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2.
Coluna/Columna ; 20(3): 161-164, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1339746

ABSTRACT

ABSTRACT Objectives To evaluate pain intensity and functional status before and 30 days following percutaneous lumbar endoscopic discectomy. Methods A retrospective cohort study that included patients who underwent percutaneous endoscopic discectomy from January 2019 to October 2020 at the Irmandade Santa Casa de Misericórdia Hospital, in Porto Alegre. The data were collected from the electronic medical records of the patients by two independent physicians. Clinical outcomes were assessed using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Results Forty-six patients with a mean age of 52.6 ± 15.8 years, 27 of whom (58.7%) were male, were evaluated. Regarding clinical outcomes, a statistically significant improvement was observed in the comparison between the pre- and 30-day postoperative VAS and ODI scores, with no significant difference in relation to sex. No peri- or postoperative complications were observed. All patients successfully completed surgery and were discharged after recovery from anesthesia. Conclusion There was a significant improvement in pain and functional status 30 days after percutaneous endoscopic discectomy performed to correct lumbar disc herniation, with no difference in relation to sex. In addition, no peri- or postoperative complications were observed. Future studies, with longer follow-up times, comparing clinical outcomes from the various techniques of percutaneous endoscopic discectomy are necessary. Level of evidence III; Retrospective comparative study.


RESUMO Objetivos Avaliar a intensidade da dor e o estado funcional antes da cirurgia e em 30 dias de pós-operatório de discectomia endoscópica lombar percutânea. Métodos Estudo de coorte retrospectivo. Foram incluídos pacientes tratados com discectomia endoscópica percutânea, de janeiro de 2019 a outubro de 2020, no complexo hospitalar Irmandade Santa Casa de Misericórdia de Porto Alegre. Os dados foram coletados do prontuário eletrônico dos pacientes por dois médicos independentes. Os desfechos clínicos foram avaliados pela pontuação da Escala Visual Analógica (EVA) e do Índice de Incapacidade Oswestry (ODI). Resultados Foram incluídos 46 pacientes no estudo, com média de idade de 52,6 ± 15,8 anos, sendo 27 (58,7%), do sexo masculino. Quanto aos desfechos clínicos, observou-se melhora estatisticamente significativa com relação às escalas de EVA e ODI na comparação entre pré-operatório e 30 dias depois da cirurgia, sem diferença significativa com relação ao sexo. Não foram observadas complicações peri e pós-operatórias. Todos os pacientes completaram a cirurgia com sucesso e receberam alta após recuperação da anestesia. Conclusão Observou-se melhora significativa da dor e do estado funcional 30 dias depois da discectomia endoscópica percutânea realizada para correção da hérnia de disco lombar, sem diferença com relação ao sexo. Além disso, não foram observadas complicações peri e pós-operatórias, assim como não houve necessidade de internação hospitalar. Futuros estudos, com maior tempo de seguimento, que comparem os desfechos clínicos através das diversas técnicas de discectomia endoscópica percutânea fazem-se necessários. Nível de evidência III; Estudo retrospectivo comparativo


RESUMEN Objetivo Evaluar la intensidad del dolor y el estado funcional antes de la cirugía y 30 días después de la discectomía endoscópica lumbar percutánea. Métodos Estudio de cohorte retrospectivo. Se incluyeron pacientes tratados mediante discectomía endoscópica percutánea, de enero de 2019 a octubre de 2020, en el complejo hospitalario Hermandad Santa Casa de Misericordia de Porto Alegre. Los datos fueron recolectados de los registros médicos electrónicos de los pacientes por dos médicos independientes. Los resultados clínicos se evaluaron mediante la puntuación de la Escala Visual Analógica (EVA) y del Índice de Discapacidad de Oswestry (ODI). Resultados Se incluyeron 46 pacientes en el estudio, con una edad promedio de 52,6 ± 15,8 años, de los cuales 27 (58,7%) eran del sexo masculino. En cuanto a los resultados clínicos, hubo una mejoría estadísticamente significativa en relación a las escalas EVA y ODI al comparar el preoperatorio y 30 días después de la cirugía sin diferencia significativa en cuanto al sexo. No se observaron complicaciones perioperatorias y postoperatorias. Todos los pacientes completaron con éxito la cirugía e fueron dados de alta después de recuperarse de la anestesia, sin casos de reingreso hospitalario. Conclusión Hubo una mejoría significativa del dolor y del estado funcional luego de 30 días de discectomía endoscópica percutánea, realizada para corregir la hernia de disco lumbar, sin diferencias en cuanto al sexo. Además, no hubo complicaciones perioperatorias y postoperatorias, así como tampoco hubo necesidad de hospitalización. Son necesarios estudios futuros, con un período de seguimiento más largo, que comparen los resultados clínicos a través de las diferentes técnicas de discectomía endoscópica percutánea. Nivel de evidencia III; Estudio comparativo retrospectivo.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Pain, Postoperative , Spine/surgery , Low Back Pain/surgery , Diskectomy, Percutaneous/methods , Endoscopy/methods , Lumbosacral Region/surgery , Retrospective Studies , Recovery of Function , Herniorrhaphy
3.
Rev. Assoc. Med. Bras. (1992) ; 67(2): 243-247, Feb. 2021. graf
Article in English | LILACS | ID: biblio-1287825

ABSTRACT

SUMMARY OBJECTIVE: The objective of this study is to compare the clinical outcome among patients who are surgically treated for lumbar disc herniation by transforaminal and interlaminar endoscopy techniques. METHODS: For the treatment of lumbar disc herniation, 31 patients were assigned to undergo the interlaminar technique and 24 patients the transforaminal technique. They were evaluated using visual analog scale and Oswestry disability index in the preoperative period, in the first postoperative period, and in the 12th month after the procedure. The clinical results between the two techniques were then compared. RESULTS: Overall, 89.1% of the patients obtained good results, with 12.5% complications in the transforaminal technique and 9.6% in the interlaminar technique. CONCLUSION: Although both the endoscopic techniques, compared in this study, are safe and effective for the surgical treatment of lumbar herniated disc, the interlaminar technique presented significantly better results and lower rates of complications than the transforaminal technique.


