Curative Effect of Percutaneous Transforaminal Endoscopic Spine System in the Treatment of Lumbar Disc Herniation Complicated with Nerve Root Canal Stenosis / 中山大学学报(医学科学版)

ObjectiveTo explore the clinical efficacy of percutaneous transforaminal endoscopic spine system （TESSYS） in the treatment of lumbar disc herniation （LDH） complicated with nerve root canal stenosis. MethodsA retrospective study was done on 40 LDH patients complicated with nerve root canal stenosis who underwent TESSYS in our hospital from April 2019 to April 2021. The clinical efficacy of the patients was evaluated by the modified Mac Nab criteria 12 months after the surgery. We also measured and analyzed the scores of visual analogue scale （VAS）， Oswestry disability index （ODI） and Japanese orthopaedic association （JOA）， the changes of structural parameters of lumbar spine and inflammatory factor levels preoperatively， 6 and 12 months after the surgery. ResultsAll the 40 cases successfully underwent the surgery and follow-ups， with a 12-month post-operative clinical excellent and good rate of 90%. The preoperative， 6-month and 12-month post-operative VAS scores were （7.38±2.06）， （2.36±0.87） and （1.62±0.82）， respectively. The respective ODI scores were （55.54±11.19）， （26.52±7.61） and （18.14±4.36）； JOA scores （13.93±2.10）， （20.26±1.35） and （22.34±1.88）. The post-operative scores of VAS， ODI and JOA were significantly improved compared with those before the surgery （P<0.05）. The preoperative and post-operative lumbosacral angles were （37.23±6.84）° and （27.37±4.31）°， respectively， with the respective lumbar curvatures of （13.48±3.06） mm and （22.36±4.51） mm. The post-operative lumbosacral angle and lumbar curvature were significantly improved compared with those before the surgery （P<0.05）. The preoperative and post-operative high-sensitivity C-reactive protein （hs-CRP） levels were （3.43±0.61） mg/L and （5.18±0.70） mg/L， respectively， with the respective tumor necrosis factor alpha （TNF-α） levels of （1.44±0.27） mg/L and （2.07±0.44） mg/L. The post-operative levels of hs-CRP and TNF-α were significantly higher than those before the surgery （P<0.05）. ConclusionIn the treatment of LDH complicated with nerve root canal stenosis， TESSYS achieves a good clinical effect， improves the structure and function of the lumbar spine， reduces the degree of lumbar spine pain， and has a mild post-operative inflammatory reaction.

Effect of acupotomy on the fat infiltration degree of lumbar multifidus muscle in patients with lumbar disc herniation after percutaneous transforaminal endoscopic discectomy / 中国针灸

OBJECTIVE@#To observe the effect of acupotomy on the fat infiltration degree of lumbar multifidus muscle (LMM) in patients with lumbar disc herniation after percutaneous transforaminal endoscopic discectomy (PTED).@*METHODS@#A total of 104 patients with lumbar disc herniation treated with PTED were randomly divided into an observation group (52 cases, 3 cases dropped off) and a control group (52 cases, 4 cases dropped off). Patients of both groups received rehabilitation training of two weeks 48 h after PTED treatment. The observation group was treated with acupotomy (L3-L5 Jiaji [EX-B 2]) once within 24 h after PTED. In the two groups, the fat infiltration cross sectional area (CSA) of LMM was compared before and 6 months after PTED, the visual analogue scale (VAS) score and Oswestry disability index (ODI) score were observed before and 1, 6 months after PTED. The correlation between fat infiltration CSA of LMM in each segment and VAS score was analyzed.@*RESULTS@#Six months after PTED, the fat infiltration CSA of LMM in L4/L5 and the total L3-S1 segments of the observation group was lower than that before PTED (P<0.05), and the fat infiltration CSA of LMM in L4/L5 of the observation group was lower than the control group (P<0.01). One month after PTED, the ODI and VAS scores of the two groups were lower than those before PTED (P<0.01), and those in the observation group were lower than the control group (P<0.05). Six months after PTED, the ODI and VAS scores of the two groups were lower than those before PTED and 1 month after PTED (P<0.01), and those in the observation group were lower than the control group (P<0.01). There was a positive correlation between the fat infiltration CSA of LMM in the total L3-S1 segments and VAS scores in the two groups before PTED (r = 0.64, P<0.01). Six months after PTED, there was no correlation between the fat infiltration CSA of LMM in each segment and VAS scores in the two groups (P>0.05).@*CONCLUSION@#Acupotomy can improve the fat infiltration degree of LMM, pain symptoms and activities of daily living in patients with lumbar disc herniation after PTED.

