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Objective:To investigate the clinical efficacy of percutaneous endoscopic interlaminar discectomy for lumbar disc prolapse.Methods:The clinical data of 60 patients with lumbar disc prolapse who underwent surgery at Luzhou People's Hospital between March 2019 and September 2021 were retrospectively analyzed. These patients were divided into an open lumbar discectomy (OLM) group ( n = 29, receiving treatment through a posterior approach) and a percutaneous endoscopic interlaminar discectomy (PEID) group ( n = 37). Perioperative conditions were compared between the two groups. The Visual Analogue Scale (VAS) and Oswestry Disability Index scores of the leg were recorded before surgery and 1 week, 1, 3, 6 and 12 months after surgery. At the final follow-up, clinical efficacy was assessed using the modified MacNab criteria. Results:The surgical time, blood loss, and length of hospital stay were (96.55 ± 15.18) minutes, 120.0 (100.0, 180.0) mL, and 10.0 (9.5, 12.0) days in the OLM group, while these values were (77.30 ± 11.03) minutes, 20.0 (15.0, 22.5) mL, and 6.0 (5.0, 7.0) days in the PEID group, respectively. Significant differences were observed in these indexes between the two groups ( t = 5.97, Z = -7.00, -6.68, all P < 0.001). At 1 week, 1 month, 3 months, 6 months, and 12 months after surgery, there was no significant difference in VAS score between the two groups (all P > 0.05). At 1 week, 1 month, and 3 months after surgery, the Oswestry Disability Index score in the PEID group was 12.0 (10.0, 24.0) points, 6.0 (9.0, 13.0) points, and 2.0 (4.0, 8.0) points, respectively, which were significantly lower than 24.0 (16.0, 31.0) points, 16.0 (10.0, 21.0) points, and 8.0 (8.0, 12.0) points in the OLM group, respectively ( Z = -3.64, -3.79, -3.26, all P < 0.05). According to the modified MacNab criteria for final follow-up assessment, the excellent and good rate was 86.21% (25/29) in the OLM group and 89.19% (33/37) in the PEID group; there was no significant difference in excellent and good rate between the two groups ( P > 0.05). Conclusion:The clinical efficacy of PEID in the treatment of lumbar disc prolapse is satisfactory.
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【Objective】 To compare the anesthestic effects of ultrasound-guided retrolaminal block (RLB) and local anesthesia during posterior approach vertebral surgery. 【Methods】 Forty patients (ASA physical status Ⅰ or Ⅱ) scheduled for transforaminal lumbar spine endoscopic surgery were recruited and randomly divided into two groups (n=20): RLB group and local anesthesia group (Group C). RLB group received the ultrasound-guided retrolaminar block using parasagittal in plane method by an anesthesiologist while Group C received layer-by-layer local infiltration anesthesia according to the operation location; 0.5% ropivacaine of 20 mL was used in the two groups. We recorded visual analogue score (VAS) and Ramsay sedation score at admission (T0), during skin incision (T1), puncture (T2), foraminoplasty (T3), nerve root decompression (T4) and suture (T5). We also recorded remedial analgesia rate, scores of the patients’ satisfaction and the intraoperative occurrence of side effects (respiratory depression, tachycardia and hypertension). The patients were followed up. Their functional status was assessed by the Oswestry Disability Index (ODI) score before surgery and three months after surgery. 【Results】 Compared with Group C, RLB group had significantly decreased visual analogue score at T2-4 and lower remedial analgesia rate (P<0.05). The patients’ satisfaction was higher in group RLB than in Group C (P<0.05). The intraoperative occurrence of hypertension and tachycardia were significantly lower in RLB group than in Group C (P<0.05). ODI score was significantly decreased three months after surgery in both groups (P<0.05), but it did not differ significantly between the two groups (P>0.05). 【Conclusion】 Ultrasound-guided RLB can provide satisfactory analgesia with greater safety when trasforaminal endoscopic surgery is used.
