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Li T, Du W, Ding Z, Liu J, Ding Y. Percutaneous endoscopic lumbar discectomy combined with platelet-rich plasma injection for lumbar disc herniation: analysis of clinical and imaging outcomes. BMC Musculoskelet Disord 2024; 25:328. [PMID: 38658984 PMCID: PMC11044406 DOI: 10.1186/s12891-024-07444-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To evaluate the clinical efficacy and imaging outcomes of percutaneous endoscopic lumbar discectomy (PELD) combined with platelet-rich plasma (PRP) for the treatment of lumbar disc herniation (LDH). METHODS A total of 155 patients with LDH between January 2020 and June 2022 were retrospective analyzed, of which 75 underwent PELD with PRP and 80 underwent PELD only. Clinical functional scores and imaging data were compared. Clinical functional scores included visual analog scale of leg pain (VAS-LP) and back pain (VAS-BP), Japanese Orthopedic Association score (JOA), Oswestry Disability Index (ODI) and modified MacNab criteria. Imaging data included disc height index (DHI), spinal cross-sectional area (SCSA), disc protrusion size (DPZ), and ratio value of disc grey scales (RVG). RESULTS Both groups showed clinical improvement, and VAS-LP, VAS-BP, JOA and ODI were significantly improved in the PRP group compared with the control group at 3, 6 and 12 months postoperatively (P < 0.05). At the last follow-up, the differences in SCSA, DPZ and RVG between the two groups were statistically significant (P < 0.05), with the PRP group being superior to the control group. The excellent and good rates of the modified Macnab criteria in the PRP group and control group were 93.3% and 90%, respectively, with no statistically significant difference (P > 0.05). No serious complications occurred during the follow-up period. CONCLUSION PELD combined with PRP is a safe and effective method for treating patients with LDH. PRP injection was beneficial for delaying disc degeneration and promoting disc remodeling.
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Affiliation(s)
- Tusheng Li
- Orthopedics of TCM Senior Dept, The Sixth Medical Center of PLA General Hospital, Beijing, People's Republic of China
| | - Wei Du
- Orthopedics of TCM Senior Dept, The Sixth Medical Center of PLA General Hospital, Beijing, People's Republic of China
| | - Zhili Ding
- Orthopedics of TCM Senior Dept, The Sixth Medical Center of PLA General Hospital, Beijing, People's Republic of China
| | - Jiang Liu
- Orthopedics of TCM Senior Dept, The Sixth Medical Center of PLA General Hospital, Beijing, People's Republic of China
| | - Yu Ding
- Orthopedics of TCM Senior Dept, The Sixth Medical Center of PLA General Hospital, Beijing, People's Republic of China.
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Xu P, Yuan J, Wu T, He D, Miao X, Cheng X. Modified Percutaneous Endoscopic Interlaminar Discectomy through the Near-spinous Process Approach for L4/5 Disc Herniation: A Retrospective Clinical Study. Orthop Surg 2024. [PMID: 38556483 DOI: 10.1111/os.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE Compared with traditional open surgery, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of less trauma, faster recovery, and less postoperative pain, so it has been widely used in the field of spinal surgery. However, it still has the defect of intraoperative fluoroscopy occurrences, complications, and even the risk of damage to the spinal cord and nerve. This study aims to compare the clinical efficacy of modified percutaneous endoscopic interlaminar discectomy (MPEID) with percutaneous endoscopic transforaminal discectomy (PETD) in treating L4/5 lumbar disc herniation (LDH) and to evaluate the effectiveness and safety of MPEID. METHODS Thirty-four L4/5 LDH patients treated at the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were studied retrospectively. Seventeen underwent MPEID and seventeen PETD. Variables analyzed included demographics, operative duration, intraoperative fluoroscopy occurrences, and surgical outcomes. Effectiveness was evaluated using the visual analogue scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria. Lumbar Magnetic Resonance Imaging (MRI) was used to assess radiological outcomes. A paired t-test was performed to compare intragroup pre- and postoperative clinical data, VAS, and ODI scores. RESULTS The average operative time in PETD group was 91.65 ± 14.04 min, and the average operative time in MPEID group was 65.41 ± 12.61 min (p < 0.001). In PETD group, the fluoroscopy occurrences averaged 9.71 ± 1.05 times, with fluoroscopy occurrences averaging 6.47 ± 1.00 times (p < 0.001) in MPEID group. At 12 months follow-up, the clinical effect showed significant improvement in both two groups. The MPEID group showed a decrease in average VAS-back score from 5.41 ± 2.18 to 1.76 ± 1.09 (p < 0.001) and VAS-leg score from 6.53 ± 1.66 to 0.82 ± 0.64 (p < 0.001). The ODI scores decreased from 51.35 ± 10.65 to 11.71 ± 2.91 (p < 0.001). In the PETD group, the VAS-back score decreased from 4.94 ± 1.98 to 2.06 ± 1.25 (p < 0.001), VAS-leg score from 7.12 ± 1.73 to 1.12 ± 0.60 (p < 0.001), and ODI scores from 48.00 ± 11.62 to 12.24 ± 2.56 (p < 0.001). According to the modified MacNab criteria, MPEID had 15 excellent and two good results; PETD had 12 excellent and 5 good (p = 0.23). No nerve root injuries, dural tears, or significant complications were reported. CONCLUSION MPEID and PETD effectively treat L4/5 LDH, with MPEID showing shorter operative times and fewer fluoroscopies. Furthermore, the MPEID group can provide excellent clinical efficacy as the PETD group in the short term.
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Affiliation(s)
- Peichuan Xu
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jinghong Yuan
- Institute of Orthopedics of Jiangxi Province, Nanchang, China
| | - Tianlong Wu
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dingwen He
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xinxin Miao
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xigao Cheng
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Institute of Orthopedics of Jiangxi Province, Nanchang, China
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Yang J, Luan H, Ren J, Tao J, Sheng W, Guo H, Deng Q. Percutaneous endoscopic lumbar discectomy for single and double segment lumbar disc herniation with sciatic scoliosis in adults: a retrospective study. BMC Surg 2024; 24:41. [PMID: 38297255 PMCID: PMC10829209 DOI: 10.1186/s12893-024-02314-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/03/2024] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVE Sciatic scoliosis can be seen in patients with lumbar disc herniation. Percutaneous endoscopic lumbar discectomy (PELD) is a common surgical method for the treatment of lumbar disc herniation. The difference between single-segment lumbar disc herniation and double-segment lumbar disc herniation with Sciatic Scoliosis in adults after PELD needs further study. The aim of this study was to compare the imaging features of single-segment and double-segment lumbar disc herniation with Sciatic Scoliosis in adults and to further explore the clinical outcomes of functional improvement and scoliosis imaging parameters of the two groups after PELD. METHODS Adult patients with lumbar disc herniation with sciatic scoliosis who received PELD from January 2019 to June 2022 were analyzed retrospectively. According to the number of operative segments, the patients were divided into a single-segment group and a double-segment group. Perioperative parameters were observed and compared between the two groups. The Visual Analogue Scale (VAS) score, Oswestry dysfunction index (ODI), Japanese Orthopaedic Association scores (JOA) and imaging parameters of the two groups were recorded and compared before the operation and during the follow-up. RESULTS A total of 53 patients with single segments and 21 patients with double segments were included in this study. During the follow-up, the VAS score, ODI index and JOA score of the two groups were significantly improved as compared with those before the operation(P < 0. 05). Ninety-two point five percent of single-segment patients and 90.5% of double segment patients returned to normal scoliosis within 12 months after the operation. The operation time, number of intraoperative fluoroscopy times and the amount of intraoperative blood loss in single-segment patients were better than those in double-segment group(P < 0. 05). At the last follow-up, the AVT, CBD and SVA in the double-segment group were 5.2 ± 2.3, 5.1 ± 1.0 and 12.2 ± 3.0 mm, respectively, which were higher than those in the single-segment group (1.9 ± 0.4, 1.1 ± 1.6 and 3.9 ± 2.1 mm) (P < 0. 05). CONCLUSION PELD is an effective treatment for single-segment and double-segment lumbar disc herniation with Sciatic scoliosis. Double-segment patients can enjoy similar clinical efficacy to single-segment patients, avoiding complications caused by decompression, fusion, and internal fixation. Scoliosis was corrected spontaneously within 12 months after operation, and the sagittal curve was significantly improved in both groups. The improvement of coronal and sagittal balance in double -segment patients may take longer.
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Affiliation(s)
- Jitao Yang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Haopeng Luan
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Jiawei Ren
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Jiyuan Tao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Qiang Deng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China.
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Li T, Yang G, Zhong W, Liu J, Ding Z, Ding Y. Percutaneous endoscopic transforaminal vs. interlaminar discectomy for L5-S1 lumbar disc herniation: a retrospective propensity score matching study. J Orthop Surg Res 2024; 19:64. [PMID: 38218844 PMCID: PMC10787476 DOI: 10.1186/s13018-024-04543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE Percutaneous endoscopic lumbar discectomy (PELD) is a safe and effective minimally invasive surgery for treating lumbar disc herniation (LDH); however, the comparative clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in treating L5-S1 LDH remains unclear. This study compared the clinical advantages of PEID and PETD for treating L5-S1 LDH. METHODS This was a single-centre retrospective study analysing clinical data from 120 patients with L5-S1 LDH between February 2016 and May 2020. Propensity score matching (PSM) was used to adjust for imbalanced confounding variables between the two groups. Perioperative data were recorded, and clinical outcomes, including functional scores and imaging data, were compared between groups. Functional scores included visual analogue scale (VAS) for back and leg pain, Oswestry disability index (ODI), and modified MacNab criteria. Imaging data included disc height index (DHI), ratio of greyscale (RVG), and range of motion (ROM) of the responsible segment. RESULTS After PSM, 78 patients were included in the study, and all covariates were well balanced between the two groups. In the matched patients, the PEID group showed significantly shorter surgical time (65.41 ± 5.05 vs. 84.08 ± 5.12 min) and lower frequency of fluoroscopy (2.93 ± 0.63 vs. 11.56 ± 1.54) compared with the PETD group (P < 0.001). There were no statistically significant differences in intraoperative blood loss, postoperative hospital stay, total incision length, and incidence of complications between the two groups (P > 0.05). After surgery, both groups showed significant improvement in back and leg pain based on VAS and ODI scores (P < 0.05). There were no statistically significant differences in clinical functional scores and imaging data between the two groups at various time points after surgery (P > 0.05). According to the modified MacNab criteria, the excellent and good rates in the PEID group and PETD group were 91.89% and 89.19%, respectively, with no statistically significant difference (P > 0.05). CONCLUSION PEID and PETD have similar clinical efficacy in treating L5-S1 disc herniation. However, PEID is superior to PETD in reducing operation time and frequency of fluoroscopy.
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Affiliation(s)
- Tusheng Li
- Orthopedics of TCM Senior Department, 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, People's Republic of China
| | - Guangnan Yang
- Department of Orthopaedics, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Wei Zhong
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Jiang Liu
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, People's Republic of China
| | - Zhili Ding
- Navy Clinical College, The Fifth School of Clinical Medicine, Anhui Medical University, Hefei, People's Republic of China
| | - Yu Ding
- Orthopedics of TCM Senior Department, 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, People's Republic of China.
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Jiang L, Xie X, He R, Da J. Analysis of risk factors for post-operative recurrence after percutaneous endoscopic lumbar discectomy in patients with lumbar disc herniation: a meta-analysis. J Orthop Surg Res 2023; 18:935. [PMID: 38057884 DOI: 10.1186/s13018-023-04378-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND This study aimed to systematically evaluate risk factors for post-operative recurrence after percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). METHODS The eligible studies were retrieved from PubMed, Embase, and Web of Science databases. Quality assessment was performed. The effects of binary variables (sex, Modic change (MC), type 2 diabetes (T2DM), and smoking) on post-operative recurrence were evaluated as odds ratio (OR) and 95% confidence interval (CI). The effects of continuous variables (sagittal range of motion (SROM), body mass index (BMI), and age) were assessed as weighted mean difference (WMD) and 95% CI. Sensitivity analysis and publication bias were conducted to evaluate the reliability of pooled results. RESULTS Eight studies were included, and their methodological quality was medium. MC (OR (95% CI) = 3.88 (2.24-6.74), P < 0.001), smoking (OR (95% CI) = 1.87 (1.45, 2.42), P < 0.001), T2DM (OR (95% CI) = 1.61 (1.12, 2.31), P = 0.010), SROM (WMD (95% CI) = 2.33 (0.95, 3.70), P = 0.001), BMI (WMD (95% CI) = 1.68 (1.37, 1.99) kg/m2, P < 0.001), and age (WMD (95% CI) = 9.95 (5.05, 14.86) years, P < 0.001) were significantly related to post-operative recurrence in patients with LDH after PELD. Significant publication bias was not observed among studies in all outcome indicators. CONCLUSION Our findings reveal that high levels of age, BMI, and SROM, history of T2DM or smoking, or more MC may be correlated with post-operative recurrence after PELD.
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Affiliation(s)
- Lin Jiang
- Orthopaedics Department, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China
| | - Xin Xie
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Rongfang He
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China.
- Department of Psychiatry, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Jun Da
- Orthopaedics Department, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China.
- Department of Nursing, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, Sichuan, China.
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Wu Z, Sun H, Zhang Y, Xiao L, Zhao Q. Biomechanical Finite Element Analysis of Percutaneous Endoscopic Lumbar Discectomy via a Transforaminal Approach. World Neurosurg 2023:S1878-8750(23)01513-9. [PMID: 37898267 DOI: 10.1016/j.wneu.2023.10.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE Based on the previously established 3-dimensional model, this study uses the finite element analytical method to observe the effects of superior articular process resection and intervertebral discectomy on the stress of the surgical segment under different motion states. METHODS A validated L3-S1 finite element model was modified for simulation. And on the basis of the normal lumbar spine model, the superior articular process and discs of different parts of L4-L5 were simulated for resection. The resection models were divided into 6 groups, and the stress characteristics of articular process and discs of the lumbar spine under different postoperative motion conditions were examined under the same loading conditions. RESULTS Simultaneous resection of the tip and base of the superior articular process increased the stress on the facet joint under various motion states compared with separate resections. In addition, the fewer herniated discs that are removed, the smaller the increase in facet joint stress. excision of the tip of the superior articular process caused a smaller stress increase in the facet joint than excision of the base under the forward bending and right-lateral flexion, and the opposite results were found under left-lateral flexion, posterior extension, and rotation. Resection of the tip of the superior articular process increases disc stress more than resection of the base of the superior articular process. CONCLUSIONS Select resection of the superior articular process base as much as possible to expose the target of the disc. And minimize annulus damage and disc removal.
