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Qu L, Wang Y, Wang F, Zhang S. Surgical outcomes of percutaneous endoscopic lumbar discectomy in obese adolescents with lumbar disc herniation. BMC Musculoskelet Disord 2023; 24:710. [PMID: 37674144 PMCID: PMC10483719 DOI: 10.1186/s12891-023-06842-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
In recent years, with improved living standards, adolescent obesity has been increasingly studied. The incidence of lumbar disc herniation (LDH) in obese adolescents is increasing yearly. No clinical studies have reported the use of percutaneous endoscopic lumbar discectomy (PELD) in obese adolescent lumbar disc herniation (ALDH) patients. This study evaluated the preliminary surgical outcomes of PELD in obese ALDH patients. Fifty-one ALDH patients underwent single-level PELD surgery between January 2014 and January 2020. Patients were divided into an obese group and a normal group. Patient characteristics and surgical variables were compared between the two groups. The VAS, ODI, and SF-36 scales were used preoperatively and postoperatively to evaluate the clinical efficacy. In this study, 19 patients were included in the obese group, and 28 were included in the normal group. There was no significant difference in age, sex, duration of low back pain, duration of leg pain, or operative level between the obese and normal groups preoperatively. The obese group had a longer operative time (OT) (101.9 ± 9.0 min vs. 84.3 ± 11.0 min, P < 0.001), more fluoroscopy exposures (41.0 ± 5.8 vs. 31.6 ± 7.0, P < 0.001) and a longer time to ambulation (29.9 ± 4.0 vs. 25.0 ± 2.9, p < 0.001) than the normal group. The groups did not significantly differ in complications. The VAS score for back and leg pain and the ODI and SF-36 score for functional status improved significantly postoperatively. The PELD procedure is a safe and feasible method for treating LDH in obese adolescents. Obese ALDH patients require a longer OT, more fluoroscopy exposures and a longer time to get out of bed than normal ALDH patients. However, PELD yields similar clinical outcomes in obese and normal ALDH patients.
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Affiliation(s)
- Lianjun Qu
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
- Department of Orthopedic Surgery, Sunshine Union Hospital, Weifang, Shandong Province China
| | - Yongli Wang
- Department of Anesthesiology, 80th Group Army Hospital, Weifang, Shandong Province China
| | - Fei Wang
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
| | - Songou Zhang
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
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Bajaj A, Telfeian AE. Pediatric applications of endoscopic spine surgery. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Fu X, Yao T, Chen X, Li H, Wu J. MEF2C gene variations are associated with ADHD in the Chinese Han population: a case-control study. J Neural Transm (Vienna) 2022; 129:431-439. [PMID: 35357565 DOI: 10.1007/s00702-022-02490-9] [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: 11/17/2021] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
Myocyte enhancer factor 2C (MEF2C) is associated with hyperactivity and might be a novel risk gene for susceptibility to attention deficit hyperactivity disorder (ADHD). Therefore, this study aimed to explore the association between MEF2C genetic variants and ADHD in the Chinese Han population. A total of 215 patients with ADHD and 233 controls were recruited for this study. The Swanson, Nolan, and Pelham version IV questionnaire was used to evaluate the clinical features of ADHD. In silico analysis was used to annotate the biological functions of the promising single nucleotide polymorphisms. Our findings indicated that MEF2C rs587490 was significantly associated with ADHD in the multiplicative model (OR = 0.640, p = 0.002). Participants with the rs587490 TT allele exhibited less hyperactivity/impulsivity than those with the rs587490 CC allele. Furthermore, the expression quantitative trait loci analysis suggested that rs587490 could regulate the gene expression of MEF2C in the hippocampus, putamen, thalamus, and frontal white matter. Our study concluded that the MEF2C rs587490 T allele is significantly associated with a reduced risk of ADHD in the Chinese Han population, which provides new insight into the genetic etiology of ADHD.
