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The original version of this article unfortunately contained one mistake. The institutions of the authors are wrong. The corrected institutions are given below.Zhi-cai DU1, 2, Li-xin ZHU11Department of Spinal Surgery, Orthopaedic Medical Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China 2Department of Minimally Invasive Spinal Surgery, The Second Affiliated Hospital of Inner Mon-golia Medical University, Hohhot 010030, China.
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Improving the closure effect of surgical suture for repair of annulus fibrosus defects remains an unsolved problem. A new type of porcine fibrin glue was reported for the repair of annulus fibrous defects in sheep models in this study. Continuous axial loading test showed that this glue could effectively improve the closure effect of surgical suture for annulus fibrous defect. Magnetic resonance imaging (MRI) of the lumbar spine confirmed that, compared with non-fibrin glue treated intervertebral discs, it contributed to preservation of the nucleus pulposus and maintained the physiological hydration of the intervertebral discs. Moreover, histomorphology evaluation showed that the porcine fibrin glue could partially reverse degeneration of the injured intervertebral discs. Taken together, porcine fibrin glue can effectively enhance the closure effect of surgical suture on annulus fibrosus, improve the repair effect and slow down the degeneration of the intervertebral disc, and provide a potential therapeutic strategy for degenerative intervertebral disc disease.
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Anillo Fibroso/cirugía , Adhesivo de Tejido de Fibrina/uso terapéutico , Técnicas de Sutura/instrumentación , Animales , Anillo Fibroso/fisiopatología , Modelos Animales de Enfermedad , Humanos , Ovinos , Suturas , PorcinosRESUMEN
This study compares the safety and efficiency of two techniques in microendoscopic discectomy (MED) for lumbar disc herniation. The two techniques are MED with automatic nerve retractor and MED with nerve hook which had been widely used for many years. The former involves a newly developed MED device which contains three parts to protect nerve roots during operation. Four hundred and twenty-eight patients underwent MED treatments between October 2010 and September 2015 were recruited and randomized to either intraoperative utilization of automatic nerve retractor (n = 315, group A) or application of nerve hook during surgery (n = 113, group B). Operation time and intraoperative bleeding volume were evaluated. Simultaneously, Visual Analogue Scales (VAS) and muscle strength grading were performed preoperatively, and 1, 2, 3 days, 1, 2 weeks, 3 and 6 months postoperatively. No dramatic difference of pain intensity was observed between the two groups before surgery and 6 months after surgery (P > 0.05). The operation time was shorter in group A (30.30 ± 1.89 min) than that in group B (59.41 ± 3.25 min). Group A (67.83 ± 13.14 ml) experienced a significant decrease in the amount of blood loss volume when compared with group B (100.04 ± 15.10 ml). There were remarkable differences of VAS score and muscle strength grading after postoperative 1, 2, 3 days, 1, 2 weeks and 3 months between both groups (P ≤ 0.05). MED with automatic nerve retractor effectively shortened operation time, decreased the amount of bleeding, down-regulated the incidence of nerve traction injury.
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OBJECTIVE: To explore the clinical effect of intertransverse approach microendoscopic discectomy for far lateral lumbar disc herniation. METHODS: From February 2005 to February 2010, 73 patients with far lateral lumbar disc herniation were treated with intertransverse approach microendoscopic discectomy. Their clinical data were retrospectively analyzed. There were 41 males and 32 females, aged from 19 to 80 years old with an average of 56.5 years; courses of disease ranged from 1 to 25 months with an average of 4.5 months. The main symptom was low back pain and sciatica, especially the sciatica was seriously. Herniation level was in L3,4 of 9 cases, L4,5 of 49 cases, L5S1 of 15 cases. Preoperative, 2 weeks after operation, final follow-up, conditions of pain relief were assessed by visual analogue scale (VAS); total life quality of patients were evaluated by Oswestry Disability Index (ODI) before operation and last follow-up. RESULTS: All operations were performed successfully, operative time was from 40 to 115 min (mean of 50 min); and blood loss was from 50 to 150 ml (mean of 110 ml). Incision infection had 1 case and incomplete nerve root injury had 1 case. All patients were followed up from 3 to 8 years with an average of 4.5 years. Postoperative VAS and ODI had obviously improved (P < 0.01). CONCLUSION: The technique of intertransverse approach microendoscopic discectomy is a feasible and effective method for far lateral lumbar disc herniation.
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Discectomía/métodos , Endoscopía/métodos , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To analyze the reasons of intraoperative complications of microendoscopic disectomy (MED) and corresponding preventive measures. METHODS: From October 2001 to January 2012, the data of 851 patients with lumbar disc herniation underwent MED were retrospectively analyzed. There were 469 males and 382 females with an average age of 42.5 years ranging 16 to 75. Course of disease was from 1 to 18 months with an average of 3 months. The segments of herniated disc including L3,4 of 24 cases, L4,5 of 418 cases and L5S1 of 409 cases . Main symptoms included low back pain with lower extremity radial pain and numbness. Of them,unilateral lower extremity symptom was in 729 cases and bilateral symptom was in 122 cases. There were at least 2 abnormal signs in the four signs which including feeling anormaly, muscle strength anormaly,dysreflexia and muscle atrophy. Distraction test of nerve was positive. CT or MRI findings must coincide with the clinical symptoms and signs. No lumbar instability,spinal stenosis,the upper lumbar disc herniation or combined with cauda equina nerve syndrome were found in 851 patients. The intraoperative complications were recorded and analyzed for the reasons of the intraoperative complication and related prevention measures. RESULTS: According to the Macnab standard,424 cases obstained excellent results, 321 good,106 fair,with excellent and good rate of 87.5%. The result was similar to the traditional open operation. One cases transferred to open operation due to equipment breakdown, case died for myocardial infarction at 11 days after the operation, 2 cases occurred acute epidural hematoma in 1 hour after operation. Injury of dura mate of spinal cord occurred in 28 cases and incidence rate was 3.29%(28/851); traction injury of nerve root occurred in 38 cases and incidence rate was 4.46% (38/851). One case occurred in retroperitoneal hematoma, 2 cases in incomplete cauda equina injury and 2 cases in incomplete nerve root breakage. CONCLUSION: Skilled endoscopic hemostasis techniques,careful and meticulous operation is very important for the prevention of intraoperative complications. Moreover,timely finding and treating the complications was effective measures to prevent the coniplications.