Application of body temperature rinse in percutaneous transforaminal endoscopic lumbar discectomy through intervertebral approach / 中国骨伤

OBJECTIVE@#To investigate the effects of two types of temperature rinses on body temperature, inflammatory cytokine levels, and bleeding volume in percutaneous endoscopic lumbar discectomy.@*METHODS@#Eighty patients underwent percutaneous endoscopic lumbar discectomy from January 2018 to December 2020 were selected and divided into experimental group (40 cases) and control group(40 cases). In experimental group, there were 19 males and 21 females, aged (38.8±9.8) years old;7patients on L4,5 and 33 patients on L5S1;Body msss index(BMI) was (27.8±7.2) kg·m-2. In contral group, there were 18 males and 22 females, aged (41.5±10.9) years old, 5 patients on L4,5 and 35 patients on L5S1;BMI was (26.4±6.2) kg·m-2. The patients in the control group were received normal saline rinse at room temperature, and the patients in the experimental group were received normal saline rinse heated to 37 ℃. Body temperature, chills, nausea, vomiting, and other adverse reactions were recorded. The levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10) in two groups were recorded before and 2 hours after operation. Visual analogue scale (VAS) was used to evaluate the degree of lumbar pain in two groups before and 2 hours after surgery. Fibrinolytic-coagulation indexes with preoperative and 2 hours after surgery, including the D-dimer (DD), fibrinogen degradation products (FDP), activated partial thrombin time (APTT) and prothrombin time (PT) were recorder. Operation time and blood loss in two groups were recorded.@*RESULTS@#The body temperature of both groups showed a downward trend, while the body temperature of the control group was lower than that of the experimental group. The levels of TNF-α, IL-6 and IL-10 in two groups were increased 2 hours after surgery compared with those before surgery(P<0.05), while the levels in experimental group were lower than those in control group(P<0.05). Postoperative VAS in experimental group 2.19±1.13 was significantly lower than that in the control group 3.38±1.35(P<0.05). The levels of DD and FDP at 2 hours after surgery in both groups were higher than those before surgery (P<0.05), while the levels of DD and FDP in the experimental group were higher than those in the control group (P<0.05). There was no significant difference in APTT and PT levels between two groups after operation (P>0.05). The blood loss in the experimental group of (45.2±14.1) ml was lower than that in the control group of (59.52±15.6) ml. The operation time of experimental group (46.7±13.8) min was less than that of control group (58.3±15.2) min(P<0.05).@*CONCLUSION@#Body temperature rinse can reduce the incidence of adverse reactions, alleviate local inflammatory reactions, reduce intraoperative blood loss and shorten the operation time.

Perioperative blood loss in different approaches by percutaneous endoscopic discectomy / 西安交通大学学报(医学版)

【Objective】 To compare the perioperative blood loss between interlaminar and transforaminal approaches by percutaneous endoscopic discectomy in order to provide more reference for guiding the proper choice of surgical methods clinically. 【Methods】 We retrospectively analyzed the clinical data of 160 patients who underwent percutaneous endoscopic lumbar discectomy from June 2019 to November 2020， with 80 patients in interlaminar approach group and 80 in transforaminal approach group. The blood loss was calculated according to Gross formula. 【Results】 The perioperative total blood loss （mL）， hidden blood loss （mL） and hemoglobin loss （g/L） were significantly lower in interlaminar approach group than in transforaminal approach group （119.73±179.26 vs. 158.6±190.65， 109.73±179.53 vs. 148.78±190.19， 3.76±8.12 vs. 4.31±7.62） （P<0.05）. However， there was no significant difference in visible blood loss between the two groups. 【Conclusion】 The perioperative hidden blood loss accounts for a large proportion in percutaneous endoscopic lumbar discectomy. In addition， the interlaminar approach causes less blood loss than the transforaminal approach.

The use of dexmedetomidine in puncture techniques for degenerative diseases of the lumbar spine / Uso de dexmedetomidina em técnicas de punção para doenças degenerativas da coluna lombar / Uso de dexmedetomidina en técnicas de punción para enfermedades degenerativas de la columna lumbar

ABSTRACT Objective To analyze the results of the use of dexmedetomidine (D) in the treatment of patients with degenerative diseases of the lumbar spine using puncture techniques. Methods The study included 77 patients who underwent surgical puncture for degenerative diseases of the lumbar spine with the use of alpha-2-adrenomimetic D: percutaneous laser denervation of the facet joints (n = 46) and posterolateral transforaminal endoscopic discectomy (n = 31). We assessed: the level of sedation using the Ramsay Sedation Scale (RSS) and the Richmond Agitation Sedation Scale (RASS); intraoperative dynamics of the cardiovascular and respiratory system parameters; the level of pain syndrome according to VAS. Results A high intraoperative level of sedation was determined, with RASS -2, -3 and Ramsay III, IV; when transferring a patient to a department (in 90 minutes) this parameter was RASS 0 and Ramsay II. There were no significant changes in central hemodynamics and respiratory depression. The minimum level of pain was determined immediately after surgery, at 30 and 60 minutes after surgery, and before transfer to the department (90 minutes): 6 (4;9); 10 (8;12); 12 (9;13); 16 (13;19) respectively. The absence of the need for additional analgesia on the first postoperative day was verified. Conclusion The use of D significantly reduces the level of pain, while maintaining the necessary verbal contact with the patient, and provides the necessary neurovegetative protection without respiratory depression or lowered hemodynamic parameters during the perioperative period. Level of evidence II; Prognostic Studies - Investigating the Effect of a Patient Characteristic on Disease Outcome. Case series, retrospective study.

