Bone resorption around the annular closure device during a postoperative follow-up of 8 years.

OBJECTIVE: Annular closure device (ACD) implantation is considered to be an effective means of preventing reherniation after microdiscectomy; however, there is an issue: the bone may resorb around the ACD. The causes of vertebral bone resorption remain unexplored; the dynamics of changes in bone resorption around the ACD have not yet been assessed or characterized. METHODS: One hundred thirty-three patients underwent ACD implantation after microdiscectomy, and 107 of them were followed up for 8 years after surgery (Oswestry, VAS). Lumbar CT scans helped characterize the bone resorption area around the ACD. RESULTS: The median of follow-up was 85 [74; 93] months (from 73 to 105 months). The prevalence of bone resorption around the ACD was up to 63.6%, and it was mainly around the polymer mesh of the ACD (70.6%). The resorbed bone volume increased with time and reached its maximum of 5.2 cm3 (12% of the vertebral body volume) once a sclerotic rim developed around the bone resorption area. No differences in VAS pain intensity or in Oswestry Disability Index were found between patients with resorption and patients without it (p > 0.05). The volume of the intervertebral disc before surgery is a predictor of bone resorption (OR = 0.79, p = 0.009): if it is less than 13.2 cm3, the risk of bone resorption increases significantly (p < 0.05). CONCLUSION: The majority of patients (up to 63.6%) with implanted ACDs have vertebral bone resorption around them. The bone resorption area around the ACD mesh increases with time to up to 12% of the vertebral body volume, with no clinical evidence, though. The formation of a sclerotic rim prevents the bone resorption area from further growth. If the volume of the intervertebral disc before surgery is less than 13.2 cm3, the risk of bone resorption increases significantly.

Anterolateral versus posterior minimally invasive lumbar interbody fusion surgery for spondylolisthesis: comparison of outcomes from a global, multicenter study at 12-months follow-up.

BACKGROUND CONTEXT: Several minimally invasive lumbar interbody fusion techniques may be used as a treatment for spondylolisthesis to alleviate back and leg pain, improve function and provide stability to the spine. Surgeons may choose an anterolateral or posterior approach for the surgery however, there remains a lack of real-world evidence from comparative, prospective studies on effectiveness and safety with relatively large, geographically diverse samples and involving multiple surgical approaches. PURPOSE: To test the hypothesis that anterolateral and posterior minimally invasive approaches are equally effective in treating patients with spondylolisthesis affecting one or two segments at 3-months follow-up and to report and compare patient reported outcomes and safety profiles between patients at 12-months post-surgery. DESIGN: Prospective, multicenter, international, observational cohort study. PATIENT SAMPLE: Patients with degenerative or isthmic spondylolisthesis who underwent 1- or 2-level minimally invasive lumbar interbody fusion. OUTCOME MEASURES: Patient reported outcomes assessing disability (ODI), back pain (VAS), leg pain (VAS) and quality of life (EuroQol 5D-3L) at 4-weeks, 3-months and 12-months follow-up; adverse events up to 12-months; and fusion status at 12-months post-surgery using X-ray and/or CT-scan. The primary study outcome is improvement in ODI score at 3-months. METHODS: Eligible patients from 26 sites across Europe, Latin America and Asia were consecutively enrolled. Surgeons with experience in minimally invasive lumbar interbody fusion procedures used, according to clinical judgement, either an anterolateral (ie, ALIF, DLIF, OLIF) or posterior (MIDLF, PLIF, TLIF) approach. Mean improvement in disability (ODI) was compared between groups using ANCOVA with baseline ODI score used as a covariate. Paired t-tests were used to examine change from baseline in PRO for both surgical approaches at each timepoint after surgery. A secondary ANCOVA using a propensity score as a covariate was used to test the robustness of conclusions drawn from the between group comparison. RESULTS: Participants receiving an anterolateral approach (n=114) compared to those receiving a posterior approach (n=112) were younger (56.9 vs 62.0 years, p <.001), more likely to be employed (49.1% vs 25.0%, p<.001), have isthmic spondylolisthesis (38.6% vs 16.1%, p<.001) and less likely to only have central or lateral recess stenosis (44.9% vs 68.4%, p=.004). There were no statistically significant differences between the groups for gender, BMI, tobacco use, duration of conservative care, grade of spondylolisthesis, or the presence of stenosis. At 3-months follow-up there was no difference in the amount of improvement in ODI between the anterolateral and posterior groups (23.2 ± 21.3 vs 25.8 ± 19.5, p=.521). There were no clinically meaningful differences between the groups on mean improvement for back- and leg-pain, disability, or quality of life until the 12-months follow-up. Fusion rates of those assessed (n=158; 70% of the sample), were equivalent between groups (anterolateral, 72/88 [81.8%] fused vs posterior, 61/70 [87.1%] fused; p=.390). CONCLUSIONS: Patients with degenerative lumbar disease and spondylolisthesis who underwent minimally invasive lumbar interbody fusion presented statistically significant and clinically meaningful improvements from baseline up to 12-months follow-up. There were no clinically relevant differences between patients operated on using an anterolateral or posterior approach.

