Effect of iliac crest on L5-S1 transforaminal puncture and catheterization evaluated by CT scan and 3D reconstruction / 西安交通大学学报(医学版)

【Objective】 To analyze the effect of iliac crest on the difficulty of L5-S1 transforaminal puncture and catheterization by using CT images and oblique sagittal reconstruction images. 【Methods】 We made a retrospective analysis of the CT images and oblique sagittal reconstruction images of the adults aged from 30 to 50 years who underwent abdominopelvic CT examination in Affiliated Hospital of Nantong University. Based on the feasibility of puncture and catheterization， all the subjects were divided into two groups： group Ⅰ （suitable for puncture and catheterization） and group Ⅱ （unsuitable for puncture and catheterization）. We compared and analyzed differences in the rostral puncture inclination angle （α）， the abaxial angle of iliac crest （β）， the distance between the highest iliac crests （a）， the distance between sacroiliac joints （b）， the height of the superior articular process of sacral （c）， the height of iliac crest （d）， and the height of the superior articular process of sacral （c’） in the oblique sagittal images between the two groups. We explored the effect of anatomical indexes and iliac crests in oblique sagittal images on puncture and catheterization. 【Results】 The number of high/low iliac crests for group Ⅰ and group Ⅱ was （117/58 vs. 63/0）， and the number of men/women was 64/111 vs. 56/7， respectively. Variables α， b and c were higher in group Ⅰ than in group Ⅱ （34.77±4.86 vs. 31.11±5.16， P<0.001； 137.19±19.24 vs. 128.56±20.73， P = 0.003； 14.34±2.38 vs. 13.02±2.68， P<0.001）， and d was lower than that in group Ⅱ （27.51±6.73 vs. 37.65±6.35， P<0.001）. In addition， no statistically significant difference was found in the height of c of coronal CT scan and c’ of oblique sagittal reconstruction images （13.99±2.53 vs. 13.93±2.40， P = 0.465）. 【Conclusion】 It is more comprehensive and effective to evaluate preoperatively the influence of iliac crest on L5-S1 puncture and catheterization of TF-PELD by using CT scan and CT 3D reconstruction oblique sagittal images. The key factors in the evaluation of iliac crest are the degree of “cohesion” and the height. It is more easily to successfully puncture and catheterize when the shape of iliac crest is wider and lower. Therefore， it has higher probability to successfully puncture and catheterize in women.

Anesthetic effect of ultrasound-guided retrolaminar block during percutaneous transforaminal lumbar spine endoscopic surgery / 西安交通大学学报(医学版)

【Objective】 To compare the anesthestic effects of ultrasound-guided retrolaminal block （RLB） and local anesthesia during posterior approach vertebral surgery. 【Methods】 Forty patients （ASA physical status Ⅰ or Ⅱ） scheduled for transforaminal lumbar spine endoscopic surgery were recruited and randomly divided into two groups （n=20）： RLB group and local anesthesia group （Group C）. RLB group received the ultrasound-guided retrolaminar block using parasagittal in plane method by an anesthesiologist while Group C received layer-by-layer local infiltration anesthesia according to the operation location； 0.5% ropivacaine of 20 mL was used in the two groups. We recorded visual analogue score （VAS） and Ramsay sedation score at admission （T0）， during skin incision （T1）， puncture （T2）， foraminoplasty （T3）， nerve root decompression （T4） and suture （T5）. We also recorded remedial analgesia rate， scores of the patients’ satisfaction and the intraoperative occurrence of side effects （respiratory depression， tachycardia and hypertension）. The patients were followed up. Their functional status was assessed by the Oswestry Disability Index （ODI） score before surgery and three months after surgery. 【Results】 Compared with Group C， RLB group had significantly decreased visual analogue score at T2-4 and lower remedial analgesia rate （P<0.05）. The patients’ satisfaction was higher in group RLB than in Group C （P<0.05）. The intraoperative occurrence of hypertension and tachycardia were significantly lower in RLB group than in Group C （P<0.05）. ODI score was significantly decreased three months after surgery in both groups （P<0.05）， but it did not differ significantly between the two groups （P>0.05）. 【Conclusion】 Ultrasound-guided RLB can provide satisfactory analgesia with greater safety when trasforaminal endoscopic surgery is used.