RESUMO Objetivo Analisar os resultados do uso de dexmedetomidina (D) no tratamento de pacientes com doenças degenerativas da coluna lombar com técnicas de punção. Métodos O estudo incluiu 77 pacientes submetidos à punção cirúrgica em doenças degenerativas da coluna lombar com o uso de um agonista alfa-2 adrenérgico: denervação percutânea das articulações facetárias com laser (n = 46) e discectomia endoscópica transforaminal posterolateral (n = 31). Foram avaliados o nível de sedação usando a Escala de Sedação de Ramsay (RSS) e a Escala de Sedação e Agitação de Richmond (RASS); a dinâmica intraoperatória dos parâmetros dos sistemas cardiovascular e respiratório; o nível de síndrome de dor de acordo com a EVA. Resultados Determinou-se um alto nível intraoperatório de sedação pela RASS (-2, -3) e pela Ramsay (III, IV). Ao transferir um paciente para outro setor (depois de 90 minutos), esse parâmetro era 0 em RASS e II em Ramsay. Não houve alterações significativas na hemodinâmica central e na depressão respiratória. O nível mínimo de dor foi determinado imediatamente após a cirurgia, 30 e 60 minutos depois da cirurgia e antes da transferência para o outro setor (90 minutos depois): 6 (4; 9); 10 (8; 12); 12 (9; 13); 16 (13; 19), respectivamente. Constatou-se que não era necessária analgesia adicional no primeiro dia pós-operatório. Conclusões O uso de D reduz significativamente o nível de dor mantendo a comunicação verbal necessária com o paciente e fornece a proteção neurovegetativa necessária sem depressão respiratória e os parâmetros hemodinâmicos reduzidos durante o período perioperatório. Nível de evidência II; Estudos prognósticos - Investigação do efeito de característica de um paciente sobre o desfecho da doença. Série de casos, Estudo retrospectivo.

RESUMEN Objetivo Analizar los resultados del uso de dexmedetomidina (D) en el tratamiento de pacientes con enfermedades degenerativas de la columna lumbar con técnicas de punción. Métodos El estudio incluyó a 77 pacientes con enfermedades degenerativas de la columna lumbar que se sometieron a punción quirúrgica mediante el uso de un agonista adrenérgico alfa-2: denervación percutánea de las articulaciones facetarias con láser (n = 46) y discectomía endoscópica transforaminal posterolateral (n = 31). Fueron evaluados el nivel de sedación mediante la Escala de Sedación de Ramsay (RSS) y la Escala de Sedación y Agitación de Richmond (RASS); la dinámica intraoperatoria de los parámetros de los sistemas cardiovascular y respiratorio; el nivel del síndrome de dolor según la EVA. Resultados Se determinó un alto nivel de sedación intraoperatoria en RASS (-2, -3) y por Ramsay (III, IV)Al transferir un paciente a otro sector (después de 90 minutos), este parámetro fue 0 en RASS y II en Ramsay. No hubo cambios significativos en la hemodinámica central y la depresión respiratoria.El nivel mínimo de dolor se determinó después de la cirugía, 30 y 60 minutos después de la cirugía y antes del traslado al otro sector (90 minutos después): 6 (4; 9); 10 (8; 12); 12 (9; 13); 16 (13; 19), respectivamente. Se verificó que no era necesaria analgesia adicional el primer día postoperatorio. Conclusiones El uso de D reduce significativamente el nivel de dolor al mismo tiempo que se mantiene la necesaria comunicación verbal con el paciente y brinda la protección neurovegetativa necesaria sin depresión respiratoria y parámetros hemodinámico reducidos durante el período perioperatorio. Nivel de evidencia II; Estudios de pronóstico: Investigación del efecto de la característica de un paciente sobre el desenlace de la enfermedad. Serie de casos, Estudio retrospectivo.