A protocol for recruiting and analyzing the disease-oriented Russian disc degeneration study (RuDDS) biobank for functional omics studies of lumbar disc degeneration.

Lumbar intervertebral disc degeneration (DD) disease is one of the main risk factors for low back pain and a leading cause of population absenteeism and disability worldwide. Despite a variety of biological studies, lumbar DD is not yet fully understood, partially because there are only few studies that use systematic and integrative approaches. This urges the need for studies that integrate different omics (including genomics and transcriptomics) measured on samples within a single cohort. This protocol describes a disease-oriented Russian disc degeneration study (RuDDS) biobank recruitment and analyses aimed to facilitate further omics studies of lumbar DD integrating genomic, transcriptomic and glycomic data. A total of 1,100 participants aged over 18 with available lumbar MRI scans, medical histories and biological material (whole blood, plasma and intervertebral disc tissue samples from surgically treated patients) will be enrolled during the three-year period from two Russian clinical centers. Whole blood, plasma and disc tissue specimens will be used for genotyping with genome-wide SNP-arrays, glycome profiling and RNA sequencing, respectively. Omics data will be further used for a genome-wide association study of lumbar DD with in silico functional annotation, analysis of plasma glycome and lumbar DD disease interactions and transcriptomic data analysis including an investigation of differential expression patterns associated with lumbar DD disease. Statistical tests applied in each of the analyses will meet the standard criteria specific to the attributed study field. In a long term, the results of the study will expand fundamental knowledge about lumbar DD development and contribute to the elaboration of novel personalized approaches for disease prediction and therapy. Additionally to the lumbar disc degeneration study, a RuDDS cohort could be used for other genetic studies, as it will have unique omics data. Trial registration number NCT04600544.

MIS-TLIF versus O-TLIF for single-level degenerative stenosis: study protocol for randomised controlled trial.

INTRODUCTION: Patients with symptomatic single-level combination of degenerative stenosis and low-grade spondylolisthesis are often treated by nerve root decompression and spinal fusion. The gold standard is traditional open decompression and fusion, but minimally invasive method is more and more prevailing. However, there is lack of high-quality studies comparing these two techniques in order to obtain the advantages and certain indications to use one of these methods. The current study includes clinical, safety and radiological endpoints to determine the effectiveness of minimally invasive decompression and fusion (MIS-TLIF) over the traditional open one (O-TLIF). METHODS AND ANALYSIS: All patients aged 40-75 years with neurogenic claudication or bilateral radiculopathy caused by single-level combination of degenerative stenosis and low-grade spondylolisthesis, confirmed by MRI with these symptoms persisting for at least 3 months prior to surgery, are eligible. Patients will be randomised into MIS-TLIF or traditional O-TLIF. The primary outcome measure is Oswestry Disability Index at 3-month follow-up term. The secondary outcomes are patient-reported outcome measures by the number of clinical scales, radiological parameters including sagittal balance parameters, safety endpoints and cost-effectiveness of each method. All patients will be analysed preoperatively, as well as on the 14th day of hospital stay (or on the day of hospital discharge), 3 months, 6 months, 12 months and 24 months postoperatively. The study has the design of a parallel group to demonstrate the non-inferior clinical results of MIS-TLIF compared with the traditional O-TLIF. ETHICS AND DISSEMINATION: The study will be performed according to Helsinki Declaration. The study protocol was approved by the Local Ethical Committee of Priorov National Medical Research Center of Traumatology and Orthopedics in August 2020. Preliminary and final results will be presented in peer-reviewed journals, especially orthopaedic and spine surgery journals, at national and international congresses. TRIAL REGISTRATION NUMBER: NCT04594980.