Establishment of individualized early warning model for predicting recurrence after percutaneous endoscopic lumbar discectomy in patients with lumbar disc herniation / 西安交通大学学报(医学版)

【Objective】 To explore the establishment of individualized prediction model of recurrence after percutaneous endoscopic lumbar discectomy （PELD） in patients with lumbar disc herniation （LDH）. 【Methods】 We selected 124 LDH patients treated with PELD in Department of Orthopedics， The First Affiliated Hospital of Xi’an Jiaotong University， from January 2017 to January 2020 as the research subjects. Their clinical data were retrospectively analyzed， and the independent risk factors affecting PELD recurrence in the LDH patients were screened by univariate analysis and Logistic regression analysis， respectively； the correlation histogram prediction model was established. 【Results】 Age， history of diabetes， course of disease， work intensity and IDDG were the risk factors for the recurrence of PELD in LDH patients （P<0.05）. Based on the risk factors screened out， the prediction model of the histogram was established， and the model was verified. The results showed that the C-index of the modeling set and the validation set was 0.944 （95% CI： 0.902-0.963） and 0.969 （95% CI： 0.911-0.978）， respectively. The correction curves of both groups were well fitted with the standard curves. The areas under the ROC curve （AUC） in the two groups were 0.944 and 0.969， respectively， which proved that the model had good prediction accuracy. 【Conclusion】 LDH patients have many independent risk factors for recurrence after PELD， and the model based on risk factors with good predictive ability can be useful in preoperative evaluation， appropriate patient selection， and decrease of recurrence rate after PELD.

Clinical study of hydraulic perfusion pump and traditional water flushing for percutaneous endoscopic lumbar discectomy / 中国骨伤

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.

Clinical efficacy and technical characteristics of percutaneous endoscopic lumbar discectomy in the treatment of upper lumbar disc herniation / 中国骨伤

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.

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.

Effect of Quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy treatment in patients with L 5, S 1 lumbar disc herniation / 中国修复重建外科杂志

Objective: To identify effect of quantitative indicators of ilium height on approach of percutaneous endoscopic lumbar discectomy (PELD) treatment in patients with L 5, S 1 lumbar disc herniation. Methods: A retrospective study between May 2014 and March 2016 was conducted, including 100 patients with disc herniation at L 5, S 1, who were initially enrolled for the PELD treatment. Among them, 66 patients were successfully treated with PELD (group A), and the other 34 patients failed to perform puncture, catheterization, or microscopical operation due to the influence of iliac bone and other peripheral bone structures and treated with alternative surgical plans. By analyzing the X-ray films of lumbar vertebrae (including bilateral ilium) of the two groups before operation, the concept of ilium height rate and ilium angle rate was put forward innovatively. The ilium height rate and ilium angle rate of the two groups were measured and compared, and the diagnostic critical points of ilium height rate and ilium angle rate were determined by ROC curve analysis. Results: The ilium height rate was 0.61±0.09, 0.74±0.05 and the ilium angle rate was 0.66±0.08, 0.80±0.08 in groups A and B, respectively, showing significant differences between the two groups ( F=69.729, P=0.000; F=65.165, P=0.000). ROC curve analysis showed that the critical point of ilium height rate was 0.71 (area under ROC curve was 0.927, P=0.000), and the critical point of ilium angle rate was 0.75 (area under ROC curve was 0.965, P=0.000). Conclusion: PELD is not recommended for patients with L 5, S 1 intervertebral disc herniation, when the ilium height rate is greater than 0.71 and/or the ilium angle rate is greater than 0.75. Other surgical plans such as transpedicular approach, transpedicular approach, or open surgery, should be recommended to reduce the risk of surgery and the pain of patients.