A prospective study on the application of staged lumbar motion chain rehabilitation based on mckenzie’s technique after lumbar percutaneous transforaminal endoscopic discectomy / 中国组织工程研究

BACKGROUND: Lumbar percutaneous transforaminal endoscopic discectomy can decompress nerve root compression caused by herniated lumbar disc. Postoperative rehabilitation not only includes the recovery of surgical trauma, but also the recovery of lumbar muscle damage accompanied by lumbar disc herniation and the recovery of pelvic-leg function imbalance. OBJECTIVE: To evaluate the effectiveness and feasibility of staged rehabilitation program of lumbar motor chain based on McKenzie’s technique after lumbar percutaneous transforaminal endoscopic discectomy. METHODS: Totally sixty-two patients with lumbar disc herniation who were treated in the Beijing Bo’ai Hospital of China Rehabilitation Research Center from January 2012 to December 2018 underwent percutaneous transforaminal endoscopic discectomy. The patients were randomly divided into experimental group and control group, 31 cases in each group. The experimental group performed remote staged rehabilitation guidance based on McKenzie’s technology according to pre-set rehabilitation program for postoperative rehabilitation of lumbar motion chain: 2-6 weeks after operation as the first stage, 7-12 weeks as the second stage and 13-24 weeks as the third stage. Control group received regular postoperative rehabilitation. Visual analogue scale score, Japanese Orthopaedic Association score, Oswestry Disability Index, and SF-36 score were assessed in both groups pre-rehabilitation and 6, 12, and 24 weeks post-rehabilitation. Cross sectional area of the multifidus of the lumbar spine was detected under MRI 12 weeks post-rehabilitation. Gait analysis was conducted 24 weeks post-rehabilitation by using three-dimensional motion acquisition and analysis system. This study was approved by the Ethics Committee of Beijing Bo’ai Hospital of China Rehabilitation Research Center (approval No. 2019-011-1). RESULTS AND CONCLUSION: (1) After rehabilitation, visual analogue scale score, Japanese Orthopaedic Association score, Oswestry Disability Index, and SF-36 score were improved to different degrees in both groups compared with those before rehabilitation. Visual analogue scale score and Oswestry Disability Index were lower in the experimental group than those in the control group at 6 and 12 weeks (P 0.05). (3) Gait analysis exhibited that the ratio of left to right in the supporting phase of the experimental group was higher than that of the control group at 24 weeks (P < 0.05). (4) Results suggest that the staged rehabilitation program after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation is in line with the characteristics of postoperative recovery of lumbar disc herniation, and has good effectiveness and feasibility.

Percutaneous transforaminal endoscopic foraminoplasty for simple lumbar spinal lateral exit-zone stenosis / 中国骨伤

OBJECTIVE@#To evaluate the clinical effects of percutaneous endoscopic foraminoplasty for simple lumbar spinal lateral exit zone stenosis.@*METHODS@#A total of 36 patients with simple lumbar spinal lateral exit zone stenosis were admitted to our hospital from January 2013 to June 2018, and received selective nerve root canal radiography and radicular block. According to the symptoms and patients' personal wills, 22 cases underwent the one-stage percutaneous foraminal surgery(the one-stage operation group), and the other 14 patients were re-admitted to the hospital for operation(the delayed operation group) because of the recurrence of symptoms after discharge. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical effects before therapy, 1 day after the radicular block, and 1 day, 3 months and 6 months after the operation.@*RESULTS@#VAS and ODI of all 36 cases were obviously improved (0.05), but when compared with its own pretherapy andbefore readmission results, the difference was significant (<0.05). There was no nerve injury in all cases. Only 2 cases were presented with the outlet root stimulation symptoms, and the symptoms relieved after short term conservative treatment.@*CONCLUSION@#The clinical effects of radicular block may be unsustainable for patients with simple lumbar spinal lateral exit zone stenosis. Instead, percutaneous endoscopic foraminoplasty was simple, safe and effective.

The Role of Percutaneous Transforaminal Endoscopic Surgery in Lateral Recess Stenosis in Elderly Patients

