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Zheng S, Zhao X, Wu H, Cuan X, Cheng X, He D. Molecular Subtypes and Immune Microenvironment Characterization of the Annulus Fibrosus in Intervertebral Disc Degeneration: Insights From Translation Factor-Related Gene Analysis. JOR Spine 2025; 8:e70064. [PMID: 40196451 PMCID: PMC11974580 DOI: 10.1002/jsp2.70064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 03/05/2025] [Accepted: 03/24/2025] [Indexed: 04/09/2025] Open
Abstract
Objective This study aims to examine the role of translation factors (TF) in intervertebral disc degeneration (IVDD) and to evaluate their clinical relevance through unsupervised clustering methods. Methods Gene expression data were retrieved from the GEO database, and the expression levels of translation factor-related genes (TFGs) were extracted for analysis. Results Two distinct molecular clusters were identified based on the differential expression of nine significantly altered TFGs. Immune infiltration was notably higher in Cluster C2 compared to Cluster C1. Subsequently, two gene clusters were identified based on the differentially expressed genes between the clusters. A Sankey diagram illustrated a high degree of consistency between the molecular clusters and the gene clusters. Additionally, four machine learning models were developed and evaluated, with the SVM model being utilized to construct a nomogram for predicting the incidence of IVDD. Validation using external datasets and clinical samples confirmed the low expression of EEF2K, which was further analyzed in a pan-cancer context. Conclusion The identification and comprehensive assessment of the two molecular clusters offer significant insights for the classification and treatment of individuals with IVDD.
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Affiliation(s)
- Sikuan Zheng
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxi ProvinceChina
- Institute of Orthopedics of Jiangxi ProvinceNanchangJiangxi ProvinceChina
- Institute of Minimally Invasive OrthopedicsNanchang UniversityNanchangJiangxi ProvinceChina
- Jiangxi Provincial Key Laboratory of Spine and Spinal Cord DiseaseNanchangJiangxi ProvinceChina
| | - Xiaokun Zhao
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxi ProvinceChina
- Institute of Orthopedics of Jiangxi ProvinceNanchangJiangxi ProvinceChina
- Institute of Minimally Invasive OrthopedicsNanchang UniversityNanchangJiangxi ProvinceChina
- Jiangxi Provincial Key Laboratory of Spine and Spinal Cord DiseaseNanchangJiangxi ProvinceChina
| | - Hui Wu
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxi ProvinceChina
- Institute of Orthopedics of Jiangxi ProvinceNanchangJiangxi ProvinceChina
- Institute of Minimally Invasive OrthopedicsNanchang UniversityNanchangJiangxi ProvinceChina
- Jiangxi Provincial Key Laboratory of Spine and Spinal Cord DiseaseNanchangJiangxi ProvinceChina
| | - Xuhui Cuan
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxi ProvinceChina
| | - Xigao Cheng
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxi ProvinceChina
- Institute of Orthopedics of Jiangxi ProvinceNanchangJiangxi ProvinceChina
- Institute of Minimally Invasive OrthopedicsNanchang UniversityNanchangJiangxi ProvinceChina
- Jiangxi Provincial Key Laboratory of Spine and Spinal Cord DiseaseNanchangJiangxi ProvinceChina
| | - Dingwen He
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxi ProvinceChina
- Institute of Orthopedics of Jiangxi ProvinceNanchangJiangxi ProvinceChina
- Institute of Minimally Invasive OrthopedicsNanchang UniversityNanchangJiangxi ProvinceChina
- Jiangxi Provincial Key Laboratory of Spine and Spinal Cord DiseaseNanchangJiangxi ProvinceChina
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Lee CC, Lin RM, Juan WS, Chuang HY, Lin HL, Cheng CH, Yao CH. Comparing Clinical Outcomes of Microdiscectomy, Interspinous Device Implantation, and Full-Endoscopic Discectomy for Simple Lumbar Disc Herniation. J Clin Med 2025; 14:1925. [PMID: 40142733 PMCID: PMC11942998 DOI: 10.3390/jcm14061925] [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: 12/28/2024] [Revised: 02/14/2025] [Accepted: 03/06/2025] [Indexed: 03/28/2025] Open
Abstract
Background/Objectives: The treatment for lumbar disc herniation (LDH) is surgical discectomy. This surgery may enhance spinal instability and exacerbate disc degeneration. The most common treatment options include microdiscectomy (MD), interspinous process device (IPD) implantation, and percutaneous endoscopic lumbar discectomy (PELD). As few studies have compared these three procedures, this study focused on collecting data on the clinical, functional, and imaging outcomes of surgery for symptomatic LDH. Methods: This is a retrospective, transverse, and analytical study, with a total of 383 patients who received operations for symptomatic LDH between 2018 and 2022. Medical information from the charts of these patients was collected. The results were followed up on for a minimum of one year by collecting responses from several questionnaires and clinical data, including patients' scores on the visual analogue scale (VAS), Oswestry Disability Index (ODI), and symptomatic improvement score (SIS), as well as wound size, blood loss, hospital stay, postoperative disc change, and complications. Results: At the end of data collection, the VAS and ODI scores all showed significant improvement following these three procedures (p < 0.01). The SISs were all ranked as good (8.1, 8.5, and 7.9) post-surgery. PELD was a minimally invasive procedure that resulted in the smallest wound size (0.82 cm), minimal blood loss (21 mL), and a short hospital stay (4.2 days). A substantial pre-/postoperative change in disc height was noted in the MD (-17%) and PELD (-15%) groups. The complication rates were similar among the three groups (3%, 5%, and 5.6%). Conclusions: IPD implantation and PELD yielded outcomes comparable to those of conventional MD for symptomatic relief and functional recovery. Although the complication rates were similar, the postoperative complications were quite different from those of the other procedures. PELD resulted in rapid recovery and minimal invasion, and IPD implantation showed a good ability to preserve disc height and spinal stability; however, the clinical relevance of these findings in disc degeneration remains controversial.
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Affiliation(s)
- Chien-Ching Lee
- Department of Anesthesia, An Nan Hospital, China Medical University, Tainan 70965, Taiwan
- Department of Medical Sciences Industry, Chang Jung Christian University, Tainan 71101, Taiwan
| | - Ruey-Mo Lin
- Department of Orthopedics, An Nan Hospital, China Medical University, Tainan 70101, Taiwan
| | - Wei-Sheng Juan
- Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan 70965, Taiwan
| | - Hao-Yu Chuang
- Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan 70965, Taiwan
- Department of Neurosurgery, China Medical University Beigang Hospital, Yunlin 65152, Taiwan
| | - Hung-Lin Lin
- Department of Neurosurgery, China Medical University Hospital, Taichung 40447, Taiwan
| | - Cheng-Hsin Cheng
- Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan 70965, Taiwan
- Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan 71101, Taiwan
| | - Chun-Hsu Yao
- Department of Biomedical Imaging and Radiological Science, China Medical University, Tainan 70965, Taiwan
- School of Chinese Medicine, China Medical University, Tainan 70965, Taiwan
- Biomaterials Translational Research Center, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Biomedical Informatics, Asia University, Taichung 41354, Taiwan
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Kim KD, Ahadian F, Hassanzadeh H, Rivera J, Candido K, Gershon S, Patel A, Gupta PB, Miller AE, Formoso FJ, Fuerst T, Zucker E, Seo T, Watanabe J, Matsuyama Y, Chiba K, Macadaeg KE. A phase 3, randomized, double-blind, sham-controlled trial of SI-6603 (condoliase) in patients with radicular leg pain associated with lumbar disc herniation. Spine J 2024; 24:2285-2296. [PMID: 39168360 DOI: 10.1016/j.spinee.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/25/2024] [Accepted: 08/09/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND CONTEXT SI-6603 (condoliase) is a chemonucleolytic agent approved in Japan in 2018 for the treatment of lumbar disc herniation (LDH) associated with radicular leg pain. Condoliase, a mucopolysaccharidase with high substrate specificity for glycosaminoglycans (GAGs), offers a unique mechanism of action through the degradation of GAGs in the nucleus pulposus. As LDH management is currently limited to conservative approaches and surgical intervention, condoliase could offer a less invasive treatment option than surgery for patients with LDH. PURPOSE The Discovery 6603 study (NCT03607838) evaluated the efficacy and safety of a single-dose injection of SI-6603 (condoliase) vs sham for the treatment of radicular leg pain associated with LDH. STUDY DESIGN/SETTING A randomized, double-blind, sham-controlled, phase 3 study conducted across 41 sites in the United States. PATIENT SAMPLE Male and female participants (N=352; aged 30-70 years) with contained posterolateral LDH and unilateral radiculopathy/radicular leg pain for greater than 6 weeks. OUTCOME MEASURES The primary endpoint was the change from baseline (CFB) in average worst leg pain score at 13 weeks, assessed using the 100-mm visual analogue scale. Key secondary endpoints were CFB in average worst leg pain score at 52 weeks, herniation volume at 13 weeks, and Oswestry Disability Index (ODI) score at 13 weeks. Safety evaluations included adverse events (AEs) and imaging findings. METHODS Participants were randomized 1:1 to receive a single intradiscal injection of condoliase (1.25 units) or sham injection followed by 52 weeks of observation. The primary and key secondary endpoints were assessed using a mixed model for repeated measures (MMRM) analysis and a protocol-specified multiple imputation (MI) sensitivity analysis on the modified intention-to-treat (mITT) population. A prespecified serial gatekeeping algorithm was used for multiple comparisons. Safety endpoints included AEs, laboratory tests, vital signs, imaging (by X-ray and magnetic resonance imaging [MRI]), and occurrence of posttreatment lumbar surgery. RESULTS Of the 352 randomized participants, 341 constituted the mITT population (condoliase n=169; sham n=172) and the safety population (condoliase n=167; sham n=174). For the primary endpoint, the condoliase group showed significantly greater improvement in CFB in worst leg pain at Week 13 (least squares mean [LSM] CFB: -41.7) compared with sham injection (-34.2; LSM difference: -7.5; 95% confidence interval [CI]: -14.1, -0.9; p=.0263) based on the MMRM analysis. CFB in worst leg pain at Week 52 favored condoliase vs sham, but the difference was not statistically significant (p=.0558), which halted the serial gatekeeping testing algorithm and dictated that the CFB in herniation volume and ODI scores at Week 13 would be considered nonsignificant, regardless of their p-values. Treatment group differences in CFB in herniation volume and ODI score favored the condoliase group vs sham at all timepoints. The MI sensitivity analysis showed differences in CFB in worst leg pain at Week 13 (p=.0223) and Week 52 (p=.0433) in favor of the condoliase group. Treatment-emergent AEs (TEAEs) were more common in the condoliase group (≥1 TEAE: 71.9%; ≥1 treatment-related TEAE: 28.1%) compared with the sham group (≥1 TEAE: 60.3%; ≥1 treatment-related TEAE: 10.3%). Of the TEAEs, spinal MRI abnormalities and back pain occurred most frequently. No treatment-related serious AEs occurred. CONCLUSIONS Condoliase met its primary endpoint of significantly improving radicular leg pain at Week 13 and was generally well tolerated in patients with LDH. Chemonucleolysis with condoliase has the potential to provide a less invasive treatment option than surgery for those unresponsive to conservative treatment strategies.
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Affiliation(s)
- Kee D Kim
- Department of Neurological Surgery, University of California, Davis, Sacramento, CA, USA.
| | - Farshad Ahadian
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
| | - Hamid Hassanzadeh
- Department of Orthopedic Surgery, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Jose Rivera
- Department of Anesthesiology & Pain Medicine, Tampa Pain Relief Centers, Tampa, FL, USA
| | - Kenneth Candido
- Department of Anesthesiology, Chicago Anesthesia Pain Specialists, Chicago, IL, USA
| | - Steven Gershon
- Department of Pain Management, Gershon Pain Specialists, Virginia Beach, VA, USA
| | - Anand Patel
- Department of Anesthesiology, Conquest Research, Winter Park, FL, USA
| | - Pragya B Gupta
- Department of Pain Management, Otrimed Clinical Research, Edgewood, KY, USA
| | - Alan E Miller
- Department of Pain Management, Coastal Spine & Pain Center, Fernandina Beach, FL, USA
| | - Ferdinand J Formoso
- Department of Acute and Chronic Pain, Coastal Spine & Pain Center, Jacksonville, FL, USA
| | - Thomas Fuerst
- Department of Musculoskeletal Medicine, Clario, San Mateo, CA, USA
| | - Evan Zucker
- Department of Biostatistics, Rho, Inc., Durham, NC, USA
| | - Takayuki Seo
- Clinical Development Department, Research & Development Division, Seikagaku Corporation, Tokyo, Japan
| | - Jun Watanabe
- Department of Drug Development, Seikagaku North America Corporation, Toronto, ON, Canada
| | - Yukihiro Matsuyama
- Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuhiro Chiba
- Department of Orthopedic Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kevin E Macadaeg
- Department of Spinal Diagnostics and Therapeutics, Indiana Spine Group, Carmel, IN, USA
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Li T, Zhang J, Ding Z, Jiang Q, Ding Y. Percutaneous endoscopic lumbar discectomy versus open fenestration discectomy for lumbar disc herniation: a retrospective propensity score-matched study with more than 5 years of follow-up. J Orthop Surg Res 2024; 19:753. [PMID: 39533378 PMCID: PMC11559210 DOI: 10.1186/s13018-024-05239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 11/04/2024] [Indexed: 11/16/2024] Open
Abstract
OBJECTIVE We compared the long-term outcomes of percutaneous endoscopic lumbar discectomy (PELD) with those of open fenestration discectomy (OFD) in treating lumbar disc herniation (LDH). METHODS 281 patients were included from January 2013 to December 2018, of whom 228 underwent PELD and 53 underwent OFD. General information of patients was collected and imbalances in covariates between groups were corrected using propensity score matching (PSM). Then, the clinical function scores, imaging data, and complications were compared. RESULTS Among participants, 102 patients were successfully matched and were followed for 62-128 months. Compared to the OFD group, the PELD group indicated greater improvements in visual analog scale score of low back pain (VAS-BP), Japanese orthopedic association (JOA), and Oswestry disability index (ODI) at 7 days postoperatively and the last follow-up (P < 0.05). At 24 months postoperatively and the last follow-up, the disc height index (DHI), ratio of grays (RVG), and range of motion (ROM) were higher and the compass value was lower (P < 0.05) in the PELD group compared to the OFD group, suggesting that the PELD procedure better maintained the mobility and stability of the responsible segment after surgery. The recurrence rates between the PELD (9.80%) and OFD (7.84%) groups did not reveal statistical differences (P > 0.05). CONCLUSION PELD and OFD both provide acceptable clinical outcomes for LDH. However, PELD is superior to OFD in terms of relieving low back pain, delaying disc degeneration, and maintaining segmental stability.
