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Byvaltsev VA, Kalinin AA, Pestryakov YY, Hozeev DV, Kundubayev RA, Biryuchkov MY, Riew KD. Prospective Randomized Comparison of Minimally Invasive Tlif versus Open Tlif: Clinical Effectiveness and Restoration of Working Capacity in Railway Workers. Global Spine J 2024:21925682241242039. [PMID: 38525927 DOI: 10.1177/21925682241242039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
STUDY DESIGN Randomized Clinical Trial. OBJECTIVE To compare the clinical efficacy and restoration of working capacity after MI (minimally invasive)-TLIF and O (open)-TLIF in railway workers with lumbar degenerative disease. METHODS 83 patients, who were indicated for two-level lumbar decompression and fusion were randomly assigned to one of two groups: group 1 (n = 44) had MI-TLIF procedure and group 2 (n = 39) had O-TLIF procedure. The functional status was assessed using SF-36, ODI and VAS for back and leg pain, preoperatively, at discharge, and at 3, 6, and 12 months postoperatively. MRI and CT were obtained 1-year follow-up. The percentage of patients who returned to work at 1-year, work intensity and the time to return to work post-operatively were analyzed. RESULTS At 1-year follow-up, the MI-TLIF group had significantly better ODI, VAS and SF-36 scores compared to the O-TLIF group. The postoperative MRIs revealed a statistically significantly less multifidus muscle atrophy in the MI group compared to the Open group. At 1-year follow-up, a comparable fusion ratio between MI group and Open group was recorded. After MI-TLIF procedure, depending on the workload, patients had a statistically significantly earlier return to work (P < .05) and statistically significantly higher return to work rate compared with the O-TLIF group (P < .05). CONCLUSIONS The use of two-level MI-TLIF in railway workers has made it possible to significantly improve long-term clinical results, reduce the risk of surgical complications, muscle atrophy and time to return to work compared to O-TLIF.
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Affiliation(s)
- Vadim A Byvaltsev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
- Department of Traumatology, Orthopedic and Neurosurgery, Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - Andrei A Kalinin
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
- Department of Neurosurgery, Railway Clinical Hospital, Irkutsk, Russia
| | - Yurii Ya Pestryakov
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Dmitriy V Hozeev
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Rustem A Kundubayev
- Department of NeurosurgeryWest Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Mikhail Y Biryuchkov
- Department of NeurosurgeryWest Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, New York, USA
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, USA
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John A, Simjian T, Lamba N, Yuxin Y, Carosella C, Song J, Trinh S, Lak AM, Mammi M, Zaidi H, Mekary RA. A comparison of the safety and efficacy of minimally invasive surgery versus open surgery in treating cauda equina syndrome: A systematic review and meta-analysis. J Clin Neurosci 2023; 117:98-103. [PMID: 37783070 DOI: 10.1016/j.jocn.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE To compare the safety and efficacy of minimally invasive surgery (MIS) and open surgery (OS) in treating cauda equina syndrome (CES). METHODS A systematic literature search was conducted, searching relevant databases for studies investigating MIS and/or OS in treating CES. Pooled outcomes and their 95% confidence intervals (CIs) were meta-analyzed via random-effects models. RESULTS Ten studies were included in the meta-analysis. Pooled mean operation times were shorter for MIS (75.4 min; 95 %CI: 40.8, 110.0) than OS (155.1 min; 121.3, 188.9). Similarly, mean hospital stay was shorter for MIS (4.08 days; 2.77, 5.39 vs. 8.85 days; 6.56, 11.13). Mean blood loss was smaller for MIS (71.7 mL; 0, 154.5 vs. 366.5; 119.1, 614.0). Mean post-op lumbar/back visual analogue scale (VAS) score was lower for MIS (3.65; 2.75, 4.56 vs. 5.80; 4.55, 7.05). Mean post-op leg VAS score was 1.27 (0.41, 21.4) for MIS and 1.29 (0.47, 2.12) for OS. Mean complete bladder recovery rate was 81.0% (55.0%, 94.0%) for MIS and 75.0% (44.0%, 92.0%) for OS. Mean complete motor recovery rate was larger for MIS (70.0%; 48.0, 85.0 vs. 42.0%; 34.0, 51.0). Mean percentages of "excellent" patient outcomes were equal for MIS (64.0%; 48.0%, 77.0%) and OS (64.0%; 22.0%, 92.0%). CONCLUSION MIS for CES was associated with reduced operative time, length of stay, and blood loss, compared to OS. MIS was also associated with better post-operative lumbar/back and leg VAS scores and complete motor and bladder recovery rates. MIS and OS produced an equal average percentage of "excellent" patient outcomes.