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Affiliation(s)
- Xihang Fu
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430030, Hubei, People's Republic of China
| | - Ting Yao
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430030, Hubei, People's Republic of China
| | - Xinzhen Chen
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430030, Hubei, People's Republic of China
| | - Huiru Li
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430030, Hubei, People's Republic of China
| | - Jing Wu
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No. 13, Hangkong Road, Wuhan, 430030, Hubei, People's Republic of China.
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Lumbosacral Transitional Vertebrae in Adolescents: Effects on the Short-Term Outcomes of Percutaneous Endoscopic Lumbar Discectomy. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9911579. [PMID: 34337062 PMCID: PMC8292041 DOI: 10.1155/2021/9911579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/03/2021] [Indexed: 12/02/2022]
Abstract
Objective To investigate whether lumbosacral transitional vertebrae (LSTV) affects the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) in adolescent patients with lumbar disc herniation (LDH). Methods This was a retrospective study with two groups. Group A was made up of 22 adolescent LDH patients with LSTV (18 males and 4 females). Group B was made up of 44 adolescent LDH patients without LSTV (36 males and 4 females), who were matched to group A for age, sex, and body mass index. All patients underwent PELD at the L4/5 or L5/S1 single level and were followed up at 18 months after surgery. We identified LSTV on radiographs and computed tomography and assessed the imaging characteristics of all patients. Outcomes were evaluated through a numerical rating scale (NRS), the Oswestry Disability Index (ODI), the modified MacNab grading system, and the incidence of additional lumbar surgery. Results At 18 months after PELD, both groups had significant improvements in the mean NRS scores of low back pain (LBP) or leg pain and the ODI scores. In terms of the MacNab criteria, 90.9% in group A and 93.2% in group B showed excellent or good outcomes. The mean NRS scores of LBP or leg pain, ODI score, and MacNab grade after surgery were not significantly different between the 2 groups. Two patients (one patient had a recurrence; one patient had a new lumbar disc herniation) in group A and 3 patients (one patient had a recurrence; two patients had new lumbar disc herniations) in group B underwent additional lumbar surgery. Conclusions Our study suggests that in terms of pain relief, life function improvement, and the incidence of additional lumbar surgery, LSTV has no effect on the short-term clinical outcomes of PELD in adolescents. A new lumbar disc herniation is an important reason for additional surgery in adolescents, regardless of the LSTV status.
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Mao L, Zhu B, Wu XT. One-Stage Percutaneous Endoscopic Lumbar Discectomy for Symptomatic Double-Level Contiguous Adolescent Lumbar Disc Herniation. Orthop Surg 2021; 13:1532-1539. [PMID: 34080296 PMCID: PMC8313176 DOI: 10.1111/os.13097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 12/21/2022] Open
Abstract
Objective To assess the clinical efficacy of one‐stage percutaneous endoscopic lumbar discectomy (PELD) for symptomatic double‐level contiguous adolescent lumbar disc herniation (ALDH). Methods This retrospective study included 16 patients who presented with back and/or leg pain due to double‐level disc herniation underwent PELD for symptomatic lumbar disc herniation (0.27%,16/5877) from January 2014 to September 2019. After follow‐up period of 17.3 months in average, numeric rating scale (NRS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results. Quantitative data were expressed as mean standard deviation (SD) and the data for the variation in the NRS scores before and after the operation were compared using the Wilcoxon two‐sample test. Analyses were performed with IBM SPSS Statistics for Windows, version 19.0 (IBM, Armonk, NY, USA). Values of P < 0.05 were considered significantly different. Results There were 11 male and 5 female patients, with an average age of 19.3 years (range, 15–22 years). One case affected the L2‐ L3 /L3‐L4 level, seven cases affected the L3‐ L4 /L4‐ L5 level, and eight cases affected the L4‐ L5 /L5‐S1 level. The NRS scores decreased significantly in both early and late follow‐up evaluations and these scores demonstrated significant improvement in late follow‐up (P < 0.05). For the modified Macnab criteria, the final outcome results were excellent in 14 patients (87.5%), good in 1 patient (6.25%), fair in 1 patient (6.25%), and the overall success rate was 93.75%. Conclusion This study's data suggest that one‐stage PELD is promising treatment strategy for selected symptomatic double‐level contiguous adolescent lumbar disc herniation.
