A network meta-analysis of different surgical methods in the treatment of lumbar disc herniation / 中国组织工程研究

BACKGROUND: At present, there are many surgical methods for the treatment of lumbar disc herniation, and the therapeutic effects have their own advantages. Although there are many meta-analyses to compare the therapeutic effects of the two surgical methods, there is no comparison of the therapeutic effects of several surgical methods. OBJECTIVE: To compare the differences of different surgical methods in the treatment of lumbar disc herniation by network meta-analysis. METHODS: PubMed, Embase, Cochrane Library, Ovid and CNKI were searched, and randomized controlled trials or retrospective studies on different surgical methods for the treatment of lumbar disc herniation were collected. According to the inclusion and exclusion criteria established in advance, the quality of included randomized controlled trials was evaluated, and the data were analyzed by STATA 15.0 software. RESULTS AND CONCLUSION: A total of 42 studies, 5 156 patients and 9 surgical treatments were included. Surgical treatments contain total disc replacement, lumbar disc fusion, standard open discectomy, microendoscopic discectomy, microdiscectomy, percutaneous endoscopic lumbar discectomy, chemonucleolysis, automatic percutaneous lumbar discectomy and percutaneous laser disc decompression. The results of network meta-analysis showed that(from best to worst):(1) There was no significant difference in leg pain relief, and the rank probability was percutaneous laser disc decompression > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > lumbar disc fusion > total disc replacement.(2) There was no significant difference in low back pain relief, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > microdiscectomy > percutaneous laser disc decompression > standard open discectomy.(3) There was no significant difference in Oswestry disability index scores, and the rank probability was microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > microdiscectomy > total disc replacement > lumbar disc fusion.(4) There were some statistical differences in the success rate, and the rank probability was total disc replacement > lumbar disc fusion > microendoscopic discectomy > percutaneous endoscopic lumbar discectomy > standard open discectomy > percutaneous laser disc decompression > microdiscectomy > chemonucleolysis > automatic percutaneous lumbar discectomy.(5) There was no significant difference in reoperation rate, and the rank probability was total disc replacement > lumbar disc fusion > microdiscectomy > microendoscopic discectomy > standard open discectomy > percutaneous endoscopic lumbar discectomy > percutaneous laser disc decompression > chemonucleolysis > automatic percutaneous lumbar discectomy.(6) There were some statistical differences in incidence of complications, and the rank probability was percutaneous endoscopic lumbar discectomy > automatic percutaneous lumbar discectomy > standard open discectomy > microdiscectomy > percutaneous laser disc decompression > microendoscopic discectomy > total disc replacement > lumbar disc fusion > chemonucleolysis. Results suggested that microendoscopic discectomy and percutaneous endoscopic lumbar discectomy are effective in all aspects. Disc replacement and lumbar disc fusion are the best in success rate of operation. Chemonucleolysis is poor in success rate of operation, reoperation rate and complications rate. Percutaneous automatic discectomy is poor in success rate of operation and reoperation rate.

Unilateral mydriasis: a complication of spine surgery in prone position / Midríase unilateral: uma complicação da cirurgia de coluna em decúbito ventral

Abstract Prone position though is commonly used for better access to surgical site, but may be associated with a variety of complications. Perioperative Visual Disturbances or loss is rare but a devastating complication that is primarily associated with spine surgeries in prone position. In this case we report a 42 year old ASA-II patient who developed anisocoria with left pupillary dilatation following lumbar microdiscectomy in prone position. Following further evaluation of the patient, segmental pupillary palsy of the left pupillary muscles was found to be the possible cause of anisocoria. Anisocoria partially improved but persisted till follow up.

Resumo O posicionamento em decúbito ventral, embora comumente usado para melhorar o acesso ao local cirúrgico, pode estar associado a uma variedade de complicações. Distúrbios ou perda visual no Perioperatório é uma complicação rara, mas devastadora, que está principalmente associada à cirurgia de coluna vertebral em decúbito ventral. Relatamos aqui o caso de um paciente de 42 anos de idade, ASA - II, que desenvolveu anisocoria com dilatação pupilar esquerda após microdiscetomia lombar em decúbito ventral. Após uma avaliação adicional do paciente, observamos que a paralisia segmentar dos músculos pupilares esquerdos seria a possível causa de anisocoria. A anisocoria melhorou parcialmente, mas persistiu até o acompanhamento.