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Affiliation(s)
- Tusheng Li
- Orthopedics of TCM Senior Dept, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China
| | - Junyou Zhang
- Department of Spine Surgery, Suining Central Hospital, 127 Desheng West Road, Suining, 629000, Sichuan Province, People's Republic of China
| | - Zhili Ding
- Orthopedics of TCM Senior Dept, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Qiang Jiang
- Orthopedics of TCM Senior Dept, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Yu Ding
- Orthopedics of TCM Senior Dept, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, People's Republic of China.
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Zhu X, Zhao Y, Liu K, Zhang Y, Cheng L. Clinical outcomes of fenestration discectomy and iLESSYS-Delta interlaminar endoscopic system for treatment of LDH: a single-center retrospective cohort study. Sci Rep 2024; 14:20087. [PMID: 39209941 PMCID: PMC11362142 DOI: 10.1038/s41598-024-70973-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
To compare the clinical efficacy of interlaminar endoscopic surgical system delta (iLESSYS-Delta) discectomy with that of classical fenestration discectomy for treating lumbar disc herniation. Patients who underwent iLESSYS-Delta or fenestration discectomy were enrolled in this study. Baseline information and clinical indicators were collected. The baseline data were matched using propensity score matching. Fifty-two patients were in each group. In the iLESSYS-Delta cohort, the volume of intraoperative bleeding was 18.17 ± 4.20 ml, the length of postoperative hospital stay was 4.16 ± 2.29 days, and the length of postoperative off-bed activity was 1.58 ± 0.88 days. In contrast, in the fenestration group, the volume of intraoperative bleeding was 32.50 ± 17.13 ml, the length of postoperative hospital stay was 6.66 ± 2.44 days, and the length of postoperative off-bed activity was 3.18 ± 1.28 days. The difference between the two groups was statistically significant (P < 0.05). The operation time was 88.90 ± 19.14 min in the iLESSYS-Delta group and 67.63 ± 19.32 min in the fenestration group, and the difference between the two groups was statistically significant (P < 0.05). Regarding the pain visual analogue scale scores at 24, 48, and 72 h after surgery, patients in the iLESSYS-Delta group had less pain than did those in the fenestration group (P < 0.05). The Oswestry disability indices of postoperative patients in both groups significantly improved at 3 months after surgery and at the last follow-up (P < 0.05); however, there was no statistically significant difference in the postoperative ODI scores between the two surgery groups (P > 0.05). The two groups showed no significant differences in clinical effects, postoperative recurrence rates, or perioperative complications. iLESSYS-Delta can cause less intraoperative bleeding and faster recovery than fenestration discectomy.
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Affiliation(s)
- Xuetao Zhu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Yixiang Zhao
- Yantaishan Hospital, Yantai, 264003, Shandong, People's Republic of China
| | - Kaiwen Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China
| | - Yuanqiang Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China.
| | - Lei Cheng
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, 250012, People's Republic of China.
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Peene L, Cohen SP, Kallewaard JW, Wolff A, Huygen F, Gaag AVD, Monique S, Vissers K, Gilligan C, Van Zundert J, Van Boxem K. 1. Lumbosacral radicular pain. Pain Pract 2024; 24:525-552. [PMID: 37985718 DOI: 10.1111/papr.13317] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Patients suffering lumbosacral radicular pain report radiating pain in one or more lumbar or sacral dermatomes. In the general population, low back pain with leg pain extending below the knee has an annual prevalence that varies from 9.9% to 25%. METHODS The literature on the diagnosis and treatment of lumbosacral radicular pain was reviewed and summarized. RESULTS Although a patient's history, the pain distribution pattern, and clinical examination may yield a presumptive diagnosis of lumbosacral radicular pain, additional clinical tests may be required. Medical imaging studies can demonstrate or exclude specific underlying pathologies and identify nerve root irritation, while selective diagnostic nerve root blocks can be used to confirm the affected level(s). In subacute lumbosacral radicular pain, transforaminal corticosteroid administration provides short-term pain relief and improves mobility. In chronic lumbosacral radicular pain, pulsed radiofrequency (PRF) treatment adjacent to the spinal ganglion (DRG) can provide pain relief for a longer period in well-selected patients. In cases of refractory pain, epidural adhesiolysis and spinal cord stimulation can be considered in experienced centers. CONCLUSIONS The diagnosis of lumbosacral radicular pain is based on a combination of history, clinical examination, and additional investigations. Epidural steroids can be considered for subacute lumbosacral radicular pain. In chronic lumbosacral radicular pain, PRF adjacent to the DRG is recommended. SCS and epidural adhesiolysis can be considered for cases of refractory pain in specialized centers.
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Affiliation(s)
- Laurens Peene
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium
| | - Steven P Cohen
- Pain Medicine Division, Department of Anesthesiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jan Willem Kallewaard
- Department of Anesthesiology and Pain Medicine, Rijnstate Ziekenhuis, Velp, The Netherlands
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andre Wolff
- Department of Anesthesiology UMCG Pain Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frank Huygen
- Department of Anesthesiology and Pain Medicine, Erasmusmc, Rotterdam, The Netherlands
- Department of Anesthesiology and Pain Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Antal van de Gaag
- Department of Anesthesiology and Pain Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Steegers Monique
- Anesthesiology and Pain Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University, Nijmegen, The Netherlands
| | - Chris Gilligan
- Department of Anesthesiology and Pain Medicine, Brigham & Women's Spine Center, Boston, Massachusetts, USA
| | - Jan Van Zundert
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Koen Van Boxem
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Genk/Lanaken, Belgium
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Abu-Zahra MS, Mayfield CK, Thompson AA, Garcia O, Bashrum B, Hwang NM, Liu JN, Petrigliano FA, Alluri RK. Evaluation of Spin in Systematic Reviews and Meta-Analyses of Minimally Invasive Surgical Techniques and Standard Microdiscectomies for Treating Lumbar Disc Herniation. Global Spine J 2024; 14:731-739. [PMID: 37268297 PMCID: PMC10802545 DOI: 10.1177/21925682231181873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Spin in scientific literature is defined as bias that overstates efficacy and/or underestimates harms of procedures undergoing review. While lumbar microdiscectomies (MD) are considered the gold standard for treating lumbar disc herniations (LDH), outcomes of novel procedures are being weighed against open MD. This study identifies the quantity and type of spin in systematic reviews and meta-analyses of LDH interventions. METHODS A search was conducted on the PubMed, Scopus, and SPORTDiscus databases for systematic reviews and meta-analyses evaluating the outcomes of MD against other LDH interventions. Each included study's abstract was assessed for the presence of the 15 most common types of spin, with full texts reviewed during cases of disagreement or for clarification. Full texts were used in the assessment of study quality per AMSTAR 2. RESULTS All 34 included studies were observed to have at least 1 form of spin, in either the abstract or full text. The most common type of spin identified was type 5 ("The conclusion claims the beneficial effect of the experimental treatment despite a high risk of bias in primary studies"), which was observed in ten studies (10/34, 29.4%). There was a statistically significant association between studies not registered with PROSPERO and the failure to satisfy AMSTAR type 2 (P < .0001). CONCLUSION Misleading reporting is the most common category of spin in literature related to LDH. Spin overwhelmingly tends to go in the positive direction, with results inappropriately favoring the efficacy or safety of an experimental intervention.
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Affiliation(s)
- Maya S. Abu-Zahra
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Cory K. Mayfield
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Ashley A. Thompson
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Oswaldo Garcia
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Bryan Bashrum
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - N. Mina Hwang
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Joseph N. Liu
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Frank A. Petrigliano
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Ram K. Alluri
- Department of Orthopaedic Surgery, USC Keck School of Medicine, Los Angeles, CA, USA
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Berg B, Gorosito MA, Fjeld O, Haugerud H, Storheim K, Solberg TK, Grotle M. Machine Learning Models for Predicting Disability and Pain Following Lumbar Disc Herniation Surgery. JAMA Netw Open 2024; 7:e2355024. [PMID: 38324310 PMCID: PMC10851101 DOI: 10.1001/jamanetworkopen.2023.55024] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/14/2023] [Indexed: 02/08/2024] Open
Abstract
Importance Lumber disc herniation surgery can reduce pain and disability. However, a sizable minority of individuals experience minimal benefit, necessitating the development of accurate prediction models. Objective To develop and validate prediction models for disability and pain 12 months after lumbar disc herniation surgery. Design, Setting, and Participants A prospective, multicenter, registry-based prognostic study was conducted on a cohort of individuals undergoing lumbar disc herniation surgery from January 1, 2007, to May 31, 2021. Patients in the Norwegian Registry for Spine Surgery from all public and private hospitals in Norway performing spine surgery were included. Data analysis was performed from January to June 2023. Exposures Microdiscectomy or open discectomy. Main Outcomes and Measures Treatment success at 12 months, defined as improvement in Oswestry Disability Index (ODI) of 22 points or more; Numeric Rating Scale (NRS) back pain improvement of 2 or more points, and NRS leg pain improvement of 4 or more points. Machine learning models were trained for model development and internal-external cross-validation applied over geographic regions to validate the models. Model performance was assessed through discrimination (C statistic) and calibration (slope and intercept). Results Analysis included 22 707 surgical cases (21 161 patients) (ODI model) (mean [SD] age, 47.0 [14.0] years; 12 952 [57.0%] males). Treatment nonsuccess was experienced by 33% (ODI), 27% (NRS back pain), and 31% (NRS leg pain) of the patients. In internal-external cross-validation, the selected machine learning models showed consistent discrimination and calibration across all 5 regions. The C statistic ranged from 0.81 to 0.84 (pooled random-effects meta-analysis estimate, 0.82; 95% CI, 0.81-0.84) for the ODI model. Calibration slopes (point estimates, 0.94-1.03; pooled estimate, 0.99; 95% CI, 0.93-1.06) and calibration intercepts (point estimates, -0.05 to 0.11; pooled estimate, 0.01; 95% CI, -0.07 to 0.10) were also consistent across regions. For NRS back pain, the C statistic ranged from 0.75 to 0.80 (pooled estimate, 0.77; 95% CI, 0.75-0.79); for NRS leg pain, the C statistic ranged from 0.74 to 0.77 (pooled estimate, 0.75; 95% CI, 0.74-0.76). Only minor heterogeneity was found in calibration slopes and intercepts. Conclusion The findings of this study suggest that the models developed can inform patients and clinicians about individual prognosis and aid in surgical decision-making.
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Affiliation(s)
- Bjørnar Berg
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Martin A. Gorosito
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Computer Science, Oslo Metropolitan University, Oslo, Norway
| | - Olaf Fjeld
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Hårek Haugerud
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Computer Science, Oslo Metropolitan University, Oslo, Norway
| | - Kjersti Storheim
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Tore K. Solberg
- Institute of Clinical Medicine, The Artic University of Norway, Tromsø, Norway
- The Norwegian Registry for Spine Surgery, The University Hospital of North Norway, Tromsø, Norway
| | - Margreth Grotle
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
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9
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Lindbäck Y, Carlfjord S. Experiences from pre-surgery physiotherapy and thoughts about future exercise among patients with disc herniation or spinal stenosis: A qualitative study. Musculoskelet Sci Pract 2024; 69:102892. [PMID: 38070465 DOI: 10.1016/j.msksp.2023.102892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/26/2023] [Accepted: 11/29/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Continuous exercising after a physiotherapy intervention for low back pain (LBP) is known to be crucial, but sustaining new habits may be challenging. AIM To describe patients' pre- and post-surgery experiences after a pre-surgery physiotherapy intervention, and their thoughts about future exercise and self-management. METHODS Individual semi-structured interviews at two time-points were analysed with content analysis. Patients randomised to pre-surgery physiotherapy in an RCT evaluating the intervention, who had participated in ≥12 sessions, were invited. Eighteen patients were interviewed 0-8 months after pre-surgery physiotherapy, and sixteen of those completed a second interview 3-14 months later. RESULTS Three categories emerged: 1) "Personal experiences from pre-surgery participation", described how participation was perceived as challenging and sometimes stressful, but wellness improved. Cooperation with the physiotherapist was considered crucial and gave confidence. 2) "Attitudes to exercise", described exercise as an action of prevention and rehabilitation that demands motivation. Exercise was perceived to be good for you, physically but also improving mental health and other systems. 3) "Future physical activity - individual responsibility", described the return to former activities and potential challenges for the future. New knowledge was perceived to have changed the prerequisites for exercise and increased security in every-day physical activities. CONCLUSION Pre-surgery physiotherapy may enhance self-management through increased confidence, improved knowledge about progression, and awareness about exercise for pain relief, producing a new mindset. Challenges for continuing exercise should be addressed during the intervention. The result can inform supportive strategies for patients to continue with self-management after LBP rehabilitation.