Subject(s)
Humans , Diskectomy, Percutaneous , Intervertebral Disc Displacement/surgery , Intervertebral Disc Displacement/diagnostic imaging , Retrospective Studies , Treatment Outcome , Endoscopy , Lumbar Vertebrae/surgery , Lumbar Vertebrae/diagnostic imaging
4.
Article in Chinese | WPRIM | ID: wpr-879441

ABSTRACT

OBJECTIVE@#To explore the clinical effect of the simple nucleus pulposus removal and small incision interlaminar window in the treatment of prolapsed and displaced lumbar disc herniation.@*METHODS@#From February 2016 to February 2018, 35 patients with single-segment prolapse and displaced lumbar disc herniation were treated by the simple nucleus pulposus removal and small incision interlaminar window under general anesthesia. Among them, there were 21 males and 14 females;aged (42±17) years;27 cases of L@*RESULTS@#All the operations were successful and the operation time was 30 to 60 min with an average of 40 min, the intraoperative blood loss was 10 to 30 ml with an average of 20 ml. All the patients were followed up for 1 to 3 years with an average of 1.2 years. Thirty-five patients with low back pain and lower limb symptoms were significantly relieved or disappeared. According to modified Macnab standard, 29 cases obtained excellent results, 5 good, and 1 fair.@*CONCLUSION@#Applying the concept of minimally invasive operation, small incision interlaminar window and simple nucleus pulposus removal for the treatment of prolapsed and displaced lumbar disc herniation has the advantages of short operation time, definite curative effect, and less trauma. And it is a safe and effective surgical method under the premise of strict control of the indications.


Subject(s)
Adult , Diskectomy, Percutaneous , Endoscopy , Female , Humans , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Male , Middle Aged , Nucleus Pulposus , Prolapse , Retrospective Studies , Treatment Outcome
5.
Article in Chinese | WPRIM | ID: wpr-879407

ABSTRACT

OBJECTIVE@#To compare the clinical outcomes of hydraulic perfusion pump and traditional water fhushing in percutaneous endoscopic lumbar discectomy.@*METHODS@#From January 2016 to December 2018, 72 patients with lumbar disc herniation failed to conservative treatment were enrolled in this study. The patients were divided into hydraulic perfusion pump group and traditional water flushing group, 36 cases in each group. There were no significant differences in gender, age, prominent segment, clinical classification, preoperative visual analogue scale (VAS) and Japanese Orthopaedic Association(JOA) score between two groups (@*RESULTS@#All the patients were followed up for 12 to 24 (15.7±5.1) months. Compared with the traditional water flushing group, the operation time of the hydraulic perfusion pump group was shorter [(65.5±21.3) min vs (74.8±19.9) min, @*CONCLUSION@#Both hydraulic perfusion pump and traditional water flushing assisted percutaneous endoscopic lumbar disc herniation can achieve satisfactory clinical results, but the former has shorter operation time, clearer intraoperative vision, less bleeding, and fewer intraoperative and postoperative complications.


Subject(s)
Diskectomy , Diskectomy, Percutaneous , Endoscopy , Humans , Infusion Pumps , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Retrospective Studies , Treatment Outcome , Water
6.
Article in Chinese | WPRIM | ID: wpr-879403

ABSTRACT

OBJECTIVE@#To investigate the biomechanical affect of percutaneous transforaminal endoscopic discectomy(PTED) on adjacent segments with different degrees of degeneration and related risk of adjacent segment diseases (ASD) caused by this operation.@*METHODS@#A healthy male adult volunteer was selected, and the lumbosacral vertebra image data was obtained by CT scan, and the external contour of the bone structure was reconstructed. On this basis, the external contour of the bone structure was fitted by using the smooth curve in 3D-CAD software, and the complete three-dimensional finite element modelof the non degenerate L@*RESULTS@#In the finite element model without adjacent segmental disc degeneration, the annulus fibrosus von Mises stress and intradiscal pressure of the PTED model showed only a slight increase under most stress conditions, and a slight decrease in a few conditions, and there was no significant change trend before and after surgery. In the original degenerated adjacent segment disc model, the biomechanical indicators related to disc degeneration in the pre- and post-PTED model showed significant deterioration, leading to an increased risk of potential adjacent spondylopathy.@*CONCLUSION@#PTED surgery will not lead to the significant deterioration of postoperative biomechanical environment of non-degeneration adjacent intervertebral discs, and the original degeneration of adjacent intervertebral discs is a important risk factor for ASD.


Subject(s)
Adult , Biomechanical Phenomena , Diskectomy, Percutaneous , Finite Element Analysis , Humans , Intervertebral Disc/surgery , Intervertebral Disc Degeneration/surgery , Lumbar Vertebrae/surgery , Male , Range of Motion, Articular
7.
Article in Chinese | WPRIM | ID: wpr-879400

