Utility of Large Diameter Visible Trephine in Percutaneous Endoscopic Lumbar Interbody Fusion: A Technical Report.

PURPOSE: In this study, a large diameter visible trephine was designed and used in percutaneous endoscopic lumbar interbody fusion to increase endoscopic bone decompression efficiency. Large diameter visible trephine-related technical notes and preliminary clinical experience are described. METHODS: A large diameter visible trephine was designed with normal diameter visible trephine as template. A total of 38 patients with lumbar degenerative diseases who underwent single-level percutaneous endoscopic lumbar interbody fusion with large or normal diameter visible trephine were included into a retrospective study. Operation time, bone decompression time, blood loss, intraoperative fluoroscopy, bone decompression fluoroscopy, and dura or nerve injury cases were recorded and analyzed statistically. Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) were used to analyze the clinical outcomes of the 2 groups. RESULTS: The baseline data of the 2 groups were statistically similar. There was no significant difference in postoperative VAS and ODI scores between the 2 groups. Operation time and bone decompression time of large diameter visible trephine group were significantly shorter than that of normal diameter visible trephine group (P < 0.05). Intraoperative fluoroscopy times and bone decompression fluoroscopy times of large diameter visible trephine group were significantly more than that of normal diameter visible trephine group (P < 0.05). Blood loss of the 2 groups were not statistically different. There were no dura or nerve injury cases in the 2 groups. CONCLUSIONS: For percutaneous endoscopic lumbar interbody fusion, the large diameter visible trephine is a safe and efficient endoscopic bone decompression tool under fluoroscopic guidance.

[Comparision of surgical outcomes between percuteneous endoscopic interlaminar discectomy and fenestration discectomy for L5S1 lumbar disc herniation].

OBJECTIVE: To investigate the clinical effects of percuteneous endoscopic interlaminar discectomy(PEID)and fenestration discectomy(FD) for the treatment of L5S1 lumbar disc herniation(LDH). METHODS: A retrospective analysis was made on 86 patients with L5S1 LDH from January 2014 to March 2017 and followed up. According to the different surgical methods, the patients were divided into PEID group(43 cases) and FD group(43 cases). All operations were performed under general anesthesia. Forty-three patients in PEID group underwent percuteneous endoscopic interlaminar discectomy (PEID) and other 43 patients in FD group underwent classical fenestration discectomy (FD). Operative incision, operative time, intraoperative blood loss, duration of hospitalization, time of lying in bed after surgery, complication were compared between two groups. Pre- and postoperative visual analogue scale(VAS) of affected extremity pain and lumbar pain were recorded. Postoperative creatine kinase (CK) was observed in two groups. Modified Macnab criteria was used to evaluate the clinical effects. MRI was used to observe the survival rate of paraspinal muscle after operation. RESULTS: The length of skin incision, intraoperative blood loss, duration of hospitalization, time of lying in bed after surgery of PEID group and FD group were(0.7±0.1) cm, (8.0±3.0) ml, (3.0±1.5) d, (1.0±0.5) d and(5.0±1.8) cm, (62.0±50.5) ml, (11.0±2.5) d, (3.0±0.8) d, there was significant differences between two groups(P<0.05). VAS of affected extremity at 24 hours and 1 year after operation was obviously decreased in two groups(P<0.05), but there was no significant difference between groups(P>0.05). VAS of lumbar pain in PEID group and FD group were respectively (2.99±0.32), (5.44±1.31) scores at 24 hours after operation, and (1.56±0.60), ( 3.05±0.24) at 1 year after operation, there was significant differences between two groups(P<0.05). CK at 24, 48 hours after operation of FD group were obviously increased(P<0.05). According the modified Macnab criteria to evaluate the clinical effect, the rate of excellent and good of PEID group and FD group were 93% and 95%, respectively. The survival rate of paraspinal muscle by MRI in PEID group at 1 year after operation was higher than that in FD group(P<0.05). No complications such as spinal dura mater tearing, nerve root injury, vascular injury, intervertebral space infection were found in two groups. CONCLUSIONS: Both of the two methods are safe and can obtain satisfactory effect, but PEID is more in line with concept of minimally invasive and has more advantages in paraspinal muscle protection, operative incision, intraoperative blood loss, duration of hospitalization, time of lying in bed after operation.

Methylprednisolone promotes recovery of neurological function after spinal cord injury: association with Wnt/ß-catenin signaling pathway activation.

Some studies have indicated that the Wnt/ß-catenin signaling pathway is activated following spinal cord injury, and expression levels of specific proteins, including low-density lipoprotein receptor related protein-6 phosphorylation, ß-catenin, and glycogen synthase kinase-3ß, are significantly altered. We hypothesized that methylprednisolone treatment contributes to functional recovery after spinal cord injury by inhibiting apoptosis and activating the Wnt/ß-catenin signaling pathway. In the current study, 30 mg/kg methylprednisolone was injected into rats with spinal cord injury immediately post-injury and at 1 and 2 days post-injury. Basso, Beattie, and Bresnahan scores showed that methylprednisolone treatment significantly promoted locomotor functional recovery between 2 and 6 weeks post-injury. The number of surviving motor neurons increased, whereas the lesion size significantly decreased following methylprednisolone treatment at 7 days post-injury. Additionally, caspase-3, caspase-9, and Bax protein expression levels and the number of apoptotic cells were reduced at 3 and 7 days post-injury, while Bcl-2 levels at 7 days post-injury were higher in methylprednisolone-treated rats compared with saline-treated rats. At 3 and 7 days post-injury, methylprednisolone up-regulated expression and activation of the Wnt/ß-catenin signaling pathway, including low-density lipoprotein receptor related protein-6 phosphorylation, ß-catenin, and glycogen synthase kinase-3ß phosphorylation. These results indicate that methylprednisolone-induced neuroprotection may correlate with activation of the Wnt/ß-catenin signaling pathway.