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STUDY DESIGN: A systematic review of the literature to develop an algorithm formulated by key opinion leaders. OBJECTIVE: This study aimed to analyze currently available data and propose a decision-making algorithm for full-endoscopic lumbar discectomy for treating lumbar disc herniation (LDH) to help surgeons choose the most appropriate approach [transforaminal endoscopic lumbar discectomy (TELD) or interlaminar endoscopic lumbar discectomy (IELD)] for patients. SUMMARY OF BACKGROUND DATA: Full-endoscopic discectomy has gained popularity in recent decades. To our knowledge, an algorithm for choosing the proper surgical approach has never been proposed. MATERIALS AND METHODS: A systematic review of the literature using PubMed and MeSH terms was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient samples included patients with LDH treated with full-endoscopic discectomy. The inclusion criteria were interventional research (randomized and nonrandomized trials) and observation research (cohort, case-control, case series). Exclusion criteria were case series and technical reports. The criteria used for selecting patients were grouped and analyzed. Then, an algorithm was generated based on these findings with support and reconfirmation from key expert opinions. Data on overall complications were collected. Outcome measures included zone of herniation, level of herniation, and approach (TELD or IELD). RESULTS: In total, 474 articles met the initial screening criteria. The detailed analysis identified the 80 best-matching articles; after applying the inclusion and exclusion criteria, 53 articles remained for this review. CONCLUSIONS: The proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.
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Diskectomy, Percutaneous , Intervertebral Disc Displacement , Humans , Lumbar Vertebrae/surgery , Diskectomy , Intervertebral Disc Displacement/surgery , Endoscopy , Treatment Outcome , Retrospective StudiesABSTRACT
Objective@#To evaluate the clinical outcomes of posterior percutaneous endoscopic cervical discectomy (PPECD) for cervical disc herniation.@*Methods@#A total of 23 patients who underwent PPECD for cervical disc herniation at Department of Spine Surgery, Guangdong Provincial Hospital of Chinese Medicine from August 2014 to April 2016 were reviewed. The mean age of the 17 males and 6 females was 49.5 years (range from 31 to 61 years). All patients had unilateral upper limb radiating symptoms, 13 patients with right upper limb radiating pain and 10 patients with left upper limb radiation pain, 17 patients with neck pain symptoms. Responsible segment: left C4-5 1 case, right C4-5 2 cases, left C5-6 4 cases, right C5-6 8 cases, left C6-7 5 cases, right C6-7 3 example.Operating time, length of hospitalization, complications, neck and arm Visual analog scale(VAS), and Neck Disability Index(NDI) were evaluated. The excellent and good rate of surgery was evaluated by using the Odom criteria. Harrison method was used to measure cervical curvature. The Cobb angle of the surgical segment was measured on the X-ray, and the range of motion (ROM) was calculated. The changes of the cervical curvature and the surgical segment ROM were compared pre- and post-operation.@*Results@#The operation time was 94.1 min (range from 80 to 150 min). The average length of hospital stay was 4.8 days. The mean follow-up period was 23.5 months (range from 15 to 35 months). The preoperative arm VAS score was 6.95±0.88, 1-week postoperative arm VAS score was 2.09±0.67, the last follow-up arm VAS score was 1.04±0.98. The preoperative neck VAS score was 3.04±0.77, 1-week postoperative neck VAS score was 1.52±0.51 and the last follow-up neck VAS score was 0.61±0.78. The 1-week postoperative and last follow-up arm and neck VAS scores were significantly reduced compared with pre-operation (P<0.01). Compared with 1 week after surgery, the last follow-up of the arm and neck VAS score further reduced, the difference was statistically significant (P<0.01). The preoperative NDI was (58.52±4.98)%, the 1-week postoperative NDI was (33.74±4.72)%, the last follow-up NDI was (19.22±3.23)%. The 1-week postoperative and last follow-up NDI was significantly improved compared with pre-operation (P<0.01). Compared with 1 week after surgery, the last follow-up of the NDI further improved, the difference was statistically significant (P<0.01). The 1-week postoperative cervical curvature was (14.65±2.89)°, and it was improved compared with preoperative(14.23±3.06)°, the difference was statistically significant (P<0.05) . The last follow-up was cervical curvature(14.64±2.68)°, there was no significant difference compared with preoperative (P> 0.05). The preoperative surgical ROM was(5.37±1.83)°, 1-week postoperative was(5.53±1.52)°, and the last follow-up was (5.62±1.48)°, there was no significant difference pre-operative and post-operation (P> 0.05). The excellent and good rate was 91.3% (excellent in 16 cases, good in 5 cases, 2 cases). There was no nerve root injury, cerebrospinal fluid leakage, wound infection, and other complications.@*Conclusions@#PPECD is a sufficient and safe supplement for cervical disc herniation, its recent clinical efficacy was good. And it has no significant effect on cervical stability.
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Objective To explore the clinical effects and application value of microendoscopic discectomy via spinal posterior access in the treatment of lumbar disc herniation. Methods Microendoscopic intervertebral space discectomy was performed for 152 patients with prolapse of lumbar intervertebral disc. The follow-up of clinical effects was carried out. Results 113 patients were followed up for 3 to 19 months. By Macnab standards, the rusult was excellent in 86 patients, good in 21, fair in 4, and poor in 2. The excellent and good rate was 94.6%. Conclusion Microendoscopic discectomy is an ideal method to treat lumbar disc herniation if the indications are suitable, for it is minimally invasive, and provides rapid postoperative recovery, good operation safety, as well as reliable effects.
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Objective To evaluate the effectiveness and safety of isometric neck strength training for the treatment of neck-type cervical syndrome.Methods The qualified patients with neck-type cervical syndrome were divided into two groups by stratified randomization: the treatment group(N=55)received isometric neck strength training,and the control group(N=40) received manipulation treatment.Two weeks constituted one treatmeat course.Visual Analog Scale(VAS) and Vernon Cervical Disability Index(VCDI) were used to evaluate the efficacy,and the safety was also monitored.Results All of the 95 enrolled patients were followed up for 3~11.4 months.No aggravation was found in the treatment group,but in the control group one patient developed into cervical spondylotic radiculopathy and one patient developed into sympathetic cervical spondylosis.The frequency of serious neck pain attack within 3 months was 6.65?2.62 times in the control group and 2.27?1.50 times in the treatment group,the difference being significant(P0.05);the result of follow-up on the 3rd month after treatment showed that the difference of VCDI score was significant between the two groups(P
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Thirty-two cases of calcaneodynia were treated with high-energy vibration wave combined with external application of Shuangbo Ointment (Group 1) and other 32 with high-energy vibration wave only (Group 2) as control. The results showed that the markedly effective rates of short-term treatment (3 weeks) and long-term treatment (3 months) were 56.25% and 84.37% in Group 2, and 81.25% and 93.75% in Group 1 respectively. It is suggested that high-energy vibration wave combined with external application of Shuangbo Ointment exerts a better effect for calcaneodynia, and can decrease the occurrence of hematoma and periosteum stripping induced by high-energy vibration wave.