STUDY DESIGN: Prospective clinical study. PURPOSE: To investigate the effect of percutaneous transforaminal endoscopic surgery (PTES) for lateral recess stenosis (LRS)(LRS) in elderly patients and to assess patients’ health-related quality of life (HRQoL). OVERVIEW OF LITERATURE: PTES is an increasingly used surgical approach, primarily employed for lumbar disc herniation treatment. However, indications for PTES have been increasing in recent years. PTES has been recommended as a beneficial alternative to open decompression surgery in specific LRS cases; PTES is termed as percutaneous endoscopic ventral facetectomy (PEVF) in such cases. METHODS: In total, 65 elderly patients with LRS were prospectively studied. Patients presented severe comorbidities (coronary insufficiency, heart failure, diabetes mellitus, and respiratory failure); thus, general anesthesia administration would potentially cause considerable hazards. All the patients underwent successful PEVF in 2015–2016. The patients were assessed preoperatively and at 6 weeks; 3, 6, and 12 months; and 2 years postoperatively. Patients’ objective assessment was conducted according to specific clinical scales; the Visual Analog Scale (VAS) was separately used for leg and low-back pain (VAS-LP and VAS-BP, respectively), whereas the Short Form 36 Health Survey Questionnaire was used for the HRQoL evaluation. RESULTS: All studied parameters presented maximal improvement at 6 weeks postoperatively, with less enhancement at 3 and 6 months with subsequent stabilization. Statistical significance was found in all follow-up intervals for all parameters (p<0.05). Parameters with maximal absolute amelioration were VAS-LP, bodily pain, and role limitations due to physical health problems. In contrast, VAS-BP, general health, and mental health were comparatively less enhanced. CONCLUSIONS: PEVF was associated with remarkably enhanced HRQoL 2 years postoperatively. PEVF is thus a safe and effective alternative for LRS surgical management in elderly patients with severe comorbidities.

Overview of risk factors for failed percutaneous transforaminal endoscopic discectomy in lumbar disc herniation / 中国骨伤

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.

Early-middle stage effect of percutaneous spinal endoscopic BEIS technique for lumbar spinal stenosis / 中国骨伤

OBJECTIVE@#To explore the clinical early-middle stage clinical effect of percutaneous spinal endoscopic with the technique of Broad Easy Immediate Surgery(BEIS) for lumbar spinal stenosis.@*METHODS@#The clinical data of 57 patients with lumbar spinal stenosis treated by surgery from June 2015 to June 2016 were retrospectively analyzed, including 32 cases treated by percutaneous spinal endoscopic with the technique of BEIS (minimally invasive group) and 25 cases by posterior approach of lumbar pedicle screws internal fixation and intervertebral disc excision with bone graft fusion surgery (open surgery group). The pre-operative general data such as age, Body Mass Index (BMI) and etc. were analysed and compared. The operation time, intraoperative blood loss, hospitalization time of the two groups were analyzed. Visual analogue score(VAS), Oswestry Disability Index(ODI), Japanese Orthopedic Association Score(JOA) of preoperative and at 1 week, 1 month, 3 months, 6 months after surgery were used to evaluate the clinical outcome of the two group.@*RESULTS@#All the operations were successful and all the patients recovered smoothly without severe complications, all the wounds got good healing. The pain of the lumbar and lower limb had been improved after surgery. All the patients were followed up more than 6 months with an average of(10.65±3.38) months. There was no significant difference in general data such as age, BMI, and etc. between two groups(>0.05). There were significant differences in VAS, ODI between two groups at 1 week, 1, 3, 6 months after surgery(0.05). Intraoperative blood loss and hospitalization time of minimally invasive group was less than that of open surgery group.@*CONCLUSIONS@#BEIS technique has the advantage of less trauma, less bleeding for lumbar stenosis when compared to open surgery. It can better alleviate the postoperative local lumbar pain, and early-middle clinical effect is equivalent to open surgery, so it can be used as a safe and effective surgical treatment for lumbar spinal stenosis.

Treatment of lumbar disc herniation with modified transforaminal endoscopic surgical system / 中国内镜杂志

Objective To explore the clinical effects and influence factors in the treatment of lumbar disc herniation (LDH) by the application of modified transforaminal endoscopic surgical system. Methods Clinical data of 178 cases with LDH from November 2013 to May 2016 was retrospectively analyzed and totally followed-up after surgery. Compare the scores of VAS and JOA preoperative and in the follow-up, the efficacy evaluation was performed using modified MacNab system, the effectiveness was observed and the factors that might affect the efficacy were analyzed. Results The VAS score in the back pain, leg pain and JOA of lumbar vertebral function, those three indexes were significantly improved (P < 0.01). Modified MacNab system: 57 cases in excellent, 85 cases in good, 20 cases in fair and 16 cases in poor, with an excellent and good rate of 79.8% and 91.0% efficiency; The results of single factor analysis showed that there was a correlation between age, course of disease, history of surgery in the same segment, symptoms and calcification of prolapse objects (P < 0.05). The results of multi-factor analysis showed that age above 45 years old, history of surgery in the same segment and numbness were the independent risk factors (OR

Observation of early clinical effect of percutaneous transforaminal endoscopic technology in treating cervical spondylotic radiculopathy / 中国骨伤

