Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy

Predictive factors associated with the onset of Kummell's disease

BACKGROUND CONTEXT

Kummell's disease (KD) is a long-term complication of vertebral compression fractures, resulting in vertebral collapse and kyphosis. Despite its clinical significance, the underlying mechanisms remain poorly understood.

PURPOSE

To identify the predictive factors for the onset of KD and provide clinical insights for early screening and intervention in KD patients.

DESIGN

Retrospective study.

PATIENT SAMPLES

A total of 170 patients were included, comprising 66 with KD and 104 with old compression fractures.

OUTCOME MEASURES

Relevant clinical and imaging data were collected retrospectively. Spinal imaging indicators were also assessed.

METHODS

We analyzed clinical data from patients admitted from May 2021 to April 2024 for vertebral compression fractures. Sixty-six diagnosed with KD based on clinical and imaging criteria were identified as the case group. The control group consisted of 104 patients with vertebral compression fractures who underwent conservative treatment and showed no signs of KD upon reexamination one year later. The clinical data included gender, age, bone mineral density (BMD), history of long-term smoking, alcohol abuse, hypertension, diabetes, coronary heart disease, osteoporosis, glucocorticoid use, previous vertebral compression fracture segment and vertebral compression ratio, Cobb angle, vertebral fracture morphology and disc degeneration grade. Independent predictive factors for KD were determined using multivariate binary logistic regression. Receiver operator characteristic (ROC) analysis and Kaplan-Meier plot were used to assess the diagnostic efficiency of parameters for predicting the occurrence of KD.

RESULTS

T-tests and Chi-square tests identified significant differences between groups in age, BMD, alcohol abuse, history of hypertension, history of diabetes, history of osteoporosis, history of glucocorticoid use, vertebral compression segment, Cobb angle, vertebral compression ratio, vertebral compression morphology, and disc degeneration grade between the two groups. Binary logistic regression revealed six independent predictors of KD: age, BMD, history of osteoporosis, vertebral compression rate, vertebral compression morphology, and disc degeneration grade. ROC demonstrated that age ≥ 70.5, BMD (T-score) ≤ - 3.65 and a vertebral compression ratio ≥ 29.9% were strongly correlated with KD (P < 0.001). Kaplan-Meier plot showed that most cases of KD occurred within one year after initial vertebral compression fractures, with significant differences in KD incidence observed across different disc degeneration grades (Log-rank test, P < 0.001).

CONCLUSIONS

The risk of developing KD is heightened in patients with the following predictive factors are present: (1) Age ≥ 70.5 years; (2) BMD (T-score) ≤ - 3.65; (3) History of osteoporosis; (4) Vertebral compression ratio ≥ 29.9%; (5) Wedge-shaped vertebral compression morphology; and (6) Grade III or higher disc degeneration. Early screening and regular follow-up of high-risk patients are recommended for timely preventive interventions.

Predicting functional outcome after open lumbar fusion surgery: A retrospective multicenter cohort study

PURPOSE

We aimed to develop and externally validate a tool for predicting short-term functional outcome after lumbar fusion surgery.

METHODS

Data of 1520 patients underwent lumbar fusion from three institutions was analyzed. A total of 855 and 1251 radiomics features from paraspinal muscles were extracted from preoperative CT and MRI scans, respectively. Multivariable logistic regression was used to identify independent risk factors of poor functional status after surgery. We developed and externally validated a combined model by integrating radiomics score and clinical features. We evaluated the clinical utility and stability of the model using decision curve and calibration curve analysis. SHAP plot was used for interpretation of predictive results.

RESULTS

At multivariable analysis, radiomics score and 4 clinical features were identified as independent risk factors of poor functional outcome, and then a combined model was generated. This model had excellent performance, with AUCs of 0.85(95 %CI, 0.81-0.88), 0.82(95 %CI, 0.77-0.84), 0.79(95 %CI, 0.73-0.84) and 0.80(95 %CI, 0.76-0.83) in the derivation dataset and three independent test datasets, respectively. Moreover, this model showed great calibration and utility, outperforming the clinical model and radiomics score alone (both p < 0.05).

CONCLUSION

The combined model allows for accurate prediction of functional outcome after lumbar fusion surgery. The model could guide clinical decisions about the necessity of surgery for potential functional recovery.

Effectiveness of percutaneous key lesion endoscopic lumbar decompression for the treatment of lumbar spinal stenosis in octogenarian patients

INTRODUCTION

With increasing life expectancy, degenerative lumbar spinal stenosis (LSS) has become a common problem in the geriatric population. LSS reduces the quality of life, limits daily activities, and requires therapeutic aids. We share our experiences of treating octogenarian patients with LSS with key lesion percutaneous single portal endoscopic unilateral laminotomy and bilateral decompression (sEndo-ULBD).

MATERIALS AND METHODS

Nine octogenarian patients who underwent sEndo-ULBD between January 2021 and July 2022 were prospectively enrolled in this study. Their visual analogue score (VAS), Oswestry Disability Index (ODI), disc height, spondylolisthesis, lumbar lordotic angle, lumbar scoliotic angle, and spinal canal area before and after sEndo-ULBD were followed up for more than six months.

RESULTS

The VAS score was significantly reduced three months after the operation (p < 0.05). The postoperative ODI scores of all patients improved relative to their preoperative scores; this difference became significant in the third month after the operation (p < 0.05). Index-level disc height did not significantly change after the operation. Spondylolisthesis, lumbar lordotic angle, and lumbar scoliotic angle showed no significant curve progression. The spinal canal area increased markedly after sEndo-ULBD (p <0.05), with no known surgery-related complications.

CONCLUSIONS

Key lesion sEndo-ULBD was an appropriate, safe, and effective treatment for octogenarian patients suffering from degenerative LSS. With an average follow-up of over one year, we did not find any significant progression in spinal curvature or instability. sEndo-ULBD is an ideal alternative to aggressive fusion fixation lumbar surgery for managing degenerative LSS in octogenarian patients with functional disability.

[Research progress of unilateral biportal endoscopy technique in treatment of lumbar related diseases]

Objective

To review the application and research progress of unilateral biportal endoscopy (UBE) technique in the treatment of lumbar related diseases.

Methods

The domestic and foreign literature on the application of UBE technique in the treatment of lumbar related diseases was extensively consulted, and the development history, clinical application, operation points and precautions, related complications and adverse reactions, advantages and disadvantages of the technique were reviewed.

Results

As a minimally invasive technique developed in recent years, UBE technique is effective in the treatment of lumbar spinal stenosis caused by different causes, with satisfactory decompression effect, less damage, and good lumbar stability. UBE technique has significant advantages over open surgery and microscopy-assisted surgery in the treatment of lumbar disc herniation. In the treatment of lumbar spondylolisthesis, the postoperative trauma of UBE technique is less than that of conventional surgery, and the fusion rate is satisfactory. There are also complications such as spinal cord injury, spinal epidural hematoma, incomplete decompression or recurrence, nerve root irritation symptoms, and postoperative infection in the treatment of lumbar related diseases with UBE technique. Detailed preoperative planning is essential for patients with lumbar related diseases who are suitable for UBE surgery.

Conclusion

UBE technique is easy to operate, has a gentle learning curve, can use conventional instruments, and has definite effectiveness. It is suitable for a variety of lumbar related diseases, but there are some defects and deficiencies.

Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study

Background

Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH.

Methods

The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria.

Results

The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups.

Conclusions

Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.