ABSTRACT

OBJECTIVE@#To evaluate the effectiveness and security of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of single level cervical spondylopathy with intraspinal ossification.@*METHODS@#Twenty three patients with single level cervical spondylopathy with intraspinal ossification were treated by posterior percutaneous endoscopic cervical discectomy between August 2017 and July 2019. There were 16 males and 7 females, aged from 29 to 74 years old with an average of (50±13) years.The disease duration were 3 to 120 months with a median of 6 months. There were 9 cases of cervical spondylotic radiculopathy, 6 cases of cervical spondylotic myelopathy, and 8 cases of mixed cervical spondylopathy. According to the characteristics of ossification, 17 cases were osteophytes on the posterior edge of the vertebral body;3 cases were protrusion ossification;3 cases were posterior longitudinal ligament ossification. According to the position of ossification in spinal canal, 14 cases were medial and lateral type, 5 cases were central type, and 4 cases were mixed type. Posterior percutaneous cervical endoscopic cervical discectomy in patients performed by the same surgeon. Japanese Orthopaedic Association (JOA) score and visual analogue scale(VAS) were compared separately before and after operation. At 3 months after operation, clinical effect was assessed according to modified Macnab standard.@*RESULTS@#All operations were successful. The operative time was 30 to 155 (69.1±27.2) min. The bedridden time was 2 to 3(3.0±0.9) h, length of postoperative hospitalization was 2 to 7(4.1± 1.5) d. Three dimensional CT reconstruction of the cervical spine at 3 days after operation showed that ossified tissue of 13 cases were completely removed, and 10 cases were left after operation, and the residual was located at the posterior edge and/or center of the upper vertebral body. VAS score at discharge from hospital was significantly lower than that before operation (@*CONCLUSION@#For an experienced surgeon, percutaneous posterior cervical endoscopic discectomy is safe and reliable in treating single level cervical spondylopathy with intraspinal ossification, and can obtain good clinical results.


Subject(s)
Adult , Aged , Cervical Vertebrae/surgery , Diskectomy , Diskectomy, Percutaneous , Endoscopy , Female , Humans , Intervertebral Disc Displacement/surgery , Male , Middle Aged , Osteogenesis , Retrospective Studies , Treatment Outcome
8.
Rev. bras. ortop ; 55(1): 48-53, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1092671

ABSTRACT

Abstract Objective To evaluate the clinical and functional results of transforaminal endoscopic lumbar discectomy. Materials and Methods From August 2015 to January 2017, 101 patients with lumbar disc hernia refractory to clinical treatment underwent endoscopic discectomy. Through clinical evaluation by the Visual Analogue Scale and functional evaluation by the Oswestry Disability Index questionnaire, the patients were analyzed in the preoperative period, the immediate postoperative period, at 1 month, 3 months, 6 months and 1 year after surgery. Results The mean age of the participants was 48.1 years. The most affected disc levels were L4-L5 and L5-S1. A total of 29 patients were treated at 2 disc levels. After 1 month of postoperative follow-up, the mean scores on the questionnaires (VAS and ODI) decreased significantly (p < 0.001). Conclusion Transforaminal endoscopic Lumbar discectomy has been shown to be a safe, effective and minimally-invasive alternative for the treatment of lumbar disc herniation. The procedure has advantages, such as short hospital stay, surgery performed under local anesthesia and sedation, early return to daily activities, and low rate of complications.


Resumo Objetivo Avaliar os resultados clínicos e funcionais da discectomia endoscópica transforaminal lombar. Materiais e Métodos De agosto de 2015 a janeiro de 2017, 101 pacientes portadores de hérnia de disco lombar refratária ao tratamento clínico foram submetidos a discectomia endoscópica. Por meio de avaliação clínica pela Escala Visual Analógica e análise funcional pelo questionário Oswestry Disability Index, os pacientes foram analisados no período pré-operatório, no pós-operatório imediato, com 1 mês, 3 meses, 6 meses e 1 ano após a cirurgia. Resultados A média de idade dos participantes foi de 48.1 anos. Os níveis discais mais acometidos foram L4-L5, seguidos de L5-S1. Um total de 29 pacientes foram abordados em 2 níveis discais. Após 1 mês de seguimento pós-operatório, a média das pontuações nos questionários (EVA e ODI) diminuiu significativamente (p < 0.001). Conclusão A discectomia endoscópica transforaminal lombar mostrou ser uma alternativa segura, eficaz e minimamente invasiva para o tratamento de hérnia de disco lombar. O procedimento tem vantagens, como curto período de internação hospitalar, cirurgia realizada sob anestesia local e sedação, retorno precoce às atividades diárias, e baixa taxa de complicações.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Postoperative Period , Incidence , Diskectomy, Percutaneous , Extravehicular Activity , Minimally Invasive Surgical Procedures , Endoscopy , Intervertebral Disc Displacement
9.
Article in Chinese | WPRIM | ID: wpr-828281

ABSTRACT

OBJECTIVE@#To analyze the clinical effects, complications and operational key points of the percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in treating LS disc herniation.@*METHODS@#The clinical data of 158 patients with L5S1 disc herniation treated from July 2015 to March 2018 were restospectively analyzed. According to different surgical approaches, the patients were divided into PETD group or PEID group, 79 cases in each group. In PETD group, there were 41 males and 38 females, with an average age of (41.38±6.25) years and course of disease of (10.06±3.14) months. In PEID group, there were 43 males and 36 females, with an average age of (41.18±5.78) years and course of disease of (9.99±2.83) months. The operation length, intraoperative blood loss, intraoperative fluoroscopy times, days of hospital stay, and complications were recorded between two groups. Visual analogue score (VAS), Japanese Orthopedic Association(JOA) score, Oswestry Disability Index(ODI), modified Macnab criteria were used to assessed clinical effects after operation.@*RESULTS@#All patients completed surgery and were followed up for more than 1 year. (1) There were no significant differences in the intraoperative blood loss or hospitalization length between two groups(>0.05). The operation length and intraoperative fluoroscopy times in PETD group were significantly higher than in PEID group (0.05). (3)The excellence rate was 89.87% (71 / 79) in PETD group and 87.34% (69 / 79) in PEID group at the latest follow-up, with no statistical significance(>0.05). (4)Complications occurred in 2 cases in PETD group and in 3 cases in PEID group, with no significant differences between two groups.@*CONCLUSION@#The short term efficacy of the PETD is equal to that of the PEID for the LS disc herniation, but PEID is superior in the operation length, the access of stereotaxic puncture and intraoperative fluoroscopy times. The complications can be effectively reduced by following the indications, mastering the endoscopic technique, operating carefully and being familiar with the key points of common complications.


