, the excellent or good rate according to the MacNab classification was 85%, with no reported complications. The meta-analysis revealed a pooled excellent or good rate of 91.8% and a low complication rate of 2.9%. Combining the findings from our retrospective cohort and meta-analysis, we observed that the CLDH group had longer operation times and slightly higher postoperative ODI scores compared to the UCLDH group. LIMITATIONS Small sample size and lack of long-term follow-up in the retrospective cohort, as well as limited inclusion of comparative studies in the meta-analysis. CONCLUSION PELD is an effective and safe treatment option for CLDH patients. In comparison to UCLDH patients, CLDH patients may experience longer operation times and slightly slower functional recovery than those with UCLDH.
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Affiliation(s)
- Guozhong Zhou
- Department of Science and Research, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China; Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Zhi Liang
- Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Fucun Gao
- Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Liqing Zhao
- Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Hongbing Gao
- Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Guoqing Xiao
- Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Jiang Xu
- Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Xuesong Chen
- Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China
| | - Chao Song
- Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China; Department of Medical Imaging, Anning First People's Hospital Affiliated to Kunming University of Science and Technology, Kunming, Yunnan Province, China
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Gerling MC, Baker M, Stanton E, Chaladoff E, Buser Z. Nerve root retraction time during lumbar endoscopic discectomy: association with new onset radiculitis, a post-operative neurologic complication. Eur Spine J 2024; 33:126-132. [PMID: 37747545 DOI: 10.1007/s00586-023-07952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To evaluate the relationship between nerve root retraction time, post-operative radiculitis and patient reported outcomes. METHODS Patients who underwent single- or multi-level lumbar discectomy between 2020 and 2022 for lumbar disk herniations were prospectively followed with pre-operative, interoperative and post-operative variables including radiculitis and patient reported outcomes including VAS, ODI and CAT domains Pain interference, Pain intensity and Physical function. Intraoperative nerve root retraction time was recorded. Paired sample two-tailed t-test and multivariate regression were utilized with p < 0.05 being significant. RESULTS A total of 157 patients who underwent single- or multi-level endoscopic lumbar discectomy. Average patient age was 44 years, and 64% were male patients. Nerve retraction time ranged from 4 to 15 min. Eighteen percent reported new radiculitis at 2-weeks post-operatively. In patients with new-onset radiculitis 79.2% reported significantly worse VAS leg at 2 weeks post-operative (4.2 vs. 8.3, p < 0.001) compared to 12.5% who had improved VAS leg (9.3 vs. 7, p = 0.1181). Patients with radiculitis and worse VAS scores had substantially longer nerve retraction time (13.8 ± 7.5 min) than patients with improved VAS leg (6.7 ± 1.2 min). At 6 months, patients with longer nerve retraction time had no significant improvement in the ODI or CAT compared to the baseline. CONCLUSIONS This is the first study in discectomy literature to show that new onset radiculitis and poorer outcomes in VAS leg correlate with longer nerve retraction time at early and later time points.
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Affiliation(s)
- Michael C Gerling
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, 94 9th Street, Unit 1-222, Brooklyn, NY, 11215, USA
| | | | - Eloise Stanton
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | | | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA.
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, 94 9th Street, Unit 1-222, Brooklyn, NY, 11215, USA.
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Wan Q, Li S, Liu W, Zhang N, Xu Y, Hu J, Xu L, Zhang D. Posterior Percutaneous Endoscopic Cervical Discectomy for Single-Level Soft, Huge Central Disc Herniation. Pain Physician 2024; 27:E99-E107. [PMID: 38285042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Posterior percutaneous endoscopic cervical discectomy (PPECD) has been proven safe and effective for foraminal cervical disc herniation (CDH). However, central CDH has long been considered as the contraindication of PPECD, because the path is obstructed by the spinal cord and nerve root. OBJECTIVES To preliminarily assess the feasibility, safety, and effectiveness of PPECD for single-level soft, huge central CDH. STUDY DESIGN A retrospective cohort study. SETTING Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College). METHODS Between 2017 and 2020, 31 patients diagnosed with single-level soft, huge central CDH were treated by PPECD. Primary outcomes included the measures of neck and radicular pain based on the numeric rating scale (NRS) and cervical neurologic status based on the Japanese Orthopedic Association (JOA) score. The global outcome was assessed using the Odom's criteria at one-year follow-up. RESULTS Compared to the baseline, there was a constant and significant reduction of NRS-rated pain and improvement of JOA-rated cervical neurologic status postoperatively (P < 0.01). According to the Odom's criteria, 96.8% (30/31) of patients had satisfactory postoperative clinical improvement (excellent or good outcomes) at one-year follow-up. Complications included C5 nerve root palsy and spinal cord injury. The total complication rate was 16.5% (2/31), but these complications were temporary and not catastrophic. LIMITATIONS The limitations of this study include the volume of the sample, a short follow-up period, and the lack of a control group. CONCLUSIONS Our preliminary experience indicates that PPECD is a feasible and promising alternative for symptomatic single-level soft, huge central CDH.
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Affiliation(s)
- Quan Wan
- Department of Pain, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Shun Li
- Department of Pain, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Wenlong Liu
- Department of Pain, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Nannan Zhang
- Department of Pain, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yun Xu
- Department of Pain, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Jiaqi Hu
- Department of Pain, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Langhai Xu
- Department of Pain, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Daying Zhang
- First Affiliated Hospital of Nanchang University, Jiangxi Province, China
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14
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Qu N, Gong L, Yang X, Fu J, Zhang B, Qi Q. In Reply to the Letter to the Editor Regarding "Cost and Effectiveness of Percutaneous Endoscopic Interlaminar Discectomy versus Microscope-Assisted Tubular Discectomy for L5-S1 Lumbar Disc Herniation". World Neurosurg 2023; 180:266. [PMID: 38115394 DOI: 10.1016/j.wneu.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Ning Qu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - LingLi Gong
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - XinMin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - JiaMing Fu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bin Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - QiHua Qi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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15
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Gujral J, Gandhi OH, Gadjradj PS. Letter to the Editor Regarding "Cost and Effectiveness of Percutaneous Endoscopic Interlaminar Discectomy versus Microscope-Assisted Tubular Discectomy for L5-S1 Lumbar Disc Herniation". World Neurosurg 2023; 180:265. [PMID: 38115393 DOI: 10.1016/j.wneu.2023.08.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 08/28/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Jaskeerat Gujral
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Om H Gandhi
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pravesh S Gadjradj
- Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian-Och Spine, New York, New York, USA
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Maayan O, Pajak A, Shahi P, Asada T, Subramanian T, Araghi K, Singh N, Korsun MK, Singh S, Tuma OC, Sheha ED, Dowdell JE, Qureshi SA, Iyer S. Percutaneous Transforaminal Endoscopic Discectomy Learning Curve: A CuSum Analysis. Spine (Phila Pa 1976) 2023; 48:1508-1516. [PMID: 37235810 DOI: 10.1097/brs.0000000000004730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE To describe the learning curve for percutaneous transforaminal endoscopic discectomy (PTED) and demonstrate its efficacy in treating lumbar disc herniation. SUMMARY OF BACKGROUND DATA The learning curve for PTED has not yet been standardized in the literature. PATIENTS AND METHODS Consecutive patients who underwent lumbar PTED by a single surgeon between December 2020 and 2022 were included. Cumulative sum analysis was applied to operative and fluoroscopy time to assess the learning curve. Inflection points were used to divide cases into early and late phases. The 2 phases were analyzed for differences in operative and fluoroscopy time, length of stay, complications, and patient-reported outcome measures (PROMs). Patient characteristics and operative levels were also compared. PROMs entailed the Oswestry Disability Index, Patient-Reported Outcomes Measurement Information System, Visual Analog Scale Back/Leg, and 12-item Short Form Survey at preoperative, early postoperative (<6 mo), and late postoperative (≥6 mo) time points. PROMs between PTED cases and a comparable cohort of tubular microdiscectomy cases, performed by the same surgeon, were compared. RESULTS Fifty-five patients were included. Cumulative sum analysis indicated that both operative and fluoroscopy time diminished rapidly after case 31, suggesting a learning curve of 31 cases (early phase: n = 31; late phase: n = 24). Late-phase cases exhibited significantly lower operative times (85.7 vs . 62.2 min, P = 0.001) and fluoroscopy times (131.0 vs . 97.2 s, P = 0.001) compared with the early-phase cases. Both early and late-phase cases showed significant improvement in all PROMs. There were no differences in PROMs between the patients who underwent PTED and tubular microdiscectomy. CONCLUSION The PTED learning curve was found to be 31 cases and did not impact PROMs or complication rates. Although this learning curve reflects the experiences of a single surgeon and may not be broadly applicable, PTED can serve as an effective modality for the treatment of lumbar disc herniation.
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Affiliation(s)
- Omri Maayan
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY
| | - Anthony Pajak
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Pratyush Shahi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Tomoyuki Asada
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Tejas Subramanian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY
| | - Kasra Araghi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | | | - Sumedha Singh
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Olivia C Tuma
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Evan D Sheha
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - James E Dowdell
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
| | - Sheeraz A Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY
| | - Sravisht Iyer
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY
- Department of Orthopaedic Surgery, Weill Cornell Medicine, New York, NY
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Song Z, Chen W, Chen X, Tang J. Striking at the root? A case of percutaneous endoscopic transforaminal discectomy for lumbar disc herniation. Asian J Surg 2023; 46:4818-4820. [PMID: 37308389 DOI: 10.1016/j.asjsur.2023.05.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Affiliation(s)
- Zefeng Song
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Wanyan Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xingda Chen
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jingjing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
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Liu G, Zhao J, Yuan L, Shi F, Zhang L. Spinal anesthesia for L5-S1 interlaminar endoscopic lumbar discectomy: a retrospective study. BMC Musculoskelet Disord 2023; 24:818. [PMID: 37838709 PMCID: PMC10576879 DOI: 10.1186/s12891-023-06956-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVE This study aimed to report our experience with spinal anesthesia (SA) in patients undergoing L5-S1 interlaminar endoscopic lumbar discectomy (IELD) and clarify its advantages and disadvantages. METHODS One hundred twelve patients who underwent IELD for an L5-S1 disc herniation under SA were retrospectively analyzed. SA with 0.5% ropivacaine was administered using a 27-gauge fine needle. Intraoperatively, the volume and level of SA, surgical time, blood loss, and cardiopulmonary complications were documented. Postoperative data was collected included the number of patients who ambulated on the day of surgery, incidence of complications and were then statistically analyzed. RESULTS Analgesia was complete throughout the entire operation in all patients and no other adjuvant intraoperative analgesic drugs were needed. Mean visual analog scale scores for intraoperative and early postoperative (24 h) pain were 0 and 2.43 ± 1.66. SA was administered at the L3-4 interspace in 34 patients (30.4%) and the L2-3 interspace in 78 (69.6%). Administration was successful with the first attempt in all patients. Mean operation time was 70.12 ± 6.52 min. Mean intraoperative blood loss volume was 20.71 ± 5.26 ml. Ninety-eight patients ambulated on the same day as surgery. Mean length of hospital stay was 24.36 ± 3.64 h. Dural injury without damaging the nerve root occurred in one patient. One patient experienced recurrent disc herniation. Intraoperative hypotension and respiratory distress occurred in five (4.5%) and three (2.7%) patients, respectively. Three patients (2.7%) received postoperative analgesia therapy and two (1.8%) experienced nausea. Two patients (1.8%) developed urinary retention. Spinal headache, cauda equina syndrome, and neurotoxicity did not occur. CONCLUSION SA can achieve satisfactory pain control for patients undergoing IELD with a low incidence of adverse events. SA may be a useful alternative to local and general anesthesia for IELD surgery. Future randomized controlled trials are warranted to investigate.