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Affiliation(s)
- Yvonne Lindbäck
- Unit of Physiotherapy, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Siw Carlfjord
- Unit of Public Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Sun C, Sun K, Wang S, Wang Y, Yuan P, Li Z, Yang S, Zhang J, Jia Y, Wang W, Qi B, Yang B, Liu J, Wei X, Zhu L. Effect of Baimai ointment on lumbar disc herniation: A multicentre, prospective, randomised, double-blind, placebo-controlled trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 122:155138. [PMID: 37922792 DOI: 10.1016/j.phymed.2023.155138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/21/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Baimai ointment is a traditional Tibetan topical ointment, which is widely used for various diseases related to the skeletal muscular system and neurological rehabilitation. It has demonstrated good clinical effectiveness. However, there is currently a lack of high-quality evidence regarding the clinical effectiveness of Baimai ointment in treating lumbar disc herniation (LDH). PURPOSE In this study, we conducted a prospective, multicenter, double-blind, randomized controlled trial at eight hospitals in China to investigate the clinical effectiveness of Baimai ointment in the treatment of LDH. METHODS Participants aged 18-65 years were diagnosed as LDH and were randomly assigned to receive either Baimai ointment or placebo. The treatment duration was 2 weeks, with 1-week follow-up after treatment. The primary outcome measures included VAS and JOA score. The secondary outcome measures included Likert scale, compliance with health education and the incidence of rescue therapy. The intervention effects on these outcomes were examined by generalized estimating equations (GEE) with baseline measurement as the covariates. All statistical analysis were performed using SPSS 25.0 and Python 3.11. RESULTS In total, 228 participants were screened from August 25, 2021 to January 31, 2022 at 8 Grade-A tertiary hospitals in China. Finally, 194 eligible participants were randomly assigned to the Baimai ointment group and placebo group in a 1:1 ratio. At the end of 2-week treatment (14th day) and 1-week follow-up after treatment (21st day), the decrease of VAS reached 39.57% (95% CI: 34.29, 44.86) and 36.85% (95% CI: 32.04, 41.66), the decrease in JOA score reached 27.74% (95% CI: 23.05, 32.43) and 26.25 % (95% CI: 20.82, 31.69) in Baimai ointment group. A significant group-by-time interaction indicated a difference for VAS between intervention over time (χ2 = 26.81, p = 0.020), but JOA score and Likert scale did not reach statistical significance. The adjusted net difference of VAS was statistically significant from 10th day of treatment (p < 0.05). After 2-week treatment, the relief rate of VAS was 30.85% (21.95, 41.34) in Baimai ointment group and 22.73% (14.75, 33.13) in placebo group (χ2 = 1.53, p = 0.217). It demonstrated Baimai ointment in improving VAS and JOA score was valuable from a clinical view by measuring MCID. Moreover, the Likert scale, the incidence of rescue therapy and compliance with health education did not reach statistical significance. There was no evidence showing that Baimai ointment could cause serious adverse reactions in treating patients with LDH. CONCLUSION Baimai ointment demonstrated significantly higher rates of symptom relief compared to the placebo for LDH patients, particularly in terms of relieving pain. Moreover, further high-quality randomized controlled trials were necessary to confirm these positive results. The study protocol is registered with the Clinical Trials Registry (registration number: ISRCTN11912818).
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Affiliation(s)
- Chuanrui Sun
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Kai Sun
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Shangquan Wang
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Yanguo Wang
- Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, China
| | - Puwei Yuan
- Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, 712000, China
| | - Zhenhua Li
- Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 130012, China
| | - Shaofeng Yang
- The First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, 410007, China
| | - Jianhua Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230031, China
| | - Yusong Jia
- Dongzhimen Hospital of Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Wei Wang
- Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Baoyu Qi
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Bowen Yang
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China
| | - Jianping Liu
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Xu Wei
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China; Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Liguo Zhu
- Wang Jing Hospital, China Academy of Chinese Medical Sciences, Beijing, 100102, China.
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Tang Y, Li H, Qin W, Liu Z, Liu H, Zhang J, Mao H, Zhang K, Chen K. Comparison of percutaneous endoscopic interlaminar discectomy and conventional open lumbar discectomy for L4/5 and L5/S1 double-segmental lumbar disk herniation. J Orthop Surg Res 2023; 18:950. [PMID: 38082370 PMCID: PMC10712144 DOI: 10.1186/s13018-023-04361-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Although spinal endoscopic techniques have shown great advantages in the treatment of single-segment lumbar disk herniation (LDH), the therapeutic advantages for double-segment LDH are controversial. To compare the outcomes of percutaneous endoscopic interlaminar discectomy (PEID) versus conventional open lumbar discectomy (COLD) for the treatment of L4/5 and L5/S1 double-segmental LDH. METHODS From January 2016 to September 2021, we included 50 patients with double-segmental LDH who underwent PEID (n = 25) or COLD (n = 25). The clinical outcomes between the two groups were evaluated using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified MacNab criteria. Moreover, the incision length, operation time, intraoperative fluoroscopy time, postoperative bedtime, hospital stays, and complications were also recorded and compared after surgery. RESULTS In both groups, the VAS and ODI scores at different timepoints postoperatively were significantly improved compared with those preoperatively (P < 0.05) According to the modified MacNab criteria, the excellent or good outcome rate was 92% in the PEID group and 88% in the COLD group. The PEID group had shorter incision length, postoperative bedtime, and hospital stays than the COLD group. However, the operation time was shorter and intraoperative fluoroscopy time was fewer in the COLD group. In addition, there was no significant difference between the two groups in terms of surgical complications during the postoperative follow-up period. CONCLUSIONS Both PEID and COLD have good efficacy and high safety for management of L4/5 and L5/S1 double-segmental LDH. Compared with the COLD group, the PEID group had more operative time as well as more intraoperative fluoroscopy, but it had a more minimally invasive surgical incision as well as faster postoperative recovery.
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Affiliation(s)
- Yingchuang Tang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Hanwen Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Wanjin Qin
- Department of Orthopaedic Surgery, Wujin Hospital Affiliated With Jiangsu University, Changzhou, Jiangsu, China
| | - Zixiang Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Hao Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Junxin Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, Jiangsu, China
| | - Haiqing Mao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, Jiangsu, China.
| | - Kai Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, Jiangsu, China.
| | - Kangwu Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215000, Jiangsu, China.
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Abdel-Fattah AR, Irving A, Baliga S, Myint PK, Martin KR. How to spot the recurring lumbar disc? Risk factors for recurrent lumbar disc herniation (rLDH) in adult patients with lumbar disc prolapse: a systematic review and meta-analysis. Acta Orthop Belg 2023; 89:381-392. [PMID: 37935219 DOI: 10.52628/89.3.11201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Despite a fast-growing evidence-base examining the relationship of certain clinical and radiological factors such as smoking, BMI and herniation-type with rLDH, there remains much debate around which factors are clinically important. We conducted a systematic review and meta-analysis to identify risk factors for recurrent lumbar disc herniation (rLDH) in adults after primary discectomy. A systematic literature search was carried out using Ovid-Medline, EMBASE, Cochrane library and Web of Science databases from inception to 23rd June-2022. Observational studies of adult patients with radiologically-confirmed rLDH after ≥3 months of the initial surgery were included, and their quality assessed using the Quality-In-Prognostic-Studies (QUIPS) appraisal tool. Meta-analyses of univariate and multivariate data and a sensitivity-analysis for rLDH post-microdiscectomy were performed. Twelve studies (n=4497, mean age:47.3; 34.5% female) were included, and 11 studies (n=4235) meta-analysed. The mean follow-up was 38.4 months. Mean recurrence rate was 13.1% and mean time-to-recurrence was 24.1 months (range: 6-90 months). Clinically, older age (OR:1.04, 95%CI:1.00-1.08, n=1014), diabetes mellitus (OR:3.82, 95%CI:1.58-9.26, n=2330) and smoking (OR:1.80, 95%CI:1.03- 3.14, n=3425) increased likelihood of recurrence. Radiologically, Modic-change type-2 (OR:7.93, 95%CI:5.70-11.05, n=1706) and disc extrusion (OR:12.23, 95%CI:8.60-17.38, n=1706) increased likelihood of recurrence. The evidence did not support an association between rLDH and sex; BMI; occupational labour/driving; alcohol-consumption; Pfirmann- grade, or herniation-level. Older patients, smokers, patients with diabetes, those with type-2 Modic-changes or disc extrusion are more likely to experience rLDH. Higher quality studies with robust adjustment of confounders are required to determine the clinical bearing of all other potential risk factors for rLDH.
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13
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Jiang X. Pin-assisted retraction technique in unilateral biportal endoscopic discectomy: a retrospective cohort study. J Int Med Res 2023; 51:3000605231164006. [PMID: 37548213 PMCID: PMC10408347 DOI: 10.1177/03000605231164006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/28/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE Unilateral biportal endoscopic (UBE) discectomy is a reliable endoscopic technique in the treatment of lumbar disc herniation. However, UBE discectomy involves a single-handed manipulation, which may compromise the utility of the procedure. The present study was performed to examine the efficacy and safety of a novel pin-assisted retraction technique. METHODS This single-center retrospective cohort study involved 57 consecutive patients who underwent UBE lumbar discectomy from July 2021 to May 2022. The patients were randomly divided into the pin-assisted UBE discectomy group (P-UBE group) and the traditional UBE discectomy group (T-UBE group). The patients' perioperative data, clinical outcomes, and radiologic outcomes were collected and compared between the two groups. RESULTS The operative time, intraoperative blood loss, endoscopic irrigation volume, and overall complication rate were significantly lower in the P-UBE group than in the T-UBE group. There were no significant differences in the clinical outcome data between the two groups. CONCLUSION P-UBE discectomy may have superior safety and efficacy over the traditional technique, and it has the potential to serve as an optional method in UBE lumbar surgery.
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Affiliation(s)
- Xiaozhou Jiang
- Department of Spinal Surgery, Beijing Jishuitan Hospital, Beijing, PR China
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14
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Zhang T, Guo N, Wang K, Gao G, Li Y, Gao F, Yang W, Wang Y, Wang Y. Comparison of outcomes between tubular microdiscectomy and conventional microdiscectomy for lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2023; 18:479. [PMID: 37400862 DOI: 10.1186/s13018-023-03962-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/27/2023] [Indexed: 07/05/2023] Open
Abstract
PURPOSE The clinical outcomes of using a tubular microdiscectomy for lumbar disc herniation were evaluated by comparison with conventional microdiscectomy. METHODS All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, and EMBASE databases as of 1 May 2023 were included. All outcomes were analysed using Review Manager 5.4. RESULTS This meta-analysis included four randomized controlled studies with a total of 523 patients. The results showed that using tubular microdiscectomy for lumbar disc herniation was more effective than conventional microdiscectomy in improving the Oswestry Disability Index (P < 0.05). However, there were no significant differences in operating time, intraoperative blood loss, hospital stay, Visual Analogue Scale, reoperation rate, postoperative recurrence rate, dural tear incidence, and complications rate (all P > 0.05) between the tubular microdiscectomy and conventional microdiscectomy groups. CONCLUSIONS Based on our meta-analysis, it was found that the tubular microdiscectomy group had better outcomes than the conventional microdiscectomy group in terms of Oswestry Disability Index. However, there were no significant differences between the two groups in terms of operating time, intraoperative blood loss, hospital stay, Visual Analogue Scale, reoperation rate, postoperative recurrence rate, dural tear incidence, and complications rate. Current research suggests that tubular microdiscectomy can achieve clinical results similar to those of conventional microdiscectomy. PROSPERO registration number is: CRD42023407995.
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Affiliation(s)
- Tingxin Zhang
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China
| | - Nana Guo
- Critical Care Medicine, Ordos Central Hospital, Ordos, China
| | - Kaifeng Wang
- Fujian Medical University, Fuzhou, Fujian, China
| | - Gang Gao
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China
| | - Yanhong Li
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China
| | - Feng Gao
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China
| | - Wupeng Yang
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China
| | - Yonghua Wang
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China.
| | - Yongjiang Wang
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China.
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15
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Yuan P, Shi X, Wei X, Wang Z, Mu J, Zhang H. Development process and clinical application of collagenase chemonucleolysis in the treatment of lumbar disc herniation: a narrative review in China. Postgrad Med J 2023; 99:529-534. [PMID: 37319161 DOI: 10.1136/postgradmedj-2021-141208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/20/2022] [Indexed: 11/04/2022]
Abstract
Lumbar disc herniation (LDH) is one of the most common causes of lumbocrural pain. In the past 20 years, the incidence of LDH has increased dramatically. There are many treatments for LDH, including conservative treatment (such as acupuncture and physiotherapy), minimally invasive interventional treatment (such as collagenase chemonucleolysis and radiofrequency ablation) and surgical treatment. The main purpose of this paper is to review the development process and application status of collagenase chemonucleolysis in the treatment of LDH at home and abroad and provide a reference for clinical treatment.
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Affiliation(s)
- Peng Yuan
- Interventional Radiology and Pain Treatment, The Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China
| | | | - Xuanjun Wei
- The 3rd clinical department of China Medical University, China Medical University, Shenyang, China
| | - Zijun Wang
- Battalion of the first Regiment of cadets of Basic Medicine, Air Force Military Medical University, Xi'an, China
| | - Jiao Mu
- Interventional Radiology and Pain Treatment, The Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China
- Hematology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Hematology, Xi'an Central Hospital, Xi'an, China
| | - Hongxin Zhang
- Interventional Radiology and Pain Treatment, The Second Affiliated Hospital of Air Force Medical University, Air Force Medical University, Xi'an, China
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Lastra-Power J, Nieves-Ríos C, Baralt-Nazario F, Costello-Serrano AG, Maldonado-Pérez AM, Olivella G, Pérez-Rosado J, Ramírez N. Predictors of reoperation in hispanic-americans with recurrent lumbosacral disc herniation following primary hemilaminectomy and discectomy surgery. World Neurosurg X 2023; 18:100172. [PMID: 36923606 PMCID: PMC10009277 DOI: 10.1016/j.wnsx.2023.100172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
Background Multiple risk factors for recurrent lumbosacral disc herniation (rLDH) have been evaluated. However, it has been difficult to establish a consensus due to conflicting results. Therefore, the aim of our study was to evaluate the predictors of reoperation in Hispanic-Americans with rLDH following primary hemilaminectomy and discectomy surgery. Methods A retrospective case-control study of 451 Hispanic-Americans with lumbosacral disc herniation (LDH) was conducted. The sample was divided into two groups: reoperated (cases) and non-reoperated (controls). Preoperative, operative, and postoperative variables of initial surgery were compared between the two groups. Results The reoperation rate was 11.5%, with a mean interval between primary surgery and reoperation of 3.32 years ± 2.07. Analysis of preoperative variables identified a higher rate of reoperation in patients who were unemployed (cases: 48.1%, controls: 17.1%, p=0.001). A significant difference was also seen regarding the presence of gastrointestinal disease (cases: 11.5%, controls: 4.3%, p=0.038). However, there were no differences in the sociodemographic factors, preoperative physical exam, preoperative management, radiological parameters, or operative data. Those patients with persistent postoperative lower extremity pain, radiculopathy, low back pain, and buttock pain demonstrated a higher correlation with rLDH. Multivariable logistic regression analysis identified a significant difference only in work status (employed; OR and 95% CI [0.60 (0.55, 0.67)], p=0.002) and presence of postoperative low back pain (OR and 95% CI [2.17 (1.13, 4.29)], p=0.014). Conclusions Patients who required reoperation due to rLDH were more frequently unemployed and/or suffered postoperative low back pain after primary hemilaminectomy and discectomy surgery.
