RESUMEN
BACKGROUND: Many modified lateral lumbar interbody fusion techniques for lumbar degenerative diseases have been described by different authors. However, relatively high rates of vascular injury, peritoneal laceration, and even ureteral injury have been reported. PURPOSE: The objectives of this study were ï¬rstly to present the detailed, standardized technical notes and describe the required standard characteristics of the designed surgical system of LaLIF and secondly to evaluate clinical outcomes and highlight the approach-related complications. METHODS: The mini-open LaLIF is described in a step-wise manner. The outcome measures were operative parameters, self-report measures, radiographic measures, and complications within 1 month of surgery. Operative parameters measured included operative time, intraoperative blood loss, and length of hospital stay. The self-report measures include Visual Analogue Scale (VAS), Oswestry disability index (ODI), and Short Form 36 Health Survey (SF-36) score. The radiographic measures including the intervertebral foraminal height (FH), intervertebral disc height (DH), and intervertebral foraminal area (FA) were assessed with plain radiography. The complication profiles were classified into intraoperative and postoperative (up to 1 month). Intraoperative complications were subcategorized into neurologic, vascular, ureteral, peritoneal, and vertebral injuries. Postoperative complications were subcategorized into infection, cage migration, and subsidence. RESULTS: A total of 126 patients who underwent LaLIF between April 2016 and December 2018 âby a senior author were retrospectively reviewed. There were 54 males and 72 females (range 42-89 âyears old, average 65 â± â11 years old). The mean follow-up was 20 â± â11 âmonths (range 6-38 âmonths). The LaLIF was conducted at 188 levels in 126 patients, with 1 level in 75 cases, 2 levels in 42, 3 levels in 7, and 4 levels in 2 cases. There were 114 patients who underwent stand-alone LaLIF and 12 patients required secondary posterior fixation. The mean operative time, intraoperative blood loss, and length of hospital stay were recorded. The patient-reported outcome scores (VAS, ODI, and SF-36) and radiographic parameters (FH, DH, and FA) demonstrated a signiï¬cant improvement after surgery and at the last follow-up. There were 25 (19.8%) complications in the 126 patients. The intraoperative complications accounted for 19 cases (15.1%) and postoperative accounted for 6 cases (4.8%). The most frequent complications were neurological injury (6.3%) and temporary psoas injury (6.3%). CONCLUSIONS: The mini-open LaLIF, as a reproducible novel technique, can be performed safely at L2-L5. It is associated with reliable mid-term clinical outcomes and an acceptable complication proï¬le when compared to traditional LLIF due to the advancements in the modified incision site, direct visualization, and usage of strictly vertical trajectory in multiple steps with the specially designed LaLIF system. TRANSLATIONAL POTENTIAL STATEMENT: To make the lateral lumbar fusion process repeatable and also maintain a shallow learning curve, especially for surgeons in the early stages of learning, by using instruments with the required standard characteristics, the standardized surgical steps, modified incision site, vertical trajectory, and the direct visualization during the entire procedure.
RESUMEN
Effective treatment of inflammatory pain is a major clinical concern for both patients and physicians. Traditional analgesics such as morphine and coxibs are not effective in all patients and have various unwanted side effects. Accumulating evidence has suggested that endomorphins (EMs), particularly EM-1, possess potent anti-inflammatory effects. However, poor bioavailability and low resistance to enzymatic degradation impede their direct application in the treatment of inflammation. A series of novel peptides based on the structure of EM-1, with lower undesired effects than their parent compounds, called MEL-EMs were discovered and synthetized in our preceding studies. Here, we selected two (MEL-0614 and MEL-N1606) to further investigate their anti-inflammatory effects. This work showed that MEL analogs exerted potent analgesic effects with the inhibition of activated glial cells and macrophages in a CFA-induced inflammatory pain model. Furthermore, multiple-dose administration of MEL analogs did not prolong CFA-induced chronic inflammatory pain, in contrast to morphine. Together, our findings revealed that MEL analogs may serve as effective candidates for chronic inflammation treatment.