Subject(s)
Adult , Diskectomy, Percutaneous , Female , Humans , Intervertebral Disc Displacement , General Surgery , Length of Stay , Lumbar Vertebrae , Male , Middle Aged , Neuroendoscopy , Retrospective Studies , Treatment Outcome
10.
Article in Chinese | WPRIM | ID: wpr-828277

ABSTRACT

OBJECTIVE@#To analyze the clinical efficacy and technical characteristics of percutaneous endoscopic lumbar discecomy in the treatment of upper lumbar disc herniation.@*METHODS@#The clinical data of 9 patients with upper lumbar disc herniation underwent percutaneous endoscopic lumbar discecomy from January 2012 to October 2019 were retrospectively analyzed. There were 6 males and 3 females, aged 26 to 79 years, including 2 patients with L disc herniation and 7 patients with L2, 3 disc herniation. Visual analogue scale (VAS) and Japanese Orthopeadic Association (JOA) score were recorded before and after surgery. The clinical efficacy was evaluated according to the modified Macnab standard.@*RESULTS@#All 9 patients were followedup, and the follow-up time was 1 day and 3 months after surgery. The operation time was 1.5 to 2.9 h and postoperative hospital stay was 5 to 8 d. No cerebrospinal fluid leakage or spinal cord injury occurred during the operation. Preoperative and postoperative at 1 day, 3 months, the VAS scores of 9 patients were 7 to 8 scores, 1 to 3 scores, 0 to 1 case, JOA scores were 5 to 7 scores, 15 to 24 scores, 21 to 26 scores, respectively. The improvement rate of JOA was 36.4% to 78.3% on the first day and 65.2% to 87.5% three months after operation. According to modified Macnab standard to evaluate effect, 4 cases got excellent results, 4 good, 1 fair.@*CONCLUSION@#Percutaneous endoscopic lumbar discecomy has reliable therapeutic effect for upper lumbar disc herniation in line with the indications, and it has the characteristics of small trauma and short operation time, so it is more suitable for middle aged and elderly patients with poor physique and can replace part of transforaminal lumbar interbody fusion.


Subject(s)
Adult , Aged , Diskectomy, Percutaneous , Female , Humans , Intervertebral Disc Displacement , General Surgery , Lumbar Vertebrae , Male , Middle Aged , Neuroendoscopy , Retrospective Studies , Treatment Outcome
11.
Article in Chinese | WPRIM | ID: wpr-828263

ABSTRACT

OBJECTIVE@#To introduce the technical key points of lumbar annulus fibrosus suture under full-endoscope and analyze the clinical efficacy of full-endoscopic lumbar discectomy and annulus fibrosus suture.@*METHODS@#A total of 50 patients with non contained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture in our department between January 2018 and November 2018 were included. Full-endoscopic single-stitch suture through transforaminal approach or double-stitch suture through interlaminar approach was selected according to lesion level. The lumbar MRI and CT were reexamined on the second day and 3 months after surgery to evaluate the completeness of the discectomy and the adequacy of nerve decompression respectively. The patients were followed up on the second day, 3 months, 6 months, and 1 year after surgery for pain relief using visual analogue scale (VAS, 100 -point scale). The patients were followed up at 3 months, 6 months, and 1 year postoperatively for the recovery of lumbar spine function using Oswestry Disability Index(ODI). At the 1-year follow-up, the Macnab standard of lumbar spine function was evaluated, and the recovery of nerve root function (sensory, muscular and reflex) was recorded.@*RESULTS@#All operations were successfully completed, of which 27 patients were treated with transforaminal approach(including 8 cases of L and 19 cases of L), and 23 patients(including 11 cases of L and 12 cases of LS) with interlaminar approach. The average operation time was 43.2 minutes. There were no surgical complications and no recurrence of lumbar disc herniation. Postoperative lumbar MRI and CT examinations of all patients showed that the herniated disc was completely removed and the nerveswere fully decompressed. All patients had significant relief of low back pain and lower extremity radiation pain, and the ODI score improved significantly(0.05).@*CONCLUSION@#Full-endoscopic lumbar discectomy and annulus fibrosus suture are safe and effective techniques for minimally invasive spinal surgery, which can reduce the recurrence rate of lumbar disc herniation after full endoscopic lumbar discectomy.


Subject(s)
Annulus Fibrosus , Diskectomy, Percutaneous , Endoscopy , Humans , Intervertebral Disc Degeneration , Intervertebral Disc Displacement , Lumbar Vertebrae , Retrospective Studies , Sutures , Treatment Outcome
12.
Article in Chinese | WPRIM | ID: wpr-828261