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Affiliation(s)
- Guanyi Liu
- Department of Orthopedics, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Jinsong Zhao
- Department of Anesthesiology, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China.
| | - Liyong Yuan
- Department of Anesthesiology, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Fangling Shi
- Department of Orthopedics, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
| | - Liangguang Zhang
- Department of Anesthesiology, Ningbo No. 6 Hospital, 1059 Zhongshandong Road, Ningbo, Zhejiang, 315040, People's Republic of China
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19
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Zhang LD, Zhang CL, Song DJ, Chen G, Zhuang YL. [Application of body temperature rinse in percutaneous transforaminal endoscopic lumbar discectomy through intervertebral approach]. Zhongguo Gu Shang 2023; 36:854-8. [PMID: 37735078 DOI: 10.12200/j.issn.1003-0034.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To investigate the effects of two types of temperature rinses on body temperature, inflammatory cytokine levels, and bleeding volume in percutaneous endoscopic lumbar discectomy. METHODS Eighty patients underwent percutaneous endoscopic lumbar discectomy from January 2018 to December 2020 were selected and divided into experimental group (40 cases) and control group(40 cases). In experimental group, there were 19 males and 21 females, aged (38.8±9.8) years old;7patients on L4,5 and 33 patients on L5S1;Body msss index(BMI) was (27.8±7.2) kg·m-2. In contral group, there were 18 males and 22 females, aged (41.5±10.9) years old, 5 patients on L4,5 and 35 patients on L5S1;BMI was (26.4±6.2) kg·m-2. The patients in the control group were received normal saline rinse at room temperature, and the patients in the experimental group were received normal saline rinse heated to 37 ℃. Body temperature, chills, nausea, vomiting, and other adverse reactions were recorded. The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10) in two groups were recorded before and 2 hours after operation. Visual analogue scale (VAS) was used to evaluate the degree of lumbar pain in two groups before and 2 hours after surgery. Fibrinolytic-coagulation indexes with preoperative and 2 hours after surgery, including the D-dimer (DD), fibrinogen degradation products (FDP), activated partial thrombin time (APTT) and prothrombin time (PT) were recorder. Operation time and blood loss in two groups were recorded. RESULTS The body temperature of both groups showed a downward trend, while the body temperature of the control group was lower than that of the experimental group. The levels of TNF-α, IL-6 and IL-10 in two groups were increased 2 hours after surgery compared with those before surgery(P<0.05), while the levels in experimental group were lower than those in control group(P<0.05). Postoperative VAS in experimental group 2.19±1.13 was significantly lower than that in the control group 3.38±1.35(P<0.05). The levels of DD and FDP at 2 hours after surgery in both groups were higher than those before surgery (P<0.05), while the levels of DD and FDP in the experimental group were higher than those in the control group (P<0.05). There was no significant difference in APTT and PT levels between two groups after operation (P>0.05). The blood loss in the experimental group of (45.2±14.1) ml was lower than that in the control group of (59.52±15.6) ml. The operation time of experimental group (46.7±13.8) min was less than that of control group (58.3±15.2) min(P<0.05). CONCLUSION Body temperature rinse can reduce the incidence of adverse reactions, alleviate local inflammatory reactions, reduce intraoperative blood loss and shorten the operation time.
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Affiliation(s)
- Li-Dong Zhang
- Department of Orthopaedics, Shuyang Hospital, Shuyang 223600, Jiangsu, China
| | - Cheng-Liang Zhang
- Department of Orthopaedics, Shuyang Hospital, Shuyang 223600, Jiangsu, China
| | - Da-Jiang Song
- Department of Orthopaedics, Shuyang Hospital, Shuyang 223600, Jiangsu, China
| | - Gang Chen
- Department of Orthopaedics, Shuyang Hospital, Shuyang 223600, Jiangsu, China
| | - Yan-Lei Zhuang
- Department of Orthopaedics, Shuyang Hospital, Shuyang 223600, Jiangsu, China
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Qu L, Wang Y, Wang F, Zhang S. Surgical outcomes of percutaneous endoscopic lumbar discectomy in obese adolescents with lumbar disc herniation. BMC Musculoskelet Disord 2023; 24:710. [PMID: 37674144 PMCID: PMC10483719 DOI: 10.1186/s12891-023-06842-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
In recent years, with improved living standards, adolescent obesity has been increasingly studied. The incidence of lumbar disc herniation (LDH) in obese adolescents is increasing yearly. No clinical studies have reported the use of percutaneous endoscopic lumbar discectomy (PELD) in obese adolescent lumbar disc herniation (ALDH) patients. This study evaluated the preliminary surgical outcomes of PELD in obese ALDH patients. Fifty-one ALDH patients underwent single-level PELD surgery between January 2014 and January 2020. Patients were divided into an obese group and a normal group. Patient characteristics and surgical variables were compared between the two groups. The VAS, ODI, and SF-36 scales were used preoperatively and postoperatively to evaluate the clinical efficacy. In this study, 19 patients were included in the obese group, and 28 were included in the normal group. There was no significant difference in age, sex, duration of low back pain, duration of leg pain, or operative level between the obese and normal groups preoperatively. The obese group had a longer operative time (OT) (101.9 ± 9.0 min vs. 84.3 ± 11.0 min, P < 0.001), more fluoroscopy exposures (41.0 ± 5.8 vs. 31.6 ± 7.0, P < 0.001) and a longer time to ambulation (29.9 ± 4.0 vs. 25.0 ± 2.9, p < 0.001) than the normal group. The groups did not significantly differ in complications. The VAS score for back and leg pain and the ODI and SF-36 score for functional status improved significantly postoperatively. The PELD procedure is a safe and feasible method for treating LDH in obese adolescents. Obese ALDH patients require a longer OT, more fluoroscopy exposures and a longer time to get out of bed than normal ALDH patients. However, PELD yields similar clinical outcomes in obese and normal ALDH patients.
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Affiliation(s)
- Lianjun Qu
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
- Department of Orthopedic Surgery, Sunshine Union Hospital, Weifang, Shandong Province China
| | - Yongli Wang
- Department of Anesthesiology, 80th Group Army Hospital, Weifang, Shandong Province China
| | - Fei Wang
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
| | - Songou Zhang
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
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Wang Z, Zhao X, Li Y, Zhang H, Qin D, Qi X, Chen Y, Zhang X. Development and validation of a multimodal feature fusion prognostic model for lumbar degenerative disease based on machine learning: a study protocol. BMJ Open 2023; 13:e072139. [PMID: 37669837 PMCID: PMC10481837 DOI: 10.1136/bmjopen-2023-072139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 08/08/2023] [Indexed: 09/07/2023] Open
Abstract
INTRODUCTION Lumbar degenerative disease (LDD) is one of the most common reasons for patients to present with low back pain. Proper evaluation and treatment of patients with LDD are important, which clinicians perform using a variety of predictors for guidance in choosing the most appropriate treatment. Because evidence on which treatment is best for LDD is limited, the purpose of this study is to establish a clinical prediction model based on machine learning (ML) to accurately predict outcomes of patients with LDDs in the early stages by their clinical characteristics and imaging changes. METHODS AND ANALYSIS In this study, we develop and validate a clinical prognostic model to determine whether patients will experience complications within 6 months after percutaneous endoscopic lumbar discectomy (PELD). Baseline data will be collected from patients' electronic medical records. As of now, we have recruited a total of 580 participants (n=400 for development, n=180 for validation). The study's primary outcome will be the incidence of complications within 6 months after PELD. We will use an ML algorithm and a multiple logistic regression analysis model to screen factors affecting surgical efficacy. We will evaluate the calibration and differentiation performance of the model by the area under the curve. Sensitivity (Sen), specificity, positive predictive value and negative predictive value will be reported in the validation data set, with a target of 80% Sen. The results of this study could better illustrate the performance of the clinical prediction model, ultimately helping both clinicians and patients. ETHICS AND DISSEMINATION Ethical approval was obtained from the medical ethics committee of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine (Lanzhou, China; No. 2022-57). Findings and related data will be disseminated in peer-reviewed journals, at conferences, and through open scientific frameworks. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Register (www.chictr.org.cn) No. ChiCTR2200064421.
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Affiliation(s)
- Zhipeng Wang
- Clinical College of Traditional Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Orthopedics, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Xiyun Zhao
- Clinical College of Traditional Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Orthopedics, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Yuanzhen Li
- Department of Orthopedics, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Hongwei Zhang
- Department of Orthopedics, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Daping Qin
- Clinical College of Traditional Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Xin Qi
- Clinical College of Traditional Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Yixin Chen
- Clinical College of Traditional Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Xiaogang Zhang
- Clinical College of Traditional Chinese Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
- Department of Orthopedics, Affiliated Hospital of Gansu University of Traditional Chinese Medicine, Lanzhou, Gansu, China
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22
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Du JS, Guan M, Duan XL, Wang GY, Xiong W. Biomechanical evaluation of graded ventralfacetectomy simulating foraminoplasty of percutaneous endoscopic lumbar discectomy. Eur Rev Med Pharmacol Sci 2023; 27:8428-8437. [PMID: 37782160 DOI: 10.26355/eurrev_202309_33769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To explore the lumbar spine biomechanics of graded ventral facetectomy and determine the appropriate extent of resection for foraminoplasty. PATIENTS AND METHODS We retrospectively measured several radiological parameters of superior articular process (SAP) and bony intervertebral foramen in computed tomography scans of 170 lumbar vertebral discs. The intact finite element (FE) spine of L2-sacrum was modified to simulate foraminoplasty with two typical graded ventral facetectomy methods (Method Ⅰ: basal part resection of SAP; Method Ⅱ: apical part resection of SAP) to explore the biomechanical effects under different physiological motions. RESULTS Examination of the radiological parameters of the bony intervertebral foramen indicated that they were generally narrower than the diameters of commercially available working cannulas. Some of these parameters showed gender differences. The biomechanical evaluation indicated that the range of motion increased gradually with the expansion of the resection extent, and the differences compared to the intact spine at the same level were greater in Method I than in Method Ⅱ. CONCLUSIONS The appropriate ventral resection extent of the basal part of the SAP (Method I) was 4 mm, 3 mm, and 3 mm on the lateral view at L3-L4, L4-L5, and L5-S1, respectively. The appropriate ventral resection extent of the apical part of the SAP (Method II) were 10 mm, 6 mm and 6 mm on the lateral view at L3-L4, L4-L5, and L5-S1, respectively. Extensive resection of foraminoplasty may destabilize lumbar motion segments.