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Affiliation(s)
- Jorge Lastra-Power
- Department of Neuroscience, Manati Medical Center, Manati, Puerto Rico, 00674, USA
| | - Christian Nieves-Ríos
- Department of Surgery, Ponce Health Sciences University, P.O. Box 7004, Ponce, Puerto Rico, 00732, USA
| | - Francisco Baralt-Nazario
- Department of Surgery, Ponce Health Sciences University, P.O. Box 7004, Ponce, Puerto Rico, 00732, USA
| | | | - Ashlie M Maldonado-Pérez
- Department of Surgery, Ponce Health Sciences University, P.O. Box 7004, Ponce, Puerto Rico, 00732, USA
| | - Gerardo Olivella
- Department of Orthopaedic Surgery, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR, 00936, USA
| | - Juan Pérez-Rosado
- Department of Internal Medicine, Manati Medical Center, Manati, Puerto Rico, 00674, USA
| | - Norman Ramírez
- Department of Pediatric Orthopaedic Surgery, Mayaguez Medical Center, Mayaguez, Puerto Rico, 00681, USA
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Yang X, Lu Y, Zhou H, Jiang HT, Chu L. Integrated proteome sequencing, bulk RNA sequencing and single-cell RNA sequencing to identify potential biomarkers in different grades of intervertebral disc degeneration. Front Cell Dev Biol 2023; 11:1136777. [PMID: 37009470 PMCID: PMC10061025 DOI: 10.3389/fcell.2023.1136777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Low back pain (LBP) is a prevalent health problem worldwide that affects over 80% of adults during their lifetime. Intervertebral disc degeneration (IDD) is a well-recognized leading cause of LBP. IDD is classified into five grades according to the Pfirrmann classification system. The purpose of this study was to identify potential biomarkers in different IDD grades through an integrated analysis of proteome sequencing (PRO-seq), bulk RNA sequencing (bRNA-seq) and single-cell RNA sequencing (scRNA-seq) data. Eight cases of grade I-IV IDD were obtained. Grades I and II were considered non-degenerative discs (relatively normal), whereas grades III and IV were considered degenerative discs. PRO-seq analysis was performed to identify differentially expressed proteins (DEPs) in various IDD grades. Variation analysis was performed on bRNA-seq data to differentiate expressed genes (DEGs) in normal and degenerated discs. In addition, scRNA-seq was performed to validate DEGs in degenerated and non-degenerated nucleus pulposus (NP). Machine learning (ML) algorithms were used to screen hub genes. The receiver operating characteristic (ROC) curve was used to validate the efficiency of the screened hub genes to predict IDD. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were performed to analyze function enrichment and signaling pathways. Protein-protein interaction (PPI) network was used to prioritize disease-related proteins. SERPINA1, ORM2, FGG and COL1A1 were identified through PRO-seq as the hub proteins involved in regulating IDD. ML algorithms selected ten hub genes, including IBSP, COL6A2, MMP2, SERPINA1, ACAN, FBLN7, LAMB2, TTLL7, COL9A3, and THBS4 in bRNA-seq. Since serine protease inhibitor clade A member 1 (SERPINA1) was the only common gene, its accuracy in degenerated and non-degenerated NP cells was validated using scRNA-seq. Then, the rat degeneration model of caudal vertebra was established. The expression of SERPINA1 and ORM2 was detected using immunohistochemical staining of human and rat intervertebral discs. The results showed that SERPINA1 was poorly expressed in the degenerative group. We further explored the potential function of SERPINA1 by Gene Set Enrichment Analysis (GSEA) and cell-cell communication. Therefore, SERPINA1 can be used as a biomarker to regulate or predict the progress of disc degeneration.
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Endoscopic lumbar discectomy vs microdiscectomy: Early results, complications and learning curve an Australian perspective. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Wang R, Liang ZY, Chen Y, Chen CM. Clinical evaluation of paraspinal mini-tubular technique vs. laminoplasty for spinal intradural extramedullary tumors: Study protocol for a multicenter, randomized controlled trial. Front Surg 2023; 9:1053885. [PMID: 36684368 PMCID: PMC9849578 DOI: 10.3389/fsurg.2022.1053885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
The development of minimally invasive surgery has promoted the use of the paraspinal mini-tubular technique (PMTT) for spinal tumors. The similarity of the efficacy of PMTT to that of traditional surgery remains unclear; randomized controlled trials (RCTs) have not been conducted to investigate this technique for spinal tumors. The conventional surgery used for such tumors is laminoplasty (LP). To compare the differences between the two surgical techniques, an RCT is significantly required. Therefore, a prospective, multi-center, non-inferiority RCT was designed to compare the safety and effectiveness of LP and PMTT for treating spinal intradural extramedullary (IDEM) tumors. Moreover, the availability of PMTT, including its advantages and disadvantages, surgical indications, procedures, complications, and prognosis, would be explored. Overall, 280 patients will be randomly allocated to the PMTT and LP groups in a 1:1 ratio. The trial hypothesis is that PMTT has superior or equivalent efficacy and cost-effectiveness to LP. The primary outcome is the Japanese Orthopedic Association score. The non-inferiority margin for the primary outcome is five. The Ethics Committee of Fujian Medical University Union Hospital, Fuzhou, China, has approved this study (project number: FJMUUH05). Any results of the trial will be published in international peer-reviewed journals and disseminated through presentations at scientific conferences. Trial registration number ChiCTR2100047582.
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Chen J, Luo Z, Liu M, Wang F, Zhou R, Wang Y, Jia Y, Wang X, Leng X. Thunder-fire moxibustion for lumbar disc herniation: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e32270. [PMID: 36626497 PMCID: PMC9750694 DOI: 10.1097/md.0000000000032270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Lumbar disc herniation (LDH) is a common degenerative disease that severely impacts the quality of life of patients. Thunder-fire moxibustion is an ancient Chinese medicine-based external therapeutic procedure that has been employed for pain relief until this day. The focus of our study was to demonstrate the effectiveness and safety of thunder-fire moxibustion in the treatment of LDH. METHODS The literature databases searched included the Cochrane Library, Web of Science, Springer, PubMed, Wanfang digital periodicals database, China national knowledge infrastructure, VIP, and Chinese biomedical literature database, and the search period was from database creation to March 2022. These include randomized controlled trials of Thunder-Fire moxibustion alone or in combination with other therapies for LDH. Two evaluators independently extracted data. We accessed the quality of inclusive studies through a Cochrane risk of bias tool. Meta-analyses were performed using Review Manager (Version 5.5). Data was analyzed using fixed-effects or random-effects models, depending on the heterogeneity test results. RESULTS The meta-analysis included 17 studies involving 1344 patients with LDH. The analysis results were as follows: compared with other therapies, the efficacy of thunder-fire moxibustion was statistically significant; the total effective rate (RR = 1.20; 95%CI [1.15, 1.26]; P < .00001), the Japanese orthopaedic association score (MD = 4.42; 95%CI [4.10, 4.73]; P < .00001), the pain score (SMD = -2.66; 95% CI [-3.39, -1.94]; P < .00001). Only 2 reported no adverse events in the included literature, and the remaining had no relevant records. The quality of the evidence in the 17 papers we examined was low or very low. CONCLUSION Thunder-Fire moxibustion is effective in relieving discomfort in patients with LDH. It has significant clinical efficacy, but there is still a need for prospective, multicentre, large-sample randomized controlled trials to enhance the clinical evidence due to the quality of included studies and methodological limitations.
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Affiliation(s)
- Jianye Chen
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Zongxiu Luo
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Mingda Liu
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Fusheng Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Rui Zhou
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
| | - Ying Wang
- The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Yuyan Jia
- The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Xukai Wang
- The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Xiangyang Leng
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, Jilin Province, China
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21
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Kwon O, Yoo SJ, Park JY. Comparison of Unilateral Biportal Endoscopic Discectomy with Other Surgical Technics: A Systemic Review of Indications and Outcomes of Unilateral Biportal Endoscopic Discectomy from the Current Literature. World Neurosurg 2022; 168:349-358. [PMID: 36527214 DOI: 10.1016/j.wneu.2022.06.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Unilateral biportal endoscopic (UBE) spine surgery for spinal diseases has been increasing in popularity because of its favorable outcomes. The goal of this systemic review is to analyze the status of outcomes and complications in lumbar disc herniation during UBE discectomy. METHODS A comprehensive search of the PubMed, Embase, Web of Science, and OVID databases published until June 30, 2021, was performed. The outcomes of interest were indications, operative time, blood loss, hospital stay, complications, visual analog scale score, and Oswestry Disability Index. RESULTS Seven studies were included in our research. UBE surgery for lumbar stenosis was excluded. A total of 230 patients with lumbar disc herniation were enrolled in the 7 selected studies. The mean operative time was 74.4 minutes, and the mean length of hospital stay was 4.5 days. Mean incidence of complications reported in the 7 articles was 6.2%. UBE showed shorter hospital stays than did microdiscectomy, no significant differences of Oswestry Disability Index or visual analog scale scores, and good recovery rate among other discectomy techniques (microdiscectomy, full endoscopic transforaminal endoscopic lumbar discectomy, and interlaminar endoscopic lumbar discectomy) at 1 month follow-up. CONCLUSIONS Even with the small number of studies and reports analyzed, biases were the main limitation of this analysis; overall, the clinical outcomes and complication rates associated with UBE discectomy were relatively good. It is clear that UBE discectomy is a good treatment choice for lumbar disc herniation, but to prevent unique UBE surgery complications, a clear understanding of the surgical procedures and careful efforts to overcome the learning curve are necessary.
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Affiliation(s)
- Ohyuk Kwon
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sun-Joon Yoo
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong-Yoon Park
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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22
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Fu Y, Yan YC, Ru XL, Qu HB. Analysis of Chronic Low Back Pain Caused by Lumbar Microinstability After Percutaneous Endoscopic Transforaminal Discectomy: A Retrospective Study. J Pain Res 2022; 15:2821-2831. [PMID: 36120089 PMCID: PMC9480581 DOI: 10.2147/jpr.s380060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Chronic low back pain (CLBP) after percutaneous endoscopic transforaminal discectomy (PTED) surgery may be caused by preoperative lumbar microinstability (MI). However, there is a paucity of research on the relationship between lumbar microinstability and chronic low back pain. The purpose of this article is to assess the preoperative radiographic characteristics of patients and evaluate the effects of lumbar microinstability on patient-reported outcomes among single-level lumbar disc herniation (LDH) patients who underwent PTED. Methods This study retrospectively reviewed the radiographic characteristics of a consecutive series of 127 patients with low back pain and leg pain caused by single-level LDH underwent PTED from August 2018 to March 2021. They were divided into three groups according to the radiographic parameters: the stable group (Group S), the dysfunctional group (Group D), and the microinstability group (Group M). The visual analogue scale (VAS) scores for leg and low back pain and Oswestry Disability Index (ODI) were evaluated preoperatively and postoperatively. Logistic regression analysis was used to identify independent risk factors for CLBP. Results Compared with Group D and Group S, Group M had the highest ODI scores (P < 0.01) and VAS scores (low back pain) (P < 0.01) after 1 year, while there were no significant differences in the VAS scores for leg pain at different time points after surgery (P > 0.05). In addition, the logistic regression analysis results regarding CLBP revealed that muscle fatty degeneration on MRI (95% CI, 1.20-8.51, P = 0.02), and facet tropism (95% CI, 1.39 -11.37, P = 0.01) may be independent risk factors. Conclusion Patients with lumbar microinstability may have CLBP after PTED, so patients with lumbar microinstability may need to take internal fixation surgery to solve their symptoms.
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Affiliation(s)
- Yang Fu
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ying-Chao Yan
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Xuan-Liang Ru
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Hang-Bo Qu
- Department of Orthopedics, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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23
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Dunsmuir RA, Nisar S, Cruickshank JA, Loughenbury PR. No correlation identified between the proportional size of a prolapsed intravertebral disc with disability or leg pain. Bone Joint J 2022; 104-B:715-720. [PMID: 35638217 DOI: 10.1302/0301-620x.104b6.bjj-2021-1725.r2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of the study was to determine if there was a direct correlation between the pain and disability experienced by patients and size of their disc prolapse, measured by the disc's cross-sectional area on T2 axial MRI scans. METHODS Patients were asked to prospectively complete visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores on the day of their MRI scan. All patients with primary disc herniation were included. Exclusion criteria included recurrent disc herniation, cauda equina syndrome, or any other associated spinal pathology. T2 weighted MRI scans were reviewed on picture archiving and communications software. The T2 axial image showing the disc protrusion with the largest cross sectional area was used for measurements. The area of the disc and canal were measured at this level. The size of the disc was measured as a percentage of the cross-sectional area of the spinal canal on the chosen image. The VAS leg pain and ODI scores were each correlated with the size of the disc using the Pearson correlation coefficient (PCC). Intraobserver reliability for MRI measurement was assessed using the interclass correlation coefficient (ICC). We assessed if the position of the disc prolapse (central, lateral recess, or foraminal) altered the symptoms described by the patient. The VAS and ODI scores from central and lateral recess disc prolapses were compared. RESULTS A total of 56 patients (mean age 41.1 years (22.8 to 70.3)) were included. A high degree of intraobserver reliability was observed for MRI measurement: single measure ICC was 0.99 (95% confidence interval (CI) from 0.97 to 0.99 (p < 0.001)). The PCC comparing VAS leg scores with canal occupancy for herniated disc was 0.056. The PCC comparing ODI for herniated disc was 0.070. We found 13 disc prolapses centrally and 43 lateral recess prolapses. There were no foraminal prolapses in this group. The position of the prolapse was not found to be related to the mean VAS score or ODI experienced by the patients (VAS, p = 0.251; ODI, p = 0.093). CONCLUSION The results of the statistical analysis show that there is no direct correlation between the size or position of the disc prolapse and a patient's symptoms. The symptoms experienced by patients should be the primary concern in deciding to perform discectomy. Cite this article: Bone Joint J 2022;104-B(6):715-720.
