ABSTRACT
ObjectiveTo explore the clinical efficacy of percutaneous transforaminal endoscopic spine system （TESSYS） in the treatment of lumbar disc herniation （LDH） complicated with nerve root canal stenosis. MethodsA retrospective study was done on 40 LDH patients complicated with nerve root canal stenosis who underwent TESSYS in our hospital from April 2019 to April 2021. The clinical efficacy of the patients was evaluated by the modified Mac Nab criteria 12 months after the surgery. We also measured and analyzed the scores of visual analogue scale （VAS）， Oswestry disability index （ODI） and Japanese orthopaedic association （JOA）， the changes of structural parameters of lumbar spine and inflammatory factor levels preoperatively， 6 and 12 months after the surgery. ResultsAll the 40 cases successfully underwent the surgery and follow-ups， with a 12-month post-operative clinical excellent and good rate of 90%. The preoperative， 6-month and 12-month post-operative VAS scores were （7.38±2.06）， （2.36±0.87） and （1.62±0.82）， respectively. The respective ODI scores were （55.54±11.19）， （26.52±7.61） and （18.14±4.36）； JOA scores （13.93±2.10）， （20.26±1.35） and （22.34±1.88）. The post-operative scores of VAS， ODI and JOA were significantly improved compared with those before the surgery （P<0.05）. The preoperative and post-operative lumbosacral angles were （37.23±6.84）° and （27.37±4.31）°， respectively， with the respective lumbar curvatures of （13.48±3.06） mm and （22.36±4.51） mm. The post-operative lumbosacral angle and lumbar curvature were significantly improved compared with those before the surgery （P<0.05）. The preoperative and post-operative high-sensitivity C-reactive protein （hs-CRP） levels were （3.43±0.61） mg/L and （5.18±0.70） mg/L， respectively， with the respective tumor necrosis factor alpha （TNF-α） levels of （1.44±0.27） mg/L and （2.07±0.44） mg/L. The post-operative levels of hs-CRP and TNF-α were significantly higher than those before the surgery （P<0.05）. ConclusionIn the treatment of LDH complicated with nerve root canal stenosis， TESSYS achieves a good clinical effect， improves the structure and function of the lumbar spine， reduces the degree of lumbar spine pain， and has a mild post-operative inflammatory reaction.
ABSTRACT
OBJECTIVE@#To explore the trend of changes in the parameters of the spine-pelvic sagittal plane before and after surgery in patients with double-segment lumbar spondylolisthesis (LSL) and to evaluate the value of the surgical effect.@*METHODS@#A retrospective analysis of 95 double-segment lumbar spondylolisthesis patients treated with posterior lumbar interbody fusion from October 2019 to October 2020 were analyzed, including 31 males and 64 females;age ranging from 41 to 63 years old, with an average of (52.10±4.35) years old;degree of lesion, 47 patients with gradeⅠand 48 patients with gradeⅡ. The surgical efficacy was evaluated according to the Oswestry dysfunction index(ODI) improvement rate at 3 months after operation. ODI improvement rate ≥50% was considered good, and <50% was considered bad. Ninety-five patients were divided into good curative effect group (74 cases) and poor curative effect group (21 cases) according to surgical curative effect. The clinical data, such as gender, age, body mass index, course of disease, degree of disease, operation time, intraoperative blood loss, and comorbidities were compared between two groups were compared. The parameters of spine pelvis sagittal plane were observed before and 3 months after operation, including spine sacral angle (SSA), T1 pelvic angle (TPA), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Clinical symptoms were evaluated using visual analogue scale (VAS) and ODI. The correlation between the changes of spine pelvis sagittal plane parameters and the changes of VAS and ODI before and after surgery were analyzed, and the value of spine pelvis sagittal plane parameters in evaluating the surgical efficacy of patients with double level lumbar spondylolisthesis at 3 months after surgery was evaluated.@*RESULTS@#The courses of disease and surgical time in the group with poor efficacy were longer than those in the group with good efficacy, and the degree of lesion was higher in the group with poor efficacy (P<0.05). The SSA, TPA, LL, and SS of the group with good efficacy were higher than those of the group with poor efficacy before and 3 months after surgery, while the PT was lower than that of the group with poor efficacy (P<0.05). The changes in SSA, TPA, LL, PT, and SS before and after surgery in the group with good efficacy were greater than those in the group with poor efficacy (P<0.05). The VAS and ODI of both groups were lower at 3 months after surgery than before, and the group with good efficacy was lower(P<0.05). The changes in VAS and ODI before and after surgery in the group with good efficacy were greater than those in the group with poor efficacy (P<0.05). The changes in SSA, TPA, LL, PT, SS before and after surgery were positively correlated with the changes in VAS and ODI (P<0.05). Three months after surgery, SSA, TPA, LL, PT, and SS were used to evaluate the surgical efficacy of patients with dual level lumbar spondylolisthesis. The area under the curve (AUC) was 0.868, 0.797, 0.875, 0.822, and 0.853, respectively. The combined evaluation of all indicators resulted in the highest AUC, 0.927, and the best sensitivity and specificity were 90.50% and 91.89%, respectively.@*CONCLUSION@#The spine pelvis sagittal plane parameters SSA, TPA, LL, and SS of patients with double level lumbar spondylolisthesis before and after surgery show an upward trend;PT shows a downward trend;PI do not change significantly. And the changes of SSA, TPA, LL, SS, and PT are closely related to the patient's pain level and the improvement of lumbar function, which can be used as parameters to evaluate the surgical efficacy.