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Affiliation(s)
- Zhongxuan Wu
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Hongzhou Sun
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Yu Zhang
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Liang Xiao
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Quanlai Zhao
- Department of Spine Surgery, Yijishan Hospital, The First Affliated Hospital of Wannan Medical College, Wuhu City, Anhui Province, China.
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Su CY, Huang GS, Chang WC, Wang CC, Chen CW, Hsu YC. The Value of 18F-FDG PET/MRI in Detecting Lumbar Radiculopathy for Selective Percutaneous Endoscopic Discectomy: a Case Report. Nucl Med Mol Imaging 2023; 57:247-250. [PMID: 37720881 PMCID: PMC10504134 DOI: 10.1007/s13139-023-00797-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) is the most popular imaging modality for investigating intervertebral disc herniation. However, it has a high chance for identifying incidental findings that are morphologically or structurally abnormal but not responsible for patients' symptoms. Although a previous study suggested that 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) may help identify neuroinflammation in lumbar radiculopathy, there is currently no direct evidence obtained from surgery. Here, we describe the case of a 32-year-old man with low back pain and right leg paresthesia for 7 months. MRI demonstrated disc herniation at the L3-L4, L4-L5 and L5-S1 levels, causing bilateral L5 and left S1 root compression. 18F-FDG PET/MRI demonstrated increased 18F-FDG uptake at the right L5 root, which was compatible with the patient's symptoms. Transforaminal percutaneous endoscopic lumbar discectomy (PELD) was performed. Intraoperative images revealed a swollen nerve root at the right L5 after removal of the herniated disc. After surgery, the patient experienced immediate pain relief and had no recurrence at the 6-month follow-up. When performing PELD in patients with multilevel radiculopathy identified on MRI, the use of 18F-FDG PET/MRI can help in accurate localization of the symptomatic roots and minimize surgical incision and soft-tissue injury.
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Affiliation(s)
- Chih-Ying Su
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
- Department of Radiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, Republic of China
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Wei-Chou Chang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
| | - Chih-Chien Wang
- Department of Orthopedic, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Chun-Wen Chen
- Department of Radiology, Taichung Armed Forces General Hospital, Taichung, Taiwan, Republic of China
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung City, Taiwan, Republic of China
- Department of Radiology, School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Chih Hsu
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec. 2, Cheng-kung Rd., Neihu Dist, 114 Taipei, Taiwan, Republic of China
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Qu L, Wang Y, Wang F, Zhang S. Surgical outcomes of percutaneous endoscopic lumbar discectomy in obese adolescents with lumbar disc herniation. BMC Musculoskelet Disord 2023; 24:710. [PMID: 37674144 PMCID: PMC10483719 DOI: 10.1186/s12891-023-06842-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023] Open
Abstract
In recent years, with improved living standards, adolescent obesity has been increasingly studied. The incidence of lumbar disc herniation (LDH) in obese adolescents is increasing yearly. No clinical studies have reported the use of percutaneous endoscopic lumbar discectomy (PELD) in obese adolescent lumbar disc herniation (ALDH) patients. This study evaluated the preliminary surgical outcomes of PELD in obese ALDH patients. Fifty-one ALDH patients underwent single-level PELD surgery between January 2014 and January 2020. Patients were divided into an obese group and a normal group. Patient characteristics and surgical variables were compared between the two groups. The VAS, ODI, and SF-36 scales were used preoperatively and postoperatively to evaluate the clinical efficacy. In this study, 19 patients were included in the obese group, and 28 were included in the normal group. There was no significant difference in age, sex, duration of low back pain, duration of leg pain, or operative level between the obese and normal groups preoperatively. The obese group had a longer operative time (OT) (101.9 ± 9.0 min vs. 84.3 ± 11.0 min, P < 0.001), more fluoroscopy exposures (41.0 ± 5.8 vs. 31.6 ± 7.0, P < 0.001) and a longer time to ambulation (29.9 ± 4.0 vs. 25.0 ± 2.9, p < 0.001) than the normal group. The groups did not significantly differ in complications. The VAS score for back and leg pain and the ODI and SF-36 score for functional status improved significantly postoperatively. The PELD procedure is a safe and feasible method for treating LDH in obese adolescents. Obese ALDH patients require a longer OT, more fluoroscopy exposures and a longer time to get out of bed than normal ALDH patients. However, PELD yields similar clinical outcomes in obese and normal ALDH patients.
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Affiliation(s)
- Lianjun Qu
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
- Department of Orthopedic Surgery, Sunshine Union Hospital, Weifang, Shandong Province China
| | - Yongli Wang
- Department of Anesthesiology, 80th Group Army Hospital, Weifang, Shandong Province China
| | - Fei Wang
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
| | - Songou Zhang
- Department of Orthopedic Surgery, Shaoxing People’s Hospital, School of Medicine, Zhejiang University, Zhejiang Province, China
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Zhang L, Zhang C, Song D, Chen G, Liu L. Combination of percutaneous endoscopic lumbar discectomy and platelet-rich plasma hydrogel injection for the treatment of lumbar disc herniation. J Orthop Surg Res 2023; 18:609. [PMID: 37605261 PMCID: PMC10440935 DOI: 10.1186/s13018-023-04093-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To determine the safety and efficacy of percutaneous endoscopic lumbar discectomy (PELD) combined with platelet-rich plasma (PRP) hydrogel injection in patients with lumbar disc herniation (LDH). METHODS A total of 98 consecutive patients with LDH who underwent either PELD combined with PRP hydrogel injection or PELD alone were reviewed. This retrospective study was performed between January 2019 and January 2021. Clinical outcomes were compared in the visual analog scale (VAS) for low back pain and leg pain, Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) scores, and Macnab criteria. Intervertebral disc height on MRI was measured, and the Pfirrmann grade classification was used pre-operatively and post-operatively. RESULTS No severe adverse events were reported during an 18-month follow-up period. VAS scores for back pain were decreased at 1 month, 3 months, and 18 months in the treatment group than that in the control group. JOA score and ODI in the treatment group at 3-month and 18-month follow-up was lower than that in the control group (P < 0.05). The excellent and good rate of the Macnab criteria was 92.0% (46/50) in the treatment group and 89.6% (43/48) in the control group (P > 0.05). The comparison of Pfirrmann grading and disc height at 18-month follow-up showed significant difference in two groups (P < 0.05). The recurrence of LDH in the treatment group was lower than that in the control group (P < 0.05). CONCLUSIONS We suggest that PELD combined with PRP hydrogel injection to treat patients with LDH is a safe and promising method. PRP injection was beneficial for disc remodelling after PELD.
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Affiliation(s)
- Lidong Zhang
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, 9 Yingbin Road, Suqian, 223600, China
| | - Chengliang Zhang
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, 9 Yingbin Road, Suqian, 223600, China.
| | - Dajiang Song
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, 9 Yingbin Road, Suqian, 223600, China
| | - Gang Chen
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, 9 Yingbin Road, Suqian, 223600, China
| | - Lei Liu
- Department of Orthopedics, The Affiliated Shuyang Hospital of Xuzhou Medical University, 9 Yingbin Road, Suqian, 223600, China
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10
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Balain B, Bhachu DS, Gadkari A, Ghodke A, Kuiper JH. 2nd and 3rd generation full endoscopic lumbar spine surgery: clinical safety and learning curve. Eur Spine J 2023; 32:2796-2804. [PMID: 37067601 DOI: 10.1007/s00586-023-07703-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
AIM 2nd and 3rd generation endoscopic spine surgery techniques offer visualisation of familiar inter-laminar anatomy to spinal surgeons. We have prospectively evaluated the clinical outcome, complications and learning curve associated with these techniques in patients with lumbar spine radiculopathy. METHODS This is a prospective study of 50 consecutive patients with radicular pain from disc herniation and/or lateral recess stenosis. In 6 patients, endoscopy couldn't be done. Operating times, PROM's (VAS, ODI and EQ-5D scores) and complication rates of 44 patients were evaluated after mean FU of 52 months (range 39-65). MRI was used to divide these into protrusions (n = 19), extrusions (n = 17) and lateral recess stenosis (n = 8). Evidence about the learning curve was gathered by curvilinear regression analyses. RESULTS Using a composite clinical success criterion, 95% patients had a successful outcome, with no major complications. ODI, VAS and EQ-5D scores had a statistically significant improvement and achieved MCID. Revision discectomy rate was only 4.5% (n = 2). MRI based grouping, case sequence and degree of difficulty influenced the duration of surgery and a learning curve was found for protrusions and lateral recess decompressions, but not for extrusions. A learning curve effect was also observed with respect to the ODI. CONCLUSIONS Although anatomy visualised in 2nd and 3rd generation endoscopy is familiar to spinal surgeons, our learning curve experience suggests a careful and MRI pathology based take up of this technique in clinical practice, despite its clinical safety in our series. LEVEL OF EVIDENCE Level 3, prospective cohort study.
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Affiliation(s)
- B Balain
- Centre for Spinal Disorders, Robert Jones and Agnes Hunt Orthoapedic Hospital, Oswestry, Shropshire, SY107AG, UK.
| | - Davinder Singh Bhachu
- Centre for Spinal Disorders, Robert Jones and Agnes Hunt Orthoapedic Hospital, Oswestry, Shropshire, SY107AG, UK
| | - A Gadkari
- Centre for Spinal Disorders, Robert Jones and Agnes Hunt Orthoapedic Hospital, Oswestry, Shropshire, SY107AG, UK
| | - A Ghodke
- Centre for Spinal Disorders, Robert Jones and Agnes Hunt Orthoapedic Hospital, Oswestry, Shropshire, SY107AG, UK
| | - J H Kuiper
- Centre for Spinal Disorders, Robert Jones and Agnes Hunt Orthoapedic Hospital, Oswestry, Shropshire, SY107AG, UK
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Jitpakdee K, Liu Y, Kim YJ, Kotheeranurak V, Kim JS. Factors associated with incomplete clinical improvement in patients undergoing transforaminal endoscopic lumbar discectomy for lumbar disc herniation. Eur Spine J 2023:10.1007/s00586-023-07636-1. [PMID: 36917301 DOI: 10.1007/s00586-023-07636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 11/22/2022] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
PURPOSES To analyze the clinical and radiographic risk factors that might predict incomplete clinical improvement after transforaminal endoscopic lumbar discectomy (TELD). METHODS A retrospective analysis was conducted from 194 consecutive patients who underwent TELD due to lumbar disc herniation (LDH). Patients with incomplete clinical improvement were defined from patient-reported outcomes of poor improvement in pain or disability after surgery and patient dissatisfaction. Clinical and radiographic characteristics were evaluated to identify predicting factors of poor outcomes. RESULTS Of 194 patients who underwent TELD procedures, 32 patients (16.5%) had incomplete clinical improvement and 12 patients (6.1%) required revision surgery. The mean ages were 46.4 years and most of the patients suffered from predominant leg pain (48.9%). The most common surgical level was L4-5 (63.9%). Overall, the Oswestry Disability Index (44.3-15), visual analog scores of back pain (4.9-1.8) and leg pain (7.3-1.6) were significantly improved after surgery. Multivariate logistic regression analysis demonstrated that high body mass index, history of previous surgery, preoperative disability, weakness, and disc degeneration were related to incomplete clinical improvement. There were 15 recurrent LDH (7.7%) with a total of 12 revision surgeries (6.2%). CONCLUSIONS We identified independent risk factors associated with incomplete clinical improvement following TELD, including overweight, significant preoperative disability or weakness and history of previous surgery. Advanced age, disc degeneration, vacuum phenomenon, and spondylolisthesis were also possible risk factors. Recognizing these risk factors would help decide whether patients are good candidates for TELD, and optimize the surgical planning preoperatively to achieve good surgical results.
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Affiliation(s)
- Khanathip Jitpakdee
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Chonburi, Thailand
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yanting Liu
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Jin Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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12
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Chen X, Li Y, Wang W, Cui P, Wang Y, Lu S. Correlation between inflammatory cytokine expression in paraspinal tissues and severity of disc degeneration in individuals with lumbar disc herniation. BMC Musculoskelet Disord 2023; 24:193. [PMID: 36918849 PMCID: PMC10012494 DOI: 10.1186/s12891-023-06295-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/06/2023] [Indexed: 03/15/2023] Open
Abstract
PURPOSE Previous animal studies have discovered dysregulation of the local inflammatory state as a novel mechanism to explain structural changes in paraspinal muscles in association with disc degeneration. This study aimed to determine whether the expression of inflammatory genes in the multifidus muscle (MM) differs between individuals with disc degeneration and non-degeneration, which may cause changes in the cross-sectional area (CSA) of paraspinal muscles and clinical outcomes. METHODS Muscles were procured from 60 individuals undergoing percutaneous endoscopic lumbar discectomy for lumbar disc herniation (LDH). Total and functional CSAs and fatty degeneration of paraspinal muscles on ipsilateral and unilateral sides were measured. Gene expression was quantified using qPCR assays. Paired t-test and Pearson's correlation analysis were used to compare the mean difference and associations, respectively. RESULTS There were significant differences in total CSAs of paraspinal muscles and functional CSA and fatty degeneration of MM between ipsilateral and unilateral sides. Participants in the disc degeneration group displayed higher fat infiltration in MM. The expression of TNF was moderately correlated with total CSAs of paraspinal muscles and functional CSA and fatty degeneration of MM. The expression of IL-1β was strongly correlated with the total and functional CSA of MM. The expression of TGF-β1 was moderately correlated with the functional CSA of MM. The expression of TNF, IL-1β, and TGF-β1 was moderate to strongly correlated with clinical outcomes. CONCLUSION The results show that there were differences in the characteristics of paraspinal muscles between the ipsilateral and unilateral sides, which were affected by disc degeneration and the degree of fat infiltration. High-fat filtration and reduction of CSA of MM are associated with inflammatory dysfunction. There was evidence of a dysregulated inflammatory profile in MM in individuals with poor clinical outcomes.