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Affiliation(s)
| | - Sohail Nisar
- Department of Neuroscience, Leeds General Infirmary, Leeds, UK
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24
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Li WS, Yan Q, Cong L. Comparison of Endoscopic Discectomy Versus Non-Endoscopic Discectomy for Symptomatic Lumbar Disc Herniation: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1012-1026. [PMID: 34402320 PMCID: PMC9344526 DOI: 10.1177/21925682211020696] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE The authors aimed to systematically compare the effectiveness and safety of endoscopic discectomy (ED) with non-endoscopic discectomy (NED) for treatment of symptomatic lumbar disc herniation (LDH). METHODS A systematic search was performed on PubMed, EMBASE, the Cochrane Library and China National Knowledge Infrastructure for randomized controlled trial from inception until August 13, 2020. Trials which investigated multiple operative approaches on lumbar disc herniation were identified without language restrictions. RESULTS In total, 25 trials involving 2258 patients with symptomatic LDH were included. Twenty trials performed the comparison between ED and NED. Five trials performed the comparison between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). The operative time of micro-endoscopic discectomy (MED) was longer than open discectomy (OD). The length of hospital stay of percutaneous endoscopic lumbar discectomy (PELD) was shorter than fenestration discectomy (FD). Significant differences in intraoperative blood loss volumes were found between PELD with FD and MED with OD. The complication rate of PELD was lower than FD (PELD: 4.3%; FD: 14.6%) and the complication rate of full-endoscopic discectomy (FE) was lower than microscopic discectomy (MD) (FE: 13.4%; MD: 32.1%). CONCLUSIONS PELD and FE have the advantage of limiting intraoperative damages. ED and NED can be both considered sufficient to achieve good clinical outcomes. PETD and PEID are able to achieve similar results but the learning curve of PETD was steeper. More independent high-quality RCTs with sufficiently large sample sizes performing cost-effectiveness analyzes are needed.
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Affiliation(s)
- Wei-Shang Li
- Department of Orthopedic Surgery, The
First Hospital of China Medical University, Shenyang, People’s Republic of
China
| | - Qi Yan
- Departments of Surgery, University of
Texas Health San Antonio, San Antonio, TX, USA
| | - Lin Cong
- Department of Orthopedic Surgery, The
First Hospital of China Medical University, Shenyang, People’s Republic of
China,Lin Cong, Department of Orthopedic Surgery,
The First Hospital of China Medical University, No.155 Nanjing Bei Street,
Heping District, Shenyang City, Liaoning Province 110001, People’s Republic of
China.
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25
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Obesity and posterior spine fusion surgery: A prospective observational study. Int J Orthop Trauma Nurs 2022; 45:100920. [DOI: 10.1016/j.ijotn.2021.100920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022]
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26
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Raymaekers V, Bamps S, Duyvendak W, Put E, Roosen G, Vanvolsem S, Wissels M, Vanneste S, De Ridder D, Plazier M. Real world data collection and cluster analysis in patients with sciatica due to lumbar disc herniation. Clin Neurol Neurosurg 2022; 217:107246. [DOI: 10.1016/j.clineuro.2022.107246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/04/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
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27
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Fonseka RD, Natarajan P, Maharaj MM, Rooke K, Mobbs RJ. Two-year continuous data capture using a wearable sensor to remotely monitor the surgical spine patient: a case report. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:170-179. [PMID: 35441110 PMCID: PMC8990385 DOI: 10.21037/jss-21-89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
We report the case of a 46-year-old male with long-standing low back pain who presented with a deterioration of symptoms characterised by back and right leg pain corresponding to the L4 and L5 dermatomes. An MRI scan revealed severe central and lateral recess stenosis at L4/5 secondary to a large central disc protrusion. We remotely monitored activity and general health metrics over a time-period exceeding two years. This is the first study to monitor these metrics remotely and continuously in the surgical spine patient. Over this time, he received several interventions including a spinal cord stimulator implant, and an L4/5 microdiscectomy. We tracked his fluctuating health status using the Oura Ring [objectively measuring metrics including step count, sleep patterns, heart rate (HR), heart-rate variability (HRV), and respiratory rate (RR)] and with daily self-reported scores on the Visual Analogue Scale. The Oura Ring is a convenient and lightweight wearable device that is worn on any finger. Taken together, metrics provided a comprehensive picture of deterioration and recovery, paralleling key events in the patient's history. The use of wearable devices is feasible in enabling long-term remote continuous monitoring. This may assist surgeons and rehabilitation providers in identifying early deterioration and monitoring the post-intervention course of recovery.
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Affiliation(s)
- R Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Monish M Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Kaitlin Rooke
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Ralph J Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
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28
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Kajy M, Higginbotham DO, Ball G, Vaidya R. "Fantasy Points" associated with Professional Athlete Performance after Lumbar Discectomy or Microdiscectomy. Spartan Med Res J 2022; 7:30766. [PMID: 35291710 PMCID: PMC8873437 DOI: 10.51894/001c.30766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The treatment of Lumbar Disc Herniation (LDH) in elite athletes is a debated topic that lacks consensus in the literature due to varying outcome reporting methods. The objective of this study was to quantify the overall performance of a sample of professional athletes before and after receiving a lumbar discectomy or microdiscectomy in a cohort of players in the National Football League (NFL), National Basketball Association (NBA), National Hockey League (NHL) and Major League Baseball (MLB). METHODS The authors identified publicly accessible data from a cohort of different types of professional players who received either a lumbar discectomy or a microdiscectomy. These records were identified through newspaper archives, injury reports, player profiles and press releases between 1993 through 2015. Fantasy and Wins Above Replacement (WAR) scores were calculated for each player. RESULTS A total of 38 professional players met study inclusion criteria. NFL players had the lowest return-to-play (RTP) at nine of 14 (64%). The RTP for NBA, NHL and MLB players were comparable with 6/7 (86%) vs 8/9 (89%) vs 7/8 (88%). NFL players had the lowest average career length after surgery at 34.8 months, while NBA players had the longest average career length at 48 months. MLB players on average required the longest time to return to presurgical level of performance (24 months) and required the longest average recovery time at 12 months. CONCLUSIONS Based on these results, the average performance of most elite athletes are likely to decrease after undergoing a lumbar discectomy. Although it appears that performance peaks in the initial years after the operation for some players, there was an overall long-term decline in this sample of elite athletes. Study limitations included small sample size, lack of controlling for possible confounding variables (e.g., age, etc.) and use of variable reporting sources. Additional studies with larger sample sizes and age-matched controls are needed to examine the effects of lumbar discectomy more comprehensively in elite athletes.
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Affiliation(s)
| | | | - Guy Ball
- Orthopaedic Surgery, McLaren Oakland
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29
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Kumar VA, Reddy R, Yerramneni VK, Kolpakawar S, Kumar KV, Pratyusha P. Minimally Invasive Discectomy and Decompression for Lumbar Spine using Tubular Retractor System: Technique, Learning Curve and Outcomes. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0041-1722825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objective To study the indications, technical nuances, learning curve, and outcomes associated with minimally invasive tubular discectomy of spine (MITDS) and minimally invasive tubular decompression (MITD) using the tubular retractor system and compare the outcomes with open microdiscectomy and open decompression.
Materials and Methods All patients who underwent MITDS and MITD received a trial of conservative management for 6 weeks prior to surgery. Patients who had undergone open microdiscectomy and open decompression during the same period were used as controls. Operating time, intraoperative blood loss, preop and postop visual analogue scale (VAS) scores, preop and postop Oswestry disability index (ODI) scores, duration of hospital stay, complications, and need for redo surgery were analyzed.
Results Thirty-two patients who underwent MITDS and 8 patients who underwent MITD were compared with an equal number of patients who underwent open microdiscectomy and open decompression, respectively. MITDS and MITD were associated with shorter hospital stay. Short-term pain outcome was better in MITDS and MITD group, although it was not statistically significant in MITD group. Functional outcome measured in terms of ODI at 6 months was not statistically significant between minimally invasive and open procedures.
Conclusion Both MITDS and MITD have a significant learning curve and have a distinct advantage of shorter hospital stay. MITDS has the distinct advantage of better short-term pain relief compared with open procedures. For MITD, comparison of short-term pain relief requires a larger sample size. To establish long-term advantages of MITDS and MITD, larger sample size and long-term follow-up are needed.
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Affiliation(s)
- V A Kumar
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
| | - Ramanadha Reddy
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
| | | | - Swapnil Kolpakawar
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
| | - K.S. Vishwa Kumar
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
| | - Patlolla Pratyusha
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
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30
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Kontakiotis N, Rushton AB, Billis E, Papathanasiou G, Gioftsos G. Development of a clinical prediction model to inform clinical decision making for classification of patients with sciatica, based on their clinical characteristics, in the Greek health system: protocol for a prospective predictive exploratory study. BMJ Open 2022; 12:e052119. [PMID: 35105622 PMCID: PMC8804639 DOI: 10.1136/bmjopen-2021-052119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Sciatica is one of the most common reasons for seeking healthcare for musculoskeletal pain. Sciatica is primarily considered as neuropathic in nature when neural tissue in the low back is compromised, but sometimes other non-neural structures may be involved. Appropriate assessment and management are important for patients with sciatica. Therapists use several outcome measures to assess patients to inform selection of the most suitable treatment. There is limited evidence for the best treatment of sciatica, and this is likely contributed to by having no reliable algorithm to categorise patients based on their clinical characteristics to inform physiotherapy treatment. The purpose of this study is to develop a clinical prediction model to categorise patients with sciatica, in terms of early clinical outcome, based on their initial clinical characteristics. METHODS AND ANALYSIS A prospective observational multicentre design will recruit consecutive patients (n=467) with sciatica referred for physiotherapy. Each patient will be evaluated to determine whether or not they will be accepted into the study by answering some questions that will confirm the study's eligibility criteria. Patients' basic characteristics, patient-reported outcome measures and performance-based measures will be collected at baseline from multiple sites in the Greek territory using this same protocol, prior to commencement of treatment. The main researcher of this study will be responsible for data collection in all sites. On completion of the standard referred physiotherapy treatment after 3 weeks' time, participants will be asked by telephone to evaluate their outcome using the Global Perceived Effect Scale. For the descriptive statistical analysis, the continuous variables will be expressed in the form of 'mean' and 'SD'. In order to assess the prognostic value of each predictor, in terms of the level of improvement or worsening of the symptoms, multiple variable regression analysis will be used. ETHICS AND DISSEMINATION Τhis study is approved from the Ethics and Deontology Committee of the University of West Attica, Athens, Greece, protocol number: 38313-09/06/2020, 10226-10/02/2021. The study's findings will be published in a peer-reviewed journal and disseminated at national and international conferences and through social media. PROSPERO REGISTRATION NUMBER CRD42020168467.
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Affiliation(s)
- Nikolaos Kontakiotis
- Physiotherapy Department, Laboratory of Advanced Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - Alison B Rushton
- School of Physical Therapy, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Evdokia Billis
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Patra, Greece
| | - George Papathanasiou
- Physiotherapy Department, Laboratory of Neuromuscular and Cardiovascular Study of Motion, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
| | - George Gioftsos
- Physiotherapy Department, Laboratory of Advanced Physiotherapy, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
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31
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Wang SF, Hung SF, Tsai TT, Li YD, Chiu PY, Hsieh MK, Kao FC. Better Functional Outcome and Pain Relief in the Far-Lateral-Outside-in Percutaneous Endoscopic Transforaminal Discectomy. J Pain Res 2022; 14:3927-3934. [PMID: 35002312 PMCID: PMC8722695 DOI: 10.2147/jpr.s342928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Even though percutaneous endoscopic transforaminal discectomy (PETD) has been widely used for the surgical treatment of lumbar herniated disc, there are only a few studies directly comparing the clinical outcomes between microdiscectomy (MD) and PETD. Therefore, further studies are needed in order to compare the clinical outcomes between PETD and MD on a single level more thoroughly. Methods We proposed a far-lateral-outside-in technique for PETD to get an entry point without complex planning and facet violation. From September 2017 to September 2019, a total of 155 patients (69 with PETD and 86 with MD) were enrolled for this retrospective study, with the inclusion criteria: single level between L2 and S1, clinical sciatica for at least 6 weeks, and failed attempts with non-surgical treatments. Patients were excluded due to cauda equina syndrome, progressive neurologic deficits, history of lumbar spinal surgery, endplate modic changes, severe disc degeneration and less than 24 months of follow-up. Results PETD showed significantly shorter surgery time and less intraoperative blood loss compared to MD. The difference between PETD and MD in VAS back pain (but not VAS leg pain) at follow-up time was significant. The ODI improvement in the follow-up time of 6 months between the 2 groups showed a significant difference (PETD: 31.23±6.59, MD: 39.85±7.81, p < 0.001). MD had a significantly higher chance of postoperative wound infection and poor healing, while PETD was more likely to have recurrence of the herniated disc. Conclusion MD has been the gold standard procedure for LDH. However, with the advanced endoscopic technology and surgical technique, PETD has emerged as an alternative method due to higher functional outcome and less wound problems.