ABSTRACT

OBJECTIVE@#To study the clinical characteristics of the patients with tiny lumbar disc herniation and severe symptoms(tLDHSS) and the therapeutic effects of percutaneous endoscopic lumbar discectomy(PELD).@*METHODS@#From January 2014 to February 2019, 34 patients with tLDHSS were reviewed retrospectively, including 20 males and 14 females, aged from 31 to 73 (48.8±10.1) years, with a follow up duration ranged from 8 to 48 (21.8±10.3) months. The clinical manifestations, imaging and surgical data were analyzed. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores were analyzed before operation, 1 month after operation and at the latest follow-up. The preoperative and postoperativescores were compared. At the latest follow up, the Macnab system was used to evaluate the effects of the operation.@*RESULTS@#The main symptom of 34 cases was severe radiation pain on one side of lower limbs. The duration of preoperative symptoms ranged from 0.33 to 84 months. The disc herniation was found in 7 cases of L and 27 cases of LS. According to the MSU division of lumbar disc herniation, 31 cases were located in area B. In all cases, it was confirmed that the protruding nucleus compressed the nerve root, and in 26 cases, the nerve root was obviously inflamed. The operation time ranged from 30 to 80 min, with a mean time of (43.5±9.5) min. The preoperative VAS score was 8.1±1.3 and ODI score was 31.8±6.7. And the VAS score was 1.1± 0.3, 0.7±0.4 on the first month after operation and the latest follow up, respectively. The ODI score was 5.3±2.1 and 0 to 10 (with a median score of 2) on the first month after operation and the latest follow-up respectively. The postoperative VAS and ODI scores were improved compared with preoperative scores.At the latest follow up, 28 cases got an excellent result and 6 cases good according to Macnab evaluation system. During the follow-up period, only one patient had recurrent disc herniation.@*CONCLUSION@#The main symptom of patients with tLDHSS is severe radiation pain on one side of lower limb. It manifests as sudden onset and shorter course of disease. Severe local inflammation was induced by local compression of the protruding nucleus pulposus on the nerve root out of the dura. For this kind of patients, thin layer CT scan has an important diagnostic value. In the treatment of this kind of patients, the symptoms are relieved rapidly, the curative effect is definite and the recurrence rate is low.


Subject(s)
Adult , Aged , Diskectomy, Percutaneous , Endoscopy , Female , Humans , Intervertebral Disc Displacement , Lower Extremity , Lumbar Vertebrae , Male , Middle Aged , Pain , Retrospective Studies , Treatment Outcome
13.
Article in Chinese | WPRIM | ID: wpr-828260

ABSTRACT

OBJECTIVE@#To investigate the clinical effects of percutaneous spinal endoscopy (percutaneous endoscopy) in the treatment of high prolapse free lumbar disc herniation.@*METHODS@#From May 2016 to June 2018, 24 patients with highly prolapse free lumbar disc herniation were enrolled in this study, including 11 males and 13 females, ranging in age from 48 to 72 years old, with an average of (59.5±7.2) years old. There were 1 case of L, 5 cases of L, 18 cases of L. The course of disease ranged from 8 to 26 months, with an average of (16.2±6.3) months. All the patients were subjected to local infiltration anesthesia. The clinical outcomes were evaluated by visual analog scale (VAS) for leg pain, low backpain and Oswestry Disability Index (ODI) at preoperative, first day after operation and 6 month after surgery. All data were statisticed by SPSS 22.0.@*RESULTS@#All the patients were followed up, and the duration ranged from 12 to 24 months, with a mean of (17.5±5.3) months. The average operation time was(69.8±14.2) minutes. One patient had cerebrospinal fluid leakage, which improved after supine rest. VAS scores of lower back pain were 6.36±1.27, 3.94±1.03, 1.62±0.87, 0.44±0.27, 0.37±0.29. VAS scores of leg pain were 8.28±1.74, 3.16±1.24, 2.83±1.13, 0.83±0.31, 0.46±0.31, and the differences were statistically significant (<0.05). The ODI were (48.79±9.83)%, (36.51±11.24)%, (21.05±6.35)%, (9.83±4.62)% and (7.24±4.72)% 1 day before and 1 weeks, 3 months, 6 months and 1 year after the operation, respectively. One year after the operation, the modified Macnab evaluation system was used to evaluate the clinical efficacy of the patients, 19 patients got an excellent result, 3 good, 2 fair and 0 poor.@*CONCLUSION@#Percutaneous endoscopic pedicle anchoring technique for the treatment of high prolapse free lumbar disc herniation can effectively improve the clinical symptoms of patients, and has the advantages of less trauma, less bleeding, rapid recovery, complete removal of the nucleus pulposus, and less pain of patients, etc., its clinical efficacy is accurate, operability is strong, it is worth promoting in the clinical use.


Subject(s)
Aged , Diskectomy, Percutaneous , Endoscopy , Female , Humans , Intervertebral Disc Degeneration , Intervertebral Disc Displacement , Lumbar Vertebrae , Male , Middle Aged , Retrospective Studies , Treatment Outcome
14.
Article in Chinese | WPRIM | ID: wpr-828259

ABSTRACT

OBJECTIVE@#To investigate the efficacy and safety of total spine endoscopy in the treatment of lumbar disc herniation combined with posterior apophyseal ring separation.@*METHODS@#From January 2015 to January 2018, a total of 21 patients with lumbar disc herniation complicated with posterior apophyseal ring separation were treated with total spine endoscopy via interlamina approach. There were 17 males and 4 females. The age ranged from 18 to 48 years old and the median age was 27 years old. All were single segment unilateral disc herniation, interlaminar approach was adopted, and the herniated disc was removed unilaterally at the symptomatic side under the microscope, and all or part of the broken bonewas removed.@*RESULTS@#There were no complications such as incision infection, intervertebral space infection, intestinal injury, dural injury and cerebrospinal fluid leakage. The operation time ranged from 32 to 92 minutes and the median time was 57 minutes. Postoperative imaging examination showed that 2 patients had complete resection of osteotomy of posterior edge of vertebral body, 16 patients had partially resection and 3 patients had no resection. All intervertebral discs were completely removed. All 21 patients were followed up, and the duration ranged from 12 to 36 months, with a median of 15 months. The VAS of lumbago was 7.10±1.20 before surgery, 3.46±0.23 on the 3rd day after surgery, 2.36±0.19 on the 6th month after surgery; and the VAS of leg pain was 8.80±0.55 before surgery, 3.54±0.28 on the 3rd day after surgery, and 2.59±0.26 on the 6th month after surgery. The Oswestry Disability Index score was (69.71±9.37)% before surgery, (32.19±6.95)% on the 6th month after surgery, and (20.95± 6.16)% at the latest follow up. Onthe 1st year after operation, 16 patients got an excellent result, 4 good and 1 fair according to Macnab evaluation system.@*CONCLUSION@#Total spine endoscopy via interlaminal approach can be used as an option in the treatment of lumbar disc herniation combined with vertebral posterior margin dissociation, which can reduce trauma and injury to the lumbar dorsal muscle and achieve similar decompression effect as open surgery. The long term efficacy needs to be further proved by prospective randomized controlled studies with larger sample size.