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Affiliation(s)
- Xiaolong Chen
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China.
| | - Yongjin Li
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China
| | - Wei Wang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China
| | - Peng Cui
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China
| | - Yu Wang
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China
| | - Shibao Lu
- Department of Orthopaedics, Xuanwu Hospital Capital Medical University, Changchun Street 45, Xicheng District, 100032, Beijing, China.
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Zhong D, Ke ZY, Chen Q, Liu Y, Lin L, Wang Y. A clinical nomogram for predicting the residual low back pain after percutaneous endoscopic surgery for lumbar disc herniation. Int Orthop 2023; 47:819-30. [PMID: 36542140 DOI: 10.1007/s00264-022-05658-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Current findings suggest that minimally percutaneous endoscopic lumbar discectomy (PELD) is a practical therapeutic approach for lumbar disc herniation (LDH). However, some patients still end up with residual low back pain, even after surgery. Our study aims to construct and validate a nomogram to predict residual low back pain after PELD. METHODS The medical records of 355 LDH patients admitted to the author's hospital were retrospectively analyzed between January 2019 and December 2021. The patients were randomly divided into two groups with a ratio of 7:3, namely a modelling group and a validation group. The univariable logistics and multivariable regression methods were used to screen the independent risk factors. A nomogram was then drawn using independent risk factors selected from the univariable and multivariable regression analyses. The concordance index (C-index), the receiver operating characteristic (ROC) curve, the calibration curve, and the decision curve analysis were used to evaluate the nomogram's performance. Finally, the accuracy of the nomogram was verified by a validation cohort. RESULTS 36.6% (130/355) of patients showed low back pain after percutaneous endoscopic lumbar discectomy, while 63.4% (225/355) showed no symptoms. Multivariable logistical regression analysis showed that Modic change (p < 0.05, OR = 1.813), fatty infiltration of the paravertebral muscle (p < 0.05, OR = 2.935), and edema of lumbodorsal fascia (p = 0.049, OR = 1.611) were significant risk factors for post-operative residual back pain. Moreover, the C-index of the predictive nomogram was 0.743 (0.681-0.805), the area under the receiver operating characteristic curve (AUC) value was 0.739, and the DCA results exhibit a net benefit between 0.16 and 0.66. The above internal validation methods demonstrate the nomogram's good predictive capability. CONCLUSION Each variable in the model had a quantitatively corresponding risk score, which can be used in predicting residual low back pain after PELD.
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Yang J, Liu R, Miao Y, Nian L, Meng X. Risk Factors for Recurrence After Percutaneous Endoscopic Lumbar Discectomy: A Meta-Analysis. World Neurosurg 2023; 172:88-93. [PMID: 36764451 DOI: 10.1016/j.wneu.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Postoperative recurrence of percutaneous endoscopic lumbar disc increases the physical damage and financial burden on patients and negatively affects physicians' treatment decisions. We conducted this meta-analysis to explore the risk factors for postoperative recurrence of percutaneous endoscopic lumbar disc for lumbar disc herniation. METHODS We conducted article search in the PubMed, EMBASE and Cochrane Library databases. PRISMA guidelines were followed in this review. The data are statistically analyzed by the Roundup Manager (version 3.6.1). The results of the meta-analysis are presented in the form of forest-like plots. RESULTS We included 13 articles and identified 7524 cases. Patients with older age (odds ratio [OR] = 1.28, 95% confidence interval [CI]: 1.18-1.40), higher body mass index (OR = 1.16, 95% CI: 1.05-1.28), smoker (OR = 1.73, 95% CI: 0.95-3.15), degenerative grades ≥3 (OR = 6.07, 95% CI: 2.81-13.11), and postoperative sagittal motion ≥10° (OR = 2.42, 95% CI: 1.63-3.58) have a higher recurrence rate. CONCLUSIONS A thorough preoperative evaluation is essential to prevent postoperative recurrence of percutaneous endoscopic lumbar discectomy. The study addresses several factors of preoperative evaluation, which is hopeful to provide a reference for neurosurgeons.
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Affiliation(s)
- Jiameng Yang
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Rui Liu
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China.
| | - Yu Miao
- Department of Ultrasound, The Third Hospital of BaoGang Group, Baotou City, Inner Mongolia, China
| | - Liwei Nian
- Department of Orthopedics, Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Xiaotao Meng
- Department of Ultrasound, The Third Hospital of BaoGang Group, Baotou City, Inner Mongolia, China
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He H, Ma J, Xiong C, Wei T, Tang A, Chen Y, Xu F. Development and Validation of a Nomogram to Predict the Risk of Lumbar Disk Reherniation within 2 Years After Percutaneous Endoscopic Lumbar Discectomy. World Neurosurg 2023; 172:e349-e356. [PMID: 36640832 DOI: 10.1016/j.wneu.2023.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To develop and validate a nomogram for predicting recurrent lumbar disk herniation (LDH) within 2 years after percutaneous endoscopic lumbar discectomy. METHODS Information on patients' LDH was collected from 1 medical center between January 2015 and September 2020. The LASSO (least absolute shrinkage and selection operator) method was applied to select the most significant risk factors. A multivariate logistic regression analysis was used to develop a predictive model incorporating the possible factors selected by the LASSO regression model. The discriminant, corrected, and clinically useful prediction models were evaluated using consistency index (C-index), receiver operating characteristic curve, calibration curves, and decision curve analysis. Internal validation of clinical predictive power was also assessed by bootstrap validation. RESULTS A total of 690 patients with LDH were included in this study. Sixty-three patients experienced recurrence within 2 years whereas 627 experienced no recurrence. The nomogram predictors included age, body mass index, Modic change, Pfirrmann grade, and sagittal range of motion. The model had good discrimination power, with a reliable C-index of 0.868 (95% confidence interval, 0.822-0.913) and interval validation confirmed a higher C-index value of 0.846. The area under the receiver operating characteristic curve was 0.868, indicating a good predictive value. The decision curve analysis indicated that it was clinically feasible to use the predictive recurrence nomogram model. CONCLUSIONS We developed and validated a new accurate and effective nomogram for predicting recurrent LDH within 2 years after percutaneous endoscopic lumbar discectomy. Age, body mass index, Modic change, Pfirrmann grade, and sagittal range of motion were significant features for predicting rLDH.
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Affiliation(s)
- Hang He
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Jun Ma
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Chengjie Xiong
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Tanjun Wei
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Aolin Tang
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Yongkang Chen
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Feng Xu
- Departments of Orthopaedics, General Hospital of Central Theater Command of PLA, Wuhan, China.
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Wang Z, Tan Y, Fu K, Meng Z, Wang L. Minimally invasive trans-superior articular process percutaneous endoscopic lumbar discectomy with robot assistance. BMC Musculoskelet Disord 2022; 23:1144. [PMID: 36587190 PMCID: PMC9805262 DOI: 10.1186/s12891-022-06060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/06/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To compare the clinical outcomes of patients with lumbar disc herniation treated with robot-assisted percutaneous endoscopic lumbar discectomy (r-PELD) or conventional PELD under fluoroscopy guidance (f-PELD). METHODS Our study group included 55 patients, 22 in the r-PELD group and 33 in the f-PELD group. The following clinical and surgical outcomes were compared between the two groups: the visual analog scale for radiculopathy pain; Oswestry Disability Index; intraoperative volume of blood loss; frequency of fluoroscopy used during the procedure; and MacNab classification. The follow-up period was 6-8 months. RESULTS Compared with f-PELD, r-PELD was associated with a lower volume of intraoperative blood loss and frequency of fluoroscopy (p < 0.01). There were no differences in complications, MacNab classification, postoperative disability and leg pain, and duration of hospitalization between the two groups. CONCLUSION Based on our findings, r-PELD provides a safe and effective alternative to conventional PELD for the treatment of lumbar disc herniations, with the accuracy for placement of punctures lowering radiation exposure.
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Affiliation(s)
- Zongjiang Wang
- grid.411176.40000 0004 1758 0478Department of Spinal Surgery, Sunshine Union Hospital, No. 9000, Yingqian street, Gaoxin District, 261041 Weifang City, Shandong Province China
| | - Ying Tan
- grid.461885.6Department of Spinal Surgery, Weifang Traditional Chinese Medicine Hospital, 261041 Weifang, China
| | - Kai Fu
- grid.411176.40000 0004 1758 0478Department of Spinal Surgery, Sunshine Union Hospital, No. 9000, Yingqian street, Gaoxin District, 261041 Weifang City, Shandong Province China
| | - Zhaowu Meng
- grid.411176.40000 0004 1758 0478Department of Spinal Surgery, Sunshine Union Hospital, No. 9000, Yingqian street, Gaoxin District, 261041 Weifang City, Shandong Province China
| | - Liang Wang
- grid.411176.40000 0004 1758 0478Department of Spinal Surgery, Sunshine Union Hospital, No. 9000, Yingqian street, Gaoxin District, 261041 Weifang City, Shandong Province China
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Cho WJ, Kim KW, Park HY, Kim BH, Lee JS. Segmental artery injury during transforaminal percutaneous endoscopic lumbar discectomy: Two case reports. World J Clin Cases 2022; 10:12345-12351. [PMID: 36483795 PMCID: PMC9724518 DOI: 10.12998/wjcc.v10.i33.12345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since Kambin experimentally induced arthroscopy to treat herniated nucleus pulposus, percutaneous endoscopic lumbar discectomy (PELD) has been developed. The branch of the segmental artery around the neural foramen may be damaged during PELD using the transforaminal approach. We report 2 rare cases in which segmental artery injury that occurred during PELD was treated with emergency embolization.
CASE SUMMARY In case 1, a 31-year-old man was transferred to our emergency department with left lower quadrant abdominal pain after PELD at a local hospital. Lumbar spine magnetic resonance imaging after the surgery showed a hematoma of the left retroperitoneal area and the psoas muscle area. Under suspicion of vascular injury, arteriography was performed. Pseudoaneurysm and blood leakage from the left 4th lumbar segmental artery into the abdominal cavity were identified. Emergency transarterial embolization was performed using fibered microcoils for bleeding of the segmental artery. In case 2, a 75-year-old woman was transferred to our emergency department with low blood pressure, right flank pain, and drowsy mental status after PELD at a local hospital. When the patient arrived at the emergency room, the blood pressure decreased from 107/55 mmHg to 72/47 mmHg. Low blood pressure persisted. Under suspicion of vessel injury, arteriography was performed, and the right 4th lumbar segmental artery rupture was confirmed. Emergency transarterial embolization was performed for bleeding of segmental artery.
CONCLUSION We were able to find the bleeding focus by angiography and treat the injury of the segmental artery successfully through emergency transarterial embolization.
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Affiliation(s)
- Wan-Jae Cho
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 07345, South Korea
| | - Ki-Won Kim
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 07345, South Korea
| | - Hyung-Youl Park
- Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 03312, South Korea
| | - Bo-Hyoung Kim
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 07345, South Korea
| | - Jun-Seok Lee
- Department of Orthopedic Surgery, Eunpyeong St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul 03312, South Korea
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Park SC, Kang MS, Yang JH, Ju W. How I do it: biportal endoscopic paraspinal approach for recurrent lumbar disc herniation following percutaneous endoscopic lumbar discectomy. Acta Neurochir (Wien) 2022; 164:3057-3060. [PMID: 36151330 DOI: 10.1007/s00701-022-05368-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although percutaneous endoscopic lumbar discectomy (PELD) has been popularized as an alternative to microscopic lumbar discectomy, it has been reported to be associated with a re-herniation rate of 5-11%. Recurrent lumbar disc herniation (RLDH) might occur not only at the same level previously operated upon but also at the annular penetration site created during PELD procedures. METHOD Biportal endoscopic paraspinal approach (BE-Para) was used for revisional foraminal lumbar discectomy. Procedures and some discussions regarding indications, advantages, potential complications, and ways to avoid complications were described. CONCLUSION BE-Para may be an effective modality for RLDH after PELD.
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Affiliation(s)
- Sung Cheol Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Inchonro 73, Seongbukgu, Seoul, 02841, Republic of Korea
| | - Min-Seok Kang
- Department of Orthopedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Inchonro 73, Seongbukgu, Seoul, 02841, Republic of Korea.
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Inchonro 73, Seongbukgu, Seoul, 02841, Republic of Korea
| | - Wonjik Ju
- Department of Orthopedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Inchonro 73, Seongbukgu, Seoul, 02841, Republic of Korea
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Yuan S, Wu Q, Zang L, Fan N, Du P, Wang A, Wang T, Si F, Li J, Kong X. Posterior Apophyseal Ring Fracture in Adult Lumbar Disc Herniation: An 8-Year Experience in Minimally Invasive Surgical Management of 48 Cases. Neurospine 2022; 19:586-593. [PMID: 36203285 PMCID: PMC9537851 DOI: 10.14245/ns.2244346.173] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/13/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Posterior apophyseal ring fracture (PARF) is an uncommon disorder that is usually accompanied by lumbar disc herniation (LDH). The aim of this study to describe the 8-year experience of performing minimally invasive treatment of PARF, giving particular attention to surgical technique and clinical outcome. METHODS We reviewed 1,324 consecutive patients with LDH seen in our department between 2013 and 2020. Forty-eight patients (3.63%) were enrolled who were diagnosed with PARF associated with LDH and underwent transforminal endoscopic lumbar discectomy (TELD). Mean duration of the final postoperative follow-up was 5.1 years. The control group was comprised of 50 patients diagnosed with LDH without PARF at the same facility. Data on clinical outcomes were analyzed. RESULTS The mean operation time in the PARF group was 105.4 minutes, which was longer than the mean operation time of the control group (83.9 minutes) (p = 0.001). Surgical complications, including dural tears (6.3%) and surgical instrument rupture (4.2%) were more common in the PARF group (p = 0.025). However, there was no significant difference in the proportion of excellent and good results and recurrence rates between the LDH patients with and those without PARF, respectively. CONCLUSION TELD is a safe and effective minimally invasive approach for the treatment of PARF. However, minimally invasive techniques may require longer operation time and steeper learning curve for inexperienced surgeons. The separation and removal of bone fragments, a key step in the procedure, requires patience and care to prevent rupture, residual surgical instruments, and leakage of cerebrospinal fluid.