Use of an Epidural Steroid Sponge for Postoperative Pain Control in Lumbar Discectomy

STUDY DESIGN: Retrospective study. OBJECTIVES: This study was conducted to evaluate the effects of using an epidural steroid sponge for postoperative pain control in lumbar discectomy. SUMMARY OF LITERATURE REVIEW: There are many methods to control postoperative pain after lumbar discectomy, including opioid analgesics, epidural catheters, and epidural steroid Gelfoam sponges. MATERIALS AND METHODS: A total of 72 patients who underwent surgery between March 2011 and February 2014 were enrolled. Their average age was 54 years (range, 24–82 years). In group A (35 patients), Gelfoam was inserted after being soaked with a solution of 2% lidocaine (400 mg/20 mL; 1 vial) and dexamethasone (5 mg/mL; 1 ampoule). In group B (37 patients), it was inserted after soaking with normal saline. Postoperative pain was assessed by visual analogue scale (VAS) scores. Pain above 5 points was controlled by a narcotic analgesic agent, and the duration and number of postoperative interventions, the period of time before walking after the operation, and the period until the date of discharge after surgery were assessed and compared. The Mann-Whitney U test was used as a nonparametric method. P-values less than 0.05 were considered to indicate statistical significance. RESULTS: In group A, 15 patients did not require analgesics on the day of surgery. In 20 patients, no analgesics were needed on postoperative day (POD) 1. In group B, 8 patients on the day of surgery and 13 patients on POD 1 did not require analgesics. In group A, 26 patients were able to walk on the day of surgery, and all patients were able to walk on POD 1. In group B, 19 patients was able to walk on the day of surgery and all patients were able to walk on POD 1. The mean number of hospital days before discharge was 6.3 in group A and 8.2 in group B. CONCLUSIONS: By continuously releasing low doses of steroids into the epidural space, this technique provided satisfactory results for postoperative pain control.

Reconsideration of lumbar spinal stenosis / 中国修复重建外科杂志

People's understanding of lumbar spinal stenosis has become more and more comprehensive and reasonable, however, there are still many controversies about the concepts of "central lumbar canal" and "lateral lumbar spinal canal", and there is no unified standard at present. In this paper, we redefine and differentiate the two concepts. We believe that some kinds of central canal stenosis caused by bilateral recess stenosis can be completely solved by bilateral percutaneous endoscopic transforaminal discectomy. At the same time, the concept of "lumbar lateral recess" is ambiguous. We redefine it as "lateral lumbar spinal canal" and propose "West China Hospital classification" to guide surgical decision-making, which has been widely recognized and applied.

Técnica de libre flotación foraminal para discectomía endoscópica percutánea lumbar (PELD): nota técnica / Foraminal Free Float Technique for Percutaneous Lumbar Endoscopic Discectomy (PELD): Technical Note

La Discectomía Percutánea Endoscópica Lumbar es una técnica mínimamente invasiva para el tratamiento de las hernias discales lumbares con resultados comparables a la microdiscectomía lumbar. La principal complicación, los fragmentos discales remanentes, son en gran parte producidos por la limitación de movimiento del endoscopio una vez realizada la punción. Presentamos una nota técnica y aplicación en un caso ejemplo de lo que hemos llamado "libre flotación foraminal": un acceso al espacio epidural por vía transforaminal que mantiene la libertad de movimiento y permite una exploración endoscópica en busca de fragmentos remanentes.

Percutaneous endoscopic lumbar discectomy is a minimally-invasive surgical approach for the treatment of lumbar disc herniation, with outcomes similar to open micro-discectomy. The main complication ­ residual disc fragments ­ is largely caused by a rigid endoscopic trajectory once the puncture has been made. We present a technical note of a surgery performed in a patient who underwent what we have called a "free foraminal flotation technique": accessing the epidural space through a transforaminal approach that maintains freedom of movement and allows for endoscopic exploration to locate residual disc fragments.