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Affiliation(s)
- Lu Mao
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Bin Zhu
- Pain medicine Center, Peking University Third Hospital, Beijing, China
| | - Xiao-Tao Wu
- Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
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Yu H, Zhu B, Liu X. Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Discectomy in the Treatment of Adolescent Lumbar Disc Herniation: A Retrospective Analysis. World Neurosurg 2021; 151:e911-e917. [PMID: 33989822 DOI: 10.1016/j.wneu.2021.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To compare and analyze efficacy and safety of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar discectomy (OLD) for adolescent lumbar disc herniation. METHODS Clinical data of 257 patients with single-segment adolescent lumbar disc herniation who underwent surgical treatment from January 2015 to December 2019 were retrospectively collected. The patients were divided into PELD and OLD groups based on the surgical method used. Propensity score matching was performed using preoperative baseline data of patients in both groups, and some patients in both groups were selected for comparative study. Clinical and follow-up data were assessed and compared. RESULTS There was no statistically significant difference in preoperative baseline data between the 2 groups of patients after propensity score matching. Visual analog scale and Oswestry Disability Index scores improved in both groups postoperatively and at each follow-up time point (P < 0.05). However, visual analog scale scores on the first postoperative day and Oswestry Disability Index scores at 3 months postoperatively were lower in the PELD group than in the OLD group (P < 0.05). Duration of surgery, intraoperative blood loss, and duration of postoperative hospitalization were lower in the PELD group than in the OLD group (P < 0.05). There was no statistically significant difference between the 2 groups when comparing complication and recurrence rates (P >0.05). CONCLUSIONS Both PELD and OLD are effective and safe surgical techniques for treatment of adolescent lumbar disc herniation. However, compared with OLD, PELD is more advantageous for rapid symptom relief and improving postoperative quality of life with a low rate of complications and recurrence.
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Affiliation(s)
- Haijiang Yu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China
| | - Bin Zhu
- Department of Orthopedics, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Xiaoguang Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.
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Shimony N, Louie C, Barrow D, Osburn B, Noureldine MHA, Tuite GF, Carey CM, Jallo GI, Rodriguez L. Adolescent Disc Disease: Risk Factors and Treatment Success-Related Factors. World Neurosurg 2021; 148:e314-e320. [PMID: 33412329 DOI: 10.1016/j.wneu.2020.12.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/25/2020] [Accepted: 12/26/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE A paucity of literature is available discussing the associated risk factors, treatment options (including the use of minimally invasive surgery), and outcomes related to lumbar disc herniation (LDH) in children. We have discussed the risk factors for disc disease among pediatric patients and evaluated the efficacy of the minimally invasive approach. METHODS A retrospective review of pediatric patients with lumbar disc disease who had undergone microdiscectomy at our institution from 2005 to 2016 was conducted. The preoperative presentation, hospital course, postoperative course, and follow-up data (≥3 years) were reviewed. We evaluated the risk factors for LDH and the surgical outcomes for both groups. RESULTS A total of 52 pediatric patients had undergone 61 lumbar disc surgeries for LDH in our department from 2005 to 2016. Their average age at surgery was 16.65 years. Of the 61 procedures, 48 (78.7%) had been performed via the minimally invasive spine microdiscectomy approach and 13 (21.3%) via the open microdiscectomy approach. The average body mass index for all cases was 29.3 kg/m2. The average interval to diagnosis was 7.9 months. Of the 61 cases, 21 (34.4%) had been required for patients who were competitive athletes. In addition, 15 had been for LDH related to trauma (24.6%). In 46 of the 61 cases, complete resolution of the symptoms had occurred at the 1-year follow-up visit (79.2% of minimally invasive spine microdiscectomy vs 61.5% of open microdiscectomy). CONCLUSION Risk factors similar to those for adult LDH, such as an elevated body mass index, can be seen in the pediatric population. However, some unique risk factors such as post-traumatic LDH were found in the pediatric age group. Minimally invasive techniques are demonstrably safe and useful in this patient population.
