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Objective:To analyze the postoperative paravertebral muscle degeneration and its correlations with health related quality of life (HRQL) in patients undergoing minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF).Methods:The clinical data of the 50 patients were retrospectively analyzed who had undergone single-segmental MIS-TLIF at Department of Spinal Cord Surgery, The People's Hospital of Henan Province from January 2019 to December 2021. The relative volumes of lumbar posterior muscle (LM), the relative volumes of the psoas major (PM), and the rates of fatty degeneration (FD) of the fused segment and its adjacent segments were compared respectively between preoperation, 6 and 12 months postoperation. The correlations were analyzed between the HRQL scores [visual analog scale (VAS) for pain and Oswestry disability index (ODI)] and the relative LM volumes, the relative PM volumes, and the FD rates of the fused segment and its adjacent segments at 12 months postoperation.Results:Compared with the preoperative values, the relative LM volumes and the relative PM volumes of the fused segment and its adjacent segments at 6 and 12 months postoperation were significantly reduced while the FD rates significantly increased. However, the FD rate of the fused segment at 12 months postoperation (20.6% ± 6.1%) was significantly lower than that at 6 months postoperation (29.7% ± 8.2%) ( P < 0.05). The VAS score was strongly negatively or positively correlated with the relative LM volume ( r = -0.819, P < 0.001) and the FD rate ( r = 0.86, P < 0.001) of the fused segment, and moderately negatively correlated with the relative PM volume ( r = -0.435, P = 0.016). The ODI index was moderately negatively correlated with the relative LM volume ( r = -0.512, P = 0.004) and the relative PM volume ( r = -0.402, P = 0.020) of the fused segment, but moderately positively correlated with the FD rate of the fused segment ( r = 0.565, P = 0.001). There was a moderate negative correlation between the ODI index and the relative LM volume of the adjacent segments ( r = -0.478, P = 0.012). Conclusions:After MIS-TLIF, the volume of the paravertebral muscles decreases and the dorsal muscles develop fatty degeneration. The improvement of LM fatty degeneration may be observed by 12-month follow-up in the fused segment, but not in the adjacent segments. The LM volume and the FD rate of the fused segment are the most closely related to the postoperative HRQL.
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【Objective】 To compare the clinical efficacy of percutaneous transforaminal endoscopic decompression （PEID） and percutaneous interlaminar endoscopic decompression （PETD） in the treatment of L5-S1 lateral recess stenosis. 【Methods】 We selected the patients in our center diagnosed with L5-S1 lateral recess stenosis from March 2018 to October 2019 and divided them into Group A and Group B according to the principle of prospective， single-blind， and randomized control （A： PETD； B： PEID）. The operation was performed by the same senior surgeon with mature spinal endoscopy technology. We recorded the basic information， operation duration， usage count of C-arm， hospital stay， VAS score and ODI index of lower back and lower limbs before operation and 3 days， 1 month， 1 year and the last follow-up after the operation， and the operative excellent and good rates （the last follow-up）. The angle of bony lateral recess was measured during pre- and postoperative CT. 【Results】 A total of 95 patients （A： n=48； B： n=47） successfully completed the operation and were followed up for at least 1 year. The two groups did not significantly differ in age， gender， hospital stay， or complication by lumbar intervertebral disc herniation， but PEID group had significantly shorter operation duration and fewer usage counts of C-arm （P<0.001）. VAS score of lower back and lower limbs， and ODI index were significantly reduced at 3 days，1 month， 1 year and the last follow-up after the operation， with no significant difference between the two groups at the same time； no statistical difference was found between the two groups in operative excellent and good rates at the last follow-up （P>0.05）. The postoperative bony side recess angle was significantly improved （P<0.05）， while there was no significant difference in either pre- or postoperative bony side recess angle between the two groups （P>0.05）. 【Conclusion】 Both PEID and PETD are effective strategies in the treatment of L5-S1 lateral recess stenosis and can achieve good clinical outcomes.
