Surgical Strategy for Lumbar Disc Herniation based on the MSU Classification: Percutaneous Endoscopic Lumbar Discectomy versus Transforaminal Lumbar Interbody Fusion: A 5-year Retrospective Study.

OBJECTIVE: Currently, there is no established guideline on whether to opt for percutaneous endoscopic lumbar discectomy (PELD) or traditional transforaminal lumbar interbody fusion (TLIF) surgery based on specific types of lumbar disc herniation (LDH). Based on the Michigan State University (MSU) classification system, this study conducted a medium- to long-term follow-up analysis of two surgical methods over 5 years for the first time, aiming to provide empirical evidence to assist in making more informed decisions before surgery for LDH treatment. METHODS: This was a retrospective study that included 273 patients with single-level LDH who underwent PELD or TLIF treatment at our hospital between January 1, 2016, and December 31, 2018. Detailed metrics included preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 1-day, 1-week, 1-year, and 5-year follow-ups. Complications, recurrences, and 5-year postoperative modified MacNab criteria scores were also recorded. Statistical methods included independent sample t-tests, repeated measures analysis of variance (ANOVA), and χ2 tests. RESULTS: Classified into seven groups according to the MSU classification, it was found that there was an improvement in the VAS and ODI scores at four postoperative follow-ups (p < 0.001). PELD showed better results than TLIF in reducing pain and improving the ODI scores in the classifications of 3B, 2B, and 2C (p < 0.05). TLIF demonstrated consistent superiority over PELD in 2A, 2AB, 3A, and 3AB classifications (p < 0.05). The total recurrence rate in the PELD group (11.05%) within 5 years after surgery was higher (p < 0.05) than that in the TLIF group (3.96%). These were mainly concentrated in the 2A, 2AB, 3A, and 3AB types. Moreover, the rate of excellent and good outcomes in the PELD was higher than in the TLIF but no significant difference (χ2 = 1.0568, p = 0.5895). CONCLUSION: This study suggests that PELD and TLIF may relieve LDH, but have advantages under different MSU classifications. The MSU classification has specific guiding significance and could aid in the surgical selection of PELD or TLIF to achieve optimal treatment outcomes for patients with lumbar disc herniation.

Lightweight and confidential data discovery and dissemination for wireless body area networks.

As a special sensor network, a wireless body area network (WBAN) provides an economical solution to real-time monitoring and reporting of patients' physiological data. After a WBAN is deployed, it is sometimes necessary to disseminate data into the network through wireless links to adjust configuration parameters of body sensors or distribute management commands and queries to sensors. A number of such protocols have been proposed recently, but they all focus on how to ensure reliability and overlook security vulnerabilities. Taking into account the unique features and application requirements of a WBAN, this paper presents the design, implementation, and evaluation of a secure, lightweight, confidential, and denial-of-service-resistant data discovery and dissemination protocol for WBANs to ensure the data items disseminated are not altered or tampered. Based on multiple one-way key hash chains, our protocol provides instantaneous authentication and can tolerate node compromise. Besides the theoretical analysis that demonstrates the security and performance of the proposed protocol, this paper also reports the experimental evaluation of our protocol in a network of resource-limited sensor nodes, which shows its efficiency in practice. In particular, extensive security analysis shows that our protocol is provably secure.