Subject(s)
Adolescent , Adult , Diskectomy, Percutaneous , Female , Humans , Intervertebral Disc Displacement , Lumbar Vertebrae , Male , Middle Aged , Neuroendoscopy , Prospective Studies , Retrospective Studies , Treatment Outcome , Young Adult
15.
Article in Chinese | WPRIM | ID: wpr-828239

ABSTRACT

OBJECTIVE@#To explore clinical efficacy of percutaneous endoscopic lumbar discectomy through two different approaches in treating upper lumbar disc herniation.@*METHODS@#From March 2015 to August 2019, 32 patients with upper lumbar disc herniation treated by percutaneous endoscopic lumbar dicecromy(PELD) were analyzed retrospectively and divided into percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) group according to different methods. There were 19 patients in PETD group, including 10 males and 9 females aged from 30 to 65 years old with an average of (44.70±12.08) years old;5 patients on L, 6 patients on L, 8 patients on L;6 patients were central herniation, 8 patients were paracentric herniation, and 5 patients were migration of herniation. There were 13 patients in PEID group, including 4 males and 9 females aged from 25 to 55 years old with an average of (42.23±12.09) years old;the courses of disease ranged from 1 to 7 months with an average of (2.90±3.02) months;3 patients on L, 4 patients on L, 6 patients on L;2 patients were central herniation, 4 patients were paracentric herniation, 3 patients were migration of herniation, 4 patients were prolapse free type protrusion. VAS and ODI score before operation, postoperative at 3 days, 3 and 6 months were compared between two groups, advanced MacNab standard at 1 year after operation were applied to evaluate clinical effects.@*RESULTS@#Operation were successful operated in 32 patients and obtained following up without nerve injury and infection of intervertebral space. One patient in PETD groups occurred dural sac tear in operation, but no adverse reaction afteroperation. PETD group was followed up from 12 to 24 months with an average of (15.80±3.48) months, while PEID group was followed up from 12 to 30 months with an average of (16.70±4.66) months, while there was no statistical difference between two groups (>0.05). VAS and ODI score at different time points after operation were higher than that of before operation (<0.05). According to advanced MacNab standard at 1 year after operation, 11 patients obtained excellent results, 6 good, 1 moderate and 1 poor in PETD group;while 7 patients got excellent results, 4 good, 2 moderate in PEID group.@*CONCLUSION@#Both of two surgical approach could achieve satisfactory efficacy in treating upper lumbar disc herniation, PETD is more suitable for central herniation, paracentric herniation and patients with mild displacement, PEID has advantage on prolapse free type protrusion.


Subject(s)
Adult , Aged , Diskectomy , Diskectomy, Percutaneous , Endoscopy , Female , Humans , Infant , Intervertebral Disc Displacement , General Surgery , Lumbar Vertebrae , General Surgery , Male , Middle Aged , Retrospective Studies , Treatment Outcome
16.
Article in Chinese | WPRIM | ID: wpr-879329

ABSTRACT

OBJECTIVE@#To explore clinical application of the new three-dimensional foramen guide in percutaneous endoscopic lumbar discectomy.@*METHODS@#Based on the principle of reverse positioning, a new three-dimensional foramen guide was designed. From May 2016 to May 2018, totally 40 patients with segmental lumbar disc herniation were underwent percutaneous endoscopic lumbar discectomy. The patients were divided into guide and control group, and 20 patients in each group. In guide group, there were 9 males and 11 females with an average age of (46.0±11.0) years old;5 patients on L@*RESULTS@#All patients had no serious complications, and successfully completed operation. Operation time, the times of fluoroscopy and puncture in guide group were better than those of control group (@*CONCLUSION@#The three dimensional foramen guide is compact in structure, simple in operation, which could reduce the time of puncture and damage of radiation, shorten the learning curve of puncture for beginners, and has certain clinical feasibility.


Subject(s)
Adult , Diskectomy , Diskectomy, Percutaneous , Female , Humans , Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Lumbosacral Region , Male , Middle Aged
17.
Coluna/Columna ; 18(4): 301-307, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055983

ABSTRACT

ABSTRACT Objective: Lumbar spine fusion is indicated in patients who are refractory to traditional treatment for degenerative disc disease. The aim of this study was to compare the perioperative and postoperative results of conventional open surgery versus minimally invasive surgery (MIS) in posterior 360° lumbar fusion with pedicle screw instrumentation. Methods: A total of 25 patients underwent MIS and 40 underwent open surgery between 2015 and 2017. Perioperative variables and lumbar and radicular pain values were compared using a visual analogue scale (VAS) and the Oswestry disability index (ODI) until 12 months after surgery. Results: The MIS cohort presented less blood loss (140 vs 345 ml; p=0.001), shorter hospital stay (1.1 vs 2.2 days; p=0.001), longer operative time (113 vs 94 minutes; p=0.001) and greater X-ray exposure (80 vs 6 seconds; p=0.001), compared to the open surgery group. The MIS cohort showed better results in the ODI and lumbar VAS scores. No significant differences were observed in radicular VAS. Conclusion: MIS surgery showed advantages over the open surgery technique; however, the learning curve should be improved in order to reduce operative time. Level of Evidence III; Retrospective descriptive observational study.