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【Objective】 To investigate the effect of decompression technique with bone-chisel under percutaneous spinal endoscopy through transforaminal approach in elderly patients with unilateral lateral recess stenosis （ULLRS）. 【Methods】 We enrolled 46 old patients with ULLRS who underwent percutaneous spinal endoscopy through transforaminal approach assisted with bone-chisel technique from March 2017 to July 2019. The visual analogue scale （VAS） score of low back pain and leg pain， the Oswestry dysfunction index （ODI）， and the modified MacNab score before and after operation were obtained. We also recorded preoperative and postoperative sagittal diameter measured by computer tomography （CT） to evaluate decompression of the lateral recess. All the patients were followed up for at least 1 year for complications. 【Results】 All the 46 patients were followed up for 17 to 42 months. Dural tear occurred in one case， transient nerve root irritation in two cases， and there were no other complications. The low back pain VAS score， lower limb pain VAS score， and ODI index of all the patients were significantly improved in the last follow-up （P<0.05）. The results of the modified MacNab efficacy evaluation at the last follow-up revealed that the excellent and good rate was 91.3% （excellent in 38， good in 4， and fair in 4）. The sagittal diameter （mm） of the bony lateral recess 1 year after surgery increased by an average of 55.8%， which was significantly better than that before surgery （t=6.354， 4.22±1.25 vs. 2.71±0.57， P<0.001）. 【Conclusion】 Percutaneous spinal endoscopy through transforaminal foramen approach combined with bone-chisel technique is effective in treating ULLRS in elderly patients.
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BACKGROUND: Lumbar disc herniation is mostly accompanied by ipsilateral compression symptoms caused by the pressure of herniated portion on the ipsilateral nerve root. Rare cases are reported to present with contralateral compression symptoms. So there is currently no specific classification and nomenclature for this type of lumbar disc herniation, which is referred to as lumbar disc herniation with contralateral symptoms in this article. OBJECTIVE: To investigate the efficacy of endoscopic lumbar nucleus pulposus removal for unilateral versus bilateral decompression in patients with lumbar disc herniation presenting with contralateral symptoms. METHODS: Forty patients with contralateral symptomatic lumbar disc herniation who underwent endoscopic lumbar nucleus pulposus surgery from January 2015 to December 2018 were enrolled in enrolled for retrospective analysis. According to the different decompression methods, the patients were randomly divided into an ipsilateral decompression group (n=20) and a bilateral decompression group (n=20). The visual analogue scale (VAS) and Japanese Orthopedics Association (JOA) scores of the lumbar and lower extremities before and at 3, 6, and 12 months after surgery were recorded. Clinical efficacy was evaluated by the modified Macnab standard at 12 months after surgery. Dynamic X-rays of the lumbar spine were used to evaluate lumbar stability. RESULTS AND CONCLUSION: All the 40 patients were followed up for 12-20 months, with an average of 16 months. There were no complications such as dural sac tear and intervertebral space infection in the two groups. The pain in the lower back and lower extremities were significantly relieved in both groups. The postoperative JOA score was significantly higher than that before surgery; and the postoperative VAS scores of the waist and lower extremities were significantly lower than those before surgery (P < 0.05). The VAS and JOA scores in the bilateral decompression group were significantly superior to those in the unilateral decompression group (P < 0.05). The improved Macnab evaluation at 12 months after surgery showed that the excellent and good rate was 70% in the unilateral decompression group, and 95% in the bilateral decompression group, with significant difference between two groups (P < 0.05). Lumbar spine dynamic X-rays at 12 months after surgery showed no lumbar instability or slippage in the two groups. For patients with lumbar disc herniation presenting with contralateral symptoms who underwent percutaneous transforaminal lumbar nucleus pulposus removal, pain symptoms eased off after treatment with two decompression methods, but the bilateral decompression had better postoperative recovery compared with the unilateral decompression.