Fistula Formation Between the Disc and Dura after Percutaneous Endoscopic Lumbar Discectomy: A Case Report

STUDY DESIGN: Case report OBJECTIVES: To document fistula formation between the disc and dura by an unrecognized dural tear after percutaneous endoscopic lumbar discectomy (PELD). SUMMARY OF LITERATURE REVIEW: The risk of durotomy is relatively low with PELD, but cases of unrecognized durotomies have been reported. An effective diagnostic tool for such situations has not yet been identified. MATERIALS AND METHODS: A patient twice underwent transforaminal PELD under the diagnosis of a herniated lumbar disc at L4-5. She still complained of intractable pain and motor weakness around the left lower extremity at 6 months postoperatively. Magnetic resonance imaging showed no specific findings suggestive of violation of the nerve root. However, L5 and S1 nerve root injury was noted on electromyography. An exploratory operation was planned to characterize damage to the neural structures. RESULTS: In the exploration, a dural tear was found at the previous operative site, along with a fistula between the disc and dura was also found at the dural tear site. The durotomy site was located on the ventrolateral side of the dura and measured approximately 5 mm. The durotomy site was repaired with Nylon 5-0 and adhesive sealants. The patient's preoperative symptoms diminished considerably. CONCLUSIONS: Fistula formation between the disc and dura can be caused by an unrecognized dural tear after PELD. Discography is a reliable diagnostic tool for fistulas formed by an unrecognized durotomy.

Comparison of the short-term curative effect of visualization of percutaneous transforaminal endoscopic discectomy and microendoscopic discectomy in the treatment of lumbar spinal stenosis / 中国脊柱脊髓杂志

Objectives:To compare the early curative effect of visualization of percutaneous transforaminal endoscopic discectomy(VPTED) and microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis.Methods:49 patients with single segmental lumbar spinal stenosis combined with lumbar disc herniation(LDH) were treated in our hospital from March 2016 to March 2017.Among them,21 cases accepted VPTED,and 28 cases underwent MED.The length of incision,amount of bleeding during operation,operation time,length of hospital stay and the cost of hospitalization were recorded in the both groups.Visual analogue scale(VAS) was used to evaluate the effect of surgery,Oswestry disability index(ODI) was used to evaluate the clinical efficacy.The modified MacNab criteria were used to evaluate the efficacy of the patients at final follow-up.Results:There were no statistical differences among the age,the ratio of male to female,follow-up time,low back pain,weakness,sensory disturbance,general reflexes and prominent segments(P＞0.05).There were statistically significant differences between the two groups in preoperative and postoperative VAS and ODI scores(P＜0.05).There was no significant difference in VAS or ODI score between groups at the same time (P＞0.05).The length of incision(0.78±0.06cm vs 1.95±0.12cm),the amount of intraoperative perspective(15.86± 2.66 vs 2.18±0.38) and the operation time(87.51±30.46min vs 47.53±13.61min) had significant difference between VPTED and MED group(P＜0.05).There was no significant difference in hospitalization time or hospitalization expenses between the two groups(P＞0.05).At final follow-up,based on the MacNab standard,it was excellent in 17 cases,good in 3 cases,fair in 1 case in VPTED group;it was excellent in 22 cases,good in 4 cases,fair in 2 cases in MED group.Excellent rate of the VPTED group was 95.24％,and that was 92.86％ in the MED group,there was no significant difference between the two groups(P＞0.05).Conclusions:Visualization of percutaneous transforaminal endoscopic discectomy (VPTED) and microendoscopic discectomy (MED) in the treatment of lumbar spinal stenosis have good short-term curative effect,it iproves that VPTED is a safe and effective minimally invasive surgery.

Clinical effect of percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation and calcification / 局解手术学杂志

Objective To discuss the clinical effect of percutaneous endoscopic lumbar discectomy(PELD) in the treatment of lumbar disc herniation and calcification.Methods The clinical data of 52 patients with lumbar disc herniation and calcification in orthopedic department of general hospital of Fushun mining bureau from June 2015 to June 2016 were retrospectively reviewed.The data included medical records,out-patient review,telephone follow-up was collected.The VAS,ODI and modified MacNab criteria were used to assess the clinical effects.Results There were significant improvement in VAS and ODI score at 6 week,6 months,1 year after surgery compared with before.According to the modified MacNab criteria,the rate of excellent and good result was 94.3％,the improvement rate was 98.1％.Conclusion PELD is an effective method to treat lumbar disc herniation and calcification,with advantages of less injury,rapid recovery,it is worth popularizing application in clinic.

