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Objective: To analyze the medium and long-term effectiveness of microendoscope-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar degenerative diseases in comparison with conventional tubular retractor-assisted MIS-TLIF. Methods: Between November 2008 and March 2013, 53 patients with single segment lumbar degenerative diseases were enrolled. According to the different working channel performed, 28 patients were treated by microendoscope-assisted MIS-TLIF (observation group), while the remaining cases received conventional tubular retractor-assisted MIS-TLIF via Wiltse approach (control group). Preoperative baseline data, including age, gender, body mass index, disease etiology, operated level, the ration for requiring bilateral canal decompression, and preoperative visual analogue scale (VAS) socre of low back pain and leg pain, Japanese Orthopedic Association (JOA) score, Oswestry disability index (ODI) score, showed no significant difference between the two groups ( P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy time, postoperative analgesic drug dose, postoperation in-bed time, and perioperative complication incidence were recorded respectively and compared between the two groups. Radiographic evaluation of interbody fusion was performed based on Bridwell grading system at 2 years after operation. VAS scores of low back pain and leg pain, JOA score, and ODI score were assessed before operation, at 2 years after operation, and at last follow-up respectively. Surgical outcome satisfaction was assessed by modified MacNab criteria at last follow-up. Results: When compared with those in control group, both intraoperative blood loss and postoperative analgesic drug dose were significantly decreased in observation group ( P0.05). At last follow-up, the results of patients' satisfaction with surgery evaluated by modified MacNab criteria, and the excellent and good rates of the observation group and the control group were 96.4% and 92.0%, respectively, showing no significant difference ( χ2=0.485, P=0.486). Conclusion: The medium and long-term effectiveness of microendoscope-assisted MIS-TLIF are similar to those of conventional tubular retractor-assisted MIS-TLIF for lumbar degenerative diseases. The former operation has the additional advantages in terms of more clear surgical site visually, less intraoperative blood loss, and reduced postoperative analgesic dose, all of which seem more feasible to clinical teaching.
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Objective To investigate clinical effect of limited decompression under endoscope combined with percutaneous transpedicular screw fixation for treatment of degenerative lumbar spinal stenosis.Methods Thirty-four senile patients with lower lumbar spinal stenosis were selected as our subjects from February 2010 to August 2011,and were treated with limited decompression under endoscope combined with percutaneous transpedicular screw fixation through posterior approach.The VAS scores of all patients were collected at the four periods including pre-operation,leaving hospital,3 months after operation,and the last follow-up.The therapeutic effectiveness for the postoperative follow-up was expressed as excellent,good,ordinary,and poor according to Nakai standard.Results The VAS scores at pre-operation,leaving hospital,3 month after operation,and the last follow-up were (7.9 ± 1.6),(2.9 ± 1.4),(1.9 ± 1.9),(2.4 ± 1.5)respectively,and the difference was significant (F =13.524,P =0.036).But no significant differences of VAS scores at three sequential tests after operation were observed (P ＞ 0.05).In the last postoperative follow-up,32 cases were graded as excellent,1 cases for good and 1 case for ordinary,and the excellent rate reached to 97％.Conclusion The therapeutic effectiveness of lumbar spinal stenosis limited decompression under endoscope combined with percutaneous transpedicular screw fixation is reliable.Furthermore,no side effects on spine and back muscles are observed.
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Objective:To evaluate the feasibility and clinical efficacy of the treatment of lumbar spine steno-sis by modified unilateral approach for bilateral decompression under microendoscope.Method:217 cases with degenerative lumbar spine stenosis from September 2003 to December 2008 were treated by modified unilater-al approach for bilateral decompression of central spinal canal and nerve root canal under microendoscope.A-mong them laminectomy of one segment was done in 163 cases,two segments were done in 54 cases.After surgery,the routine radiograph were carried out and the Nakai criterion was used for assessment.Result:The mean operative time was 48±13min (range,25 to 95min),the average blood loss was 37±9ml (range,25 to 180ml),the average skin incision length was 2.2±0.2cm(1.8 to 2.4cm).2 cases had dural matter tearing,which healed after filling with gelatin foam and 2 weeks bed rest,after that no cerebrospinal fluid leakage was noted after surgery.Mislocation was noted in 1 case.No nerve inury and postoperative infection oceurred.Postoperative CT scan demonstrated complete decompression of the central spinal canal and nerve root canal.All patients were followed-up for an average of 14 months (range,3 months to 24 months).The Nakai criterion at final follow-up showed clinical excellent in 134 cases,good in 63 cases,fair in 16 cases and worse in 4 cases, with the excellent and good rate of 90.8%.No lumbar spine instability was noted.Conclusion:Treatment of de-generative lumbar spine stenosis by modified unilateral approach for bilateral decompression under mieroendo-scope has the merit of minimal invasive,less complications and reliable therapeutical effect.
