ABSTRACT
Objectives:To compare the early curative effect of visualization of percutaneous transforaminal endoscopic discectomy(VPTED) and microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis.Methods:49 patients with single segmental lumbar spinal stenosis combined with lumbar disc herniation(LDH) were treated in our hospital from March 2016 to March 2017.Among them,21 cases accepted VPTED,and 28 cases underwent MED.The length of incision,amount of bleeding during operation,operation time,length of hospital stay and the cost of hospitalization were recorded in the both groups.Visual analogue scale(VAS) was used to evaluate the effect of surgery,Oswestry disability index(ODI) was used to evaluate the clinical efficacy.The modified MacNab criteria were used to evaluate the efficacy of the patients at final follow-up.Results:There were no statistical differences among the age,the ratio of male to female,follow-up time,low back pain,weakness,sensory disturbance,general reflexes and prominent segments(P＞0.05).There were statistically significant differences between the two groups in preoperative and postoperative VAS and ODI scores(P＜0.05).There was no significant difference in VAS or ODI score between groups at the same time (P＞0.05).The length of incision(0.78±0.06cm vs 1.95±0.12cm),the amount of intraoperative perspective(15.86± 2.66 vs 2.18±0.38) and the operation time(87.51±30.46min vs 47.53±13.61min) had significant difference between VPTED and MED group(P＜0.05).There was no significant difference in hospitalization time or hospitalization expenses between the two groups(P＞0.05).At final follow-up,based on the MacNab standard,it was excellent in 17 cases,good in 3 cases,fair in 1 case in VPTED group;it was excellent in 22 cases,good in 4 cases,fair in 2 cases in MED group.Excellent rate of the VPTED group was 95.24％,and that was 92.86％ in the MED group,there was no significant difference between the two groups(P＞0.05).Conclusions:Visualization of percutaneous transforaminal endoscopic discectomy (VPTED) and microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis have good short-term curative effect,it iproves that VPTED is a safe and effective minimally invasive surgery.
ABSTRACT
STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate postoperative muscle damage after microendoscopic discectomy (MED) and open discectomy (OD), using analysis of serum creatine phosphokinase (CPK) levels. SUMMARY OF LITERATURE REVIEW: Paravertebral muscle damage after retraction during posterior lumbar surgery can cause postoperative back pain. Serum CPK level is elevated in these patients and may indicate postoperative muscle damage. MATERIALS AND METHODS: We examined 35 cases with MED (group 1) and 11 cases with OD (group 2). Serum CPK levels were checked preoperatively and postoperatively at day 1 and day 3. We analyzed intra-group and inter-group differences in CPK levels according to sex, age, and operation time. Surgical outcomes were evaluated with a visual analog scale (VAS) preoperatively and 1 year postoperatively. RESULTS: CPK levels at postoperative 1 day were increased significantly and decreased significantly at postoperative 3 day in both groups (p<0.05), with levels in group 1 significantly lower than in group 2 (p<0.05). There were no differences in CPK levels according to sex, age, or operation time, except between the 3rd and 5th decades of age at postoperative 1 day in group 2. VAS was significantly different in intra-group analysis (p<0.05) with no significant differences in intergroup analysis. CONCLUSIONS: MED induced a lower increase in serum CPK than OD with similar VAS outcomes. MED results in less postoperative muscle damage than OD, with similar surgical outcomes.
Subject(s)
Humans , Back Pain , Creatine Kinase , Creatine , Diskectomy , Retrospective Studies , Visual Analog ScaleABSTRACT
[Objective]To investigate the surgical feasibility and efficiency with microendoscopy discectomy technique for the recurrent lumbar disc herniation.[Method]Ninteen cases underwent disc excision with different operative approaches,11 cases had undergone previous surgery with MED,7 cases with conventional approach,2 cases removing whole vertebrate plate approach,3 cases removing half vertebrate plate approach,2 cases with minor vertebrate plate window approach.There were 13 cases of ipsilateral protrusion and 2 cases of contralateral protrusion,3 cases of adjacent segment protrusion.All of these cases were revisioned by MED except for 1 case.[Result]Eighteen cases were finished by MED technique successfully except for 1 case which was changed to open operating.All cases were followed up from 6 months to 2.5 years,averaged 1.5 years.Postoperative JOA score was improved from preoperative average (9.61?3.40)? to average (26.17?2.60) ?,the rate of improvement final was 86.32%.In terms of Macnab scoring system,the satisfactory rate was 88.89%.[Conclusion]MED technique is an effective method for recurrent lumbar herniation,but the operator needs lots of experience in minimal invasive spine surgery.