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Affiliation(s)
- Sheng-Fen Wang
- Department of Anesthesiology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Feng Hung
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yun-Da Li
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ping-Yeh Chiu
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Kai Hsieh
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Fu-Cheng Kao
- Department of Orthopaedic Surgery, Spine Section, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Institute of Biomedical Engineering, National Tsing Hua University, Hsinchu, Taiwan
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Behrbalk E, Uri O, Masarwa R, Alfandari L, Fatal S, Folman Y. Age-related Differences in Clinical Outcomes of Lumbar Discectomy. Geriatr Orthop Surg Rehabil 2021; 12:21514593211066732. [PMID: 34992895 PMCID: PMC8724981 DOI: 10.1177/21514593211066732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Lumbar discectomy is a common and effective treatment for symptomatic disk herniation. It has been suggested that lumbar discectomy in older patients may result in poorer clinical outcomes and lesser satisfaction. The purpose of this study was to assess age-related difference in patient reported outcomes of patients undergoing lumbar discectomy for chronic low back and radicular pain. MATERIALS AND METHODS Patients with chronic lumbar radiculopathy without neurological deficit underwent non-urgent single level lumbar discectomy in our institution between 2014 and 2017. Pain level (using VAS score), Oswestry Disability Index, and SF-12 scores were retrospectively reviewed and compared between younger patients (<60 years, group 1) and older patients (>60 years, group 2). RESULTS Seventy-three patients, aged between 34-76 years participated in this study. VAS, ODI, and SF-12 scores improved significantly after the surgery for each group (P < .01). When comparing between the groups, no significant differences in the outcomes measured were found after the surgery in both early post-operative follow-up and late post-operative follow-up (P > .05). DISCUSSION Elderly patients undergoing lumbar discectomy report a significant reduction in VAS, ODI, and SF-12 scores justifying the procedure. CONCLUSION Lumbar discectomy improved function and decreased pain level to similar extent in both younger and older patients suffering from radicular symptoms related to lumbar disc herniation.
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Affiliation(s)
- Eyal Behrbalk
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofir Uri
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Rawan Masarwa
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Liad Alfandari
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Shifra Fatal
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yoram Folman
- Spine Surgery Unit, Orthopedic Department, Hillel Yaffe Medical Center, Hadera, Israel
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Hua W, Ke W, Wang B, Xiang Q, Zhang Y, Wu X, Li S, Wang K, Zeng X, Gao Y, Yang S, Xiao B, Yang C. Comparison of the Clinical Outcomes of Full-Endoscopic Visualized Foraminoplasty and Discectomy Versus Microdiscectomy for Lumbar Disc Herniation. Orthop Surg 2021; 14:280-289. [PMID: 34914186 PMCID: PMC8867436 DOI: 10.1111/os.13087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 04/15/2021] [Accepted: 05/10/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This retrospective case-control study aimed to evaluate and compare the clinical outcomes of full-endoscopic visualized foraminoplasty and discectomy (FEVFD) with microdiscectomy (MD) for lumbar disc herniation (LDH). METHODS Data from 198 patients who presented with LDH between January 2016 and December 2017 treated by either FEVFD or MD were retrospectively analyzed. The inclusion criteria were single-level LDH, unilateral radiating leg pain with or without positive Lasegue's sign, and failure of standard conservative treatment for at least 12 weeks. The patients were categorized into an FEVFD group (n = 102) or an MD group (n = 96), according to the surgical procedure performed. Operative time, time in bed after surgery, postoperative hospitalization time, complications, and reoperations were recorded. Visual analog scales (VAS) for leg and back pain, Oswestry Disability index (ODI), 36-Item Short-Form Health Survey physical function (SF36-PF), and bodily pain (SF36-BP) scores were assessed and compared between the two groups. RESULTS The demographic data and baseline characteristics of the two groups were not significantly different. Operative time for the FEVFD group (73.82 ± 20.73 min) was longer than that for the MD group (64.74 ± 17.37 min) (P = 0.003), and fluoroscopy time for the FEVFD group (1.71 ± 0.58s) was longer than that for the MD group (1.30 ± 0.33s) (P < 0.001). However, time in bed experienced in the FEVFD group (8.51 ± 2.10 h) was less than that in the MD group (9.24 ± 2.01 h) (P = 0.014), and postoperative hospitalization time experienced in the FEVFD group (2.89 ± 0.83d) was also shorter than that in the MD group (4.94 ± 1.35d) (P < 0.001). All patients completed 24 months of follow-up. Postoperative scores at each follow-up for the VAS for leg and back pain, ODI, SF36-PF, and SF36-BP all improved significantly for both groups, as compared to the preoperative data (P < 0.05). The mean preoperative and postoperative scores for the VAS for leg and back pain, ODI, SF36-PF, and SF36-BP were not significantly different between the two groups. According to the modified MacNab criteria, the outcomes of the procedures were rated as excellent or good by 92.16% and 93.75% of the patients in the FEVFD and MD groups, respectively. One patient suffered a nerve root injury during the discectomy, one patient suffered from a dural tear, and two patients suffered from a residual herniation in the FEVFD group. One patient in the MD group suffered from poor wound healing. Moreover, recurrence happened in two cases in the FEVFD group, and in one case in the MD group. CONCLUSION FEVFD and MD are both reliable techniques for the treatment of symptomatic LDH. FEVFD resulted in a more rapid recovery and equivalent clinical outcomes after 24 months of follow-up.
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Affiliation(s)
- Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wencan Ke
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingjin Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Xiang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yukun Zhang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinghuo Wu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuai Li
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianlin Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Gao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuhua Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Baojun Xiao
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Wang R, Liang ZY, Chen XY, Chen CM. Technical Tips for Percutaneous Transforaminal Endoscopic Discectomy: A Three-step Maneuver for Puncture and Early Clinical Experience. Orthop Surg 2021; 14:104-110. [PMID: 34873865 PMCID: PMC8755869 DOI: 10.1111/os.13113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/19/2021] [Accepted: 05/26/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To investigate the feasibility and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) with three-step maneuver for puncture (TSMP) for lumbar herniated disc (LDH). METHODS We performed a retrospective review of 30 patients who underwent PTED using TSMP for LDH and met inclusion criteria from January 2018 to September 2018. The primary outcome, leg or back pain, was assessed using Visual Analogue Scale (VAS). Patient surgical satisfaction was measured at 12 months post surgery using a five-point Likert scale. Potential prognostic factors measured were demographic characteristics, duration of symptom (DOS), and involved levels. Statistical analysis was performed using Fisher exact test and t-test. TSMP is a three-step maneuver that builds on the concept of needle puncture site and trajectory determination based on the principles of Kambin's triangle. First, accurate direction of the puncture is confirmed by inserting the needle horizontally. Then by gradually raising the needle tail in the manner described, the superior articular facet and the intervertebral foramen are sequentially located. Finally, the needle tip slides into the intervertebral foramen to reach the target superior articular facet. RESULTS Preoperative mean VAS was 7.6 ± 1.19, which decreased to 1.4 ± 0.97 at 12 months following treatment (P < 0.0001). Rates of surgical satisfaction per Likert scale were as follows: very satisfied and satisfied in 26 patients (86.7%). Three recurrent disc herniations of adjacent segmental levels were observed in the L5-S1 group at eight and 12 months after surgery. VAS scores at 12 months varied significantly between L4-L5 level surgery and L5-S1 level surgery groups (P < 0.01). CONCLUSION TSMP is a reliable technique for puncture into the intervertebral foramen.
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Affiliation(s)
- Rui Wang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ze Yan Liang
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xin Yao Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chun Mei Chen
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fuzhou, China
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Bailey CS, Glennie A, Rasoulinejad P, Kanawati A, Taylor D, Sequeira K, Miller T, Watson J, Rosedale R, Bailey SI, Gurr KR, Siddiqi F, Urquhart JC. Discectomy Compared with Standardized Nonoperative Care for Chronic Sciatica Due to a Lumbar Disc Herniation: A Secondary Analysis of a Randomized Controlled Trial with 2-Year Follow-up. J Bone Joint Surg Am 2021; 103:2161-2169. [PMID: 34637408 DOI: 10.2106/jbjs.21.00448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Randomized controlled trials evaluating acute sciatica have not demonstrated prolonged improvements in terms of patient-reported pain and function. For chronic sciatica, however, microdiscectomy has been found to be superior at 1 year. Whether this effect persists during the second year is not known. The purpose of the present study was to report the 2-year outcomes following lumbar microdiscectomy as compared with standardized nonoperative care for the treatment of chronic sciatica resulting from a lumbar disc herniation. METHODS The present study is a secondary analysis of a previously reported randomized controlled trial with extension to 2 years of follow-up. Patients with radiculopathy for 4 to 12 months resulting from an L4-L5 or L5-S1 disc herniation were randomized to microdiscectomy or 6 months of nonoperative care followed by surgery if needed. Intention-to-treat analysis was performed at 2 years for the primary outcome (the intensity of leg pain) (range of possible scores, 0 [no pain] to 10 [worst pain]) as well as for secondary outcomes (including the Oswestry Disability Index score, the intensity of back pain, and quality of life). RESULTS One hundred and twenty-eight patients were randomized in the present study. Twenty-four (38%) of the 64 patients who had been randomized to nonoperative care crossed over to surgical treatment by 2 years following enrollment. At the 2-year time point, the follow-up rate was approximately 70%. At 2 years, the operative group had less leg pain than the nonoperative group (mean, 2.8 ± 0.4 compared with 4.2 ± 0.4; treatment effect, 1.3 [95% confidence interval, 0.3 to 2.4]). The treatment effect favored surgery for all secondary outcome measures at 6 months and 1 year and for back pain intensity and physical function at 2 years. CONCLUSIONS At 2 years, the present study showed that microdiscectomy was superior to nonoperative care for the treatment of chronic sciatica resulting from an L4-L5 or L5-S1 disc herniation. However, the difference between the groups did not surpass the minimal clinically important difference at 2 years as was reached at earlier follow-up points, likely as the result of patients crossing over from nonoperative to operative treatment. LEVEL OF EVIDENCE Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christopher S Bailey
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Andrew Glennie
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Parham Rasoulinejad
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Andrew Kanawati
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David Taylor
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Keith Sequeira
- Regional Rehabilitation and Spinal Cord Injury Outpatients, Parkwood Institute, London, Ontario, Canada
| | - Thomas Miller
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Physical Medicine and Rehabilitation, St. Joseph's Hospital, London, Ontario, Canada
| | - Jim Watson
- Department of Anesthesia and Perioperative Medicine, St. Joseph's Hospital, London, Ontario, Canada
| | - Richard Rosedale
- Occupational Health and Safety, London Health Sciences Centre, London, Ontario, Canada
| | - Stewart I Bailey
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Kevin R Gurr
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Fawaz Siddiqi
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Jennifer C Urquhart
- Department of Surgery, London Health Sciences Centre, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
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Comparison of interventions for lumbar disc herniation: a systematic review with network meta-analysis. Spine J 2021; 21:1750-1762. [PMID: 33667683 DOI: 10.1016/j.spinee.2021.02.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/06/2021] [Accepted: 02/27/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Implants for use in disc herniation surgery have been commercially available for some time. Several clinical trials have shown promising results. There are now a wide variety of surgical methods for treating lumbar disc herniation. PURPOSE The objective of this systematic review was to compare all current surgical methods for disc herniation, including newer methods with implants for annulus repair and dynamic stabilization. STUDY DESIGN Systematic review and network meta-analysis. METHODS PRISMA-P guidelines were followed in this review. Literature search in PubMed, Embase, and Cochrane library databases identified eligible randomized controlled trials (RCT) studies comparing interventions for lumbar disc surgery. The investigated outcomes were: changes in pain score, disability score and reoperation rate with a minimum follow-up of 1 year. Risk of bias was assessed in concordance with Cochrane Neck and Back Review Group recommendation. A network meta-analysis was performed using gemtc and BUGSnet software, and each outcome evaluated using Confidence in Network Meta-Analysis (CINeMA). RESULTS Thirty-two RCT studies, with 4,877 participants, and eight different interventions were identified. A significant difference was seen in change of pain score, as all treatments were superior to conservative treatment and percutaneous discectomy. This difference was only found to be of clinically importance when comparing conservative treatment and dynamic stabilization. There was no significant difference in reoperation rates or change in disability score, regardless of treatment. However, SUCRA plots showed a trend in ranking annulus repair and dynamic stabilization highest. Risk of bias assessment showed that 15 studies had a high overall risk of bias. Meta-regression with risk of bias as covariate did not indicate any influence in risk of bias on the model. Confidence in Network Meta-Analysis evaluation showed a high level of confidence for all treatment comparisons. CONCLUSIONS With this network meta-analysis, we have aimed to compare all treatments for herniated lumbar disc in one large comprehensive systematic review and network meta-analysis. We have compared across the three main outcomes: disability score, pain score and reoperation rate. We were not able to rank one single treatment as the best. Most of the treatment performed at the same level. However percutaneous discectomy and conservative treatment consistently performed worse than the other treatments. In general, the CINeMA evaluation according to the GRADE recommendations gave a high level of confidence for the study comparisons.
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Wei FL, Li T, Gao QY, Yang Y, Gao HR, Qian JX, Zhou CP. Eight Surgical Interventions for Lumbar Disc Herniation: A Network Meta-Analysis on Complications. Front Surg 2021; 8:679142. [PMID: 34355013 PMCID: PMC8329383 DOI: 10.3389/fsurg.2021.679142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/16/2021] [Indexed: 01/05/2023] Open
Abstract
Objective: Therapeutic options for lumbar disc surgery (LDH) have been rapidly evolved worldwide. Conventional pair meta-analysis has shown inconsistent results of the safety of different surgical interventions for LDH. A network pooling evaluation of randomized controlled trials (RCT) was conducted to compare eight surgical interventions on complications for patients with LDH. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for RCT from inception to June 2020, with registration in PROSPERO (CRD42020176821). This study is conducted in accordance with Cochrane guidelines. Primary outcomes include intraoperative, post-operative, and overall complications, reoperation, operation time, and blood loss. Results: A total of 27 RCT with 2,948 participants and eight interventions, including automated percutaneous lumbar discectomy (APLD), chemonucleolysis (CN), microdiscectomy (MD), micro-endoscopic discectomy (MED), open discectomy (OD), percutaneous endoscopic lumbar discectomy (PELD), percutaneous laser disc decompression (PLDD), and tubular discectomy (TD) were enrolled. The pooling results suggested that PELD and PLDD are with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss. Conclusion: The results of this study provided evidence that PELD and PLDD were with lower intraoperative and post-operative complication rates, respectively. TD, PELD, PLDD, and MED were the safest procedures for LDH according to complications, reoperation, operation time, and blood loss. Systematic Review Registration: PROSPERO, identifier CRD42020176821.