Cervical Disc Degeneration and Vertebral Endplate Defects After the Fused Operation.

STUDY DESIGN: Longitudinal study of cervical MR in patients with degenerative disc disease (DDD). OBJECTIVE: To evaluate the evolution of the degenerative changes in the C2-D1 cervical segments and to assess the association magnetic resonance imaging (MRI) parameters with clinical symptoms after surgical treatment in patients with DDD. SUMMARY OF BACKGROUND DATA: The evolution of degenerative changes in the cervical spine is poorly understood. Endplate defects can be of great importance in progressive disc degeneration (DD). Clarification of this predictor may be important in determining the treatment tactics in patients with DDD. METHODS: The study included patients who had 2-years' follow-up after cervical fusion for spondylotic radiculo- with/without myelopathy. Demographic data (age, sex, surgical data) were assessed; clinical data (visual analogue scale [VAS] neck, VAS arm, Neck Disability Index [NDI]) and cervical MRI (DD grades by Pfirrmann, Modic changes (MC), total endplate scores (TEPS) were compared to preoperative data. RESULTS: The median follow-up term was 26.5 (18.9-33.1) months. All patients reported a decrease neck pain and arm pain at follow-up (P < 0.001). There was observed the change in MC types (P < 0.001) and an increase of TEPS (P < 0.05). 71.7% discs remained unchanged during the follow-up, but a significant number of discs went from Grade 2 to Grade 3 and from Grade 3 to Grade 4 by Pfirrmann (P < 0.001). Clinical scores (VAS neck, VAS arm, NDI) had no correlation with MRI changes (P > 0.05). DD was associated with TEPS (odds ratio [OR] 2.05-5.47, P < 0.05) and patients' age (OR 1.11-2.33, P < 0.05) at all cervical levels; with MC types, but only at C4-C5 and C6-C7 levels (OR = 2.91 and 2.79, respectively, P < 0.05). Receiver-operating characteristic analysis showed a TEPS threshold value of 7, above which the probability of DD significantly higher. CONCLUSION: During 2 years' follow-up the significant increase of DD grades by Pfirrmann was observed at C4-C6 levels (P < 0.001). A significant association DD with TEPS and age at all cervical levels was determined.Level of Evidence: 3.

Aspects of the use of propensity score matching methods in neurosurgery / Aspectos do uso dos métodos de pareamento de escore de propensão em neurocirurgia / Aspectos del uso de los métodos de emparejamiento de puntaje de propensión en neurocirugía