Uso de un nuevo implante: U-Force N6 a nivel L5 S1 para evitar la inestabilidad lumbar tras discectomía simple / Using a new implant: U-Force N6 to level L5 S1 to avoid lumbar instability after single discectomy

Resumen: Introducción: Estudio prospectivo en pacientes afectos de hernia discal lumbar L5 S1 tratados mediante la U-Force interespinosa N6. El espaciador interespinoso denominado "U" está realizado en titanio y es colocado entre las apófisis interespinosas. Material y métodos: 50 pacientes operados de hernia discal lumbar fueron evaluados; 25 pertenecían al grupo U-N6 y 25 sólo fueron tratados con microcirugía. Se les realizó valoración clínica y estudios radiológicos seriados. Todos los individuos tuvieron un seguimiento durante dos años (2013-2014). Resultados: Nuestro estudio revela que el uso del dispositivo fue más efectivo (estadísticamente significativo) para el retraso de la inestabilidad que sólo la técnica quirúrgica (p < 0.01). Permitió su colocación en 90% de los sujetos. Conclusión: El uso de este dispositivo retrasa el colapso vertebral y, por ende, la inestabilidad del segmento operado. Noventa por ciento de los casos del grupo N6 presentan el dispositivo a nivel de L5 S1 versus 60% del grupo histórico con otros dispositivos (2004-2011).

Abstract: Introduction: We conducted a retrospective study in patients with disc herniation and compared the results obtained in individuals treated with the U device N6 with those acquired in patients treated without any device. The U device is a titanium alloy implant that is placed between the spinous processes. Material and methods: In a cohort of 50 patients with degenerative lumbar disc, 25 underwent surgical treatment in which the U device was placed and 25 control individuals were treated with discectomy alone. Patients underwent serial follow-up evaluations, and radiographic assessment was used to determine the outcome. Up to two years of follow-up data were obtained in all patients (2013-2014). Results: Statistically significant improvement was seen in patients treated with the coflex device in the management of lumbar disc degeneration to avoid lumbar instability in the future (p < 0.01). It allowed its placement in 90% of the patients. Conclusions: Our study shows that the coflex device was more effective than the discectomy group in the management of lumbar instability. Ninety percent of the cases of the N6 group present the device at L5 S1 versus 60% of the historical group with other devices (2004-2011).

Lesión iatrogénica de la arteria iliaca común izquierda durante discectomía lumbar posterior / Iatrogenic injury to the left common iliac artery for posterior lumbar discectomy

Las lesiones vasculares durante la cirugía de hernia discal son infrecuentes, pero asociadas con una alta mortalidad dependiendo del vaso afectado, requiriendo de una sospecha diagnóstica y manejo temprano que puedan evitar el desenlace mortal. Dependiendo del nivel intervertebral intervenido las lesiones vasculares comprometerán en mayor o menor frecuencia los diferentes grandes vasos, siendo más frecuentes los traumas a la aorta en niveles altos y el compromiso de los vasos arteriales y venosos ilíacos comunes o sus ramificaciones en niveles inferiores, las estadísticas en cuanto a incidencia se creen son subestimadas debido a la infrecuencia con que son reportados estos casos. El objetivo de este artículo es exponer el caso de una lesión traumática intraoperatoria de la arteria ilíaca común izquierda durante un procedimiento de hemilaminectomia y microdisectomia L5 - S1, en la que la temprana sospecha de la lesión y contar con equipo quirúrgico altamente capacitado en la institución permitió realizar un manejo oportuno sin secuelas neurológicas o vasculares para el paciente. Compartimos este caso dado lo infrecuente de sus reportes en la literatura revisada, si tenemos en cuenta la frecuencia con el que neurocirujano o cirujano de columna realiza procedimientos para corrección de hernias discales, sin dimensionar en muchas ocasiones el alto riesgo de morbi-mortalidad derivadas de una complicación quirúrgica, que en nuestro caso de no haber contado con el equipo quirúrgico idóneo (anestesia, cuidados posoperatorios, cirujanos generales y vasculares), no se hubiera obtenido el buen resultado para el paciente.