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Affiliation(s)
- J-S Du
- Yiling Hospital, Hubei Province, Yichang City, China.
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Zhang L, Zhang C, Song D, Chen G, Liu L. Combination of percutaneous endoscopic lumbar discectomy and platelet-rich plasma hydrogel injection for the treatment of lumbar disc herniation. J Orthop Surg Res 2023; 18:609. [PMID: 37605261 PMCID: PMC10440935 DOI: 10.1186/s13018-023-04093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To determine the safety and efficacy of percutaneous endoscopic lumbar discectomy (PELD) combined with platelet-rich plasma (PRP) hydrogel injection in patients with lumbar disc herniation (LDH). METHODS A total of 98 consecutive patients with LDH who underwent either PELD combined with PRP hydrogel injection or PELD alone were reviewed. This retrospective study was performed between January 2019 and January 2021. Clinical outcomes were compared in the visual analog scale (VAS) for low back pain and leg pain, Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) scores, and Macnab criteria. Intervertebral disc height on MRI was measured, and the Pfirrmann grade classification was used pre-operatively and post-operatively. RESULTS No severe adverse events were reported during an 18-month follow-up period. VAS scores for back pain were decreased at 1 month, 3 months, and 18 months in the treatment group than that in the control group. JOA score and ODI in the treatment group at 3-month and 18-month follow-up was lower than that in the control group (P < 0.05). The excellent and good rate of the Macnab criteria was 92.0% (46/50) in the treatment group and 89.6% (43/48) in the control group (P > 0.05). The comparison of Pfirrmann grading and disc height at 18-month follow-up showed significant difference in two groups (P < 0.05). The recurrence of LDH in the treatment group was lower than that in the control group (P < 0.05). CONCLUSIONS We suggest that PELD combined with PRP hydrogel injection to treat patients with LDH is a safe and promising method. PRP injection was beneficial for disc remodelling after PELD.
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Affiliation(s)
- Lidong Zhang
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, 9 Yingbin Road, Suqian, 223600, China
| | - Chengliang Zhang
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, 9 Yingbin Road, Suqian, 223600, China.
| | - Dajiang Song
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, 9 Yingbin Road, Suqian, 223600, China
| | - Gang Chen
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, 9 Yingbin Road, Suqian, 223600, China
| | - Lei Liu
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, 9 Yingbin Road, Suqian, 223600, China
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Rapčan R, Kočan L, Witkovsky V, Rapčanová S, Mláka J, Tirpák R, Burianek M, Kočanová H, Vašková J, Gajdoš M. Endoscopic discectomy of the herniated intervertebral disc and changes in quality-of-life EQ-5D-5L analysis. Medicine (Baltimore) 2023; 102:e34188. [PMID: 37390280 PMCID: PMC10313260 DOI: 10.1097/md.0000000000034188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023] Open
Abstract
Herniated lumbar discs are a common cause of low back pain, which can negatively impact the quality of life of working-age individuals. This study aimed to evaluate changes in the quality of life in patients with sciatica who underwent endoscopic discectomy, a minimally invasive surgical procedure. The study (ClinicalTrials.gov NCT02742311) included 470 patients who underwent transforaminal, interlaminar, or translaminar endoscopic discectomy. Quality of life and pain perception were evaluated by comparing statistically weighted values of EQ-5D-5L, EQ-VAS, Oswestry disability index, and numerical pain scales for lower limb and back pain before and 12 months after the endoscopic procedure. After the procedure, there was a significant improvement in the reduction of back and lower limb pain, as well as in all monitored questionnaires (P < .001), which persisted 12 months after the endoscopy. All evaluated dimensions of the EQ-5D-5L questionnaire indicated a significant improvement in the assessed quality of life (P < .001). The study showed that percutaneous endoscopic lumbar discectomy is an effective pain-treating intervention that can improve the quality of life. There was no observed difference in the percentage of complications or re-herniations when comparing the transforaminal and interlaminar, approaches.
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Affiliation(s)
- Róbert Rapčan
- Europainclinics, Bratislava, Slovak Republic
- Europainclinics, Poliklinika Terasa, Košice, Slovak Republic
- Europainclinics, Bardejov, Slovak Republic, Slovak Republic
| | - Ladislav Kočan
- Clinic of Anaesthesiology and Intensive Care Medicine, East Slovak Institute of Cardiovascular Disease, Košice, Slovak Republic
| | - Viktor Witkovsky
- Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | | | - Juraj Mláka
- Europainclinics, Poliklinika Terasa, Košice, Slovak Republic
| | - Róbert Tirpák
- Europainclinics, Poliklinika Terasa, Košice, Slovak Republic
| | | | - Hana Kočanová
- Clinic of Anaesthesiology and Intensive Care Medicine, Railway Hospital and Clinic Košice, Košice, Slovak Republic
| | - Janka Vašková
- Department of Medical and Clinical Biochemistry, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Trieda SNP 1, Košice, Slovak Republic
| | - Miroslav Gajdoš
- Department of Neurosurgery, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, and Louis Pasteur University Hospital, Košice, Slovak Republic
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Kotheeranurak V, Liawrungrueang W, Quillo-Olvera J, Siepe CJ, Li ZZ, Lokhande PV, Choi G, Ahn Y, Chen CM, Choi KC, Van Isseldyk F, Hagel V, Koichi S, Hofstetter CP, Del Curto D, Zhou Y, Bolai C, Bae JS, Assous M, Lin GX, Jitpakdee K, Liu Y, Kim JS. Full-Endoscopic Lumbar Discectomy Approach Selection: A Systematic Review and Proposed Algorithm. Spine (Phila Pa 1976) 2023; 48:534-544. [PMID: 36745468 DOI: 10.1097/brs.0000000000004589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/28/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A systematic review of the literature to develop an algorithm formulated by key opinion leaders. OBJECTIVE This study aimed to analyze currently available data and propose a decision-making algorithm for full-endoscopic lumbar discectomy for treating lumbar disc herniation (LDH) to help surgeons choose the most appropriate approach [transforaminal endoscopic lumbar discectomy (TELD) or interlaminar endoscopic lumbar discectomy (IELD)] for patients. SUMMARY OF BACKGROUND DATA Full-endoscopic discectomy has gained popularity in recent decades. To our knowledge, an algorithm for choosing the proper surgical approach has never been proposed. MATERIALS AND METHODS A systematic review of the literature using PubMed and MeSH terms was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient samples included patients with LDH treated with full-endoscopic discectomy. The inclusion criteria were interventional research (randomized and nonrandomized trials) and observation research (cohort, case-control, case series). Exclusion criteria were case series and technical reports. The criteria used for selecting patients were grouped and analyzed. Then, an algorithm was generated based on these findings with support and reconfirmation from key expert opinions. Data on overall complications were collected. Outcome measures included zone of herniation, level of herniation, and approach (TELD or IELD). RESULTS In total, 474 articles met the initial screening criteria. The detailed analysis identified the 80 best-matching articles; after applying the inclusion and exclusion criteria, 53 articles remained for this review. CONCLUSIONS The proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.
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Affiliation(s)
- Vit Kotheeranurak
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | | | - Javier Quillo-Olvera
- Department of Neurosurgery, The Brain and Spine Care, Minimally Invasive Spine Surgery Group, Spine Center, Hospital H+, Queretaro City, Mexico
| | - Christoph J Siepe
- Schön Clinic Munich Harlaching, Munich, Germany
- Paracelsus Medical University (PMU), Salzburg, Austria
| | - Zhen Zhou Li
- The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | - Gun Choi
- Wooridul Spine Hospital, Pohang, South Korea
| | - Yong Ahn
- Gachon University, Incheon, South Korea
| | | | | | | | - Vincent Hagel
- University Spine Center Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Sairyo Koichi
- Tokushima University Graduate School, Kuramoto, Tokushima, Japan
| | | | - David Del Curto
- School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Yue Zhou
- Xinquiao Hospital, Third Military Medical University, Chongquing, China
| | - Chen Bolai
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Jun Seok Bae
- Wooridul Spine Hospital, Gangnam-Gu Seoul, Korea
| | - Muhammed Assous
- Razi Spine Clinic-Minimally Invasive Spine Surgery, Amman, Jordan
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Khanathip Jitpakdee
- Orthopedic Department, Queen Savang Vadhana Memorial Hospital. Sriracha, Chonburi, Thailand
| | - Yanting Liu
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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De Bonis P, Musio A, Mongardi L, La Marca F, Lofrese G, Visani J, Cavallo MA, Scerrati A. Transpars approach for L5-S1 foraminal and extra-foraminal lumbar disc herniations: technical note. J Neurosurg Sci 2023; 67:213-218. [PMID: 33297610 DOI: 10.23736/s0390-5616.20.05165-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The short pars and the narrowed surgical corridor for far lateral L5S1 herniation make the transpars approach challenging. The aim of this study is to determine the feasibility, efficacy, and safety of the transpars microscopic approach for the treatment of L5-S1 foraminal and extraforaminal lumbar disc herniation. METHODS From 2015 to 2019, patients with L5-S1 far lateral lumbar disc herniation were prospectively recruited. Drug intake, working days lost, NRS-leg, NRS-back, nerve-root palsy, Oswestry disability-index, Macnab criteria were recorded before surgery and at follow-up. Patients were seen at 1-6-12 months after surgery. Lumbar dynamic X-rays were performed at 6-12 months after surgery and again at 2-4 years after surgery. Key-steps of surgery are described. RESULTS Fourteen patients were enrolled. NRS-leg and NRS-back scores significantly improved (from 7.93 to 1.43 and from 3.2 to 0.6, respectively; P<0.0001). Oswestry Score significantly decreased (from 63.14 to 19.36 at 12 months; P<0.0001). L5 Root palsy improved in all cases (from 3.72/5 to 5/5; P<0.0001). At 12-months, excellent or good outcome (Macnab criteria) was achieved in 12 (85.7%) and 2 (14.3%) patients, respectively. All patients who were not retired returned to work within 30 days after surgery. No recurrence, instability or re-operations occurred. CONCLUSIONS The trans pars microscopic approach is feasible, safe, and effective for L5-S1 foraminal and extraforaminal disc herniation. During surgery, the key-point is the oblique working angle, directed caudally, parallel to L5 pedicle. The iliac crest does not seem to constitute an obstacle.