ABSTRACT Objective Observational studies and register data provide researchers with ample opportunities to obtain answers to questions that randomized controlled trials cannot answer for organizational or ethical reasons. One of the most common tools for solving this problem is the use of propensity score matching (PSM) methods. The purposes of our study were to compare various models and algorithms for selecting PSM parameters, using retrospective clinical data, and to compare the results obtained using the PSM method with those of prospective studies. Methods The results of two studies (randomized prospective and retrospective) conducted at the Novosibirsk Research Institute of Traumatology and Orthopedics were used for comparative analysis. The trials aimed to study the effectiveness and safety of surgical treatment of degenerative dystrophic lesions in the lumbar spine. We compared the results using the recommended PSM parameters (caliper=0.2 and 0.6) the propensity score is the probability of assignment to one treatment conditional on a subject's measured baseline covariates. Propensity-score matching is increasingly being used to estimate the effects of exposures using observational data. In the most common implementation of propensity-score matching, pairs of treated and untreated subjects are formed whose propensity scores differ by at most a pre-specified amount (the caliper widthand the caliper values often used in real-life studies (0.05, 0.1, 0.25, 0.5, and 0.8) with the those obtained in a similar prospective study. Results After eliminating systematic selection bias, the results of the retrospective and randomized prospective studies were qualitatively comparable. Conclusion The results of this study provide recommendations for the use of PSM: when evaluating efficacy scores in neurosurgical studies (with a sample size < 150 patients), we recommend matching on the logit of the propensity score using calipers of width equal to 0.6 of the standard deviation of the logit of the propensity score. Level of evidence V; Type of study is expert opinion.

RESUMO Objetivos Estudos observacionais e dados de registro fornecem aos pesquisadores amplas oportunidades de obter respostas às perguntas que os estudos clínicos randomizados não podem responder por razões institucionais ou éticas. Uma das ferramentas mais comuns para resolver esse problema é o uso dos métodos de Propensity Score Matching (PSM, pareamento de escore de propensão). O objetivo do nosso estudo foi comparar vários modelos e algoritmos para a seleção de parâmetros de PSM, usando os dados clínicos retrospectivos e comparar os resultados obtidos com esse método com os de estudos prospectivos. Métodos Os resultados de dois estudos (randomizado prospectivo e retrospectivo), realizados no Instituto de Pesquisa de Traumatologia e Ortopedia de Novosibirsk, foram utilizados para análise comparativa. Os estudos visaram estudar a eficácia e a segurança do tratamento cirúrgico de lesões distróficas degenerativas na coluna lombar. Comparamos os resultados usando os parâmetros recomendados pelo PSM, isto é calibração (caliper) de 0,2 e 0,6 e os valores de calibração usados com frequência em estudos da vida real (0,05, 0,1, 0,25, 0,5 e 0,8) com os obtidos em um estudo prospectivo semelhante. Resultados Depois de eliminar o viés sistemático de seleção, os resultados de estudos randomizados prospectivos e retrospectivos foram qualitativamente comparáveis. Conclusões Os resultados deste estudo fornecem recomendações para o uso do PSM: ao avaliar os escores de eficácia em estudos neurocirúrgicos (com tamanho de amostra < 150 pacientes), recomendamos a correspondência do logit do escore de propensão com calibração de largura de 0,6 do desvio padrão do logit do escore de propensão. Nível de evidência V; Opinião do especialista.

RESUMEN Objetivos Los estudios de observación y los datos de registro brindan a los investigadores amplias oportunidades para obtener respuestas a preguntas que los estudios clínicos aleatorizados no pueden responder por razones institucionales o éticas. Una de las herramientas más comunes para resolver este problema es el uso de los métodos de Propensity Score Matching (PSM, emparejamiento de puntaje de propensión). El objetivo de nuestro estudio fue comparar varios modelos y algoritmos para la selección de parámetros de PSM, utilizando los datos clínicos retrospectivos y comparar los resultados obtenidos con ese método con los de estudios prospectivos. Métodos Los resultados de dos estudios (prospectivo aleatorizado y retrospectivo) realizados en el Instituto de Investigación de Traumatología y Ortopedia de Novosibirsk se utilizaron para el análisis comparativo. Los estudios tuvieron como objetivo estudiar la eficacia y seguridad del tratamiento quirúrgico de las lesiones distróficas degenerativas en la columna lumbar. Comparamos los resultados usando los parámetros recomendados por el PSM, esto es, calibración (caliper) de 0,2 y 0,6 y los valores de calibración usados con frecuencia en estudios de la vida real (0,05, 0,1, 0,25, 0,5 y 0,8) con los obtenidos en un estudio prospectivo semejante. Resultados Después de eliminar el sesgo sistemático de selección, los resultados de estudios prospectivos aleatorizados y retrospectivos fueron cualitativamente comparables. Conclusiones Los resultados de este estudio proporcionan recomendaciones para el uso del PSM: al evaluar los puntajes de eficacia en estudios neuroquirúrgicos (con tamaño de muestra <150 pacientes), recomendamos la correspondencia del logit del puntaje de propensión con calibración de ancho de 0.6 de la desviación estándar del logit de puntaje de propensión. Nivel de evidencia V; Opinión del especialista.