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Objective: To summarize the efficacy of percutaneous endoscopic transforaminal unilateral decompression for the treatment of lumbar spinal stenosis, and to investigate the incidence and possible reasons for lower extremity symptoms of non-surgical side after surgery. Methods: The clinical data of 46 patients who underwent percutaneous endoscopic transforaminal unilateral decompression for lumbar lateral recess stenosis between February 2016 and March 2018 were retrospectively analysed. There were 22 males and 24 females with an average age of 56.9 years (range, 21-90 years). The disease duration was 6 months to 12 years (mean, 4.8 years). There were 37 cases of single-segment lumbar lateral recess stenosis and 9 cases of multi-segment stenosis. All patients underwent single-segment surgery, including 2 cases of L 3, 4, 35 cases of L 4, 5, and 9 cases of L 5, S 1. For patients with multi-segment lumbar lateral recess stenosis, the single segment consistent with radicular symptom was selected for surgery. The visual analogue scale (VAS) scores of low back pain and sciatica and Oswestry disability index (ODI) scores were recorded preoperatively and at last follow-up to evaluate the relief of symptoms. Postoperative symptoms on non-surgical side of lower extremity including new or aggravated radiation pain and numbness were recorded. The surgical effectiveness was evaluated according to modified MacNab score at last follow-up. Results: All the 46 patients underwent successful operations without postoperative complications such as wound infection, permanent nerve root injury, and deep vein thrombosis. The patients were followed up 12-37 months (mean, 23.8 months). Four patients suffered from radioactive pain and numbness for the non-surgical side of lower extremities at 1-3 months postoperatively, and the symptoms were improved after conservative treatment without revision surgery. VAS scores of low back pain and sciatica and the ODI scores were significantly improved at last follow-up when compared with preoperative ones ( P<0.01). According to the criteria of modified MacNab scores, 25 cases were excellent, 17 cases were good, 3 cases were fair, and 1 case was poor. The excellent and good rate was 91.3%. Conclusion: Percutaneous endoscopic transforaminal unilateral decompression for lumbar spinal stenosis would be able to relieve pain effectively and achieve good results. Lower extremity symptoms of non-surgical side may be observed postoperatively. Although the symptoms can be relieved by conservative treatment, further investigation should be carried out for the long-term result of those cases.
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<p><b>OBJECTIVE</b>To explore the safety and effectiveness of percutaneous transforaminal endoscopic BEIS technology for lumbar lateral recess stenosis in the elderly.</p><p><b>METHODS</b>From February 2014 to May 2016, 21 patients with lumbar lateral recess stenosis in elderly were treated with percutaneous endoscopic BEIS. There were 13 males and 8 females, aged from 70 to 85 years old with an average of 74.3 years. Preoperative, 1 and 12 months postoperative visual analogue scale(VAS) scores and Oswestry Disability Index(ODI) were statistically analyzed. MacNab was used to assess the clinical effects.</p><p><b>RESULTS</b>All the operations were successful. The time ranged from 90 to 130 min with an average of 110 min. All the patients were followed up for 12 to 38 months with an average of 18 months. Preoperative, 1 and 12 months postoperative VAS scores were 8.47±1.23, 1.78±0.72, 0.68±0.32, and ODI scores were 32.48±10.03, 19.53±3.55, and 5.15±1.02, respectively. Postoperative scores of VAS and ODI were obviously improved(<0.05). According to modified MacNab standard to evaluate the clinical effects, 14 cases obtained excellent results, 5 good, 2 fair. Lower limb paresthesia occurred in 1 case, and the condition was restored at 3 months postoperatively with conservative treatment. One patient was complicated with emphysema before operation secondary to pulmonary infection, and was effectively controlled with regulate antibiotic therapy. No infection of vertebral body or intervertebral space, no injuries of blood vessels or nerve root, no tear of dura, or the leakage of cerebrospinal fluid were found.</p><p><b>CONCLUSIONS</b>Percutaneous transforaminal endoscopic BEIS is a safe and effective method for lumbar lateral recess stenosis in the elderly.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Diskectomy, Percutaneous , Endoscopy , Lumbar Vertebrae , Lumbosacral Region , Pathology , Spinal Stenosis , General Surgery , Treatment OutcomeABSTRACT
