[Treatment of senile lumbar spinal stenosis by unilateral approach and bilateral decompression with large channel endoscopy].

OBJECTIVE: To evaluate clinical effect of unilateral approach and bilateral decompression via large channel endoscopic system for the treatment of lumbar spinal stenosis. METHODS: The clinical data of 32 patients with lumbar spinal tenosis treated by unilateral approach and bilateral decompression via large channel endoscopy from February 2018 to February 2019 were retrospectively analyzed. There were 18 males and 14 females, aged 65 to 84 years old with an average of (70.6± 8.4) years. The course of disease was from 1 to 12 years. All 32 cases were accompanied by numbness or pain in the lower limbs, of which 28 cases were accompanied by intermittent claudication. Narrow segments were L3, 4 of 2 cases, L4, 5 of 19 cases, L5S1 of 13 cases, including double segments of 2 cases. Preoperative imaging showed 3 cases of central canal stenosis, 21 cases of bilateral lateral recess stenosis and 8 cases of mixed stenosis. Operation time and complications were recorded. X-ray, CT and MRI were analyzed at 3 days, 3 months and 1 year after operation. Visual analogue scale(VAS), Oswestry Disability Index (ODI), single continuous walking distance(SCWD) were observed before and after operation. Modified Macnab standard were used to evaluate the clinical effect at 1 year after operation. RESULTS: All the patients were followed up for 12-24 (17.68±2.43) months and all operations were successfully completed with the operation time of 70-160(85.64±11.94) min. Spinal dural tear occurred in 1 case during the operation, and sensory disturbance in the other side of lower limb in a short period of time occurred in 2 cases, all improved after corresponding treatment. Postoperative imaging showed that the spinal canal was significantly enlarged and the nerve root was fully released. Before operation and 3 days, 3 months, 1 year after operation, VAS scores of low back pain were 4.62 ±1.41, 2.73 ±1.35, 1.21 ±1.17, 1.11 ±0.34, respectively;VAS scores of leg pain were 6.83 ± 1.71, 3.10±1.50, 1.08±0.19, 0.89±0.24, respectively. VAS scores of low back pain and leg pain each time point after operation were obvious improved (P<0.05); there was significant difference between 3 months and 3 days after operation(P<0.05), and there was no significant difference between 3 months and 1 year after operation (P>0.05). Before operation and 3 days, 3 months, 1 year after operation, ODI scores were 38.40 ±6.48, 18.42 ±2.40, 5.48 ±0.77, 3.05 ±0.28, respectively; SCWD was (47.48±5.32) m, (52.89±11.23) m, (245.43±18.94) m, (468.97±55.87) m, respectively. The differences in ODI score and SCWD postoperative time points were statistically significant compared with those before operation (P<0.05). The difference between 3 months and 3 days after operation was statistically significant (P<0.05). The difference between 1 year and 3 months after operation was statistically significant (P<0.05). According to Macnab standard to evaluate clinical effect at 1 year after operation, 15 cases got excellent results, 14 good, 3 fair. CONCLUSION: It is a safe and effective way to treat lumbar spinal stenosis with unilateral approach and bilateral decompression via large channel endoscopic system. It has the advantages of sufficient decompression, less trauma, fast recovery, high safety and low incidence of postoperative complications. It can minimize the damage to the stable structure of the lumbar spine and is an ideal minimally invasive operation for the treatment of lumbar spinal stenosis.

Posterior percutaneous endoscopic versus traditional surgery for cervical disc herniation: A protocol for systematic review and meta analysis.

BACKGROUND: Posterior percutaneous endoscopic cervical diskectomy (P-PECD) can be used posterior microdiscectomy for cervical disc herniation. But only some small sample sizes of clinical studies have evaluated the efficacy and safety of P-PECD. This study aim to evaluated the efficacy and safety of P-PECD compared with traditional open surgery. METHODS: We will search the following seven electronic databases from their initiation to the May 1, 2020: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM) and Wanfang database. All randomized controlled trials, non-randomized controlled trials and retrospective case controls that compared the efficacy and safety of P-PECD and traditional open surgery in the treatment of cervical disc herniation will be included. The pooled odds ratio with 95% credible intervals (CIs) was used for the dichotomous variables. The mean difference with 95% CIs was used for the continuous variables. All analyses were conducted by Comprehensive Meta Analysis 2.0. A 2-tailed P value < 0.05 is considered statistically significant. RESULTS: The results of systematic review and meta-analysis will be submitted to a peer-reviewed journal. CONCLUSION: Our study will provide clarity regarding for clinicians to choices best surgical approach for patients with cervical disc herniation. Any changes that need to be made during the process of this study will be explained in the final full-text publication. PROTOCOL REGISTRATION NUMBER: CRD42020164011.

[The relationship between angle of puncture and distribution of bone cement of unilateral percutaneous kyphoplasty for the treatment of thoracolumbar compression fractures].

OBJECTIVE: To explore the relationship of bone cement distribution and the puncture angle in the treatment of thoracolumbar compression fractures with unilateral percutaneous kyphoplasty (PKP). METHODS: The clinical data of 37 patients with thoracolumbar osteoporotic compression fractures underwent PKP between January 2013 to March 2014 were retrospectively analyzed, all punctures were performed unilaterally. There were 6 males, aged from 65 to 78 years old with an average of (71.83 ± 6.15) years; and 31 females, aged from 57 to 89 years old with an average of (71.06 ± 7.89) years. Imaging data were analyzed and puncture angle and puncture point were measured before operation. According to the measured data, the puncture were performeds during the operation. Distribution area of bone cement were calculated by X-rays data after operation. The effect of bone cement distribution on suitable puncture angle was analyzed; VAS score was used to evaluate the clinical effects. RESULTS: The puncture angle of thoracic vertebrae in T8-T12 was from 28° to 33° with an average 30.4°; and the puncture angle of lumbar vertebrae in L1-L5 was from 28° to 35° with an average of 31.3°. Postoperative X-rays showed the area ratios of bilateral bone cement was 0.97 ± 0.15. Bilateral diffuse area were basic equal. Postoperative VAS score decreased significantly (1.89 ± 1.29 vs 7.03 ± 1.42). CONCLUSION: Through measure imaging data before operation with PKP,the puncture point and entry point can be confirmed. According the measured data to puncture during operation, unilateral puncture can reach the distribution effect of the bilateral puncture in the treatment of thoracolumbar compression fractures.