<p><b>OBJECTIVE</b>To explore the early clinical effect and safety of percutaneous transforaminal endoscopic technology for cervical spondylotic radiculopathy.</p><p><b>METHODS</b>From August 2016 to September 2017, 14 patients with cervical spondylotic radiculopathy who responded poorly to non-surgical treatment for at least 6 weeks underwent percutaneous transforaminal endoscopic discectomy via posterior approach. There were 6 males and 8 females, aging from 32 to 68 years old with an average of (40.5±7.6) years. The course of disease ranged from 0.5 to 13.0 months with an average of (6.0±1.33) months. The lesions involved C₄,₅ in 2 cases, C₅,₆ in 8 cases, C₆,₇ in 4 cases. Visual analogue scale (VAS), Japanese Orthopedic Association (JOA), Short Form 36 health survey questionnaire(SF-36) were recorded preoperatively and during the latest follow-up to evaluate the clinical outcome. Horizontal displacement and angular displacement of vertebral body were measured by cervical dynamic X-rays.</p><p><b>RESULTS</b>All operations were successful. No spinal cord injury, nerve root or vascular injuries were found. Operation time was from 60 to 100 min with a median of 75 min;intraoperative bleeding was from 30 to 80 ml with a median of 40 ml. All patients were followed up for 2 to 13 months with a median of 9 months. During the follow-up period, the patients with neck and shoulder pain were significantly relieved without recurrence. No nucleus pulposus protrusion was found in the primary surgical segment, and there was no obvious sign of degeneration in the adjacent vertebral body. At the latest follow-up, VAS, JOA and SF-36 scores were obviously improved(<0.05). There was no significant difference in horizontal displacement and angular displacement of vertebral body before and after the operation (>0.05). The cervical curvature at the latest follow-up was higher than preoperative findings (<0.05). And there was no significant difference in intervertebral disc height preoperatively and postoperatively(>0.05).</p><p><b>CONCLUSIONS</b>Percutaneous transforaminal endoscopic discectomy in treating cervical spondylotic radiculopathy can effectively and safely relieve neck and shoulder pain, improving nerve function, enhance life quality, maintaining cervical stability. It is worthwhile to generalize and apply in clinical settings.</p>

Clinical study of exercise rehabilitation and gait analysis during the perioperative period of lumbar percutaneous transforaminal endoscopic discectomy / 中国骨伤

<p><b>OBJECTIVE</b>To explore the clinical effect of exercise rehabilitation during perioperative period on residual pain, gait and activities of daily living (ADL) in patients with lumbar spinal stenosis (LSS) after lumbar percutaneous transforaminal endoscopic discectomy(PTED).</p><p><b>METHODS</b>The clinical data of 48 patients with LSS underwent PTED from December 2015 to December 2016 were retrospectively analyzed. Patients were divided into observation group and control group according to different rehabilitation patterns, being 24 cases in each group. The patients of observation group received exercise rehabilitation and the patients of control group received conventional rehabilitation. Visual analogue scale(VAS), Oswestry Disability Index (ODI) and the ratio of supporting phase were recorded before operation and 12 days, 6 months after operation. The correlation between the ratio of supporting phase and VAS, ODI was analyzed.</p><p><b>RESULTS</b>The ratio of supporting phase of observation group was significantly higher than that of control group at 12 days after operation(<0.05). The VAS and ODI in observation group were significantly lower than that of control group at 6 months after operation(<0.01). There was no correlation between the ratio of supporting phase and ODI or VAS in two groups (>0.05).</p><p><b>CONCLUSIONS</b>Lumbar percutaneous transforaminal endoscopic discectomy combined with exercise rehabilitation during the perioperative period can release or eliminate postoperative residual pain, improve gait balance, enable activities of daily living, and has a positive effect in patients with lumbar spinal stenosis.</p>

Application of broad easy immediate surgery in percutaneous transforaminal endoscopic technology for lumbar lateral recess stenosis in the elderly / 中国骨伤

<p><b>OBJECTIVE</b>To explore the safety and effectiveness of percutaneous transforaminal endoscopic BEIS technology for lumbar lateral recess stenosis in the elderly.</p><p><b>METHODS</b>From February 2014 to May 2016, 21 patients with lumbar lateral recess stenosis in elderly were treated with percutaneous endoscopic BEIS. There were 13 males and 8 females, aged from 70 to 85 years old with an average of 74.3 years. Preoperative, 1 and 12 months postoperative visual analogue scale(VAS) scores and Oswestry Disability Index(ODI) were statistically analyzed. MacNab was used to assess the clinical effects.</p><p><b>RESULTS</b>All the operations were successful. The time ranged from 90 to 130 min with an average of 110 min. All the patients were followed up for 12 to 38 months with an average of 18 months. Preoperative, 1 and 12 months postoperative VAS scores were 8.47±1.23, 1.78±0.72, 0.68±0.32, and ODI scores were 32.48±10.03, 19.53±3.55, and 5.15±1.02, respectively. Postoperative scores of VAS and ODI were obviously improved(<0.05). According to modified MacNab standard to evaluate the clinical effects, 14 cases obtained excellent results, 5 good, 2 fair. Lower limb paresthesia occurred in 1 case, and the condition was restored at 3 months postoperatively with conservative treatment. One patient was complicated with emphysema before operation secondary to pulmonary infection, and was effectively controlled with regulate antibiotic therapy. No infection of vertebral body or intervertebral space, no injuries of blood vessels or nerve root, no tear of dura, or the leakage of cerebrospinal fluid were found.</p><p><b>CONCLUSIONS</b>Percutaneous transforaminal endoscopic BEIS is a safe and effective method for lumbar lateral recess stenosis in the elderly.</p>