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Affiliation(s)
- Shuo Yuan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Qichao Wu
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lei Zang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China,Corresponding Author Lei Zang Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100043, China
| | - Ning Fan
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Du
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Aobo Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Tianyi Wang
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fangda Si
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jian Li
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaochuan Kong
- Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Wang H, Yuan H, Yu H, Li C, Zhou Y, Xiang L. Percutaneous Endoscopic Lumbar Discectomy Using a Double-Cannula Guide Tube for Large Lumbar Disc Herniation. Orthop Surg 2022; 14:1385-1394. [PMID: 35656704 PMCID: PMC9251283 DOI: 10.1111/os.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/28/2022] Open
Abstract
Objective To compare the effect of percutaneous endoscopic lumbar discectomy (PELD) using a double‐cannula guide tube (DGT), traditional PELD, and open lumbar discectomy (OLD) to treat large lumbar disc herniations (LLDHs). Methods Seventy patients who presented with LLDH without cauda equina syndrome and were treated with surgery in our hospital from October 2015 to October 2017 were included. The detailed index included the visual analog scale (VAS) for back and radicular leg pain and the Oswestry Disability Index (ODI) in the immediate preoperative period and at the final follow‐up. The operation time, radiation exposure time, surgical satisfaction rate, and modified MacNab criteria score were also recorded. Results The leg and back pain of the patients in these groups improved significantly in the postoperative period. No significant differences were observed in leg pain improvement between the other two groups; however, patients in the PELD group (with or without DGT) presented with significantly higher improvement in back pain than the OLD group (t = 9.965, p < 0.001). The final ODI scores were 12.1 ± 4.9, 11.2 ± 2.9, and 16.4 ± 3.6 in the PELD, PELD‐DGT, and OLD groups, respectively. Patients in the PELD and PELD‐DGT groups presented with significantly lower postoperative ODI scores than those in the OLD group (t = 20.834, p < 0.001). The mean postoperative hospital stays were significantly shorter in the PELD group and PELD with DGT group than in the OLD group (t = 46.688, p < 0.001). The mean operation time was significantly shorter in the PELD‐DGT group than those in the PELD group (t = 25.281, p = 0.001). No perioperative complications were observed in either group. Based on the modified MacNab criteria, excellent and good outcomes were achieved in 20 out of 21 patients (95.2%) in the PELD group, 23 out of 24 patients (95.8%) in the PELD‐DGT group, and 22 out of 25 patients (88.0%) in the OLD group. The rates of excellent and good outcomes were higher in the PELD and PELD‐DGT groups than in the OLD group, but there were no significant differences (χ2 = 1.454, p = 0.835). Conclusions PELD using DGT is a safe and effective option for LLDH and features advantages such as improvements in back pain, a lower hospitalization cost than OLD, a shorter operation time, and less fluoroscopy than traditional PELD.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China.,State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Science, Shenyang, China.,Department of Orthopedics, Xinqiao Hospital, the Army Medical University, Chongqing, China
| | - Hong Yuan
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, the Army Medical University, Chongqing, China
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, the Army Medical University, Chongqing, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Northern Theater Command of Chinese PLA, Shenyang, China
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21
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Zhu H, Hussain Z, Zhang M, Ji F, Mao H, Li H, Chen H. Percutaneous Endoscopic Lumbar Discectomy for Lumbar Disc Herniation With Type II Modic Changes. World Neurosurg 2022; 164:e143-e149. [PMID: 35489597 DOI: 10.1016/j.wneu.2022.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has become a favorable surgical approach for lumbar radiculopathy caused by intervertebral disc herniation. Studies have revealed patients with type II Modic change may suffer from unrelieved low back pain and higher lumbar disc herniation (LDH) recurrence after herniated nucleus pulposus removal. Therefore, in this study, we aim to evaluate how PELD performed in management of LDH patients with type II Modic change. METHODS We collected 267 single-level LDH cases aged 20-50 yearswho underwent PELD from December 2016 to December 2019. The mean follow-up time was 26.3 months (range: 12-48 months). The visual analog scale (VAS), Oswestry Disability Index (ODI), and MacNab scores, as well as the recurrence rate, were analyzed pre- and post-surgery, as well as at the time points of 3 months, 12 months, and the final follow-up time after surgery. The clinical outcomes in LDH patients with or without type II Modic change who underwent PELD were thoroughly analyzed. RESULTS Within the 267 LDH patients enrolled, 145 cases present Modic signals, among which 3 are type I and 142 are type II. The VAS and ODI scores of the patients in the 2 groups at different follow-up times were significantly lower than those before surgery. The excellent and good MacNab scores in the control group and Modic type II change group were 87.0% and 82.1%, respectively. However, with the extension of follow-up time, the VAS and ODI scores, as well as the recurrence rate, were found to be higher in the type II Modic change group when compared with those in the non-Modic change group. CONCLUSIONS PELD performed well in management of LDH patients. However, we need to pay more attention to the continuous low back pain and the recurrence possibility in the cases with type II Modic change. In these cases, longer brace support or other interventions could be applied.
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Affiliation(s)
- Hai Zhu
- Department of Orthopedic Surgery, The Affiliated Huaian First People's Hospital of Nanjing Medical University, Huaian, China
| | - Zakir Hussain
- Department of Orthopedic Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Meng Zhang
- Department of Orthopedic Surgery, The Affiliated Huaian First People's Hospital of Nanjing Medical University, Huaian, China
| | - Feng Ji
- Department of Orthopedic Surgery, The Affiliated Huaian First People's Hospital of Nanjing Medical University, Huaian, China
| | - Haiqing Mao
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hanwen Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Chen
- Department of Orthopedic Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou, China.
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22
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Chen C, Sun X, Liu J, Ma X, Zhao D, Yang H, Liu G, Xu B, Wang Z, Yang Q. Targeted fully endoscopic visualized laminar trepanning approach under local anaesthesia for resection of highly migrated lumbar disc herniation. Int Orthop 2022; 46:1627-1636. [PMID: 35474397 DOI: 10.1007/s00264-022-05401-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To introduce a new fully endoscopic visualized laminar trepanning approach with a periendoscopic trephine under local anesthesia for resection of highly migrated lumbar disc herniation (LDH) and report the clinical outcomes of one year follow-up. METHODS Twenty-one patients with highly migrated LDH who underwent percutaneous endoscopic lumbar discectomy via the laminar trepanning approach from June 2019 to August 2020 were retrospectively reviewed. Patient-Reported Outcomes Measurement Information System (PROMIS) Short Forms-Pain Interference (PI) and Physical Function (PF) were selected as outcome measures. The operating duration and complication were documented. RESULTS The average age of the 21 patients (15 males, 6 females) was 37.8 ± 6.0 years (29-52 years). Disc migration originated from L4/5 in 19 patients, L5/S1 in two patients. The mean operative duration was 54.1 ± 9.0 minutes (42-79 min). All patients were followed up to 12 months after the operation. PROMIS PI T-scores decreased significantly from pre-operatively mean 68.6 ± 2.4 to 54.4 ± 1.9 (P < 0.001) and 47.1 ± 4.3 (P < 0.001) at six weeks and 12 months, respectively. PROMIS PF T-scores improved significantly from pre-operatively mean 26.7 ± 4.7 to 44.3 ± 4.2(P < 0.001) and 58.4 ± 4.0 (P < 0.001) at six weeks and 12 months, respectively. No complications and disc herniation recurrences occurred. CONCLUSION The targeted full endoscopic laminar trepanning under local anesthesia with a visualized periendoscopic trephine offers a safe, efficient and cost-effective option for the resection of highly migrated LDH.
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Affiliation(s)
- Chao Chen
- Clinical School/College of Orthopedics, Tianjin Medical University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China.,Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China
| | - Xun Sun
- Clinical School/College of Orthopedics, Tianjin Medical University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China.,Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China
| | - Jie Liu
- Clinical School/College of Orthopedics, Tianjin Medical University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China
| | - Xinlong Ma
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China
| | - Dong Zhao
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China
| | - Haiyun Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China
| | - Gang Liu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China
| | - Baoshan Xu
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China
| | - Zheng Wang
- Department of Orthopedics, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China.
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin University, No. 406 Jiefangnan Road, Hexi District, Tianjin, 300211, China.
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23
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Hu W, Hu F, Liu C, Liu W, Jiang Y, Li J, Wang Y, Li T, Li L, Zhang X. A Comparison Between Retaining and Resecting the Posterior Longitudinal Ligament in Percutaneous Endoscopic Transforaminal Discectomy for Disc Herniation: A Retrospective Cohort Study. Orthop Surg 2022; 14:892-901. [PMID: 35445546 PMCID: PMC9087450 DOI: 10.1111/os.13257] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/23/2022] [Accepted: 02/18/2022] [Indexed: 01/03/2023] Open
Abstract
Objective To compare the efficacy and safety of retaining the posterior longitudinal ligament (PLL) with resecting the PLL in inside‐out percutaneous endoscopic transforaminal discectomy (PETD) surgery for lumbar disc herniation (LDH). Method A total of 135 patients with symptomatic LDH who were treated by inside‐out PETD surgery from January 2015 to January 2017were included in this retrospective analysis. There were 38 males and 30 females in the PLL resection group (mean age = 52.40 ± 8.73 years) and 35 males and 32 females in the PLL retention group (mean age = 53.50 ± 9.24 years). The visual analogue scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria were used to evaluate clinical outcomes. Operation time, blood loss, recurrence of LDH, and complications were recorded. Three months after surgery, magnetic resonance imaging was performed to confirm that nerve root compression was relieved. Results The VAS and ODI scores improved significantly immediately after surgery, at 1 month after surgery, at 3 months after surgery, and at last follow‐up compared with those before surgery (P < 0.01). The scores also improved significantly between immediately after surgery and 1 month after surgery in the two groups (P < 0.001). Multivariate analysis indicated that age ≥ 50 years (odds ratio (OR) = 6.33, 95% confidence interval (CI): 1.64–21.98, P = 0.014), pain duration ≥6 months (OR = 4.68, 95% CI: 1.29–6.51, P = 0.025), pre‐ODI score ≥ 40% (OR = 5.97, 95% CI: 2.41–14.86, P = 0.003) were all associated with poor functional outcomes. There was no significant difference in the excellent/good ratio between the two groups and the mean operation time of the retention group was 71.5% of that of the resection group (82.7 ± 18.5 min vs 115.6 ± 24.6 min, P < 0.01). In the patients, no serious complications, such as dural tear, wound infection, or persistent nerve root injury, were observed during the follow‐up period. There was no significant difference in the complication rate between the two groups (6/68 vs 6/67, P = 0.979). Although the recurrence rate was higher in retention group, there was no significant difference between the two groups (1/68 vs 2/67, P = 0.551). Conclusion The PLL is recommended to be retained for inside‐out PETD surgery.
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Affiliation(s)
- Wenhao Hu
- Department of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fanqi Hu
- Department of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chao Liu
- Department of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Weibo Liu
- Department of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yi Jiang
- The Scientific Research Office, Chinese PLA General Hospital, Beijing, China
| | - Jing Li
- Department of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yan Wang
- Department of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Teng Li
- Department of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li Li
- Department of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xuesong Zhang
- Department of Orthopaedics, The Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
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Jiang HW, Chen CD, Zhan BS, Wang YL, Tang P, Jiang XS. Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study. J Orthop Surg Res 2022; 17:30. [PMID: 35033143 PMCID: PMC8760683 DOI: 10.1186/s13018-022-02929-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/06/2022] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Hao-Wei Jiang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Cheng-Dong Chen
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Bi-Shui Zhan
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Yong-Li Wang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Pan Tang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China
| | - Xue-Sheng Jiang
- Department of Orthopaedics, Huzhou Central Hospital, No.1558, Sanhuan North Road, Wuxing District, Huzhou, 313000, Zhejiang Province, China.
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25
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Lyu Z, Bai J, Chen S, Liu J, Yu W. Efficacy of lumbar kinetic chain training for staged rehabilitation after percutaneous endoscopic lumbar discectomy. BMC Musculoskelet Disord 2021; 22:793. [PMID: 34525980 PMCID: PMC8444361 DOI: 10.1186/s12891-021-04674-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) is a promising minimally invasive treatment for lumbar disc herniation (LDH). Postoperative rehabilitation can improve patient outcomes. Not only rehabilitation for surgical trauma but also rehabilitation for lumbar spine and lower kinetic chain dysfunction should be performed. The aims of this study were to investigate the efficacy of a lumbar kinetic chain training for staged rehabilitation after PELD for LDH. METHODS Fifty one LDH patients treated with PELD were studied. After surgery, patients underwent lumbar kinetic chain training for staged rehabilitation( staged group) or regular low back rehabilitation (regular group). The staged rehabilitation programme included three phases from 2 to 6, 7-12, and 13-24 weeks postoperatively, and different physical therapies were performed during these phases. The low back pain visual analogue scale (VAS), JOA score, ODI, SF-36, and cross-sectional area of the lumbar multifidus on MRI were assessed, and gait analysis was performed. RESULTS Twenty five patients in staged group and twenty six patients in regular group were included. There were no significant differences in age or sex between the two groups at baseline (p > 0.05). The VAS score decreased and the JOA and SF-36 scores increased in both groups from baseline to 6 weeks (P < 0.05). In the staged group, compared with the regular group, the VAS and ODI scores were lower and the JOA and SF-36 scores were higher at 6 weeks (P < 0.05); the VAS and ODI scores were lower and the SF-36 score was higher at 12 weeks (P < 0.05); the SF-36 score was higher at 24 weeks (P < 0.05); the cross-sectional area of the lumbar multifidus showed no differences at 12 weeks (P > 0.05); and the left-right support ratio of gait was higher at 24 weeks (P < 0.05). CONCLUSIONS The staged rehabilitation programme for LDH after PELD promoted postoperative recovery, and the efficacy of lumbar kinetic chain training was higher than that of regular low back muscle exercise.