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【Objective】 To analyze the effect of iliac crest on the difficulty of L5-S1 transforaminal puncture and catheterization by using CT images and oblique sagittal reconstruction images. 【Methods】 We made a retrospective analysis of the CT images and oblique sagittal reconstruction images of the adults aged from 30 to 50 years who underwent abdominopelvic CT examination in Affiliated Hospital of Nantong University. Based on the feasibility of puncture and catheterization, all the subjects were divided into two groups: group Ⅰ (suitable for puncture and catheterization) and group Ⅱ (unsuitable for puncture and catheterization). We compared and analyzed differences in the rostral puncture inclination angle (α), the abaxial angle of iliac crest (β), the distance between the highest iliac crests (a), the distance between sacroiliac joints (b), the height of the superior articular process of sacral (c), the height of iliac crest (d), and the height of the superior articular process of sacral (c’) in the oblique sagittal images between the two groups. We explored the effect of anatomical indexes and iliac crests in oblique sagittal images on puncture and catheterization. 【Results】 The number of high/low iliac crests for group Ⅰ and group Ⅱ was (117/58 vs. 63/0), and the number of men/women was 64/111 vs. 56/7, respectively. Variables α, b and c were higher in group Ⅰ than in group Ⅱ (34.77±4.86 vs. 31.11±5.16, P<0.001; 137.19±19.24 vs. 128.56±20.73, P = 0.003; 14.34±2.38 vs. 13.02±2.68, P<0.001), and d was lower than that in group Ⅱ (27.51±6.73 vs. 37.65±6.35, P<0.001). In addition, no statistically significant difference was found in the height of c of coronal CT scan and c’ of oblique sagittal reconstruction images (13.99±2.53 vs. 13.93±2.40, P = 0.465). 【Conclusion】 It is more comprehensive and effective to evaluate preoperatively the influence of iliac crest on L5-S1 puncture and catheterization of TF-PELD by using CT scan and CT 3D reconstruction oblique sagittal images. The key factors in the evaluation of iliac crest are the degree of “cohesion” and the height. It is more easily to successfully puncture and catheterize when the shape of iliac crest is wider and lower. Therefore, it has higher probability to successfully puncture and catheterize in women.
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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 (@*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, @*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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Humains , Discectomie , Discectomie percutanée , Endoscopie , Pompes à perfusion , Déplacement de disque intervertébral/chirurgie , Vertèbres lombales/chirurgie , Études rétrospectives , Résultat thérapeutique , EauRÉSUMÉ
【Objective】 To explore the establishment of individualized prediction model of recurrence after percutaneous endoscopic lumbar discectomy (PELD) in patients with lumbar disc herniation (LDH). 【Methods】 We selected 124 LDH patients treated with PELD in Department of Orthopedics, The First Affiliated Hospital of Xi’an Jiaotong University, from January 2017 to January 2020 as the research subjects. Their clinical data were retrospectively analyzed, and the independent risk factors affecting PELD recurrence in the LDH patients were screened by univariate analysis and Logistic regression analysis, respectively; the correlation histogram prediction model was established. 【Results】 Age, history of diabetes, course of disease, work intensity and IDDG were the risk factors for the recurrence of PELD in LDH patients (P<0.05). Based on the risk factors screened out, the prediction model of the histogram was established, and the model was verified. The results showed that the C-index of the modeling set and the validation set was 0.944 (95% CI: 0.902-0.963) and 0.969 (95% CI: 0.911-0.978), respectively. The correction curves of both groups were well fitted with the standard curves. The areas under the ROC curve (AUC) in the two groups were 0.944 and 0.969, respectively, which proved that the model had good prediction accuracy. 【Conclusion】 LDH patients have many independent risk factors for recurrence after PELD, and the model based on risk factors with good predictive ability can be useful in preoperative evaluation, appropriate patient selection, and decrease of recurrence rate after PELD.