RESUMO Objetivo: A fusão espinhal lombar é indicada para pacientes refratários ao tratamento tradicional da doença degenerativa do disco. O objetivo do presente estudo consistia em comparar os resultados peri- e pós-operatórios da cirurgia aberta convencional versus a cirurgia minimamente invasiva (MIS) na fusão lombar de 360º por via posterior com instrumentação de parafuso pedicular. Métodos: Foram estudados 25 pacientes submetidos à técnica de MIS e 40 submetidos à cirurgia aberta entre 2015 e 2017. As variáveis perioperatórias e os valores da dor lombar e dor radicular foram comparados com a escala visual analógica (EVA) e Oswestry Disability Index (ODI) até 12 meses após a cirurgia. Resultados: O grupo MIS apresentou menores índices de perda sanguínea (140 vs 345 ml; p = 0,001) e menor permanência hospitalar (1,1 vs. 2,2 dias; p = 0,001), maior tempo de cirurgia (113 vs. 94 minutos; p = 0,001) e maior exposição às radiografias (80 vs 6 seg; p = 0,001) em relação ao grupo de cirurgia aberta. O grupo MIS apresentou melhores resultados nos escores de ODI e EVA lombar. Na EVA radicular não foram observadas diferenças significativas. Conclusão: A cirurgia minimamente invasiva apresentou vantagens em relação à técnica da cirurgia aberta, embora a curva de aprendizagem deva ser otimizada para reduzir o tempo de cirurgia. Nível de Evidência III; Estudo retrospectivo descritivo observacional.


RESUMEN Objetivo: La fusión espinal lumbar es indicada para pacientes refractarios al tratamiento tradicional de la enfermedad degenerativa del disco. El objetivo del presente estudio consistía en comparar los resultados peri y postoperatorios de la cirugía abierta convencional versus la cirugía mínimamente invasiva (MIS) en la fusión lumbar de 360º por vía posterior con instrumentación de tornillo pedicular. Métodos: Se estudiaron 25 pacientes sometidos a la técnica MIS y 40 sometidos a la cirugía abierta entre 2015 y 2017. Se compararon las variables perioperatorias y los valores del dolor lumbar y dolor radicular con la escala visual analógica (EVA) e índice de incapacidad de Oswestry (ODI) hasta los 12 meses post cirugía. Resultados: El grupo MIS presentó menores índices de pérdida sanguínea (140 vs 345 ml; p=0,001) y menor permanencia hospitalaria (1,1 vs 2,2 días; p=0,001), mayor tiempo de cirugía (113 vs 94 minutos; p=0,001) y exposición a las radiografías (80 vs 6 seg; p=0,001) con relación al grupo de cirugía abierta. El grupo MIS presentó mejores resultados en las puntuaciones de ODI y EVA lumbar. En la EVA radicular no se observaron diferencias significativas. Conclusión: La cirugía mínimamente invasiva presentó ventajas con relación a la técnica de la cirugía abierta, aunque la curva de aprendizaje deba ser optimizada para reducir el tiempo de cirugía. Nivel de Evidencia III; Estudio retrospectivo descriptivo observacional.


Subject(s)
Humans , Spinal Fusion , Diskectomy, Percutaneous , Intervertebral Disc Degeneration
18.
Coluna/Columna ; 18(3): 222-225, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019775

ABSTRACT

ABSTRACT Objective The aim of this study was to evaluate the clinical and functional results of endoscopic lumbar discectomy in obese patients. Methods We selected 56 patients with lumbar disc hernia refractory to clinical treatment that underwent endoscopic discectomy. Twenty-five patients with a body mass index (BMI) greater than or equal to 30 kg/m 2 were analyzed through the Visual Analogue Scale and functional evaluation using the Oswestry Disability Index questionnaire and compared to 31 patients in the control group (BMI between 18.5 and 24.9 kg/m 2 ). These data were obtained in the preoperative period, in the immediate postoperative period, at 1 month, 3 months, 6 months and one year after surgery. Results The mean BMI in the control group was 22.1 kg/m 2 , and in the obese group, 33.6 kg/m 2 . In both groups there was a statistically significant improvement in clinical and functional analyzes. There was no statistical difference between the groups. Conclusions Lumbar transforaminal endoscopic discectomy has been shown to be a safe, effective and minimally invasive alternative for the treatment of lumbar disc herniation in obese patients. Level of Evidence III; Retrospective and Comparative Study.


RESUMO Objetivo A meta do estudo foi avaliar os resultados clínicos e funcionais da discectomia endoscópica lombar nos pacientes obesos. Métodos Foram selecionados 56 pacientes portadores de hérnia de disco lombar refratário ao tratamento clínico submetidos à discectomia endoscópica. Através de avaliação clínica - pela Escala Visual Analógica - e funcional - pelo questionário de Oswestry Disability Index. Foram analisados 25 pacientes com índice de massa corpórea (IMC) maior ou igual de 30 kg/m 2 e comparados com 31 pacientes do grupo controle (IMC entre 18,5 e 24,9 kg/m 2 ). Esses dados foram obtidos no período pré-operatório, no pós-operatório imediato, com 1 mês, 3 meses, 6 meses e um ano após a cirurgia. Resultados O IMC médio no grupo controle foi de 22,1 kg/m 2 , e no grupo obeso de 33,6 kg/m 2 . Em ambos os grupos houve melhora estatisticamente significativa nas análises clínicas e funcionais. Não se observou diferença estatística entre os grupos. Conclusão A discectomia endoscópica transforaminal lombar mostrou ser uma alternativa segura, efetiva e minimamente invasiva para o tratamento de hérnia de disco lombar em pacientes obesos. Nível de Evidência III; Estudo Retrospectivo, Comparativo.


