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OBJECTIVE@#To investigate clinical efficacy and safety of single and double segmental percutaneous lumbar discectomy for young and middle-aged patients with double-segment disc herniation.@*METHODS@#Retrospective analysis was undertaken for 32 young and middle-aged patients with percutaneous endoscopic lumbar discectomy (PELD) in the treatment of double-segment lumbar disc herniation from January 2015 to October 2018 in Peking University First Hospital. In the study, 18 cases were treated with single-segment treatment and 14 cases with double-segment treatment. Visual analogue score (VAS) and oswestry disability index (ODI) assessment were used to compare clinical symptom outcomes before surgery, 3 months after surgery and at the last follow-up. Macnab criteria were used to assess the patients' overall satisfaction after surgery. Imaging parameters included lumbar lordosis, intervertebral height at each segment and endplate angle of lesion segment on the X-ray. And Michigan State University(MSU) rating and Pfirrmann scoring system were used to evaluate the grade of disc herniation and disc degeneration respectively on magnetic resonance imaging (MRI). The perioperative parameters included the surgeon, anesthesia method, operation time, postoperative hospital stay, postoperative bracing time and perioperative complications.@*RESULTS@#The mean follow-up time was (26.78±10.64) months. There was no significant difference in the follow-up time and baseline information between the two groups(P > 0.05). ODI scores 3 months post-operatively and at the last follow-up were lower in the double segment (P < 0.05). The ODI improvement was also more significant in the double-segment group at the last follow-up (P < 0.05). There was no significant difference in radiographic parameters at baseline (P>0.05). MSU scale for the primary segment was significantly lowered after both operations (P < 0.05). MSU scale for secondary segment was significantly lowered in double segment group but not in single segment group. Other imaging parameters were similar between the two groups (P > 0.05). The operation time of the single-segment group was significantly shorter than that of the double-segment group(P < 0.001). No perioperative complications were found in either group, but three patients underwent secondary lumbar surgery during the postoperative follow-up period in the single-segment group.@*CONCLUSION@#For young and middle-aged patients with double-segment disc herniation, this study suggests double-segment PELD may be more advantageous than single-segment PELD in terms of asuring clinical efficacy without increasing perioperative risks.
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Humans , Middle Aged , Diskectomy , Diskectomy, Percutaneous , Endoscopy , Intervertebral Disc Degeneration/surgery , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Single-segment and double-segment osteotomies are often used to treat ankylotic kyphosis. However, the selection of preoperative strategies, especially for segmental and osteotomy methods, often depends on clinical experience. At present; there are few reports on the biomechanics of double-segment vertebral column decancellation and vertebral column resection osteotomy. OBJECTIVE: To establish a two-segment osteotomy model for ankylotic kyphosis, and to compare and discuss the total displacement of the spine, stress analysis of the internal fixation system, and equivalent stress intensity of the osteotomy contact surface. METHODS: MIMICS software and Geomagic studio software were used to establish two kinds of models of ankylotic kyphosis with vertebral column resection osteotomy and vertebral column decancellation. Each kind of model was divided into single-segment osteotomy and double-segment osteotomy, i.e., L1 single-segment vertebral column resection osteotomy model, L1 single-segment decancellated osteotomy model, L2 single-segment vertebral column resection osteotomy model, L2 single-segment vertebral column decancellation model, T12L2 double-segment vertebral column resection osteotomy model, T12L2 double-segment vertebral column decancellation model, T12L3 double-segment vertebral column resection osteotomy model, and T12L3 double-segment vertebral column decancellation model. ANASYS software was imported to load model. The whole spine displacement, pedicle screw, connecting rod, and bone interface equivalent stress nephogram were recorded under different conditions of osteotomy. RESULTS AND CONCLUSION: (1) Whether it was vertebral column decancellation or vertebral column resection osteotomy model, the total spinal displacement of single-segment osteotomy was less than that of double-segment osteotomy. The displacement of vertebral column resection osteotomy was less than that of vertebral column decancellation in both single-and double-segment osteotomy models. L2 single-segment vertebral column resection osteotomy model had minimal displacement. (2) Whether it was vertebral column decancellation or vertebral column resection osteotomy model, equivalent stress of the single-segment osteotomy was less than that of the double-segment osteotomy. The equivalent stress of the internal fixation device of the vertebral column resection osteotomy was less than that of vertebral column decancellation in both single-and double-segment osteotomy models. The equivalent stress of the internal fixation device of the L1 single-segment vertebral column resection osteotomy was smallest. (3) The equivalent stress of the osteotomy contact surface of all single-segment osteotomy models was smaller than 28 MPa. In the two-segment osteotomy model, the equivalent stress of the osteotomy contact surface of the vertebral column resection osteotomy was less than that of vertebral column decancellation. (4) These results suggest that the biomechanical stability of the single-segment osteotomy model was better than that of the double-segment osteotomy model. The stability of vertebral column resection osteotomy was better than that of vertebral column decancellation.
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Objective To compare the postoperative imaging anatomical parameters and the related perioperative parameters of continuous double-gap cervical spondylotic myelopathy patients who underwent anterior cervical disectomy and fusion (ACDF)or anterior cervical corpectomy and fusion (ACCF)and ACDF so as to learn about the clinical effects of the two methods.Methods We included 5 1 patients in ACDF group (male∶female ratio=32∶19;mean age 56.3±29.4 years),and 47 patients (male∶female ratio=35∶12;mean age 49.1±22.8 years)in ACCF group.We measured the sex ratio,mean age,average length of hospital stay,mean operative time, and average intraoperative blood loss in ACDF group and ACCF group.The patients were followed up at six months,1 year,and 2 years after operation.The JOA score and imaging parameters were recorded for statistical analysis by SPSS 19.0.Results Patients in ACDF group had shorter operative time,less operative bleeding and shorter hospitalization duration than those in ACCF group.There was no significant difference in postoperative JOA score between ACDF and ACCF group.Patients in ACDF group had better imaging indexes than those in ACCF group.Conclusion ACDF has better screening efficacy than ACCF in treatment of continuous double-gap cervical disc herniation of cervical spondylotic myelopathy.
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BACKGROUND: Paresthesia is unpleasant for patients and more importantly, is related to neurological injury in some cases. There have been few studies comparing combined spinal-epidural anesthesia (CSE) techniques such as needle-through-needle technique (NTN) and double segment technique (DST) regarding the incidence of paresthesia. METHODS: Eighty-four parturients undergoing CSE for an elective cesarean section were divided into NTN and DST groups. A CSE was performed using 27 G Sprotte needle, 18 G Tuohy needle and 20 G multiport catheter in both groups. In the NTN group, at L3-4 or L4-5, a spinal anesthesia was performed and then an epidural catheter was inserted through the same Tuohy needle. In the DST group, an epidural catheter was inserted at L1-2 or L2-3 and then a spinal anesthesia was done two interspaces caudally. Incidences of paresthesia with each procedure were recorded with block characteristics and adverse effects. RESULTS: Overall frequency of paresthesia was higher in the NTN group (54.8% vs. 29.3%, P = 0.033). Incidences of intrathecal paresthesia were three times higher (21.4% vs. 7.3%, not significant) and epidural paresthesia was significantly higher (45.2% vs. 22%, P = 0.044) in the NTN group. Sensory and motor block characteristics and side effects were mostly comparable between the groups. CONCLUSIONS: Double-segment technique shows less incidence of overall paresthesia compared to needle-through-needle.