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Affiliation(s)
- Pasquale De Bonis
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy -
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy -
| | - Antonio Musio
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Lorenzo Mongardi
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Frank La Marca
- Department of Neurosurgery, Henry Ford Allegiance, Jackson, MS, USA
| | - Giorgio Lofrese
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Bufalini Hospital, Cesena, Forlì-Cesena, Italy
| | - Jacopo Visani
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Michele A Cavallo
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
| | - Alba Scerrati
- Department of Morphology Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
- Department of Neurosurgery, Sant'Anna University Hospital, Ferrara, Italy
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Ma X, Li W, Gao S, Cao C, Li C, He L, Li M. Comparison of unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30412. [PMID: 36181014 PMCID: PMC9524944 DOI: 10.1097/md.0000000000030612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to analyze unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the treatment of lumbar disc herniation. METHODS PubMed, EMBASE, Web of Science, Cochrane Database, CNKI, and Wanfang databases were searched online. All statistical analyses were performed using STATA 16.0. RESULTS The selection criteria were met by 6 studies with a total of 281 patients (142 cases in the UBE group and 139 cases in the PELD group) and good methodological quality. PELD has the potential to improve outcomes such as operation time and intraoperative hemorrhage (MD = 36.808, 95% CI (23.766, 49.850), P = .000; MD = 59.269, 95% CI (21.527, 97.010), P = .000) compared with UBE. No differences were found in the back pain VAS score at preoperative (MD = -0.024, 95% CI [-0.572, 0.092], P = .998), at 1 day after operation (MD = -0.300, 95% CI [-0.845, 0.246], P = .878), the VAS score of leg pain at preoperative (MD = -0.099, 95% CI [-0.417, 0.220], P = .762), at 1 day after operation (MD = 0.843, 95% CI [0.193, 1.492], P = .420), at 1 month after operation (MD = -0.027, 95% CI [-0.433, 0.380], P = .386), at 6 months after operation (MD = 0.122, 95% CI [-0.035, 0.278], P = .946), hospital stay (MD = 3.708, 95% CI [3.202, 4.214], P = .000) and other clinical effects between UBE and PELD group. CONCLUSIONS There are no significant differences in clinical efficacy between UBE and PELD, according to the research. However, PELD has the potential to improve outcomes such as operation time and intraoperative hemorrhage. As just a result, PELD is better suited in the treatment of lumbar disc herniation.
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Affiliation(s)
- Xu Ma
- Hebei North University, Zhangjiakou, Hebei, China
- Spinal Surgery Medical Team of Orthopedics, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Wenyi Li
- Hebei North University, Zhangjiakou, Hebei, China
- Spinal Surgery Medical Team of Orthopedics, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Shangju Gao
- Spinal Surgery Medical Team of Orthopedics, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Can Cao
- Spinal Surgery Medical Team of Orthopedics, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Chuntao Li
- Hebei North University, Zhangjiakou, Hebei, China
| | - Liang He
- Hebei North University, Zhangjiakou, Hebei, China
| | - Meng Li
- Hebei Medical University, Shijiazhuang, Hebei, China
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Kong Q, Feng P. Comments on "Varied Low Back Pain Induced by Different Spinal Tissues in Percutaneous Endoscopic Lumbar Discectomy: A Retrospective Study". Pain Physician 2022; 25:E880. [PMID: 36122275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
| | - Pin Feng
- Sichuan University West China Hospital
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Li BQ, Liu QY, Ren J, Zhang ZH, Lu WD, Jin LF, Zhu YH. [Spinal endoscopic revision for atypical extreme-lateral lumbar disc herniation complicated with spinal stenosis in elderly patient:a case report]. Zhongguo Gu Shang 2022; 35:771-774. [PMID: 35979772 DOI: 10.12200/j.issn.1003-0034.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Bing-Qi Li
- The Second Hospital of Jilin University, Changchun 130033, Jilin, China
| | - Qin-Yi Liu
- The Second Hospital of Jilin University, Changchun 130033, Jilin, China
| | - Jie Ren
- The Second Hospital of Jilin University, Changchun 130033, Jilin, China
| | - Zhi-Hong Zhang
- The Second Hospital of Jilin University, Changchun 130033, Jilin, China
| | - Wei-da Lu
- The Second Hospital of Jilin University, Changchun 130033, Jilin, China
| | - Li-Fu Jin
- The Second Hospital of Jilin University, Changchun 130033, Jilin, China
| | - Yu-Hui Zhu
- The Second Hospital of Jilin University, Changchun 130033, Jilin, China
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Hu M, Zhang Y, Zhao WJ, Liu X, Shi PZ, Wang JW, Cai TC, Zhang L. Perioperative Hidden Blood Loss in Lumbar Disk Herniation Patients With Percutaneous Endoscopic Transforaminal Discectomy and Influencing Factors. Clin Spine Surg 2022; 35:E438-E443. [PMID: 34923505 DOI: 10.1097/bsd.0000000000001282] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective study. OBJECTIVES This study aimed to evaluate hidden blood loss (HBL) and its influencing factors in lumbar disk herniation (LDH) patients treated with percutaneous endoscopic transforaminal discectomy (PETD). SUMMARY OF BACKGROUND DATA PETD is a minimally invasive spine surgery and is widely used to treat LDH. It is generally believed that there is less bleeding during PETD. However, HBL during the perioperative period is always ignored. MATERIALS AND METHODS From January 2018 to March 2021, 74 LDH patients treated with PETD was selected. The patient's sex, age, height, weight, previous medical history (hypertension and diabetes) and other basic information were recorded. The preoperative fibrinogen (FIB) level, activated partial thromboplastin time and prothrombin time were recoded. The hemoglobin, hematocrit, and platelet immediately after admission and the next day postoperative were recorded. The surgical time, intraoperative blood loss, intervertebral disk degeneration grade and soft tissue thickness of the PETD approach were recorded. The total blood loss was calculated according to the Gross formula, and then HBL was calculated based on total blood loss and visible blood loss (VBL). The influencing factors were analyzed by single factor correlation analysis and multivariate linear regression analysis. RESULTS Among the 74 patients, there were 34 males (20-68 y old) and 40 females (26-75 y old). The mean amount of VBL was (85.04±26.53) mL and HBL was (341.04±191.15) mL. There were statistically significant differences between HBL and VBL (P=0.000). Multiple linear regression analysis showed that sex (P=0.000), disk degeneration grade (P=0.000), preoperative FIB level (P=0.022) and preoperative platelet (P=0.026) were independent risk factors that contributed to HBL, but age (P=0.870), BMI (P=0.480), hypertension (P=0.867), diabetes (P=0.284), soft tissue thickness (P=0.701), preoperative prothrombin time (P=0.248) and preoperative activated partial thromboplastin time (P=0.521) were not. CONCLUSIONS There was a large amount of HBL during the perioperative period of PETD in patients with LDH. Sex, disk degeneration grade, preoperative FIB level and preoperative platelet are the independent risk factors of HBL in the perioperative period of PETD. More attention should be paid to the patients with risk factors to ensure perioperative safety.
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Affiliation(s)
- Man Hu
- Department of Orthopedics, Dalian Medical University, Dalian
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yu Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Wen Jie Zhao
- Department of Orthopedics, Dalian Medical University, Dalian
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xin Liu
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Peng Zhi Shi
- Department of Orthopedics, Dalian Medical University, Dalian
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jun Wu Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Tong Chuan Cai
- Department of Orthopedics, Dalian Medical University, Dalian
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Liang Zhang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Yangzhou, China
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Lou C, Yu WY, Chen J, He DW. [Percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion]. Zhongguo Gu Shang 2022; 35:448-453. [PMID: 35535533 DOI: 10.12200/j.issn.1003-0034.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore the clinical effect of percutaneous endoscopic lumbar discectomy in the treatment of adjacent segment lumbar disc herniation after lumbar fusion. METHODS From February 2010 to June 2018, 64 patients with adjacent segment lumbar disc herniation after lumbar fusion were retrospectively analyzed and divided into observation group and control group. In observation group, there were 23 males and 10 females performed with percutaneous endoscopic lumbar discectomy, including 27 cases of single segment fusion and 6 cases of double segment fusion, aged from 55 to 83 years old with an average of (65.7±7.4) years old. In control group, there were 22 males and 9 females performed with traditional open fusion revision, including 25 cases of single-segment fusion and 6 cases of double segment fusion, aged from 51 to 78 years old with an average of(64.8±7.8) years old. The operative time, intraoperative blood loss, fluoroscopy times, postoperative ambulation time and length of postoperative hospital stay were recorded. The clinical efficacy was evaluated by visual analogue scale(VAS) and Oswestry Disability Index(ODI). The complications between two groups were observed. RESULTS All patients were followed up for at least 2 years. The observation group patients were followed up with an average of (2.4±0.5) years. The control group patients were followed up with an average of(2.6±0.7) years. Compared with control group, operation time, intraoperative blood loss, postoperative ambulation time and length of postoperative hospital stay of the observation group were significantly reduced (P<0.05), and the fluoroscopy times of observation group were significantly increased compared with control group(P<0.05). The VAS of low back and lower limb, and ODI at the latest follow-up between two groups were all significantly improved compared to those of pre-operation (P<0.05). The VAS of low back at each point and ODI at 1, 3 months after operation in observation group was significantly reduced compared with control group(P<0.05), however there was no significant difference in VAS for lower limb between two groups (P>0.05). The difference of complications between two groups was statistically significant (P<0.05). CONCLUSION Compared with traditional open fusion revision surgery, percutaneous endoscopic lumbar discectomy for the treatment of adjacent segment lumbar disc herniation after lumbar fusion has the advantages of reducing operation time and intra-operative blood loss, shortening ambulation time and the length of postoperative hospital stay, and promoting pain and functional improvement, and decrease incidence of complications. However, long-term clinical efficacy needs further study.