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Affiliation(s)
- Nir Shimony
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Division of Pediatric Neurosurgery, Institute of Neuroscience, Geisinger Medical Center, Danville, Pennsylvania, USA; Department of Neurosurgery, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.
| | - Christopher Louie
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - David Barrow
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Brooks Osburn
- Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Mohammad Hassan A Noureldine
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA
| | - Gerald F Tuite
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Carolyn M Carey
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - George I Jallo
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Luis Rodriguez
- Institute for Brain Protection Sciences, All Children's Hospital, Johns Hopkins University and Medicine, St. Petersburg, Florida, USA; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
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Gadjradj PS, Harhangi BS. Percutaneous transforaminal endoscopic discectomy in a nine-year-old patient with sciatica: case report, technical note and overview of the literature. Childs Nerv Syst 2021; 37:2343-2346. [PMID: 33772354 PMCID: PMC8263397 DOI: 10.1007/s00381-021-05135-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/17/2021] [Indexed: 11/03/2022]
Abstract
Percutaneous transforaminal endoscopic discectomy (PTED) is an alternative procedure to open microdiscectomy (OM) to treat sciatica caused by lumbar disk herniation. Even though robust evidence comparing PTED with OM is lacking, PTED is becoming increasingly popular to treat spinal disorders. In this technical report, the surgical technique and outcomes of PTED in a 9-year-old patient are described. Furthermore, an overview of the literature on full-endoscopic techniques to treat sciatica is given, showing that PTED is feasible, safe and effective to treat lumbar disk herniation in the pediatric population.
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Affiliation(s)
- P. S. Gadjradj
- Department of Neurosurgery, Park MC, Hoofdweg 90, Rotterdam, The Netherlands
| | - B. S. Harhangi
- grid.5645.2000000040459992XDepartment of Neurosurgery, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Hu Y, Zheng Y, Chen G, Chen W. Comparison of percutaneous endoscopic discectomy and microendoscopic discectomy in treatment of symptomatic lumbar disc herniation: A protocol of cohort study. Medicine (Baltimore) 2020; 99:e22709. [PMID: 33080722 PMCID: PMC7572032 DOI: 10.1097/md.0000000000022709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite some researchers have compared the safety and effectiveness of percutaneous endoscopic discectomy (PED) and microendoscopic discectomy (MD) for the lumbar disc herniation; however, they got conflicting outcomes in several variables. Therefore, our aim was to clarify whether PED produces less surgical trauma and better clinical results than MD. METHODS A single-center, retrospective cohort trial was conducted for the comparison of the safety and effectiveness between the MD and PED in the patients with lumbar disc herniation who received surgery from May 2016 to July 2018 in our hospital. The inclusion criteria for our investigation included:The follow-ups were performed 6 weeks, 3, 6, 12 and 24 months after the surgery. Numeric Rating Scale, Short-form 36, and Oswestry Disability Index, as well as complications were evaluated in our study. The software of SPSS Version 22.0 (IBM Corporation, Armonk, NY) was applied to analyze all the statistical data. When P is less than .05, the difference is significant in statistics. RESULTS This protocol will provide a solid theoretical basis for exploring which technique is better in treatment of lumbar disc herniation. TRIAL REGISTRATION This protocol was registered in Research Registry (researchregistry6005).
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Affiliation(s)
- Yabin Hu
- Department of Orthopedics, The Second Hospital of Nanjing, Jiangsu
| | - Yong Zheng
- Department of Bone injury, Shaanxi Hospital of Traditional Chinese Medicine, Shaanxi
| | - Guangfu Chen
- Department of Anesthesiology, Fuzhou Second Hospital Affiliated to Xiamen University, Fujian
| | - Wei Chen
- Department of Spine Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fujian, China
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