Therapeutic Effect of TESSYS Technique of Percutaneous Transforaminal Endoscopic Discectomy Combined with Oral Use of Chinese Medicine for Lumbar Disc Herniation / 广州中医药大学学报

Objective To observe the clinical efficacy of the TESSYS (transforaminal endoscopic spine system) technique of percutaneous transforaminal endoscopic discectomy combined with oral use of Chinese medicine for the treatment of lumbar disc herniation.Methods Thirty-nine patients with lumbar disc herniation were treated by the TESSYS technique of percutaneous transforaminal endoscopic discectomy,and then received oral use of modified herbal medicine Xubi Recipe,a formula mainly having the actions of tonifying kidney and strengthening governor vessel for 4 weeks after the operation.The visual analogue scale (VAS) and Oswestry disability index (ODI) and modified MacNab criteria were employed to assessed the surgical outcomes before the operation,and 3 and 6 months after the operation.Results (1) All of the 39 cases completed the operation successfully,and were followed up for 6-12 months after the operation.(2) Three and 6 months after the operation,the VAS scores and ODI scores were obviously lower than those before the operation,and the differences were significant (P ＜ 0.05).(3) Six months after the operation,the excellent rate of clinical efficacy assessed by modified MacNab criteria was 89.74％.(4) Only 4 cases had severer transient pain and numbness in the affected limbs,and there was no occurrence of complications of permanent neural root trauma,dural tear,vascular injury,intestinal damage,spondylodiscitis or retroperitoneal hematoma.Conclusion The TESSYS technique of percutaneous transforaminal endoscopic discectomy combined with oral use of Chinese medicine is effective for the treatment of the lumbar disc herniation with the advantages of satisfactory short-term effect,less bleeding,less trauma,faster recovery and less complications.

Clinical outcomes of percutaneous transforaminal endoscopic discectomy and Quadrant minimally invasive system in treatment of lumbar disc herniation / 中国内镜杂志

Objective To compare the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and Quadrant minimally invasive system in treatment of lumbar disc herniation (LDH). Methods 59 single-level LDH patients were randomly divided into PTED group (n = 31) and Quadrant group (n = 28). Then compare the operative time, incision length, blood loss, length of hospital stay, and the return-to-work time between the two groups. In addition, visual analogue scale (VAS), Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and modified MacNab criteria were used for surgical efficacy evaluation. Results In PTED group, compared with Quadrant group, we observed, shorter incision length, less blood loss, shorter hospital stay, and shorter time of returning to work (P 0.05). According to the improved MacNab criteria, there was no significant difference in excellent or good rate between the two groups (P > 0.05). Conclusion The clinical results of PTED and Quadrant minimally invasive system in treatment of lumbar disc herniation were satisfactory, and PTED were less traumatic method with rapid recovery.

Lumbar artery embolization for the treatment of massive hemorrhage caused by percutaneous transforaminal endoscopic discectomy: preliminary experience in 4 patients / 介入放射学杂志

Objective To evaluate the curative effect and safety of lumbar artery embolization in treating massive hemorrhage caused by percutaneous transforaminal endoscopic discectomy (PTED).Methods From January 2013 to December 2016,lumbar artery angiography was performed in 4 patients with massive hemorrhage caused by PTED.Based on the angiographic findings,lumbar artery embolization therapy with embolic microspheres and spring coils was carried out.Results Lumbar artery angiography revealed that extravasation of contrast agent was detected in 3 patients and pseudoaneurysm in one patient.The bleeding completely stopped immediately after lumbar artery embolization in all 4 patients.The patients were followed up for 1-3 months,and no re-bleeding or serious complications occurred.Conclusion It is very difficult to make medical and surgical management for massive hemorrhage caused by PTED.Lumbar artery embolization is safe,effective and minimally-invasive for the treatment of massive hemorrhage caused by PTED.This therapy is worthy of clinical use.