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Affiliation(s)
- Zhen Lyu
- Department of Spine and Spinal Cord Surgery, Beijing Bo'ai Hospital, Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, 10th JiaoMen North Road, Fengtai District, Beijing, China
| | - Jinzhu Bai
- Department of Spine and Spinal Cord Surgery, Beijing Bo'ai Hospital, Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, 10th JiaoMen North Road, Fengtai District, Beijing, China.
| | - Shizheng Chen
- Department of Spine and Spinal Cord Surgery, Beijing Bo'ai Hospital, Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, 10th JiaoMen North Road, Fengtai District, Beijing, China
| | - Jiesheng Liu
- Department of Spine and Spinal Cord Surgery, Beijing Bo'ai Hospital, Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, 10th JiaoMen North Road, Fengtai District, Beijing, China
| | - Wenlong Yu
- Department of Physical Therapy, Beijing Bo'ai Hospital,China Rehabilitation Research Center, School of Rehabilitation, Capital Medical University, Beijing, China
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26
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Chen F, Xin J, Su C, Liu X, Cui X. Pain Variability of Tissues Under Endoscope in Percutaneous Endoscopic Lumbar Discectomy and Its Significance: A Retrospective Study. Pain Physician 2021; 24:E877-E882. [PMID: 34554708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD), as a representative minimally invasive spine surgery technique for lumbar disc herniation (LDH), has been standardized. In PELD, tissues such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate were exposed, removed, and decompressed. However, during PELD, whether there is pain or not in the tissues under endoscope in LDH patients has never been thoroughly discussed in the previous research. OBJECTIVES The purpose of the study is to evaluate tissue pain variability during PELD as for the treatment of LDH, to provide references and guideline for the operation, and to give humanistic care for patients. STUDY DESIGN A retrospective analysis. SETTING All data were collected from Shandong Provincial Hospital Affiliated to Shandong First Medical University. METHODS From January 2008 to December 2020, 3,600 patients with LDH were enrolled in this retrospective study. All patients suffered from low back and leg pain because of LDH and underwent PELD. The pain of these tissues under endoscope was assessed according to the Visual Analog Scale (VAS) scores for the back and legs (VAS-B and VAS-L, respectively). RESULTS For VAS-B, the tissues were ranked from the highest VAS scores to the lowest in the following order: posterior longitudinal ligament; next, dural sac/nerve root; then, endplate/annulus fibrosus/ligamentum flavum. For VAS-L, they were in the following order: dural sac/nerve root; next, posterior longitudinal ligament; then, endplate/annulus fibrosus/ligamentum flavum. LIMITATIONS Retrospective nature of data collection. CONCLUSIONS Tissues, such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate, have different kinds of pain in PELD for LDH.
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Affiliation(s)
- Feifei Chen
- Shandong Provincial Hospital, Jinan, PR China
| | - Jun Xin
- Shandong Province Hospital, Shandong University School of Medicine: Shandong University Cheeloo College of Medicine, Jinan, PR China
| | - Cheng Su
- Shandong First Medical University,Tai'an Campus, Jinan, PR China
| | | | - Xingang Cui
- Shandong Provincial Hospital, Shandong University, Shandong Province, China
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27
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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28
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Jia M, Sheng Y, Chen G, Zhang W, Lin J, Lu S, Li F, Ying J, Teng H. Development and validation of a nomogram predicting the risk of recurrent lumbar disk herniation within 6 months after percutaneous endoscopic lumbar discectomy. J Orthop Surg Res 2021; 16:274. [PMID: 33882995 PMCID: PMC8059294 DOI: 10.1186/s13018-021-02425-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/14/2021] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To develop and validate a nomogram useful in predicting recurrent lumbar disk herniation (rLDH) within 6 months after percutaneous endoscopic lumbar discectomy (PELD). METHODS Information on patients' lumbar disk herniation (LDH) between January 2018 and May 2019 in addition to 26 other features was collected from the authors' hospital. The least absolute shrinkage and selection operator (LASSO) method was used to select the most important risk factors. Moreover, a nomogram was used to build a prediction model using the risk factors selected from LASSO regression. The concordance index (C-index), the receiver operating characteristic (ROC) curve, and calibration curve were used to assess the performance of the model. Finally, clinical usefulness of the nomogram was analyzed using the decision curve and bootstrapping used for internal validation. RESULTS Totally, 352 LDH patients were included into this study. Thirty-two patients had recurrence within 6 months while 320 showed no recurrence. Four potential factors, the course of disease, Pfirrmann grade, Modic change, and migration grade, were selected according to the LASSO regression model. Additionally, the C-index of the prediction nomogram was 0.813 (95% CI, 0.726-0.900) and the area under receiver operating characteristic curve (AUC) value was 0.798 while the interval bootstrapping validation C-index was 0.743. Hence, the nomogram might be a good predictive model. CONCLUSION Each variable, the course of disease, Pfirrmann grade, Modic change, and migration grade in the nomogram had a quantitatively corresponding risk score, which can be used in predicting the overall recurrence rate of rLDH within 6 months.
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Affiliation(s)
- Mengxian Jia
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yadong Sheng
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Guoliang Chen
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wenbin Zhang
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiajin Lin
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Sheng Lu
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fayi Li
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinwei Ying
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Honglin Teng
- Department of Orthopedics (Spine Surgery), The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Zhou Z, Ni HJ, Zhao W, Gu GF, Chen J, Zhu YJ, Feng CB, Gong HY, Fan YS, He SS. Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach for L4/5 and L5/S1 Two-Level Disc Herniation. Orthop Surg 2021; 13:979-988. [PMID: 33821557 PMCID: PMC8126944 DOI: 10.1111/os.12862] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022] Open
Abstract
Objective The purpose of the present study was to discuss a new surgical strategy that combines percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous endoscopic interlaminar discectomy (PEID) for L4/5 and L5/S1 two‐level disc herniation. Methods This was a retrospective study. A total of 19 patients with L4/5 and L5/S1 two‐level lumbar disc herniation (LDH) who underwent percutaneous endoscopic lumbar discectomy (PELD) in our hospital from January 2015 to June 2016 were retrospectively examined. The average age of these 19 patients was 42.21 ± 14.88 years old, including 12 men and 7 women. One experienced surgeon who had carried out more than 3000 lumbar surgeries performed PELD for these patients. During the PELD surgery, the transforaminal approach was adopted for L4/5 level disc herniation and the interlaminar approach was adopted for L5/S1 level disc herniation. The demographic data, operation time (min), fluoroscopy times, hospital stay (days), and complications were recorded and analyzed. The visual analogue scale (VAS), Oswestry disability index (ODI) scores, and the modified MacNab criteria were used to evaluate the surgical outcomes. MRI was conducted to evaluate the radiographic improvement. Results All patients underwent PELD via the transforaminal approach combined with the interlaminar approach successfully and achieved satisfactory efficacy. The follow‐up points were 3, 12, and 18 months. The average hospital stay (days) and the average follow up (months) were 3.32 ± 0.98 and 18.63 ± 3.84, respectively. The operation time and fluoroscopy times were 85.79 ± 12.90 min and 39.05 ± 4.59 times, respectively. The fluoroscopy times (frequency) for L4/5 and L5/S1 were 26.95 ± 6.41 and 12.11 ± 3.49 (t = 7.00, P < 0.05). Furthermore, there was no significant difference for fluoroscopy times between male and female patients (t = 0.89, P = 0.99). The preoperative back pain (VAS‐Back) and the last follow‐up VAS‐Back were 5.58 ± 2.01 and 2.37 ± 1.01, respectively (t = 7.14, P < 0.05). The preoperative leg pain (VAS‐Leg) and the last follow‐up VAS‐Leg were 7.00 ± 1.56 and 1.63 ± 1.01, respectively (t = 20.97, P < 0.05). There were significant differences between preoperative VAS‐Back and the last follow‐up VAS‐Back in men (t = 4.61, P < 0.05) and women (t = 6.57, P < 0.05). In addition, there was significant differences between preoperative VAS‐Leg and the last follow‐up VAS‐Leg in men (t = 13.48, P < 0.05) and women (t = 26.87, P < 0.05). There were significant differences between preoperative ODI scores (44.84 ± 10.82%) and the last follow‐up ODI scores (11.12 ± 5.80%) (t = 10.92, P < 0.05). Preoperative ODI scores and the last follow‐up ODI scores were significantly different for men (t = 8.80, P < 0.05) and women (t = 6.63, P < 0.05). All patients received significant pain relief and functional improvement after the surgery. Except for two cases of postoperative dysesthesia and one dural tear, no severe complications occurred. The dysesthesia symptoms of these two patients disappeared within 1 week with the application of dexamethasone and neurotrophic drugs and the dural tear case also recovered well as the dural laceration was small. No poor results were reported and 89.47% of patients achieved excellent or good recovery. Conclusion Percutaneous endoscopic lumbar discectomy via the transforaminal approach combined with the interlaminar approach under epidural anesthesia can treat L4/5 and L5/S1 two‐level disc herniation safely and effectively.
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Affiliation(s)
- Zhi Zhou
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Hai-Jian Ni
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Zhao
- Orthopaedics Department, Taian City Central Hospital, Shandong, China
| | - Guang-Fei Gu
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jia Chen
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan-Jie Zhu
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Chao-Bo Feng
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Hao-Yu Gong
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yun-Shan Fan
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Shi-Sheng He
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
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Wakaizumi K, Wu B, Huang S, Fan L, Shen B, Wu B, Zhang J, Baliki MN, Apkarian AV, Huang L. Momentary pain assessments reveal benefits of endoscopic discectomy: a prospective cohort study. Pain Rep 2021; 6:e906. [PMID: 33981932 DOI: 10.1097/PR9.0000000000000906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 12/18/2020] [Accepted: 01/23/2021] [Indexed: 11/27/2022] Open
Abstract
Both pain rating and exponential model revealed that percutaneous endoscopic lumbar discectomy provided rapid pain recovery that was maintained for at least 3 months compared with conservative treatments. Lumbar disc herniation (LDH) is a common back disorder that evokes back and/or leg pain. Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive surgery for patients with LDH. However, there is little evidence of effectiveness of PELD compared with conservative treatments.
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Guan YH, Wu J. [Clinical study of hydraulic perfusion pump and traditional water flushing for percutaneous endoscopic lumbar discectomy]. Zhongguo Gu Shang 2021; 34:63-7. [PMID: 33666022 DOI: 10.12200/j.issn.1003-0034.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the clinical outcomes of hydraulic perfusion pump and traditional water fhushing in percutaneous endoscopic lumbar discectomy. METHODS From January 2016 to December 2018, 72 patients with lumbar disc herniation failed to conservative treatment were enrolled in this study. The patients were divided into hydraulic perfusion pump group and traditional water flushing group, 36 cases in each group. There were no significant differences in gender, age, prominent segment, clinical classification, preoperative visual analogue scale (VAS) and Japanese Orthopaedic Association(JOA) score between two groups (P>0.05). All operations were performed by the same surgeon, and the operations were completed by hydraulic perfusion pumpflushing or traditional water flushing assisted surgery. The operation time, intraoperative blood loss, hospital stay were recorded;VAS and JOA scores were observed before and after operation;the incidences of postoperative complications were compared between two groups. RESULTS All the patients were followed up for 12 to 24 (15.7±5.1) months. Compared with the traditional water flushing group, the operation time of the hydraulic perfusion pump group was shorter [(65.5±21.3) min vs (74.8±19.9) min, t=9.465, P=0.003], and intraoperative blood loss was less [(21.2±12.9)ml vs (27.4± 14.1) ml, t=8.331, P=0.012], there was no statistical difference in hospital stay between two groups. Postoperative VAS scores at 1 day, 2 weeks and the final follow-up and postoperative JOA scores at the final follow-up of the two groups of patients improved compared with those before operation, but there was no significant difference between two groups (P>0.05). In the traditional water flushing group, the intracranial hypertensionoccurred during operation and the operation time was forced to shorten in 5 cases, the nerve root adventitia injury in 4 cases, and the postoperative recurrence in 4 cases. No intracranial hypertension during operation was found in the hydraulic perfusion pump group, nerve root adventitia injury occurred in 1 case, postoperative recurrence in 2 cases. The incidence of complication of the hydraulic perfusion pump group was lower than that ofthe traditional water flushing group. CONCLUSION Both hydraulic perfusion pump and traditional water flushing assisted percutaneous endoscopic lumbar disc herniation can achieve satisfactory clinical results, but the former has shorter operation time, clearer intraoperative vision, less bleeding, and fewer intraoperative and postoperative complications.
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Affiliation(s)
- Yue-Hong Guan
- Department of Rehabilitation, the Second People's Hospital of Changshu, Changshu 215500, Jiangsu, China
| | - Jian Wu
- Department of Rehabilitation, the Second People's Hospital of Changshu, Changshu 215500, Jiangsu, China
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Wu X, Ma Y, Ding R, Xiao X, Yang D. Should adjacent asymptomatic lumbar disc herniation be simultaneously rectified? A retrospective cohort study of 371 cases that received an open fusion or endoscopic discectomy only on symptomatic segments. Spine J 2021; 21:411-417. [PMID: 32947038 DOI: 10.1016/j.spinee.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In the treatment of multiple disc herniations, the decision of whether to include the presumed asymptomatic lumbar disc herniation (asLDH) at adjacent segments remains uncertain. On the one hand, the untouched asLDH might soon become symptomatic and require treatment. On the other hand, additional surgery involving more segments will introduce greater risk, complications, and cost. PURPOSE To investigate the prognosis of untreated asLDH after open fusion or percutaneous endoscopic lumbar discectomy (PELD) on symptomatic lumbar disc herniation (LDHs) in patients. STUDY DESIGN This is a retrospective cohort study. PATIENT SAMPLE A total of 371 patients with multiple disc herniations who underwent open discectomy and fusion or PELD only for symptomatic levels from January 2012 to July 2018 were included. OUTCOME MEASURES The primary outcome of interest was the development of symptomatic LDH at the previous asLDH of both groups that required reoperation. A second analysis was performed to compare the reoperation rate due to deterioration of asLDH among different severity grades of herniation. Reoperation rates of the original surgery at the symptomatic segment in both fusion and PELD groups were also reviewed. METHODS The patients were divided into two groups based on the surgical procedure, with 264 patients undergoing fusion surgery and 107 patients undergoing PELD. Clinical and imaging follow-ups were performed at routine intervals for more than 3 years. The reoperation rates due to deterioration of previously asLDH and failure of original surgery were investigated and compared between the two groups, as well as among the different severity grades of herniation. RESULTS The follow-up times were 48.2±24.2 and 41.1±17.5 months for the fusion and the PELD groups, respectively. The overall reoperation rate at the previous adjacent asLDH was 6.7% (25/317). According to the severity of the asLDH, a higher grade of asymptomatic herniation yielded a significantly higher rate of reoperation rate in both groups. If the nerve root was displaced by disc material prominently (nG2), the reoperation rate of asLDHs was 42.9% (3/7) in the fusion group and 20% (3/15) in the PELD group. Twenty out of 264 patients (7.6%) in the fusion group and 5 out of 107 patients (4.7%) in the PELD group required reoperation due to deterioration of asLDH. Reoperation rates due to failure of the original surgery were 7.6% (20/264) in the fusion group and 8.4% (9/107) in the PELD group. CONCLUSIONS With multilevel LDHs, if the asLDH is left untreated, the reoperation rate is closely related to the degree of herniation. When confronting an asLDH graded as G2, a high possibility of reoperation should be clearly discussed with the patient, regardless of open fusion or PELD techniques. Considering that fusion and minimally invasive nonfusion techniques did not yield significantly different overall reoperation rates, ongoing degeneration seemed to have a greater contribution in terms of the deterioration of asLDH.