Vascular injury during surgery herniated disc are rare, but associated with high mortality depending on the affected vessel, requiring a diagnostic suspicion and early management to avoid a fatal deselance. Depending on the level involved surgical, vascular lesions are more commonly involved trauma of the aorta at high levels and commitment of arterial and venous vessels common iliac, less frequently commits its branches at lower levels. Due to the low incidence of reporting of these cases statistics are underestimated. The aim of this article is to present the case of a traumatic injury intraoperative left common iliac artery for a microdiscectomy procedure hemilaminectomy and L5 - S1, where a timely management was conducted through early suspicion of injury and the surgical team highly trained in the institution. There were no neurological or vascular consequences for the patient. We share this case due to the rareness of their reports in the literature reviewed, if we consider the frequency with which neurosurgeon or spine surgeon performs procedures to correct herniated discs, not to mention the high risk of surgical morbidity and mortality. In our case you have not had the ideal surgical equipment (anesthesia, postoperative care, general and vascular surgeons) had not obtained the good result for the patient.

Microdiscectomia lombar: acessos interlaminar e intertransverso com uso de afastador de Caspar tubular cilíndrico e dreno de Penrose como auxiliar no afastamento da musculatura ­ estudo de 502 casos / Lumbar Microdiscectomy: Interlaminar and Intertransverso Access using Tubular Retractor Caspar Cylindrical and Penrose Drain as an Aid in Muscular Retraction ­ Study of 502 Cases

Os autores fazem uma revisão da literatura abordando conhecimentos neuroanatômicos da raiz e do gânglio da raiz dorsal. Descrevem a técnica para os acessos interlaminar e intertransverso com o uso de afastador de Caspar tubular cilíndrico e dreno de Penrose como auxiliares no afastamento da musculatura. Basearam-se em 502 casos operados em 25 anos. O objetivo deste trabalho é descrever uma técnica com incisão pequena na pele, baixa agressividade para as estruturas anatômicas, sem perda funcional da musculatura paravertebral, campo cirúrgico amplo, facilidade de execução com as duas mãos, alta hospitalar precoce em torno de 24 horas e baixo custo.

The authors review the literature addressing neuro-anatomical knowledge of the root and root ganglion dorsal. Describe the technique for the interlaminar and intertransverso access using tubular retractor Caspar cylindrical Penrose drain as an aid in muscular retraction. Based-seem 502 cases operated in 25 years. The objective of this paper is to describe a technique with small skin incision, low aggressiveness anatomical structures without functional loss of paraspinal musculature, broad surgical field, easy work with both hands, high early hospital about 24 hours and low cost.

Comparison of Microscopic Lumbar Discectomy Between under Local and General Anesthesia in Lumbar Disc Herniation

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the effectiveness of microdiscectomy under local anesthesia in comparison with general anesthesia. SUMMARY OF LITERATURE REVIEW: No co RESULTS: Between both groups there is no significant operation time difference. However, the average hospital stay duration in the general anesthesia group was 7.3 days, while it was 4.7 days in the local anesthesia group (P0.05). Three patients in the general anesthesia group and 7 patients in the local anesthesia group needed a reoperation. CONCLUSIONS: A microdiscectomy under local anesthesia shows faster recovery period. But it shows also a relative high revision rate. In patients with old age and underlying disease, local anesthesia can be used for the microdiscectomy selectively and careful exploration of the herniated disc is required.

Surgical Tips to Preserve the Facet Joint during Microdiscectomy

Lumbar microdiscectomy (MD) is the gold standard for treatment of lumbar disc herniation. Generally, the surgeon attempts to protect the facet joint in hopes of avoiding postoperative pain/instability and secondary degenerative arthropathy. We believe that preserving the facet joint is especially important in young patients, owing to their life expectancy and activity. However, preserving the facet joint is not easy during lumbar MD. We propose several technical tips (superolateral extension of conventional laminotomy, oblique drilling for laminotomy, and additional foraminotomy) for facet joint preservation during lumbar MD.

Implementation and Outcomes of a Critical Pathway for Lumbar Laminectomy or Microdiscectomy

OBJECTIVE: The aim of this study is to implement a critical pathway (CP) for patients undergoing lumbar laminectomy or microdiscectomy and describe the results before and after the CP in terms of length of hospital stay and cost. METHODS: From March 2008 to February 2009, 61 patients underwent lumbar laminectomy or microdiscectomy due to stenosis or one- or two-level disc herniation in our department and were included in the prepathway group. After development and implementation of the CP in March 2009, 58 patients were applicable for the CP, and these were classified as the postpathway group. RESULTS: The CP, which established a 6-day hospital stay (5 bed-days), was fulfilled by 42 patients (72.4%) in the postpathway group. The mean length of stay was 5.4 days in the postpathway group compared to 6.9 days in the prepathway group, demonstrating a 20% reduction, which was a statistically significant difference (p< or =0.000). There was a statistically significant reduction in charges for bed and nursing care (p=0.002). CONCLUSION: Implementation of a CP for lumbar laminectomy or microdiscectomy produced significant decreases in length of hospitalization and charges for bed and nursing care. We believe that this CP reduces the unnecessary use of hospital resources without increasing risk of adverse events.