Predictors of Treatment Success Following Limited Discectomy With Annular Closure for Lumbar Disc Herniation.

BACKGROUND: Previous studies have demonstrated bone-anchored annular closure to significantly reduce reherniation and reoperation rates after lumbar discectomy in patients with large annular defects. It is important to identify the prognostic factors that may be associated with successful treatment. This study aimed to identify predictors of treatment success in patients with lumbar disc herniation treated with limited microdiscectomy supplemented by a bone-anchored annular closure device (ACD). METHODS: This study was a retrospective analysis of 133 consecutive patients with lumbar disc herniation treated with the ACD. Treatment success was defined as ≥24% improvement in visual analog scale (VAS) for back pain, ≥39% improvement in VAS leg pain, and ≥33% in the Oswestry Disability Index (ODI), with the raw ODI score ≤48. Success was calculated at 3, 6, and 12 months after surgery. Potentially predictive outcomes included patient characteristics, operative data, and imaging outcomes, such as disc, facet, and end plate morphology. Logistic regression was used to determine the significant predictive factors for treatment success. RESULTS: After 3, 6, and 12 months, 97 of 131 (74%), 104 of 129 (81%), and 112 of 126 (89%) patients, respectively, achieved the success criteria. At 3 months follow-up, a higher proportion of younger (17-40 years) versus older (41-65 years) patients met the success criteria (P = .025). On the basis of logistic regression, the following factors were significantly associated with treatment success at 1 or more of the follow-up time points: sex (male), lower body mass index, higher baseline pain and ODI scores, lower grade preoperative disc degeneration, and the absence of a postoperative complication. The rates of index-level recurrent herniation and reoperation were 1.5% and 3.0%, respectively. CONCLUSIONS: This real-world evidence supports a promising benefit-risk profile for augmenting limited microdiscectomy with a bone-anchored ACD and provides some insights into the patient populations that may have a greater chance of realizing significant improvements in pain and function. LEVEL OF EVIDENCE: 2 (Cohort study).

The importance of psychological testing in predicting the effectiveness of lumbar spine surgery / A importância do teste psicológico na previsão da eficácia da cirurgia da coluna lombar / La importancia de las pruebas psicológicas en la predicción de la efectividad de la cirugía de la columna lumbar

ABSTRACT Objective: The result of treatment of patients with degenerative disc diseases is partly determined by the psychological characteristics of the patients. The aim of this study was to examine the correlations between the psychological scales scores in patients with degenerative lumbar disc diseases and the effectiveness of surgical treatment. Methods: The efficacy of the operation and patients' satisfaction were compared with the preoperative psychological characteristics, according to the questionnaires and scales (BBQ Symonds, Zung Scale, FABQ, PCI, BBQ Catastrophization). Results: In patients with neurogenic intermittent claudication syndrome without significant pain, the operative treatment depended significantly on the value of the BBQ Symonds scale (p = 0.016). In patients with severe radicular pain in the lower extremity, the effectiveness of the operation depended significantly on the value of the subscale "protection" of the PCI questionnaire (p = 0.04), the ODI index filled out before the operation (p = 0.0). In patients with lumbar syndrome, the effectiveness of operation depended significantly on the value of the PCI questionnaire as a whole (p = 0.042) and its subscores "rest" (p = 0.028), the index of the Oswestry filled out before the operation (p = 0.035). Conclusion: The effectiveness of the operation of degenerative lumbar disc diseases is associated with the results of preoperative psychological testing. It has been established that the BBQ Symonds scale, PCI protection and rest subscales, and the ODI questionnaire are the most significant; these psychological scales have the power to predict the effectiveness of surgical treatment. Level of Evidence II; Therapeutic Study - Investigating the Results of Treatment.