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Objective: To identify effect of quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy (PELD) treatment in patients with L 5, S 1 lumbar disc herniation. Methods: A retrospective study between May 2014 and March 2016 was conducted, including 100 patients with disc herniation at L 5, S 1, who were initially enrolled for the PELD treatment. Among them, 66 patients were successfully treated with PELD (group A), and the other 34 patients failed to perform puncture, catheterization, or microscopical operation due to the influence of iliac bone and other peripheral bone structures and treated with alternative surgical plans. By analyzing the X-ray films of lumbar vertebrae (including bilateral ilium) of the two groups before operation, the concept of ilium height rate and ilium angle rate was put forward innovatively. The ilium height rate and ilium angle rate of the two groups were measured and compared, and the diagnostic critical points of ilium height rate and ilium angle rate were determined by ROC curve analysis. Results: The ilium height rate was 0.61±0.09, 0.74±0.05 and the ilium angle rate was 0.66±0.08, 0.80±0.08 in groups A and B, respectively, showing significant differences between the two groups ( F=69.729, P=0.000; F=65.165, P=0.000). ROC curve analysis showed that the critical point of ilium height rate was 0.71 (area under ROC curve was 0.927, P=0.000), and the critical point of ilium angle rate was 0.75 (area under ROC curve was 0.965, P=0.000). Conclusion: PELD is not recommended for patients with L 5, S 1 intervertebral disc herniation, when the ilium height rate is greater than 0.71 and/or the ilium angle rate is greater than 0.75. Other surgical plans such as transpedicular approach, transpedicular approach, or open surgery, should be recommended to reduce the risk of surgery and the pain of patients.
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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 L 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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Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Discectomie percutanée , Déplacement de disque intervertébral , Chirurgie générale , Vertèbres lombales , Neuroendoscopie , Études rétrospectives , Résultat thérapeutiqueRÉSUMÉ
BACKGROUND: At present, there are many surgical methods for the treatment of lumbar disc herniation, and the therapeutic effects have their own advantages. Although there are many meta-analyses to compare the therapeutic effects of the two surgical methods, there is no comparison of the therapeutic effects of several surgical methods. OBJECTIVE: To compare the differences of different surgical methods in the treatment of lumbar disc herniation by network meta-analysis. METHODS: PubMed, Embase, Cochrane Library, Ovid and CNKI were searched, and randomized controlled trials or retrospective studies on different surgical methods for the treatment of lumbar disc herniation were collected. According to the inclusion and exclusion criteria established in advance, the quality of included randomized controlled trials was evaluated, and the data were analyzed by STATA 15.0 software. RESULTS AND CONCLUSION: A total of 42 studies, 5 156 patients and 9 surgical treatments were included. Surgical treatments contain total disc replacement, lumbar disc fusion, standard open discectomy, microendoscopic discectomy, microdiscectomy, percutaneous endoscopic lumbar discectomy, chemonucleolysis, automatic percutaneous lumbar discectomy and percutaneous laser disc decompression. The results of network meta-analysis showed that(from best to worst):(1) There was no significant difference in leg pain relief, and the rank probability was percutaneous laser disc decompression > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > lumbar disc fusion > total disc replacement.(2) There was no significant difference in low back pain relief, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > microdiscectomy > percutaneous laser disc decompression > standard open discectomy.(3) There was no significant difference in Oswestry disability index scores, and the rank probability was microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > total disc replacement > lumbar disc fusion.(4) There were some statistical differences in the success rate, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > percutaneous laser disc decompression > microdiscectomy > chemonucleolysis > automatic percutaneous lumbar discectomy.(5) There was no significant difference in reoperation rate, and the rank probability was total disc replacement > lumbar disc fusion > microdiscectomy > microendoscopic discectomy > standard open discectomy > percutaneous endoscopic lumbar discectomy > percutaneous laser disc decompression > chemonucleolysis > automatic percutaneous lumbar discectomy.(6) There were some statistical differences in incidence of complications, and the rank probability was percutaneous endoscopic lumbar discectomy > automatic percutaneous lumbar discectomy > standard open discectomy > microdiscectomy > percutaneous laser disc decompression > microendoscopic discectomy > total disc replacement > lumbar disc fusion > chemonucleolysis. Results suggested that microendoscopic discectomy and percutaneous endoscopic lumbar discectomy are effective in all aspects. Disc replacement and lumbar disc fusion are the best in success rate of operation. Chemonucleolysis is poor in success rate of operation, reoperation rate and complications rate. Percutaneous automatic discectomy is poor in success rate of operation and reoperation rate.