Comparative Study of the Outcomes of Percutaneous Endoscopic Lumbar Discectomy and Microscopic Lumbar Discectomy Using the Tubular Retractor System Based on the VAS, ODI, and SF-36

OBJECTIVE: Percutaneous endoscopic lumbar discectomy (PELD) and microdiscectomy with the microscope endoscopic tubular retractor system(METRx-MD) are considered popular minimally invasive surgery (MIS) methods for the treatment of lumbar disc herniation. Many authors have also reported good clinical outcomes of these methods, but there are few comparative studies of them. This report compares the clinical outcomes of PELD and METRx-MD for lumbar disc herniation as MIS methods and discusses the efficacy of PELD. METHODS: Seventy-two patients who had undergone single-level unilateral discectomy using two different methods, PELD and METRx-MD, between 2009 and 2011 were given a follow-up examination prospectively. Thirty-seven of these patients underwent discectomy using PELD, and the remaining 35 patients underwent discectomy using METRx-MD. In addition to the general parameters, clinical outcomes were assessed as specific parameters using the Visual Analogue Scale (VAS) score, the Oswestry Disability Index (ODI), the Short-form 36 (SF-36), and the return-to-work time. RESULTS: Sixty-seven percent (25/37) of the patients in the PELD group and 74%(26/35) in the METRx-MD group were included in follow-up more than 6 months post-operatively. The mean improvements in the VAS scores for the back pain, leg pain, and ODI were 2.6, 4.8, and 30.1% for the PELD group and 2.8, 4.6, and 33.2% for the METRx-MD group, respectively. The SF-36 physical health component subscale score improved from 40.6 pre-operatively to 68.3 at the last follow-up for the PELD group post-operatively, and from 48.5 to 65.1 in the mental component subscale (METRx-MD group: from 34.4 to 66.5 and from 44.87 to 56.7). Complications occurred in 3/37 patients in the PELD group and in 2/35 patients in the METRx-MD group in the peri-operative period. The mean return-to-work times were 37.5 days in the PELD group and 42.5 days in the METRx-MD group. CONCLUSION: The outcomes for the PELD group are comparable to those for the METRx-MD group. It can thus be concluded that PELD for lumbar disk herniations may be performed safely and effectively. Also, PELD can be considered one of the treatment modalities of lumbar disk herniation.

Fragmentectomy versus Conventional Microdiscectomy in Single-Level Lumbar Disc Herniations : Comparison of Clinical Results and Recurrence Rates

OBJECTIVE: This retrospective study aimed to compare clinical outcomes in terms of pain relief and recurrence rate between fragmentectomies and conventional microdiscectomies in patients with lumbar disc herniation (LDH). METHODS: Between January 2008 and May 2011, a total of 175 patients met the inclusion criteria of this study. The visual analogue scale (VAS) scores of back and radicular pains were recorded before surgery, 2 and 6 weeks after surgery. Recurrence was defined when a patient had the same pattern of preoperative symptoms and was confirmed with magnetic resonance imaging. RESULTS: Seventy-four patients (42.3%) were suitable for fragmentectomy, and 101 patients underwent conventional microdiscectomy. There were no significant differences in VAS scores between the fragmentectomy and conventional microdiscectomy groups 2 and 6 weeks after surgery. During the follow-up period, 3 patients (4.05%) in the fragmentectomy group and 7 patients (6.93%) in the conventional microdiscectomy group relapsed. CONCLUSION: If patients are selected according to well-defined criteria, fragmentectomy can be a good surgical option for LDH, in the physiological aspect of preserving healthy intervertebral disc materials.