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Affiliation(s)
- Chao Lou
- Department of Orthopaedics, Lishui Central Hospital, Lishui 323000, Zhejiang, China
| | - Wei-Yang Yu
- Department of Orthopaedics, Lishui Central Hospital, Lishui 323000, Zhejiang, China
| | - Jian Chen
- Department of Orthopaedics, Lishui Central Hospital, Lishui 323000, Zhejiang, China
| | - Deng-Wei He
- Department of Orthopaedics, Lishui Central Hospital, Lishui 323000, Zhejiang, China
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Yu Z, Lu Y, Li Y, An Y, Wang B. A one-step foraminoplasty via a large trephine in percutaneous endoscopic transforaminal discectomy for the treatment of lumbar disc herniation. PLoS One 2022; 17:e0268564. [PMID: 35609055 PMCID: PMC9128989 DOI: 10.1371/journal.pone.0268564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/03/2022] [Indexed: 11/26/2022] Open
Abstract
Background Transforaminal percutaneous endoscopic lumbar discectomy (PELD) is a widely used basic technique for lumbar disc herniation (LDH) with advantages including causing less trauma and fast recovery. The secure, efficient, and rapid enlargement of the intervertebral foramen is a key step in PELD procedures. However, the conventional multi-step trephine system for foraminoplasty involves complicated surgical procedures. In this study, we reported an improved one-step foraminoplasty via a large trephine with simplified surgical procedures, reduced radiation exposure, and shortened operative time. Methods 70 LDH patients who underwent PELD were retrospectively reviewed in this study. The conventional multi-step trephine system was used for foraminoplasty in 35 patients in the multi-step (MS) group, and the single large trephine was used in the other 35 patients in the one-step (OS) group. Indicators including the operative time, the time to establish the working cannula, intraoperative fluoroscopy times, the radiation dose, and postoperative complications were compared between the MS and OS group. Results The operative time and the time to establish the working cannula in the OS group was significantly shorter than that in the MS group (P < 0.01); intraoperative fluoroscopy times and the radiation dose in the OS group were significantly smaller than those in the MS group (P < 0.01). There was no statistical difference in the incidence of postoperative complications between the two groups (P > 0.05). The postoperative VAS scores and ODI scores (2 days and 3 months after the surgery) were significantly lower than the preoperative scores in both groups (P < 0.01), and there was no statistical difference in VAS scores or ODI scores between the two groups at the same time points (P > 0.05). Conclusions The one-step foraminoplasty via a single large trephine is an optimized technique evolving from the conventional multi-step foraminoplasty, showing significant superiority in simplified operation, shorted operative time, and reduced radiation exposure.
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Affiliation(s)
- Zhaoyu Yu
- The Second Clinical Medicine College, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
- Guangdong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, P.R. China
| | - Yao Lu
- Guangdong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, P.R. China
| | - Yong Li
- Guangdong Province Hospital of Traditional Chinese Medicine Zhuhai Branch, Zhuhai, P.R. China
| | - Yan An
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, P.R. China
- * E-mail: (BW); (YA)
| | - Bo Wang
- Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, P.R. China
- * E-mail: (BW); (YA)
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Rosa D, Graziano M, De Paola I. Evaluation of Intracranial Pressure During Neural Laser Discectomy. Pain Physician 2022; 25:E414. [PMID: 35323006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Donato Rosa
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Mario Graziano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Ilenia De Paola
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
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Zhang YJ, Luo LZ, Guo TF, Wei MJ, Du KR, Liu XX, Li JM, Deng Q. [Robot assisted percutaneous laser vaporization decompression for lumbar disc herniation:a case report]. Zhongguo Gu Shang 2022; 35:162-165. [PMID: 35191270 DOI: 10.12200/j.issn.1003-0034.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Yan-Jun Zhang
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China
| | - Lin-Zhao Luo
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China
| | - Tie-Feng Guo
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China
| | - Mei-Juan Wei
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China
| | - Kai-Ran Du
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China
| | - Xiao-Xue Liu
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China
| | - Jia-Ming Li
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China
| | - Qiang Deng
- Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou 730050, Gansu, China
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Zhang H, Wang Z, Li K. Clinical application of enhanced recovery after surgery in lumbar disk herniation patients undergoing dynamic stabilization and discectomy. J Back Musculoskelet Rehabil 2022; 35:47-53. [PMID: 34180404 DOI: 10.3233/bmr-200238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Enhanced recovery after surgery (ERAS) has been demonstrated to improve early postoperative outcomes and is becoming a crucial component of any perioperative management paradigm. OBJECTIVE To investigate the effect of an ERAS protocol on lumbar disk herniation (LDH) patients undergoing dynamic stabilization and discectomy. METHODS A total of 119 lumbar disk herniation (LDH) patients undergoing Dynesys dynamic stabilization and discectomy were divided into the ERAS (n1 = 56) and control group (n2 = 63). ERAS group received an enhanced recovery after surgery (ERAS) protocol, and control group received a traditional care protocol. RESULTS Both the ERAS and control groups had significantly decreased visual analog scale (VAS) score and Oswestry Disability Index (ODI) and increased Japanese Orthopaedic Association (JOA) score at postoperative 1 week, 1 month and 3 months compared with preoperative scores. Moreover, the ERAS group had lower postoperative VAS score and ODI and higher postoperative JOA score and rate of improved JOA score compared with the control group. Intraoperative blood loss, operation time, ambulation time and length of stay were all lower in the ERAS group than in the control group. CONCLUSIONS The ERAS protocol designed was feasible for LDH patients undergoing dynamic stabilization and discectomy with significantly improved perioperative outcomes.
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Cao J, Xie P, Feng F, Li K, Tan L, Chen Z, Ren J, Zheng R, Rong L. Potential Application of MR-MR-US Fusion Imaging Navigation with Needle Tail Intelligent Positioning in Guiding Puncture in Percutaneous Transforaminal Endoscopic Discectomy. Ultrasound Med Biol 2021; 47:3458-3469. [PMID: 34593278 DOI: 10.1016/j.ultrasmedbio.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 06/13/2023]
Abstract
This study sought to investigate the feasibility of using magnetic resonance-magnetic resonance-ultrasound (MR-MR-US) fusion imaging navigation (FIN) with needle tail intelligent positioning (NTIP) to guide puncture in percutaneous transforaminal endoscopic discectomy (PTED). First, in a pig experiment, we found that puncture errors in lumbar intervertebral foramen (LIF) puncture using magnetic resonance-magnetic resonance-ultrasound (MR-MR-US) FIN with NTIP for experienced and novice operators were 2.00 ± 1.00 and 2.57 ± 0.98 mm, respectively (p = 0.231), suggesting this technique was minimally dependent on experience. Then, two experienced surgeons agreed (inter-observer agreement к=0.801) that the quality of MR-MR fusion images was good or sufficient. Finally, we performed PTED in eight patients using MR-MR-US FIN with NTIP, and no significant complications were reported during LIF puncture. Overall, MR-MR-US FIN with NTIP may be a potential application for guiding puncture in PTED, but more clinical studies with a larger sample size are required to further evaluate the advantages of MR-MR-US FIN with NTIP.
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Affiliation(s)
- Junyan Cao
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Peigen Xie
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Feng Feng
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Kai Li
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Lei Tan
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Zihao Chen
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Jie Ren
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Key Laboratory of Liver Research, Guangzhou, China.
| | - Limin Rong
- Department of Spine Surgery, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China.
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Wu Q, Yuan S, Fan N, Du P, Li J, Yang L, Zhu W, Zang L. Clinical Outcomes of Percutaneous Endoscopic Lumbar Discectomy for the Treatment of Grade I and Grade II Degenerative Lumbar Spondylolisthesis: A Retrospective Study With a Minimum Five-Year Follow-up. Pain Physician 2021; 24:E1291-E1298. [PMID: 34793656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Degenerative lumbar spondylolisthesis (DLS) occurs mainly in geriatric patients. Some authors have reported satisfactory short-term outcomes following percutaneous endoscopic lumbar discectomy (PELD) for DLS; however, the long-term clinical outcomes remain unknown. In addition, it remains unclear whether PELD causes further progression of spondylolisthesis over a long period of time. OBJECTIVES To evaluate long-term clinical outcomes in patients who underwent PELD and to study the degree of slippage in DLS over a long period following minimally invasive surgery. STUDY DESIGN Retrospective case series. SETTING The study was conducted at the Beijing Chaoyang Hospital, Capital Medical University, China. METHODS The study included 24 patients with DLS who complained of radicular pain and lower back pain who underwent PELD and were followed up for at least 5 years (mean duration of 6.1 years). Visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, and the modified MacNab criteria were used to evaluate clinical outcomes. Preoperative imaging findings, including the percent slippage of spondylolisthesis (SR), disc height (DH), segmental lordosis angle (SL), and lumbar lordosis angle (LL), were compared with those obtained at follow-up. RESULTS All operations were successfully completed; the mean operative incision length, intraoperative blood loss, and operation duration were 8.7 ± 0.6 mm, 11.3 ± 4.5 mL, and 121.8 ± 32.3 min, respectively. The mean VAS-back score, VAS-leg score, and ODI score were 6.5 ± 0.9, 6.0 ± 1.1, and 55.4 ± 4.4 points before surgery, respectively, and decreased to 2.6 ± 0.8, 2.2 ± 0.5, and 27.3 ± 5.3 points, respectively, at 3 months after surgery and 2.5 ± 0.9, 2.0 ± 0.5, and 21.1 ± 4.4 points, respectively, at the latest follow-up. The imaging variables related to DH were lower at the final follow-up before surgery; however, no significant differences in SR, SL, and LL were found. The proportion of excellent and good results following MacNab evaluation was 87.5%. Symptomatic re-herniation occurred in one patient, and cerebrospinal fluid leakage (CSFL) was found in another patient. LIMITATIONS A small number of patients were included who were all treated by one surgeon. CONCLUSIONS PELD maintained satisfactory clinical outcomes for the treatment of grade I and grade II DLS after a minimum 5-year follow-up; the operation did not cause further progression of spondylolisthesis. However, further large-scale multicenter studies are necessary.