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People's understanding of lumbar spinal stenosis has become more and more comprehensive and reasonable, however, there are still many controversies about the concepts of "central lumbar canal" and "lateral lumbar spinal canal", and there is no unified standard at present. In this paper, we redefine and differentiate the two concepts. We believe that some kinds of central canal stenosis caused by bilateral recess stenosis can be completely solved by bilateral percutaneous endoscopic transforaminal discectomy. At the same time, the concept of "lumbar lateral recess" is ambiguous. We redefine it as "lateral lumbar spinal canal" and propose "West China Hospital classification" to guide surgical decision-making, which has been widely recognized and applied.
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Objective To utilize the magnetic resonance neurography (MRN) as a feasible tool for measuring the anatomical parameters of lumbar spinal nerves, and further to evaluate the neuro-safety of interlaminar percutaneous endoscopic lumbar discectomy.Methods Thirty healthy adult volunteers without significant history of low back pain or lumbar deformity were selected in our hospital from September 2016 to December 2016. All subjects accepted MRN. The nerve roots of L2-S1 were measured at the starting point of dural sac, and the angles between nerve roots and dural sac were measured. The distances between L2-L5 nerve roots and the edge of ipsilateral dural sac were measured and analyzed statistically.Results All MRN showed a gradual increase in the origin of the nerve roots from L2 to S1. The origin of the root was found to be below the corresponding disc for the L2 to L4 roots. There were 70% of the L5 roots originated below the L4/5 disc, 26.7% at the L4/5 disc, and 3.3% above the L4/5 disc; about 70% of the S1 roots originated above the L5/S1 disc. There were no statistically significant differences in the angles between dural sac and both left and right nerve roots (P>0.05). The angels between the nerve root and the dural sac from L5 and S1 was smaller than those from L2, L3, and L4 (P<0.05); that from S1 was significantly smaller than that from L5 (P<0.05). The distance of the nerve root and the ipsilateral dural sac was significantly increased in each side from L2 to L5 (P<0.05). There was no statistically significant difference in the distances between the left and right nerve roots and the edge of the ipsilateral dural sac in the same segment (P>0.05).Conclusion MRN is a feasible tool to measure the anatomical parameters of the lumbar spinal nerve, and there is a safe neurological area of the percutaneous endoscopic lumbar discectomy through the interlaminar approach.
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La Discectomía Percutánea Endoscópica Lumbar es una técnica mínimamente invasiva para el tratamiento de las hernias discales lumbares con resultados comparables a la microdiscectomía lumbar. La principal complicación, los fragmentos discales remanentes, son en gran parte producidos por la limitación de movimiento del endoscopio una vez realizada la punción. Presentamos una nota técnica y aplicación en un caso ejemplo de lo que hemos llamado "libre flotación foraminal": un acceso al espacio epidural por vía transforaminal que mantiene la libertad de movimiento y permite una exploración endoscópica en busca de fragmentos remanentes.
Percutaneous endoscopic lumbar discectomy is a minimally-invasive surgical approach for the treatment of lumbar disc herniation, with outcomes similar to open micro-discectomy. The main complication residual disc fragments is largely caused by a rigid endoscopic trajectory once the puncture has been made. We present a technical note of a surgery performed in a patient who underwent what we have called a "free foraminal flotation technique": accessing the epidural space through a transforaminal approach that maintains freedom of movement and allows for endoscopic exploration to locate residual disc fragments.