RESUMO Objetivo: O resultado no tratamento de pacientes com doenças degenerativas do disco é parcialmente determinado pelas características psicológicas dos pacientes. O objetivo do estudo foi examinar as correlações entre as escalas de índice psicológico em pacientes com doenças degenerativas do disco lombar e a eficácia do tratamento cirúrgico. Métodos: A eficácia da operação e a satisfação dos pacientes foram comparadas com as características psicológicas pré-operatórias, de acordo com os questionários e escalas (BBQ Symods, Zung Scale, FABQ, PCI, Catastrofización de BBQ). Resultados: Em pacientes com a síndrome de claudicação neurogênica intermitente sem dor significativa, o tratamento cirúrgico dependeu significativamente do valor da escala BBQ Symods (p = 0,016). Em pacientes com dor radicular grave no membro inferior, a eficácia da operação dependeu significativamente do valor da "proteção" da subescala do questionário de ICP (p = 0,04), preenchido antes da operação pelo índice ODI (p = 0,0). Nos pacientes com síndrome lombar, a eficácia da operação dependia significativamente do valor do questionário PCI como um todo (p = 0,042) e seu subscore "repouso" (p = 0,028) e o índice do Oswestry preenchido antes da operação (p = 0,035). Conclusão: A efetividade do funcionamento das doenças degenerativas do disco lombar está associada aos resultados dos testes psicológicos pré-operatórios. Foi estabelecido que a escala BBQ Symods, subescalas de proteção e descanso de PCI e o questionário de ODI são mais significativos; essas escalas psicológicas têm poder preditivo em relação à eficácia do tratamento cirúrgico. Nível de Evidência II; Estudo Terapêutico - Investigação dos resultados do tratamento.

RESUMEN Objetivo: El resultado del tratamiento de pacientes con enfermedades degenerativas del disco está parcialmente determinado por las características psicológicas de los pacientes. El objetivo del estudio fue examinar las correlaciones entre las escalas de índice psicológico en pacientes con enfermedades degenerativas del disco lumbar y la efectividad del tratamiento quirúrgico. Métodos: Se comparó la eficacia de la operación y la satisfacción de los pacientes con las características psicológicas preoperatorias según los cuestionarios y escalas (BBQ Symonds, Zung Scale, FABQ, PCI, Catastrofización de BBQ). Resultados: En pacientes con síndrome de claudicación neurogénica intermitente sin dolor significativo, el tratamiento quirúrgico dependió significativamente del valor de la escala BBQ Symonds (p = 0,016). En pacientes con dolor radicular severo en la extremidad inferior, la efectividad de la operación dependió significativamente del valor de la subescala "protección" del cuestionario PCI (p = 0,04), el índice ODI llenado antes de la operación (p = 0,0). En pacientes con síndrome lumbar, la efectividad de la operación dependió significativamente del valor del cuestionario PCI como un todo (p = 0,042) y sus subcategorías "reposo" (p = 0,028), el índice de Oswestry llenado antes de la operación (p = 0,035). Conclusión: La efectividad de la operación de las enfermedades degenerativas del disco lumbar se asocia con los resultados de las pruebas psicológicas preoperatorias. Se ha establecido que la escala de BBQ Symonds, las subescalas de protección y reposo PCI y el cuestionario ODI son los más significativos; estas escalas psicológicas tienen poder predictivo en relación con la efectividad del tratamiento quirúrgico. Nivel de Evidencia II; Estudio Terapéutico - Investigación de los resultados del tratamiento.