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Affiliation(s)
- Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jian Li
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lihui Yang
- 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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Xu W, Yang B, Lai X, Hong X, Chen Z, Yu D. Comparison of microendoscopic discectomy and percutaneous transforaminal endoscopic discectomy for upper lumbar disc herniation: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27914. [PMID: 34797347 PMCID: PMC8601282 DOI: 10.1097/md.0000000000027914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED), as two alternative surgical techniques in minimally invasive spine surgery (MISS), are widely conducted in the treatment of upper lumbar disc herniation (ULDH). This study will systematically assess and compare the clinical outcomes of MED and PTED in treating ULDH combining with the meta-analysis. METHODS All the randomized controlled trials (RCTs) will be searched at the databases including PubMed, EMBASE, Cochrane Library and Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP), and WANFANG Database from inception to December 2025. The primary outcome will involve Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and visual analog scale (VAS) scores. The secondary outcomes will be the short-form 36-item (SF-36) health survey questionnaire and the modified MacNab criterion. We will perform data synthesis, subgroup analysis, sensitivity analysis, meta-regression analysis, and the assessment of reporting bias using RevMan 5.3 software. RESULTS This systematic review will comprehensively evaluate the clinical outcomes of comparison of MED and PTED in the treatment of ULDH and provide a reliable and high-quality evidence. CONCLUSION The conclusion of this study will elucidate the clinical outcomes of MED compared with PTED and clarify whether PTED generates better clinical effects than MED in treating ULDH. PROSPERO REGISTRATION NUMBER CRD 42021244204.
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Affiliation(s)
- WeiJun Xu
- Guangdong Chaozhou Health Vocational College, The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong, China
- Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Bingxuan Yang
- Guangdong Chaozhou Health Vocational College, The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong, China
- Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Third Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xidan Lai
- Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Master Degree Application of Equivalent Educational Level of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinxin Hong
- Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Zihao Chen
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Dongqing Yu
- Guangdong Chaozhou Health Vocational College, The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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Hu B, Wang H, Ma T, Fu Z, Feng Z. Effect Analysis of Epidural Anesthesia with 0.4% Ropivacaine in Transforaminal Endoscopic Surgery. J Healthc Eng 2021; 2021:2929843. [PMID: 34659682 PMCID: PMC8514919 DOI: 10.1155/2021/2929843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/15/2021] [Accepted: 09/13/2021] [Indexed: 11/18/2022]
Abstract
Background Epidural anesthesia used in percutaneous endoscopic lumber discectomy (PELD) has the risk of complete neurotactile block. Patients cannot timely respond to the operator when the nerve is touched by mistake, so the potential risk of nerve injury cannot be avoided. According to pharmacodynamics, with the decrease of local anesthetic concentration, the nerve tactile gradually recovered; however, the analgesic effect also gradually weakened. Therefore, it is necessary to explore an appropriate concentration of local anesthetics that can keep the patients' nerve touch without pain. By comparing the advantages and disadvantages of 0.4% ropivacaine epidural anesthesia, local anesthesia and intravenous anesthesia on intraoperative circulation fluctuation, the incidence of salvage analgesia and the incidence of nerve non-touch, the feasibility of using low concentration epidural anesthesia in PELD to obtain enough analgesia and avoid the risk of nerve injury was confirmed. Methods 153 cases of intervertebral foramen surgery from October 2017 to January 2020 were selected and divided into local anesthesia group (LA group), 0.4% ropivacaine epidural anesthesia group (EA group), and intravenous anesthesia group (IVA group) according to different anesthesia methods. The changes of blood pressure and heart rate, the incidence of rescue analgesia and nerve root non-touch were compared among the three groups. Results The difference of map peak value among the three groups was statistically significant (P < 0.001); pairwise comparison showed that the map peak value of the LA group was higher than that of the EA group (P < 0.001) and IVA group (P < 0.001), but there was no statistical significance between the EA group and IVA group. The difference of HR peak value among the three groups was statistically significant; pairwise comparison showed that the HR peak value of the LA group was higher than that of the EA group (P < 0.001) and IVA group (P < 0.001), but there was no statistical significance between the EA group and IVA group. There was significant difference in the incidence of intraoperative hypertension among the three groups (P < 0.05); pairwise comparison showed that the incidence of intraoperative hypertension in the EA group was lower than that in the LA group (P < 0.05), while there was no significant difference between the IVA group, EA group, and LA group. There was significant difference in the incidence of rescue analgesia among the three groups (P < 0.01); pairwise comparison showed that the incidence of rescue analgesia in the EA group was lower than that in the LA group (P < 0.05) and IVA group (P < 0.05), but there was no significant difference between the LA group and IVA group. Due to the different analgesic mechanisms of the three anesthesia methods, local anesthesia and intravenous anesthesia do not cause the loss of nerve tactile, while the incidence of nerve tactile in 0.4% ropivacaine epidural anesthesia is only 2.4%, which is still satisfactory. Conclusion Epidural anesthesia with 0.4% ropivacaine is a better anesthesia method for PELD. It not only has a low incidence of non-tactile nerve, but also has perfect analgesia and more stable intraoperative circulation.
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Affiliation(s)
- Bingwei Hu
- Department of Pain, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Hongwei Wang
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Tingting Ma
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Zhimei Fu
- Department of Anesthesiology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
| | - Zhiying Feng
- Department of Pain, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Chen X, Gao JA, Du Q, Qiao Y, Kong WJ, Liao WB. Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results. Pain Physician 2021; 24:E811-E819. [PMID: 34554701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Studies that focus on percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) have rarely been reported. Therefore, the available data on the surgical design of PEATCD and related clinical outcomes are very limited. OBJECTIVES To design a surgical plan for PEATCD and to evaluate its clinical efficacy in clinical application. STUDY DESIGN A retrospective cohort study. SETTING A center for spine surgery, rehabilitation department and pain medicine. METHODS Based on the size and precise location of the disc protrusions on magnetic resonance imaging (MRI), the diameter and direction of the bone channel were designed to make a surgical plan for PEATCD. A total of 26 patients with central/paracentral cervical disc herniation (CDH) who underwent PEATCD through the designed surgical plan from October 2015 to September 2016 were enrolled in the retrospective study. Clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and the modified Macnab criteria. Radiologic follow-up included cervical computerized tomography (CT) and MRI evaluations. RESULTS The diameter of the designed bone channel was about 7.5 mm, and the direction was from the upper edge of the lower endplate obliquely toward the disc protrusion. Through the designed surgical plan, 26 cases of discectomy were successfully completed. The average operation time was 91.50 ± 16.80 min, and the average hospital stay was 4.07 ± 0.84 days. All patients were followed for an average of 19.61 ± 4.04 months. The postoperative VAS and JOA scores were significantly improved compared with the preoperative scores (P < 0.0001). Clinical efficacy at the final follow-up was evaluated by the modified Macnab criteria, and the excellent and good rate was 92.31%. Postoperative MRI showed that the disc protrusion was completely removed, and CT showed no collapse of the vertebral body. LIMITATIONS This study has several limitations, including the lack of a control group, the small sample size, and the unavoidable nature of the single-center study design. CONCLUSIONS Based on the size and location of the disc protrusion on MRI, the diameter and direction of the bone channel are designed, which is conducive to have enough space under the full-endoscopic field of view to completely expose and remove the disc protrusion, to avoid residuals, and to ensure that PEATCD achieves good therapeutic results. TRIAL REGISTRATION The study was registered at Chinese Clinical Trial Registry (ChiCTR1900027820).
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Affiliation(s)
- Xi Chen
- Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Jian-An Gao
- Department of Hospital Infection Control, The First People's Hospital of Zunyi, Zunyi, Guizhou, China
| | - Qian Du
- Department of Orthopaedic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Yang Qiao
- Department of Orthopaedic Surgery, Henan Provincial Orthopedic Hospital, Zhengzhou, Henan, China
| | - Wei-Jun Kong
- Department of Spine Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Wen-Bo Liao
- Department of Spine Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; Department of Spine Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Chen F, Xin J, Su C, Liu X, Cui X. Pain Variability of Tissues Under Endoscope in Percutaneous Endoscopic Lumbar Discectomy and Its Significance: A Retrospective Study. Pain Physician 2021; 24:E877-E882. [PMID: 34554708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD), as a representative minimally invasive spine surgery technique for lumbar disc herniation (LDH), has been standardized. In PELD, tissues such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate were exposed, removed, and decompressed. However, during PELD, whether there is pain or not in the tissues under endoscope in LDH patients has never been thoroughly discussed in the previous research. OBJECTIVES The purpose of the study is to evaluate tissue pain variability during PELD as for the treatment of LDH, to provide references and guideline for the operation, and to give humanistic care for patients. STUDY DESIGN A retrospective analysis. SETTING All data were collected from Shandong Provincial Hospital Affiliated to Shandong First Medical University. METHODS From January 2008 to December 2020, 3,600 patients with LDH were enrolled in this retrospective study. All patients suffered from low back and leg pain because of LDH and underwent PELD. The pain of these tissues under endoscope was assessed according to the Visual Analog Scale (VAS) scores for the back and legs (VAS-B and VAS-L, respectively). RESULTS For VAS-B, the tissues were ranked from the highest VAS scores to the lowest in the following order: posterior longitudinal ligament; next, dural sac/nerve root; then, endplate/annulus fibrosus/ligamentum flavum. For VAS-L, they were in the following order: dural sac/nerve root; next, posterior longitudinal ligament; then, endplate/annulus fibrosus/ligamentum flavum. LIMITATIONS Retrospective nature of data collection. CONCLUSIONS Tissues, such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate, have different kinds of pain in PELD for LDH.