Small Bowel Injury as a Complication of Lumbar Microdiscectomy : Case Report and Literature Review

Small bowel injury resulting from unforeseen penetration of the anterior annulus fibrosus and longitudinal ligament is a rare complication of lumbar microdiscectomy. The patient complained of abdominal tenderness and distention immediately after microdiscectomy for L4-5 and L5-S1 disc herniation. Using abdominal computed tomography, we found several foci of air overlying the anterior aspect of the vertebral body at the L5-S1 level. Segmental resection of the small bowel including small tears and primary anastomosis of the jejunum were performed. Here, we present a case of intestinal perforation after lumbar microdiscectomy and discuss technical methods to prevent this complication with a review of literature.

Minimally Invasive Muscle Sparing Transmuscular Microdiscectomy : Technique and Comparison with Conventional Subperiosteal Microdiscectomy during the Early Postoperative Period

OBJECTIVE: The authors introduce a minimally invasive muscle sparing transmuscular microdiscectomy (MSTM) to treat herniated lumbar disc disease. Its results are compared with conventional subperiosteal microdiscectomy (CSM) to validate the effectiveness. METHODS: Muscle sparing transmuscular microdiscectomy, which involves muscle dissection approach using the natural fat cleavage plane between the multifidus to expose the interlaminar space, was performed in 23 patients to treat a single level unilateral lumbar radiculopathy. The creatine phosphokinase (CPK)-MM serum levels were measured on admission and at 1, 3, and 5 days postoperatively. Postoperative pain was evaluated using a 10-point visual analogue scale (VAS) and recorded on admission and at 1, 3, and 5 days postoperatively. The results were compared to those from the conventional subperiosteal microdiscectomy (43 patients). RESULTS: The CPK-MM levels were significantly lower in the serum of the MSTM group compared to the CSM group on postoperative days three and five (p = 0.03 and p = 0.02, respectively). The clinical scales for back pain using VAS were significantly lower in the MSTM group than in the CSM group on postoperative days three (p = 0.04). The mean VAS scores for leg pain in both groups showed no significant differences during the early postoperative period. CONCLUSION: Muscle sparing transmuscular microdiscectomy is a minimally invasive surgical option to treat lumbar radiculopathy due to herniated disc. The approach affected minimal injury to posterior lumbar supporting structures with alleviated postoperative back pain.

The Effects of Epidural Anesthesia in Elderly Patients during Single-Level Lumbar Microdiscectomy

OBJECTIVE: To analyze the effect of epidural anesthesia in elderly patients with single-level lumbar discectomy. METHODS: Medical records of 28 patients aged between 60 and 90 years who had undergone single-level lumbar microdiscectomy by two surgeons from January 2004 to December 2008 were retrospectively reviewed. Patients were divided into 2 groups: Group I was comprised of patients with lumbar discectomy under epidural anesthesia and Group II was comprised of patients with lumbar discectomy under general anesthesia. Factors taken into account when comparing the effects of epidural and general anesthesia were surgical time, anesthetic time, starting time of ambulation after surgery, hospital stay, postoperative headache, nausea, vomiting, urinary difficulty, back pain and patient satisfaction. The score on the visual analogue scale(VAS) for back pain was measured after surgery. RESULTS: 15 patients(Group I) underwent discectomy under epidural anesthesia. The mean age of patients in Group I and II were 65+/-6.1 years and 67+/-6.7 years, respectively. 19 patients had underlying co-morbidities, such as cardiovascular, pulmonary, cerebrovascular diseases and cancer. Demographically, there was no statistical diffe- rence between the two groups. Surgical time, anesthetic time, starting time of ambulation after surgery and hospital stay were longer in patients in Group II. The incidences of urinary difficulty and VAS score for back pain were significantly lower in Group I. The incidences of headache, nausea and vomiting and patient satisfaction were not different between Group I and II. CONCLUSION: Epidural anesthesia was as efficacious and as safe as general anesthesia. Elderly patients who need to undergo single-level lumbar discectomy could be offered epidural anesthesia.

Outcomes of microdiscectomy for treatment of recurrent lumbar disc herniation / 中华显微外科杂志

Objective To evaluate the outcomes of microdiscectomy for treatment of recurrent lumbar disc hemiations. Methods There were 18 cases of recurrent lumbar disc berniations accepted microdiscectomy (reoperation group), compared with 30 cases of primary lumbar microdiscectomy (primary group). Operating time, blood loss and length of hospital stay were compared between two groups. MacNab criteria were used to evaluate the outcomes. Results Operating time was a mean of 75 min in reoperation group, 52 min in primary group. Blood loss of reoperation group was 70 ml, 50ml in primary group. Length of hospital stay was 8.5d in reoperation group, 6.5d in primary group. There were one dural tear, two Ls root lesions and 5 more numbness reoperation group, but recovery all patients. There were one dural tear in primary group. 17 cases got follow-up mean 12.1 months in reoperation group and 29 cases in primary group mean 11.8 months. The results demonstrated 88.2% success rate in reoperation group and 93.1% in primary group. There was no significant dif-ference in two groups (P ＞ 0.05). Conclusion Outcomes of Lambar mierodisceetomy with mini-open for treatment of recurrent lumbar disc herniations are similar to primary lumbar mierodiscectomy.