Surgical treatment of lumbar disc herniation in pregnant women: report of two cases and a systematic review / Tratamento cirúrgico da hérnia de disco lombar em gestantes: relato de dois casos e revisão sistemática / Tratamiento quirúrgico de la hernia discal lumbar en embarazadas: informe de dois casos y revisión sistemática

ABSTRACT Objective: To review the surgical treatment of lumbar disc herniation in pregnancy. Methods: We systematically reviewed cases of surgical treatment of pregnant patients with lumbar IVD herniations in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. We searched on electronic databases, including PubMed, Scopus, and Google Scholar, to find relevant articles by keywords. Results: A literature review of 42 cases is presented. Conclusions: The authors' own data and the literature data demonstrate that decompression surgery in pregnancy is effective and safe for both mother and fetus; however, radical surgery (fusion) can lead to very adverse sequelae for the fetus. Level of Evidence III; Systematic reviewb of Level III studies.

RESUMO Objetivo: Nosso objetivo foi rever o tratamento cirúrgico da hérnia de disco lombar na gravidez. Métodos: Revimos sistematicamente os casos de tratamento cirúrgico de pacientes grávidas com hérnia lombar por DIV, de acordo com o Manual Cochrane para Revisões Sistemáticas de Intervenções. Procuramos, através de bases de dados eletrônicas, incluindo PubMed, Scopus e Google Scholar, encontrar artigos relevantes por palavras-chave. Resultados: Revisão da literatura de 42 casos foi apresentada. Conclusões: Os dados dos próprios autores e os dados da literatura demonstram que a cirurgia de descompressão na gravidez é eficaz e segura tanto para a mãe como para o feto. Entretanto, a cirurgia radical (fusão) pode levar à sequelas muito adversas para o feto. Nível de Evidência III; Revisão sistemáticab de Estudos de Nível III.

RESUMEN Objetivo: Nuestro objetivo fue revisar el tratamiento quirúrgico de la hernia de disco lumbar en el embarazo. Métodos: Revisamos sistemáticamente los casos de tratamiento quirúrgico de pacientes embarazadas con hernias de DIV lumbar de acuerdo con el Manual Cochrane para Revisiones Sistemáticas de Intervenciones. Realizamos búsquedas en bases de datos electrónicas, incluidas PubMed, Scopus y Google Scholar, para encontrar artículos relevantes por palabras clave. Resultados: Se presentó la revisión de la literatura de 42 casos. Conclusiones: Los propios datos de los autores y los datos de la literatura demuestran que la cirugía de descompresión en el embarazo es efectiva y segura tanto para la madre como para el feto; sin embargo, la cirugía radical (fusión) puede conducir a secuelas muy adversas para el feto. Nivel de Evidencia III; Revisión sistemáticab de Estudios de Nivel III.

Outcomes of surgical treatment of lumbar disk herniation using an annular closure device / Desfechos do tratamento cirúrgico da hérnia de disco lombar com aparelho de fechamento anular / Resultados del tratamiento quirúrgico de la hernia de disco lumbar utilizando un dispositivo de cierre anular

ABSTRACT Objective: The aim of the study was to investigate the clinical and radiological results of using the annular closure device in patients with lumbar disc herniation (LDH). Methods: The study involved 120 patients with LDH operated on by limited discectomy and annular closure using the Barricaid device. A literature review was conducted to evaluate the effectiveness of the annuloplasty. Results: All patients showed postoperative regression of the radicular pain syndrome and were mobilized on the day of surgery. The correlation between the removed nucleus pulposus and changes in DHI was studied by linear regression. The results revealed that disc height loss is directly correlated with the volume of removed nucleus pulposus (p <0.05). Modic changes were present in 22 (22%) patients. Endplate changes (resorption and erosion) were present in 25 patients (20.7%). We found that these changes in MR and CT images have no effect on the clinical presentation of the disease. No intraoperative complications, such as severe hemorrhage requiring blood transfusion, or injury to the dura mater or nerve roots, were observed in our case series. Postoperative complications occurred in 3 (2.5%) patients. The reoperation rate was 4.2%. Conclusions: The use of the Barricaid annular closure device in 120 patients with lumbar disc herniation and high risk of recurrent herniation showed good clinical and radiographic outcomes. The reoperation rate in our study was 2.5%; disc reherniation at the operated level was observed in 1.7% of patients. This is a good outcome compared to the data reported for patients having a high risk of disc reherniation. Level of Evidence IV; Case series.