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Affiliation(s)
- Feifei Chen
- Shandong Provincial Hospital, Jinan, PR China
| | - Jun Xin
- Shandong Province Hospital, Shandong University School of Medicine: Shandong University Cheeloo College of Medicine, Jinan, PR China
| | - Cheng Su
- Shandong First Medical University,Tai'an Campus, Jinan, PR China
| | | | - Xingang Cui
- Shandong Provincial Hospital, Shandong University, Shandong Province, China
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Ghimire P, Lavrador JP, Grahovac G. Letter to the Editor Regarding "A Historical Review of Endoscopic Spinal Discectomy". World Neurosurg 2021; 150:229-230. [PMID: 34098645 DOI: 10.1016/j.wneu.2021.02.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Prajwal Ghimire
- Department of Neurosurgery, King's College Hospital, London, United Kingdom.
| | | | - Gordan Grahovac
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
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Wang D, Xu JC, Cheng W, Gao WS, Bao JH, Zhu L, Hu QF, Pan H. [Treatment of migrated lumbar intervertebral disc herniation by percutaneous spinal endoscopy through bone tunnel]. Zhongguo Gu Shang 2021; 34:994-1001. [PMID: 34812013 DOI: 10.12200/j.issn.1003-0034.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the clinical effect of percutaneous endoscopic lumbar discectomy (PELD) through bone tunnel in the treatment of migrated lumbar intervertebral disc herniation. METHODS The clinical data of 42 patients with migrated lumbar intervertebral disc herniation treated through PELD techniques were retrospectively analyzed from October 2015 to December 2018. There were 26 males and 16 females, aged from 39 to 71 years old with a mean of(58.55±7.16) years. There were 7 cases where the affected segment was L3,4, 24 cases of L4,5, and 11 cases of L5S1. According to modified free nucleus pulposus classification, 3 cases of type A1, 6 cases of type A2, 8 cases of type B1, 8 cases of type B2, 6 cases of type C1, and 11 cases of C2. Among these 42 cases, 22 patients were treated with transpedicular approach (transpedicular approach group), 6 cases were type A2, 6 cases were type B2 and 10 cases were type C2, and 20 cases with translaminar approach(translaminar approach group), 3 cases were type A1, 8 cases were type B1, 6 cases were type C1, 2 cases were type B2 and 1 case was type C2. The operation time, intraoperative and postoperative complications of the two groups were recorded, and the pain visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to assess the improvement of the clinical symptoms before surgery, immediately after surgery, and 12 months after surgery, and the modified Macnab evaluation system was used to evaluate the clinical efficacy. RESULTS The operative time was from 69 to 105 min with a mean of (88.29±9.85) min;and no intraoperative complications such as neurovascular injury or dural tear were occurredin all patients. One case in the transpedicular approach group was changed to general anesthesia and translaminar approach due to local anesthesia intolerance. All the patients were followed up from 13 to 34 months, with a mean of (13.71±3.56) months. VAS and ODI were significantly improved in two groups immediately after surgery and 12 months after surgery (P<0.05). According to modified Macnab criteria, 27 cases obtained excellent results, 11 good, 3 fair, and 1 poor. There were no postoperative complications such as lumbar fractures and postoperative infections in the follow-up patients. CONCLUSION For migrated intervertebral disc herniation, the modified nucleus pulposus classification can be used to estimate the precise target before operation, and the reasonable bone tunnel approach can be selected to obtain good results.
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Affiliation(s)
- Dong Wang
- Department of Orthopaedics, Dingqiao Hospital of Hangzhou, Dingqiao Area of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310016, Zhejiang, China
| | - Jin-Chao Xu
- Department of Orthopaedics, Dingqiao Hospital of Hangzhou, Dingqiao Area of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310016, Zhejiang, China
| | - Wei Cheng
- Department of Orthopaedics, Dingqiao Hospital of Hangzhou, Dingqiao Area of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310016, Zhejiang, China
| | - Wen-Shuo Gao
- Department of Orthopaedics, Dingqiao Hospital of Hangzhou, Dingqiao Area of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310016, Zhejiang, China
| | - Jian-Hang Bao
- Department of Orthopaedics, Dingqiao Hospital of Hangzhou, Dingqiao Area of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310016, Zhejiang, China
| | - Li Zhu
- Department of Orthopaedics, Dingqiao Hospital of Hangzhou, Dingqiao Area of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310016, Zhejiang, China
| | - Qing-Feng Hu
- Department of Orthopaedics, Dingqiao Hospital of Hangzhou, Dingqiao Area of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310016, Zhejiang, China
| | - Hao Pan
- Department of Orthopaedics, Dingqiao Hospital of Hangzhou, Dingqiao Area of Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310016, Zhejiang, China
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Zhou YQ, Wang XH, Li ZW, Yang J, Zhang XA, Shen MK. [Targeted one channel percutaneous transforaminal endoscopic discectomy for the treatment of adjacent segment degeneration after spinal fusion surgery in young patients]. Zhongguo Gu Shang 2021; 34:1001-1005. [PMID: 34812014 DOI: 10.12200/j.issn.1003-0034.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To compare clinical efficacy between targeted one-channel percutaneous transforaminal endoscopic discectomy (TO-PTED) and transforaminal lumbar interbody fusion (TLIF) in treatment of adjacent segment degeneration (ASD) after spinal fusion surgery in young patients. METHODS The clinical data of 64 patients with adjacent segment degeneration after spinal fusion fusion surgery from September 2017 to February 2019 were retrospectively analyzed. Among them, 30 patients were treated with TO-PTED (TO-PTED group), there were 19 males and 11 females, aged from 23 to 34 years, with a mean of(31.20±1.67) years;the course of disease was from 10 to 39 months, with a mean of (26.30±0.41) months. And other 34 patients were treated with TILF(TILF group), there were 21 males and 13 females, aged from 22 to 34 years, with a mean of (31.10±1.74) years;the course of disease was from 11 to 40 months, with a mean of (27.10±0.32) months. The operation time, intraoperative blood loss, hospitalization time, X-ray fluoroscopy times were compared between two groups. Visual analogue scale(VAS) and Japanese Orthopaedic Association(JOA) scores were used to evaluate the clinical efficacy between two groups before operation, 1 month after operation and at the final follow-up. RESULTS Operation time, intraoperative blood loss, hospitalization time, X-ray fluoroscopy times were (76.30±5.08) min, (38.80±4.21) ml, (3.90±1.13) d, (8.80±2.53) times in TO-PTED group, and (118.50±11.06) min, (162.71±19.31)ml, (7.30±1.42)d, (4.10±0.82) times in TLIF group, respectively, the difference between the two groups was statistically significant. All patients were followed up from 12 to 24 months, with a mean of (18.00±5.63) months. VAS and JOA scores at 1 month after surgery and at final follow-up were obviously improved, and TO-PTED group was superior than TLIF group. CONCLUSION Both TO-PTED and TLIF can achieve good results in the treatment of adjacent segment degeneration after spinal fusion surgery in young patients. TO-PTED has advantages in reducing operation time, intraoperative blood loss and postoperative recovery time, but it will increase the number of patients receiving intraoperative radiation.
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Affiliation(s)
- Ya-Qi Zhou
- Southern University of Science and Technology School of Medicine, Shenzhen 518055, Guangdong, China
| | - Xiao-Hu Wang
- Southern University of Science and Technology School of Medicine, Shenzhen 518055, Guangdong, China
| | - Zhi-Wei Li
- Southern University of Science and Technology School of Medicine, Shenzhen 518055, Guangdong, China
| | - Jie Yang
- Southern University of Science and Technology School of Medicine, Shenzhen 518055, Guangdong, China
| | - Xin-An Zhang
- Southern University of Science and Technology School of Medicine, Shenzhen 518055, Guangdong, China
| | - Ming-Kui Shen
- Southern University of Science and Technology School of Medicine, Shenzhen 518055, Guangdong, China
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Ruan DK. [Consideration on progressive expanding the indications of percutaneous endoscopic spine surgery]. Zhongguo Gu Shang 2021; 34:991-993. [PMID: 34812012 DOI: 10.12200/j.issn.1003-0034.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Di-Ke Ruan
- Department of Orthopaedics, the Sixth Medical Center, PLA General Hospital, Beijing 100048, China
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Song SK, Son S, Choi SW, Kim HK. Comparison of the Outcomes of Percutaneous Endoscopic Interlaminar Lumbar Discectomy and Open Lumbar Microdiscectomy at the L5-S1 Level. Pain Physician 2021; 24:E467-E475. [PMID: 34213872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although many studies have compared full endoscopic spine surgery and open spine surgery, few have compared the outcomes of percutaneous endoscopic interlaminar lumbar discectomy (PEILD) and open lumbar microdiscectomy (OLM) at the L5-S1 level. OBJECTIVES We compared the clinical, surgical, and radiological outcomes of patients with disc herniation at the L5-S1 level who underwent either PEILD, or OLM, performed by a single surgeon with novice-level proficiency. STUDY DESIGN Observational, retrospective matched cohort design. SETTING An analysis of clinical data was performed at a single center, collected from September 2012 to August 2016. METHODS The study enrolled 56 patients who underwent discectomy at the L5-S1 level, with a minimum one-year follow-up. Patients were allocated to 2 groups: a PEILD group (n = 27; September 2014 to August 2016), or an OLM group (n = 29; September 2012 to August 2014). Clinical, surgical, and radiological outcomes were retrospectively evaluated. RESULTS Baseline characteristics including age, gender, past medical history, body mass index, preoperative symptom, and preoperative radiological findings did not differ significantly between the groups. Further, overall clinical outcomes including back and leg pain; surgical outcomes including blood loss, complication rate, and recurrence rate; and radiological outcomes including degree of decompression, disc height, and sagittal alignment were not different significantly between the 2 groups.However, the PEILD group showed significant advantages including lower immediate postoperative back pain (mean 1.44 [95% confidence interval (CI), 1.16-1.72] versus 2.41 [95% CI, 2.14-2.69], P < 0.001), favorable immediate postoperative Odom's criteria (excellent 57.14% versus 24.14%, P = 0.025), shorter operation time (mean 63.89 ±17.99 minutes versus 109.66 ±31.42 minutes, P < 0.001), shorter hospital stay (3.15 [95% CI, 2.21-4.09] days versus 5.72 [95% CI, 3.29-8.16] days, P < 0.001), and rapid return to work (15.67 [95% CI, 12.64-18.69] days versus 24.31 [95% CI ,19.97-28.65] days, P = 0.001). LIMITATION Due to its retrospective nature, it was not possible to control for all variations. Moreover, the number of patients in the final cohort was relatively small. CONCLUSIONS Our findings indicate that the PEILD group achieved better perioperative outcomes despite no significant intergroup difference in mid-term clinical and radiological outcomes.
