ABSTRACT
Objective@#To investigate the clinical efficacy of spinal endoscopic surgery for lumbar posterior ring apophysis separation (PRAS) via percutaneous transforaminal approach.@*Methods@#A retrospective case series study was conducted to analyze the clinical data of 32 patients with lumbar PRAS admitted to the First Affiliated Hospital of Fujian Medical University from September 2016 to March 2018. There were 20 males and 12 females, aged 20-47 years [(33.7 ± 6.6)years]. All patients had single-segment lesions. The injured segments were at L3/4 in seven patients, L4/5 in 14 patients, L5/S1 in 11 patients. All patients were treated with spinal endoscopic surgery via percutaneous transforaminal approach. The incision length, operation time, intraoperative blood loss, intraoperative fluoroscopy times of C-arm X-ray machine and operational complications were recorded. At 24 hours, 3 months and 12 months after operation, the efficacy was evaluated by visual analogue score (VAS), Oswestry dysfunction index (ODI) and modified MacNab criteria.@*Results@#All patients were followed up for 12-30 months, with an average of 15.5 months. The incision length was 7-9.5 mm [(8.0±0.9)mm], the average operation time was 60-155 minutes [(80.5±13.2) minutes], the average intraoperative blood loss was 5-25 ml [(10.6±5.7)ml] and the average number of fluoroscopy was 5-25 times [(9.4±3.4) times]. The patients were permitted to move wearing hard waist 8-12 hours after operation and returned to normal work and life 6 weeks after operation. Postoperative dysesthesia was noted in one patient, who recovered after neurotrophy and physiotherapy after one week. There were no complications such as open surgery conversion, intervertebral space infection, nerve root injury and dural sac laceration. The VAS and ODI at 24 hours, 3 months and 12 months after operation [low back pain VAS: (3.4±1.5)point, (1.8±1.1)points, (1.7±0.9)points; leg pain VAS: (1.8±1.0)points, (1.6±0.8)points, (1.4±0.6)points; ODI: (26.8±9.7)%, (13.9±4.3)%, (12.8±2.8)%] were significantly improved compared with those before operation [ back pain VAS: (7.3±2.1)points, leg pain VAS: (7.9±2.7)points; ODI: (56.2±15.6)%] (P<0.05). According to the modified MacNab criteria, the results were excellent in 25 patients, good in five patients, and fair in two patients, with the excellent and good rate of 94%.@*Conclusion@#Spinal endoscopic surgery for lumbar PRAS via percutaneous transforaminal approach is an effective method with advantages of small incision, less complications, effective pain relief and fast functional recovery.
ABSTRACT
Objective To investigate the clinical efficacy of spinal endoscopic surgery for lumbar posterior ring apophysis separation (PRAS) via percutaneous transforaminal approach.Methods A retrospective case series study was conducted to analyze the clinical data of 32 patients with lumbar PRAS admitted to the First Affiliated Hospital of Fujian Medical University from September 2016 to March 2018.There were 20 males and 12 females,aged 20-47 years [(33.7 ± 6.6)years].All patients had singlesegment lesions.The injured segments were at L3/4 in seven patients,L4/5 in 14 patients,L5/S1 in 11 patients.All patients were treated with spinal endoscopic surgery via porcutaneous transforaminal approach.The incision length,operation time,intraoperative blood loss,intraoperative fluoroscopy times of C-arm X-ray machine and operational complications were recorded.At 24 hours,3 months and 12 months after operation,the efficacy was evaluated by visual analogue score (VAS),Oswestry dysfunction index (ODI) and modified MacNab criteria.Results All patients were followed up for 12-30 months,with an average of 15.5 months.The incision length was 7-9.5 mm [(8.0 ±t 0.9) mm],the average operation time was 60-155 minutes [(80.5 ± 13.2) minutes],the average intraoperative blood loss was 5-25 ml [(10.6 ± 5.7) ml] and the average number of fluoroscopy was 5-25 times [(9.4 ±3.4) times].The patients were permitted to move wearing hard waist 8-12 hours after operation and returned to normal work and life 6 weeks after operation.Postoperative dysesthesia was noted in one patient,who recovered after neurotrophy and physiotherapy after one week.There were no complications such as open surgery conversion,intervertebral space infection,nerve root injury and dural sac laceration.The VAS and ODI at 24 hours,3 months and 12 months after operation [low back pain VAS:(3.4 ± 1.5) point,(1.8 ± 1.1) points,(1.7 ± 0.9) points;leg pain VAS:(1.8 ± 1.0) points,(1.6 ±0.8)points,(1.4±0.6)points;ODI:(26.8 ±9.7)％,(13.9 ±4.3)％,(12.8 ±2.8)％] weresignificantly improved compared with those before operation [back pain VAS:(7.3 ± 2.1) points,leg pain VAS:(7.9 ± 2.7) points;ODI:(56.2 ± 15.6)％] (P ＜ 0.05).According to the modified MacNab criteria,the results were excellent in 25 patients,good in five patients,and fair in two patients,with the excellent and good rate of 94％.Conclusion Spinal endoscopic surgery for lumbar PRAS via percutaneous transforaminal approach is an effective method with advantages of small incision,less complications,effective pain relief and fast functional recovery.
ABSTRACT
Objective To evaluate outcomes of modified transforaminal lumbar interbody fusion (TLIF) assisted by the minimally invasive expandable access system and spinal channel endoscope for acute and chronic lumbar intervertebral disc injury.Methods From March 2013 to November 2014, 45 patients with lumbar intervertebral disc injury were managed with minimally invasive (Group A) or open TLIF (Group B).Location for disc injury was at L3/4 in 5 patients, L4/5 in 28 patients and L5-S1 in 12 patients.Group A composing 12 males and 10 females showed age of (53.70 ±3.59) years (range, 43 to 67 years).Group B composing 14 males and 9 females showed age of (54.80 ± 4.37) years (range, 42 to 68 years).Between-group comparison was conducted with respect to operation time, blood loss, postoperative drainage loss, ambulation time and postoperative complications.Clinical outcomes were evaluated using the visual analogue scale (VAS), Oswestry dysfunction index (ODI), and bone fusion rate.Results Except for the comparable operation time, group A was associated with better results in the blood loss [(152.1 ± 15.5) ml vs (409.9 ± 28.3) ml], drainage volume [(106.1 ± 14.3)mlvs (223.0 ± 19.4)ml], ambulation time[(4.5 ±1.1)d vs (8.9 ±1.4)d] and 1-week postoperative VAS [(3.0±0.7) points vs (4.7 ±0.4) points] (P ＜0.05).At the final follow-up, VAS and ODI of both groups were significantly improved compared to the preoperative levels (P ＜ 0.05), but the differences between groups were insignificant (P ＞0.05).Bone fusion rate in Group A was 95％ (21/22) versus 96％ (22/23) in Group B 6-month postoperatively (P ＞ 0.05).No nerve root injury, intervertebral space infection or other complications occurred.Conclusion Modified TLIF assisted by the minimally invasive expandable access system offers the benefits of less trauma, less bleeding and a quicker recovery for acute and chronic lumbar intervertebral disc injury and has similar long-term clinical outcomes with open TLIF.