Revision surgery for symptomatic postoperative pseudocyst following full-endoscopic lumbar discectomy: clinical characteristics and surgical strategies.

BACKGROUND: A symptomatic postoperative pseudocyst (PP) is a cystic lesion that is formed in the operation area of the intervertebral disc, leading to worse symptoms. Some minority patients who developed PP experienced rapidly aggravating symptoms and could not be treated by any kind of conservative treatment. However, no clinical studies have evaluated the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after full-endoscopic lumbar discectomy (FELD). This study aimed to demonstrate the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after FELD. METHODS: We retrospectively analyzed the data of patients who received FELD revision surgeries due to symptomatic PP formation between January 2016 and December 2021. Common characteristics, time intervals of symptom recurrence and revision surgery, strategies for conservative treatment and revision surgery, operative time, imaging characteristics, numeric rating scale (NRS) score, Oswestry disability index (ODI) and overall outcome rating based on modified MacNab criteria were analyzed. RESULTS: Fourteen patients (males = 10, females = 4), with a mean age of 24.4 years, were enrolled. The mean time intervals of symptom recurrence and revision surgery were 43.5 and 18.9 days respectively. While the patients were conservatively managed with analgesics and physical therapy, pain persisted or progressively worsened. In comparison to the initial herniated disc, the PP was larger in 11 cases, and up- or down-migrated in four cases. The PP location included the lateral recess (n = 12), foraminal (n = 1), and centrolateral (n = 1) zones. One of the two cases treated by percutaneous aspiration (PA) was eventually treated by FELD as pain was not relieved. Follow-ups revealed an improved mean NRS score from 7.1 to 1.4, mean ODI from 68.6 to 7.9% and promising overall surgical outcomes. CONCLUSIONS: The progressively severe pain experienced due to PP might be a result of its enlargement or migration to the lateral recess and foraminal zones. As complete removal of capsule is the goal, we recommend FELD instead of PA.

[Comparison of curative effects between minimally invasive locking plate internal fixation and open reduction with internal fixation for the treatment of proximal humerus fractures].

OBJECTIVE: To investigate the comparison of curative effects in treating proximal humerus fractures' patients between minimally invasive locking plate internal fixation and open reduction with internal fixation, and to provide guidance for the operation method of the proximal humerus fracture patients. METHODS: In the study, 157 patients of proximal humerus fractures from May 2006 to December 2012 in Peking University Third Hospital were analyzed retrospectively, of whom 78 were followed up, including 19 males and 59 females. They were from 15 to 90 years old, with the mean age of 60.5 years. According to Neer classification, there were 53 cases of two-part fractures, 19 cases of three-part fractures and 6 cases of four-part fractures. According to AO classification, there were 49 cases of type A,21 cases of type B and 8 cases of type C. There were 24 cases treated with minimally invasive locking plate internal fixation operation and 54 cases treated with open reduction with internal fixation operation. The patients were followed up with postoperative physical examinations and X ray examinations. Postoperative shoulder pain after 1 week and more than 6 months was assessed using the VAS score. Postoperative shoulder joint function with the use of Constant-Murley score and ASES score were evaluated after 3 months and more than 6 months. The results were analyzed by SPSS 18.0. RESULTS: The follow-up time was 6 to 85 months, with the mean time of 33.8 months. According to the rank sum test: there were significant differences in operation time (P=0.002), postoperative hospital day (P=0.001), the satisfaction of patients (P=0.029), postoperative shoulder pain after 1 week (P=0.024), postoperative Constant-Murley score after 3 months (P=0.012) and postoperative ASES score after 3 months (P=0.001) between minimally invasive group and non-minimally invasive group. There weren't significant differences in clinical union time of bone (P=0.446), postoperative shoulder pain after more than 6 months (P=0.894), postoperative Constant-Murley score after more than 6 months (P=0.122) and postoperative ASES score after more than 6 months (P=0.351) between minimally invasive group and non-minimally invasive group. There were no breakage of the internal fixation and humeral head osteonecrosis. Minimally invasive group had 2 cases with internal fixation loosening (8.3%) and 1 case with complete limitation of abduction (4.2%). Non-minimally invasive group had 1 case with tracture nonunion (1.9%), 1 case with internal fixation loosening (1.9%) and 1 case with complete limitation of abduction (1.9%). CONCLUSION: The operation method of proximal humerus fractures is an important factor affecting the recovery of shoulder joint function. Minimally invasive locking plate internal fixation operation in early stage (1 week) of pain control, early (3 months) functional recovery, operation time, postoperative hospital day and patient satisfaction are better than those of traditional operation.