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Affiliation(s)
- Xiaoliang Wu
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yangyang Ma
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ruoting Ding
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiao Xiao
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dehong Yang
- Division of Spine Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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Fu CF, Tian ZS, Yao LY, Yao JH, Jin YZ, Liu Y, Wang YY. Postoperative discal pseudocyst and its similarities to discal cyst: A case report. World J Clin Cases 2021; 9:1439-1445. [PMID: 33644213 PMCID: PMC7896671 DOI: 10.12998/wjcc.v9.i6.1439] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postoperative discal pseudocyst (PDP) is a rare condition that presents after surgery for lumbar disc herniation. Due to the lack of information, the diagnosis and treatment of PDP remain controversial. Herein, we report a PDP case that occurred following percutaneous endoscopic lumbar discectomy and received conservative treatment. Additionally, we review all the published literature regarding PDP and propose our hypothesis regarding PDP pathology.
CASE SUMMARY A 23-year-old man presented with a relapse of low back pain and numbness in his left lower extremity after undergoing percutaneous endoscopic lumbar discectomy for lumbar disc herniation. Repeat magnetic resonance imaging demonstrated a cystic lesion at the surgical site with communication with the inner disc. The patient was diagnosed as having PDP. The patient received conservative treatment, which resulted in rapid improvement and spontaneous regression of the lesion, and had a favorable outcome in follow-up.
CONCLUSION PDP and discal cyst (DC) exhibit similarities in both histological and epidemiological characteristics, which indicates the same pathological origin of PDP and DC. The iatrogenic annular injury during discectomy might accelerate the pathological progression of DC. For patients with mild to moderate symptoms, conservative treatment can lead to great improvement, even inducing spontaneous regression. However, surgical cystectomy is necessary in patients with neurological deficits and where conservative treatment is ineffective.
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Affiliation(s)
- Chang-Feng Fu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Zhi-Sen Tian
- Department of Spine Surgery, China-Japan Union Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Li-Yu Yao
- Department of Pediatric Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ji-Hang Yao
- Department of Traumatology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yuan-Zhe Jin
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Ying Liu
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Yuan-Yi Wang
- Department of Spine Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
- Department of Spine Surgery, Jilin Engineering Research Center for Spine and Spinal Cord Injury, Changchun 130021, Jilin Province, China
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Song Z, Ran M, Luo J, Zhang K, Ye Y, Zheng J, Zhang Z. Follow-up results of microendoscopic discectomy compared to day surgery using percutaneous endoscopic lumbar discectomy for the treatment of lumbar disc herniation. BMC Musculoskelet Disord 2021; 22:160. [PMID: 33563264 PMCID: PMC7874495 DOI: 10.1186/s12891-021-04038-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) is satisfactory for hospitalized patients with lumbar disc herniation (LDH). Currently, only a few studies have reported about the day surgery patients undergoing PELD. METHODS A total of 267 patients with LDH underwent PELD during day surgery and were followed up for at least 3 years. Clinical outcomes were assessed using the visual analog scale (VAS) for leg and lower back pain (VAS-B and VAS-L, respectively) and the Oswestry disability index (ODI). The radiological outcomes, such as lumbar lordosis (LL), sacral slope (SS), the disc-height ratio, and disc instability, were recorded and compared. The clinical effects between patients treated by PELD during day surgery and microendoscopic discectomy (MED) for contemporaneous hospitalized 116 patients with LDH were compared. RESULTS Patients treated by PELD had lower blood loss and shorter hospital stay (P < 0.001) compared to those treated by MED. VAS-L, VAS-B, and ODI decreased significantly after PELD than before the operation and 3 years postoperatively. The postoperative VAS-B in the PELD group was significantly decreased than in the MED group (P = 0.001). The complications rate was 9.4% in the PELD group and 12.1% in the MED group (P = 0.471). The 1-year postoperative recurrence rate in the PELD group was much higher than that in MED group (P = 0.042). The postoperative LL and SS in the PELD group improved significantly compared to the values in the MED group (P < 0.001). According to the disc-height ratio at 3-year follow-up, a significant height loss was observed in the MED group than in the PELD group (P = 0.014). CONCLUSIONS Although the 1-year postoperative recurrence rate was relatively high, the day surgery for LDH undergoing PELD had advantages in terms of less blood loss intraoperatively, short hospital stay, efficacy for back pain, and efficiency to maintain lumbar physiological curvature.
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Affiliation(s)
- Zhaojun Song
- Spine Surgery Department of Suining Central Hospital, Suining, Sichuan, People's Republic of China
| | - Maobo Ran
- Spine Surgery Department of Suining Central Hospital, Suining, Sichuan, People's Republic of China
| | - Juan Luo
- Medical Record Department of Suining Central Hospital, Suining, Sichuan, People's Republic of China
| | - Kai Zhang
- Day Surgery Unit of Suining Central Hospital, Suining, Sichuan, People's Republic of China
| | - Yongjie Ye
- Spine Surgery Department of Suining Central Hospital, Suining, Sichuan, People's Republic of China
| | - Jiazhuang Zheng
- Spine Surgery Department of Suining Central Hospital, Suining, Sichuan, People's Republic of China
| | - Zhi Zhang
- Spine Surgery Department of Suining Central Hospital, Suining, Sichuan, People's Republic of China.
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Jin M, Lei L, Li F, Zheng B. Does Robot Navigation and Intraoperative Computed Tomography Guidance Help with Percutaneous Endoscopic Lumbar Discectomy? A Match-Paired Study. World Neurosurg 2020; 147:e459-e467. [PMID: 33385595 DOI: 10.1016/j.wneu.2020.12.095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of robot-assisted percutaneous endoscopic lumbar discectomy (rPELD) using a specially designed orthopaedic robot with an intraoperative computed tomography-equipped suite for treatment of symptomatic lumbar disc herniation and compare rPELD with fluoroscopy-assisted percutaneous endoscopic lumbar discectomy (fPELD). METHODS We retrospectively reviewed and compared demographic data, radiologic workups, and patient-reported outcomes of 39 patients treated with rPELD and 78 patients treated with fPELD at our institution between January 2019 and December 2019. RESULTS Our data showed that a single-shot puncture in the rPELD group was significantly more precise compared with 4.12 ± 1.71 trials in the fPELD group (P < 0.001). There was an overall reduction of fluoroscopy (21.33 ± 3.89 times vs. 33.06 ± 2.92 times, P < 0.001), puncture-channel time (13.34 ± 3.03 minutes vs. 15.03 ± 4.5 minutes, P = 0.038), and total operative time (57.46 ± 7.49 minutes vs. 69.40 ± 12.59 minutes, P < 0.001) using the rPELD technique versus the fPELD technique. However, there were no significant differences in patient-reported outcomes, length of hospital stay, and complication rate between the 2 groups (P > 0.05). CONCLUSIONS Taken together, our data indicate that rPELD provides a precise skin entry point and optimal trajectory for puncture, which increases the success rate of PELD, negating the need for revision surgery. However, further studies are required to confirm the superiority and application of the rPELD technique.
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Affiliation(s)
- Mengran Jin
- Department of Orthopaedics, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Longyue Lei
- Department of Orthopaedics, Yuhang Bang Er Hospital, Hangzhou, China
| | - Fengqing Li
- Department of Orthopaedics, Yuhang Bang Er Hospital, Hangzhou, China
| | - Biao Zheng
- Department of Orthopaedics, Yuhang Bang Er Hospital, Hangzhou, China.
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Feng WL, Yang JS, Wei D, Gong HL, Xi Y, Lv HQ, Wang XG, Xia B, Wei JM. Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study. J Orthop Surg Res 2020; 15:413. [PMID: 32933553 PMCID: PMC7493882 DOI: 10.1186/s13018-020-01939-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND During the process of shearing the ligamentum flavum, rotating the working channel, and manipulating the annulus fibrosis, the sinuvertebral nerve and the spinal nerve root can be irritated, inducing intolerable back and leg pain. Thus, general anesthesia is recommended and well accepted by most surgeons when performing percutaneous endoscopic lumbar discectomy (PELD) via the interlaminar approach. The aim of our study was to explore the efficacy and safety of percutaneous endoscopy interlaminar lumbar discectomy with gradient local anesthesia (LA) in patients with L5/S1 disc herniation. METHODS This retrospective study was conducted between December 2017 and June 2018. The study included 50 consecutive patients who met the study criteria, had single-level L5/S1 disc herniation, and underwent PELD via the interlaminar approach under gradient LA. Different concentrations of local anesthetic compound (LAC) were injected into different tissues inside and outside the ligamentum flavum to complete gradient LA. The evaluation criteria included the intraoperative satisfaction score, visual analog scale (VAS) score, Oswestry Disability Index (ODI), complications, and adverse reactions. RESULTS The intraoperative satisfaction score was consistently over 7, with an average score of 9.3 ± 0.7, indicating that LAC can achieve satisfactory pain control throughout the PELD operation without additional anesthesia. The postoperative VAS score and ODI were dramatically improved at each follow-up interval (P < 0.001, respectively). There was no serious complication such as dural rupture caused by puncture, dural laceration caused by manipulation under endoscopy, total spinal anesthesia, iatrogenic nerve root injury, epidural hematoma, infections, or local anesthetic-related adverse reactions. Three patients experienced transient postoperative dysesthesia of the lower limbs that gradually recovered within 24 h. CONCLUSIONS Gradient local anesthesia can satisfactorily and safely control intraoperative pain during the PELD via the interlaminar approach. It can not only improve intraoperative satisfaction, but also reduce local anesthesia-related adverse reactions and surgery-related complications.
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Affiliation(s)
- Wan-Li Feng
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, People's Republic of China
| | - Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No. 76 Nanguo Road, Xi'an, 710054, Shaanxi, People's Republic of China
| | - Dongmei Wei
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Han-Lin Gong
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yong Xi
- Department of Orthopaedics, Tongchuan People's Hospital, Tongchuan, Shaanxi, People's Republic of China
| | - Hui-Qiang Lv
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, People's Republic of China
| | - Xin-Gang Wang
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, People's Republic of China
| | - Bin Xia
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, People's Republic of China
| | - Jian-Min Wei
- Department of Spine Surgery, Baoji City Hospital of Traditional Chinese Medicine, Baoji, Shaanxi, People's Republic of China.
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Sun DD, Lv D, Wu WZ, Ren HF, Bao BH, Liu Q, Sun ML. Estimation and influence of blood loss under endoscope for percutaneous endoscopic lumbar discectomy (PELD): a clinical observational study combined with in vitro experiment. J Orthop Surg Res 2020; 15:281. [PMID: 32711563 PMCID: PMC7382085 DOI: 10.1186/s13018-020-01797-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The purpose of this study is to come up with new methods to quantitate the blood loss under endoscope and explore the influence of blood loss on percutaneous endoscopic lumbar discectomy (PELD). METHODS Clinical research and in vitro experiment are combined. In the in vitro experiment, 2.0-ml blood was diluted in different ratio to simulate the rinse solution of PELD, the hematocrit method (HCT-M) and red blood cell count method (RBC-M) were came up to estimate blood loss and the new methods were calibrated with the direct measurement method (Direct-M). In clinical research, 74 patients with L5/S1 disk herniation were treated with PELD, and HCT-M and the empirical method (EMP-M) were used to estimate the blood loss under endoscope. According to blood loss, all patients were divided into group A (≤ 10 ml) and group B (> 10 ml). The blood loss, operation time, fluoroscopy frequency, visual analog scale (VAS), and Oswestry Disability Index (ODI) scores were compared between the two groups. RESULTS In the in vitro experiment, the hematocrit of the rinse solution was always stable over time. The estimated blood loss by HCT-M was stable and quite approximate to actual blood volume (2.0 ml) whatever the blood dilution ratio, while according to RBC-M, the estimated blood loss was close to the actual blood volume only when the dilution ratio was greater than 300 times. In clinical research, the blood loss estimated by HCT-M was higher than that by EMP-M in both groups (P < 0.05). There was a significant difference between group A and group B in blood loss (7.40 ± 1.61 vs 19.91 ± 10.94 ml), operation time (80.51 ± 34.70 vs 136.51 ± 41.88 min), and fluoroscopy frequency (6.92 ± 1.52 vs 11.11 ± 2.32 times) (P < 0.05). The VAS and ODI scores in group B were higher than that in group A 1 week after operation (P < 0.05); however, the scores were not different between the two groups at pre-operation (P > 0.05). CONCLUSION HCT-M is a reliable method to estimate endoscopic blood loss in PELD. The amount of endoscopic blood loss affects the operative procedure in operation time and fluoroscopy frequency, as well as clinical effects in VAS and ODI scores after operation in short term.
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Affiliation(s)
- Dong Dong Sun
- Department of Orthopedic, Characteristic Medical Center of Chinese People's Armed Police Force, 220 Cheng Lin Road, He Dong District, Tianjin, 300171, China
- Logistics University of Chinese People's Armed Police, Tianjin, 300300, China
| | - Dan Lv
- Department of Orthopedic, Characteristic Medical Center of Chinese People's Armed Police Force, 220 Cheng Lin Road, He Dong District, Tianjin, 300171, China
| | - Wei Zhou Wu
- Department of Neurology, The 985th Hospital of the Joint Logistics Support Force of the PLA, Taiyuan, 030001, China
| | - He Fei Ren
- Logistics University of Chinese People's Armed Police, Tianjin, 300300, China
| | - Bu He Bao
- Clinical laboratory, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, 300171, China
| | - Qun Liu
- Logistics University of Chinese People's Armed Police, Tianjin, 300300, China
| | - Ming Lin Sun
- Department of Orthopedic, Characteristic Medical Center of Chinese People's Armed Police Force, 220 Cheng Lin Road, He Dong District, Tianjin, 300171, China.
