ObjectiveTo investigate the effectiveness and safety of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for upper lumbar disc herniation. MethodsRetrospective analysis was made on the clinical data of 26 patients with upper lumbar disc herniation, who were in line with the selection criteria and underwent MIS-TLIF in 14 patients (MIS-TLIF group) and open transforaminal lumbar interbody fusion (OTLIF) in 12 patients (OTLIF group) between December 2007 and May 2012. There was no significant difference in gender, age, disease duration, level of disc herniation, side of disc herniation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, and complications were compared between 2 groups. The clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI) scores. The fusion rate was determined by using CT three-dimensional reconstruction and dynamic lumbar radiography at last follow-up. ResultsPrimary healing of incisions was obtained in both groups. No difference was found in operation time between 2 groups (t=0.858, P=0.399), but MIS-TLIF group had less intraoperative blood loss and postoperative drainage volume than OTLIF group (P<0.05). The average follow-up duration was 34.1 months with a range of 12-50 months. No complication of dural tear, infection, spinal nerve trauma, and implant failure occurred. The VAS scores of lower back pain and radicular pain and ODI scores at preoperation showed no significant difference between 2 groups (P>0.05). The VAS score of lower back pain and ODI score at 1 day after operation in MIS-TLIF group were significantly lower than those in the OTLIF group (P<0.05), but no difference was found in VAS scores of radicular pain between 2 groups (P>0.05). Difference in all scores was not significant at last follow-up between 2 groups (P>0.05). The fusion rate was 92.8% (13/14) in MIS-TLIF group, and was 100% (12/12) in OTLIF group at last follow-up. ConclusionMIS-TLIF is a safe and effective procedure for upper lumbar disc herniation as an alternative to other techniques.
ObjectiveTo summarize the research progress of resorption of lumbar disc herniation (RLDH). Methods The literature on RLDH at home and abroad in recent years was reviewed to summarize its influencing factors, pathogenesis, imaging findings, and predictive effect, as well as its influence on the treatment selection of lumbar disc herniation (LDH). ResultsThe main mechanism of RLDH is the combined effect of inflammatory response and neovascularization. Age, smoking, body mass index, and clinical manifestations are the influencing factors. Studies have shown that the annular enhancement around the nucleus pulposus on enhanced MRI images is the characteristic imaging manifestation of RLDH, which is a predictor of whether RLDH occurs. In the treatment of LDH, cyclooxygenase 2 inhibitors may have a negative impact on RLDH. ConclusionThe occurrence of RLDH suggests that strict conservative treatment is the first choice for LDH treatment, but surgery is still an important treatment method when the patient’s symptoms and imaging symptoms don’t significantly improved after conservative treatment.
ObjectiveTo evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation.MethodsBetween June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L4, 5 in 15 cases and L5, S1 in 19 cases; 2 cases had lumbar disc herniation at both L4, 5 and L5, S1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up.ResultsAll patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores (P<0.05); there was no significant difference in VAS score between the different time points after operation (P>0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%.ConclusionPELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.
Objective To investigate diagnosis and treatment of farlateral lumbar disc herniations. Methods The clinical data from 16 patients with far-lateral lumbar disc herniations from January 1999 to January 2004 were retrospectively analyzed. The CT scanning showed that the shadow density of the CT scanning values in the corresponding intra-foramen, extraforamen and all-foramen was as the same as that of the intervertebral disc. Of the 16 patients, 10 were operated on by the interlaminar approach, 3 were operatedon by the laterolaminar approach, 3 were operated on by the combined interlaminal and laterolaminal approach.Results According to the follow-up for 6 monthsto 5 years, excellent results were obtained in 8 patients, good results in 5, and fair results in 3. The postoperative CT examination showed that the space occupying in the foramen or extraforamen of the corresponding segment vanished and the nerve root compression of the identical segment also vanished. Conclusion The lamellar highresolution CT is a better way to diagnose lumbar disc herniation. The operative approach should be chosen according to the position of the intervertebral disc protrusion, pathologic type, and presence or absence of the lesions in the vertebral canal.