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Objective To explore the feasibility of the treatment of special types of lumbar disc herniation using microendoscopic discectomy system(MED-Ⅱ) Methods Posterior interlaminal approach microendoscopic discectomy using the MED-Ⅱ was employed in 53 cases of bi-interspace lumbar disc herniation,75 cases of central type lumbar disc herniation,and 9 cases of extraforaminal lumbar disc herniation.Results All the operations were successfully completed with an operation time of(60~110 min) (mean,70 min) and an intraoperative blood loss of 50~130 ml(mean,70 ml).The length of hospital stay was 5~19 days(mean,13 days).The stitches were taken out at 12 days after operation and the sutured wound healed by first intention in all the cases.Follow-up for 3~8 months(mean,5 months) showed no complications.According to the Nakai classification,there were 40 cases of excellent results,11 cases of good results,and 2 cases of fair in the 53 cases of bi-interspace lumbar disc herniation.Of the 75 cases of central lumbar disc herniation,53,17,and 4 cases were endowed excellent,good,and fair results,respectively,and 1 case got a poor result.Of the 9 cases of extraforaminal lumbar disc herniation,the numbers were 6,2,and 1,respectively.(Conclusions) Use of the MED-Ⅱ for the treatment of special types of lumbar intervertebral disc herniation is effective.
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Objective To explore the clinical effects and application value of microendoscopic discectomy via spinal posterior access in the treatment of lumbar disc herniation. Methods Microendoscopic intervertebral space discectomy was performed for 152 patients with prolapse of lumbar intervertebral disc. The follow-up of clinical effects was carried out. Results 113 patients were followed up for 3 to 19 months. By Macnab standards, the rusult was excellent in 86 patients, good in 21, fair in 4, and poor in 2. The excellent and good rate was 94.6%. Conclusion Microendoscopic discectomy is an ideal method to treat lumbar disc herniation if the indications are suitable, for it is minimally invasive, and provides rapid postoperative recovery, good operation safety, as well as reliable effects.
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Objective To evaluate the application value of Microendoscopic Discectomy (MED) in the treatment of lumbar disc herniation and lumbar spinal stenosis. Methods 188 cases of lumbar disc herniation and lumbar spinal stenosis were treated by MED, 38 cases of them performed lateral recess decompression. Results The mean follow-up period was 6.9 months. excellent and good therapeutic result rate was 97.4% (Macnab's standard). Conclusions MED in the treatment of lumbar disc herniation and lumbar spinal stenosis has short-term satisfactory therapeutic efficacy.
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Objective To investigate the clinical application value of microendoscope in the treatment of laryngeal,tracheal,and bronchial diseases.Methods Under microendoscope,laryngological operations or tracheal or bronchial foreign body removal were carried out in 166 cases,including 19 cases of vocal nodule,75 cases of polyp of the vocal cord,16 cases of papilloma of the vocal cord,6 cases of cyst of the vocal cord,9 cases of cyst of the epiglottis,5 cases of laryngeal hemangioma,19 cases of laryngeal amyloidosis,3 cases of keratosis of the vocal cord,2 cases of leukoplakia of the vocal cord,6 cases of glottic cancer,and 6 cases of tracheal or bronchial foreign body.Results Foreign bodies in the trachea or the bronchus were removed successfully in all the 6 cases.Of the rest of 160 cases,laryngological operations were accomplished smoothly in 157 cases while a relatively large amount of hemorrhage was encountered in 3 cases and treated with microwave hemostasis.The operation time was 30~60 min(mean,45 min).No postoperative complications occurred.Follow-up observations for 2~12 months(mean,6 months) showed 148 cases of full recovery of vocal function and 12 cases of improvement.No recurrence was found in the 6 cases of glottic cancer during 1 year of(follow-up).Conclusions The application of microendoscope in the treatment of laryngeal,tracheal,and bronchial diseases has advantages of broad surgical view and direct and clear visualization.This minimally invasive procedure can remove the lesion thoroughly and reserve functions to the greatest advantages.
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Objective To investigate the method and the effect of posterior approach low lumbar spinal nerve root sheath decompression under microendoscope (MED-Ⅱ). Methods Thirty-nine patients with low lumbar disc herniation, accompanying severe preoperative limb numbness and radiculalgia, who were found obvious edema of nerve root with adhesion during surgery, entered the study. In the course of lumbar discectomy, a self-made mini-scalpel was used for the incision and decompression of the nerve root sheath, in which a 3～5 mm longitudinal incision was made along the dorsal side of the nerve root. Results Decompression was achieved under microendoscope (MED-Ⅱ) in all the 39 patients. Limb numbness and radiculalgia subsided completely in 17 patients within 24 postoperative hours, while the symptoms trailed off within 2 weeks following the surgery in the remaining patients. The time to complete disappearance of the symptoms was 1～14 d (mean, 6 5 d). Conclusions Minimally invasive spinal nerve root sheath incision and decompression can give a prompt relief from limb numbness and radiculalgia, improving the recovery of nervous system. Lumbar spinal nerve root sheath incision and decompression under microendoscope (MED-Ⅱ) is a safe and effective procedure.
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Objective To investigate the measures for the prevention of postoperative complications and dissatisfactory effects of posterior approach microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis in elderly patients. Methods A retrospective analysis was made on complications and causes of dissatisfactory effects following MED procedure in 62 cases. Results Follow-up observations in all the 62 cases for 3 ～ 40 months (mean,16 months) showed a "good" or "excellent" rate of 87 1% (54/62).Complications occurred in 4 cases (6 45%),including 1 case of interspace infection,1 case of injuries on cauda equine,and 2 cases of symptomatic healthy limbs; there was little symptomatic improvement in 4 cases. Conclusions Strictly-controlled indications for surgery,appropriate treatment of complications,and skillful surgical performance is the key to minimize the complications of MED.