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Affiliation(s)
- Sung Kyu Song
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Seong Son
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Sun Woo Choi
- Gachon University College of Medicine, Incheon, South Korea
| | - Hwi Kyung Kim
- Gachon University College of Medicine, Incheon, South Korea
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Ran B, Wei J, Yang J, Zhong Q, Chen X, Wen X, Liu Y, Wang J. Quantitative Evaluation of the Trauma of CT Navigation PELD and OD in the Treatment of HLDH: A Randomized, Controlled Study. Pain Physician 2021; 24:E433-E441. [PMID: 34213868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND More evidence is required to support that computerized tomography navigation percutaneous spinal endoscopy in the treatment of highly migrated lumbar disc herniation is a more minimally invasive surgery than open discectomy . OBJECTIVE To quantitatively evaluate the efficacy and minimal invasiveness of computerized tomography navigation percutaneous spinal endoscopy and open discectomy in highly migrated lumbar disc herniation. STUDY DESIGN A prospective randomized study. SETTING First Affiliated Hospital of Gannan Medical College. METHODS From August 2016 to February 2020, 68 patients with highly migrated lumbar disc herniation had undergone discectomy. Thirty-five of them randomly received computerized tomography (CT) navigation percutaneous spinal endoscopy at the pain department (CT navigation percutaneous spinal endoscopy group), and 33 patients received open discectomy at the orthopedics department (open discectomy group). The Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and modified MacNab criteria were applied to evaluate the clinical situations pre- and post-operation. The serum concentrations of IL-6, TNF-alpha, creatine phosphokina (CPK), and C-reactive protein (CRP) in the 2 groups were quantitatively measured. RESULTS The postoperative VAS scores of the back and lower extremity were lower than those pre-operation in both groups, while the VAS score of back pain in the open discectomy group was significantly higher than that in the CT navigation percutaneous spinal endoscopy group at one week post-operation (P < 0.01). The postoperative JOA scores were significantly higher than those pre-operation in both groups. The serum concentrations of IL-6, TNF-alpha, CPK, and CRP in the open discectomy group were higher than those in the computerized tomography navigation percutaneous spinal endoscopy group postoperatively (P < 0.01). LIMITATIONS This is a single-center randomized study and with the limitation of the sample size. CONCLUSION CT navigation percutaneous spinal endoscopy is a more minimally invasive surgery than open discectomy.Certificate number for the medical institution conducting the clinical trials for humans in China: 934.
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Affiliation(s)
- Bing Ran
- The First Affiliated Hospital of GanNan Medical College, GanZhou, China
| | - Jun Wei
- The First Affiliated Hospital of GanNan Medical College, GanZhou, China
| | - Jun Yang
- The First Affiliated Hospital of GanNan Medical College, GanZhou, China
| | - Qiong Zhong
- The First Affiliated Hospital of GanNan Medical College, GanZhou, China
| | - XinRong Chen
- The First Affiliated Hospital of GanNan Medical College, GanZhou, China
| | - XinYuan Wen
- First Affiliated Hospital of GanNan Medical UniversityCollege, GanZhou, China
| | - Yong Liu
- First Affiliated Hospital of GanNan Medical UniversityCollege, GanZhou, China
| | - Jian Wang
- First Affiliated Hospital of GanNan Medical UniversityCollege, GanZhou, China
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Wei FL, Zhou CP, Zhu KL, Du MR, Liu Y, Heng W, Wang H, Yan XD, Sun LL, Qian JX. Comparison of Different Operative Approaches for Lumbar Disc Herniation: A Network Meta-Analysis and Systematic Review. Pain Physician 2021; 24:E381-E392. [PMID: 34213864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND New approaches and technologies can be beneficial for patients but also bring corresponding complications. Traditional pairwise meta-analyses cannot be used to comprehensively rank all surgical approaches. OBJECTIVES The purpose of this systematic review and network meta-analysis (NMA) was to compare the outcomes of different surgical approaches for lumbar disc herniation (LDH). STUDY DESIGN NMA of randomized controlled trials (RCTs) for multiple treatment comparisons of LDH. METHODS The PubMed, Embase, MEDLINE, Ovid, and Cochrane Library databases were searched for RCTs comparing different surgical approaches for patients with LDH from inception to February 10, 2020. The Markov chain Monte Carlo methods were used to perform a hierarchical Bayesian NMA in WinBUGS version 1.4.3 using a random effects consistency model. The primary outcomes were disability and pain intensity. The secondary outcomes were complications and reoperation. The PROSPERO number was CRD42020179406. RESULTS A total of 22 trials including 2529 patients and all 5 different approaches (open discectomy or microdiscectomy [OD/MD], microendoscopic discectomy [MED], percutaneous endoscopic discectomy [PED], percutaneous discectomy [PD], and tubular discectomy [TD]) were retrospectively retrieved. PED had the best efficacy in improving patients' dysfunction with no statistical significance (probability = 50%). PD was significantly worse than OD/MD, MED, and PED in relieving patients' pain (standardized mean differences: 0.87 [0.03, 1.76], 0.94 [0.06, 1.88], and 1.02 [0.13, 1.94], respectively). There was no statistically significant difference between any 2 surgical approaches in dural tear; intraoperative, postoperative, and overall complications; or reoperation rate. PED had the lowest dural tear rate and the lowest intraoperative and overall complication rates (probability = 51%, 67%, and 33%, respectively). TD had the lowest postoperative complication and reoperation rates (probability = 35% and 39%, respectively). LIMITATIONS The limitations of this NMA include the inconsistent follow-up times, the criteria for complications, and the reasons for reoperation. CONCLUSIONS Compared with other approaches used to treat LDH, PED had the best safety and efficacy in general, and TD had the lowest reoperation rate. Finally, we recommended PED for LDH.
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Affiliation(s)
- Fei-Long Wei
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Cheng-Pei Zhou
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Kai-Long Zhu
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ming-Rui Du
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China; School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Ya Liu
- Department of Outpatient, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Wei Heng
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Huan Wang
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xiao-Dong Yan
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Li-Li Sun
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ji-Xian Qian
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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Ji QH, Xue Y, Qiao XF, Shi L, Liu SC. Study on the effect of percutaneous intervertebral foraminoscopic discectomy in the treatment of lumbar disc herniation. Medicine (Baltimore) 2021; 100:e25345. [PMID: 34106586 PMCID: PMC8133092 DOI: 10.1097/md.0000000000025345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/10/2021] [Indexed: 11/27/2022] Open
Abstract
This study explored the effect of percutaneous intervertebral foraminoscopic discectomy (PIFD) in the treatment of lumbar disc herniation (LDH).This retrospective study collected a total of 88 patient cases for inclusion. Epidemiological and clinical data of patients with LDH at the First Affiliated Hospital of Jiamusi University between May 2017 and January 2020 were retrospectively analyzed. Of those, 44 patients received PIFD and were allocated to an intervention group. The other 44 patients administrated fenestration discectomy (FD), and were assigned to a control group. We compared surgery time (minute), incision length (cm), duration of hospital stay after surgery (day), pain intensity (as checked by Visual Analogue Scale (VAS), health-related quality of life (as examined by Oswestry Disability Index, ODI), and complications between 2 groups.There were not significant differences in surgery time (minute) (P = .56), VAS (P = .33) and ODI (P = .46) after surgery between 2 groups. However, there were significant differences in incision size (cm) (P < .01) and length of hospital stay (day) (P < .01) after surgery between 2 groups. When compared before the surgery, patients in both groups had significant improvements in VAS (P < .01) and ODI (P < .01) after the surgery. Moreover, both groups had similar safety profiles (P > .05).The findings of this study showed that both PIFD and FD benefit patients with LDH. However, PIFD can benefit patients more than FD in the incision size and duration of hospital stay after surgery.
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Affiliation(s)
| | - Yu Xue
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | | | - Lei Shi
- First Ward of Orthopedics Department
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An G, Guan Y, Wan R, Wei T, Shi X, Liu J, Huang T, Liu K, Wang Y. Pathomechanism of Lower-level Discogenic Groin Pain and Clinical Outcomes of Percutaneous Endoscopic Discectomy for the Treatment of Discogenic Groin Pain. Pain Physician 2021; 24:E289-E297. [PMID: 33988950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Groin pain can be induced by high-level (L1-L2 or L2-L3) lumbar disc herniation. However, 4.1% of patients with lower-level (L4-L5 or L5-S1) lumbar disc herniation also complained of groin pain. The pathomechanism of groin pain occurring due to lumbar disc herniation at and below the L4-5 levels is still unclear. OBJECTIVE To investigate the afferent pathways of lower-level lumbar disc herniation induced groin pain. And evaluate the clinical results of transforaminal endoscopic discectomy treatment for discogenic groin pain. STUDY DESIGN This retrospective observational study used an experimental design (institutional review board: HROH 201-C2-100). SETTING The research took place in the Laboratory Research Center and spine center at The First Affiliated Hospital of Harbin Medical University. METHODS Firstly, 14 adult Wistar rats were randomly divided into 2 groups: control group (the paravertebral sympathetic trunks were preserved) and experimental group (the paravertebral sympathetic trunks were resected). All Wistar rats were intraperitoneally anesthetized, and then 1 (mu)L of fast blue was injected into the dorsal rami of L2 spinal nerves on the right side. Forty hours later, 2 (mu)L of nuclear yellow was injected into the right posterior portion of the L5-L6 intervertebral disc. The L1 and L2 spinal ganglia were sectioned 8 hours later to observe fluorescently double-labeled cells and the effect of paravertebral sympathetic trunk resection. Secondly, 14 adult Wistar rats were anesthetized, and the right posterior portion of the L5-L6 intervertebral disc was electrostimulated to observe potential changes in the genitocrural nerve in the ipsilateral inguinal region. To evaluate the clinical outcomes of transforaminal endoscopic discectomy for the treatment of discogenic groin pain, between September 2015 and May 2017, transforaminal endoscopic discectomy was performed on 30 patients with lower-level discogenic groin pain. Outcomes were analyzed utilizing the visual analog scale, Oswestry disability index, and MacNab Criteria. RESULTS The total proportion of cells in the right L1 and L2 spinal ganglia with fast blue/nuclear yellow double labeling was 3.33% and 3.41% (48 and 56), respectively. The number of fluorescently double-labeled cells in the resected paravertebral sympathetic trunk group was significantly less (P < 0.01). Electrical stimulation of the right posterior portion of the L5-L6 intervertebral disc could elicit action potentials in the ipsilateral genitofemoral nerve. All patients were followed for 12 months, and the visual analog scale score at 1 week, 1 month, 3 months, 6 months, and 12 months after the operation was 0.79 ± 0.55, 0.54 ± 0.55, 0.47 ± 0.65, 0.51 ± 0.65, and 0.69 ± 0.55, respectively, showing a significant decrease compared with the preoperative visual analog scale score (P < 0.01). Based on the MacNab scoring system, the effective rate was 100%, and the rate of good and excellent results was 93.3%. LIMITATIONS A relatively small number of patients and a short follow-up period. CONCLUSIONS Discogenic groin pain is transmitted by sympathetic nerves and appears in the area segmentally innervated by the anterior rami of the L1 and L2 spinal nerves. Posterolateral percutaneous transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty are effective minimally invasive alternative treatments for discogenic groin pain.
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Affiliation(s)
- Gang An
- The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P.R. China
| | - Ying Guan
- The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P.R. China
| | - Ran Wan
- The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P.R. China
| | - Tianli Wei
- The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P.R. China
| | - Xu Shi
- The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P.R. China
| | - Jingsong Liu
- The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P.R. China
| | - Tianwen Huang
- The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P. R. China
| | | | - Yansong Wang
- The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P.R. China
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