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Humains , Hernie , Discectomie percutanée , Discectomie , Région lombosacraleRÉSUMÉ
Objective: To evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation. Methods: Between June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L 4, 5 in 15 cases and L 5, S 1 in 19 cases; 2 cases had lumbar disc herniation at both L 4, 5 and L 5, S 1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up. Results: All patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores ( P0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%. Conclusion: PELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.
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STUDY DESIGN: Case report OBJECTIVES: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). SUMMARY OF LITERATURE REVIEW: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. MATERIALS AND METHODS: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. RESULTS: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. CONCLUSIONS: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.
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Humains , Adhésifs , Diagnostic , Discectomie , Électromyographie , Fistule , Membre inférieur , Imagerie par résonance magnétique , Nylons , Douleur rebelle , LarmesRÉSUMÉ
Objective To discuss the clinical effect of percutaneous endoscopic lumbar discectomy(PELD) in the treatment of lumbar disc herniation and calcification.Methods The clinical data of 52 patients with lumbar disc herniation and calcification in orthopedic department of general hospital of Fushun mining bureau from June 2015 to June 2016 were retrospectively reviewed.The data included medical records,out-patient review,telephone follow-up was collected.The VAS,ODI and modified MacNab criteria were used to assess the clinical effects.Results There were significant improvement in VAS and ODI score at 6 week,6 months,1 year after surgery compared with before.According to the modified MacNab criteria,the rate of excellent and good result was 94.3%,the improvement rate was 98.1%.Conclusion PELD is an effective method to treat lumbar disc herniation and calcification,with advantages of less injury,rapid recovery,it is worth popularizing application in clinic.
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Objectives:To compare the early curative effect of visualization of percutaneous transforaminal endoscopic discectomy(VPTED) and microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis.Methods:49 patients with single segmental lumbar spinal stenosis combined with lumbar disc herniation(LDH) were treated in our hospital from March 2016 to March 2017.Among them,21 cases accepted VPTED,and 28 cases underwent MED.The length of incision,amount of bleeding during operation,operation time,length of hospital stay and the cost of hospitalization were recorded in the both groups.Visual analogue scale(VAS) was used to evaluate the effect of surgery,Oswestry disability index(ODI) was used to evaluate the clinical efficacy.The modified MacNab criteria were used to evaluate the efficacy of the patients at final follow-up.Results:There were no statistical differences among the age,the ratio of male to female,follow-up time,low back pain,weakness,sensory disturbance,general reflexes and prominent segments(P>0.05).There were statistically significant differences between the two groups in preoperative and postoperative VAS and ODI scores(P<0.05).There was no significant difference in VAS or ODI score between groups at the same time (P>0.05).The length of incision(0.78±0.06cm vs 1.95±0.12cm),the amount of intraoperative perspective(15.86± 2.66 vs 2.18±0.38) and the operation time(87.51±30.46min vs 47.53±13.61min) had significant difference between VPTED and MED group(P<0.05).There was no significant difference in hospitalization time or hospitalization expenses between the two groups(P>0.05).At final follow-up,based on the MacNab standard,it was excellent in 17 cases,good in 3 cases,fair in 1 case in VPTED group;it was excellent in 22 cases,good in 4 cases,fair in 2 cases in MED group.Excellent rate of the VPTED group was 95.24%,and that was 92.86% in the MED group,there was no significant difference between the two groups(P>0.05).Conclusions:Visualization of percutaneous transforaminal endoscopic discectomy (VPTED) and microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis have good short-term curative effect,it iproves that VPTED is a safe and effective minimally invasive surgery.