RESUMEN Objetivo El objetivo de este estudio fue evaluar los resultados clínicos y funcionales de la discectomía lumbar endoscópica en pacientes obesos. Métodos Se seleccionaron 56 pacientes portadores de hernia discal lumbar refractaria al tratamiento clínico, sometidos a discectomía endoscópica. Se analizaron 25 pacientes con índice de masa corporal (IMC) mayor o igual a 30 kg/m 2 ) por medio de la Escala Visual Analógica y evaluación funcional mediante el cuestionario Índice de Discapacidad de Oswestry y se compararon a 31 pacientes del grupo control (IMC entre 18,5 kg/m 2 y 24,9 kg/m 2 ). Estos datos fueron obtenidos en el preoperatorio, en el postoperatorio inmediato, al mes, a los 3 meses, 6 meses y un año después de la cirugía. Resultados El IMC promedio en el grupo control fue de 22,1 kg/m 2 y en el grupo obeso, de 33,6 kg/m 2 . En ambos grupos hubo una mejoría estadísticamente significativa en los análisis clínicos y funcionales. No hubo diferencia estadística entre los grupos. Conclusiones La discectomía endoscópica transforaminal lumbar se ha mostrado una alternativa segura, eficaz y mínimamente invasiva para el tratamiento de hernia discal lumbar en pacientes obesos. Nivel de Evidencia III; Estudio Retrospectivo y Comparativo.


Subject(s)
Humans , Diskectomy, Percutaneous , Minimally Invasive Surgical Procedures , Endoscopy , Intervertebral Disc Displacement , Obesity
19.
Rev. Assoc. Med. Bras. (1992) ; 65(6): 779-785, June 2019. graf
Article in English | LILACS | ID: biblio-1012995

ABSTRACT

SUMMARY OBJECTIVE: To investigate the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar spinal stenosis (LSS) combined with osteoporosis. METHODS: Eighty patients with LSS combined with osteoporosis were divided into a control and PTED group, which received conventional transforaminal lumbar interbody fusion and PTED, respectively. The surgical indications, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores, bone mineral density (BMD), and adverse reactions were observed. RESULTS: Compared with the control group, in the PTED group, the operation time, bleeding loss and hospitalization duration, incision VAS scores at postoperative 12, 24 and 48 h and lumbar and leg pain VAS and lumbar ODI scores on postoperative 6 months were significantly decreased (P < 0.01), and the lumbar JOA score on postoperative 6 months was significantly increased (P < 0.05). There was no significant difference in BMD between two groups (P > 0.05). Compared with the control group, in the PTED group, the total effective rate was significantly higher (P < 0.05), and the incidence of adverse reactions was significantly lower (P < 0.05). CONCLUSIONS: PTED is safe and effective in the treatment of LSS combined with osteoporosis.


RESUMO: OBJETIVO: Investigar a eficácia e segurança da discectomia endoscópica percutânea transforaminal (DEPT) no tratamento da estenose lombar (EL) combinada à osteoporose. MÉTODOS: Oitenta pacientes com EL combinada à osteoporose foram divididos entre um grupo de controle e um grupo de DEPT, que receberam tratamento convencional com fusão intersomática lombar transforaminal e DEPT, respectivamente. As indicações cirúrgicas, a escala analógica visual (VAS) da incisão e de dor lombar e nas pernas, os escores lombares de acordo com a Associação Ortopédica Japonesa (JOA) e o Oswestry Disability Index (ODI), a densidade mineral óssea (DMO) e possíveis reações adversas foram observados. RESULTADOS: Em comparação com o grupo de controle, no grupo de DEPT o tempo de operação, a perda de sangue e duração de internação, os escores VAS da incisão no pós-operatório após 12, 24 e 48 h, o VAS para dor lombar e nas pernas e os escores ODI lombares após 6 meses de pós-operatório foram significativamente menores (P < 0,01); já o escore JOA lombar após 6 meses de pós-operatório foi significativamente maior (P < 0,05). Não houve diferença significativa na densidade mineral óssea entre os dois grupos (P > 0,05). Em comparação com o grupo de controle, o grupo de DEPT teve uma taxa efetiva total significativamente maior (P < 0,05), e a incidência de reações adversas foi significativamente menor (P < 0,05). CONCLUSÕES: A discectomia endoscópica percutânea transforaminal é segura e eficaz no tratamento de EL combinada à osteoporose.


Subject(s)
Humans , Aged , Aged, 80 and over , Osteoporosis/surgery , Spinal Stenosis/surgery , Diskectomy, Percutaneous/methods , Lumbar Vertebrae/surgery , Osteoporosis/complications , Postoperative Care , Spinal Stenosis/complications , Time Factors , Bone Density , Reproducibility of Results , Treatment Outcome , Diskectomy, Percutaneous/standards , Disability Evaluation , Visual Analog Scale , Middle Aged
20.
Article in Chinese | WPRIM | ID: wpr-776112

ABSTRACT

The lumbar disc herniation is a common and recurrent disease in the department of orthopedics. At present, the treatment means mainly include conservative treatment and surgical treatment. Compared with traditional open surgery, percutaneous transforaminal endoscopic discectomy (PTED) is safe, effective, economical and minimally invasive. It is widely used in minimally invasive treatment of lumbar disc herniation. However, the clinical reports of the failure of PTED are also common. According to the research reports of domestic and foreign scholars, there are varieties of risk factors for surgical failures, including the selections of patients, indications, surgical approaches and anesthesia methods preoperative. Occurrences of surgical complications including infection or left pains, and reasonable rehabilitation exercise after the operation are related to failures. There is no unified conclusion at present. In this paper, we reviewed the literatures about failed PTED, and try to make an overview about the general situation of failed operation in clinical practice, the risk factors for failures and the countermeasures.


Subject(s)
Diskectomy, Percutaneous , Endoscopy , Humans , Intervertebral Disc Displacement , Lumbar Vertebrae , Risk Factors , Treatment Outcome
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