Short-term effectiveness of percutaneous endoscopic lumbar discectomy in treatment of buttock pain associated with lumbar disc herniation / 中国修复重建外科杂志

Objective: To evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation. Methods: Between June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L 4, 5 in 15 cases and L 5, S 1 in 19 cases; 2 cases had lumbar disc herniation at both L 4, 5 and L 5, S 1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up. Results: All patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores ( P0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%. Conclusion: PELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.

A retrospective study of epidural and intravenous steroids after percutaneous endoscopic lumbar discectomy for large lumbar disc herniation / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To assess the early curative effect of epidural or intravenous administration of steroids during a percutaneous endoscopic lumbar discectomy (PELD).</p><p><b>METHODS</b>28 consecutive patients who underwent PELD due to large lumbar disc herniation between November 2014 and January 2016 were followed up for 6 months. These patients were divided into two groups according to the treatment they received after PELD. 14 patients (Group A) were treated by PELD and epidural steroids, while the other 14 patients (Group B) were treated by PELD and intravenous steroids. We evaluated the effectiveness by the preoperative and postoperative visual analogue scale (VAS) scores for back and leg pain, and the postoperative Oswestry disability index (ODI) at 3 weeks after surgery via the clinical charts and telephone interview. Postoperative hospital stay and time return to work were investigated as well.</p><p><b>RESULTS</b>There is a significant decrease in VAS (back, leg), ODI, and time return to work (p < 0.05). For VAS (back), Group A showed a significant decrease compared with Group B at 1 day and 1 week after surgery (p = 0.011, p = 0.017). As for VAS (leg), Group A showed a significant decrease compared with Group B at 1 day, 1 week, 3 weeks, and 3 months follow-up examinations (p = 0.002, p = 0.006, p < 0.001, p < 0.001). For ODI, Group A showed a notable decrease compared with Group B (p < 0.001). The postoperative hospital stay in two groups was not statistically different (p = 0.636). But the time return to work in Group A was significantly shorter than that in Group B (p = 0.023).</p><p><b>CONCLUSION</b>Patients who underwent PELD with epidural steroid administration for large lumbar disc herniation showed favorable curative effect compared with those who underwent PELD with intravenous steroid administration.</p>

Isolation and identification of nucleus pulposus mesenchymal stem cells from tissues removed by percutaneous endoscopic lumbar discectomy / 中国病理生理杂志

AIM:To explore a novel method to isolate human nucleus pulposus mesenchymal stem cells (hNP-MSCs) in vitro and to identify their biological characteristics.METHODS:The explant culture method was employed to isolate hNP-MSCs from nucleus pulposus tissue obtained by percutaneous endoscopic lumbar discectomy (PELD).The isolated cells were passaged for purification and cultured in vitro followed by morphological observation.The cell proliferation ability was detected by CCK-8 assay.Growth curves of the cells were drawn and surface antigens were detected by flow cytometry.The cells at the 3rd~6th passages were induced for adipogenic, osteogenic and chondrogenic differentiation, and examined by oil red O staining, alizarin red staining and Alcian blue staining.RESULTS:The cells with self-renewal were obtained from nucleus pulposus tissue obtained by PELD.The results of flow cytometry analysis revealed that the cells were positive for CD29, CD44, CD90, CD73 and CD105, but negative for CD34 and CD45.The proliferative capacity was consistent with the growth characteristics of MSCs and multilineage differentiation potential was identified.CONCLUSION:A novel method to efficiently isolate and culture hNP-MSCs,PELD combined with explant culture method,was established, which would promote the study of regenerative medicine based on hNP-MSCs.