Cervical Disc Herniation Producing Acute Brown-Sequard Syndrome

Brown-Sequard syndrome may be the result of penetrating injury to the spine, but many other etiologies have been described. This syndrome is most commonly seen with spinal trauma and extramedullary spinal neoplasm. A herniated cervical disc has been rarely reported as a cause of this syndrome. We present a case of a 28-year-old male patient diagnosed as large C3-C4 disc herniation with spinal cord compression. He presented with left hemiparesis and diminished sensation to pain and temperature in the right side below the C4 dermatome. Microdiscectomy and anterior cervical fusion with carbon fiber cage containing a core of granulated coralline hydroxyapatite was performed. After the surgery, rapid improvement of the neurologic deficits was noticed. We present a case of cervical disc herniation producing acute Brown-Sequard syndrome with review of pertinent literature.

Comparative Evaluation of Percutaneous Endoscopic Discectomy and Microdiscectomy Using Tubular Retractor System at L4-5 Level / 대한척추외과학회지

STUDY DESIGN: A prospective, non-randomized study OBJECTIVES: To evaluate the early clinical results of percutaneous endoscopic lumbar discectomy (PELD) and microdiscectomy (MD) using a tubular retractor. SUMMARY OF THE LITERATURE REVIEW: There are few reports comparing the clinical results of different minimal invasive surgical procedures for disc herniation. MATERIALS AND METHODS: Out of 41 patients who underwent a discectomy at the L4-5 level, 16 patients (Group I) underwent PELD and 25 patients (Group II) underwent MD. The surgical techniques were based on the patient's selection. The characteristics of the operation(operation time, time for C-arm, amount of removed disc) were compared with the clinical outcomes by evaluating the SLR (straight leg raising test), leg VAS (visual analogue scale), ODI (Oswestry Disability Index), hospital day, changes in disc height. RESULTS: Group I showed a larger amount of disc removed and exposure time for the C-arm than group II (p<0.05). However, the hospital day was shorter in group I than in group II (p<0.05). There were no differences in the leg VAS, ODI, the change in disc height and surgery time between the two groups at the last follow up. One case in group I had a neuropraxia of the L5 root that had recovered fully at postoperative 3months. In group II, there was one case of a postoperative hematoma and 2 cases of a dural tear. CONCLUSION: Although the early clinical outcomes were similar in both groups, group I showed a larger amount of disc removed and more exposure time to radiation but a shorter hospital stay.

Eficiência dos métodos fisioterapêuticos de reabilitação no pós-operatório de hérnia de disco lombar / Efficiency of physiotherapeutics methods of rehabilitation in the post-operative of lumbar disc hernia

Os programas de reabilitação no pós-operatório imediato de microdiscectomia lombar são descritos de maneira pouco detalhada na literatura médica, principalmente no que diz respeito às duas primeiras semanas após a cirurgia. Detalhar essa fase da reabilitação, assim como os métodos de avaliação utilizados foram os objetivos deste estudo. Participaram desse estudo experimental 46 pacientes, divididos em três grupos, o grupo 1 realizou um tratamento durante as duas semanas seguintes à cirurgia com exercícios específicos, supervisionados diariamente pelo mesmo fisioterapeuta e recebeu orientações por escrito e de maneira verbal durante a internação hospitalar. O grupo 2 recebeu o mesmo tratamento do grupo 1, adicionando o uso de um colete lombar do tipo putti-baixo sempre que saísse do leito, durante as duas semanas seguintes à cirurgia, retirando-o somente para o banho e ao deitar-se. O terceiro grupo recebeu apenas orientações sobre cuidados com a coluna e atividades diárias, semelhante aos grupos 1 e 2 durante a internação hospitalar. Os pacientes foram avaliados antes e após duas semanas de cirurgia utilizando-se escala analógica visual de dor, questionário SF-36 de qualidade de vida, teste de alcance funcional e alterações posturais pelo método flexicurva. Foi constatado que os pacientes que fizeram uso do protocolo de exercícios domiciliares, bem como do colete lombar obtiveram resultados tão significativos quanto o grupo que recebeu orientações sobre cuidados e atividades de vida diária para as próximas duas semanas. Portanto, os serviços que adotarem quaisquer dos métodos de intervenção aqui descritos obterão evolução significativa durante as duas semanas seguintes após a microcirurgia de hérnia de disco lombar.