RESUMO Objetivo: O objetivo do estudo foi estudar os resultados clínicos e radiológicos do uso do dispositivo de fechamento anular em pacientes com hérnia discal lombar (HDL). Métodos: O estudo envolveu 120 pacientes com LDH operados por discectomia limitada e fechamento anular usando o dispositivo Barricaid. Uma revisão da literatura foi realizada para avaliar a eficácia da anuloplastia. Resultados: Todos os pacientes apresentaram regressão pós-operatória da síndrome da dor radicular e foram mobilizados no dia da cirurgia. A correlação entre o núcleo pulposo removido e as alterações no DHI foi estudada por regressão linear. Revelou-se que a perda de altura discal está diretamente correlacionada com o volume do núcleo pulposo removido (p <0,05). Alterações modicadas reveladas em 22 (22%) pacientes. As alterações no endplate foram reveladas em 25 pacientes (20,7%). Descobrimos que essas mudanças nas imagens de RM e TC não têm efeito sobre a apresentação clínica da doença. Não foram observadas complicações intraoperatórias, como hemorragia grave que necessitou de transfusão sanguínea, lesão da dura-máter ou raízes nervosas, em nossa casuística. Complicações pós-operatórias foram reveladas em 3 (2,5%) pacientes. A taxa de reoperação foi de 4,2%. Conclusão: O uso do dispositivo de fechamento anular Barricaid em 120 pacientes com hérnia discal lombar e alto risco de hérnia recorrente mostrou bons resultados clínicos e radiográficos. A taxa de reoperação em nosso estudo foi de 2,5%; reinteriato discal no nível operado foi observado em 1,7% dos pacientes. É um bom resultado comparado aos dados relatados para pacientes com alto risco de reintervenção com disco. Nível de evidência IV; Série de casos.

RESUMEN Objetivo: El objetivo del estudio fue estudiar los resultados clínicos y radiológicos del uso del dispositivo de cierre anular en pacientes con hernia de disco lumbar (LDH). Métodos: El estudio involucró a 120 pacientes con LDH operados por discectomía limitada y cierre anular usando el dispositivo Barricaid. Se realizó una revisión de la literatura para evaluar la efectividad de la anuloplastia. Resultados: Todos los pacientes mostraron regresión postoperatoria del síndrome de dolor radicular y se movilizaron el día de la cirugía. La correlación entre el núcleo pulposo retirado y los cambios en DHI se estudiaron mediante regresión lineal. Los resultados revelaron que la pérdida de altura del disco se correlaciona directamente con el volumen del núcleo pulposo retirado (p <0,05). Cambios módicos revelados en 22 (22%) pacientes. Los cambios de placa terminal (resorción y erosión) se revelaron en 25 pacientes (20,7%). Descubrimos que estos cambios en las imágenes de RM y TC no tienen ningún efecto sobre la presentación clínica de la enfermedad. En nuestra serie de casos no se observaron complicaciones intraoperatorias, como hemorragia severa que requiriera transfusión de sangre, lesión de la duramadre o raíces nerviosas. Las complicaciones postoperatorias se revelaron en 3 (2,5%) pacientes. La tasa de reoperación fue del 4,2%. Conclusiones: El uso del dispositivo de cierre anular Barricaid en 120 pacientes con hernia de disco lumbar y alto riesgo de hernia recurrente mostró buenos resultados clínicos y radiográficos. La tasa de reoperación en nuestro estudio fue del 2.5%; la hernia recurrente del disco en el nivel operado se observó en el 1,7% de pacientes. Es un buen resultado en comparación con los datos informados para pacientes que tienen un alto riesgo de hernia recurrente del disco. Nivel de evidencia IV; Serie de casos.