Objective To compare the therapeutic effect of conventional discectomy, posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF) on the recurrent lumbar disc protrusion (RLDP). Methods From January 2000 to January 2008, 65 patients with RLDP underwent different surgical procedures, namely conventional discectomy (group A, 25 cases), PLIF (group B, 22 cases), and TLIF (group C, 18 cases). There were 44 males and 21 females aged 26-65 years old (average 41 years old). All the patients were single-level protrusion, including 33 cases at the L4, 5 level and 32 cases at the L5, S1 level. The primary procedure included laminectomy discectomy in 39 patients, unilateral hemilaminectomy discectomy in 15 patients, and bilateral laminectomy and total laminectomy discectomy in 11patients. The recurrent time to the primary operation was 13-110 months (average 64 months). The location of recurrent disc protrusion was at the ipsilateral side in 47 cases and the contralateral side in 18 cases. No significant differences among three groups were evident in terms of basel ine data (P gt; 0.05). Results The incision all healed by first intention. The incidence of perioperative compl ication in group A (24.0%) and group B (22.3%) was significantly higher than that of group C (5.6%) (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). The operation time and bleed loss during operation of group B were obviously higher than that of group A and group C (P lt; 0.05), and there was no significant difference between group A and group C (P gt; 0.05). There were no significant differences among three groups in terms of the length of hospital ization (P gt; 0.05). Six-one patients were followed up for 12-36 months (average 20 months). At 1 week after operation, the satisfied rate of patients was 84.0% in group A, 81.8% in group B, and 88.9% in group C (P gt; 0.05). All the patients in group B and group C achieved fusion uneventfully. There were no significant differences among three groups in terms of visual analogue scale (VAS) and Oswestry disabil ity index (ODI) when compared the preoperative value with the final follow-up value (P gt; 0.05). There was significant difference within group A, B, and C in terms of VAS and ODI when compared the preoperative value with the final follow-up value (P lt; 0.05), but there were no significant differences among three groups in the improvement rate (P gt; 0.05). The intervertebral space grading method proposed by Roberts et al. was adopted to evaluate the intervertebral space height (ISH), the preoperative value was 2.04 ± 0.93 in group A, 2.18 ± 0.91 in group B, and 2.11 ± 0.90 in group C, andat the final follow-up, the value was 2.64 ± 0.58 in group A, 1.05 ± 0.59 in group B, and 1.06 ± 0.42 in group C. There were significant differences among three groups in the ISH when compared the properative value with the final follow-up value (P lt; 0.05). Conclusion All of the three surgical procedures are effective for RLDP, but conventional discectomy and PLIF have more compl ications than TLIF. Conventional discectomy may result in the further narrow of the intervertebral space and the occurrence of segment instabil ity, whereas TLIF is safer, more effective, and one of the ideal methods to treat RLDP.
ObjectiveTo compare the early efficacy between Quadrant channel and traditional method in treating lumbar disc herniation. MethodBetween July 2010 and December 2012, 60 patients with lumbar disc herniation were randomly divided into two groups with 30 in each. Quadrant channel and traditional method were used respectively to do the same one single segmental pedicle screw fixation with single pieces of cage bone grafting fusion and internal fixation. Then, we compared the two groups in incision length, operative time, blood loss, incision healing time and postoperative incidence of low back pain between the two groups of patients. ResultsThere were no significant differences between the two groups in terms of operation time, blood loss, and recent curative effect (P>0.05), while Quadrant channel was superior in small skin incision, reduced incidence of low back pain, and shorter postoperative incision healing time (P<0.05). ConclusionsTreatment of lumbar disc herniation using Quadrant channel is minimally invasive with less complications. Mid-and long-term efficacy remains to be further analyzed.
ObjectiveTo investigate the effect of body mass index (BMI) on the outcome of posterior 360° fusion for single-level lumbar degenerative diseases. MethodsA retrospective study was carried on 302 cases of singlelevel lumbar degenerative diseases treated with posterior 360° fusion between September 2009 and September 2013. All patients were divided into 3 groups according to BMI: normal weight (BMI<24 kg/m2) in 105 cases (group A), overweight (24 kg/m2≤BMI< 28 kg/m2) in 108 cases (group B), and obese (BMI≥28 kg/m2) in 89 cases (group C). There was no significant difference in gender, age, disease duration, disease patterns, affected segments, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) among 3 groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The lumbar function was assessed by JOA score and ODI at pre- and post-operation (at 3, 6, and 24 months). ResultsThe operation time, intraoperative blood loss, and postoperative hospital stay of group C were significantly more than those of groups A and B (P<0.05), but no significant difference was found between group A and group B (P>0.05). The patients were followed up 24-45 months. Postoperative JOA score and ODI showed significant improvements in each group when compared with preoperative ones (P<0.05), but there was no significant difference among groups at each time point after operation (P>0.05). There was no significant difference in the incidence of total complications among 3 groups (χ2=3.288, P=0.193). The incidence of incision-related complications (infection and poor healing) in group C was significantly higher than that of groups A and B (P<0.05), but no significant difference was shown between group A and group B (P>0.05). However, there was no significant difference in cerebrospinal fluid leak, pseudarthrosis formation, and revision among 3 groups (P>0.05). ConclusionPosterior 360° fusion for single-level lumbar degenerative diseases can obtain good effectiveness in patients with different BMI, but patients whose BMI was ≥28 kg/m2 have longer operation time, more intraoperative blood loss, longer hospital stay, and higher incidence of postoperative incision-related complications.