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Affiliation(s)
- Fei-Long Wei
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Tian Li
- School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Quan-You Gao
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yi Yang
- Department of Pain Treatment, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Hao-Ran Gao
- Department of Orthopedics, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Ji-Xian Qian
- 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
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de Bruijn TM, de Groot IB, Miedema HS, Haumann J, Ostelo RW. Clinical Relevance of Epidural Steroid Injections on Lumbosacral Radicular Syndrome-related Synptoms: Systematic Review and Meta-Analysis. Clin J Pain 2021; 37:524-537. [PMID: 33859113 PMCID: PMC8162229 DOI: 10.1097/ajp.0000000000000943] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Epidural steroid injections (ESIs) can be used to reduce lumbosacral radicular syndrome (LRS) related pain. The clinical relevance of ESIs are currently unknown. This systematic review and meta-analyses aims to assess whether ESIs are clinically relevant for patients with LRS. MATERIALS AND METHODS Comprehensive literature searches for randomized controlled trials regarding steroid injections for LRS were conducted in PudMed, EMBASE, CINAHL, and CENTRAL from their inception to September 2018 (December 2019 for PubMed). For each homogenous comparison, the outcomes function, pain intensity and health-related quality of life at different follow-up intervals were pooled separately. The GRADE approach was used to determine the overall certainty of the evidence. RESULTS Seventeen studies were included. Two different homogenous comparisons were identified for which the randomized controlled trials could be pooled. In 36 of the 40 analyses no clinically relevant effect was found. The certainty of evidence varied between very low to high. Four analyses found a clinically relevant effect, all on pain intensity and health-related quality of life, but the certainty of the evidence was either low or very low. Two of the 33 subgroup analyses showed a clinically relevant effect. However, according to the GRADE approach the certainty of these findings are low to very low. DISCUSSION On the basis of the analyses we conclude there is insufficient evidence that ESIs for patients with LRS are clinically relevant at any follow-up moment. High-quality studies utilizing a predefined clinical success are necessary to identify potential clinically relevant effects of ESIs. Until the results of these studies are available, there is reason to consider whether the current daily practice of ESIs for patients with LRS should continue.
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Affiliation(s)
- Thomas M. de Bruijn
- Department Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam
- National Health Care Institute, Diemen
| | | | - Harald S. Miedema
- National Health Care Institute, Diemen
- Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | | | - Raymond W.J.G. Ostelo
- Department Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam
- Department of Epidemiology and Biostatistics, Amsterdam UMC (Location VUmc) and Amsterdam Movement Sciences, Amsterdam
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Shan L, Yang J, Meng S, Ruan H, Zhou L, Ye F, Tong P, Wu C. Urine Metabolomics Profiling of Lumbar Disc Herniation and its Traditional Chinese Medicine Subtypes in Patients Through Gas Chromatography Coupled With Mass Spectrometry. Front Mol Biosci 2021; 8:648823. [PMID: 34179074 PMCID: PMC8220151 DOI: 10.3389/fmolb.2021.648823] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/27/2021] [Indexed: 01/31/2023] Open
Abstract
Lumbar disc herniation (LDH) possesses complex pathogenesis, which has not been well elucidated yet. To date, specific or early diagnosis of LDH remains unavailable, resulting in missed opportunity for effective treatment. According to Traditional Chinese medicine (TCM) theory, LDH can be divided into two subtypes (reality syndrome and deficiency syndrome). The purpose of this study was to analyze the metabolic disorders of LDH and its TCM subtypes and screen out potential biomarkers for LDH diagnosis. Gas chromatography coupled with mass spectrometry (GC-MS) was applied to test the urine samples from 66 participants (30 healthy volunteers, 18 LDH patients with deficiency syndrome and 18 patients with reality syndrome). PCA analysis showed a distinct separation tendency between the healthy subjects and LDH patients but no obvious separation between the different syndromes (reality syndrome and deficiency syndrome) of LDH patients. As a result, 23 metabolites were identified significantly altered in the LDH patients, as compared with the healthy subjects. The altered metabolites belong to amino acid metabolism, nucleic acid metabolism, carbohydrate metabolism, and vitamin metabolism, which are related to osteoporosis and inflammation. Our results indicate metabolic disorders of LDH and thereby propose a group of metabolic biomarkers for potential application in early diagnosis of LDH in clinic, which provide a reasonable explanation for the pathogenesis of LDH.
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Affiliation(s)
- Letian Shan
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jinying Yang
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shijie Meng
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongfeng Ruan
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Li Zhou
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Fusheng Ye
- Department of Orthopaedics, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Peijian Tong
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chengliang Wu
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
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Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021; 63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
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Affiliation(s)
- Kurt T Hegmann
- American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
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Maron SZ, Dan J, Gal JS, Neifert SN, Martini ML, Lamb CD, Genadry L, Rothrock RJ, Steinberger J, Rasouli JJ, Caridi JM. Surgical Start Time Is Not Predictive of Microdiscectomy Outcomes. Clin Spine Surg 2021; 34:E107-E111. [PMID: 33633067 DOI: 10.1097/bsd.0000000000001063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/24/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective analysis of clinical data from a single institution. OBJECTIVE The objective of this study was to assess the time of surgery as a possible predictor for outcomes, length of stay, and cost following microdiscectomy. SUMMARY OF BACKGROUND DATA The volume of microdiscectomy procedures has increased year over year, heightening interest in surgical outcomes. Previous investigations have demonstrated an association between time of procedures and clinical outcomes in various surgeries, however, no study has evaluated its influence on microdiscectomy. METHODS Demographic and outcome variables were collected from all patients that underwent a nonemergent microdiscectomy between 2008 and 2016. Patients were divided into 2 cohorts: those receiving surgery before 2 pm were assigned to the early group and those with procedures beginning after 2 pm were assigned to the late group. Outcomes and patient-level characteristics were compared using bivariate, multivariable logistic, and linear regression models. Adjusted length of stay and cost were coprimary outcomes. Secondary outcomes included operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates. RESULTS Of the 1261 consecutive patients who met the inclusion criteria, 792 were assigned to the late group and 469 were assigned to the early group. There were no significant differences in demographics or baseline characteristics between the 2 cohorts. In the unadjusted analysis, mean length of stay was 1.80 (SD=1.82) days for the early group and 2.00 (SD=1.70) days for the late group (P=0.054). Mean direct cost for the early cohort was $5088 (SD=$4212) and $4986 (SD=$2988) for the late cohort (P=0.65). There was no difference in adjusted length of stay or direct cost. No statistically significant differences were found in operative complications, nonhome discharge, postoperative emergency department visits, or readmission rates between the 2 cohorts. CONCLUSION The study findings suggest that early compared with late surgery is not significantly predictive of surgical outcomes following microdiscectomy.
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Affiliation(s)
| | | | - Jonathan S Gal
- Anesthesia, Perioperative and Pain Medicine, Mount Sinai Hospital, New York, NY
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Kim CH, Choi Y, Chung CK, Kim KJ, Shin DA, Park YK, Kwon WK, Yang SH, Lee CH, Park SB, Kim ES, Hong H, Cho Y. Nonsurgical treatment outcomes for surgical candidates with lumbar disc herniation: a comprehensive cohort study. Sci Rep 2021; 11:3931. [PMID: 33594185 PMCID: PMC7887235 DOI: 10.1038/s41598-021-83471-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
Physicians often encounter surgical candidates with lumbar disc herniation (LDH) who request non-surgical management even though surgery is recommended. However, second opinions may differ among doctors. Therefore, a prospective comprehensive cohort study (CCS) was designed to assess outcomes of nonsurgical treatment for surgical candidates who were recommended to undergo surgery for LDH but requested a second opinion. The CCS includes both randomized and observational cohorts, comprising a nonsurgery cohort and surgery cohort, in a parallel fashion. Crossover between the nonsurgery and surgery cohorts was allowed at any time. The present study was an as-treated interim analysis of 128 cases (nonsurgery cohort, n = 71; surgery cohort, n = 57). Patient-reported outcomes included visual analogue scores for the back (VAS-B) and leg (VAS-L), the Oswestry Disability Index, the EuroQol 5-Dimension instrument, and the 36-Item Short-Form Health Survey (SF-36), which were evaluated at baseline and at 1, 3, 6, 12, and 24 months. At baseline, age and SF-36 physical function were significantly lower in the surgery cohort than in the nonsurgery cohort (p < 0.05). All adjusted outcomes significantly improved after both nonsurgical and surgical treatment (p < 0.05). The nonsurgery cohort showed less improvement of VAS-B and VAS-L scores at 1 month (p < 0.01), but no difference between cohorts was observed thereafter for 24 months (p > 0.01). Nonsurgical management may be a negotiable option even for surgical candidates in the shared decision-making process.
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Affiliation(s)
- Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea. .,Department of Brain and Cognitive Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Yonsei University Health System, 50-1 Yeonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yeonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Youn-Kwan Park
- Department of Neurosurgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.,Department of Neurosurgery, Korea University College of Medicine, Korea-daero 73, Seongbuk-gu, Seoul, 02841, South Korea
| | - Woo-Keun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea.,Department of Neurosurgery, Korea University College of Medicine, Korea-daero 73, Seongbuk-gu, Seoul, 02841, South Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Chang Hyun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.,Department of Neurosurgery, Seoul National University Boramae Hospital, Borame Medical Center 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Eun Sang Kim
- Department of Neurosurgery, Spine Center, School of Medicine, Samsung Medical Center Sungkyunkwan University, Seoul, Korea
| | - Hyunsook Hong
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Yongeun Cho
- Department of Neurosurgery, Yonsei University College of Medicine, 50-1 Yeonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Department of Neurosurgery, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
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Kienzler JC, Heidecke V, Assaker R, Fandino J, Barth M. Intraoperative findings, complications, and short-term results after lumbar microdiscectomy with or without implantation of annular closure device. Acta Neurochir (Wien) 2021; 163:545-559. [PMID: 33070235 DOI: 10.1007/s00701-020-04612-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Standard microscopic lumbar discectomy (MLD) is a short operation with minimal blood loss, and a low rate of peri- and intraoperative complications. The objective of this study was to evaluate intraoperative findings, complications, and early postoperative neurological outcome (< 105 days) in patients undergoing MLD with or without implantation of an annular closure device (ACD). METHODS This study is based on data analysis of a post-marketing, prospective, multicenter RCT in Europe including patients undergoing standard MLD with or without implantation of an ACD (Barricaid®, Intrinsic Therapeutics, Inc., Woburn, MA). Enrollment of 554 patients in 21 centers in Europe (Germany, Switzerland, Austria, Belgium, The Netherlands, and France) started in 2010 and was completed in October 2014, with 276 patients randomized to the ACD group and 278 to the control group. RESULTS Mean operation time was 70 min in the ACD group and 52 min in the control group (p < 0.0001). Intraoperative fluoroscopy time was 24 s in the ACD group and 7 s in the control group (p < 0.0001). Average blood loss was 94.2 ml in the ACD group and 64.7 ml in the control group (p = 0.0001). Serious device- or procedure-related adverse events occurred in 3.7% (10/272) of the ACD group and 7.9% (22/278) of the control group. Dural injuries occurred in 13 (4.8%) patients in the ACD group and 7 (2.5%) in the control group. There was one device-related nerve root injury resulting in a nerve root amputation. Surgical complications included 3 hematomas in the ACD group and 4 in the control group; 3 infections occurred in both groups. Device migrations were documented in 3 patients in the ACD group. Patients in the ACD group (n = 7, 2.6%) underwent fewer reoperations compared with that in the control group (n = 16, 5.8%, OR = 2.3 (0.9-5.7)). Mean VAS leg pain at 3 months was 11.9 in the ACD and 15.1 in the control group, respectively. CONCLUSION Short-term outcome after MLD with or without implantation of ACD was similar in both groups. Patients included in the ACD group underwent fewer reoperations in the first 3 months after surgery. Nevertheless, longer operation time, higher amount of blood loss, and risk of nerve root lesion during device implantation should be considered additional risks in patients undergoing ACD implantation after MLD.
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Affiliation(s)
- Jenny C Kienzler
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland
| | - Volkmar Heidecke
- Department of Neurosurgery, Klinikum Augsburg, Augsburg, Germany
| | - Richard Assaker
- Department of Neurosurgery, Centre Hospitalier Régional Universitaire of Lille, Lille, France
| | - Javier Fandino
- Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland.
| | - Martin Barth
- Department of Neurosurgery, Klinikum Frankfurt, Frankfurt, Germany
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Gopal VV. Degenerative Lumbar Disc Disease: A Questionnaire Survey of Management Practice in India and Review of Literature. J Neurosci Rural Pract 2021; 12:159-164. [PMID: 33531776 PMCID: PMC7846326 DOI: 10.1055/s-0040-1722103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective
To identify the current management modalities practiced by neurosurgeons in India for degenerative lumbar disc disease.
Materials and Methods
Survey questionnaires were prepared in Google forms. It covered the following aspects of managing the lumbar disc pathology: (1) Demographic, institutional details, experience of surgeons, (2)choice of surgical procedures, (3) use of endoscopy and minimally invasive techniques, and (4) pre- and postoperative care. Responses obtained were entered in SPSS datasheet and analyzed.
