Clinical Efficacy of Large-Channel Percutaneous Lumbar Endoscopic Decompression in the Treatment of Lumbar Spinal Stenosis Secondary to Old Compression Fractures.

OBJECTIVE: We sought to explore the clinical efficacy of lumbar spinal stenosis (LSS) secondary to old vertebral compression fractures (OVCF) treatment by large-channel percutaneous endoscopic lumbar decompression. METHODS: Medical data for a total of 17 patients diagnosed with LSS secondary to OVCF and treated with large-channel percutaneous endoscopic lumbar decompression in our institution from January 2019 to January 2021 were collected. The dural sac cross-sectional area and morphologic grading of the magnetic resonance imaging cross-sectional area were recorded. Lumbar spine stability was assessed using the White-Panjabi scoring system. Visual analog scale and Japanese Orthopaedic Association scores were used to evaluate the surgical efficacy, and the SF-36 health questionnaire was used to evaluate the quality of life of patients. Type and probability of complications were also recorded. RESULTS: The operative segments of the enrolled patients were all in the lower lumbar spine. One-year follow-up post operation showed that the dural sac cross-sectional area was significantly enlarged compared with preoperation, and the morphologic grade was significantly improved (P < 0.05). There was no difference in White-Panjabi score between preoperation and postoperation (P > 0.05). Visual analog scale and Japanese Orthopaedic Association scores at each follow-up time point after operation were higher than those before operation and were significantly improved (P < 0.05). The SF-36 health survey score at 1 year after operation was significantly higher than that before operation (P < 0.05). The complication rate was 6%. CONCLUSIONS: Large-channel percutaneous lumbar endoscopic decompression has an evident clinical effect in the treatment of LSS secondary to OVCF and has little effect on the stability of the lumbar spine, which is worthy of clinical application.

Management of traumatic hemipelvectomy through ERAS pathway: A case report.

RATIONALE: Traumatic hemipelvectomy is a rare but life-threatening injury that involves separation of the pelvic ring from pubic symphysis usually results from high energy trauma and associated with other injuries. PATIENT CONCERN: In this report, we describe a case of traumatic hemipelvectomy, who presented in hemorrhagic shock associated with other injuries such as: right groin injury with limitation of passive movement of right hip and knee joint, left pelvic visceral protruded out, and wrapped by peritoneum, all of the vulva and anal tear, lumbar vertebrae transverse process fracture. DIAGNOSES: Traumatic hemipelvectomy. INTERVENTIONS: The patient was managed through enhanced recovery after surgery (ERAS) pathway with multidisciplinary coordination. OUTCOMES: Patient was able to walk with prosthesis or crutch, with associated injuries managed appropriately. The course was complicated with hemorrhagic shock and infection which were dealt promptly, with good recovery. LESSONS: In our case, the multimodal management through ERAS path has helped decrease stress level, decrease complication, decrease morbidity, decrease the length of stay in the hospital, and aid in faster recovery.