Objective To evaluate the clinical efficacy and safety of biportal endoscopic discectomy combined with annulus fibrosus suture in the treatment of recurrent lumbar disc herniation (RLDH). Methods The clinical data of patients with RLDH who underwent biportal endoscopic discectomy combined with annulus fibrosus suture using a single-use suture device at Mianyang Orthopaedic Hospital between May 2020 and July 2022 were retrospectively collected. Visual Analogue Scale (VAS) scores for low back and leg pain and Oswestry Disability Index (ODI) scores on postoperative Day 3 and at the last follow-up were used to assess pain and functional status. Postoperative lumbar CT, MRI, and dynamic X-rays were obtained to evaluate the extent of decompression, disc removal, and spinal stability. Clinical efficacy during follow-up was assessed using the MacNab criteria since postoperative 3 months. Results Twenty-one RLDH patients (16 males, 5 females) with a mean age of (45.14±15.26) years (range: 17-62 years) were included. The involved segments were L3-L4 in 1 case, L4-L5 in 9 cases, and L5-S1 in 11 cases. All surgeries were successfully completed without complications such as nerve injury, symptomatic epidural hypertension, dural tear, cerebrospinal fluid leakage, or infection. All patients were followed up for a mean duration of (11.38±3.51) months (range: 4-17 months). No recurrence of disc herniation or segmental instability was observed during follow-up. Significant improvements were seen in VAS scores for low back pain (2.90±0.70, 1.38±0.81), leg pain (2.33±0.58, 1.29±0.46), and ODI scores [(24.12±5.05)%, (11.29±1.86)%] on postoperative Day 3 and at the last follow-up compared to the preoperative values [5.90±1.09, 6.10±0.77, (57.08±9.72)%; all P<0.05]. According to the MacNab criteria, the clinical efficacy was rated as excellent in 16 cases, good in 3 cases, and fair in 2 cases, yielding an excellent-good rate of 90.5%. Conclusion Biportal endoscopic discectomy with annulus fibrosus suture is a safe and effective treatment for RLDH, demonstrating favourable clinical outcomes and warranting further research and application.
ObjectiveTo explore the feasibility and effectiveness of unilateral pedicle screw rod and single poly (ether-ether-ketone) (PEEK) Cage for lumbar intervertebral disc protrusion. MethodsA total of 126 cases of single segment of lumbar intervertebral disc protrusion between January 2006 and June 2012 were divided into 2 groups in the randomized clinical trial. Unilateral pedicle screw fixation and single PEEK Cage was used in 63 cases (research group), and bilateral pedicle screw fixation and single PEEK Cage in 63 cases (control group). There was no significant difference in gender, age, disease duration, side, and affected segment between 2 groups (P>0.05). Schulte evaluation criterion was used to assess bone graft fusion, Oswestry disability index (ODI) to estimate the quality of life situation, and visual analogue scale (VAS) to evaluate the improvements of lower back pain. Macnab standards was applied to assess postoperative effectiveness, and Emery ways to measure the height of intervertebral space. ResultsThe incision length, operation time, intraoperative blood loss, hospitalization time, and hospitalization fee in research group were significantly less than those in control group (P<0.05). The patients were followed up 12-79 months (mean, 21.3 months) in research group, and 15-73 months (mean, 22.6 months) in control group. The postoperative lordosis was recovered well, and the height of intervertebral space was increased. No loosening or breakage of internal fixation occurred. The time of bone graft fusion was (6.8±1.3) months in research group and was (7.1±1.2) months in control group, showing no significant difference (t=1.153, P=0.110). The height of intervertebral space, ODI score, and VAS score were significantly improved when compared with preoperative ones in 2 groups (P<0.05), but no significant difference was found between 2 groups at preoperation and last follow-up (P>0.05). At 3 months after operation, postoperative effectiveness was assessed according to Macnab criterion, the excellent and good rate was 95.23% in research group (excellent in 13 cases, good in 47 cases, and fair in 3 cases) and was 71.42% in control group (excellent in 7 cases, good in 38 cases, fair in 15 cases, and poor in 3 cases); the research group was significantly superior to control group (χ2=6.110, P=0.006). ConclusionUnilateral pedicle screw fixation and single PEEK Cage has the advantages of small trauma, reliable fixation, shorter operation time, less bleeding, less economic cost, and early off-bed activity time. It can provide a simple and reliable choice in single segmental lumbar intervertebral disc protrusion.