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<p><b>OBJECTIVE</b>To analyze the complications of lumbar intervertebral disc herniation treated with percutaneous endoscopic lumbar discectomy(PELD), and discuss how to avoid these complications.</p><p><b>METHODS</b>The data of 132 patients with lumbar intervertebral disc herniation underwent PELD from October 2013 and June 2015 were retrospectively analyzed, including 85 males and 47 females with an average age of 42.9 years old. There were 6 cases of L₃,₄, 68 of L₄,₅ and 58 of L₅S₁. The incidences of intraoperative and postoperative complications were analyzed.</p><p><b>RESULTS</b>There was spinal dura mater injury in 1 patient, but no cerebrospinal fluid leakage and nerve function deficit was found, the muscle strength did not decrease postoperatively and the incision healed well. Two patients converted to open surgery ultimately because of stenosis of the intervertebral foramen and adhesion between nucleus pulposus and spinal dura mater; two patients complicated with early recurrence(in 3 months);nucleus pulposus residue developed in 3 patients; all of them were treated by open surgery and got satisfactory results. One patient with heart disease history complicated with supraventricular tachycardia after surgery and 2 patients with the increased cerebrospinal fluid pressure during surgery.</p><p><b>CONCLUSIONS</b>PELD have a steep learning curve, and the technology is a safe and effective method in treating lumbar disc herniation, but the beginners must have enough open surgery experience, and to grasp indications strictly.</p>
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<p><b>OBJECTIVE</b>To assess the effect of percutaneous endoscopic lumbar discectomy (PELD) combined with epidural injection for prolapsed lumbar disc herniation(PLDH).</p><p><b>METHODS</b>In this prospective randomized controlled study, the clinical data of 126 patients who had undergone a PELD because of a single-level PLDH from March 2014 to June 2015 were analyzed. There were 67 males and 59 females, ranging in age from 17 to 75 years old with an average of(41.0±13.5) years old, 9 cases were L₃,₄, 76 cases were L₄,₅ and 41 cases were L₅S₁. According to the random number table, the patients were randomized into two groups, with 63 patients in each group. Patients in group 1 were injected normal saline after PLED, patients in group 2 were subjected to an epidural injection of Diprospan, Lidocaine and Mecobalamine after PLED. All the patients were followed up from 6 to 20 months with the mean of 12.4 months. Complications, the postoperative hospital stay, the period of return to work, visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) score were compared between two groups, and clinical outcomes were evaluated according to modified MacNab criteria.</p><p><b>RESULTS</b>All the operations were successful, and no complications were found. The mean postoperative hospital stay and the period of return to work in group 1 were (4.61±1.25) days and (4.31±0.47) weeks, respectively, and in group 2 were (2.53±0.69) days and (3.14±0.52) weeks, there was significant differences between two groups(=0.000). Postoperative VAS and JOA scores in two groups were obviously improved (=0.000). At 1 day, 1 week, 1 month after operation, VAS, JOA scores in group 2 were better than that of group 1(=0.000), and after 6 months, there was no significant difference between two groups(>0.05). According to the modified MacNab criteria, 39 cases got excellent results, 21 good, 3 fair in group 1, and which in group 2 were 41, 20, 2, respectively, there was no significant difference between two groups(=0.087).</p><p><b>CONCLUSIONS</b>PELD is an mini-invasive technique for PLDH, it can fleetly reduce pain and improve function. And combination with epidural injection has the advantages of pain releasing and function improving in the short-term postoperative period, and it can decrease postoperative hospital stay and time of returning to work, and it is a safe and effective method.</p>
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STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the effectiveness of percutaneous endoscopic lumbar discectomy (PELD) for adjacent lumbar disc herniation through radiologic evaluations. SUMMARY OF LITERATURE REVIEW: PELD minimizes posterior structural damage, allowing rapid rehabilitation. SUBJECTS AND METHODS: This study was conducted on 45 patients who were followed up for 1 year after PELD for adjacent lumbar disc herniation from March 2014 to February 2016. The modified Macnab criteria, the modified Suezawa and Schreiber score (MSS score), and visual analogue scales for the back (VAS-B) and legs (VAS-L) were evaluated. The disc height ratio and segmental angulation change were compared before posterolateral fusion and before PELD. Moreover, spinal stenosis was confirmed on magnetic resonance imaging (MRI) before PELD. RESULTS: Based on the modified Macnab criteria, 53.3% patients received an evaluation of at least “good,” and the mean MSS score improved from 4.77 to 6.99 at 1 year after the operation. The mean VAS-B score decreased from 7.02 to 4.67, and the mean VAS-L score decreased from 8.15 to 4.24 at 1 year after the operation. The mean disc height ratio was 87.1%, and the mean segmental angulation change was 6.5°, with a greater change in the “fair” or “poor” group, and the rate of spinal stenosis on MRI was also higher in the “fair” or “poor” group. CONCLUSION: The clinical outcomes of PELD, which is accompanied by degenerative changes on simple radiographic images such as disc space narrowing and increased segmental angulation or spinal stenosis on MRI, may not be satisfactory. Therefore, decisions regarding surgery should be made carefully in such cases.