Evaluation of the primary outcomes of minimally invasive lumbar microdiscectomy / 中华显微外科杂志

Objective To evaluate the primary outcomes of minimally invasive lumbar microdiscectomy. Methods There were 34 cases with single lumbar disc herniation treatment of tubular retractor access with METRx system and microdiscectomy(MMD group)and same cases with treatment of conventional discectomy(CD group).Operating time,blood loss,time of leaving the bed and length of hospital stay were compared in two groups.The postoperative wound pain was measured using a visual analog scale(VAS).The modified MacNab criteria were used to evaluate the outcomes. ResuIts The mean operating time was 65 min in MMD group,63 min in CD group.The mean blood loss was 34 ml in MMD group,85 ml in CD group.To compare in two groups,there was significant difference(P＜0.05).The mean time of leaving the bed after operation was 3.2 d in MMD group.5.8 d in CD group.The mean length of hospital stay was 5.8 d in MMD group.9.6 d in CD group.The mean VAS of the postoperative wound pain was 3.2 scores in MMD group,5.6 scores in CD group.To compare in two groups,there was significant difference(P＜0.05).There was one complication in MMD group,4 in CD group.Thirty-three cases got follow-up mean 8.5 months in MMD group.The success rate was 93.9%. Conclusion The minimally invasive lumbar microdiscectomy has the advantages on less trauma,safety,quickly postoperative recovery,and satisfactory outcomes.

Comparative study on lumbar microdiscectomy and small-incision discectomy for the treatment of lumbar disc herniation / 中国矫形外科杂志

[Objective]To study the efficacy and related problems of lumbar microdiscectomy and small-incision discectomy in the treatment of lumbar disc herniation.[Method]A total of 82 cases were treated with lumbar microdiscectomy,70 cases were treated with small-incision discectomy.The results of two groups were compared.[Result]Compared with the small incision group,the operative time and the complication rates were significently reduced.The effective rate between the two groups had no significent difference.[Conclusion]Small-insion discectomy is as an effective operation as microdiscectomy,while lumbar microdiscectomy had the advantages of minimal invasive,more indications,less bleeding.Strict selection of indications,sufficient preoperative preparations and practiced surgical techniques are the key points of the two minimally invasive techniques to award good outcomes.

The Clinical Comparison between Open Surgery and Percutaneous Endoscopic Lumbar Discectomy in Extraforaminal Lumbar Disc Herniation

OBJECTIVE: The objective of this study is to evaluate and compare the clinical results between classical open surgery and percutaneous endoscopic lumbar discectomy(PELD) in cases of extraforaminal lumbar disc herniation. METHODS: We obtained the clinical data from 47 patients with extraforaminal lumbar disc herniations who underwent the open paramedian muscle-splitting approach or percutaneous endoscopic lumbar discectomy(PELD) between January 2001 and February 2004. This study consisted of patients with soft disc extraforaminal herniations. The patients were assessed with the visual analogue scale(VAS) and MacNab's criteria before surgery, just before discharge, and postoperative 1 year. RESULTS: There were 25 cases in the open surgery group and 22 cases in the PELD group. The average operating time was 78+/-36.71 min in the PELD group and 110+/-29.68 min in the open surgery group. The mean hospital stay was 2.73+/-2.62 days in the PELD group and 7.68+/-2.59 days in the open surgery group. VAS decreased from 8.34+/-0.66 to 1.29+/-2.27 in the PELD group and from 8.40+/-1.40 to 1.70+/-1.72 in the open surgery group at the one-year follow-up. The success rate of PELD was 86.4%, compared with 80.0% for open surgery. However, there were no statistically significant difference between two groups for success rate and VAS. CONCLUSION: Although the success rates were similar in both groups, PELD is less invasive, faster, and safe procedure than open surgery for extraforaminal disc herniation in selected patients.