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Lin W, Ma WT, Xue Y. Low Back Pain Induced by Posterior Longitudinal Ligament Incision in Percutaneous Transforaminal Endoscopic Lumbar Discectomy. Orthop Surg 2020; 12:1230-1237. [PMID: 32700363 PMCID: PMC7454223 DOI: 10.1111/os.12747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/23/2020] [Accepted: 06/18/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To illustrate the posterior longitudinal ligament is one of the tissue candidates who can contribute to low back pain (LBP). METHODS This is a retrospective study. A series of 72 patients who underwent single-level percutaneous endoscopic lumbar discectomy performed for lumbar disc herniation with LBP from June 2014 to June 2016 were examined. There are 42 males and 30 females. The ages of patients were 40 to 57 years, and the mean age was 49.8 years. The symptomatic disc level was at L4-5 in 43 patients and L5 S1 in 29 patients. Thirty-two patients (19 patients in L4-5 disc level, 13 patients in L5 S1 disc level) had LBP (which was limited to the lower back and buttock area) before the operation. All of the operative approaches were performed under local anesthesia. A posterior body diagram (15 cm × 10 cm) was made for this study to record the pain distribution. The centered foci of low back pain were subjectively recorded before, during, and after the operation. The transforaminal endoscopic spine system technology was used in this study. Radiological examinations (X-ray, computed tomography, and magnetic resonance imaging) were performed prior to and after surgery. The Visual Analogue Score (VAS) and Oswestry Disability Index (ODI) scores were taken before and after the surgery to observe the degree of pain. The VSA and ODI score before and after operation were expressed as mean ± SD, and compared by t-test for statistical analysis. RESULTS When inciting the posterior longitudinal ligament during the operation, all 72 patients had provoked low back pain. Forty-three patients with symptomatic discs at L4-5 had pain foci in the lower back and upper gluteal region under the L4 spinous process. Twenty-nine patients with symptomatic discs at L5 S1 had pain foci in the gluteal region under the S1 spinous process. The pain localizations of L4-5 and L5 S1 were different. After the surgery, the provoked low back pain disappeared, and had not returned in any of the patients at the 6-month follow-up. After the operation, one patient suffered from lower limb pain that he did not have before the operation, and the lower limb pain abated a few days later. Three patients had cerebrospinal fluid leakage and were treated with higher pressure applied on the incision and bed rest for 10 days. During the 6-months follow-up period, the mean VAS decreased from 5.97 ± 1.10 to 2.13 ± 0.78. The mean ODI score decreased from 23.14 ± 3.28 to 7.92 ± 1.85. CONCLUSIONS The intervertebral posterior longitudinal ligament may be one of the tissues from which low back pain originates.
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Affiliation(s)
- Wei Lin
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Wen-Ting Ma
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China
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Abstract
Context: Pseudomeningocele is a relatively uncommon postoperative complication of spine surgery. Although the condition tends to be asymptomatic and self-limiting, it may cause radicular pain and neurological defect due to herniation of the nerve root or the spinal cord. Its pathophysiology remains unclear. Only few cases with intraoperative photos have been reported. Finding: We present a case of pseudomeningocele with nerve root entrapment after percutaneous endoscopic lumbar discectomy (PELD). A 52-year-old man had undergone PELD for sciatic pain and showed good postoperative recovery. Unfortunately, he was readmitted for progressive right leg pain at six weeks after the surgery. After the failure of conservative therapy, he received PELD again to explore the surgical site. Intraoperatively, a pseudomeningocele-containing nerve root, herniating through a small defect in the dural sac, was identified. During the dissection process, the pseudomeningocele was broken, which led to entrapment of the nerve root. Thereafter, the microsurgical technique was adopted to relocate the nerve root into the thecae sac and to repair the dural tear by non-resorbable suture. Conclusion: To our knowledge, this case report is the first documented instance of identification of a pseudomeningocele under an endoscope, and provides insights into the transformation of a pseudomeningocele into a cerebrospinal fluid fistula with nerve root entrapment. For neurological deficit caused by pseudomeningocele following PELD, operative revision by the microsurgery technique is the appropriate strategy.
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Affiliation(s)
- Wei Shu
- Beijing Institute of Function Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Haipeng Wang
- Beijing Institute of Function Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hongwei Zhu
- Beijing Institute of Function Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yongjie Li
- Beijing Institute of Function Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jiaxing Zhang
- Beijing Institute of Function Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guang Lu
- Beijing Institute of Function Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Bing Ni
- Beijing Institute of Function Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China
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Wang F, Ju XC, Song RX. [Clinical efficacy and technical characteristics of percutaneous endoscopic lumbar discectomy in the treatment of upper lumbar disc herniation]. Zhongguo Gu Shang 2020; 33:430-4. [PMID: 32452180 DOI: 10.12200/j.issn.1003-0034.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To analyze the clinical efficacy and technical characteristics of percutaneous endoscopic lumbar discecomy in the treatment of upper lumbar disc herniation. METHODS The clinical data of 9 patients with upper lumbar disc herniation underwent percutaneous endoscopic lumbar discecomy from January 2012 to October 2019 were retrospectively analyzed. There were 6 males and 3 females, aged 26 to 79 years, including 2 patients with L1,2 disc herniation and 7 patients with L2, 3 disc herniation. Visual analogue scale (VAS) and Japanese Orthopeadic Association (JOA) score were recorded before and after surgery. The clinical efficacy was evaluated according to the modified Macnab standard. RESULTS All 9 patients were followedup, and the follow-up time was 1 day and 3 months after surgery. The operation time was 1.5 to 2.9 h and postoperative hospital stay was 5 to 8 d. No cerebrospinal fluid leakage or spinal cord injury occurred during the operation. Preoperative and postoperative at 1 day, 3 months, the VAS scores of 9 patients were 7 to 8 scores, 1 to 3 scores, 0 to 1 case, JOA scores were 5 to 7 scores, 15 to 24 scores, 21 to 26 scores, respectively. The improvement rate of JOA was 36.4% to 78.3% on the first day and 65.2% to 87.5% three months after operation. According to modified Macnab standard to evaluate effect, 4 cases got excellent results, 4 good, 1 fair. CONCLUSION Percutaneous endoscopic lumbar discecomy has reliable therapeutic effect for upper lumbar disc herniation in line with the indications, and it has the characteristics of small trauma and short operation time, so it is more suitable for middle aged and elderly patients with poor physique and can replace part of transforaminal lumbar interbody fusion.
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Affiliation(s)
- Feng Wang
- Department of Orthopaedics, the 960 Hospital of Liberation Army, Jinan 250000, Shandong, China
| | - Xiao-Cong Ju
- Department of Orthopaedics, the 960 Hospital of Liberation Army, Jinan 250000, Shandong, China
| | - Ruo-Xian Song
- Department of Orthopaedics, the 960 Hospital of Liberation Army, Jinan 250000, Shandong, China
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Hao L, Li S, Liu J, Shan Z, Fan S, Zhao F. Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present. J Orthop Surg Res 2020; 15:176. [PMID: 32410638 PMCID: PMC7227219 DOI: 10.1186/s13018-020-01695-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To investigate the relationship between Modic changes (MCs) and recurrent lumbar disc herniation (rLDH) and that between the herniated disc component and rLDH following percutaneous endoscopic lumbar discectomy (PELD). Methods We included 102 (65 males, 37 females, aged 20–66 years) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperatively. The presence and type of Modic changes were assessed. During surgery, the herniated disc component of each patient was classified into two groups: nucleus pulposus group and hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of rLDH was assessed based on a more than 2-year follow-up. Results In total, 11 patients were lost to follow-up; the other 91 were followed up during 24–60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P < 0.05). We found 2 cases of rLDH in the non-MC group (n = 71); 6 cases of rLDH were found in the MC group (n = 28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P > 0.05). rLDH was more common in patients with MCs (P < 0.05). We found 5 rLDH cases in the hyaline cartilage group (n = 32); 3 rLDH cases were found in the nucleus pulposus group (n = 67). rLDH was more common in the hyaline cartilage group (P < 0.05). Conclusions rLDH following PELD preferentially occurs when MCs or herniated cartilage are present.
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Affiliation(s)
- Lu Hao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang University, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China
| | - Shengwen Li
- Department of Orthopaedics, Haining County People's Hospital, No.2 Qianjiangxi Road, Haining, People's Republic of China
| | - Junhui Liu
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang University, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China
| | - Zhi Shan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang University, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China
| | - Shunwu Fan
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang University, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China
| | - Fengdong Zhao
- Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Key Laboratory of Musculoskeletal System Degeneration and Regeneration Translational Research of Zhejiang Province, Zhejiang University, No. 3, Qingchun Road East, Hangzhou, 310016, People's Republic of China.
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Sun B, Wu H, Xu Z, Lu J, Wang Y, Zhang K, Gao X, Shen X, Wu XD, Zhang Y, Gu X, Shi C, Yuan W. Is selective nerve root block necessary for learning percutaneous endoscopic lumbar discectomy: a comparative study using a cumulative summation test for learning curve. Int Orthop 2020; 44:1367-1374. [PMID: 32367234 DOI: 10.1007/s00264-020-04558-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/30/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to investigate the effect of lumbar spine selective nerve root block (SNRB) experience on the learning efficiency of percutaneous endoscopic lumbar discectomy (PELD) for junior trainees. METHODS A total of 480 patients undergoing single-level PELD performed by eight junior trainees were included. The trainees were divided into two groups based on whether they had previous SNRB experience (group A, yes; group B, no). Surgical proficiency was defined as total operation time less than 65 minutes and cumulative radiation exposure time no more than 40 seconds. The learning curve was analyzed by cumulative summation (CUSUM) test. Clinical evaluations included Macnab classification, visual analog scale (VAS)-low back score, VAS-leg score, and Oswestry Disability Index (ODI). Follow-up information at 12 months was also obtained. RESULTS Integral number of cases before achieving an acceptable surgical level in group A (47.75 ± 2.50 cases) was significantly smaller than that in group B (56.50 ± 1.29 cases, p < 0.05), along with less accumulated failure (18.75 ± 0.96 cases vs. 25.50 ± 1.75 cases, p < 0.05). The two groups were comparable in clinical outcomes. Forty-seven cases of complications were observed, with 17 in group A and 30 in group B (p < 0.05). CONCLUSION Previous experience of SNRB improved the performance of PELD with shorter operation time and less radiation exposure. SNRB practice may reduce the complication rate without a significant effect on the recurrence of symptoms and reoperation.
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Affiliation(s)
- Bin Sun
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Huiqiao Wu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Zeng Xu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jiajia Lu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yunhao Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Ke Zhang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xiaoxiang Gao
- Department of Orthopaedics, The 455th Hospital of Chinese People's Liberation Army, Shanghai, China
| | - Xiaolong Shen
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xiao-Dong Wu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Ying Zhang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Xin Gu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Changgui Shi
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Wen Yuan
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200003, People's Republic of China
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He S, Ren Z, Zhang X, Li J. Neurophysiologic monitoring for treatment of upper lumbar disc herniation with percutaneous endoscopic lumbar discectomy: A case report on the significance of an increase in the amplitude of motor evoked potential responses after decompression and literature review. Int J Surg Case Rep 2020; 67:271-276. [PMID: 32109861 PMCID: PMC7044662 DOI: 10.1016/j.ijscr.2020.01.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 11/17/2022] Open
Abstract
There was an increase in the amplitude of MEP after PELD surgery decompression. The immediate increase in amplitude of MEP can be considered as an improvement of the treated levels. The immediate increase in amplitude of MEP can help surgeon to judge the efficacy of nerve root decompression.
Introduction Intraoperative neurophysiological monitoring (IONM) has been widely used in spinal surgery. There is lack of report about IONM for the treatment of upper lumbar disc herniation (HIVD) with percutaneous endoscopic lumbar discectomy (PELD), the relationship between an immediate increase in amplitude of intraoperative MEP after decompression and improvement of the treated levels is rarely studied. Here we reported a surgical case in which an elderly patient with HIVD underwent PELD with IONM and there was a distinct increase in the amplitude of MEP after decompression, showing an immediate improvement of the treated levels. Presentation of case A 60-year-old male patient underwent PELD to remove the large disc fragments extruded upward into L2-3 intervertebral space. The nucleus pulposus was successfully removed and an increase in the amplitude of MEP responses after decompression was observed. Pain was alleviated immediately after operation and no complication and recurrence was observed at 1 year follow-up. Discussion This is a surgical case of PELD for HIVD with IONM. In this study, we reviewed related studies on PELD for HIVD with IONM and discussed the relationship between an immediate increase in amplitude of intraoperative MEP and the outcomes of the treated level. Conclusion We conclude an immediate increase in amplitude of MEP after decompression can be considered as an improvement of the treated levels. IONM can not only be used to prevent the risk of neurological injury in PELD for HIVD, but also be helpful to surgeon to judge the efficacy of decompression via an immediate increase in amplitude of intraoperative MEP.