Therapeutic effect of transforaminal endoscopic discectomy in treatment of obese patients with lumbar disc herniation / 局解手术学杂志

Objective To evaluate the efficacy of percutaneous transforaminal endoscopic discectomy ( PTED) in the treatment of obese patients with lumbar disc herniation (LDH).Methods From February 2015 to January 2017,52 obese patients with lumbar disc herniation who underwent percutaneous endoscopic surgery were included in this study .Comparison of preoperative and postoperative 1 week,3 months, 6 months and 12 months VAS,JOA and modified MacNab criteria were employed to measure the clinical outcome .Complications during and after the operation were recorded to evaluate the safety of surgery .Results All the patients were followed up for 6 to 12 months,average of 8 months.Four patients experienced abnormal sensations in the nerve root exit zone postoperatively ,and disapperaed after 3 days of treatment with dehydratio and administration of hormone .Three cases of recurrence were observed at 3 months,6 months and 7 months postoperatively and were treated by open window discetomy .The postoperative VAS scores were significantly reduced compared to that before the operation , with significant difference(P<0.05).The JOA scores had significantly improved after surgery (P<0.05).In the last follow-up,the clinical effects of modified Macnab criteria were evaluated ,excellent in 16 cases,good in 29,fair in 4 cases,poor in 3 cases,and 86.5％of patients had excellent and good outcomes .Conclusion Percutaneous transforaminal endoscopic discectomy is effective for obese patients with lumbar disc herniation ,which has the advantages of minimally invasive ,less bleeding and quick recovery for the patients .

Clinical therapeutic effect of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of lumbar zygapophysial joint pain / 实用医学杂志

Objective To investigate the clinical value and effect of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of lumbar zygapophysial joint pain. Methods From August 2008 to October 2013 ,96 patients diagnosed as lumbar zygapophysial joint pain were included in the research. 36 patients were treated by spinal nerve medial branch ablation through transforaminal endoscopic ,while 60 patients received conservative treatment. The visual analogue scale (VAS) and Japanese Orthopedics Association(JOA) scores before treatment,1,3,6 and 12 months after treatment were recorded and analyzed. The MacNab scores were recorded and analyzed 12 months after treatment. Results The VAS and JOA scores of surgical treatment group showed significant improvement compared with that before operation (P < 0.05),and there were no significant difference at each time point after surgery. The VAS and JOA scores of conservative treatment group in showed significant improved at 1 months after treatment compared with that before treatment(P<0.05),but there were no significant difference at each time after treatment compared with pretreatment. The VAS and JOA scores of surgical treatment group showed significant improvement compared with conservative treatment group at each time after treatment(P<0.05). The MacNab scores of surgical treatment group(94.44%)was significantly higher than that of conservative treatment group(33.33%). Conclusion The spinal nerve branches ablation under transforaminal endoscopic is an effective and safe minimally invasive spine surgery technique with important clinical value in the treatment of lumbar zygapophysial joint pain.

TRANSFORAMINAL PERCUTANEOUS ENDOSCOPIC DISCECTOMY FOR LUMBAR DISC HERNIATION AND NERVE ROOT DECOMPRESSION FIRST TIME IN MONGOLIA / Мэс засал

Introduction: Various modalities oftechniques from standard discectomy,microdiscectomy, percutaneous discectomy,and transforaminal endoscopic discectomyhave been in use for lumbar intervertebraldisc prolapse1. The access to spine is keptto a minimum without stripping paraspinalmuscles minimizing muscle damage bytransforaminal endoscopic approach2.Currently in the population of the Mongoliabeen increased of the spinal nerve rootcompression, which are resulting in lumbardisc pathological changes. In other developedcountries has been successfully introducingthe spine endoscopic surgery use for thatpathological changes. In regard to our countryhad not yet implemented for until now asthese high technological surgeries3. Spinesurgery department team of the GrandMedhospital had successfully introduced that thespine endoscopic surgery.Materials and Methods: We performedtransforaminal endoscopic lumbardiscectomy surgeries on patients age of 24,38, 78 on July/23/2016 All patients withsingle nerve root compression due to Lumbardisc herniations, including sequestrated ormigrated and selected central disc at L4-5. All patients had preoperative MRI andpostoperative MRI to check the adequacy ofdecompression. All patients were operatedby 18-mm ports of the S-Gun endoscopicequipments. Procedure had done under localanesthesia. Postoperatively, all patients weremobilized as soon as the pain subsided anddischarged within 24-48 h post-surgery.Patients were followed up at 2, 6 weeks.Results: The mean follow up was 2-6weeks. The average surgical time was 70min (range 25-210 min). Average blood losswas 20-30 ml. Postoperative MRI showedcomplete decompression. All of patients hadgood-to-excellent results and straight raisingleg test (Lasegue) were 90/90 respectively.All patient is preoperatively visual analogyscale was 8±1 and then became to 1±1.Conclusion: Microendoscopic discectomyis minimally invasive procedure fordiscectomy with results of this procedure areacceptable safe and effective. However, forthis technique has required to do accuracyand experienced surgeon.