<p><b>OBJECTIVE</b>To analyze the clinical effects of percutaneous endoscopic technique via three different approaches for highly migrated lumbar disc herniation.</p><p><b>METHODS</b>The clinical data of 68 patients underwent percutaneous endoscopic technique from June 2011 to June 2014 were retrospectively analyzed. There were 43 males and 25 females, aged from 11 to 77 years old with an average of (42.29±15.92) years. The patients were divided into three groups according to different operative approaches, of them, 45 cases were by transforaminal approach (group A), 15 cases by translaminar approach (group B), and 8 cases by transpedicular approach (group C). There was 1 case in level L₂,₃, 12 cases in L₃,₄, 36 cases in L₄,₅, 19 cases in L₅S₁. The herniated disc was migrated superiorly in 23 patients, inferiorly in 45 patients. MRI were available to confirm migrated disc pre-and post-operatively. Operation time, loss blood volume, intraoperative and postoperative complications, time of back to work (postoperative recovery time) were recorded. Preoperative and postoperative VAS were used to evaluate low back pain and sciatica and JOA and MacNab criteria were used to evaluate functional recovery.</p><p><b>RESULTS</b>All the operations were successful and all the patients were followed up from 12 to 40 months with an average of (18.0±15.9) months. Seven patients(3 cases in group A, 3 cases in group B, 1 case in group C) complicated with transient paraesthesia (hyperalgesia or hypesthesia), and the symptoms relieved after symptomatic treatment with neurotrophic medicine, at final follow-up, no symptoms were left. One case in group B complicated with dura mater tearing during operation and it was untreated, there was no resulted complications such as headache and sinus tract of skin. In group A, B, C, the mean VAS score of sciatica improved from preoperative 6.93±1.34, 6.33±1.23, 6.13±1.73 to 0.80±0.87, 0.73±0.70, 0.38±0.52 at final follow-up; and JOA score improved from preoperative 9.09±2.62, 9.80±2.31, 10.50±2.93 to 26.82±1.53, 25.93±1.58, 26.50±1.51 at final follow-up, respectively(<0.05). There was no significant difference among three groups(>0.05). There was no significant difference in loss blood volume, postoperative recovery time among three groups. But operation time of group B was shorter than other two groups. According to MacNab criterion to assess the clinical effects, 42 cases got excellent results, 21 good, 5 fair.</p><p><b>CONCLUSIONS</b>Percutaneous endoscopic technique is a safe and effective method for surgical treatment of highly migrated herniation. The decision of operative approach should be made by characters of anatomy. By tanspedicular approach the lesion could be found directly. However, it depends on good skill and equipment.</p>
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Percutaneous endoscopic spinal surgery performed in the awake state offers a new paradigm for treatment of symptomatic lumbar disc prolapse. We report the outcome of 23 patients who underwent this procedure. Visual analogue scale for pain improved from 7.3 to 2.1; 19 of the 23 patients achieved good to excellent results according to the MacNab criteria. Patient acceptance of the procedure was 91.3%. All but one patient were discharged from hospital within 24 hours. One patient developed foot drop post oper
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OBJECTIVE: The aim of this study was to compare the therapeutic and functional values between the L5-S1 transforaminal epidural steroid injection (TFESI) and L4-5 TFESI in patients with L5 radiculopathy. METHOD: Among 30 patients with unilateral herniated nucleus pulposus (HNP) and L5 radiculopathy, 15 patients received L5-S1 TFESI and 15 patients received L4-5 TFESI. All patients were checked visual analogue scale (VAS) and functional score before injection, after 1 day, 2 weeks and 4 weeks. RESULTS: The VAS of before injection, after 1 day, 2 weeks and 4 weeks were 6.6, 4.0, 3.0, and 2.8 in L5-S1 TFESI, 6.2, 3.9, 2.7, and 2.6 in L4-5 TFESI, respectively. The functional score of before injection, after 1 day, 2 weeks and 4 weeks were 1.8, 2.3, 2.6, and 3.0 in L5-S1 TFESI, 1.6, 2.2, 2.5, and 2.8 in L4-5 TFESI, respectively. There was no statistical difference between the groups (p>0.05). CONCLUSION: This study suggested that either L5-S1 TFESI or L4-5 TFESI could be a valuable treatment of L5 radicular pain.
Subject(s)
Humans , RadiculopathyABSTRACT
OBJECTIVE: The goal of this study was to compare the therapeutic and the functional value between translaminar approach and transforaminal approach of epidural steroid injection in patient with refractory radicular pain. METHOD: Among 31 patients with unilateral herniated nucleus pulposus (HNP) which was confirmed by physical examination and magnetic resonance imaging (MRI), 17 patients received a transforaminal approach and 14 patients received a translaminar approach. All patients were evaluated by independent observer and were checked by visual analogue scale (VAS), functional score before and 1 day, 2 weeks and 4 weeks after injection. RESULTS: The VAS of transforaminal approach was significantly lower than that of translaminar approach after 2 weeks and after 4 weeks (p<0.05), although there were no statistical difference before and 1 day after injection. The functional score of transforaminal approach was significantly higher than that of translaminar approach after 4 weeks (p<0.05), although there were no statistical difference before and 1 day, 2 weeks after injection. The translaminar approach needs more frequent injection (p<0.05). CONCLUSION: This study suggests that both translaminar approach and transforaminal approach could be valuable to the initial management of refractory radicular pain, but the duration of therapeutic effects was relatively short in translaminar approach. Transforaminal approach will be the promising treatment of refractory radicular pain, because it has better therapeutic efficacy, safety and longer duration of therapeutic effects than translaminar approach.