Percutaneous endoscopic lumbar discectomy versus microendoscopic discectomy for lumbar disc herniation: a Meta-analysis / 中国内镜杂志

Objective To compare the curative effect of percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) in lumbar disc herniation.Methods A literature search was performed in PubMed, Web of Science, Embase, Wanfang, CNKI. Two authors reviewed all articles individually. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool, and the quality of retrospective studies was evaluated by the modified Newcastle-Ottawa scale. The data was extracted by the Review Manager 5.30.Results A total of 19 articles were brought into this Meta-analysis. The outcomes were divided into primary outcomes and secondary outcomes. Excerpt for the short-term VAS score was lower in PELD group (P = 0.010), other index, including long-term VAS score (P = 0.120), ODI score (P = 0.260), complication (P = 0.100) and recurrence (P = 0.100), didn't had significant difference in two groups. The blood loss (P = 0.000), hospital stay (P = 0.000) and the length of incision (P = 0.000) were all superiority in PELD group. Whereas the operative time was shorter in MED group (P = 0.001).Conclusion PELD was a more minimally invasive and secure technique in lumbar disc herniation.

Efficacy assessment of percutaneous endoscopic lumbar discectomy in treatment of far lateral lumbar disc herniation / 中国内镜杂志

Objective To evaluate the clinical efficacy of percutaneous endoscopic lumbar discectomy (PELD) on treatment of far lateral lumbar disc herniation (FLDH). Methods We retrospectively analyzed 27 patients with FLDH underwent percutaneous endoscopic lumbar discectomy from June 2014 to September 2015, age from 41 to 64, average 52.3. The average operation time, intraoperative blood loss and length of hospital stay were collected. The lumbocrural pain perception of patients before and after surgery was assessed by visual analog scale (VAS) and postoperative lumbar functional recovery after surgery by modified MacNab criteria. Results Average operation time was 69 min (58~109 min), intraoperative blood loss was 18 ml (11~40 ml), and length of stay was 5.0 d (3.0 ~ 10.0 d). VAS score from (8.12 ± 1.25) preoperatively improved to (2.80 ± 1.12) at the 3rd d after operation, (1.59 ± 1.06) at 3 months after operation, and (1.31 ± 0.89) at the last follow-up after operation; There was a statistical difference between preoperative scores and postoperative scores (P < 0.05). Modified MacNab criteria was a ratio of 88.9%. Conclusions PELD on the treatment of far lateral lumbar disc herniation have small area of trauma, faster postoperative recovering and several other advantages,which is a safe and effective minimally invasive surgery.

Occurrence and prevention of complications after percutaneous endoscopic lumbar discectomy / 局解手术学杂志

Objective To analyze the occurrence of the complications after percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation or stenosis,and to reveal the effective prevention methods.Methods Retrospectively analyzed the clinical data of 568 cases who undertaken PELD,and all the related complications,possible causes,prevention and treatment methods were analyzed.Results There were 24 cases of complications occured in all the 568 cases treated with PELD,and the gross incidence rate was 4.23％,including 4 cases of dural laceration(0.70％),3 cases of hemorrhage of intravertebral vein plexus injury(0.53％),6 cases of postoperative wound pain (1.06％),8 cases of postoperative recurrence (1.41％),1 case with persistent symptoms after surgery (0.18％),2 cases of postoperative paresthesia(0.35％).Conclusion PELD is a minimally invasive surgery with high security and low incidence of complications.The effective preventions including careful decision-making,elaborate operation,and precise identification of the anatomical abnormality.

Observations on the Application of She Medicine Therapy to Rapid Rehabilitation after Lumbar Spinal Endoscopic Surgery / 上海针灸杂志

Objective To investigate the clinical efficacy of She medicine therapy in rehabilitation after endoscopic surgery for lumbar intervertebral disc herniation.Methods Sixty patients with lumbar intervertebral disc herniation were allocated, using random number table method following registration order, to treatment and control groups, 30 cases each. The treatment group received She medicine therapy and the control group, oral administration of conventional drugs. The excellent and good rate was observed in the two groups after treatment. Post-treatment active straight leg raising times and analgesic dosages were compared between the two groups.Results Active straight leg raising time was significantly advanced (P<0.01) and the number of potent analgesic uses was significantly decreased (P<0.01) in the treatment group after endoscopic surgery for lumbar intervertebral disc herniation. The excellent and good rate was 93.3％ in the treatment group and 80.0％ in the control group; there was a statistically significant difference between the two groups (P<0.05).Conclusion She medicine therapy can help rapid rehabilitation after endoscopic surgery for lumbar intervertebral disc herniation.