Sujet(s)
Humains , Discectomie , Jambe , Imagerie par résonance magnétique , Réadaptation , Études rétrospectives , Sténose du canal vertébral , Poids et mesuresRÉSUMÉ
Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine surgery. Constant improvement in the imaging modality especially with introduction of the magnetic resonance imaging, it is possible to identify culprit degenerated disc segment and again with the discography it is possible to diagnose the pain generator and pathological degenerated disc very precisely and its treatment with minimally invasive approach. With improvements in the optics, high resolution camera, light source, high speed burr, irrigation pump etc, minimally invasive spine surgeries can be performed with various endoscopic techniques for lumbar, cervical and thoracic regions. Advantages of endoscopic spine surgeries are less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring, reduced hospital stay, early functional recovery and improvement in the quality of life & better cosmesis. With precise indication, proper diagnosis and good training, the endoscopic spine surgery can give equally good result as open spine surgery. Initially, endoscopic technique was restricted to the lumbar region but now it also can be used for cervical and thoracic disc herniations. Previously endoscopy was used for disc herniations which were contained without migration but now days it is used for highly up and down migrated disc herniations as well. Use of endoscopic technique in lumbar region was restricted to disc herniations but gradually it is also used for spinal canal stenosis and endoscopic assisted fusion surgeries. Endoscopic spine surgery can play important role in the treatment of adolescent disc herniations especially for the persons who engage in the competitive sports and the athletes where less tissue trauma, cosmesis and early functional recovery is desirable. From simple chemonucleolysis to current day endoscopic procedures the history of minimally invasive spine surgery is interesting. Appropriate indications, clear imaging prior to surgery and preplanning are keys to successful outcome. In this article basic procedures of percutaneous endoscopic lumbar discectomy through transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy and percutaneous endoscopic thoracic discectomy are discussed.
Sujet(s)
Adolescent , Humains , Athlètes , Cicatrice , Sténose pathologique , Diagnostic , Discectomie , Discectomie percutanée , Endoscopie , Fibrose , Foraminotomie , Chimiolyse de disque intervertébral , Durée du séjour , Région lombosacrale , Imagerie par résonance magnétique , Qualité de vie , Canal vertébral , Dysraphie spinale , Rachis , SportsRÉSUMÉ
Objective To investigate the clinical efficacy of She medicine therapy in rehabilitation after endoscopic surgery for lumbar intervertebral disc herniation.Methods Sixty patients with lumbar intervertebral disc herniation were allocated, using random number table method following registration order, to treatment and control groups, 30 cases each. The treatment group received She medicine therapy and the control group, oral administration of conventional drugs. The excellent and good rate was observed in the two groups after treatment. Post-treatment active straight leg raising times and analgesic dosages were compared between the two groups.Results Active straight leg raising time was significantly advanced (P<0.01) and the number of potent analgesic uses was significantly decreased (P<0.01) in the treatment group after endoscopic surgery for lumbar intervertebral disc herniation. The excellent and good rate was 93.3% in the treatment group and 80.0% in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusion She medicine therapy can help rapid rehabilitation after endoscopic surgery for lumbar intervertebral disc herniation.