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 investigate the effectiveness of combined Pregabalin and Celecoxib for neuropathic pain after percutaneous endoscopic lumbar discectomy. Methods Between January and June 2014, 178 patients with lumbar disc herniation underwent percutaneous endoscopic interlaminar discectomy (PEID). Ninety patients who met the inclusion criteria were recruited in this study. Every case in group A was recruited to match its counterpart in group B and group C according to gender, disease duration, herniated level, smoking history, preoperative Leeds assessment of neuropathic symptoms and signs (LANSS), and Oswestry disability index (ODI). Nine patients were excluded due to incomplete study or loss of follow-up. In each group, 27 cases were included in the final analysis. There was no significant difference in gender, age, height, body mass index, herniated level, disease duration, smoking history, preoperative LANSS, ODI, and visual analogue scale (VAS) between groups (P>0.05). All patients of 3 groups received oral administration of Celecoxib from preoperative 3rd day to postoperative 14th day. Pregabalin was taken orally from preoperative 3rd day to postoperative 14th day in group A, and from postoperative 1st to 14th day in group B. Adverse drug reactions were observed during medication. The LANSS score and VAS score in rest state and active state were conducted before operation and at 1 day, 1 month, and 3 months after operation. ODI was conducted before operation and at 1, 3 months after operation. The number of neuropathic pain cases was recorded, and the effectiveness was evaluated by modified Macnab criteria at 3 months after operation. Results During period of increasing Pregabalin dose, 1 patient of group A suffered severe dizziness, and 1 patient of group B suffered sleepiness, who were eliminated from this research. Another 2 cases (1 case of group A and 1 case of group C) suffered dry mouth, and 1 case of group B suffered muscle weakness. At 1 day after operation, the LANSS score and VAS in rest state and active state of group A were significantly lower than those of groups B and C (P<0.05). At 1 month after operation, the LANSS score, ODI, and VAS in rest state and active state of group A and group B were significantly lower than those of group C (P<0.05). At 3 months after operation, the LANSS score, ODI, and VAS in active state of group A and group B were significantly lower than those of group C (P<0.05). There was no significant difference in the above indicators at the other time points between groups (P>0.05). Neuropathic pain occurred at 3 months after operation in 1 case (3.7%) of group A and 6 cases (22.2%) of group C, showing significant differences in incidence of neuropathy pain between groups A, B and group C (P<0.05), but no significant difference was found between group A and group B (P>0.05). The excellent and good rate of modified Macnab criteria was 92.6% in group A, was 88.9% in group B, and was 85.2% in group C at 3 months after operation, showing no significant difference between groups (P>0.05). Conclusion Combined use of Pregabalin and Celecoxib during perioperative period can reduce postoperative pain and incidence of postoperative neuropathic pain. Preoperative oral Pregabalin can reduce the incidence of acute postoperative neuropathic pain.
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.
Objective To evaluate and select essential medicine for herniated lumbar disc based on the burden of disease for township health centers located in eastern, central and western regions of China. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Six clinical guidelines on herniated lumbar disc were included, five of which were evidence-based. (2) In total, there were 35 medicines (of four classes) listed in the guidelines. (3) We offer a b recommendation for paracetamol and ibuprofen as essential medicine and a weak recommendation for aspirin, indometacin and diazepam according to WHOEML (2011), NEML (2009), CNF (2010), clinical guidelines and the quantity and quality of evidence. (4) Five recommended medicines have been marketed in China with the dosage forms and specifications corresponding to guidelines and their prices were affordable (0.31 to 3.38 yuan daily). (5) Results of domestic low-quality studies indicated that ibuprofen and aspirin were effective with efficiencies of 63% to 84.5%; however, both of which were less effective than other trial medicines (efficiencies: 88.60% to 95.2%). We didn’t find any efficacy or pharmacoeconomic evidence of other medicines in Chinese literature databases. Conclusion (1) Pharmacotherapy should focus on symptomatic treatment of herniated lumbar disc. (2) We offer a b recommendation for paracetamol and ibuprofen used in the treatment of herniated lumbar disc and a weak recommendation for aspirin, indometacin and diazepam. (3) There is lack of evidence and high-quality guidelines on pharmacotherapy of lumbar intervertebral disc in China, especially pharmacoeconomic evidence. (4) We propose that guidelines should be established in basis of evidence so as to effectively direct clinical treatment. The effect of medicine in clinical practice should be based on current evidence from inside and outside China.
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.
目的 探讨老年人腰椎间盘突出合并侧隐窝狭窄症的临床特点及手术方式，总结和介绍小切口单侧椎板开窗椎间盘摘除联合侧隐窝扩大术的优点和可行性。 方法 2006年7月－2011年1月对76例患者行后正中切口4.0～6.0 cm，在C臂X线机定位下，保留棘上、棘间韧带和棘突，骨膜下剥离骶棘肌，显露椎板、椎板间隙和关节突起，在椎板间隙间开骨窗，切除关节突内侧小部分后，环形切除突出的纤维环取出髓核，扩大成形侧隐窝，解除所有卡压脊神经根组织，彻底松解脊神经根。 结果 术后76例随访15～24个月，平均18个月，均按中华脊柱外科学会脊柱学组腰腿痛手术评定标准评定：优63例，良10例，一般及差3例，优良率达96.05%。手术前后Oswestry功能障碍指数评分与腰痛及腿痛视觉模拟评分法评分比较，差异有统计学意义（P＜0.05）。 结论 小切口单侧椎板开窗椎间盘摘除联合侧隐窝扩大术，是一种手术创伤小，能在直视下操作，避免手术失误，彻底去除神经根致压物，不仅能够扩大神经根管，而且可行侧隐窝的探查及松解，同时兼顾脊柱稳定结构基本不被破坏，疗效满意，尤其在老年人中值得推广。