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Affiliation(s)
- Alvin John
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA; Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas Simjian
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Nayan Lamba
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yao Yuxin
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Claudia Carosella
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Jimin Song
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Stephanie Trinh
- School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA
| | - Asad M Lak
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Marco Mammi
- Neurosurgery Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Hasan Zaidi
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rania A Mekary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences (MCPHS) University, Boston, MA, USA.
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Minimally invasive decompression alone versus fusion surgery for acute lumbar disk herniation combined incomplete cauda equina syndrome. Clin Neurol Neurosurg 2023; 225:107589. [PMID: 36640736 DOI: 10.1016/j.clineuro.2023.107589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 01/02/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
STUDY DESIGN Retrospective single center study. BACKGROUND Cauda equine syndrome (CES), which caused by acute lumbar disc herniation (LDH), often requires urgent surgical treatment. Currently, there is no standard defining the type of surgery, and approaches to the treatment of patients are based on the experience of the surgeon. PURPOSE to compare the clinical efficacy of minimally invasive decompression alone (Decompression alone group) and transforaminal lumbar interbody fusion (Fusion group) in the treatment of the incomplete CES, caused by acute LDH. PATIENTS AND METHODS 89 patients with acute incomplete CES associated with LDH either underwent decompression alone and fusion surgery from January 2005 to January 2020 in single-center, and data were collected and retrospectively analyzed. The patients were divided into 2 groups according to the operation technics: the Decompression alone group (n = 46) and the Fusion group (n = 43). The perioperative clinical data (neurological deficit, control of the urinary bladder sphincter, ODI scale, SF-36) was used to assess the efficacy of the respective surgical methods before operation and with a minimum follow-up 24 months. RESULTS Verified statistical significance more bleeding, longer surgery time and hospital stay, in the Fusion group than in the Decompression alone group. The postoperative clinical data dramatic improved after Decompression alone and Fusion surgery. At early postoperative period registered better clinical outcomes according to ODI, SF-36 after Decompression alone surgery, but at minimum follow-up 24 months verified better in the Fusion group. The number of revision interventions in the Decompression alone group was 28.3% (n = 13), in Fusion group - 9.3% (n = 4) (p = 0.02). CONCLUSIONS The prevalence of acute incomplete CES due to LDH in our series was registered in 1.02% of patients (124 of 12087). In the Fusion group, in the long-term period, there were better clinical outcomes and fewer revision surgical interventions compared with Decompression alone.
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Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Satardinova EE, Goloborodko VY, Khozeev DV. [Long-term results and predictors of postoperative outcomes in patients with cauda equina syndrome following degenerative lumbar spine disease]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:35-43. [PMID: 36763551 DOI: 10.17116/neiro20238701135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Cauda equina syndrome (CES) associated with acute disc extrusion or spinal stenosis often requires emergency surgery. Analysis of the Pubmed, Medline and eLibrary databases revealed a few studies devoted to long-term postoperative outcomes in patients with CES caused by degenerative spine disease. OBJECTIVE To evaluate long-term postoperative results and predictors of clinical and neurological outcomes in patients with CES caused by degenerative lumbar spine disease. MATERIAL AND METHODS. D Ecompressive and decompressive-stabilizing procedures were performed in 211 patients with CES caused by degenerative lumbar spine disease between 2000 and 2020. Long-term clinical parameters were available in 174 patients with mean follow-up period of 7 years. Sixty-eight patients had unsatisfactory postoperative outcomes. We assessed postoperative clinical and neurological outcomes in patients with CES and predictors of these outcomes. RESULTS We identified the following predictors of clinical and neurological outcomes using binary logistic regression model: period between clinical manifestation and surgery >48 hours, preoperative neurological impairment, spinal canal diameter, surgical procedure, dimension of herniated disc, ASA score and long-term postoperative analgesia with narcotic analgesics. CONCLUSION Preoperative planning and possible correction of the above-mentioned risk factors will potentially improve postoperative outcomes in patients with CES caused by degenerative lumbar spine disease.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia
- Russian Railways-Medicine Clinical Hospital, Irkutsk, Russia
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia
- Russian Railways-Medicine Clinical Hospital, Irkutsk, Russia
| | - V V Shepelev
- Irkutsk State Medical University, Irkutsk, Russia
| | | | - E E Satardinova
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | | | - D V Khozeev
- Irkutsk State Medical University, Irkutsk, Russia
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