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Affiliation(s)
- Shenghua He
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518033, China
| | - Zhiqiang Ren
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518033, China.
| | - Xiufang Zhang
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, 518033, China
| | - Jiao Li
- Department of Paediatrics, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, 518034, China
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Ren Z, He S, Li J, Wang Y, Lai J, Sun Z, Feng H, Wang J. Comparison of the Safety and Effectiveness of Percutaneous Endoscopic Lumbar Discectomy for Treating Lumbar Disc Herniation Under Epidural Anesthesia and General Anesthesia. Neurospine 2020; 17:254-259. [PMID: 32054145 PMCID: PMC7136111 DOI: 10.14245/ns.1938366.183] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 12/24/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the safety and effectiveness of percutaneous endoscopic lumbar discectomy (PELD) under epidural anesthesia (EA) and general anesthesia (GA) for treating lumbar disc herniation (LDH). METHODS A retrospective study involving 86 patients with LDH managed by PELD under EA and GA was conducted from July 2018 to March 2019. These patients were divided into 2 groups according to the type of anesthesia. Patient's demographics data as well as the operation time, complications, fluoroscopy shots, visual analog scale (VAS), Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA), and MacNab scores of the 2 groups were recorded. All of the patients were followed-up at 6 months after operation. RESULTS There were no significant differences were detected in the preoperative demographics between the groups (p > 0.05). Two cases (4.8%) under GA developed transient motor weakness, 3 cases (7.4%) presented numbness of lower limb, and 1 case (2.4%) had cauda equina syndrome after operation. In EA group, 1 case (2.2%) had motor weakness and 3 cases (6.7%) had lower limb numbness, which resolved completely at the last follow-up. There was significant difference between preoperative VAS, JOA, and ODI scores and postoperative scores (p < 0.01). Moreover, there were no differences in the operation time, fluoroscopy shots, and MacNab scores between the 2 groups (p > 0.05). CONCLUSION EA and GA in PELD are effective and safe, and no significant difference in complications was observed. Based on our experience, we recommended junior surgeons to perform PELD under EA for getting feedback from the patient to avoid nerve injury and reduce the radiation dose. The concentration of ropivacaine in EA should be considered carefully.
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Affiliation(s)
- Zhiqiang Ren
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Shenghua He
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jiao Li
- Department of Paediatrics, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Yeguang Wang
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Juyi Lai
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Zhitao Sun
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Hualong Feng
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Jian Wang
- Department of Spinal Surgery, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Li K, Gao K, Zhang T, Lv CL. Comparison of percutaneous transforaminal endoscopic lumbar discectomy through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms: technical notes and a prospective randomized study. Eur Spine J 2019; 29:1724-1732. [PMID: 31734805 DOI: 10.1007/s00586-019-06210-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE In this study, the authors described the technical notes of percutaneous transforaminal endoscopic lumbar discectomy (PTELD) through unilateral approach and compared PTELD through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms. METHODS A prospective randomized clinical study was performed from June 2014 to October 2016. A total of 71 patients with lumbar disc herniation (L3/4 or L4/5) and bilateral symptoms were divided randomly into Unilateral-Approach group (n = 35) or Bilateral-Approach group (n = 36). Operation time, blood loss, intraoperative fluoroscopy and recurrences were recorded and analyzed statistically. Visual Analogue Scale scores, Oswestry Disability Index and the MacNab standard were used to analyze the clinical outcomes of the two groups. RESULTS The baseline data of the two groups were statistically similar. There was significant postoperative improvement in VAS and ODI scores in both the groups, and clinical outcomes are comparable according to the MacNab standard. However, VAS score of back pain at 1 day after surgery in Unilateral-Approach group was significantly lower than that in Bilateral-Approach group (P < 0.05). Moreover, operation time and cumulative time of intraoperative fluoroscopy of Unilateral-Approach group were significantly shorter than that of Bilateral-Approach group (P < 0.05). CONCLUSION For L3/4 or L4/5 LDH with bilateral symptoms, PTELD through unilateral approach is effective, with advantage of shorter operation time, shorter cumulative time of intraoperative fluoroscopy and milder postoperative short-term back pain compared to bilateral approach. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Kang Li
- Department of Spine Surgery, Jining No. 1 People's Hospital, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China.,Department of Spine Surgery, Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China
| | - Kai Gao
- Department of Joint Surgery, Jining No. 1 People's Hospital, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China
| | - Tao Zhang
- Department of Spine Surgery, Jining No. 1 People's Hospital, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China.,Department of Spine Surgery, Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China
| | - Chao-Liang Lv
- Department of Spine Surgery, Jining No. 1 People's Hospital, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China. .,Department of Spine Surgery, Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China.
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Wu K, Zhao Y, Feng Z, Hu X, Chen Z, Wang Y. Stepwise Local Anesthesia for Percutaneous Endoscopic Interlaminar Discectomy: Technique Strategy and Clinical Outcomes. World Neurosurg 2019; 134:e346-e352. [PMID: 31634623 DOI: 10.1016/j.wneu.2019.10.061] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Due to suboptimal pain control under conventional local anesthesia, percutaneous endoscopic interlaminar discectomy is typically performed under general anesthesia. The purpose of this study was to develop a stepwise approach of local anesthesia for endoscopic interlaminar discectomy and evaluate its efficacy. METHODS A stepwise local anesthesia was developed, which mainly includes 3 steps: conventional local anesthesia from skin to laminae, epidural injection, and nerve root block. From June 2015 to May 2017, consecutive patients who underwent endoscopic interlaminar discectomy were included. Local anesthesia or general anesthesia was used based on patients' preference. Anesthetic effectiveness was evaluated as excellent, good, or poor, and adverse events were recorded. Hospitalization expense was compared between the 2 groups. Clinical outcomes were assessed using the Visual Analog Scale and the Oswestry Disability Index. RESULTS There were 98 patients included in the study. Among them, 48 received stepwise local anesthesia and the other 50 received general anesthesia. In the stepwise local anesthesia group, 40 (83.3%) patients rated anesthetic effectiveness as excellent, 7 (14.6%) as good, and 1 (2.1%) as poor. Nine patients had complications that may be associated with local anesthesia, including dyspnea, temporary paresis of legs, and temporary worsened dysesthesia or numbness in legs. After surgery, the patients' leg pain and Oswestry Disability Index significantly improved in both groups. On average, hospitalization expense was approximately 20% less when local anesthesia was used, as compared with using general anesthesia. CONCLUSIONS The stepwise local anesthesia can achieve satisfactory pain control and seems to be a good choice for endoscopic interlaminar discectomy.
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Affiliation(s)
- Kai Wu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yuwei Zhao
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiyun Feng
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaojian Hu
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhong Chen
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Qian J, Dong FL, Zhang YS, Li W, Zhang RJ, Ge P, Tao H, Xu P, Gao F, Shen CL. [Clinical observation of the low back pain and posterior thigh pain in the early stage after percutaneous endoscopic lumbar discectomy]. Zhonghua Yi Xue Za Zhi 2019; 99:2445-9. [PMID: 31434425 DOI: 10.3760/cma.j.issn.0376-2491.2019.31.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the incidence, causes and prognosis of the low back pain and posterior thigh pain in the early stage after percutaneous endoscopic lumbar discectomy (PELD). Methods: A total of 88 patients who underwent PELD from December 2017 to June 2018 in the First Affiliated Hospital of Anhui Medical University were enrolled in this study. PELD was performed by posterior-lateral approach and the interlaminar approach in 44 cases, respectively. During the 3-month of follow-up post PELD, the number of cases who suffered low back pain and posterior thigh pain, complications and postoperative treatments were all followed and evaluated. Results: All the 88 cases underwent PELD successfully. Twelve cases (27.3%) suffered low back pain after PELD by posterior-lateral approach totally, 4 patients (9.1%) were new cases and the low back pain aggravated after PELD in the other 8 cases (18.2%). The posterior thigh pain occurred in 9 cases (20.4%) after PELD in posterior-lateral approach group, of them, 5 patients (11.4%) were new cases and it was aggravated in 4(9.1%) cases after the surgery. As for the low back pain after PELD performed by the interlaminar approach, 7(15.9%) cases suffered low back pain and 1 case (2.3%) occurred after surgery. The posterior thigh pain happened in 5 cases (11.4%) after PELD in the interlaminar approach group, 2 cases (4.6%) were new cases and the pain was aggravated in 3 cases (6.8%) after surgery. According the classification of MacNab, 42 of 88 cases were classified excellent, 25 cases good, 17 cases fair and 4 cases poor after PELD. Totally 18 cases were classified into fair and poor because of the low back pain or the posterior thigh pain during the follow-up. Furthermore, none of 88 cases had infection or nerve root injury after surgery. All cases suffering the low back pain or the posterior thigh pain treated conservatively and no one needed surgery again. Conclusions: The pain in low back or posterior thigh may be one of the complications after PELD, and it can be treated conservatively. Incidence of the low back pain or the posterior thigh pain after PELD with posterior-lateral approach is higher than that in patients with interlaminar approach, and it may affect the efficacy of PELD.
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Liang JQ, Chen C, Zhao H. Revision Surgery after Percutaneous Endoscopic Transforaminal Discectomy Compared with Primary Open Surgery for Symptomatic Lumbar Degenerative Disease. Orthop Surg 2019; 11:620-627. [PMID: 31402585 PMCID: PMC6712385 DOI: 10.1111/os.12507] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/23/2019] [Accepted: 06/20/2019] [Indexed: 01/13/2023] Open
Abstract
Objective To evaluate the clinical outcome of reoperation after percutaneous endoscopic lumbar discectomy (PELD) as compared with primary spinal decompression and fusion. Methods A retrospective study from December 2014 to December 2017 was conducted at Peking Union Medical College Hospital and comprised 39 patients with symptomatic lumbar degenerative disease (LDD): 13 post‐PELD who underwent reoperation (revision surgery group) and 26 who received primary spinal decompression and fusion (primary open surgery group). The two groups were compared regarding: operative time, blood loss, transfusion, hospitalization, postoperative visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, Japanese Orthopedic Association (JOA) improvement rate, and postoperative complications. The Mann–Whitney U‐test was applied to analyze continuous parameters, and the χ2‐test for categorical parameters. Fisher's exact test was used for small data subsets. Results There was no statistically significant difference between the two groups in mean age (52.7 years vs 52.9 years), gender ratio (6 men‐to‐7 women vs 12 men‐to‐14 women), body mass index, medical history, preoperative diagnosis, or surgical spine level (P > 0.05). The mean operative time of the revision surgery group was significantly longer than that of the primary open surgery group (160.0 min vs 130.2 min, P < 0.05). The revision surgery group also had a significantly higher mean estimated blood loss, postoperative drainage, and length of hospital stay (P < 0.05). However, no significant differences were found between the two groups in terms of hemoglobin and hematocrit values, preoperatively and postoperatively. The rate of transitional neurological irritation was higher in the revision surgery group (61.5% vs 3.8%; P < 0.05), as was intraoperative durotomy and cerebrospinal fluid leakage (30.8% vs 3.8%, P < 0.05). At 1 month, the VAS and ODI scores of the primary open surgery group were significantly better than those of the revision surgery group, while the improvement in JOA scores was similar. After 6 and 12 months’ follow‐up, the VAS and ODI scores and the rates of JOA improvement were comparable. Conclusion Patients with LDD who received primary spinal decompression and fusion experienced lower rates of perioperative complications and shorter hospitalization compared with patients who underwent revision surgery after PELD, but the clinical outcomes at the last follow‐up of both groups were satisfactory.
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Affiliation(s)
- Jin-Qian Liang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Chong Chen
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Hong Zhao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
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Frucella G, Maldonado D. [Percutaneous Lumbar Endoscopic Discectomy: Presentation of 60 Cases Intervened in Argentina with Awake Patients]. Surg Neurol Int 2019; 10:S37-S45. [PMID: 31772818 PMCID: PMC6863058 DOI: 10.25259/sni_325_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique that has been used in different countries since the late eighties for the treatment of herniated discs. OBJECTIVE The objective of this study was to describe the results of PELD in a series of awake patients, treated with epidural anesthesia and mild sedation. MATERIALS AND METHODS In a group of 60 patients, who together had 77 discs operated on between April 2016 and March 2018, data were collected on patient age and gender, clinical presentation, and MRI abnormalities. The main outcome of interest was the difference between preoperative and postoperative Oswestry (Oswestry disability index [ODI]) scores 8 weeks after the procedure. Macnab criteria, operation duration, length of hospitalization, surgical complications, and the need for reoperation were other outcomes evaluated. All patients received epidural anesthesia and mild sedation. RESULTS The average reduction in ODI at 8 weeks was 48 points (standard deviation [SD] = 5), representing an average percentage reduction of 85% (SD = 8). By Macnab's criteria, 85% of patients experienced either an excellent or good result, while 10% and 5% had a fair and poor result, respectively. Average surgery time was 50 min and in-hospitalization stay 8.6 h. CONCLUSIONS In our series of surgical patients with lumbar disc herniations, PELD yielded very good results, manifest as significantly reduced pain, brief procedural durations, no complications, and short hospital stays. Patients accepted the option of being awake and immediately ambulatory, and the approach proved highly feasible to execute.
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Affiliation(s)
- Guillermo Frucella
- Servicio de Neurocirugía COT. Servicio de Neurocirugía Grupo Gamma, Rosario, Argentina
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Qin H, Huang S, Xu L, Wei P, Jiang J, Xie Z, Luo X, Tan H, Huang W. Radiation Exposure and Operation Time in Percutaneous Endoscopic Lumbar Discectomy Using Fluoroscopy-Based Navigation System. World Neurosurg 2019; 127:e39-48. [PMID: 30802551 DOI: 10.1016/j.wneu.2019.01.289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study evaluated radiation exposure and operation time of percutaneous endoscopic lumbar discectomy (PELD) by using a fluoroscopy-based navigation system for access and localization. METHODS Eighty-six PELDs performed by a single surgeon were retrospectively analyzed. Patients were separated into 2 groups: group A (using a three-dimensional [3D]-printed navigation instrument and fluoroscopy-based navigation system) and group B (with conventional fluoroscopy and standard instrumentation). The operation, fluoroscopy, and total access time were collected, as well as fluoroscopy and access times. RESULTS The operative time for group A was 59 minutes (standard deviation [SD], 6 minutes) and 106 minutes (SD, 15 minutes) in group B (P < 0.001). In group A, fluoroscopy was used an average of 5 times (SD, 0.7) and 29 times (SD, 8) in group B (P < 0.001). The fluoroscopy time was 9 minutes (SD, 2 minutes) in group A and 40 minutes (SD, 8 minutes) in group B (P < 0.001). The number of access attempts was 1.3 (SD, 0.5) in group A and 8 (SD, 2 times) in group B (P < 0.001). The total access time was 11 minutes (SD, 2 minutes) in group A and 28 minutes (SD, 5 minutes) in group B (P < 0.001). CONCLUSIONS PELD using the fluoroscopy-based navigation system showed lower operative, fluoroscopy, and access time compared with conventional techniques. In addition, fewer fluoroscopy images and access attempts were made in the navigation group. These data suggest that this novel technique reduces fluoroscopy and operation time and may reduce risks of repeated surgical access attempts.
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