Results
Of the 300 surveys sent, 80 were returned and response rate was 26.6%. But four surveys were highly incomplete and were discarded from the analysis. So, the study content is from the analysis of practices of 76 spinal surgeons working in different parts of the country. Majority of the spine surgeons (
n
= 70) were neurosurgeons, while 6 were orthopaedic surgeons. Fifty-four were from urban area, 12 from semiurban area, and 10 from rural area. Forty-seven spine surgeons practiced in a teaching hospital. Total 73.6% of spine surgeons opted initial medical management. Sixty-three percent preferred microlumbar discectomy (MLD) and only eight neurosurgeons preferred minimally invasive techniques. None of the respondents used in situ fusion. Fifty-three percent of spine surgeons preferred early mobilization (first postoperative day). Fifty-nine percent preferred to follow-up patients clinically and opted for magnetic resonance imaging only when recurrence or infection was suspected. The institutional nature (government teaching, government nonteaching, private teaching, and private nonteaching) and location of the hospital (urban/semiurban/rural) were found to be influencing the preferred surgical technique, trial of medical management, or postoperative care and complications. Considerable practice variations exist for medical and perioperative management.
Conclusion
The preferred treatment of choice of majority was MLD, although laminectomy and discectomy were still used by many. Consensus lacks in the operative, perioperative, and postoperative management of degenerative disc disease. Present survey points toward the importance of making management guidelines for this common spinal surgical entity.
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Affiliation(s)
- Vinu V Gopal
- Department of Neurosurgery, Medical College, " Gowreesapattom," Kottayam, Kerala, India
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45
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Elkheshin SE, Soliman AY. Endoscopic interlaminar lumbar discectomy: How to decrease the learning curve. Surg Neurol Int 2020; 11:401. [PMID: 33274114 PMCID: PMC7708962 DOI: 10.25259/sni_588_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Herniated lumbar disc is a common cause of lumbosacral pain. Endoscopic interlaminar lumbar discectomy (ILD) is a well-established technique that provided comparable results to micro-discectomy. The aim of the study is to describe the learning curve of endoscopic ILD and explore measures that could improve effectiveness and decrease blood loss and operative time with accumulation of reasonable experience. Methods: This retrospective cohort study included 65 patients presenting with symptomatic herniated lumbar disc who underwent endoscopic ILD. Patients were divided into two groups: Group I (standard technique) and Group II (modified technique). Collected data included patients’ age, gender, preoperative manifestations, visual analog score (VAS) for pain, Oswestry Disability Index (ODI), disc level, operative time, intraoperative blood loss, complications, and follow-up data at 1, 6, and 12 months postoperatively. Primary outcomes included total operative time, amount of intraoperative blood loss, and post-operative improvement in pain. Secondary outcomes included intraoperative complications, rate of conversion to open surgery, and recurrence. Results: Post-operative VAS and ODI improved significantly in both groups. Mean total surgical time and intraoperative blood loss were significantly lower in Group II compared to Group I (P < 0.001). The learning curves for operative time and intraoperative blood loss were shallow in Group I, and almost flattened in Group II. Complications were recorded in only three cases, and no symptomatic recurrences were reported. Conclusion: The learning curve of endoscopic ILD was shallow with standard technique, indicating difficulties in mastering the procedure. The proposed modified technique helped reaching the required level of proficiency in the early phase of the curve, providing a significant reduction in operative time and blood loss, with comparable effectiveness and safety as the standard technique.
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Affiliation(s)
| | - Ahmed Y Soliman
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
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46
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Should Initial Management for Lumbar Herniated Nucleus Pulposus Resulting in a Dense Nerve Palsy Be Surgical. Clin Spine Surg 2020; 33:293-295. [PMID: 31913175 DOI: 10.1097/bsd.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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47
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Xie P, Feng F, Cao J, Chen Z, He B, Kang Z, He L, Wu W, Tan L, Li K, Zheng R, Rong L. Real-time ultrasonography-magnetic resonance image fusion navigation for percutaneous transforaminal endoscopic discectomy. J Neurosurg Spine 2020; 33:192-198. [PMID: 32217792 DOI: 10.3171/2020.1.spine191223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/02/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Percutaneous transforaminal endoscopic discectomy (PTED) is usually performed under fluoroscopic guidance and is associated with a large radiation dose. Ultrasonography (US)-MR image fusion navigation combines the advantages of US and MRI and requires significantly less radiation than fluoroscopy. The purpose of this study was to evaluate the safety and effectiveness of US-MR image fusion navigation for PTED. METHODS From January to September 2018, patients with L4-5 lumbar disc herniation requiring PTED were randomized to have the procedure conducted with US-MR image fusion navigation or fluoroscopy. The number of fluoroscopies, radiation dose, duration of imaging guidance, intraoperative visual analog scale (VAS) pain score, intraoperative complications, and clinical outcomes were compared between the groups. RESULTS There were 10 patients in the US-MR navigation group and 10 in the fluoroscopy group, and there were no significant differences in age, sex ratio, or BMI between the 2 groups (all p > 0.05). Intraoperatively, the total radiation dose, number of fluoroscopies performed, duration of image guidance, and VAS low-back and leg pain scores were all significantly lower in the US-MRI navigation group than in the fluoroscopy group (all p < 0.05). There were no intraoperative complications in either group. Postoperative improvements in Japanese Orthopaedic Association, Oswestry Disability Index, and VAS pain scale scores were similar between the 2 groups. CONCLUSIONS US-MR image fusion navigation is a promising technology for performing PTED and requires significantly less radiation than fluoroscopy.Clinical trial registration no.: NCT03403244 (ClinicalTrials.gov).
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Affiliation(s)
- Peigen Xie
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
| | - Feng Feng
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
| | - Junyan Cao
- 2Ultrasound, and
- 6Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Zihao Chen
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
| | - Bingjun He
- 3Radiology, The Third Affiliated Hospital of Sun Yat-sen University
| | - Zhuang Kang
- 3Radiology, The Third Affiliated Hospital of Sun Yat-sen University
| | - Lei He
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
| | - Wenbin Wu
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
| | - Lei Tan
- 2Ultrasound, and
- 6Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Kai Li
- 2Ultrasound, and
- 6Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Rongqin Zheng
- 2Ultrasound, and
- 6Guangdong Key Laboratory of Liver Research, Guangzhou, China
| | - Limin Rong
- 1Departments of Spine Surgery
- 4Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University
- 5Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery; and
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Yang Y, Yan X, Li W, Sun W, Wang K. Long-Term Clinical Outcomes and Pain Assessment after Posterior Lumbar Interbody Fusion for Recurrent Lumbar Disc Herniation. Orthop Surg 2020; 12:907-916. [PMID: 32495446 PMCID: PMC7307241 DOI: 10.1111/os.12706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 04/23/2020] [Accepted: 04/25/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives The aim of this study was to investigate the long term effects of posterior lumbar interbody fusion (PLIF), applied after recurrent lumbar disc herniation (rLDH), on pain relief and clinical outcome improvement. Methods The current study is a retrospective study. We observed 22 cases from 85 patients that had undergone PLIF during February 2003 to October 2012 and all patients were followed for at least 5 years. The average age of those patients were 53 years, among them there were eight men and 14 women. Plain radiography and dynamic plain films were obtained, pre‐operation, for every patient. Magnetic resonance imaging (MRI) or computed tomography (CT) was conducted to confirm the diagnosis of rLDH before the operation. All surgeries were performed from posterior approach by the same surgeon using PLIF. Quality of life (QOL) and clinical outcomes were assessed by Numerical Rating Scale (NRS), Japanese Orthopaedic Association (JOA) scoring system, and Oswestry Disability Index (ODI) before revision surgery and at 1 week, 3 months, 12 months, and 24 months postoperative. These were also examined every time they came back to the hospital for a review. Results All patients were discharged and no serious comorbidities occurred. Three cases with wound infections and one case with dural laceration were cured and discharged. The end point of follow‐up was August 2018 and the mean follow‐up after revision surgery was 85 months. There were significant differences in NRS. It decreased from 7.32 ± 1.17 to 2.77 ± 1.31 (P < 0.05). The mean postoperative NRS score was 2.27 ± 1.48 (P < 0.05), 1.90 ± 1.51 (P < 0.05), and 2.36 ± 1.36 (P < 0.05) at 3, 12, and 24 months after surgery. There were no statistically significant differences (P > 0.05) in ODI scores. The average JOA score improved from 5.00 ± 1.08 to 8.18 ± 1.59 (P < 0.05) 1 week after revision surgery. RR was between 50% and 70%. Overall satisfaction rates were beyond 80%. Only one patient required subsequent lumber surgery during the follow‐up period. Conclusion If surgical indications are mastered, undergoing PLIF after rLDH may induce efficient pain relief and major improvements in clinical outcome scores, as well as quality of life scores.
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Affiliation(s)
- Yalin Yang
- Department of Orthopedics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xu Yan
- Department of Orthopedics Emergency, Tianjin Hospital, Tianjin, China
| | - Wenhui Li
- Department of Orthopedics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Weizong Sun
- Department of Orthopedics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Kai Wang
- Department of Orthopedics, The Second Hospital of Tianjin Medical University, Tianjin, China
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Cheng L, Cai H, Liu Z, Yu Y, Li W, Li Q. Modified Full-Endoscopic Interlaminar Discectomy via an Inferior Endplate Approach for Lumbar Disc Herniation: Retrospective 3-Year Results from 321 Patients. World Neurosurg 2020; 141:e537-e544. [PMID: 32492545 DOI: 10.1016/j.wneu.2020.05.234] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Percutaneous endoscopic interlaminar discectomy (PEID) is a widely used minimally invasive procedure that shows satisfying outcomes for the treatment of L5-S1 and even L4-5 disc herniation. PEID can be divided into direct and indirect approaches according to the established method of the working channel. The direct approach mainly uses the puncture needle directly through the intervertebral space into the intervertebral disc under indirect vision and insertion of the guidewire into the puncture needle to guide the dilator and into the working channel to retract the ligamentum flavum, dural sac, and nerve roots. This approach requires a skilled puncture technique, given the high risk of damage to the nerve roots and dural sac. Therefore, we improved this interlaminar access procedure, placing the puncture target at the inferior endplate and performing preoperative epidurography to expose the spinal nerve roots and dural sac after the puncture needle was passed through the ligamentum flavum. We then positioned the puncture needle at the posterior edge of the superior centrum. Finally, we inserted the working sleeve for the operation. This approach is convenient and effectively reduces the learning curve and intraoperative complications. Here we introduce the procedure and report the safety and efficacy of full-endoscopic interlaminar discectomy via an inferior endplate approach for the treatment of lumbar disc herniation. METHODS We performed full-endoscopic interlaminar discectomy via the inferior endplate approach in 321 patients who met our inclusion criteria between May 2014 and May 2017. All operations were completed under local anesthesia. Under fluoroscopic guidance, we performed epidurography to expose the spinal nerve roots and dural sac. The working sleeve and endoscope were then introduced into the inferior endplate of the superior centrum. Herniated disc material was removed using forceps and a laser under clear endoscopic visualization. We retrospectively evaluated the 321 patients with more than 30 months (range, 12-48 months) of follow-up. The therapeutic effects were assessed using scores of the visual analog scale (VAS), Oswestry disability index (ODI), Macnab standard, and infrared thermal imaging. RESULTS The mean VAS score for radicular pain improved from 6.3 ± 1.01 preoperatively to 1.01 ± 0.35 at the final follow-up (P < 0.01). The mean ODI score improved from 85.5 ± 12 preoperatively to 12.4 ± 3.7 at the final follow-up (P < 0.01). According to the MacNab standard, the excellent and good outcome scores were 96.5%. The infrared thermal imaging scores indicated significantly improved skin temperature of both lower extremities at 1 week after surgery compared with the preoperation temperature (P < 0.01). CONCLUSIONS The inferior endplate approach for percutaneous endoscopic interlaminar discectomy provides a safe and effective alternative for the treatment of lumbar disc herniation.
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Affiliation(s)
- Liang Cheng
- Department of Spine Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Heguo Cai
- Department of Orthopedics, The Third Hospital of Xiamen, Xiamen, China
| | - Zhongguo Liu
- Department of Orthopedics, The Third Hospital of Xiamen, Xiamen, China
| | - Yuyu Yu
- Department of Pain Medicine, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Weixing Li
- Department of Pain Medicine, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Qingchu Li
- Department of Spine Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
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Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disc Herniation: Two-Year Results of a Randomized Controlled Trial. Spine (Phila Pa 1976) 2020; 45:493-503. [PMID: 31703056 DOI: 10.1097/brs.0000000000003314] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective randomized controlled study. OBJECTIVE To clarify whether percutaneous transforaminal endoscopic discectomy (PTED) has better clinical outcomes and less surgical trauma compared with microendoscopic discectomy (MED). SUMMARY OF BACKGROUND DATA Two kinds of minimally invasive spine surgeries, PTED and MED, are now widely used for the treatment of lumbar disc herniation (LDH). It is still a controversial issue to choose the proper surgical approach. METHODS In this single-center, open-label, randomized controlled trial, patients were included if they had persistent signs and symptoms of radiculopathy with corresponding imaging-confirmed LDH, and were randomly allocated to PTED or MED group. The primary outcome was the score of Oswestry Disability Index (ODI) and the secondary outcomes included the score of Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain and physical function scales, European Quality of Life-5 Dimensions, and Visual Analogue Scales for back pain and leg pain. RESULTS A total of 250 participants were randomly assigned to two treatment groups, 241 of that received the specific surgical procedure. Two hundred twenty-two patients (92.1%) have completed the 2-year follow-up. Both the primary and secondary outcomes did not differ significantly between the two treatment groups at each prespecified follow-up time (P > 0.05). For PTED, the postoperative improvement of ODI score in the median herniation subgroup was less compared with paramedian subgroup. For MED, less improvement of ODI score was found in far-lateral herniation subgroup compared with paramedian subgroup. Total complication rate over the course of 2 year was 13.44% in PTED group and 15.57% in MED group (P = 0.639). Ten cases (8.40%) in PTED group and five cases (4.10%) in MED group suffered from residue/recurrence of herniation, for which reoperation was required. CONCLUSION Over the 2-year follow-up period, PTED did not show superior clinical outcomes and did not appear to be safer procedure for patients with LDH compared with MED. PTED had inferior results for median disc herniation, whereas MED did not appear to be the best option for far-lateral disc herniation. LEVEL OF EVIDENCE 2.
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